Another baby

I had a strong feeling last night that I really wanted another baby. I was even thinking about talking to my husband about it. But I decided to wait and it's a good thing I did. I get the urge to have another baby from time to time because I miss having a baby in the house. When I examine my feelings closely, I know that I have some regrets over my birth and breastfeeding experiences. Because when I think of the reality of having another baby in the house - well, doesn't sound quite as thrilling. I imagine the toll another pregnancy would take on my arthritis - I don't do pregnancy well to begin with. So, go away urges!

Stories

I was thinking about some of the really heartbreaking stories I hear sometimes.

I have a lady who is in the latter half of her pregnancy. She's young, this is her first baby, and the FOB is very involved. She was raped about four years ago and never told anyone but her best friend, and me. Her boyfriend has no idea. I don't know the cirumstances of the rape, but it becomes very clear that she has PTSD and is also suffering from depression. For unrelated reasons, I don't do a pelvic until about halfway through the pregnancy. It was tough for both of us - her because of unresolved issues, me because of the distress I caused her. Turns out she has chlamydia :( She hasn't told her boyfriend about her past and now this. She tells me he is very kind and supportive, truly a good guy. He comes for all her visits (she wanted him to leave for the pelvic which is when I discussed him with her). I encouraged her to not only tell him about the STD (of course, I would provide treatment for him as well) but about her history so he would understand what she was going through. She is entering into counseling also. She does tell him and when I see them, we talk about the STD, and about her history. She seems more relaxed and happier than I have seen her previously! He seems concerned but remains supportive and attentive. I am so happy that it is working out well - I was worried about his repsonse to all this.

I am hoping this child will be a positive life-changing event for them both.

Humdinger of a Hemorrhage

I had a heck of a postpartum hemorrhage today. This patient came in and had a great natural labor and birth (ok,well I had a body dystocia that lasted almost two minutes) followed by a waterfall after the spontaneous, intact placenta. I threw everything at her including the dreaded hemabate (the nurse was thanking me for ordering lomotil as well). A resident popped in at this point to offer help. I'm looking at him and thinking "well, jump right in". He asked me if I had given cytotec. Um, yeah, about four drugs ago! Anyway, she's ok two liters less but ok!

Validation

I have been a little unhappy with my rheumatologist lately. I haven't been feeling well due to my immune related arthritis, for a few weeks now. I had an appointment recently and informed her of this. She basically blew me off but did draw my usual labs. Well, it turns out my C-reactive protein (a marker of inflammation) was significantly elevated. So she calls me and tells me, also saying this validates how I have been feeling. Gee...I feel so incredibly validated now that the labs showed it wasn't all in my head. :P

Anyway, I get to try increasing my Friday night poison now :p

On the lighter side, I had a really nice birth in the wee hours of the morning. She had an epidural, and it was her fourth baby, which made it really straight forward. She came in about 6 cms dilated, wanting an epidural. I got there just as she had gotten comfy. I wanted to check her and maybe break her water, which she was agreeable to. She was 8cm with a paper-thin cervix and a big bulging bag. After I ruptured it, she immediately dilated to 9 and then we had a baby 20 minutes later. She breathed/pushed/breathed the baby right out over an intact perineum. Nicely done!

Looking for a midwife

Turns out the midwife I thought was coming back isn't. Bummer. So the search is on for just the right person. We have such a great group now, so this person needs to really fit well to be hired on :)

Doulas

I had a response from Kathy, who had some questions about my perspective on doulas and when things were not cool.

Your comment about the doula overstepping her bounds made me curious -- would you sometime give some examples of this happening? Not that I'm doubting it happens, but just wondering what it looks like. On one of my email lists, I sometimes read stories written from the doulas' perspective, and I read how they view the birth (and many times the manipulation they see women undergo, to accept things they have clearly stated they did not want), so I'm looking for a balancing opinion -- from someone who likes it when women have doulas, because so many stories I read include birth attendants who most obviously did *not* like doulas in general, or at least that doula in particular.

I want to address the 'manipulation' first. That term bothers me a bit because I am not sure what you mean by it. There are times when I do have to make a recommendation for 'something' that I know the woman may not want. This usually involves exhausting all other options first, then trying 'whatever' to achieve a certain goal. This typically comes with an explanation of why I think we need to do 'something'. When it comes down to it - the doula is a support person. I am the one who bears ultimate responsibility for the outcome for both mother and child. It's a heavy burden.

