Wednesday, May 28, 2008

Iaterogenic prematurity

The New York Times reports the fastest growing segment of premature babies is in the 34-37 week gestational age group. Moreover, researchers suspect unwarranted Caesarean deliveries are "causing" many of these early births.

"It is often hard to tell from medical records exactly why a Caesarean was done," reports the article. Amen.

My only client to have a scheduled C-section did so officially because of "suspected macrosomia" -- big baby. That is what is in her charts. What is NOT in her charts is that she had professional experience dealing with babies who had aspirated meconium, most of whom were post-dates, and did not want her baby born any later than her due date. When she had not started dilating by week 39, her doctor told her induction would end in a C-section anyway, "diagnosed" and scheduled her.

Fortunately none of my clients have been pushed to induce or deliver before their babies were full term. Nor have they pushed their doctors to induce or deliver early. Sadly, this does not appear to be the case for the U.S. in general.

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Thursday, May 15, 2008

New England Road Trip Sweater

A month ago we made a 2,000 mile tour of New England, visiting two of my spouse's brothers and his parents. The visits were fine, but how 'bout all that time in the car? I took the perfect car pattern, Sitcom Chic. It was lots of stockinette stitch, only a bit of counting, and relatively small (for an adult sweater).

New England Road Trip

I knit almost the entire sweater in a week's time! This is certainly a record for pokey-needled me. I cast on and off a sleeve in one day. Amazing.

Better still, I love, love, love the sweater. It is amazingly soft. The color is beautiful. Complete strangers came up to me as I was knitting and commented on the color. It's a spot-on fit. Absolutely no complaints.


To boot, I found a button I adore.

New England Road Trip

A friend says it's Edelweiss, which makes me feel better. I thought it was a poinsettia (but had determined to wear it regardless).

New England Road Trip
Pattern: Sitcom Chic by Bonne Marie Burns from Knitty.
Yarn: 7 skeins Classic Silk by Classic Elite in cobalt.
Needles: Clover bamboo circulars, size 6 and 8.
Notes/Thoughts: I followed the pattern except for making the sleeves an inch longer than called for (I have long arms) and using an i-cord edging for the button and neck band.
Also, I learned the consequences of asking one's 10-year-old son to help with photographing knitwear (or anything else for that matter):

New England Road Trip


Thursday, May 08, 2008


I'm still new enough to the doula profession that many births bring me a "first:" first VBAC, first stillbirth, first twins, first delivery out of bed, first hemorrhage, etc. Many firsts have yet to happen in my experience. I am waiting for my first water birth, home birth, breech birth (right!), car birth and birth in an unruptured placenta.

I was already going to write about how my most recent client was my first client to have preeclampsia. She was diagnosed yesterday, nearly 2 weeks past her due date, and promptly admitted to the hospital.

Last night began her induction. She had gotten a gel earlier in the day. Around seven they began cytotec. At 11 she was contracting regularly so they opted not to go another round with cytotec and instead began a low dose pitocin drip.

After all this she remained dilated the same 1-2 centimeters she had been for weeks. They sent her spouse home to sleep, gave her Ambien and a little morphine so she could sleep, and sat back for the pitocin to start its long work.

At 1:00 my client suddenly found herself in serious discomfort and was quickly given the epidural she requested. When the doctor checked her at 4:00 she was complete. She called in her spouse and after less than 1/2 hour of pushing, delivered her healthy baby.

This is what her spouse told me over the phone this morning when he called to say the baby had been born. I assumed the call was for me to come in to the hospital because she was getting uncomfortable with contractions. When I heard a baby crying in the background my heart jumped. I thought her blood pressure must have risen precipitously and they'd had to do an emergency c-section. No.

Everything was okay. She just didn't call me. It was the first birth I've ever missed.

I visited them this morning. It sounds like two things accounted for my full night's rest. First, when things got uncomfortable, they did so quickly. And just as quickly the epidural eased her pain and she rested some more. Her spouse didn't even know she was getting an epidural. He was at home, resting up for the long haul.

Second, my client was very dopey. She said that between the Ambien and the morphine, she had a difficult time even understanding what was going on. She slept when they said sleep and called her spouse when they said it was time to call. No one said call the doula.

Her spouse said this morning that they'd much rather have had this kind of birth than one where they really needed a doula. Indeed, that was the birth we all were anticipating.

I have been replaying the night over and over. Despite their reassurances to the contrary, I can't help but feel like I failed in my job. I saw her at the hospital early yesterday evening, before they started cytotec. At everyone's urging -- the mother's, the doctor's, my own id's -- I went home to rest up.

No one thought this would be a quick birth. I have been an many an induction where the first 24 hours are all sitting and waiting for contractions to even start.

But I do not like leaving clients alone for this very reason. One never knows what will happen. Especially when cytotec, that jackhammer of a drug, is involved. Yes, she could have had 24 hours of cytotec and never responded. I have seen that before. Or she could have done what she did, jump all over it.

I don't think the birth would have gone differently. No one is saying it went poorly. But the thought of my client laboring alone haunts me.

I know this won't be my last missed birth, but I hope it's the last I miss from letting my guard down.