That week of babies- #1

I've been wanting to write about this for a while now. Of course, after I caught up sleep, hung out with my family, caught up with the postpartum visits and the regular prenatals, I was just ready for bed again.

But I wanted to recap that week of births, it was a long, but wonderful week.

On Saturday the 9th, I got a call in the morning hours from a first time mom who was
having contractions every ten minutes and felt like she was leaking water. I got up and checked on her and the baby and we discussed what more active labor might be like, telling her to call me when she needed me. I checked in again in the early afternoon and by 5pm my assistant and I were there. The woman was in early/active labor, but seemed like she wanted us there. She's a very quiet woman. One of those kinds that never makes a sound during the entire labor, even while pushing (which wouldn't come for a while yet)!
We tried to stay out of her way and encouraged her to rest, eat, etc.
After midnight, her labor really got kicking. She continued to trickle water and baby continued to sound great. By 4am she had thrown up a few times. She was getting tired, it was hard for her to drink much, and her contractions started to space out. I checked her around 5am and she was 6cm. I had her drink as much as she could and then encouraged her to rest. It was now Sunday morning, and her family was beginning to wake up and get breakfast going. I slept for about a half hour. Contractions were still spaced out, and the mama was getting some rest. Around 11am I went back home (which fortunately was VERY close), leaving them instructions to check the mom's temp every couple hours since her water had been leaking 24 hours and she was exhausted.

Once home, I tried to eat breakfast, washed (without showering) "my dirty bits" as my husband would joke, then took my daughter to a birthday party with her friend. I came back home and slept for two hours. I went back to the woman's house around 4pm. She was having closer contractions, but somewhat irregular and less strong. She felt a bit more rested and was able to eat a little. Her temp was 97. An hour later, 98.9. Another hour latter 99.5. Contractions were still all over the place irregular and not as strong as they had been in the night. (She had also tried homeopathic caullophyllum and cotton root bark tincture during the day to make things more regular.)
I was concerned about possible infection, dehydration and exhaustion. We discussed going to the hospital for these concerns. She was so disappointed and we were all sad about the decision to go in, but felt like it was the best. Her mother was there and she said this amazing prayer over her daughter, the baby, the situation, and basically for acceptance and surrender for whatever lay on the path ahead. We cried a few tears at the beauty and truth of the prayer and packed up to go.
The weather was freezing. Little House on the Prairie cold. Seriously -20 below zero with a strong, howling wind. The hospital is only 5 minutes away, so the cars never even warmed up.
It was nearly 8pm.
I had called ahead to triage to tell them we were coming in and explained my concerns about maternal dehydration and a small, yet creeping temperature. Once we were in the hospital, we were met by an amazingly sweet and gloriously NOT condescending nurse. We got the feeling straight away that she was on "our side". Once in a triage room, my client's temp was taken and it was normal. 98 degrees. WTF? I was thrilled, but she just drink a little and we did just come in from the prairies of Ypsiville. Her urine was checked and it was crazy high with ketones, a sure sign of dehydration and no recent nourishment. The nurse was optimistic. She said off the bat that maybe with "a bag or two of fluids, labor will get going again and you can go home and have your baby!"
Say what?! Never have I encountered such sweetness at the hospital. Not as a mama myself, nor as a doula and certainly never as a homebirth midwife.
The nurse sets her up with a fabulously fast-dripping IV bag, that makes my client very cold but gets contractions going immediately. Regular, strong, 4-minute-apart contractions. YES!
Soon a resident comes in and checks my client. They ask why I haven't checked her since early that morning. I explain because she's not really had regular-enough, nor strong enough contractions to warrant another check. She had trickled some fluid on an off and I didn't want to introduce any more bacteria than I needed to.

So the resident does an exam and states my client is still 6cm. Then she looks at me and asks, "Is this baby head down?" While she's got her hand in there! I felt a rush of adrenalin and then just as quickly a Wait...She's-Fucking-With-Me epiphany.
"Yes the baby is head down. I felt the suture lines, can't you? I mean, there's a bulgy forebag there, but that's definitely a head."
See it's a good thing I waste time reading medical student blogs and learn all about their strange hierarchy and nasty ways of climbing up the ladder by belittling others. (Only partly kidding, I also know of a lot of fabulous, big-hearted, sincere medical folks whom I love and respect.)
The resident agrees with the nurse that we can probably go back home after we finish the fluids and get another urine check. They're also not concerned about leaking fluid since there's still a big forebag. At the "Other" big hospital in town, I've seen them freak out about hind leaks and going over 24 hours, etc. So that was nice to hear.
Soon a second year and then a third year intern come in and they're happier to use scare tactics in soft, soothing tones. Like late night radio hosts they smoothly say, "Well, we have to wonder WHY you've not dilated in 12 hours. That's not normal. Why isn't this baby coming down? (Baby was +1 !!) If you stay, we'll likely keep you on IV's, maybe augment with a little pitocin and see how it goes. If you're not fully dilated by 11 or midnight, we'd have to discuss other options, like a cesarian..."

