Seren’s Birth Story

Seren’s Perfect Home Birth

Born May 23, 2010 at 9:46 pm

7 lbs 10 oz, 13.5 inch head circumference , 20 inches long

I think I knew I was going to be going into labor on Saturday night (May 22).  I had just spent Friday and Saturday at the Colorado Midwives Association conference listening to the legendary Ina May Gaskin and when I got home I just felt like I needed to get the house ready.  I was sort of irritable, flying around putting laundry away, etc.  Kyle said, “Just do it tomorrow” but somehow I knew I should do it then.  I had some sporadic contractions all Saturday evening (about 5-10 minutes apart but nothing serious), then had a glass of wine and went to bed.

I continued to be woken by contractions all night long, some of them even working their way into my dreams!  I had a dream we got pulled over by two cop cars for making an illegal U-turn.  I was in the driver’s seat but somehow Kyle was driving.  They asked me to step out of the car and I proceeded to have a contraction (in the dream and in real life) and squatted next to the car.  The cops sort of backed away and said “Umm, never mind!”

I woke up around 7 am with contractions that were about 10 minutes apart and 1.5 minutes long.  They were stronger than they had been and just weren’t going away.  At that point I was thinking that I was maybe 75% sure I was going into labor.  I got up to eat breakfast around 9 and as soon as I was upright they got a lot closer together (3-5 minutes) but still very manageable.  I tried to eat some cereal but was kind of nauseous and gave up.

Laboring in the bathtubKyle took care of the girls while I spent some time in a lavender bath my friend Ashley had gotten me.  They would slow down to about 10 minutes apart when I was laying down so I knew it was still early.  I decided to take advantage of it and get some rest while I still could.  I got out of the tub and laid down for about an hour.  Haven came in to join me and we cuddled with her rubbing my back during my “belly squeezes.”  It helped so much to see her sweet little face looking at me during the contractions!  I just kept thinking that I was about to have a sweet little girl just like the one in front of me.

I got up around 1:30 pm and Heather (one of my best friends) came over to hang out with Haven while Lyric took a nap and Kyle and I walked around the park by our house.  It was a BEAUTIFUL day!  Blue skies, warm but not hot, light breeze, perfect.  We had a leisurely time walking around and swaying during contractions and talking.  We definitely got some looks from neighbors!  The only down side was that there was only one port-a-potty in the park and with Seren’s head so low I had to pee all the time.  Whenever my bladder was full I’d have lots of contractions (about 2 minutes apart) which made walking to the potty really hard!  Not to mention the ones I would have in the port-a-potty…

Haven and I nappingStacie (my midwife) and Miranda (my friend and doula sister) kept telling me that I didn’t have to keep walking if I didn’t feel up to it but it felt so good to be out in the sunshine.  I even got a little bit of a sunburn during my labor which I think is fabulous!  We walked around for about two and a half hours, just making loops and walking with one foot on the curb when I could.  Sometimes we’d sit for a bit in the shade and update our birth team.  Heather was the only one at our house yet so we were letting Stacie, Miranda, Jessica (our other midwife), Diane (one of my best friends), and Ashley (my friend and photographer) know where things were at.  The contractions were (on average) 3 minutes apart while we were walking and sometimes spaced out to 5 minutes apart when we were sitting down, so I knew we were down to business but things were still early.

Back from the park

Back from the park

At about 4:30 pm I started to feel like we should head back to the house.  We got home and ordered some sandwiches from Jimmy John’s (the peppers were great until they weren’t).  I could feel something switching over in my mind and body, and I felt like I wanted to start turning inward and go inside myself.  I sat on the couch, Lyric in my lap, and breathed through some strong contractions.

Stacie came at 5:30 pm and I could feel things starting to move into active labor as I was rocking on the birth ball.  The contractions were getting much more intense, much harder to relax into, and I started feeling sort of shaky.  Stacie wanted to check me just once to try and figure out when to call Jessica, our second midwife.  Seren’s head was so low in my pelvis it was hard for her to feel behind it and all the way around my cervix, but she told me that I was safely 5 cm, if not 6 or 7.  This made me so happy!  I was so worried I’d be 2 cm and be disappointed.  I told myself I’d be satisfied with 4 cm and happy with 5 cm so this was perfect!

