20 Lessons from 20 Births

I've been practicing as a birth doula for a year now, and just a attended my 20 birth. It has been an amazing journey and I am deeply grateful to all the families that took a chance on a new doula. I try to come away with something new from every birth I attend. It isn't hard to do, since birth is so different for everyone and I have so much to learn. Here are 20 lessons and reflections from my first 20 births. Some are practical techniques, some are observations about the nature of labor and birth, and some are observations that have lent emotional nuance to my dealings with clients, care providers and nurses.

1) Labor is strange and unpredictable. You can experience it in ways no one has ever heard of before.

2) Second time moms are not messing around.

3) Labor is not all physical. You can psych yourself out with very real physical consequences. I also learned a focusing technique from a midwife that I have used many times since.

4) First time moms can have quick labors, too, and transition can be quiet for a mom who is deeply focused. Always believe the mom when she says "We need to go now." If it takes over 30 minutes to get down the stairs and out to the car because the mom has to stop every few steps to deal with a contractions, it is probably a good time to head to the hospital.

5) Posterior labors can have their own particular pattern that can be recognized if you are looking for it. And it is possible for a posterior baby to be born quickly and easy.

6) You can do everything "right" and still end up watching a client brave a c-section. A good heart, a good attitude and a good provider can make the most difficult labor (even one that veers wildly off course) a positive experience in the end. This mom was truly the strongest woman I have met.

7) Inducing with a negative Bishop's Score is not a great idea, but you can't make the decisions for your client.

8) Inductions aren't always bad, and Hypnobabies can get you through 18 hours of Pitocin-induced labor without drugs. This was my first VBAC mom, and she was so inspiring.

9) You are helping and guiding your clients even when you don't know it. This couple seemed to work so beautifully together without any help from me. When I mentioned this postpartum, they both said, in unison, "NO!" The dad then said "I just started doing whatever you did; you helped me find my rhythm and be more relaxed and involved."

10) Second time moms are seriously not, under any circumstances, messing around.

11) Learning to facilitate and honest discussion between parents and care providers in the heat of a potentially unnecessary c-section call is an art. I need to work on it.

12) Supporting a mom (and dad!) to stand up to a pushy, unreasonable OB who just wants to go home is stressful. But it is so amazingly rewarding when she gets every single thing that she wants and takes back her voice and her power after two previous birth experiences that were catastrophically bad.

13) A quick first stage does not equal a quick second stage. The fear of becoming a parent and uncertainties about one's partner can make labor longer and more difficult than it might be if those fears are dealt with and released.

14) A baby born en caul is incredibly rare and amazing to witness. And the look on this dad's face after his wife's successful VBAC was absolutely priceless!

15) If you have a client who gets an epidural, you can give the baby more room to descend by having the mom lie on her side and prop one knee on the bedside table. Epidurals can be a great tool that when utilized in certain situations, can prevent a c-section. This dad caught his baby and I still wish I had had my camera to capture the look of awe on his face as his child was born into his hands.

16) My job is much more than just making mom comfortable or offering informational support. Knowing she has someone to help her through contractions when her husband vomiting violently because he has food poisoning from the bad calamari he ate can be very helpful. This was the weirdest birth I've ever attended. Food poisoning, people yelling at the nurses, mom kicking her husband out, dad pilfering the thermometer to see if he had a fever, people trapped and screaming in broken elevators. Weird weird weird.

17) If mama wants an epidural, mama's gonna get one, even if she's nearly complete when she gets to the hospital. The OB at this birth was marveling over and over about how this mom made it all the way through her birth without the use of Pitocin. Like she had never seen it before.

18) You can't make everyone happy. Sometimes you will do or say something that may mean nothing to you, but that deeply affects the mom or the dad in a way you couldn't ever anticipate. And you may never know what it was or why it upset them. Always gets a signed contract at or before the first prenatal. Consults are mutual interviews. If you have a niggling feeling that a family isn't a good fit, then don't under any circumstances take them on as a client.

