The end of  2007 I attended two very long births back to back.  Out of 63 hours I was gone 57.  I was home for a few hours of sleep between them.  I missed my 2 year olds birthday and honestly I don’t know where my boys were during that whole time.  I wasn’t worried, I knew that they were with friends and DH and they were fine. 

Both births were for first time moms who were induced, hence the longness.  (I am not sure if that is a word, but it seems right for this post!)

Here is the short version. 

Tuesday night go to hospital to support my single mom client, A.  She was on pitocin by 5am.  She started having back labor and when she discovered she was still 1.5 cm. she wanted an epidural.  Her OB said Ok.  She did progress and had baby vaginally around 6:30 pm.   Got her settled in postpartum and headed home by 9pm Wed.  

In bed at 10 pm and up at 3am Thursday off to another birth.  Mom B, was induced with pitocin at 5am on Thursday. (had been in hospital since 3 pm Wed. afternoon because of low amniotic fluid) She handled things well throughout the day.  She chose to get water broken at 6pm when she still hadn’t progressed.  Things got very intense and she chose an epidural at 8:15 pm.  She rested, but was quickly getting exhausted and by 4 am was so discouraged and back pain started coming through the epi.  Baby was posterior and at 5am mom chose elective cesarean.  I was going to be able to go in with Dad and Mom, but her sister got there just in time so she got to go in and I got to go rest.   I was able to see mom after recovery.  She was just exhausted.   Didn’t even hold the baby yet when I saw her at 10 am.   It was so sad for me to see.   Baby was fine, mom was past exhausted, but ok physically… I was exhausted too.

My reflections on these births. 

Interestingly enough, I felt like A, while she had a better outcome (vaginal birth), was not treated with the same respect as B.  The nurse for A caught her eating and read her the riot act.  Then after she accepted the epidural, there was a time when the baby’s heart rate was looking fishy, so she ended up with an internal monitor.  The nurse said, in a snotty voice, “That’s what you get for having a 2 page birth plan!”  I was shocked and saddened by her unkindness.  

 Mom B on the other hand was treated very respectfully by everyone.   They respected her choices.  While it ended in a cesarean, I was happy to see how she was not coerced into it.  This is from my birth story I wrote for mom. 

OB comes in at 5 am, she talks to B.  “How are you doing?” 

B. says, “Horrible, I just can’t do this anymore.  I am nauseous.

OB, “Let’s check to see how you are progressing, baby looks good and you are ok, so there is no emergency.”   B is 7cm.  OB checks baby’s position, baby is positioned a little funny.  OB goes over options.  “We can wait and keep on going, baby is doing well, but it may continue to be slow progress because of babies position.  Or we can do a cesarean now.”

B. quickly responds she wants the cesarean.  He DH agrees and in many ways I do too.  She is SO exhausted I really don’t know if she could push a baby out even at this point if it was time to push.   

I was still heartbroken about it, because I knew it wasn’t a medically necessary cesarean and I hated to see her get cut, to join the sisterhood of the scar.  I cried for a few days because of it.  But she was informed and she made the choice.  I think it was the best one for her at the time.  I went through a lot of second guessing, what else could I have done as her doula to help prevent this?  Did I fail her somehow?   B and I have talked a few times about it.   Her saddest part is she doesn’t remember the first time she held her baby. 

It was interesting, I went to visit her after she got out of recovery.  But I didn’t want to see her baby in the NICU, because I did not want to see her baby before she did.  That seemed to wrong to me.  I remember that empty feeling, when my Devon was in the NICU and I was in a room alone.  So empty.  I think this birth was an interesting step for me in regards to emotionally dealing with some issues from my birth.  But that is a whole other post! 

[youtube=http://www.youtube.com/watch?v=I4_hId8fjoc]

 Here is the article.  Here is my response.

This is really a shame that this mom had a negative experiences with her doula.  My role as a doula is to support the mom in whatever SHE wants.  This isn’t MY birth, it is HERS!  I would NEVER leave a mother during her birthing time, no matter what she chooses, she still needs support. 

I think it is important for moms to talk to a doula about their flexibility before hiring them.  I think most doulas are up front about their limitations… for instance the doula in the article who won’t take moms who are planning epidurals.  Good to know as a mom hiring her.  If you are even a little on the fence about getting medication, then choose a different doula!  Also if you hire a doula like that, make sure you ask, what if I change my mind!?

