So I'M actually taking the Journey of the Bump too???!

Well the time has finally come!  Many of my clients, past and present, have often said that they can't wait to hear all about when I take this little ol' Journey of the Bump myself... so here we are!  A sweet little bean has finally decided to set up shop inside of me!! {And by finally, I should say that I mean that I've waited my whole life for this... but when the time came we were blessed to conceive after only our 2nd try!}. I've decided to share this journey through my blog since I think that I have a unique perspective. I am a childbirth professional who knows {and by knows I mean intellectually, intuitively, and through "experience" having studied and worked as a supporter and observer} her fair share not only about the major physical changes this journey brings to a woman's body, but also the hugely transformative experience of the mind, the heart, and the spirit through pregnancy and childbirth.  And yet, with all of this "knowledge" I have never been blessed with the chance, until now, to walk the walk myself (and we all know that talking the talk and walking the walk are two very different things!).  Those of you who know me, even just a tad, know that I am beyond thrilled to be taking a turn at this amazing experience!

So while this won't be published until my husband, Andy, and I decide to "go public" with our news (which means if you're reading this then I've finally made it to my second trimester!!), I've decided to start my blog from...well naturally, the beginning!  While I've decided to pull back on my work load during my pregnancy, I will still be attending births and providing bodywork, so of course I will enjoy sharing these beautiful experiences as one who is taking this journey alongside my clients.   I hope those of you who choose to read along will enjoy this journey with me as my professional perspective shifts, my own motherly fears arise and (hopefully!) subside, and if all goes well...as my own precious little blessing enters this world in his or her very own special way.  Now here we go!

A guide to choosing a care provider and place of birth

{Before I begin I would like to disclaim that I am in NO WAY against one side or another (regarding both care providers and places of birth).  In sharing information it is always a sticky task and quite easy to misconstrue factual information as having some sort of negative agenda.  This is in no way what I aim to do, as I am simply trying to bring greater awareness to society's knowledge on the subject through both research and observation.}


Choosing your care provider and place of birth during pregnancy is an incredibly important task and can feel quite overwhelming at times.  Often moms choose their care provider because it's someone their insurance covers and recommended in the area, he/she has been their gynecologist for years, they chose them from a quick internet search, or even from misguided information.  Some choose their place of birth simply because it is nearest in proximity to their home without knowing what the facility has to offer.  Without knowing what to look for, or that something better even exists, many moms end up frustrated throughout their pregnancy, labor, and delivery.  Whatever your preferences, do your homework so that you know your options!

OB vs. Midwife?  
Ah the start of this whole process.  Do you want an Obstetrician or do you prefer a Midwife as your care provider?  First it's important to know the difference between the two.  An obstetrician is an MD (a medical doctor) with a specialty in childbirth. Therefore many people say, "ok yeah, then that's the one I definitely want... because they know more, right?".  Not necessarily.  Don't get me wrong... OB's unarguably know their stuff, but it's important to note that just like any other professional, not all OB's are the same. {I'll come back to that point in a moment.}  In general, Obstetricians are considered specialists in pregnancy and childbirth, and are experts at identifying pregnancy and birth related problems and being able to counteract these complications with medicine or surgery.  They are surgeons.  This is often where they thrive.  In other countries you see a specialist ONLY when you have a problem.  OB's in other countries are only seen IF you have a complication or are at a higher risk of developing one.  So one might think, "ok well I'd rather have the specialist so that they can better find any unforeseen problems or handle them better if they arise... right?".  Not always.  Midwives are specialists too... but they are specialists in normal birth.  In other countries everyone sees a midwife first and then are referred to an OB only in cases where problems arise.  Midwives are also fully capable of identifying complications (proactively) and referring patients to an OB when a complication extends past their scope of practice (before, during, and even after labor and delivery).  So in other countries, if you mention having an OB, you might hear, "oh... I'm so sorry" as it indicates things aren't normal in your pregnancy.  And just to add a not-so-fun fact in case you're thinking "well other countries aren't as developed as ours, so they're just behind"... our country is actually ranked 41st for maternal mortality.  That means 40 other countries (some "less developed" than ours) have better birth outcomes than we do.  In other words in case you still don't understand: 40 other countries have fewer women die in childbirth than we do!  Quoted from an article from the LA Times by Shari Roan and Lisa Girion back in 2010, "Though the U.S. spends more per birth than any other nation, maternal mortality is higher here than in 40 other industrialized countries, including Croatia, Hungary and Macedonia, and is double that of Canada and much of Western Europe."  Why????  Well, there are many areas where we can point the finger, from maternal age being higher than it used to be, poor health, overweight mothers, heredity, poor prenatal care, to underserved communities.  But one of the major preventable causes that raises eyebrows is that of intervention. Roan and Girion also write, "Some experts implicate the rise in rates of cesarean sections, which account for one-third of all births — up from one-fifth in 1997. Although many are done to save the life of a mother and her baby, perhaps half are elective, meaning the surgery is medically unnecessary. After one C-section, cesareans are typically recommended for subsequent pregnancies. Yet these are major operations and "should not be taken lightly," said Dr. Michael Lu, a UCLA associate professor of obstetrics and gynecology. Each additional cesarean increases the risk of placental complications that threaten the lives of mother and baby." -- "The induction or prompting of labor by medication, which is sometimes medically advisable but more often performed for the doctor's or patient's convenience, has climbed so steeply — it now occurs in 22% of births — that the American College of Obstetricians and Gynecologists felt compelled to advise its members last year to avoid inductions before 39 weeks' gestation.  When labor is induced a week or so before the due date, the uterus may not be ready, leading to prolonged labor. After delivery, the exhausted muscle may not contract properly to stop bleeding. Blood can no longer clot and becomes the consistency of water."  {Click here if you'd like to read the full LA Times article on the rise of maternal mortality rates}  So while we can't be certain of one direct cause, we can start with "if it ain't broke, don't fix it!".  If a pregnancy is normal, then I believe (as do good doctors and midwives) that you shouldn't mess with it or try to make it abnormal just in an attempt to find something to do!  There is no need to try and better a very natural process by speeding things up with drugs or conveniently scheduling when your little one "should' arrive. With this said, and going back to my point about not all OB's being the same... there are most certainly excellent OB's out there who fully support and honor the natural processes of pregnancy and childbirth and only step in when a true need arrises.  So if you think you definitely want an OB, then that's great... just do your homework in finding the right fit (or if you're local, ask me!) :).  Again, I'll come back to this point on how to find the right one for you in a moment.  First let's talk about the "other side".  So we already know that a midwife is a specialist in normal birth.  But it's also important to know which kind of midwife you are seeking.  In some states there are both CNM's which stands for Certified Nurse Midwives and there are CPM's which stands for Certified Professional Midwives.  Basically a CNM is a registered nurse who has gone on to become a midwife. They are legal in all 50 sates.  She has privileges in hospitals, but is always overseen by a physician.  She is able to administer drugs and some insurance companies may cover CNM care. So again, some would say "then I definitely want a CNM because they can work at the hospital where we're safest, right?!".  That is certainly fine if you feel strongly about delivering in a hospital...  but do remember that not only are they overseen by a physician but some would say (and I'm making a general statement which does not in any way reflect my personal opinion of all nurse midwives) that they are really "medwives"  as they seem to push the same interventions on moms that OB's sometimes do.  Hm... why?  Perhaps a product of their medically minded environment, or perhaps some are wannabe OB's?... who knows, but I too have witnessed this in SOME cases.  I have equally witnessed wonderful nurse midwives who are just as natural and less pushy as the home birthing kind, so again, just do your homework when finding the right CNM for you!  Now on to CPM's.  CPM's are not legal in all 50 states, though they have been in VA since 2005.  CPM's cover home births and free standing birth center births in the area and do not have privileges in the hospital.  Some believe that they have more autonomy in their practice as they are not overseen by a physician (though it's important to have good relationships with physicians in cases of transfer). They do not administer medications but instead use natural methods in their practice and are fully trained and prepared for neonatal resuscitation if the need arrises (though less than 1% of baby's born at home or birth center need resuscitation).  

