know your hospital, make your birth plan concise and relevant, don’t go in with guns blazing trying to pick a fight, and be respectful without being condescending.  She also mentioned communicating well with your nurse.  I’ll add that your nurse is the one person who can make or break this for you.  It’s ok to request a different one if you’re not getting along–it’s done all the time.  The best thing you can do is have a convsersation on admission about the basic concepts of Hypnobabies (maybe explain the lightswitch, definitely stress being quiet during contractions so mom can concentrate, explain why dad will be answering most questions, etc) and also about any specific preferences you have that might be counter to hospital policy, so that the nurse actually hears it (birth plans are not always read).

I will say first that I do agency work (which means I work at several different hospitals, not just one) in the Baltimore/Annapolis/Southern Maryland region, so my experience comes directly from those hospitals.  You’ll find that hospitals differ from each other, but also practices tend to vary widely even in different regions of the country.  I hear stories from other travel nurses of policies and attitudes that are completely opposite in various regions.  My point in this is to know the hospital where you will be birthing.  Go on the tour, ask questions, and like you’re doing now, find out what points are important for you so you/your husband/your doula can actually advocate well for you when the time comes.

Some things that are on standard birth plans just don’t happen in a lot of hospitals, and some hospitals are still in the dark ages.  I personally would recommend that if you need to have a birth plan stating a LOT of things will be different from policy, the best thing might be to choose a different hospital/birth location if possible.  You’ll note as an L&D nurse, I’m planning to birth at home.  ‘Nuff said.

So, some questions to ask the nurses on the L&D unit when you tour–
(Please note that many hospital “policies” aren’t policies at all, but just how things are routinely done.  Often you can overcome this with simple conversation or, for actual policies, a doctor’s order.  For instance, if everyone gets an IV and you don’t want one, your doc/midwife simply needs to write the order stating “no IV access needed until *previously agreed upon situation inserted here*” or for eating and drinking, your provider can write an order for a regular diet.)

-What is the procedure for admission? (Do I go to a triage room to be examined first, or straight to a labor room?) This is mostly so you know what to expect when you get there.  Please note that many places require all support people to leave, at least briefly, while they obtain your medical history because there are very personal questions being asked (about STDs, abortions, etc) and because this is a prime time to assess a woman for domestic abuse.  We can’t do that if her partner is in the room.  You can choose how and whether you’d like to get around that, or maybe ask if it’s something that is done at your facility.

-What is your policy on walking while in labor?

-What about after my water has broken?

-What is your policy on eating and drinking in labor?

-What is your policy on having IV access while in labor? (some facilities will require it, some require for “high risk” moms (and you’ll want to ask what the definition is for that) and some leave it up to the provider.)

-Is it standard for the anesthesiologist to obtain consent for anesthesia on all moms upon admission? (some places do this and if you’re not expecting it, I could see how this might derail your thinking a little.  On the other hand, if you know they’re going to come talk to you about epidurals, general anesthesia, emergency c-section, etc, you can be ready for the conversation, bubble of peace firmly in place

-What is your visitor policy? Can I have my husband and doula with me for the entire labor?  While I push? For delivery? In the OR?

-What is your policy on continuous monitoring during early labor? active labor? pushing?  Do you have telemetry monitoring (the kind Lyssa referred to where you can walk around and still be on the monitor) and if so, how many tele monitors do you have (some places have one for each room, some have one for the whole floor, some don’t have it at all).  You may also want to ask your provider(s) about how often their patients “require” internal monitoring.  In some places it’s reserved for emergencies;  howerver, in many places it’s used for convenience only, and it is explained to the pt as it is being inserted, not prior to doing so.  It’s much easier to measure and chart what’s going on with the baby when using internals, so be aware of that.

-What is your policy on photography and video during labor? during delivery? in the OR? after delivery?  (every place is different, and it doesn’t matter if your doc says it’s ok, if the nurse doesn’t agree or any other personnel in the room don’t agree, so you want to know what the rules are before going in)

-What is your policy on baby care immediately after birth? Is the baby taken to a warmer?  Is the baby taken to a nursery for the bath or is that done in the room?  Do they even have a nursery?  Is mom allowed time to nurse the baby before the footprints, weight, shots and drops are done?  After you ask these questions, remember that YOU are the one who gives permission for these policies to be carried out, YOU can refuse any treatments for baby at any time, and that if the baby is healthy YOU can have the baby discharged as a patient so that the policies are not even an issue.

