Thursday, January 31, 2013

Catfish, Nola Anne's Birth story Part 3

When there's nowhere else to run
Is there room for one more song
One more song
If you can hold on
If you can hold on, 

hold on

When I left you hanging on the story of Nola's birth.. It was Monday, my due date had passed the Wednesday before. I had walked out of my midwife's office with labor start herbal remedy in my purse but had decided I'd trust time a while longer. She wanted to see me on Thursday. I hoped I'd see her well before then.

I hoped desperately that labor would start.

any minute now.

I decided I'd try every fun recipe ever purported to start labor. I had more spicy Thai then parmigiana and pineapple...


more walking and then the fun stuff (ahem wink, wink)

and nothing.

Thursday morning rolled around and I found myself back at the midwife's. She recommended the non-stress test with the back up OB. I said is that for at 41 weeks or within the 41st week? This was a big distinction for me at this point because if I had to do it at 41 weeks I needed to go right then. Otherwise I had six more days.  She was happy that I had kept detailed kick counts, looked over those and said I could wait until Monday.

I was beginning to be more open to trying the herbal route, even though I desperately didn't want to "induce" labor in anyway. I was starting to feel like the herbal path outweighed the risks. I left her office saying I'll think about it and might start taking it. 1 teaspoon an hour when I was ready were my instructions.

Called and cancelled the birth photographer I had lined up after the one I had arranged early in the pregnancy bailed on me. The one that was coming I didn't know, and now I might have to use the money I had set aside for a non stress test.

I went with the two littles in tow to buy valves for my medela.

I was trying to get everything in order. I didn't know if there was anything mentally blocking me from going into labor.

Called my sister from the store parking lot. "Hey Meg, I bought boob juice valves. I'm going home and I'm gonna take this stuff." Want to come over in the off chance I get sent into orbit with it and have a baby in like an hour?

She was on her way.

Called Kyle. Hey babe. I'm gonna take this stuff.

"Should I come home?"

Nah. Meg is coming over. If you leave work I'll feel bad and there will be pressure - besides nothing will happen anyway... just keep your phone close.

Meg and her bestie Ashley came over and we went back and forth from chillin to dancing. All the while I took a hit of the midwife's mix every hour.

I danced around the island to Killers.

We oppa'd gangnam style

Hour after hour and ....


Kids came home from school. Kyle came home from work. Ashley had to leave. I fought major feelings of defeat.

Meg and I decided to head over to sprouts and see what herbal concoctions they had available to the overdue and desperate.  Bought a some cohosh from them and she was going to take me back home and head back to her house.  One the way I saw a sign twirler swinging a sign that said:



"I want catfish."

We pulled into the eclectic catfish place that smelled of grease and walls were covered in handwritten scriptures and African American Christian artwork. All was just as it should be! The best catfish has to come in an eclectic environment. (Thems the rules)  I ordered my catfish which came in the requisite red basket fried to soul searching goodness. I said I hope you added something that will make me go into labor. She looked at me right in the eyes. "It's a girl".

Come back and tell me if its a girl ok?

Meg and I sat and ate. I let my mind rest. I took one drop of the newly purchased non-midwife approved stuff and it burned under my tongue. I said officially that was it. No more trying to prod labor along. No more I tell you.It would happen when it was time to happen. No more mental bargaining. I screwed the cap back on and wished I hadn't bought it.

The catfish was delicious. Of all the meals I had that week, ones that should have been fun, there was too much hope that it would help flick labor into motion. This meal was just what I wanted. A gal from Louisiana's dream meal. I was ready to get some sleep and enjoy one more morning waking up with a belly full of baby.

Meg said she better head back home I stood up from the table, tummy full and heart at ease, and was met with a contraction the likes of which I hadn't felt since ... oh the last time I had a baby...

Things were happening. Just when I fully surrendered to the process.

Here is the place to get catfish.. I need to get back there and tell her yes I had a baby girl.

and this is the Killers song I recommend dancing to, whenever but especially if you are trying to get labor going:

Friday, January 25, 2013

Dr. Cummings on trusting Birth

Here are my notes from the amazing Tarrant County Birth Network meeting hosting Dr. Fred Cummings OB/GYN in Denton, TX.

Dr. Cummings is one of a select few doctors who wholeheartedly support women's ability to birth naturally and vaginally even in "special situations" meaning VBAC's, vaginal twin delivery, and breech birth.  He has the hands of an OB and the heart of a midwife.

