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Birth Story of Elisha (Eli)

8/25/2011

8 Comments

 
Have you ever been on the bumper cars at the fair and before you start driving someone smacks into you? You’re a little shaken but try to jump back into the fun. You start steering and BAM! You’re hit again but this time you’re hit from both sides. You try to spin and pull out but these cars have you cornered and now they are getting smacked. This is not the fun you envisioned when you handed over your ticket and quite frankly you want to get out. This is what my last pregnancy with Elisha (Eli) was like. It started with hopeful excitement but before I could enjoy the positive pregnancy test problems started smacking me from all sides.

This was my third baby and the fear of labor and birth is not what I had to talk myself through. This pregnancy was immediately followed by two miscarriages. It began with a cautious optimism. We didn't want to walk on egg shells, so to speak with this pregnancy, as the previously two losses taught me that I can do everything right and still not have things turn out the way they were planned.

I'd already been blessed with two beautiful daughters. I had endured hyperemesis graviduram (severe nausea and vomiting) and the doctors warned me with my first child that it doesn't go away and tends to grow more severe with each pregnancy. Because of the two losses maybe I was hoping that this disorder would pass me this time, almost like I expected my body to grant me the favor of a peaceful, easy-going pregnancy. It owed me right? To my dismay, like clock-work, nausea hit me like a Mack truck around six weeks. It was father’s day weekend and the girls and I had just told my husband about the new baby. We celebrated by eating a big breakfast at our local cafe with the kids. By that evening I could barely consider dinner and by morning I could barely get out of bed. I forced myself to attend church with the family, only to make it through half of the service. I excused myself and sat reclined in the car with the windows open for the remainder. I did not attend church for another seven months.

This began a horrible cycle of being in the bed for days at a time barely keeping liquid down, going into the emergency every other day for IV fluids because of dehydration. I tried several prescriptions of Reglan, Zofran and other combinations. Nothing seemed to help this time. The hyperemesis was so bad we checked three times for multiples. There was always only one baby. A baby I feared for daily. I had a picc line (A peripherally inserted central catheter) inserted and home health care set up. My husband and I were taught how to give me IV fluids twice a day totaling seven hours of being hooked to medical equipment. At least I was home, I absolutely hated the hospital. In between the administering of IV fluids we were to give me shots of Zofran which lessened the nausea but not enough to eat adequately.

 At this point eating was a secondary. For me and the baby's sake I had to stay hydrated. I had to check my ketones throughout the day and every day they were high, even with the iv fluids. Having the presence of ketones means your body is in starvation mode and it starts to create a toxic chemical in your body which is not only life threatening for an adult but also for an unborn child. This was concerning. My body was in starvation mode for weeks that turned into months. My husband took time off of work because I was unable to care for neither our four year old nor myself. The most I could do was get up to use the restroom and even that I sometimes needed help.  I felt helpless, hopeless, depressed, frightened and alone. All I could do was lie in bed and pray that I could get through another day. At this point all I could think about was surviving and wondering if we could make it through this. Because I was on the smaller side and had lost 15 pounds in two weeks I did not “show” until much later than usual (about six months).  It made it easy to forget why I was experiencing what I was experiencing and often forgot that a beautiful child would await me at the end of all of this. Or would there be? Sometime I couldn't even think about that because it brought on more fears. To help ease our concerns I had bi-weekly viability checkups for the first two trimesters. Baby was doing well, mama wasn't.

I have to mention that I was seeing an ob because of the picc line. I am a big fan of midwives and had planned on choosing a midwife as my provider during the pregnancy. Having a picc line that needed to be managed with home health care was out of the scope of practice for midwives here.  I was hopeful that the symptoms of hg would improve around 6 months like it had in the pass. So I interviewed and chose a pair of home birth midwives who I saw simultaneously with the ob.

By the end of the second trimester I was able to incorporate a few items into my system other than IV fluids. They were often short lived (nausea and vomiting was still a nuisance) but I was willing to try anything because at that point it was either eat or be fed food through the IV.

Around 30 weeks, right when I was starting to eat more but still couldn’t keep fluids down (fluids are usually the last thing to be tolerated with hg)it was the midwives and the home health care nurse who noticed my blood sugar levels were starting to be elevated. I did not want to take the glucose test when it was offered because I thought the drink would make my h.g. worse and my ob didn’t insist. I appreciated that.  I never tested positive for gestational diabetes in my previous pregnancies, I was healthy pre-pregnancy and my two previous babies were small (6-7 pounds). We both agreed to skip it.

