Speaking of Birth, this is the story of what I learned giving birth in a teaching hospital....
Some time before I became a childbirth worker but some time after I witnessed calves being born on a farm, I gave birth to our baby boy. It was a beautiful sunny day in May in New York City.
At the time I did not know about doulas and natural birth alternatives, but I knew I did not want any medications. I didn’t want medications because I’m a bit of a nature girl and I was concerned they would intervene and slow down the natural process. I figured if it was just one day I could bear it.
I did know enough to seek out a midwife at our hospital, however in my last trimester I risked out of using midwifery care due to gestational diabetes
I was using the local, public hospital at the time I became pregnant, I did not have health insurance and when I asked my Obstetrician how much it would be to pay out of pocket for the prenatal care and actual birth, the answer was around $20K. So I visited a public hospital just a few blocks from my apartment to see if they could help. I learned about the cost of medical bills.
Can you guess which New York City hospital it was? It was founded in 1736 and is the oldest public hospital in the US. Its psychiatric wing has a famous history and recently in 2014 it was in the new for successfully taking on ebola patient, and Doctors Without Borders’ MD, Craig Spencer. If you guessed Bellevue Hospital you are correct!
Bellevue took me in and I received medicaid, which I was embarrassed to tell my mother and family because they would not agree with going on medicaid, however I didn’t have a lot of options, so I did what I needed to do for the health of my baby. When my sister asked my mother who was paying for the healthcare, my mother told my sister, “You are, dearie.” (my sister was a New York resident). Thank you New York residents!
So the morning of, I was getting ready for my office temp job when my body produced a giant gush of fluids on the bathroom floor! Was it pee or was it amniotic fluid? I felt pretty sure it was fluids, so called the hospital around 8:00 a.m. and they said to come in, so naturally I postponed going in and opted to clean my apartment instead. This was pre-doula days so I didn’t know much, but I knew NOT to go the hospital right away, especially if your water has broken but you are not contracting.
Around 10:00 a.m., I waddled up and over the 7 blocks and 2 avenues from 20th and 3rd, on Gramercy Park South, to 27th and 1st in Kip’s Bay.
I went to buy some milk from a street cart vendor when I arrived at 27th and 1st, and he wanted to gift it to me. He actually got kind of offended when I paid. I should have let him gift it. I learned a lesson in grace.
In I went to the hospital with my milk, red medical card, and little overnight bag. Bellevue is a teaching hospital, affiliated with NYU and I can safely say the birth of my son provided lots of teaching opportunities for lots of residents.
In triage there was the intern who tried and tried to put the large gauge IV into my RIGHT hand only to find out about 30 mins later that he was supposed to put a smaller gauge IV into my LEFT hand, where he tried and tried again. That day, an intern learned where and how to put in an IV.
Around 11:00 a.m. someone must have checked me because they said I wasn’t contracting and I wasn’t dilated, so they wanted to give me Pitocin.
I called and let my fiancee, and now husband, know that I was at the hospital, but having a very strong work ethic (never misses a day of work type of guy), he thought nothing of saying he’d be there as soon as work was done. For some reason I didn’t really care as I was satisfied to labor without his presence - without a daddy either not knowing what to do (hire a doula if you want your partner to learn how to be more involved!), or seeing me such an intense state.
They admitted me to labor and delivery where I was watched over by nice nurse. I don’t recall her name but she helped me breath. Since I was not contracting, they wanted to give me some artificial oxytocin known as Pitocin or pit. Now as a birth doula, a labor support person, I know many other ways to get nature's oxytocin hormone to release (as well as the negative side effects!), but not having a clue about anything because we only took one parenting class at Bellevue, I agreed.
Next thing I knew, all I can see are my white knuckles gripping the bed rail and my nurse saying, "Ms. Rachel, you need to breath for baby! Breath for your baby!" It was a command and I’m glad she reminded me, because otherwise I definitely would have forgotten to breath for long periods of time. I learned about my own strength that day.
They kept offering pain meds but I was concerned they would slow things down and I didn't want the whole process spiraling downward (I later learned was called the "Cascade of interventions"). As it turns out, I was glad I didn’t have any pain medication because I could feel just how horrible these chemical induced contractions were. Pitocin contractions are much more forceful than a natural contraction, which is more of a wave – Pitocin ones are more of a strong spike.
Being able to feel the contractions made me realize how strong they were – much too strong – how could my baby breath? Now I understand more how it works and how during labor the baby and its cord (supplying oxygen and nutrients) gets kind of squished during contractions and the baby’s oxygen supply gets cut off until the contraction is over when the bay catches its breath again. If I’d had pain medication I would not have felt how strong the contractions were and know how my baby was not getting a break from being squished. I said, ‘turn it down, turn it down” I wasn’t getting a break, they were on top of one another!
After several hours of labor I said I couldn’t take it anymore and I wanted pain medication. A doctor came in – like a real doctor I think (not a student) - and told me I was all the way open and let’s do this. Okay. Let's do this.
It was close to 6:00 p.m. and my fiancee arrived around that time, but all I remember is his washed out red shirt with a constellation of little white bleach stains that he wore. I asked him to stand at my head and shoulders. (I secretly replaced this shirt with new one sans bleach stains after).
The local residents also arrived - in came, what seemed like no less than 15 residents and interns to see this crazy lady on pit with no pain meds deliver her baby (it was probably closer to 8-9 interns). It was a wall of white coats - short and long. They all stood there watching, framing the room. I didn’t really care how many people were present – I don’t know why. My mother, mother to 6 children, always used to say, all modesty goes out the window when you have a baby and I found that to be true - I really didn’t care who or what was in the room. As long as me and my baby could breath and my fiancee was at my head and shoulders, I didn’t care. I know this would not be true for many other women who desire privacy.
The attending was present and she was lovely and very encouraging. I don’t remember much from the pushing phase other than it was really exhausting. I was so tired from laboring all day and the pushing phase was so intense and required so much energy. I felt I could NOT do it! Now when I coach moms, I am glad I know just how exhausted they are when they need to push their baby out, so I can support them the right way. It is hard to imagine the exhaustion. I learned how it feels to have absolutely zero energy left and be told you have to bicycle up a giant hill anyway, on a hot day.
The attending told me I was a good mom and I hadn't even had my baby yet. She made me feel so good with just a few words of encouragement here and there.
Our baby boy was born at 6:30 pm. Our hearts completely exploded with love and joy upon welcoming our son.
Whisked away to nursery because I was “high risk” – I asked my husband to follow them as I didn’t want a switched at birth scenario or anything - haha protective mother I guess! They returned baby soon after and with it my fiancee brought a pint of Vanilla Swiss Almond ice cream, my favorite and something I’d gone without for months due to the gestational diabetes. Thank you Steve!
Baby took right to breastfeeding and soon after, my mom in law arrived and looked with such treasure on her new grandson – it was a site to behold! My parents came the next day and that will always be one of my favorite and most treasured memories is my mother and father coming to meet my new baby – my son and then 3 years later, my daughter. Now that my mother is gone, I treasure those moments even more. In my doula role, whenever a grandparent visits a mom right after the birth, I think how the parents will look back on that as one of their favorite memories and they will miss the grandparents some day. Of course, I cannot say that, but I try to do whatever I can to contribute to them enjoying the moment as much as they can.
So, to me and my Irish sense of humor, the birth was a comedy of errors. I could probably write the same story through a traumatic birth lens and getting poked with IVs, provided not comfort measure, having a classroom full of residents present, but I really don’t feel that way - I feel I had a pretty good birth because it was fast and positive and I could feel what was happening in my body. I learned each birthing woman writes her own story.
