Sunday, June 15, 2008

If you give a Woman an Epidural...

You all know the book "When You Give a Mouse a Cookie"? Well, here we go....

If you give a woman an epidural, she'll need a big bag of lactated ringers to go with it, the lactated ringers will keep her blood pressure from plummeting when she gets her epidural, but it will also swell her tissue with excess fluid so her legs and breasts will swell and she'll be shedding water weight for days if not weeks. The fluid in her breasts will make it hard for the baby to latch on at first, so the nurses will think the baby's not able to nurse and they'll recommend some formula, just until the nursing goes better, this will probably make mom feel insecure and crappy about her mothering skills and it could interfere with bonding.

After the epidural's in, she'll probably need a catheter because she won't be moving around much anymore, and hey! she can't feel anything below her belly button anyway! If she gets the catheter, she might get a urinary tract infection to go with it.

Once she gets the epidural and the catheter, even with the extra fluid, her blood pressure might drop anyway in response to the medication she's getting, she might get some epinephrine which has the following common side effects:

Anxiety; difficulty sleeping; dizziness; fearfulness; headache; nausea; nervousness; paleness; sweating; tremors; vomiting; weakness.

If she's unlucky she might even experience these side effects:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fast heartbeat; irregular heartbeat; wheezing.

If she gets the fluid, the epidural, the catheter, and the epinephrine, the baby might not respond very well, so the doctor will want to know what the baby's heart rate looks like all the time, and the doctor will also want to see whether mom's contractions are strong enough to dilate her cervix, so an electronic fetal scalp electrode will be screwed into the baby's head, and another special catheter, one that measures the strength of the contractions, will be pushed up inside mom's uterus. Of course, to do this, the bag of waters would have to be broken, so that the catheter can go in. Once the bag of waters is broken, the doctor will be paying close attention to the time, because doctors don't like women to walk around with a ruptured amniotic sack for much longer than a day, even if the mom and baby need longer to birth.

When she gets her fetal scalp electrode and the intrauterine pressure catheter is in place, the contractions might not look very strong on paper, so the nurse or doctor will do some cervical exams, to see how things are going. Lots of people, from the nurse, to the doctor, to the resident, to the medical student might put their fingers up inside of mom's vagina, so they can get a better idea of what's going on. But it's no big deal how many people put their hands up there, because remember, mom can't feel it! If they put their fingers up there over and over again, mom might get sick. She might get a fever, she might even get a fever in response to the epidural! But the doctors won't know exactly what's causing it, so they'll just give her a full spectrum anti-biotic to cover everything.

And if they give her a bunch of anti-biotics over the course of labor, she might get a yeast infection to go with it! If she gets a yeast infection she might give the infection to her baby too, then the baby would have thrush, which could cause more breastfeeding problems.

Once she's got the fluid, epidural, iupc, fse, the catheter, the cervical exams, and the anti-biotics, her contractions might poop out altogether, so she'll get some pitocin. The pitocin will blast her body into labor, making her contract harder and harder, faster and faster, but it won't cross the blood-brain barrier like natural oxytocin does, which is what triggers our bodies to create nature's pain killers: endorphins, so the contractions will be excruciating and very difficult to work with.

And if the contractions are very difficult to work with....

chances are.....

She'll want an epidural!

Friday, June 13, 2008

High Dose Pitocin Inductions

Apparently high dose pitocin inductions are becoming all the rage. Hospital in the big city number 2 at which I work is doing a study on them.

Color me unimpressed.

"The Literature" says women deliver more rapidly with HDPIs and that HDPIs decrease the number of C-sections. I'm skeptical, I can't wait to read the studies.

This was my first, and only I should add, experience with an HDPI.

Mom was a first timer, barely "past dates" (she was due on a Friday, we started the induction on Wednesday after her due date), she was given cervidil, a cervical ripening agent, overnight, which caused mild cramping but not much else. I placed the cervidil and BOY was her cervix posterior! I could barely reach the posterior fornix, the little pocket just behind the cervix, and I had a very difficult time trying to get to the opening of her cervix, the os, to check her dilation. In otherwords, her body had very few indicators of being ready for labor. In fact, her Bishops score, which we use to measure a woman's "inductability" was 2, not impressive.

So she recieved her cervidil overnight and pit was started, at FOUR MILLIUNITS AN HOUR, the next morning. Apparently in some places they're starting it at six milliunits an hour!

