Thursday, October 14, 2010

When Hello Becomes Goodbye....

**Warning...this post is about pregnancy loss. I know this is an extremely sensitive topic, and I wanted you to be aware. But even the midwife has a story she needs to tell. Much love, Jennifer**

LM was a "hand me down" client, as I teasingly call them. Her midwife was leaving town for several months, and I was handed a stack of charts, with instructions on when visits were due, directions to different homes, and a wave goodbye. I gleefully made my rounds each week, checking growing bellies, charting vital signs and heart tones, and listening to the complaints, concerns, or questions - as the case may be - of each mama that I saw. LM was one of my favorites, if there really can be such a thing. She wasn't an incredibly expressive lady, but her glad smile every time I came always let me know that I was very welcome. We spent many a visit at her kitchen table, me asking questions and hearing all the latest family and gardening news, while trying not to spill on her chart any of the fresh blackberry pie I was eating. We made plans for her upcoming birth, making sure that all was in order.

One day, a Thursday, I made my usual rounds, and was told that her husband (HM) was going out of town on church business. LM wasn't worried at all, as she had been overdue with each of her previous nine children, and was only about 38 weeks at this point. I did my usual baby check, letting her listen to the heartbeat, watching her smile at the sound. I'm so glad I did. Before leaving, I made sure she had my number on hand so she could call if she needed anything while HM was gone. With a smile and a "See you next week on the usual day!" I was off.

Sunday evening in the middle of a church celebration, my phone rang, and I quickly answered as I do every time I see that particular "Amish-land" area code. I could barely hear her quiet voice over the hubbub in my background. "Hi, this is LM, and I think I'm in labor. I've been having contractions for a little while. No, I haven't been able to contact HM yet. I can't get his driver on the phone." I assured her I would be there soon, and that we would get to her intended place of birth, that being the out-of-town midwife's birthing room. In due time, we got settled in, the ticking clock the only noise in the empty house. I started the usual tasks of charting, checking vitals and heart tones, and the other little things we do to get mom comfortable and ready for birth.

She got up on the bed so I could examine her progress, and found her to be a little dilated, with the curious finding of the baby being a lot higher than it had been just three days before. The next moments are the ones that changed me forever. I got out my doppler and gel and began the routine check for heart tones. Nothing. I smiled, "The baby is hiding from me...I can't find the heartbeat yet!" I moved the probe here and there, struggling to breathe as my heart leaped in my throat, the most awful silence meeting our ears. I tried not to let the worry I was feeling be too apparent in my eyes. "Let me get more gel. I might not have enough on the probe." Still, nothing. Dreadful silence. Unnatural silence. Empty space not responding to the plea of my mind and heart at the moment - "Please baby, be ok. Please just be hiding. Please let my doppler be broken. God....?"

I questioned her about fetal movements. "Well, I think I felt it yesterday, but I know I haven't felt any movements today."

I looked in her eyes, seeing the mirror of my own fear and inner struggle, while our faces remained upbeat and stoic. "Let's go in to the hospital and see if they can find them. I'm a bit worried about your elevated blood pressure, too. We'll let them help us." She acquiesced, and we loaded up to go to the hospital. My mom, my faithful prayer warrior, was quickly updated as to what was going on. I made a phone call to my collaborating physician, and before long we had arrived, and were whisked straight to Labor and Delivery. More machines, more doppler gel, more professionals listening for that elusive sound. More silence. I watched, eyes wide with unshed tears, knowing that for now, it was about her, and she needed me to be strong. An ultrasound tech was called in, and I moved to the end of the bed where I could see the monitor. The wand slid smoothly all over LM's belly, the image of the baby showing up in the unusual form that ultrasounds present. Then the wand stopped, and I could see the immobile object at which it was aimed, and my mourning officially began with each slow type of her fingers - H E A R T.

Her husband still unreachable, we were given a room in which to labor, while the caring, loving nurses tried to make her comfortable, while doing all the usual procedures that hospital birthing requires. One thing about birth in the hospital is that it's noisy - the "whomp whomp whomp" of the fetal heart monitor is never ending, along with the odd assortment of pings and beeps from various machines. Not this time. Again, that silence.

