Butterfly Kisses

When Heather Ramsey, CNM (Certified Nurse Midwife) called me a few weeks ago with her news I didn't even believe it at first. She had given her 90 day notice to the University of Nebraska system and was teaming up with one of my personal favorite doctors to open a birth center here in my own city, Bellevue Nebraska. It seemed like a dream. Just a few months back I had been telling one of my doula clients and friends that it would be my biggest dream come true if Heather and this doctor went into business together.

I quickly checked my calendar and saw it was not indeed April Fools Day and the more I talked to her, the more I started to believe her! It was set to open sometime in 2011, if all went well, summer time! We talked for quite some time about various ideas and my excitement just grew and grew.

Over the next few weeks I became more and more excited and it was so difficult to quell it! I wanted to shout this wonderful news from the roof tops! I managed to somehow keep it under wraps until after I met with Heather again today.

We met to discuss many things, including bringing Brio Birth classes into her facility. We also talked about the variety of support groups that I can lead there as a counselor and birth professional as well as some really big plans for down the road as the business grows and grows. I left the meeting feeling like I was on the top of the world and am just so excited for the women and babies of Nebraska and Eastern Iowa. Finally we have a birth center of our own!!

Would you like a sneak peak of the new Birth Center's Website? It is still a work in progress but it has a great deal of basic information on it! http://bellevuebirthcenter.webs.com/

As I reach the end of my first full year in business I want to reflect on all the amazing beautiful births I have had the priviledge to be a part of. This year took me in directions that I never imagined that I would go and to places I never dreamed I would be fortunate enough to see. I wanted to share with you all my official birth statistics as a Natural Childbirth Educator as well as a doula. Granted I can't take credit for all my positive outcomes, I worked with some pretty amazing couples.  I also can't take all the criticism for outcomes that weren't the way my couples had hoped, some times there are just some circumstances out of anyone's control. That being said I do believe statistics can give you a glimpse into a person's practice. This year I am very proud of my statistics and I can only hope that future years will continue to hold as strong.

