Monday, June 25, 2012

Epic Birth Journey and the Midwife's Bag of Tricks

   The longest day of the year was celebrated in high style at Sacred Ways Homebirth, with one of the longest home births of the year.  Much congratulations and love to Ajay and Walker, who have given me permission to inspire others with their heroic journey into parenthood.  
    There is usually a big difference between the labor of a first time mother (primip) and that of a second or third or fourth time mother (multip).  Once you have given birth to a baby, the next one is remarkably faster and easier.  This spring my assistant Amber and I attended several multip births where we arrived, set up, hung out for an hour or so, and the baby came out.  Lovely, beautiful births;  happy families; midwife home for dinner.  Then came our first-time mama Ajay's birth.
   Ajay began her labor on Sunday afternoon.  Contractions were 10 or 15 minutes apart and Ajay did exactly what was best for her;  carried on with her day alternating between activity and rest.  She tried to "rest" at bedtime, but by then they were a consistent 10 minutes apart.  By 2 am she was uncomfortable and in a regular labor pattern, and made the call to us.  When we arrived I could see that her contractions were strong and in a good labor pattern, but that she had a way to go.  She asked if I would check her cervix, but I procrastinated and put her in the birth tub instead.  I had a hunch she was a small amount dilated, and I didn't want her to get hung up about that.  (Midwife trick #1)
    The birthing tub was just the thing for her.  She relaxed beautifully between the contractions, and moved through the water during them.  Walker got in the tub and held her.  It was dark, with candles lit.  We gave them privacy;  they got sensual and snuggly. (Midwife trick #2)  The contractions got stronger and closer;  a sign that the labor was progressing well.  At 6 am she got out of the tub and I checked her - 7 cms!   An hour later she felt "some pressure"  and wanted to get back in the tub one more time before pushing.  Two more hours of hard labor went by.  We checked again and found  - 8 cms.  That is only one centimeter more in three hours- ugh.  Ajay's progress had stalled.  I could feel that the baby's head was not down against the cervix because the bulging bag of water was in the way.  We decided to break it, which would bring the baby's head down and hopefully help finish the dilating.  (Midwife trick #3).
    With her waters broken, Ajay walked around and worked with the intense sensations.  I could tell she was losing steam.  We fed her miso soup, a whole bottle of Recharge, and put her back in the tub.  She was so tired, she started saying things like "I can't do this anymore.  This isn't working.  The baby won't come".  I knew that the baby could come.  She had in her favor:  1. The baby in an excellent position, NOT posterior.  2. an excellent labor pattern of strong, long contractions.  3. She had stayed well hydrated.  4.  The baby was doing great;  perfect heart tones, clear fluid, and movement.   But I needed to change her mindset, because I could feel that emotionally I was losing her.  I told her we would not make her do this forever, but let's give it one more hour to get to complete dilation.  I gave her a homeopathic remedy, caullophylum.  (Midwife trick # 4) Then I gave her affirmations to say with me, instead of  "I can't."  They were something like "I am allowing body to open.  My cervix is opening now."  I said it with her, Amber said it with her, Walker said it with her.  As she repeated the words, she relaxed and became centered again.  It worked.  (Midwife trick #5).  At noon there was just an anterior lip of cervix remaining.  I had her push mightily while I lifted the rim of cervix up and over the baby's head.  (Midwife trick #6) 
     Ajay is a strong woman, an Enloe  nurse I might add!  She munched some chocolate covered almonds (Midwife trick #7), downed another bottle of Recharge,  sat on the birth stool, and pushed.  She felt the pressure and she pushed and pushed and pushed.  She got up and pushed on the toilet, (Midwife trick #8) tried several different positions including standing lunges (Midwife Trick #9), and pushed and pushed and pushed.  The baby did not really budge.  At all.  After two hours.   In the hospital, this would be called "arrest of descent"  and a cesarean would be done for the baby "not fitting through".  Hmmmm.   I sorted through all the files of past births in my brain, to find one last trick.  I remembered a birth many years ago.  "Ajay, "  I said.  "Stop pushing now.  Let's have you take a break and just stand in the shower for a little while" (Midwife trick #10)  Ajay enjoyed the hot water coursing over her, and I guess she grabbed something and squatted during her contractions because after ten or so minutes alone in the shower she yelled " Something is bulging in my butt!"  Eureka - that something would be the baby!   I popped my head in, saw that progress had been made, and kept her in there another ten minutes.
     Back on the birth stool, we could see the baby's head peeking through.  The baby had come down through the bones, and was almost here.  With each push now, progress was made, although it was still slow.  We heard a deep drop in the baby's heart rate for the first time. We heard it again.  It recovered, but I told Ajay that it was time to just have the baby now.  Finally, finally, the head came through, the baby slipped right about, and Ajay's nine pound baby arrived.  He was dusky and his  breathing was labored, so we rubbed him up, talked to him, and let the pulsing intact cord keep providing him oxygen. (Midwife trick # 11) We gave him blow-by oxygen and his color turned a rosy pink (Midwife trick #12)  Once it stopped pulsing we cut the cord to take him in the steamy bathroom with the hot shower running full blast.  The hot vapor did the trick, and his breathing was easy and regular by the time he was ten minutes old  (Midwife trick #13). 
        Then Mom, Dad and Baby cuddled into bed.  Chicken enchilada casserole was warmed, and things were quietly tidied while bliss and bonding occurred in the family bed. 

