Friday, March 27, 2009

Beauty in Birth

Many times women have asked me about the moms I support in labour. Well a picture is worth a thousand words.

As a doula, my focus has always been on the mom. It is incerdible to see the emotions and feelings, expressions and that smile, smile of knowing.

I wish to share with all my view of progress in labour...

Thursday, March 26, 2009

Birthing: Who is the specialist?

As I drove up and down the DND flyway each day, I found these series of advertisments on billboards. As it is with kids asking questions ... mine were full of them on long drives. They first brought to my notice how each billboard was a speciality... some of which like Gastro I explained to them.

And then they said "Oh! Birthing is a speciality too".

This stayed with me for many days. Do the hospitals see this "Birthing" the way we (my birth friends) do ? So I took this video as I drove past the billboards the next time around. See how Birthing, not birth though is tucked away between Lungs and Cancer.

Each of these department have specialists, who would diagnose and treat each of the problems. Its no surprise that Department of Birthing, will diagonse the Symptoms of pregnancy and treat us with best care of specialists.

Birthing is a speciality, but the important question is who is the specialist? Its something to think about

Thursday, March 12, 2009

Faith, Hope and Change

(Mom, Dad, baby and Me, 7hours after birth. Around 4 pm, 12th March 2009
A few hours later .. Dad and me look tired after the night's effort but the real "expert" looks glorious)

The drama around this birth was phenomenal. To begin with the mom got a cervical stitch, progesterone and bed rest.Once she was deemed to be fit to move..she came for my class. She was enthusiastic about birth and was exploring her own feelings about natural birth. My story begins when she was at 36/37 weeks.

There was uncertainty about the due date with LMP, length of the cycle and first trimester ultrasound. At this time her ultrasonologist (expert!) said that the baby was not growing well and was lagging by 3 weeks... also that there were two loops of the cord around the neck. At first, the loops were a total non issue. The low weight kept her worrying ... She lived in fear for the baby's well being.

A week later there was another ultrasound. The baby had put on adequate weight but now the loops had become really tight. It was presented as if that there was danger to the baby. She was suggested restricted movement and bedrest so that it may not cause any kind of harm to the baby. She went for a non stress test twice a day. Just to make sure that the baby was still ok. The two loops, it was serious since the loops were really tight. It was the experts opinion that there was no way this could change since there is no room for much movement for the baby. The course of action suggested was to some how get through the next few days so that it would become officially 38 weeks. Infact, the expert opinion was that much can malfunction after 38 weeks so its a good idea to have them (the baby) out about that time for most women.

She was hysterical would be an understatement. When I met her (to hold her hand as she went for a second opinion) it seemed that her baby was in a ICU unit. She visited and checked on her well being twice a day at scheduled half hour (NST). She was trying to get through each day safely to reach 38 week when it would be ok to get the baby out.

I looked for the wise women in my life ( fellow CBE, doulas, midwives) for inspiration, and it was wonderful to see how many took time out to respond and while there were varied opinions ...
We went for a second opinion and the baby was in danger zone was clearly ruled out.
I thought hard about how I could best support her. I posted a gist of what happened on my wise women forum as below

Hi Everyone,

As always there are many aspects to this particular situation. here are facts as I heard them today...

There is a mismatch between the EDD with first trimester ultra sound and LMP. There was always a mismatch between the age of the baby and the EDD (ultrasound)
The fluid is fine
The placenta looks good
the blood flow to the baby is just fine.
She for the past two days has been paranoid about the baby choking to death with the cord around the neck. her concern wasnt really about the c sec or birth or scheduling the C sec... here it is about safty of her baby. She wants to hear the heart rate every half hour now and would panic if she didnt feel any movement for half hour.

Firstly, we asked the doctor if the baby was under any threat right away
(her first concern was the baby is in crisis)

After the doctor reviewed her records and ultrasounds and a physical exam...(not internal) reassured her that with adequate amniotic fluid the baby and cord were able to move around and that even with two cords he was not going to choke. She said it was important that she relax and not be paranoid.