However, because of the increased glucose levels the midwife recommended that I test and chart my levels in the morning and an hour after meals for a week. I did and they were sky high (around 200 after meals and over 150 for a morning fast). I tried to manage with food. This was difficult because even entering my third trimester there were only so many things I could keep down. Ironically these things were doing a number on my pancreas. I was too physically weak because I wasn't taking in enough calories daily and exercising was hard because of this. I shared my findings with my ob who immediately diagnosed me with gestational diabetes and sent me to the diabetes clinic nearby. Within an hour of testing and counseling I was giving stacks of paperwork to chart, insulin, a glucose meter and explained why treating this was critical to my baby's health and my own in the long term. I was frightened and sat in the office and cried for an hour. This changed everything. No homebirth (once you are on insulin it is out of the scope of practice for midwives.) My birth was becoming more and more hospital/intervention based with eight + weeks to go.

My midwife offering to be my doula was a relief because she knew what I did and did not want and how to help me convey that to my ob and the nursing staff. She listened when I cried with my heart break and would offer encouragement with any fears or concerns I had. Concerns and fears I had plenty of. My ob began to immediately start talking induction, possible c-sections (always mentioning the possibility of a big baby), more ultra sounds and bi-weekly biophysical‘s of the baby.

 I chose my particular OB because I had attended births with her (her clients were my doula clients). I liked her bed side manner and she appeared to be patient with the birth process and slow to intervene. I was seeing a different side of her when became diagnosed with gestational diabetes. She became a little defensive when my husband and I questioned the medical necessities of more ultra sounds and the biophysicals. Were they medically necessary or just routines? She knew how I felt about unnecessary interventions and tests and I believed she had me and the baby’s best interest in mind. However, there was something about her reactions to our questions that made me get on the defensive and to make sure that I was the biggest advocate for this baby. My husband also rose up as papa bear a few times (very attractive) to let them know to not treat me as another pregnant patient but as an individual and to listen to my concerns and work with me.

We came to an agreement that I would do one more ultrasound to check on fluid and baby’s weight, (I kept in mind that there is a large margin for error). Baby was measuring large (at 32 weeks he was measuring 7+ pounds) and she kept talking induction by 38 weeks. I hated this whole process. I was at this point having bi-weekly appointments again and also 2 stress tests a week. I was having very strong contractions that they were detecting on the stress tests.  I was already on a modified bed rest and still doing about 3.5 hours of IV fluids. At this point I was drinking maybe 8-16 ounces orally of fluid.  

 The Point of No Return

Call me superstitious, but I was never one to get the nursery all set up months before my baby’s arrivals. It was less about me worrying that something bad would happen but more about it causing more anxiety to sit and stare at a prepared nursery and wondering, “When is the baby going to come?” Also, we wanted to wait to find out the sex of this baby so I didn’t want to buy of lot of green/gender neutral cloths. It had also been four years since our last baby so things were still packed away. We aren’t prepared; we had nothing except a onesie that our oldest bought at Babies-R-Us after we told her about the baby.

A few nights prior I woke up and said, “We need to get ready (we still had about 6 weeks left), let’s go looking for a crib today, a car seat, supplies, etc.” I had this strong urgency and energy to clean and that’s what I did. I stormed through the house like a tyrant. Cleaning every inch of the house, top to bottom, organizing, de-cluttering. The night my water broke I’d sent my husband and kids to my in-laws so that I could rest peacefully but all I did was clean. When they came home later I was on my hands and knees picking lent off of the stairs.

I woke at 3 am with what I could only describe as an air bubble in my stomach. For some reason my first thought was, "Oh no. I could be having an amniotic anabolism." Oddly the weeks previous to this happening, I felt strongly that my water would break while I was in bed sleeping but I am not sure why an anabolism would be my first concern. Those fears were immediately silenced as a trickle began to flow. I was confident that I knew what was taking place. I lay in bed trying to calm myself as I was afraid to move. I’m only 35 weeks pregnant.

So I lay in bed, trying to calm myself as the amniotic fluid begins to flow heavily. I have quickly replayed the last few months in my head. I quietly tap my husband and tell him that my water just broke. He stretched, rolled over and said, “Oh yeah, what does that mean?” He is clearly out of it and I tell him that it’s the point of no return. He jumps up with the biggest smile until he realizes that it’s too early. He sits back on the bed and asked what we should do. I went over the plan which was to go to the hospital and make sure everything was okay with baby. I didn’t want to go because I know that once you are there they try to keep you there. I called ahead and let the maternity floor know we’d be coming in and also mentioned that if everything was fine with the baby that I’d want to come back home and labor at home. Like I expected she mentioned that once you are registered and checked in that they wouldn’t encourage me to leave, especially since I had premature rupture of membranes, baby was early and I was insulin dependent. I took my time going; I showered, packed, refreshed up on the Thinking Woman’s Guide to Birth, printed out my birth plan and made arrangements for my two girls. During this time my contractions started as mild cramps and began to build from there. They were irregular but they were what I remembered with my two previous pregnancies. This baby was coming, ready or not.

