What's really routine?

Our friends at Safer Midwifery for Michigan have a terrific "Ask an OB" post today about "routine" interventions. I think this is a really important post, because many of the things I see women worrying about (like routine episiotomies) are really not done anymore.

Quinn's beautiful hospital birth

I'm so happy that my friend Regina chose to share her story here! She sent it to me after we were talking about how we both felt misled by "The Business of Being Born":

Before jumping into my second child’s hospital birth story, let me give you some background. Our first child was born at home with a certified professional midwife who, although she was highly recommended, ended up being a big bully and pushed many “natural” interventions on me by playing on my fear of the hospital. I am thankful that my daughter and I are safe despite the midwife’s mismanagement of my labor. That experience with the midwife led me to search out why my experience was so different from others who have homebirths, but then I learned that it wasn’t so different and I realized that there are birth bullies everywhere.

Fast forward to when I became pregnant with my second child. I was so sick at the thought of calling our former midwife for my files that I made my husband do it. I couldn’t bring myself to even talk to her on the phone. We talked to many people during our search for an OB/GYN (which began before we got pregnant, but continued for 12 weeks into it). We finally settled on a doctor who was highly recommended by friends, strangers (on the internet), homebirthers, and hospital birthers. She was from Ghana and didn’t bat an eye when she heard our first birth had been at home, instead she asked why we were choosing to use the hospital this time. She made no judgement of anyone after my story was shared, simply said, “Well, we’re going to make this birth a good one.”

On to the birth story! My labor began early one morning. We were using Hypnobabies for our “birthing method” so I chose to remain still and utterly relaxed in the quiet house. For 5 hours I labored this way, enjoying the quiet, and believing that I was still in the very early stages of labor since my contractions were no worse that strong menstrual cramps. When I finally started timing the contractions, I was surprised to see how regular they were: lasting 1 minute and coming every 5 minutes.

I finally forced myself to get up and start collecting things for our hospital bags and our 2.5-year-old girl’s bag. Within minutes of getting up, the contractions severely intensified and I started feeling sick. My husband woke up in the midst of this and I informed him of what was going on. The lucky man was only aware of my labor for the last quarter of it. ;) Somewhere in the midst of packing, contractions, dealing with my fear of labor, getting our girl up, fed, and off with the child care I lost my center and couldn’t regain full control of myself. There was no where to retreat to hide; I had to keep going forward and I didn’t want to.

After what seemed like an eternity, we finally arrived at the hospital. I had been laboring for 6.5 hours at this point. As the nurses cheerfully checked me in, they tried to comfort me. When I expressed my desire to be left alone, they quieted down and stopped touching me except for necessary things (which is exactly waht I wanted--I can’t stand being touched while in labor). One of those necessary things was an IV for antibiotics since I was GBS+. It took several tries to get the IV in because I was mildly dehydrated from not drinking much over night and because I kept moving during contractions. I was never scolded, but eventually the nurses figured out a way to help me hold still long enough to get the tricky IV in.

Once most of the business was taken care of (I later learned they totally ditched the intake interview and paperwork), they finally checked my dilation. At that point, I learned that--yay!--I was almost 8cm dilated but, sadly, that meant that there wasn’t time to set up the birthing tub. I had been looking forward to a water birth. Guess we should have gotten to the hospital sooner, but I thought I still had hours and hours to go.

As soon as they were done with those checks, I was off that hospital bed as quickly as I could move. They brought me a birthing ball that I draped myself over and rocked and moaned. At some point, they fastened the baby heart monitor onto me and that thing proved to be a pain. The baby did not like staying on the monitor and that made the nurses (and therefore, me) nervous. If there were one thing I could change about the whole birth, it would be the monitor alarm. I understand they need to know the baby’s doing OK (they were just trying to get the baseline at this point so they could switch to intermittent monitoring) but if only they could have turned off the alarm sound I could have focused so much better. The alarm kept going off and it would startle me out of any focus I had been able to find.

Otherwise, the nurses were great. They brought me hot rice packs, took the clock off the wall so that I couldn’t see it, rearranged the room so that I could labor on the floor, and were otherwise very helpful and sweet. Sometime in all this, my OB arrived and sat quietly in a corner doing paperwork and observing. About 40 minutes after arriving at the hospital, I started feeling the urge to push. My OB commented on it and had the birthing stool brought in but didn’t do anything else except encourage me until my water broke.

