homebirth

The Birth of the Water Baby

 
The cover of Midwifery Today magazine from Autum 2015

The cover of Midwifery Today magazine from Autum 2015

 

“In 1977, a state hospital near Paris began quietly changing the way women gave birth.

Obstetrician Dr Michel Odent believed that childbirth had become too medicalised and he wanted a more natural approach.

So he introduced a pool to ease the pain of labour and eventually some babies were even born in the pool.

Witness speaks to Dr Odent about the innovation that has become a revolution using the power of water.”

This intriguing 4 minute BBC Witness video documents the introduction of the birth pool to labor and delivery. Watch it here.

HOME BIRTH STORY: Trust, Surrender and the Magic of Home Birth with Melissa Thormahlen

Melissa Thormahlen, who had her son, Tyler, at home with us last year, shares her birth story on the Doing It At Home Podcast. Thank you Melissa for telling your beautiful story so other families can learn about home birth! <3 <3

Hear Melissa's home birth story here

Below is a written excerpt from the podcast:

Melissa Thormahlen knows how to give me “all the feels.” I knew her story would impact many when her first email to me about her birth story had me tearing up.

 
melissa and tyler
 

She experienced most of her birthing experience at home with her first baby Emmeline, before transferring to a hospital and having a beautiful birth.

For Tyler, baby number 2, she knew she wanted to go for a home birth again because she trusted her body and her amazing birth team. 

In Tyler’s birth story, Melissa explains the trust and surrender to the process. She also took time to be close and intimate with her husband, Paul in the time before active labor.

When baby Tyler was born in the bathtub after a strong surge that took everyone by surprise she exclaimed, “I DID IT!”

 We even get to hear from baby Tyler as he chimes in a couple of times. We love when the babies make little appearances, they’re the reason we’ve come together to chat after all!

BONUS! Melissa emailed me a written version of her birth story before we got into it on the podcast. So for you readers out there, you can check out a very beautiful and detailed summary of Melissa's birth story below : )

 Melissa Thormahlen's Home Birth Story

I'm sure you'll get lots of stories but I feel compelled to share mine. My little home birthed man, who is 11 weeks, is sleeping on my chest as I'm writing to you.

Tyler was born at home on October 22. I have an older daughter who is 2.5 years old and I also planned her birth to be at home but she had different plans. She was posterior and my labor with her was long and exhausting so we ended up transferring to the hospital with her at 9.5cm. When we decided to have our second I knew I could birth at home I had so much faith in my body and my team. I used the same doula but since we had moved I had a different midwife. With Tyler I got the amazing homebirth I always wanted.

I'm not sure how much of the story you wanted people to share via email but here is my birth story:

Baby Tyler

 

On Thursday October 19th at 1:30am my water broke. I was due October 26th. I got up to go to the bathroom and when I got back in bed I felt a blurb of water roll down and out. Then there was quite a bit of fluid. Not an alarming amount but enough to know I wasn't peeing myself. For about an hour after that I had contractions, but then they petered off and I feel asleep. 

In the morning I called my mom to come pick up my 2.5 year old for her stay with grandma while we had the baby. Then called my midwife and doula and we we made a plan. Since my water had broken I was on a clock and I knew my labor had to start within 24-48 hours. Luckily my midwife felt comfortable waiting the 48 before going to the hospital for a medical induction. Shortly after my mom left with Emeline, Firen (my midwife) came to the house to check on baby, double check it was in fact my waters that ruptured, and bring herbs that were supposed to bring on labor. 

All that day I tried to induce labor naturally. I took a combination of cotton, black cohosh and a labor tincture every 15 minutes for about 4 hours. I also was advised to do some nipple stimulation. I only had contractions if I was laying in bed on my left side. If I got up or moved they went away. I was beginning to become hard on myself. So at some point I told Paul (my husband) I wanted to get up and go for a walk. We got up and dressed and out we went. Because it was so close to Halloween we looked at all the decorated houses and talked about how fun it will be that our son will have a birthday so close to Halloween. We live relatively close to downtown so at the end of our walk we decided to go out to dinner. We had a wonderful time just the two of us. We came home and crawled into bed. I went to sleep that night and didn't have any contractions. 

When we woke up on Friday Paul asked what I wanted to do and I said go get eggs Benedict so off we went. We had a wonderful love filled breakfast at a local restaurant, Chows. We snuggled and ate leisurely something that is harder to do with a toddler. After breakfast I figured I'd try one labor inducing activity, so I plugged in my breast pump. Besides the feeling of sore nipples and some very light contractions nothing came of it so I gave up. I decided instead that I should get my nails done so off I went. On my way into the nail salon I had my first good surge! 

