The purpose and value of labor support.

As part of my doula certification I had to write an essay on the purpose and value of labor support. Here is an excerpt:

To understand the purpose and value of labor support I think you have to first understand why you would even need support to begin with. No matter what you are trying to achieve in life, it is much easier to reach your goal when you have people: loved ones or strangers, there to encourage you and remind you why you are pursuing that goal in the first place. I can imagine no greater place for the need of continuous support than in the endeavor to grow and birth a human being.

When a woman decides to give birth, whether naturally or with pain medications, she is going to need a lot of support. She will need someone to help her discover her own strength. Someone to help her with the enormous amount of information she will be taking in and help her learn how to choose what is best for her and her baby. Support does not mean that we make choices for her, take steps for her or rescue her from difficult choices.

A doula has the honor of being invited in to a very private and deeply personal event in the lives of a family. A doula has to make sure to always evaluate her role in the happenings of the “birth” day. Everyone attending a birth has a specific function and role. For example: the physician is responsible for the clinical well being of mother and baby. The nurse is responsible for the clinical care as dictated by the caregiver’s orders and hospital policies. The father/loved one is there with intermittent support and physical comfort. And the doula, is there continuously for the duration of the labor as a continuous presence with emotional support, physical support, non-medical advice and guidance for the partner.

When trying to study the benefits and outcomes of a continuous doula, Penny Simkin compiled a review of the research that had been conducted to show such information. Her findings found that the obstetric outcomes “in hospitals where intervention rates were very high, doula care lowered the intervention rates.” There are also some positive physiological outcomes linked with the support from a continuous doula including, according to the study, “enhanced breastfeeding, better maternal-infant interaction, less postpartum depression and anxiety, and greater self-esteem. Also higher maternal assessments of their baby when compared to the ‘standard baby.’ And greater satisfaction with the birth experience.” (Per DONA International, paper “Benefits of a Continuous Doula”).

If going by those benefits alone, it is obvious that a doula is a huge help to better the outcomes for mothers and newborn babies. There are many other benefits that come from having a doula. Among them, from my own personal experience, was her understanding. My doula knew the enormity of the task at hand: Labor. She understood what I was going through and also understood, and had great confidence in, what my body was made to do during labor. Her confidence was contagious. In those moments when I was ready to “give up” (as if I could) she would quickly remind me what beautiful reward I was about to hold, the reward for all my hard work.
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So tell me, momma’s, what was your best memory from your labor support?

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Birth Story: Greta and Bob, NCB Baby #3!

I tell ya, there is something exciting about having a “repeat customer.” The fact that they invited you into a special event in their lives the first time is honoring.. but to be invited back again, well that is just amazing.

You may remember Greta’s first NCB (with baby #2) but if not you can read my version here. I wasn’t sure that I was going to be able to attend Greta’s birth for a couple of reasons. The biggest being that I would still be on Isaac sabbatical at the time of her due month. Also, I had to turn away lots of others because of that reason. But down to the last minute..everything opened up that I could do it. (it helped that she delivered on a Saturday and my hubby was home AND Isaac actually took a bottle with the babysitter).
Okay.. yes, you want to hear about the amazing birth.
Mrs. Greta was 1 1/2 weeks past her EDD with her third son. Yes, she was beyond ready to meet him. So on that Saturday morning she had an appt with her doc and asked for him to strip her membranes. He obviously did a great job and she started contracting a few hours after her appointment. It should be noted that she had already lost her mucus plug prior to her appointment.
She called me around one o’clock in the afternoon to tell me her contractions were coming about every 7 minutes but weren’t lasting that long. I suggested she go for a walk around the neighborhood to see if they would become closer or more intense. Which they did. For the next two hours they moved to 3 minutes apart lasting about 45-60 seconds. Great!! After the call that they were so close I thought that I should head over to her house and get a look at her because Greta is a very difficult client to “read” when it comes to “intensity of the contractions.” Let me explain. (she will be nodding her head in disagreement as she reads this). She is a unique woman. The model if you will. I’ve seen laboring women like this, but it always boggles my mind because I am NOTHING like it while in labor.
She is calm. Nay smiling during transition. Well, in between contractions that is. Conversation. Chatting. Able to laugh. That is not typically the emotional signpost of a woman that is in the transition phase of labor. With that in mind.. asking her how intense the contractions are is kinda pointless. She seems to breeze through them whether it’s her first one or the transition one.
With that being said, I knew I would have to see her in person since my normal “reading a mom” over the phone was not going to get me anywhere. So out the door I went. I only live about 5 minutes from her house. But it actually took me about 40 minutes to get there. Not because of traffic. But because I got stuck in the median on I-65. Yes, that means that I attempted, unsuccessfully, to turn around in the median on a major interstate. And got stuck. had two good ole boys pull over, plus the mayor of Alabaster, to offer assistance. The police officer that was called out was nice too. He didn’t give me a ticket for my illegal stunt gone awry. I believe his exact words were, “Nah. I think you learned your lesson.” Yes. Thank you. Natural consequences effect lasting change.
So thankfully, I was pulled out of the mud and headed to Greta’s house. However, my pride was still in the mud. I arrived to her house and upon seeing her I thought it was a good idea to go ahead and make our way to the hospital. She was about 5 min apart on the ctx’s but anything we could do at home, we could do at the hospital (in way of comfort) bc her doc is amazing and will let her do anything her heart desires. And the hospital is about 30 minutes away.
We made a quick drive through Chickfila to get some food for us all and started toward the hospital. When we got to the hospital, at about 6 p.m., and to the room, she wasn’t as interested in talking anymore and got set up on the EFM to get a strip on the baby. She was checked and found to be 5 cm’s dilated. Bo (the baby boy) had a couple of decels so we changed Greta’s position and she labored in a side lying position on the bed. Because of the timing of when we came in, we got started with one nurse but the shift was about to change and then we would be getting a different one. After Greta’s heplock was started, and Bo was looking much better on the monitor, we started discussing going for a walk around the hallway. So I suggested she empty her bladder first. And when she got out of the bed, her water broke. This was shortly after 7 p.m (an hour after getting to the hospital for those not keeping track). She went to the bathroom and labored through some contractions on the toilet. We were about to head out to the halls when the nurse asked if she could check Greta first. She was now 9/100/-1!! Why yes, she went from 5cm to 9cm in an hour!
So we decided to stay in the room and asked for the squat bar. Which mom did not like very much, btw. In the meantime, she sat on the bed while leaning on the birth ball and was able to bear down as she felt the urge, but there was no pressure to push until she was ready. At about 7:30 she started some serious pushing (more than bearing down) and was making some great progress.
She really on pushed for about 10 minutes and his head was out. That’s when the real work began. That big boy was big and his shoulders were stuck (shoulder dystocia). The doctor was fantastic and remained calm (all the while leaning Greta back a bit from her semi sitting up position) and turned the baby a bit so that it could loosen his shoulder. Bo also had a Nukal cord so that caused a pause once he was out a bit more. Greta did a fantastic job and remained calm (externally) through the whole thing. Baby Bo was born weighing in at 9 lbs 13 oz’s!! Hello Hoss! He came out very bruised from his more than bumpy entrance but is perfectly pink now.
The thing I love about Greta is that she is a solid rock. Rock, I tell ya. Calm, collected and focused. And she has fun doing it. She is prepared for her births and knows what to expect and welcomes her contractions. I am always amazed at how this woman labors. She is awesome. A very strong woman. And the thing about her husband, Bob.. he is a great support that knows his wife and wants to encourage her, and make her laugh. They are an adorable couple and are a great compliment to each other. And their three boys: handsome.
Greta and Bob.. congrats and I look forward to #4 (if you wanted me there. no pressure), when Bob has been sworn in to a pact that if Greta has a girl, Bob will HAVE to cut the cord. I heard it, and about four other people in the room heard it too! 😉
You can read Greta’s version here.