Clients often ask if I can provide them with a receipt that they can submit to insurance. Yes, I can, but you will want a back-up plan. Doulas are not automatically covered by insurance although many people feel they should be. Choices in Childbirth (CiC) put out a big report on this topic earlier this year, Overdue! Insurance Coverage of Doula Care. Warning: it's complicated. In the report they say, “Private insurance plans should include services of a trained doula as a covered service, and state legislatures should pass legislation mandating private insurance coverage of doula services, as they have done for a broad range of services." Even in states where there are programs and the insurance companies are supposed to reimburse (the only states being Oregon and Minnesota), it is not a slam-dunk, “At this time, few doulas, if any, have actually received reimbursement in either Oregon or Minnesota.”
So some people try to get covered with some effort. For this, the doula needs to provide an itemized receipt. The theory is that there are insurance companies that cover support services that fall into a second tier of health options such as therapeutic massage, gym memberships, breast pumps, lactation consultants and doulas, and typically the companies require the insured to provide paperwork and receipts. As an example of how to submit, DONA offers this DONA 3rd party reimbursement manual, but keep in mind it needs updating as it still includes CPT code, which I will go into below: http://www.dona.org/PDF/3PRSampleLetter.pdf. As doulas, we can provide a detailed receipt including our National Provider Identification (NPI#) and a description of services. As per describing services - I have not heard of the insurance companies being impressed with doulas describing relaxation and pain-coping techniques or that doulas are preventive medicine and statistically reduce the need for expensive surgeries and epidural anesthesia. The companies seem to better respond to tangible services they are familiar with, such as childbirth education and breastfeeding support.
Anecdotally, I have heard of a doulas being reimbursed when the provider signs a letter of medical necessity, including a medical code, indicating labor support increases the chances of the patient having an unmedicated birth with no pain management (I guess if it's doctor's orders then it is taken more seriously). What is this secret code you ask? Midwives and Doctors can offer CPT code 99499, since they are medical, but since doulas are not medical we cannot offer this same code. Per DONA, “As of this date, there is no national CPT (current procedural terminology) code for doulas.” So doulas cannot sign-off on this type of letter/receipt because doulas are not medical therefore we do not have a diagnosis code. Having a provider sign-off on our services is not realistic option for most of us since we are hired by the client and not by the provider, but there are offices in my home turf of northern NJ that have doulas on staff, such as Wombkeepers and Midwives of NJ.
So what are the options? Some clients have been able to use their Health Savings Account (HSA) accounts and Flexible Spending Accounts (FSA), that can reimburse an individual or help one pay for eligible health care expenses not covered by one's health plan. Typically, the amount designated from your paycheck, that you put into your FSA, is taken out pre-tax. You will still need a receipt with NPI# and description of services for this purpose.
In closing... The insurance piece is going to take some time. Feel free to get involved by raising awareness via the CiC report or by contacting the rep at your doula organization who handles insurance questions. Personally, I don't recommend clients invest too much time with insurance. As for women who cannot afford a doula - recommend saving, offer a payment plan, request money for doula-savings at their baby shower/registry, ask a doula to barter services. Also, there are always student doula training and attending births, as they work towards their certification. To find these doulas just look on doulamatch and see how much they charge – rates often correlate with experience.
What is your experience with insurance reimbursement for doulas and what are creative ways you've heard of how people afford a doula? How do you respond when people ask if you provide insurance? I hope to read your response.
If you are interested to read the full report, visit Choices in Childbirth's Toolkit Overdue Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health http://choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage/.
Skylands doulas, a group that generates supports and advocacy for the role of doulas based in northwest New Jersey, periodically hosts doula meet-ups. This past year we had the pleasure of hosting 3 midwives as part of our meet-the-midwife gatherings. The 3 midwifes all came from different practices here in NJ.
Let's quickly outline the different license options for midwives here in NJ as there are 3: CNM (prescriptive and non), CM, & CPM.
According to American College of Nurse Midwives, "CNMs are licensed, independent health care providers with prescriptive authority in all 50 states, the District of Columbia, American Samoa, Guam, and Puerto Rico. CNMs are defined as primary care providers under federal law.
"CMs are also licensed, independent health care providers who have completed the same midwifery education as CNMs. CMs are authorized to practice in Delaware, Missouri, New Jersey, New York, and Rhode Island. CMs have prescriptive authority in New York and Rhode Island. The first accredited CM education program began in 1996. The CM credential is not yet recognized in all states." Read more on the ACNM Website.
A Certified Professional Midwife (CPM) "is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings." Read more at NARM.org
According to NJ Homebirth Midwives "All New Jersey licensed midwives have undergone both clinical and academic training and have met rigorous standards set out by the NJ Board of Medical Examiners. For midwives certified as Certified Midwives or Certified Nurse Midwives, their training has been university based and usually includes a graduate degree. For midwives certified as Certified Professional Midwives, their training is community based, which means they’ve done extensive study under experienced midwives and have graduated from a MEAC-accredited academic program as well. CPMs are the only type of midwife whose training is specifically focused on out-of-hospital birth."
To learn more about the regulation of midwifery practice in NJ pls visit NJ Consumer Affairs Midwifery Liason Page.
Ok so, let's begin...
The first midwife who visited us was Kacey DiVine, RN, CPM who does homebirths with Babycatcher Midwifery & Motherlore Midwifery. Kacey shared about the experience, homebirth midwives sometimes go thru, of transferring from home to hospital and what to expect regarding: transport, continual support from birth team, choice of hospital based on location of medical back-up, reception of hospital staff, and more.... In the story she shared, all was well, but it was clear more communication and collaboration could be fostered between the homebirth communities and local doctors and hospitals. Kacey feels that having a good collaborative relationship with an OB practice (like the relationship they have with One to One Female Care) "makes transfer safer and less stressful for the mom. The goal that we homebirth midwives are working on is expanding those relationships to other docs and hospitals." What ideas do you have how to educate and inform regarding home to hospital transfer? Thanks to Kacey as we were very grateful she was able to come share about her experience with the Skylands Doulas.
What programs do you know of that help foster the relationship between #homebirth communities and local doctors and hospitals? Tweet
The second midwife, who we were honored to have visit, was Donna Tabas CNM, MS of North Jersey Midwifery Care, who currently attends births at Hackensack UMC at Pascack Valley. Donna has a solo practice and works as a "dedicated” midwife, meaning that she is the midwife you will have for all your prenatal care, the birth, and postpartum period. Donna shared about her journey to becoming a midwife as well as how we must carefully choose the words we use when speaking of birth - it's all on her blog, read more about it on Donna's blog. Donna also shared some of the exercises she does with clients including a meditation on cesarean surgery. The cesarean meditation released tension and emotions in the room for all the women present - both on a personal level as well as professional as it released tension we hold from clients and the stories we become vessel to. Thank you Donna for helping us find our way through this space, which is often traumatic, and helping us find new words and helping us reframe.
What is one of your favorite activities/exercises you do with #doula clients to help release fear and tension?
The third midwife, we were lucky to have visit, recently became credentialed at two NJ hospitals after working as a Homebirth Midwife for 24 yrs. Linda Perry CNM, of Lifelong Midwifery writes that she is, "So excited.....bringing my practice very soon to Mountainside Hospital and Hoboken University Medical Center. Have you heard bad things about Hoboken? Times a changing over there. They are bringing back many of the St. Vincent's crew across the river, renovating both the rooms and the outlook." Linda also shared with us about Hoboken's new Pampered Pregnancy Program, "A family-centered childbirth and parent education program emphasizes mother and baby wellness, information for all family members, and family autonomy." Through this program, all of Linda's clients will have their own Pregnancy Coach included in their care. Follow Linda at https://www.facebook.com/YourMidwife/ Linda is excited to be working closer to home where she is short drive to be with her mamas. She is also looking forward to collaborating with the hospitals to further enhance their motherbaby care.