Home vs. Birth Center vs. Hospital
Now, just as some moms believe that they are safest at the hospital "just in case something happens", others believe they are safest at home.  It is always important to remember when comparing the two that often the "emergencies" that arise in hospital settings are created by the interventions that have been introduced there.  I'm not saying that hospitals are unsafe, but when people say "oh had I been home, I would have died... or had I been home my baby would have died" it's important to understand that at home, many of those same complications don't arise because no one is messing with the process with medical interventions.  It's important not to really compare the two as they are two very different avenues. With that said, unfortunate, unforeseen outcomes happen every day in both home, birth center, and hospital, so none of this is to say anyone is immune by choosing one vs. another.

• Home birth (and I'll reiterate that home birth is for normal, healthy pregnancies and births): Moms are in their own environment where they are able to relax, eat, and drink without time constraints, and are able to move about freely while listening to their body as a guide.  They aren't tethered to IV cords or monitors (though it is important to understand that baby's heart rate will still be monitored periodically with a hand held doppler).  At home moms are able to avoid the sterile feel of hospitals, in a designated gown feeling like a "patient" (which often translates to feeling like one is sick or that something is wrong), and where they are able to avoid the constant poking, prodding and monitoring that has been shown to negatively impact the natural birth process by creating an adrenaline response to anxiety.  In addition, moms have a built-up immunity to the germs and bacteria in their own home (and therefore so does baby since they have mom's immunity) unlike the host of bacteria and viruses in hospitals. 
• Birth Centers:  Some believe they are "safer" than home birth because it's sort of an in-between: not so extreme as home and not so medical as hospital.  While this isn't exactly true, it's about where you FEEL most at ease. Again, be sure to do your homework.  Is the birth center run by CNM's and physicians using medicine or even attached to a hospital?  This may be just what you are looking for as it can be a really nice alternative to the medicalized setting of a hospital. They are often just like normal hospital rooms that happen to look a little cozier, have a bathtub, and keep the interventions better hidden so they aren't as "in your face".  For some this is a nice "in between". Or is it a free standing birth center that is providing a birth much like a home birth (we'll call it a home-away-from-home birth) with a full staff of CPM's and birth assistants and more "natural" equipment?  This can be a nice alternative to home birth if you live in a setting either with roommates, thin walls, or just want to get away to a nice atmosphere that is already set up for your needs (usually already equipped with massive birth tubs!).  Neither is necessarily better... just know what you're looking for when seeking your birth center!  There are a few great ones in this area if you'd like more information.  
• Hospital Birth: this is a great option for those who are certain they want to be at the hospital, definitely want an OB as their care provider, are at higher risk for complications, or are nervous about the idea of NOT being in a hospital.  Within the hospital setting, things are going to be much more medicalized, though it is completely possible to have a beautiful natural birth here if you so desire.  You will be monitored every hour (if not more frequently), you will most likely have a saline lock if not a full IV, you will have blood drawn, and will be limited (most likely) in what you are able to eat and drink.  In MOST hospitals (but not all from my experience), as long as you are unmedicated, you will be free to move around the room or walk the halls (when not on the monitors unless your hospital has wireless ones which would allow this throughout), you can usually get in the shower, or you can change positions with your doula on or around the bed.  All interventions are just a phone call away, but do realize that sometimes they are used faster because they are so readily available. 

Ok... so while this entire post could easily be about the comparison between OB's, CNM's, CPM's, where they practice, and the rise of maternal mortality (which let's be honest deserves a post all on it's own), I do still want to cover HOW to pick your care provider.  So how do you find the provider that's right for you? Happily, I can say, that these things to look for are important no matter which type of care provider you choose.  Unfortunately, sometimes the answers lie in the behavior and not in the questions... so do be observant when you're at your visits.