"Over the phone" doula.

I think everyone knows that I am on a doula “sabbatical.” It’s hard for me to not be helping mommas on their very important day. But Isaac, and the rest of my family, deserve to have my full attention.

During my last trimester of pregnancy was when I officially said I would not be able to take more clients after Isaac got here, until he was weaned (whenever that may be.. sadly, most of mine stop at a year). Since that time, I have had to turn away at least 12 momma’s.
Not fun.
But I always tell them “should you need me for anything, please email me or call. I’ll be happy to help any way I can.”
Well, apparently that opens doors to continue doula-ing..even in a smaller sense. In the last few weeks i have been “called” on three different times to help a momma during her labor. It’s actually pretty funny how each opportunity presented itself. My favorite was with a first time momma. It was probably 2 a.m and i was up nursing Isaac. When i do “midnight” feedings I come out to the living room so I don’t wake up my hubby. I decided to hop on to Facebook. And checked this certain momma’s page to see if there were any updates (she was waiting for spontaneous labor and was past her due date). Lo and behold her status said something like “It appears labor has begun ..” and her post was about 5 minutes earlier from when I got online. So I wrote a comment “Awesome.. how exciting. Call me if you need me, Im up.” and I gave her my cell number. (it’s important to note that she was one of the momma’s that I had to “turn away”bc of the sabbatical). Well, not three minutes later my phone was buzzing. Ha!
To make a long story short.. I tried to help reassure her when to go to the hospital, later was able to suggest a position change when she had been in the water for about three hours with small cervical change. I suggested she get out of the water and walk the halls for 30 minutes. I think that actually helped speed up her labor and within the hour, when I called back to check on her, she was in transition. At that time, I could hear her on the phone (I was talking to a friend of ours this whole time who would relay what i said, to the mom and dad) and I could tell that momma was either not in a good position, or, at least not a helpful one. So that’s when I suggested another position (over the head of the bed while on the knees). Found out later that she handled that much better. Later she expressed her thanks for the help, even though I wasn’t actually at the birth. It truly was so much fun.
I had two more opportunities to help a laboring mom over the phone and have to say.. it is just as fun as being able to help “hands on.” Although, I prefer hands on. The whole time on the phone I just want to drop everything and head straight to the hospital to help that momma in person. But alas, I know now is not the time.
Soon enough it will be.
So please, if you are planning a pregnancy.. wait until, lets say.. after September of this year to get pregnant… then I can help you. And boy do I want to help!!!
**I do not, in any way think you should plan a pregnancy to coincide with my schedule. I am only joking. Please, no hate emails. thank you.**

Non-overwhelming Birth Plan

I may change my mind on this after years of doing this, but I am pretty sure that my view on birth plans is going to be different than with most doulas. Here are two presuppositions that make my view the way it is:

1. I assume that a shorter birth plan is a good idea, especially if you are planning on using adoula. Let me explain. A doula understands what it takes to have a natural childbirth in a hospital setting. Therefore, we automatically advocate for such needs whether it’s written on a piece of paper or not.
2. I assume that since you are giving birth in a hospital, you are understanding the “battle” for that birth plan and therefore desire to do everything in your power to make it a team effort, not a war zone. Let me explain. There are doula’s out there in this great big world that are angry, frustrated and bitter with the fight for natural childbirth in a hospital setting and therefore do not trust anyone that is in said hospital on their payroll. This make it very hard for them to work in a way that promotes unity. However, if you approach it with the expectation that you may run in to road blocks, but that dialogue goes a long way, then advocating for the patient may not create the “war zone” some are familiar with.
Back to the birth plan. Understanding that a long birth plan only frustrates medical staff, even the nicest of doctors, will help you understand that a shorter one may go a lot farther. Also, understanding that having a doula is statistically proven to increase your chances of having that birth plan succeed makes a longer birth plan unnecessary too.
Here is an example of a “longer” birth plan. And this one is even longer. Here is my point: these birth plans are great to get acquainted with, but will be scoffed at if handed to a doctor. But if you aren’t planning on having a doula, by all means take it and keep it with you so that you can refer back to it yourself when “road blocks” start happening. And expect them too. It’s only “natural,” its a hospital.
But if you are using a doula, I believe the following birth plan (with anything else added that you want to add) covers the biggest “road blocks” that may come up:

1. I would like to have SROM. (spontaneous rupture of membranes/bag of waters).

2. I would like freedom of movement after SROM as long as head is well engaged. (That is generally accepted to be -1 station, to prevent cord prolapse).

3. I prefer to have EFM for 20 minutes out of every hour. (ACOG standards are 30 minutes for first stage labor.)

4. I would like a HEPLOCK only, and no IV fluids unless dehydration is suspected.

5. I do not want to be offered pain medication. If I need it, I will ask.

6. I do not want to have an Episiotomy.

7. I prefer not to be coached in pushing, rather to push when I am ready and for as long as I am comfortable. No counting, please.

8. I would like to push in any position that is most comfortable including: squatting while standing on the floor, all fours while in the bed or sitting up. I do not wish to push inLithotomy position.

TTThere you have it. Obviously you can add any that you want for after birth:

I would like for the cord to stop pulsating before it is clamped.

I want to wait for the placenta to deliver on its own, without forced pulling.

I I would like to nurse the baby immediately to help with bleeding, as opposed to using Pitocinautomatically.

Then there are the issues dealing with the baby:

I Whether you want the Vit K shot or not, the eye ointment or they baby bathed in yourpresence.

I really do hope this helps. It is important to know that the goal is to be firm but kind. Understanding that the battle is against a culture of “how things are done” not a personal attack on “someone.” At the end of the day we are all people with feelings.. so be firm in what you want, but don’t make people feel like idiots for doing what they do naturally. If that makes any sense. Sounds like what I want to say about some of the medical staff and their treatment of moms and doulas. But it does go both ways.

I

Birth Story: Greta and Bob, natural labor-baby#2.

First let me say how much fun, yes fun, it was to partner with this very cute and funny couple. They are so cute to watch. They know each other very well and are both full of quick wit.

I met with the funny couple at their home about two weeks before the actual due date. After telling me the story of their first birth with son Sam (an induction due to post date, epidural delivery) we discussed what they could expect from the flow of a natural birth and my role in helping to be their advocate for their birth plan. Both had concerns but by the end of the meeting, they were both on board to go for it!!
Flash forward to Aug 6th (2 days before due date). Greta informed me that she had lost her mucus plug early in the day, and at 9 pm she texted me (gotta love technology) that she had been contracting 6-8 minutes apart for about 2 hours. I suggested that she try to go to bed, and if she couldn’t sleep to take a warm bath and then try again. At about 1 a.m she called with a concern about some bleeding. Her contractions had slowed down and weren’t as “uncomfortable” after resting. I said I was pretty sure (based on the description that it was in fact bloody show) but if she were still concerned to give her doc a call, however, to be prepared that he would recommend for her to come in to the hospital.
Greta and Bob decided to head over to the hospital and got there around 3:30. I got there at 4 a.m. Upon arrival Greta found out that she was 3cm/70%/-2. It was our expectation that after the bleeding was checked out, she would go back home. But I explained to them about the hospital “way of doing things” and that they (doc on call) would find some reason to keep her there, even at 3 cm. The nurse wanted desperately to get Greta’s heplock started, even though the doctor hadn’t even come in yet to give his “approval” of whether mom would be staying or not. So after some advocating on that end (hint, hint).. heplock was finally delayed until we could talk to the doc. So we sat in triage for about two hours until the doctor finally got there.. Mom looked great. ctx’s every 4-5 minutes, but certainly didn’t seem to be more than “uncomfortable.” So imagine our excitement when the doc came in, checked her and she was 5-6cm/80%/-1. Not only that but after a quick review of the birth plan (with approval from the doc- for the plan, which wasn’t her primary doc) we headed to a suite ready to stay out of the bed!
Mom did some knee raises while walking back and forth to me and Bob. Ending with some squats when she met us! This is where humor was evident. Mom was enjoying the work and didn’t seem to be more than “uncomfortable” with each contraction, coming every 2-3 minutes. I’ll tell ya, I was SHOCKED to KNOW that she was in fact in active labor.. but seemed like she was having braxton hicks because of the way she dealt with them. Completely calm and relaxed!! A great Bradley birther! She walked and paced and rested for three more hours and decided to get checked again. She was 6cm/90%/0. PROGRESS!! YAY! It was great to see her excited that she had just gone three hours without dilation but still understanding that her body was making great progress!! A little plateau, but not for long.
We headed out to the halls again (yes, hospital was willing to let us walk the halls) and after about 15 minutes of walking.. she stopped for a contraction (she was leaning against Bob while I used tennis balls for counter pressure on her back) and at the start of the contraction.. we all heard “GOOOOSH!” Her BOW broke right there on the carpeted floor! Now of course, knowing that this momma has a great sense of humor (and she was in between contractions) I said, “Oh Greta, can I please get a picture of you right now?!” To which she laughed and said, “yes, hurry!” while water was puddled around her feet and soggy flip flops. LOL!!
She wanted to head back to the room so we got set up for a quick strip on the baby (which looked great, btw) and mom was getting tired from leaning on the ball while standing up, so I got her in the bed, on her knees facing the head of the bed while leaning completely against the head of the bed that was tilted almost all the way up. She got to rest her entire upper body on comfy pillows from home and labored through her entire transition this way. *Except for a 20 minute bathroom break where she was able to empty her bladder but liked sitting on the toilet for some of the ctx’s.* After about 30 minutes went by with her up in the bed, leaning, she said she felt pressure. I encouraged her to go ahead and bear down if she wanted with each contraction and to not be afraid, we would know when the baby was coming out. She did that for about 15 minutes and then was checked again: 9 (with a small lip)/100%/+1. She took on about 10 more minutes of contractions and then decided to sit on the bed to start pushing more intently.
The sweet nurse (she was AMAZING, btw) asked if Greta would like stirrups to which Greta said very matter of factly, “ummm NO thank you.” So, Bob and I just pulled her legs back to help and she sat up and pushed with each contraction. No one was counting or telling her what to do.. we just encouraged and waited for her to push when she was ready. Oh and of course, tell her what amazing progress she was making!! After about 20 minutes it was very clear to me that although the doctor had been paged.. he was NOT going to make it if he wasn’t walking in right then to catch this baby.. so after seeing the nurse check the door quite a few times I looked at Great and said “Sweetie, your baby is right there ready to pop right out. And I know the doctor isn’t here but Jada (the nurse) is and I am confident she has caught a few babies in her time. So, no one is going to tell you Not to push, if you want to push.. so can push your baby out on this next contraction.” To which Jada said, “Well maybe he will get here…..” and with that out came the head and she finished her sentence, “oooh… okay.. there’s the head.” LOL.. I laugh just thinking about it. Greta was still in that contraction and took a breath and then pushed the rest of little Grey right out. And of course the awesome doctor came right in the room as Jada was putting the baby on mommy’s chest!!! It was beautiful. The doctor came in so excited and happy for Bob and Greta and even congratulated Jada on a great catch!
As much convincing as tried to do to get Bob to cut the cord, he gets a bit queezy at this kind of thing, he wasn’t up for the task. So the good ole’ doc asked mom is she would like to cut the cord. So there she is, holding her baby on her chest and reaches over and cuts the cord! It was awesome!! Way to go guys!
This birth was proof that there are still some people in the medical institution that are more willing to work with the momma and partner with her goal of less interventions and more freedom! It just gives me chills. Cool!
Congratulations Bob, Greta, Sam and Grey!!! You are an amazing family!