I decided I really wanted to get in the birth tub and I wanted Jessica and Miranda to come.  I wanted to give Jessica a lot of time since she was driving up from Colorado Springs just for us!  I think everyone got here exactly when they were meant to, even Ashley who flew in from Oklahoma at 6 pm and still made the birth!

Haven laboring with meI got into the tub and have seriously never felt anything so wonderful!!  The warm water washed over me relaxing all the muscles that I could relax and I felt like I could sink into the contractions so much easier!  I labored in the tub while Jessica, Diane, and Miranda made their way here.  Heather, Diane, and the kids played together outside and it was fun to hear their voices in the backyard.  I think it was a good distraction for Haven and Lyric to have some friends to play with them.  They came up periodically.  Haven was particularly interested and wanted to hold me through some “belly squeezes.”  Lyric came up and saw me have a contraction on the toilet and looked a little concerned, but when she saw everyone’s smiling faces (including mine) she seemed reassured.

Birth teamI stayed in the tub most of the time, leaning on Kyle and moaning through contractions.  Miranda was rubbing my back, and Stacie and Jessica would wipe my forehead and hold my hand if I needed them to.  Everyone was perfectly in sync and were exactly what I needed!  If one of them had to leave the room for something it felt like there was a definite void.  The contractions were getting more intense and taking on a different quality.  The contraction itself felt mostly muscular, but during the peak they started to take on a skeletal quality as well.  I just felt like my whole pelvis felt sort of achy.  This was different than my births with Haven and Lyric.

Kyle and IIt turns out that this was because Seren was facing sunny side up.  For those of you who don’t know, most babies come out OA (occiput anterior, or facing mom’s back).  If a baby is OP (occiput posterior, or facing mom’s front) there is usually a greater surface area to the head and the back of the head pushes into mom’s sacrum causing what’s called “back labor.”  Because I was carrying Seren totally different than Haven and Lyric (Seren’s back was always on the right, the girls were always on the left) this was my number one fear!  I’ve been at births with women experiencing back labor that described it like an axe embedded in their back, even in between contractions. It can also cause a lot of false starts to labor, long labors, long pushing stages, etc.

I didn’t want this to happen to me!  The completely ironic thing was that I never had back labor.  Besides the sort of aching in my pelvis it was completely normal!  Not only that but it was by far my fastest birth!  Apparently I have one of those pelvises that can accommodate an OP baby.

Around 8 pm things started to get really intense.  The contractions were coming about every 3 minutes and it was getting more and more difficult to relax through them.  In between, however, I was really able to relax and be present and happy about my baby being born that day.  I asked to have some music played (Heart Sutra: Bliss and Serenity) and it just made me cry!  It was the music that was playing at our wedding and at Lyric’s birth, and it made me think of when my last sweet baby was born.

Getting more difficultI was starting to think that this intensity was going to last forever.  I had only been checked once (I had GBS, group B strep, in my urine and everyone agreed on keeping vaginal exams to a minimum) and I had no idea how close I was to giving birth.  I also had never lost any of my mucous plug or had any bloody show, the usual signs that you’re getting closer.  I was starting to think I couldn’t do it.  Jessica said, “Don’t worry, she’s just packing up her womb” which made me laugh.

And then everything happened at once, LITERALLY!  I felt a huge gush as my water broke like a torrent.  I immediately started projectile vomiting (on Kyle, sorry babe!), and as soon as that subsided I felt her stretching my perineum.  I shouted, “She’s coming NOW, go get Haven!” and that was all I could muster before my body took over and started to bear down.  It was the most amazing, crazy, beautiful, frightening thing I’ve ever felt!  Haven’s pushing and birth had been very coached (first baby, epidural) and even though I waited for a while with Lyric I never had that urge to push.  This was completely different.  My body took over and it was like I was hanging on by my fingernails!  Jessica told me later, “It’s like throwing up except it’s throwing down,” which is exactly how it felt!  I’d never realized how strong the fetal ejection reflex is.

She's born!Kyle jumped in the tub to catch Seren like we planned (in his clothes, there was no time to put on a swimsuit) and Haven did as well.  A few minutes later Seren’s head was born, it whipped around like a corkscrew, then shoulders, and then she was out.  I couldn’t believe how aware I was of every sensation.  I could feel every contour of her body as she came out and there was such a relief once she was out.  I had really wanted not to tear with this one like I did with the others and had told everyone prenatally that I wanted reminders to go slowly, stretch, breathe her out, etc.  Now everything was happening so fast that I felt like my my mind was telling my body “Slowly, breathe!” and my body was saying, “Nope, here we go, out she comes!”  Even so, Stacie told me later that my body eased her out beautifully, that it took breaks when it should have to let her rotate, that I stretched wonderfully, etc.  In fact I didn’t need stitches after all!  I only had a “skid mark” that would heal if I rested enough postpartum.