Scenarios and Questions

1.  "I want a natural birth and I started asking my care provider questions about it at one of my first visits (8-12 weeks).  They quickly brushed me off by answering, 'we aren't even going to discuss this at this time... we'll touch on that when you're more like 30+ weeks'."  Ok... THIS IS A HUGE RED FLAG!  If your care provider can't take the time to answer your questions FROM THE BEGINNING, then be aware that they are just going to keep putting them off until you feel that it's too late to switch, even if you don't like what you hear.  (Though do be aware that while less convenient, it is NEVER too late to switch care providers!).
2. "Every time I'm in the office I'm in and out in a matter of minutes and the Dr. never really remembers anything we discussed at our last visit."  Again, not a good sign!  Some large practices are so busy that moms start to feel like they're part of a factory.... just a number in a large line.  You should always feel that you are getting individualized care, from the start, and if you don't then move on!
3. "I asked my care provider how they feel about having a doula present.  They looked at me kinda funny and then said, 'well yeah... I'm fine with that' but they didn't exactly seem encouraging.  Thoughts?"  Yes... this usually means that they don't love doulas.  They'll "tolerate" one, but do you really want a provider who has to tolerate the presence of someone you've hired?  (I can tell you personally, it's not fun for us!) or do you want to have a care provider that not only encourages it and wants to work as a team, but can even refer you to doulas that they've really enjoyed working with?  If you think you want a doula, it's important to have a provider who is equally happy with this choice.
4. "My provider told me throughout my pregnancy that they were fine/supportive of natural birth, but now that I'm 39 weeks along, they're getting out the calendar to schedule my induction.  What do I do??"  I see this one more than most of the scenarios.  Some doctors are incredibly quick to induce if you go past your estimated due date, others even suggest it ON or BEFORE your date.  As always, ask the questions as early as possible. It's a very simple question that many moms forget to ask, or don't know how to ask, so here is an example: "how far past my due date are you willing to let me go without induction?  Are you willing to monitor me regularly around my due date with biophysical profiles/non-stress tests to make sure that my baby and I are fine?  If all is well, are you willing to let me go all the way to 42 weeks without medical intervention?" If not, how far ARE you willing to let me go?  If you find that you're running into this at the end of your pregnancy, don't ever be afraid to find someone who will allow you the time and space to go naturally within reason.  They do exist.
5.  Get a feel for your provider's philosophy.  Do they believe that this is a natural normal process and are they willing to truly let it be just that until proven otherwise?  Or are they anxious types with a fear of lawsuits looming over their actions causing them to be intervention happy or quick to cut?  It's usually not difficult to tell when speaking to them which way they lean, but I have seen those providers that answer everything just as you hoped in pre-natals but when the big day arrives they seem like a different person.  For that reason, it's also a good idea to ask their personal intervention rates.  What is their rate of induction?  What is their rate of cesarean?  If it's a midwife, what is her rate of transfer?
6. If you're someone who wants to write a birth plan, do so in enough time so that you can go over it with your care provider and gauge their responses.  If you have strong desires on your birth plan, make sure to listen to the answers they give you in regards to these issues.  If they aren't accepting of your wishes, and you know that your wishes are realistic, start shopping for another provider!
7. I could never have a man as my doctor.  Women are much warmer and more empathetic.  Yes and no.  As I've said repeatedly, not all providers are the same.  I always thought the same for myself when thinking of my future care provider and then I saw some cold, bitter, and well.. just plain rude women doctors who have the, "oh buck up, you're just being a baby" mentality.  With that said, some of the best doctors I've witnessed in this area are male.  Sometimes they're more compassionate, and sympathetic to what their patient is going through BECAUSE they haven't been through it themselves and don't even pretend to know what they are experiencing.   Just a thought before potentially eliminating a whole gender of very suitable providers!
8. Extend your homework to learn about your place of birth.  If you're delivering at a hospital, especially, look at the hospital's intervention rates. Are almost half the births there cesarean? (If so, that's high!) Are they an emergency hospital? (i.e. Do they treat every patient like their case is an emergency?)  Do remember that the entire team is part of your birth and you don't get to interview your nurses in advance.  A hospital that is used to more naturally minded parents and that sees normal births is going to be more flexible with your birth wishes than a hospital that is used to most of their births being high risk or having some sort of intervention at the very least.  In addition, find out the hospital's baby care protocols.. are they mother baby friendly?  Do they allow the baby to stay with you in your room and will they allow you that first hour (at least) to bond with your baby or do they take the baby away shortly thereafter to the nursery?  Do they leave you alone with your baby or do they feel that it's more important to weigh him/her and start vaccinating baby before you've even had a chance to breastfeed?  Do they allow you to at least DRINK fluids, (the good hospitals are coming around and allowing moms to eat actual meals just FYI) or are they stuck in the dark ages and only allowing ice chips no matter what your circumstances? Do they allow you to move around freely or do they make you have continuous fetal monitoring (rather than intermittent fetal monitoring) which keeps you tethered to the bed and its' surrounding areas?  If they do insist on continuous fetal monitoring (though most don't.. the recommendation is now 20 minutes on the monitor and 40 minutes off) will they allow you to unplug them to at least use the bathroom on your own (which in labor should be approximately every 30 minutes!). Do they allow a saline lock or do they insist on IV fluids at all times? If you are looking at a birth center or home birth, do they have the tools needed or do you need to purchase your own birth kit?  Do they allow water birth?  How far away are they from the nearest hospital and how often do they need to transfer?  Do they have good relationships with the area physicians if a transfer is needed?  All of these details are important to know when deciding on where you want to experience childbirth.

All in all just make sure that your provider is someone that you trust and feel is truly out for your best interest.  Make sure you feel comfortable enough to ask them even the toughest questions.... comfortable is key (remember you're going to have your panties off with them eventually!).  And always observe HOW they answer your questions, not just the answers themselves.   And for your place of birth, make sure that it is a place where you feel most at ease and safe.  If you do your homework, you can have a beautiful birth no matter where or with whom you choose to do it!

