Midwives Deliver

Jennifer Block defends midwifery again. Read her article from the LA Times on Christmas Eve. 

Midwives Deliver

Quick and sweet

Donovan's arrival was quick and easy, so says her dad, Matt. Marcia just sang away to the Christmas songs in between contractions. Donovan Taylor was the perfect Xmas gift. She was born on December 20, 2008 at 11:33pm. Welcome Donovan and congratulations to Marcia and Matt.

Welcomen Elliott Finn!

Elliott Finn was born early and quickly at home on December 1 - so early and quick there was no time to set up the aqua-doula or finish the matzo ball soup we had hoped to make for our birth team! Maria and Nancy were amazing and remarkable in so many ways - supportive, decisive, compassionate and, most of all, caring.
Elliott and Tara are safe, sound and healthy, yet tired and looking forward to long family naps. - Stephen

Much to be thankful for

Moments after an amazing birth

We have much to be thankful for this year:
Amelie Renata Pan arrived on Thanksgiving night at 8:55pm!
Height 21 inches, Weight 8.5 lbs.

She was born at our home with the help of our excellent midwife, Maria, and our terriffic doula, Alexis. It was a fast labor with no major complications and the team did fabulously. We're so grateful for a healthy mom and baby, an amazing birth experience, and for Stacy's parents' incredible help and support.


Roland, Stacy and Amelie

Sante Dante

Look who's coming to town: Dante Alexander Barrionuevo was born on November 22, 2008 at 5:56pm. Proud parents Michelle and Javier couldn't be happier. It certainly will be a merry Christmas!

Another Three boys

What a pleasure and a joy it is for me to follow a family as they grow! I have had the pleasure of seeing all three babies in a family come into the world only a handful of times. Here's our latest triptych: Samson Holcombe Appel joins his brothers Calder and Hayes!

Samson was born on November 7, 2008 at 3:46am. He weighed a whopping 9 pounds 11 ounces! Home Sweet Homebirth!

Welcome Home Ella Marie!

