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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.

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A Doctor Writes a Birth Plan

Guess who has started blogging! Check out Dr. Polo Shirt’s thoughts on birth plans.

Students becoming educators

Lately my childbirth students have been teaching medical professionals all about birthing positions.

1)  A first time mama was her OB’s first natural birth.  Seriously, first natural birth EVER witnessed.  And my student gave birth standing up!  Providing her own counter-pressure while her husband sat on the bed and held her from behind.  She gave birth to an 8lb+ baby without any tearing.  She said she felt her OB and nurse believed her to be a giant liability disaster waiting to happen! 

The next day, her OB had lots of questions about the birth.  The OB was surprised the woman did not “blow out her vagina.”  OB:  I’ve always supported the use of epidurals so I can control pushing and you don’t blow out your vagina.  But you didn’t seem to have a problem.  Mom:  I had instant feedback from my body about how fast/slow to push.  

2)  This mom was a VBAC who never got to active labor during her induction with her first baby.  And she wasn’t “allowed” to get out of bed.  This time, she stayed at home and birthed 17 minutes after arriving at the hospital.  She chose a hands/knees position.  There was no doctor on the floor so three nurses assisted.  The one catching had never done a hands/knees births.  I could pick up on some anxiety about the position but mom did all the work.  She made it easy for the nurses.  And thankfully, they were supportive of her choice–not that I think she would have willingly changed positions at that point!  The nurse passed the baby straight to mama where she snuggled skin-to-skin for over an hour. 

3)  A resident had only done back births.  Her words:  “I see that you’re pushing well on your knees.  But what I like to do for natural births is break down the bottom of the bed, scootch you down and have you pull your legs back.”  I wanted to ask, “Um, how is that different from medicated births?”  Mom was tricked onto her back “so we can check you.”  But she rolled to her side.  And instinctively gave herself her own counter-pressure.  This clearly made the resident uncomfortable but the mom ignored the nurse’s attempts to move her hand.  I heard the attending whisper to the resident “the manuevers are the same for a side birth as a back birth.”  When the resident gave me some instruction I can’t remember now, I replied, “Oh, ok.  I haven’t done a back birth in a long time.  The last birth I attended the mom was standing up.”  Wide-eyed resident shook her head in disapproval.  Sigh.  I hope that one moves on to a hospital far far away. 

I’m so proud of my students and other families who are changing the way birth is “managed” in the hospital.  It can be a tricky place to navigate and the balance of power can be overwhelming.  I think of my client who had a breech baby.  While she knew cesarean was her only option in the hospital, she also insisted on delayed cord clamping and skin-to-skin contact.  She made a path that other women can more easily trek. 

These amazing families inform and change one birth at a time.

Blazing Trails

Recently, my repeat client had a repeat breech.  I blogged once before about this amazing woman.

As you know, in the US, it is impossible challenging to find an OB willing to manage a vaginal breech birth.  Heading into a repeat cesarean, this mama did her research and opened a dialogue with her OB about her choices.

I’m delighted to report that Dr. Cowart with Greer OB supported her choice to wait 1 minute before clamping the cord and to have baby placed skin-to-skin.  She enjoyed skin-to-skin contact for over an hour after her baby’s birth. 

I hesitate in posting this because I’m afraid Greer OB will be overrun with families who want choices in their births!  Soon, they might become like Dr. Polo Shirt who is so busy he’s turning expectant families away. 

Thank you to this mama who maybe blazed a trail for other women to have this conversation!  And congratulations on your beautiful baby!

Brady’s Birth Story

[shared with permission]

I had not thought a lot about birth before I became pregnant with Preston. All I did think about birth was mainly negative and never in my wildest dreams would I have thought it could be such a positive experience. I think if more women shared their positive birth stories, we would have a different view of the whole birthing process. Before I start I do believe that every woman is entitled to bring her child into this world how she wants to.  So here is how Preston entered this world, hope you enjoy it and take something from it.