My water broke with a very loud snap. As the nurses cleaned it up, they realized I was bleeding with it. I was bleeding steadily, though not heavily. They moved me up to the bed to get a better look and after a pushing contraction, they guessed that I must have torn inside the birth canal though they couldn’t tell for sure at that point (this did turn out to be true, thankfully). At this point, the OB requested that I remain on the bed so she could keep a closer eye on the bleeding and asked me to push as hard as I could with each contraction--I believe her words were, “Time to get this baby out!” They allowed me to get comfortable and change positions for pushing, they just wanted me to stay up on the bed for now. Somewhere in a lull between contractions, one of the nurses joked to me that she was sad I was up on the bed now, she had been looking forward to seeing the OB get down on the floor to catch the baby. This lightened the mood, which was helpful.

Within 10 minutes the baby was crowning, and the OB asked if I wanted to catch the baby (I had expressed this desire in my birth plan), I didn’t care at that point and just wailed, “I don’t care; I just want the baby out!” Our baby boy’s head was born with the next contraction and the OB said very calmly, “The umbilical cord is around his neck twice. Not tight but not loose. Don’t push just yet, Regina.” As soon as the cord was unlooped, his body was born and he was handed directly to me.

I was surprised when our son didn’t cry right away. He waved his arms around a bit and kind of mouthed at the air. It seemed strange to me, so I started rubbing him. The nurses started rubbing him as well almost as soon as I had started, so I assume that was the right thing to do. He started crying within a few seconds and everyone left us him alone again.

I kept him on my chest for almost an hour before anyone asked to examine him. Because I was GBS+ and had delivered only an hour after getting the IV started, he needed separate antibiotics and some blood drawn for culturing (I know some people call this ridiculous, but I didn’t want to mess around with GBS). I hated to do it, but they promised to hurry. He was away from me for about 5 minutes and was in my husband’s arms or the bassinet (hospital liability rules) for the whole trip. After he was returned, he was weighed and measured in our room, the hospital bed was exchanged for a queen-sized murphy bed, the much-delayed intake interview was finally conducted (which the nurse giggled through because the questions were ridiculous post-birth), and then we were left alone.

About 5 hours after the baby had been born, I finally called a nurse and asked her when they would wash him (I wanted to feel my baby’s soft hair--it was still matted with blood and mucus or vernix). The nurse said they’d do it in a while. So, 8 hours after birth, he finally had his first bath with both my husband and me in attendance. That night, I snuggled in bed with our finally-clean baby and no one batted an eye when I kept him there with me rather than putting him in the bassinet.

Overall, this was a nice experience. Sure, I don’t like giving birth, but I don’t think it could have gone much better with all the small things that went wrong. This hospital was just a small hospital in a small town but they did a great job taking care of me and my baby. It was like staying at a nice hotel. Oh! And the food? It was delicious! The meals were good-sized and the kitchen delivered extra snacks to the new mothers throughout the day. It was great! I was ready to go home after our 48-hour stay, but it was a nice, restful time there and I would be glad to deliver there again.

It's OK to be broken

New post on my personal blog about feeling like your body is defective because of how you gave (or will give) birth.

Laboring under misconceptions

Have you seen this going around on Facebook yet? I saw it the other day, and it really ticked me off:

"Can I labor over there?
Can I labor on the chair?
No! No labor over there!
Don’t labor on the chair!
Sit there, sit there, you will see,
You must labor with this IV!
I do not like this sharp IV!
I need to move, to dance, to pee!
...Doctor, Doctor, let me be;
Say, get your pesky hands off me!
No! You can’t move, or dance, or pee!
You must labor with this IV!
Not over there, not on the chair,
Not with the ball, you’ll have a fall!
Can I labor with a doula?
Can I use some calendula?
Can I labor on hands and knees?
Can I birth just how I please?
No! Not with a doula!
No – what’s calendula?
Lay back, lay back, count to ten,
Breathe – he he hoo – push again!
No thank you, doctors, nurse, and crew,
I’ll go and labor without you.
I’ll labor here, I’ll labor there!
In the shower – everywhere!
I’ll labor standing, squatting, sitting
I’ll labor on my couch while knitting!
I’ll have a doula –I’ll have three!
They’ll let me eat and bring me tea.
Try them! Try them! You will see!
You can go shove that darn IV."
- author unknown

This is in no way representative of my three birth experiences in a hospital, or of the stories submitted here, and it irks me that this is being passed around as what typically happens at a hospital. (I'm not saying that it never does, but I have yet to have a woman relate an experience like this to me that happened more recently than the 1970s.)