If you are a midwife or a birthworker and would like to come speak to Skylands Doulas, please contact Birth Doula & NJ Birth Photographer Rachel Connolly Kwock at firstname.lastname@example.org or 917 676 7177. Thank you!
Thanks to all the midwives of the world!
Not everything comes naturally but that is no reason to be discouraged from pursuing something you want to pursue.
Sometimes we need to learn the basic skills first in order to feel comfortable enough to let our intuition really flow and to allow things to come naturally – to have the ability to “just know” something without any proof or evidence.
Take a chef for example – to be able to say “oh I just added a touch of this and stirred in a little bit of that” is usually from years of trial and error – from souring sauces and burning side dishes. Now they can play around with seasonings.
Or consider a businesswoman who says, “I followed my gut” or “I had a hunch about that deal” – it’s often from years of experience and observing behavior, analyzing metrics, and taking risks. They already know how far they can push things and what the likely outcome will be.
Intuition as a learned skill applies to business and creative pursuits as well as many of other vocations – and in my personal experience, it applies to working as a birth doula in northern New Jersey.
As a birth doula, a woman who supports and serves women in childbirth, it was frustrating when I started to have more-experienced doulas tell me – “just to follow your intuition”. I would think–I have no idea where this intuition, you speak of, starts or where it leads, so can you please provide me a little direction?
When I started as doula, I would always do a simple hip squeeze – placing my hands on either side of mom’s hips, applying pressure to relieve pain and tension. I did this repeatedly because neither my skills nor intuition was guiding me anywhere else. About a year ago I participated in a workshop where we learned in-depth information about positioning for mother and baby and am now able to follow my intuition more. The workshop changed by practice.
Knowing more helped me be more intuitive.
Now when I support a mother – I know to breath out any tension and let any thoughts go from my own mind – to leave the suitcase at the door. I listen to what comes intuitively - to the sounds of the birthing space and the birthing woman.
Tuning in helps me listen to the sounds of her movements – whether they be tired, tense, relaxed, imminent.
I can sense her clenched jaw and gently rub her jawbone to provide release. I can tell she is hold tension in her pelvic area by how she paces and positions herself during contractions – and can gently place my hands on her sacrum to offer her release and support.
Are her legs tired from standing all night? I can feel if her muscles are taught or wilted and go on to provide a gentle foot massage or little wiggle to shake out her lax limbs.
It took me years of building my knowledge and skills to get to the point where I felt I could follow my intuition but now I feel confident to enter the space of a birthing woman and close my eyes and listen to the space and to what her body is telling me – where her body is guiding my hands to go, to be intuitive. To “just know.”
So if this skill of intuition was there all along and is available to all of us - how can we hone it? How can we simply be more attuned and responsive to the subtle clues we receive?
Scientific America Magazine wrote that intuition is linked to the basal ganglia area of the brain – an area that controls fast, automatic, cognitive operations. So it would make sense that to hone our intuition we need to improve or maintain our brain health.
As many studies show – brain health can be maintained with good diet, exercise, plenty of sleep, and clearing the mental clutter. To be a good listener and more intuitive, it is important to turn off the chatter in our brains. We can do this using meditation or periods of silence and solitude where we focus on our breathing or something that brings us peace.
In order to be better listeners in our environments, we need to turn off the noise.
So intuition may not be a mystical thing for all of us. If we are experts or even very experienced in our fields – it may be a matter of just connecting the constellation of silent clues we receive in order to yield an intuitive response.
Being intuitive can be a wonderful, freeing feeling. I will never, ever say to a doula starting out – “oh just follow your intuition” as if they already have that roadmap. For some of us, it is only possible to follow our intuition after we have created a map that charts skills, knowledge and experience. Only then can we can paint with broad brush strokes of intuition over the charted ones.
As Picasso says, “It took me four years to paint like Raphael, but a lifetime to paint like a child.”
Fellow doulas, what helped you to follow your intuition more?
Photo shared with permissions. PC: Rachel Connolly Kwock. Feat.: Doula Holly Graff & Midwife Donna Tabas.
Professional Photographers dedicate years of learning and experience to master their craft, invest thousands of dollars in camera bodies, lenses, and equipment and editing programs, create a legal photography business entity recognized by the state from which to conduct business....
My offerings are a little different....
I am birth doula certified by Doulas of North America (DONA), a (former) professional filmmaker, and hobby photographer currently merging my love for all the roles here in Northern New Jersey. So how does it work - how can I be your birth doula and photographer at the same time and what exactly is my level of expertise?
Well, to answer the first part of the question... If I am hired solely as your Birth Photographer then yes, 99% of the time I will capture everything that you would want captured. If I am hired in a dual role as your Birth Photographer/Doula, I can do both jobs at about 95%, as there will definitely be a few moments where I am not able to capture a photo or not provide the support needed depending on what you have expressed you want. At our prenatal visit, we can discuss what is more important to you, either the birth photography or the doula support, with the caveat being that birth is fluid, and oftentimes intense, so your needs may change in the moment and as a doula I am trained to respond to the woman's physiological needs.
Okay, so what is my level of expertise? I have been a lifelong hobby photographer, however once I committed to offering birth photography services, I invested in a new digital camera/lens/flash. editing system, etc... took a class to polish my skills, paid for pro membership and enlisted the help of a designer friend to create a watermark. Photographers are always learning, however I feel confident with my skills and equipment at this time. Please see my gallery page to see the progression of my work. I will continue to build my portfolio over the next year.
So yes, I believe a doula and a birth photographer can fulfill both roles simultaneously, but with limitations. I also feel a client can hire a professional birth doula photographer in just one role but feel secure knowing they have hired someone with doula expertise as their photographer or someone with photography skills (if enlisted) as their doula. I will always have the heart of a doula and the eye of the photographer whatever role I am in. Best wishes for you birth and props to all the birth doula photographers in the world!
It was such an honor to be doula to Matt, Megan, and Baby Atticus. It was humbling to see a husband and wife so dedicated to one another and to their baby. The endurance and struggle Megan went thru, to try and provide her baby the birth she felt was best, was immense. It was inspiring to be witness to her coping - to see her roaring her way thru labor humming and moaning, rocking and swaying side-to-side, back-n-forth on the bed, in the tub, in the shower- allowing herself to surrender to the power of birth. I will never forget the heartbreaking look on Megan's face when she was told she will need to have surgery. I know the end result is a million miles away from where they thought and hoped it would be, but personally I will never forget being amongst a circle of women in the presence of an incredibly powerful lioness who thundered her way thru every surge, and her devoted husband who provided incredible support, focus, assuring words, gentle touches, and constant devotion and attention. Megan, thank you for sharing your experience of challenge, healing, and love.
"Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby. " - Megan
By Megan Stark
I’ve been a doula since 2012, trained in both birth and postpartum support and I am obsessed with birth.
But let me start at the very beginning.
When I was born, I was diagnosed with pulmonic stenosis, which for me was a condition that required immediate emergency surgery. I was whisked away to NYC to have open chest surgery, which as a new mom, I can’t even wrap my head around how incredibly terrifying this must have been for my parents. I healed well, and became an avid rock climber in my teens. After college I completed an internship in Boston, and while there I suffered from a TIA (stroke). This alerted my cardiologist that perhaps something else was going on with my heart. She discovered a hole in my heart – which is a far more common condition than my pulmonic stenosis. After my internship I moved to the New River Gorge in WV with my future husband. I wanted to learn more about the hole in my heart and how it might affect future pregnancies, but the health insurance laws prevented me from obtaining health insurance for some time (pre-existing condition clause). Once I did obtain insurance, I had to wait a whole year to be seen by a specialist for my heart (again the pre-existing condition clause which has now been ruled illegal by the new health insurance laws). Finally – in 2010, I was able to learn more details about the hole in my heart and what it might mean to pregnancy and birth. I was told that the hole was of such a size that pregnancy would be dangerous – and so began my journey toward providing a provider that could close the hole without another open chest surgery.