- What is your policy on supplementing breastfed babies with formula? When do you consider it “necessary”?  Do you ever give breastfed babies a bottle of water?  Do you give pacifiers to breastfed babies?  (Every facility will be different on this as well.  The safest thing to do is tape a sign to the crib like the one you get in class specifying that your baby is breast only, and you do not consent to any pacifiers, bottles, or formula.  Taping it to the crib in addition to talking to your baby’s nurse is important because many people will come in contact with and care for the baby in the nursery (nursery techs, pediatricians, the person doing the hearing test, other babies’ nurses, lab techs) and you will not have the chance to talk to them or even know that they are caring for your baby.  If the hospital requires formula supplementation for low blood sugar, you can specify that you want to breastfeed if that happens.)
Some other things to remember about common practice in hospitals:

- Asking patients about their pain level is a JCAHO (the organization that accredits hospitals) requirement. Most facilities now have a checking system in place and nurses are often reprimanded if they haven’t charted that they asked about pain every so often.  (this varies from every hour to every 8 hrs).  I get around this by charting that the pt requests I not ask and states they will let me know when they want something.  You may want to have a conversation w/ your nurse stating you don’t want to be asked about pain and you’ll be sure to let her know if you need anything from her.

- How you push is not a hospital policy issue. It’s something to be discussed with your provider (midwife or doc) AND with the labor nurse assigned to you when you start pushing.  A lot of nurses count to ten and have you “purple push” and a lot don’t.  At some teaching hospitals you may have a physician with you the entire time you push.  At most hospitals, your nurse is with you the entire time and the phys literally steps in to catch, sews up any tears or episiotomy, and leaves.  Midwives in the hospital can fall anywhere in between that with some being very attentive and some being very busy w/ multiple patients or just more inclined toward the medical model and the fact that you have a nurse with you.  Find out what your provider does, explain what you want to do, and do the same when you meet your nurse.

- Perineal Massage is something again to be discussed w/ provider ahead of time, and with the nurse who is with you when pushing, since she is likely to be the one doing it while you push if you want.  There won’t be a hospital policy on this, and it’s also something your husband or doula can do, and if you’ve read up on it and he’s been doing it the whole time anyway, that might make the most sense, but will get you some strange looks from the staff

- Treatment of the baby at delivery is another one to discuss w/ ANY provider you might have, especially if you have a physician practice and you don’t want the baby manipulated (pulled on, etc).  Treatment of baby immediately after the birth is something discuss with the provider, but is ultimately up to the nurse.  Find out what the usual sequence of events is from your provider (do they deliver, clamp and cut the cord and hand baby to a nursery nurse at the warmer?  Do they deliver, lay baby on your chest, leave the cord alone and let you bond?  Do they hand the baby to the delivery nurse at the bedside and let her decide what to do?)  With some docs/facilities, just getting the baby on your chest for a few seconds after delivery before being whisked off to the warmer is an uphill battle.  In other places we would never dream of taking the baby away from mom in the first hours after birth for any reason short of a medical emergency.  So, find out the procedure from your doc ahead of time, THEN, talk to your nurse when you get there about what you actually want done.  If you need to, you can gently remind her that even if this is not routine for her, you are not consenting to having the baby taken from you.  Let her know what is important to you, and then, at delivery, you may want to remind doc “remember we talked about not pulling on the baby and leaving the cord intact until it stops pulsing”  Old habits die hard and if his/her habit is to clamp and cut before they even hand the baby to anyone, it might be done without thinking!  Another thing that is often done without thinking is that whoever has the baby (delivery nurse or nursery nurse) is generally rubbing and scrubbing the baby with towels/blankets to stimulate the baby to cry.  If you don’t want this done, you need to talk with your nurse about it before hand and remind at delivery.  Most nurses aren’t familiar or comfortable with waiting for a baby to pink up without this stimulation while still be oxygenated by the placenta/cord.  You may go through all that discussion just to have the nurse declare that the baby was blue and needed help, and do the rubbing and scrubbing anyway.  Letting the baby be and not drying him/her vigorously is just not done in most hospitals.

- Cord traction on the placenta is completely up to the provider you have at delivery.  Discuss ahead of time with ANYONE that might be the provider for your delivery and remind them at delivery.