Jennifer and I are thrilled to announce the arrival of a new family member, Ella Marie. I have the short version and the long version of the story for those who would rather not read a long winded description of the birth. The short version is: Ella Marie Okonsky Rankin was born on Tuesday, November 4th at 12:39 PM. She is early (expected due date was December 31) so she is little and adorable. She weighs 3 pounds 10 ounces and is 16 inches long. She is in good health and she and Mama are doing well. She was born at St. Luke's Hospital here in San Francisco. We had planned to have a home birth but little Ella had other plans. After the birth Mama and daughter were transferred to UCSF to their Neonatal Intensive Care Unit. This is standard for premature baby's so not to worry. She will stay for about a month. Sometimes with baby's born this early they need help breathing but Ella is breathing fine on her own so Mama and Papa have been able to spend hours holding her.
On Monday night Jennifer and I attended our birth class held at our midwife's practice. We had a great instructor, Jane Austin, who also teaches pre and postnatal yoga classes. Jennifer was taking the "pre" courses and now will move on to the "post" classes. Luckily, Monday night's class was devoted to labor. Little did we know that 13 hours after leaving the class we would have a little one on the outside. That night Jennifer was having some pain in her lower abdomen and felt some contractions but just assumed they were Braxton-Hicks contractions (practice contractions for those unfamiliar). In retrospect, she may have just been hoping that was the case since we would have liked her to stay in a little longer (at the time - now we are thrilled she's here). We went to bed and Jennifer woke up at around 3am and was having contractions. I woke up around 5am and we talked about it and I gave her a massage to try and help. I got up and left for work and thought everything was normal. Meanwhile the contractions continued and Jennifer grew concerned. Next thing I knew I get a phone call at 9:30am. Jennifer was upset and concerned and needed to go to the hospital. I left immediately. Ella wasn't even born yet and she's already getting me out of meetings. Good girl! I was very worried about Jennifer and baby at this point and literally ran out of the building and did my best impression of how I used to drive at 17. I'm a little slower but I am still able to maneuver quite well in traffic. I made it home safely and picked up Jennifer. She asked me to grab her a jacket on the way out and of course I grabbed the wrong one. :-) She was in some pain and concentrating on her breathing. I got a little impatient with the city traffic when Jennifer brought me back to reality and reminded that my role in labor is to support her and not ADD stress but REDUCE it. She said that my "words of advice" to the other vehicles on the road wasn't helping her and she had to waste precious breath on that reminder. Whoopsy. And by they way, she added, watch the bumps! We went to St. Luke's Hospital because it was the designated back up when we arranged the home birth. We got into the building and waited about 47 days for the elevator. We went to the third floor and were taken into labor and delivery room 3. They put Jennifer on the bed and it was approximately 10:30am. Things were a little slow from my perspective and the gravity of the situation wasn't readily apparent yet. Not everyone knew yet that this was early and an unexpected labor. That changed quickly and they brought in the monitor to check Ella's heart-rate. Now, we had been going to a midwife and Jennifer had not been hooked up to any equipment to this point except for a "quick" ultrasound at 16 weeks. When they first put the monitor on there was not a heartbeat but that was because they had to find the right spot. Not knowing this, I was a bit freaked. Luckily they found the heartbeat but it was fluctuating a lot due to the contractions. At 32 weeks the little ones aren't as well suited to deal with the stress of labor. They gave Jennifer some magnesium sulfate to try and stop the contractions. Let me just say that Jennifer and I made decisions about how we wanted her pregnancy to proceed as well as how we will proceed with Ella Marie's healthcare. We make no judgments on decisions taken by anyone else, just do what we think is best. I say that because this is a sensitive topic. One reason we wanted a home birth is because we wanted to avoid medical interventions if possible and once in a hospital setting, in a tense time you have a knowledge gap, even when Mama is a health professional. It's the classic if I knew 2 days ago what I know now I think we would have avoided the magnesium sulfate. It hasn't proven to be effective at stopping labor and Ella proved that. What's done is done but it's overwhelming when you have a room full of people telling you what should be done. Which led us to a moment I'll always remember. They had already tried the magnesium sulfate and were giving antibiotics and some steroids to help Ella's lungs when the doctor mentioned to Jennifer that she would like to give her something else, perhaps for the pain. Jennifer very clearly stated that she didn't "want any more crap put into her body," to which the doctor responded, "it's not crap." Good stuff. No more crap added. Jennifer went from 3-cm dilated at approximately 11am to 10cm dilated at 12pm. The most difficult part from the time we arrived until 12 was that the labor was being treated as a problem to be stopped, not a birth to embrace. That is not stated to point fingers, just describe what was going through my mind. It was between 11:30 and 12:00 where it just became "we're going to be parents today." Game on. After that I wasn't worried that something was wrong with Jennifer and baby although it's very difficult to watch someone you love in pain. Don't like it one bit. In the meantime we had put in a call to our midwife, Maria Iorillo, and St. Luke's had a midwife, Emily, on duty as well as a pediatrician named Karen. These 3 women were amazing and kept the mood positive, explained things and were who provided a profound sense of calm. Once it was determined Jennifer was 10cm dilated they decided to move her to the OR because Ella was a premie but they also broke out the C-section consent form. That's where it was great having Maria who we had spent time with discussing all these things and we all knew that there was no need for that. Ella made the decision for everyone. They didn't have time to move Mama and Ella to OR. At this point there was a tremendous amount of activity in the room with machines, doctors, nurses, midwives, Mama and Papa. Someone directed me to the right side of the bed. I went over but realized my view was terrible and I was restricted from being close to Jennifer. Maria said to come back over to see the baby be delivered. As I was making my way around the bed through the maze of people and equipment, Jennifer was saying "I feel a lot of pressure, I feel a lot of pressure." Boy did she. As I got to the left corner of the bed, Jennifer's waters burst. It was projectile and doused Maria and Emily. I thought, "Whoa, I'm not sure if that's something you see everyday." 2 minutes later Ella's little head was crowning and she entered the world. She was brought right over to a little bassinet to be checked out by Karen and me. Karen explained what she was doing and I chatted with Ella and we looked into each other's eyes. I then cut the umbilical cord. After a couple of minutes I went to check on Mama and said, "ok, let's deliver that placenta!" Papa too late once again. Already done said Mama. Karen brought Ella over to Mama for a kiss before taking her upstairs to wait for the transfer over to UCSF (Univ. California San Francisco). After about 20 minutes Jennifer was asking when she could go up and see Ella. She was told she needed to rest and then they would bring her up in a wheel chair. She hurried that along and pushed the chair aside. After some quality time with Ella the transfer team showed up and brought Ella to UCSF. Jennifer was transferred at 5pm as I went home to collect clothes and vote. I heard it was a big day for some other reasons. We've now been spending all our time at UCSF with little Ella Marie. She's on the 15th floor and has an incredible view of San Francisco, the Golden Gate bridge and beyond. I know other parents already know and it's a cliche, but all we want to do is sit and hold Ella. We're transfixed and love this little person in a way I can't articulate. She's too small to hug her the way I'd like to but some gentle nose petting is quite fun. To put the feeling into an easily watched, pop culture reference I point you to this link (http://www.youtube.com/watch?v=1nqP3p5IBx8) and advise you to watch from minute marker 7:12 to 8:18. For those that already know the reference, it is when Ed is handed Nathan Jr. (so they think) by one H-I McDunnough. Her spontaneous teary announcement of her affection for this child is how it feels.

