We had two moms deliver last week. One on friday and one on saturday. Both were water births with baby girls and lovely chinese mommas. =)
Friday's went great. Mom's water broke around 3am. Labor picked up soon after and they headed over to the birth center. They live in Sacramento so it was a good 2 hour drive at least. Judi called me around 7am saying that they had arrived and that it was still a bit early, but to be prepared to come around 12. I decided to head out a bit earlier and got a call from Judi while I was on BART. She said I should get there as soon as i could, things had picked up. Luckily I was just 2 stations away at that point.
When I walked in Judi was fervently setting up the tub and mom and dad were in the front exam room laboring hard. Gradually they made their way over to the birth room and she got into the tub. I had never seen a first time mom in active labor be so relaxed. She literally melted and floated in the water. Her partner was right at her side supporting and helping remind her to drink to stay hydrated.
As usually the warm water slowed things down a bit, so we had C change position a few times and eventually squat and stand swaying for a few contractions. It definitely did the trick and her contractions picked up again. Baby was doing great the whole time. Good strong heart tones. =) Soon it was time to start pushing and she worked so hard to bring her little girl down and out. Emmi was born at 1:59pm. Beautiful, pink and a bit early at 37 weeks and 3 days.
On Saturday I came in to help out with a "Mother and Baby Care" class that Judi was teaching from 2-5pm. Around 3pm we got a call from H who was 41 weeks and 6 days. Once moms hit 42 weeks they aren't allowed to birth at the center and have to go their back up hospital instead. So over the last few days H had been working with Judi to naturally induce labor using herbs, castor oil and membrane stripping. This was H's second baby, so we just had to get labor kicked in and her body would take care of the rest.
Apparently the castor oil had worked, because she was having contractions every 4-5 min for about a minute long since 1pm. Judi said for her to come in at 5pm as planned to see if she had dilated some more. When Judi checked her she was 6-7cm with a bulging back of waters. Both Judi and H decided to go for broke and do a full on "natural" induction and break her water. Normally most midwives try to avoid breaking waters as it can cause issues if the baby isn't positioned right or not ready. But in H's case, she was well past due, already dilated and having contractions, and baby's position was perfect. And luckily in her case, it totally worked.
Labor got stronger and stronger. And we helped her deal with her fears. Her first labor had lasted 52 hours and ended in a transport with an epidural. So she had never felt the full strength of contractions before. We decided to welcome them as friends and helpers with a positive mind set. As they became stronger she needed some more help and Judi guided her through each contraction chanting "OOOooopppppeeeeennnnn" with her to help visualize her cervix opening.
Soon after she got into the tub with her partner supporting her and the water was very comforting. Eventually her "open" chants became less fluid and more grunty, usually meaning that the pushing stage was beginning. She began to push with each contraction and slowly her daughter came closer and closer. We could she her little head full of dark hair and H put her hand down to help ease the head out herself and then pick up her daughter as she was born.
Both were very sweet births. Totally normal with no resuscitation or abnormal bleeding. Just pure birth, and bliss and love.
In December there are 15 moms due. Some are bound to spill over into November like friday's birth. And some are likely to last into January. Simon and I are going away from dec 25th till Jan 3rd. So I'm going to miss some births. But I'm hoping to catch most of them =) I'm up to 5 births at the center, but I'm only counting 3 as official because i was there from beginning to end. And that makes a 17 total since March.
I've decided not to take the second apprenticeship and just do Tuesdays and Thursdays at the center. That way I can focus on finishing my modules. I really want to finish them by spring of 2010, take the NARM exam and then go traveling with Simon for 6 months. I know I can do it. I just need lots of coffee to help focus =)
Tuesday, November 18, 2008
Monday, November 10, 2008
Second Apprenticeship?
So during my hunt for an apprenticeship I heard about a group of three midwives who have a home birth practice in the east bay and SF. I had hoped to talk with them before deciding on working at Sage Femme, but the timing was not right. A week after I accepted the apprenticeship at Sage Femme I got a response from these midwives that they were interested in meeting with me.
I wrote them back explaining that I had already accepted my apprenticeship, but that it was only one day a week, and whenever there were births. I asked if they would in interested in working with me when I wasn't at Sage Femme since I don't have another job or kids yet. The only potential issue would be if there are overlapping births. They wrote back and said that there isn't a conflict with Sage Femme, because they don't regularly see clients on the day I'm scheduled to work there. And as for conflicting births, if its meant for us to work together, then we'll find a way to work things out.
So I'm going to meet with them on Wed for lunch and see how things go. I have a feeling that I will really like working with them. Just from the impression I got from their website and birth photos. I did meet one of the midwives briefly at a conference in March. She was also a student at Sage Femme for a while before leaving to do home births. So Judi knows her well and I talked to her about my plans to meet with them so that everyone is in the know.
