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Archive for the ‘Birth’ Category

At night, they sleep in star fields, by day they run with wildflowers.

10/14/2000

Lily Rose 2/8/2005

 

A gift from my sister. If you are remembering anyone today, I’d love to know about it, to hear your story. You can leave a link or just share in the comments. As you can see, I am 10 and 5 years out from these pregnancy losses of my girl children. I’m upright and alright. If you are needing support, I recommend Share and Glow in The Woods, a best friend, some brownies, maybe a glass of wine.  Beyond that I have no advice, I’m just listening.

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Trauma

(As always birth stories are told with time mysterious delays and details changed).

The birth looked lovely. We were in a mother friendly hospital with very nurturing midwives. The mother labored well. Her husband held her hand. Her sister pulled her hair off her neck and teared up. I was busy with cool cloths, juice and words of comfort. It was her second baby. The labor was quick and relatively easy. Her baby was born in perfect condition.

We were in a play. Everyone acted just as they should – and still, there was something not right. My client was unkind to her spouse, dismissive towards her sister, and distrustful of the staff, arguing her case for things that they were trying to give her. She was getting everything she wanted, but she was not able to access it. Communication lines were failing. The midwife was lovely, but too soft spoken under the circumstances. I was translating in both directions. They didn’t know each other – that happens sometimes with on-call schedules.

Everything went so well but felt so wrong. It wasn’t the pain. I’ve been with many women in labor so I’ve seen pain. This was trauma. It may have been a previous birth or it may have been abuse – I don’t think from the current relationship – or it may have been both.

She was more peaceful and herself in deep labor. Her anxiety abated but swept back over her after the first moments of her baby’s birth. They were healthy. The dad held the baby and took pictures. They’d be sent home in a few days. I went home painfully aware of statistics.

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If you have heard of Henci Goer, it is probably because you have reading A Thinking Woman’s Guide to a Better Birth. Her other major work is Obstetric Myths Versus Research Realities, which is quite dense book, not exactly light fare pregnancy reading. I read this work as part of my childbirth educator certification. What I sensed intuitively, she has documented thoroughly: many of the most common practices in American obstetrics have little medical basis.

Working as a doula at hospitals here in Connecticut, I see in practise things that I know serve no purpose, that have no benefit and even can do more harm than good. I see different practitioners at the same hospital stating their preferences as though they were set medical truth which must not be questioned (No, you may not get in the hot tub if your water is broken. Yes, of course you can get in the hot tub if your water is broken. No, you may not get in the hot tub until you are 4 cm dilated. Yes, you may get in the hot tub, until you are 4 cm dilated.)
As a professional, I find this to be frustrating. As a laboring mother myself, I found it maddening. After Henry was born, I was very much in need of stitching; he had been transverse & the last moments of labor were just dreadful and messy. At some point after I had nursed him a bit and cooed him to sleep, the baby was whisked away to the nursery & I shooed Matt after him, as was always our plan. My own medical needs taking precedence at the moment. I hardly noticed his absence, wrapped up in my own pain and then transferring over to the maternity floor. By the time I’d gotten re-patched, cleaned and had my first dose of codeine, he was back. We nursed again and fell into a deep sleep.
Twenty two months later, I birthed Theo without a scratch. A hearty 9lb 3 ounce baby, after just a few hours of labor. They took him to the nursery after our feeding, to be watched for a whole hour (or was it 2?) – I was hardly tired, felt fine and literally watched the clock. I rang my bell begging for my baby to come back. I sent Matt in to be with him, but it all felt so stupid. We did not need the separation. It’s not ideal, though sometimes helpful or necessary, but in our situation, well, it was just dumb. If he had been on my chest, we would have slept. Instead, I stewed and got upset. I was told, of by huge baby with big old huge APGARS to match, that if “something” was going to happen, it would be within the first few hours. Oh, yes! They played the horrid “dead baby” card that I hate so much. I hate it because, sadly, sadly, babies do die. To me, the manipulative use of the “dead baby” card is a form of disrespect towards families who have suffered loss. Also, I see it as some form of terrorism for new mothers – who 48 hours from when you say that, you are going to ship off home with a 1-800 number, a few newborn pampers and a car seat check…with the seed planted, that “anything could happen.”
Damn it, people, we are all scared enough. Aren’t we?