Childbirth Education Stats 2010

Total vaginal births: 87%

Of those percentage unmedicated: 96%

Percentage of cesarean births: 13%

Total percentage of successful VBACs 90%

Doula Stats 2010

Percentage of vaginal births: 92%

Of these percentage of unmedicated births: 91%

Percentage of inductions/augmentations 16%

Percentage of cesarean births:  8%

Total percentage of successful VBACs 100%

Fun Facts about my Doula Babies

Girls 83% Boys 17%

Biggest baby 10 pounds 14 ounces

Smallest baby 4 pounds 3 ounces

One baby short NICU stay

Babies were born in every hospital in Omaha except for Immanuel

June was a stressful month for us. We were supposed to move (and then had paperwork problems) we had the boys' second birthday and their birthday parties and then we had Becca's due date all wrapped together. Becca's due date came on the 23rd of June...and went. Over the next 13 days I analyzed every 'sign' I got that I was in labor. Sadly these were few and far between. On our anniversary June 27 I had contractions that were close together and steady for several hours but eventually they puttered out. I even lost my mucous plug but nothing else. For the next week I did lots of visualizations, 'Come out baby' from hypnobabies, red raspberry leaf tea. We tried sex, pineapple and spicey foods. The only thing I didn't try was castor oil since I felt pitocin was better than castor oil! I would have contractions off and on but nothing really steady or close together until July 4th. That night I had pretty consistent contractions until 3 am, but eventually they once again puttered out and I went to bed. On Sunday July 5th I had contractions pretty much all day but only about 2-3 an hour. Around 3:30 or so in the afternoon they started to get more and more regular however it wasn't until around 10ish that things started to really pick up. It was then that I started to realize this really might happen. Dave was going to go to sleep but I was in enough discomfort that I asked him to stay awake. I took a bath but it really didn't help much. I ate, drank, walked around and tried (unsuccessfully) to sleep. Nothing was helping. Between eleven and twelve I took to lying in bed while Dave just rubbed my lower back. I would say 80-90% of my pain was in this tiny spot in my lower back. Nothing made it feel better but Dave made it bearable. He was the most amazing coach ever! Every contraction hurt so much. They were right on top of eachother with only 2-3 minutes apart. It felt like non-stop pain. He kept massaging and talking to me and assuring me that I could in fact do this. He believed in me long after I stopped believing in myself. Around midnight I started my 'obsession' with the toilet as David later called it. I felt like I had this horrid diarrhea. I was also so nauseous. I never threw up but man I thought I was going to. Sitting on the toilet felt good. It was also during this time I felt like I needed a break from everyone. I was in such intense, never ending pain that I thought to myself there was no way I could make it any longer. I was still convinced these contractions were just going to fizz out like the others had. I thought there was no possible way that I could do this anymore. I even tried to figure out how I could get medication without having to leave the house since I was in too much pain to even do that! Around one I decided that it was time to go to the hospital. Not because I thought it was time for us to go, but because I figured with the intensity of my back labor pains that perhaps I could get some sterile saline injections to help. David, knowing my plan was to stay home as long as possible (and knowing my 'secret' plan to plead with him for drugs) discouraged us from leaving, however I put my foot down so he called his mom to watch the boys and she showed up about 1:30. We left immediately. On the way we called our doula to meet us at the hospital and the midwife's answering service to page her. I somehow wobbled to the car and we made the 20 minute or so drive. It took us forever to get into the building. Since it was after hours it was nearly impossible to get it! Once in the contractions were about a minute apart so we found a wheelchair since that was the only way we could make any time! I still had to stop for every contraction! We got to the L&D floor around 2:30. It took them forever to check us in. They finally took us back to triage. They asked a bunch of questions but I just ignored them and let David answer. He was still doing such a great job of supporting me! He would still massage my lower back for every contraction and continued to praise me the whole time. Once we got to triage they were asking if I wanted an epidural. Everything inside of me was screaming YES but somehow I found the strength to say no. She asked me to rate my pain, I said about an 8...she asked how intense I have ever had pain without taking medication, I told her 'we passed that about three hours ago'. So the brand new fresh outta med school resident wanted to check me for dilation. I made them wait out a contraction and let her go ahead. She took forever feeling around (okay like a minute but it felt like forever since I only had a minute between contractions) then the chief resident wanted to check me also. I told them to wait til after the contraction. Once he was able to check they were shocked (as was I) to find I was between a 7-8. I was so relieved to find out all that pain had been worth it! I could DO this! I didn't need drugs I could handle this! So they paged the midwife and took me to the room. They were telling me how I would be able to use the whirlpool or walk the halls and such (I kept thinking to myself, ummm I am a VBAC I don't think I am allowed to do any of that) but I decided to keep that all to myself! The nurse wanted me to lie on the bed so they could get some baseline measurements and to get my heplock in. For some reason or another the chief resident checked me again and said something about my bulging bag of water. It was about 30 seconds later that I had another contraction and my bad BURST. It was shocking to me just how obvious it was when that happened. Things started moving much faster then. They checked and saw that there was meconium in the fluid so the nurse called down to the NICU to have their staff come up for deep suctioning. The nurse was sounding kind of panicky. She kept telling them to hurry because this baby was coming! I remember thinking: It is?? AWESOME! I am almost done. My doula and my husband were both so encouraging during this time. The nurse told me to let her know if I was feeling 'pushy' so I said okay and then with the next contraction I said "Oh...I'm feeling pushy" that's when things moved into crazy high gear. There was so much movement around me they asked me to stop pushing and I totaly ignored them. They got the chief resident and the other resident gal in the room and made sure I was completely dilated. They were trying to break down the bed and I just kept pushing along with the next contraction. The nurse was paging the NICU staff to report to my room stat to be ready for suctioning. With contraction number three they told me I could start pushing. I pushed throughout that one and her head was almost all the way out. It burned so much but I kept trying to relax as much as I could. To be honest I was feeling kind of panicky. I'm not sure how to explain it, but I felt out of control, my body was just acting instictively without worry or care to what I mentally was contributing. Since everything was happening so fast and because of the meconium they wouldn't let Dave catch the baby or to cut the cord. So he stayed by my side while my doula rubbed my cramped foot. Next contraction came and I pushed with everything I had. I squeeze Dave's hand so hard. He told me 'you are doing it!!' and all of a sudden I felt it! The head came through, I took a deep breath and out came her body. She was all covered in green meconium...they cut the cord and handed her off to get suctioned. Dave went with her. They wanted to start pitocin since I was bleeding 'too much'. I asked if it was necessary (yes) could it wait til after I started nursing (no) did they have to do my stiches at the same time (yes). They then put in an IV for fluids (not really sue why they did that, I started to argue with them about it but decided to pick my battles and let it go). Then Dave carried Becca back in and handed her to me so I could nurse her. It had been a short few minutes but it seemed like forever. It felt so great to nurse my daughter. She took to it so fast. During this time I learned I had a second degree tear that they were stitching up. Eventually it got quiet in the room They checked out the baby mostly while she was in my arms. I refused the eye goop and vit K shot. I asked them to save the placenta (there was a pregnant pause with that question) but they did so. At some point they weighed her 8 pounds 4 ounces. 20.5 inches long. Her apgars were 8 and 9 due to color. It was around then that the midwife showed up and was very apologetic. The call center never called her when we had left the house. They didn't call until we were checked into our room (a little after three) which didn't give much time for her to get across town since she was born at 3:17! I really hate that she wasn't there. I think had she been there Dave could have caught, we could have avoided pit and the unnecessary IV, but in the end it didn't matter. Our baby girl came into this world nearly two weeks late but in a blaze once she decided it was time to get here!