The part that struck me as funny about this is that I specifically did all of those things in my last labor, with Natalie -- I asked for a birth ball, and they brought me one promptly.  I asked to be in the shower, and they happily unhooked my IV (I was GBS-positive) so I could go stand in there as long as I liked. I didn't have a doula, because I didn't want or need one, but I had one at my first birth, and everyone was very welcoming of her. I don't recall sitting in a chair, but I DO recall doing some bellydancing-type hip circles quite a lot. I pushed when and how I wanted, in the position I wanted. And yes, I most certainly peed. (Good lord, where is this hospital that doesn't let laboring women PEE, for crying out loud?)

If you are passing around this sort of thing, please call and find out what your local hospital actually DOES. If they are not allowing laboring women out of bed, and most particularly if they are not letting them even PEE, then take it up with them -- please. You have my blessing. Heck, drop me a line, and I'll write them a letter, too.

But please be aware that hospitals that have these sorts of policies are the tiny, tiny minority nowadays in the U.S., and you are in great likelihood spreading misinformation in the name of "educating" women.

Join me on Facebook!

I totally forgot to share this! I recently started a Facebook page for Happy With Hospital Birth -- come join us!

My talk with Kelli of Birth Stories on Demand

I had a wonderful time talking the other day with Kelli, fellow Michigander and host of Birth Stories on Demand, for her radio show! We talked about how this blog started, plus lots of other stuff (especially regarding the homebirth movement), and had some callers -- yay!

You can check it out here or download it here on iTunes. No making fun of our Upper Midwest accents allowed!

Baby Evan's birth by C-section

Michelle shares her son's birth story:

I’ll start at my doctor appt on April 22 (36w4d). My blood pressure was suddenly much higher than it had been, which seemed to be the start of mild pre-eclampsia (which I also had with my first baby, Miranda, who was 3 ½ when her brother was born).  The next day was spent getting a NST at the hospital birth center, and letting everyone know that I was officially out of commission — on bed rest.

Surprisingly, bed rest at this point in pregnancy was not a bad thing. It certainly beat going to work, which had gotten progressively more difficult as I had gotten bigger, more sore and more tired. Miranda was in school three days a week, and a friend was kind enough to watch her the other two days. My blood pressure continued to swing wildly, so my OB, Dr. C., decided to move my C-section date to May 4, when I would be 38 weeks.

I had been induced with my first baby (due to pre-eclampsia) and ended up with an emergency C-section when baby Miranda did not tolerate labor well. My OB and hospital were supportive of VBACs for women who wanted them, but due to the possibility of needing an induction again, and my fear of the risks of VBAC, I had chosen to have a repeat C-section.

During my weeks of bed rest, I went to the doctor’s office a couple of times for NSTs, and got several blood draws to check various things related to liver function, or whatever else they worry about with pre-e. Fortunately, my NSTs were perfect, which was quite a relief. All blood tests were normal as well. It was just my BP and some minor swelling that were concerning.

As the delivery got closer, I started to feel more uneasy. I had a great doctor’s appt and NST on Friday, April 30, which put my mind at ease. But that evening, I was getting ready for bed and my husband, Reid, suggested I check my BP again. I was feeling pretty good, so I wasn’t expecting anything out of the ordinary. But it was 158/113. Yikes. A phone call to the on-call doc (Dr. P., sounded kind of grumpy at 11:30 at night), and I was told I needed to go in to the hospital to be monitored.

We had a bit of a dilemma — Miranda was sound asleep, my parents hadn’t arrived yet, and asking anyone to come and stay at our house would mean waking them up, disruption, etc. So I decided to leave my Reid at home and go in by myself. Of course at that time of night, I had to go in through the ER entrance. That got great reaction, both from staff and patients. I told everyone I was NOT having a baby that night, but they didn’t seem to believe me.

