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Tuesday, 05 November 2013 01:58

Experience vs Information: Your Choice

This post started out as a piece on optimal cord clamping, but has become a whole new beast. (Optimal, or delayed cord clamping is the process whereby the umbilical cord is left to cease pulsating before cutting). I read and I researched, after which time, this article changed tracks. I don’t need to tell you the pros and cons of delayed cord clamping. You can read all about it on the websites listed below. After which time you can make your own mind up. 

Could this be my shortest ever blog post? No, what all this lead me towards is the fact that in so many cases, women are not given factual evidence-based information to make a choice. Often it is the experience of others that leads us toward making our decisions, when it should be the combination of experience and information. 

It is in our nature to want others to have the benefit of our own experiences. Informed choice happens when we consider the experience of others and combine it with scientifically proven, evidence-based information. Sharing experience is a vital way to keep ideas flowing. Experience, or the stories that we tell, should serve as a motivation to gather more information on a particular topic; people usually make choices based on what is best for them. Being that individuals are unique, this will vary from person to person. I have made different choices in all four of my births. Many of them ill informed, but all of them mine. I hope to share my experience, tell you a story, then give you some information so that you can make your choice. First, a non-birth related example:

My husband is the sort of person who falls in love with a new product, and immediately wants others to experience the same revolution that he has. If something makes his life easier, cheaper or gives him pleasure, he shares his experience with all around him. When we were first married, we bought an “upside down” fridge. He would show all his friends the said upside down fridge, spout the benefits on not having to bend down to get vegetables, and marvel at the convenience of the mighty upside down design. Despite his enthusiastic sales attempts, I don't think any of the afore mentioned friends jumped aboard the upside down fridge revolution. I am sure that they looked at them, but made their choice based on what suited them and their family and not solely on the eloquent ramblings on my husband. Simply put, they listened to his experience, did their own research and make the choice that was right for them. 

So often advice is based on the experience of others, and not the evidence and information available. Many women that I speak to don’t know that they have a choice in regards to management of the umbilical cord after birth. The World Health Organization (WHO) recommends an actively managed third stage of labor, (another choice here, as you can request natural or physiological third stage) but recommends that after the birth of most infants, regardless of gestational age or weight, the cord should be left for 1 to 3 minutes before clamping.  

When I discussed my preference for a natural third stage with my fourth child, my caregiver refused. She told me that there are too many risks of postnatal hemorrhage, and that she would “not allow it.” We went back and forward over the issue of delayed cord clamping and a natural third stage. Eventually she “allowed” me to have optimal cord clamping if I would agree to an actively managed third stage. Interestingly, I have learnt while researching optimal cord clamping, that what I fought my caregiver for is exactly what the WHO recommends should be standard practice. It was her experience that women having their fourth + baby were are greater risk for hemorrhage. I accepted her expertise and experience as my sole source of information. 

I don’t want to underplay the importance of closely monitoring the third stage of labor. I understand in many cases, administration of an oxytocin based drugs has saved lives. In my circumstance, had I done my own research, and searched for evidence-based information, I would have refused active management. I was very low risk, regardless of the fact it was my fourth birth. I am left wondering how many birth related choices are influenced by experience instead of evidence. I was educated, informed and proactive, but still managed to be persuaded to do things differently based on the words that were spoken to me, and the manner in which they were delivered.

You always have choices. Don't let anyone take them away. You wouldn't go out and buy an upside down fridge simply because my husband, or even a well versed fridge expert told you they are the bomb. You might use his experience to motivate you go out and learn more about them; hey, you might even go out and buy one. Choice is always there, beware of advice and experience that disguises itself as information, and it truly becomes yours. 

Over to you now- make your choice. Here is some evidence-based information on optimal cord clamping and different options for the management of the third stage of labour. 

Midwife thinking - the placenta the essential resuscitation equipment

delayedcordclamping.com

Dr Sarah Buckley on the third stage of labour

thirsstageoflabour.org

Published in Birthing Facts

In between contractions I had Marcel set up our video camera on a tripod because I wanted the whole birth process captured; everything that was said, every sound, everything. It was hard for him because I needed him right there with me through every contraction, so he had to run back and forth to set it up!

