Sunday, 12 June 2011

My 2nd birth ever- baptism by fire

Some first births of a new Midwife can be so teaching, so foretelling, so scary that we call them baptism by fire.
This birth proved to be mine. It didn't say that I shouldn't be a Midwife but that I was there/here for a reason, get my act together and do what I needed to do, without hesitation.

My 2nd birth without any other Midwife or doc, I had a new apprentice.

I was working with an ND. and he was confident that I could do any birth, thank goodness.
Mom and dad were both over 6 feet tall, this was their 5th baby and both were EMT's. Both very experienced in "catching babies" and having intense situations in emergencies. I'm glad at who they were. However, looking back on it, it should have been a clue for me as they spoke of many of the intense situations they had been through together in the medical field.

In her pregnancy she had told me about her placentas "being ripped out of her" and that she had "bled a bit" with each of them. This is a clue !
I spoke alot of being prepared for birth and letting it happen. They were both excited about this home birth. They had always wanted to birth at home but them being in the military always seemed to interfere with their wishes.
We discussed her options of letting the placenta detach on it's own and that it could take awhile, but that we "probably won't see a large bleed". I have learned to not be that specific anymore.

She went into labor and was going rather quickly, so I was anxious about going on a military base as they had told me home births are not allowed.
Got lost so I got flagged by an MP who gave me the right info, he noticed the bags in the back and asked me why were we going to someones house at 3 am on a military base? I told him the truth, he thought it was weird, but when he tried to delay me I asked him if he wanted to help me "catch" this baby and he let me go quickly.

Anyway, we get there, and dad helped get our stuff in their house. Oh, by the way it was in the winter so it was about 30-40 below. So once I got my glasses frost free and could hear and see that indeed she is in labor. It was then that I got introduced to their priest. My brain exploded- like why do we have a priest here? I understand wanting prayers for the birth- but it was a clue.

Mom is doing great and is now in transition, she's decided to be on the sofa couch- pulled out into a bed in the living room and that would leave any noise downstairs so we wouldn't wake up their other daughters.
All of a sudden her water bag broke and it consists of water and much blood. Baby has sounded great with the Doppler, but this is clearly an abruption and a large one! In the background I hear the priest praying VERY LOUDLY. (Let me tell you for years if I had an intense birth, my hearing would go funny and I could only hear my own thought process going on) but I also heard him. I was past scared as this was the first abruption I'd ever seen and I knew this one was bad.

Wonderfully, the baby's head came quickly as I tell mom to push, and baby just needed a bit of stimulation, so I hand baby to mom and dad and here comes a waterfall of blood. Literally like a water fountain. My brain is screaming (I am very calm at births though).
Cord goes flaccid in a matter of seconds and with all the other clues that was another huge one that just confirms the abruption and there was no more oxygen supply, however the placenta is not coming out.
Mom and dad are still talking and dad looks over and sees the continued waterfall of blood. He goes a bit pale.
All I can think of is to get that uterus shut down, so my apprentice had already drawn up pitocin and methergine, I give her instructions to give them to mom as I take my hand out of mom. I was going to do my first manual removal of this woman's placenta.
There is sticky blood everywhere in my path so I grabbed the cord and followed it up inside mom, I warned mom she would feel my hand go in her. I found the placenta (or what I thought had to be the placenta- warm mushy mound of tissue.There were lots of clots inside and I would just squeeze them out on my path up. Somehow my hands knew what they were doing, and when I reached the placenta, my hands just started to loosen the tissue from the wall. As, I did this slowly I knew I was doing the right thing because her uterus was slowly reacting to what I was doing. As I got it all out, the whole placenta slid right out and her uterus started closing down. I went all throught the uterus again making sure I didn't leave anything else in there and it was feeling cleaner and much more room now everything was out including the huge clots. I told my apprecntice and she gave the shots. That uterus was very firm now.
Now, my hearing is coming back and I continue hearing the preist and look at him and he and everyone in the room looks white. Everyone saw how much blood she lost. I didn't think to call the EMT's cause I was busy taking care of mom. I knew if I didn't do what I did I could have lost her.
There was no more bleeding, I tried to figure out how much blood she lost, but with what I came up with, she would have lost all her blood, so I knew I was off. She looked very pale but she and husband refused to go in for a transport for blood loss. Dad started an IV on her to get fluid in her and we kept her warm and monitored her vitals for the next 24 hrs. In my mind she was going to drop dead any minute, so I did what the priest did- pray and went over everything I did.
I checked her hematricrit and she was VERY low, parents still refused to go in.
So, meanwhile I had called my ND and asked him for advice. I said transport and I let him know the parents wishes. So he let me know all the homeopathics and suppliments to get in her to allow her to heal quicker. She and I did everything he told us to do. and within a week her hemoglobin was up to 9.
Her 2 week postapartum visit she came to the clinic, I couldn't believe she was up walking, let alone pink and talking and breastfeeding her baby.

