Archive for July, 2011

The Mini-Midwife

During my bouts of pre-labor contractions with number 3, one of my favorite positions was to kneel in front of the couch and lean forward so my upper body rested on the seat cushions.

One such time, Felicity, my 16-month-old daughter, decided to investigate. She came up behind me and started rubbing my lower back. Then she patted my butt, lifted up the skirt of my dress, and peered underneath.


I think she may grow up to be a midwife.


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Not too long ago at a birthday party I talked to a mom of a brand-new little baby boy. Her fourth baby. She was telling me about her birth; that she was five days past her due date and the doctor decided she “had to” induce. So, this sweet lady went in and was given a magical little “miso pill,” as she called it. “It’s a tiny little white pill they stick next to your cervix to start labor. My baby was born at noon. They had to do that to get my third baby out too.”

I stood there talking to her, trying to act normal and fervently hoping my look of horror didn’t show. That little “miso” pill, as she called it, is none other than Misoprostol, the generic name for Cytotec, a drug used off-label that has caused the damage and death of myriads of laboring women and their babies. Of course, I wasn’t horrified at the mom. There is no way she could know that the doctor she trusted was essentially performing an experiment on her to start labor. I was shocked that the doctor (who also happened to be my childhood doctor, which made it even more disturbing) would knowingly put this mother at risk without giving her any information on the drug she administered.


Miso was first used as an induction drug in the mid-1990s. FDA approved as an ulcer drug, this pill has never been tested or approved for use on pregnant women. In fact, in 2000, the manufacturing company sent out a letter to all obgyns and midwives, warning against the use of miso because it causes uterine rupture (the uterus detaches and breaks open) and can harm or kill both mother and baby. And yet, eleven years and many deaths and lawsuits later, doctors still use it.

Essentially, the pill is dangerous because it’s unstoppable. With other induction drugs, like Pitocin, Prepidil, or Cervidil, the source of the drugs can be removed or slowed if a woman’s uterus shows signs of hyperstimulation or the baby goes into distress. Those drugs aren’t foolproof, but they don’t have as many cases of infant or maternal mortality due to uterine rupture as does misoprostol. A “miso” tablet, once absorbed into the body, cannot be stopped. It is an all or nothing deal. Therefore, even if the contractions strain the uterus to the point of rupture, there is no way to reverse or slow down those contractions.


Talking to that mother got me thinking… if you know something about a drug a woman is given for childbirth, what do you say? Should you just stay silent, even though you know it causes death, disability, or infertility? Is it even ethical to stay silent? Do you tell her that the drug is that dangerous? Do you tell her to research it, knowing that she probably won’t? What on earth do you do in a situation like that?

In my mind, it would be different if the information was well known and in the news, such as the dangers of smoking cigarettes or binge drinking or a mainly fast food diet. Then I wouldn’t say anything because I know she made a conscious, informed choice. But medical interventions or prescriptions are an entirely different ballgame. We tend to trust our doctors and what they give us, believing that they have done the research and will give us the most beneficial treatment. This is not always the case. Most women don’t even know the potential side effects of labor drugs until it is too late and they’ve experienced the damage.

Women like the one from the party are the reason I started this site. Every woman deserves the right to make an informed choice about what is done to her body, especially during one of the most normal and natural processes she experiences: bringing forth life.

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In light of writing a few weeks ago about how hearing normal, uncomplicated birth stories can help soothe a pregnant mother’s fears, I decided that it may be appropriate to include the birth story of my first daughter. I wrote it shortly after her birth. At the time, my husband and I had just been introduced to the world of natural childbirth, so we found a practice with nurse-midwives who delivered in a local hospital, took a Bradley Childbirth class, and prepared as best we could. Keep in mind that nurse-midwives are different than midwives in that they are also trained as nurses in hospital protocol and procedure.

I will admit that, when I think about it, I am still frustrated with the nurse-midwife for reasons you will discover. And upset about the “hospital protocol” that took my new baby away from me after only a few moments of skin-to-skin cuddling. However, I did experience a natural birth in a hospital setting, which may be what you are hoping to achieve.

As a plug for homebirth, the care of a homebirth midwife is so much better than at a hospital! It is centered around what is best for the mother and baby, rather than around what is convenient for the hospital staff or what their protocol is. Anyway, enough of that little soapbox. Here is my normal birth story:


Natalie’s Birth

I kept thinking I was in labor a week before my daughter was born.  Every day around noon I’d start having contractions that got stronger and closer throughout the day and night, but petered off early in the morning.  Then they started all over again the next day.  On Sunday night we went to the hospital in possible labor, but decided to go home early in the morning when nothing happened.