8:45 pm The doctor is here!!

I remember so clearly the moment he walked in the room. I could smell him before I even heard his voice (he wears very strong cologne!) and I was instantly relieved! I said,

“You made it!” and I must have had the biggest smile on my face. He said he had a feeling I’d have this baby in the next day or two, and I reminded him that I told him I wouldn’t have this baby when he was on vacation! There were a lot of smiles and laughs and I felt very safe and secure. He asked if I was ok with him checking to see where things are at and possibly breaking my water and I said that’s fine. He said after that I can get in the Jacuzzi or back on the birth ball; whatever I feel like doing. He estimated I was about 6.5 cm along now. I told him I was feeling rectal pressure. He said, “Well maybe you’re a little further along…” He reassured me that he reviewed my birth plan again and is on board with everything.

I climbed on the dreaded bed and lay down so he could check my cervix. That hurt bad. I didn’t like lying down at all, but I was ok with him checking me so it was fine. He patiently waited through a contraction so I was comfortable. He said, “Well that’s why you’re feeling so much pressure… you’re about 9 cm dilated and at about a +1 station!” Haha, I knew it! He broke my water which I was totally fine with and guessed with me about how many more contractions I would have till we had a birthday.

I was smiling, everyone was laughing and joking, it was so fun. He complemented me with how well I was in control. The lights were still turned down like they were the whole time, and I felt so powerful, happy, and peaceful. He asked me what I wanted to do now, giving me some off the bed suggestions, but I just wanted to stay where I was for the time being. He just said no problem, do what I need to do and he’ll just be hanging out here doing his “doctor thing.” I was told by the photographer and my husband that it seemed like he was meditating or sleeping on his stool, just hanging out with us. (I guess this was in between all his funny jokes… he had us all laughing and I still laugh when I watch the video, which I had Marcel start when I was lying down for the exam and we taped all the way till a couple hours after birth.)

The contractions were so very intense. After maybe two contractions after he broke my water I felt a small urge to push but fought it. I told him I felt a little pushy with that one and was holding back. He didn’t do anything about it, which is what I wanted, but I found myself a little scared to push without being told I’m complete and can push. It was amazing. Here I had researched so much about trusting my body and listening to my instincts and there I was, looking for direction to push! Thankfully the doctor knew my plan and just left me alone.

So I was searching for the strength to listen to my body and trust my ability to birth this baby without a doctor’s direction. It did take a few contractions to get there. It felt like forever, but realistically I think there was about 10 minutes of contractions with no urge to push. I realize now this was the time it took for me to gather myself and follow my body’s direction. I reminded the doctor not to clamp the cord right away, and he said absolutely and he didn’t forget. It was like I was making sure everything was perfect and in order before I brought my baby earth side. I still didn’t fear each contraction like I did with my other labors. They did hurt and were very intense, but I was aware of everything going on and felt like I was in total control of everything. It was an amazing feeling, especially knowing how close I was to giving birth, and still felt so calm and secure.

The doctor told the nurse to remove my contraction monitor because he could clearly see when I was having a contraction. I laughed.
I remember clearly the moment I realized I wanted to raise the bed more. I realized I didn’t want to give birth on my back and that’s exactly how I was at the moment! So I put the back up a little at a time. Every time I raised the bed, I had more pressure with every contraction and that urge to bear down was coming back; only this time I felt ready for it. I didn’t feel the need to strongly bear down, but I liked the feeling and wanted to continue letting my body bear down on its own. It felt great. I was grunting through the contractions and toward the end of them quietly moaned “oh yeah” because just felt awesome!

The doctor, who was still leaving me alone, could tell I was getting close and started getting things quietly ready. He said he had a feeling that when it’s time this baby is gonna get here like “gang busters” (whatever that meant!) so he wants to get ready. He told me he wanted to eliminate some of the chaos by not breaking down the bed, but instead we can just lower the foot part of the bed (as a precaution in case he needed to do something with the shoulders) and he tucked in the bag to catch all the “shtuff” under my bum.