Lastly, we've also been thinking that she took us too literally when we read to her in utero. The book we would read to her is "Oh, Baby, the Places You'll Go!" adapted from the works of Dr. Suess. The last page of reads:

You'll find that this world's
a great place to begin,
but it could use some help–
which is where you come in.
So now, as my voice
burble-urps in your ear–
with a bump-thumpy sound
that is not very clear–
the words I am saying
you hear in your heart,
and know that I wish you
the very best start.

It's a scrumptulous world
and it's ready to greet you.
And as for myself...
well...
I can't wait to meet you!

It seems she was ready to meet us too and decided to come out. She's her mother's little girl.
But, she is also her own strong little self. We later found out that the reason for the pre term labor was the bodies anticipation of a placental abruption. Once the placenta was delivered, a tear was noticed, indicating its beginning of coming away from the uterine wall. Placental abruption is a complication wherein the placental lining has separated from the uterus. It is the most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies world wide with a fetal mortality rate of 20-40% depending on the degree of separation. Placental abruption is also a significant contributor to maternal mortality.

It is our belief that the body is so efficient, as is little Ella, that the body and her knew that they needed to exit and enter the world before the abruption happened. And thankfully all that 'crappy' magnesium sulfate did not work to stop the labor or we would have been in real danger.

Ella was discharged from the NICU on December 3rd, weighing in at 4 lbs. 14 oz.

Guest Blogger: Kelly Kilpatrick

Kelly has written an article on Natural Childbirth for Women in Charge. Sit back and enjoy!

Childbirth – The Natural Way is the Best Way

There’s nothing in the world that’s more natural than childbirth, so it’s a more than a little ironic that we’re talking of learning how to give birth naturally. The advent of medicine and technology has made us so dependent on drugs to deal with pain of any kind that we’ve taken to using it for childbirth too. Research has proven that births without painkilling drugs and epidurals of any kind are the best kind, because the baby is born more alert and the mother is also more refreshed and in tune with her child. If you’re pregnant and want to deliver your baby naturally, here’s what you can do to make your task easier:

