Sentinel Event Alert: Maternal Mortality

The Joint Commission, the organization that accredits and certifies more than 17,000 health care organizations and programs in the United States, has issued a Sentinel Event Alert focused on Preventing Maternal Death. Joint Commission accreditation and certification is recognized nationwide as proof of a health care facility's adherence to certain performance standards. More importantly, its accreditation has become a condition of licensure, and subsequently, of Medicaid reimbursement.

Here are some highlights from the Alert:

Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S., despite the rarity of the incidence of maternal death – deaths that occur within 42 days of birth or termination of pregnancy. Since 1996, a total of 84 cases of maternal death have been reported to The Joint Commission’s sentinel event database, with the largest numbers of events reported in 2004, 2005 and 2006. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, in 2006, the national maternal mortality rate was 13.3 deaths per 100,000 live births.

"There clearly has been no decrease in maternal mortality in recent years, and we are not moving toward the U.S. government’s Healthy People 2010 target of no more than 3.3 maternal deaths per 100,000 live births,” says William M. Callaghan, M.D., M.P.H., senior scientist, Division of Reproductive Health, Centers for Disease Control and Prevention.

The leading causes of maternal death are: hemorrhage, hypertensive disorder, pulmonary embolism, amniotic fluid embolism, infection, and pre-existing chronic conditions (such as cardiovascular disease). (Research) also indicated a four-fold increased risk of pregnancy-related death for black women, and increased risks for older women and women with no prenatal care. The numbers of deaths related to hemorrhage are declining, while deaths attributable to other medical conditions – including cardiovascular, pulmonary and neurologic problems – have significantly increased.

Several studies determined that from 28 to 50 percent of maternal deaths were preventable. In 2008, Hospital Corporation of America (HCA) looked at individual causes of maternal deaths among 1.5 million births within 124 hospitals in the previous six years. According to the HCA study, the most common preventable errors are:

-Failure to adequately control blood pressure in hypertensive women
-Failure to adequately diagnose and treat pulmonary edema in women with pre-eclampsia
-Failure to pay attention to vital signs following Cesarean section
-Hemorrhage following Cesarean section

“Pregnancy is a known major risk factor for venous thrombosis and pulmonary embolism. HCA now advocates for the universal use of pneumatic compression devices for all pregnant women undergoing Cesarean section.” Unlike nearly all other adult patients undergoing major surgery, pregnant women undergoing Cesarean delivery have traditionally not received prophylactic measures for the prevention of venous thromboembolism afforded similar surgical patients who lack this risk factor.

Each case of maternal death needs to be identified, reviewed, and reported in order to develop effective strategies for preventing pregnancy-related mortality and severe morbidity. To this end, The Joint Commission encourages participation by hospital physicians, including obstetrician-gynecologists, in state-level maternal mortality review and collaboration with such review committees in sharing data and records needed for review. The following suggested actions can help hospitals and providers prevent maternal death:

1.Educate physicians and other clinicians who care for women with underlying medical conditions about the additional risks that could be imposed if pregnancy were added; how to discuss these risks with patients; the use of appropriate and acceptable contraception; and pre-conceptual care and counseling. Communicate identified pregnancy risks to all members of the health care delivery team.

2.Identify specific triggers for responding to changes in the mother’s vital signs and clinical condition and develop and use protocols and drills for responding to changes, such as hemorrhage and pre-eclampsia. Use the drills to train staff in the protocols, to refine local protocols, and to identify and fix systems problems that would prevent optimal care.

3.Educate emergency room personnel about the possibility that a woman, whatever her presenting symptoms, may be pregnant or may have recently been pregnant. Many maternal deaths occur before the woman is hospitalized or after she delivers and is discharged. These deaths may occur in another hospital, away from the woman’s usual prenatal or obstetric care givers. Knowledge of pregnancy may affect the diagnosis or appropriate treatment.

Additional suggested actions for hospitals and providers to take for patients identified as high-risk (for example, those with pre-existing medical conditions such as hypertension, diabetes, morbid obesity):

4.Refer high-risk patients to the care of experienced prenatal care providers with access to a broad range of specialized services.

5.Make pneumatic compression devices available for patients undergoing Cesarean section who are at high risk for pulmonary embolism.

6.Evaluate patients who are at high risk for thromboembolism for low molecular weight heparin for postpartum care.

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This is a huge step in the right direction. However, two of the four main preventable causes of maternal death result from cesarean sections. In light of research showing the correlation of elective cesareans to increased maternal death, what seems glaringly missing from the Joint Commission's suggested course of action is a campaign to educate patients (and physicians!) on the risks of elective cesarean section surgery. Instead of education, the Joint Commission suggests the universal use of pneumatic compression devices and prophylactic embolism prevention for women who undergo c-section surgery.

