Friday, August 9, 2013

1 birth center, 2 births, 24 hours. My vision of individualized care.

This week I had the distinct honor of attending two births within a 24 hour period.  I will begin by briefly and anonymously sharing the birth stories from my perspective.

JJ and little Summer.
This labor began with a sort of slow, steady, process of having periodic contractions for a couple days.  Once things kicked over into a steady upward incline things progressed very nicely.
I arrived on the scene at her Mom's apartment overlooking a beautiful park in Bellevue, Wa.  around 8pm. We spent most of our time in the kitchen, leaning over the kitchen sink.  There were a few variations, spending a little time in the bathroom (there was a little reverse digestion) and a little time in the living room to spare her little feet from the hard kitchen floor.  There were beautiful arrangements of flowers and colorful, inspiring ceramic artwork on the wall.  In attendance was her Mom, warm, attentive, supportive, patient, and lighthearted.  Her husband, patient, present, smiling, confident, willing to do, or not do, whatever she needed. Her best friend (and her new baby, born just 2 weeks prior), sweet, uplifting, trusting, and (very impressively) able to be present for this mama without projecting her experience on her at all. And me.
Our time at the apartment cam to a close around 10:30pm as J began to show ongoing signs of progress.  She was, vocalizing, swaying and making large circles with her hips, required constant support in her hips during contractions, she was vomiting some, there was some bloody show, she was perspiring with contractions, she did not want to be left alone, even in the bathroom.  She also had an increasingly colorful vocabulary with regards to the intensity of the contractions.  Quite funny, and also very helpful. We watched and waited and supported for awhile, knowing that the midwife and the birth center were just a stones throw away.
Once at the birth center, getting the tub was nearly immediate after a brief stint in the bathroom, getting vital statistics etc.  Candles were lit and lined the edge of the tub. The midwives were present, and patient.  The environment, other than J being in labor, was what I would consider to be like a party.  Quiet conversation, and eager anticipation, of course, but celebratory, fun, funny, and also, intimate. Like a gathering with people that you would consider to be your tribe.  Many women have words that they repeat, like a mantra, to help get them through contractions.  The nature of her contractions throughout active labor was a swift assent into intensity. They kind of jumped up on her, taking her by surprise.  The combination of this fact, combined with her colorful vocabulary resulted in the funniest labor mantra I've ever heard.  "Fucking Balls!" or some variation on the theme, was chanted at the onset of her transition contractions.
There was a very powerful, tender moment, a release, that occurred when her Dad arrived.  "I can have the baby now!" she said, with a couple tears, and the sense of security, having her Dad there was palpable.  She was literally surrounded with support.  Her Husband, her Mom, her Dad, her best friend (best friends infant sleeping peacefully in a little baby hammock), me, her beloved midwife, and a student. There was also a quiet, respectful, professional photographer peeking in and shooting photo's! The music playing reminded me of the kind of music I might listen to if I was driving in my car on a summer day with the windows down, on my way to something I'm really excited about. Music that I like to sing along with even if I catch someone looking at me. Very soon, she began making some other noises, low, guttural, sounds that tell us that there is some downward pressure happening. They did not check her cervix until there was an obvious urge to bear down, checking only to make sure that she was complete.  As opposed as I am to a billion exams, a check at this time can be wise, because like J, many women may push against a cervix that is not "complete" and can cause it to swell up, like a fat lip.  The check revealed that she was at 9cm, almost there, but still better to try to breath through that urge until it is gone entirely.  It only took a contraction or two to move that last centimeter out of the way and the pushing stage had begun.  Her bag of water was still intact and pushing brought new sensations with that "water balloon" bulging down into the birth canal ahead of the baby.  Lots of pressure.  As the baby moved down, pushing that balloon of water ahead, all at once the bag broke.  It sent a visible gush of water into the tub and the baby moved down quickly filling the space that the bag had made.  Now, it should be noted here that this was her second baby, and therefore the pushing stage of labor is commonly much shorter than that of a first time mom.  2 or 3 pushes later, Summer was born into a tub of warm water, to the sound of a song that repeated the words "All we can do is keep breathing" (copy this link to hear it: ) and into the arms of her beautiful, powerful Mommy.  Approximately12:45am.  It was stunningly beautiful.  Her Mommy was understandably as relieved to be done (at first) as she was to meet her daughter.  Once the midwives evaluated the well being of both Mom and baby, the atmosphere was calm, joyful, relaxed. Champagne toast and a few quick stitches later, a new family was headed out the door.  They carried with them a beautiful baby girl, the eager anticipation of introducing her to her big brother, and the kind, loving, memory of her welcome.

I went home around 4pm, went to bed, got up at 9 when my phone rang.  Another Mama in labor.  Her water had broken early in the morning and contractions had begun, but were still working on building into a solid pattern and growing in intensity.  I checked in with them periodically throughout the day, and around 7 pm, I was called to go.