Birth Story: Lindsay and J.C, unmedicated induction.

I attended this birth a few weeks ago and am just now posting the the birth story, honestly, because I had forgotten to ask for permission and new I needed to do that before sharing. I have a terrible memory.

Anyhoo, Lindsay actually was scheduled to be induced on a Monday. She sent me an email on Thursday night asking me some questions because she knew that I delivered naturally while onPitocin. After reading her email, I knew that I would just have to talk to her. So Friday morning we talked and I told her what to expect with Pitocin and how it changes things/pain and how she would want to get through it. I also told her that, if the Lord provided the childcare, I’d be happy to help her. (**At that point, I had no IDEA if I could even get childcare that last minute, but knew my God is bigger than my IDEA of how it could happen**). She said she would talk to J.C and get back to me.
Meanwhile I was on the phone trying to find childcare or at least, see who was available. I found two people that could help and would take different times of the day. Done. (**this is HUGE, btw. And increased my faith that God is in charge of the details and when He wants you to do something.. He always provides where He guides.**). So after telling Lindsay that childcare was taken care of, she was very eager to have the extra help.
Lindsay’s first birth with son Eli was an induction due to Pre-E with Toxemia and Eli was born at 32 weeks. You can imagine that when her BP numbers started going on extremes again this time, even though it was 37 weeks, it became evident that induction was necessary to avoid the same thing as the first time around. Which is why Lindsay and J.C opted for an induction at 38 weeks. They were ecstatic to have made it this far and were ready to do what they had to do to have a healthy baby and momma.
Monday rolled around and they got to the hospital at 6. I got there at 8 and missed the meeting with the doctor before everything was started (*note to self/other doulas- you really, really need to be there for that meeting, so that you can go over the birth plan/expectations, otherwise you are the odd man out when dealing with the nurse..if said nurse has a certain way she wants to do things). When I got there Lindsay was already at 6 mu/min of pitocin and was casually sitting up in the bed. She was 1-2cm/70%/-3. She looked great, excited and able to talk while having contractions. Things started to pick up an hour into it, but she was still sitting upright in the bed, just closing her eyes with ctx’s..very calm. The nurse, we’ll call her Mary, was still increasing the pit and by the third hour into the drip, Lindsay was in a great ctxpattern and was having to focus through the ctx’s. I had asked the nurse if we could check to see how the baby’s head was doing that way we could get momma out of the bed for a change in position. Mary replied that the doc should be in shortly and he would check her then. (apparently, she didn’t want to check). But what she did want to do was increase the pit, which she did, to 10 mu/min. At that point, I felt I had to advocate for Lindsay:
Me: Mary, can we keep the pit where it is right now until the doctor comes in to check her?
RN: (she looks at me, then the monitor, then back at me.. and with much frustration asks..)Why?

