Whip 'em out

On public breastfeeding

My first VBAC client

VBAC is the acronym for vaginal birth after cesarean.  In the past, there has been some debate about whether or not VBAC is a safe option, due to the slight risk of uterine rupture at the site of the scar from the previous surgery- a very serjous complication requiring emergency surgery.  However, the overwhelming evidence is in- VBAC is safe, and even the ACOG now recommends that all women be given the opportunity to have a vaginal birth after a cesarean... in fact, even after two previous cesareans!

My client approached me several months ago, about her upcoming August due date.  We had a few discussions by email about her history and previous cesarean surgery.  Her main goal in her upcoming birth was to give birth with medical intervention only if it became necessary.  Mom dropped out of contact with me- we both had vacations, and she was a busy working mom.  I assumed she was no longer interested.  And then suddenly...

I got  a phone call from the mom, and we arranged a meeting.  She was already 39 weeks pregnant when I met her and her husband and their son.  We spent three hours talking about the Cascade of Intervention, and strategies for dealing with labor this time around.  Using The Thinking Woman's Guide to a Better Birth as a guide, mom decided to attempt to wait until at least 5cm before getting an epidural, thus reducing the chances of the epidural derailing her labor.  As a safety net, we also talked about setting a limit on how long labor would go on for before mom would get an epidural, as her last labor had stalled out, and she did not feel like she could cope with the idea of an endless labor without pain relief. Mom's homework was to determine exactly what her time limit would be, and how we would handle it if she had labored for that long and still had a fair bit left to go.

I suggested we meet again in a few days to continue talking through labor and birth, but mom was sure we could wait a full week, as the baby would not come early.

The best laid plans of mice and men...

Two days after I met this wonderful couple, my cell phone started to ring... at 5am.  Frederic and I looked at each other, and I said, "That's her!"  Sure enough, mom was in labor and heading to the clinic.

When I arrived at 7am, mom was on the monitors in the triage room.  She was 1cm dilated, with a long, posterior cervix.  She was really concentrating with each contraction, and occasionally needing to vocalize with them.  Both the doctor and the midwife assured mom that she was making too much of a circus for being in early labor, and to try to get some rest or get the epidural.  Luckily, the doctor left and the midwife went off shift, to be replaced by a wonderful, supportive midwife. 

We moved to the labor and delivery room at about 8am, and mom chose to get on the birth ball for a while.  And things PICKED UP a lot.  At 9am, she was 3cm.  At 10am, mom said she was reaching the end of her coping ability, and that she couldn't do it anymore.  I knew what that meant!  I suggested she ask for a check in order to get some encouraging news.  Sure enough, she was 7-8cm dilated.  So much for making a circus over nothing!  And let me say, this mom was laboring calmly and although she felt like she was reaching the ends of her reserve, from the outside, she was doing beautifully. She still had the energy to smile and laugh between contractions.  The dad was also a fantastic coach, very encouraging of mom's hard work. 

An hour later, mom was ready to push, and an hour after that, a beautiful little baby boy was born.  Mom coped incredibly well, pushed like a bear, and ended up not wanting an epidural at all.

If you are considering a VBAC, be sure to check out these resources:

• International Cesarean Awareness Network (ICAN)
• Lamaze Healthy Birth Practices videos (and text)
• Finding a supportive doctor
• Reviewing the benefits of vaginal birth for you and your baby

Breastfeeding Week is coming to an end

I thought I'd talk a bit about my personal experience of breastfeeding, in honor of the occasion. 

Adding my two children together, I have been breastfeeding now for two and a half years, and am still nursing my 17 month old. 

With each child, as soon as they passed beyond the newborn stage, I began to prepare myself to recieve the inevitable negative comment about breastfeeding in public.  And gosh darn it, I have yet to get one!!!  When you have spent endless nursing minutes thinking up snappy come-backs, this is almost a disappointment!

I have had several people stop to tell me that it was beautiful to see a mother nursing her child, that nursed children are smarter/cuter/friendlier/whatever, I've even had srangers stroke my baby's head while I'm nursing.

Sigh.  So much for getting to be snappy and sarcastic.

Really though, nursing has been one of the single greatest treasures of motherhood for me.  It is hard to remember that with a teething distracted toddler, and about a week ago, I decided to go ahead and wean Ivy.