I stood by her bed for the next long hours. I can't even remember just how many times the second hand went around the clock face. I felt helpless, missing the verbal tools I normally had in great supply. It was cruel to say, "You're doing'll see your baby soon!", or many of the other comforting things we murmer during labor. Every contraction brought a strong squeeze of my hand, and I didn't waver when her eyes sought mine in concentration. I'm here with you...I love you...I care...we're going to make it together. I don't know if those words came out of my mouth, or went straight from my heart to hers. I hardly know what I said. I do know what was not said. Through all of this, LM had remained calm, a few whispered phrases to me occasionally showing me the hurt that was welling up inside, but her outward demeanor was one of acceptance and duty - she knew she still had a job ahead of her, and that is what she focused on. She didn't cry, didn't panic, just...labored.

Soon, she was complete and was given the okay to push whenever she felt like it. The doctor gloved up and stood quietly by, just observing. No bright lights, no grand displays, just a word of reassurance every now and then. Soon, the top of the head was seen, then the head was born, and yet the doctor still didn't move. "You're doing just fine...a few more pushes and we'll be there." I watched as the baby oh, so slowly, was born, the doctor holding a basin for it to be born into, as the stillborn are extremely fragile and must be handled as little as possible. A perfectly beautiful baby girl with a cupid's-bow mouth came into view. Every part of me screamed silently against the proceedings. "No, it's not supposed to be this way! Hold her! Why is she so quiet? Birth isn't supposed to be about death..." Still that silence reigned. It's a silence that doesn't make sense.

Then a sound caught my ear and the silence was broken as her mama's face crumpled with grief. We reached for each other, and I held her as she mourned, sobbing for her baby, crying the hurt out. I could say nothing but, "I'm sorry...I love you...she's beautiful...I'm so sorry..." We stayed like that for a full 10 minutes, midwife and mama, holding each other, tears flowing, sharing grief too deep to name.

They took the baby - soon named Mary - away to be bathed and dressed. I found out later that they took pictures, too, just in case these Amish parents might decide they wanted one. She was brought back to LM for her to see and admire. Little Mary was born with Down's Syndrome compounded by numerous internal anomalies, and had apparently been sick for awhile, but there was no way to know that without the routine ultrasounds that are generally declined by the Plain communities. With great faith and resignation, LM looked at me and said with tears in her eyes, "I guess this was just God's will." It was almost posed as a question, one which I could only nod to, affirming her belief in the Father and his unsearchable ways.

The next hours are a blur from shock and sleep deprivation. At some point in the morning her husband arrived, distressed to have not been there. His face, when being shown his lifeless daughter for the first time, is one that lives on in my memory. Some things never leave you. Soon, more family arrived, hushed tones respecting the palpable sorrow. The hospital staff prepared the baby to be taken away by the funeral home. Did I really see that tiny form being wheeled away on a gurney, maroon cloth covering all, or is that a figment of my imagination, blurred by time and the inevitable forgetfulness that comes with stressful situations? No, I think it was real.

Oh, that silence, still ringing in my ears...

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

In another birthing room nearly 2 years later, LM lay quietly laboring. We passed smiles between us, our deep bond and friendship needing few words to communicate. I was proud to be her midwife again, this time being of her choosing. Our prenatal visits went much like before, with every milestone we passed being a blessed relief. She had felt much better this pregnancy. Although joyful to attend her again, every time I applied the doppler probe to her belly, a quick shot of fear would go through my heart, until the faithful "Ca-lunk ca-lunk ca-lunk" would echo through the room. Such wonderful sound. After a long, slow, tedious labor, she was finally able to push. Soon, the top of the head was seen, then the face, then the head was fully born. Midwife hands settled gently on the baby, helping guide its entrance into the world. Another shot of fear. A quick smile and a cheerful word to LM. "You're almost're doing great!" One more valiant push and a gorgeous baby boy with a head full of bright blond hair was born - lustily shouting his arrival. My tears of joy at the noise joined his protestations. This is what it's supposed to be. Noisy. Lungs filling up. Little hands reaching automatically. Mama hands meeting them in welcome.

A look of peace and joy passed between LM and me, knowing that all was well. Later, as I held him, adoring his tiny features, tears and laughter mingling together in a strange mix, I said to LM, "I think he looks like a Levi." She just smiled, admiring him with me, pleased and thankful.

