Beyond 40 Weeks... An Email

One of my best high school girlfriends sent me the following email that other day and I asked her, pretty please, if I could share it as I thought there might be many women who can relate to the sentiments she shares.  She said that I could post if I included this disclaimer: "I am normally very rational and sweet-tempered!"  Here's to a baby soon, friend... we're all pulling for you! 

Hi friends-

So... my due date has now come and gone (it was yesterday), and I am still pregnant and getting more and more annoyed by the minute.  I know I should be happy to have the baby make it to 40 weeks and yadda, yadda, yadda, but I'm still sick, my ankles are now swelling, I can't sleep, my back constantly hurts, and I'm just down-right GRUMPY!  Since all of you can relate, you are going to bear the brunt of my crabbiness.  Hopefully my effort to expel some negative energy into the following list at least makes you laugh!

TOP 10 THINGS THAT ARE REALLY PISSING ME OFF AT 40 WEEKS PREGNANT

10.  Everyone breathlessly answering the phone when I call.

9.  People asking me if "I'm still hanging in there."  As if I have a choice!

8.  People's eyes popping out of their sockets when they see how big I am.  Get a good look at the freak show, folks!

7.  Even better, the people who apparently can't help themselves when they see me and exclaim, "Whoa!"

6.  Men who claim that they "know what I feel like."  Dude, just shut up.  Just. Shut. Up.

5.  People who gleefully tell me that God makes women uncomfortable in the last few weeks of pregnancy so that they look forward to labor.  This is so dumb I can only respond with a blank look and walk away.   

4.  People asking me when I'm going to get induced.  Like a ride on the Pitocin train will make it all better! 

3.  My coworkers walking into my office, feigning surprise, and saying, "Oh!  You're still here!"  Umm, duh.  You're looking right at me. 

2.  People asking me how much I weight I've gained.  See #8.  Answer - "a lot." And beyond that, it is none of your damn business!

1.  My coworkers asking, in front of a room full of people, about my Dr. appointments and whether there is any indication that the baby is coming.  Do you honestly think I'm going to talk about the status of my cervix in a meeting?  In front of my 60 year old male boss?  Seriously! 

Alright, off to scrub some floors....

K

Pregnancy Loss and Infertility... Books & Other Resources

I was recently asked for some suggestions of books that might be helpful for couples who are dealing with pregnancy loss and infertility.  I posted the question in a doula support community that I am a part of and thought I'd share the suggestions here in case they might be of help to anyone who's reading or knows someone who might be encouraged through them.  I'm also sharing the comments from the women who made the suggestions.

I've not suffered loss or infertility myself... but I know a number of couples who have.  Often, I'm at a loss for words and I think that's ok.  While I know there are a number of books, as well as blogs and organizations (see below), I try to keep in mind that while some are looking for resources such as these, others are not.  My usual rule is to listen and speak if it seems helpful or needed... but most of the time, to simply listen.  Those who are looking for books or resources will ask or find them.  Please offer the suggestions below with great discretion and only if you're asked.  Be a friend and know that it is absolutely ok to not have answers.  Your presence and willingness to listen and walk beside friends who are dealing with loss and/ or infertility is enough. 


A says: "Here are 3 books that helped me through 3 losses... #1 and #2 have a Christian perspective to them, and #3 is a little more secular."
Silent Grief by Clara Hinton
Empty Arms by Pam Vredevelt
Free to Grieve by Maureen Rank

C says: "I loved this book.  It is written from a Christian perspective and does have some photos so it might be disturbing to some people. For me it helped to know what I might see and experience. I wanted as much information as possible about fetal development etc. so I loved it. It might be too much for others though."
Answers in a Time of Miscarriage by Bethany Marie Kerr

R says: "I will carry you is AMAZING- but maybe better for someone who had a stillborn. But still Amazing. The second was was great for me after having 2 miscarriages in a row before I got my 3 boys."
I Will Carry You by Angie Smith
When the Cradle is Empty by John and Sylvia Van Regenmorter

Another resource that I've been sharing with women is this series on the blog of a friend of mine.  She writes candidly about her ongoing struggle with infertility... check out Infreakinfertility- Part 1 and be sure to read the following parts as well.

I have a few online organizations listed under the heading "Pregnancy & Infant Loss" on this resource page here on my site. 

Doula Jenna "Families Reunion" 2012

As I supported families throughout 2011, I had the idea to host a gathering at the end of the year.  The main reason was to reconnect in person with the parents and babies that I had a chance to work with.  I was also excited for many of them to meet one another and for my own family, my husband and daughters, to get a chance to meet my clients as well.

