what happened to the revolution?
I really want a doula at my birth, but...
I really want a natural birth, but...
I really want a VBAC, but...
I really want a homebirth, but...
Someone once said "There is no 'but' that is not followed by an excuse."
Really wish people would say what they feel, and do what they want. And take some responsibility for their choices. Like this:
I want to have an epidural and feel absolutely no pain from the very first twinge of a contraction.
I don't want a doula at my birth, I just went through the motions of looking for one because my girlfriends all hired doulas.
I do want a doula but my doctor's practice doesn't work with doulas and I don't want to rock the boat or look more closely at why the practice is so unfriendly to labor support, because that would mean looking more closely at myself.
I don't want to try to have a VBAC because it is scary and feels out of control; I'd rather live through a predictable, familiar process than try something new and fail. or try something new and succeed. And I don't really trust my body but I am too afraid to say so.
I don't want a homebirth because it's too much pressure and I do honestly feel safer in the hospital, and gee how silly I was when I, a grown woman, said "I do want a homebirth but my husband won't let me."
I know I said my doctor pressured me into the c-section, but honestly I was so tired of being in labor that I didn't want to struggle any more. It was nice to know it would all be over soon and I would get to hold my baby.
I know I said my doctor made me get induced but I really was done being pregnant and impatient waiting for labor to begin.
Once we start to speak honestly about our birth choices, when the facades fall away, then the revolution can get back on track. There are very few women holding the threads of honest birthing. Whatever their choices may be, when they are made authentically, I salute them .
23 March, 2009
28 February, 2009
blame the midwives
Placentas are appearing in the Urbana, Illinois sewer system. From the article:
"The unprecedented finds have officials wondering if a midwife or veterinarian, stressed by economic woes, has been avoiding the expense of paying for a medical waste disposal service."
Right, because they couldn't possibly be from a doctor's practice or hospital. Or from--gasp--unassisted births.
One of the investigators implies it would be difficult to flush a placenta down a toilet. Really? Think about the aperture of a woman's pelvis and yoni.
Most of the homebirthers I know have such respect and reverence for the Arbol de Vida, they would never just discard it. Usually people bury it and plant a tree or shrub, or process into placenta medicine.
Are the sewer placentas just another symptom of our profound cultural disconnect from nature and the cycles of life and death?
homage
"The unprecedented finds have officials wondering if a midwife or veterinarian, stressed by economic woes, has been avoiding the expense of paying for a medical waste disposal service."
Right, because they couldn't possibly be from a doctor's practice or hospital. Or from--gasp--unassisted births.
One of the investigators implies it would be difficult to flush a placenta down a toilet. Really? Think about the aperture of a woman's pelvis and yoni.
Most of the homebirthers I know have such respect and reverence for the Arbol de Vida, they would never just discard it. Usually people bury it and plant a tree or shrub, or process into placenta medicine.
Are the sewer placentas just another symptom of our profound cultural disconnect from nature and the cycles of life and death?
homage15 February, 2009
linked up
The tale of my last night at Hospital Lorena is on its way, I promise. Currently getting reacquainted with typing on my "anglo" keyboard, driving a car, speaking only one language, making transactions in US currency, and talking on my cell phone. Feeling infinitely grateful for the everyday privileges of a hot shower, toilets with seats, and a comfortable mattress!
Hard to believe a mere week ago we were all having brunch at Jack's, following descent from Temple of the Moon.
Letting go of constantly counting my change to be sure I have enough soles for cab fare, the ever-present cognition of the state of my scrubs and hospital tote bag, the location of my purple ear plugs so I can attempt to nap on lumpy mattresses while our kindly neighbors blast music through the wall, needing to drop off/pick up laundry, wondering if I have time to grab food somewhere before work, and where, and what? What classes are scheduled today and should I remain semi-alert so I can sit in circle? Is this a good time to shower since few people are using electricity right now? Is anyone else in a shower? Is this shower working today? How many coffee presses are still functional and is one available RIGHT NOW?
my friend Claire started an excellent blog, replete with photos of our house, our street, the hospital, and Cusco environs. check it out here.