I can't stress enough that I think doulas are very valuable members of the team. What I hate, and this has rarely been a problem, is a doula who gets in the way of the relationship I have established with the woman throughout her entire pregnancy. Part of that relationship is the building of trust. I would certainly hope that a woman trusts me enough to know that whatever recommendations I may make, are made with no ulterior motive (i.e. golf tee times, etc). If a woman can't trust me, then she sure shouldn't be seeing me!

So, I have had a doula who would start whispering in the woman's ear the minute i left the room. The gist of the conversation being that the woman didn't need 'whatever' I was suggesting. A family member told me later about it. I was not happy. That's sabotage. I don't have a problem if a doula wants to bring up other suggestions, or questions in an open conversation - that's totally great!

The only other negative experience I have had was with a doula who really didn't do squat for the woman, other than kinda hang out. That ticked me off as this doula was being paid for her services and I felt like my patient was not getting her money's worth.

All my other experiences have been very positive. I recommend doulas to women who express interest :) I view them as a member of the team, right along with dad, the nurse, myself, etc.

Thanks, as always, for your comments Kathy!!!!

Dear Dogs and Cats

Dear Dogs and Cats:

The dishes with the paw prints are yours and contain your food. The other dishes are mine and contain my food. Please note, placing a paw print in the middle of my plate and food does not stake a claim for it becoming your food and dish, nor do I find that aesthetically pleasing in the slightest.

The stairway was not designed by NASCAR and is not a racetrack. Beating me to the bottom is not the object. Tripping me doesn't help because I fall faster than you can run.

I cannot buy anything bigger than a king sized bed. I am very sorry about this. Do not think I will continue sleeping on the couch to ensure your comfort. Dogs and cats can actually curl up in a ball when they sleep. It is not necessary to sleep perpendicular to each other stretched out to the fullest extent possible. I also know that sticking tails straight out and having tongues hanging out the other end to maximize space is nothing but sarcasm.

For the last time, there is no secret exit from the bathroom. If by some miracle I beat you there and manage to get the door shut, it is not necessary to claw, whine, meow, try to turn the knob or get your paw under the edge and try to pull the door open. I must exit through the same door I entered. Also, I have been using the bathroom for years --canine or feline attendance is not required.

The proper order is kiss me, then go smell the other dog or cat's butt. I cannot stress this enough!

To pacify you, my dear pets, I have posted the following message on our front door:

To All Non-Pet Owners Who Visit & Like to Complain About Our Pets:

1. They live here. You don't.
2. If you don't want their hair on your clothes, stay off the furniture.. That's why they call it "fur"niture.
3. I like my pets a lot better than I like most people.
4. To you, they are an animal. To me, he/she is an adopted son/daughter who is short, hairy, walks on all fours and doesn't speak clearly.

Remember, Dogs and cats are better than kids because they:
1. Eat less
2. Don't ask for money all the time
3 Are easier to train
4. Normally come when called
5. Never ask to drive the car
6. Don't hang out with drug-using friends
7. Don't smoke or drink
8. Don't have to buy the latest fashions
9. Don't want to wear your clothes
10. Don't need a gazillion dollars for college, and..
11. If they get pregnant, you can sell their children.

Babies everywhere

There were babies everywhere this weekend - some fertility goddess or another seems to have blessed me. From Friday nigt to Sunday night I had 8 hours of sleep...and they weren't consecutive either!

Friday night I had a lady pop out her big (but not her biggest!) 9-4 baby with ease. Course the epidural helped in the whole pain department. While I was waiting on her to birth, a primip came in. She walked for awhile and changed so i thought I would keep her but ultimately sent her home for therapuetic rest when she didn't change anymore. She was 4cms at that point. I told her she would be back more than likely over the weekend. But before I sent her home another lady came in dilated 8cms, and her second baby.

She had her first baby at a birth center, so was planning natural for this one as well. She had a doula also. I like doulas :) The only time I don't like a doula is when they overstep their boundaries - that's only happened once. Most seem to work with me as a team to help the patient achieve her goals while having a safe and healthy labor and birth. Anyway, this one was very good. The patient pushed out her child in a squatting position which was cool. She had a couple of small tears - nothing that required suturing. But I kinda wondered if they were a result of the squatting position. This baby was considerably smaller than her first. I have heard that there can be increased tension on the perineum.

After her birth, I went home...it was about 4:30 am when I left.

I slept about 4 hours.