I got to the FBC and all the nurses expressed surprise that I had come by myself. I explained why (sleeping 3-year-old) and met my nurse, Cindy, who was very kind and had a lot of energy. Seems like good qualities in a nurse on the night shift. BP was still high, but lower than it had been at home. I had yet another NST and blood draw and both were perfect. So, at Dr. P.’s instruction, I just hung out for a few hours and watched my BP go down. It eventually got nice and low — not quite healthy, but low enough to be considered “normal.”  During all of this, I watched my contractions on the monitor — strong and regular, as they had been for a couple months, but still not causing labor. I drove myself home around 2 a.m.. Cindy told me she would see me Tuesday night after my C-section, since she would be working that night.

The rest of the weekend was fairly uneventful. My parents arrived, I stayed in bed and checked my BP. Miranda liked having extra adults around to pay attention to her. Monday was the day before the scheduled C-section, and I cheated on my bed rest a little bit to get my hair cut. Nice haircut, but I felt fat, hot and dumpy at the salon, and I had to pee the whole time.

Monday evening, Reid and I went out to dinner (more bed-rest rule breaking — I checked my BP first, of course). Over pasta, we ironed out our final name choice — both first and middle names. I was not very hungry, and it was at that point that I realized I was getting nervous. We went home and puttered around — packing up our hospital bags, taking a couple of last pictures of the belly, putting Miranda to bed, etc. Despite an early wake-up time (4:15 so we could be at the hospital by 5:30), we went to bed fairly late. Reid snored, I tossed and turned, and neither of us slept much.

We were tired and weary the next morning, but made it to the hospital on time. The nurses quickly started getting me prepped for the surgery. An IV was placed (easy — this was my biggest fear when Miranda was born, and it turns out to not be a big deal), and I changed into a lovely gown with no back, and was hooked up for another NST. In contrast to all the non-eventful NSTs I had been having for the past few weeks, the baby was not responding well. It took a long time before they saw what they wanted to see from his heart rate/reactivity. I just thought, “Hmmm … good thing we’re getting him out today!”

I was very anxious to meet the anesthesiologist. I had found out during Miranda’s C-section that this person has the most visible and active role (at least from my point of view) during the surgery. And yet, like most surgeries, you have no idea who the anesthesiologist will be ahead of time, nor do you get to meet them. I had a neat typed list of questions for this mystery doctor. Eventually, Dr. W. bustled in at about 7:15 (surgery scheduled for 7:30). The only way I could describe him is as a “dude.” He was loud and boisterous, muscle bound, called me “kiddo.” He kind of blew off the questions, and I was a little irritated. He unhooked the IV bags from the pole, and said it was time to go down to the OR. I guess I hopped out of the bed and flew out of the room pretty quickly, because he had to hustle to keep up. “You’re nine months pregnant and faster than I am!” I realize that at this point maybe most women turn to say goodbye to their husband, or get teary or something. Well, I just really wanted to get this show on the road. I was a little bit tired of being pregnant, and really ready to meet this baby.

The OR was freezing. It was odd to me that I just walked down there and climbed up on the table by myself. No one knew where Dr. C. (my OB) was. Dr. W. was pretty adamant about finding Dr. C. before placing the spinal anesthesia, which I appreciated, and that helped make up for a few “kiddos” in my mind. Dr. C. finally showed up (he had been on call all night — this made me a little nervous) and introduced me to the assisting OB, Dr. M (“This is the guy who will push your baby out for you”). That sounded okay to me, how often do we get to make men do the pushing?

I rested my head on the shoulder of a nice nurse while Dr. W. did the spinal. It did not hurt much at all. I lay down and waited to become numb while they started draping and prepping. Unfortunately, a few minutes later I could still feel everything that was going on (including catheter placement — yuck). So we waited some more. They continued to prep. I got nervous, and told them what I could feel — my legs, that contraction, the baby moving, them washing my belly, etc. Dr. C. did a pinch test, and I felt each one. So they had me sit up and Dr. W. did another spinal injection. Again, it didn’t hurt, but I was really getting nervous at this point. I knew they wouldn’t do the surgery without me numb, but I was worried they would say I needed general anesthesia. Luckily, whatever he did the second time seemed to take, and I did not feel the pinch tests.  Nor did I feel when they actually started the surgery, which was before Reid was even in the room.