He has three children that he loves dearly. One born vaginally and two by cesarean. None of these comments come from a place to guilt women about their birth experience. Csections have their rightful place in the obstetrical world and if not for them we would have less healthy mothers and babies today. The overuse of surgical birth is a problem though and Dr. Cummings has hard earned wisdom on the subject.

I will type up my notes as-is, but they are from my chicken scratch handwriting done while baby wearing. I'll fill in gaps with my memory. This is from rough notes with paraphrasing and not in the exact order that his talking points progressed in. Please excuse any errors and grammar. And excuse that OB is always referred to as he and nurse always as she, Dr. Cummings himself admits to not being too PC and admittedly its easier that way. Even though I rushed, I thought it was important to get these notes up for the many women around the metroplex who wanted to be there:

I am blessed to help women have their babies. Really I just watch - there is not much to "do". Women tell me 'thank you so much Dr. Cummings" all the time but that is funny I just smile at them, What did I do? They were the ones grunting, moaning, twisting, turning... but then they forget the pain -- there is a disconnect in their minds. Women forget so they will do it again.
Men are not like that. Men work hard not to hurt. Men would not do it again, yet women keep having babies.

I love my books but I don't trust in them...I believe in God. I trust God. I don't think we are flawed. The design is perfect. Babies are made and babies come out.

100 years ago women stopped talking to their daughters about babies and birth and started trusting people who have nothing to do with it.
And it used to be women just fed their babies. No need to ask for permission.

Then he talked about an old obstetrical photo of a man separated from the birthing mother by a screen with cut outs for his arms through which he is trying to help her.

A good doctor talks to you about you having a baby he doesn't tell you about how other people have babies and how you will compare.

It is NOT true that twins means csection. Now if the doctor is not comfortable with a twin vaginal birth then yes his hands are dangerous because he has not been trained properly.

Cesareans are a late phenomenon - when they were first performed you just died. Sometimes they sewed you up sometimes they didn't even do that. You just died. We have perfected the cesarean and made it rather convenient. I can get a baby out in 42 seconds.

Csections are not horrible but our overuse of them is.

I do not do csections to protect a perineum because mom is just scared.

Doctors are afraid of being sued. And it takes very little to convince a woman to have a csection. All that needs to be said is "I don't think things are going well"

If the fear of being sued was gone there would be less csections tomorrow.

Men want to know what labor is like sometimes. I ask them if they've run the 100 yard dash. Its like that running the 100 yard dash flat out with all you got. EVERY FOUR MINUTES for 12 hours.

I believe it is a miracle. What your body is doing is a miracle. I ask these things of mom: Eat well, sleep well, and exercise - and that you will have a miracle.

Don't be afraid of this "you can only have two csections" rule. You want more babies - you can have more csections. Have babies.

If you had a csection. Get your surgery report. Read it. Read it with someone who knows what it means. You will then know ... nothing. They will always make it seem like it was needed.

Do not be opposed to the proper use of forceps. I don't use those vacuum things always popping off the baby's head. No thank you.

Find a midwife or OB who will talk with you, not talk at you.

Do not be frightened - we have statistics that support VBAC.  Find someone to SERVE you.

He told a story of bravely going with a mom's wishes to VBAC during his residency, He said they didn't call it that though and he was called out the next day for letting a woman vaginally deliver after prior cesarean. He  played like he didn't realize it was such a big deal.  So they made him present the case at grand rounds. He prepared for his own barbecue. "I knew they'd put me over the coals and have at my flesh"  I prepared as best I could and they did grill me:

Did you measure her pelvis? Yes.
Did you palpate the baby? yes.
Did you estimate baby's size? yes.

When Dr. Pritchard (He coauthored the 14th edition of Williams Obstetrics with Louis Hellmann in 1971, after which he became its senior author.) in the back addressed him as Dr. Cummings and said "Did you feel this woman presented with the conditions to vaginally birth?" to which he said yes.  And he said well that ends the case. Move on to the next.

"In that moment I knew there were doctors supporting this effort to let women's bodies work"

There is no arbitrary number of csections a woman might have that excludes the chance to VBAC. I had a woman VBAC after five cesareans and one of the largest babies of my career.

It just takes time. Birth takes time. And you have to give it that time.