A Special Birthday Bond

Way back in April I met a couple that I soon knew would be my friends for a long time.  Chia and Greg came to me through the midwives of Birth By Design and we clicked very quickly.  The couple already had 2 young, ADORABLE twin girls (about 16 months old at the time) and so this birth would be a VBAC for Chia.  As a massage lover, Chia purchased The Mother Load package of massages so we spent hours together every other week with the goal of getting her body in a great place for pregnancy, but often found our spirits in an amazing place as well.  We would laugh and laugh to the point that Chia once mentioned that she wondered if we would be able to be serious in labor at all!  I assured her that when the time came, we would have our laughs but we would most certainly get serious :)
Then Greg came along for the Pampered Papa massages.  His easy spirit was such a great balance to the mix and I so enjoyed spending time with him pre-birth-day as well.
Then on October 5th, Chia came over for her usual massage at 8pm but happened to be contracting every 6 or so minutes.  With her twins being born at 33 weeks, Chia found it strange/interesting that this was her 3rd baby but had no clue what to expect for actual labor!  During her session, we definitely had our laughs, but Chia started breathing through her contractions in a way that made me think, "I'll be seeing her again really soon!".
Sure enough at 2:52am I got a text from Chia that read, "Happy Birthday!" (It happened to be mine) :)  She followed with details of her contractions, nothing unbearable but they were getting stronger and longer.  We all tried to get more rest, though Chia wasn't feeling particularly sleepy and Greg was getting excited!  At 5:55am I heard from her again.  Her contractions were now 3-4 minutes apart but she felt that she was still coping really well so we all just kept on with our morning.  By 8:25am I arrived at Chia and Greg's house and everyone was doing just fine.  The girls were eating breakfast with Greg, and Chia was getting a little relief in the shower.

By 10:30am the girls had been dropped off at a friends house and we were all together at the NOVA Natural Birth center.  While we waited for Peggy and Kim to complete some appointments, we walked the halls and chatted like nothing was going on.  My favorite quote from Chia that was repeated throughout the day was "ok, so now what?" or sometimes it would be "ok, what next?" (said in a very 'chipper/excited yet bored by this anticlimactic labor thing' tone).  At 11:03am Kim checked Chia and she was 4-5cm!  We decided to take a few light hearted photos before things got less chipper... (Fun Props: compliments of her friends from her baby shower!)

We walked the halls for the next hour and then around noon Chia got into this huge, amazing tub...

It wasn't long before Greg joined her and I have to say, if I hadn't known from Kim's cervical check that Chia was in active labor, I would have assumed she was still in very early labor by her demeanor!  Chia, Greg and I sat over the next few hours literally telling jokes between contractions!  And I don't mean "joking around"... I mean:

Chia- "Hey guys... know any good jokes?"  

Greg- "Oh I know some"... 

Juli- "So a guy walks into a bar... and says 'ouch'".  {...Crickets}

Who would have thought??  Honestly, if Chia could have had a board game in that tub she would have!  

After only two hours in this amazing pool of belly buoyancy, Kim checked Chia and she was 7cm with a bulging bag!  A few hours after that, she hadn't progressed much and we noticed baby was hanging out to the side.  Having had twins before, Chia's uterus was much larger than a uterus having previously carried a singleton, so this baby had PLENTY of space to go wherever it wanted and in this case it was literally tilted off to her right.  

All day when contractions would intensify, either myself or one of the other midwives would ask Chia if she was feeling any "butt pressure yet".  Every time she said no, and every time we said "you will".  Finally instead of asking we decided she would just let us know when she did!  

At 6:28pm I heard those magic words come from Chia's mouth..."ok now I'm feeling some definite rectal pressure"!  I called the other midwives in, letting them know we had a change!  We were so excited, but then shortly thereafter Chia said that the pressure had subsided and her contractions seemed to slow.  So we worked together for the next few hours to get her contractions closer and stronger again.  

During this time while Chia and Greg were in the tub, we all just sat quietly waiting between contractions.  The mood was light but definitely grew quiet as she began working harder.  I was able to reflect during this time... that 32 years ago to the day my very own mother was working just as hard to bring me into this world.  Choking back tears of gratitude, I had a newfound appreciation for my mother thinking of all that she did to bring me life.  

Around 7:30pm Chia decided to get out of the tub for a while.  We all transitioned over to the big ol' queen bed and tried to help Chia get comfortable.  

These next few hours were definitely hard work, but Chia always kept her wits about her.  Always "with it" enough to ask questions and to jokingly say to me, "you shut your mouth!" after making a joke of my own, I was surprised at her amazing clarity of mind when so many moms turn so deep within.   

After a few hours of slowly opening and pushing (and Kim holding Chia's belly straight so that baby wasn't leaning too far to the side),  a baby girl was born at 9:42pm!  Once examined it became much clearer by the little moulding from baby's head that she was asynclitic (which also caused the stall in Chia's labor towards the end).  All in all, a beautiful, successful VBAC was achieved and I will forever have a sweet little birthday baby bond with miss Brooklyn Grace Richardson.  

Late that night, after midnight, I returned to my own home where my mother was waiting for me (visiting from Richmond) for my birthday.  She'd made me a special birthday dinner earlier that evening and had it heated for my late arrival.  32 years later, my mother is still mothering me and I feel so grateful for all that she's done and continues to do throughout my life.  I can't wait for the day that I get to be a mother... to bring a little one into this world the way she, and Chia, and every single mom out there works so hard to do... so that after 32+ years I may still be there to heat their birthday dinner after midnight :)  

Thank you Chia, Greg, Sierra, Kennedy and Brooklyn for allowing me into this special part of your life!  And thank you for sharing such a unique birthday gift with me!!  

Is a Positive Peanut Gallery Possible??

A Cesarean is Not a Failure: One Woman's Story

I just read the above story on the Birth Without Fear blog and the comments following startled me.  This is EXACTLY what I was speaking of when I recently wrote "Judgement".  Perhaps my idea of everyone being supportive of each other, kind, and open-hearted is all just a "hippy, granola, I-wish-for-world-peace" mentality... but really, why is that SO difficult to achieve?

Everyone is entitled to voicing their opinion, and I feel that with today's access to the internet, blogs, social networking and most importantly HIDING behind a computer screen, "voicing" has been made much easier without the thought of how it might effect others.