Dr. Steven Clark, medical director for women and newborn services for HCA, says in the Alert that "the only cause of maternal death amendable to nationwide systematic prevention efforts is pulmonary embolism." I urge Dr. Clark to take this statement further. Any maternal death that resulted from an unnecessary intervention or surgery was preventable. Proper nationwide systematic prevention efforts MUST include universal prenatal education about risks of and treatment following obstetric interventions.

BIRTH STORY: A Natural, Hospital VBAC

(by Nikki Zizak, about the birth of Anabelle Lily, born 01.04.09)

The night I went into labor, around 8 p.m. my husband, Chris and I were watching a movie when I felt a bit of pressure on my lower back. It wasn’t bothering me too much so we continued watching the movie while he rubbed my feet. We went to bed around 11 pm.

Around 1:00 a.m. I awoke with a strong contraction and stronger back pressure. I started to get really nervous and was hoping I wasn’t going into labor. My “VBAC friendly” doctor was not on call at the hospital that weekend and I was told that if I showed up at the hospital in labor, I would have to have another cesarean. At that point, my only hope of a VBAC was to hold off as long as possible, and show up at the hospital ready to push.

My contractions were coming every 30 minutes, which allowed me to sleep between them until around 4:00 a.m. when they started getting stronger and more regular. At 4:00 a.m., my lower back pressure really got to be painful. I had to stand up and lean over the bed during the contraction to help alleviate some of the pressure. I was getting nervous because I was pretty sure that Anabelle was posterior and was unsure of how I was going to handle back labor. I woke up Chris and told him what was going on. I was actually not positive I was in labor. It almost felt like I had to have a bowel movement, so I spent a good portion of an hour on the toilet trying to go. The sitting on the toilet actually helped alleviate the back pain.

When the contractions and back pain started to get stronger, I decided it would be a good idea to take a shower and bath, which also felt wonderful. At this point, I was still not positive I was in labor so I hadn’t called my doula or anyone else yet. My contractions were 10-15 minutes apart.

By 7:00 a.m., I was starting to think maybe I really was in labor so I decided to call my mother in law who would come over to pick up my son, Gavin so we could get ready to go to the hospital. She lives in North Port, so we knew it would be awhile before she would be here. The back pain was getting to be bad enough to where the only way I could really get around was to hunch over, or crawl around on my hands and knees. I was scrambling around trying to get Gavin and my bags packed while Chris fed everyone (Gavin, dog, cats).

Around 8:30 a.m. I called my “doula, Ann (who was acting as my doula, she is actually a massage therapist who is good personal friend of mine). Anyway, when I called her she could tell by my voice that I was getting close. The contractions seemed to be coming constantly. I wasn’t sure when one ended and the other began because the back pain was constant. It made it really hard to time the contractions. What got me through was breathing and trusting my body. I kept thinking “This isn’t so bad, I can do this”. (Compared to my intervention laced first birth, this was so much more manageable).

At 9:00 a.m. my mother in law came to pick up Gavin. I was having a really hard time moving around so the only place that felt good was to kneel on the floor and lean over onto the couch. I kept rocking back and forth when my mother in law came in and gave me some encouragement. I started crying because for some reason I felt like I was giving up by going to the hospital this early. I was starting to reach the end of my rope and I was really dreading the long drive to SMH.

At 9:30 a.m. we left for the hospital. I was unable to sit in the seat so I had to squat on the front seat of the car. It was the longest car ride ever. I just closed my eyes and envisioned waves crashing on the beach. We called Ann, my doula and she said she would meet us at the hospital. I was mentally preparing myself for the likely possibility of having to undergo another cesarean and was beginning to feel defeated because, again, I didn’t think I was far enough into labor. I couldn’t believe how bad back labor was and felt myself giving up physically and emotionally. I was praying they wouldn’t try to get me to have another cesarean. I remember Ann asking me several times, “how much are you willing to fight?”

When we got to the hospital, we went to check in. I had not pre-registered so this would have took a long time until a nurse walked by and saw me trying to fill out paperwork when she told the receptionist that she should just let me go and get a room. I got to the room at around 10:15 A.M. Ann was with us and she and Chris were wonderful support. I really didn’t want to be touched or anything, but just having them there was all I needed. Ann gave the nurses a copy of my birth plan while I got dressed and signed a couple papers. The nurse did a cervical check and found out I was 8 cm. I couldn’t believe it. No wonder I was feeling rough. That was when they had read over my medical chart and found out I was VBAC. The two nurses looked at each other with shock on their faces. The contractions and back pain were so bad now, I couldn’t think of anything else except how I was feeling.

The doctor came in and said, “Ok, let’s go”. The nurse asked if he was going to let me VBAC, and he told her that it was too late to turn back now. The next few minutes were a blur but I remember them getting me on all fours to attempt to turn Anabelle so she wasn’t posterior. Then it came time to push and I was feeling itchy, so pushing felt really good. After a few minutes she was out, 35 minutes after arriving at the hospital. I was so proud of myself, and so happy. Anabelle was the most beautiful little person in the world. She breastfed right away, and for the most part, my birth plan was followed. I’m so thankful and fortunate to have had such a good hospital VBAC.