On a Sunday in January, we met up at a local park (my favorite one) and enjoyed lots of yummy treats and a few hours of talking, laughing and playing together.  One of my dear friends and also a client of mine, graced us with her photography talent and captured some priceless shots.  This is something I plan to do annually.  If you are a doula, or anyone who works with people, for that matter, I encourage you to do the same.  We need to take advantage of reasons to gather and celebrate.  It's wonderful on so many levels.

some of the 2009-2011 babies

 i get to meet and work with some of the coolest women

 the best husband this doula could ask for (the man sans stroller)

 sweet twin girls and their wonderful mama

so many amazing families!!

 an attempt at a "chronological order of birth" shot... close :)

 special family... babies number one and sixteen for me

* all photos taken and posted with permission by Katherine Nagel

A Day in LA with Ina May

You know those days where you have a hunch that what you're doing and who you're interacting with seems like it very well might be a once in a lifetime opportunity?  That was me on January 6, 2012.  I found myself headed northbound to LA in the company of my dear friend and co-doula, Annely Allen.  Our destination was BINI Birth, a unique space that's dedicated to offering support, education, and resources for families and birth professionals.  I've been familiar with BINI for a few years and was thrilled to have the chance to see it in person.  I'd received notice a few weeks earlier that Ina May Gaskin was going to be speaking there.  Double hooray.  I've read some of Gaskin's work and her book Ina May's Guide to Childbirth is one that I recommend to women often.  She is someone who has had a deep influence in maternity care worldwide and the way childbirth is perceived.  I wouldn't say that I am her #1 fan, as there are others who would rightfully claim that title, but I do have great respect for who she is and the work that she has committed her life to.  Below are some photos and bits of wisdom I gathered from what she shared.

"We always think that paying more for something = better and typically, this is true... but not when it comes to the birth industry."
- Referring to the cost of maternity care and how often because hospital birth costs more (before insurance contribution) it is seen as the superior environment to give birth in

"Birth is not about making money... especially when the people making the most aren't the ones actually caring for the women and babies."
- Talking about insurance companies and policy makers

"When you don't have midwives, you don't have obstetrics either.  You just have surgery."
- Voicing the need for midwifery to continue to play a vital part in maternity care throughout the world... the need for both midwives and obstetricians to care for women and babies.  Not either/or.  Both have a rightful place.


"Wouldn't it be amazing if our little girls grew up knowing that the place babies came out of went from little to gigantic?"
- Talking about the fear women often have of giving birth vaginally and not fully understanding that the vagina is created to expand and accommodate birthing a baby.

 

Ana Paula & Ina May

Following the workshop, Ana Paula Markel, founder of BINI and a childbirth educator and doula herself, graciously invited anyone who was interested over for dinner and more discussion time with Ina May.  Annely and I looked at each other and without saying a word knew that the other was thinking "no-brainer."  There were a handful of other San Diego doulas who were in attendance and had the same reaction.  We headed to the grocery store and picked up some pasta, salad, and bread and made our way over to Ana's house.  We arrived before she and Ina May got there.  I LOVE how Dawn, one of the SD doulas, made Ana's kitchen her own and along with a few others, started working on preparing dinner.  Over the next few hours, we shared a meal and talked more with Ina May, Ana, and the 20 or so other women who joined for dinner.  It was a rich opportunity to connect with women who all have the goal of supporting and caring for women, babies, and their families. 

 

San Diego Doulas & Ina May Gaskin

In closing, after spending the day listening to, talking with and observing Ina May, here's what I most admire about this woman...

• She's one of those people who you know has so much wisdom and a wealth of life experience and yet is humble and quite unassuming.
• She's approachable and engaging.  I never felt like she was looking past the person she was talking with or that she was annoyed by the hundreds of requests to talk or take a photo with her.  
• She speaks very plainly and candidly.  While she has great passion in the things that she shares, yet she doesn't get lost in the emotion, which would be so easy to do.
• She's respectful and appreciative of many obstetricians and medical doctors.  She calls many of them personal friends.  
• She's an avid reader and learner.
• She appreciates the diversity and beauty of cultures throughout the world.
• She's funny.  
• She's a normal woman, who early on in her life, saw that there was a need and rose to the occasion.  She didn't assume that someone else was going to step in and do what needed to be done.  Instead, she got her hands dirty (literally) and looked for ways to learn and grow and teach others. 
• She's a wonderful picture of someone who isn't slowing down as she ages.