I busied myself with the necessary paperwork, cleanup, footprinting, weighing, and assessing that comes with the postpartum period. I turned to see LM with a smile on her face, and getting a nod from her husband, said, "His name is Levi." I exclaimed with delight, feeling as happy as if they had named a child after ME! It was an honor for them to take my suggestion and make it a reality.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Sometimes hello becomes goodbye....then with a joyful noise becomes "hello" again. To all those who have loved, yet lost, your arms empty, your heart permanently missing a piece, I lovingly dedicate these words. May blessed time dull the ache, while you never let us forget the baby that remained unseen and unknown by an outside world. We care...we hear...we love you.

Sunday, October 10, 2010

The Story Of A Midwife...

I am often asked how I "got into" midwifery. It's such an unusual profession, off the beaten path, so ancient in it's history. I think it might seem odd to some that someone my age is a midwife - I've been told before that I did not match a person's mental image of what a midwife was. Apparently, I don't have enough gray hair!

Here is my story...

I have always been in love with babies. When I was too young to be in the church choir, I busied myself with every baby I could get my hands on while their mama was occupied. I carried babies on my hips before I even had hips! The maternal instinct was so strong in my little life. I used to pretend I was giving birth, groaning and moaning as I pulled my baby dolls out from under my shirt, then immediately pretending to nurse them. I don't know where, at such a young age, I got my notions of how babies were born! As I got older, I would sit, fascinated, when anyone would tell the story of their baby's birth. I remember one family friend waving aside the idea that birth was horribly painful, as her babies had all come quickly and easily.

On the other side of the coin, I thrived on anything medical, loving the stories of Florence Nightingale and other historical figures, wanting to be that life-saving heroine, calm in the face of danger, holding a flickering lamp as I aided the wounded and hurting. It was romanticized a bit, to be sure! I laugh when I think how that played out in real life. My brothers and I were very active, constantly reenacting some historical period or another. Sometimes I would join in the battles, scattering the enemy to the four winds while we bravely chased after them on our horses (bicycles)...other times I would be seen with my little pink plastic suitcase, full of "bandages" I had rolled. The poor wounded soldiers would get bandaged up, then I would carefully squirt red food coloring on those same bandages to simulate blood. Apparently, it wasn't enough to have them simply wrapped up in strips of cloth!

I thought I would be firmly headed down the path of nursing, until one day when I was about 12 years old I learned what a midwife was. I *knew* that was what I would be one day. I don't remember ever questioning that or looking back. When I was 14, I had the privilege of being in the house where a baby was being born. I was in awe of meeting "real live midwives" and I tiptoed around sharing excited giggles with my best friend. I will never forget when the baby was born and they let us into the room. I proclaimed with pride for years that, "I was the second person to get to hold a brand new baby!!" I can still see that bedroom in my mind's eye, mom in the bed, beaming with joy, the midwives quietly working in the background, a thrill in the air.

After that amazing experience, I read every age-appropriate thing I could about babies, birth, midwifery, and other related topics. I had the wonderful privilege of attending my first birth as an observer when I was 19. I remember being in shock at the intensity of the birth experience. To further break any preconceived ideas I had of what birth was like, she had the baby standing up, leaning over a chair. I remember quietly watching in the corner, overwhelmed and emotionally withdrawing, yet trying, in a clinical manner, to mentally walk through each step of the process. I smile when I think of how I was trying not to completely lose it! One lesson I haven't forgotten from that birth is how hungry a new mom is after her baby finally arrives. I was offering her "sick people" food in the form of soup, toast, etc. She said, "No, I want lasagna! I'm hungry!" It makes me smile even now...

The next birth I was able to attend happened over a year later. By that time I was older, wiser, and more educated. I had read a lot about labor support, and it was at that birth I believe I discovered my gift as a doula. Scenes are imprinted in my, dad, and student midwife all walking down the long dirt lane, goats and mules fist pushed firmly against her sacrum to alleviate the back labor while she held onto her strong husband...the blue sky and warm sun on our shoulders...the excitement in dad's voice as he proclaimed over the wails of his new baby, "It's a girl! No...a boy. No! It's a girl!!" The birth of that baby after a very long labor had the opposite affect of my first observed birth - this time I cried, joyful with them in the arrival of their little baby girl after 6 boys! I wasn't fearful anymore...

By the time of that birth I had been enrolled in midwifery school for almost a year. I loved my studies, awed by the whole new world opening before me. I wanted so much to be a good midwife one day. Since we lived rurally, my opportunities for hands-on learning were minimal. I was able to attend approximately one birth a year for those first few years, scenes from which will always be imprinted on my mind.

