The First Breaths of Life

     It seems my clients like being written about on their midwife's blog.  I had no idea when I started this a couple months ago that folks would be so open to my writing about them.  Talia and Mishu are my most recent new parents and they have graciously agreed to let me tell about their story.  So here it goes...

  Talia and Mishu came to me a little less than 2 years ago, nine months pregnant.  With tears in her eyes, lovely red-headed Talia requested that I take her on in the eleventh hour.  She explained how over the nine months of pregnancy, she slowly realized she should be having a homebirth.  She had been seeing the hospital midwives and but now REALLY wanted a homebirth after all.   Mishu was a recently graduated nurse, and they were prepared to do whatever was needed for birth at home .  We went for it.   Talia rocked her first birth with twenty-four hours of early labor and then a straightforward active labor the following night.  She did great and little Livia happily came into this world.

    For her second pregnancy, Talia came to me from the get-go.  Mishu has become a very well-respected RN at our local hospital.  (I love it when local RNs choose to birth at home!)   Right around her due date, the 1st of March, she had some bouts of contractions during the night that went away at dawn.  This happened a few nights in a row.  Then, on Wednesday, they didn't go away at dawn.  Talia had irregular mild contractions throughout the day, and in the evening they got a bit stronger, although still not strong.    I had checked her in the afternoon and  she was barely 1 cm open with the baby's head high.  That evening, my assistant Amber went over to check in on her, and she texted me updates such as "No need to rush over here, not that much going on.  Contractions, but irregular. Baby's heart tones sound great."   Well, around 9 pm a little voice deep inside me said "Go over there now".   I went.   When I was approaching her street, Amber texted me "Water broke, gush of clear fluid."  Oh yeah, it was time.
     Talia was sitting in her bathroom on the pot, cranky about how the contractions felt but still chatty and not really looking like she was deep into labor.  About fifteen minutes later she stood up to wash her hands, turned a deep red color and p*u*s*h*e*d.   "Talia, hold on there a second"  I said, running to peel off my street clothes and throw on my baby-catching clothes.  With my shirt half on, I heard Amber say "Dena, I see the head!"   Sure enough the head was crowning.   Talia was on her hands and knees in her small bathroom.  I climbed behind her, half in the shower, and Mishu and I together put our hands on the head as it was slowly born.   The little face was pink and she was making little movements.  Hello dear!   Then we waited for the next contraction.  And waited.  And waited.  It was a few minutes but it felt long.  These dang irregular contractions!  I had Mishu reach down and rub her belly.  I had Talia crawl a few feet into the bedroom to give me more space to work.

    A contraction came, Talia pushed, and the baby was born.  She was floppy like a rag doll and a mottled purple and white color.  She was not grimacing or sneezing or trying to breathe.  I quickly dried her with a warm flannel blanket and rubbed her up to stimulate her.  While doing so I placed my fingers on the skin where her  umbilical cord inserts and felt a normal heart beat.  "Good heart beat" I said.  But still no effort to breathe at all.  And limp.  Amber had the oxygen tank and ambu bag ready.   I had recently taken the neonatal resuscitation training of Karen Strange CPM, who is the pre-eminent authority on resuscitation in the home birth setting.  She talks about mouth-to-mouth breathing as an initial alternative to ambu-bag and oxygen tank.  For more info, see her website  www.newbornbreath.com 
       I lifted the baby to my face, placed my mouth firmly over her nose and open mouth, and carefully, slowly gave the baby an "inflation breath."  With mouth-to-mouth,  I can literally feel her lungs' alveoli inflate, and her lungs expand to take in oxygen.  I am so connected to the baby's life force.  A newborn baby's alveoli must inflate so she can take in oxygen through her lungs.  In the womb, the alveoli are collapsed and the lungs are filled with water.  That is why the baby's  first, big breaths are so important.  I pulled her away a bit to look at her.  She opened her eyes and looked at me.  But didn't breathe. "Okay baby, lets breathe"  I said, and gave her four more mouth-to-mouth breaths.  By the fourth, I felt her suck in on her own, she mewed, and then gave a good cry.  She turned a rosy pink from head to toe, and her arms and legs bent into normal position.  She was breathing fine.  Her heart rate was fine.  Her tone was strong.  She was a little more than a minute old.  I had been working on the baby right beside Talia, with the cord intact and pulsing away, providing oxygen to the baby even while she wasn't breathing.  In the hospital, if the baby is not breathing, they cut the cord right away and take the baby across the room to work on her.  At home we leave the cord, which is still  bringing oxygen to the baby via the placenta for several minutes,  and work on the baby beside the mother. I would like to see hospitals learn to do things that way - it is definitely to the baby's advantage.

   The baby was now warm, pink, and perfect in Talia's arms.   She was letting us know all about it.  Talia stood to get into bed and the placenta plopped into a bowl I had at the ready.  She hardly bled a drop.   Within two hours, and baby had eaten,  been cuddled skin to skin with both her Mom and Dad, Talia had been up and showered, and we were all eating blueberry birthday cake.  The baby was strong and alert and weighed in at 9 lbs!

Here she is after being checked out thoroughly by her midwives.  That is yours truly holding her lovely footprints, her first mark on the world.

   Today when I called to check in on the family, Mishu told me they have decided to name their baby Adina, partially in honor of their midwife, who provided her with her first breath of life.   I am the one deeply honored, and so grateful to all my teachers and mentors, and supportive, wonderful assistants.  Most of all, I am grateful to all the moms and babies I have served over the years, who have truly been my real teachers.