You're Invited: An Evening with Healthy Start

Next Thursday, January 21, The Healthy Start Coalition of Sarasota County is partnering with Sarasota Architectural Salvage to host “An Evening with Healthy Start”, a fundraising event featuring live music by local band The Equines, food from local restaurants, beer and wine, fabulous raffles, and in-store specials with all proceeds going directly toward Healthy Start services.

The Healthy Start Coalition of Sarasota County is a non-profit, 501 (c)(3) organization dedicated to improving the health and well-being of pregnant women, infants, and young children in our community. We coordinate a variety of specialized programs to serve high-risk groups and address specific risk factors that contribute to fetal death, prematurity, low birth weight, and infant death. Our program includes home visits, education, counseling, and referrals for at-risk pregnant women. We also educate the community about important topics in maternal and child health.

Sarasota Architectural Salvage is a unique home remodeling store, featuring an eclectic array of furniture, architectural relics, and artifacts from historic Sarasota to around the globe. Located on Central Avenue near downtown Sarasota, it is a well-known staple of Sarasota businesses, popular among local designers, restoration specialists, remodelers, and the general public.

Tickets are $15 in advance and $20 at the door and include 2 drink tickets and a $5-off coupon to SAS. Tickets can be purchased online at www.sarasotasalvage.com or by calling (941) 362-0803.

Healthy Start's goal for this event is to raise at least $2,000 to go toward training three Certified Lactation Counselors to provide breastfeeding education and support to Sarasota families. These services are invaluable to new mothers and greatly increase the success rate of breastfeeding, which provides the most optimal nutrition for newborns, increased maternal-child bonding, and stronger immune systems.

Please join us for what is sure to be a fun and memorable event!

BIRTH STORY: A Harmonious, Healing Birth

(by Jessica Dempsey, about the birth of Gavin Newton Robertson, born 01.22.08)

Well, my water broke at a trickle at 7pm on Jan. 21st. I was getting off of the sofa and felt a little "pop" in my upper belly. I didn't think anything of it until I stood up and started trickling! After I was sure it was my water and not just me peeing myself (not going to miss THAT finer point of pregnancy!!), I called my midwife, Harmony. Since I had not started having any contractions yet, she told me to go to bed and get some rest. Being as excited as I was, I got off the phone with Harmony and promptly started cleaning my house. After cleaning and making sure everything was packed, I showered. I recall looking down at my pregnant belly while I was in the shower, thinking that this was the last shower I'd be taking with my baby inside of me...next time he would be earth-side.

Around midnight, I finally went to bed. I woke up at 2:45am Jan. 22nd with contractions that weren't bad, but were enough to wake me up and not let me go back to sleep. So, at about 3:30am, I called Harmony back and told her about the contractions. She said "Well, it looks like we're having a baby!" and we made arrangements to meet at the birthing home at about 5am. It was cool outside and lightly raining. We settled in, and waited for my family so they could watch Deklan, then Travis and I holed up in the birthing room. It was so beautiful and relaxing...fresh flowers, candles lit, dim lights, and soft music playing, the bed was turned back and waiting for us...it was better than home! I rocked on my ball for a while, then my back started aching and I decided to get into the bed.
Travis got a hot pack for my back, then we snuggled up in the bed with the hot pack sandwiched between us for a while and just let the contractions come and go. They were painful, but I could easily breathe through them. At about 8am, Harmony checked my cervix and saw that I was at 8cm already! And not only that, but when she checked me, the forebag of waters released with a gush. She called in her birth assistant, Jodi, who rushed to the birthing home, thinking it would be soon...well, my ornery little boy threw us all a curve ball!! I got into the birthing tub and relaxed a bit (by the way, I would recommend water birth to ANYONE!). When people call a nice, warm tub of water an "aquadural", they're not kidding...it was amazing how much it relieved the discomfort. I had also studied Hypnobirthing, and was loving how it was helping me relax through each contraction.

After a while, Harmony checked me again, I had actually gone BACK to 7cm! I started to get discouraged, which made me lose my focus, which in turn made the contractions seems twice as painful. After one particularly painful contraction which left me wondering if I could actually do this, I looked at Harmony with what must have been a look of utter despair, because she read my mind and said "Jessica, you are not going to have to go to the hospital." I tried vocalizing through the pain, and found that it only distracted me...made me focus on the pain instead of on the relaxation. At one point, Harmony told me (so softly and gently, but firmly) that if I wasted my energy whining, I wouldn't have enough energy for the rest of my labor! Ha! I really was whining, and that was exactly what I needed to hear. I decided she was right, reached down deep and found my focus again, relaxed, and let the contractions do their job instead of tensing up and fighting against them.

