|Posted by fullerbirthsupport on March 9, 2011 at 11:09 AM||comments (3)|
This is one of my favourite births! (Birth story published with permission)
“Sorry to be the bearer, but I’m pretty sure this baby is coming today!” the text message read. Ok, I thought, why not? All the other babies are coming today, why not baby Johnson? It was after all my 1st wedding anniversary, and I remember specifically telling Ashley when she first hired me as her birth doula and she told me her due date was September 29th, that just don’t have your baby on the 27th, ok? Well, I guess she didn’t have the baby on the 27th; she delivered him just after midnight on the 28th. But that’s not the point; the point is that I have learned my lesson about telling my clients when not to have their babies! Anyways, I got the text message, and I got ready to drive back into the city for baby # 2 of the day!
Previously….. Ashley had been in pre-labour for the past couple weeks, but it wasn’t until Friday, September 25th, that her braxton hicks contractions changed into regular labour surges. They had started after her acupressure appointment and doctor’s appointment, where she had gotten her cervix rimmed and was found to be 2 cm dilated and 100% effaced. The surges stayed between 10-20 minutes apart for the rest of Friday, and all day Saturday. Ashley was doing everything she could think of to try to make her labour more effective. Saturday evening she went over to her cousin’s house for a massage and more acupressure. She was a little worried that she hadn’t felt the baby move much since Friday afternoon, and so Sunday morning after breakfast at Denny’s they decided to stop at the hospital and get checked out. I was still at the hospital from the morning’s previous birth, so I met Ashley and Craig in their triage room. The baby looked perfect on the monitor and Ashley was assured that all was well. While I was still hanging out with them, Ashley had a surge that was a bit more intense than they had been for the past 2 days. But they still had things under control, so I left the hospital and drove home to Airdrie in hopes of a shower, some food and rest. I had a shower, and had some food. Then I got Craig’s text message.
Oooooooooo-pen I arrived at Craig and Ashley’s house around 1 pm. Craig had taped a note to the door to tell me to just go in and they were upstairs. Ashley was in the tub and Craig was trying to keep her calm. Once they had left the hospital, Ashley’s surges had become much more intense in the car and were about 4-5 minutes apart right now. She was being very vocal during the surges, and so I suggested that she try to keep her voice low, and breath low moans out on her exhale. This worked for a couple of surges, but Ashley was having trouble controlling it, so I suggested for her to say “open” on her exhale. This immediately worked for her, and Craig chanted it along with her. And thus began 10 hours of “oooooooooooo-pen” during every surge. Once Ashley had her ritual in place for her surges, she was able to control and cope very well. She tried a variety of different positions, in the tub, on the toilet, in the shower on the birth ball, and on the bed; either on her side or her hands and knees. Craig and I stayed by her side, chanting with her, massaging her back and offering her sips of water.
It’s go time! It was around 4 in the afternoon when Ashley started talking about wanting to leave for the hospital. So we started the process slowly: we got Ashley up and dressed, to the toilet, got her hair up in a ponytail, she drank some juice, we got various items together that needed to come with us to the hospital. By 5 pm we were at the Foothills Hospital. In triage, the doctor assessed Ashley’s cervix, and she was 3-4 cm dilated. Ashley said she would like to try something different for pain relief, so the nurse got her into a labour and delivery room right away. Once in the room, Ashley got into the shower. After a little while in the shower, Ashley needed to come out so that the nurse could put her IV in place and start the antibiotics Ashley needed for her Group B Strep. Ash was on the birth ball, and she decided to try the entonox- laughing gas. At first she didn’t like it, but after using it for a few surges, Ashley was back to chanting “open” on her exhale behind the mask. Just before 8 pm, the doctor came in to check Ashley again. She had progressed to 5-6 cm, and the doctor ruptured her membranes. This made the pressure increase a lot for Ashley, and by 8:30 pm, she was feeling an irresistible urge to push with her surges. A cervical check told us that she was still at 6 cm open. Ashley was working incredibly hard to blow away the urge to push, and so we talked about her options. She mentioned just once that she might want an epidural. I reminded her to take small steps, and that she hadn’t tried the phentanyl yet. Ashley agreed and thought that was what she would like. So at 9 pm, Ashley got some phentanyl. It helped to relax her in between surges, as she was only getting about 30 seconds of rest before another one would start. Ashley kept using the gas mask as well. She stayed mostly on the bed, on her hands and knees, and on her side, and every hour we helped her up to go to the bathroom. The desire to push stayed strong, but Ashley breathed past it to open up the rest of the way. By 10:20 pm she had opened up to 7 cm. Craig and I remained by her side, encouraging her that she was close, and that she would soon have her baby. Craig guessed that the baby would be born around midnight.
