Twin VBA2C

I got up at 1:30 this morning to use the bathroom. When I returned to bed, my next due client was on my mind. Had I provided enough prenatal support for her thus far? Was there anything else I could do for her in the days, weeks before she delivered?

What's that? The phone is ringing? 1:50 a.m. Who else could it be?

My client's water had broken around the time I got up for the bathroom. She was going to drop her other children at a friend's house and then head in to the hospital. I met her there around 2:30. She was lively, chatty and witty. And, when they checked her, eight centimeters dilated. The nurses were amazed.

Because she was carrying twins, the protocol was for her to deliver in the OR. A second vaginal exam 40 minutes later had her at 9-10, so they took her in the OR. Though she wanted a natural delivery, she still had to get an epidural catheter placed. Again, standard procedure. Her spouse and I waited outside while they got the epidural in and gave her a bolus dose to make sure it worked. Only then could we come it. I don't understand why her husband couldn't go in with her. For that matter, I don't understand why she had to deliver in the OR. And I certainly don't see why she needed a "dry" epidural in place, "just in case." But if that's what she had to do to try for the birth she wanted, so be it.

So with nine people in the room in addition to my client, her spouse and me, she was instructed to begin pushing. She was on her back with her legs up in stirrups. I have never seen this setup for a delivery, which I suppose says good things generally about the hospitals around here. It was the classic "dead cockroach," lithotomy position.

Anyway, my client couldn't feel when to push because the bolus was stronger than they'd said it would be. She pushed a few times but then the doctor rechecked her cervix and reported it had significant anterior and posterior lips and that she was probably about eight centimeters. The doctor said with a cervix that has been through labor before, it can sometimes slide down with the baby.

I don't doubt that. But I also had to wonder whether the 20 minute separation from her spouse, the bright lights and commotion of the OR and the lock-step order with which she was being moved from one thing to the next hadn't made her body feel it was not a safe time or place to deliver.

They ended up moving her to a room where she labored fabulously and with increasing power as the bolus wore off. The was one tough woman. When nurses asked how she was doing with the pain, she always said "fine" and forced a smile that said "I will choke you if you ask me that again and don't you dare ask me if I want any medication."

Finally she had just a tad of lip that the doctor slipped past the head while she pushed. After that she could not hold back from pushing. It was probably ten minutes from that point to the birth of her first child. They ran her down the hall into the OR. Nurses and pediatricians were flying all over the room getting into position. After the first baby arrived, there was just enough time to get a quick ultrasound of the second baby and confirm it was head down before my client delivered that baby, too. They were born five minutes apart. Both healthy and with a combined weight of more than 14 pounds!

This was the third VBAC for this mother, who describes her first VBAC as "transforming." We can NOT take away this option from women.

Wanting What You Have

This morning as I was walking (walking! not sitting in gridlock traffic listening to morning radio) to work (work! employment when Michigan's economy is tanking; a job I really enjoy; a job that permits me a flexible schedule so I can take my children (who are beautiful and, for the moment, healthy -- no bird flu, no leukemia, no drug abuse problems, suicidal tendancies or any of the other scary things I worry about) to school and day care), I was aware despite the cold of what a gorgeous day it was. The sun was out, birds were singing. Daffodil and tulip leaves were starting to push up through the dirt. And when it couldn't get any better, my spouse (spouse! I have a lifemate, a partner, a kindred spirit) caught up to me on HIS walk to school and we had twenty minutes to walk and talk together.

I am feeling extremely fortunate and blessed today.

Survey Says Women Want VBAC Option

In a survey jointly sponsored by Childbirth Connection and Lamaze International, 85% of women surveyed felt pregnant women should have the option of VBAC if they want it. In reality, however, only 12% of women reported having a VBAC. Nearly half of the women who had a subsequent Cesearean delivery said they were interested in a VBAC, but found their caregiver or hospital did offer the option.

Don't we have more political power than that? If 85% of us think VBACs should be offered, certainly we can get our hospitals, insurers, physicians and midwives to provide them. If we can get strings removed from children's coat hoods, we can call attention to the VBAC issue.

Cataloging Challenge

I just learned from her beautiful post today that the Yarn Harlot is also a doula. This throws my whole blogroll categorization into question. And what of the Canadian bloggers I link to? Should I have a separate "Canadian Blogs" category? I may soon separate out knitting blogs into their own category, but I could have Canadian Knitting Doula Blogs. What about that?

The decisions, the decisions. Aaaaaaaaahhhhhh!