19) I love love love to witness a woman in her power, birthing exactly the way she feels best. It is such a blessing.

20) It is harder to get what you want when you and your doctor are not on the same page. It is easy to get caught up in the energy of the nurses counting and the doctor shouting to push harder. Always ALWAYS be the quiet voice in the mother's ear that says "follow your body, listen to your wisdom."

I love this work. I am so lucky. Looking forward to the next 20 births.

 

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Kaylee and Alyssa's Birth Story

This is a twin birth story from my online mama friend, Lori. I love when a cesarean birth story ends with a perfectly happy mom who got everything she needed AND healthy babies. Goes to show that there is joy in every birth, no matter the mode of delivery!

***

We were told at our very first ultrasound that we were having twins. We had done IUI (a fertility procedure) and Clomid (a fertility drug) so we always knew there was a chance - but the surprise was that they were identical, which neither of those things can cause! From the next appointment on (and there were many many appointments and many ultrasounds) we were thoroughly explained the many risks of carrying not only twins, but monozygotic/diamniotic twins. I had been told that the hospital and doctors were willing to allow a vaginal birth in the case that: Baby A (the one presenting) was head down and that a doctor comfortable with a breech delivery (in case B was breech or flipped to breech during A’s delivery) was on staff and willing to do the delivery. I did every amount of planning and “type A” preparation that I could. I had a birth plan written out and my hospital bags packed and in the car by 28-ish weeks. They had both been head down for weeks, and at around 30 weeks, it seemed like something had “slipped”, causing me to be in enough pain to go into triage to be monitored - babies were okay, but were both now breech.

 

Contractions began on their own at 35+1. I kept a pretty good record of them via a phone app (highly recommended! the app will do the math for you, especially once they really start up, math is hard to do.) and I was only having them every 7-10 minutes, if that. Lots of yoga ball bouncing and trying to stay comfortable for the night and calling triage nurses to confirm when they wanted me to come in. We all agreed on “when they get closer together” because the hospital is about an hour from us (the closer to us does not have a NICU and weren’t able to deliver identical twins without the risk of being flight transferred to Seattle while I was stuck behind). The next afternoon they jumped pretty suddenly to being about 5-7 minutes apart, so we hopped in the car and went to the hospital.

 

Upon arrival, they hooked me up to the monitors and I was checked for dialation, at that point I was at 3cm. They weren’t all too sure about whether or not I would deliver or be sent home, but because of both babies still being breech, we filled out the c-section consent form so it didn’t need to be done in a rush of activity later. They let 2 hours go by and checked me again (while having constant back labor, all contractions showing on the monitor, and me stuck on a break away bed with the break right where the contractions were in my back, mind you!) - I was now a 6-7cm and Kaylee kicked the doctor!

 

This is where things became a blur; We were delivering that day and quick. They confirmed when the last time was that I had eaten, discussed giving me my epidural in the triage room so it had enough time to take effect before being rushed to the OR for a c-section (they didn’t end up doing this). Because I had dilated relatively quickly (and babies clearly wanted out!) they were concerned with both being breech that they would continue to try to come on their own before they could get in for the c-section. We were taken to a delivery room, epidural given, and moved to the OR pretty quickly.

 

From there, it really became a blur in the quickness of activity, the drugs, the hormones, and the emotions. We had arrived at triage around 4pm and Kaylee and Alyssa were born via c-section at 8:38 and 8:39pm, both with Apgar scores of 9! Kaylee (5lb 3oz) immediately came to the room with me, Alyssa (4lb 2oz) was admitted to the NICU per policy due to being low weight. She was able to room-in with me and her sister after overnight monitoring.

 

I went into my birth with a full researched plan of what I wanted in a best case scenario, but also knowing at that point I needed to “let go” and that the girls may have their own plans. I controlled what I could, I stood up for what I needed to, and the girls came out healthy and happy.