My husband and I moved back to my home state of NJ, and in 2011 I had the ¾ in. hole in my heart closed via a cardiac catheter procedure. The most amazing thing happened after my procedure – I no longer felt like I was suffocating when I exercised! I had never quite realized I felt his way, since I never knew any differently.
In the summer of 2012 I finally got pregnant, we were excited and elated, and shared our news with my family in one of those adorable Pinterest worthy ways. At seven weeks we lost that pregnancy, and I was devastated. Miscarriage is a cruel and sad event, and one so many people experience but it is so commonly written off, ignored and covered up. If you have experienced a miscarriage (nearly 30% of all pregnancies end in miscarriage), please know that you are not alone, and if you are struggling with this loss seek support from your friends, family or a professional. It is a true and profound loss, and you are absolutely allowed to mourn that loss.
As I said, I was devastated. So I decided to re-focus my attention, and began my doula training in 2013. Training to become a doula was this incredibly intense and powerful experience – just like birth! I loved attending births, and was feeling positive and excited about becoming pregnant again. In the summer of 2013 I achieved that goal, and gun shy this time, told our family in the quietest way possible. This time, I was sick – soooo sick. I was bloated and hormonal, and miserable and scared. I was terrified we would lose this pregnancy, and wanted to keep it as quiet as possible. At 12 weeks we went for our ultrasound.
There was no baby.
Our pregnancy was a “complete molar pregnancy” and my sickness was related to my out of control pregnancy hormones. I lost my mind. As a doula, I knew about these types of pregnancies, but they are rare, and having made it to 12 weeks, I was so hopeful that this pregnancy would stick. A molar pregnancy is dangerous, so a D&C is necessary and follow up blood tests are required. Women who have suffered from a molar pregnancy must also hold off on trying to get pregnant again for some time. This is to be sure that if the pregnancy hormones go up again, that Doctors can be sure it is not from pregnancy and instead from the molar pregnancy. (While rare, molar pregnancies can turn into a form of cancer, so the blood tests monitor that the hormones are going down and not up.) Here's the link for support group I found: FB.com/groups/mymolarpregnancy/
Another year passed and we finally decided to try again, one last time.
And this time it worked. We were due in April 2015, and I had one of the most amazing pregnancies. I wasn’t sick, I felt great and I was so hopeful! I also began working from my doula trainer, Debra Pascali-Bonaro, and was greatly immersed in all things birth and babies. It was such an amazing time! I was one of the most over prepared mamas-to-be you could imagine. I hired my doula co-worker and friend Rachel Connolly-Kwock as my doula, prepped my husband with too much information, took Debra’s new childbirth class, “Pain to Power”, and found an awesome midwifery group “The Midwives of New Jersey” which have an incredible water birth record. I wanted providers that I knew I could trust. As a birth doula, I had heard and saw so many women who felt coerced or disrespected in their births, and I wanted to avoid questioning my providers motivations, after everything I’d been through, I needed to know that they too wanted to avoid a cesarean as much as possible.
I planned a natural, intervention free water birth and wanted to labor as home as long as possible with my doula and husband. When I went into labor early Saturday morning, I was sleeping on the couch (at 41 weeks, while still quite comfortable, I was having some trouble sleeping). I worked through the surges on my own for a couple of hours, but was suffering from (what I later realized was) really intense back labor, decided to wake my husband for more support. At 9am things were progressing so quickly, we decided to call our doula. Let me say, that when your doula shows up, there is an incredible feeling of relief knowing you now have the professional, knowledgeable, kind and understanding support of a trained doula by your side to support you and your birth partner. We labored at home until after noon that day, and then made a plan to meet up with my lovely midwife Chrisy at their office. The office was closed that day, so it was particularly peaceful to labor with my support team. I was encouraged by my midwife to hydrate, take some honey, and eat as we knew labor could still be quite a while. We decided to check my dilation and I was just about 6cm. After a couple of hours we decided to move to the hospital, as I was desperate to get into the tub!
I labored in the shower and the tub for hours, but I was not progressing. My contractions were not coming at a steady clip, my back was killing me, and I was becoming discouraged. My doula, husband, 2 midwives and midwife assistant were incredibly encouraging and supportive. We agreed that breaking my waters might help my contractions to become steadier, assisting me in progressing. At this point I was still only 6cm, nothing had changed.
Hours later, I was done. I mean done. I asked for an epidural, something I swore I would never do. My lovely midwives distracted me, suggesting we instead try a very tiny amount of Pitocin, to see if we could get things going. I did not want this, but was feeling exhausted beyond anything I had ever felt before. I knew if my midwives were suggesting it, they felt it was likely needed. The goal was a vaginal birth above all else, and I knew that I would not be able to go on like this forever. Along with the Pitocin, I agreed to another drug that would allow me to rest between contractions. A couple of hours later, I roared awake during an intense surge. I was DONE- and this time I meant it! We decided to check my dilation again, and I was fully dilated. After some time, the midwife asked if I wanted to push. I had absolutely no urge to do so, which I thought was odd. But, ready for baby to arrive, I got to it! I pushed in every position you could think of. On my bed legs up, legs down, on all fours, standing, squatting, up, down and practically inside out! I was falling asleep between surges, completely worn out – my strong and amazing husband was literally holding my sleeping body up. Two hours later there was no progress, the baby’s heart rate was decelerating, there was meconium present and I was making no progress. The backup OBGYN was called in, and I was told that a cesarean was now on the table. My wonderful midwives knew how much I did not want this. They gave me the time and space to consider my options. I knew when my midwife Cindy told me that it would be safe to try a little longer, but that she really felt that nothing was going to change, that she meant it from her heart.
Sometimes births take a turn from what we anticipated. When a woman has a cesarean, she often feels she has failed herself and her support team. This is so sad but the reality is that we end up needing to ask for self-forgiveness. For a mother, who dreams of natural birth, to be told that your dreams have been dashed is heartbreaking on so many levels... You wanted the experience for you and your baby, you wanted to know that experience other women speak of- of birthing your baby and holding them skin-to-skin, a moment when all time stands still. You are scared and don't want surgery. You are aware of the benefits of natural birth from reading studies that show the hormones released during the birthing phase may be critical to emotional development, the shaping and molding of the cranium can ignite cranial-sacral balance, the baby being exposed to microbiomes can provide a lifetime of strong gut health and improved immune system. It is not to say some of the health benefits of natural birth can not be nurtured over time in a surgically born baby, but when you are told you are going to have a cesarean these are just some of the thoughts that flood your mind.... and it is devastating. Most prominent and most upsetting is the sudden lack of control - you were in control of your body (sort of, right - as much as we can be birthing a baby) and you were looking forward to responding to your body and baby's needs as the birth process progressed, but then all of a sudden your body, your baby, your birth, became my body, my baby, their birth.