  With that twinkle in her eyes and glow of her grin, would you guess Ajay had just labored for 24 hours?   Would you guess it took her 6 hours of labor to get from 7 cms to 10 cms?   If she had planned a hospital birth, she would be in surgical recovery, instead of here.  This is why home birth is important.  The truth is, women are stronger than one would ever believe.  Birth works, folks.   Now I am off call for a month, for family time.  Happy Summer!  

Tuesday, June 12, 2012

Emotional Freedom Workshop at the ACNM Conference

    I was blessed to attend the ACNM (American College of Nurse-Midwives) conference and annual meeting last week in Long Beach, CA.  Not only did I attend, but I was a presenter.   My offering was a four-hour workshop entitled Healing Trauma for Mothers, Families, and Midwives with EFT (Emotional Freedom Technique).
    Twenty-two midwives signed up for my workshop.  Many were directors of large practices, university faculty midwives, and pioneers in the midwife movement.  I was humbled and deeply moved by the honor of teaching this energy healing work to them.   I created a healing, sacred circle for these powerful midwives, complete with an alter in the center.  The workshop was experiential.  We learned about EFT, and then practiced healing each other.  Several of my sister midwives experienced profound healing.  It was beautiful to witness these women, who give so much of their lives in service to mothers and babies, take care of their own emotional well-being.  Here they all are, at the end of the workshop:

     Aren't happy, emotionally tended midwives beautiful?

    Two summers ago, I had the opportunity to study EFT with an internationally acclaimed EFT trainer named Sonia Sophia Illig   ...    Sonia's Website here   .  EFT is both a talking and a physical / energy therapy.  As you talk about your emotions, you "tap" on acupuncture points in a relaxing, beautiful series of movements.  This combination of reviewing your trauma and the emotions around it verbally, and tapping on the points, actually releases the trauma from the nervous system and tissues.  It is easy to learn and do, and results occur quickly.  Emotional pain is diminished  and a person feels lighter, more clear, and free.

    I use EFT in my midwife practice when painful emotions and past traumas are identified during  prenatal visits.  It is so empowering to be able to heal emotional pain, right there, in the office. Before I knew EFT I would listen compassionately to women's stories and feel frustrated that I couldn't do something to fix it other than offer referrals to therapists and healers.  Now I say, I can help you heal this;  lets do some EFT on this.  All VBAC clients must do at least one session with me. (See my other VBAC posts for more on this).
      The workshop at the ACNM conference really became about healing the healer.  Self-care for midwives is vital; we carry so much responsibility and often take difficult births or outcomes personally.  Midwives tend to burn out, and have health problems and divorce rates at record numbers.  There are little to no professional avenues to process the trauma midwives experience, and it was amazing to bring that to the American College of Nurse-Midwives.  
   A neat thing about EFT is that you can use it on yourself, and then easily use it to help others.  When you are healing others, you get healed as well.   Here is what one attendee said about my workshop:

  "Hi Dena,
I really appreciated the EFT learning session, which you offered at the ACNM conference 2012. It was wonderful. I'm a CNM who offers Home birth and Birth Center births and always love to learn alternative modalities to offer to our mama's. Attending your workshop gave me new tools for my clients but, also for all of the Midwives and staff who I work with. What a wonderful healing opportunity we now have to offer to the healers themselves.
Within days of your workshop, I was able to offer the healing modality to one of my pregnant clients. She tearfully thanked me for the comfort it provided and planned to use it at home as well, to continue with her self healing.
How empowering, I thought. Love it.
Thank you for bringing this loving modality to us.
Blessings, Lorri
 PS, you can use this as you see fit. Good luck. hugs

Lorri Walker, RNC, NP, CNM
Founder & Director
South Coast Midwifery & Women's Health Care"