My grunts were getting pretty loud and the nurse asked if I felt like I could push (which I ignored because I didn’t want to hear that). The doctor quickly corrected her and said my body is naturally bearing down right now and he thinks baby’s head is “right there”. A couple contractions later he checked to see if he was right, and he said “oh yeah, the head is right there”. He asked if I could move my bottom to the edge of the higher part of the bed. When I did that I couldn’t lean on the back of the bed anymore so I was straight up in a squat and held myself up with my arms off the back of the bed, and my feet were on the lowered part of the bed. I had one contraction in this position and it was the first and only one that I felt a strong urge to bear down with and it was the most amazing, powerful, and gratifying contraction I have ever had. I could feel his head moving down as I pushed and he was right there, and I did all of this on my own, with no I.V., and everything was going exactly as I had hoped, and it all lead up to that moment. I felt like I was a goddess and could conquer anything. I was moaning very loudly, screaming “Oh yeah” over and over. If anyone heard me in the hallway, they must have wondered if I was having a baby or making love. It was the most empowering moment of my life and also brought my baby’s head low enough to see!

That baby was right there, ready to greet the world. The doctor wanted to follow my plan of having my husband help with the delivery so he had him get gloves on and told me I had to lay back some if I wanted him to help. I really did not want to do that, and it hurt to lean back, but I really wanted Marcel to have an active part in receiving our son. As a struggled to lean back, I heard the nurse say to someone “no one can come in right now, she’s in the threshold!” I yelled, “who is it?!” and heard my mom say “it’s your mother!” I knew how badly she wanted to witness his birth, so I said, with much relief and shock that she made it in time, “she can come in!” I told her where to stand and with that hit the crowning contraction.



Now that did hurt, really bad. I screamed because that ring of fire was SO intense! I recognized that this was the crowning ring of fire so many women talk about (not sure why I didn’t notice it with my other births… maybe because I wasn’t as aware of what was going on?) and said, “he’s crowning isn’t he?!?” I heard everyone say “oh yeah, he’s right here” and specifically remember Marcel looking up at me and saying “he’s right here baby!” and that was so comforting.

The next push I birthed my son's head into my husband’s hands. Again, everyone was talking, but what I remember is seeing Marcel’s face. He kept me centered through the pain. He was so amazed and excited and said “Oh my God, oh baby, here he is!” I tried looking down so I could see him, but I couldn’t see around my belly. I’m so happy that I was so conscious and aware of all this and I think it’s so amazing that all I remember is Marcel. It felt so natural to have him down there telling me what was going on and encouraging me. I think God meant for it to be this way; for the father to receive his child and be involved in the birth in this way.

Then doctor told me he needs me to push again for the shoulders. I didn’t feel the urge to, so I asked if I had to do that right now. He said yes he needs to get this shoulder out, and I knew this was a crucial time and trusted him (I found out later that one of his shoulders came out with his head, something that we had discussed prenatally as one of the reasons he’d tell me to push the shoulders out without the urge to do so) so I pushed as hard as I could and ouch did that hurt! I never had pain when I birthed my daughter’s shoulders, but this boy has some broad shoulders!

9:16 pm I heard everyone say “here he is!” and I opened my eyes and saw Marcel handing my beautiful baby boy to me! I immediately said, “Oh sweetie, oh baby, oh my God, hi sweetie” and fell completely in love.


Words just can’t describe this moment. I’m so thankful for these pictures though, because my photographer perfectly captured this moment for us and they perfectly show how I felt! I was laughing and crying and felt like I was floating on a cloud.

I cleaned off Malachi’s face while I was in awe at my beautiful baby that I birthed, after months of growing him inside of me! I did it! I felt so strong and amazed at how perfectly my body created this child and brought him earthside and so thankful to God for giving my body this ability!

Just a few minutes after he was born, the cord stopped pulsating and the doctor asked me if I wanted to double check and make sure I didn’t feel any pulsating. I enjoyed feeling the cord, and it was indeed done, so Marcel cut the cord.