Personally, I tend to only work with moms who take my Hypnobabies class.  This is mostly because I only take 1 or 2 clients a month and in each class I teach I have some  students wanting to hire me, so I save my spots for them.  It works great; we already have a relationship from class, I know they are educated about the different interventions typical in a hospital; they understand normal birth and they have great tools for staying relaxed and comfortable during birth.  But I am totally open for them getting interventions, if they make an informed choice during the birth.  It is interventions done out of routine, rather than medical need, that parents tend to be concerned about. 

Honestly I was sad to see that a hospital has banned doulas.  I would be very hesitant to birth in a hospital like that, “From a nursing standpoint, too many crossed a line and interfered with my job,” is the comment from the article.  Well what were these doulas doing… supporting their clients rights to move around, make choices, say no to interventions, etc?  I don’t know, so I can’t really comment on it.  But I would be interested to learn more what these doulas were “doing”. 

During a birth I am not focused on what the nurses and doctors think, though as doulas we need to walk that line carefully.  I am there for the mom, not the staff.  I have only had one negative interaction with a nurse.  I could have done things differently in that instance and will in the future.  But she was scaring my VBAC mom needlessly and my protection instincts flared up.  I am fine with staff talking and informing my clients about hospital routines, but you don’t need to do it in a threatening, scary way. 

In conclusion, hire your doula carefully.  Pick a doula that is flexible!   I am open to my clients having whatever birth is best for THEM.  Most of my clients plan on going without medication, but this may change during the birth, depending on the circumstances.  I will support them in whatever they choose and I tell them that from the beginning of our relationship.     

As usual this is not meant as medical advice.  This is just information with a lot of links so you can do more research!   Then make the best decision for yourself! 

Everyone wonders why the cesarean rate is so high, I think a huge reason is all of the inductions happening today.  Over 40 % of mother’s careproviders try to induce them and over 47% receive pitocin during their births.  I think inductions are something moms really need to be proactive about, because it carries many risks.  Hopefully this article will help some moms who are being offered inductions! 

5 RISKS of induction

1.  It may not work.

If your body is not ready to have the baby, an induction most likely will not work, which increases your chance of ending up with a cesarean.  A good way to tell if your body is ready is to find out your Bishop’s Score!  If it is over 9 an induction will probably be successful (if all goes smoothly)  if it is below a 9, odds are you will end up with a cesarean.  Either way, make sure there is a GOOD reason for an induction. 

2.  It can cause stress for the baby, which can lead to other interventions and possibly a cesarean.  (Usually due to the medications they are using to induce)

3.  It can exhaust the mom. 

They often have moms come in at midnight, put in cervidil and then in the morning start pitocin.  So even before active labor begins, mom is tired.  Then the contractions can be so strong and powerful for so long, mom is tired and this leads to #4. 

4.  Since the pressure waves tend to be more intense than natural waves, moms may want to get an epidural which can lead to other issues. 

5.  An induction can be the first step down the road to a very intervention filled birth and is more likely to end in a cesarean, than a birthing time that starts because mom and baby are both ready!

5 Ways to Avoid an Induction!

1.  Ask questions to your care provider from early in your pregnancy, to see where he/she stands on these issues.  The answers may raise some red flags and you may choose to change care providers. 

How often do you induce your moms?

When do you suggest induction?

What happens if I am still pregnant at 41 weeks?

How do you do inductions?

2.  Take an Independent Childbirth Class to learn about normal birth and educate yourselves on your choices before and during birth.

3.  Trust your body and baby and your instincts!

4.  Refuse late term ultrasounds.  If your pregnancy has been low risk, there is no medical need to do one.  Care providers often use the results to “suggest” inductions.  Your baby looks big, etc.

5.  If an induction is suggested, ask questions,  do your research, see if it is really MEDICALLY needed.  Know that you are in charge, it is your body and your baby!

5 things to do if you choose to get induced. 

1.  Ask – What is my Bishop’s Score?

2.  Ask – What will happen during the induction? 

Knowing what to expect can help you feel more prepared.

3.  Ask – What medications will you use? 

Make sure you are ok with the medications they are planning on using (if they say cytotec/misoprostol/miso do some research on that, here is another great article… scroll down to the bottom to read a very telling OB quote of why they love cytotec.)