After getting my nails done I went home and took care of some things around the house. Alli my amazing doula came over  around 2 and we walked to town. I was having some sort of regular contractions at this point but it still seemed like they could go away at a moments notice so it wasn't alarming. We went to The Coffee Shop and had smoothies, tea, Alli got a salad and a coffee and we sat outside and talked about random things. She was my doula with my first as well so we have a strong relationship. I had a few contractions while at the coffee shop where I needed to stop talking which meant I was making some progress. 

We walked back to the house after that and I got into the shower. It was nice to rinse off and upon getting out I had a really nice strong surge. They were still about 20 min apart, but it was a welcome feeling. Even if they stopped I had a feeling they would return. Firen came and checked me out while Alli was still there and it was perfect to have the team together. The baby was doing great and so was I so there was no reason to change our plan of heading to the hospital the next morning for the Rupture of Membrane Test unless I went into labor that night....

Once Firen left we took Alli to Walnut Creek to meet her family. When we were heading home we noticed Skipolini's  Pizza was in the area and they serve a Preggo pizza that is supposed to put you into labor. Since I was already having some contractions I figured it wouldn't hurt to try that too. We went in and had another nice meal together just Paul and I. I was having more regular surges and they felt like they were getting a bit more intense. 

We went home after the pizza to regroup. We were supposed to go to a movie but it didn't start for a while so we came home first. Then we both realized how tired we were and crawled into bed. Amy my sister arrived at 9:00 we chatted with her for a bit and around 9:30I told everyone to get some sleep. My body must have know what was coming because I feel asleep fast and slept hard for 2 hours. At 11:30 I woke up to a really strong contraction. Paul immediately jumped into gear and supported me through each contraction. He lit candles around the house and put on Enya. It was so romantic and sweet. He supported me through each surge and told me sweet things after each one. He was my rock.

My sister had slept until around 2am when things became more serious and I needed help. Mentally I was having a hard time staying on top of the contractions. We called Alli to come over and she gave me two more positions to try. I got into the shower first and it felt like one long continuous contraction. I think there was too much pressure and it didn't feel good to stand. Then I sat backward on the toilet and Paul massaged me from behind. It was ok but I was having lots of thoughts of self doubt so I made Paul call Alli back and demand she come over. She arrived at 2:45. She witnessed a few contractions, had Amy make me oatmeal and bring me drinks. After a particularly strong contraction she decided to call Firen to tell her it appeared I was already bearing down. Firen came immediately arriving at 3:50. When she arrived I was laying on the bed, Alli behind me, Paul on my front and Amy by my feet. I was so supported. Firen began setting up and checking my vitals. She listens to baby and determined everyone was happy and healthy!

I made her wait a little before checking for dilation and when she finally did I was 7cm. Which was great progress for a second time mom. They all ensured me I would progress fast but I couldn't bare down anymore. So Alli would breath, hiss and huff through each contraction with me helping me to keep from pushing. Which I have to say might very well be the hardest part for me, not pushing when your whole body is screaming to do so. At some point Paul suggested I get into the bathtub because it could help me relax and keep me from pushing. So they set it up and I got in. It was wonderful but the surges were really strong and I kept saying how I was dreaming of an epidural. This is transition! My doula handed me a small elephant figurine and I clutched onto it like my life depended on it. In my head I kept saying "if an elephant can be pregnant for 2 years then I can do this".

At this point in the tub my surges were so strong I was having a hard time fighting the urge to push and they were coupling. It was a lot. I asked how long until they could check me again and my midwife told me she'd wait 10 more contractions, 30 more minutes. I didn't want to go a second longer without being able to push, so this was hard. I sunk into the water and clutched my elephant. I powered on. After only 4 more contractions she said she'd check me but I had to turn over to the other side of the tub.

When I got up to turn over I had the strongest surge yet which was immediately followed by another one. Once I laid back down in the tub Firen checked me and announced I was 10cm. She looked at me as said, "do you want to have this baby here or..." and just then another surge came and I pushed with all my might. I reached my hands down and got in two more pushes feeling my son's head emerge. Then at the tail end of the surge I pushed once more and out came his body. My doula describes this moment as Tyler swimming up into my arms. I pulled him onto my chest and felt overwhelming rush of joy and love. "I did it" was all I said for a good 5 min.