My beautiful, calm, intelligent client says with no sass whatsoever, "I appreciate your concerns. I really appreciate the IV fluids and I feel much better. My contractions are regular and as strong as they were last night. I'd like to finish up this second IV bag and go home. Thank you so much for your help."

Intern in a not-so-soothing tone, "Well I don't know. You'll have to sign out AMA. Against medical advice. Let me go get the doctor. Huff."

The doctor comes in (got to see every rung of the hierarchy in 30 minutes). He was great. Honestly, maybe in his 50s. He said all the same things the interns said, but one got the feeling it was because he HAD to. He also said that if she chose to stay, then I could stay, not just as a doula, but as her midwife. "I'll be in the room, but she can still catch your baby." We were stunned.
"Not all doctors are as bad as we're made out to be, you know." (I guess he knew what ACOG had just said about MY camp a couple weeks ago.)
My client explained she'd really love to go back home. The doctor was gracious to me, asked me what my plan was at home, I told him and he nodded his sage, gray head.
"All right. We'll have the nurse get the AMA forms. Go home and have your baby."
Then he looked at me and said, "Now I want you to call me at 11:30 and tell me she had that baby, okay?"
I laughed and said, "I'd be thrilled to call you at 11:30 with that news!"
"No, I mean it," he said. "If you have any problems, call us back. I'll be here all night. Ask for me."

Everyone left us alone. My client, her partner, her mother and I were incredulous to say the least. The client's mother is very spiritual and had been saying very calming, solid-rock prayers that helped ground us all. I felt she had some direct connection with God. I loved her presence as much as her daughter did.
My client got up to pee again and to catch it in a cup so that they could do one more ketone check before we finished the fluids. She and her husband came back from the bathroom with big eyes. Apparently, as soon as she waddled down the hall and sat on the toilet, her water broke with a bang (she caught it in the pee cup)! As soon as she sat back on the bed it was clear she was in transition. Strong contractions every 2 minutes.
We sped up the already fast IV so we could get home. We had a good laugh about how amazing it was she made it to the toilet for her water to break. Had it happened in the hall, everyone's Go Home tone may have changed. I told the client's mother that now I firmly believed she's got a direct line to God!

We managed to get the AMA forms and everything taken care rather quickly. I think we were back home again by 10pm. I called my assistant and told her to come quick to the house, we were coming back and things were moving quick. She was awesome and was there super fast and we scurried to re-set up the birth tray and other supplies.

Just after 11pm my client was pushing in earnest with great progress. A few minutes after midnight, she pushed out her gorgeous baby, who came with fairly sticky shoulders that only required the running-start position and turning baby into the oblique to free up the shoulders. Pink and crying and healthy! 40 hours from beginning to end, with only a 50 minute 2nd stage!

I called the hospital back a few hours after the birth and wasn't able to talk to the doctor or the nurse themselves, but I did leave a message saying, "Please tell Dr. X that the woman planning the homebirth had her baby and everyone is healthy. Tell him he was a 1/2 hour off though. Baby came at midnight. And tell him thank you for the respect."

The Big Push for Midwives

Check it out.

Bathe in Calgon Soap 1960s commercial

THIS is what I forgot to pack in my birth bags last week!!

We had 3 babies in 5 days, which is great. But two of the labors were 2-3 days long and every night last week I was called away from home if I wasn't already gone. I'll write more about them when I can. It was an amazing week, even though my back seems permanently damaged and my family were a little mad at midwifery for a few days. Life is coming back to normal again. I celebrated my short stint of off-call-ness by drinking two large glasses of 2 Buck Chuck with G. Now I'm a little dehydrated and head-achey... off to make coffee and get these children ready for the day.
My makeup artist and stylist are waiting to make me fabulous so we can board our private jet and get off to school. I hope they can find that swinging background music...

in respone to ACOG's anti-homebirth statement.... PASS IT ON AND SUPPORT YOUR LOCAL MIDWIVES!

RESPONSE from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc. rr.com

FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;”
tries to play the “bad mother” card

(February 7, 2008) The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia andPuerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630,RedQuill@kc. rr.com.

More seizures

Doose64 described a group of children with myoclonic and astatic seizures, often in combination with absence, generalized tonic-clonic, and tonic seizures. In this syndrome, astatic seizures (defined as seizures during which the patient is unable to stand) occurred suddenly, without warning, and the children collapsed onto the floor as if their legs had been pulled from under them. No loss of consciousness was apparent. At times the astatic seizures are so short that only a brief nodding of the head and slight flexion of the knees are seen. From the clinical description of these seizures, it appears that they are atonic.