Finally, it was time. At quarter to 12, the nurse did a quick in and out catheter to drain Ashley’s bladder. After she was finished, she checked to see if Ashley was fully dilated. She didn’t need to reach far, because baby’s head was right there! Ashley no longer had to resist the urge to push, and she gave it her all. After just a few minutes, Ashley was able to reach down and feel her baby’s head. “Oh my god” was all she could say. Ashley was pushing in a semi reclined position on her side, holding behind her legs, and Craig and I on either side of her supporting her legs. Ashley brought her baby down into the world slowly but effectively. Baby boy Johnson was born at 12:23 am on September 28th. Ashley did such a great job of pushing that the doctor didn’t even need to show off her stitching skills. Myles was a bit stunned after his journey, and needed to be brought over to the warmer for a minute. He started squawking soon after. He weighed 6 lbs and 15.8 oz. Ashley was also in shock after the birth, she couldn’t believe she had just given birth to her son, exactly how she had wanted to. She also couldn’t believe how sore she was, and managed to say with a smile, “it feels like my vagina was wrapped around my own head”. Uh, Ashley, it was wrapped around a head, but not yours! Ashley and Myles were both cleaned and wrapped up, and soon it was time for mother /son bonding time. Ashley latched Myles on for their first attempt at breastfeeding, and I brought her some much needed and deserved peanut butter and jam toast.
Ashley and Craig, Congratulations!! It was such a pleasure to be with you on your most special day together. You were both amazing, and did such a fantastic job of bringing your son into the world; I know that you will do the same as parents. Ashley, there are just no words to describe how proud I am of you for the work you did. Craig, you were excellent at bringing Ashley back to earth, the way you coached her through it made all the difference. Thank you for the experience!!
|Posted by fullerbirthsupport on January 10, 2011 at 12:13 PM||comments (1)|
Group B Strep is a bacterial infection that women are tested for usually in their 36th week of pregnancy. Although it is harmless to us, there is a small risk of the infection being transferred to the baby during delivery, and so it is procedure in hospitals to administer antiobiotics to the mother during labour if she has tested positive for GBS, or if her GBS status is unknown.
Here is a great article that every pregnant woman should read about Group B Strep:
Newborn Group B Strep Infection: Top 10 Reasons to Not Culture at 36 Weeks
by Judy Slome Cohain
Copyright: Midwifery Today 2010
1. Culturing at 36 weeks and treating GBS-positive women prophylactically in labor has never been shown to decrease newborn GBS disease more than not culturing and only treating women who go into labor prematurely, have ruptured membranes for more than 18 hours, or have a fever and is far more costly. Culturing at 36 weeks and treating GBS-positive women prophylactically in labor has never been shown to decrease newborn GBS disease by randomized controlled trials.
2. The premise that GBS cultures are accurate for five weeks is based on a single study of 116 women. Larger studies failed to reproduce these results and have shown GBS cultures are not reliable for even 24 hours.
3. Penicillin-resistant GBS has been documented since 2007 and in one study already makes up 10% of GBS cultured from women. Based on history, 25-45 years from now, 50% of GBS is likely to be resistant to penicillin. It is plausible, that giving mega doses of penicillin to a million women in labor each year will speed the selection for penicillin resistant strains. No new antibiotic families have been discovered since 1960 so there is little hope for discovery of more effective antibiotics.