Me, Ina May & Annely

Closing Remarks for 2011

With the close of this year and a new one on the horizon, I naturally look back and find myself reflecting.  I've decided to share these here.  It may seem a bit scattered and a smattering of thoughts... I'm ok with that.  These are thoughts I've had this past year-- take them or leave them.

As the EDDs of women I'm supporting approach and come and go, I find myself in a similar mindset as a doula to what I felt like waiting for my own labors to begin.  "Should I schedule our car for service tomorrow, plan to go to the zoo as a family, host dinner with friends this weekend or will baby decide that this is the day and I'll be called to a birth?"  It's easy for me to get antsy from time to time and to hear myself say "Well, it all depends on if there's a baby being born or not."  What I'm trying to remember is that like all of life, we make our plans and then adjust accordingly.  I encourage the women I'm working with to go on with life and to enjoy the moments and memories they have before birthing their baby... and I'm telling myself the same thing.  Live today.  Live now.  Live.

I've seen doctors mention possible interventions to their patients (my clients), such as "cutting a small episiotomy because the perineum seemed short" and then changing their minds moments later, resulting in a woman birthing her baby just fine with very little natural tearing.  I keep on hearing that "episiotomies aren't used all the often anymore," and while this may be the case, I can count at least five births where I've heard them be discussed or used in the past year.  My advice here would be to ask your care provider under what circumstances they would suggest this procedure and then make certain that they know that you are wanting to avoid one unless absolutely medically necessary.

I posted this on my Facebook page in November and it's truly at the core of who I am as a doula.  "I'm all for 'healthy mom, healthy baby,' as being of the utmost importance when it comes to birth... BUT I'm for 'HOLISTICALLY healthy mom, healthy baby,' meaning that mom's and baby's emotions and psychological state are of utmost importance too.  Women giving birth deserve to look back on their experience and feel that they were heard, respected, and cared for on all levels and that they were an active participant in making decisions regarding their care."  At the end of the day, whether a birth went along without a hiccup or a birth took unforeseen and surprising twists, my deep desire for the families that I support is that they know without a shadow of a doubt that they made the best decisions for their specific situation.  This looks different for each woman and each situation.  Whether a labor and birth are intervention-free or riddled with necessary interventions, my hope and prayer for the maternal care system is that women and their families have trusting and mutually respectful relationships with their care providers and that they have the information and space to make informed decisions for their individual labor and birth. 

I'm convinced more and more that choosing a care provider is one of the most important decisions a woman will make.  I want to shout from the rooftops that just because you've gone to a specific care provider for your gynecological care DOES NOT mean that they are necessarily the best fit for you when it comes to prenatal care.  You might find that your OB/GYN is too medical for you and you'd fit better with a midwife or an OB/GYN who takes a more "midwife model of care" approach to pregnancy, labor and delivery.  Before conceiving and then in the early prenatal period, it is vital that you think about what approach to birth you are more in line with.  I go into this at length in this post.  It's unlikely that you've been concerned with your OB/GYN's cesarean rate, their birth philosophy, or under which circumstances they'd recommend induction when only seeing them for gynecological care.  However, these are of utmost importance to know and be on the same page with as you're figuring out what your values are for the birth of your baby.

This year I witnessed the following:

• a medically necessary induction that went on and off for three days resulting in an otherwise unmedicated, vaginal birth
• women overcoming deep fears they had about giving birth
• women taking ownership of their care and switching care providers at the end of their pregnancies
• an unmedicated, vaginal birth of twins
• women showing up at the hospital complete and ready to birth their babies
• babies born in their homes
• women who were planning for an unmedicated birth choose an epidural and it being the very best decision they made... helping me shape my opinion that epidurals are not all good or all bad, but that it's key to be wise with when to have it, if you have it
• women having uneventful labors and births and very eventful third stages (postpartum)... showing me again and again that birth is unpredictable
• a baby being born en caul
• women who go to the hospital thinking they are in active labor only to be sent home since they were not dilated 4cm yet, only to head back to the hospital a few hours later in very active labor, almost transition... showing me that letting go is everything
• women laboring very quietly and women laboring very vocally... women birthing very quietly and women birthing very vocally
• husbands and partners being AMAZING supports and anchors to the mothers of their children
• women knowing what they want and what their rights are and in a firm-but-kind-manner, communicating their wishes to hospital staff
• women who have rapid labors and make giving birth look like such a piece of cake (yet I know that it is intense for them, all the same)
• women birthing with their families surrounding them- children, husbands, mothers, sisters, dads, in-laws, friends... all privileged to witness new life entering this world

Thank you to all of the families who invited me into their deeply life-transforming moments as their babies were born.  I am so, so honored and grateful.  Thank you to the OBs and midwives, doulas, L&D nurses, childbirth educators and others in the birth world who encouraged, mentored and taught me something new this year.

