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!
Tuesday, May 24, 2011
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!
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
WTHeck??...
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....
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....
Saturday, April 23, 2011
Action!
The night sky was inky and the air was apple crisp on my checks. I was pacing. There was student midwife with me and she joined in. The room was ready, I had hastily gotten all the tasks done. So, now I was outside on the breezeway, pacing in the night. It was her second baby and I didn't know if they were gonna make it in. They had said the drive was about 10 minutes, by now it had been 20. I anxiously watched the street for car headlights turning my way. Finally, I saw them, and I took a nice long breath, they had made it.
The car door opened and I heard the Mama...the unmistakable sounds that mean a baby is just about to crown. She stepped out of the car and grabbed onto the gate, fell down to her knees and groaned. I quickly and gently felt between her legs...we had a few minutes, maybe. "Your baby is very close. We can have her here or we can go inside. Do you want to try and walk inside?" She says that she would like to walk inside, the next moment, she is sprinting across the breezeway with myself, the student midwife, and her husband trying to catch up.
Once inside, she returned to her hands and knees, groaning and full of power. We must have been quite the sight, she was crawling down the hallway, we were trying to get her clothes off, the baby was working her way down and out. I told her that she could stop crawling and have her baby where she was, however, she was determined to have her daughter in the room that she had loved during her prenatal care and classes. The instant she crawled into the bed, her sweet little girl arrived and all were well. A few minutes later, the nurse arrived and came in the room laughing. She said that the hallway looked like a movie scene...with clothes strewn about, socks, pants, underwear, etc. leading to the bedroom. We all laughed together. These moments are so special and sweet, I am honored to be a part of them.
The car door opened and I heard the Mama...the unmistakable sounds that mean a baby is just about to crown. She stepped out of the car and grabbed onto the gate, fell down to her knees and groaned. I quickly and gently felt between her legs...we had a few minutes, maybe. "Your baby is very close. We can have her here or we can go inside. Do you want to try and walk inside?" She says that she would like to walk inside, the next moment, she is sprinting across the breezeway with myself, the student midwife, and her husband trying to catch up.
Once inside, she returned to her hands and knees, groaning and full of power. We must have been quite the sight, she was crawling down the hallway, we were trying to get her clothes off, the baby was working her way down and out. I told her that she could stop crawling and have her baby where she was, however, she was determined to have her daughter in the room that she had loved during her prenatal care and classes. The instant she crawled into the bed, her sweet little girl arrived and all were well. A few minutes later, the nurse arrived and came in the room laughing. She said that the hallway looked like a movie scene...with clothes strewn about, socks, pants, underwear, etc. leading to the bedroom. We all laughed together. These moments are so special and sweet, I am honored to be a part of them.
Wednesday, April 20, 2011
and Beyond
Well, it has most definitely been an amazing year with women! I started my blog in May, but I had started catchin' babies in April. As this anniversary has been approaching, I have been wondering what to do with this blog. I have loved keeping it, and am surprised (very happily) that a few others actually read it. It has been therapeutic, fun and in a real way has helped to foster my growth. The introspection involved is much appreciated...though not always easy to accept. After some thought, though not much because it was an easy decision, I have decided to keep the blog going. I have no idea how to change my url without loosing the content and followers, so I will keep the original name. This may be an homage to this first year and how special it has been and to the hopes of many more amazing years to come.
Monday, April 18, 2011
Stats..the first 100!
Wow, again, it seems hard to believe that I have reached this milestone! I have compiled a rough group of stats from these births, but I do have some disclaimers. First, these births are only the ones that I was able to "catch". So, these do not include Mama's that I labor sat with and then passed to my midwife sisters. Second, these do not include Mama's that I had to transfer to the hospital before the birth...which would include both vaginal births and cesarean sections. In putting these numbers together, this is an area that I realize I have unfortunately missed. In the future, I plan to also keep track of those births as well. Also, the first 40 births were done as a student and 21 of those ocurred in a hospital. Well, here goes:
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
Saturday, April 16, 2011
A Milestone
All I can say is, WOW! I have reached a big milestone recently. I was blessed to catch baby #100! It seems somewhat surreal, but wonderful. I can realize how much I have learned and grown...I can also realize how much more I have to learn. Currently, I am in the process of putting together some stats about these births...boys v girls, birth positions, water v land births, etc and will be sharing them. But, I couldn't wait to share the news of my Big 100.
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