 

 

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Adventures in Placenta Encapsulation

Placentas are really cool. Like " Holy cow, I grew a new organ that grew a baby and then my body totally just got rid of it and now it's been in my freezer for four years because that is way too fascinating to just throw away" kind of cool. Seriously, I could just look at placentas all day long. They are bloody, messy, gross, slippery, slide-y and amazingly, astonishingly unequivically beautiful. A true testament to the power and wisdom of the human body.

And people just throw them away every day! I know a lot women think placentophagy (mammals consuming the placenta postpartum) is gross or off-putting, but really, it is no grosser than popping a vitamin. Unless you are planning to eat it raw and steaming straight from your uterus. That's pretty gross, in my opinion. But to each her own...

A couple of weeks ago, I had the opportunity to learn how to encapsulate and tincture placentas. It's a pretty cool process, and since I am not sure how a paying client would feel about me documenting their placenta encapsulation, I decided to thaw my own two frosty life-popsicles and make some medicine. Since I had my kids, I have found that I have raging, horrifying, lock-myself-in-an-underground-bunker-for-a-week PMS. I'm hoping that if I take these capsules in during that hell week might make life easier for my family and co-workers. I also want that tincture since it will likely last me through menopause, and if that is anything like my PMS, we are all gonna want a little help.

So here it is: Lucy and Malcolm's placentas, medicine-ized.

Lucy's placenta, with extra-long cord:

One of the first memories I have of Lucy extra-utero is the midwife unwrapping the cord from around her neck two times. In my memory, she is swinging it around my slimy newborn like a lasso, though I highly doubt the cord was flying as widely as I am remembering.

But seriously, it was long enough to spell out LOVE:

Malcolm's placenta was smaller, with a much shorter cord:

One of my first memories of Malcolm was not being able to get him up very far on my chest, because his cord seemed short. It was pretty short, but I could still make a little heart with it. I placed the cords on the dehydrator.

So the first thing I did was thaw the placentas in the fridge for about 3 days. My intention was to get to them as soon as they were unfrozen enough to work with, but I needed to go to the liquor store to get some vodka for the tincture. This week, I discovered at the Montgomery County liquor stores don't open until noon, and stopping at the liquor store after picking up your kid from preschool is awkward. Perhaps less awkward than being the lady waiting at the door for the store to open and promptly buying the largest bottle of 100 proof vodka available, 4-year-old in tow. Maybe that's totally justifiable...

So, thawed placenta. I decided that since I had two placentas, I would use the two most common methods (maybe the only two?) for preparation: raw and Traditional Chinese Medicine-inspired. Lucy's was prepared raw, Malcolm's with TCM. First, I rinsed them and removed as much blood as possible. Lucy's had a lot of blood in it, Malcolm's looked as though it had been drained already, although there were several large clots on the maternal side. I set Mal's aside and worked with Lucy's. After rinsing, I patted it dry as thoroughly as I could with a paper towel and sliced it into chunks. After slicing and dicing. I placed it on the dehydrator tray. Yum!

After the chop chop, I dropped a good-sized chunk of placenta into roughly 18 oz of vodka. This will sit in a cool dark place for about six weeks, after which I will strain it through cheesecloth and use it to tame the wild hormonal beast. I made a tincture from a piece of both placentas, since it can also be used for the child's hose placenta it was. I have heard it is like a "reset" button for a kid having a crappy day. I am hoping it is sort of like the "Easy" button from the Staples commercials, though I am sure to be disappointed in that regard, as I don't expect an army of nannies to arrive when I use it on the kids, nor do I expect they will bring me a million dollars.

Lucy decided she wanted to help, so of course, she had to wear gloves like Mama. It's pretty cool, though. I mean how many people can say they've seen and held their own placenta??!

She wasn't entirely sure she wanted to be holding it.

But while we are looking at pictures of my kid, is she not the cutest girl EVER?