Because I accepted at Sage Femme first, I plan to make them my priority. If I'm already at a birth at Sage Femme, then I won't be able to leave for another birth. And if I'm at a birth with the other midwives and get a call for Sage Femme, I'll have to leave. This could potentially really really suck. If I've developed a strong relationship with the mother I won't want to leave in the middle of her birth. I'm hoping that the chances of births overlapping will be slim. But it really depends on how busy they are.
We will talk about everything and figure it out. I think maybe doing a trial period of a few months to see if I can actually pull it off is a good idea. I don't want to over commit or burn myself out. But at the same time I'm very eager to gain experience and take advantage of my time right now. And I would LOVE to be in the homes again. 2 of the three births I have attended at the birth center resulted in transporting to the hospital. Both were necessary, but it makes me wonder...
I have a theory that mothers that choose home birth are more committed and willing to have a natural birth. And that mothers who choose a birth center are still afraid or not trusting of birth. They don't want to be at home, but don't want to be in a hospital. It's a safe middle ground. Both deserve unconditional support and excellent care. But part of me wants to work with mothers who trust birth as much as I do. That is one of the things I need to work on personally.
So we'll see how it goes. I need to keep studying. It's hard to with distractions at home. The internet, Cody (our kitty), and wanting to get organized around the house still. I find it's easier to study at night when everything is quiet and dark. =) Wish me luck!
I wrote them back explaining that I had already accepted my apprenticeship, but that it was only one day a week, and whenever there were births. I asked if they would in interested in working with me when I wasn't at Sage Femme since I don't have another job or kids yet. The only potential issue would be if there are overlapping births. They wrote back and said that there isn't a conflict with Sage Femme, because they don't regularly see clients on the day I'm scheduled to work there. And as for conflicting births, if its meant for us to work together, then we'll find a way to work things out.
So I'm going to meet with them on Wed for lunch and see how things go. I have a feeling that I will really like working with them. Just from the impression I got from their website and birth photos. I did meet one of the midwives briefly at a conference in March. She was also a student at Sage Femme for a while before leaving to do home births. So Judi knows her well and I talked to her about my plans to meet with them so that everyone is in the know.
Because I accepted at Sage Femme first, I plan to make them my priority. If I'm already at a birth at Sage Femme, then I won't be able to leave for another birth. And if I'm at a birth with the other midwives and get a call for Sage Femme, I'll have to leave. This could potentially really really suck. If I've developed a strong relationship with the mother I won't want to leave in the middle of her birth. I'm hoping that the chances of births overlapping will be slim. But it really depends on how busy they are.
We will talk about everything and figure it out. I think maybe doing a trial period of a few months to see if I can actually pull it off is a good idea. I don't want to over commit or burn myself out. But at the same time I'm very eager to gain experience and take advantage of my time right now. And I would LOVE to be in the homes again. 2 of the three births I have attended at the birth center resulted in transporting to the hospital. Both were necessary, but it makes me wonder...
I have a theory that mothers that choose home birth are more committed and willing to have a natural birth. And that mothers who choose a birth center are still afraid or not trusting of birth. They don't want to be at home, but don't want to be in a hospital. It's a safe middle ground. Both deserve unconditional support and excellent care. But part of me wants to work with mothers who trust birth as much as I do. That is one of the things I need to work on personally.
So we'll see how it goes. I need to keep studying. It's hard to with distractions at home. The internet, Cody (our kitty), and wanting to get organized around the house still. I find it's easier to study at night when everything is quiet and dark. =) Wish me luck!
Sunday, November 9, 2008
First official day =)
So my last post was on the Sunday before I officially started. I got a call the next day, Monday, and there was a mom in labor. Judi wanted to know if I would like to observe the birth. Of course! It was still a bit early but I headed over to the center to be there when the mom arrived. While waiting I started the scavenger hunt around the center and got very familiar with where all the supplies and equipment are stored. A few hours later and still no momma, so Judi called to see how she was doing. Her contractions were becoming irregular again and waning so they were probably not going to be coming in. I was disappointed but grateful to get to know the center a bit more and went home.
The next morning at 5:30am I got the call from Judi. L had come in around 4am and she was around 6cm with fairly regular contractions every 5-7 minutes. I jumped in the car and drove over the bridge into the city with the early morning traffic. By the time I got there L's contractions had slowed a bit, and she was being well supported by her husband and doula. I ate some breakfast and got introduced to them. Sweet couple, mom in her early 40's, first baby, its a boy "Paulo". At this point I was just helping with taking vitals and timing the contractions occasionally.
The next 12 hours seemed to fly by with taking vitals and trying to help her swing Paulo into a better position. The silly monkey had his back on one side and his head turned the other way. To help do that we had her changing positions and walking, trying to keep her contractions going, but it was hard because of his funky position, his head wasn't applying the even amount of pressure on the cervix to synchronize the contractions.