And so I let her nurse one last time, and I remembered all of the things I loved about nursing, and tried to really honor the final event.

And in doing so, I fell back in love with our nursing relationship.  Ivy only nurses once or twice a day, and doesn't really ask to nurse, but accepts happily when it's offered or she suddenly remembers my breasts.  So I do think she is on her way to self-weaning.  And so for now, I'm ok with letting her lead.  I'm never going to look back and say I wasted too much time nursing.   

Questions to ask a doula

Doulas of North America (DONA) has a page designed to help moms find a good match from their local doulas.  They have a list of questions to ask your doula, and just for fun, I thought I would answer those here:

For any doula

• What training have you had? (If a doula is certified, you might consider checking with the organization.)

I am a certified Labor Doula through the organization Childbirth International.  This organiztation offers self-guided learning, with a regional trainer who grades work, answers questions, etc.  The training is divided into three modules- communication skills, pregnancy and birth physiology, and doula skills.  I began studying in 2008, and recieved my certificate in 2010.  

• Do you have one or more backup doulas for times when you are not available? May we meet her/them?

Yes.  I only take on one client per month, which allows me to virtually guarantee my presence.  In the event of an accident or emergency, I am in close contact with several local doulas who could take on a client at a moment's notice.  However, none of these women are native English speakers.  Most do speak adequte conversational English and would be excellent support during labor and birth, despite the language difference.

• What is your fee, what does it include and what are your refund policies?

My fee is 600chf.  It includes 3 prenatal visits to discuss your needs and wants, and to work on birth preparation, an on-call period starting at 37 weeks until you give birth, and 3 post-partum visits for help with any aspects of new mothering.  I offer a refund of 350chf if I miss the birth because it is simply too fast for me to get there on time.  I do not offer a discount if you simply decide not to contact me at the moment of the birth.

When interviewing a birth doula

• Tell me about your experience as a birth doula.

I am not the world's most experienced doula, but I have witnessed a home birth, a hospital birth, and a private clinic birth.  I've seen two water births (and had one myself!), an induction, and a VBAC. I feel very comfortable in the birth environment and do not feel that my limited birth experience has any negative impact on my clients, and neither have they.

• What is your philosophy about birth and supporting women and their partners through labor?

I believe birth is normal until proven otherwise, and that women should be allowed full autonomy in their decision making as it relates to their child's birth.  Women should have facts, and not opinions, with which to base their decisions.  

• May we meet to discuss our birth plans and the role you will play in supporting me through birth?

Yes, I offer a free consultation with anyone who would like to discuss the possibility of having me as their doula.

• May we call you with questions or concerns before and after the birth?

Absolutely.  

• When do you try to join women in labor? Do you come to our home or meet us at the place of birth?

I come when you feel like you need support.  For different moms, this can mean different things.  I don't mind being with you from the first contraction, and I don't mind waiting until you are in really active labor.  Keep in mind that you should call me about one hour before you think you'll need me.  This gives me time to arrange my stand-by child care, and travel to your location.

• Do you meet with us after the birth to review the labor and answer questions?

Yes.  I think this is a really important part of the post-partum sessions.  When a mom is in labor, it is easy for her to lose track of time, space, reality... she is working hard to bring her baby into the world.  Often times, moms later find themselves curious about what exactly happened and when, why certain decisions were made or interventions proposed or administered, etc.  This information can be very useful for the mom in processing her birth experience.  

Birth Doula film

What's on my bookshelf?

I am having a hard time getting started with this blog. I feel like there are many more experienced and more informed bloggers out there covering the big news, and it's hard to just jump in the pack and run with the she-wolves!

Baby steps, baby steps...

I have been reading a lot, as usual, and am going to add a page feature about what's on my bookshelf, and try to do some regular book reviews as well. This will give me some good filler content and hopefully be useful to someone out there!!!

I have finally polished off my entire collection of "entry-level" reading, by that I mean those books which would also appeal to expecting or new moms, as well as midwife memoirs, so I'll start with those.

I've got three fat midwifery texts left- I hope to get through them in the next couple of years, so that I'm primed and ready to start school when my kids do.

Out of the blue...

Online Nursing Degree