 

Moving on. I got to work on Malcolm's next. Traditional Chinese Medicine says that we steam or simmer the placenta with warming herbs (lemon or lemongrass, ginger and a hot pepper). I sliced up a lemon, a good-sized chunk of ginger and a hot pepper, placing them in pot and filling with enough water to cover. My teacher said to lay the placenta on top of the herbs and gently simmer for an hour. I am pretty bad at remembering things on the stove for more than 20 minutes or so. Just ask my husband who more than once has come home to a house filled with burning something-or-other and me blithely taking a shower or napping or something else that didn't involve remembering stuff on the stove. My first attempt at TCM ended with a huge, stinky placenta mess all over the stove because the whole shebang boiled over. So I decided to steam instead of simmer, since steaming was a 12-15 minutes on one side, then flip over and steam for another 12-15 minutes kind of process. Better for my attention span.

So, I wrapped the placenta in the membranes, such as they were. I remember after the birth, my midwife showed me that the two layers of amniotic sac had separated, and so it was a somewhat slippery mess, especially after 2+ years in the freezer.

Looks a little like a heart in an autopsy tray.

I brought the water to a boil and then turned it WAY way down, to minimize boil-over risk. I steamed it for 12 minutes, flipped it over they steamed for another 12 minutes.

The first placenta I prepared according to TCM started out the size of a salad plate and was about the size of my fist after I boiled it over. It should cook down a little bit, but not THAT much. After it cooled a bit, I removed the membranes and I sliced it into little chunks.

I placed it on the dehydrator tray and set it for ~150 degrees. Basically, anything above 140 is fine. Anything below that temperature will not inhibit the growth of bacteria, and so...y'know...yuck.

Now, the part about TCM preparation that you don't hear about a lot is that the mom is supposed to drink the broth created by the steaming process. So...I strained the herbs and pepper out, poured a big steaming cup of placenta tea, put some honey in it and gave it a try!

And the verdict is...HOLY SHIT THAT'S SPICY!

Oh yeah...hot pepper...Damn. It was not expecting that at all. It really wasn't bad, per se...just...that was a lot of ginger and hot pepper and I was drinking it. I did manage to drink about a cup of it before it was just too spicy to continue. The taste definitely grew on me, but I froze the rest in an ice cube tray and plan to use it a cube or two at a time, diluted and (heavily) honeyed, during my cycle.

Back to the dehydrator! It ran for about 20 hours. Here is the end result:

 

 

 

 

 

 

 

 

 

 

 

A cord dehydrated fresh will be more of a tan translucent color after dehydrating. You can see the blood vessels better in a more translucent cord, but this one is really beautiful if you hold it up to the ligh

After dehydrating, I put the dried placenta into a blender. It made a great deal of noise. And powder flies out like crazy. I would recommend putting a piece of parchment paper or Saran Wrap under the lid of the blender to keep the dust to a minimum, since I am pretty sure no one wants to breathe powdered placenta.

It turned out like this:

I loaded the capsule filler:

Scooped a heaping tablespoon of powder in:

Filled and tamped down the capsules:

Put the tops on:

And ejected the capsules into the waiting bin:

Malcolm's placenta yielded 73 capsules, which is a pretty skimpy number. Lucy's made 108, also a pretty small-ish number, though more in the range of average. I'm wondering if TCM preparation reduces the yield of capsules, since they were both pretty similar in size to begin with. The other TCM prepared placenta I did only yielded 86 capsules...though that may have had something to do with the fact that I boiled it to within an inch of its life. Or perhaps past an inch of its life. It was bad. At least I wasn't charging her for it.

See? Nothing gross about this!

I wish I had separated the raw from the TCM capsules, but I just went on autopilot and they all ended up in the same bin. I popped two of these suckers today, just to see what (if any) effect there would be. I felt a definite mood boost, though no difference in energy. The placenta broth/tea gave me a burst of energy.

So now I have two cord keepsakes...and what does one do with dried umbilical cords? Lucy really wants to keep hers, and I am inclined to let her. It is her cord, after all. Malcolm could care less, I'm sure. Maybe a shadow box? They are actually really pretty. Especially, I imagine, if you don't really know what they are.

 

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