4.  Stay upright as long as possible during your birthing time

            This can help the baby move down and get in a good position for birthing. 

5.  Watch the nurses each time they come in the room.

They tend to up the pitocin quickly and every time they come in, without telling you.  So watch them.  Tell them to go slowly, this isn’t a race! 

5 different things care providers use for inductions

1.  Cytotec aka Misoprostel aka Miso – very BAD!  Dangerous for mom and baby.  Go to this link to learn more.  Know that if your OB tends to use this you have the right to refuse it and I would put it in writing! 

2.  Cervidil – There are some minimal risks…. but it helps to soften the cervix in starting an induction, usually this is the first step, followed by Pitocin.

3.  Foley Bulb – use a “balloon” to help open the cervix, it will fall out when mom dilates to about 3 to 4cm.  As far as I know there are no risks to this.   I guess there would be a risk of infection as there is anytime you introduce something foreign into the vagina. 

4.  Pitocin – Man made oxytocin to help contractions to start and or to strengthen contractions.  These contractions tend to be very strong contractions which can lead to some different issues.  Discomfort for mom and stress on the baby.  A key is to WATCH what the nurses do when they come in.  They like to up the dose each time, ask them to do it 1 at a time (many do it 2 at a time) if you have a good pattern going, ask them to stop turning it up!  They will up it without asking so you MUST WATCH!

5.  AROM – Artificial Rupture of Membranes (Care provider breaks your water)   In most cases this puts you on the clock.  Once your water has broken most care providers want to see the baby born within 24 hours.  It also increases your chance of infection and can cause added stress on the baby.  Without the cushion of water around the baby, they may experience some stress.  In recent studies they say it doesn’t prove that it speeds things up.  So you may choose to keep your bag of water intact! 

For Part 2 of this article click here.

Here I am on vacation, checking e-mails and blogging.  I am the Hypnobabies Yahoo Group Moderator.  It probably takes me about 1 hour a day on average to be in charge of that group.  Well maybe 5 hours a week, there are not as many messages on the weekend.  I do not get paid for doing it, I volunteered to do it and I LOVE it. 

Why?  My husband wonders this a lot… here is my answer.

10.  I loved the group before I was an instructor, when I was a Hypnobabies Student myself.  It was empowering to find a group of women who didn’t say, “Why don’t you just get the epidural?”   There were other women out there who understood my desire for an un-medicated birth and encourage me to go for it!

9.  I love getting to know moms all over the world.  We have moms from USA, Europe, Australia, South America, Canada, New Zealand, and some cool islands like Tahiti.

8.  I love that this group of women for the most part are really supportive and kind and loving to each other.  Maybe once a year things get a little heated, but it is quickly and easily tamed.

7.  I love that these women believe in and TRUST birth.  They  also believe that birth can be COMFORTABLE and ENJOYABLE!

6.  I love that I have made a lot of online friends and even some IRL friends.  It is so fun to see moms on the group who I knew a from a few years ago, rejoin the group because they are expecting again and are using Hypnobabies again!

5.  I love answering these moms questions about Hypnobabies and normal birth stuff.

4.  I love that answering these questions helps me be a better instructor for my live Hypnobabies Classes.

3.  I love that I can help hundreds of women have better, more enjoyable births, rather than just 5 women at a time.  (5 is the limit on my live class size.)

2.  I love when these moms thank me for my help after their babies are born.  (My love language is words of affirmation)

and the number 1 reason is 

I love all the birth stories that the moms share.  I started my positive birth story website before I became a Hypnobabies Instructor, so the world could read all these wonderful, inspiring birth stories. 

Why, why, why must you try to scare moms?  Why can’t you just say “It’s hospital policy”, or give them pros and cons rationally, then let the mom decide.  Why lie to them?  Why bully them?  Why treat them like they are a stupid child? It really is starting to make me MAD! 

I am a birth doula, I have the honor of helping families during the birth of their baby.  In each birth I see different things.  I also have seen a few different types of births in a few different hospitals.  (I have my first homebirth coming up in March).  I have enjoyed many nurses and care providers and been shocked by others.

The problem with a hospital birth is you have little control over who you are going to get when you go into a hospital.  Having a doula does help… but there is a limit to what we can do, we can do clean up and encourage moms after a negative experience… but as a doula, I can’t ask for a different nurse or care provider, that is up to the parents.    