Now not everyone is successful at VBAC'ing and there is a good reason. Csections are good when the are needed.
(He told the story of his children, one vaginal birth and two needed csections for elevated blood pressure)

He told the story of one uterine rupture presenting with dark blood at 8 centimeters baby was looking good on the monitor. He knew "we should stop" Uterus was open upon abdominal incision - Baby did fine and her uterus did fine.  There are indicators that something is amiss. Do not let them ignore you. Have someone always paying attention to you.  (a doula?)
Mothers really do know when their baby is in trouble. That is how I trust when it is really time to have a csection.

Some dads can't do this. They can't watch their wives hurt. They go crazy. Let them step out. That is when it is good for you to have someone who can stay with you with a level head. Because there will be a point where you won't be sure either. And then you are done. It's when she thinks she can't do it that she is almost done. And then I say sweetie you are there. Yes I say sweetie, sorry I'm not PC.

It is an honor and a privilege to help a woman have a baby. If there are people delivering babies that don't feel that way then it's time for them to stop.
There is nothing more intimate and vulnerable than a woman saying "help me do this"  If you can't back up and go away.

I mean how often is a woman, clothes off saying "lets get this going" laughter ensues... I don't mean in a sexual way, rolls eyes and laughs.. She is trusting me to care for her body.

I have been screamed at, cursed at, if I was a woman I'd have had a mastectomy - a laboring woman will grab anything close she doesn't care if it is attached to you. You learn to lean in with your back arched away. I was even trapped in the clutches of a woman's knees before thinking "I gotta get outta here"

But it is still a sacred inspirational time and 97% of the time it goes off without a hitch.
There is nothing you will do more impressive than give birth to a child. You will do something harder. Raising the kid, that is harder.

The group I am speaking to here. You are the minority. But keep questioning.

When asked about inductions and doctors being pressured to not do them before 39 weeks he said.

You think its the doctors wanting to do them.. but you should walk a mile in my shoes.
37 weeks the moms start talking about wanting to be induced. "Dr. Cummings my back hurts, my feet hurt.. etc"  Yeah well that's normal I say. And they say can't we get the baby out now.
The next appt they bring the husband. And he's sitting in the corner angry that he has to be there and he's putting on the stink eye about get this over with. She says "the baby will be fine." No I don't know that I don't know that your baby will be fine. Next appt she brings her mother. The mother who is wondering why her daughter is uncomfortable and telling you its time to get this going. I ask her "Who told you how to have  a baby? blank stare... No really who told you how? You know what? no one. Your body knows how to have a baby... That shuts her down, she doesn't like me but she's quiet."

Pregnancy is split into three trimesters but the last trimester is split into three mini-mesters:
"this is okay"
'this is a disaster"
"NO REALLY THIS IS A DISASTER. Nothing will ever make you comfortable again."

Don't misunderstand. Doctors are well trained and they know their stuff. I mean us OB's you can't touch us.  But if you make a mistake... You WILL be sued.
Why should they put themselves at risk for you?
If doctors weren't afraid of being sued there would be less csections in the country TOMORROW.
Most doctors don't want to trust the body because its easier to walk the middle of the road and not come out where I am. You need to find someone who will listen to you and be willing to take the risks.

Stay in shape.
Look at what you are eating.
Don't let your kids eat trash.
Think about what you feed your baby, unless it is absolutely impossible, breastfeed your baby. The design is perfect.
I didn't have a hamburger that wasn't made by my mom until I was in college. And I didn't have soda you know why because my mom said "you can't have that stuff"

When asked what influence his grandmother who was a midwife was on him:

I'm not sure really except that she and my family expected your best. You didn't have to be number one or the best around but it had to be YOUR best.

I was going to be a pediatric neurosurgeon but the parents drove me nuts - thought I'd do something that makes me happy and being there when babies are born makes me happy.

On VBAC'ing out of the hospital:
My quirk is that I'd like women to VBAC in a hospital, its just a Dr. Cummings quirk.  But you can go with a skilled midwife, just make sure she has done this, and that you are no more than 15 minutes out from a hospital.

When asked about time after rupture:
How long you have you don't know. After 15 minutes you are on borrowed time. But we had one mom take hours to get to us and they were ok.

The thing is VBACing moms have no interest in putting their babies at risk. And a doctor who is not skilled can use that.  But mothers really do know when their baby is in trouble. That is how I know when it is really time to have a csection.

What to ask a doctor about when wanting a VBAC:
First: Do you believe in VBAC? Their answer to that one question will tell you a lot if you listen carefully.
Then after that:
Does your hospital support VBAC?
Do the nurses support VBAC?
We are only assisting - you are doing it.