Do you think that if you were to wake up tomorrow and someone offered you 20 million dollars to start a marathon that day and you had to finish it but there was no time limit could you do it? It might not be pretty, but most of us could manage to finish that darn thing even if it took us a month. Now contrast this to someone who has been carefully preparing for this same marathon. They have been eating and training with the marathon in mind for months. They have prepared physically, emotionally and mentally. While the marathon is still hard work they are able to accomplish it with significantly more ease and grace (and typically in much shorter times!)

How does this relate to labor and delivery? Childbirth is a marathon and of course you can simply show up on your baby’s birthday and know that eventually that baby will come out one way or another. However if you thoroughly prepare and train for it you will complete it with much more ease and grace (and once again typically in much shorter times!)

Do any of you remember the Seinfeld episode where George talks about how he does a ‘leave behind’ to arrange for a woman to see him three times “What's the difference? You know they way I work. I'm like a commercial jingle. First it's a little irritating, then you hear it a few times, you’re hummin’ it in the shower, by the third date it's (sings) "Cos-tan-za!"” Preparing yourself mentally is a little like this. If you do not have faith in your ability to confidently birth your child it is just short of impossible to do this in most cases. Attitudes and habits take weeks of reinforcement to change. Often times I have students who are so self confident and assured in their abilities during the early weeks of class. Then about halfway through the week they need a pep talk about it since other influences in their life have caused them to question their innate ability. By the end of the class my students are no longer doubting themselves, they are secure in the knowledge that their body was made to do this and that they will have their best birth!

An important aspect of a childbirth class is information. That’s what you are going there for in the first place. There are a lot of things out there to wade through in terms of understanding childbirth in America. We have a lot of arbitrary rules out there that originally intended to provide for safer outcomes in childbirth however much research doesn’t support these routine protocols. In 12 weeks I barely scratch the surface of these issues and still expect my couples to do outside readings and homework. I cannot even begin to fathom how someone is able to cover even a fraction of the relevant material in a class that isn’t even half as long.

Another key component of a childbirth class is the introduction of techniques and time to practice them. In a twelve-week series you are given an entire toolbox of ideas of how to manage your labor and exactly how to use them. Then you are given time in class to practice them so you can feel confident that you are using them in a way that will maximize the benefits your receive from them. Many couples report this time in class is the only time they find to truly focus on these activities in their busy lives.

In order to have your best birth you need to be in your optimal physical condition. Obviously pregnancy isn’t the time to try to lose weight or start an intensive exercise routine however you do want to be in your best condition in order to stay low risk and to have an easier labor and delivery. This includes eating a balanced diet and adding moderate exercises including pelvic rocking, light squatting and something for overall fitness like walking or swimming. Building physical strength and stamina takes time and we want to encourage you over the course of twelve weeks to be in your optimal health.

The biggest reason behind 12 weeks of classes is that it works. Statistical analysis done by the American Academy of Husband Coached Childbirth shows us that couples who completed a full and continuous 12 weeks of classes were significantly more likely to have an unmedicated birth. The fewer the weeks of class the higher the rate of medication. You deserve your best chance at your best birth. Do not settle for less!