But my question is this: Is our "right" to voice our opinion more important than how it may effect those who read/hear it?  Is sending someone into a tailspin of self doubt or guilt just for a few sentences of "speaking your voice" worth it??  Perhaps if we all just went by this motto:  "If it's going to negatively impact those reading it.. don't say it", then perhaps we'd have a bit more harmony in this world.  I'm not saying for everyone to walk around and lie all the time or pretend that certain things in life just don't plain hurt because I realize they do.  But I think we allow things to hurt enough on our own, we self deprecate enough on our own, and we all live with our share of guilt very well WITHOUT the negativity from the peanut gallery.. so perhaps if the peanut gallery started working on adding a dose of positive, the world would be a happier place.  Just sayin'... since I have the RIGHT to do so :)

the birth of baby Shelby

We all know that birth requires a certain degree of open mindedness. We can "plan" all we want, but at the end of the day these little babies come into this world on their own clock, without any specified plans in tow.  Flexibility is a must, and the following events were a great example of just that.  Usually they unfold calmly.. often even slowly, but I have to say that parts of this story started to feel a bit like Lucy and Ethel!  :) 


Meet Ami and baby Shelby.  Born September 9, 2011 at 6:15pm with the cutest little nose a girl could ask for!  This is their story.  

Back in January a “Military Mom”, named Ami, met with me to see if we'd make a good fit as her birth team.  At this time I learned that she was only 6 weeks pregnant, already had 3 other children, her 3rd was only 4 months old (yep, I said 4 months old), she held an active status in the air force and her husband was being deployed to South Korea in a few short months. SERIOUSLY?! Needless to say she was a bit shocked to be pregnant again and a bit overwhelmed with the journey ahead! 


This birth was going to be different than any other I’d taken on so far.  I would need clearance to get onto the base, would labor with her at her home, I was to be her transportation to the hospital, would need clearance to get into the naval hospital, I would be her primary birth partner... wowza!  I had no problem with all of this... in fact I was excited about it.  I just knew that my role was going to be a lot more specific and a little harder to juggle than the more common mom-partner-doula trio that I'd grown used to.  Needless to say, I was thrilled to work with Ami and couldn't wait to be of service to her!  During this initial meeting, we also discussed birth photography as an option for her husband to be able to see as much of the birth as possible. (Skype was also discussed but depending on time of day, lack of internet connection at the hospital etc., we hoped for something more concrete). This is where Ali enters the picture.  My friend, Ali Caudill of  Ali Caudill Photography had mentioned to me a while back that she would love to get involved in birth photography.  So I told Ami about her and as a photographer/photography-lover herself, she was thrilled with the idea!  I contacted Ali and soon everyone was on board for the upcoming fall birth. 

Many months came and went... we kept in touch throughout Ami's entire pregnancy but we didn't meet again until she was quite visibly pregnant!  We plotted and planned all that we could for the big day, doing our best to make the transitions smooth for everyone involved.  One of the "plans"  that we discussed was how she wanted to have this baby.  She had medicated births for all of her 3 previous babies, but was curious to see if she could have this one (the last according to her!) unmedicated.  "Curious" usually means (in her words): that the idea sounds really good right now, but I have a good feeling that once I'm actually in labor I'm going to say, "screw it!  Give me an epidural!"  I explained to her that if that was what she decided then of course I would support her, but that if she wanted an unmedicated birth then she could almost certainly have one! Coming from a mom who literally ran 3 miles a day until the week before she delivered, I had no doubt that this mama could push herself if she wanted to!  

Cut to Sept 8th 2011.  Ami was 38 weeks pregnant and really beginning to walk with that "baby is LOW waddle".  I met her out at the base to get a month pass so that no one would have to check me in during her labor.  Everything was squared away and we parted ways.  The very next day Ami called me and said she was having contractions and that they were definitely NOT Braxton Hicks.  She said that they were coming pretty close together, but that she wasn't timing them and was headed out to her baby shower at work :)  (Now THAT'S the mark of a 4th timer!!!)  So she said that she would call me afterward to update me.  Meanwhile I contacted Ali to let her know that Ami’s time had come (seemed like FOREVER since that first meeting back in January!) and to make sure she was available to come and shoot the birth.  Ali was indeed available and after taking care of some things at home was headed in my direction. 

When Ami called after her baby shower she said that she still had to get things squared away at home: get the kids from daycare, pack their bags to spend the night at a neighbors house, etc. etc.  I told her that Ali was on her way to my home and that we would drive together so that no one would have to check Ali into the base.   During this phone conversation, Ami was having to stop and breathe during contractions, but still seemed to be chipping away at her to-do list.  She did say that her contractions were getting MUCH closer together... to the point that if she moved at all, another contraction would start. This began to make me antsy… as a fourth time mom, I wondered just how long Ali and I had to get there… not to mention we were entering the 4pm window of Friday traffic in DC.  {Gulp}.

At about 4:15pm I sat waiting in the car devouring a granola bar (hey you never know how long these births will last!) while waiting for Ali to arrive.  Within seconds of pulling into my parking lot she literally jumped into my car and we were off.  About 10 minutes later we got a text from Ami that read, "I can't wait any longer... I'm getting a ride to the hospital from a friend."...  WOAH!!!, I thought, Change of plans!  She must REALLY be moving quickly! I was grateful Ami had someone nearby to give her a ride and just as grateful to have Ali in the car with me who was able to navigate our sudden change of route. I would have been one seriously nervous doula, trying to drive and get a new map on my iphone, if she hadn't been there! (Ok, I was STILL one nervous doula driving as fast as I could with white knuckles.. but Ali was a lifesaver in our seemingly frantic navigation!).  

When we pulled into the naval hospital, I thought, DARN IT!  Ami was supposed to be IN the car to get us through the gate!!!  How the heck are we gonna get into this place???  We pulled up to the gate where we gave the officer our ID's.  Then we gave him Ami's name and he checked the in-patient list.  Nothing.  Then he called up to labor and delivery.  Nothing.  Then I called Ami's cell.  Nothing.  Called one more time.  Nothing.  I looked at Ali as my stomach dropped... "you don't think we're at the wrong hospital do you?????". (I wish I could have taken a photo of Ali’s face at that moment... insert Lucy and Ethel). 