On nurses:
Your nurse can determine if you have a csection or not. If you have been mean or your family, or if she doesn't like you then you have a problem because she'll be calling the doctor all day saying she doesn't like the way things look and he will opt for a csection. All she has to say is we have a problem and he doesn't want to be sued.

When asked if there was ever a situation where a mom should be told to have a csection:
He looked up and went hmmmmmm...
Well.. There was this one time:
Mom, back surgery, back fused in three places. scoliosis, skewed pelvis.
(heads around the room nod in understanding of a csection with a collective 'mm-hmm.)
to which he says:
She delivered vaginally just fine.
So I think mom can go for it unless she says "I don't want to do that" or unless you know her vagina is closed or something (rolling his eyes)

When asked about uterine windows (fragile areas of uterus from previous csections.
Well you won't know unless you have to operate. But if I cut you and I gave you a scar is your uterus going to rip open? (with the impression that care with operative skills reduces risks in future VBACs)
The original repair allowed for thinness - repair it properly and she can have more children.

Its like this - a T incision the statistical evidence is rupture in 2.5% of cases. That means with a special scar 97.5% of the time everything is just fine.

When asked why doctors want VBAC moms to deliver before 40 weeks:
There is really no reason.
Now after 42 weeks I get nervous, I'll do it but I get nervous. Midwives have all these herbal things. Utilize those things because they work and they won't hurt anything.

When asked about cord clamping:
I don't see a difference. But you want it to keep pulsing. I don't care. Let it.

When asked about ways to prevent a csection
Come to me... laughter... I hear my name's out there.

But listen birth takes time. If you're waters ruptured and you are only at 1 cm... GO HOME.
Seriously go home.
You will labor all day. You will be tired. Your doctor will be tired. You will have not made much progress and you will have a csection because he is tired.

When asked about gentle csections:
What do you mean gentle? Want me to cut you open 'gently?'
... laughter...
"No like skin to skin immediately after."
Well that's not the csection and yes skin to skin is good.

When asked about adhesions:
You just won't know unless you have to open her up.

Mom from audience on pain:
There is pain.
If you have a natural birth the pain comes before. If you have a csection the pain comes after. I'd always take the natural birth if I could.

Wednesday, January 09, 2013

To intervene or not to intervene...

40 weeks

Pregnancy with baby boo was kind of tough - I'll be honest. Even with mad prep for morning sickness it still took a toll on our family. The guilt that comes with not being able to participate in your own life is heavier than the frustration of being sick in the first place. Why does nausea have to be part of gestating a new life? I mean



And why do some women have almost no nausea and some wish for death? My favorite quote about severe morning sickness:

"First you are afraid you are going to die...Then you are afraid that you won't."

After coming back to survive from that, I was in the swamp that is a faith crisis and things were hard mentally.

Preparing for baby takes a lot of mental preparation and I was struggling with it. I had panic attacks. Thought I was tempting fate. Five beautiful healthy babies so far - what were the odds we'd be that lucky again?

And I knew what was in store birth wise, felt some undue pressure to be a pro at it. I thought what if it is harder? What if God punishes me for doubt through some horrific childbirth complication?  My mind wandered to OT school where we watched a documentary of a woman who's child was stuck (most likely shoulder dystocia though it was never stated) and she was in that situation for 14 HOURS while her husband traveled by horse and buggy to come back with help. Her baby survived with cerebral palsy.

I woke up a few times with classic anxiety attacks. Nameless fear, unbridled panic. My heart racing, not enough air in the room and like a child I had to turn on a light and sometimes even wake up Kyle.

All of this is hard to write now. I want nothing more than to sing the joys of pregnancy and motherhood but I can't help but keep it real. Sometimes it is scary and you feel woefully inadequate.  As the weeks drew closer and after spending some time with my mom I started to get a handle on things.

I was also reading intensely for my upcoming training as a Birth Boot Camp instructor. In one book, this one, it outlined ways to make sure the pregnant mother is taking care of herself in all areas. Under emotional, it said "Do you ask for the affection or communication you need when you need it."  And I realized I needed to talk about things with Kyle, out loud. I needed my words to go out into the atmosphere and get diluted by sense and compassion.

We were not taking a childbirth class ourselves this time around and I could tell the difference. There was no homework to report. No relaxation to be prodded to do. I did my squats upstairs, my kegels in the checkout line, and tried to relax on my own.