Some information taken from www.bradleybirth.com

I received a phone call the other day asking for information about my childbirth education classes. The woman was very interested in all the information that I was providing and seemed to really think the class would be just what she and her husband needed to prepare for their birth until she asked how many weeks the class would last. “Twelve weeks!” she exclaimed “You expect me to spend twelve weeks on something so simple as giving birth?” I was truly at a loss for words. Something as simple as giving birth huh? I reflected on these words for a couple of days and soon found myself getting angry. Was twelve weeks really too much time to ask someone to plan for one event? I started thinking about other events I have taken time in my life to prepare for. The only thing that came to mind was my wedding. For over fifteen months I planned. I was on wedding planning message boards, would interview every single person who was recommended to me and spent countless hours agonizing over the colors, the music, the flowers, the dress and everything in between. Most couples I know do the same. Of course at the end of the day all that really matters is that they are able to marry their partner but very few people say ‘well the minister/priest/rabbi etc is the expert on marriage I will just do whatever they say in regards to my wedding’ yet when it comes to birth so many couples simply defer to whatever their doctor tells them is best even when there is no medical evidence supporting those choices. We invested 15 months into planning our wedding which only lasted about 7 hours from the march down the aisle to the last dance. The average labor for a first time mom is 12 hours. Even if you are planning a medicated birth doesn’t it make sense to put even a quarter of the effort into the plan as you did your wedding day?

Is 12 weeks of childbirth preparation really too much time to invest in preparing to bring your child into this world? Honestly I don’t think its long enough and find myself supplementing my materials with emails, articles and research throughout the week. When you really start looking to how to prepare for such an extraordinary occasion I suggest you find the longest, most through childbirth class you can find and then supplement it with as much reading material as you can. When it comes to bringing your child into the world this is truly not a case of less is more.

What a beautiful and amazing baby girl you are. You are also so very very lucky to have a mom and dad who love you so very much.. I met your parents about 3 months before you were born and I wanted to tell you just how much your parents loved you before they even laid eyes on you. They did a lot of things to make sure you had the very best start in life. You were a little trickster as the time came closer and closer. You gave your parents a few tough times. They even went to the hospital because your mommy was bleeding and thought something might be wrong. The midwife couldn’t find anything wrong and suggested to your parents that since you were so close to your arrival date anyway that they could start labor with a pill the your mom and dad had learned about in class. Your mom and dad were so smart and strong. Although they were so very excited to meet you they held strong and told the midwife they wanted to wait until you decided it was time. This was hard for them to do, but they just knew it was in your best interest so they did it. Your mom and dad went home and tried to rest. For several days you would start contractions, making it tough for your parents to rest, but you still weren’t ready to really getlabor going yet.  Eventually things started to progress and your mommy and daddy decided it was time to head to the hospital. They were so tired! Shortly after they arrived they discovered that Kate, one of their favorite midwives was going to be working with them. What great news that was. Your mommy was having a great deal of back labor pain. Once Kate checked things out they quickly learned that you were ‘occiput posterior’ which meant your face was looking out  instead of looking at your mom’s spine. What this meant was a great deal of back pain during labor for your mom as well as a harder journey for you to get where you needed to be. The midwife suggested some ideas for your mom and dad to use to get you to turn. She suggested they go on the hospital staircase taking two stairs at a time, leaning into a deep lunge giving you room to turn the way you needed to turn. They went back to the room to rest for a bit.Your mom received sterile water injections to help relieve some of the pain.What an amazing difference this made! Your mom was finally able to rest for a short while. It was during this time your dad let me know what was going on and I was so excited to come up and assist your mom and dad as they worked together  to bring you to this world. When I first came in your mom was resting. When shewould have a contraction your dad would work with her through them. It was truly amazing to see how well they would work together. Your mom relaxing and breathing while your dad would massage and put counter pressure on her body.After a while your mom decided it was time to get to work again. We went back to the stairs. Your mom worked so hard at this! Your dad was also just amazing with his endless amounts of encouragement and support. Your mom would climb from the fourth floor to the eighth over and over again. I lost track of time during this phase, but I know she was at this for quite a long time. We went back to the room for your mom to get back on the birthing ball. Your dad was so kind and so loving to her during this. He would insist she drink some water or eat a small snack at every chance he got. They brought some energy drinks from home and these seemed to really help them both stay energetic and focused.Your mom would sit on the birthing ball, rotating her hips trying so very hard to get you to move into the right position and when a contraction would come she would complete melt against your dad. He was able to be her strength when she needed it the most.  Eventually Kate came to see if your mom had any luck getting you to move around. At this point you had moved a little but were still in the OP position. Your mom had some slight changed to her cervix, but not as much as the midwife had hoped for.Kate then decided to order some calcium to help rejuvenate the exhausted muscles. The days without sleep were really taking their toll. Then Kate came out into the stairs with us and goodness did she have your mom and dad working hard. Those contractions started to come one on top of another. Your mom was asight to behold. Your dad would hold her in his arms and they would slowly dance during the contractions. Softly moving together, working to bring you down a little lower with each one. The love your parents have for each other and for you was so strong that day; one couldn’t help but be moved by it. Time ticked on and eventually it was time for your mom to be checked again. It wasat this time Kate gently advised your mom and dad that it was time to start ani ntervention. Your parents were so educated about birth that this scared them.They knew that anytime you do something artificial in labor that there is a risk involved, however your mom’s energy clock was really starting to wind down. She was working so very hard the eventually her body was going to stop working and demand a rest. It was clear to your parents that something needed to change in order for you to be born. Your parents made a very informed choice to begin pitocin, a drug to make contractions stronger. One of the downsides of this medication is that it makes contractions significantly stronger and more painful. Most moms who are put on pitocin end up taking pain medication. Not your mom. She knew that it was so important not to have an epidural. She knew that it was risky for her labor and for your birth and despite the intensity of the pain, she knew how to handle it. It is in this moment that your parents bond truly took my breath away. Without a doubt your dad was such a source of support and love for your mom as she rode the waves of the contractions. It was just amazing. Your mom was on the pitocin for several hours working with the contractions, fighting her way to you. At one point Kate checked and you had moved! You were finally facing the right way! All that hard work your mom and dad had done was worth it.