• Choose a good place: You need to decide if you’re going to have your baby at the hospital or at home. If it’s the latter, you need to be prepared to deal with any kind of emergency or at least be able to get to the nearest hospital in time to prevent any untoward complications relating to the birth.
• Childbirth classes help: You’ll learn how to cope with the pain and pick up relaxation and breathing techniques that help minimize your discomfort.
• Gather a support group: If you’re planning to have the baby at home, you’ll want supportive people around you, one of whom must be a qualified midwife who can guide you through the birth, and in case of any complications, suggest that you move to a hospital to prevent any untoward occurrences.
• Get familiar with birthing positions: Natural childbirth is easy when you’re in the right position, so learn all you can about the right positions that both ease your pain and help the baby move along your birth canal.
• Learn about water births and hydrotherapy: The women who’ve tried it swear by it – giving birth in water is supposed to be the easiest and most natural way to deliver your child. The lapping warm water soothes your body and eases the passage of your baby through your birth canal. Since the baby is surrounded by fluid in your uterus, it feels more comfortable when it comes out in water as opposed to air. If you’re planning to give birth in water, get someone who knows the procedure to assist you during the delivery.
• Learn how to relax: There are various techniques that help you relax once your water has broken and your contractions start to set in. Choose the method that works best for you and learn to relax before the birth. If you’re tense or anxious, it’s bad for the natural birth process. Use birth balls, music, different positions, walking, massage – anything that works for you.
• Read up on the subject: I know they say that a little knowledge is a dangerous thing, but it’s best to be as prepared and informed as possible when you’re getting ready to deliver your baby naturally. Reading about natural childbirth and talking to people who’ve done it will help you learn more and be better prepared when the big day comes.

This post was contributed by Kelly Kilpatrick, who writes for http://www.collegetrainingschoolsonline.com/. She invites your feedback at kellykilpatrick24@gmail.com.

Homebirth on the Hill

The Potrero Hill neighborhood of San Francisco has got it goin' on. Here's their article from the local newspaper: Homebirth on the Hill!

Cesarean Section Homebirth Style -- My Birth Story

By Rachel

The pediatrician described my labor and delivery as death by a thousand cuts. I’m not sure I would describe it that way, but it was intense. My water broke on Friday morning at 7:30. Contractions started by 8. My friend, Theanna, and Maria, the midwife, came over to the house. The morning and afternoon went as expected. Lots of rocking and swaying, humming, breathing, and counting. Cassie applied counter pressure to every contraction which also helped. I hung out in the shower, draped myself over an exercise ball, dropped into it instead of resisting, walked around outside in the sunshine, listened to the soothing music Theanna brought over, and did everything else we had learned to do to manage labor. I had an IV drip of antibiotics every 4 hours (to combat GBS which I tested positive for. GBS is a virus(?) that lives in the vagina of some women and can cause sepsis if it gets on the baby on the way out the birth canal). Cassie chased me around with water and OJ which I threw up on two occasions which was awful but usual apparently. Every few hours the contractions shifted to something more intense and we found a new rhythm, new pain management techniques, and kept moving through it.

This all went fine until late in the evening when we hit some new pain intensity that I could not believe. I had no idea it would hurt that much. None of the previous tricks were working and I was so tired. I had never lain down all day because it hurt too much. The midwife got me lying on the bed somehow so I could rest between contractions. That roller coaster was an amazing ride. Up with the excruciating pain, Maria talking me through the panic and sense of being trapped. Then down, still stiff and shaking, while Maria coaxed me to breathe, relax my shoulders, and rest. I would actually fall asleep during those 1 to 3 minute breaks and it was the most restful relief of my life.

We had one last secret weapon -- the warm birthing tub in the middle of the living which was set up with much hullabaloo in the morning. But I suppose we miscalculated when to use it. I threw up one last time during one of my rests on the bed which did it. My hold on control was so tenuous at that point that the trauma of coughing and spitting out vomit on the pillows sent me over the edge. I was done. I wanted it over. I was 5 centimeters.

I hung in there 20 more minutes for one last IV while bags were packed and we got ready to go to the hospital. I knew that complete relief was only moments away. I sort of remember having a contraction on the walkway on the way to the car, in the car, and again in the hallway of the hospital as I staggered towards to elevator. I'm sure I looked and sounded like someone dying a painful death. Finally the labor and delivery room, vital signs, blood drawn, fetal monitor attached, and news that they wouldn't even call the anesthesiologist until the blood work was back. I think we waited nearly two hours.