I arrived at the hospital about 5:45am. I was checked in, assigned a nurse and agreed to let them do fetal monitoring for 15 minutes to check on baby. Baby was doing well and was still head down (via ultrasound), fluid was flowing like a river, my vitals were fine. My chiropractor came in (per my request) and adjusted me to help with my pelvis which was always yanked out of alignment. I had breakfast as I waited for the on-call doctor to come in and discuss a plan. We agreed on a “won’t stop- won’t start” plan. If labor continued to progress we wouldn’t stop it with drugs, but we also wouldn’t try to speed things up. The longer baby could stay the better it would be. They did a test to see how mature the baby’s lungs were and they were still pretty immature. This isn’t uncommon for gestational diabetes baby’s. They are large but their lungs are the last to catch up with the rapid growth.

By the afternoon I noticed meconium coming in big chunks when I used the bathroom. I knew immediately that the only way for it to be coming out that much (or at all) was for him to be butt down. I actually felt it so strongly in my spirit that I sat in the bathroom and called Steve with tears in my eyes. I told him, I think the baby is breach. I showed him the meconium that was still coming out. I had the nurse come and look and she suspected the same thing. They tried to feel where he was on my stomach but couldn't tell for sure. The told the ob who was on call and she ordered an ultrasound. The ultrasound technician came to me because it was slow that evening and showed me how my baby was sitting straight up, his head was between my breastbone and his little bum was resting on my pelvis. My heart sank with this confirmation. I was heartbroken because I knew what was to follow. My ob called me in my room and softly and humbly explained my situation. They know from my relationship with the nurses from being a doula and from my birth plan that if this were to happen that I would like to try to deliver the baby breach. The only problem was (as she explained) that none of the ob's in the practice were trained to deliver a breach baby. At least they were not comfortable with trying to do so. The plan was to continue to keep baby in as long as we could and try to get baby to turn while we still had time. I contacted Gail Tully, founder of Spinning Babies (she's also a local midwife and we had met because of the birth community). I also contacted my doula (former midwife) and explained to her what was going on and she offered her encouragement and some things we could try. That night I quietly sobbed. Time stood still as I felt so incredibly alone. All I could hear was the sounds of the machines I agreed to be attached to. Other than that the maternity floor was very calm. Every hour a nurse would come in, stroke my arm and wipe my tears and ask me if I wanted something to help me sleep. Remember, my water broke at 3am the previous morning. I haven't slept. It was going on 24 hours and I was physically and emotionally exhausted. I kept denying their offers of something to help me sleep. I know that being exhausted is counterproductive when you are in labor. But up until this point I was trying to restrict any unnecessary medications for this baby. By 5am I finally agreed to some Tylenol because my head was hurting so bad from all of the crying. The relief from the headache allowed me to sleep for a few hours.

The next morning the nurse came in checked my vitals and asked me if I was aware of how strong my contractions were (she’d been watching them from the station). I was. I noticed they increased in intensity and felt like they were getting closer together. I told her that I forgot to mention that my baby’s start slow but fly out when they are ready. My first stalled at 4cm’s for a few hours, the nurse checked me and said no change, went to get me some ice chips and baby was crowning by the time she came back. My second baby “stalled” at 6cm’s and same story. They went to get the midwife because I said I felt like I was going to explode and by the time they came back baby was crowning.

I wasn’t exactly sure what would happen with a breach baby but I thought they should have some kind of game plan should baby follow his/her sisters. The nurse agreed and spoke with the ob on-call. They wanted to check me to see if I had dilated at all (I refused any checks before then because of risk of infection). They checked me and I was only 3cm’s. This was a surprise to all of us because of how intense and close the contractions had been all night. I ordered breakfast and went to take a shower. My husband helped me and washed my back. I sat on a stool and started to cry. He asked me if I was afraid of a c-section and I nodded yes and began to sob uncontrollably. I’m not sure what he said after that but I knew it was full of love and comfort. I was still nervous but I wasn’t as afraid. It was almost like the release of the fear and tears gave my body the go ahead to finish laboring because by the time I stepped out of the shower I could barely walk. The contractions were hitting me so hard and fast it took him and a nurse to get me from the shower to the toilet. I wanted to sit on the toilet because it helped with the contractions but the nurse kept trying to get me back in bed. This baby was coming like a runaway train and the toilet was speeding it up. It took my husband and two nurses to get me to the bed. I did not want to go to the bed. The contractions felt worse there and I felt out of control there. My husband managed to separate long enough to call my doula Sara (previous midwife) and ask her to come in right away. The nurse called the ob and in a blink of an eye there was a team in my room prepping me for surgery. My doula arrived and my husband gently passed me to her. I was contracting so hard that I could barely breathe through them. I bellowed and called on Jesus so loudly I didn’t care who heard me, I didn’t care if it scared the other laboring women. I began to slap the hands of the nurses because they kept trying to get the monitors on me and make me lie back. They backed off and my doula Sara began to speak gently with me and help me breath through the contractions.