At 7pm after having a bit of yogurt with honey for energy L vomited and her water broke at the same time. Even though most people think vomiting is a bad thing... in labor it can actually help a lot. Her waters were clear and perfect. Throughout the whole day Paulo's heart rate was fantastic. The little guy wasn't even phased =) Now that her water was broken we needed to monitor her temperature to see if she was at risk for an infection. So far so good =)
After her water broke she became a bit dehydrated so Judi suggested an IV and they accepted gratefully. After an hour or so of the IV she was feeling much better and had much more energy. She was rocking and swaying with the contractions. Around 10pm Judi decided to check her again to see if she'd made any progress. If she hadn't we were going to talk about transporting because the contractions she had kept coming and going and weren't strong enough to help turn Paulo. If she got a bit of Pitocin at the hospital it would help, and before she was too tired for the pushing stage.
When Judi checked her she was still 7-8cm, but very stretchy. So Judi decided to hangout for a contraction and see if the head came down when L pushed. It did. So through a few contractions Judi helped move the cervix out of the way for the head to come down. And down he came. We moved L to a birthing stool to let gravity help and with each contraction and push he came closer and closer. Soon we could see his little head full of dark hair molding perfectly to fit. As he started to crown she panted through the contractions and his head came out perfectly. He had turned the right way!
With the next couple contractions his whole body came out and we helped lift him to L's lap. He was pretty flaccid (floppy) and didn't start to cry after being stimulated with rubbing, talking and some suctioning. Judi listened to his heart and it was pretty slow, so she clamped him and brought him to the resuscitation table. I was right there ready with the oxygen on and a warm blanket to help dry him and stimulate him more. After a few seconds he started to pink up, I listened to his heart and it was back up to a good range. But he still wasn't crying or making strong efforts to breath. Judi asked me to call 911 and ask for a neonatal resuscitation team.
I flew to the other side of the room and called. Somehow I remembered the address even though I'd only been here twice before. While on the phone I could see Paulo moving around and starting to make a little noise. Once I confirmed everything I went to the front of the building to wait for them. They arrived about 8 minutes later (longest 8 minutes of my life) and I let them in. When I went back to the room Paulo was breathing on his own but still wasn't crying. So the decided to transport him just to be cautious. So Paulo and dad went to the hospital and mom stayed with us to make sure she was doing ok.
During the commotion of resuscitate and calling and waiting L had delivered her placenta with the help of the other student midwife and her doula and was doing great. Before we could let her leave we had to make sure she wouldn't hemorrhage, was able to go to the bathroom, get something to eat and rest for a bit. We got her in bed and I made her some scrambled eggs. While feeding her the eggs and some yogurt we talked about what happened and how Paulo looked to me, and that I was certain that he was going to be fine. As the EMS was leaving with him we heard him cry.
After about an hour and a half, with a good nap, food and being able to walk around without feeling dizzy... I drove L to the hospital. We had her sit and she was finally able to hold Paulo and cuddle him skin-to-skin. They had done some blood tests and found that his hematocrit was higher than normal, meaning his blood was thicker than they liked. The talked to the parents about doing a procedure to help dilute his blood, by extracting some from his umbilical vein and adding saline through and IV. The risk of a high hematocrit is having his blood clot and potentially give him a stroke. The benefits of the procedure definitely out weighed the cons so they agreed to go forward with it.
I offered to stay at the hospital and wait with them till after the procedure and Paulo was all settled with his mom again. The father still needed a ride back to the center to pick up their things that were left behind in the rush and to get their car. So around 9am everything was finished, Paulo was back to cuddling with his mom and resting so it was time for me to head out. I as so grateful to be able to support them. I was able to help assess L's bleeding while at the hospital to make sure she was still doing fine and make sure she stayed hydrated.
Even though I had been awake for more than 27 hours, I was high on adrenaline from the whole evening and so satisfied and happy that they were all doing great and finally together again. I learned a ton and was so grateful that I was able to help so much during the birth and afterward. Judi does have another midwife on staff, but the decision to start pushing happened so quickly that even if she had called her, she wouldn't have made it there on time. And I'm super glad that I came early on monday and got to know my way around the center. Knowing where everything was helped a ton and I was able to preemtively prepare things. I was fast and efficient. It felt great =)
I got home around 10am, took a shower, ate and then crashed into bed =) *sigh* It was a good start to my new apprenticeship =)
The next morning at 5:30am I got the call from Judi. L had come in around 4am and she was around 6cm with fairly regular contractions every 5-7 minutes. I jumped in the car and drove over the bridge into the city with the early morning traffic. By the time I got there L's contractions had slowed a bit, and she was being well supported by her husband and doula. I ate some breakfast and got introduced to them. Sweet couple, mom in her early 40's, first baby, its a boy "Paulo". At this point I was just helping with taking vitals and timing the contractions occasionally.