Finally, on Tuesday night, labor really started.  After trying to induce through natural methods such as walking, etc, hard contractions started around 11 p.m.  My husband and I went to bed, knowing that I wouldn’t sleep through having a baby, and that we’d need all the sleep we could get.  For the next two hours I got up with a few of the stronger contractions.  At 1 a.m. I felt my water break, and barely made it to the bathroom.


My husband asked me if I was okay.

Well, I think my water just broke.

He said, you should call the midwife now.

Yeah, maybe I should.


So I called the midwife on duty that night (who was the only one of the four in the practice we didn’t want), and she said to come on in.

Can I stay at home a little longer?

You can, she said, but since your water broke and your contractions are three minutes apart, we recommend that you come in soon. 


So my husband got everything ready, and I sat on the bed, breathing through contractions.  We took our time, and arrived at the hospital at 2 a.m.  A nurse got me a wheel chair to sit in and my man checked us in.  I sat, relaxed, and couldn’t believe it was actually happening.  I mean, I knew it was time, but I didn’t feel ready to be a mother, or believe that all the long months of terrible pregnancy were finally at an end.


We had the same nurse as when I had the false labor, and she said I looked much more serious about the whole thing than the last time we were there.  We gave her our birthing guide, and she said she’d ask before doing anything.  I let her put in a buff cap, even though I hate needles.  She checked my vitals, and the baby’s, and monitored my contractions.


Wow, she said, when I look at you I can’t tell when you’re having a contraction. But when I look at the screen your contractions are peaking at the highest level.  On a scale of one to ten, ten being the worst pain you’ve ever felt, what’s your pain level during each contraction? 


Maybe a four or five, I replied.  I started to feel excited because, if these were considered strong contractions, then I could definitely do this!


Once the nurse was satisfied baby and I were both doing okay, she unhooked me to give me some freedom.  I had wanted to walk around to speed up labor since my mom’s labors were all really long.  But, instead, I didn’t feel like doing anything except soak in the jetted tub.


Half an hour later I was in it, soaking, and started to feel a little desperate.  I was feeling nauseous, like I was going to throw up.  The pressure on my pelvis got a lot stronger, and, suddenly, I felt like I didn’t want to do this anymore.  Labor was too hard, I either wanted the baby to stay in there so I could go home, or have them cut her out of me.  Either way, I was done with this whole labor deal.  Then I checked myself: I was having all the signs of transition!  But it was way too soon!  There was no way I could be in transition already!  It hadn’t been long enough!  I decided to not mention any of my emotions to my husband, because I didn’t want him to think I was in transition, since there was no possible way I could be.  But it turns out he knew anyway because I was having all the physical signs as well, and he didn’t want to say anything to me either.


It took me what felt like forever to get out of the tub and put my gown back on.  The contractions were so hard and so close together that it was really difficult to do anything.  I still had it in my mind that I wanted to walk around and speed up labor (ha-ha), but, again, didn’t feel like it. So I laid down on the bed in a side relaxation position, listened to calming music, and my husband told me a story.  He had just finished and the midwife had just walked into the room for the first time, when I had one last really hard contraction, then felt like I had to push.


Um, I think I should push now.

That’s what we want to hear! said the nurse.  

I sat up a little bit, my husband supported me on one side and the nurse on the other, and I pushed with the contractions.


The midwife wanted me to hold the baby down with each contraction, I didn’t want to, but I compromised and did a little of both.  After a while I had an overwhelming desire to sit up and squat, but the midwife said I was almost there and I should just keep pushing.  I got pretty annoyed, but was too busy giving birth to argue, and definitely couldn’t sit up without help.  When baby started crowning, I took it easy because I wanted to stretch without tearing.  The midwife told me I had to push harder and longer, because she didn’t want to have to do an episiotomy.


What?! I thought. That’s ridiculous! 

But, it really didn’t matter anyway because my beautiful daughter came out with her fist up next to her eye, and tore me pretty badly.


The moment of birth will forever remain a surreal, golden, grainy photograph in my mind.  I felt her come out and saw the top of her head as the midwife lifted her up.  I looked at my husband, he kissed my forehead, then my baby girl was suddenly sprawled across my chest, with a perfectly-shaped head and smooth skin.  I don’t remember if she was crying or not.  I think she wasn’t, but all that’s vivid is the way she looked.  She didn’t look at all like the pictures of newborns one usually sees.  She wasn’t purple, or pruny, or have a cone-head.  But she was tiny.  And a lot more squirmy than I thought a newborn baby had any right to be.  The nurse took her away much too soon, because she said my baby needed to be warmed up.  I knew it would have been best to just throw a blanket over us both, but my voice was still lost somewhere else in this silent movie so I could only watch.  I have no idea what the nurse did, my eyes were only for my family, over at the warmer.  My husband and my daughter.  I felt like I was someone else, watching the three of us from somewhere outside the room.  My man, with his broad shoulders and camera in hand, and stormy-sea eyes gazing at his child.  Our daughter, with her miniature fists still held close to her elvish face like a boxer and her tiny eyes squinted closed against the warmer light.  And me, hair escaping from a ponytail, face turned toward them, being stitched up and wanting them back next to me.