Hard to believe a mere week ago we were all having brunch at Jack's, following descent from Temple of the Moon.
Letting go of constantly counting my change to be sure I have enough soles for cab fare, the ever-present cognition of the state of my scrubs and hospital tote bag, the location of my purple ear plugs so I can attempt to nap on lumpy mattresses while our kindly neighbors blast music through the wall, needing to drop off/pick up laundry, wondering if I have time to grab food somewhere before work, and where, and what? What classes are scheduled today and should I remain semi-alert so I can sit in circle? Is this a good time to shower since few people are using electricity right now? Is anyone else in a shower? Is this shower working today? How many coffee presses are still functional and is one available RIGHT NOW?
my friend Claire started an excellent blog, replete with photos of our house, our street, the hospital, and Cusco environs. check it out here.
08 February, 2009
posterior and breech births
Hospital shifts and classes are over! Yesterday we celebrated with a 12-hour Changing Woman ceremony at a gorgeous retreat center in the hills above the city. I am finally caught up on sleep and that means my brain is quasi-functional to blog once more.
These births actually occurred 2 weeks ago: the posterior presentation birth on Saturday and the breech birth on Sunday night. Taken together, the pair makes an interesting contrast.
I could tell by palpation in the dilation/labor room that Carmen's baby was lying directly posterior. Verified this by taking heart tones with my fetoscope: the heartbeat was clearest right around Carmen's navel. This position did not seem to concern any of the hospital personnel. Of course C. was laboring almost flat on her back, providing little impetus for her baby to rotate.
Once determined to be completely dilated, Carmen made the 20 foot trek to the Sala de Parto. She exhaustedly purple-pushed for about 45 minutes. The Obstetra placed his forearm across her fundus and began some steady pressure. Nada.
Meanwhile, as soon as the baby's head was beginning to show, an Intern cut a generous episiotomy through Carmen's perineum, ensuing a minor torrent of blood and rendering her yoni a pulpy wreck.
The Obstetra inserted his fingers and pressed them against the baby's head, attempting to assist rotation from posterior to anterior.
Maria and I simultaneously pressed inwards on Carmen's hips to open her pelvic outlet a bit wider. The Obstetra climbed atop a stepstool and leaned his full weight onto Carmen's fundus, jabbing rhythmically as though administering CPR chest compressions. And slowly, finally, the baby made his entrance.
Questions:
1. What would have happened if Carmen had not been laboring flat on her back?
2. What if she had not been exhorted to push once declared "complete"?
3. What if she had been able to push her baby out in a position other than lithotomy?
4. How horrifed do you think I was?
Next night:
Jessica is brought into the Sala de Parto on a gurney, accompanied by two doctors. I am washing up from a prior birth. Jessica is completely dilated and her baby is presenting breech. "Parto vaginale?" I inquire dumbfoundedly. "Si!"
Cool.
As soon as Jessica is positioned up on the table of torture, a window of glossy white shows between her legs. The doctors are joking around and gowning up, arranging instruments, and preparing to break her membranes. Suddently the next contraction blossoms and Jessica's membranes balloon fantastically from her yoni. SPLASH! All over the doctor, the floor, the wall.
And two pinkish purple legs wiggle between two chestnut legs.
The doctor grabs the baby's legs, gently tugs for a minute, then picks up the episiotomy scissors. Even though Jessica has birthed before, apparently the doctor thinks she needs extra room this time. He is still chatty and not quite paying attention. Before he can actually do anything, the baby girl's body births up to her neck.
Now the adrenaline in the room is palpable. The Obstetra on for the night has realized the situation and gowned up. She and the doctor both grasp the baby and begin to hoist her upwards to deliver the head.
Except there is this crazy gringa volunteer standing against the wall jibbering at them in English: "Wait for the nape of the neck! You can't see the nape of the neck!"
