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Greenville Memorial and Family-Centered Cesarean

I guess Greenville Memorial didn’t want me to only blog about Greer. They one-upped Greer’s family-centered cesarean.

History: When I first started doula work, sometimes I was permitted in the operating room at Greenville Memorial with my client. It was still hit or miss. However in recent years, the “rule” is only one support person for cesarean births. Until now.

Much to my surprise, at my last Greenville Memorial birth, JoAnn the trailblazing midwife, told me I was going back. I threw on some (cloth!) scrubs and Louise, a favorite nurse of mine, insisted I go with my client as she was being wheeled back.

That was the one-up.

Whenever I’ve been allowed back, I’ve first waited with dad until mom was prepped. This time, I stayed with mom the entire time. I was able to wipe a few tears while she waited, hold her while she received her spinal anesthesia, and talk with her as the surgery began. After the surgery, when dad left for a little while with their baby, I stayed until she was wheeled into recovery.

True continuous care.

Even better? JoAnn says the policy has now changed to allow two support people into the operating room.

I’m not saying I’m responsible for that. I’m just saying I’m glad I didn’t trip and face plant on mom’s uterus or something. Ruin it for everybody, you know? ūüôā

Now, look at this adorable poppet enjoying skin-to-skin time with daddy in the operating room. Don’t worry, she got lots of immediate skin-to-skin time with mama first. Mom voluntarily permitted dad a turn.

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It looks like family-centered cesarean birth will be standard care now at Greenville Memorial.

Now, let’s keep that cesarean rate on the decline!

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Another Family-Centered Cesarean Birth

This post contains pictures of cesarean birth. 

I am more and more impressed with Greer Memorial’s cesarean practices. ¬†If I had to plan a cesarean, that’s the place I’d give birth.

There are four OBs who attend cesarean births at Greer so the policy and practice is fairly cohesive. ¬†None of the “well, if you get dr. so and so, then expect x, y, z.”

I was honored to attend a repeat client’s planned cesarean. ¬†I use the term “planned” loosely since her darling boy decided to come early. ¬†Just to keep us on our toes! ¬†Come to think of it…her last “planned cesarean” also had me rushing to the hospital. ¬†Her babies don’t like to be told what to do, I suppose.

Here is her birth in pictures.  I only took 150 snapshots so it was easy to narrow it down to a few.  Hehe.

Top reason I prefer Greer? ¬†Doulas can enter the sacred operating room. ¬†And I dig the nurse’s scrubs instead of the paper ones. ¬†In this picture, I’m waiting with dad. ¬†The mom goes back first and there is about a 30 minute wait while she receives her spinal anesthesia and her stats are monitored. ¬†Dad was nervous even though it wasn’t his first rodeo so we talked about our kids while we waited.

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Now we’re in the operating room. ¬†Notice mom’s arms are not strapped down.

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Dr. Danielle Harris is the OB. ¬†She is lovely; relaxed and accessible. ¬† I remember my first birth with her four years ago. ¬†I suggested something wildly uncommon and she responded with a “hey, let’s try it!”

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The sweet baby grabs an arm and says, “Wait! ¬†I want delayed cord clamping!” ¬†No, actually, Dr. Harris delays cord clamping because it’s not a big deal to delay cord clamping.

(which is interesting because I’ve heard all sorts of reasons from other OBs as to why they can’t delay cord clamping during a cesarean)

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So, who’s this guy? ¬†He’s the pediatrician on call. ¬†Typically, the pediatrician or neonatologist examines the baby in the warmer immediately after birth. ¬†When he walks in, Dr. Harris tells him, “Mom would like immediate skin-to-skin with her baby.” ¬†And he says, “Fine by me.”

(again, I’ve heard all sorts of interesting reasons why this can’t happen: ¬†a nurse will have to rotate out in order to hand baby to mom or it’s too darn cold in the operating room).

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Now you’ll see how fantastic it is that mom’s arms are free.

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Beautiful.  Mom will never forget this moment.  And perhaps, just as important, significant aspects of bonding, breastfeeding, heartrate and thermal regulations are happening in this moment.

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A little while later, that laid back pediatrician asks if he can just take a quick listen to baby’s heartbeat. ¬†He does so without disturbing mom or baby and then steps back once more.

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Twenty minutes after the birth, as they prepare to transfer mom to her room, Dad gets in on the skin-to-skin.

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Focus on the calm, alert baby.  Do not focus on the bloody gauze behind him.

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Then mom is transferred to her hospital bed via a clever inflatable people-mover blown up with a shop vac. ¬†Fascinating stuff, hospital ingenuity. ¬†Side-note, many nurses wrap hep-locks in Glad press ‘n seal wrap so they won’t get it wet in the shower. ¬†Necessity is the mother of invention. ¬†

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The hospital bed returns to mom’s original room where she will stay until she goes home. ¬†There are no recovery or postpartum rooms at Greer. ¬†There is no nursery either.

Mom gets down to the first order of business.