So, where was I? Yes, Henci Goer, whose thoughts are much more organized than mine, led a seminar about the Illusion of Choice in Childbirth. It was a fascinating, interactive two hours at Yale – many midwives and midwifery students were there as well as local doulas. We went back and forth on what value information has in the obstetric setting of American hospitals. Knowing that separation from his mother was neither valuable nor helpful, did not keep my baby near me at Hartford Hospital, which is one of UNICEF’s 80 Baby Friendly Hospitals in the United States (Which seems to mean, I got a Whole Foods gift bag, instead of formula on my way out the door)

Birth doulas and childbirth educators have been working under the assumption, that if women have better information, they will have (and make) better (“better”) choices. It just doesn’t turn out to be that simple. Should I inform clients and students of options not reasonably available to them? There are no providers who will attend vaginal breech births here in CT. None, to my knowledge. So, hadn’t I better help them understand the procedures of a surgical birth and what the recovery will be like? When realities show me that choices are limited in scope, and in my ability to chose in a truly autonomous way

Yes, we birth junkies have our little illusion. I’ll tell you all about “natural” childbirth, and then you can go into the hospital and make your informed choice. Perhaps my own bias weighs too heaviliy there at times; perhaps I screen it out better on some issues than on others. We all have our non-negotiables. Maybe I have given you all the information in the world about the high risk of surgical birth associated with scheduled inductions, but it matters not one whit, your doctors are going to induce you, or fire you.

Hospitals have an alarmingly similar illusion – only it tends to translate into reality because in a hospital setting there are some big time power differentials at play. Their game is called informed consent. Its practice in the obstetrics department of hospitals is very nearly a laughing matter & usually goes something like this “it is time to break your water so your labor can move along, okay?” See, information and consent. The information is sparse, the consent is implicit. Informed refusal is hardly ever mentioned. Should you refuse that induction, you will have to find another care provider, late in your pregnancy. You could choose that, but your choice is now being made under duress, isn’t it? How free is your choice in that case?

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The baby was just 34 weeks. Her water had been broken for several days. He was a hearty little soul, quite fiesty – but tiny at just over 4lbs. To the NICU he went to be watched and cared for. Yesterday mom was discharged, and baby stayed, because we have no rooming in at the NICUs in our city hospitals. Nor is there any step-down NICU, for the babies being watched for potential problems, rather than being treated for problems. It was bittersweet. We were all so happy to see him doing so well. It was hard for them to leave their baby there. Yes, they may visit as much and as often as they like, but that is a far cry from coming home with a baby in your arms, a far cry from rooming in at the hospital. This baby is fine. His only requirements for discharge are taking all his feedings by breast of bottle (which he is doing), breathing on his own (which is he doing) and maintaining his body temperature (which he is not yet doing.) The crunchy doula in me wonders if he’d be just as well of rooming in with mom, sleeping at the breast, skin to skin under a blanket. The worried mother in me wants him and his mother to have the security of incubators and NICU nurses. Every part of me wonders, why can’t they have a little bit of both?

Next week I am going to join other caregivers in this area for a discussion with Henci Goer on the illusion of choice in childbirth. Tell me about it. No one plans for their water to break at 33 1/2 weeks. After that, choices are limited.

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The baby was just 34 weeks. Her water had been broken for several days. He was a hearty little soul, quite fiesty – but tiny at just over 4lbs. To the NICU he went to be watched and cared for. Yesterday mom was discharged, and baby stayed, because we have no rooming in at the NICUs in our city hospitals. Nor is there any step-down NICU, for the babies being watched for potential problems, rather than being treated for problems. It was bittersweet. We were all so happy to see him doing so well. It was hard for them to leave their baby there. Yes, they may visit as much and as often as they like, but that is a far cry from coming home with a baby in your arms, a far cry from rooming in at the hospital. This baby is fine. His only requirements for discharge are taking all his feedings by breast of bottle (which he is doing), breathing on his own (which is he doing) and maintaining his body temperature (which he is not yet doing.) The crunchy doula in me wonders if he’d be just as well of rooming in with mom, sleeping at the breast, skin to skin under a blanket. The worried mother in me wants him and his mother to have the security of incubators and NICU nurses. Every part of me wonders, why can’t they have a little bit of both?

Next week I am going to join other caregivers in this area for a discussion with Henci Goer on the illusion of choice in childbirth. Tell me about it. No one plans for their water to break at 33 1/2 weeks. After that, choices are limited.

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Birth: I can help

I need to work more. I’m thinking so much about birth, where I can work, what services I can offer, how to help more women, and earn more money that my mind resembles this wordle. Click on it to see it bigger.

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The more births I go to, the more I realize that other people exist. They really do exist, just as they are, and what’s more they are very often other. Which is to say, I find them not at all like me.