- Circumcision is never done without signed consent, so refusing it in your birth plan really isn’t necessary.  Plenty of people don’t circ.  It’s something your provider will ask so they know whether or not they need to come back and do it, but I’ve never been in any situation where anyone just assumes a boy will get circ’d, and it fact, most people are happier when you choose not to.  Less work for the staff

- Induction methods and how long you’re “allowed” to labor before requiring induction will be up to your provider (midwife or doc) and not up to hospital policy.  That discussion needs to take place in the office and with the agreement/understanding of ANY physician or midwife that might end up on call.  If you have a big practice, you can have your doc/mw write out what you agreed to and sign it on an order sheet that you take to the hospital with you during your birthing time.  That avoids relying on the on-call person to order something they’re not used to, but doesn’t guarantee they won’t just order something else instead.

You asked about natural methods of induction–there are many methods used, especially by midwives, especially in birth centers or at home, that are not pharmaceutical in nature.  The most natural are things like sex (semen softens the cervix, orgasm causes uterine contractions), nipple stimulation (releases oxytocin, causes contractions, can be done w/ hands or a breast pump, or nursing an older sibling), or I would consider AROM to be natural as well, although it is definitely an intervention that has risks (it releases hormones, helps the baby come down on the cervix and generally speeds up labor, but the biggest risk is cord prolapse and other risks include infection).  Then you have gentle herbal options like taking Evening Primrose Oil in pregnancy (softens the cervix), using a labor tincture that includes blue and black cohosh with other herbs (usually prescribed by a mw in my area, stimulates contractions), or other remedies like castor oil (not for the faint of heart, induces diarrhea which irritates the surrounding tissues (including uterus) and stimulates contractions).  One other option, if I’m not mistaken, I think there might be an HB “baby come out” cd for post dates moms that might be useful.  Hospitals tend to be pretty unimaginative in terms of induction, and using pitocin is the standard.  There are other drugs that are used to soften the cervix or induce labor, but I think the birth plan is referring to speeding things up once labor is established, and that’s really only going to be done with pitocin or AROM when you’re in the hospital.

The main thing I would find out from your provider is why/when they would want to induce/augment you. Is there a time limit?  What if I get to 6 and don’t change my cervix for 2 hours? 6 hours? 12 hours?  What if my water is broken?  (my midwife has the attitude that as long as mom and baby are well, she’ll wait with me as long as I want to wait, and try to help with things like positioning to solve the problem if there is one.  many physicians are taught that 2 hours without cervical dilation is failure to progress, and is an indication for induction or c-section.  By the way, you do NOT have to induce immediately if your water is broken before labor starts.  If that happens, you should take measure to limit your chance of infection (no cervical exams, nothing in the vagina), verify well being of the baby (ie is baby still kicking?), and know how you want to proceed before speaking with your provider.)

Writing the Birth Plan
When it comes to writing the birth plan out, unfortunately, keep in mind the stereotypical nurse will groan aloud at the nurses station when she reads through your birth plan.  This is because often people come in with ridiculous requests (like getting a tub to birth in when there are no tubs on the unit) or worse, a stock birth plan found online with the blanks not filled in.

My suggestion is keep it concise and relevant. No more than a page, bulleted points are great, and use actual conversation with your providers as your primary means of communication, with the birth plan being an easy reference tool for reminders that the nurse can keep or even post at the bedside.   The John and Mary birth plan has a lot of excellent points that you should be educated about and is a great starting point for you to decide how you want things to go, but is not necessarily going to be relevant to every birthing location.  For instance, the part about leaving the hospital if you’re checked and found to be less than 4 cm is excellent, and something you should be aware of and maybe even discuss with your provider.  But, it doesn’t need to be written in a birth plan because you’ll just do it if you’re in that situation.  You haven’t been admitted yet, and there’s no reason that you should be, and most places will be happy that you’re smart enough to know you’re not in active labor yet.  You may even want to write out your own birth plan just to get your ideas down on paper, and a separate, more concise one for your providers and hospital.  (I have one for myself that includes no unnecessary cervical exams–not something I need to write for my midwife, but something I definitely need to tell myself because I get curious and check myself way too often!!)

I hope this is a good reference for you, and please feel free to email me on or off list if I didn’t explain something well enough.  Again, these are based on my experiences in my area, and your mileage may vary!

~Becky

(I haven’t forgotten about the give away.  I should have the winner announced in a day or so!)

I hadn’t had a birth since June of ’08.   For a lot of different reasons.  Lots of family trips, DH was SO busy working and the June birth was an emergency cesarean at 34 weeks and frankly hit a little too close to home.    I still continued to teach Hypnobabies, but would refer students to my fellow doulas. 