It was around this time that your mom hit what we call transition. This is typically the time in labor when moms get really upset, panicked or even ready to give up. Not your mom. She was as cool as can be. She started to feel the urge to push but she wasn’t fully dilated yet so she had to work hard to move past that feeling. She  tried so many different positions to try to get you to keep moving down.There was no relaxing through this labor. Your mom was so hard at work, yet she did it with grace and style. Truly amazing. Your mom kept telling the midwifeit was time to push; yet she wasn’t yet dilated. Finally your mom was almost there. She pushed for a contraction then breathed through the next few. She was quickly able to finish dilating and then it was time! Your dad was doing such a great job of supporting her. He was holding her and loving her while she pushed you down. As you got closer I took your dad’s place at her side and he moved where he would be able to support her, yet be able to help catch you as you emerged. Finally we started to see your head emerging. Here you mom just knocked me over in amazement. You see you crowned for a very long time. Many other moms at this point would have pushed with all her might and hurt herself badly. Not your mom. She had the presence to go slow and easy. She could have demanded the midwife make a cut in order to open the area more, but your mom knew a natural tear was more beneficial. So she was calm, cool and collected and slowly with each push you worked your way out. Your mom pushed for over an hour. She looked in the mirror and saw your head. She was so determined. As exhausted as she was, she held on, working with you to give you the birth that you needed. Then with one last breath your mom pushed you into this world. Your daddy’s hands were the ones there to greetyou, the first person to touch you earth side. Your mom reached down and pulled you up. Your dad had tears in his eyes. It was truly one of the most amazing moments I have ever been a part of. Kate and the nurse worked to help you with your breathing. You however were exhausted after such a journey. You had breathed in a little meconium on your way out. The midwife did a quick APGAR evaluation and found your numbers to be a little on the low side. They paged in a few special nurses and took you to the next room to do some deep suctioning and make sure you were able to breath okay. Your daddy went in with you and took lots of pictures and then came back to tell your mom how wonderful you looked and how great you were doing. Your mom was catching her breath and having some repair work done by the midwife. Your dad came back out and said that the nurses wanted to know your name but your dad thought that your labor team deserved to know it first. They explained the meaning of your name. It was so beautiful. You came back to be with your mom for a few minutes. The nurses wanted to keep you for a couple of hours and your mom and dad really needed to sleep for a bit in order to be ready to be your parents!

Your parents were so excited they were to get to finally see you, touch you, and hold you. Theyare truly looking forward to spending a lifetime with you, teaching you about life and all it has to offer. You are so lucky to have such wonderful parents that love you this much already. You are a blessing to them as well. I wish you nothing but a happy, healthy, prosperous life. I feel honored to have had the opportunity to help your parents prepare for you and to be there on your very first birth day! 