Aside from the nursery nurse checking his breathing and putting on our bands, no one touched him. No one took him from me at all, just like I stated in my plan. There was no resistance or problems with this. No one even tried to take him.

 

Malachi was so calm and peaceful in my arms.

This image is very powerful to me. This was the first birth my mother was able to witness, and I love how she looks over at our initial bonding, looking so satisfied and happy for us.   Pure, raw, excitement and joy!

I was so happy to be able to kiss his sweet head before he was cleaned off and handed to me like a little burrito.

Look how excited the RN was for us… The only people in the room during his birth besides Marcel and I were my birth photographer, my mom, my doctor, the RN and LPN who was aware of our birth plan, and one nurse from the nursery that was told to read our plan as well. We had no need to give anyone else our “baby care plan”. Everyone knew exactly what we wanted and followed it perfectly. If there was anything they weren’t sure of, they asked. Everyone was very respectful of our needs. Once the placenta detached and delivered, the doctor worked quickly to finish up so he could get out of our way. He checked me for tears, thinking I might have torn more since Marcel delivered the baby, and I only had a small skid mark in the perenium area. After numbing me up really well he gave me a couple stiches, made sure the nurses knew what we were doing with our placenta, gave us tons of congrats, and had the nurses turn off the overhead light so we can peacefully get baby to the breast.

9:30, less than 20 minutes after birth, I was able to breastfeed my baby. He hadn’t even been weighed yet!

The nurses would check in on us to see if we needed anything, and to monitor my bleeding and blood pressure.

He latched on perfectly, and stayed on for an hour!

The nursery nurse told me to let her know when I was ready for her to do his assessments and said she can just do his bath at the same time. I let her know I just wanted his hair washed with my baby wash, and she said that was no problem.

Enjoying my calm, peaceful bonding time!

At 10:30 the girls meet their baby brother! (He still had not left my arms!) He was so alert and peaceful, as soon as they stood next to the bed and he heard them, he turned to look at them and checked them out. A beautiful sibling bonding moment!

 


Proud daddy!

Photographer momma… haha

Malachi decided an hour wasn’t enough time to eat… so he nursed on the other breast for another 45 minutes!!

After the girls left I was so curious about how much he weighed, so I paged the nursery nurse to come in and do his assessments.

She came in around 11:30 pm. He was so content and peaceful he didn’t even fuss while she was checking him out, and I was able to watch and focus on him.

He weighed 8 lbs. 14 oz.! (Notice he’s still not crying)


His head was 14 in. around and he was 21 in. long

Happy baby getting his hair washed with momma’s organic baby wash.


The nurse asked if I wanted her to put a diaper on or not, and if it was ok to wash the ink off his feet which I was fine with. She also asked if I wanted her to put a HUGS tag on him (the security system tag) since he wouldn’t be out of my sight. I told her I didn’t even know that was an option, and since it is in the way and pointless, let’s leave it off. I was impressed that not only was she following my birth plan, she was thinking of other things I might want or not want done and asking about it.   My happy, peaceful son after he was cleaned up.

I wanted her to leave him undressed so we can have a lot more skin to skin time. Since he was so big for his gestational age, she let me know they normally do blood sugar checks, but quickly offered to just throw that on my list of procedures I was refusing on the waiver form, and I went with that option. I said I’d watch for symptoms of low blood sugar (she informed me what they were) and we’d check him if that happened. He was eating like a champ though, and at no time needed the check.
Shortly after his bath we were taken to our post-partum room where we had a lot more nurses to meet, and all of them read our birth plan and were very respectful of it. I was almost totally pain free. I always heard that the after pains get worse with every baby, but this was by far the least pain I had experienced after birth. The cramping was almost worse than the labor after #2 and 3. I was taking 800 mg of Motrin every 8 hours for at least 2 weeks after all my babies, but I didn’t even feel like I needed anything after I had him. A couple times a day, for the first 3 days, I had 400 mg of Motrin just because I felt a little crampy and feared it would get worse. My bottom wasn’t sore at all (again, first time ever). I had no Pitocin at all (Pitocin is routinely given after all births) and I think this might have something to do with it.   
All of Malachi’s checks were done in our room and he never left our sight. The only time he was poked was for his 24 hour test for the state (which I consented for), and he didn’t even cry for that even though he had to be poked twice because his blood clotted so fast (even though he had no vitamin K injection). He was very alert and breastfed every hour at least. I was pretty sore from that, but didn’t mind. I knew it would pass once he got his latch perfected and my milk came in. Once my milk came in we started having some latching issues, he still nursed at least every hour around the clock, and that lasted about two weeks, but didn’t stop me from breastfeeding. No formula was given; he perfected his latch by three weeks, and at one month of age weighed 11. lbs. 11 oz. and grew an inch in length!