I was so excited when Sierra wanted me as her doula.  I got back from a trip the day before she turned 37 weeks.  She was cool with that.  I had Cindy on call in case she had her baby before I came home.  It was a little hard to get used to being on call again, but totally worth it.  I did get REALLY sick one weekend and had Cindy be on call for me for a day or so.  I knew that Sierra’s birth would be fast, so I kept all my friends on alert, in case I needed them at a moments notice.

Tuesday night Sierra called and said that nothing much was happening, though the midwife had stripped her membranes that day.  I actually knew that my 2 main people were not available to watch my boys Wed morning and I was in charge of Jenn’s son that morning too.  So I was glad nothing was happening.  I went to bed happy. 

I got a call from Adam at 6 AM  Wednesday morning saying Sierra was having pressure waves every 5 minutes.  I said I would hop in the shower and be there soon.  I panicked a bit in the shower, who was going to have my boys?  Then Rob said he had an IMPORTANT phone call at 9 am.  I made a list of people for him to call, called Jenn to say I couldn’t take L. and ran out the door, with a quick “Good Luck!” and kiss for Rob.

I got to Sierra’s by 6:40.  Adam was surprised I was there that quick.  Sierra was just getting out of the shower.  I got out my notebook and knee pad and she came down and started getting breakfast ready for the kids.  She would pause every 5 minutes or so and have a pressure wave.  I would do the relax cue and say some mini scripts.  We turned on the Birthing Day affirmations.  I got the birth ball and made her sit down and stop getting breakfast ready.  She went to the bathroom around 7:12.  I could sense she needed to get a little more focused to stay relaxed so we headed upstairs around 7:20.  Her sister Jen had arrived and was helping Adam with the kids.  Sierra was telling Jen she needed to bring the dogs in to get groomed. 
 
Sierra got settled on the bed and we put in the East First Stage script and I figured out how the cameras worked and would do the relax cue when she had a pressure wave.  I could tell because she would moan softly through them.  She was staying nice and relaxed.    I could hear Jen getting directions to the groomers from Adam and I ran downstairs between pressure waves and said, “Don’t go now.  This baby will be here within 2 hours!”  I wanted to be sure there was someone to be with the kids.  J
 
7:50 her friend Karrie arrived.  She is an OB/GYN from Northern California, but happened to be down visiting and was so excited to be at Sierra’s homebirth.   In fact when Sierra wanted to do a home birth, her mom asked, “What does Karrie think?”  Sierra was able to say, “She thinks I am a great candidate!”
 
8:00 Sierra goes to the bathroom and we start running water into the tub.  She was so excited to get into the tub. 
 
8:10 Angela arrives, Sierra tears up and is just so happy.  Angela listens to the baby, who sounds great.  She uses a cup to drip water on her back while she has a pressure wave and Sierra LOVES that.  I do the relax cue and say scripts and Karrie takes over water duty and later pushes on her lower back.  We made a good team.  Sierra doing all the work, but Karrie and I helping out during her pressure waves.
 
Sierra’s mom arrives around 8:30 and she comes up and says, “How are you doing?  Are you having pain?”   Sierra looks surprised and shocked at the word.  “No,” she hesitatingly answers and looks at me questioningly, “I am feeling a lot of pressure!”  I reassure her, “Yes, just pressure.”    I asked Sierra about this later and she says that it was true.  She was just having a lot of pressure, it was getting more intense at that point, but no pain.  At one point when Sierra was resting between pressure waves (which seemed to be coming every 3-4 minutes) she asked, “Do you really think I will have the baby today?”  She still wasn’t sure it was really her birthing time!
 
Not long after things change a bit, she starts making pushy noises at the top of her pressure waves and they get closer together.  Karrie and I smile at each other knowingly.   I tell Sierra betweens pressure waves that she is doing great and I think the baby will be here within and hour.  She still doesn’t really believe me.
 
9:00 Angela comes in to check on the baby. Sierra asks if she should get checked.  Angela says OK.  So she checks her with Sierra still in the tub.  She is 9 cm.  Sierra is shocked, “REALLY?  Are you lying to me?”  Angela reassures her she is 9cm and doing great.  Sierra says, “I am really having the baby TODAY?”  It is almost as if she still doesn’t believe it is her birthing time.
 
Things pick up and Sierra wants Adam in the tub pushing on her back during pressure waves.  Around 9:15 she decides she wants to get out of the tub.  She wants to get in the shower to rinse off.  “Your baby will be born in the shower if you get in now.” Angela tells her.  So we help rinse her off in the tub.  Which is a challenge – first the water is too hot and then it is too cold. 
 
