Madeleine's Birth Story

September 25th 2007

On Tuesday morning, at (35 weeks, 6 days pregnant) before she went to work, McKenzie had the sensation that maybe her bag of waters had broken. She made the decision to just keep an eye on things and continued on with her day. As time went on, she became more concerned that she may be leaking amniotic fluid, so she called her doula, Amy, to get her opinion. Amy suggested that she contact her doctor and get an opinion from them, but also told McKenzie that everything was probably fine and not to worry. McKenzie trusted her instincts and despite speaking to someone at her doctor’s office who did not think that her water had broken, insisted that she get checked, so she and her husband went to Labor and Delivery. Once she had checked in, it was determined that McKenzie was correct, her bag of waters was ruptured and her baby was going to be born that day. She was feeling some mild contractions at that point. After a vaginal exam, her doctor wasn’t sure if the baby was head down, so an ultrasound was performed and McKenzie and Treven discovered that their baby girl was in a breech position. She would need to be delivered by cesarean section. The surgery was scheduled for 9:00 p.m., as McKenzie had eaten on the way to the hospital (wanting to keep up her strength for impending labor).

Despite the change of plans, McKenzie and Treven maintained such a positive attitude, focusing on getting to meet their healthy baby. McKenzie’s mother arrived at the hospital around 7:00 p.m. and was soon followed by McKenzie’s father, step-mother and then her brother. The grandparents were so excited for the birth of their granddaughter, although a little nervous about what their daughter may have to go through. All during this time, the baby’s heart rate was monitored with an external fetal monitor, and her she sounded very healthy and active. At 8:00 p.m. the anesthesiologist consulted with McKenzie about the details of her surgery. Twenty minutes later, family left McKenzie and Treven for the waiting room, allowing the couple some alone time to reflect on their impending parenthood before the surgery.

At 8:30 Treven’s mother and brother arrived and were able to go back and quickly wish the parents luck before they also came to the waiting room to wait it out. Everyone anxiously awaited any news and were watching the doors for Treven’s face. At 10:45, Treven finally came into the waiting room to let everyone know that Madeleine had been born at 9:24 p.m., was 6 pounds, 6 ounces, and 18 inches long. Baby was doing well and had been able to nurse and spend time with mom and dad very soon after delivery. Much cheering and hugging ensued. The grandparents (and doula) were invited back to see mom and baby in the recovery room. McKenzie looked so happy and proud, and despite her trembling arms, was able to cuddle little Madeleine to her with ease. She was a natural mother. Everyone gushed over the very adorable baby and took lots of pictures.

Although McKenzie didn’t get to have the exact childbirth experience she wanted, she was able to deliver a very healthy baby with the encouragement of her husband and loving family. I felt so honored to be able to support McKenzie and Treven at the birth of their daughter. It is something that I will always remember.

Kegels -- the Exercise For "Down There"

I remember being about 34 weeks pregnant with my second son when my midwife sat me down and had the "kegel talk". She basically informed me that if I had a desire to minimize perineal tearing at birth, prevent urine leakage, and have a speedier recovery, I needed to get serious about doing kegel exercises on a regular basis. Previously, I had been half-hearted, at best, in my efforts to exercise my pelvic floor muscles, not doing anything with any regularity -- a kegel here, a kegel there, even though I knew the potential benefits. I suppose, until my midwife got serious with me, I didn't truly understand the benefits of kegels for not only pregnant women, but women of all ages.

The Kegel exercise is named after a doctor who developed the exercises to tone and strengthen the pelvic floor muscles. These muscles act like a hammock, holding up the uterus, bladder, and bowel. A strong pelvic floor prevents organ prolapse (vaginal, uterine, rectal) and urine leakage, while promoting healing to the perineum. The exercise also tightens and strengthens the muscles in the vagina, providing greater sexual sensation.