By age 23, we had relocated to West Virginia, where I began a formal apprenticeship with a local midwife. That opened so many more doors, and I have had the wonderful privilege of training under and working with other fabulous midwives. Midwives form a special sisterhood, one that is universal. I'm so grateful for the privilege of being a member.

In 2006 my practice sprouted it's wings, and the rest is history! What friendships I have forged...what amazing memories I've made. I wouldn't trade my life with anyone. It's not always easy - it takes a lot of work, requires long hours and much sacrifice, but all so worth it.

Last year, while at a conference, the question was asked, "How did you become a midwife?" As the circle of ladies answered that question one by one and I waited my turn to speak, I thought about what I would say. A long-buried memory surfaced and brought tears to my eyes. In my mind's eye I saw a mom, belly swollen, lying down on her bed, while her three-year-old daughter pressed an ear to her pregnant belly. The little girl laughed when the baby kicked her. And I knew. That is when I fell in love with the unborn, with pregnancy and birth; that is when my fascination with life started.

And in the beginning, a midwife was born...

Tuesday, October 5, 2010

Guest Post: Three Things Nurses Wish You Knew About Childbirth

An article has been circulating, bearing the same title as this post. I encourage you to read it, by clicking on the title above. Here is what Joni Edelman, former Labor & Delivery nurse, had to say in response to it. I found her comments quite insightful, and am reposting them with her permission, fascinated to see her view from the "inside".

Here's what I wish my patients knew:

1. Doulas. Yes. The statistics don't lie and a good doula is an asset to the RN too.

2. REAL childbirth prep. Yes.

3. Birth plans. Yes. But be flexible. Only because in my experience, the more rigid the birth plan, the more likely you'll end up in surgery. I can't explain it but it's true.

4. Pain medication is available and we are happy to give it to you. However, sometimes it's too late for the epidural or that last shot. Labor hurts. Sorry. We can't always make it pain free. Frankly I'm shocked at the number of women who expect this.

5. YOU have the right (and responsibility) to make choices for your baby and yourself. You can refuse intervention and treatment you don't want. (IV, induction, etc) Your RN or OB might be mad or even mean to you but it's your baby and your body.

But what I REALLY wish people knew is that the statistics are true AND scary. The hospital creates as many problems as it solves. Where else can you walk in healthy and still have a 32% chance of having major surgery? Also pitocin, whether they'll acknowledge it or not, makes for complicated deliveries. OB's like pitocin. They like to exert control when they can because unfortunately they are all terrified of a lawsuit. Most OB's pay more in malpractice insurance than most people make in a year. Don't get me wrong, I LOVE OB's. They have an important role to play when NEEDED. Otherwise they really aren't acquainted with normal, unaltered labor. They rely on quantified information which is great, when necessary, but usually is unnecessary.

So what I wish people knew is it's safe, and often safer, to have your baby at home with a skilled midwife. I just did and even with a delivery complicated by a severe shoulder dystocia, I'm still glad I had my 10 lb 6 oz baby in my kitchen. It's a long story but because of my experience I know what likely would have happened in the hospital making me that much happier I wasn't there."

Thank you for sharing with us, Joni!

Baby Danny's Story

Yesterday I went to my Monday "job", putting on my cleaning/nanny/organizer cap for the day. I was there long enough to grab clothes for a little one, and load the dishwasher, when my phone rang. I heard the midwife's voice crackling through the bad reception on the other end. "Well, I think O.M. is in labor. Actually, she's not really sure, but she couldn't sleep well last night. She's had some bloody show, but not really any contractions to speak of. Oh, and I think she's 6-7cm dilated." With that bombshell, she gave me her schedule for the next couple of hours, and asked if I would go ahead and come over. Sure, no problem. My sweet friend told me to quickly GO...and I headed down the road.

I traveled the hour-plus into Ohio, listening to podcasts I had previously downloaded. With so much time on the road, it helps to find ways to pass the time and enrich my mind. On the way, I saw an unusual sight of a very long row of ambulances, lights blazing, and cars with their lights on, sandwiched between more ambulances and fire EMS vehicles. Come to find out, it was the funeral procession for an EMS personnel. I had never seen anything like it!

