Monday, May 3, 2010
The Birth that Makes me Go Hmmm...
As a mom of 3 little ones..and even more so now that i am a doula..people tell me their birth stories and I love each one. Even when the list of interventions is longer than my arm and the mis-information the doctors gave makes me want to rip my eyes out..it's still uniquely her story..the day she birthed her baby.
Lately I've been thinking about my second birth...my daughter is 2 and a half and I've given little thought to certain aspects of her birth. But as a doula I've been learning more and more and am amazed at how many 'dangerous' and 'life threatening' things happened and yet..it never occurred to me at the time. I so deeply trusted birth. Lately I've been humbled a bit when thinking of her birth and had to wonder..was I just *lucky*?
My baby girl presented with a nuchal hand...making pushing very painful..not to mention the fact that she was a healthy 9pounds 4oz's to boot. I had heavy bleeding right after delivery so my desires to bond with my baby in the warm waters of her birth and nurse..were dashed in the reality of needing to assess how much blood I was losing.
The room was filled with family and I was busy bonding with my new little one and snugging with my 19 month old as well. All the while my midwives were quietly busy changing my chux pads, pushing on my fundus, taking my vitals, asking me if I felt *dizzy*...and I took no notice. I was just nursing away...laughing..and eating my Jack in the box. Time was passing and the placenta was not coming..my midwives quiet busyness was quickly giving way to quiet concern as I continued to bleed heavily. I was informed I was going to get a shot of Pitocin in my leg. Sure..ok I said. I trusted my midwives and knew there must be a reason and never missed a beat. More chux pads were changed and again not knowing why but I was handed a pill and instructed to swallow it...Methergine. Again..Sure ok..
Everyone was asked to leave the room and at a time when I didn't want to EVER push anything out of my vagina again I was being urged to push as hard as I could. My belly was mush..my legs were shaking..I didn't feel like anything was happening. And yet the placenta did come..but not all of it. I was instructed to get on my, jello, knees while they inspected the trailing membranes and strategized about getting them to come out. The rest is a blur..but sooner or later I was back in the bed..baby in arms.
Next as we examined the placenta it is discovered I had a velamentos insertion (http://www.vasaprevia.org/vasaprevia/velamentous.html). I believe it was explained to me what it was and I discovered it was a really *rare* condition. One of the midwives was a student so she took pictures of it to share with her class. My bleeding continued and at this point they talked with me about the fact that I was losing a lot of blood..faces were serious. I did NOT want to go to the hospital..I was exhausted and desperate to crawl into my own bed with my new baby. So my daugther was born at 10 minutes before 11pm and we eventually went home around 3:30am once my bleeding was satisfactory.
I continued to take the Methergine the next day to help my uterus to clamp down and as was hoped for, I passed a colossal clot into the toilet the next evening. Let's talk about passing the clot shall we? If you've had a vaginal birth your care provider probably told you to *call* if you pass anything larger than a small orange. Well, I sat down to pee and did not so much feel the clot slip out but *heard* the splash and thought, Uh Oh..that sounded BIG. Not wanting to alarm anyone (my husband and mother in law were in the living room) I went into the kitchen and rummaged around for the appropriate utensil to fish it out. What is the appropriate utensil you might wonder..I wondered the same thing and finally settled on a soup ladle. I returned to the scene of what now looked like a murder..with blood smeared all over the toilet seat..filling the toilet bowl..down my legs..you get the picture. B.A.D.
Ok, so ladle goes in...and the large pear/small pineapple size clot comes up. Alarmed at it's size..many things went through my mind at lightning speed..*unborn twin? my uterus? do I have only minutes to live?* you know..that kind of thing. So feeling sure I might die I call my midwife and explain what has happened. To my horror (relief?) she is overjoyed and excited. WHAT??? And instructs me to place the clot in a bag and they will be out to dissect it tomorrow. Only while this call is taking place in my bathroom, my living room has now filled with well wishers wanting to see the baby. The guest list included: My Aunt and Uncle from Canada, the youth pastor and his wife from upstairs, our church pastor and his wife...and also my husband and his mother. awesome. So I place clot in requested bag and not knowing what else to do with it I shove it in the right crisper drawer of my refrigerator.
Now ready for my close up I go out to meet the well wishers and say out of the side of my mouth to my husband, Whatever you do.. DO.NOT.OPEN.THE.CRISPER.DRAWER. Of course he responds immediately with, Why? I say, just DON'T! and he asks, Why again and if you are a wife you know exactly the look I gave him in front of company that implied he would SEVERELY regret asking me again and hate his life later if he did. So he did not press me a third time.
Ok, so the MW's come out for the home visit and with extreme excitement they don blue gloves and a scalpel and cut apart the clot I gave birth too the previous day. Here the cause of my continued bleeding is discovered as retained membranes inside the clot. Those membranes secreted just enough hormone to tell my uterus there was still a baby inside and to keep sending blood. Alas..the bleeding was done..total blood loss including Colossal Clot = 1780cc's. Lay men's terms: 1/3 of my total blood supply. Another fact a post partum hemmoraghe is considered to be 500cc's or more...um...ya.
