In a Mother's Words; A Home VBAC Story

 Here is a guest post by Chico mother Michelle Burdette

In Praise of Midwives: A joyful HBAC experience

Avery Marie Burdette was born on November 16^th in the comfort of her own home. Her father lovingly supported me through labor and was able to see his daughter’s first breath. Dena Moes and her assistant Amber guided me along the journey and delivered Avery on their knees on my bedroom floor. I feel so blessed to have had this experience and were it not for Dena and the option of home birth, I would have had to undergo a repeat cesarean section.

I distinctly remember sitting in the doctor’s office after viewing my first ultrasound and discussing my birthing options. The doctor stated that I could not have a VBAC in the hospital due to regulations. He then stated that there was one OB/GYN in town that would sometimes “let” his patients labor until it was too late for a C-section, but he would generally end up doing a C-section in most cases.

I did not like any of these options! I felt trapped, like I had no choice but to go ahead with a scheduled C-section. I saw this doctor a few more times and was very depressed about the actual birth my child was going to have. You see, I did not get to experience my first daughter’s birth at all. I had an emergency C-section for footling breech presentation. I did not get to see her until an hour after her birth. Her father was able to hold her soon after she was born, but it pains me to know that no one familiar to her was there when she was born. I wanted this birth to be different, and now I was being told that due to a policy, I could not have the birth I wanted.

During a family get-together, I was discussing this situation with my cousin’s wife. She told me that they were planning on having a home birth and gave me reading material. I told her that I did not think home birthing was for me, but thanked her for the information. One of the articles she gave me was written by Dena Moes, CNM. The article was all about VBAC’s at home and I was inspired by the strength of her experience and her conviction. I was overjoyed to learn that she was a midwife in Chico and that there was another way for me to give birth.

I read everything I could get my hands on and discovered so much information that I wish I had known before giving birth to my first child. Who knew that Pitocin could be so problematic? I had no idea that I could have any say in my birth outside a “birth plan”. My husband and I met with Dena and were given the great news that I would be a good candidate for a home birth after C-section (HBAC). We were very nervous because this was outside the norm of what all of our friends and relatives had chosen. My family was nervous about birthing at home and worried that something catastrophic might occur. My husband and I looked at all of the statistics and were far more worried about birthing in a hospital setting. When we told people that we had decided to have our baby at home, people said things like: “you are so brave”, and “Aren’t you worried?”. Only a few people voiced their support.

We met with Dena throughout our pregnancy and with each meeting felt so blessed to be getting a home experience. We would meet in Dena’s office and there was a flannel sheet on a comfy table with a real pillow! There were no metal stirrups for your feet, no hospital gowns and no one pushed me to get testing done due to my advanced age of 37. I felt comfortable and like pregnancy and birth were natural, not fraught with peril. It was a gentle and holistic experience. We also attended a child birth class taught by Serra Wells that supported home birth as a viable choice. It was so helpful to meet others who had chosen home birth.

The day before my daughter was born I went to my regularly scheduled appointment with Dena and she informed me that the contractions I was feeling were the real deal and that we would be having our baby soon. There was no sense of emergency, just warmth and excitement radiating from Dena and Amber. This was so reassuring that I was able to enter labor with joy and confidence. Dena and Amber were very supportive throughout labor and the birth of our daughter. They helped guide me through the final stages of labor and calmly helped our baby into the world. Avery took a little bit to breathe, but Dena cleared her lungs and gave her a little puff and she cried her first little cry. With a home birth, the umbilical cord remains attached to the baby and the placenta until all of the blood has returned to the baby. This allowed Avery to remain at my feet receiving oxygenated blood rather than whisked off to a table in a delivery room. I was able to hold my baby right away and experience all of her first moments. This was so incredible for me as I did not get to be with my first daughter until she was an hour old.

Dena and Amber remained with us for several hours after Avery was born, unobtrusively checking us to make sure we were both doing fine. A defining moment occurred when Dena was helping me after I took a shower. I was still a bit unsteady and she actually dried my legs off for me. I can’t imagine a hospital setting where a doctor would deliver your baby, fix you breakfast and then dry your legs after a shower! I was so pleased that Dena and Amber would be back to visit us several more times in the week following Avery’s birth. I did not feel alone or abandoned as I had after the birth of my first child. I owe a great deal of thanks to Dena for allowing me to trust my body and the process of birth despite a prior C-Section. Our home birth was a beautiful and powerful experience. My husband and I are very grateful to Dena for providing women the opportunity to birth at home and to have a natural birth after a C-Section.

Thanks Dena and Amber! Michelle Burdette and Family

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!  

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.