FamilyFrom my water breaking to Seren coming out was just 6 MINUTES!  At this point Lyric was upstairs as well.  We had tried to get her up here for the birth but everything happened so fast there just wasn’t a good opportunity.  She jumped in the tub with us and started blowing bubbles in the birth water (oh well)!  The girls took turns smooching Seren’s head and Lyric kept pointing to her saying “Baby, nursing!” though quizzically looking at my empty belly.

Beautiful girlWe all looked our new baby over.  No one could get over the fact that she was such a pretty baby!  So perfect and chubby with a button nose and sweet little rosebud lips and a little round head.  She reminded me a lot of Haven, especially the nose.

Since she came out so fast Seren was a little stunned.  Her APGARs were 8-8 (off for color and tone) but her respirations and heart rate were as perfect as it had been during labor.  A little postural drainage from Jessica helped her get some of the gunk out and then she pinked up quite nicely (no bulb syringes at this birth thank you very much!).  Kyle felt that the cord was still pulsing so we knew that she was still getting lots of oxygen from the placenta.  About 25 minutes later Seren latched on (and I got a dose of Angelica herb), and I felt cramping and pressure, as well as a little separation gush of blood.  Then I pushed out the placenta.  All in all I only lost 250 cc’s of blood, which is really great!

In bedWe decided to go and get cozy on the bed as a new family.  Seren kept nursing like a champ.  After a long while of that I got up to try and pee and Kyle took Seren for a while.  He was such a sweet daddy, smooching and loving on her.  He had waited for a long time to hold an itty bitty baby.

Haven cutting Seren's cord

Haven cutting Seren's cord

I came back and we did the newborn exam and of course she was perfect, term, and healthy!  Stacie helped Haven to cut the cord like she had been telling her preschool teachers for months.  Then Haven got to hold her (Kyle had to put Lyric to bed, she was so tired) and Miranda made placenta prints which turned out beautiful.  I was feeling great and Seren was nursing and pink and beautiful when everyone went home.  In fact, Seren nursed until 2:30 am when I finally cut her off and gave her my pinkie finger so I could get some sleep.  She’s still a champion nurser.

It was by far the most perfect, lovely, empowering, beautiful birth I could have ever hoped for!  I absolutely loved giving birth in my own home because I could settle into my space and my body and it made everything really peaceful and manageable.  I wouldn’t do it any other way!

Daddy smooches

Our midwife Stacie Meredith

Our midwife Stacie Meredith

Haven holding her sister

Haven holding her sister

Seren's first morning

Seren's first morning

Advertisements

Fabulous Sibling Prep Book!

I just got the best sibling prep book for any sibling and/or parent who is interested in attending a birth.  My Brother Jimi Jazz follows the story of Trinity as she prepares for the birth of her new baby brother.   It’s frank and honest, but still very beautiful.  It has the laboring mom in all these great, active positions like hands and knees and squatting.  It talks about making birth noises, the crowning, umbilical cord, how the placenta looks like a tree, everything!  The book has great illustrations that are both realistic and beautiful.  I think this book is essential to anyone planing to have a child attend a birth!  Of course, it is a part of my lending library.  You can view the author/illustrator/mama/doula’s website here.  You can purchase it from Attachments Catalog and it’s a little cheaper.  She also has a new book on breastfeeding that I’m interested in buying.

New book/dvd in my library!

I’m so excited, I just ordered a new book/dvd set entitled “I Watched My Brother Being Born.” I think it’ll be great to add to my list of kids books and a resource for my Sibling Doula niche.

Here is a synopsis for the book:

This book by mother and daughter team Anne and Katarina makes a great compliment to the DVD by the same title. Katarina and her five year old brother Magnus watch their baby brother being born and tell about it in this charming and fact-filled book. The book takes on the voice of Katarina but also has an introduction for parents.