As my cervix was slowly melting away, I tried pushing with a contraction to see if it would complete my cervix, but that didn't work...it just hurt. At her suggestion, I got out of the water (she figured it might have been a little too relaxing!) and tried changing positions. Before I made it to the bed, I had a contraction which came with a wave of nausea and I threw up everything that I had been drinking. I tried laying in bed, but that killed my back. I found that the most comfortable position was sitting on the edge of the bed. With contractions, I circled and swayed, which helped. Finally, I just had a rim of cervix left, but that little bit would not go away! Harmony started giving me herbs to help my cervix finish dilating. They tasted terrible, but I drank the concoctions willingly knowing that they would help. When she saw that I was tired and struggling and that Gavin was having some trouble getting into place, Harmony got behind me and supported my tummy with a rebozo with each contraction, and let me rest against her between them. My belly was so BIG (I forget what my fundal height was at my last appointment...48 cm, I think?) that we thought it, along with Gavin, might have been leaning forward in a strange position that might have been inhibiting him from moving down.Since my labor had lasted longer than we had thought it might, and since I wasn't keeping much down, Harmony asked if I wanted an IV of fluids, just to give me a little extra energy, and I said YES! I knew it would help. I wanted to be checked again, but at the same time I knew that if I hadn't progressed, I would get discouraged again. So I told myself that I would have her check after the IV bag was empty. When the bag was almost empty, Harmony suggested that I try to get up and use the bathroom, so I (reluctantly...I didn't feel like moving at all) said O.K., and that I'd get in the water again after I went, and she'd check me in the tub. But when I stood up at the side of the bed, I had a massive contraction and it hit me like a ton of bricks that my body was PUSHING...without me! I remember leaning forward onto the bed, roaring like a lion, then looking at Harmony and saying "I have to push!"

Suddenly, a whirlwind! The tub was being filled, my IV was getting disconnected, someone was trying to help me get something on for the walk from the bed to the tub (I couldn't stand the feeling of clothes on me, though), and I was trying to make that forever-long journey from the bed to the tub. I really wanted the tub to get filled in time, so I tried my hardest not to push, breathing (well, it was more like a growl, but it worked!) out the contractions while bearing down instead of holding my breath and pushing. I had two big contractions like that at the bedside while waiting for the water to get going in the tub, the IV to be disconnected, etc. At this point, my friends and family, including Deklan, piled into the room, filming and taking pictures. Travis helped me across the room, me almost breaking his neck as a huge contraction washed over me and I curled into myself while holding onto his neck...poor guy! Then I got in the tub, and my first instinct was to get to my hands and knees. The whole time that I was in the water previously, I had been floating on my back and didn't want to move, but the thought of being like that during this phase never even crossed my mind. The water was only about 4 inches deep, not deep enough to give birth yet, so I breathed (growled) thru another two contractions like that. FINALLY the water was deep enough and I could really work with my body and bear down and push...the first or second time I pushed, he crowned. It burned, but I remembered to relax with the burn and stop pushing, to let me stretch. The next time I pushed out his head...I remember Harmony telling me that his head was out and that I could feel it. I remember reaching down and feeling that smooshy little head and being once again in awe of birth. The next contraction, and a push and joy! that crazy squirmy feeling of a baby being born! Harmony told me to get my baby and I reached down into the water and caught my sweet little boy, and held him to me...I did it!The last phase was so much shorter with Gavin than it had been with Deklan. Waiting until my body was ready to push was amazing. I remember in my body and in my mind it was so crazy and intense...the thoughts, the sensations, the feelings seemed loud and rushing and incredible. Yet when I watched the birth back on video, it was so incredibly quiet! You could hear the water swishing as I moved in the tub, nobody talking, only water and me breathing. I had a 3rd degree tear with Deklan, and only ended up with a first degree tear and a couple of superficial lacerations this time. I think the perineal massage really helped a lot with that, and also, when he crowned and it really started burning, I tried to breathe and not push and let his head stretch the tissue rather than pushing his head right out. When his head was out, I had still not torn. But he had a little arm right up by his face (nuchal hand), so with the next push it wasn't just his shoulders that popped out, but an arm too. Travis said that it burst out like a sports fan pumping his fist in the air. When I pushed him out and caught him and pulled him up out of the water and held him to me...it was awesome! I held him in the bath until the cord stopped pulsing. I was bleeding quite a bit, so we decided to go ahead and cut the cord so that I could get into the bed and get a better idea of how much I was losing. So Travis cut the cord and held him while I birthed the placenta. Then I got out (thinking how strange and empty and light my belly felt), climbed into bed, and started breastfeeding him. It was so cool. Travis and Deklan climbed into bed with us and inspected him while he had his first meal. While we were in bed and everyone was gathered around us, Jodi showed us the placenta and gave us all a little tutorial. It was really cool to see the organ that we formed and that nourished and protected Gavin for his first 9 months! She showed us the inside, the outside, the sac that was once the bag of waters, the vessels in the umbilical cord and the "tree of life"...the huge blood vessels that supplied blood to the placenta. They also took placenta prints by pressing the placenta and cord onto paper, and it really looks like a tree!