If we use the analogy of labor being like running a marathon, think of an induction as being tied to a car with which you must keep up in order to reach the finish line. Most times, the car would start slow, walking pace, like two miles an hour, and over the course of the day, the car (pitocin) would go a little faster, and a little faster, 'til you're finally running along at a good clip, and hopefully not being dragged behind the car! With HDPIs you sort of get pushed out of the car when it's already going 25 miles and hour and you just go faster from there.

When I took her the next afternoon, her pitocin was already up to 30 milliunits, which is pretty much the maximum recommended dose for any laboring woman, she couldn't feel it though because of course she had an epidural, not that I blame her a bit, I doubt I could take a pit induction that high myself without some pharmaceutical help.

Unfortunately, such a high dose caused, surprise surprise, hyperstimulus of the uterus so baby was having deep decels, and her uterus wasn't relaxing between contractions and she was contracting every minute.

We cut her pit in half and she started having a nicer labor pattern, but every so often baby would have a very deep variable deceleration. We suspected the cord might be wrapped around something at that point.

We started easing the pit back up again, this time using a low dose protocol, and soon her water broke with clear fluids. Whew! Despite the stress, baby hadn't pooped inside of her. Good.

Her uterus seemed to be pooping out (not suprising that she wasn't maintaining contractions with all the pit pumped into her from before, this is pretty common) so we kept increasing the pit.

About an hour after her water broke, we started seeing meconium, the baby's first bowl movement. Thick, thick, pea soup mec.

Finally, she was complete, we had her start pushing. The baby was having fewer variables, but his baseline had risen, which can indicate fever, or stress in a fetus, I was afraid he was on the verge of pooping out completely and he'd be plummeting down, and we'd be headed for a section.

After an hour an forty minutes of pushing, a pretty average time for a first time mom, the baby was born, covered head to toe in thick mec, floppy, dusky as all get out, with that glazed unfocused very not-present look. Yeesh. He had his cord wrapped around his neck AND his left had, which because of the cord was tucked up along side his head when he was born. I am so so thankful the Neotal Nurse Practitioner was there, I would not have wanted to try and resucitate that baby myself. She intubated him twice, and he didn't give his first small cries until four minutes after he was born. His apgars were five(!) and eight. Yikes. Yikes. Yikes.

So, what do I think about HDPIs so far. It seems like an impossible induction to do without drugs, I think it's a good set up to stress out babies, as well as leading to hyperstimulation of the uterus, which in turn could cause the uterus to rupture. The dreaded abruption.

Ladies, do your research, advocate for yourself, and if you can't, get a doula who will advocate for you.

Wednesday, May 21, 2008

hello again

bad me, I've been neglecting my blog.

Well, I'm working out of home again, at a new hospital-in-the-city. I didn't realize how stressed I was working at the county until I left work one day smiling. I don't get to see as many of my Somalian mamas anymore but I'm enjoying working with our newest wave of immigrants, the Karen people of Burma/Myanmar (I'm still sorting out what the best name for this country is, I believe Myanmar might actually be more colonialist, I'm looking into it).

I'm dragging my heels getting back into school, I think I'm not looking forward to statistics. Sad indeed.

On other fronts I have decided to yank my kiddo out of school and unschool him next year. I am STOKED. No more will he learn that Abraham Lincoln was "the great emancipator" and other lock, stock, and crock. It's trips to the museum, IWW meetings, forays into funky scavenged architectural stores and hopefully a trip to see Wicked, when it comes to town.

I'm busy getting ready for the RNC, coming to a hometown near you, you can bet your butt that if it was the DNC I'd be just as busy. I'll be working as a street medic on day one, with other plans later in the convention.

I'm loving my CSA and encourage everyone and anyone to check out this awesome way of supporting local organic agriculture for not much dinero. Who knew that the tastiest quiche I've ever had would be one made of wild ramps, stinging nettles, and sorrel.

I'm hoping to bring BOLD (birth on labor day) to Minneapolis, I loved doing The Vagina Monologues years ago in college. Birth is like fire these days, everyone is inflamed!

Just a quick update, more musings and meanderings soon.

Friday, December 28, 2007

It's not you, it's the system

How many times have I heard a woman say "I feel like my body just doesn't work", "I feel like my body failed me", "I guess I just can't have vaginal deliveries", "I guess I just can't breastfeed".

Listen up.

It's not you. It's our completely messed up system.

YOU are fine. YOUR BODY is fine. Birth works, boobs give milk, boys have foreskins for a reason and no, your baby is NOT too big.