Did this birth teach me, sure and alot. I learned how to look for clues that around the room, clues she's giving. Take in everything.
Was this birth dangerous? Yes, the top thing in the world that causes women to die in postpartum is bleeding to death.
It was something I was suppose to see and do, scared the you know what out of me, so I have a healthy respect for the unexpected realities of birth.
I don't think birth is dangerous, but I think people and Midwives need to know these things can happen. Rarely, but they do.
I think that she had scar tissue built up in her uterus from "ripping out other placenta's before they were ready", I'm not sure if it caused this horrendous bleed, but I do believe it played a part in it.
Could it have been a precreta, or acreta placenta, no. They usually don't bleed like this.
I just knew in my head that I had every chance of changing how things were going by getting that placenta OUT.
I didn't want to do any births for a bit, but don't you know the next time I got a call I went,

Saturday, 30 April 2011

Two births in 2 days

Update on this post.

I have had many births on the same day.
It seems that I have had months when I have had up to 4 births per day.
They were all short labors, but of course they were all far away from each other.

One time, it was my 5th in less than 36 hrs,
my client lived a block away and she woke up needing to push. I ran to her house with my bag, ok, once I got there I realized I had my  pajamas on !!!
After the birth, the parents laughed and teased me about it. They had a lovely very fast labor and birth.


Not a long story.
About 25 years ago, I had 2 VERY different births outcomes.
Earlier in the day I "caught" a full term 4lb baby boy, later I went to another house to catch another baby boy: he was 14lbs !

Similar births, wonderful births, one I caught with one hand, the other I felt like I needed a crane !

I have a (yes, old) video of the first one.
The only difference in these births was
the smaller perfectly formed baby was born to a family of people in several generations were less than 5'2 and all had small babies.

The other family of the bigger baby were all over 6'4.
I felt like that baby and I were the smallest in the house
What a day.
I think I walked around with a silly grin on my face.
Have a silly day!

Sunday, 17 April 2011

Odd things

Births can bring many interesting situations.
I had a 48 yr old mom Gravid 18 Para 12. Had had all her other babies @ the hosp, never a problem, no complaints. A good friend of hers suggested she come and see me and that she might like a birth center birth. She became my client.
She was great to get along with and had a huge span of childrens ages.
She goes into labor on time, birth was pretty normal.
Out comes this little( 5lbs) baby girl who had to be stimulated, but came around quickly. I kept looking at this child and thinking she looked "different", but the newborn exam was normal. Her color looked odd. She looked like this old, old book paper, that old weak yellow, tan color. But parents thought she was perfect. She nursed fine. I sent them home cause I couldn't think of a reason to send the baby to a doc. Mom brought her in for her baby checkups and I noticed baby had that same color and she didn't have much weight gain. I was seeing this baby every wk, Mom insitsted baby was fine. I did ask mom to take baby to her pediatrician. Came back next wk and said he told her everything was fine, but mom did notice baby also wasn't gaining much. Finally I told mom, "somethings really wrong ,please take her back to the doc". Again all they did was suggest mom supplement with some formula.
I was ok with that becasue this baby did not look ok. I saw the mom again and baby still wasn't gaining any weight. I called her several days later ( by now mom was getting worried.) and talked to her about this. About a week later mom left a message at the clinic that they were at a Denver hosp. I called back and mom told me they still weren't sure what was wrong. Several days later she called and said they discovered the baby had " giant idopathic red blood cells- the baby had a liver disorder. ! How bizarre ! I had sent her records to the Neonatologist and spoke to her at length about moms care and baby's care. Mom had had a water birth and the doc said she always wondered about those births, I explained why and how and she says" that makes sense"
Anyway, she commended  that she was pleased that I pushed the mom to persue investingating babys health issue. She found no contrubuting factors of mom under my care- in fact she said even the hospital was having a hard time figuring out that there was even a problem other that the odd color and no weight gain. She also later told me that there was nothing that could have been tested for or done differently  even if it was a hosp birth, and that because there was no real stress on this baby in labor and at the birth, her liver didn't get even more stressed out.  She suggested that perhaps it was the best thing that little girl was born out of the hospital. Mom had  never had any type of liver problems or disorders or any illnesses in pregnancy, the docs didn't even know how this could have happened.
I'd say that's odd.