Now mind you, I ALWAYS pre-plan where I'm headed, have my map laid out on my phone etc., but it's amazing what fear based ideas will bubble up when trying to figure out what on EARTH is going on!   At that moment, I looked at the officer with WIDE eyes:

me-- um... this IS the naval hospital right?? THE ONLY naval hospital in the area???? 

officer--............Yep. 

me-- {breathing a huge sigh of granola breath all over his face} THANK GOD.  

officer-- I dunno if you can reach her on her phone though.  I never can get cell service in the hospital.

me-- {thinking} so how the heck is she to know we’re here to let us in???  

officer-- hey, I just bought those same UGGs for my girlfriend.  

me- Oh!  haha {courtesy laugh} great choice! {aka DO YOU REALIZE THIS WOMAN IS PUSHING OUT HER BABY AND I'M HER ONLY PARTNER??? let us IN PA-LEASE!}!!!!!!  *I would have tried the ol' bat-my-eyelashes-at-the-strapping-young-officer-trick, but sadly that just doesn't work the same way it did 10 years ago.*

Finally he told us to pull through the gate and over to the side of the road. He said that as soon as he received word of Ami's arrival that he'd let us through.  ARGH!  Ali took out her phone and called the hospital directly to see if Ami was on the in-patient list.  NOTHING.  Our hearts raced impatiently. 

After what felt like an eternity, Ami finally called us back...

Ami— {through laboring breaths} we're ALMOST there!  

me—wait WHAT??? You're not here yet????   

Ami-- HOLD ON I'M BREATHING... and i'm sh-sh-shayyyyy-k-k-k-kiiinnngg.  

me— {attempting to calm us both} you're doing SO great... it sounds like you're in transition!!! 

Ali-- {big eyes; loud whisper} TRANSITION?!  WOAH SHE’S ALMOST DONE!!!  

After 9 minutes of talking Ami through contractions over the phone, her friend flew through the entrance gate and the young officer came running up to the car, throwing our ID's through the window (literally), and yelling 'GO GO SHE'S HERE GO GO GO GO!".  And we were off!  Both cars raced into the drop-off circle at the hospital’s entrance.  After kindly barking some orders at a pack of military types (let me tell ya, that felt kinda odd) we quickly got a wheelchair, left our cars parked smack in the middle of the fire lane, and quickly headed upstairs stopping for each contraction on the way.  

Triage was interesting to say the least.  A tiny room, some slightly cold nurses, and a chilly young resident Dr. crowded together to determine whether she was ready to have her baby.  The resident announced that Ami was 8cm dilated with a bulging bag and ready to push as soon as he could break her water.  She quickly asked when he could make that happen... he said, as soon as we get you in the room... and that's NOW.  He said that if she wanted her epidural then he needed to order it immediately.   She took one look at me and said, can I do this without the drugs??  I said, OH MY GOSH OF COURSE YOU CAN!!! YOU’RE SO CLOSE NOW… MOST OF THE WORK IS DONE!  She immediately turned to the doctor and said, let's go... I wanna have this baby NOW.

  We all stumbled into suite 20: Ali was snapping pictures, Ami's AWESOME neighbor/friend/driver was carrying bags and helping fill in the details of their car ride,  nurses were poking and prodding to get monitors on Ami and an IV inserted, and Ami and I were holding hands and just focusing on each individual breath. 

I offered Ami water and ice to cool her down, but she was only interested in one thing.  Her strength was amazing!  Ami’s mind was set and there was NOTHING stopping her from having her baby NOW!  Finally after a bit of fumbling on the part of multiple residents, her membranes had been ruptured and her cervix was complete. It was time to push! 

 As a fourth time mama, she was nothing short of a pro and within only 30-45 minutes of setting foot in the hospital and a few short pushes, her sweet baby girl was gently placed on her chest! 

A few minutes after Shelby was born, Ami squealed, WOW… I FEEL LIKE A ROCK STAR!  NOW I KNOW I CAN DO ANYTHING!  And holy moly was she right!  Less than an hour after Shelby was born Ami was walking around the room like nothing had even happened!

For the next few hours we enjoyed the calm as we sat snapping pictures and cuddling with her new sweet button-nosed-bundle and laughing like old friends about the frenzy that had unfolded just a few hours before. 

 As suspected, Ami’s husband was still sleeping in South Korea when his daughter entered the world.  For him, these pictures will forever allow him to see his daughter’s first breaths.  For me, they will forever remind me of what it’s like to be in the presence of a real rock star.

Thank you Ami and Shelby for sharing your special journey with us!  


Photos: Compliments of Ali Caudill Photography.   

Judgement

For the last few months I've noticed that I've been reluctant to blog.  I've been feeling less motivated to tell birth stories from my perspective and wondering if I should continue.  After some searching from within, it recently dawned on me as to why.  Why I wasn't blogging and also why I should.  