After he had nursed on both sides (I'm sure he needed those few sips of colostrum after such a harrowing journey!) and I had eaten some fruit and cheese and drank some fluids, Harmony took him to weigh and measure him. He weighed in at a whopping 10 lbs., 1 oz., and was 22 inches long! Big boy! It made sense then why my labor took so long.

After he was checked and weighed and got dressed and all, I was taken back to the exam room to get stitched up. Laying flat on my back was so terribly uncomfortable, although Jodi and Holly tried endlessly to make me comfortable. Harmony mentioned how she loved suturing, and I said sarcastically that I was thrilled to give her the opportunity! After that, I took a shower, then went downstairs and had a bowl of soup and got my post-partum instructions. Then we went home! All in all, it was a long (well, longer than I had thought it would be, anyway!) labor...about 11 hours long. But it was worth every bit of it. It alternated between exhausting and empowering. At one point, I looked at my hubby and said "Next time I'm having a c-section!", and was only half kidding. Long labor can be so taxing, more mentally than physically. But then, just minutes after I wanted a c-section, I was laughing to myself when Travis was asking Harmony why I hadn't had a contraction for a long time...I had had two of them, but since I was quiet and relaxed and focused, he thought I was sleeping!! It's amazing to know that you really have that much control over your mind and body...to be in pain and out of control one minute, and resting and quiet and focused the next. Travis was very helpful, but when things got intense, he got quiet because he was worried for me. Harmony helped me so much, encouraging me and grounding me. She did things for me that no doctor would ever have done. Toward the end, when she was in the bed with me, sitting behind me supporting my tummy with a rebozo and letting me lean back against her and rock...it was just a really unique experience. Small things made the biggest difference to me...like when I was sitting on the edge of the bed and circling and swaying until that IV bag was empty, and I saw Jodi sitting cross-legged on the floor at the foot of the bed, silently circling and swaying with me and inconspicuously timing my contractions. Seeing her do what I was doing made me feel like I was doing something right! Even though I'd say that this labor was harder than my first, it was still better. I liked the whole birthing home/midwife experience, and wouldn't have traded it for the world. We learned so much, and with that new knowledge, we are doing things differently this time around, like co-sleeping and babywearing. Gavin is very happy and alert, and is very much attached to us. I think the initial time of bonding immediately after birth makes a huge difference!! Also, the fact that Deklan saw his baby brother "come out of mommy's tummy" helped him adjust easier. It wasn't like we just came home with a new baby. He has really made an easy adjustment and loves being a big brother. And I love sitting and nursing my little guy and reaching back and feeling that soft, smooshy head that I felt as he was exiting me and entering this world, and it just takes me back to that moment. As he's growing bigger and his head is less smooshy, it makes me sad to know that that tangible link to such an awesome part of birth is leaving. I hope someone who loves reading birth stories as much as I do enjoys his birth story! Writing it all down is such a powerful reminder. Now, about that third baby... ;)

BIRTH STORIES: Different Perspectives

(by Selena Charlton, about the births of Steven and Lycia)

Steven's Birth

(January 24, 1999, 3:00 a.m.) I am fast asleep. Kyle, who is up playing computer games, comes in and asks me a stupid question, I can’t even remember what it was, that could have waited until morning. Upset that he would wake me for something so trivial, I try to go back to sleep. Then I realize I am and have been having contractions. Timing them reveals that they are 7 minutes apart. I could have slept through them a little longer, but now I am up.

I lay there for an hour and decide to time them again since they picked up intensity slightly, and they are now 5 minutes apart. Then I decide to tell Kyle that they are 5 minutes apart, and we will need to call the birthing center soon.

I spent the next hour on the toilet clearing my bowels. Then I decide it is time to call the birthing center. Carol, the midwife on call, says that she is going to take a shower and to come in around 8:00 AM. The car ride was horrendous. There is no worse place to be while in labor than riding in a car. The seat belt straps you down. It’s bumpy. Just when you’ve got yourself in a good place during a contraction, the light turns red and you have to brace yourself to stop. Next time I’m birthing at home and skipping this part!

Carol greets me at the birth center just as I have a good contraction. She hugs me and supports me. For the first time this labor I feel warmth. After being checked she tells me that I’m 3 (cm dilated) and it will be a while so go get some breakfast and come back. There is a Village Inn down the road. Put a pad on in case your water breaks. It won’t stop the flow, but it will help.

