VBAC

I've had the opportunity to attend several very interesting and eye-opening births during the course of the past year. A few were with moms who had c-sections previously. Two, in particular, stand out in my memory because they happened within a few days of each other but had very different patterns. One mother had a successful VBAC and the other had an emergency repeat section. Both moms and their babies are doing well. I hadn't attended a VBAC or even a TOLAC in a while so it was interesting to see how things can go and how I applied my midwifery skills in each situation. Granted, I was their doula and not their midwife, I couldn't help but to apply my midwifery training to give these women the best care I know how to give. And I'm glad I did.

When the mom who experienced the repeat c-section complained that she "felt a pop or pulling sensation" in her lower abdomen I knew to watch her baby's heart rate and her contraction pattern closely. Sure enough, within 20 min, her contractions became in-coordinate and her baby's heart rate began taking disturbing dips. Her midwife and I agreed that this wasn't going in a positive direction and the attending OB was called in to perform the c-section. After being rushed into surgery, it was discovered that this mom's uterus had indeed begun to rupture and her baby was in certain distress. He was fine, thankfully.

A few weeks later, the other VBAC mom went into labor spontaneously on a clear, cold morning and I met her at her house to monitor her progress. after a while, she began to feel some slight rectal pressure and we decided that it was time to move to the hospital where her midwife was awaiting us. This mother went on to birth her baby serenely and without incident. I felt confident at this birth because I knew what to look for. I knew what a uterine rupture could potentially look like and how it should be handled. Seeing that rupture in the previous birth, made me more aware of the fact that a rupture is certainly possible for every laboring woman regardless of their birth history. It also made me aware of the realities of a rupture. Its not exploding uteri or sudden death. It's often silent and relatively painless. Therefore, VBAC requires more vigilance, care, and respect.

The issue of VBAC, when discussed among professionals and lay-people alike, is often polarized. Many people, mostly health professionals, feel that attempting to give birth vaginally after having a surgical birth is inherently dangerous and they often spread that sentiment to the patients they come into contact with. There is also a contingent of people who feel that VBAC holds no increased risk at all. And then, there are folks like myself who feel that VBAC does potentially hold increased risk, especially if mom's medical/birth history is not a great one.

I think it's important to promote VBAC as a viable choice for moms who would like to attempt it. I also think it's important for everyone involved to be on the same page. That means midwife, mother, partner, back-up or co-managing OB, etc. Until that and malpractice reform happens, the issue of VBAC will remain polarized and access will be limited. And that isn't the healthiest scenario for moms and babies.

Musings of a Doula/Midwife and a Birth Story

Sorry for the lack of posts. It's been a bit hectic around here. Between weddings, births, home visits, childbirth classes, etc. I miscarried what I believe was a blighted ovum. Holding that little, Oreo cookie-sized placenta in my hands was, and still is, heart-breaking and somehow awe-inspiring at the same time. Despite all the running around, I have had time to do a few things such as grieving the loss (mercifully), bathing (thankfully) and checking up on my family on FB (this is what the world has come to, people). Recently, I also had the opportunity to be the doula for a woman who was having a planned hospital birth. This isn't normally the kind of doula work I do. Most of my clients are planned home births. Being a doula (or a midwife) in a hospital setting can be difficult. Being both can be very, very uncomfortable. So here's the story...

This mother was in great health and having an uncomplicated pregnancy. However, she was going to an OB practice that specialized in high-risk pregnancies because she had developed a good rapport with one of the OBs there after suffering a traumatic loss a year ago. The OB and parents decided to undergo a medical induction at 41 weeks. We had already discussed the pros and cons of medical induction and all the likely scenarios. The mother decided that she was okay with receiving Cervadil but did not want Pitocin. I was feeling like the champion of informed consent before we went into the hospital. Then things began to change.

First, they couldn't give her the Cervadil because of an allergy issue. After much debate and confusion on the part of the parents as well as the medical staff, she was sent home to "wait it out" for the night with instructions to return in the morning. This left the mother feeling frustrated because she was ready to be in labor and tired of being pregnant. However, she decided to go home and wait. Two days later, on the morning that she was to return for another shot at medical induction, her water broke. When she called to tell me this, I asked how she felt about forgoing the induction since it seemed like she was beginning labor on her own. She informed me that she was just at a point where she was "over it" and just wanted the baby out. So, we went to the hospital.

I'm sure you know how things progressed from that point but for those who may not have guessed, let me re-cap: Pitocin started and doubled every 20 min --> Mom in unbearable pain --> Vaginal Exams every 2 - 3 hrs --> Epidural --> More Pitocin --> Failure to wait and fear of "big" baby --> C-section --> Mom distraught over how everything played out.