Within five minutes they cut my gown off of me and had me drink an antacid. They wheeled me into the operating room where the ob was along with the anesthesiologist, two neo-nurses. My nurse, my husband and doula joined me. The anesthesian gave me an epidural which was hard to do because the contractions were on top of each other. Can you imagine having to be still while getting an epidural during a transitional contraction? It was brutal. My husband was by my head and my doula was in the corner. My nurse began to explain every step which eased my concerns about the process. I couldn’t feel anything but pressure. I kept my eyes closed as I breathed through the surgery and within 10 minutes our son was born. He looked so much like our youngest and we both began to weep. They brought him over to me and I so badly wanted to touch him but all I could do was throw up and shake. I turned my head away from him because I was so sick. My husband took the baby to the neo-natal room and Sara came and sat with me. She held and stroke my hand as tears streamed down my face. This part was worse. I could feel him putting things back into place and I so badly wanted it to be over. I was there may be a half an hour and brought back into my room. Sara explained what was going on with our son as Steve stayed with him.  The nurse came and explained what the rest of the day would look like. The catheter, pain meds, etc. I felt so out of it. Everything felt like a world wind but I was so happy that it was over. My heart was aching because I didn’t have my son in the room with me, on my chest like I’d imagined. He was going to need to be in the nicu so they could check his blood sugar which was low.

When Steve returned he was floating on air. He was beaming about our little guy and asked if our family could step in and say hi. The visits were short which was fine because I was exhausted. After every one left (except Sara) the nicu nurse “snuck” the baby in to see me which brought on another wave of tears. I was in so much pain but I sat up, took my gown off and placed him on me. He immediately latched on and began to nurse. It was absolutely beautiful. We didn’t have a name yet because we did not know the sex of the baby and he was early so after my doula left my husband I am searched online for a name that would suit this little guy. We agreed on Elisha which means “God is my salvation”. I think that is very fitting looking back on the pregnancy, labor and delivery. It was certainly God who I held on to during all of this and my prayer is that Eli will do the same when life doesn’t go the way you plan it. 

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To Induce or Not to Induce

5/21/2010

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“Induction of labor is like pushing a parked car up a hill. It requires a lot of help, hands and/or machine (tow truck). ”

There are many reasons a woman may be admitted to the hospital for an induction; past expected due date, pregnancy-induced hypertension, spontaneous rupture of membranes without labor and just because. As you can see most of these reasons are perfectly valid and are most likely for the best interest of the mother and baby. However, there are 2 reasons in particular I have seen take place for convenience or according to the doctors or hospital policy, not necessarily because the mother and baby were in any danger.

The Estimated Due Date Myth

Most women do not know when they ovulated, therefore conceived so the common method is based on your LMP (last menstrual period). The problem with this method  is you may have been told that you ovulate or are most fertile on day 14 of your menstrual cycle, mid-cycle or even 14 days before your period is expected. These are myths. While this may be the case for some women, it may not be true for you, even if your cycles are regular. Your own fertility pattern is unique to you and unless you observe and chart your cycles your estimated due date can be off by as much as 2-3 weeks.

When we are given a due date (even on the basis of it being just an estimate) we hold on to it as if it is in stone. We watch the calendar and check days off and the closer we get to it with no sign of labor starting we panic. Not to mention the annoying phone calls, emails and now texts from well meaning and loving family and friends asking, “Have you had the baby yet?” If you happen to have a doctor who has a vacation coming up or who “doesn’t like to see their patients so uncomfortable”, that’s a lot of pressure for an expectant mother.

“One of the biggest obstacles to natural birth is misunderstanding your "due date." A due date does not mean there is only one safe day for your baby to be born. It is meant to establish a range of time that your baby is mature and safe to be born. Because modern obstetrics narrows this to a specific day, unnecessary interventions, like inducing labor, come into practice.” Mothers Naturally

“Is this baby ever going to come?”

These words and thoughts may start to be uttered days before the estimated due date. But we have forgotten one thing, it’s an estimation.

Sometime we are literally evicting the baby before he/she is ready. There are many things that need to come together for true labor to begin. It is not just about jump starting contractions. When we begin to play with nature and its timing there is no wonder the snowball effect of interventions begin. It’s almost like our bodies are saying, “I wasn’t ready but since you are trying to make it happen you are going to have to finish it”. That is exactly what happens.

 “Pitocin is like normal contractions on steroids”

Oxytocin is a natural hormone produced by a woman's body that cause uterine contractions, when her body and baby are ready. Pitocin is the synthetic form of oxytocin. Pitocin is generally used in two ways: 1) to induce labor, and 2) to augment (speed up) labor. Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby.