A and Little a
I arrived at their beautiful apartment in Maple Valley, it was a "mother in law" above a garage.  It is literally surrounded by beautiful forest.  Quiet, and peaceful.  I was greeted at my car by the property owners dog.  A large long haired shepherd...I can't remember his name.  He knew something was happening, the couple told me that he had been hanging around them when they were out walking.  He escorted me all the way up the stairs and I had to actively squeeze in the door without letting him sneak by.  Dogs are so intuitive, I love em'.  Once inside I was very pleased to see that her contractions did not change in response to my arrival.  It is a great sign that labor is progressing when contractions stay hard and frequent even with a change of position, activity, surroundings, increased watchfulness, adding support people, changing locations, etc.  Early labor contractions can be easily "scared away" by any of those.  Upon arrival, A was still able to communicate easily between contractions, although during her contractions she needed total focus/concentration on breathing.  As I watched, even though she was not a very vocal laboring mommy, there were other signs that presented telling me that she was making good progress.  I little wrinkle of concentration and effort appeared between between her brows.  Between contractions she began making more frequent observations about discomfort in her hips, with tension radiating down onto her legs.  Her husband, was awesome.  Totally present with her, providing a safe harbor in his arms for her to give in to and feel secure within.  I get a front row seat to true intimacy, and I respect it deeply.  They have a beautiful union.  I spoke with the midwife on call, and we determined that it was appropriate to move to the birth center.  As we were preparing to leave, A mentioned that she was dreading the drive.  Since his parents were nearby, planning to come to the birth center anyway and could bring their car with them at that time, I offered to drive them in my car.  It was quite a drive from Maple Valley to Bellevue, and as it turned out A's contractions didn't slow down, even a baby bit, in route.  Uncommon, and I was very glad to have them in my back seat, where her husband could keep her in his safe harbor and I could help guide her through contractions verbally as I drove, very carefully.  Once at the birth center, A found herself comfortable sitting upright on a chair for awhile, allowing the student midwife to check all vitals on her and baby.  We then got her into the bathroom to try to empty her bladder and she hung out there for a little while.  The room was dark and quiet, in attendance was A, her enveloping, warm, husband, me, the Midwife, and her student/assistant who seemed almost invisible, allowing us to labor without interruption aside from sneaking in a quietly listening to baby periodically, silently delivering ice water for cool compresses, lighting candles, bearing witness and documenting the labor, all while remaining totally unobtrusive. We moved to the tub after the bathroom and she settled in to a corner and allowed her body to do it's work.  There was music playing, a somewhat short set of spiritually significant music that played through a few times.  Occasionally, I would catch a glimpse of him singing or praying in her ear and she was so peaceful in those moments, fully trusting her husband, her body and her creator.  It was blessed.  As she progressed into transition, she, like most others, developed a mantra.  Hers was "Wow, wow, wow, wow".  Almost a whisper, respecting the power of her body.  She mentioned that she could feel the baby moving down several times.  She slowly shifted to feeling only pressure, not pain with contraction.  After  awhile, the midwife offered to check and see if she could push with the contraction, and indeed, she was complete.  We coached her a little bit, but it was obvious that she and her husband had practiced some of the pushing techniques they learned in my birth class.  Using body position and breath, she ultimately made pretty swift progress for a fist time mom, pushing closer to the one hour mark than the other end of average...around 3 hours.  She made nice, slow steady progress.  Slowly but surely moving the baby ever closer.  Her most effective position was a full squat, in the tub. Her husband in the corner behind her helping to lift her into a squat with the onset of each contraction, and grasping my wrists, I was sitting in front of her, outside the corner tub.  It can take a while for the baby to clear that pubic bone, but once cleared. we start to see some of baby's head, then a little more and then a lot more.  She was composed and powerful while pushing, amazed and patient, with a content smile based in deep joy in between.  The excitement on his face as we started to talk about seeing baby was nothing short of a small child on Christmas morning.  They both reached down and touched the baby's head, making it become very real, very fast.  And then, with some guidance easing off her push, letting her body and her baby do the work, the head was out, followed quickly by the body.  They fell in love like a ton of bricks.  Little a joined the world at 12:45am.  After validating and verifying the well being of Mom and baby, the atmosphere turned to quiet reverence.  A quick shower for both, a visit from her paternal Grandparents, meeting their first grandchild, followed by a few stitches (due to a compound presentation of her head and arm) and another new little family was headed home with a whole new world wrapped up in blankets and tucked snugly into a carseat.  The long ride home was, no doubt, a profound transition from life before her, to a new life with her.

These two births, took place literally exactly 24 hours apart.  The labors were about the same length of time. The were at the same birth center, in the same room, in the same tub, had the same Doula.  Both had a baby daughter.  They both had a small tear that required a few stitches that were done on the same bed.  They were both strong, beautiful women, with adoring partners. And yet, the experience they had was unique, individual.  Their personalities were a massive component in the kind of care that was provided, the kind of support they required, the positions they chose, the atmosphere that they created, the wishes that they stated.  All different. Two completely different experiences of birth, even considering all the similarities. This is why I believe so much in individualized care.  And there is no reason why this shouldn't be made available EVERYWHERE, especially in "low risk" births.  Hospitals use their "high risk" patients as scapegoats, saying that they are forced to practice medicine, basically, defensively, because of the high risk scenario's they are exposed to.  I'm sorry, I'm through accepting that.  When the risk factors are not present, none should be introduced . In fact, the medical professionals attention should be able to turn to support when their medical expertise is not required.  I understand that there will always be watchful observation, but if a midwife can "watchfully observe" and also hold a laboring woman's hand or look into her eyes when she needs it, then more of the OB's of the world should be able to do it too.
In both of these scenario's, the common factors were: an informed, educated couple, a clear and reasonable birth plan, a birthing suite, skilled birth professionals and a doula. This can be replicated.

1 comment:

  1. Oh I do love J and the words she assigns to situations! I heard a verbal account from her 'bestie', and loved reading your perspective!


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