“My goal with this book is to teach our children that giving birth is a natural, safe and fulfilling process. Unless the birthing mother has an illness that needs special medical attention, it need not be treated like a disease. By including our children at birth they can see that it is a normal and healthy physical event…”

Illustrative photos from Anne’s third childs actual birth at home in a birthing tub make this book a rare find.

Here is a synopsis for the dvd:

I’m really excited about this great DVD that shows home water birth with children present. This is a great tool you can use to get your child(ren) ready to experience the birth of a sibling. This 21 minute movie is about two siblings ages five and seven who are present for their brother’s home water birth. Partially told in the voice of seven year old Katarina, this is an excellent resource for expectant parents and birth professionals who are wanting to prepare children for the arrival of a new baby. A paperback book version seen above is also available which is a great accompaniment to watching the video. 21 minutes long.

Getting Breastfeeding Off to a Great Start

Here are some tips for gaining the advantage in successful breastfeeding:

  • Get baby to breast immediately! – The time right after your baby is born is precious.  Babies are often alert right after birth (especially if the birth was unmedicated) and will usually latch on.  However after an hour or so baby falls into a deep sleep (being born is hard work!) and may not wake to breastfeed again for a while.  Also it’s important that baby recognize and bond with mom as well as imprint on the breast at the start.
  • Room in with Baby – Keeping the baby with you (rooming in) and not in the nursery allows you to feed entirely on demand and helps you and your baby get to know each other.  Babies who room in lose much less birth weight than babies in the nursery.
  • Only Mama – Make sure your baby gets nothing but you to eat!  Supplementing with formula can lead to a decrease in milk supply.  If a baby gets a pacifier or bottle this can lead to nipple confusion.  A baby actually has to work to get milk out of a breast by actively sucking.  With a bottle, all baby has to do is stop the flow with his/her tongue.  This can spoil and confuse babies and they might refuse the breast.
  • Natural Childbirth – Studies have shown that some babies who received drugs during labor (via IV, mouth, or epidural) can be sleepy or have trouble latching on.  This can be because the drugs make their lips numb and they have more difficulty with their rooting reflex.  If you can, try and get the hands-on support you need during labor so you don’t have to take medication unless it’s necessary.
  • Get Support – Attend a La Leche League Series Meeting for mother-to-mother support, join a breastfeeding moms group, or consult a lactation expert.  I even recommend that women planning to breastfeed attend a La Leche League Series (4 meetings in a row) while they are pregnant.  Each meeting has a different topic and you can get a great base of knowledge before the baby is even born!  Visit this site to find a meeting near you.

Tips on Writing a Birth Plan

Here are some things to consider when writing a birth plan:

Some people like birth plans, others feel it’s too restrictive.  If you’ve thought about what you want and talked with your provider and feel comfortable that everyone’s on the same page and you just want to go with the flow, please do!  If it feels better for you to have things organized on paper rather than in your brain, here are some tips to help you along!

  • Know your options – They say if you don’t know your options, you don’t have any.  Research different elements of labor, birth, and postpartum.  A great place to start is to read The Thinking Woman’s Guide to a Better Birth by Henci Goer and Gentle Birth Choices by Barbara Harper
  • Keep it brief – No hospital staff is willing to read a 20-page manifesto!  Keep it simple and use bullets or numbers.
  • Prioritize – There are so many things you might want in your birth but choose the few that really mean a lot to you, ie, keeping the baby with you skin-to-skin after birth.  Don’t put things in your birth plan that you know aren’t allowed, for example if the hospital doesn’t allow waterbirth, it won’t mean much that it’s in your plan.
  • Use positive language – No one wants to deal with a belligerent person!  Instead of “We don’t want the baby taken away” say “We prefer the baby to be examined on mom’s chest and to stay skin-to-skin as long as possible”
  • Separate wishes into categories – By organizing the list into “Labor”, “Birth”, “Postpartum”, and “Newborn Care” staff can easily find what your wishes are.
  • Talk with your Partner – It’s important you’re on the same page
  • Show the plan to everyone involved – Make sure your midwife/OB/doula know what your wishes are and can respect them.  If they can’t respect a vital point, it may be time to find a new care provider.  Remember, it’s never too late to make a change that could mean a world of difference to your birth!
  • Find out about waivers – See if you need to sign waivers to decline something in hospital/birth center policy.  For example, you may need to sign a waiver if you don’t want eye drops for the baby because you don’t, say, have a venereal disease.
  • Have care providers sign the plan – Keep the plan in your chart and carry one with you in your bag if it makes you feel more at ease.
  • BE FLEXIBLE! – Everyone has an idea of their ideal birth but it’s important to be flexible if something unexpected happens.  The main point is that you feel respected and consulted at every twist and turn of labor and birth.