Defeated and exhausted, I apologized to my husband for not being able to do it, and agreed to the cesarean section. My husband of course thought that was silly, he was so proud of me for what I had accomplished - but at the time I felt like a lemon. My dream of my intervention free water birth had been lost earlier that evening, and now my vaginal birth was gone too. As I was rolled into the OR, I was mentally numb. The surgery is quick, bright, intense and bizarre. All around you are strangers, your partner isn’t allowed in the room for the prep, your doula isn’t allowed in at all, and after all those hours of intensity, your body is numb. I feel so lucky that my midwife Chrisy was in the room during the prep, which for me was the scariest part. She held my hand, talked to me, and kept me company as I prepared for the birth of my baby. Finally, my husband was ushered in, and what felt like seconds later, my baby was born. A quick flash of the baby over the curtain, screaming and purple and my husband was rushed over to the baby. He was able to bring the baby to me for a quick kiss before the two of them were taken to the nursery. Another dream, of immediate skin to skin time and delayed cord clamping was taken away.
Birth via cesarean in an amazingly quick process, but the closing up is tedious and lengthy. Without my baby or husband there, it was sad and lonely. Again my midwife’s presence was so comforting. She continued to hold my hand, chat when I needed to, and let me know what was happening when I asked. Everyone in the OR is concerned about your body, but my midwife was there for my emotional support, and I am so grateful for that, in a way I will never be able to express fully with words.
Finally, finally, I was rolled to recovery, and sometime thereafter reunited with my husband. This time when I saw my baby I was able to hold him and kiss him. He nursed immediately, was so tiny, beautiful and perfectly healthy. So much love was in the room as I was surrounded by my doula Rachel, midwives Cindy and Chrisy, and midwife assistant, Ashley. Everyone was exhausted, and the outcome was not what anyone had wanted or predicted. The OBGYN confirmed that the baby was OP, which confirmed what all had suspected and explained my back labor, lack of progress, and the fact that I never felt an urge to push. OP babies can be born vaginally, but Gail Tully of Spinning Babies explains that OP babies are unpredictable – some can be born vaginally “sunny side up”, some turn during labor and some get stuck and need to be born by cesarean.
So now, I heal. I forgive myself for not having a vaginal birth. I come to terms with my cesarean scar. I trust that my providers did all they could for my “dream birth.” I learn to not obsess about the health implications for a cesarean baby. I talk about my birth and my disappointment. And I nurse, like crazy, because I need a victory, I need to know that my body isn’t lemon, because it isn’t. Birth is unpredictable, cesareans can be necessary, and moms are strong. Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby.
I want to thank my midwives:
Cindy – for her wisdom and experience and because I knew I could trust that she had the same goals for my birth as me.
Chrisy – for her kindness, warmth, and comfort when I needed it most.
Ashley – the midwife assistant, for her beautiful photography and the way she told me I was strong when I needed to hear it most.
Rachel – my doula, for always knowing what I needed when I needed it, for supporting my birth wishes, my husband, and for taking care of me, even now as I heal.
To Matt – my rock, my strength. For literally and figuratively holding me up when I needed it most.
Photo Credits: Midwives of NJ & Matt & Megan Stark
Courtney's story was so amazing because she had no expectations or desire for a waterbirth but when her midwife acted quickly to fill the tub yet and Courtney's veins responded slowly to iv fluids, she arrived somewhere she did not think she would be. Thank you Courtney for sharing your story....
I was due May 1st. This is my birth story: My contractions started at 5:30pm the evening before and they were very intense and strong but were not consistent or close together. 18 minutes apart, half hour apart, 12 minutes, 11 minutes apart. They never got closer together than 11 min apart so I called the midwife on call at 2 am (Lisa Milstein at Avalon Midwives) who said to call back when there 5 to 7 minutes apart. I called her again at 9 AM with the same news no updates and she suggested to set up an appointment for me to go to the office to get checked. She said we will just take it from there. I started using my TENS machine to deal with my contractions. Joanne Cunha was going to try to be available to deliver my baby but she was working in the office that day so she met with me at the office to check me. I told her that I lost my mucous plug yesterday and that my contractions are really intense. She said since the contractions are so far apart that this could be false labor and contractions can last for a few days like this. She wanted to do an internal check but basically suggested that we go home and wait until the contractions are closer together. I was so disappointed I really wanted to have my baby on May 1st- I love that date.
Joanne said before you leave let's just do an internal check, she said wow!!! you are 6 cm dilated right now!! She said you are going to have his baby today! She said if she breaks my water right now the contractions will be closer together and everything will start progressing normally. I was so afraid for her to break my water I was afraid it would hurt. She told me I wouldn't feel it, so she broke my water with a little pin prick on the end of a rubber glove. It didn't hurt at all but I started gushing water immediately and she put a giant chuck pad folded up in my pants lol so we can drive to the hospital without getting water everywhere. She said she wouldn't be available to deliver my baby today but Kim Kirby will be there and she is great. I love Kim I was so happy to hear that she was on call!! As soon as we left Avalon and walked out to the elevator the contractions started and they were five minutes apart the way they are supposed to be. My TENS machine really helped. We got to the hospital at 11am and I had to pee so bad. When I came out of the bathroom Rachel my Doula was in the waiting area with Rob! I was so happy to see her! I started telling her what happened at Avalon just when a big strong contraction came, she said don't worry about telling me the story let's just get through this contraction. Then I saw Kim with her iced coffee (which she never got to finish ) she gave me a kiss on the cheek and we were so happy to see each other. She said let's get you into a room! Do you want a tub? I said yes.
We were in the room that we saw during the tour. They sat me down on a yoga ball which was so relaxing and took away all the pressure. They were trying to put the belt on monitor on my belly but could not get it in the right position. Rachel was rubbing my back softly and using aromatherapy- citrus smelled so nice ! I told her I wanted an epidural and Kim said that they have to first flush me with Iv fluids for half hour and then they have to request the epidural. That takes a lot of time and Kim couldn't find my vein to get the IV fluids going I have black and blues all over my arms. She asked me if I wanted to get into the tub to get through the contractions more easily. I told Rob that they are tricking me I don't think I will be able to get the epidural. I wasn't panicking I don't think it really clicked in my mind what that would mean. Once I got in the tub I wouldn't be able to get an epidural quickly. Rachel looked at me and said think about the opportunity that you have right now you can do this! When I got into the tub it was so relaxing and warm it's unbelievable how wonderful it felt. The temperature was absolutely perfect. During contractions I would press the whirlpool button. Before I got into the tub I kept yelling that I feel pressure! I feel pressure! Kim said what kind of pressure ? I kept yelling I don't know I don't know I don't know I think it's the head.
Kim told me that she felt the head and that it was right there! She said there's no point in getting out of the tub the head is right there! She told me I could start pushing. I kept yelling I don't know I don't know I don't know I don't know how do I know when to push? I felt a contraction and I pushed and she said we see the head!! She said keep pushing I pushed again and I yelled I feel the ring of fire I feel the ring of fire! As I was pushing the head I felt my whole crotch stretch and burn. By that time the entire head was out I heard the nurse say okay shoulders are next. She told me to give a big push she said do it harder that's not hard enough! I pushed again and she said one shoulder was out I felt like my entire insides, my pelvic bones were separating as I felt the baby move through. I was yelling beastly sounds and started screaming get it out ! get it out! Why aren't you getting it out ?!! I don't know understand why you cant get it out!! I gave a long push, the push was so long I couldn't believe that the push lasting that long and the rest of the baby came out.
I went from intense horrific pain to complete bliss with no pain at all. The moment the baby came out there was absolutely no pain. Rob was crying because he said the birth was so beautiful just like on TV. He said the water was completely clear no blood, no poop! When the placenta came out that's when the tub turned red. She was born and they put her right on my chest in the warm water. She was beautiful 8 lbs. 13 oz. 20 3/4 inches. Rob cut the cord. We got to the hospital at 11 and I delivered at 1:06. I was really frustrated with how much pain is involved with the pushing the midwife said I only pushed for six minutes. She said stop complaining and can you just be proud of yourself? Look what you just did! You just had an unmedicated water birth- do you know how many people want to do that?! You are so strong and had so much control. You did an amazing thing today and you're still intact, no tearing! That's amazing!