It is amazing how much of an impact the nurses and other care providers can have on a birth.    I saw this at the last birth I attended.  This mom was subjected to quite a few different scare tactics/tirades to try and get her to bend to the will of the hospital/nurse.  The OB was actually ok with some of the things C. wanted, but the nurse wasn’t.  So she made it difficult.  I mentioned a few times to C. and her husband they could ask for a new nurse, but they chose not to. 

This nurse was efficient and had some good ideas for positioning with pillows.  (Mom had an epidural and I am used to helping moms without epidurals)  So I learned some good ideas from her and she did get a bit nicer after C. complained to the OB about her. 

Here is what happened… night shift was great, very supportive of C and her needs.  Morning shift came on and everything changed!

When the nurse originally came in after shift change, I made a comment about going to get C. something new to drink.  The nurse FREAKED OUT!  She wasn’t calm and nice saying, “that is against hospital policy”, she was in C.’s face saying, “You are a high risk mom as a VBAC, your uterus could rupture at any time and you would need an emergency cesarean.  If you eat you could aspirate your vomit…” and on and on… leaning over C. lecturing her.  She must have said emergency cesarean at least 3 times in 3 minutes. 

I didn’t help, because I made a comment about the studies say it is safe.  Well, that was the wrong thing to say. The nurse said we should ask our OB.   Which we did and the OB said it was fine to drink water.  So there!  Not to mention of course it is safe to eat and drink during your birthing time.  Study after study have shown that it is safe.  The nurse brought me the form I needed to sign as the doula saying I wouldn’t interfere with the staff or I would be asked to leave. 

C. had explained about the pains in her legs breaking through the epidural.  The nurse said she would send the anesthesiologist in.  Well, he was the biggest pompus donkey’s bum.  He called himself the candy man.   He was condescending and outright rude to C.  He started off ok, talking about the epidural asking questions and saying that we might need to replace it if the next bolus didn’t help.  That she was no longer having a natural birth, so she might as well do whatever they say.  Then he started lecturing C. about how she needed to listen to the nurses and do what they told her.  How she should have gotten the pitocin last night and she needs to be a good girl.  Then went on to explain how she can’t eat or drink because she might need a cesarean and might need general anesthesia and would need to be intubate and if she vomited she might aspirate.  I SO wanted to say, “So you are an incompetent anesthesiologist, because that is pretty rare if things are done correctly.”   BUT I didn’t. 

After he leaves C. says, “I do not like this day shift!  I am going to talk to Dr. H. about this.”   I again said, “We can ask for a new nurse!”  Dr. H. comes in around 8 and C. explains what happened.  Dr. H. says that shouldn’t have happened.  She said it was ok to drink some water.  Then goes on to say, “well, you are doing ok, but this is a big baby, that is my only worry that you might not be able to push this baby out.  This could be a 8 pound baby.”  C. and I look at each other speechless… hello!  Wasn’t C. just explaining how we didn’t want the negativity.  C. says, “I am NOT worried about the size of this baby or pushing it out.”  Dr. leaves and C. says, “I don’t believe that big baby bull**** I can push any size baby out.”  I told her what a great VBAC patient she is not believeing or accepthing any of the fear they are trying to push on her. She really was AWESOME.  WE kept saying “Bubble of Peace”  I loved that she didn’t let any of this crazy attitudes and negativity around her get her down. 

The nurse she had the attitude “It’s all about the baby”  Basically mom didn’t matter in her eyes.  A few times C. said, “Can you wait to do that until after my pressure wave?”  “No, I need to make sure your baby is safe, that is more important!”  How is C. supposed to respond to that?  “No I’m more important than my baby!”

Well, yes in many ways she is.  She is at least AS important as her baby.   Baby wasn’t showing any signs of distress, she had just fallen off the monitor. Baby was always doing great.  So the nurse could have waited for 40 seconds!  I had already had an altercation with the nurse earlier in the birth and was a bit worried she might try to kick me out. So I just encouraged C. verbally through these few time when the nurse told C. she didn’t matter throughout the end of her birth.  (She didn’t want to be touched at all during pressure waves and that should be respected above all else.  I guess I could understand if the baby was showing signs of distress, but again, baby was fine.)