Oxytocin, your body's natural hormone, is secreted in bursts. However, when you are given pitocin you are placed on a regulated intravenous pump, to regulate the amount of pitocin to a steady flow. Therefore, pitocin induced contractions are different from your body's natural contractions, in strength and effect. (For more detailed information on Pitocin FAQ )

This domino effect, I have unfortunately seen more than once, has a higher chance of ending with a c-section. The mother wonders; how did I get to this point, what went wrong, did my body fail me? I have been in these moments; it can break your heart to witness.

Are there times when inductions are needed? Absolutely, and when they are done during those times can give a mother and child the best outcome. However, similar to c-sections, it can be a matter of convenience and control and less about a woman’s ability to labor successfully on her own.  “In a well-nourished, low risk pregnancy it is normal for your baby to be born between 37 and 42 weeks gestation*. Many natural events take place within your body during the last weeks of pregnancy to prepare you for labor. Allow time for the natural process to occur.”

I would like to encourage mothers to-be and their providers to 1) allow nature to take its course which will require some patience, 2) if assistance is needed to consider all the options, pros and cons of induction, 3) consider alternatives to start and augment labor.

To induce labor:

  • Walking
  • Nipple Stimulation
  • Intercourse (Only if the bag of water is intact.)
  • Enemas
  • Castor Oil
Augmenting Labor:

  • Walking
  • Change positions
  • Avoid exhaustion
  • Nipple stimulation
  • Employ a professional labor support person
Do not be afraid or intimated.

Ask questions about what is being suggested. Ask why, are there any alternatives and what are the pros and cons. When we want someone to do something we tend to glorify the benefits and downplay the risks. This is a time you want to know (equally) both sides of the coin. If your doctor seems impatient or acts as if your questions are stupid or annoying (I’ve seen it) in the middle of labor (especially an induced one) is not the best time to address your concerns. You may feel vulnerable, afraid and as if you do not have any choices, or that you can’t make the right one.

 

Resources:

Childbirth.org

The Doula Book

mothersnaturally.com


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Letting labor begin on its own is almost always easier and safer...

4/6/2010

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There are also times when when induction may be safer than waiting for labor to start on its own. Watch this informative video so that you can determine what is best for you and your baby. I'd love to hear your thoughts.
healthybirth_1.pdf
File Size: 545 kb
File Type: pdf
Download File

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How Past Child Abuse Hinders Best Intentions

3/24/2010

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"It is often claimed that traumatic events are repressed, yet it appears that the trauma more often strengthens memories due to heightened emotional or physical sensations.[1]" A classic visual image of repression is the image of one trying to hold a tennis ball under water. All of your physical and mental energy is focused on keeping that ball down and as soon as it is released it resurfaces. The same is similar for memories, events, habits, etc. that we try to submerge in our thought lives. Often these memories resurface like the tennis ball and usually when we least expect it.

For years due to public awareness we are more educated on how abuse on children, adolescents and later on adulthood. "The effects of sexual abuse extend far beyond childhood. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of self-esteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life." [2] (My emphasis).

One in four women is estimated to have been sexually assaulted at least once in her life. This statistic is derived from two large-scale national studies that show the incidence of childhood sexual abuse to be 27%, with a further 17.6% of women reporting adult rape (attempted or completed), half of whom were also survivors of childhood sexual abuse.[3] That is quite sobering especially if you are hearing this while sitting in a room with a group of women. The effects of sexual or child abuse has on a women during her childbearing years, especially during labor and delivery has been overlooked, however awareness is starting to be raised. Unfortunately, because it wasn’t often discussed during prenatal visits or during childbirth education (or the woman does not feel safe to discuss it or has repressed it so deep) the doctor, midwife, nurses, and labor companions assume that the expectant mother couldn’t handle child birth and are labeled as such. Because of this their specific needs and concerns are not addressed.

If you have given birth to a child you can attest to the fact that it is one of the most vulnerable times you will ever experience in your life. The double-sided coin is that to possess complete control during the process a woman must give up complete control. She must trust and work with her body, baby and the process. The end result is the same for all women as it has been since the beginning of time, a baby will be born. However, the difference in how that mother receives that baby can range depending on the circumstances. If not handled correctly instead of feeling empowered and confident as a woman, new mothers are often left having to relive traumatic experiences and feeling victimized all over again.

With the above stats it is more likely than not that I will come across more and more clients who have experienced some sort of sexual abuse trauma. I am fully aware of my scope of practice and that I am not a therapist or counselor, but it doesn’t release me from the responsibility of being aware of how a mother is reacting to pregnancy, labor, delivery, post-partum and motherhood. During prenatal visits I try to build a relationship with all my clients by educating them as well as spending time learning about their experiences and expectations. Sometimes the subject may come up during our visits; other times intuition and experience will be my guide. During labor and delivery I am to adapt my response to these mothers so that I may not cause further harm. I need to be mindful of words used that can encourage your average mom but can make a survivor mom completely withdraw or become defensive. A touch that can sooth and comfort most women may send a survivor mom into a cocoon or worst have her completely shut down prolonging her labor.