In these children, the loss of postural tone often is immediately preceded by myoclonic jerks-hence the term myoclonic-astatic seizures. The myoclonic seizures in this disorder involve symmetric jerking of the arms and shoulders with simultaneous nodding of the head. Some myoclonic jerks are violent, causing the arms to fling upward, and some are so mild that they are easier to feel than see.

This disorder is more common in boys than in girls. The age of onset is between 1 and 5 years. With few exceptions, mental and motor development is normal before the onset of the illness. The prognosis is generally unfavorable, however, and dementia develops in most patients. Absence status is reported to play a role in the pathogenesis of the dementia.

I read this last night and panicked a bit. This was on the "Professionals" page at epilepsy.com. Little E has been having more seizures despite upping his dose from 60 to 125. Now we're moving up to 150. That's as high as we can go on the Topomax for the time being.
The seizures are "drop seizures", or atonic or astatic. The definition from above is for Myoclonic-astatic seizures. Myoclonic is for a single jerk usually followed by a fall. Like when he falls so fast and violently his arms shoot straight up into the air before his body collapses.
Had an appointment today with the neurologist, who is sweet, but is so giddy about me being a midwife and knowing his good doctor friend that the conversation runs all over the place. So far, most of our appointments have been followed by a "Let's wait and see" approach.

I brought in the above definition of Myoclonic-astatic seizures and the neurologist seemed perplexed. "Oh no, Doose is baaad. He's not a Doose case."
"Well those are the types of seizures he has. I've never heard any mention of dementia before." I said.
"Doose cases describes kids who are cognitively impaired and who have seizures."
"That's not what that description says." I said.
And then he redeemed himself. He looked at me and said, "These are fairly rare. All I remember of Doose is that it's bad stuff. Let's get out the text books and see what they have to say."
I appreciated his honesty. I hit my text books all the time. Almost after every birth. And often times when I'm perplexed by a little something at a prenatal or when trying to decipher a lab I don't usually order.And that's how it should be, you know.
So here's our brilliant neurologist admitting he didn't know or remember, and we're cracking open the latest editions of two popular texts on epilepsy (one British, one American).
Turns out Doose loosely describes a collection of behaviors/symptoms surrounding Myoclonic-astatic seizures but doesn't always imply cognitive impairment or God forbid, dementia. I think I gathered that these seizures are indeed quite rare, more common in boys, has an onset generally between ages 2-6~ Little E started at 28 months (worse if history of febrile seizures in the first year~ which Little E doesn't have), and that in children who are born with cognitive impairment issues and later develop these types of seizures, well, the prognosis isn't that great.
However, children developing on a regular course, meeting regular milestones, have a 50-85% chance of out-growing these seizures, with I assume, their mind and memory intact.

So I think I feel a little better about the whole thing. When he's seizure-free for a little while, we forget about this issue (still medicate of course, but it's not so heavy of an emotional burden). But when the seizures comes back despite the medicine, and he smashes his face into a table, or cracks his head on the floor, we all feel so vulnerable.
I feel like we can't leave him alone, we can't take him out, ugh! I just want to hibernate with my baby bear until he out grows this crap!
G was wondering out loud last night if Little E would ever be able to work and live on his own. Will he have to live with us always and collect Social Security at 18? Ack, one day at a time! I remind him. But I wonder these things too, I just don't say them out loud.

Oh well. Today an increase in meds. Tomorrow another day. The kids are happy and such good children. Really and truly. Miss S is full of sass but her wit gets her through without getting into trouble and E is sweet and gentle and not the least bit spazzy (ADHD is another common theme with his seizure disorder).

The other morning I asked G if he dreamed that night. He told me about this really crazy nightmare that involved politics, Big Brother type secret forces, and the government re-drawing the US map borders to eradicate some Texas town. Yowza.
I told him my dream: I made my friend T some lentil soup. Later I realized I forgot to put salt and pepper in it, so I ran to her house with my salt and pepper shakers in hand and sprinkled them in her mail box. Completely irrelevant happy little dream.

Later that day I told my friend T about the two dreams and laughed about how pointless my dream was, how boring my subconscious must be.
She said, "I think your day to day life is stressful enough between prenatals, births, post dates, crazy placentas, jaundiced babies, Little E's seizures, trucking kids to school and just being a mom...your brain probably loves to just relax and have peaceful, boring dreams while you sleep!"
Good point.
Now I'm off to sleep to have lovely boring dreams about folding laundry or something along those lines.

Summer Peace

My neighbor just sent me this great (I think) pic of the kids playing in her yard last summer. The grass is so green! It's pics like these that help us remember that warm weather will come (in about 4 months...).

Peace!