Thank you for sharing your story Courtney.... It is so interesting the details of what we remember - for Courtney it was the words and the pain and the bliss :). Bring more bliss! I remember Courtney saying at our postpartum visit that she was so amazed how, with water birth, baby just went from being inside you to being on your belly - without interruption. Also, there were a few funny details... Courtney said thank goodness their wasn't a tour or something going on outside her door and I told her, there was- it all happened so quickly that the midwife needed to remind the nurse to close the door right as the maternity tour was walking by. It was also funny when Courtney said "This is orgasmic!' when they put the ice pack on her crotch or right after the birth when Courtney said "I feel so powerful, I feel like I could punch someone in the face!" I said okay Courtney - if that is how you want to use your power! May all postpartum mothers feel so powerful to want to punch someone in the face. Courtney tells me shops closed after baby #2 but I am secretly hoping to attend more of their births. To read Courtney's Tips & Tricks on early motherhood, visit her blog Angelic Treasure https://angelictreasure.wordpress.com/
Thank you Courtney (& Rob & Lucas & Rosa Lia!) for sharing your story! I of course wish for all women and, personally, all my clients to have such easy and uncomplicated beautiful births and if presented with more challenging births - I wish for safe and healthy motherbabies. May we all be happy and healthy at the end of the day(s).
(I originally wrote this blog for Orgasmic Birth June 2012)
Lately I have been hearing so many success stories about Baby Friendly Hospitals providing optimal motherbaby care following cesarean surgery. Just last night I heard a success story about Mountainside Hospital in Montclair NJ.
Last fall I had the privilege of attending seminar led by Dr. Nils Bergman's Skin-to-Skin, It's What's in . . . the Evidence, the Research and the Literature at Robert Wood Johnson University Hospital's 7th Annual Breastfeeding Conference at the New Jersey Hospital Association in Princeton and witnessed this shift starting to take place.
Dr. Nils Bergman spent about 7 hours working on convincing a room full of birth professionals of the many things of and related to skin-to-skin contact, breastfeeding, and the "buffering protection of adult support" required for the baby to go thru its "needed neural processes" and develop properly in a safe, warm, reassuring environment - in the light of the mother's body. It was almost comedic- here was Dr. Bergman speaking to a room full of 80% nurses with a sprinkling of doctors, midwives, lactation consultants, and doulas trying to convince us here in NJ, a state with one of the highest cesarean rates, that their was actually no scientific evidence that the incubator is effective. The incubator was invented and used and then after-the-fact research was done evidencing that "mother is a superior incubator" - but, as Dr. Bergman informed, only 8% of hospital care is evidence-based so the findings do not necessarily translate into practice. Trying to get our heads around this shift in thinking is all part of the paradigm shift currently taking place in the birth world. Dr. Bergman said it might take us all a few days to get our heads around it and for those pathways to develop.
We talk about paradigm shifts and the big change one person can make, which is why it was so meaningful to listen when a nurse asked when was the appropriate time to attempt latch if the mom had an epidural? To witness medical personnel asking questions and showing interest regarding how they were going to support skin-to-skin motherbaby care in their labor and delivery room or after cesarean was just awesome.
Dr Bergman's response offered options regarding the half-life of the medication and also using the father or partner more. He helped us understand how the father or partner is an extremely necessary person in post-partum and can offer that skin-to-skin contact and "buffering protection of adult support" baby needs to experience "needed neural
"It is easier to build strong children than to repair broken men." - Frederick Douglass
He even shared a story with us about a father who was embarrassed when Dr. Bergman needed to gently break the latch baby had on daddy's nipple so Dr. Bergman could bring baby to mom to breastfeed. And he suggested that, as with all things, when we do something new, we don't have to be cowboys about it and we need to do it safely.
Dr. Bergman gave the U.S. kuddos on several occasions - once because we have lots of great research on breastfeeding and another time because several hospitals encourage skin-to-skin immediately following cesarean section delivery. In post-conference research I did find several hospitals that support Skin-to-Skin care such as: Yale New
Haven, McKay-Dee Hospital in Utah, and the Children's Hospital of Philadelphia. Do you know of another hospital that supports skin-to-skin motherbaby care? Please share with us in our comments section.
"If you are a mammal that doesn't breastfeed, you become a fossil!"- Dr. Bergman
How do YOU see the Future of Breastfeeding and Skin-to-Skin MotherBaby Care?
It was a wonderful and fascinating day with Dr. Bergman. Catch him if
you can as he has a few more speaking engagements and if you are not
able to attend here are a few ideas.
Things you can do:
Be prepared with a PRIVACY TAG - this one created by California
Department of Public Health you can put on your door or the door of
"Put Dad to use!" says Dr. Begman. If daddy/partner is there put baby
skin-to-skin with them following a delivery where mom might not be
able to hold baby, such as cesarean delivery or if mom's medication is
still wearing off.
EDUCATE yourself so you can be an ambassador of skin-to-skin
motherbaby care: Read all about it at Dr. Bergman's website offering
wonderful products, research, and suggestions about how to implement
skin-to-skin motherbaby care http://www.kangaroomothercare.com/.
INSPIRE yourself by looking at these beautiful images on the WABA
(July 5, 2009) Sometimes we here at Birth POV have the privilege of publishing a birth story- this is one of those times.... In 2009 I was so honored to be invited into Jennifer and David's life to attend my first birth as an apprentice doula- it was very exciting! Thank you Jennifer, David, and Jacob for letting me share your story here. This was originally written for DONA evals so there are a lot of little details.
Thursday afternoon, Jennifer and I spoke on the phone. She had an appointment that morning and was found to be 1.5 cm dilated, 50% effaced, and -2 station. She felt like maybe the exam had gotten things moving a bit because she was feeling a little crampy and was spotting. I made sure all my bags were packed.
Friday morning Dave called around 8a to say the contractions were 2-3 minutes apart and they were probably going to hospital that day. I showered, left the kids at daycare, and headed due west on route 80 to Hackettstown Regional Medical Center. I arrived at the hospital at 10am and was scooped up by Dave & Jennifer as they were driving in, “you wanna’ get in?” I loaded in my bags and body on top of their bags and we headed up the hill to the hospital. We all went in – a passer-by said “what a wonderful day for you” to Jennifer. Jennifer ambled up to the receptionist and said “I’m having a baby” All the ladies behind the desk laughed. “I’m in labor, right? This is labor right? “They took all Jennifer & Dave’s information and sent us upstairs. We had so many bags between us that we asked the newspaper delivery guy to help us with his cart. He seemed happy to do so. Jennifer kept saying that she thought she brought too many towels.
We unloaded all our belongings onto the floor of the labor room, specially designed with a waterbath for birthing - one of the only facilities in northern New Jersey. The midwives (Lisa Lederer CNM of Midwives of NJ and apprentice midwife Karen) came in and listened to Jennifer as she caught them up on her laboring and how she’d been laboring all through the night and not getting any rest. Jennifer was indeed in early labor but since she laughed her way through every statement the midwives joked they didn’t believe she was in labor if she was laughing so much.