Interviewing Your Midwife

Know your Midwife

It is so important to know what you’re getting into before you’re in labor!  Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you.  Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).

Here are some questions to ask your Midwife to make sure you find one who is on the same page with your birthing beliefs.  These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 249 (a great book, also in my library).

  1. What is your education and training as a midwife?
    It is good to discern if you are hiring a certified nurse-midwife (CNM), a certified professional midwife (CPM), or a direct-entry midwife.  Find out what their training or midwifery school was like.  The three groups represent vast differences in educational experience but not necessarily in the way they practice.
  2. What kind of testing or licensing procedure did you go through to become a midwife?
  3. How many years have you been practicing?
    Do you want to trust a midwife who is just starting out in independent practice or do you continue your search for a more experienced midwife?  Find this out right away.
  4. What is your general philosophy about pregnancy and birth?
    Midwives in general hold the philosophy that normal birth is not a medical event and needs to be respected for the creative process that it is.  I would be surprised if you found a midwife who viewed birth as a potential emergency to be prepared for.
  5. Are you a mother yourself?  How old are your children now?
    If you are choosing a midwife with young children, how will she be able to attend your birth if there are family needs?  Are you open to her bringing her young children and perhaps nursing child with her to your birth?  Ask her to share her birth stories with you.  Many women become midwives after a not-so-wonderful birth experience.  Find out about your midwife’s births.  Some argue that midwives who have never given birth cannot be as good as those who have had children.  I don’t agree with this assumption; I know some wonderful, talented, caring midwives who have not had the opportunity to give birth.
  6. Do you work alone or with a partner or assistant?  If you work with someone, what is his or her experience?
    It is important to meet all the people who will have any responsibility concerning your prenatal care, labor, or birth.  Some midwives take on apprentices or students.  Find this out in the beginning.
  7. How many births have you attended as the primary caregiver?
    How long has your midwife been in independent practice?  Has she always worked with an experienced partner?  You may ask for references from former clients.  Some midwives provide a chance for past clients and future clients to meet each other at informal classes or support groups.
  8. Do you attend births in a birth center or hospital?
    Perhaps this midwife has hospital privileges or attends births at home or in a birth center.
  9. How many births do you typically attend each month?
    For a home-birth practice, the most births that one midwife with one assistant can possibly attend is six to eight per month.  If she tries to attend more, there could be two women in labor at the same time, leaving one with no coverage.  Midwives in birth centers can handle many more births per month because they can attend more than one laboring woman at a time.
  10. Who takes over for you if you go on vacation or get sick?
    A very important consideration is who will take over the midwife’s practice if she is unable to continue or needs to leave for a certain period of time.  Make these plans with your midwife early on in your pregnancy.  Know that if you will be covered if anything happens to your midwife.
  11. Do you have guidelines or restrictions about who can give birth at home?
  12. Are these your policies or those that the state licensing requires?
    A midwife should have the same screening criteria as a doctor screening for risk factors.  Depending on licensing status, some midwives must refer to a physician for cases of breech or twins or even VBAC.  Other states have less restrictive or no guidelines.  This must be discussed.
  13. Do you require that I see a physician during my pregnancy even if everything is all right?
    A visit to a backup physician is usually in order just so you can meet and he or she can establish a chart on you.  If your midwife does not have an active relationship with a backup physician, it may be your responsibility to obtain a doctor and see him or her.
  14. What are your fees and what do they include?
    Just as with a doctor, most midwives’ fees cover all prenatal care, birth, newborn assessment, home care, and follow-up for six weeks.  Any lab tests, diagnostic tests, or extra doctor’s visits are not included.  Also not included are the costs of a hospital transfer, including ambulance, hospital, and doctor’s fees.
  15. Can you submit your charges to my insurance company?
    Many CPM and CNM services are covered by health insurance plans or state-funded Medicaid programs.
  16. What payment arrangements do you make?
    Most midwives will make an affordable arrangement to take payments throughout pregnancy.  Many even have payment forms and billing systems on their computers.  Payment of services in full is usually required before the birth.  Be considerate about the midwife’s bill and make clear and early arrangements for payment.
  17. How often will I see you?
    Visits are scheduled once a month until the seventh month, every two weeks until thirty-six weeks, and once a week after that.  Extra appointments can be scheduled at any time between regular visits.
  18. What are your guidelines concerning weight gain, nutrition, and exercise?
    Nutritional status will be monitored throughout pregnancy.  Most midwives focus on the importance of a healthy balanced diet and work with women to get the most out of what they eat.  Many midwives have special education in the use of herbs, food supplements, and homeopathy for pregnancy.
  19. Do you require that I take a childbirth education class?  Do you teach a childbirth preparation class?
    Midwives will often teach their own preparation classes.  Some midwives feel that they give so much individualized attention that couples do not need extra classes to prepare for birth.
  20. If I am planning a home birth, do you visit my home before I go into labor?