As long as I can remember I always wanted to be a counselor. I remember watching "Growing Pains" as a child and thinking that what Dr. Seaver did had to be the coolest job on the planet. When I entered high school I learned of guidance counselors and I was hooked. Along the way I took many twist and turns but eventually decided to follow my original dream and return to graduate school to get my counseling degree. However I quickly learned to work in the schools you need to first be a teacher. So I obtained my teaching degree and taught for a couple of years while I earned my masters degree. I then had our twins and decided to stay home with them for a year so I could be a full time mom to them and finish my masters degree. This was no easy feat. Newborn twins were tough! A year later I returned to work part time to do my practicum and finish this dream, which I had been hard at work on for seven years. When I started finally working in the schools it was so great. I loved working with the students, the teachers and their families. I couldn't believe how amazing my dream job was. It was everything I had wanted and more. Yet something was still missing. I couldn't put my finger on it at the time. I was perfectly happy. During this year I learned I was expecting our daughter. I worked hard graduate in May instead of August like I had planned. I also started teaching a few graduate courses to supplement our income. As you probably already know during this pregnancy something changed. We knew we wanted a different birth for our daughter. We became an informed consumers and eventually had a natural childbirth.

To say our daughter's birth was life changing would truly be an understatement. I suddenly understood religious zealots who had 'seen the light'. Birth wasn't the way it was described on TV; it was something magical and amazing and I felt every should be get to have this experience. The pain in childbirth wasn't like the pain of a headache, a broken leg of really anything I had ever experienced before. With that one day the course of my entire life's work changed. I knew without a doubt I wanted to spend my life helping couples to experience what my husband I had experienced. During my maternity leave I took training to become a Bradley Childbirth Instructor and started teaching classes. Being a childbirth instructor felt like my calling in life.  I wanted to change the world with my birth work. My students quickly became friends and suddenly they were asking me to be their doula when it was time to give birth. I did some additional research, signed up for a doula training and got started!

Over the past few months my business has grown tremendously. I began to have requests for clients during the next school year. I couldn't decide what to do. I was worried about their labors starting while I was at work. I knew it was time to make a choice. Would I continue to be a school counselor, limiting my ability to be available for my doula clients or should I take a leap into this exciting but unknown territory? This was a tremendously scary idea. We recently bought a house and  depend on my income to make it work. How could we manage this? What if my business, like so many other businesses have, failed in this economy. Who would watch the kids when I went to births? So many questions, so many fears. My amazing husband and I would have endless conversations about it. He would encourage me to continue to reach for my dream, although of course he too was concerned. Eventually we closed our eyes,held hands and took that leap together.

My last day as a school counselor was last week. What a tremendously emotional day that was for me. I knew in my heart as I walked out those doors,that it was my last time as a school counselor. My life long dream was coming to an end. Of course I could return to it someday, but for some reason everything inside of me tells me I won't. Out on the horizon is something new. A new dream. The career I never knew that I always wanted. As time passes on it seems things are working out just fine. I wish you all the same. I am even starting to get full and having to refer clients who are due several months down the road. I am so blessed to get to have an amazing husband, family support and kick butt babysitter who all are willing to work to help make my calling a reality. Thank you all.

When I first heard from the laboring Mom and Dad it was around 9 in the evening. Dad told me that they had been having steady contractions for several hours. I was very excited for them, but I went to bed knowing that they would let me know if/when they needed help. I awoke around midnight to another message that there was a great deal of blood and the doctor was talking emergency cesarean with them. There was a fear that there was placenta previa or detachment. I held my breath for that entire next hour until I heard that things had checked out and the doctor was allowing them to continue laboring. I slept a restless sleep and checked in again in the morning. I was concerned about the large amount of bleeding Mom reported having. I was concerned that they had been at the hospital so long. In general I was very concerned about their labor. I took some deep breaths and prepared to meet my next series of Bradley students. All during class Mom and Dad were heavy on my mind. Class ended and I checked in with them again. The long labor was starting to take its toll on both of them so I loaded up Becca-boo and headed off to Grandma's house to drop her off with her brothers.

I arrived at the hospital around 2:30. Mom and Dad both looked exhausted. They had been laboring well over 24 hours at this time. They were going on little rest. She was given the green light to eat and drink, however she was exhausted so this was difficult for her to motivate herself to do. She however was such a rockstar that she did it inspite of how little she wanted to eat. I was surprised at how upbeat they were. The contractions were pretty close together and pretty intense but Mom and Dad were working together in perfect harmony. I was so impressed with just well she was relaxing through the contractions. I really would have thought they were totally painless by how amazingly well she was handling them.

