I think that the first issue I would like to tackle is birth trauma. Unfortunately, this happens all too often and is not relegated only to the hospital setting. The idea that I ponder about the creation of birth trauma is exactly why/how does it happen? Clearly, there are myriad reasons and individual situations and I don't mean to water the issue down to one cause.....but, having worked in the birth field for years, both in and out of the hospital, I have seen and heard many woman's stories. To go back to the first part of this question, the birth story....
It was the two day postpartum visit. Both Mama and Baby were doing well, babe was happily nursing and Papa was ecstatic. We went through all of the "nuts and bolts" business....physical assessments, etc. and all was well. Then, we sat and talked about the birth. I was worried that it may have been difficult for them, so many things had happened, particularly with the baby resuscitation. So, when I asked, "How do you feel about your birth?" I was pleasantly surprised to see the big smile grow across Mama's face and hear her say, "It was amazing and wonderful!" We talked about everything that had happened, they asked thoughtful questions and it was clear that they had a realistic understanding of what had happened. Finally, Papa said, "We knew that serious things were happening, but you and the nurse were so calm and really knew what you were doing, so we felt safe and it was never scary." There was not one ounce of trauma to be found! I include the Papa's statement NOT to "toot my own horn" but to illustrate what I think is a crucial component to the creation of birth trauma......
How the birth is handled, how the family is treated, management of the "background" noise, followed by open and transparent discourse between care provider and client....I think that these have much more to do with birth trauma than what actually happens. Of course, there are major exceptions, sometimes, no matter how much care and thought are involved, the outcome can be so devastating that trauma is inevitable. As women we have to start educating ourselves and each other about our options and we have to demand thoughtful, compassionate care. All options for birthing need to be universally discussed and available to all. It is time that we stood together and began to create the atmosphere for this change......
Monday, July 18, 2011
Thursday, July 14, 2011
Normal Birth?...part 1....
What is normal birth? I often ask this question. Often times a normal birth may include many things that are not "normal" but that happen. Here is an example...
She was a sweet first time Mama, her man was supportive and loving, her Mother was present and wonderful. She labored beautifully, was in the pool and started to push all on her own, instinctively and with strength. Soon the babe was crowning, and crowning, and crowning and crowning..my senses prickled up a bit...and crowning, then with one push the head emerged and quickly retreated back into the perineum. With speed, we moved her out of the pool to her hands and knees on the floor, babes head was still tightly squished up against the perineum...with some help and effort, one minute after first emerging, he was out! He was not fully with us, his cord was pulsing strongly but he was purple and not breathing. We stroked him and spoke to him, his Dad loved on him, eventually we had to use the ambu bag and give him some breaths. Immediately, he turned pink and began to cry...of course, the BEST sound in the world. We moved the new family to the bed, baby boy skin to skin on Mama with Dad curled up next to them and a radiant Grandma at the bedside. One of my favorite times of a birth...the afterglow. The nurse and I were busy trying to strike that balance between invisible and present. I was ever so gently holding the umbilical cord, feeling the pulse of life, when something felt off...there was a "loosening" feeling and a gush of bright red blood. However, for some reason I knew it was not the normal cord lengthening and placental separation gush. I immediately felt up the cord, into her vagina and felt a partial cord evulsion!! I grasped the cord and crimped it off, while asking the nurse to hand me a clamp. I clamped the cord and took a deep breath for myself. A few minutes later, her placenta emerged all intact, thick and healthy. Again the new family was the picture of beauty, baby was crawling on Mama finding his prize of the breast. Then a little while later, Mama started to bleed and pass clots and bleed and pass clots....with some vigorous massage, herbs and finally medications, the bleeding eased up. Finally, all were well and healthy, basking in that afterglow.
This birth was "normal", so what does normal mean? As a midwife, I must always guard the birth process; help to create and hold a space that is calm, centered and uninhibited. The vast majority of the time I am not needed...but in those times when I am, I REALLY am.