I headed straight to the midwife's house, where she has a birthing room set up for her clients. An interesting thing about the Amish is that they keep their pregnancies very secret. The children are told nothing about pregnancy, birth, or babies. If expectant mothers are questioned as to why they're "getting fat", they will tell their children, "I've been eating too many donuts!" Once, I was actually told just that when being given the news about someone in the community, and a child was present. "Did you hear about So-and-So? She's been eating too many donuts!" It was rather funny! Those with large families especially appreciate the use of the midwife's birthing room, knowing they will have more privacy and less questions from the other children.

I pull up to the house...and no one is there. I go in and make myself comfortable, working on my computer to get some projects accomplished. I was a little puzzled as to how I beat the midwife there, but knew they would show up sooner or later. Sure enough, about an hour after I arrived, the laboring entourage drove up...only there really wasn't any labor happening! I got O.M. comfortable, doing vitals, listening to fetal heart tones, and the initial charting that goes with all of it. Upon exam, she was indeed 7cm, but couldn't honestly say when her last contraction was. We settled in to wait, giving her some natural products to see if they would help her contractions get into any kind of pattern. She patiently waited all afternoon, having one contraction an hour....then two an hour....then three an hour. In her words, she was "disgusted." She had never had a labor like that, and while she didn't look forward to painful contractions, she just wanted her baby! In the meantime, we talked and visited, sharing stories and news, the most surprising of which to her was that I didn't have any children of my own. I just smiled and said that I hadn't had my chance yet, so I was content to help everyone else with their families. This whole time the baby's heartbeat sounded great and movements were good. The baby's head was up rather high, so we knew she'd have to labor him down. We enjoyed giving her a little childbirth education, complete with drawings out of books and a pelvis model I had given to the midwife a long time ago. I love watching the light go on in someones eyes when the mysteries of their body is explained. Suddenly, labor made sense to her, for the first time in eight births.

About 5:30pm, she grimaced with a contraction. "My, that one was stronger." Five minutes later, another grimace and tightening of her hands. 15 minutes later...another. Then five...and five...and five...and we have a pattern! The poor dear went from 0 to 60 in no time, so it was a little hard for her to cope with the suddenness of it, but she did wonderfully. I busied myself with rubbing her back, soothing her shoulders, explaining how it would help her if she didn't clench her jaw against the intensity of the contractions. I vocalized with her, watching her body relax every time she quit fighting against the strength of what she was feeling. We applied warm compresses to her perineum, preparing for the soon arrival of her baby.

Another exam..."complete!"...the water broke with a whoosh, and we saw meconium in the water. The baby had had a bowel movement at some point, most likely due to the fact that he was 12 days overdue, so we prepared for possible respiratory problems, and had the bulb syringe ready to make sure there was nothing in his mouth for him to aspirate. Meconium is very slick and if the baby breathes it in, it can coat the lungs so that they can't get the fluid out of them when they take those first few breaths.

We quickly called to dad to join us as he was enjoying his magazine in the other room so much that he about to miss the birth! One mighty push brought baby all the way down and to crowning...then face...then head. One more push and out came a very lusty baby boy, at 6:45pm! Almost immediately he gave us his protesting cry, and we laughed at the fact that his vigorous crying made him wet all over the midwife! After a gentle yet quick suctioning, he was given to his mama. As soon as he was in her arms, he quieted, content to be where he belonged.

The other midwife smiled in satisfaction that her prediction of a boy was right, and after the little champ nursed and was weighed, I smiled in satisfaction because my guesstimation of his weight was exactly one ounce off. I love when that happens!

They named him Danny after his grandfather. He weighed 7lb 9oz, and was 21" long, her smallest baby yet. Such a handsome fellow! I did a full exam, measuring him, making sure his reflexes were normal, his spine was straight, and all the other little details we get reassurances of. I got a print of his feet on the keepsake birth certificate we always give them - he was very cooperative and they were perfect. I gave him a bath in a basin by the bed so his mama could watch, and he went from fussing at me to relaxed and opening his eyes. It was so sweet. Afterwards, I got to dress him in the beautiful clothes that she had lovingly made, then settled him back into mom's arms where he went blissfully to sleep.

She was feeling so well that by 3-hrs postpartum, she was wanting to go home and sleep in her own bed. I was happy to oblige and saw them safely settled across their doorstep. Two of his brothers had come over to the house to do chores and were all smiles at seeing the baby that Jesus had brought them.

In the meantime, the other midwife set off for a distant town to check on another possible labor....and I set off for home. I drove home with a smile and a yawn, wanting to shout to a sleeping world, "I just saw another miracle! I'm a midwife, and I love it!"