With all of the literature, education, training for professionals and counseling for survivors have become available as awareness for this subject continues to bring healing to women and mothers. I admit that I am still resolving to learn more so that I may better assist and be a better and comfort and support to survivors of abuse.

Resources

References:

  1. ·  ^ NPR: Why It's Hard to Admit to Being Wrong
2.      Besharov, D. J. (1994). Responding to child sexual abuse: The need for a balanced approach. In R.E. Behrman (Ed.), The future of children, 3 & 4, 135-155. Los Altos, CA: The Center for the Future of Children, The David and Lucile Packard Foundation.

Bottoms, B., & Epstein, M. (1998). Memories of childhood sexual abuse: A survey of young adults. Child Abuse & Neglect, 22(12), 1217-1238.

U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2007). Child maltreatment 2005. Washington, DC: U.S. Government Printing Office.

3.      National Research Council. 1993. Understanding Child Abuse and Neglect. Washington, D.C.: National Academy Press; Tjaden, P., and N. Thoennes. 2000. Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence against Women Survey. National Institute of Justice: NCJ 183781. (www.ncjrs.gov/pdffiles1/nij/183781.pdf)

 


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Dads and Doula's

3/19/2010

1 Comment

 
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I had the great opportunity to spend the evening with a group of women last night at the Childbirth Collective . "The mission of the Childbirth Collective is to enhance the childbearing year for parents by promoting quality doula support, advocating evidence-based care, and providing accessible education based on the wellness model of maternity care."

The theme of the evening was birth stories. There we all sat, women of all ages, races, first timers, some having their fifth and sixth child, grandmothers (to-be), and a variety of childbirth experts. Their stories reiterated that there is no ideal birth scenario and much like weddings "the best laid plans..." and so the phrase goes.

I am reminded that a successful outcome is in the eye of the mother; whether she felt like she had control of her birth experience, whether she felt supported, if the birth was faster or longer than she expected and so on.

I also was proud to learn that every woman there had a doula for support (one lady had two). The common thread with doulas were that they were invaluable to their birth experience and that their husbands/partners could see the benefit even if at first they were skeptical. A common misconception is that the father to be is fully capable of supporting a woman throughout her entire labor and delivery experience. I believe this is an unfair burden to put on anyone, especially men who may be squeamish over bodily fluids, or surprised by unexpected sounds to seeing the one they love be in "pain" and not being able to take it away. 

This reminds me of a couple I was with a few weeks ago. They were a team. It was obvious they practiced their breathing, comfort techniques, words, and he encouraged her like I had never seen done before. It was beautiful and I feel blessed to have witnessed a couple so in sync bringing their child into the world. They were home for most of her labor and when they arrived at the hospital it took a little over an hour for her to deliver. I told mom, "that's very smart that you did most of your laboring at home." The father to be said, "I wasn't that much help, I slept most of the time". This surprised me because he appeared so confident (and I am sure he was) in his ability to help his wife, but in reality, when I came on the scene he felt like the weight of the world was off of his shoulders (his words). He was exhausted and at a loss for ways to comfort her especially during the transition period.

I only regret that they didn't call sooner, as most of the women and their husbands at this meeting collectively experienced and expressed. Hearing that it was common to wait until they couldn't handle the labor alone saddened me because an experienced doula is trained to not only encourage and support mom, but dad as well. This also taught me to make during my prenatal visits to encourage my clients to call me as soon as they think they are in real labor, that it's not a bother but what they hired me to do.

A doulas job is not to replace the father to-be role. He is a very important part of her birth experience. He can love her in only the way that he can, he knows her more than a doula or any labor support person can. It is great to see a father settle into that loving role.

If you have any questions about what and how a doula supports a family before, during and after pregnancy feel free to contact me, I'd be happy to help.

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Healthy Birth Your Way- Intro

3/18/2010

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Effects of Fear in Childbirth Part 2- How to Overcome

3/12/2010

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In my last post I spoke of the possible influences that affect the way women and society view childbirth. In this post I would like to help from a different angle. We’ve heard that knowledge is power. I wonder if we’ve really grasped the meaning of this, or is it just another inspiring quote. One way to combat fear head on is to know your enemy or the perceived enemy in most cases.

I am going to use a job interview as an example of having fear and anxiety about the unknown and methods to overcome them
that can be applied to childbirth. When you are interviewing for a job it is not uncommon to begin to have some anxiety about
the interview itself and the outcome. Sometimes we begin to play in our mind all the negative possibilities that can take
place only paralyzing us all the more. There are several books and websites dedicated to preparing potential job hunters for
their interviews. One in particular allbusiness.com has helped me compile this list which I will apply towards childbirth.

