Thursday, June 19, 2014

My Heroes

I'm sure you have heard it said that every birth is unique, each its own story. But no one talks about how deeply that story is written into women. Each woman's birth story is carried in their bones and sinews. It has put its stamp on their bodies and breasts and the very energy contained within their cells. This is how they know "birth" to be.

I have been very lucky in my life to able to attend women in birth. I am constantly in awe of womanhood, its power and its grace. Every birth IS a story. I have so many stories jammed in my head and packed into my heart. Some are private stories only shared with a sacred circle. Others are meant to be shared with the world. Some demand to be shared. So it was with my preemie twin vaginal birth. Now I want to speak about cesareans. Next post I'll share a recent positive cesarean birth story.

For many years I struggled with each cesarean birth my clients had. I took it as a personal failure. If I had just been a better doula this wouldn't have happened. I could have, should have, rescued her. Over time I grew to understand that these stories weren't my stories to write. They belonged to the birthing woman. They were her story. I tried to let go of my arrogance in thinking I held the power and turned it back to the mothers. I am there to help a mother find her own path. Success or failure is in her hands not mine. This attitude helped me, but did it help them?

Recently I have begun to question and be more critical of the whole idea of cesareans as being failures. I have never been with a mother who just gave up. Every one struggled mightily; pushed themselves to the edge of their personal precipice and beyond. How can that be labeled a failure? Who is to blame for this stigma?

The ugly truth is the blame lands squarely at the feet of the natural birth movement. A movement which is near and dear to my heart. A movement which sprang up in direct response to the over medicalization of birth. A movement which wanted to give women back their power; their belief in their bodies.We wanted women to be in awe of their own strength and abilities. A movement I signed on to many years ago. It gave me strength to do my work and replenished me when I was tired, weak, or hopeless. A movement which has branded the heart of every woman with a big fat F who began labor with the intention of birthing vaginally and ended up in the operating room . You failed at the very essence of womanhood. Enough.

I want all the mothers who have courageously fought to win that medal of female honor, only to see it fade from their grasp, to know they are heroes. They are the walking wounded who gave it all in battle for their comrades; their partner and child. Many suffer with post traumatic stress disorder. Some face on-going health issues. All of them have had their bodies invaded by friendly fire and have the scars and internal adhesions to prove it. Why do we treat them as shoddily as the returning Vietnam Vets? If you are for the war, people who believe in the medical model, you are numb to their tremendous sacrifice. If you are an anti-war protester, pro-natural birther like me, you actually have the unbelievable gall to question their loyalty to the cause. Enough!

Isn't it enough that she stayed the course for 9 hours at 8 centimeters without ANY pain medication? What about the fact that the last 4 hours were with pitocin to make her contractions even harder? What if you knew she was in active labor for 26 hours with back pain from a posterior baby? Enough?

Isn't it enough to join the club of "successful" birth if you labored with no medication and then pushed with ALL your strength for 3 hours at home AND THEN had to face your fears of transferring to the lion's den? Your midwife, your doula, your husband, your mother, didn't they all do everything they could? Why isn't that enough?

What about the mothers who train for the war but never get to feel their mettle tested? Herpes outbreaks, breech babies, high blood pressure, intrauterine growth retardation, or their baby's size can have them falling on their sword and relinquishing their bodies to be invaded for the sake of their children before a single shot has been fired. Their birth dreams laid waste upon the surgical table as the fog of war descends upon them.

What about this mom so great fully full of life? First she was told she would have to have a cesarean because her baby was breech. Then she went through an external version to turn her baby, only to have her water break with no labor. She did everything she could to make labor start. She and her husband held off the medical staff for hours and hours and finally, with time running out, submitted to one of her biggest fears; pitocin. After many hours on pitocin her baby's heart rate climbed. Could this be from infection? No mother wants to risk her baby. So she said yes to her deepest fear; a surgical birth and was wheeled off to the operating room. Surely she did enough. Would you have had her say no? She allowed them to cut her body open for the sake of her son. Isn't that enough?

                                             It should be enough.

