Staci Bishop

Saturday, March 31, 2012

REVIEW: The Birth Partner (Penny Simkin)

I recently completed this book as my 2nd option from the Childbirth International reading list. My notes below are based on the questions I answered to complete my book review for the course.
What did you enjoy about this book?

I loved this book! In fact, I think it could easily serve as a textbook for doulas. It truly covers all the bases. I loved how in-depth in went into each individual labor & delivery topic and also covered aspects of pregnancy, post-partum, breastfeeding, and baby care. The pain relief techniques were very helpful and I have already been able to utilize many of them. This book laid out the material very nicely with quick and easy charts, lists and bullet points to review. I think the book handled the pros and cons of most procedures in a very fair and balanced way, which was refreshing. It also served as a good reminder that not all labors are textbook and sometimes you have to improvise all the while trusting the birth process. Certain sections also discussed routine procedures and gave appropriate suggestions for alternatives. I seriously cannot say enough good things about this book. In fact, I plan to add it to my own personal library.

What did you not like about this book?

Part of what I loved is also what I hated. The book was so thorough that it was almost repetitive at times. As I was reading the material I would sometimes get frustrated that I had just read that same information or I would come across a very detailed chart, when I really just wanted something quick and easy to look at. However, in the end, I think repeating the material helped me to remember it better.

What was the most significant thing you learned when reading this book?

It was very interesting to see that this book was mainly written for Dads. I greatly appreciated how the author listed possible emotions that the Dad or Mom may feel at every step of the process. I think this will help me to better connect with the Dads because I can anticipate what they might be feeling. It was also interesting to see that many of my emotions often mirror what Dad may be feeling. This helped to reinforce that we are on the same team and we just want to help Mom. Emotion plays such an integral part of the birth experience and I am thankful that this was covered in such a significant way.

How do you think this book will affect your role as a doula?

Mainly, I will use the specific pain-relief techniques that I learned and I will probably refer back to this book often for positioning suggestions and to review the list of alternatives when labor is progressing slowly. I loved learning about the three Rs and think I will be able to better detect when this is happening for mom. As mentioned above, I think this book will help me to better relate to the Dads and understand how they may be feeling during the process of labor.

This was a great book! I would definitely recommend it for parents and doulas! (Preview Here)

Saturday, March 17, 2012

A Doula Story: Supported Hospital VBAC

I was downright giddy after my first doula birth but I am an emotional mess (in a good way) after this second one. I just stood side-by-side my Nashville bestie as she delivered her sweet baby girl. For this story to make any sense, you are gonna need a little background info.

Her first baby was delivered by emergency C-section around 35 weeks for IUGR and baby spent a few weeks in the NICU before going on to become the amazing, perfectly healthy, 4-year old that he is now. For this pregnancy, mom had to overcome some serious mental and medical obstacles. She feared that this pregnancy would be a repeat of the first resulting in another NICU stay after a planned cesarean. However, mom desperately wanted a VBAC. The first step was getting past 32-34 weeks because this is where things went downhill last time. Mom's cervix also started thinning early. We had many late night conversations to work through her concerns and to help her trust her body and our God. I will always remember those chats fondly. Once 37 weeks arrived, we celebrated that she was full term. Mom now faced the possibility of an induction if she went too long. Ultimately, this would mean an automatic repeat cesarean due to the concern of uterine rupture by her OB. Mom researched her options. I continued to reassure and encourage her.

Fast forward to 37 weeks, 3 days. Mom called saying she "thinks" her water might have broken. We chatted for a bit and I was convinced. I arrived to their home and mom was excited that labor was actually beginning and this was not more Braxton-Hicks. Contractions were 3-4 minutes apart and lasting about 30-45 seconds. Her OB requested for them to come in to the hospital so we loaded up. It took about an hour after arrival to finally get mom checked in and situated in her room. Mom was at 5-6 cm. Let me tell ya, hospitals love them a paper trail and they like to ask lots of questions, over and over. Hospitals also love their policies and protocols. Despite her OB being okay with intermittent monitoring, hospital policy said she had to be on continuous monitoring. Her Group B strep test had not come back yet so they automatically gave antibiotics. Because she got IV antibiotics she had to have IV fluids as well. All of the above said she had to wear a blood pressure cuff which automatically inflated every 15 minutes. This is a perfect example of how one intervention leads to many. We asked for a couple of alternatives but they were denied. They did finally allow mom to be out of bed but she couldn't go far because of the wires. She really only had about 2 somewhat comfortable positions to use that would also keep baby on the monitor. Mom wasn't necessarily happy about these policies either but she took it like a champ and carried on in spite of being hooked up to lines left and right.