Incidentally, my camera is still in the shop so I can't show you the baby blanket and Baby Hooded Cardie I'm working on. But I'm pleased with both. I gave the hooded poncho to a former client for her daughter's first birthday before I could get a photo of it but she's promised to send me one. That was my Olympic medal-winner.

update: I used the camera at work and snapped these shots of the Hooded Cardie in progress and the pattern's view of the finished product (from last month's Creative Knitting, which doesn't have permalinks).


Notice that I'm up to the armhole on the front left panel. The back is already finished. Now I'm seeing that it is more challenging to knit in pieces, where the distance between the bottom trim and armhole has to be the same on the two pieces that will be joined.

Hospital Haiku

When one of my clients went in for a Cesarean delivery, the hospital staff pointed me to the recovery room and said I should wait there. It was nearly an hour before the mother was wheeled in. During that hour I was completely alone in this large room with curtained recovery bays. Bored, I wrote the following:

Prodromal labor
Occiput posterior
Cesarean birth

***

Right now I could steal
thermometer probe covers
and bulb syringes

***

I could also test
my blood for glucose levels
with this kit I found

***

"vacuum oxygen"
"place sharp horizontally"
words on every wall

Six Degrees from Doulicia

Here's a new game I thought of:

Start at your own blog site. Select one of your blogroll links and click to it. That is click 1. Then select (preferably at random, without even trying to deduce the subject matter) one of that blog's featured blogroll links. That is click 2. Repeat this process and see where you are by your sixth click.

Today, I started by clicking the Mommy Blawger and ended up here. I don't even understand what they're talking about. Just goes to show, there is more than one world people live in. I suspect Ernie Schenck wouldn't know what "brow presentation" or meconium are either.

Cruel and Unusual

A former client and subsequent friend called last night after too long a silence. It was great to talk with her. In the course of our conversation she asked if I'd seen this article about prisoners giving birth in shackles. I had not. Hey, I don't read the paper when I'm on vacation.

Anyway, can you believe that inmates often remain in leg restraints during labor? Sometimes they remain chained to a guard?

Typical of the corrections system, they view birth as a time of increased security risk (because we all know how fast laboring women can run) rather than a time of potential transformation for the mother.

I know this is my social liberalism (and class stereotyping) shining through, but it seems if anything could turn a woman from a path of crime, if would be rising above a lifetime of victimization and low self-esteem to have an empowering birth and successful bonding experience with her baby.

That can not happen if she moves through birth reminded at every moment of her sub-human stature in the penal system.

Tragedy and Comedy (or Vacation, Part II)

In Florida, we stayed at the condo owned by my aunt's boyfriend. He lives a few doors away, with my aunt. My parents, who generously footed the bill for the trip (giving credit where credit is due here, since I'm about to look the proverbial gift horse in the mouth), stayed in the same condo with my family. Tight quarters. Especially if your parents are -- and whose aren't? -- crazy.

Quotes of the week:

Mother (when the rest of us returned from a day trip to a nature preserve and she'd stayed home): "I just had the best morning! I got the whole condo cleaned and two loads of laundry washed and folded."

Father (on the way to the beach, with the children in the back seat, after days of his deepening depression over environmental degredation and our sinful contribution to it): "Do you think ecology and economics are inherently incompatable?" Friends, let me tell you, this is a question there is no good answer to if you wish to enjoy your time at the beach.

Father (in the on-going debate of whether to use the energy-wasting dishwasher or not, after I pointed out that we were only running it once every two days, compared to heating water for hand-washing after every meal): "Yes, but think of all the dishes you have to have to allow you to build up a full dishwasher. A lot of energy goes in to making those dishes." Margarita anyone?

Mother (at the pool): "I noticed you cleaned yourself up." Tequila shots anyone?

Roundup

Work's been busy since returning and I've tried to be good about NOT blogging at work. Still, I'm building a backlog of things to note, so let me sum a few of them here:

1. Stress contributes to early miscarriage. UM researchers studied women in the first three weeks of pregnancy and found that women with elevated cortisol levels miscarried 90% of their pregnancies, compared to 33% of women with normal cortisol levels. I know of another UM study that several of my clients participated in, that is examining cortisol levels before, during and after pregnancy and maternal depression. Cortisol is a mighty hormone and we're only starting to understand its impact on gravid women and their fetuses. Nonetheless, all evidence points toward benefits from eliminating stress during pregnancy.

2. Suffocation often at fault in SIDS. Much of last year's recommendations by the American Academy of Pediatrics was reiterated in this article from our local paper. However, I had missed somewhere the notion of a barren crib. I knew to not put blankets on the baby and to make sure crib sheets fit tightly, but I had not heard that even crib bumpers could cause suffocation.

More interestingly -- and continuing in the hormone vein -- is new evidence that babies who die from SIDS may have disruptions in the serotonin levels. Serotonin helps us gasp when we stop getting air. Sleep apnea "survivors" owe a lot to their serotonin. Sadly, SIDS victims are not apnea survivors.