Me: Why? Well because she is already in a very good pattern of contractions 2-3 minutes apart lasting at least 45 to 60 seconds long. And I know that the more we go up the harder it’s going to be to make her comfortable in the bed.. our goal is to do a marathon not a sprint and he (the doc, as I am looking at the clock) should be here soon, right?
RN: *sigh* (and with no answer to my question, she just turns around and goes back to staring at the monitor).
A few minutes later she steps out of the room and I explain to Lindsay and J.C why I had that dialogue with Mary and that the hospital policy states that you can titrate the pit to get the pattern you want and anything after that is unnecessary.
About 20 minutes later Mary comes back into the room and says:
“Well, you know I am just going to have to increase this pitocin or this baby won’t get here by Christmas.” (see my post here, on what I think about that comment).
At this point, I start praying, “Lord, please bring Dr. R in here NOW!”
And what do you know, Dr. R comes in (*let me just say that Dr. R is my personal doc and I know for a fact that he is wonderful and would agree with me about the pit). Dr. R checks Lindsay and she is (three hours after starting pit) 7 cm/90%/0, YAY!! At that point I say:
Me: So doc, can we hold the pit where it is?
Dr. R: Yeah, sure. I don’t see why not. She is progressing very well!
Me: Well in that case, can we go down?
Dr. R: Umm.. yeah. lets start decreasing it 2 mu/min and then go down from there.

He leaves and we get Lindsay out of the bed. She decides she likes sitting on the birthing ball and leaning against the bed. 15 minutes go by and then I glance over at the Pit monitor.. would you believe that Mary turned it completely OFF! OFF, people!! And after I praised her for doing so, it was like she became a different person. No monitors to stare at made her a much more pleasant person!
Two hours go by and Lindsay has gone from the ball to the bathroom (labored there for a little while. One of my favorite places to get a momma. ) and then decided to get back into the bed. While in the bed, the only position she liked the best was sitting straight up and letting her legs just fall open on the bed. Almost Indian style. And can I say that during the entire time her BP looked incredible!!! Not one problem!! Praise the Lord.
So at this point she is checked again and we find out she is 9cm/100%/0. So I encourage her to try getting out of the bed to help drop that baby’s head down. However, she isn’t tolerating the contractions as well and after about 15 minutes of standing she tells us she is not going to continue unless she is sitting in the bed! Gotta love a momma that knows what she wants! 😉
So back in the bed she goes. Although, at this point she reaches the signpost that we all know and love: self-doubt. And not just self-doubt, yes, she even tells us to get the epidural ready! Call the doctor.. she doesn’t want to do this anymore. Well that just means I have to step up my game and get her through one contraction at a time and convince her she is in fact doing it! It was a beautiful picture of teamwork and encouragement because between contractions she was gently telling us that she really didn’t think she could make it and understood we wanted to help but….. and then during a contraction she was very emphatic that she wanted no part of this. My favorite line was when she said (she is an insanely sweet people pleaser) “Rachel, I appreciate you coming but I do NOT want to do this anymore!” I couldn’t help it, that made me laugh.
Keep in mind here folks that, while she does not have pit anymore, it is still her her system. So she is dealing with contractions that are still stronger than normal. So when I say that most all women have the self-doubt stage, it is more profound with Pitocin. In my own birth, I was thinking the same thing!!
After about 30 minutes of this i asked if we could check her again.. only because Lindsay was having a hard time staying on top of the contractions and also telling me that she didn’t have a huge amount of pressure (sign that the baby was still “high.”). Upon checking she was 9cm (with a small lip)/100%/0. At this point.. I had two seconds to debate with myself and then decided to go against what I have always held “sacred”: the philosophy that you don’t start pushing until you are 10cm/100%/+2. However, I know that pushing with contractions feels “good” and will get her mind off the contractions themselves. Sooo.. I ask Lindsay if she can bear down and push with her next contractions.
Dr. R comes in and after pushing through 3 contractions, Lindsay is 10cm/100%/+2. (I think this being her second baby and being able to feel her bottom, had everything to do with it.. I would never recommend a momma with an epi to start pushing unless baby was at +2!).
After pushing for 10 more minutes Lindsay pushed baby Tessa Kate right on out!! She did so beautifully. And I must add that while resting between pushing, Lindsay did in fact confirm that it felt sooo much better to push! Lindsay and J.C are a such a cute couple. They are quiet and very strong. I was amazed that up until 9 cm’s I hadn’t really heard anything from Lindsay, except calm breathing and that was with Pitocin. She blew me right out of the water.
Great job Lindsay. And if you guys are interested in a small clip of Tessa’s arrival click here.

Birth Story: Chris and Laura. Placental abruption

Chris and Laura, expecting their fourth child, felt that the Lord was leading them to consider a natural child birth. They happen to go to my church and Laura saw my “ad” in our church Peddler (similar to a bulletin). I met with them for an informational meeting in which I just discuss what they can expect a typical labor to be like, and my roll in it.