Then my pager went off, with the nurse informing me that my primip was back, now 6cms. Woohoo - I was probably not too terribly excited. She delivered nicely....late afternoon.

I then went shopping with my mother...probably not a smart idea when I had bags big enough to pack, under my eyes. I went to bed late...

After an hour and a half of deep, deep, deep sleep, my pager went off. Grrr. A multip had come in at 5cms. It's 3am. No way can I go back to sleep, I don't want to miss the birth, on account that I live a little ways from the hospital. So I get up and head in. I manage to sleep another three hours in the call room.

So basically I am getting enough sleep to function on, but maybe not be terribly cheerful.

The multip delivers in the morning around 9am. At this time I have another patient who is there due to her water breaking around 1 am. We decide to start pitting her as it is her first baby and she isn't contracting...at all. I also have an induction there as well.

The primip delivers second - going from 5 to 9.5 in one hour and ten minutes - wow! Apparently, there is a history of fast labors in her family. All we had to do was give her a little kick in the butt to get going.

My induction finally takes off and she delivers mid-afternoon. That one was a bit of an emotional drain. She is a personal patient of mine who is putting her baby up for adoption. The birth parents were there, with the adoptive mother catching the baby. I know how my patient must have felt, to some extent anyway. It was incredible to see how joyful and happy the adoptive parents were with this handsome little baby. But it was also sad because I know how much pain my patient was going through to do this. I had to go in an empty room and cry my eyes out afterwards. Even thinking of it now makes me teary-eyed.

Sunday night, I got one page at 10pm about another induction admitted for preeclampsia. Then off to dreamland with not another peep from pager. I think I would have cried if I had to go back in.

More changes

We have lost a midwife...but we have another already lined up. What does this mean to me? Well, I will miss medwife but it may be just as well seeing how it just wasn't working out.

I am very excited about the new midwife. She actually used to work at my practice previously which makes orientation pretty simple!

Still Laboring Conclusion

...So a couple hours go by. I keep hoping that she will say she needs to push. She's looking way more uncomfortable, really working hard to cope. The doula is doing a great supporting her, as is everyone else. My plan was to give her about 3 hours after ROM to make some progress, which is what I had discussed with them. But she starts asking about chemical pain relief options. Before going there I suggest we check her (she was feeling some mild pressure at this point) - she's now 8cms but the head has come down a little to a 0 station. I suggest some other positions first or the tub, if no better after that, we will have the pain med discussion.

Well, she's exhausted and totally had it now. I think we all were pretty exhausted at this point. So about an hour later we are putting in an epidural. I re-check after the nurse puts in her foley and she's now 9/100/0. Another couple hours pass by and she progresses to complete. She has now been in labor approximately 24 hours. I'm trying to figure out the hold-up. Earlier I felt like the baby was OP or 'sunny-side up' but is now definitely OA. Baby doesn't seem that big - I figure 7 to 7 and a half at most. Pelvis is roomy. Contractions are probably not too hot but have been able to get her this far. Hmmm.

We have her rest for an hour prior to start pushing (she started feeling pressure). She pushes for a long time...maybe 2 and a half hours. We do the birth bar for squatting, semi-fowlers. I try to do some hands-on things to encourage the baby to come down and under the pubic bone. Then I try another little trick that has worked everytime I have ever used it. And it's so easy....

I flipped her to one side, had her push for 15 minutes...then flipped to the opposite side for pushing...and we delivered like that. The baby was over 8 pounds....ooops.

Still laboring

So here's the lowdown on this lady. She came in around midnight intact, had been contracting since 8pm-ish. She was 4cms. At 5am-ish she was checked by the midwife who was on and was 6am. Now granted, her exams tend to be more jealous than mine. When I finally check her 6 hours later, I can call her barely 7cms. A little more time, maybe two hours or so, goes by. You can learn a lot about a laboring woman just by watching her. I don't perceive any significant change in how she's laboring. I give them my spiel about breaking her water. AFter some discussion they agree to that plan. So now she's 7.5 when I break her water. She's doing very well even now that they are stronger and more frequent.

Stay tuned for the final installment!

Laboring now

I have a lady laboring beautifully and naturally. She was 6 cms when she was last checked 6 hours ago. She's intact. Anyone wanna bet she's still 6cms?????

My favorite saying

My favorite saying by patients...typically occurs at first meeting or first trimester, ocassionally at the end...

"I want to have my baby vaginally."

Really? Imagine that.