1) Do your homework.  Although childbirth is a natural process which a woman’s body is designed to achieve most people do not understand the physiological, psychological and emotional components that go along with it. Childbirth classes help expectant parents learn about and prepare for labor and birth. There are several kinds to choose from.
In childbirth classes you will learn about the labor and delivery process, how your body is working with you (not against you), ways to manage pain and other information that will help you feel more comfortable about the process and knowing what to expect. Research them as much as you can to become familiar with each technique until you find an course that seems right for you.

2) Know where you’re going.
Are you having a home birth, birth center, or giving birth at a hospital? Will your health care provider be an obstetrician, a midwife or your family practitioner? Each option has their strengths and weaknesses and it is best to know beforehand who you’d like to be involved with the delivery of your child.   

 

3) Look the part. Well, your body is already taking care of this one. I would add that it is not only important to take care of yourself physically during this time but your overall well being is important as well. If you exercised before baby keep at it (with doctors guidance). In fact, if you abruptly stop your routines it may cause some stress and anxiety.  If you did not exercise regular before baby, I don't believe doctors recommend starting up a program, but Pilate's, walking, stretching, etc. not only benefit you but baby as well.  There are (thank God) a lot of great maternity clothing now. Have fun, enjoy this time, get a massage, a facial, be pampered. This is your time, in a few months it wont be so much.

4) Rehearse beforehand. Is there a breathing technique or hypno birthing method you would like to use? Most people make the mistake of skimping on the practicing; they figure they can wing it. The problem is with most methods and techniques they benefit you the most with when you put in the work before labor starts. Many times someone will try something and say it didn’t work,  in reality they really didn’t commit to learning it completely. What are some ways you relax, distress? This is the time to practice some comfort measures to see what helps and what would irritate the daylights out of you.



5) Secure your references. Build your support system. Women who labor and deliver alone tend to have less than ideal birth experience. When I say alone, keep in mind that most obstetricians are either taking care of several patients at one time, and most only want to be called to come in when delivery is very near. Most labor and delivery nurses chose that profession because of their sincere desire to serve and comfort women during their most vulnerable time. Unfortunately they also juggle several patients and have to follow procedures and monitors which keep them from the one on one experience with expectant mothers. Midwives can vary depending on if it’s a hospital, home or birth center delivery. They can be more attentive to the laboring mother but as delivery become closer their role rightfully changes from solely nurturing the mother to making sure that a safe delivery is the end result. Whether it’s your best friend, your partner, mother or doula, you will want to consider who you will want with you as each person brings along their experience, fears, and expectations which can positively or negatively influence your birth experience.



6) Arrive early. Or maybe not. Most women (and the fathers-to-be) have anxiety about her water possibly breaking at the movies or trying to determine if she’s having real contractions, Braxton hicks or gas. You will want to discuss with your caregiver at what point you should contact them and head to the hospital, birth center, or should expect them to come over if you are having a home birth. Often women have reported being in labor and rushing to the hospital only to have labor slow down or stop, and this may be due the change in environment, paper work, unfamiliar faces, etc. Whatever the plan is make sure you have it and contact numbers close by and that your support person(s) have access to it a well. Also, taking a tour of the hospital before, finding out their procedures for admitting, labor, delivery and recovery is a good idea.

7) Bring necessary documentation.  Make a checklist of everything you will need to bring to the hospital. Toiletries, music, comfort and focus items to name a few. Consider getting a new robe, a new night gown as a gift for yourself, any medications you take, journal, camera, whatever you can think of. This is helping you to be proactive. Being unprepared can caused unnecessary stress to an already potentially stressful situation.

8) Sell yourself. You have to advocate for yourself. This is your birth experience. Work with your doctor, midwife or doula about the benefits of a birth plan. The great thing about creating a birth plan is it causes you to learn about the pros and cons of interventions, how you would like to handle situations as they arise, etc. The process of creating a birth plan empowers you to take responsibility for your birth experience and may ease some fears of the unknown by leading you to search for more knowledge to make informed decisions. Don’t forget to present a copy to your doctor and discuss it with him and also the nursing staff when you are admitted. Be advised that like weddings, things do not always go as planned. Your birth experience may not go exactly as planned but you will have the information to discuss any changes so that you can make an informed decision that you can live with.

9 Don’t neglect to ask questions. It doesn’t matter if it’s your first baby or fifth, there are no dumb questions. If your doctor or midwife responds impatiently or negatively to your questions, it may be time to look for a new one. If you are hiring a doula she can be a wealth of information and resourceful as well. Connect with mothers who have succeeded with the birth plan you desire. Another warning: stay away from people who only want to tell you horror stories. You’d be surprised (especially as an expectant mom) how things stick to you. Before you know it, you’re staring at the ceiling at 3 am wondering if you will have a 46 hour labor that will end up in a c-section because you were so exhausted and you had a small pelvis and the baby’s shoulder got stuck and they ran out of cranberry juice!


