Update: I'm BAAAAAAAACCCKKKKK!!!

So, I'm 29 weeks and 3 days pregnant now. Here's what's been going on in my life since my last post:

*I thought I was nauseaous during that last post, but honey, I didn't know what nausea was! Right around week 12, when I thought that the mild nausea I was having would be passing, my body kicked into high, vomit-y gear. I was barely keeping down water on some days. It was lovely, really. Who knew vomit came in so many fabulous colors? My last barf session occurred at 17 weeks and it ceased quite suddenly thereafter. Thank the good Lord!

*Been getting increasingly annoyed w/ one of the midwives I attend birth with. Don't get me wrong. The nurse-midwives I assist are wonderful folks, bless them dearly, but one of them often tries my patience with some of the things she says and does in and out of a labor/birth setting. And her labor management skills sometimes border on...hmmm. Let's just say she could use some good, strong support in the form of a second (knowledgeable) midwife in most situations. That, and a course on interpersonal communication. Maybe some sensitivity training, too. She's not a bad person by far, but, sheesh. She sure can rub people the wrong way at times. Of course, I'm too diplomatic (or is it chicken-shit?) to say much about this to her. Actually, I've tried to have conversations about cultural differences that some clients might have and how we need to be sensitive to these things. Well, that's never gone in the direction I thought it might. She either claims people are just so ignorant and that's why their beliefs differ or that others are displaying "reverse racism" by not simply accepting her views or her care as is. *sigh* Uh, yeah. Okay.

*Went down to see my sister who is also pregnant. For the love of Christmas, that was one stressful trip. I love seeing my family and my sisters in particular, but after dealing w/ one pregzilla, she and her husband constantly bickering, family blood pressure issues, a first grade terrorist in the making (and her mother who believes that yelling = discipline)??? I was ready to come home ASAP. I was only there for 4 days and it felt like 4 weeks. I was so stressed out that on the plane trip back home, I began having contractions. Oh, yeah. More to this story below...

*I thought the contractions I was having were due to the change in air pressure or whatever on the plane. After we landed, those suckers continued. And they got stronger. And more organized. Well, after I downed a liter of coconut water and laid myself down, I expected things to stop. I was only 25 weeks, for crying out loud. They didn't stop. In fact, they were every 4 minutes. I texted my midwife and got hubby to take me to the nearest hospital. By this time, I had been contracting for several hours. The intern (who as it turns out lives in the building next to mine) ran a fetal fibronectin which came back positive. Yay. VE revealed I was fingertipping but not very soft or showing change over several hours. Contractions finally stopped after I got 2000mL of Lactated Ringer's solution. Until I got up to walk out of L&D. I didn't even bother to tell the nurses. I was tired and assured that my cervix wasn't dilating. I just took my ass home and put myself on temporary bedrest. Apparently, I have an excitable uterus. Yay, me.

*I FINALLY got my midwifery license to practice in the state that we're planning to move to next year! I'm so excited. *does a twirl*

*What else? Hmm. I think that's it for now. Especially since it's past 4am right now. *Yawn* Oh, wait! Did I mention that I'm having a baby boy? If not, I'm mentioning it now. I so love him already. I know what you're thinking. Yep, I now walk around with a vagina AND a penis. How cool am I? Don't be jealous. :o)

Peace.

I Haven't Been Abducted By Aliens...Well, kinda.

Hey, folks. I've been a total slacker when it comes to this blog and for this I apologize. What I haven't been slacking on, apparently, is baby-making. It's true. Two pink lines. SQEEEEEEEE!!!! Just over 12 weeks now and the nausea is really starting to kick it up a notch at this point. It's generally supposed to be easing up around now (or soon, prayerfully), but as usual, my body must be the exception to all rules, right? *sigh* Barf.

Overall, though, I'm doing well (other than the N/V and crushing exhaustion) and the little alien/sprout is growing nicely. Even taught childbirth class and attended a lovely birth the day before yesterday, so I'm not slowing down much. Holy fark, I'm growing a person! My mind is officially blown. I seriously hope I'm better at this than I am at growing plants. Cuz I totally suck rat balls at that. Sheesh. Taking my tired butt to bed. But I promise to not be a total blog slacker from here on out. Or I'll at least try.

Peace and chicken grease. :o)

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

A Birth Story

I've been on hiatus. Isn't that what what folks say when they don't wanna say that they've been too lazy to keep up with their blog? Well, it's what I'm saying. I apologize. Please accept my gift of a birth story as a token of my.... Ah, hell. Let me just tell you this story.

About a week ago, I had the privilege to be an attendant at a beautiful, if mildly frustrating, birth. My frustration didn't stem from the mother or her labor pattern. It stemmed from the fact that, even though she was choosing to birth in a hospital, she was being cared for by a group of nurse midwives, and I had rather high expectations. My bad. So the story goes...