Mom labored quite easily for several hours. A nurse would appear any time baby was off the monitor, reposition mom, and then leave. Things started to get more intense around 3:30 a.m. Mom was still doing great and showing good signs of progress. Dad and I helped mom with whatever she needed. She has doing fantastic with her breathing and was coping very well. Mom was definitely in active labor but the atmosphere was calm and peaceful. Around 4:45, mom moved to a side lying position. This slowed things down considerably. I let mom have a little rest because I knew she needed it. I also knew if contractions stopped completely, that they would push pitocin. After a short rest, we got mom back up on hands and knees. Mom felt a little pushy so the nurse came in to check her. She said mom was a 7-8. As I expected, that number was devastating for mom to hear. I knew she was right there because she was showing all the signs of transition (sweating, nausea, feeling pressure, thinking she can't do it anymore). This is where labor becomes a mental battle. She labored just a bit longer but couldn't quite seem to get in front of the contractions so she asked for her options regarding pain relief. Even then, she waited about another 10 minutes before choosing an epidural. Considering her frustration with all the monitors and belts and IV lines, I was thrilled that mom had made it this far.

Anesthesia arrived and we were told that only one non-medical person can be allowed in the room while they place the block. Her husband was the obvious choice so I voluntarily left the room. This may have been the hardest part of the night for me. I stood alone in the hallway and listened to my friend and client try her best to cope with contractions on her own. I knew that strangers were asking her to get into an impossibly uncomfortable position and remain absolutely still. After standing side by side with her all night long, I now felt helpless. Not being able to verbally reassure and physically comfort this mom was painful for me. After what seemed an eternity (apx. 30 minutes), I was finally allowed back into the room. Mom could still feel her contractions but they were much more manageable. I told mom this would be a good time to rest as I suspected she would be ready to push with the next shift change.

Mom, Dad, and I got comfy and closed our eyes. We had a whopping 10 minutes before the day nurse arrived and asked to check mom. Mom was complete so she prepared the bed and coached mom on how to push from her back. Mom asked for the epidural to be turned down so that she could feel some pressure that might help her know how to push. Baby was already at +3 station at this point and her head was visible from the very first push. They asked mom her preference on a few decisions. This was the other difficult part of the process for me. As a doula, my job is to provide information but I absolutely cannot make decisions for the parents. Mom looked right at me. I simply held mom's gaze and gave her a reassuring smile knowing that she would make the appropriate choice on her own. Had she asked me a question or for more information, I would have happily provided it. However, time seemed to stand still as I watched her weigh the pros and cons in her own mind. It was a proud moment to see her make these decisions and stand up for her preferences.

The day shift folks seemed to be a lot more reasonable and were much more laid back. At this point, all signs were pointing to the fact that this would be a successful VBAC and I was doing a little happy dance in my head. Mom had pushed for just over an hour, when she delivered her baby. This was a huge emotional moment for mom, dad, and me. OB allowed the cord a full 3 minutes before he put the clamp on. Mom had not specifically asked for this but I was pleased to see him offer it and explain the benefits to the family. Dad had been really quiet all night long but really perked up during this final stage. He even cut the cord. I was really proud of him too. As they snuggled their baby girl, I teared up. She did it! My bestie really did it! From the very beginning, we prayed for a normal, normal, normal pregnancy, labor, and delivery and that's exactly what she got. She patiently waited, trusted, worked hard and got her VBAC! Little miss weighed 7 pounds 7 ounces. It just doesn't get more "normal" than that! :)

Baby was very calm and content while dad snuggled her. I just love seeing the dads with their baby girls. When baby started sticking her tongue out mom gave nursing another try. She latched right on and proceeded to nurse for a good 30 minutes, both sides. I showed mom a couple of positions and she was doing fantastic with it! This was also something new and different and "normal" compared to her first birth. Mom and I were both simply ecstatic!

When I left, mom and dad were all squared away and studying the precious face of their new daughter. Let me tell ya, this particular hospital isn't exactly known for their VBAC rate so I definitely walked out of there with my head held high. Now, I was an emotional basket case for the rest of the day but it was for good reason. Part of my emotional state was the fact that I ended up going 36 hours before finally getting some sleep but also because I was just so happy and proud for this mamma.

Looking back on the whole experience, the best part was hearing both mom and dad say, "I'm so glad you were here. I don't know what we would have done without you." That, my friends, is what this is all about.

And here's a little Facebook evidence to prove it! :)

Saturday, March 3, 2012

A Doula Story: My 1st Client

I just helped my 1st official client as a doula and it was nothing short of spectacular. Seriously, I don't know how a birth can get much better than this one. I am downright giddy with the details. First, this mom is also a friend of mine who has been encouraging me to pursue my doula training way before she was pregnant with this baby. She asked me to be present at this birth before I was even actively pursing my certification and I was so honored to be trusted and welcomed for their experience. Secondly, this mama chose to deliver at The Farm, which is world renowned. I was literally star struck the first time I visited for her prenatal appointments. Thirdly, This mamma trusted her body and this process from the very beginning. I love that she was eating healthy and geting chiropractic adjustments regularly. She started acupuncture in the last few weeks and waited for her body to go into labor on its own without interventions despite the fact that she was 42 weeks, 1 day. Based on her previous pregnancy, I'm convinced that she just takes a little longer to grow her babies. The fact that she delivered a perfectly healthy, average-sized baby is proof. Finally, this was a Leap Day baby! It was such a memorable day to begin with and now will be one that I will never forget. In fact, this momma had picked February 29th as her guess date from the very beginning. I'm a huge fan of mother's intuition. Sometimes, we just KNOW!