I wanted more than anything to have a homebirth and this experience was pure magic. After Tyler was born my husband and I and baby Tyler crawled into bed where I birthed the placenta. My doula made us a delicious breakfast and we ate and rehashed the whole night. Tyler came into this world at 5:29am in the bathtub at our home surrounded but love and faith in my body. I wish everyone could experience the joy that is natural birth in a way where the woman feels completely supported.

I hope you enjoy my story! Thank you for all you're doing to normalize homebirth. And congratulations on your precious little girl. 

 
melissa family
 

A Blueprint for Waterbirth: ACNM's Practice Template

Midwife Firen Jones (Nightingale Birth founder) supporting a mother in the tub

Midwife Firen Jones (Nightingale Birth founder) supporting a mother in the tub

Water is delightfully therapeutic whether you are swimming in the ocean, taking a hot bath, icing a sore muscle or floating in a pool.  It is only sensible that women in labor can benefit from showers and submersion in a warm tub of water; it relaxes tense muscles and eases the weight of pregnancy as gravity lessens, and you are able to rest more comfortably. 

Families in the Bay Area are discovering the benefits of hydrotherapy for pain relief during labor and to help them have a natural, unmedicated birth. And while some hospitals may allow their patients to labor in the shower for a short while, they do not have birth tubs to labor in or offer waterbirth as an option.  This is one of the many reasons families are turning midwives for their care.  Using water for therapy throughout the labor process is so ingrained into the education and practice of midwives that it is offered by every home birth midwife I know.  

While most of our clients use water at some point during their labor and birth, whether they actually deliver in the water is about 50/50 and completely up to their preference in the moment.  But I can say that water is an important therapeutic option in labor; it offers a whole different environment to labor in.  

In November 2016, representatives from American Association of Birth Centers, American College of Nurse Midwives, Midwives Alliance of North America, and National Association of Certified Professional Midwives and other birth experts developed a model template for safely using hydrotherapy during labor and for water birth.  

Personally, I think this was a smart move by the ACNM. It provides information and direction in how to approach waterbirth for providers who are less familiar with the practice.  It also creates a standard of care (born from the midwifery model of care) that hospitals can adopt if they are considering offering waterbirth.  

Lets take a look at the basics they’ve outlined: 

Pool Rules:

  1. Baby is head down
  2. There is only one baby
  3. Pregnancy has reached term (37 weeks gestation)
  4. Baby’s heart rate has been evaluated.  Their baseline, heart rate and rhythm appear to be normal.

Golden Rules of Hydrotherapy:

  1. If she might have trouble getting herself out of the tub, maybe she shouldn’t be in there.  Basically if she has a musculoskeletal condition or reduced mobility, has taken any sedative medications, had an epidural or abnormal blood loss (hemorrhage) she may not have the strength or wherewithal to remove herself from the water.  Makes sense.
  2. Keep the water warm, but not too hot.  Use a thermometer to monitor the water temp – it really shouldn’t be over 100F.  And it is likely your client will be letting you know it's too hot.  Body temperature or a little warmer is ideal.
  3. Keep it clean.  No one wants to see a turd floating by as they are trying to relax, plus it smells and is gross.  Sure lots of people poo a little when giving birth, but one of the many magic tricks of midwives is for our clients to never realize they poo during labor. Let's keep it that way.  A disposable fish net or even using a gloved hand to remove debris works just fine. 
  4. Empty and refresh the tub.  We definitely want to avoid mini science experiments during these labors so regularly emptying, rinsing and refilling the birth tub not only provides an opportunity for your client to get out, walk around and change her position (which is good during longer labors), but it also helps avoid bacterial contamination that can result from prolonged heating of water.
  5. Slip and slides have no place in labor.  Make sure she can get in and out without slipping. Labor is hard enough and slipping on a wet floor will only make it worse.  Have able-bodied support available if she needs help, as leg-lifts are ten times more difficult in labor.
  6. Use your clinical judgment.   This probably isn’t your first rodeo with a waterbirth.  Listen to your laboring client and follow your intuition about whether she should stay in or get out.