The next 12 hours seemed to fly by with taking vitals and trying to help her swing Paulo into a better position. The silly monkey had his back on one side and his head turned the other way. To help do that we had her changing positions and walking, trying to keep her contractions going, but it was hard because of his funky position, his head wasn't applying the even amount of pressure on the cervix to synchronize the contractions.
At 7pm after having a bit of yogurt with honey for energy L vomited and her water broke at the same time. Even though most people think vomiting is a bad thing... in labor it can actually help a lot. Her waters were clear and perfect. Throughout the whole day Paulo's heart rate was fantastic. The little guy wasn't even phased =) Now that her water was broken we needed to monitor her temperature to see if she was at risk for an infection. So far so good =)
After her water broke she became a bit dehydrated so Judi suggested an IV and they accepted gratefully. After an hour or so of the IV she was feeling much better and had much more energy. She was rocking and swaying with the contractions. Around 10pm Judi decided to check her again to see if she'd made any progress. If she hadn't we were going to talk about transporting because the contractions she had kept coming and going and weren't strong enough to help turn Paulo. If she got a bit of Pitocin at the hospital it would help, and before she was too tired for the pushing stage.
When Judi checked her she was still 7-8cm, but very stretchy. So Judi decided to hangout for a contraction and see if the head came down when L pushed. It did. So through a few contractions Judi helped move the cervix out of the way for the head to come down. And down he came. We moved L to a birthing stool to let gravity help and with each contraction and push he came closer and closer. Soon we could see his little head full of dark hair molding perfectly to fit. As he started to crown she panted through the contractions and his head came out perfectly. He had turned the right way!
With the next couple contractions his whole body came out and we helped lift him to L's lap. He was pretty flaccid (floppy) and didn't start to cry after being stimulated with rubbing, talking and some suctioning. Judi listened to his heart and it was pretty slow, so she clamped him and brought him to the resuscitation table. I was right there ready with the oxygen on and a warm blanket to help dry him and stimulate him more. After a few seconds he started to pink up, I listened to his heart and it was back up to a good range. But he still wasn't crying or making strong efforts to breath. Judi asked me to call 911 and ask for a neonatal resuscitation team.
I flew to the other side of the room and called. Somehow I remembered the address even though I'd only been here twice before. While on the phone I could see Paulo moving around and starting to make a little noise. Once I confirmed everything I went to the front of the building to wait for them. They arrived about 8 minutes later (longest 8 minutes of my life) and I let them in. When I went back to the room Paulo was breathing on his own but still wasn't crying. So the decided to transport him just to be cautious. So Paulo and dad went to the hospital and mom stayed with us to make sure she was doing ok.
During the commotion of resuscitate and calling and waiting L had delivered her placenta with the help of the other student midwife and her doula and was doing great. Before we could let her leave we had to make sure she wouldn't hemorrhage, was able to go to the bathroom, get something to eat and rest for a bit. We got her in bed and I made her some scrambled eggs. While feeding her the eggs and some yogurt we talked about what happened and how Paulo looked to me, and that I was certain that he was going to be fine. As the EMS was leaving with him we heard him cry.
After about an hour and a half, with a good nap, food and being able to walk around without feeling dizzy... I drove L to the hospital. We had her sit and she was finally able to hold Paulo and cuddle him skin-to-skin. They had done some blood tests and found that his hematocrit was higher than normal, meaning his blood was thicker than they liked. The talked to the parents about doing a procedure to help dilute his blood, by extracting some from his umbilical vein and adding saline through and IV. The risk of a high hematocrit is having his blood clot and potentially give him a stroke. The benefits of the procedure definitely out weighed the cons so they agreed to go forward with it.
I offered to stay at the hospital and wait with them till after the procedure and Paulo was all settled with his mom again. The father still needed a ride back to the center to pick up their things that were left behind in the rush and to get their car. So around 9am everything was finished, Paulo was back to cuddling with his mom and resting so it was time for me to head out. I as so grateful to be able to support them. I was able to help assess L's bleeding while at the hospital to make sure she was still doing fine and make sure she stayed hydrated.
Even though I had been awake for more than 27 hours, I was high on adrenaline from the whole evening and so satisfied and happy that they were all doing great and finally together again. I learned a ton and was so grateful that I was able to help so much during the birth and afterward. Judi does have another midwife on staff, but the decision to start pushing happened so quickly that even if she had called her, she wouldn't have made it there on time. And I'm super glad that I came early on monday and got to know my way around the center. Knowing where everything was helped a ton and I was able to preemtively prepare things. I was fast and efficient. It felt great =)
I got home around 10am, took a shower, ate and then crashed into bed =) *sigh* It was a good start to my new apprenticeship =)
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