It may take a little practice to find the right muscles to exercise, but a great way to initially practice the contraction is to try and stop the flow of urine while you are going to the bathroom (do not make a habit of stopping and starting your urine flow, as it can actually weaken the pelvic floor, but just try it initially to find the right muscles). If you succeed, then you have just practiced the most basic move. Try it a few more times until you feel confident that you know what muscle to squeeze. You should feel your vagina tighten and your pelvic floor move upward. In relaxing the squeeze, you will feel your pelvic floor move down and your vagina relax. As your muscles get stronger -- and you get more experienced -- this movement will become more pronounced.

As far as a regimen goes, most proponents of the exercise say you need to do about 200 a day to get the benefits. My midwife recommended finding four different times a day that I could spend five minutes doing kegels. I usually was only able to fit in two times a day. I recommend that each session include 10 sets of 10 quick squeezes (with a 10 count rest in between each set of 10) followed by 10 sets of long squeezes (with a 10 count rest in between each set of 10). This should develop into a lifelong habit so that you can see lifelong results.

How to Avoid a C-Section

I recently read an article posted on CNN (linked to by several blogs that I read) which listed very succinctly five ways to avoid a c-section.

1. Don't get induced unless medically necessary

2. Labor at home until you're approximately 3 centimeters dilated.

3. Choose your hospital, and your practitioner, carefully

4. In the delivery room, ask questions if your practitioner says you need a C-section.

5. Get a doula.

Please read the whole article to get more details. With the amount of hospitals who are willing to allow patients to attempt V-BACs (Vaginal Births After Cesarean) nearly disappearing off of the landscape, it is even more important for pregnant ladies to be informed of their practitioner's and hospital's cesarean rates. And while a doula cannot "protect" a woman from getting a c-section, working with a doula can help you endure the last weeks of pregnancy, avoiding induction, and labor in the comfort of your home for as long as possible.

Wondering Whether to Hire a Doula?

If finances has been a concern in whether or not to hire a doula for your upcoming birth, I wanted to put it out there that I will be offering my services at a HUGE discount while I am working towards DONA certification. Please contact me if you would like more specific information.

What About Dad?

Many fathers may wonder how having a doula present at birth will affect their role in their child's birth. I think it's natural to feel nervous about the prospect of bringing another person into the birthing space. Penny Simkin, P.T., a world-renowned doula and birth educator wrote the following, which will hopefully put dad's mind at ease.

Myth 1 - If a woman has her partner, the doula becomes redundant.

Reality - The doula may be the only person at the labor besides the partner who is there solely for the emotional well-being of the woman. The nurse, the doctor, the midwife have other priorities that compete with the emotional care of the woman: for example, breaks, shift changes, clinical responsibilities, office hours and hospital policies. The doula has few or no other priorities. She stays through shift changes, and until after the baby is born She is not just another stranger with the couple; she has the woman's needs as her sole priority. In some cases, the couple will bring several other friends or family members into labor with them. Sometimes these people can be uncertain of how to help which leads to confusion and actually adds to the woman's stress. The doula can direct and coordinate the efforts of a group of people, giving them all something useful to do, so they work as a team on the woman's behalf.

Myth 2 - The doula "takes over", displacing the partner and interferes with their intimate experience.

Reality - The doula can actually bring the couple closer. By making sure that the partner's needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together. The doula allows for the partner to participate at his own comfort level. Some partners prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman's comfort and emotional security. The doula can fill in and allow the partner to participate as he wishes, without leaving the woman's needs unmet. When the partner chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance and comfort. During a long tiring labor, she can give the partner a break for a brief rest or change of scene. While the doula probably knows more than the partner about birth, hospitals, and maternity care, the partner knows more about the woman's personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of partner and doula, along with a competent, considerate and caring staff gives the woman the best chance of an optimal outcome.

Myth 3 - The doula has her own beliefs about how the birth should go, and imposes it on the woman or couple.

Reality - The doula's true agenda is to help ensure that the woman's or couple's agenda is acknowledged and followed as much as possible. If the doula is thoroughly familiar with the couple's wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes if a birth plan is not followed, the couple later look back with regret or disappointment. The doula helps with decision-making by asking questions that will ensure that the right information is given to the woman or couple so that they can make an informed decision. She may also suggest alternatives for the couple to consider. She does not, however, make decisions for the couple. In summary, the doula helps make the birth experience to be as rewarding and satisfying as possible.