So I started to ask for what I needed. We talked. I said I was quite frankly terrified of this delivery.

And issue by issue it was worked out in my mind and through my words.

We had a wonderfully trained midwife who would be with us. With a back up midwife. We are not 14 hours away from a hospital.  Birth is natural. Birth works if you let it.

God, if he or she is there, loves me and doesn't actively punish life on this earth.

I took deep cleansing breaths and my heart became ready for the labor.

The labor that was NOT starting.

So there I was the morning after mall walking: Belly measured, pee stick good, weight check skipped (thank you very much), baby's head position down.

Do you want a vaginal exam? she asked - it would be the first one of the pregnancy five days past EDD.  And I said what any informed  but nevertheless desperate woman would say "I don't knowwwwww...."  slow blink.

Midwife - "It's up to you."
Me - "ok yes" wait... no..... ok yes.

Now have in mind I was almost 4 cms dilated at 38 weeks with my first child. So here with my sixth at 40 weeks 5 days I was:

2 centimeters!!!

I was not ok with this information.  And this my friends is the classic reason why vaginal exams are not only pointless but in fact harmful. They don't really mean anything, they are not a crystal ball telling you if, how, or when labor will start. And in my case it can make you incredibly frustrated and start doubting your body when you need confidence.

Everything seemed well overall and for precaution's sake only, it was recommended I get a non stress test by the back up OB. Problem was though that we were flying without insurance. Long story.

Actually its a short one, even with benefits insurance is too expensive. So we don't use it anymore. And being that we were paying out of pocket for everything, paying $400 for a non stress test on a baby I felt actively moving inside of me seemed unnecessary. So I declined and we talked methods of natural induction. I had tried all the usual suspects. Walking? check. Spicy foods? check. Sex? check.

The next options to discuss were herbal methods. I said hell to the no on castor oil. This wasn't my first rodeo I didn't want to start labor with forced diarrhea. The next up was a concoction called labor start with a base of cohosh.

I said I'd think about it.

Went home with a bottle. Left it in my purse and called a woman at church who's first labor was helped along with this herbal remedy.

Asked her every single question you could possibly think of. Hung up, meditated, took some deep cleansing breaths, rubbed my belly and thought to myself:

nope, not yet.

Wednesday, January 02, 2013

A pregnant woman gets what a pregnant woman wants? Nola Anne's birth story part one

Nola Anne rushes for no man

And there I was, past my estimated due date. Again.

I've toed the natural childbirth party line. I know it is completely and utterly normal to go past one's due date. In fact its more close to normal than going before one's due date. What is normal anyway? Such a useless term sometimes.

But that doesn't mean its not hard.

Somehow I thought that this being the sixth human carried in my womb I might be more prone to get the show on the road. Alas no. My midwife said "actually, pregnancies tend to go longer in subsequent pregnancies, there is more elasticity in the uterine wall. Labor might be faster but you may go longer."  So I went home and cried about my old stretched out uterus. And waited.

I kept plenty busy. In the week our baby was due I went to: Patriotic Assembly for Maiya, Annie audition for Ella, PJ turned two (on my due date) and we celebrated, Annie Parent meeting, Kyle's birthday, and a campout for Ben.  And the week ended.

I prepared for what happened with PJ- three days past my due date I thought the following would occur: a bonafide emotional breakdown, a good long walk, then labor. I fell into the trap of thinking one labor would be similar to another labor. So I complained a little, savored a little, wrote this, walked the streets for a while, then went to bed expecting any minute now. Woke up still pregnant. That Sunday I went to church, still pregnant.

After church we drove to my favorite mall,  not for the shopping but because I wanted a watermelon drink from the food court and I liked the playground.  Rushed to the food court ready to get my beverage of choice for all the mall walking I was about to do. And that particular food vendor was gone. out of business. My stretched uterus was sad. But we soldiered on.

We walked the crap out of that mall. And I contracted regularly while looking at goods I had no money to buy and wouldn't if I did. Do people really dress their children in clothes from neiman marcus? pure silliness I say, even for family pictures.

The contractions got so good I thought: This. This is it. I'll walk the mall one more time then we go home to rest for the big show. I was really hoping my days of midwife appointments were almost through. Love my midwife, but was tired of peeing on a stick.

Little did I know I had TWO more midwife appointments to go.

and I still never got any fresh watermelon drink.

to be continued.