I suppose the reasons that I felt less inspired to write were created by much of the negativity that I've witnessed in response to such stories all over the internet, but ultimately these reasons were the product of my own mind.  That "little voice"succeeded in talking me out of sharing time and time again.  After each birth I would think, Would anyone really be interested in that one?  It was pretty text book (which if you ask me, "text book" is pretty great!),--OR-- Will people just think I'm dramatizing the situation?--OR-- I don't want people to think I'm bragging about myself as a doula--OR-- I don't want to make someone feel badly who didn't have a positive birth experience by reading someone else's great story. The main reason, however, that constantly came up in my mind was this:  No matter what birth story I read on the internet, SOMEONE always judges and comments negatively about it.  And that, I realized, was the root of my resistance:  Judgement.  Readers write comments on how it really SHOULD have gone, or WOULD have gone if THEY were the one there, or how ignorant the team was, or why would these parents ever choose {blank} when they CLEARLY should have chosen {blank} if they knew ANYTHING about the latest research... and on and on and on.  I found myself analyzing the amazing births I've attended in an effort to find what others would say about them BEFORE they could butcher it themselves!  Then it hit me.  If I'm going to pick these stories apart for everyone else in my own mind in order to avoid hearing judgment, then not writing them doesn't prevent the judgment from happening at all!  I realize that people are ALWAYS going to judge...(my self judgement included).  They'll judge the story, the writer, the birth team, the mom, the choices and on and on.  But I now realize that I don't care.  The story is what it is... it happened how it happened for one reason or another and most importantly, the reader WASN'T THERE.  They don't truly know WHAT they would choose if they were facing each given situation and at the end of the day that's life.  People have always and will always have an opinion but it doesn't make it fact.  These experiences, I realize, deserve to be told because they're REAL, they're authentic, and hopefully they inspire.  No, they aren't always perfect.  Not every mom has every single desire met that she wanted with her birth.  Some do, some don't even come close, and most are somewhere in between.  But I can say that with all the negativity out there and all the horrific stories that people love to tell in order to process their story (and I'm not knocking the process of sharing traumatizing birth stories), there need to be some positive ones to balance them.  Too many clients come to me saying Oh my gosh, I just read {blank} on the internet and that REALLY freaked me out!  When searching on the internet, we always read of the extremes and yes, they can be terrifying.  So I'm realizing that we need more empowering stories, fun stories, exciting stories, and most of all uplifting stories that give these curious moms hope and renew their sense of trust in this process. 

So why am I blogging about why I haven't blogged?  Because I've noticed that sometimes the birth community (both professionals and parents rallying for a certain type of birth experience) can actually be quite harsh.  Instead of coming together to SUPPORT each other, they end up scrutinizing each other and the choices everyone has made.  And yes, there are times where I'm guilty of it too... I don't exactly type out a diatribe in response to forums or blogs, but internally I certainly share in the shoulda-coulda-woulda's from time to time if not careful!  So here's to sharing positive stories and hoping that our community can actually be more supportive of one another in the births that these moms not only desire, but also the ones that they choose.  

A Perfect Intervention

I just had the honor of attending one of the most amazing births... and not in the way that most may consider "amazing".  No, it wasn't quick, it wasn't easy (are they ever easy?), it wasn't all natural, and it wasn't even at home which was something VERY important to this particular couple.  In fact it was almost everything they DIDN'T want (almost) as the cards were truly stacked against them, yet in the end it was perfect in every way.

A few months ago a seriously adorable couple came to me looking for a doula for the home birth of their first baby through the midwives of Birth By Design. Aside from an incredibly not-fun pregnancy for this mom (in many ways), all was looking good for them to be candidates to have their baby at home. That is until about 38 weeks or so.  At this point (a few weeks ago) mom's blood pressure started to rise quite high, coupled with weight gain, swelling, and the same general feeling of "truck-hit-ness" that she'd experienced through her whole pregnancy, to the point where we decided to head to the hospital.  We suspected preeclampsia which of course would no longer be conducive to her having a home birth.  So we did our best to prepare these parents for what to expect at the hospital... a huge change from what they wanted their birth to look like.  So with heavy hearts and some baked bribery for the nurses to treat us well, we headed out on our journey to Fauquier hospital.  We prepared these parents for the high probability that the doctors would push to induce, but with her blood pressure as high as it was, we all knew intervention in this particular case was likely best.  Much to our surprise all labs came back clear, they monitored her blood pressure for a few hours, baby looked great and they happily sent us on our way saying "you go have that baby at home"!  We were shocked and amazed as we all walked out to our cars with a major extra pep in our step!

Cut to early Monday morning of this week.  My phone rang at 12:30am and in my sleep I woke to an ecstatic voice squealing, "MY WATER JUST BROKE!!!".  Mom was SO excited that labor had begun on its own as she was now 41 weeks pregnant, and like many first time moms who reach 41 weeks, started to wonder if her baby would ever come on its own.  We chatted briefly about what was going on... she wasn't contracting yet... so we all went back to bed to be ready for the journey ahead.  (From the excitement in her voice I knew she would be getting very little sleep!).  I waited through the night and heard no updates.  I woke the next morning and still nothing.  I sent mom a text to see how she was doing and she said she'd started contracting in the night, everything was manageable, and to come over around 1pm.  I headed over and could see that this mom was still in very early labor. (Usually after membranes rupture we want moms to be in active labor by approximately12 hours after). She was in a great mood folding her laundry and setting up the house for everything to come.  Kim Pekin and Peggy Franklin came over at about 2:30pm to see how she was doing.  Her blood pressure had stayed consistently high since our hospital visit a few weeks prior, and with continued lab monitoring every few days, all else was still looking ok.  Kim checked mom's cervix and she was only 1cm dilated and 50% effaced.  Gulp.  We knew that since her membranes had ruptured at the onset of labor 14 hours prior that we were racing against the clock to have this baby.  Suddenly it became an incredibly real possibility AGAIN that we may have to head to the hospital if we couldn't get things moving along.  The midwives left us for the day to labor after our team devised a plan of action.  Every 15 minutes and every minute in-between there was something to do...from nipple stimulation to walking to belly lifts to ligament releases to acupressure points to herbal tinctures... we were on a mission!  This couple worked tirelessly with me as dad's watch went off every 15 minutes for our next dose of herbs between all of our activities.  It didn't take long for mom's contractions to go from 10 minutes apart to every 2 1/2-5min!  Things were looking good and the intensity of the contractions began to grow, but when Kim returned at 9pm (6 hours later) to assess the situation mom's cervix had not changed. At all :(  Talk about hearts sinking!  Everyone was disappointed as we knew right then that we needed to go the hospital.  We packed our bags and cars while talking about what to expect upon arrival:  If we're lucky they'll give mom Pitocin (never thought I'd use Pitocin and lucky in the same sentence) to get her labor going and if not so lucky; cesarean. Kim called ahead and thankfully the nurse who answered remembered all of us from our last Fauquier excursion.  Thankful for our ability to have intervention when necessary, I quietly sent some prayers "upstairs" on my drive over. I'm sure I wasn't alone.