Welcome home to ALL the mothers who began their births with the bright shiny intention of a natural un-medicated vaginal birth. As you marched off to do battle, you hoped against hope you would come home whole. You raised the banner of natural birth high above you. You held tight to your talismans of homebirth, nurse midwives and doulas believing they could bring you home safe from the war. You counted on your training from Bradley, Hypnobirth, or yoga to sustain you in the trenches. Bravo to those of you who made it through; war weary, battle hardened and whole. But let us not forget the walking wounded that sacrificed it all. Our highest motherhood medal of honor should be reserved for them for their bravery and selflessness. My heroes.

Welcome Home

Ruth M.      Miriam M.       Rebecca P.       Megan B.       Larissa H.

Yselle L.      Kelly B.          Kristina G.        Suraya S.       Wendy M.

Fara H.      Rochelle W.       Shelly F.          Sarah M.R.         Shannon L.

Katelen F.    Anna R.           Jenna M.          Star A.           Colby L.

Janet M.        Eva N.         Gwendolyn S.     Amy E.         Kambria D.

Stacie S.     Jennifer W.        Bridget B.       Georgie W.       Amy O.

DeAna C.     Amy H.           Jennifer K.         Traci C.        Heather S.

        Kat K.        Michelle L.        Tomi M.            Cindy L.          Linda S.       
   Patti D.         Steph W.        Sarah R.          Kendra W.       Lisa N.
Sabrina S.       Anna T.       Glo       Stephanie A.       Annie R.

Kathryn D.       Sara M.  

Do you have a hero that belongs on my memorial wall?

After 20 years of listening to mothers and witnessing births;
I have more names than I can remember.
Each is an important story.

If you or a loved one or friend belong on my wall please let me know and I will include them.

Thank you to the mothers who allowed me to use their stories and photos.

Next post will be a mother facing down her fears 
with a planned cesarean birth!

Friday, June 6, 2014

What's a Mother to Do?

Normally I take photos at births and write notes throughout the process. I think it is important to chronicle this important family event. I give them to my families and hope that they will treasure them forever. After two back-to-back high risk preemie births I felt these special stories needed to be shared. I had never experienced any births quite like these before. I learned an incredible amount and my hope in posting these stories is to educate future parents. Hopefully it will take some of the fear out of an incredibly fearful situation. 

Yesterday Ada Rose came into this world.
All 1 pound 10 ounces of feisty little girl.
Thank you to Ada's parents for allowing me to share a part of their birth story. 

When babies come unexpectedly in the middle of pregnancy it is quite challenging for everyone involved. Suddenly needing to have a surgery to save your little one's life is scary as hell. Being separated from your new child fills a mother with fear and grief in every fiber of her being. Not being able to put her baby to her breast is an additional sorrow. Keeping it together under these conditions is heroic.

So what's a mother to do? Like every other mother she is going to do the best she can for her baby at that moment on that day. In this situation nothing helps a mother more than getting her colostrum to her baby. And of course the colostrum is VERY helpful to the baby. The colostrum of the mother who just gave birth to a premature baby is designed specifically for them. It has a special balance of nutrients to help their brains and bodies continue to grow outside the womb.

Getting the colostrum out of mom and into a teeny weeny baby who can't suck, swallow and breath yet is quite a trick. So what's a mother to do? Pump! Ada's mama was pumping by the time Ada was 2 hours old. The nurse at Sierra Vista tracked down a hospital grade pump. She brought it to mom's bedside and showed her all about it. I talked to her about tricks to help her let down her breastmilk to a pump.  We had just gotten started when dad got the word he could come be with their daughter in the NICU. I told dad to take photos and send them to mom. 

Poor mom looked devastated after he left the room. Of course she wanted him to go be with Ada. Of course she wanted him to not to leave her yet. After all she just went through major abdominal surgery; a really scary experience. Of course she felt it was totally wrong for him to be the first to touch and see her. Of course she felt horribly guilty for all of these conflicting thoughts. So what's a mother to do? Pump out way more colostrum than anyone expected!

Many mothers of preemies are able to only produce a few drops the first day or so. Vickie, the lactation consultant who came in said, "every flood begins with just a few drops. Don't worry how much you get. Just keep at it and your body will eventually respond." Wise words from a woman who works with breastfeeding moms every day.

