Tuesday, May 24, 2011

Fancy a Swim?

I love waterbirths, I have always loved them. My second child was born in the water and my first would have been if the hospital had "allowed" it, at least I was "allowed" to labor in the water. The funny thing about waterbirths is that they are wet ;) and there is a lot of water involved...splashing water, dripping water, sloshing water...you get the point. I have joked with the owner of our birth center that she should buy us wet suit tops so that we don't end up looking like contestants in a wet t-shirt concert....

It was her second baby and she was doing beautifully. Her husband was great and she had a fabulous doula. As her labor progressed, she moved into the pool and soon after her husband joined her. This if course, raised the water level pretty high, so I was on bucket brigade and removed some of the water. She started pushing while on her hands and knees, then she moved to squatting, followed by leaning back into her husbands arms. With each move she got a little bit further away from me...and I leaned a little bit more over the side of the pool. Then as her babe started to crown, she pushed her legs against the sides of the pool, pinned her husband against the back of the pool and sat on the pool bottom. Now, I am a pretty hands off midwife, especially in the water, but I do like to feel for cords and make sure it is ok for Mama to bring/pull her babe up out of the water. (Also, it can be a little difficult for a baby to emerge when its Mama is sitting.) So, I ended up basically in the pool from the waist up, gently lifting/encouraging Mama to squat and make room for baby. Her son was very soon born and was welcomed into the loving arms of both Mama and Papa. I looked like a drowned cat and was literally dripping all over the floor...my hair was wet, my shirt was soaked (along with my bra), my pants were wet and the water dripped down into my shoes. And we all laughed. I love waterbirths!

Wednesday, May 4, 2011

You say frenectomy, I say frenotomy

So, being a midwife is not only all about labor and birth. I am blessed to work in a practice that also provides newborn care for the first two weeks, and I love it!!

Recently, I have learned how to perform frenotomy's. These are done when a baby is "tongue tied" and they cannot stick out their tongues...which can make nursing very difficult indeed. Being tongue tied happens when the frenulum (little piece of skin) that anchors the tongue to the base of the mouth is too tight or extends too far. In the frenotomy, this little piece of skin is clipped. It seems scary and yes, is a little intimidating...especially to have scissors in a newborns little mouth. However, it is very easy, the babies tolerate it well and it hardly bleeds. This is a topic near and dear to my heart. My sweet firstborn was tongue tied and I was not able to find anyone to clip it for me, I was not yet a nurse and had no idea how to do it myself. Together, we endured weeks of very difficult breastfeeding with a couple bouts of mastitis thrown in for fun. Eventually, we were able to work through it, but I would never want a Mama to have to deal with that...when it can be so easily fixed.

This week, I saw two Mama's struggling with these tight frenulum's. They were both working with lactation consultants who recommended an assessment for frenotomy. Both had seriously beat up nipples and were in a lot of pain and their babies were not gaining enough weight. The procedures went great and both babies were immediately put to breast....and the look of relieved surprise on the faces of the Mamas was priceless..."oh, this is how it is supposed to feel?!?" The baby that came in earlier in the week is already gaining weight!

These times are when this "job" is truly rewarding!

Sunday, May 1, 2011


I was very happy to get a call from this awesome family. They were expecting their first baby. We met at the center and she did seem to be in a great labor pattern. She spent a little time getting settled in, going to the bathroom, being in the room. Her vital signs were stable and the babe sounded good. Then came time for a cervical exam. I gently eased my fingers into her vagina and easily found her cervix, which was lovely and soft, opened to 6cm. Then, it became confusing...what is this presenting part? It feels so soft...are these the sutures?..What am I feeling...then something floated into my fingers....are these fingers?....no!...this is a foot!!

I have often heard providers describe finding a breech presentation by internal exam, and they have all talked about a certain level of confusion. How you try to somehow make sense of what you are finding, and try to make it fit into being a head. That is exactly what I did in this situation. Additionally, for some reason, I had not as I usually do, done Leopold's yet on this beautiful belly. When I did do Leopold's after the exam, it was not a clear case...had I not felt that little foot, I would not have suspected.

Then came the most difficult part...telling this family that their sweet little one was breech, that she was in active labor and that her only option at this point was a cesarean section at the hospital. We all cried a bit, but then this great family was able to switch gears and quickly just focus on the fact that their babe was soon to arrive. I was in awe of their strength and grateful for their grace.

I work in a large urban setting and providers willing to do vaginal breech births are rare. We are blessed to work with one such great physician. However, he will only do "scheduled" vaginal breech births....breeches that are found during prenatal care. In these cases, we can send a family to him, he will do an evaluation and discuss all the pros and cons about vaginal breech and cesarean section, give truly informed consent and follow the family's decision. He will also offer to preform an external version, if he feels it is a safe option. We have had a couple babes born with us after he completed a successful version. Unfortunately, for this Mama, we did not discover her breech baby early enough....