The nurse finally gave my baby back, but all swaddled and hatted.  I hated that.  I wanted to take her out and cuddle her and feed her and look at her.  Not have her bundled up and hidden from me.


After a while, when the nurse and midwife had finally left us for a few moments, my husband asked me what we should call her.  Oh! She does need a name, doesn’t she.

What name do you like best?

 Jayna or Natalie, I replied, hoping that he liked Natalie, a name he didn’t like before because the meaning didn’t make sense.

 I like Natalie too.

 Natalie Grace. It sounds good.

Natalie Grace, our ‘born on Christmas’ baby, met the world at 5:47 in the morning, to the piano rendition of Hushabye Mountain.  She weighed 7 pounds, 3 ounces, and was 20.5 inches long.  Her eyes were grey, her hair exactly my shade of brown, and her toes looked like monkey feet.  A spring blizzard stormed outside that day, but we didn’t notice.


To check out Natalie’s sister’s birth stories:

Felicity’s Home Birth Story

Charlotte’s Home Birth Story

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So, when are you due?

This is the most frequently asked question I’ve heard during all three of my pregnancies. I’m sure the same is true for most women. Everyone from close family and friends to strangers you meet in the checkout line want to know: when are you due? 

Having a general idea of when you can expect to have a baby is fine, but it gets pretty frustrating when you reach your “due date” and are still pregnant. Especially when you pass that date.

Well, I am at that point now. And I am tired of people acting as though it is an awful ordeal to be pregnant past my due date. Maybe I’m weird, but I am totally fine still having the baby inside instead of in my arms. Not that I don’t want to meet my baby, because I definitely do. I can’t wait to meet this new addition to our little family. However, I realize that a due date isn’t set in stone, it isn’t usually accurate, and a baby will come when a baby is ready. Unless you force it. The worst part of this very end of pregnancy isn’t the largeness, the heat (I hope I am never extremely pregnant in July again!), or the fact that I cannot sleep without pillows propping up my belly. Or even the brutal rounds of contractions I’ve had for the last month. The worst part is the pitying looks or comments when someone knows this baby is “late.” And pointing out the obvious with a question: so… no baby yet? 

People, it’s not late!

I wish we could just do away with due dates. Maybe it should be an estimated birth month instead. Or, in my case, an estimated birth window of late June/early July.

Let me tell you a little bit about due dates and why we really need to stop treating the calendar as our ultimate authority.

First, every baby is different. Just like no two people develop at the same pace, so no two babies develop at the exact same pace. The 40 weeks of gestation time is an estimate. Some babies arrive sooner, most babies arrive later. If a healthy mother is allowed to go into labor on her own, with no induction forced on her, the average length of pregnancy is 42 weeks and a couple days. If you think about it, when doctors induce at 40 weeks, or even 41 weeks, they are inducing many babies who are not ready to be born.

Second, the pregnancy calendar wheel is inherently flawed. All pregnancy wheel charts that determine when a woman’s official due date is are based on a fertility cycle of 28 days, with ovulation occurring 14 days after the beginning of the menstrual cycle. I’ll give you one guess as to why this is a problem. Yep, you got it. No two women are the same. Imagine that! And because no two women are the same, there is a large range of when conception actually occurs. Some women have closer to 20-day cycles, and some women have close to 40-day cycles. That is a big difference, and a huge range of possible conception dates. Also, menstrual cycles begin roughly 12-16 days after ovulation, so the ovulating-on-day-14 idea is fundamentally flawed as well. Even if the 40-week gestation was correct for every single baby, the simple fact that the actual date conception can vary between women so drastically would throw off the dates by a couple weeks either way!

So, if you are pregnant or know someone else who is, don’t get caught up in the dates! They are always an estimate, and just because a woman is past her due date doesn’t mean something is wrong with the baby or the woman. Your body knows what it’s doing. Take care of it with healthy food and exercise, and tell everyone your due date is two weeks later than it actually is. That’s what I’m considering doing next time!


Taking Charge of Your Fertility by Toni Weschler
Ina May’s Guide to Childbirth by Ina May Gaskin
Natural Childbirth the Bradley Way by Susan McCutcheon et al.

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