I was pretty hungry when we arrive, and I order some pancakes. The contractions pick up while waiting for our food to come, and when the food got there I was no longer hungry and only ate a few bites. I spend the next hour in the Village Inn bathroom pooping. After washing my hands, I had a nice contraction and was squatting down hanging on to the counter. A lady walks in and asks if I’m alright. I say, “yep, just having a contraction. It’s over now.” With a shocked look on her face, she says, “as in having a baby!” “Yep. On my way back to the birthing center” I reply nonchalantly. Then she just looks at me really oddly for a second, and I walk out.

Now I know things are really cooking. We get back to the birthing center, Carol checks me, and I am 7 cm. I dilated 4 cm at the Village Inn. I lay down a bit and Carol calls my doula, Christina, to come. When she arrives the tub is full and suggests that I get in because of my back labor. The jets were aimed right at my back and felt wonderful. Christina suggests that I get in an all-fours position to get the baby to turn anterior and relieve the pressure on my back.

Hallelujah! the baby turns after a short while on all fours! It should hurt less right? Wrong. It hurts more! I learned to manage back labor quite well. This was new all-in-the-front labor, and I couldn’t handle it. After a couple more contractions I leaned back to get him posterior again. He complies and I am back to my happy (yes I said happy) back labor. I got out of the tub to pee a couple of times and the contractions were much harder to deal with on land. Just getting out of the tub brings one on.

I reach a point where I feel like when my cat was having her kittens and she was flipping all around. I couldn’t sit still. I was in agony. I was in transition.

I hear a loud pop! My lower half was underwater, the jets were on, and everyone in the room heard my water breaking. That really set me over the edge. I start saying how I give up, I can’t do this anymore, I’m done, etc. I have said it once and I’ll say it again; Transition is Hell. After thinking I could endure no more, a moment of clarity came over me. The turbulence ceased, and I realized it was time to push.

It took me a good hour of pushing before I really got into a groove and was doing it well. After an hour and a half of pushing, my son was born in the water, followed a couple of minutes later by the placenta. Finally getting to see what my baby looks like and feeling him for the first time was the most beautiful thing that I have ever experienced.

I was helped out of the tub by my doula and taken to the bed to have my perineum repaired, and Steven was taken to be weighed. Steven was born face up and I needed three stitches. Having the lidocane injected was excruciating. It hurt more than the tearing. With as many times as I was poked by the needle, I would have been better off not having it numbed.

Steven would not nurse, his breathing was too fast. Carol tried giving him a homeopathic to help his wet lungs and some (cringe) formula to see if it would help while I ate some Boston Market that my mom ran out and got for me. Looking back I would have asked for a breast pump before resorting to formula. After a second attempt at getting him to latch on, we knew we had to transport to the hospital. The paramedics took his blood sugar and it was pretty low. I expected this since I hadn’t really eaten anything all day.

We were separated when we got to the hospital. Steven went to the NICU, and I went to mother baby. He was kept in an isolette because they didn’t want his germs to infect the other babies. I saw this the other way around, protecting him from the nasty hospital bugs. My bleeding was pretty bad since I was not able to get my son to nurse. I felt winded and I passed grapefruit-sized clots. He didn’t nurse well during the time he spent in the NICU. I was sent home after two days with a breast pump.

After three days he came home. I was wonderful to be reunited with him after our three-day separation. He nursed like a champ at home, and I didn’t need to use formula and exceeded his birth weight by the next week.

Lycia's Birth

(Saturday, August 25, 2008, 7:00 a.m.) I wake up disappointed that I am not in labor. The night before I was really crampy and thought for sure I would go into labor during my sleep. So, I lay there for 20 or so minutes and will myself into labor.

The contractions, or rushes as Ina May Gaskin more correctly puts it, were so beautiful and powerful that I thought anyone in close proximity could feel them. A ball of energy would swell out of my heart until it would envelop my entire body and finally concentrate in my uterus. I really enjoyed them at this point. This is the energy of my baby girl trying to come into this world.

Since I for sure thought that the energy of the contractions radiated far from my body, I thought I would test it. After waiting for the next one, I woke up Mikey and asked if he could feel it. Much my disappointment, he couldn’t.

At about 8:00 I start timing the contractions to see if I should call Christina. They were 5 minutes apart. I get up, go pee, have a few good contractions, and realize I have bloody show. Yes, it is time to call the midwife.

Mikey calls Christina in the other room while I lay back down. He hands the phone to me and I tell her I had bloody show, that it kind of freaked me out, and that the labor slowed a little because I was freaked out. Since I tested GBS positive she said she would be over in the afternoon to start my IV antibiotics, take off to a post-natal out on Boca, and then return. (She thought it would be a long labor considering the size (my last fundal measurement was 47cm) and position (OP) of the baby, but I knew better.)