Sierra is starting to get pushy while standing in the tub and seems incredulous that she needs to climb out of the tub.  It is as daunting as climbing Mount Everest.  She finally climbs with both feet up onto the edge of the tub and then she is stuck there.  There are 4 of us supporting her, but I was really hoping she didn’t have a pressure wave while high centered on the edge of the tub.  She finally steps down and we help get her to the bedroom. 
 
9:25 Sierra arrives in the bedroom.  She drops on the floor next to the bed for a pressure wave and starts to push.   Then she climbs up onto the bed and is on all fours and starts to really push.  Her water breaks on the bed.  She is ready for the baby to come out.  She keeps asking “When will the baby be out?”  
 
Someone goes to get her kids and then with the next push the baby’s head is out.  Angela has Adam come around so he can catch the baby.  He seems surprised that it is time already.  Then suddenly the baby is out.  Just like that the baby is born.  It is somewhere around 9:35. 
 
Someone asks, “What is it?”  Adam checks and announces, “It is a boy!”  Aidan said, “I wanted a girl…. Next time it will be a girl.” 
 
Sierra lays down on the bed and holds her sweet baby boy.  Oliver was 7 pounds 10 ounces.    Her birth really went like she had visualized, only a bit faster.    Sierra was a little stunned that the baby was actually here! 
 
About an hour after the baby was born, Aidan asked, “Mommy, you aren’t pregnant anymore?”  Sierra confirmed that it was true.  Aidan was overcome with JOY and ran through the house shouting, “Mommy isn’t pregnant anymore!!!!!  Mommy isn’t pregnant anymore!!!!”  Apparently Sierra had not been able to do quite a few fun things the last few weeks and he was so excited to get his mom back!

When I got home Rob was on the phone.  I tried to ask him where the boys were, but he was too involved to even tell me that.  So I started calling people on my list and asking if they had my boys.  I finally found them at Jenny’s.  Jenn had called Jenny to see if she could watch L. and explained the situation.  Jenny called Rob and offered to take my boys!  I have the best friends!!!!

It was a wonderful birth and I love how things always work out with my family when I am called away!

Repost from last year!  Happy 1st Birthday to Superman and PJ!    Thanks for a fun crazy few hours. 

I have had 2 moms who were going to have their babies at any time for the past few weeks. They also happen to be good friends, so I really wanted to make sure I made it to both births!

Birth 1 – hospital birth

S. was having her 4th baby. She had never gone past 37 weeks and on Tuesday the 18th she was going to be 39 weeks… so she was READY to have this baby. Monday night she called and said she was having some intense PW (pressure waves), I was teaching my Hypnobabies class, so said I would call her after we were done. I did and they had slowed down, so she was going to bed.

The next morning, she called and said they were still there, but less intense. I got care lined up for my boys, which basically included 3 different people caring for them until 9:30 PM because DH had scouts that night. (He is Scout Master) I went to Carson’s play at school and then talked to S, she had gone to the hospital and was 3cm, still having PW every 5-7 minutes, so was staying. I headed out to her hospital, which was almost 2 hours away with all the traffic.

I got there and then her DH got there not long after around 4:30. I must say that this was a fun atmosphere for a birth. S’s DH is just a funny guy and S is tons of fun, so it was like a party. We walked the halls for awhile. S listened to a script relaxing in bed… then I think we walked a little bit more. S ate some cheerio mix snack. The nurse was so funny because later when she was helping S get in bed she said, “Ahh, a tell tale cheerio in your robe… BUSTED!” But then said nothing else. Completely different than the other nurse from a different birth who verbally attacked a mom about drinking.

6:30 she was still 3cm and chose to have her OB break her water.

7:30 we watched Wheel of Fortune, which is apparantly a tradition, she had watched it during 2 of her other births. Then we also watched American Idol. S wanted the distraction. When it was done she listend to another script and we all rested. She was starting to have longer and stronger PW but they were spacing out to about 7 min apart.

I have to interupt and say that the nurses were GREAT, they were supportive of everything S wanted. Her OB was too, he was not trying to push pitocin or anything.

11:30, S gets checked and she is 4cm, 80% effaced and 0 station.

Midnight – OB comes in. Still every 7 min. S asks, “What do you want to see here?” The OB said, “A baby to come out.” He said, “Baby looks great, how are you doing?” S. was good, tired and wanted to rest. He said, “Whatever you want.”