Here's to 2012 and all that it brings.  I'm ready for it... eager to learn and grow and be shaped some more.

Birthing in the Hospital... What to Expect

I often support women giving birth in hospitals.  Birthing in the hospital means that there will likely be routine procedures and potential interventions that take place... it comes with the territory.  It's important that women and their partners are familiar with 1) what these procedures and interventions are, 2) why and when they may occur and 3) what the risks and benefits are to each.

To be clear- the point of this post is not to list out the pros and cons, but to instead list the most common routine procedures and interventions so that they are all in one place.  My hope is that clients of mine, fellow doulas, and parents looking for a list like this can use it as a springboard and do their own research.  I want people to KNOW what can be expected when laboring and giving birth in a hospital.  Follow the rabbit trails of links and suggested reading and be very familiar with what these common procedures and interventions are.

So without further adieu, I give you the list.

Amniotomy or Artificial Rupture of Membranes (AROM) aka "Breaking your Water"
This is often suggested as a way to help induce (start) labor OR to augment (speed along) labor.

• Very detailed article on AROM at PregnancyToday

• Information on AROM along with other induction measures at American Pregnancy Association

Routine IV Placement
Upon being admitted, it's routine for either an IV (Intravenous Fluids) to be started or for a saline lock sometimes called a "Hep Lock," a hold-over from when heparin was used, to be placed.  IV fluids are administered to help with hydration.  If an IV is not started, but the saline lock is placed, it's done so medical staff can have quick access to veins should the need arise.  The jury is still out on whether routine IV placement is the best standard of practice among low-risk pregnant women.  What is important for you to know and to discuss with your care provider is what your options are.  Do you absolutely need to have an IV while in labor if you're not planning to receive pain medication and/ or not needing antibiotics because you didn't test positive for GBS?  Do you need to have a saline lock placed at admission or is your care provider comfortable with waiting to have it placed until you need it? Once you know what your care provider and your place of birth require, you can plan accordingly for your labor. 

• Quick rundown on IV's during labor from the blog Suite101

• Lamaze International's stance on IV use during labor

Denying Food and Water During Labor
For many years, it's been common procedure to restrict eating solid foods and drinking liquids during labor.  Spoonfuls of ice chips have been the main "soup du jour" in many hospitals.  This is mainly due to the concern that should a woman undergo general anesthesia for a Cesarean, she could aspirate anything she'd eaten or drunk while in labor, a condition known as Mendelson's Syndrome.  However, in recent years, there's been much debate on the current likelihood of this happening since general anesthesia routines have changed over the years. 

• The Cochrane Library review on restricting oral food and liquid intake during labor.

• ACOG's (American Congress of Obstetricians and Gynecologists) 2009 statement on food and water during labor.

•  Very, VERY informative article on NursingCenter site with LOTS of links to other resources on the subject.

• Article on MedicineNet discussing food and liquid intake during labor.

• Article on PubMed evaluating the debate on eating during labor.

• Sheridan Ripley of the blog Enjoy Birth writes a post on eating and drinking during labor and links to previous posts on the subject as well. 

Electronic Fetal Heart Monitoring (EFM)
Your baby's heart rate is monitored throughout your pregnancy and during labor and delivery.  During pregnancy, this is typically done with either a fetal doppler or in the case of a non-stress test, with an external fetal monitor. During labor, the external fetal monitor is primarily used and in some instances, the internal fetal monitor. 
EFM is heavily relied upon in hospitals.  Most hospitals and care providers require continuous EFM, but a few allow for intermittent EFM.  It's important that you know what is routine where you'll be delivering and to talk with your care provider accordingly.  

• WebMD takes a look at external and internal fetal monitoring.

• Editorial piece in the American Family Physician (AAFP) online journal on why EFM is being used; very informative.

• SUPER detailed article from the American Family Physician journal on the interpretation of EFM.  More info than you'll likely want to know, but very thorough.