I received a phone call at about 8:25pm while sitting on the couch with the hubby. Turns out, this mama who I'd been expecting to go into labor soon had broken her water but wasn't having regular contractions yet. After having a brief conversation with her, I instructed her to call her midwives and see if they would like her to go to the hospital right away. Being that she was GBS positive, I suspected that they would tell her to come in, so I got dressed and waited for her to call me back. I was right. Off to her house I went. Because this mom and her partner had decided that the partner would stay with their young daughter if labor began at night, I would be the one to pick the mama up and drive her to the hospital.

We get to the hospital around 10pm and wait in the waiting room for about an hour while the maternity unit staff tried to find this mom a bed in the triage unit. Her contractions at this point are becoming regular and are about 4-6min apart lasting 30-45 seconds. Mom is hooked up to monitors when we finally get into the triage room and the monitors are showing decent contractions and good fetal reactivity. So, she's admitted and we're both told to go to sleep and she'll receive her first vaginal exam at 2am. She's been told my the midwife on that if she's not in good labor by then, they probably start her on pitocin. "All you'd probably need is just a whiff of pit to get things cranking.", she says. At this point, I'm thinking, "Oh, boy. The p-word already? From a midwife? Hmm." So this mama and I go into the labor room and attempt to sleep.

Instead of sleeping, I lay down in a chair and watch this mama (who is lying on her left side) for a while. Every so often, I notice that she reaches around and rubs her hand on her lower back. I ask if she wants me to rub her back, but she says she's okay and doesn't need it at that moment. She does ask me to check the monitor to see if it's registering her contractions. (Oh, did I mention this mom was on continuous fetal monitoring through most of her labor even though she was told that she'd be monitored intermittently?) I looked at the strip coming out of the monitor and noted that her contractions were not being accurately recorded even as I stood there with my hand on her belly during a contraction. I mentioned this to the nurses on several occasions and the monitor was readjusted several times.

At 2pm, the vaginal exam revealed that the mama was about 3-4cm, 50% effaced, and +1 station. She was also told that her contractions were insufficiently strong and that they could start pitocin or wait a couple of hours more. She opted to wait. As the midwife walked out of the room, the mom asked me why they were pushing pitocin on her when she'd created and given the midwives a birth plan that indicated a preference for no drugs including pit. I told her that I really didn't know, but could speculate that maybe that's what they're used to seeing and doing. I told her that whether she decided to take the pitocin or not would be up to her and her partner and they should discuss it.

A few hours later, the midwife returned and asked what mom'd decision was regarding the pitocin. The mother stated that she like to hold off on the pit for a while longer. Again, she was told that her contractions, at 6 min apart, were insufficient and pitocin would help to move things along. The mother declined the pitocin again. That midwife went off shift and another came on. The new midwife removed mom off the monitor (after readjusting it for the millionth time and getting the monitor to actually read the contractions which were quite strong) and sent us into the hallways to walk. The contractions weren't much closer together but were building in intensity. Mom's partner got to the hospital around 8am while we were walking. We went back into the room and the midwife came in to tell the couple that the contractions were still not very strong and pitocin would be their best bet. "...With your GBS status, CDC guidelines recommend delivery as soon as possible. Yes, we've given you antibiotics but the literature tells us that even if we do that, babies can still get the GBS infection...", the midwife stated. When the mom nodded that she understood and began saying that she and I had discussed the pros and cons of receiving the pitocin, the midwife cut her off by say, "Well, she's the doula. I'm the midwife. And I'm telling you that you need this pitocin." I didn't even bother to inform her that I was also a midwife. I don't think it would've helped.

At this point, the mom started having a contraction and went into the bathroom. Her partner followed and the midwife turned to me and said, "Why's she so resistant to the pitocin? I mean, I don't think she gets it. I haven't heard her say that this GBS infection could be deadly!" Umm, okay. So I replied, "I think she gets it. She's had this conversation with me, with her partner, and with the midwives she's seen during her prenatal care." Exasperated, the midwife walks out of the room shaking her head. 10 minutes later, the couple call me into the bathroom and mom has the look of a woman getting ready to push etched on her face. I step outside to call the midwife who was sitting 10 feet away. I called her name, said the mom looked like she was getting ready to push and was not acknowledged. Another nurse told me she'd send the midwife in. 5 min passed and I poked my head out the door again to call the midwife and was not acknowledged. A third time 5 min later and I was told by yet another nurse (not the midwife) that mom had to be out of the bathroom in order to be checked. 5 min later, the midwife walks in to check the mom who is completely dilated and pushing. After pushing for less than an hour, a beautiful 6lb 9oz baby boy emerged.

After the birth, we had a few more hurdles to jump in order to get baby to room with his amazing mother but we did it. I was exhausted and frustrated at how my expectations of the midwives at this hospital were not fully met. This mother delivered a healthy, beautiful baby a little over 12 hours after breaking her water. She DID NOT need pitocin. And none of the midwives sat with her long enough to monitor her contraction pattern themselves. I take the meaning of midwife, "with woman", to heart and I expected the midwives to be with this woman. All in all, I know that things could've been worse and I appreciated the midwives' willingness to let the mother and her partner have time to discuss things. I thanked both midwives for their patience. However, I also know that while things could have been worse, they could've been a little better, too. And I know that's not strictly due to the midwives, but our entire system of maternity care.