Too late. Head flexes and sweeps across the perineum. 6 lb. baby girl is born to a triumphant mother. Double footling breech. Sweet.
These births actually occurred 2 weeks ago: the posterior presentation birth on Saturday and the breech birth on Sunday night. Taken together, the pair makes an interesting contrast.
I could tell by palpation in the dilation/labor room that Carmen's baby was lying directly posterior. Verified this by taking heart tones with my fetoscope: the heartbeat was clearest right around Carmen's navel. This position did not seem to concern any of the hospital personnel. Of course C. was laboring almost flat on her back, providing little impetus for her baby to rotate.
Once determined to be completely dilated, Carmen made the 20 foot trek to the Sala de Parto. She exhaustedly purple-pushed for about 45 minutes. The Obstetra placed his forearm across her fundus and began some steady pressure. Nada.
Meanwhile, as soon as the baby's head was beginning to show, an Intern cut a generous episiotomy through Carmen's perineum, ensuing a minor torrent of blood and rendering her yoni a pulpy wreck.
The Obstetra inserted his fingers and pressed them against the baby's head, attempting to assist rotation from posterior to anterior.
Maria and I simultaneously pressed inwards on Carmen's hips to open her pelvic outlet a bit wider. The Obstetra climbed atop a stepstool and leaned his full weight onto Carmen's fundus, jabbing rhythmically as though administering CPR chest compressions. And slowly, finally, the baby made his entrance.
Questions:
1. What would have happened if Carmen had not been laboring flat on her back?
2. What if she had not been exhorted to push once declared "complete"?
3. What if she had been able to push her baby out in a position other than lithotomy?
4. How horrifed do you think I was?
Next night:
Jessica is brought into the Sala de Parto on a gurney, accompanied by two doctors. I am washing up from a prior birth. Jessica is completely dilated and her baby is presenting breech. "Parto vaginale?" I inquire dumbfoundedly. "Si!"
Cool.
As soon as Jessica is positioned up on the table of torture, a window of glossy white shows between her legs. The doctors are joking around and gowning up, arranging instruments, and preparing to break her membranes. Suddently the next contraction blossoms and Jessica's membranes balloon fantastically from her yoni. SPLASH! All over the doctor, the floor, the wall.
And two pinkish purple legs wiggle between two chestnut legs.
The doctor grabs the baby's legs, gently tugs for a minute, then picks up the episiotomy scissors. Even though Jessica has birthed before, apparently the doctor thinks she needs extra room this time. He is still chatty and not quite paying attention. Before he can actually do anything, the baby girl's body births up to her neck.
Now the adrenaline in the room is palpable. The Obstetra on for the night has realized the situation and gowned up. She and the doctor both grasp the baby and begin to hoist her upwards to deliver the head.
Except there is this crazy gringa volunteer standing against the wall jibbering at them in English: "Wait for the nape of the neck! You can't see the nape of the neck!"
Too late. Head flexes and sweeps across the perineum. 6 lb. baby girl is born to a triumphant mother. Double footling breech. Sweet.
30 January, 2009
reading labor
I'm fairly perplexed that experienced Obstetra interns in Peru (and OB nurses in the States) have no ability to assess a woman's labor pattern via observation. Even some of the matriarchal Technicas (kind of a cross between a nurse and an orderly) haven't a clue.
A woman having her first baby got up out of bed to urinate. She was contracting every 4-5 minutes and very much still "here"; i.e. her level of consciousness had not altered appreciably. Still, once she became vertical, one of the interns alarmedly inquired if she needed to push.
Another woman lay in bed having back-to-back, strong contractions which required all of her energy and focus. She appeared to be in transition. She was not holding her breath nor was there any catch in her throat during contractions. Interns abruptly questioned her desire to push during her time of deepest work and most expansive opening.
Then there's ignorance of the period of quiescence. Often a woman's labor will crescendo as she opens, then pause before the expulsive phase begins. I witnessed this very pattern here one night. As the woman's formerly intense, frequent contractions became more widely spaced apart, the Obstetra lectured her interns on Friedman's curve and ordered an IV bolus of pitocin to speed things along. Oh, if only they had been more patient! The laboring mother was gathering her strength, rounding the peak, and about to accelerate once more.