As one father said, "I heaved a big sigh of relief when she (the doula) walked in. I hadn't realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down."

I know my own husband was so happy with our doula's services that he wished we could have paid her twice her fee, because her presence made him feel so much more relaxed and able to focus on the birth, rather than worrying about me.

Birth Planning

Many pregnancy websites and books suggest that you write up "birth plan" before your delivery in order to share your preferences with your care provider ahead of time. You can also have that birth plan put in your file, so that those that you come in contact with at the hospital or birth center will have access to that information. Things that you might include in your birth plan are your desires for who is present at your birth, ideas about pain management, what you want done with baby after delivery, etc.

I heard something interesting last night at my doula meeting, from some very wise and experienced doulas about how to write a birth plan. They suggested that instead of trying to orchestrate every detail of your birth from lighting to cord clamping (using the laundry list templates that you can find around), pick about three things that are most important to you about the labor and birth to write down and document. The idea is that if you focus on the big picture and less on the minor details, you will be more likely get what you want when you ask for the big things, and receive a warmer reception from your physician and attending labor and delivery nurse.

Those long lists with all of the check-boxes do have a use, however, in my opinion. These can be used as great communication tools for your partner, doula, and your care provider prior to delivery. They can not only help you form ideas about what you would like your birth to be like, but to also identify things that you can be flexible on. It is important to ask whoever is delivering your baby what they perceive as "typical" for their deliveries -- Do they encourage movement? What pushing positions are "allowed"? What is their percentage of episiotomies? What tends to happen to baby after delivery? Do they delay cord clamping? Do they take baby right away or do they put the baby on mom's chest? These types of questions can help you get a feel for your doctor's style, especially if she takes the time to answer your questions and meet your concerns, if you have any.

When approaching birth, it is important to balance a feeling of "go-with-the-flow" with "honoring mother's and baby's experience", as many aspects of your birth you just will not have any control over (timing and length of labor and pushing, how baby is engaged, etc.). This should not diminish the fact, however, that you are the most important person, save baby, in the room when you are in labor. You deserve to be respected, honored, listened to and spoken to directly. If your partner and doula are aware of your "ideal" birth, they will have the ability to support you in a way that will leave you with positive feelings about your birth experience. And if you can single out a couple of the most important things to you and share them with the hospital staff, in writing, you will be more likely to have them "hear" you without overloading them with too much information.

Picking out your most important wish for each stage of labor makes it simple:

1. What is your most important need during labor? Do you want to be allowed to move? Do you want to labor in the tub? Do you not want medication offered unless you ask? Do you not want an IV?
2. What is your most important need while you are pushing? Do you want to try squatting if baby is having difficulty descending? Do you want to push on your side (protecting your perineum)? Do you want someone to count for you or do you want silence?
3. What is your most important need once baby is born? Do you want the cord clamping to be delayed? Do you want baby immediately on your chest? Do you want to establish nursing before tests and weight are done?

Remember to share this short list with your care provider ahead of time, so they can tell you that they are completely on board for what is on your birth plan. Better yet, have them sign it. For the majority of the time that you are laboring (even if you have a midwife) you will be attended by a labor and delivery nurse who will be accustomed to "hospital policy". If you have something on your birth plan that is different than what is normally done at your particular hospital, your nurse will have your doctor's written permission in hand (they might also call them for further confirmation) to allow you to exercise your wishes without the impediment of the hospital staff. This is why a shorter list is so useful and will most likely have a warmer reception than a three page script.

If it makes you feel any better, I was one of those who brought a three page script, along with about 17 extra copies (in case it got lost), to the hospital. I don't recommend it. Everything turned out okay, but I definitely got several eye-rolls from my nurses when I asked them if they had read my birth plan.

Induction -- Risky Business or Blessed Reprieve?