4. About 50% of GBS is already “resistant” to the antibiotics (clindamycin and erythromycin) used by the 7-10% of women who are allergic to penicillin. When the GBS is resistant, the alternative antibiotic, vancomycin, has been causing strong side effects such as hypotension and “Red Man syndrome” (i.e. hives, histamine reaction and feeling lousy).
5. The US Centers for Disease Control (2002) declared antibiotics a “temporary solution” because of the known risk of penicillin-resistant GBS, though failed to define temporary.
6. A GBS vaccine is never going to happen, because the surface antigens of GBS mutate too quickly to give the vaccine before pregnancy, and the legal liability of giving pregnant women vaccines is too great. The last 30 years of efforts to find an effective vaccine have failed.
7. One in 10,000 women have serious anaphylactic reactions to penicillin.
8. Vaginal GBS is twice as prevalent in states and countries that overuse antibiotics.
9. If the noses of newborns who have no GBS disease, are cultured, many will culture positive for GBS even if the mother was given Penicillin in labor. But the newborns who culture positive for GBS who’s mother’s received Penicillin in labor had three times more newborn respiratory distress (nasal flaring, grunting, retraction or tachypnea i.e.respiration rate >60 breaths/minute, within 48 hours after birth compared with GBS colonized newborns of untreated mothers. Antibiotics given during pregnancy also seem to be associated with increased allergies and asthma in children.
10. Telling women they have a bacteria that may kill their newborn is terrifying to most pregnant women.
Top 10 Things We Don’t Yet Know About GBS of the Newborn
1. How many full-term babies are injured (not killed) from GBS disease of the newborn? What morbidity do they experience?
2. Do prophylactic antibiotics to GBS-positive women prevent GBS morbidity in full-term newborns (vs. mortality)?
3. What is the effect of giving antibiotics to pregnant women with asymptomatic GBS bacteriuria on the occurrence of GBS disease of newborn?
4. Since prolonged ROM is known to increase the risk of GBS disease, how would eliminating AROM as well as scalp internal electrodes affect the occurrence of GBS disease of newborn?
5. Since frequent vaginal exams (more than six) have been shown to increase the risk of GBS disease, how would eliminating vaginal exams affect the occurrence of GBS disease of newborn?
6. We know that 99% of babies colonized with GBS don’t get GBS disease. Why? We know that 99.999% of women colonized with GBS don’t get GBS vaginitis. Why? Why does GBS sometimes cause infection and sometimes live in ecological balance?
7. Why is GBS present in two to three times as many women in the US than in Ireland, Cambodia, Taiwan, Philippines or Africa?
8. How does GBS inhibit the growth of lactobacillus in the vagina?
9. Since many have tried and no one has ever demonstrated that GBS crosses intact fetal membranes, why is it still believed that that happens? If so, how?
10. How many newborns will die of GBS disease in 10 years? 20 years? 40 years?
Judy Slome Cohain, CNM, is devoted to illuminating the field of women’s health with objective evidence.
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|Posted by fullerbirthsupport on January 10, 2011 at 11:45 AM||comments (0)|
This will be my first attempt ever at blogging! My goal for this blog is to raise topics that will help you ask questions, really important questions about pregnancy, giving birth, and raising our children. As parents, our job is to do the best for our kids, and sometimes that doesn't mean going along with the norm of society just because that's what we are told is best for us by the media, the government, doctors, and by the family down the street with 6 kids that knows it all. It means thinking outside the box, and learning for yourself what is best for you and your family.
As a parent, doula and childbirth educator, I continue to learn everyday, because I now know to ask the important questions. As a first time mom giving birth 5 years ago, I wasn't asking these questions, and there are so many things that I know I would have done differently if I had. But that's the learning process and you do your best with what you've got at the time!
Here I will post articles that I find interesting, videos, other blogs, my own writing, and pretty much anything that I think will spark your mind. Thanks for reading!