A little later the nurse came in and asked S if she was open to any augmentation. S said, “You mean, pitocin?” The nurse said yes. She explained she could just do a little and not up it, just to try and get them a bit closer together. She said, that S. could take some time to think about it and just to let her know.

Minutes later after talking together about pros and cons, S said, “Let’s do it!” So at 12:25 pitocin was started at the lowest setting and by 12:45 the PW were more like 4-5 min apart. S started feeling the baby starting to move down more. She listened to a script in bed and was doing really well relaxing.

1:20 the nurse asks if she can check S. S. agreed and she was 8cm.

1:40 the nurse turns off the pitocin, so S can have more of a break. At this point S was starting to lose some of her focus. She just wasn’t getting much of a break (the PW were lasting over a minute and only a minute break between them) after the pitocin was turned off they spaced out again to 4 or 5 minute breaks.

1:50 S hustles to the bathroom to pee. She asks if there is anything to help take the edge off. The nurse explains she might be too close to pushing.

So at 2:00 S is checked again and is 9.5, just a little lip left. No time for any medication and S is just ready to be done, time to push! The nurse goes to get the OB. DH is so great at encouraging S. She is doing it!

2:10 the OB is ready and S pushes for 1 or 2 PW, completely mother directed. No one telling her how long to push. Little C is born at 2:16! She did it! Horray. He is so cute and has curly dark hair. He was 7 pounds 14 ounces, her biggest baby and no tears! DH did not want cut the cord, so I got to! This was my first time.

I left not long after, because I knew I would be on mommy duty in the AM and it would be a long ride home, I wanted the adreniline rush to help keep me awake. S is a pro at breastfeeding, so they were fine with me leaving. With no traffic I was home and in bed by 3:30.

My thoughts… I think had she not had the pitocin she would have had a more relaxed time for the last hour. But she was ready to have the baby and was already tired. I don’t know if waiting a few more hours with no sleep would have been the best choice for S. I talked to her today and she was happy with how things had gone. That last hour was really intense and she said she didn’t really feel any pain, it was just so strong and she wasn’t getting any breaks! So she agrees without the pitocin it would have been a smoother ride. But she was fine with how it all turned out, which I am glad for!

I also think that really it was meant to be that her baby was born by 2:15 so I was home in bed by 3:30. You will now see why.

Birth 2: HBAC (home birth after cesarean)

The phone rings at 4:30.

Yes, 1 hour after I had fallen into bed.

It is Alison, she says she is having PW every 5 minutes for an hour. I think my first words out of my mouth were, “How exciting!” But honestly for about 20 seconds I am thinking… who, what, huh? But then my brain starts to wake up and I ask if she has listened to any CDs yet. She had not, so I explained I had just gotten home and asked if I could sleep a bit more and she could call with an update after her CD. She said, OK.

I got back in bed and found it hard to sleep. I wanted to go be with her, but thought if this is another long birth (her first was 24 hours and ended in a cesarean) I am going to need more than 1 hour of sleep to help her through it. I thought if I can just sleep until 7:30 (4 hours) then I can shower and get there around 8 and can do it.

I still couldn’t relax or stop thinking, so I thought even if I get 1 more hour of sleep and she calls and needs me, I should be fine!

I still couldn’t sleep so I said a little prayer along the lines of, “Help Alison and let me be able to get some sleep so I can go and help her in a little while.” I then got a very strong impression that I needed to get up NOW and go or I would not see her baby be born. I also felt that she needed me NOW. I think I lay there for a few more seconds and thought, what if she is listening to a script and I call back and interupt her? But again, “go NOW”

So I got up and got dressed and called her to say, “I feel like I should come now.” She said something like, “Oh good.” While driving I prayed, “Please let Michelle (midwife) get there with plenty of time to catch this baby. If she doesn’t get there in time, help me to be calm and that things will work out just fine.”

I pulled up and the door was a little open, so I walked right in. DH was upstairs and waved me up. I go into the office and Alison was on all fours on chux pads and her water had literally just broken. I sat down next to her and we had a little chat about what was happening. Her first PW was around 3:18 and then had another 13 min later then they were suddenly 5 minutes apart and REALLY strong. She had thought the baby was coming when her water broke. So she was a little on edge. She had a nice long break before another PW started (probably 10 min or so) I was thinking, “Is this the rest and be thankful stage?” (Sometimes there is a break between transformation/transition and pushing. Where PW space out and mom can gather strength to push baby out.)