What kind of a sick system/society do we live in and with, that we've taken a nearly perfect process in which a woman's faith in herself and her body's ability is so key and completely anihilated it? To the point where instead of complete trust, there is only distrust and fear.

Apply this to ANY other bodily function and you'll see how fucked up it really is.

Do we need robotic legs to make our legs walk and run and dance? Do we need to have our rectums cut open in order to shit? Do we need scientists standing over us, telling us how to fuck?

No, of course not. We'd be crazy to suggest such things. But we absolutely CAN NOT believe that women's bodies, which have been carrying and birthing babies for MILLIONS of years are actually self sufficient and good at what they do. We crave more and more technology, more vaginal exams, more tests, more more more. Instead of high tech, what we really need is high touch.

I hear women talk about being "allowed" to eat and drink. "Will my doctor 'allow' me to labor out of bed?" "Will I be allowed to keep my baby with me?" This is YOUR body! This is YOUR baby! This is YOUR birth! Once you give up your own body you are complicit in your own slavery to this system!

Women forget, you have a RIGHT to decline ANY and ALL: tests, procedures, vaginal exams, etc etc etc. But I fear that, like any other right, if we do not use them, they will disappear.

A good birth is your birthright. Your body is your own and no one else, and NO ONE has the right to invade it without YOUR permission.

So the question should not be "Will I be allowed this that or the other" but rather "Will I allow the doctor/nurse/midwife etc..."

The Winds of Change are Blowing

I jumped without a net.

This week I gave notice of my resignation at the BIG CITY HOSPITAL. Walked past a woman laboring in the hall, all nicely hooked up to IVs, wearing her "property of the hospital" gown like a good girl and it turned my stomach a little.

I want to imagine something different.

I find it massively fucked up that it's totally okay to go to school, and get an education on how to care for long as they're not your own. It's great to get a degree in educating long as they belong to someone else.

So ironic, when Sage was a baby, I felt COMPELLED to work (actually WAS compelled to work as the "state" was providing it's meager provisions to me and mine) just so people wouldn't think I was a "lazy" welfare recipient. But sneaky me, I got jobs, nothing sexy, which allowed me keep my baby with me, and until he was eighteen months old, and I was back in school for a few hours a day, he never was without me.

Now, dare I hope, after waiting so long to have another baby. After doing it by the book I could stay home and take care of my baby? Not likely. The capitalist machine keeps grinding.


I have a plan

There is a possibility that I might be able to do what I love. Educate women about birth, care for pregnant women, without being a nurse. I'm talking, of course, about being a doula. Not labor, not yet, not while Poppy's so small and needs me so much, but rather a post-partum and pre-natal doula. God knows, with as many high risk pregnancies out there I'd have a niche.

I wonder though, why it is that I lack the faith in myself to try to do this? I'd like to believe that I'm stronger than that. That I haven't swallowed the message that a) nothing can be done with out the permission of the capitalists and b)you must continue to live at the level of comfort to which you are accustomed.

Fuck that, let's live dangerously! Let's throw out the cable T.V! Dig up the dirt in the back yard for a garden, sell beautiful things! MAKE beautiful things! Grow rich in character and experiences and not in stuff!

I think I can do it.

Wednesday, December 12, 2007

Poppy's Birth

A special thanks to Dark Daughta for getting me off my ass to finally write this.

Towards the end of my pregnancy my blood pressure started to rise. As I wrote in my previous blog, it was causing some concern, so I stopped working entirely and just concentrated on caring for myself and my babe. I recognize how fortunate I was to have been able to do this.

I have never eaten so much protein in my life. The shakes were nasty but I gave my normally vegetarian self permission to enjoy some salmon guilt-free, grateful to the fish nourishing me and my baby.

The day I was "due", I met with my family at the hospital where my aunt was being cared for. Her Hep C was killing her. She'd been on the transplant list for nine days and her Meld score kept rising and rising, she looked nothing like the vibrant, sassy, beautiful Italian woman I'd known all my life. Unresponsive for days, she had, I feel, given her all, the machines kept her alive, but barely.

I know my aunt Cara had given everything she had to try to get Tawn a liver, but, as the doctors told the family, even if a liver had arrived at that moment, there were other complications which basically revoked Tawn's candidacy for the surgery. After having our questions answered, it was decided that the most humane act would be to remove life support. I have no doubt that this was the right thing to do, the medications and interventions were prolonging her suffering and postponing her death, more than they were keeping her alive.

We surrounded her bed after all the lines had been removed, speaking words of love, holding her hands and gently touching her limbs and face. I provided some oral care for her and made sure her dry lips were given balm. We wished her well on her journey, gave her permission to be free of her pain, and waited. She passed into whatever is to come later that night.