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I don’t attend many cesarean births. ¬†I’m honored when I am invited to a planned cesarean as part of the team. ¬†Many thanks to this sweet family for sharing their positive birth experience with the community.

Another family-centered cesarean birth is featured here.

Doulas as pacers

Truth? ¬†Sometimes I’m baffled by my work as a doula. ¬†I’m confused by the mystery that my presence makes an impact. ¬†Especially when I don’t *do* anything.

Take Julia’s birth. ¬†I left Julia’s birth feeling like her three year old did more than I did. ¬†I mean, really. ¬†What did I possibly offer to that family? ¬†And then later, Julia’s husband says I was worth every penny.

It made no sense.

Or Melissa’s birth. ¬†I fanned her. ¬†With a manilla folder. ¬†That’s about all I did. ¬†And then later, she says she couldn’t have done it without me.

It made no sense.

I read about the early studies on doula support. ¬†In those double-blind randomized controlled trials, the laboring women had no idea that the extra woman in the room was a doula. ¬†They’d never met before. ¬†Yet, their birth outcomes were significantly better than the births that did not get the “extra person.”

It made no sense.

Nearly 8 years into this gig, I think I’m maybe beginning to understand how doulas work.

We’re pacers.

I’m reading an incredible book titled¬†The Worst Is Over: ¬†What to Say When Every Moment Counts. ¬†I bought the book thinking it would help with my kids. ¬†Norah has an anxious tummy and Cedar is ever catapulting from high places. ¬†I never imagined how it might relate to my birth work. ¬†But, of course, women in childbirth are in an altered state of consciousness just like people who experience trauma. ¬†Childbirth is NOT trauma and not always even painful but the brain does go into an altered state. ¬†Women in childbirth are often dreamy, time becomes hazy, thoughts may be confusing, suggestions plant deeply. ¬†I already knew how important language is for birthing women but this book took it up 10 notches. ¬†And it taught me about pacers.

So what’s a pacer?

You know how you modify your body language, voice, words to become more in sync with others? ¬†It’s a normal part of communication. ¬†Or sometimes a strong personality can change the entire mood of the room when that person is having a bad day. ¬†The author describes pacing as “our natural human tendency to tune in to others nearby by matching our words and our behaviors to theirs.”

The author talks about the importance of pacers when people are afraid, hurting, in shock, etc.  Pacing builds confidence, healing, comfort, rapport, and cooperation.

supportHow does this work in childbirth?

Nancy is deep in the birth zone. ¬†She is in an altered state of consciousness. ¬†She is barefoot in the hospital shower–a state that would disturb her any other time. ¬†Usually a very modest woman, Nancy is naked. ¬†Her husband, in swim trunks, supports her physically in the shower. ¬†What am I doing? ¬†I’m leaning against the wall, offering a sip of water from time to time. ¬†I don’t say a word. ¬†But here is the non-verbal pacing that is happening: ¬†Nancy locks eyes with me as she welcomes each surge. ¬†My eyes are confident, grounded, and full of love. ¬†She knows I’ve done this before. ¬†My eyes tell her everything is normal. ¬†What else? ¬†My posture is relaxed. ¬†I’m not carrying tension or shedding adrenaline. ¬†As we lock eyes, I take a deep cleansing breath and release it slowly. ¬†She mimics me. ¬†I smile.

IMG_2632Sarah sits on her birthing ball leaning on her king-sized bed.  Her husband rubs her back.  Bon Iver plays in the background and the rain is falling outside.  There is nothing for me to do so I sit in the corner and knit.  Sometimes, Sarah looks over at me and I smile.  My calm, slow knitting reassures her that all is progressing perfectly and there is no rush.

Heather’s labor is showing signs that baby is not in an optimal position. ¬†I show her a technique to lunge during her waves. ¬†Her husband stands behind her providing extra support. ¬†I stand in front of her and lunge with her. ¬†We are exactly in sync as we lunge and lunge and lunge some more.

What makes doulas uniquely suited for pacing?

The doula’s focus is entirely on the mom. ¬†Midwives are amazing pacers but they sometimes have other important tasks that may come first or interrupt: ¬†monitoring baby, checking mom’s blood pressure, etc. ¬†Particularly in those rare cases of emergency, it is vital to have a pacer who can remain focused on mom.

Dads, close friends, family members are not always the best pacers. ¬†Why? ¬†They’re emotionally caught up with the experience. ¬†They should be! ¬†I remember catching a glimpse of my mother’s concerned face at my first birth. ¬†It did not reassure me. ¬†Sometimes dad isn’t sure if what his wife is feeling is normal and his face can mirror it. ¬†And the birthing mom’s spidey senses can smell fear and uncertainty.

Giving name to this intuitive process has helped to deepen my understanding of what seems so mysterious–how the presence of a doula-who-does-nothing can be enriching and often crucial to the birth.

New Classes and Doula Availability

Have you liked me on Facebook yet?? ¬†What are you waiting for? ¬†Click here and then click “like” to ¬†follow my business there. ¬†My work is entirely dependent on social media and word of mouth. ¬†Help a doula out.