At 10:30 am they examined Jennifer but said she was only 3cm, 75% effaced, station –2. They also said they thought the baby was a little right occiput posterior so it was kind of looking front and to the side a bit, instead of directly back. They suggested Jennifer go home to labor or walk across the street. Jennifer wanted to stay in the room and hospital but Lisa said “there’s nothing magical about our hospital - babies don’t come out just because you’re here!” Besides, the midwives said the moms tend to walk around the corridor and then just want to come back in and lie down in the bed, which doesn’t help labor progress. We all wanted to go outside but didn’t want to move all the bags again! The hospital agreed to hold the cordblood banking kit but we had to take the rest. Moving all the bags seemed like a drag but leaving seemed like a good idea – worth moving all the bags for. I was grateful that the midwives told us to go labor elsewhere and let things transpire naturally rather than start intervening so early in the labor. Once we got outside, I asked Jennifer if she could start walking thru the contractions and she did. Jennifer felt defeated and embarrassed at being asked to labor elsewhere. I asked her if she could let go of that and without pause, she replied, “yeah! I can let go of that.” We walked down the hill surrounded by blue skies and green mountains. Dave knew of a café at the bottom of the hill where he suggested we eat lunch.
At the bottom of the hill, we walked across the street to the Willows – a cute little café run by a German woman who was very excited to have a woman laboring in her café! She sold us on the “German fries,” which were basically like hashbrowns, and her helper made us some chicken wraps that Dave and I ate. Jennifer didn’t have the stomach for much but ate a little chocolate and drank some water. What Jennifer really had a palette for was the monstrous plate of berries the owner brought to her! Blueberries, raspberries, and a peppermint leaf to top it off, which Jennifer would sniff repeatedly throughout the afternoon. She found the peppermint smell soothing during contractions. Eventually we dumped all the berries into a cup, said goodbye to the Willows Café and took our berries on the road where they acted as the little inter-contraction treat. Arm and arm with Dave, Jennifer pushed herself to walk thru her contractions – pushing herself a little more all the time. Berries, sniff of mint leaf, uh-oh here it comes again, hold onto Dave, hold onto Dave, hold onto Dave, okay it is going away now. In addition to being there for Jennifer to lean on, Dave was also busily timing the contractions with his device. Jennifer and David figured out they had been mistiming the contractions in the morning and that is why they thought they were further along than they were. They now had it down to a science and the contractions really were 2-3 minutes apart!
So with Jennifer contracting and eating berries we walked down the street. No outlet - turn around, thru the development – too hot, into the midwives' offices – the midwife says keep moving and roll those nipples, into the car – "sitting is horrible!" Short ride to Stephen’s Park, a beautiful shaded park with a river gushing through. Dave suggested the park and it was a great idea because it was cool and shaded and semi-private so Jennifer could roll her nipples without an audience. There was one group of kids there who looked a bit curiously on us when I was bent over like a triangle trying to do a double hip-squeeze on Jennifer while she was moaning and groaning her way through a contraction but they kept walking. I massaged Jennifer for a little bit until we decided to take a walk down one of the paths to an island Dave knew of. Walking down the path, Jennifer pushed herself to walk and sometimes stopped to just hang onto Dave.
Her contractions were building. The walking and nipple stimulation seemed to be helping. We crossed over the bridge to the island. Jennifer used the bridge as support to push and pull against - balancing on bridge rail. It was here that Jennifer found her yogic ohm sounds that helped her through this part of labor. We hoped the technique would open things up – ode to Ina May and the Sphincter concept. It was a beautiful thing watching Jennifer and Dave on the bridge – Jennifer’s voice a clear and present ohm. Jennifer and David so affectionate and loving with one another – kind of in a slow dancing position, intertwined on the bridge in a contraction wave. Who knew labor could be so peaceful? This was a really special time during the labor. We spent a long time there on the bridge with Jennifer ohming, eating berries, sniffing the peppermint leaf, taking pictures. Eventually the berries became overly ripe and Jennifer was ready to move onward.
We walked back to the picnic table where we did the double hip-squeezes and I suggested Jennifer get in the hands and knees position for a little while I did some effleurage, but wasn't sure if I was supposed to be gently coaxing the baby the right direction or kind of pulling it, so as a novice doula, I went with gently coaxing. Jennifer was such a good sport and reluctantly stayed in the hands and knees position until her arms ached. Jennifer later admitted the rock (which was actually hard ground) was very uncomfortable.
Meanwhile, David took to reorganizing the car and removing the extra towels from the bags and filling the flower vase with water from the Stephen’s Park water fountain that never turned off. Once he was done we realized it had been 5 hours since the last exam so it was time to check back in with the midwives. In thru the door of midwives' offices we went and down the hall where Jennifer traded her bottle of water for a bathroom key. In the bathroom, she moaned and groaned her way through a contraction so loud that the MD stopped in his tracks and with a look of concern but excitement asked if someone was laboring in there.
We gathered in the exam room and the apprentice midwife, Karen, took a look at Jennifer and reported she was 4 cm, 75% effaced, -2 station. Since it had been 5 hours since the last exam we were all hoping things would be further along. Jennifer explained she was extremely tired after laboring all night. Karen massaged Jennifer through one contraction and then left the room to call Lisa who had gone home for a little bit. Karen returned and in so many words explained that the midwives were concerned because Jennifer's contractions were still not coming really strong and regular and they felt if the labor continued this way, it would go well into the next day with an extremely tired uterus. They suggested Jennifer get a shot of morphine to rest and after 2-3 hours start a low-drip pitocin. Jennifer and David were extremely reluctant to have any intervention. They imagined a natural birth, a waterbirth. Besides, Jennifer’s mom relayed stories from when Jennifer was born and there were details of intervention and screaming that Jennifer did not want to repeat. From Jennifer's perspective - intervention equaled bad experience.
Friday afternoon 5p yay – mom is admitted to the hospital! The contractions were coming a little stronger now – “Aye carumba!! Jennifer yells. Karen met us and was saying a little sleep medication combined with oxytocin augmentation might help but Jennifer wanted to stick to her plan of no intervention. Karen tentatively started filling the bath to honor what Jennifer & David wanted but stopped a quarter way full. We were at a standstill until Lisa arrived. Karen got Jennifer into hands and knees position again to help reposition the baby. Lisa came in after about 20 minutes and saw the bath a quarter full, “what happened to the morphine shot in the butt?, and we informed her that Karen was going to let Jennifer try to do it the way she wanted,Lisa said “didn’t we already try that?” Lisa felt the labor was progressing too slowly and without augmentation Jennifer would still be laboring the next morning and she examined Jennifer herself. Another contraction, “Jesus Christ!” – Lisa says “I wouldn’t expect that out of you“ "I’m not Jewish! David is.” “Fuck!” followed by yogic ohms. Lisa finished her exam and then basically said this is what we are doing and Jennifer and David hesitantly agreed and in a matter of minutes the nurses had Jennifer hooked up to the EFM & IV, stuck her with the morphine in her right cheek butt (ouch!) and within 20 minutes Jennifer went from saying “this isn’t what I wanted!” and “I feel so restricted!” to “this feels good” and it feels “druggy.” About 10 minutes later, they started the pitocin at a very low drip, 2 ml.
Pretty soon the room was like an oasis of scents and sounds. I put on some “insurgent country” girl Neko Case and David got the lavender aromatherapy pumping out from the diffuser. Jenn was trying to eat some snacks, like fruit roll ups and nuts and dried cherries. She had the talent of eating a fruit roll-up (organic of course) while in hands and knees position! David comforted Jennifer during the contractions while I rubbed her feet with peppermint foot rub and massaged her back with the lavender oil. Since baby was slightly occiput posterior she found it comforting when I applied pressure to her sacrum or applied a double hip squeeze during contractions. Our nurse kept a close eye on the monitor and levels.