Facilitating a Safe Waterbirth:

  1. Monitoring is as normal.  On this note, definitely get a waterproof doppler probe and keep the other end well protected from water!
  2. Support spontaneous physiologic pushing.  Since the baby will be born into the water there is no need to “catch” them so you can take a hands-off approach or help your client catch their baby. 
  3. Gently bring baby up and out of water immediately following birth.  We’ve all seen that video where the OB is allowing baby to stay submerged for several moments following birth.  Don’t do that, evidence doesn’t support that practice.  Help your client bring her baby up into the lovely fresh air.
  4. Do not submerge baby’s face once it has been exposed to air.  If just their head is born into the air (client suddenly stands up), assist your client in a supported position where baby is born avoiding re-submersion into water.  Likewise, once baby is brought to the surface of the water, support your client in holding their baby to prevent submersion of baby’s airway following birth.
  5. Maintain newborn's temperature. This is best done by drying their head and keeping them skin-to-skin.  They can stay partially submerged in the tub or covered with warm dry blankets in the immediate postpartum.
  6. Monitor third stage per normal.  This is greatly based on comfort level and experience of the midwife, but barring excessive bleeding the placenta can be delivered normally in the tub.  Just be sure to grab a bowl!

 Signs that it is time to get out of the tub:

  1. Client’s temperature is above 100.4 degrees Fahrenheit
  2. Tight nuchal cord that cannot be reduced
  3. Apparent shoulder dystocia
  4. Excessive bleeding
  5. Client loses consciousness… obviously…

This work of the ACNM and collaborators provides an evidence-based template for larger institutions to develop guidelines so birthing families can have the option for laboring and birthing in water.  Quite honestly, I am a midwife who recognizes the importance of evidence-based practice and appreciate having this kind of information available to guide my practice.  I also respect the unique needs of each birthing family and know to be judicious with how I use guidelines for each individual.

Interested in reading the full article?  Find it HERE

What are your thoughts?  How might this inform your choice to use hydrotherapy in labor or have a waterbirth?  If you are a provider, how might this inform your practice?

 

 

9 Ways To NOT Have A Cesarean

 
Photo courtesy of Gilberto Santa Rosa

Photo courtesy of Gilberto Santa Rosa

 

Cesarean section is the most commonly performed major surgery in the United StatesOne-third of pregnant women now deliver this way. The procedure has become so widespread that it can be easy to forget that it is a major abdominal surgery that carries risk for both mom and baby, interferes with bonding and breastfeeding, is very painful, and requires significant recovery time. In the US, about 3% of C-sections are elective and approximately 5% are true emergencies. But that's only 8%. What about the other 25%? Those fall in a grey area - meaning it is hard to know how many are truly medically indicated. And the truth is, many of them are probably not medically necessary. Read below to learn about 9 ways you can avoid ending up with an "unnecessarean"

1. Double check your due date

If you go past your due date, you are likely to face A LOT of pressure to get induced starting at around 40-41 weeks. Induction for post-dates has a high failure rate and often ends in C-section. Why? Because your body and your baby aren’t ready to go into labor yet, or they would have done so on their own. Research has shown that getting induced before your "cervix is ripe" makes you 3.5x more likely to end up with a Cesarean section, usually due to "failure to progress". In fact, "failure to progress" in labor is the number one reason for unplanned Cesarean sections.         Unfortunately, post-dates induction is very common because many OBs and midwives still use an antiquated system that was devised in 1830 to calculate your due date (I know, it's hard to believe!). Naegele’s rule, popularized by German obstetrician Franz Naegele, calculates pregnancy at exactly 40 weeks. It doesn’t take into account how long your menstrual cycles are or how many babies you’ve had - both of which are likely to affect how long you carry this baby. So what's the best way to calculate a due date? Comparing 1) a very careful medical history taking into account your menstrual & obstetric history (last normal menstrual period, regular vs. irregular, cycle length, how long you carried any other babies), 2) a first trimester ultrasound (second and third trimester ultrasounds have high error rates) and 3) your date of conception (if you know it), to come up with a date is your best bet. 

2. Encourage optimal fetal position

Baby’s position in relation to your pelvis matters a lot when it comes to laboring that baby out. A baby that’s butt-first (called “breech”) will end you in an automatic C-section in many parts of the country. Similarly, a baby that has its back facing your back is called “posterior” and can cause a long and more painful labor due to baby’s head rubbing against your tailbone. A posterior baby can usually be birthed vaginally, but is often much harder to push out than a baby that is in the “anterior” position (baby’s back towards your front). To encourage your babe to get in the best position, avoid “lounging” positions for long periods of time in your third trimester. Leaning back in a recliner or lounging on the couch on your back encourage baby to rotate to posterior position because the baby’s back is heavier than its front. Instead, adopt forward leaning positions, stand up straight and keep yourself moving throughout pregnancy. Walking and swimming are excellent ways to move. Lunges and squats are also great for opening up your pelvis and giving baby room to maneuver. And don't forget chiropractic adjustments throughout pregnancy - they are an excellent way to ensure your pelvis and spine are correctly aligned so that your baby can find just the right spot to hunker down. Check out www.spinningbabies.com to learn all about how to help your baby get into the best position.

