June Babies

So believe it or not, but I have 7 new birth stories I need to write about. June was incredibly busy with births on the 1st, 7th, 8th, 19th, 22nd, 26th and the 30th!

The first birth of June was my first transport and first cesarean. With her first son, L had tried for a natural birth in the hospital with a doctor. It ended in an c-section which left her scarred emotionally and physically. For her second son she tried for a natural birth in a hospital again with a nurse midwife, which also ended in a disappointing c-section. For her third pregnancy she decided to try again for a natural birth, but this time at home with a midwife. Although it too ended in a cesarean, this time L was very happy with her birth experience.

VBAC's and HBAC's (vaginal birth after cesarean/ home birth after cesarean) have spurred a lot of controversy. Many hospitals will not let a woman who had a previous cesarean even try for a natural birth. They've coined the phrase "once a cesarean, always a cesarean". There's a whole movement by the International Cesarean Awareness Network (www.ican-online.org) to prevent unnecessary cesareans through education, to support women who have had cesareans so they can heal emotionally and physically and to promote VBACs. It's an issue that I'm very passionate about, especially because I've had friends and family who experienced unplanned cesareans.

So naturally this birth shook me a bit. I wanted to believe that if a woman trusts in herself and her body, and has a completely supportive team and environment to birth in, that a cesarean can be avoided. I've learned first hand that even with all those things, sometimes cesareans are neccessary. What reaffirmed my faith in midwifery is knowing the statistics. That the cesarean rate among midwives is only 3-4% compared to 25-30% in most hospitals.

So what are midwives doing so different? They openly communicate with the mother so she understands what is happening, they work together as a team to try different positions or techniques to try and help the baby turn or descend. What is so fantastic about midwifery is that in the rare case that a cesarean is neccessary, you know that you tried everything, that it you didn't just give up or get pushed into something scary. That the mother is always calling the shots and is in control of her birth experience. And that makes a world of a difference.

I got the call around 3am. It seems like I get most of the calls at 3am these days =) Luckily there was very little traffic because this family lived an hour and a half away. I was the first to arrive, as usual. They had the pool inflated, but Sue had the hose adapter so we couldnt fill it yet. L was laboring beautfully. Staying hydrated and rocking her hips on her birthing ball. Her husband B was at her side helping to time the contractions. Their two sons asleep on the air matress set up in the living room.

When Sue and Jake (her other apprentice who was about to get her license) arrived I helped them set up her equipment and started to fill up the tub. Sue checked L to see how dilated she was, around 4 cm. We got the tub filled up and she got in and was able to relax and be more comfortable. She labored in the tub for a while and we monitored the baby's heart. They didnt know the sex of the baby, it was going to be a surprise =) As the contractions intensity grew she needed to really focus. Her sons woke up while we were bustling around setting things up, so they decided to have them go over to the neighbors. Her older son was none to happy about that and started crying.

He really wanted to be there for the birth. I was able to talk to him quietly, telling him that I knew he wanted to stay and help, but that the best way he could help right now was by giving his mom some quiet space. And I promised that as soon as the baby was born I would run over and get him. This calmed him down and he told his mom that he loved her as he agreed to go. (I didn't know that we'd endup transporting though, and still feel a bit guilty wishing that I had been able to run over and get him...)

After a few hours went by Sue checked her again to see if she was making any progress. It seemed that the baby's head was tilted to the side a bit with her chin up a bit, making it hard to apply even pressure to the cervix so it would dilate. Ideally the baby's head would be straight with its chin tucked down so the top of the head is right on the cervix. We suggested to have her get out of the tub and try to walk around a bit. Sometimes the movement of walking and the gravity an help the baby reposition its head. By then the sun was rising and it was really nice outside. They lived on a ranch in the hills, so we were surrounded by trees and birds singing. She walked around for a bit outside, and drank some tea with honey, but was pretty tired so we headed back in. I suggested that we set up her birthing ball next to the bed, and put a bunch of pillows on the bed, so that she could sit and lean forward and rest her head.

This worked perfectly and she was able to get some rest between contractions. Another hour later and Sue checked again to see if the baby was able to reposition its head, no luck. With her energy restored a bit we went for another walk outside. The warm sun helped her perk up and we suggested she stomp around a bit and wiggle her hips. I demostrated for her which got a good laugh and then she did it herself including some sassy shoulder/chest shakes. So together we wiggled and stomped our way back and forth across their lawn smiling and giggling between contractions. We even went up and down a couple steps to see if that would help.

Once back inside Sue checked her again. Baby wasnt budging =( inspite of all the strong contractions and our dancing. We talked about the options. We could try and keep going at it, but L was getting tired. She'd been up the night before with some toning/practice contractions and even with little breaks between contractions didnt feel like she could keep going another 12 hours. She decided she was ready to go to the hospital while she still had energy and the baby was still doing great. It was a hard decision to make and her husband was reluctant, but L was certain, so they packed up and got ready to go. They decided to go to a better hospital that was about 40 minutes away, instead of one that was closer because Sue knew about its reputation.

So they drove off to the hospital and I was left behind with my car to clean up, pack up and meet them at the hospital. Draining the tub felt like it took forever, I finished packing everything up and took a small nap while the tub was being pumped down the toilet. (fyi bigger tub + long hose = long time to drain) Finally I was on my way and realizing how tired I was. Since that drive I've decided to keep some chocolate covered espresso beans in my car to help keep me awake and alert. I arrived at the hospital and they were filling out paper work and getting her set up for the cesarean. Sue talked with the doctor and nurses, handing over her charts and talking about the labor so far and what she observed.

Once everything was ready we gave her hugs and let them know we'd be waiting for them as they wheeled her off. They said it would be about an hour before we could see them. The three of us headed down to the cafeteria for some much needed food and caffeine. We talked about the labor, and all the what ifs and I was able to ask any questions I had. After that we went to the hallway where they would be passing through to the nursery and waited. About an hour later B came out with his new daughter, bundled up in her little hospital trolly. She was perfect, the operation went perfectly, and L was doing fine in recovery.

Sue and Jake needed to leave. Sue was exhausted and had some other moms due any minute, so she had to get some rest. I on the other hand fully caffeinated offered to stay behind till L came out of recover and keep B company. He went to the nursery with his daughter and the nurse and I was able to watch from the other side of the window as they took her foot prints, trimmed her cord, gave her a diaper, checked her temperature, etc. The nurse took her time doing all these things, coming and going, while the baby fussed and cried. B was a very loving father and held her as much as he could inbetween, trying to console her.

Eventually she was all done and wrapped up cozy. They were issued a room that L would be going to shortly, so we went there to wait. B and I talked as the baby slept and a few minutes later L was wheeled in. Inspite of the hard labor and cesarean, she was glowing and had the biggest smile. She was so happy to have a girl, and told me that she was grateful to have had the labor she did, knowing that it helped prepare her daughter to be born giving her the hormones she needed to help her transition to life outside. She said that she felt very well cared for by us and thanked me for helping and staying.

Relieved to see her so happy I was able to leave content. I knew we did the best we could, and I was grateful myself to be working with a midwife that was skilled enough to know when it was time to go, and not wait till it became an emergency. I hope that someday I'll have all the skills, knowledge and intuition to make the right choices at the right times.