This birth made me think of two things: 1) unassisted birth and 2) birth trauma. I will follow up with my initial thoughts and my follow up with this lovely family, but what are your thoughts? How do you feel about unassisted birth? How does birth trauma happen and what can we do to lessen it?
She was a sweet first time Mama, her man was supportive and loving, her Mother was present and wonderful. She labored beautifully, was in the pool and started to push all on her own, instinctively and with strength. Soon the babe was crowning, and crowning, and crowning and crowning..my senses prickled up a bit...and crowning, then with one push the head emerged and quickly retreated back into the perineum. With speed, we moved her out of the pool to her hands and knees on the floor, babes head was still tightly squished up against the perineum...with some help and effort, one minute after first emerging, he was out! He was not fully with us, his cord was pulsing strongly but he was purple and not breathing. We stroked him and spoke to him, his Dad loved on him, eventually we had to use the ambu bag and give him some breaths. Immediately, he turned pink and began to cry...of course, the BEST sound in the world. We moved the new family to the bed, baby boy skin to skin on Mama with Dad curled up next to them and a radiant Grandma at the bedside. One of my favorite times of a birth...the afterglow. The nurse and I were busy trying to strike that balance between invisible and present. I was ever so gently holding the umbilical cord, feeling the pulse of life, when something felt off...there was a "loosening" feeling and a gush of bright red blood. However, for some reason I knew it was not the normal cord lengthening and placental separation gush. I immediately felt up the cord, into her vagina and felt a partial cord evulsion!! I grasped the cord and crimped it off, while asking the nurse to hand me a clamp. I clamped the cord and took a deep breath for myself. A few minutes later, her placenta emerged all intact, thick and healthy. Again the new family was the picture of beauty, baby was crawling on Mama finding his prize of the breast. Then a little while later, Mama started to bleed and pass clots and bleed and pass clots....with some vigorous massage, herbs and finally medications, the bleeding eased up. Finally, all were well and healthy, basking in that afterglow.
This birth was "normal", so what does normal mean? As a midwife, I must always guard the birth process; help to create and hold a space that is calm, centered and uninhibited. The vast majority of the time I am not needed...but in those times when I am, I REALLY am.
This birth made me think of two things: 1) unassisted birth and 2) birth trauma. I will follow up with my initial thoughts and my follow up with this lovely family, but what are your thoughts? How do you feel about unassisted birth? How does birth trauma happen and what can we do to lessen it?
Thursday, July 7, 2011
And Tantrum Makes Three....
It was a good to have a baby...I had two lovely first time Mama's working on their little ones. The sun was shining, the flowers were out and the sky was sapphire blue. Day time births are less common and so seem somehow different and rare to me.....
Andrea's water had broken the day before, early in the morning. It was well over 24 hours later and her labor was flirting around the edges....not quite ready to take off, and Andrea was on the verge of losing her steam. She came in with her Mom, Susan, who was such a great support. Andrea's husband is in the military and is deployed overseas, which of course was difficult for her. We did an NST (non stress test) and her babe looked good. We decided to try and help her labor along. We sat down and had a good talk about how she was feeling, about letting go of wanting/missing her husband and letting her labor happen and I gave her an herbal tincture. Then I sent Andrea and her Mom out to get some lunch and to go for a nice walk.
Meanwhile, another Mama, Ellen was ready to come in with her husband. She was laboring beautifully, really letting her body go with the flow and opening up to it. Her husband was great and just followed her lead. It is so wonderful to see couples at this time, working well together and being present to see the love they share.
Andrea came back from her outing and had good news....she was able to call her husband and he was going to be able to be on the phone, on speaker, to be "with" her during the birth! It was great...somewhere from a ship, somewhere in the world...he was at least able to be present with us. Her labor was picking up a little bit, but still not too strong. We decided to try the breast pump and after a "round" of that.....she kicked into serious gear. After an hour of serious, consistent contractions I checked her cervix for the very first time since her water breaking and she was 4cm....great news! She got in the pool and we all settled in for the work. She talked to her husband a lot and despite the distance the love was so palpable in the room. Literally, 30 minutes later, Andrea said she had to push! A quick cervical check...she was C/+1 and after 24 minutes of beautiful, instinctual pushing a beautiful baby girl was welcomed to the world.