During the first few hours we walked, talked, rested and just managed it. When a contraction came Mom would total melt into Dad and I would massage her sore spots and support them both. During this time Dad’s parents came up and brought the most beautiful flowers. They were clearly so excited and so very supportive! They didn’t stay long, just long enough to give their love and support. It was funny because it turned out that the nurse who had been supporting Mom and Dad all day long was a friend of Dad’s sister. She had even been in the sister’s wedding if I remember correctly. What a small world indeed. As things progressed she would rock, dance on the birth ball and even took a warm bath. As day turned into night it was decided that both Mom and Dad should try to get some rest. Dad covered up with his blue and white blanket that perfectly matched his blue and white swim shorts. Mom was in her adorable polka dot bikini top and honestly looked like one of the most beautiful pregnant women I had ever seen. They both rested for over an hour. When a contraction began to build I would gently start to wake her and help support her through it. She barely flinched the entire time. Don’t think for a minute this means these were not painful! She was just incredible at managing/relaxing away her pain.

After she woke things really started to pick up. Her doctor began to express concern about just how slowly she was progressing through labor. She knew it was time to really get to work and she became as active as she could be getting those contractions going. Her mom came up around this time and brought a great deal of energy back into Mom. Its funny just how amazing grandmas can be with their daughters during labor. She reported that the contractions were “ridiculous” (which may have been the funniest thing I had ever heard based on just the way she said it…Dad, her mom and I all fought off the giggles with that one) but as she once reported “I totally kicked that contraction’s butt” and really she did. She was amazing. She was peaking, and double peaking. They would arrive one on top of another. She was nauseous, throwing up, hot, then cold, confused and really starting to have some serious self doubt. Every single thing she did screamed transition. She was still managing these contractions like a pro. I am certain without any doubt she would have handled the pain and intensity for three more days if necessary. I became so excited. I knew she was making progress and baby would be there soon. This went on for about six hours until her doctor decided it was time to check her around 4 am.

Now we talk about cervical dialation a lot in class. We know that a woman can go from a 3 to giving birth in a matter of minutes. Knowing this is what kept Mom going throughout her labor. You see Mom had been a 4 for a very long time. In fact when I arrived at 2:30 she was a 4 and at the few periodic checks in between she remained a 4. Most women would have given up on their birth plan after not showing any cervical changes for well over 15 hours. Not this Mom. Mom and Dad were nothing short of amazing. They took each contraction one at a time. They worked there way through and were truly a sight to behold. Instead of feeling defeated after each cervical check she felt more determined and would work all that much harder to get her daughter in a better position.

I would love to say that at this cervical check she was a ten and pushed her daughter out shortly after. This however was not the case. I think everyone on the entire floor’s heart dropped when he reported she was still a four. In fact her doctor had to step out of the room a minute before reporting the number to get a hold on his emotions. This was not good news.

There was a lot of talk about what to do next. We had tried to get her to sleep earlier but the contractions were so right one top of another she was only sleeping for a minute or two at a time. She had been in labor/without sleep for more than 50 hours. We all know what happens to tired muscles. They stop working effectively. This is what was happening to Mom. She was so exhausted that even though her body was still doing the work, her cervix would not open up. It became fairly clear that until Mom got some rest her exhausted body would not birth this baby. The doctor and nurses were starting to get very concerned for Moms well being and were beginning to talk about a cesarean section. It was at this time that Mom knew something needed to be done. The nurse and doctor talked with her about her options. They offered some narcotic through an IV to help diminish the pain so she could try to rest or to give her an epidural so she could really sleep. I advised them that if they were going to make the choice to go with medication, then to really think about what the goal of the usage of medication was and which medication would fulfill that. Taking into account just how exhausted her body was and how overwhelming the need for sleep was they made the choice to have an epidural.

The anesthesiologist came, administered the medication and both mom and dad slept almost instantly. Mom was gently awoken a few hours later and was able to push her daughter out into this world. That moment was no less special or amazing because of an epidural. Because Mom’s body had worked so hard before the epidural was given she was able to very quickly move into the next stage once her body was rested.

I consider this birth an amazing birth story and am so proud to have been a part of it. I realize that someone reading this story might feel the need to judge their choices. In one camp you have people who will tell you that if they had just waited eventually she would have either progressed or become so exhausted she would have slept on her own without the medication. In the other camp you have the people who will tell you that’s what is wrong with having a birth plan in the first place and that she should have just had the epidural 30 plus hours ago and been done with it.