This is most interesting when I am at a birth in the role of a doula. As a doula, I am there exclusively to serve the laboring woman. I have no other task. The medical staff are there to monitor the health of the mother and fetus. They are there to intervene in a medically emergent situation, or even just an urgent situation, or in some cases when things go particularly quickly and well, just in the knick of time to catch the baby. If a woman’s partner is their, most often a husband, he is having his own experience of the birth – sometimes becoming a father for the first time. In that room, he is there as her partner and as father to be. He cannot possibly put all his wants and needs aside for this block of time – they are too melded into the experience. Sometimes other family members are there. Most often they purpose is to be among the very first to welcome this child into the world. They may or may not be off some service or comfort to the laboring mom. There is a lot of variation in that area, to be sure!! In any case, as the doula, I am usually the only person in the room exclusively their for the laboring woman.

There is little a doula can do to help, which is why I focus on serving. Those of you who have birthed know that the work belongs to the laboring mother alone. We cannot pass around the contractions and each do a few & then later pass around the pushes like it is eenie, meenie, miney, mo. I may be able to rub your back, your feet, or talk you through a contraction, but ultimately you are still in labor – a fact which becomes more and more apparent with each contraction & push. I think my work is purposeful, that it brings comfort, that it is worth respecting and listening to the laboring woman, but I also belief the birth is powerful, we can no more control it with water therapy and essential oils than we can with IVs and epidurals. Birth is big, so I attempt only to serve the woman I am with and leave the rest to internet debates and forums.

One of the most serving things I have to do is to remember that it isn’t about me. The birth I am in is only about the laboring woman. Sometimes I don’t feel any inner conflict about this at all. Sometimes it is easy to give up my time; at other times, not so much (I do get paid, but being on-all means a birth could come on a super convenient day or a really inconvenient night – like 13 days into staying up too late to watch the Olympics). Sometimes I am all energy & other times I am in the middle of my cycle and feel totally anemic. There are times when everything a woman chooses is just what I would in her situation. There are also times when the television is on the entire birth & I think Why is that on? Oh, because this is not my birth.

Some women birth completely in the nude – which bothers me not at all unless they are cold but hate the idea of clothing or blankets and it is July and she is in a hot tub on the second floor of a stuffy apartment. Then I think, why are we doing this? Why aren’t we in an air-conditioned hospital? Oh, because this is not my birth.

Some women are super modest & don’t want anyone seeing “anything”. So even though she may be 5 foot 2 – which means her head and her vagina are not all that far away from each other and she needs some encouragement to push with her epidural, I ask her permission to look and see if she is pushing effectively. Even though I can see just fine permission or no. Why? because this is not my birth.

I may think it is the very best idea in the world for one woman to get an epidural and take a nap and let it run off in the morning when she is 1ocm. Or I may think it is the best idea in the world for another to not get an epidural because her water is broken and it might slow things down and then we are looking at a long birth with pit in the bag & she is only 4 cm. I may think that if you get an epidural at 3am it would be a good idea to sleep. Or I may think if the pain is more than you are coping with well that a hot tub would be just the thing. Or I may think that the baby is posterior and want to run a series of position changes to shake him loose. But this is not my birth, which is to say that if she doesn’t to do what I think is a good idea, I just have to get over myself and move along to another idea that will serve her. Because, it is not about me.

And I confess to you hear and now blogosphere, that sometimes it is hard to get over myself. Sometimes I don’t want to sublimate my will, & ditch what would be my choice in a situation. Sometimes I just want to be the kid in the class who blurts out the answer before the teacher has finished formulating the question, but I do not, because that does not serve the laboring woman. She must find her own way. I must support her in that. It may be hard. It may be easy. She may be a pleasure to work with. She may be difficult and demanding, but it is not about me.

And so I hope you will understand that when I hear stories about doulas judging women for not breastfeeding, about them leaving when a woman chooses to get an epidural, about them being combative with the medical staff (who do after all have their own job to do & must work inside their scope of practice), well I just about lose it all together. So, one behalf of this doula, trying to stay real and sane and well within my scope of practice, I’d like to say, I’m sorry to any woman whose doula left her, bullied her or judged her. You deserve better. You deserve to be at the center of your own birth and have the people around you value you. And to any nurse, CNM or OB who got the wrath of the entire natural birth community tossed your way just because you walked in wearing scrubs, I’d like to reach across the aisle and say, Hi, I am a doula, but I’m not insane. I’m not scared of you. Please don’t be scared of me. Let’s do this together & do it well.

I had the rare pleasure of working in perfect harmony with the staff at a local community hospital. It was my first time there. There was respect and acknowledgment of my unique position from every single person I encountered – including the security guard at the ER who remembered I was coming, remembered my clients name and escorted me up to L&D on his way off his shift and home. In turn, I learned the names of every nurse who came in the room, had a friendly and professional chat with the Obstetrician and received a warm goodbye from the entire nursing staff. I told them I couldn’t wait to go to another birth in their corner of the birthing world. They were incredibly respectful to the laboring mom, who didn’t want to nap at 3am with her epidural. But that’s okay, because we all knew it wasn’t about us.

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