My doctor stopped in to see me on the 16th, even though he was on vacation! I was enjoying relaxing at the hospital and having the nurses take care of us, so we decided to stay as long as we could (which was a first for me). He and I stayed practically naked the whole stay and he either nursed or lay on my chest the whole time. He was a mommy’s boy right from the start and would get very upset if I set him down. He just wanted to be with me, and I wouldn’t have had it any other way. I felt like I was dreaming; it just didn’t even feel real. Everything had gone so perfectly. We had no attitude or problems from any of the staff the whole time. Everyone followed our birth plan and respected us. I am so glad I made the choice to birth my baby at the hospital! Even though I didn’t have any problems with the delivery, I felt safe and secure, having my respectful, funny, talented surgeon in the room with me and all the medical equipment we would need in case of an emergency, but still had a calm, peaceful, 100% natural birth experience; and all this was covered by my insurance!

I feel different now. I feel stronger and more confident. I am very happy and peaceful. I like myself now and have a much higher self-esteem. When I think back to the labor and delivery, I don’t remember any of the pain (normally that doesn’t happen until at least a year after). I just remember all the joy, strength, excitement and satisfaction I felt.  I am still amazed at what my body has done!  It’s amazing to me how much of an impact a birth experience can have on a woman, and I thank God that I was able to have this experience!




The Natural Hospital Birth of Malachi James Part 1

The Natural Hospital Birth of Malachi James Part 2

The Natural Hospital Birth of Malachi James Part 3



Published in Birthing Stories

June 15, 2012
 
Intro

I’m writing my birth story to document all the details for me personally, to share this amazing experience with friends and family (all those that love a good birth story as much as I do!), and to help women advocate for themselves and achieve the birth experience they want and need. I have had four hospital births and went through three of them having no clue what I could have and how easily I could have it, although I always desired a natural birth experience. I feel there is too little information out there on natural hospital birth; that it IS possible and how to go about having one. With all the negative information out there about hospital birth and OB’s, I feared them and never thought to try for the things I did with my last birth. For this reason, I’m trying to tell as many women as I can about my experience. I hope to give women hope, strength, and inspire them to educate themselves. I am not advocating for homebirth, hospital birth, medicated birth, or any specific type of birth here. I am advocating for women to educate themselves about birth, deciding what they want for their birth, and making sure they get the birth they want and need. I understand that birth in unpredictable, but even with-in that unpredictability, wishes can be followed. I always state in my birth plan and when discussing my birth plan with the doctor that I’m flexible and understand that things may not go the way I hope.

So this story will start at the beginning of my journey. I’ll try to make it as brief as I can without leaving out important details, and I’ll make subtitles for those that already know about my journey and just want to read about the big day. If anyone has any questions or would like to know more about a topic I wrote about just ask! I’m also keeping a digital copy of my birth plan for anyone that’s interested in reading it. Enjoy!

My Previous Births
I think it’s important to briefly touch on my previous birth experiences to start. I have three little girls. My first was born February 18, 2003 when I was 18 years old (yes I’m a young mom and all my pregnancies were planned) my second born November 23, 2005 and my third born June 12, 2008. All four of my births were at the same hospital, and babies #2,3, and 4 all delivered by the same O.B. I didn’t have any pain medications in any of my labors, and #1,2, and 3 were Pitocin induced. With each birth I was more educated and had a better idea of what I wanted and what my rights are. I would like to add too (just because I’m so proud of this) that I exclusively breastfed all my babies for at least two years!  

My First