    Midwives generally make at least one home visit before they come to the house for labor.  They assure that the home is adequate and clean, and they help plan any necessary details with the couples, such as where the birth pool should go.
  21. When should I call you after my labor begins?
    Each midwife sets her own protocols about when and the reasons why to call after labor begins.  Generally midwives want to know as soon as contractions begin so they can plan their day (or night).  Some midwives will have apprentices who come right away, others arrive when they are needed.  Most encourage women to enjoy the early stages of labor and to get plenty of rest and eat if they are hungry.
  22. How do you handle emergencies?
    Ask very carefully just what kind of emergencies she is prepared to deal with and has dealt with in different situations.  A very experienced midwife may have different answers from someone just graduating from midwifery school, but their protocols should be very similar.
  23. In what situations would I need to go to the hospital?
    Find out exactly why you might be transported.  Transports can sometimes be an emergency, but more than likely they are for women who have been laboring for more than a day and become exhausted.  Find out what your midwife’s transport rate is and evaluate it.  Most home birth midwives and birth centers have a rate of less than fifteen percent.
  24. Would you stay with me in the hospital?
    Most midwives can accompany their clients into the hospital and stay with them, but in some states where midwifery is still illegal, the midwife cannot come into the hospital and admit that she has been attending a home birth.  Find out if your midwife has a good working relationship with a local hospital.
  25. What is your experience with water for labor and birth?
    Midwives traditionally have used water for pain relief during labor.  Many are now advocating its use by all of their clients.   It is difficult to find a midwife today who doesn’t use water in labor or for birth.
  26. Can I give birth in water?
    Ask if your midwife has access to a birth pool for her clients or if she knows where you can rent or purchase one.  Find out if she truly supports the option of waterbirth.  I have talked with many women who have said that their midwives talked about waterbirth prenatally and even encouraged water labor, but then asked the mother to get out of the birth pool at the last minute.
  27. How ‘hands off’ are you during a birth?
    Is your midwife is willing to “allow” the family to conduct the birth under her supervision?  Ask if she is willing to give you complete control.  Will she encourage or instruct you and your partner when and how to catch the baby?  Will she leave you alone in another room if that is what you want?  How involved can your children be in the labor and birth?
  28. What is your experience with breech births?  How many have you attended?
    Breech may be beyond the scope of practice for some licensed midwives.  Others handle it just like any other birth and specialize in breeches, especially in water.
  29. What in your experience with twins?  How many have you attended?
    Twins may also be beyond the scope of practice.  Find this out before you make further plans. (It is also illegal to have twins anywhere but in a hospital in Colorado)
  30. Do you cut episiotomies and suture perineal tears?
    Home-birth can birth-center midwives usually have an episiotomy rate of close to zero, but tears do sometimes happen during birth.  Unless your midwife sutures well, you may need to travel to a hospital if you need stitches.  This might influence your choice of practitioners.
  31. What is your experience with a VBAC?
  32. Will you attended a VBAC at home? in the hospital?
    Many midwives cannot legally attend a first-time VBAC at home because of licensing restrictions.  Some are willing to look the other way in order to give the woman a chance.  This is a very serious consideration that requires much discussion with your midwife.
  33. Have you ever had to resuscitate a baby?
    Assess the resuscitation skills of the midwife.  Midwifery organizations and nursing schools teach courses in neonatal resuscitations, and your midwife should have a current certificate.  As to see it.  Ask if her resuscitation course focused on the latest information about the consciousness of newborns.
  34. What kind of equipment do you bring to a birth?
    Find out what kind of drugs, oxygen, resuscitation equipment, intravenous (IV) equipment, and other emergency equipment your midwife keep sin her bags.
  35. Do you examine the baby after birth?
    Midwives perform a normal newborn exam on the baby usually an hour or two after the baby has been born and breast-fed.  Assess from the midwife what her routines are for newborn exams and what she uses for eye drops and vitamin K.  She may use alternatives such as oral vitamin K.
  36. Will you help me with breast-feeding?
    Midwives should be on call twenty-four hours a day, seven days a week, for all problems after birth, especially breast-feeding.  Many even have special classes or private sessions to evaluate breastfeeding readiness and answer any questions.  Some have great relationships with lactation conselors or consultants for more difficult problems.  Babies born without medications usually have an easier time breast-feeding, but that doesn’t mean every mother automatically has an easy time.
  37. How often do you come to see me after I give birth?
    Home-birth midwives generally come back for follow-up visits after twenty-four hours, two days, five days, and ten days.
  38. Do you provide or know of anyone who will help new mothers after birth?
    Some home-birth services provide a postpartum doula or can recommend one for help after the baby’s birth.  There is generally an extra charge that is well worth every penny.
  39. Do you have a pediatrician you work with or recommend?
    Some naturopathic doctors who attend home births automatically become the pediatrician.  Midwives often have collaborative relationships with pediatricians who support home birth and possibly delayed immunizations or not immunizing at all.  Interview pediatricians the same way you would your provider.
  40. How do you feel about circumcision?
    I don’t know of very many midwives who will present both viewpoints about circumcision unless their clients are Jewish or Muslim.  If there is a religious consideration, the thoughtful midwife will support her clients’ decision.