Laura had two births at 38 weeks and one induction at 39 weeks. On Friday, Sept 18th, she was in her 35th week (due Oct 21st). I called her at 9:30 that morning (while at my own dr’s appt) to see how her dr’s appt had gone just two days before. She said it was fine, she was a fingertip dilated and about 60%. She said she was having contractions but that they didn’t hurt (just uncomfortable, “like braxtons,” she said) and that she was trying to lie down and that was helping. She also said they were very sporadic. NOTE TO SELF: anytime any momma, even one that is having her fourth.. NEVER assume these are just braxtons.
I encouraged her to drink a good bit amount of water (since we both thought they were justbraxtons). this is funny in hindsight. So I tell her to call me if anything changes. I get home and have to deal with three children and lunchtime and getting everyone down for naps.. I don’t even think to call Laura back and check on her.. I just assume, she’ll call if anything changes.
Well I got a call at 2:30 from her husband, Chris: “Rachel, this is Chris. We are at the hospital and Laura is 6 cm’s and we had to come by ambulance.” THIS was NOT what I wanted to hear. Turns out that Laura kept contracting after i got off the phone with her.. not painful and not in any pattern. And at about 1:30 she stood up to go to the bathroom and a “gush of blood came out.” It scared her and so she called 911.
She had two contractions in the ambulance. When she got to the hospital, Dr. R (my doctor, that I happened to see earlier that day, lol) checked her and saw what looked like a “typical amount of blood” you’d expect to see during a birth. So he explained that maybe the blood was related to rapid cervical dilation. I’ll be honest, I knew that if it were a “gush” as mom said, it was not going to be due to rapid cervical dilation. BUT thankfully, Dr. R is a doctor that practices medicine based on evidence and NOT on emotion or speculation. The baby’s heartbeat was great and mom was not having any “gushes” so he proceeded with the vaginal birth as planned. And should anything rise, he would treat it accordingly.
I got there at 3:30 and could immediately tell she had entered transition. I encouraged her to get out of the bed and onto the ball (beside the bed, since she was strapped). She did that and did much better. About 15 minutes later we got her to go pee and then back on the ball. At that point she was checked again and was 9/100/+1. She got back on the ball for one contraction and then started to really “loose it.” But only because she had to push but was trying not to. So after two of those contractions she hopped (literally) onto the bed and was ready to push. Keep in mind this is about 7 minutes after being checked. 😉 She was complete.. but no one told us that.. because when she hopped on that bed and spread her legs.. I said, “oh wow..” then the nurse asked, “what?” I said, “well, I hope the doctor is ready.” you could see the baby’s head. And a bulging perineum.
She pushed for about three contractions and had her precious little boy, Joseph: 7lbs, 19 inches. After the birth of the placenta it was obvious, then, that in fact there was a small placentalabruption. The baby did come out in a lot of blood and Laura had a good bit of blood and clots afterwards. But with some pitocin and nursing the baby, she was doing great by the time I left.
I told her the next day that I was absolutely amazed at her birth. I believe that natural childbirth is about 80% mental fortitude and preparation. And having such a scary ride to the hospital and seeing that gush of blood, and for her to still “stay in it” mentally and handle the labor.. is truly amazing. I was impressed. She said though, that had she known that it was anabruption on the front end she may not have been able to focus. I understand. But God took care of everything and working with the evidence that was being presented at the time.. everything went PERFECTLY!!

Birth Story: Patrick and Tara, Natural Birth

This birth happened last month, but I am just now able to post about it. I was contacted by Tara after a friend of a friend recommended she give me a call. Tara had talked to two otherdoula’s, and for different reasons, they did not work out. At the point that she called me she was getting nervous that she may not find someone to help in time. She was 34 weeks with her second child (Kirsten, 5) and the first baby came at 35 weeks.

We set up the informational meeting at her house, which we found out was about .5 miles from my house, and were able to review her desired birth plan. The birth plan she was given, by a previous doula (one that didn’t work out) was, in my opinion, too long. There was no doubt in my mind that most any doctor would NOT want to read through all that, let alone have a serious conversation about it. It was two pages, typed, single spaced if that gives you any idea. Tara admitted that she really just went along with it but that she wasn’t sure about all the details on the list. Now while they all sounded “reasonable” I assured her that I could sum up that two page paper in about 8 bullet points that wouldn’t put off the doctor. (*separate post about that later*).
Fast forward to Saturday, September 19th (two days before EDD). Around 7:30 Tara called me to tell me she had lost her mucus plug. Throughout her entire last trimester she seemed to have lots of uncomfortable hip and lower back pain. So when I asked her to keep me posted on when contractions started, she (thankfully) called me to tell me that she wasn’t having so much pain in her belly but was having it in her hips and lower abdomen and her back. I asked if they were coming in “waves” and she said yes! Good, those count!
So the waves were coming every 10 minutes or so. Around 10 she called and said she had been lying down and it was getting more painful but still about 10 minutes apart. Since she hadn’t eaten yet, I encouraged her (*read, threatened) to eat something and to then try getting up and walking. She did both and at 12 p.m she called and said that once she started walking that they were coming every 4-5 minutes and were very painful. At that point I suggested that she try to sit on the birth ball and rest (from walking) and see if they slowed down. At that point, I talked to Patrick and asked how she was handling the pain, to which he said, “she is getting more intense.”
So I got in my car to head to her house. When I got there at 12:15 she was able to talk in between contractions and within the hour she was starting to cry (not uncontrollably) with each contraction. She kept saying “I can’t do this pain, I just don’t handle pain well.” That really made me laugh because to look at her she was a PRO! She was staying calm and relaxed and was working one contraction at a time. *later at the hospital during their annoying 50 questions they ask while you are trying to labor, the nurse asked, “how do you deal with stress? by talking to someone, crying, internalizing it, etc” to which Tara said she cries. Interesting to know since she would tear up when she had a contraction.*
So it was about 1 p.m and the contractions were still 3-4 mintues apart and, while her signpost wasn’t “self-doubt,” I suggested we head to the hospital.. mainly because their hospital was a 30 minute drive away. So Patrick got their van ready and he drove us while Tara and I were in the very back of the minivan with the back row seat folded over. Poor momma had to deal with a small area to work with, while on a bumpy ride all while having contractions every 2-3 minutes. You could definitely say it was a long 30 minutes. But she did great!! I mean that. In fact, when they kept asking me how long I thought it would be I just said, “it could be in an hour it could be three hours.” No man knows, but based on signpost, I thought we had a while.
So you can imagine our excitement when we got to the hospital and she was 8/90/-1! Awesome! Tara did part of transition in the van!! What a trooper. She really felt better sitting up in the bed so that is where she pretty much where she camped out. She stayed on top of her contractions and about 45 minutes later she told us she was feeling lots of pressure. Her doctor was in the room at that moment (which let me just say, she had an amazing doctor!) and wanted to just check, which Tara was okay with.. she was 9 with an anterior lip and at a 0 station. Just as the doctor was pulling her hand out I asked “and her bag of waters is still intact, right?” and literally at that moment a gush came.. it was so funny because the doctor, knowing that momma wanted a spontaneous rupture of membranes, immediately said, “uh well, (as she pulled her hand out) I PROMISE that wasn’t me!”
about 15 minutes later Tara started to bear down with each contraction. She pushed for a total of one hour and 15 minutes. She even tried “squatting” while on the bed (she was on her knees leaning on Patrick” but the baby was having some ugly decels so we tried sitting on the bed at a 45 degree angle and the baby did much better (turns out that was because there was a nukal cord, wrapped around the neck 360 degrees, so gravity was NOT helping).
At 4:04 Tara pushed out (with NO tearing) Isaiah who was 6 lbs 14 oz and 19 1/2 inches long.
She didn’t think she would be able to handle the pain, but she did! She, and Patrick, did an amazing job! The nurses were so compliant with the birth plan and kept referring back to it and at one point when the doctor was in the room our nurse said, “what do you want to do about (something I can’t remember)” and the doctor said, “well whatever momma wants!” It was beautiful and refreshing. Our nurse was so hands off that at one point during the pushing I looked at her and said, “feel free to step in at any time, I am not trying to run this show. We are a team!” She said, “oh no.. everything is going great and I did natural births for 15 years and I know the one thing the momma needs is to be allowed to do what she needs to do.” Tell me that ain’t awesome!
Great job Tara. Your sisters were shocked to find out you “actually did it.” But I knew you could even before the big day! You rocked! You truly made it look easy!