3. Have an out-of-hospital birth with a midwife

A study done by the Midwives Alliance of America of nearly 17,000 births showed that midwives attending low risk births in freestanding birth centers and homes had a C-section rate of 5.2%!  If having your baby outside of a hospital seems like a crazy proposition to you, I encourage you to do some research to see what the numbers really show. Ricki Lake's documentary, The Business of Being Born (available on Netflix), and the website www.evidencebasedbirth.com are two great places to start.

4. Hire a doula

Doulas have been shown to lower the risk of C-section by 28%. They also do a million other amazing things. Read our post on doulas for more information on this fantastic resource.

5. Eat & drink in labor

Think of labor as a marathon. Would you want to run 26.2 miles without any water? Without anything to give your body fuel to continue the race? Probably not. Your body needs energy and hydration in order to function properly. When it doesn’t receive proper nourishment it begins to malfunction and shut down. Similarly, when you don’t give your body fuel and hydration during labor, your uterus doesn’t contract as efficiently (meaning your contractions don't produce the positive results, like opening your cervix and bringing baby down, that we want to see) and you lose the ability to cope as well with your labor. While it is true that many women don’t feel like they want to eat when they’re deep into labor, even small things like a spoonful of honey or an electrolyte drink can be a HUGE pick-me-up. Many hospitals still won’t “allow” women to eat or drink during labor because of the risk that you could inhale your stomach contents if you have to undergo emergency general anesthesia. There is no evidence to support withholding food and drink during labor. The risk of aspiration is literally so small, 7 events in 10 million births, you have a better chance of getting struck by lightning!

6. If you have already had at least one C-section, be doubly prepared
 

Having had a prior C-section drastically increases your chances of having another C-section. Choose your place of birth and your provider very carefully. Ask for numbers - what is the VBAC (Vaginal Birth After Cesarean) success rate of your provider and hospital (if you are having a hospital birth)? Pay attention to language. Does your provider say they will "allow you to try for a VBAC" or allow you a "trial of labor"? This can be a bad sign, as the terminology itself already implies failure and loss of decision-making power. Learn everything you can about VBACs and their risks and benefits. Have a strong support team (including a doula), and birth in a place and with a provider that has an excellent VBAC track record.

7. Don’t let people put things in your vagina if your water has broken

Hands (or anything) in the vagina introduce bacteria that can go straight into your uterus and cause infection if your bag of waters has broken. This is because the water bag is the protective barrier between your baby and the outside world. Once it is broken, you are at risk for infection. If you develop an infection in labor, you are headed straight for the OR. Believe it or not, there are a lot of other ways to tell if you are getting close to being fully dilated. There is no need for your care providers to check you every hour or even every several hours. If your bag is intact, don't break it, as it automatically puts you on a "clock" and can increase your chances of ending up with a Cesarean.

8. Be very skeptical of the “big baby” argument

It is extremely difficult to estimate a baby's size before birth. Ultrasounds are notoriously unreliable (they can be several pounds off the mark) and many midwives and obstetricians do not have the skills to effectively estimate a baby's weight. The fear of "big baby" revolves around the risk of having a shoulder dystocia during the birth. This is when the baby's head is born, but the shoulders do not immediately rotate into the optimal position for birth. While this is a stressful event, it is very rare for a baby to be permanently damaged from a shoulder dystocia. No study has ever shown that elective Cesareans for big babies improves their health or that of their mothers. If you are diabetic, a big baby can be a legitimate concern. However, if you aren't, and your care provider is telling you your baby is too big and you will need a C-section or an early induction, find a new care provider. This is not a good sign.

9. Do your research, know your rights, and read between the lines

This is by far the most important thing you can do to ensure you get the kind of care that you desire for your birth. Know that you can say "no" to procedures that are offered to you. Know also that many times a course of care will be presented to you as if there are no other options, and this is almost always false. You can say "no" to these too - but you will probably be met with a lot of opposition - even coercion - so be ready. If you haven't read it yet, read this doctor's blog post that went viral about how she was pressured to have an unnecessary C-section. If you have done some research you will be able to ascertain when it is safer to say "no" and when the course of care proposed is actually a good one. Many procedures done during labor in the US are not supported by scientific evidence. And often, a care provider will tell you what you want to hear rather than tell you how they actually practice. Ask for their statistics. What is their induction rate? What is their C-section rate? Ask questions, look for the evidence, and don't take anything you hear for granted. This is your baby and your body - it's important - so do your homework and speak up!