While arrangements were made over the next few days I just prayed to the universe and the baby to wait a little while longer. Friday arrived, three days after my due date and I woke up to a bit of bloody mucous in the morning. Oh yes, sex will surely help a woman who is ready along. The memorial would be on Saturday and I felt confident I'd make it.

Saturday morning I found a huge mucousy clot when I first went to the bathroom, and new I wouldn't be pregnant much longer. I had woken up at five in the morning, unable to sleep, so I just got ready for the day. For an October in Minnesota it was ungodly hot, we were looking at a high of eighty-five for the day and I certainly didn't want to be laboring in that kind of heat.

It was going to be a very busy day, as Pam England, of Birthing from Within fame was presenting a workshop in town that day. I planned to attend the morning session, then go to the memorial in the afternoon.

I felt loved, surrounded by so many doulas, midwives, and birth workers in the community, I personally knew well over half of the hundred or so women who attended the morning session. Everyone knew I was close to delivering and were eager to know how I felt, I was happy to report that I was very near labor, and indeed began to feel contractions every twenty minutes or so as we sat and listened to Pam.

At the noon break I was able to chat with the midwife from my son's birth as we ate Indian food at a local restaurant. It all felt like destiny.

The memorial was a testament of my aunt's crazy, colorful life. She was loved by so many people, my family laughed and cried through the service.

Afterwards I went home exhausted, with well-wishes from my family, to a much needed, but brief, nap.

That evening, refreshed, I went to listen to Pam recite the story of Innana. How fitting. The story of a woman dying to herself, to be reborn as something else. Life and death are ALWAYS with us, but in our death-denying culture, we are so fearful of what is to come, of what is unknown, of what is beyond, we have lost the ability to trust ourselves, our bodies, our births, and we cannot let go when death (both literal and metaphorical) is the best option. When I said good night to my birth work sisters I told them I'd have a baby within forty eight hours.

Sunday was a bit cooler, the wind had picked up and the weather was due to change. I knew my baby would be coming soon and I was busy with last minute preparations. Contractions came every twenty minutes, then every seven, but they didn't hurt so I acknowledged them but didn't stop what I was doing. That evening, as dusk fell, we walked around the lake, knowing I would not be pregnant the next time we did this.

That night the contractions picked up, but I was able to sleep well until three at which time I moved from the couch to our bed and tried to sleep just a bit longer. At that point I felt contractions every five minutes, but fell asleep between them. They were stronger than menstrual cramps but by no means unbearable so I stayed where I was.

Finally at five I woke up and started making ginger compresses and herbal pads for my perineum, I knew I was going to meet my baby very soon. At six thirty, more lonely than anything else I woke my husband who asked if I should call the midwives or the doula, I said I didn't want to bother them at least until sunrise.

Spurred by some maternal instinct my Mom called around seven o'clock. When I burst into tears she asked me if I was in labor and I told her that I was, she asked if I'd called the midwife and I told her that I was about to, she agreed that that was a good idea and wished me well, telling me to call her as soon as the baby came. I promised I would. As soon as she hung up I called my midwife and my doula who agreed to come right away, I assured them they had time for a shower and to grab some coffee and that I'd expect them within the hour.

It was eight on the dot when they arrived, my primary midwife and my friend and doula arrived first to find the candles from my blessingway lit, my birth alter arrayed with flowers and essential oils we might need. My secondary midwife and another friend arrived soon after. By then I was vocalizing loudly through contractions which swept over me ever two to three minutes, I spiralled my hips and sank into a squat with each contraction, dropping my shoulders and saying "Open", willing my body into birth. I felt like I was really in my head and thought I might be behaving a little melodramatically since I couldn't possibly be that far into labor. Could I?

The bath was being filled and when I finally got in I thought "liquid epidural my ass!" Where was the sort of euphoric relief I'd been expecting? Though not as nice as I had hoped it would be, the birth tub did take the edge off, especially between contractions. Even though it was only around eight thirty I felt like the contractions weren't stopping.

There were some sort of amusing moments. Although I felt like I was laboring hard I was still aware of what was going on around me. I'd hear my son ask a question of someone else during a contraction, but once I came out of my contraction I'd answer him. At one point everyone was giving my verbal support telling how well I was doing, how strong and brave was, how beautiful, and I said I felt like this was payback for every time I'd said that to a laboring woman in the past nine years. My midwife laughed and said "It's just a dance" to which I replied "I like the dance that got the baby in better".