See you later

TWINS ,Yes- it can be done at home

Ok, I promised some older births that I have done.
My first set  of twins came as quite the surprise. I had done quite a few other babies for this couple, so it didn't surprise me when they called again. They had 7 children already.
Everything was going well until about 30 wks gest. She claimed she was feeling more movement with this one, but then recanted and said "well maybe not", she wasn't measuring all that much different than her other babies. But her previous babies were 9 to 10lbs. When I palpated her belly I could only feel one, and could only find one heartbeat. I asked her several times over the rest of her pregnancy if she wanted a sonogram and she kept saying no. She had sonos in her other pregnancies.
She did require more rest but we put it up to that this was her 8th pregnancy/birth.
She went into labor as usual. She doesn't have long labors, as she took my Uterine Toner that I sell. I don't remember being there for very long before she got to 10 cm. She didn't feel like pushing, so we just hung around, while she walked and her husband, her and I talked. I think some of the kids were in the living room also. About an hour later I said "Mary, why don't we go into the bedroom and try a push or two. She agreed, however this time she wanted to squat for the birth. We got the floor ready. She squatted and pushed and about 10 minutes later out come this perfect little girl. A bit smaller than her others, but again, we weren't really paying that much attention. We got her up on the edge of the bed to wait for the placenta and she got to love on this new one. I and my student got them settled and I went in to the bathroom to take off my gloves and wash up. About 5 minutes later, my student said "Ahhh, Sherri I think you need to come back in here!" I came back in to the bedroom and saw a bag of water coming out of Mary and I though "What the heck?"
I broke the bag with my fingers and saw a little head ! I start to chuckle but I can't form the words and I said "Mary, I need you to squat again" She said curiously "ok" and she squatted. Oh, by the way we had cut the cut a few minutes before on the first baby. I'm kind of underneath her and she says "Sherri why am I squatting?" I tell her "cause there's another baby" and she kinda laughs, her husband is blown away. And I asked her to push, out comes another little girl ! We are all just awe struck but laughing. The girls were 17 minutes apart.
When it came to the placenta : it looked like 2 placentas with another placenta like looking thing all fused together. When I inspected it, the only thing that separated them was a membrane. Two cords and 2 placentas fused into one very big placenta. Very curious. Both girls weighed about 7 lbs each. Turns out the girls are identical mirror twins. Quite rare as I understand.
Any way, the parents were very glad we didn't have a sonogram.
 I went around with a silly grin for about a month. She breastfeed those babies for about a year. They were now a family of 9 children in a matter of a few hours. I was so proud of her.

Soon to come other twins and a surprise set of triplets born in the water.

My 2nd BREECH- 30 years AGO.


A young professional couple in their 30's came to our clinic for prenatal care in the early 1980's. After dealing with her tremendous nausea and vomiting was helped a great deal with Homeopathic remedies, her pregnancy went as normal as can be. Lovely couple, looking forward to their new child birthing at home.
She calls me one night and said she was sure she was in labor, described it and indeed I agreed to come quickly as it should like she was already close to transition. It was very cold  and snowy that night in Anchorage.
 I went over and she was sitting on the toilet. Her water bag had just broke right before I got there. As dad and I were setting up the room,  in a very loud voice my client asked "Is it normal to have black stuff  coming out of my vagina?" as was showing me the toilet paper with  Black poop !
What does that mean, girls and boys?
Yes, frank breech baby.                
This was my 2nd one by myself.

I had let them know I had only done 1 other breech and that was a surprise hospital birth, the surprise was I caught  the baby with just mom and dad in the room. That baby had just slid right out.