Mikey and I decided not to tell anyone I was in labor so we could have our privacy. The only problem was we needed pancakes. After calling my father in law, who was the only one we could count on not to spill the beans, we realized that we would have to get pancakes on our own. Originally we planned on going to IHOP in Punta Gorda, but we realized that was too far. So, off to the McDonald’s drive thru we go.

After pancakes comes nap time as I figured this will be my last opportunity to nap for the next, oh, four years. I don’t know how I was able to sleep through those contractions, but I did. After nap time comes shower time. The shower slowed things down a bit, so I decided we needed to go for a walk. After walk time comes picture time. I realize that I will never be this big again, so I tell Mikey that he has to take a picture of my belly.

We had decided long before labor started that we would pass the time playing dominoes. As we were playing and watching Grosse Pointe Blank on DVD, I sat on my birthing ball and ate grapes, which are oh so awesome while in labor. Soon I realized that I couldn’t concentrate on the game due to the contractions which had picked up intensity. After declaring me the winner, I went to the bathroom and had a lot more bloody show. I think this is around 3:00 or 4:00.

As I sit on the floor of the family room leaning over the birthing ball, the doorbell rings. Christina is here to start my IV. She gets everything ready and tells me that she will wait until my next contraction to poke me. Just then my back door opens. It’s my mom and my friend Julie. Someone let the cat out of the bag--no one was supposed to know I was in labor!

All of this hullabaloo puts my labor to a halt. This is obvious because Christina is waiting for a contraction so she can start my IV. 15-20 min later I have a milder-than-before contraction. Now, I wasn’t keeping track before, but I know they were much less than 20 minutes apart, probably less than 2 minutes apart, before everyone paraded in.

As I sit and let the IV do its thing, my mom and Julie inflate the birthing pool. When the IV is done, Christina leaves in the heparin lock for the next round in 6 hours. At this point I am sure Christina is still not convinced that it isn’t going to be too much longer because of the commotion causing my labor to stop and the fact that my baby is huge and OP. Good thing she decided to check me before she took off to that post-natal out on Boca. This was my only vaginal exam during the labor and the only reason we did it was because she was about to leave. She says, “I’m not going anywhere. You’re 6 (cm. dilated) and the head is coming down nicely.”

Christina left the room and left my husband and me to labor all alone. Then she went and told Maugh and Julie that I was at 3 cm, it would be awhile, and they should just go home and wait. Having all those people in my house was stalling my labor. To this day I feel as though I was further than 6 before all the commotion started and put me in reverse.

Alone with my husband we tried to finish watching the movie. I had reached that point where I did not want my husband to leave my side. So if I had to pee, I NEEDED him there. We never did get to finish watching that movie.

During my last trip to the bathroom, with my husband in front of me, things started to get interesting. With the contractions I started have sensations that were quite sexual in nature. I turned my neocortex off during contractions and when I would emerge from them I would find myself making out with my husband. The feelings were just so primal and amazing—the most intense experience ever.

All that hanky panky was brought to an abrupt end when we hear a loud POP and a ker splash! I made Mikey run and get Christina. “Something happened!” I exclaim. She said that my water broke and it was nice and clear, and helped me to the birthing ball where I had some pretty intense rushes.

Around this time I was wondering why the pool was not filled because I needed it right then. Maybe we shouldn’t have kicked Maugh and Julie out whilst assembling the pool. Enter Jodi, Birth Assistant.

The pool could not fill fast enough. Jodi and Christina boiled water on the stove because the hot water ran out. I almost did this myself, but my midwife redirected me. I labored on my feet hanging from my husband as he supported me in my limp, neocortex-shut-down body. Jodi took some good pictures of this.

Finally the pool was filled enough for me to get in. The second my foot touched the water I was put into transition. After one triple-peaked contraction by myself, Mikey got in the pool. I felt like I had to poo, and I could feel a lot of pressure on my sacrum as my baby labored down. This was the only time during this labor that I felt pain. Mikey, after some direction on where the sacrum is located on a person, poured cups of warm water over it which was wonderful. My sacrum was pretty sore for weeks later from a large, ”sunny-side up”, baby laboring down on it, and surprisingly was the only thing that was sore afterword.

Transition is Hell, but this time I was prepared by my son’s birth. With every, “this sucks”, “I’m done”, and profanity I yelled, in my mind I was saying, “she’s almost here”, and “this will be over soon and I’ll be holding my baby and get to see what she looks like.” I still would not describe the rushes at this point as painful, but they definitely were powerful and insane. They had their own unique energy which was hard to handle and very interesting.

While grunting through a contraction, I pushed, and it felt GOOD. After informing Christina of this and asking when you know it’s time to push, she said if it feels better to push then it is time.
While pushing I felt and heard a loud POP! It felt like the baby’s head exploded, scared the crap out of me, and I yelled, “what the @#%& was that!” Christina said that was my water breaking, so I guess that was the second layer to the bag.