DH was on the phone with the midwives and they told him to read the Emergency Childbirth handout. He told them I was there and they said they would call right back. He read the sheet and looked at me and said, “Do you know this stuff?” I took the sheet and read it and said, “Yes, we will be fine.” I felt totally calm. I loved that at the top of the sheet was a scripture and something along the lines of everything will be ok.

Alison’s PW started again and they were 5 min apart lasting about a minute. We got her iPod plugged into some speakers, but I couldn’t find the easy first stage script and I didn’t want to leave her. So I put the birthing affirmations on. Alison was relaxing great between and during the PW. I got the birth ball so she could be on all fours, but rest her upper body. I got clean chux pads down so she wasn’t kneeling in a wet puddle. I got a towel to cover her, because she was cold. Then we just chatted between waves and relaxed through them, I would talk her through each one. Sometimes she would sound just a bit pushy and I just listened and said you are doing great.

The midwives called back to get an update, they wanted to know if the bed was ready. I said I would check and then the phone went dead. I didn’t think much of it, I figured they would call back soon. But apparantly Alison’s phone had gone out and they tried to call back but couldn’t get through. They just prayed all would be well.

At some point I had her lie on her side because she was tired of all fours. She found it hard to be comfy on her side… not open enough. Though I honestly didn’t want her TOO open until the midwives got there. She was also on the floor of the office as the bed was not ready and she didn’t want to move anyway.

They arrived around 6. There was some confusion because the plastic tarp for the bed was missing and there were limited chux pads. Alison and I hung out in the office while they helped get things together. They were coming in and checking out the baby and Alison between organizing things. She was getting more vocal with her PW, sort of moaning through them… nice low sounds. She wanted to get checked and Michelle suggested waiting because of the risk of infection with her water broken. So probably around 6:45 when Alison asked again, Michelle did check her. She was 8 and stretchy with just an anterior lip. So part of her cervix was complete, there was just a bit left on one side. So Michelle said if she felt an urge to push she could just follow that urge.

Alison continued to vocalize through her PW and started making some little pushy noises during them. We encouraged her and said she sounded great!

About 7:15 we helped Alison move to the toilet, where she started really pushing. Then we helped her move to the birth stool and Michelle checked and she was complete. She showed Alison how far the baby needed to move down to come out. Alison soon moved to the bed for some side lying pushing, she then switched back to all fours. Alison was encouraging the baby to come out.

Suddenly after a few pushes in that position the baby was crowning. It was so cool! DH at this point was laying next to Alison and I was in a place where I could see the baby coming out! The head was out and Alison paused a bit, it was so calm and peaceful in the room. No yelling for her to push, just gentle encouragement to follow her body. She soon pushed out the whole body. “I did it!” Alison shouted.

They put the baby on her back to rub dry baby off. Alison asked what is it! Dad checked and with confirmation from Michelle (he was in an awkward position to see) announced it was a girl! Alison was so shocked, everyone was sure it would be a boy. She got turned over and held her baby. She announced her name was Penelope Jane. Alison was exhausted but thrilled.

They left the cord alone until after the placenta was out. DH didn’t want to cut the cord, so I got to cut my second cord about 6 hours after I cut my first cord. How crazy is that???!!!! I then got to watch Carly (midwife’s assitant) examine the placenta. It was pretty cool!

So Penelope was born at 8:06 AM. If I had not listened to that impression, I probably would have missed the birth. I am SO glad that I prayed and followed that impression that I needed to go NOW. I feel like I probably was more needed during 5 to 6 am than I had ever been needed another birth. It allowed Dan to get things ready while I supported Alison.

It was my first homebirth and it was wonderful. I felt a calm and peace I had never felt before at a birth. Even when it was Alison and I alone in the office and me thinking, I might get to catch this baby. It was just so right. I think that it shows that intuition is really important during birth… not just the moms intuition, but also her support people too.

I am SO glad that I prayed and that I followed that prompting to leave right then. I am SO glad that the timing worked out that I was able to attend both of these births. While I was hoping for a good nights sleep between them, it didn’t really matter. God worked it all out as He always does!

You can read Alison’s version of her birth story here.

There is nothing more exciting than to recieve a book in the mail, except recieving a BIRTH book in the mail.  I got it on Friday and had finished the book by Sunday. 

The Labor of Love was written by Cara Muhlhahn, was the midwife who is shown in the movie, The Business of Being Born.  It was interesting to read about her journey into midwifery and her experiences as a homebirth midwife.   

Cara started her studies assisting lay midwives, went onto nursing schools and spent time working in L&D as a nurse.  Cara was often disturbed by what she saw going on at births in the hospitals.  