Birth Story: Jennifer and James, VBAC-natural birth

Jennifer and James, a very funny, precious couple already have three children. Their first baby was adopted into their family, the second child was a medicated birth, third child was a emergency C-section due to placental abruption and upon finding out she was pregnant again, Jennifer knew she wanted to pursue a VBAC.

She contacted me early in her pregnancy and told me her doctor was on board for a VBAC too. With her past pregnancies, Jennifer had not made it past 37 weeks. She also had a discrepancywith this one. From the beginning of her pregnancy she felt that the doctors were off by two weeks on her due date. She felt she was actually two weeks further along than their guess. But because she only measured a week ahead on the u/s they did not want to change her date. This actually worked to her advantage later.
At 39.4 weeks (41.4-her guess), she woke up at 2 am with a very strong ctx. She said she then felt and heard a large push down into her pelvis by her little man and then her water broke. She called me at 2:15. I hopped in the shower (I live very close to her) and asked her to get comfortable and see what the ctx’s were doing and I’d call her as soon as I was out of the shower and on my way. They were about 4 mins apart. I got to her house at 3 a.m. and she was sitting on the side of her bed. She was in great spirits and still making last minute arrangements with her hubby, planning all the things they needed to take, or leave for the kids that would be at home. She is a multi-tasker for sure. 😉
She got on the birth ball and laid against the side of her bed for a little bit and also got into a side lying position on the bed too. After about 45 minutes of watching her I suggested we get ready to head to the hospital. She wasn’t at transition yet (I thought) but it was very close. We also had at least a 30-40 minute ride to the hospital, so we wanted to make sure we weren’t delivering a baby en route.
We got to the hospital at 4:45 am and she was found to be 7-8/100/-1!! Woohoo! Talk about staying at home the perfect amount of time. And she handled the car ride like a trooper! She stayed in control and even had a sense of humor asking for a song she had downloaded: “more than a feeling.” It was hilarious.
Because she was a VBAC, we knew there would be continuous EFM on the baby. So she started in a side lying position in the bed and after being checked (the earlier numbers) I suggested she lean over the head of the hospital bed so that we could get baby to move down some more. An hour later she was 10/100/+1. She was already starting to bear down with each ctx but wasn’t intentionally pushing. We got the squat bar attached to the bed and then she moved over to start pushing in a squatting position. She did really well and within about 20 minutes her urge to push was stronger and then we could see that the head was crowning.
The doctor was called in. Jennifer went to a sitting position, with the lower part of the bed lowered down, like she was sitting in a chair. The dr was very patient with the head and did LOTS of perineal massage and Jennifer did a fantastic job of slow, controlled pushing. And only when she was ready. No one was counting AT her or yelling, PUSH. And after about 10 minutes his precious head came out. Now at this point, it was obvious on the next push that the “little” guys’ shoulders were “stuck.” (now, because the medical staff was not familiar with the Gaskinsmaneuver they immediately pushed the bed all the way back, put Jennifer on her back and started to push on her belly to get the baby out). The doctor didn’t use forceps but did “pull” the baby. Jennifer handled it all like a trooper and did a great job in really focusing on pushing her baby out!
Baby Owen came out at 7:25 a.m (that’s 5 hours from the time her water broke at home!). And once he was weighed, yeah, he was 10 lbs 8 oz, 22.5 inches long! I looked at Jennifer and said, “Girl, that’s a big baby you just pushed out!” and she said with a wink, “Yeah, you know what causes that, right? I knew I was right!” Of course she was referring to the fact that she always believed that her baby was two weeks ahead of what the docs said.
And because she was a VBAC the docs would’ve wanted her to schedule a repeat section if she had not started labor on her own by 40 weeks. but because of the edd issue, she was actually 41.4 weeks when she went into labor on her own. There were two things shown during that delivery: 1) a mom CAN deliver VBAC after 40 weeks to a healthy baby and be a healthy momma. and 2)a mom CAN deliver a 10+ lb baby with out incident. I think had they known theGaskin maneuver, it may have been a smoother delivery, but it all worked out in the end. A patient doctor helped a great deal too!
I’ll post mom’s version as soon as she posts it, but I should tell you that even though everyone GASPS when they hear how “big” her baby was, she was perfect afterwards! She was happy, felt great and so thankful for her natural birth!
Great job Jennifer and James! You guys did a fantastic job!