So...I left that birth feeling like I had done all I could do barring locking the doors or throwing myself prostrate over this woman's burgeoning belly. I gave her the information and allowed her to make her decisions free of judgement on my part. But when her choices led to the unwanted scenarios that we had repeatedly discussed for months, I felt like she was upset with me for not protecting her from those choices. I felt I had let her down. Maybe my mistake was in assuming that informed consent meant informed responsibility. Maybe it was that, in an effort to not make it seem as if her trusted provider was setting her up, I wasn't blunt enough with her about the writing I had already seen on the wall. How does one balance tactfulness and brazen defiance? After her doctor did the final vaginal exam and declared that she had made NEGATIVE progress (even after making positive progress all along) and gave her the c-section talk, I could've opted to check her with the mother's consent. But what would I have done if I had discovered that the doctor's exam was "inaccurate" and the mother was actually further along? At best, it would've seriously broken the trust this woman had in her doctor. At worst, it would've done that and possibly seen me arrested for practicing medicine without a license.

What would you have done?

Ramblings

So...it's been a while since my last post. After the catastrophic earthquake in Haiti (and the many other world tragedies since then), I decided to take a break to breathe, to think, and to get really, really fat. Okay, that last one may not be 100% true, but let's just say that the treadmill is calling my name and I'd better answer that bad boy soon because I cannot afford to court the whole host of obesity-related diseases that plague my family. So, Operation Healthy Weight is in full effect as of yesterday.

In other news, it looks as though the hubby and I are moving toward the possibility of having a baby sooner rather than later. Or at least trying to. For those who don't know, (TMI alert!!!) my ovaries seem to hold onto their eggs like a two year old holds onto his "blankie". Those little gonads of mine just don't want to ovulate in any kind of regular pattern that I can discern. I'm talking period once or twice a year kind of irregular. And before anybody even THINKS, "Oh, you're so lucky to not have a period every month", just consider how hard it would be to try to concieve when your window of opportunity is reduced from a couple of days every 30 - 40 days to MAYBE a couple of days a year. Yeah... So, I'm basically trying to "regulate" my cycle through natural means such as acupuncture, herbs, and homeopathics. And I'm sure losing 15-20 lbs wouldn't hurt, either. We'll see.

To be honest, I'm not in a great hurry to storm the gates of Babyland because it's all kind of intimidating, isn't it? I mean, not the pregnancy and birth part of it all. I'll happily tackle pregnancy and birth because as challenging those aspects of the journey can be, for me, parenting is the monster under my bed. I know I'll do my best like most folks out there and, chances are, the wee ones would probably be no more screwed up than the rest of us. The thing about parenting that worries me the most at this point is the fact that there is no "right" way but there are a helluva lot of "wrong" ways to parent. Or so it seems. The amount of judgement that parents encounter from other parents, well-meaning relatives, and know-it-all strangers is crazy. It's hard enough trying to make the decisions that parents must make: breast or bottle, cloth or disposable, child care, sleeping arrangements, vaccinations, etc. Who needs flack from an outsider looking in? And, unfortunatley, when the choices one makes for their family are unconventional, judgement rains down from every direction and support can be hard to find. Especially for parents of color.

I see myself as someday being a home-birthing, exclusively breastfeeding, co-sleeping, cloth diapering, baby-wearing, organic garden growing, semi-crunchy, midwife mama. And I'd be a minority within a minority within a minority.

Poem for Haiti (by Milk Chocolate Midwife)

Mother of my mother
Who taught me to love
Upon your visage is an ache
For babies lost before their first gurgled cry
Memories of your fruitful seasons woven into the fabric of time
How you once wore the dewy, green bloom of youth
I remember
How you conjured up colors that hushed me
Blue-green blades of grass on hillsides
So beautiful the sun would beg for a peek
Streaking auburn fires and golden lightning bolts
Splashed upon cliff faces
Your beauty is forever
Though a cloak of fragility and desperation
Is what adorns you now
The memory of your warrior's spirit
Carried with you from Guinea
Is not forgotten
I remember
The strength of a mother
Too mighty to be overcome
Though man and beast
And forces of Nature have tried
You were born of the ashes of genocide and slavery
Baptized in the fires of dictatorship and terror
Nursed on the bitter teat of corruption and racism
You strike fear in the hearts of men
For secrets held close to your granite bosom
Secrets of your strength
And joy
Your hour of need, mother, is upon us
And as your need is my need
My hand is your hand to lift you
I am yours
You are Haiti
Mother of my mother
Who taught me to love