Upon arrival we were thrilled to have a nurse who quickly said, "I just want you to know, I'm on your side.  I had 2 home births myself."  You could feel all of us let out a huge sigh of relief as anyone who births in a hospital knows that the nurse assigned to you is just as important, if not more so, than your doctor when it comes to your experience as a whole. [So...Great nurse? Check]  We got mom settled in and set the room with lights off, dim flickering candles, and the calm scent of lavender masking the sterile environment as we waited anxiously to meet our OB.  While waiting, the nurse told us that they don't administer Pitocin during the night because the Dr. isn't there. "UM... WHAT? What do you mean you don't administer it??" we thought. Now for a 'normal' birth we want to run as fast as we can from Pit, but when it's Pitocin vs. Cesarean, we were practically begging for Pitocin to give this mom a chance!  At this point we just knew it ~ our Dr. was going to walk in and say this mom needed to be sectioned.  But instead when the Dr. arrived from her home she quickly flipped on the lights separating us from our zen space [Peaceful doctor? Negative] and much to our surprise ordered some Pitocin (jaw drop!) and said that as long as mom and baby were doing fine that she would allow her to labor well past 24 hours with ruptured membranes!!! (double jaw drop!) [Taking back negative comment from Dr turning on lights? Check].  Oh my gosh were we elated!  She was going to have a chance!


It didn't take long for the Pitocin to kick in and mom's contractions quickly escalated to pretty darn miserable (I know, I know.. who's aren't miserable?). We all worked tirelessly for hours and hours trying to help her body relax so that her cervix could open.  When it finally got to where she just couldn't take it anymore we asked if we could get her into the shower.  Negative.  Major bummer.  They decided to check her cervix hoping that her progress would give her some drive to continue.  Now I have to say, from my personal experience watching cervical checks: whenever I see a care provider feel around in there for a REALLY good while before saying ANYTHING looking as though they're up to their elbows trying to even find the darned thing, I always know the dilation is going to be lower than we want to hear... but when I heard, "she's 1.5cm" I just about lost it and mom really did. HOW could this mother be contracting this strongly for SO long (5 hours on Pitocin at this point) and not be progressing at all??? She could no longer physically relax and Kim and I looked at each other and quietly nodded: "Epidural".  So against mom's original hopes for her birth she adamantly requested an epidural and was finally able to let her body go.  Once it began to take effect at about 6:45am Kim and I curled up on either end of the little hospital couch and dad half-dozed in a chair.  We cat napped for a bit and woke to the nurse coming in to give mom a check.  Within 2 hours she was 4cm dilated and 80% effaced!!!  The OB came in only 10 minutes later and said "she's 5-6cm and 100% effaced!". IN 10 MINUTES??? HOLY PITOCIN BATMAN!  We all felt like dancing!  Progress was being made and a chance was being given... we were thrilled.  Exhausted but thrilled.

Sure enough, a few more hours into the epidural phase, mom developed a fever.  We weren't sure if it was a side effect of the epidural or if she was developing an infection from having ruptured membranes for so long.  Again:  perfect time for Dr. to throw in the towel and intervene with a cesarean.  Nope... she treated mom with antibiotics and let her continue!  Kim and I just looked at each other with "well ok then!" faces as each of these surprising moments came and went.  

As the hours passed our team grew closer.  When it finally came time to push, our nurse allowed Kim to use hot compresses, perform perineal massage AND check mom's progress vaginally.  SERIOUSLY?!  This was awesome. We knew we were on their turf when we walked through those hospital doors and thought we knew what we'd signed up for, but this nurse graciously allowed Kim to maintain her role as this mother had originally hoped.  Next thing we knew the Dr. unexpectedly popped in and there stood Kim in her purple sterile gloves..... our hearts raced for a second as we thought "uh oh" and the doc just smiled and waved us on to continue as we were.  Again, SERIOUSLY?  Was this a dream???  So mom pushed as we massaged, rotated legs, hips and changed positions and a few hours later it was finally time for this baby to be born.  Nurses scrambled in assembling tables and disassembling the bed in the usual baby's-crowning-fashion.  [side note: Hours prior when explaining to the nurses some of the hopes that the parents had for their birth, dad expressed wanting to help catch the baby.  The nurse doubted that this would 'fly' but said she would speak to the OB.]  So during said scramble, in walked the Dr. and said to dad, "Would you like to help catch?"  REALLY??!  All eyes bulged and mouths dropped (including every nurse in that room)! "YESSSS!!!" Dad said as they quickly suited him up to look like the finest of Dr's.  What amazed us most was when baby's head emerged, the Dr. wasn't the one guiding it while playing the "you rest your hands on top of mine and pretend like you're doing the work" game.  DAD had his own hands on his sweet baby's head and the Dr. calmly rested hers on top of his [tears are streaming down my face as I write this].  This precious baby girl entered into this world in her father's very hands... in a hospital no less!  HOT DOG!!! (as my grandfather used to always say when excited)... We laughed and cried as we cheered this little one into this out-of-belly-world.

This birth was amazing in so many respects.  I've never been an "anti-hospital" doula at all, but when a couple wants a home birth you just know it's going to be a VERY different story when you have to transfer to a hospital.  It's a different ballgame and you just have to be willing to play it when you step onto their court.  This hospital staff proved otherwise.  They did their very best to preserve this mothers birth wishes despite the ever so many ways they could have intervened.  This gave me hope... if only more hospitals, nurses and doctors would be willing to welcome us with open arms and to truly play as a team.. utilizing all of our collective talents and knowledge TOGETHER to create a positive birth environment for everyone... just take a moment and imagine what we could accomplish!  Upon leaving, Kim put it very well: had any ONE single element of that birth been missing, then it would have gone SO differently.  Many OB's would have sectioned this mom weeks ago upon seeing her blood pressure alone!  Every single person on this journey was essential, and every path we took was perfect in every way.  God has a much greater plan and coordinated everything so that this baby would come into the world in the perfect way that she did; which really taught me... when you think you know exactly what will happen in life because the cards are stacked HIGH against you, something Greater laughs in your face and proves you wrong. And by golly I had no idea being wrong could feel soooo good!