Birth Story: Julianne and Micah, First time mom

Julianne and Micah were referred to me by a prior client. I guess that is the best thing to have happen, huh? They were expecting their first baby and I was amazed to finally have a client that was a “primigravida.” To this point, they have all been “multigravida’s.” It did help that Micah is one of 7 children and Julianne one of 4, both their mothers did natural childbirth. So, Julianne and Micah were very enthusiastic about the fact that NCB is normal and absolutely possible.

Julianne was about 3-4 cm’s from about 38.5 weeks. Once she reached 40 weeks she had an appointment with her OB and decided to have him strip her membranes. The next day, following the appointment, she called me in the morning to let me know that she had been contracting since 4 a.m. They were fairly consistent at about 5-6 minutes apart. We would check in with each other throughout the morning and I suggested that maybe they go see a movie or do something outside the house (if she were up for it) to keep her mind off of counting ctx’s. Because at that point it was still the excitement stage.
Around noon, Micah called and said they decided to stay home since the ctx’s were getting more intense and would just keep me posted. I told him what I was looking for from Julianne, in way of ctx’s in order to know if she was getting closer. About an hour later he called and said he thought it would be good for me to come at that point.
I got to their house (beautiful, btw.. and Micah is quite the handyman.. he made their baby bed himself!) around 2 o’clock in the afternoon to find Julianne upstairs in their master bedroom lying in a side lying position on her floor. She looked so beautiful. Handling the ctx’s (then at 4-5 min apart since 4 am), wonderfully and just calmly breathing through each one. I suggested she stay there and rest for an hour or so, since she was obviously in the “worker mode.” She was definitely in active labor. So exciting.
At around 4 pm i suggested she try walking around downstairs to help baby drop some (water was still in tact at this point) and try the ctx’s in a squatting position when she got one, to help baby’s position. She did great and of course those ctx’s sped up to 3-4 min apart and then started to last longer than a minute. After about an hour downstairs, with the timing of thectx’s and the change in Julianne’s concentration with them, I could tell it was time to head to the hospital so that she could do transition there, instead of in a car. She got some OJ before heading out, she felt a bit shaky, and off to the hospital we went. We left the house at 5:40 p.m.
We got to the hospital, which was not busy at all, and they put us in an L&D room that is across the hall from their main nurses station. It is very out of the way and quiet. Perfect. Julianne, was checked and found to be at 6-7 /90/-1. Awesome. And within about 15 minutes of getting to the hospital you could see the definite change into transition. Not that Julianne was anything less than controlled, but the ctx’s were lasting over 90 seconds and coming every 2-3 minutes. I kept telling her how easy she was making it look, but I don’t think she believed me. As a first time mom, she blew me out of the water. Seriously. She was so calm and best of all, CONTROLLED.
After an hour of rest in the bed (side lying), sitting on the toilet (a great place to labor) and moving about, she was standing at the end of the bed leaning against the birth ball. I was behind her applying counter pressure on her back with the tennis balls when I said, “hey, you know I have got on much better shoes than I had when Greta’s (past client who had referred them) water broke. So feel free to let go whenever you want.” haha.. I thought to myself. No sooner did I get that out of my mouth and then “gush.” Her water broke (although, none got on my shoes, just hers). 😉
Obviously, at that point the ctx’s get more intense and she stays standing/rocking until the doc, who wants to check her, comes in and Julianne is 9cm/100/0. Julianne wants to head back to the bathroom to sit. The toilet is truly a wonderful place to transition because you are so much more free to drop your hips/bottom, open your legs wide and help that baby come down. After about 20 minutes, she says she is feeling some pressure and that maybe she should push. She wants to head back to the bed. So the nurse finds her to be 10/100/+1. At this point, I tell the nurse that I’d love for us to wait for her to start pushing until she is at least +2 and has a strong urge to push. The nurse (fabulous, btw) agrees and so Julianne decides.. yep, back to the bathroom. She was there for about 30 minutes, yes at 10 cm’s, but waiting on that natural urge to push and allowing the uterus to do some more work for her. Then the urge to push comes and she starts the pushing.
She tried several positions and seemed to like the side lying best and after a little while to get used to what she needed to do, at 9:08 (40 minutes of pushing!! Fantastic) she pushed out her sweet little boy, Jeremiah. She had a delayed cord clamp, and held that little man for almost an hour before anyone asked her to hand him over. It was heavenly. The doctor, the nurses- all amazing. Of course, the trooper of them all, Julianne, did an incredible job and looked like a Pro at it the whole time. She trusted her body and stayed calm and controlled the entire time. It truly was a text book NCB. And as my first primigravida, let me just say, I hope they all do that well! ;-P Good job Julianne and Micah!