We discuss the pros and cons, true informed consent, warning them of my lack of experience with breech. Parents and I pray about it. They decided to go ahead with the home birth. I call my back up doc  give him the info, he said politically he needed to tell me not to do it and to transport- I explained that I thought she was going quickly and wasn't sure we would get there. I had brought one assistant who had never attended a breech birth, so I called an RN who has said she attended many breech births in huts in Viet Nam in the 1970's as I thought she would be able to help me. She only lived a block away and she got there quickly.
All was going well, mom was dilating quickly. and quickly got the 10 and was begging to push but I  was taught to check cervix and make sure it was all gone before "allowing mom to push" I brought her bottom to the end of the bed.
 His body started out as anterior and quickly rotated to complete posterior and I never saw this in the "text books" so I knew he had to turn. I gently rotated him to anterior position. Now I realized his arms were above his head, I waited for them to come out, but everything slowed down, all I could think of was to reach above his head, one arm was twisted behind his head, but ended up sweeping them across his chest one at a time to bring out his little arms to his waist. Wow, I thought ok any time he's just going to fly out.
I did at some point gave her a large episiotomy, mediolateral that required a hosp repair, it did give me more room to maneuver my hand but did nothing to bring him out. I let him dangle with hands off until again he was not moving out any further, He came out to his mouth and I realized his head was coming out asynclitic-off centered. All I could think was to get o2 on him so I had my assistant place the tube by his nose mouth. Now, all of a sudden I realized his head did not flex downward with his chin pointed downward on his chest. So he was trying to come out with his head not coming down correctly. I had a thought that popped into my head, either I read it somewhere or what, I asked her to hang on one more time as I was going to place 2 fingers in her rectum. She just wanted her baby out to make sure he was ok.
As I place my fingers I could feel his forehead coming out wrong, so I flexed his forehead downward so his chin now repositioned to his chest, I felt it release the trapping of his head and out he came.

I gave him a few seconds and knew he was stunned, he had a great heartbeat as he did through out the labor. I gave him a puff with the bag resuscitator and he got a big lung full of oxygen and cried.  Mom and dad grabbed for him and cried with joy and anticipation.

I felt weary but joyous that he finally came out and looked great. His body was nice and pink but his head was pale white. The RN now started freaking out, saying something was wrong with him, and the fact his legs were folder up above his head. She quietly called the EMT's when she went into the other room.
By the time they got there the baby was nursing well, so parents refused a transport.
The RN continued to freak out, and mom started bleeding heavily as she forgot her own self and all her thought were on her baby,because the Rn had totally scared her. for her and the "baby". I told her I thought baby was just fine, but perhaps the RN knew something I wasn't aware of. I used everything to stop her heavy bleeding but as her lips now started to get pale, I told them I thought a transport was needed, as she was going to need an extensive repair. I apologized for having invited the RN, thinking she was going to be of help but instead in some ways showed me she didn't know much about breeches and said I thought she was fine we just needed extra help. That was the first time I transported for a PP hemorrhage.

We went in and I was greeted by my least favorite OB, He was an older German Dr with a heavy accent. He was quite scary, and bullied everyone. He asked me what happened and why did we stay home. I told him the truth. He lightened up and  said well, lets see about her repair. He looked at baby and the color of his head and said" his head was fine, it had gotten squeezed and it would soon get pink. He got a Pediatrician to check him out.
Mom did end up loosing quite a bit of blood and was required to stay in the hospital for several days. I knew she was upset that we ended up in the hospital, so she allowed me to do minimal care for them.  Both her and the baby's dad later thanked me for doing so much, they just couldn't get over being so scared by the RN. I was so sad, as I knew they  might regret  having a breech at home at that time. This boy is now a man and he should be about 30 now.

I almost stopped being a Midwife because of this birth. There was so many lies that came out through the hospital personnel, thus going through the community. I did much praying and re- evaluating the way I practiced.


I have done many breeches since and I believe that the first complicated breech helped me with all the other breeches I have attended. I believe that all Midwives and Docs need the training, because you never know what you could walk into.
Do I think all breeches are safe at home? No. Do I think all Midwives should be doing breeches? No. I think you have to have a strong trust that birth usually works just fine, women have unbelievable strength and that we should be ready for everything that could happen. For most of us that do attend breeches have chosen to do so, learning extra skills and are ready to do anything that is needed to have a safe birth. Know to transport when things aren't working, if you have the time. In my experiences breech labors are quite quick.