The anesthesiologist came back in when C. needed another bolus.  He proceded to tell her how it would hurt while she was pushing, that if she didn’t push well, they would have to turn the epidural down so it would hurt more.  C. just stared at him.  He then said, “Are you listening to me!?”  She nods yes.  After he left we asked that he not be allowed in the room anymore. 

  At 1:20 C. was feeling a LOT of pressure and after breathing through it for awhile, asked to get checked.  She was 10 cm still 0 station, so they didn’t want her to actively push yet… labor down.  So for an hour, C. struggled to breathe through her desire to push.  I said it was ok to push if it felt better, so she did push sometimes, but tried not to. 

Then 2:20 the nurse decides it is time for a practice push.  C. did great and nurse sets up the stirrups.  She gets her up and then C. does 1 push and the baby starts crowning.  Then the nurse has her wait there while she finishes setting up the room and calls for the OB.  I was trying to help C. just pant through it telling her she was doing great, because there wasn’t anyone even standing there in case the baby came out.  I so wanted to go and catch that baby.  She just NEEDED to push!  Finally the OB gets there, puts on her booties and then C. is saying I need to push the baby out, I don’t care who catches.

Then they have her purple push 4 times in one pressure wave and the baby is out.  I don’t understand this…. WAIT for 20 minutes while the OB gets here, but then when the OB is here, you have 1 minute to get the baby out.  PUSH PISH PUSH… come on you can do one more push.  I had to remind her to breathe, they didn’t even give her a chance to breathe. 

Then the baby is on her.  The baby nurses are hovering like vultures.  C. says I want to keep her for awhile.  They leave her alone for maybe 5 minutes and then they come back… we just need her for a few minutes she’ll be right back….  Swoop and she is off.  C. then has to just lay there while she is stitched up alone on the bed.  I talk to her and help her focus on something else, but if she had her baby in her arms that would have helped more. 

The baby was 9 pounds 6 ounces.  19.5 inches.  What an awesome job C. did proving that she COULD push out any size baby!  Baby latched right on and nursed like a champ when she got in her moms arms. 

What I love about C. was that she didn’t believe a word they said.  IT just made her stronger and more determined to get her VBAC and she did!  She ROCKED!  It sucked that the end was her waiting in such an uncomfortable position for so long.  I wish I could have gone and caught that baby for her. 

Things did go well overall, but C. would have had a much better experience if her care providers trusted birth and were KIND and respectful to her.      

This is a common concern of moms interested in using hypnosis for childbirth.  They wonder if they will just be zoned out on a bed and not aware of what is going on. 

The easy answer is NO, but read on for more details.  One of the great things about the Hypnobabies program is that it is an eyes open hypnosis.  So you are able to open your eyes, talk, walk around all while deep in hypnosis still relaxed and comfortable during your birth. 

I was WAY more connected to the whole birth experience using Hypnobabies then I was with Carson’s birth, once I had an epidural.  With that birth, I felt as if I almost didn’t even need to be there, because I wasn’t even aware of what was going on with my body.    Also since I didn’t need my DH to help me he was chatting with the nurses and that bugged me.     I felt sort of ignored.

With Bryson’s birth, using Hypnobabies I was aware of everything that I wanted to be aware of during my birth.  For instance I didn’t notice the lady yelling in the room next door.  I also ignored the chaos when it was time to push and the nurse couldn’t figure out how the new bed worked.  I stayed calm and peaceful in my own special place in my mind.  But a few minutes later I was instructing the OB that I wanted the cord to keep pulsing and Rob to cut the cord, just minutes before Bryson was born.   

I was not disconnected from others during my birth.  I was talking and laughing between my pressure waves.  (You can see that in Bryson’s Birth Video)

During transformation (transition) I needed to focus through my pressure waves and as transformation progressed I remained focused even in between pressure waves, but this was only the last 2 hours of Bryson’s birth.  Most moms having an un-medicated birth naturally seem to turn inward during this portion of birth. 

I was not disconnected from the physical aspect of my birth either.  I was aware of everything that was happening in my body, I just interpreted it as pressure instead of pain.  So I knew when I wanted to get up and change positions.   I was aware of Bryson moving down and out when I was pushing.  I had all the endorphins and wonderful physical benefits of any mom having natural birth.