Reid joined us mid-surgery, and everything went really quickly from that point forward. Dr. M. pushed the baby out (it felt like he was standing on my chest), and Dr. C. announced a healthy baby boy. A moment later I heard the baby cry, at which point I started crying and fogged up my glasses. Reid went over to the warming table to be with the baby.

Despite his “dude” demeanor, Dr. W., the anesthesiologist, turned out to be very gentle and attentive throughout the surgery — patient and reassuring as he started (and restarted) the spinal, sitting next to my head during the surgery, wiping my glasses when they fogged up, checking if I was warm enough, asking how I was feeling, smiling reassuringly, etc. All this on top of the more demanding and important job of making sure I was healthy and safe during the surgery. For surgery with a conscious patient, it’s like the anesthesiologist is the patient’s own ambassador and advocate — a really amazing role, and vital to my positive experience and comfort. 

Dr. C. mentioned that it was a good thing I was having a C-section, and that we had done it that day instead of waiting a week — there was meconium in the water, the cord was around baby’s neck twice, and was between baby’s head and the cervix. I was a little nervous hearing about the meconium, but could hear the baby crying vigorously. He was quickly wrapped up and brought over to me. I got my arms free so that I could “hold” him with Reid’s support. His face was scrunched up in a grimace, eyes closed tightly. I peeked under his hat and saw lots of hair. Reid, Evan and I posed for a picture by one of the nurses. A nurse then gently suggested that Reid take the baby back to our room since the OR was so cold. I was sad about this, since I thought I would get to stay with Evan the whole time, but it was really cold in that room.

They left, and to my surprise, the surgery was completely finished about 10 minutes later, and I was ready to be wheeled back to my room. Once in my room, I was given Evan to hold almost immediately. I held him skin-to-skin under my gown, and we were piled with blankets since he was a little cold. I think nurses were fiddling around with me, but I was not really paying attention, I was just focused on my new little one. We tried nursing, and he latched on pretty quickly. He opened his eyes briefly, but mostly kept them tightly closed.

The spinal wore off after about an hour, and I was starting to be in pain. I was a little perturbed, since I had hoped to avoid IV narcotics. During recovery from Miranda’s birth, I had felt very sick and out-of-it, and had concluded that whatever was in my IV had caused that feeling. But when the pain started interfering with my ability to focus on Evan, I asked for the drugs. Thankfully, the morphine did help the pain, and didn’t make me feel too sleepy or loopy, and I was able to focus on Evan again.

After a bit, he needed to be weighed, bathed and given his vitamin K and eye ointment. They did this all in our room. I knew he was a little peanut — 6 lbs. 13 oz. It was nice that he did not cry for the vitamin K shot, and he liked his bath in the sink of warm, soapy water. I loved getting to watch the bath, since that was something I missed when Miranda was born. He was quickly back in my arms and stayed there for the rest of the day.

The day was a blur, but happy and cozy. Evan napped, I napped, we nursed.  The nurses removed various gadgets (BP cuff, IV, etc.) throughout the day and I started eating real food. I was hungry almost immediately after the surgery, but they encouraged me to go slowly (jello, Saltines, and such).  I finally got a smoothie and a bowl of soup that evening and it tasted awesome. It was so incredible to eat without the nausea that had plagued me for the past nine months.

Miranda and my parents came by that evening to meet Evan. Miranda was a little bit unsettled, and understandably was much more interested in me than in her new little brother. We shared a packet of graham crackers, which delighted her. She still talks about that. “Remember when I came to visit you at the hospital and you shared your snack with me?”

My milk came in the second night (less than 48 hours after birth), which is nice and early for a C-section. Evan and I were lying in my bed together, both of us on our sides while he nursed. I realized that I heard him swallowing, which was new, so I knew he was getting milk. He slept for several hours after that.

The rest of the hospital stay was relaxing and uneventful. I was having a great time resting, ordering good food from room service and getting to know Evan.  I felt so good that I spent nearly all my time holding, nursing and caring for Evan, and Reid started to get bored. He asked, “When do I get to hold the baby?” 

I still look back very, very fondly on those peaceful, magical first days. Evan, Reid and I were in our own little world and waited on hand and foot by the caring, attentive nurses. Every morning, Evan’s pediatrician would show up and exclaim over what a perfect baby he was. I felt great, and by the day after surgery I was moving around easily. We left the hospital on Friday morning, three full days after my C-section on Tuesday morning.