Labor Timeline
Mom called me about 2:30 having regular contractions but they were just starting to get uncomfortable. She texted me at 4:15 that they were consistently 10 mins apart and painful. I am an hour and a half from The Farm so I decided to make my way down there. I arrived at 6:30. Mom said they were now 7 mins a part. I watched her for a few contractions and she was handling them beautifully. She was making good noises and coping well. She commented several times how much better natural labor was versus being induced in the hospital like her last birth. She ate a few bites of dinner and I noticed that her contractions seemed to be coming a little closer at this point. She timed a few and they were indeed now 5 mins apart. She decided she would take a shower and then try to lie down and rest. I could hear that the contractions were definitely getting closer together. Mom was still jubilant so I changed into some comfy clothes and got out my journal.

Mom tried to sleep but called for me to be with her about 10 minutes later. She was still doing well with the contractions, making good noises, and squeezing my hand. Things were definitely picking up and she decided she was ready for the tub so I started making calls to her midwife. The backup midwife called us back and said she was on her way. I gave an update on mom's contractions (4-5 mins a part & lasting over a minute) and she decided she would call for the midwife who lives next door to come check on us. Mom could no longer lie down so we got her changed into her swim top and moved to the floor on hands & knees with the birthing ball. At this point, she was asking for some counter pressure on her back and I was happy to oblige.

The next-door midwife arrived and checked mom who was now having contractions about 2-3 minutes apart. She was "very open, dear" with a bulging bag of water. The midwife began to get everything set up and gently prepare mom that she may have this baby before the tub arrived. Mom's water broke. Dad had just gotten their son to sleep in the next room and came in. The backup midwife also arrived around this time. When mom said she didn't think she could do this without the tub, we all looked at each other and grinned (this was a good sign as far as transition is concerned). We gave her some verbal reassurance that she was doing fantastic because she absolutely was. She had a good rhythm and ritual (rocking, vocalizing), was generally content (aside from wanting the birth tub), and clearly communicating what she needed. Mom commented that with her last birth this is where she got stuck because she was scared but "I'm not scared this time." This statement made me swell with pride. I always say that knowledge is power and this momma was using all the information she had gleaned in the last few months to overcome her fears. ♥

With my hands on her back, I could feel her tailbone expanding and I told mom that baby was definitely on the move down. Mom started to sound a little "grunty" and the midwife gave her verbal confirmation that she could push if she wanted to. Three pushes later, at 9:17 p.m., she delivered her baby. Mom had chosen not to have an ultrasound during her pregnancy so the gender was a surprise. Dad announced that they now have a new baby GIRL!

We helped mom and baby get skin-to-skin up to the bed. Mom is euphoric and says "that really wasn't that hard." I think the fact that she was mentally prepared and had such a joyous attitude had a lot to do with that! At this point, her primary midwife arrived. Sometime later, Dad cut the cord. We all stood around oohing and ahhing and talking about how fast everything happened. We watched mom and dad both fall instantly in love with their daughter. Eventually baby was ready to nurse and had a great latch. Baby nursed for a good long while and then they took her weight and length and gently did her newborn exam. Dad did some skin to skin while they checked mom again and helped her get settled. We left with mom and dad snuggled into bed with their precious baby. *swoon*

I had been wondering for weeks how I would handle my role as a doula. Hands down, this was the most amazing experience ever! I was never anxious and felt very calm. I was very trusting of mom's ability and the entire process. I felt like I was recognizing all the right signs as far as how fast this labor was progressing, which was reassuring. I felt I was able to read mom's body language to be able to determine when contractions were beginning and ending. This was all confirmation that I have been learning the right things and retaining that information. I loved how knowledgeable the midwives were knowing exactly what mom needed and how she was doing without constant monitoring. I especially loved how she didn't use a number when she checked her and allowed mom to stay on hands and knees to deliver. They just worked around whatever mom thought was best. I adored how this family was allowed as much time as they needed to bond (2 hours) before they began the full postnatal check. Even then, they were very, very gentle and baby never fussed. In fact, from the time she was born until I left 3 hours later, I only heard her cry one sweet, short cry. There is something to be said for babies who are born peacefully.

Overall, I had the best possible client delivering under the most ideal circumstances at the most birth-friendly location on the most memorable day of the year. It was a literally a Dream. Come. True. (!!!!)