• Article from 2011 in the American Journal of Obstetrics & Gynecology on the use of EFM and its relation to neonatal and infant mortality

• Post from The Clinical Advisor on EFM vs. Intermittent Auscultation (IA)

Vaginal Exams, Cervical Checks, Pelvic Exams
It's not uncommon to want to know what your cervix is up to in the last few weeks of pregnancy and during labor.  Many care providers will offer to begin checking at 37 weeks.  It's important to know that it is YOUR choice to have a vaginal exam or not.  This is true both during pregnancy and during labor.  It should be noted that checking your cervix and reporting the findings cannot and will not indicate when labor will begin and/ or how it will progress.  There are a few different things that can be measured during a vaginal exam

• Well-written and thought-provoking post on the ICAN of Western Maryland site: "Routine Vaginal Exams During Labor"

• Another thought-provoking post on Dare to Birth Naturally site: "The Vaginal Exam During Labor: Is It Necessary?"

Hospital Gown
To some, this may seem like a silly thing to list as a routine procedure and to others, this might be really important to consider.  It's common for a woman to be encouraged to change into a hospital gown when she is admitted during labor.  We've all seen them... the lovely open-in-the-back kind.  There is absolutely nothing wrong with using the hospital gown.  At the same time, there is absolutely nothing wrong with requesting to stay in your own clothes.  For some women, the thought of putting on a hospital gown makes them feel like they're a sick patient vs. a healthy woman who's in labor and happens to be birthing in the hospital.  If you want to wear your own clothes, this is something that you'd want to check out with the L&D at your hospital.
Some alternatives to wearing a hospital gown that I've seen are: a sports bra or nursing tank and loose skirt, a short tank-style, loose-fitting night gown, nothing at all, a custom made labor gown (see links below), or a sarong, to name a few.

• Pretty Pushers

• BINSI

• Gownie by Baby Be Mine Maternity

• B.Y.O.G.

I realize there are more procedures and interventions to write about and I plan to do so in future posts.  These include the use of epidurals, Pitocin, Cytotec/ Misoprostol and Cervidil and various newborn procedures such as Vitamin K shot and eye prophylaxis (Erythromycin).  The ones listed above are what I tend to see as the basic standards of care during labor at the hospitals in which I've attended births.

You might be asking, what now?  I suggest asking questions and conversing with your care provider about what you've read.  Take a tour of the hospital you're planning to birth in and ask questions of the tour guide and/ or the head nurse.  The more you know about what it will be like when you are laboring and birthing in the hospital, the more informed you will be.  The more informed you are, the easier it is to be ready for the routine procedures and possible interventions that will be offered.  As mentioned earlier, the main goal is to be aware and have information so you, along with your care provider and birth team, can make the best decision for your labor and birth.  It's important to remember that in choosing to give birth in a hospital, there are rules and procedures that come along with that choice.  Some of those are flexible and others are not.  In talking with your care provider, my biggest suggestion is to do so without an agenda and without an "Us vs. Them" approach.  Instead, do your research and engage in an open discussion.  If you feel you're not getting anywhere or coming up against resistance, remember you are the one who gets to choose who you're entrusting your care to.  If you want to find a new care provider who might be a better fit, you can. 

As you prepare to give birth in the hospital, keep this in mind, with any suggested intervention- use your BRAIN.

Further Online Resources on Routine Procedures and Medical Interventions
Lamaze Healthy Birth Practice #4
Common Medical Birth Interventions You Should Know
Routine Labor Care

Doulas at Home Births

A majority of the women I support are giving birth in the hospital.  I've been asked recently to support a few women who are planning to give birth at home under the care of a Licensed Midwife.  As I've considered what my role might look like in the home setting vs. the hospital setting, I posed the question to a few birth focused communities that I'm a part of on Facebook.  I thoroughly enjoyed reading responses that I received and thought that sharing them here might be beneficial to other women who are considering hiring a doula for their home birth team and/ or other doulas who are asked to provide support at a home birth.  Feel free to comment below with any additional thoughts or experiences.  

Thoughts from women who've birthed at home...

M- I did have a doula, yes. Her role was "whatever needed doing." She offered emotional support to the whole family, helped filling and emptying the pool, helped care for the kids, tidied up about us. I found her really good! I would suggest having a close friendship with your doula though, because women who don't bond well with them don't find them as helpful as I did!

S- Yes. I had my partner, a doula and 2 midwives (they come in pairs for safety reasons). It was extremely helpful especially at end with my long labor and pushing phase. My partner got really exhausted so I leaned on my doula for support. She also helped by taking care of all the little things like water/hydration, birth pool water temp, food, etc., so my partner could attend to me 100%. I would definitely have doula support at my next birth as well! Very helpful!