I have another parents-to-be series for Natural Baby coming up in June. ¬†Click here to sign up or to share with some expectant couples you know. ¬†Six Monday nights to explore parenting and learning to listen to your instincts. ¬†Class 1: ¬†Learning to understand and soothe your baby. ¬†Class 2: ¬†Breastfeeding. ¬†Class 3: ¬†The first six weeks postpartum. ¬†Class 4: ¬†How babies (and parents) sleep. ¬†Class 5: ¬†Saving money and creating a mindful gift registry. ¬†Class 6: ¬†The first year of parenting. ¬†If you can’t take an entire series, pick and choose the classes you want for 25.00/couple/class.

Registration is open for July/August Hypnobabies classes meeting Tuesdays beginning July 23rd in Greenville.  Email me for information (j_byers @ bellsouth.net).

I only have a few more doula spaces left this year.  I have space for 1 client in late June or July, 1 client in October, and 2 clients in November.

Thank you for helping me serve families!

April is Cesarean Awareness Month

Many bloggers have written incredible posts about the shocking cesarean rate, VBAC support, and resources for healing.

I’m not going to try to repeat what they have already so eloquently written.

I want to talk about the idea of family-centered cesarean birth.

I don’t attend many cesareans. ¬†The ones I’ve attended lately are so vastly different from the ones 5 or 6 years ago. ¬†Those involved babies sent to nurseries while mom was in recovery–sometimes alone. ¬†Waiting family members snapped pictures of this new life while mom caught only a quick glimpse in the operating room.

Now, I witness something astoundingly different. ¬†It is much more common to witness births in the operating room involving skin-to-skin contact, sometimes delayed cord clamping, moms with arms unstrapped, and recovery together as a family. ¬†Baby is often held skin-to-skin with dad when not on mom’s chest. ¬†Doulas are more frequently allowed to accompany the family for the cesarean.

Recently, one of my couples experienced a cesarean birth.  After pushing for hours in every position imaginable, their posterior baby (with a 15 inch head, mind you!) was born by cesarean.  Their medical team gave us all the time we needed to try every trick I knew.  The couple was disappointed but they remained empowered throughout their birth experience.

They won’t be showing up for the 18 month cry.

I want to share a few of the pictures from their cesarean birth.  The obstetrician called in to perform the cesarean was Dr. Danielle Harris.  She immediately agreed to their wishes for delayed cord clamping and skin-to-skin.  The family physician who had supported them through the birth was Dr. Keith Stafford.  You know him on this blog as Dr. Polo Shirt.

Dr. Harris hands baby to Dr. Stafford who places him¬†directly¬†onto mom’s chest. ¬†He doesn’t dry the baby first or take a detour to the warmer first.

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Dad steps in to help mom hold their son. ¬†Mom’s arm is free to touch her baby.

Here’s hoping that more babies who must be born by cesarean will experience a gentle welcome like this one.

Huge thanks to my clients for permitting me to share a little of their birth experience.

Goodbye 2012

I like stats.

Firsts in 2012:

  • First dad to leave me in the dust on the drive to the hospital. ¬†You know who you are, J.S.
  • First missed births. ¬†I missed one due to dengue fever and one because I was away for the weekend (she birthed early). ¬†I’m ever indebted to Angie and Laura for doula-ing in my place.
  • First time supporting back-to-back births.
  • First hospital waterbirth.
  • First time driving 1000 miles for a birth (which I missed, so that’s three missed births this year. ¬†Painful.).

I am excited to see what 2013 has in store for me! ¬†My doula availability is booking quickly and my first Hypnobabies class is filled to maximum capacity. ¬†And how could it not be an amazing year with this adorable pumpkin as the first baby I snuggled in the new year? ¬†He also peed on me three times. ¬†I’m sure it is a sign of good things to come.

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I have only one resolution.  I will not miss any births.

Blooper #12 and #13

I added two new bloopers.

12) ¬†At a homebirth, the mom was deep in her hypnosis. ¬†I was pressing a warm rice sock on her lower back. ¬†I looked down to see rice spilling all over the carpet. ¬†It seems my stitches were less than precise. ¬†I had to use two ponytail holders to twist up the split seam. ¬†Thankfully, I remembered to remove the ponytail holders with their metal attachments before microwaving the sock. ¬†Otherwise, this blooper would be more serious. ¬†If I’m going to continue sewing my own rice socks, perhaps I should add a sewing kit to my doula bag.

13) ¬†In my Hypnobabies class, we were discussing perineal counter-pressure. ¬†At the end of the class, I reminded them of the birth rehearsal we would be doing the next week. ¬†I mentioned we would practice positions, techniques, and counter-pressure. ¬†Never noticing their uncomfortable faces, I continued on until a doula who was auditing my class (and had taken Hypnobabies for her own birth) interrupted, “What Julie means is we’ll practice counter-pressure on your lower BACK; not your perineum.” ¬†There was a collective, “Whew!” ¬†Right. ¬†Different counter-pressure altogether.

At some point, I need to wonder if it is a savvy business move to admit to these blunders.