Not many pushes later, my baby’s head appeared, and Daddy was the first one to touch her head—something that he will always be proud of. He would have caught her hadn’t her shoulders gotten stuck.

“Alright, everyone out of the pool!” commanded Christina. “I have a blanket laid out here. Next contraction I need you to get on all fours and push.” I knew this would happen--the Gaskin Maneuver for shoulder dystocia. After a few minutes of this not working, she had me flip on to my back. I pushed, and pushed, and pushed, and nothing happened.

Then I felt her turn completely around, then completely around the other way, and then she was out! Christina says, “wow, she’s over 10!” All I hear is Christina say, “heartbeat’s good” and Jodi and Mikey telling me how beautiful she is—no cry. I say I know she is beautiful even though I can’t see her.

After Christina works on my baby for a few moments to get her started, finally I get to see her. She was even more beautiful than I imagined. I held her on my tummy and she wormed her way up to my breast as Christina delivered the placenta and checked for tears. I gave birth to a 10 lb baby with only a minimal tear inside the hooha that did not require stitching.

After a few minutes I announced that BabyFace would like to nurse. I cut the cord because Mikey wouldn’t, and they helped me up to my bed. Lycia latched right on like she had been doing it for years and nursed for 3 hours. I was so amazed that she knew exactly what to do, and she continues to amaze me every day.

Lycia's Birth...through Daddy's eyes

"Ummm...sweety?" Blurry eyed, I awoke to my wife shaking my shoulder.

"Hmm?" was my articulate reply.

"Can you feel that? .... it's going to be today" was the response.

Now normally, I would have been my calm and collected self (insert laugh track here) and responded with a demeanor that would belie my excitedness. "Mmmm...are ya sure?" .....was all I could come up with.

My job, through 12 weeks of exercise, studying, role plays, and public flatulence (inside joke) was to keep things calm and organized and to quietly and internally freak out.

"...Should I call Christina?" I asked in a soothing voice.

"...Not just yet...but soon." she responded.

Three seconds later I made my phone call.

"...Agghh...goobbly gook--- baby coming!!...ummm fill the tub, boil the water get the hot towels.... (Christ I needed a drink) *** this was a private conversation with the midwife while Selena was coming to terms with what was going on.*** I'm glad someone was, because it was evident that I was a spectator/partnerI'm-to-be-responsible-for-a-life, ummm......daddy?

Breakfast came next. Could you believe that? Growing up, I must have watched the Lucy episode (my mom was fan) a hundred times. Ricky was the epitome of nervousness, and while he paced, went bug-eyed, and did his best to remove 'native- make-up' ***get net-flix, and rent the episode*** Lucy was busy having 'little Ricky'.

My impresssion of child-birth was just that. Chaos personified. And, for some reason, that day was one of the most calmest, serene, and most perfect days of my life. Within twelve hours, my life would change forever.

Where was I? Oh yes, breakfast. A quick phone call to my father (later known as "Paw-Paw") would reveal that we would have to get pancakes on our own. After that, a walk around the block would follow. Now keep in mind, my beautiful wife is in labor, and wanting TO WALK AROUND THE BLOCK. After our stroll, an odd request: "...we should get a picture of this....I will never be as far along as this.." **snap** I photographed her, as pretty as she'll ever be.

Things started getting a little hectic around three-ish...which meant (drum-roll) a shower and...ummm nap? This is so far removed from what I've always expected.

Insert family here. Sister-in-laws, mom-in-laws, midwives, midwife assistants, some guy down the road that wandered into an open door, etc...(just kiddin' about the last one)....bottom line, a house full of people in a very short period of time, to the point where the baby (yes baby) said "KICK EVERYBODY OUT!" I then proceeded to clear the place.

With just my wife and and I in the house, there was a moment of crazy-off-the-wall-eroticism, that I will not divulge in print for you people! (needless to say, it was HOT...see my blog at www.makingoutinthebathroomwhileyourhotwifeispregnant.com).

"....umm...'ker-splash'" that was the sound of water breaking in the bathroom. By that time the kiddie-wading pool was filled in the living room, and my wife was circling the house looking to get comfortable. Eventually, we were both down to our bare essentials and in the water. Christina, our midwife, was the Cecil B. DeMille for the afternoon/evening, and directed every step of the way. Not that our new arrival was at all interested in being directed.... Quite the contrary. Our mump was going to do things her way from the start.
After about an hour or two in the tub, it was clear the mump, was going to be...how to put it?..ummmm HUGE, and we needed to come out. (Not before I was able to feel her little head coming into the world...I still professs to this day, I did most of the work.)

After a while of pushing and changing positions, we found ourselves on the living room floor.....within about six minutes she found her way out, and to mommy......I was confused, and tearful. A minute before, there was Selena and Mikey. Then there was Mommy and Daddy, and Lycia.