While mom was pumping dad sent photos and a video back to the room of precious baby Ada. The photos were hard for mom to see; all the tubes and wires. Seeing her wiggle in protest weighed heavy on a mom's heart. I pointed out her perfection. That her color being so pink was a good sign. It meant she could get the oxygen they were giving her into her lungs, into her blood and circulate it through her body. How much better that she was trying to push them away than lying there limp. What a strong little girl she created. 

So what's a mom to do? Why pump out 3 whole milliliters of colostrum. That's what! It wouldn't all fit into the teeny weeny syringe the nurse had brought. They had to go get a larger one. The nurse exclaimed. The lactation consultant exclaimed. The NICU nurse exclaimed. They said, "Why that's about a week's worth of food for such a tiny little person." Yippee!

Mom sent the milk down the hall to her baby. They carefully put some on a swab and ran it around inside her mouth. Now mom's immune system is protecting her baby even though they are apart. Her colostrum is stuffed full of antibodies which can help give her the best chance on life. Right now she is too young to be able to suck, swallow and digest breastmilk. That day is coming though. It is just around the corner. Not to worry, mom will be ready. At 24 hours from birth she pumped out this much liquid gold. Priceless!
so the flood begins...
Every day in the nicu is a scary, hopeful, exhausting roller coaster ride for a family. Neonatal Intensive Care Units across the country are filled with babies and families every day. Please take a moment to hold them in your heart.

Read Eleanor and Caroline's premature twins story

Thursday, June 5, 2014

When Home Birth Intentions Meets High Risk Birth

Thank you to Amanda and Jose for allowing me to share their story. 
Amanda hopes it will help other parents.

My third set of vaginal twins has a unique story. Like many of my clients Amanda came to me committed to a natural vaginal birth free of medical interventions, including pain medication. She wished for a home birth but she knew that wasn't possible in our area because she was carrying twins. So she settled on hiring a doula and planned to turn down as much medical "help" as possible.

But of course life rarely goes as planned...

One day, WAY too early in pregnancy, she begin to be concerned about how her body was feeling. Being a smart mama she listened to her intuition and took herself in to see her OB. Yes, her blood pressure was climbing dangerously. Before she could really grasp what was happening she was admitted to the hospital and begun on medication to bring it down.

I begin to capture Amanda's journey with my phone camera.
I came to the hospital and we talked for a long time about all the natural ways she could support her system and help bring things into a better balance, including her blood pressure. I reassured her I would come to give her birthing classes in the hospital. We strategized over how to deal with a long hospital bed rest.

One week later her water broke. Her body decided it was time to have her babies, 26 weeks or not. With contractions came climbing pressures. When I walked in Amanda was laying in bed surrounded by and attached to more medical contraptions than I have ever seen before. Blood pressure cuff, IV meds for blood pressure, IV fluids, heart monitor for mom, contraction monitor and 2 baby heart rate monitors. A bewildering array. The nurse was glued to the screen giving her all the info from all the machines. Amanda had to remain horizontal for her labor.

Let me explain. I have seen lots of moms hooked to LOTS of things but NOT a mom who was birthing without labor stimulants and/or pain medication. Here was Amanda in the midst of a high tech, high risk birth doing it "au natural".

So we labored. We breathed. We visualized. We relaxed. I sprayed the room with lavender and smoothed essential oil on her feet. We massaged her shoulders and gave her sips of water. Absolutely no food because of the high potential of an emergency cesarean. When her back began to ache I showed Jose how to use my purple rebozo to provide counter pressure with a mom on her back in bed.

The sensations were coming closer and getting more intense. With such tiny babies, with tiny heads the magic number of 10 as a goal for dilation goes out the window. You are ready to push whenever the cervix is pulled back far enough for a head to slip through. I was pretty certain we were closing in on pushing. Then Amanda began to make pushing sounds and spoke of pressure. I alerted the nurse and she did a vaginal check. Yep. No more cervix. Time to push out baby A.

Now everyone began to scramble. I don't know why they were all so surprised.