Secondly, the doctor said that since each doctor had their own way of setting protocols, while she would be willing to wait and watch , her doctor may feel that it needs more take charge appoach. However, it would be helpful for all of them if she would speak to her doctor openly how much this was scaring her. Also, she suggested that maybe she could negociate more time with her own doctor by agreeing to monitoring, and seeing that the baby was putting on weight now or what ever the doc was comfortable with.

While she assured her that the baby was in no immediate danger, the doctor encouraged her to speak openly with her doctor as well. At no point did the mom or the dad suggest change of care and neither did the doctor.

I knew at that point changing her ob was not an option they were looking at. For many reasons that are best known to her... she was going to be with the same doctor.
Then what did this second opinion mean here... reassurance and answers to questions that her own doctor did not give
Changing her doctor was agood choice but it had to be her choice, but it was redundant as a choice here. And she needs support, how can i support her here? that was my bigger dilemma.

I spent last night thinking...

I reinforced that each doctor had their own way of working and it would be unfair to say right or wrong at this time to one or the other, therefore she should discuss it with her husband and then choose. What i gathered was that she had just been through an argument with her extended family about this.

More than making it perfect, it was important to make it right for her. So I suggestd that even though nothing may come of her talk with her doctor and negociation for time, She still had a few days to show her baby that a good world awaited him. I think it was important for her get connected with her baby and reassure him that while all this is going around him, she is still excited about his birth and that no matter how and when it took place, mom is going to be there for him. She was crying and said that it has been over a week that she hadnt thought of her baby as a healthy person, she felt he had been in a ICU unit while she was worrying about his well being. So she and her husband are going to try and spend a lot of time together.. uptil 4th. Also, they intend to speak to the doctor in terms of all other aspects being healthy, and baby growing, and monitoring maybe they can negociate for more time. And even if they dont manage to change that, they are focusing on the birth of their baby.

It has been a difficult day... and while it may not be the perfect solution, it may be the right one for her in this case.

Thank you everyone for yor input and support.
Love
Divya


The Sunday before the scheduled C section she did come to my childbirth class... It was the session on labour and birth. She sat through it, albeit distractd. After the class we talked about how we could negociate for more time. While I am not a big fan of ultrasounds... we thought if the next one showed that baby was putting on weight then perhaps we could buy some time.

However, she got admitted to the hospital for the surgery, for some reason she insisted on another ultrasound. "No need since the space is tight, cord loops are tight its rather impossible for status to change".. yet she insisted. Lo beold! no loops or loop any more. At some point I had said that baby inside was a living miracle and we should never underestimated his potential for achievement... So I was the first to get the call that said... "we had checked in the hospital for a C sec but with loops gone .. i have checked myself out"
Aparently the ultrasound expert felt that was a waste of effort since her structure (size, height, hips what ???) was such that she would invariably have a C section.
Considering that the fluid was adequate, cord and placenta we just fine, the baby was putting on weight, seemed like she was very fine and normal. Few days ago she had a show... the doctor wanted to induce her. This mom negociated and delayed the induction. After all this and much discussion she made the descion (with the support of her family) to change her doctor.

Last night, her waters leaked at around 11 pm. She called me at midnight and the doctor called me as well seperately saying that I should come and support her. There was much flurry around her as I walked into her room. Seemed like her contractions that were good and going had slowed down .. really slowed down. A resident on the floor wanted to help her along..so I was negociating right off the bat.
As we shut down the lights and got down to foot massage... contraction began again. She laboured through the night dozing in between contractions, contractions never closer than 5 mins, and early morning she had a back ache.

A check in the morning by the doctor showed her to be 7 ... moving to 8 and then to 9 in one contraction. The head was not entirely in position so we got her in all four/ knee chest position.

8:45 am this morning she gave birth to a beautiful baby girl weighing 2.95 kg. Baby and mom were resting together as I left the hospital .