I've witnessed nurses in the US ask women "Oh are you having one?" (a contraction; really, they can't tell?) and attempt to complete medical and social histories right in the middle of seriously surging concentration. Overreliance on external fetal monitors creates an inability to trust one's own senses.
It's so simple. You just observe with all your senses wide open. There are several external signs that a woman is completely dilated: the reddish purple line extending from anus to sacrum, the rise of her fundus to meet the sternum, the open point on the top of her head, the other open points on the bottom of her feet, and the horizontal crease running across her low abdomen. Some birth attendants can actually smell a change in the labor, or feel their own cervixes opening. When I accompany a laboring woman to the bathroom, I stand outside the door and listen. Is her breath even or is she holding it at all? Is she grunting or throaty? What noises are splashing into the toilet?
And,
it's so simple,
except when it isn't.
Last night I was working with a young woman having her first baby. Her contractions came in rapid succession, with tremulous vibrations rocking her entire body. She wanted to urinate and defecate but could not. As I squeezed her aching hips I could feel them pulsing open. So I added up all the signs and thought the baby's head was descending and she was probably in transition, about 8-9 centimeters dilated. Imagine my surprise to find her cervix 4-5 centimeters and the head very high in her pelvis.
Checked myself. Make no assumptions. Stay open. Stay humble.
A woman having her first baby got up out of bed to urinate. She was contracting every 4-5 minutes and very much still "here"; i.e. her level of consciousness had not altered appreciably. Still, once she became vertical, one of the interns alarmedly inquired if she needed to push.
Another woman lay in bed having back-to-back, strong contractions which required all of her energy and focus. She appeared to be in transition. She was not holding her breath nor was there any catch in her throat during contractions. Interns abruptly questioned her desire to push during her time of deepest work and most expansive opening.
Then there's ignorance of the period of quiescence. Often a woman's labor will crescendo as she opens, then pause before the expulsive phase begins. I witnessed this very pattern here one night. As the woman's formerly intense, frequent contractions became more widely spaced apart, the Obstetra lectured her interns on Friedman's curve and ordered an IV bolus of pitocin to speed things along. Oh, if only they had been more patient! The laboring mother was gathering her strength, rounding the peak, and about to accelerate once more.
I've witnessed nurses in the US ask women "Oh are you having one?" (a contraction; really, they can't tell?) and attempt to complete medical and social histories right in the middle of seriously surging concentration. Overreliance on external fetal monitors creates an inability to trust one's own senses.
It's so simple. You just observe with all your senses wide open. There are several external signs that a woman is completely dilated: the reddish purple line extending from anus to sacrum, the rise of her fundus to meet the sternum, the open point on the top of her head, the other open points on the bottom of her feet, and the horizontal crease running across her low abdomen. Some birth attendants can actually smell a change in the labor, or feel their own cervixes opening. When I accompany a laboring woman to the bathroom, I stand outside the door and listen. Is her breath even or is she holding it at all? Is she grunting or throaty? What noises are splashing into the toilet?
And,
it's so simple,
except when it isn't.
Last night I was working with a young woman having her first baby. Her contractions came in rapid succession, with tremulous vibrations rocking her entire body. She wanted to urinate and defecate but could not. As I squeezed her aching hips I could feel them pulsing open. So I added up all the signs and thought the baby's head was descending and she was probably in transition, about 8-9 centimeters dilated. Imagine my surprise to find her cervix 4-5 centimeters and the head very high in her pelvis.
Checked myself. Make no assumptions. Stay open. Stay humble.
26 January, 2009
taking stock
I'm halfway through my Peru trip.
I have received 7 babies, completed 6 postpartum visits & 6 newborn examinations.
I'm feeling like I am in pretty good shape and will be able to complete all of my state's "numbers" requirements (combined with prior experience).