Interviewing Your Place of Birth

It is so important to know what you’re getting into before you’re in labor!  Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you.  Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).

Here are some questions to ask your hospital or birth center to make sure you find a place that is on the same page with your birthing beliefs.  These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 246 (a great book, also in my library).

  1. Does the hospital [/birth center] encourage women to follow written birth plans?
    This is a question for a hospital [/birth center] but it may also be asked of the physician.
  2. Could you tell me how a routine vaginal birth is handled here?
  3. When do I need to check into the hospital [/birth center]?
    The longer you stay at home in early labor, the less possibility there will be for interventions.
  4. Can I labor, give birth, and stay with my baby in the same room?
    The concept of labor, delivery, recovery, and postpartum (LDRP) in the same room has been promoted for the last ten years.  If your prospective hospital is one that still transfers women into a delivery room, request that they make an exception in your case.  (There is nothing worse than being moved right before pushing!) Also be aware of the “cosmetic cover-up” discussed in chapter 8.  Not all LDRP rooms are alike, and not all allow women to do what they want.
  5. Do you routinely require an IV?
  6. Do you routinely require electronic fetal monitoring during labor?
  7. How often does someone do a vaginal exam to assess progress?
  8. What mechanism is in place so that I can refuse routine interventions like vaginal exams?
  9. How soon after my labor begins will you (or the doctor on call) come to see me?
  10. Whill you stay with me during labor?
  11. Can my partner stay with me the entire time?
  12. Can the rest of my family members, including my children or my mother and father, be present during labor and birth?
  13. Does the hospital have showers or baths in each room?
  14. Can I eat and drink during my labor?
  15. Do you encourage women to walk, squat, or be on their hands and knees during labor?
    Understanding the philosophy behind why you need to remain active during labor encourages women to move.  Lying still on a bed during labor is probably the hardest thing for women to cope with.
  16. Can I birth the baby in the position of my choice?
    Hospital beds often break apart at the foot to “allow” a woman to semi-squat.  What some women have found easier is to simply put the mattress on the floor or be supported by their partners while they squat on the floor.  Assess early on if those alternatives are acceptable to your doctor and the hospital.
  17. Can I use a warm bath for pain relief during my labor, even if my water has broken?
    There is absolutely no reason to restrict the bath even with ruptured membranes.  One woman at Santa Monica Hospital was promised that she would be able to use the brand-new baths that had been installed for labor.  What her doctor did not tell her was his list of restrictions:  A woman could not take a bath if her water had not broken and the head had not engaged into the pelvis (for fear of a cord prolapse), and she could not enter the water after her water had broken (for fear of infection).  She never once used the new baths and ended up with an epidural and her baby experienced the application of low-forceps.
  18. Can I stay in the water to birth my baby?
    Find out right away what position your doctor takes on waterbirth.  It might be your opportunity to educate him or her.
  19. What kind of pain medication do you routinely use?
  20. What kinds of nonpharmacological pain management techniques do you recommend?
  21. If I want an epidural, what are your guidelines?
    Some doctors offer a “walking epidural” which is a different kind of epidural.  Question your doctor carefully about the kids of medication used and the guidelines with which they are administered.
  22. Do you do episiotomies?  Why?  In what percentage of births?
    Does your doctor think that episiotomies are necessary?  Is he or she willing to allow you to try other techniques?  If a doctor cuts more than 10 percent of birthing clients, look for a new doctor.