For the natural birth advocates I will say perhaps you are right. If she had waited another hour, two hours, eight hours, twenty hours, forty hours her body would have given up and she would have slept. The stress to her baby and to her body during that time was a concern. There is of course danger in pushing your body to the brink like that and her doctor was worried about the strain of it all on her body and her baby. They made a very informed and educated choice. They knew just what the risks of an epidural were. Whether or not you would have made the same choice is irrelevant. They had fought hard for a very long time.

As for those who say she should have given up the fight hours ago I strongly disagree. During that time her body was working hard. It was moving Baby girl down her body. She felt the pain and pressure move from high on her back to low within her hips and pelvis during this time. Baby girl was making progress. Epidurals are famous for stalling out cervical dilation. Can you imagine what that would have done to an already stalled cervical dilation? With all of my training and every single thing I know about birth and medicated labors I am certain that had she had an epidural earlier she would have had a cesarean. In my mind there is no doubt about that.

Never before had I been so honored to have been with a couple who knew just what they wanted and were so willing to fight for it. They were amazing. Truly truly so awe-inspiring. Their birth is truly a success story and I thank you both again for allowing me to be a part of it.

After I made the choice that I wanted a VBAC for the birth of our daughter I had an extremely difficult decision to make. You see our twin boys had been born with an OB and with as often as I saw him, I felt really close to him. I was comfortable and to be honest I really liked him to. However I knew from our previous conversations that he truly didn't understand the whys of natural childbirth (liking it to getting major surgery without anesthesia) and while on paper he was supportive of a VBAC he had so many restrictions (as long as I went into labor by exactly 40 weeks, as long as I stayed on the monitors the entire time, as long as I stayed in bed, as long as I had IV fluids, any irregularities straight to surgery, etc) all things I knew were not conducive to a natural childbirth, but I liked him and I didn't want to hurt his feelings (this makes me laugh now, but it was a real fear at the time).

After much urging by my friends I finally agreed to make an appointment with the only midwife group in town that would see a VBAC, the midwives at UNMC. I met with Heather Ramsey and was just astonished by how non-medical the whole thing was. We talked about VBAC and birth in general. Every single one of their standard policies was exactly what all the research I had been doing supported. I suddenly realized what it would be like to have care providers who actually supported what the most up-to-date birthing research says. What it would be like to have people supporting me, not fighting me. I instantly canceled my next OB appointment and never looked back.

My pregnancy was amazing and so very normal. Becca was born at 41 weeks and 6 days. Long past when my OB would have insisted upon a section. I was able to realize my dream of birthing my baby with the loving support of my husband and my doula. Becca entered the world so calmly and peacefully. This was such a gift to her and to me given to us by the loving care and guidance provided to me throughout my pregnancy by my midwife. So in honor of "International Midwives' Day" I want to say thank you to all those midwives out there doing what they do. As a mother, a childbirth educator and a doula I say thank you for providing researched based choices when so many do not.

In my class on Saturday we were discussing concerns and fears about childbirth. One couple mentioned they were concerned about knowing when to leave for the hospital. They have around an hour's drive to get to the hospital they have chosen. If they get there too soon they are subject to longer billable labor room times, more medical interventions and labor slowing down as a result of the too early arrival. If they go too late they are suject to having to go to another hospital where they are not going to be with their chosen physician or even a baby born in an unexpected location! We talked through things to look for to know when time is getting closer and later I emailed them to really emphasis the emotional signposts of labor. It was mentioned that perhaps it would be a good idea to have a doula with some training in how to check cervixes come out and check the couple before leaving. This was mentioned as a possible idea as to know if they are a really low number to stay home and if they are a higher number to go.

I sat and pondered this suggestion for most of the rest of the day. We talk a lot in class about cervical checks. What they measure and how useful that information is. We talk a great deal about minimizing unnecessary checks especially if you are at a higher risk of infection in a situation such as a ruptured membranes (water broken). We talk a lot about whether or not it is a good idea to depend on these measurements.We've all heard dozens of stories about women who were a 2 and an hour later their child was born. What if this happened to this woman? What if the emotional signposts were urging her to go, but the numbers were telling her to stay?

So what do you think? Taking out any legal issues of having someone do a cervical check on you at home (not feeling like hitting that murky field today!)  If you were in this situation what would you do? Cervical check before leaving? If not what advice would you give them on when they should go?