Tyler and I decided that we really wanted to bring Preston into this world without medication or interventions during labor. We started working with our doula, Julie, who educated us on how to follow through with the birth we wanted. Tyler and I read and read and researched and took classes and met with Julie and asked probably a million questions. We learned how to labor together and different methods to help ease the pain of labor. Finally the day was here!

January 24th, 2009
I woke up with a lot of back pain and just did not feel good. Tyler and I went for a long walk and still the pain did not ease up. Needless to say I spent a lot of time in the bath and having Tyler apply counter pressure to my back. We watched a movie and I tried to sleep but could not.

January 25th, 2009
We called Julie around 6:30 a.m. and she told us to try and get some rest. I got into bed and ended up sleeping for about 3 hours. Thank goodness I got at least that because little did I know I was about to do the hardest thing I have ever done in my life. Julie decided to come by and check Preston’s position (most posterior babies put a lot of pressure on the back during labor causing the mother to have back labor). Julie walked in at 11:54 and my water broke at 11:57. I remember being excited and scared all at once. We were going to have a baby and I was going to meet Preston, but at the same time I knew that I had a big job cut out for me. My labor progressed quickly. Julie wanted to try to see if Preston would rotate, so that he would be anterior and take some pressure off my back. After doing what she called the “rotisserie,” Preston flipped.

img_7407Labor was starting to get very challenging and I just kept pacing and had not gotten my rhythm down to get through my contractions. My personality is so independent and I think I can do everything myself but I realized that I needed Tyler and I needed to allow him to help me through these contractions. I finally got into a ritual during my contractions. I leaned on Tyler and held his hands over my face and rocked back and forth. Strange, but it seemed to work. My contractions were getting so intense; we decided to head to the hospital. I have to admit in the back of my head I was thinking that natural childbirth was for the birds and I was wondering what I was thinking doing it naturally! The car ride was interesting, my contractions seemed to be back to back and Tyler was driving like a race car driver to get me there. I think he was a little nervous about birthing a baby in the car. I remember not wanting to hear any noises, it was like I was so deep into myself that everything around me was a big blur.

We arrived at the hospital at 3:30 p.m. and instantly I wanted to push. It was a feeling that was welcomed and one you cannot resist. It is funny how your body just takes over and knows exactly what to do (if you allow it to). We walked in and got into the room and immediately I was pushing. The nurse tried to get my IV in, but she failed because my contractions were coming and I could not help but move. I was exhausted and I really wanted to just rest. I kept thinking if I could just rest then maybe I could do this, but I had to dig deep way down inside me and find the strength to continue pushing. Julie and Tyler were great and really helped me to find the strength I needed to get Preston here. I remember thinking that this was much harder than I ever thought it was going to be, but then I felt Preston start to crown and I knew that Tyler and I would be able to meet our son soon if I could just keep pushing. At 5:27 pm Preston was in my arms and it was the best feeling in the whole entire world. Tyler and I created this img_7465beautiful child and all that work during labor was what got him here.

Labor is not easy and it was the hardest task that I have ever done; however it was the most rewarding. After Preston’s birth I felt stronger than I have ever felt in my life. There were many times during my labor where I hit walls and I wanted to quit, but I did not. I climbed them and that feeling is a remarkable feeling. Tyler and I are closer today than we have ever been. Going through the labor experience together fused us together even more than we were before. It took “us” to a new level. Looking back at Preston’s birth it was one of those memories that I will treasure forever. Did it hurt? Yes. Was it hard? Yes. But I learned more about myself and what I am capable of in those 6 hours than I could ever imagine. So childbirth can be a positive experience and I cannot wait until I get to do it again! It is a beautiful part of life and I am blessed to have experienced it.

[I would like to add that Brady made many healthy choices in her pregnancy.  She also made the difficult choice of switching care providers and hospitals in her last few weeks to a more natural birth-friendly practioner.  When I saw Brady and Tyler at a postpartum home visit, they were beaming with respect for each other and adoration for their baby.  It is such a pleasure to watch them grow into a family!]