But I am a firm believer that most breeches can turn out just great out of the hospital. Do I think there should be a breech experienced person there to help? you bet! Do I do breeches now? Yes, but the parents are very well educated about the possibilities. I have done frank breech, complete breeches,  a knee presentation about 60 miles from a hospital-that was a complete surprise. and many footlings some presenting in twins. Several 2nd babies turning complete transverse, and required  maneuvering  then to footling, All of these breech baby's have come out successfully and none of these mothers or baby's needed to be transported for problems.

 My mom was a footling breech at home in 1933, with an old country doc on a kitchen table in Michigan.

Beginning my Travelling Midwifery

Well, I'm moving to Oregon in 3 wks for good.
I already took most of my clinic and home things up there already, but still have another small load to take up there. Glad I am getting away from New Mexico.They say they are midwifery friendly but they are not !
One of my new adventures is I will be doing traveling Midwifery to other areas for women who don't have midwives in their area or who want VBAC's in non supportive areas.

Traveling Midwife

Ok, I am now a traveling midwife, and I love it. I'll probably do this for at least several yrs. This way I can offer midwifery home births for people who don't have supportive midwives in their area for their births.
I flew to Bermuda on May 13 and I landed on a very beautiful island. There are no midwives there as it is illegal. The minute I landed I felt right at home like I've lived there forever.
Last winter I had been hired by a couple who wanted a home birth. Their first child was born in Canada, a transported home birth to the hospital for meconium staining. They were fine with it, but this time they wanted to try for a home birth again. I got to know the couple well as well as her family, as I was living upstairs with her mom and dad. So by the time she gave birth, it definitely was the whole family who organized the home birth. I was so grateful that Mom and I talked about not being attached to the experience of the birth, in other words she let go of all of her worries, wishes and was willing to just let the birth happen without allowing her brain take over or worry she might not get a home birth. It would be what it was.
She stayed at 3cm to 5cm for about a wk or so. She woke up in the am knowing something was going on. They got their son together to go of with Granny B for the day.
Real active labor started@ 10 am. I checked her and she was 7cm 100%.  She was in good humor but you could tell where her brain was. Dad was excited, and I'm excited for the both of them. Her last birth had been about 6 hrs total- but for some reason as I'm watching her, it seemed as though something was off with this birth. She got in the birth tub, only to have her contractions slow and almost stop after about 1/2 hr in tub. I had her get back out and things started picking up. I checked her again and she was 9cm, and feeling pushy. But after  1/2 hr to 45 mins her contractions slowed to nothing. I gave her a homeopathic to get her going again. It kind of did something but not much. She got out of tub again, and was walking with her husband. She labored for awhile and all pushing urge went away. I checked her one more time, because now I suspect a head malposition, and indeed it was confirmed that she was now 7 cm and baby was coming down asynclitic. Baby was trying to come out with the right side of it's head, and it wasn't working. So, mom and dad and I talked about what was going on, baby sounded great so I started to try to reposition baby's head. Now, gals, it's not pain free with almost a full hand in you with a head down there also, but you can cope with it fairly easy and it's better than a vacuum birth or c/section. At this point we are on the tile floor, of course with all of our paper padding. Mom, dad and I are all entwined with our legs to birth this baby-so we all felt like we birthed this baby. Baby was trying to help me, but just as I got the head position right, it would turn right back to the old position. Mom now has her head under the bed, and I burst into laughter at the picture of the three of us. Mom keep up her energy and after an hr of pushing finally the head is crowning, I grabbed dad's hand and placed it on the head as it emerged, so gently. The head came out, and rotated and mom was ready with open arms. This couple greeted their newborn son, in dim lights on the floor in a cave like room, it was perfect, it was holy.
This is why I'm a midwife.

Side line- several nights before the birth, I had a dream that our wonderful doula was not at the birth and that it would only be the three of us. I told mom, and we just thought about it. The day of the birth the doula came over, all excited at being at another home birth. After being there for 15 minutes, she got a call from a couple who were birthing at the hospital. We told her we were fine and that the other couple really needed her. The dream came true.

with much love, sherri