Vaginal twins are unheard of in some areas of the U.S. but here moms can birth vaginally as long as the babies are positioned right. Amanda's OB, stuck to that promise although he had plenty of opportunity to use the situation to send the birth down a cesarean path. He never once brought it up. When things got tricky he stayed calm and talked mom through exactly what needed to be done, including the urgency of the situation, enlisting her help without scaring her.

But twin births are required to take place in the operating room, just in case. So here we go...
Heading down the hall at Sierra Vista on the way to the OR.

On our way to push out two babies sans pain medication or pitocin.


At the last moment they separated us and made Jose and I wait in the waiting room while they got mom "prepped". I nervously wondered what they were prepping her for? Usually they make us wait outside while they put in an epidural before a cesarean. Poor Amanda was told to not push, even though you can't stop your body from pushing once it begins. A doula can really make a difference when this chaotic circumstance arises, but there I sat in the waiting room, waiting. So I snapped this handsome photo of dad sporting his hazmat birth suit.

At last we were reunited. The room was FULL of people. They had to have the whole OR team as if she was having a surgical birth just in case it suddenly became a surgical birth; obstetrician anesthesiologist, surgical nurses, labor nurse, plus 2 sets of recovery teams for the babies, respiratory specialists, Neonatal Intensive Care Unit (NICU) nurses, and pediatrician. Jose and I squeezed our way in next to Amanda's side.

Pushing in the OR is very difficult. A mother has to block out everything going on around her and stay focused on her body's sensations. At the same time she has to tune into the directions she is given by her OB. It takes a tremendous amount of concentration. Plus she is flat on her back. Not an ideal position for pushing something out of one's body.

Keeping lovingly connected is also a challenge with so many on lookers; especially when your heart is racing with fear for your little girls. Jose's physical presence was a powerful support.

Soon a slippery teeny tiny Eleanor is born...

 to a room FULL of people ready to help.

A relieved Jose; one down, one to go!

2 pound 4 ounce Baby Eleanor gets help getting started

        Is there a baby in that bundle?

Mom meets Eleanor outside her womb room.
   Now we wait for Caroline to make her entrance...

Mom's blood pressure is up; Baby's heart rate is dropping.
Time to get serious about birthing this baby.

Forty minutes after her sister tiny Baby Caroline arrives;
 raising her fist in the air to say, "I made it!"

A very short cord makes for a very rough trip.

         Whew two babies born!            A relieved mom and grateful dad celebrate.

Two pound Caroline gets help getting started.
Preemies have no body fat and lose heat fast.  Saran Wrap traps heat.     
 Daddy gets as close as he can.

First father daughter photo with Caroline.
It's official! They're here.
I'm so blessed to be part of miracles.
I am grateful to all the many people who helped at this birth and who continue to help provide care to these teeny weeny babies. When I first began working as a doula these babies would have been flown to a hospital with a higher level of care than we had in the county at that time. Mom and dad would have been left behind to wait and worry until Amanda was healthy enough to discharge from the hospital.

Don't get me wrong. I still feel way too many babies born at Sierra seem to "need" to be taken to the Neonatal Intensive Care Unit. Almost all my clients have their babies spend at least a short period in the NICU for observation before being given the "all clear" to reunite with mom and dad. Please keep in mind most of my clients are not high risk and birth their babies vaginally. The conundrum for me is when a baby truly needs NICU care I am eternally grateful they can receive high quality, high risk care right her in our community. I am also grateful they are trying to move the NICU in a more family-centered, baby-friendly direction. 

Three days later I snapped this photo of an exhausted dad getting skin to skin time 
snuggled up with Caroline in the NICU.   
Shhhhh!!! Don't wake the baby.


Throughout it all Amanda has stayed strong. Threading her way through her increasingly complicated birth and postpartum period. She stuck to her goals of having as natural a birth as possible while never forgetting to safeguard her babies. The nurses at Sierra are blown away. They say, "You birthed preemie twins vaginally with no pain meds? Amazing!" It brings home for me the difference in our frame of reference because I never doubted Amanda a bit.

Twelve days old 
Cuddle time with mom at last!
 With all the stress Anna unfortunately ended up with a cold. 
She had to delay the sweetest of moments in a mother's life.