3. Turning from sad to horrifying, I found this account of an Auschwitz midwife inspiring and revolting. She delivered over 3,000 babies during her imprisonment and not one of them died at delivery. Unfortunately, only a few dozen Auschwitz babies left the camp alive.

"Until May 1943, all the children born in Auschwitz were drowned in a barrel. These operations were performed by Schwester [sister] Klara, a German midwife who was imprisoned for infanticide. 'After each delivery, the mothers were able to hear the characteristic gurgle and splashing water' as their babies were disposed of."

4. Returning to a more nurturing model of motherbaby care, some Syracuse (NY) doulas have added a "Mommy Meal Plan" to their services. Visit their [very well-developed but questionably soundtracked] website at www.doulasofcny.com to see meal options. It's an interesting intermediate step for women who might not want to hire a postpartum doula, but need some nourishing food.

5. And in Australia, women may move from the hospital into a luxury hotel for the first few days postpartum and have access to an in-house midwife. It appears insurers are behind the move, no doubt because a $250/night hotel stay is still markedly cheaper than the hospital equivalent. And I hear the beds are nicer, too.

6. Finally, I went with my gut last night and agreed to be the doula for the woman who anticipates a twin VBA2C. How exciting! Actually, she's had two "successful" VBAC births already. So I'm more concerned about the twin aspect of it than the VBAC ones. Any good "twin" labor, delivery and postpartum reading out there? I need to get crackin'.

Philosophical Waxing (or vacation, Part I)

I've said it at least twice before: no one likes to hear about others' kids, vacations and dreams. But hey, I've shared dreams with you, so why not a little vacation.

Two Fridays ago I went to Durango, Colorado, for my friend J's wedding. J and her college roommate, S, were my best friends for my junior and senior years at Michigan State University. They were the women I had some of my funnest moments ever with. Whether it was "swimming" the Red Cedar River (it's about 18 inches deep), mashing with the same guy (we took turns -- we were kind that way) or holding each other's hair out of the toilet when the party ended, we went through all the usual rites of passage together.

Now one of us lives in New Hampshire, one in Michigan, and one in Colorado. Is there a better excuse for a reunion than a wedding?

Of course, times have changed. S and I both have small children who wake us up early and demand all our waking time. We spent our Durango hours together going for a jog along the Animas River, reading on opposite sides of our hotel room, going to bed early, and sleeping late. It was glorious.



We got to help behind the scenes at the wedding, getting J positioned for her pre-ceremony photos and making her laugh just right for the photographer. S and I were the only representatives of her MSU years. What an honor.

As with all weddings, there was little time to talk to the bride herself. But, like with doula work, I viewed my role as one of witness. I was there to watch and watch over her ceremony, to keep the memory of it in my head and support her with my presence. I had my little camera and got lots of candid shots, the kind photographers are not privy to because they don't have the intimacy with the subjects. I snapped lots of S, J, J's sister and me in the bathroom -- the BATHROOM! -- where J had to wait until her turn to walk down the aisle.



Lest I seem too sentimental and sedate you should know that I did let S -- always the adventurous one -- talk me into one "Girls Gone Wild" moment. She promised that my husband would be okay with it, that I wouldn't mind once I got over the initial shock, that there were somethings worth taking your pants off for. And so it was that I found myself in the spa around the corner for a bikini wax.

Regular readers may recall that just a few weeks ago I mocked waxing. This is why I rarely, in person or in writing, take a strong stand on anything. Life always has a way of making me eat my words. This is also why I tend to be a pretty unmemorable conversationist. I tend to moderate on most issues.

Anyway, the wax. Did it hurt? Yes, but not that badly and certainly not for long. It's like pulling off a [really big and poorly placed] bandaid. Did I go porn-star? Only my spouse knows for sure, but you can surmise from my inclination toward moderation and low pain threshold that a less extreme "shaping" might have more appeal. Would I do it again? Yes. Only because the waxed area remains hair free for longer than shaving and, I'm told, is less itchy and pimply when the hair grows back in. I have something to compare it to, since the wax only went around my bikini area; I had to shave the rest of my upper legs. They were a mess before I even arrived in Florida.



And Florida is the next part of the trip. I'll relay the few details of that leg -- including the injury to my camera that is preventing my showing my gold-medal olympic knitting project -- the next chance I get to post.

I left Durango eager to return, rolling my eyes at S, who'd never had a bikini wax before and was basing all her assurances to me on her one experience getting her eyebrows waxed, and with my next knitting project -- a baby blanket, possibly for J, who according to my sources (i.e. S) was beginning conception efforts within hours of the wedding -- cast on my needles.