Ok..that's the story..here's the review. First of all I am eternally grateful to my midwives for being so incredibly skilled at what they do and that they managed my hemorrhage amazingly. Obviously..I didn't die and have had another beautiful birth with them. What I appreciated is that though they were *concerned* they did their job without causing unnecessary drama. So that when I remember that birth I just recall having ample time to hold and bond with my baby, visit with family, and just enjoy myself. What if I had been in a hospital? How would it have been different?
And now the placenta...
I was recently at a playgroup of all first time mama's with babies ranging in age from 4 months to 1 year. Inevitably the conversation always turns to birth and so it did this day also. A young mother was encouraged to tell her story of how her and her baby are lucky to be alive. I internally take the Lord's name in vain and wait for my tongue to begin bleeding. I won't get into all the details but the story ends that after her healthy baby is csectioned out it comes to light that she had a velamentous insertion which all the medical staff gathered around to see, b/c as I mentioned before it is extremely rare. So it is at this time that the doctor informs the mother that 'its a good thing we didn't have you do a vaginal birth because your baby would have bled to death and died.'
And so since the day 4 months prior that the doctor had said that, this mother really believed that csection saved her baby's life. Also I guarantee you that as many times as she had told that story NO ONE she told had ever encountered this themselves..until *that* day. When I calmly said...Oh, I had a velamentous insertion with my 2nd daughter. I think I almost heard the internal gears grind to a halt and her face froze looking at me. I shrugged my shoulders like it was no big deal and said, Ya..she was 9#4oz..I had her in the water..it was fine. I responded this way because of how my midwives handled my birth by choosing to focus on the joy of a new baby and the celebration of a mother having had a great birth instead of focusing on what *could* have happened. Anyways, I hadn't given her velamentous insertion detail another thought since that day. The new mom looked me dead in the eye and cautiously asked me, Do
you think I could've had a vaginal birth?
Everything in me wanted to scream from the rooftops, YES! YES! YES! but because I am a birth professional working within a tight knit community I must weigh my answers carefully at all times. Personal agendas and Rants are for Facebook Status updates..not playgroups full of first time mom's. So after a moment I answered saying only this, 'I think doctor's make things seem a lot more scary than they really are at times.' And this seemed to appease her but I could see her begin to question her *life saving* c section.
Ok, so I left that playgroup shortly after that interaction, with an extreme headache and a bleeding tongue (metaphorically) and enraged by what I had heard. All the way to Sonic Burger, where I planned to *treat* myself after hearing about all these csections and cytotec induced births, I raged in my car about, WHY WOULD A DOCTOR SAY THAT? WHY WOULD THEY TELL HER WHILE SHE IS CELEBRATING HER BABY THAT HER BABY COULD'VE DIED? WHY?WHY?WHY? No one told me that Samantha could've died...wait..
could she have died?
So I make a call to an awesome local midwife who is like a textbook or birth wikipedia or something. I barely even said Hi before raging into the phone, Tell me everything you know about velamentous insertion..are there risks? Is it dangerous??..she sighed and says, Ah yes the elusive velamentous insertion and vasa previa. She then explained vasa previa to me. And as rare as velamentous insertion is in the first place the fact of vasa previa is even MORE rare.rare.rare. Like that mom took a bigger risk putting her new baby in the car to drive her home than she would've had risked having a vaginal birth. Also I should note that velamentous insertion is not detected on ultrasound but only discovered after delivery of the placenta. So...in the event of vasa previa you wouldn't know it was a risk factor and it wouldnt matter much where you were (at home or hospital) chances are you wouldn't get to the baby in time to save it..a sad fact.
So I thank my midwives for treating birth as it is normal and for treating me like a woman who was in her high harvest day. Because for two and a half years I've retold Sam's birth as a peaceful, powerful experience..where I also bled...a.LOT. but that is SUCH a side note to the actual labor and birth that brought her to us. But now I guess I can say, My baby and I are lucky to be alive after I had a MASSIVE post partum hemmoraghe losing 1/3 of my blood supply and the baby could've bled to death and died via vasa previa from her undiagnosed velamentous insertion. Thank GOD we were in a hospital and everyone is still alive..oh..wait..:)
But in all seriousness after learning about vasa previa I did feel a little bit ill after thinking I *could've* lost my baby but then the truth of the matter is a thousand other things *could've* happened but DIDN'T happen and my daughter is a happy, healthy 2 year old. And really what would've been the point of within an hour of birthing my baby if my midwife had looked at me and informed me of the rare complication that *could've* killed my baby? How would that have impacted the *memory* of her birth..forever? Instead they skillfully, respectfully,and safely cared for me and honored my memory of birth and that is such a gift. A gift I try to be highly aware of when attending other mom's in their births in how I can protect *their* memory of their own birth.