After a about 20 minutes, Jennifer or Dave fell asleep - I am not sure who but I heard the sound of snoring and deep breathing. I took the opportunity to eat dinner, which was a plate of spaghetti & meatballs we got from an extra tray left another mom didn't want. I ate half and saved the other half for Dave, who was also famished. Jennifer was still contracting during her sleep and when she did, Karen showed me how to rock her in the direction we wanted the baby to go. Also, the midwives administered pulsatilla, a homeopathic medicine to help reposition baby. I am still not clear how it works but the midwives seemed amazed that homeopathy works at all so I guess I am not alone in my wondering.
The midwives returned a while later and when they came in they wrinkled their noses at all the smells, “eew I touched it" Lisa said when her fingers accidentally touched some essential oil. They probably have to be careful - imagine how scenty they would be if they dipped their fingers in the essential oils every time they went into a labor and delivery room!
Unfortunately, everything Jennifer ate came back up. She vomited throughout labor and afterwards would always say - "that felt so good!" Jennifer also got the hiccups periodically. Lisa was very impressed with her hiccups and recounted one other mom's birth experience who also had the hiccups. I think it was around this time that she told us pregnant cats will seek out raspberry leaf to eat but it may have been another herb. Lisa brushed Jennifer’s hair to get it out of her face. Jennifer looked so beautiful I had to take a picture.
After the morphine wore off a bit and the pitocin was kicking in Jennifer got in the waterbath. The water provided some comfort - Jennifer tried different positions like squatting and lying to her side. The position that seemed to work the best was kneeling and burrowing her head into Dave and covering him with kisses. The contraction would came over her and she would burrow her head into Dave’s shoulders, sometimes pulling hair, sometimes digging her nails into his skin, and he reciprocated with kisses and nuzzles. Jenn found comfort giving and receiving affection and Dave was right there with her – even to the point of having scratches all over the back of his neck! I was really so amazed by how loving they were - kissing and hugging and nuzzling the entire time - and thought how reaffirming it is of the birth process that different women find different ways of coping during labor. I wondered if they are always that close or if birth brought them closer – probably a little of both. They were loving and sensual and supportive and such an exquisite example of what a mother and father can be.
But then Dave let a coca-cola burp go right in Jenn’s face “ew gross! I am the only one allowed to do anything disgusting!” "I didn't mean to." Dave replied. This was a funny side because for the most part Jenn and Dave were totally loving and affectionate with one another.
Jennifer continued laboring, when she was hot in tub I held an ice-cold cloth to her forehead and when she was cold we covered her in blankets. We could not do anything about Jennifer being wet from the waterbath but Nurse Karen didn’t seem concerned, "it is the same as if you stay in a wet bathing suit at the beach for 3 hours."
Around 10 pm the midwives did another exam, Jennifer was 7-8 cm, almost 100%, thin lip. The exams always seem to get things moving so the next thing we know is Jennifer is experiencing a lot of bloody show while on the potty. The midwives were very happy about that because it meant things were moving along down there. They got Jennifer bouncing on the birth ball and within a few contractions her water broke, "that felt really good" Jennifer said.
We were all tired at this point. Dave yawned but still let Jennifer dig her nails into him. Dave was tireless. Midwife Karen’s back was hurting – a pinched nerve or something - so the nurse fashioned an ice-backpack for her. Midwife Lisa was yawning and I think I saw her nod off for a second – sitting up no less! Quite a midwifery talent! I could not believe the midwives waited so patiently in the room the entire time - that is very unusual. And then there was Jennifer who expressed major discomfort at 2 cm but then here at 9 cm when we were all sleepy and dopey she was moaning her way thru every contraction like a champ. She found the resources within her. “oh God, God help me” she would say.
Around 11 pm the nurse did her halfway thru the shift dance and by 11:30 pm all of us were there on the family birth bed. Earlier we were joking about who or why someone would use the birth bed but then there we were – all six of us! Jennifer had gone into the transition phase of you labor and the baby’s heart rate decelerated – Lisa said, "when the babies head gets mashed they don’t really like it” (when they enter the birth canal). It quickly returned to normal levels.
They discussed bringing Jennifer back to the waterbath but were concerned to do so in case they had to get her out quickly. Jennifer was hoping for a waterbirth so they brought her back to the water and there she labored for a bit longer. I held her under her arms during the contractions and David sat beside Jennifer. Things started to seem more imminent because the LifeBank cordblood box and tools for labor came out. Maybe due to Jacob's position or some other reason, Jacob was taking his time and we still had a little ways to go. After about an hour, the midwives asked Jennifer to return to the bed. Since the 2nd stage was progressing so slowly the midwives were concerned there was a reason, either a tangled cord or shoulder dystocia, and wanted to be able to tend to whatever the scenario was quickly and efficiently if the need arose.
So there we were on the bed again - Jennifer pushing. Dave put on a Matisyahu Cd to carry us into the midnight hour. When Dave got back on the bed, Jennifer said, “don’t shake the bed!" but that was about as abrupt as Jennifer got the entire night. I asked Jennifer to open her eyes and look at Dave's eyes so he could help focus her pushing and breathing. Counting seemed to help in terms of providing a beginning, middle and end to the contractions. After each contraction we’d have to slow your breathing down - “breathing in - one, two, three four five, and out” over and over again. They put an oxygen mask on Jennifer to get more oxygen to the baby. At first Jennifer didn’t want it and was concerned but then later would say, “oxygen is good.” At one point the midwives were concerned about the baby so they lowered the pitocin and the baby’s heartrate returned to normal once they made adjustment.
The midwives were joking if Jennifer had the baby before midnight they could only stay two days whereas if the baby was born after midnight they could stay 3 days. Once the clock ticked past midnight Dave said “well the baby will definitely be born today.” We all thought that was hilarious and all piped in – “it had better be!,” what with 24 hours to go.
Jennifer pushed and pushed through this very long 2nd stage. Eventually I just stood back and took pictures because Dave was helping with Jennifer’s breathing and only so many people can tell a mom to “push!” Apprentice Midwife Karen was standing ready to catch the baby with Lisa standing to her side. The midwives played with a little tuft of the baby’s hair that was sticking out. We told Jennifer we could see the baby’s hair and that energized her for these last round of pushes.
Then at 1:42 am Baby Jacob was born into this world, “my baby!!!” Jennifer elated, opening her arms to her new baby, letting all the anguish and pain of labor vanish into pure joy. And the look of Dave's face was of wonder and relief. Karen caught Jacob and bundled him up so quickly I hardly got a look at him. The funny thing is everyone was so excited to see him and hold him, that no one bothered to look at what sex he was! “Did you look? I didn’t look!” The midwives took a peek. “A boy!” Jennifer and Dave smothered him with kisses. He coughed and cried and within a few seconds was looking at his mommy and daddy – so cute and so alert. And we joked he talked more than his mommy!
Dave cut the cord and a few minutes later, the midwives massaged Jennifer's uterus and the placenta was expelled. The midwives did their charts and left to get some much needed sleep. The nurse watched over Jennifer saying, “You are doing just what I need you to do – lie there and nurse your baby.”
Then within minutes, both of Jennifer and David's families swooned in! Wearing lipstick and jersey granddaddy t-shirts and everything! They had a very supportive family and they were all very excited to see their first grandchild!
It was such an honor to be present at Jacob’s birth. I was so moved how loving Jenn and Dave were with one another – kissing and hugging and nuzzling the entire time. In one sense it reminds us of how Jacob came to be but also what a beautiful bond the mother and father have with one another and how lucky Jacob is to be born into their world. Thank you Jennifer & David for letting me witness the miracle of Jacob’s birth! ~ Rachel Kwock CD(DONA) Birth Doula