10) Follow up. After your delivery it can be helpful to find out from those involved what they experienced. As you mentally are revisiting your birth experience (journaling is great too) their feedback can help fill in the gaps of things that were missing from your story. It’s not uncommon to hear about things that happened that you didn’t notice because you were so focused and tuned in to your body.

 Please keep this in mind: Every birth will be a different experience. Your level of enjoyment with each experience will be determined on how prepared you are for the journey. Knowledge is power. You will have the power to allow your fears to influence your birth experience or to face them head on and use them to push you to the birth you’ve always wanted.


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Effects of Fear on Childbirth-Part 1

1/28/2010

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About a year ago our twelve year old made an interesting proclamation. She said, "I'm not having kids, I want to adopt".  We were naturally surprised at the humanitarianism that this young girl possessed but as we dug deeper we discovered the root to this assumedly noble decision. 

My husband has a saying that he says to me when I am thinking and speaking negatively about myself or a situation. He immediately says, "Where did this come from. Who told you that?” For example, when I question my competence as a mother or wife he says, "Where is this coming from, who told you that you weren't a good mom, etc." He doesn't let up until I navigate through the information highway I call my brain and land at the heart of the issue.

I decided to try this with our daughter. In short, she was afraid of birth, the pain to be exact. She had already made up in her mind that instead of enduring the "excruciating pain" of childbirth that she'd rather pass and go another route. Who told her it was too much to handle? 

I know as a woman (especially if you are expecting) that you sometimes receive unsolicited advice from everyone. I once had an older man at a checkout line ask me “if I planned on breastfeeding because it was the best thing I could for my child”. Although I agreed with him, I was taken back by the fact that he thought he had a say in how I fed my child. 

This conversation with my daughter opened my eyes to the fact that there is another influence that we tend to overlook. It can be as subtle as in your favorite sitcom or drama to as graphic and extreme as the baby shows on TLC and the Discovery channel. About a week ago I was watching one of my favorite shows, Friends.  My husband doesn’t understand how I can watch the same episodes over and over again and laugh as if it were the first time. This particular episode really struck a nerve in me and I found myself arguing with the TV. 

It was the one were Rachel’s (Jennifer Aniston) water broke and they immediately went to the hospital. Now every woman is different, and our bodies respond differently to labor but on average, after a woman's water breaks it could still be hours before active labor starts. Ok, rant done. When she was admitted to the hospital 90% of the time she was laying down. The episode prior to this one she commented that she was only being nice to her obstetrician because "she has the drugs". These were funny scenes and lines but sad seeds planted unknowingly into the minds of woman. 

You may be thinking, “It was show; they wrote it for entertainment not to educate women on childbirth”. How many of us watch movies or television shows when the woman is in labor, she's always on her back, screaming at the top of her lungs, threatening to kill her husband and begging and pleading for drugs? Would you agree that most of them portray that stereotypical labor and delivery? If we believe that disrespectful music, violent movies and video games have an influence on our young people, then images of women treating childbirth as a sickness and as something to be feared may be negatively influencing us as well.

In the movie Nine Months with Hugh Grant and Julianne Moore there were two women who were totally out of control during labor. The whole scene (although very funny) was incredibly chaotic and didn't portray labor and delivery the way that it can be 90% of the time. I would love to see "normal birth" shown in movies and television shows but it may not be as entertaining because it can be pretty serene, peaceful if allowed. 

I am not trying to tell any one what to do, including my daughter. If she wants to adopt, then I would support that. She’s more informed now, maybe too informed, but I believe whatever desicion she makes won’t be fear-based. 
There is no perfect birth scenario, no template as to how it should go. Some women (my self included with my first) do not understand their options and feel that every one knows what's best for her body better than she does. If a woman wants to labor and deliver on her back, have at it. If a woman wants to have a natural birth, hospital or home birth, pain relief, induced labor, have a water birth, use a birthing stool or have an elective c-section, it's her choice. My wish and passion is for women to take ownership of their birth experience(s). To not let TV or someone’s negative experience lead them to make uninformed decisions. Having fear of the unknown is natural. It’s not uncommon to have fears throughout your pregnancy. However, to have an enjoyable pregnancy, labor and delivery you need to address those fears and concerns. Speak with your doctor or midwife, a childbirth educator, in some cases a counselor may be required. The more you know about how your body is working with you and not against you it will help quiet some of those fears.  


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    A Woman's Design

    A Woman's Design Doula & Childbirth Educators are here to walk along side you during such a precious time. Whether it is your first journey or tenth, empowering women and families with education and support to trust their inner wisdom and make wise choices in pregnancy, birth and early parenting is the heart of A Woman's Design. 

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