The contractions were coming fast and furious at this point and I asked to be checked. It was now ten to ten. My midwife found me to be a dissapointing (to me) three cm. Not possible! I thought; I was working too hard to be a mere three centimeters! Never the less I got back up and talked to the baby, pleading with each contraction "Please baby, please baby, please baby" I continued to walk and work and squat and spiral, contractions moving through me less like waves and more like huge breakers, tsunamis, I learned to surf them, moving through each one as best I could and trying not to drown.

Soon it was time for another blood pressure check. Too high, the midwife encouraged me to labor on my side for a time. This did NOT appeal to me, but wanting to bring my reading down I agreed to do so for a little while. As I as walking to the bedroom my water broke on our wooden floors, splashing down my naked leg. I was sure I saw meconium and waddled to the bathroom to check. Sure enough, the toilet paper was stained a light green.

Not terribly worried, but hoping the baby chose to come sooner rather than later I moved to the bed asking to do "just one more" before getting in. At the very end of that contraction I couldn't help but grunting just a bit. Intense pressure. I heard one midwife ask the other from another room "was that grunting?" I called out "Yes! yes that was grunting!"

I lay down and from that moment on it was all I could do NOT to push. My "pah pah pahs" sounded more like "Pahpahpah pah pah paaaaaahhhhhhuuuunnngggrrr" I couldn't NOT push! Finally, frantic I asked to be checked again, my midwife found just a small cervical lip to one side. She asked me if I'd like to move to the tub "Yes" I said "Now" I knew there wasn't much time left.

I moved to the tub and the moment I was was in I felt the baby's head fill my vulva. I pulled away from the sensation physically and mentally, but only a milisecond later resolved to open.

It was less an experience of pushing the baby out than allowing my body to open to the baby. With the next contraction I felt the baby's head fill me again, and I allowed the baby's head to crown up into my hand. I felt so much hair and at that moment of first contact I knew it was a girl.

At this point my Midwife said something like "Now, when the head crowns..." but I interrupted her, "The heads already out" I said calmly, I was concentrating, and in a completely present state, I checked for the baby's cord and found nothing, I heard everyone and sensed a lot of activity around me but I was simply too busy birthing my baby. Another contraction and her body slid from me. Such ecstasy. I love that feeling. I brought her slowly from the water and up to my chest. Having made such a gentle entrance into the world she took her time deciding to breathe, but her cord still pulsed with Oxygen rich blood and cooed at her, telling her to come into her body, calling her by name "Poppy Ireland Jones" and welcoming her into the world.

When I asked what time it was someone told me it was eleven thirty nine in the morning. "Seriously?" I said. I couldn't believe it went so fast! Soon I felt a separation gush of blood and stood with the help of my husband and the midwives to get out of the tub so I could birth the placenta. A birth stool was placed just outside the tub and after a few minutes I pushed a bit and the placenta was out. I was helped to the bed and checked for tears. Not even a skid mark, and in truth, I didn't feel as though I'd just had a baby. Even with a fairly decent blood loss of eight hundred milliliters I felt fine, if a little hungry.

I snuggled down with my beautiful daughter, my son, and my husband and soon she was nursing like a natural.

I am grateful to my midwives, my ancestors, my body, and my faith in myself for this empowering, and blissful birth.

Wednesday, October 3, 2007


It's been a complex couple of weeks. Just visiting the farmer's market last weekend was a reminder of how bittersweet life is. Harvest is a beautiful time of year, but we know that just around the corner lies winter, the corn is going out, the squash is coming in.

My "due date" (which of course is irrelevant) was yesterday, I don't anticipate baby for another good week.I enjoy the last few days of pregnancy before birth.

On the other side of the coin, my aunt, who fought Hepatitis C for the last few years and who had been awaiting a liver was deemed to ill to remain on the list, and was removed from life support yesterday, she died last night.

On top of all of this, my blood pressure has been rising, which in and of itself does not concern me, it rose just before Sage was born as well. But in order to go into this birth "clear" I've had to come to the understanding that my perfect homebirth may not happen, I have shed many tears at that thought. I don't believe I'm sick, I don't feel sick, but I know it's not just about me. I am doing everything in my power to bring it down, the Brewer diet, Calcium and Magnesium, tincture of Linden Blossom, rest, but my Midwives must protect themselves too, despite how strongly I feel that all is well.

Birth is the door that opens both ways, I sometimes think that I've allowed the negativity of the hospital to affect me. Now is time for faith in birth.