Much of the information for this post was taken from Penny Simkin's book Pregnancy, Childbirth and the Newborn (pages 260-261).

Inducement, or the artificial starting of labor before it begins spontaneously, is probably the most common medical intervention during late pregnancy. While the majority of inductions are elective or planned, some are for medical reasons. A few of the most common reasons your physician might suggest this type of induction are:

• Prolonged pregnancy
• Prolonged rupture of membranes
• Fetus who is no longer thriving or growing in the uterus
• You are suffering from an illness, such as high-blood pressure or diabetes, which puts both mother and baby at risk.

When any of these conditions is presented, usually tests are performed and monitoring is done to determine the readiness of the mother and baby for birth. It is important to understand that some hospitals and physicians may have specific policies that determine when your baby is to be born (before 41 weeks gestation, within 24 hours of membrane rupture, etc.), despite the health of mother and baby. All medical interventions carry with them risks, which I'll talk more about later on, so it is important to find out what your care provider's policies are ahead of time, so that you can make sure you are both on the same page when it comes to how you would like your child to be born.

As mentioned earlier, the vast majority of inductions are for non-medical reasons, and the induction rate is increasing at the same pace as the cesarean rate (could there be a link?). There are many, many reasons that someone may decide to have an elective induction. These reasons include:

• Convenience for the caregiver or mother is the most common reason for elective induction. Many doctors work in large practices where they are only on-call during certain days of the week. A woman may want to deliver with a specific doctor and therefore will schedule when she is available. Doctors also like to deliver their primary clients' babies. They are eligible to receive the largest chunk of the fee if they attend the delivery.
• Predictability is very appealing to many women, especially those with other children, whom they will have to find care for when they go to deliver their baby. Women who experience very rapid labor and birth, or live far away, may worry that they will not make it to the birth center on time.
• For some, the last few weeks of pregnancy are unbearable.
• Both women and caregivers may worry that if they wait for the baby to be born spontaneously, he will grow too large and will not be able to fit through the pelvis and cause damage to the perineum. Please note that studies have found that fetal measurements done by ultrasound and by external measurement cannot be counted as predictors for actual fetal size. There can be as much as a 10% margin of error using these methods.
• Sometimes caregivers and their patients go ahead with an induction simply because there seems to be no apparent reason not to do it. The cervix is ripe (soft and effaced), the baby seems big enough, and the mother is ready to have her baby. The question becomes, "Why not?" rather than "Why?"

Induction is seductive. It can be one of the greatest temptations a very pregnant mother can face, but it is important to understand that it is not a risk-free procedure, especially for first-time mothers. Here are some things to think about:

• Babies have something called a "fetal-placental clock", which greatly influences when she is ready to be born. Babies continue to mature and develop in the last few weeks of pregnancy and may benefit from a few more days in the uterus.
• As mentioned, induction is not risk-free, and there is no guarantee that it will be successful. The chances of a cesarean are much greater for those that choose induction as opposed to those with spontaneous onset of labor, especially for first-time mothers (which is the group most likely to go over-due).
• An induction can take as little as four hours or as long as three days. A long or unsuccessful induction is more likely if there is little dilation or effacement before admission to the hospital, and if you are a first-time mother.
• Continuous monitoring is pretty much inevitable if you are induced. You will be limited in where you are able to position yourself (usually on your side or on your back, in bed), which can make it very difficult to deal with the intensity of contractions.
• You usually are not allowed to eat solid foods while Pitocin is running, though you can usually drink clear liquids. If you have a long wait, you can get pretty hungry.
• Induced labors, even in early labor, may be more painful and intense than a spontaneous labor, usually leading to more interventions to assist in pain relief.

If you or your physician are considering an induction, make sure that you are clear if it is medically indicated or elective. Weigh your options so that you can make an informed decision that is best for you and your baby. When offered an elective induction, some women decide to wait for labor to begin spontaneously, while other may decide to go ahead with the procedure, feeling that the benefits outweigh the potential risks. Only you will know what is best for you and your family.

Stay tuned for: Possible Ways to Get Labor Going on Your Own