The flip-flopping of obstetrical absolutes is a disturbing trend to me.  There is something suspecious about “truths” that change every few years, especially regarding a physiological process that has not changed much since the beginning of time. 

She ended up going on to become a nurse-midwife and after working in a birth center eventually chose to go on her own as a homebirth midwife.  

The satisfaction I get from midwifery makes it worth the high degree of dedication and sacrifice.  My work takes a lot out of me.  But I like the adventure that midwifery brings to my life.  I like having to drop everything to answer to a higher calling, the ruggedness of hard work and the idea that when nature calls, there is no choice but to answer. 

I really liked this quote.  While I don’t have the same level as stress as a midwife does, I get a taste of “when nature calls” and having to respond when it does.  Birth is very unpredictable and being on call as a doula is quite an adventure.

Labor of Love was an easy, enjoyable read.   I think that this is a great book for doulas, midwives or anyone working in the birth field.    So I am thrilled to be able to do a give away of a copy of Labor of Love on my blog! 

To enter leave a comment saying why you want to win this book!

You can earn another entry by blogging about this give away and letting me know, you can either e-mail me at sheridan AT enjoybirth DOT com or leave a comment.

You can earn another entry by adding the Enjoy Birth Blog to your RSS and letting me know, you can either e-mail me at sheridan AT enjoybirth DOT com or leave a comment. (What is this? Here is a great explination in video form.)

[youtube=http://www.youtube.com/watch?v=0klgLsSxGsU]

You can earn another entry by posting about the give away on e-mail groups or bulletin boards and letting me know, you can either e-mail me at sheridan AT enjoybirth DOT com or leave a comment.

Good luck!  The last entry will be accepted at midnight on March 21st.

 *I don’t know that I would recommend Labor of Love to expecting moms as Cara does share her scariest birth and saddest birth in the book.  As a Hypnobabies Instructor I think it is important for pregnant moms to read positive birth stories only!

I read an interesting post on a nurse’s blog about The “perfect” patient.   Go read her post and then come back and read this.

She had some good points.

1.  Open mind.  I agree with this.  Some moms who are so focused on one thing, sometimes create that reality.  So focus on what you DO want.  Prepare for the best, but realize that birth is unpredictable and be flexible.  But also pick a great care provider who will support you in what you want (as long as mom and baby are ok then they should be supportive.)

2.  Of course all care providers (nurses, OB’s, midwives) want healthy mom and baby.   That is what mom wants too.    But again, as long as mom and baby are doing ok, then there should be much flexibility.

3.  Develop a relationship with your nurse!  This is SO true.  In a hospital birth a good nurse is going to help so much in having a positive birth experience.  The nurse has to keep mom happy, the OB happy and the hospital happy.  Not an easy job.

4.  Be prepared!  YES this is huge, educate yourself and then share what you want with your nurse.

5.  Bring treats.  This is something we teach moms in Hypnobabies, bring treats, the nurses love them!  It also helps with number 3.

So what makes a “good patient”?  I think that truly moms shouldn’t worry about that.  Also they shouldn’t think of themselves as patients, this is the problem.  Moms are giving birth.   Usually birth is a normal life event, not a medical event.  (As long as mom and baby are ok, certainly there are times when it should become a medical event.)

Having said that, if a mom chooses to birth in a hospital on the one hand she needs to be flexible and on the other she needs to be ready to really fight for what is important to her.

Your focus during birth shouldn’t be, Am I being a good patient?  Your focus should be on you and your baby!

I never really thought about homebirth until after I was a doula.  The more I learned about birth and then saw birth as an observer at a hospital, the more homebirth made sense.  I have had 3 hospital births and if we ever decide to have another baby, he will probably be born at home. 

But here is a great comparison from a mom who has done both.  I think this should be a must read for pregnant moms.

Some moms may wonder why I posted about inductions and the risks and questions to ask, etc.  

Would a care provider suggest something if it is not really medically necessary?  If so, why?

I think that depends a lot on the care provider and this is why I encourage moms in my class to TALK to their care providers about this early in pregnancy, to get a feel at how they practice.  But then beware of the bait and switch! 

Here is a link to a letter from a CNM showing that health of mom and baby are not always top priorty of choices of care providers.   

Talk to your care providers early.  If you don’t like their answers switch.  If they try the bait and switch, talk to them again and remember, it is never too late to switch and you can always say NO!  Educate yourself, don’t just blindly trust your care provider.  You are the Mom, you know what is best for you and your baby.