Not long after that birth, Ellen was ready to welcome her sweet babe. Ellen was complete...but not ready to push...instead she paced and paced, unable to relax. She did not like the sensations and seemed to try and run away from them. She was fidgety and had a lot of trouble getting into the work of pushing. I have seen other ladies do this and eventually they stop "running" away and get into it. Just over an hour later, Ellen was getting frustrated....her energy was spilling over and she was busy trying to contain it. I felt that she needed to have a "melt down", let the energy go and move forward....and then it happened. Ellen threw a temper tantrum; seriously stomping around the room, crossing her arms, pouting her lips and kicking things!...in true three year old style!! She was saying things like wanting to the hospital, this "sucks", whose dumb idea was this, etc. I was actually happy and trying not to laugh, this needed to happen...and after she calmed down, Ellen sat on the birth stool and gracefully with strength pushed out her gorgeous baby girl.
Every birth is a gift and teaches me new things. These births were very different but had one thing in common: a true and genuine love between a man and a woman, that was supportive and strong. One was witnessed in person and the other was felt from a distance but both were amazing.
Andrea's water had broken the day before, early in the morning. It was well over 24 hours later and her labor was flirting around the edges....not quite ready to take off, and Andrea was on the verge of losing her steam. She came in with her Mom, Susan, who was such a great support. Andrea's husband is in the military and is deployed overseas, which of course was difficult for her. We did an NST (non stress test) and her babe looked good. We decided to try and help her labor along. We sat down and had a good talk about how she was feeling, about letting go of wanting/missing her husband and letting her labor happen and I gave her an herbal tincture. Then I sent Andrea and her Mom out to get some lunch and to go for a nice walk.
Meanwhile, another Mama, Ellen was ready to come in with her husband. She was laboring beautifully, really letting her body go with the flow and opening up to it. Her husband was great and just followed her lead. It is so wonderful to see couples at this time, working well together and being present to see the love they share.
Andrea came back from her outing and had good news....she was able to call her husband and he was going to be able to be on the phone, on speaker, to be "with" her during the birth! It was great...somewhere from a ship, somewhere in the world...he was at least able to be present with us. Her labor was picking up a little bit, but still not too strong. We decided to try the breast pump and after a "round" of that.....she kicked into serious gear. After an hour of serious, consistent contractions I checked her cervix for the very first time since her water breaking and she was 4cm....great news! She got in the pool and we all settled in for the work. She talked to her husband a lot and despite the distance the love was so palpable in the room. Literally, 30 minutes later, Andrea said she had to push! A quick cervical check...she was C/+1 and after 24 minutes of beautiful, instinctual pushing a beautiful baby girl was welcomed to the world.
Not long after that birth, Ellen was ready to welcome her sweet babe. Ellen was complete...but not ready to push...instead she paced and paced, unable to relax. She did not like the sensations and seemed to try and run away from them. She was fidgety and had a lot of trouble getting into the work of pushing. I have seen other ladies do this and eventually they stop "running" away and get into it. Just over an hour later, Ellen was getting frustrated....her energy was spilling over and she was busy trying to contain it. I felt that she needed to have a "melt down", let the energy go and move forward....and then it happened. Ellen threw a temper tantrum; seriously stomping around the room, crossing her arms, pouting her lips and kicking things!...in true three year old style!! She was saying things like wanting to the hospital, this "sucks", whose dumb idea was this, etc. I was actually happy and trying not to laugh, this needed to happen...and after she calmed down, Ellen sat on the birth stool and gracefully with strength pushed out her gorgeous baby girl.
Every birth is a gift and teaches me new things. These births were very different but had one thing in common: a true and genuine love between a man and a woman, that was supportive and strong. One was witnessed in person and the other was felt from a distance but both were amazing.
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