  23. Do you ever use vacuum extractor?  In what percentage of births?
    Vacuum extractors were developed to take the place of low forceps.  A large suction cup (usually made of hard plastic and sometimes silicone) is placed on the baby’s scalp.  The cup is attached to a tube that is attached to a vacuum.  When a suction on te baby’s head has been achieved, constant suction will quite literally pull the baby out within ten to twenty minutes.  There are some risks with extraction, such as perineal lacerations, hematomas on the baby’s scalp, and pain for both mother and baby.  It requires a fully dilated cervix, a baby with at least some part of the scalp visible in the birth canal, and the cooperation of the mother.  Vacuum extraction is preferred over the use of forceps.
  24. Do you ever use forceps?  In what percentage of births?
  25. What is your policy concerning stripping or rupturing membranes?
    Rupturing membranes is often the first intervention that doctors do to “get labor going.”  Ask your doctor if a labor can progress normally and slowly without rupturing the membranes.  Will you be informed of his or her desire to break your water?  Do you have the right to refuse this intervention?  Assess your doctor’s guidelines for ruptured membranes.  How long will he or she allow you to go without starting labor?  What lab tests are required? Some doctors take white blood counts every twenty-four hours and body temperatures every hour and leave a woman alone.  Others want her hospitalized immediately and induce labor with Pitocin.  Studies have shown that women who walk and remain active have fewer cesareans and generally give birth before those who receive Pitocin.
  26. How long will you allow me to labor before starting interventions?
    Does your doctor go by the book in judging length of labor?  What are his or her considerations:  maternal exhaustion, nutritional needs, movement?
  27. How long will you wait to cut the cord and deliver the placenta?
    (Cutting the cord after it stops pulsing allows the baby’s organs to perfuse with much-needed blood, replenishes iron stores, and creates a smoother transition from oxygen from placenta to oxygen from baby’s lungs)
  28. Can my partner cut the cord?
    Is cord cutting viewed as a medical procedure or simply part of the process of birth that the couple has shared?  Are fathers included in this process?
  29. Is it necessary to put antibiotics in the baby’s eyes right away or can we delay that for 24 hours?
    State laws mandate that an antibacterial agent be put into the baby’s eyes to reduce the incidence of blindness from venereal disease that has been passed from the mother to the baby.  The use of silver nitrate has been abandoned by most hospitals.  More common antibiotic agents are now used.  Find out from your doctor what he or she recommends, and ask if you can choose not to use anything at all, especially if your baby is not at risk.
  30. Do you routinely give vitamin K shots to newborns?
    Vitamin K is routinely given to prevent hemorrhagic disease in newborns.  The incidence of intracranial hemmorhage is extremely low.  The administration of vitamin K has also been given to counteract the possibilities of bleeding after circumcision.  There has been an unusually high incidence of childhood ancer linked to vitamin K shots.  Oral vitamin K has not shown any relationship to cancer in children.  Ask your doctor if oral vitamin K may be substituted and if he or she has access to the latest research.
  31. Can I breast-feed immediately after birth?
  32. Can I delay weighing and measuring the baby for at least an hour?
  33. Can the baby stay with me in my room (rooming-in)?
  34. Do you routinely recommend circumcision?
    If your doctor is still suggesting circumcision and does not stress the normalcy of the intact penis, take the opportunity to educate him or her before you find another doctor.
  35. How soon after the birth can we leave the hospital?
    Most doctors recommend a short stay in the hospital.  Some are even willing to discharge after twenty-four hours.  Find out if your doctor is open to discharge after six to twelve hours, especially if you have given birth vaginally and you have adequate help at home.