"Best Doula Ever"

Today was the day of one of my happiest and most beautiful births (thus far).

The couple hired me late in their pregnancy after they took a childbirth education class at St. Joseph's (43% cesarean rate as of 2008)  and the teacher recommended that they hire a doula if they were wanting an unmedicated birth. I had met the couple a few times and was super excited to work with them. They were incredibly nice and the mom had such a beautiful pregnancy I just knew her birth was going to be amazing! Plus I had never doula'd at St. Josephs and was up for the challenge of preserving a vaginal birth at the hospital tied with Brandon Regional for the highest cesarean rate in the county.

I met the couple at their house around 2:30 pm yesterday after the mom's water started leaking at work around 10:30. After hanging out for a couple of hours (watching a child care video, walking on the elliptical, eating the best grilled cheese sandwich and with nipple stimulation for 20 seconds every 5 minutes) the contractions picked up a regular pattern. Around 8 pm the mom took a shower and the contractions were getting stronger, longer and closer together as time moved on. The dad did an AMAZING job at timing the contractions and keeping a log!

Dad's contraction log

Around 10:30 pm we decided to go to the hospital because I suspected the mom was in transition (good moaning sounds during the contractions, hot flashes, shaking). At 11:10 pm we were in our cars and on our way to the hospital (honorable mention: we made it to the hospital in 30 minutes when it usually takes 45)

Hospital art in the lobby

When the nurse checked her in triage she was 9.5 centimeters dilated! Family soon arrived and the baby was born gently, completely unmedicated and natural around 2:30 am. 

Beautiful baby boy

Today when I went to the bank to deposit the check that the dad had written for the birth in the 'for' line it read: "best doula ever." That just made me smile. While I am honored at the title, that birth would not have happened the way it did without the incredible way they worked together and their faith in her ability to birth their baby. It was an amazing experience to be a part of. I am so proud of them, it was beautiful.

Lunch with the ladies.

I just got home from a really nice get-together with the other student midwives in Pinellas county. It was so fun! One of the girls couldn't make it but me and the other two sat around and talked about birth for over 2 hours! It's so awesome to share the experience with wonderful people like my sister-midwives!

Hopefully we can keep it up and meet more often. It's always nice to share time with like minded people with similar interests!

Your placenta IS an organ

SO, I was at this (typical) hospital birth ALL day yesterday. After the birth the mom wanted nothing more than to be "unplugged" from all of the machines that were tying her to the bed. Joking with the mom I said, "you're already down one organ what more do you want?" The nurse, rudely snapped, "the placenta is not an organ it's the inside of an organ."

Ok, I'm not one to argue or bet but this woman is out of her mind. The placenta IS an endocrine organ. The first sentence of Wikipedia (which the entire world can access) begins, "The placenta is an organ..." The placenta is the only temporary organ. It's the baby's little apartment. It keeps the baby warm, safe and fed along with other magical things.

I really shouldn't be in shock. This woman was the nurse at my first birth that ended in a cesarean last January. She was rude to me then and was no better this time around, she wouldn't even sign my silent birth observe form!

Sometimes I wonder how and why some people became nurses! I don't even mean that in a bad way because I love nurses. My best friend is a nurse. My favorite teacher is a nurse. I respect and admire nurses. I wouldn't even mind being a nurse. They are typically full of amazing information, however, last night the nurse was way off base because: The placenta IS an ORGAN! (I promise)

I just don't understand how someone could complete something as difficult as nursing school, work in labor and delivery (for at least a year) and not know that the placenta is an organ. People with the "I don't know I just work here"- attitude really shouldn't be nurses and the nurse last night was one of those people!

ROM

ROM- rupture of (amniotic) membranes
SROM- spontaneous rupture of membranes, happens naturally during labor, pushing or at birth
PROM- premature rupture of membranes, happens at least an hour before the onset of labor
PPROM- preterm premature rupture of membranes, happens before the onset of labor before 37 weeks gestation
AROM- artificial rupture of membranes, happens when a physician or midwife purposefully rupture the amniotic sac releasing amniotic fluid

Before you arrive at your due date it is important that you research the rationale, benefits, risks and alternatives (including doing nothing) of AROM. It is one of the most commonly performed procedures in hospital birth. It has pros and cons and proponents on both sides of the coin.

Pro's
-May speed up labor by an hour
-Allows for the placement of internal fetal and contraction monitors
-Allows for the examination of amniotic fluid for the presence of meconium
-Used for labor induction (ALSO, understand the rationale, benefits risks and alternatives of induction before consenting to an induction)

Con's
-Opens the mother and baby to infection
-Places the laboring mother on a "time-clock" for delivery which may lead to other interventions (ie, Pitocin)
-Lack of mobility (must now stay on monitors)
-Umbilical cord prolapse
-May make contractions more painful

If you are declining AROM be sure that your provider is aware of your refusal of AROM before they perform each vaginal exam. If you are consenting to AROM it may behoove you to delay AROM until you have established a consistent contraction pattern in active labor, this way allowing for shorter time between rupture and birth. A shorter time frame between ROM and birth may help lower your risk of infection because of fewer vaginal exams.

Please, research your options. It is your right as a health care consumer!

Home Births are Awesome

So my goal of keeping up to date on my birth observs hasn't gone exactly as plan. Sorry, I've been busy with school and the such. However, I did want to share about this awesome birth I was at. The mom totally trusted herself and her baby. It's so refreshing to have that experience because often we, as women, look to others to tell us if this is "right" and that everything is "normal" and "ok."

Trust your bodies, ladies, they know how to birth your babies!

"Strike when the iron's hot"- preserving vaginal birth

I had the amazing opportunity to attend a birth at Brandon Regional Hospital. I was nervous about my doula clients delivering there because their cesarean rate (as of 2008) is over 40%. Although the birth did not follow my clients ideal birth plan, ultimately our goal moved from wanting an unmedicated birth to preserving a vaginal birth.

SROM occurred at home with no contractions for over 12 hours. Pitocin was started and the contractions maintained a beautiful pattern until the mom pushed her baby out, over 24 hours after rupture of membranes at the hospital with the highest cesarean section rate in the county! Every decision that was made regarding the birth was based on the informed choice of the mother. She owned her experience!

Every intervention that exists in the hospital exists for a reason. Do I think that the rate of intervention is too high? Of course I do, however, there is often a time and a place for most interventions. It is important, as birth professionals, to understand the resources available at the hospital (Pitocin, epidural...) that can be utilized to achieve a gentle birth which preserves a vaginal birth.

As always, be flexible. Every birth is uniquely different!

Conviction

"As I have observed in subsequent encounters with midwives around the country, the decision to embrace this calling often seems to strike with a force akin to religious conversion."
- Jessica Mitford, The American Way of Birth