I'm also realizing that shift work is so not for me. In a strange way I am looking forward to the return of my on-call lifestyle. One or two births per month sounds just peachy, especially with women who know that they have options and won't just lie down and take it! Right now I feel like I am midwifing with my hands tied behind my back.
Saturday night 5 babies were born, two to Quechua women in their beds in the dilation room. These indigenous women labor so differently than the others: no drama, no moaning and groaning, usually in an upright position. I caught one of those babies, untangling him from his cord on the way out.
Now that I have had my share of straightforward births, I asked to see some complications. In response I witnessed the lengthy emergence of a posteriorly positioned baby on Saturday, and a very unusual vaginal breech birth on Sunday.
The sauna beckons and I am exhausted, so the newest birth stories shall have to live in my head and heart a while longer...
Liz, Natalie, & Sunday at Hospital Antonio Lorena
I have received 7 babies, completed 6 postpartum visits & 6 newborn examinations.
I'm feeling like I am in pretty good shape and will be able to complete all of my state's "numbers" requirements (combined with prior experience).
I'm also realizing that shift work is so not for me. In a strange way I am looking forward to the return of my on-call lifestyle. One or two births per month sounds just peachy, especially with women who know that they have options and won't just lie down and take it! Right now I feel like I am midwifing with my hands tied behind my back.
Saturday night 5 babies were born, two to Quechua women in their beds in the dilation room. These indigenous women labor so differently than the others: no drama, no moaning and groaning, usually in an upright position. I caught one of those babies, untangling him from his cord on the way out.
Now that I have had my share of straightforward births, I asked to see some complications. In response I witnessed the lengthy emergence of a posteriorly positioned baby on Saturday, and a very unusual vaginal breech birth on Sunday.
The sauna beckons and I am exhausted, so the newest birth stories shall have to live in my head and heart a while longer...
Liz, Natalie, & Sunday at Hospital Antonio Lorena
24 January, 2009
unconventional hospital births, part three
on Thursday night's shift, 9 babies entered the world. two girls came first, almost at the same time. their mothers rested on gurneys in the recovery room, adjacent to the Sala de Parto, while two more mothers birthed, this time to two boys.
12:30 am: both gurneys and both delivery room tables are full of women, and in walks Elizabeth in hard, active labor. She is fully clothed. There is nowhere to put her so she stands in the center of the delivery room. As the Obstetra and Technica are pondering logistics, Zuki notices that Elizabeth is holding her breath and bearing down.
"Adrienne, get under there!" Zuki exhorts. I bend down, reach under Elizabeth's skirt and receive a slippery little girl into my arms.
The Obstetra comes to help me bring the baby up to her mother's arms, then she grabs the requisite hemostats and clamps/cuts the cord. Elizabeth is looking rather shell-shocked. She is assisted up onto a delivery room table to birth her placenta. Her legs, socks, and shoes are covered with blood and she is shaking. We fetch her some juice, check her pulse, and reassure her that all is well.
I did catch two more babies that night in the more usual hospital style. I am loving that these unusual experiences are finding me and birthing me as a midwife!
12:30 am: both gurneys and both delivery room tables are full of women, and in walks Elizabeth in hard, active labor. She is fully clothed. There is nowhere to put her so she stands in the center of the delivery room. As the Obstetra and Technica are pondering logistics, Zuki notices that Elizabeth is holding her breath and bearing down.
"Adrienne, get under there!" Zuki exhorts. I bend down, reach under Elizabeth's skirt and receive a slippery little girl into my arms.
The Obstetra comes to help me bring the baby up to her mother's arms, then she grabs the requisite hemostats and clamps/cuts the cord. Elizabeth is looking rather shell-shocked. She is assisted up onto a delivery room table to birth her placenta. Her legs, socks, and shoes are covered with blood and she is shaking. We fetch her some juice, check her pulse, and reassure her that all is well.
I did catch two more babies that night in the more usual hospital style. I am loving that these unusual experiences are finding me and birthing me as a midwife!
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