Maria said that she wanted me to do my best but that it wasn't supposed to be torture. It was torture. I continued to feel trapped and panicked every time. I remember staring at one spot on the ceiling to try to stay focused. My mind kept screaming to Cassie to "get me out of here!" Maria (I'm sure) did her best to guide me through. I refused some narcotic that was offered, knowing that the anesthesiologist would be there any minute. She finally arrived and I truly felt like she was the angel of mercy. Within a short period of time the needle was in. Someone looked at the monitor and said, "You're having a contraction." "I am?” I said. Cassie, Theanna and Maria looked at me in disbelief.

Then we slept. I am in tears of gratitude now thinking of the dedication of my birth team. Theanna slept in a chair, and Cassie and Maria slept on the cold, hard hospital floor. I could not believe it. Three or four hours later it was morning. I was 9 and more centimeters. Hooray! They said we would have a baby by noon.

There was only a little lip of cervix left which everyone thought wouldn't impede progress. I was absolutely done with pain and didn't want the epidural turned down so I could feel the contractions and know when to push. Maria and the hospital midwife coached me, and the pushing felt incredibly weird since I couldn't feel anything. After a few tries, the midwife checked and said I was pushing right but the baby wasn't coming down. Also, that little remaining bit of cervix wasn't moving. One problem with epidurals is that they can slow down contractions. So I agreed to a little bit of pitocin to get things moving again.

What happened after that gets blurry. There was much fiddling with epidural and pitocin levels. I could feel contractions again. I was exhausted from pain by then and shied away from every contraction. It hurt and I couldn't focus. I finally accepted the narcotic which didn't take the pain away but kept me fairly relaxed during contractions, and totally relaxed in between, without me having to do anything. I cried really hard. I couldn't see my way through. Everyone was helping me relax and get through it moment by moment. My dad appeared and held my hand.

Suddenly we changed gears. They wanted me to push. The nurse said something about if I wanted to avoid a c-section I had to work harder than I ever had in my life. I would not. I could not. I couldn't even get mad. I still felt trapped and powerless. Then I realized that, in fact, I was absolutely powerless over what was happening and what was to come. Theanna said a prayer with me, and then I let go of everything knowing I would be taken care of. I focused on a spot on the floor, blocked everything else out, and, following the cues from the contractions and the voices around me, put every ounce of myself into pushing.

This went on for some time. I could have gone on like that forever. We tried two positions. From time to time Maria or the hospital midwife checked. There was a swelling on the head that was moving down, but the bones of her skull were not passing under the pubic bone. They just bumped up against each other over and over. The hospital midwife said my pushing was stronger than any she had seen in a long time.

About two hours into it, the hospital midwife said it wasn't going to work and recommended a c-section. Maria agreed. I let down my guard and cried. That was it. It was over.

Or was it? Maria said there was one more position we could try. I said I could not do it. I couldn't regroup. The hospital midwife didn't come back. Maybe the hospital had given up. It was just me, Cassie, Theanna and Maria again. I regrouped enough to agree to try three more pushes in the new position just to say I had tried everything. We did more than three, and then Maria checked. She said she thought maybe a little something was happening, but she couldn't really tell. She said that she had a little bit of hope with this position, but that it could be two or three more hours of pushing, maybe two or three hours before we even knew anything. I freaked out. I couldn't go on this roller coaster ride anymore. What to do? "Little Bit of Hope" versus "Two or Three More Hours." I said no. I would not do it. At once, I was wheeled away for a cesarean.

That is the moment. The one I replay in my head over and over. "Little Bit of Hope" versus "Two or Three More Hours." Did I make the right call? I said I would do everything I could. I could have pushed for two or three more hours, couldn't I? Maybe, but I could not accept the idea that we might not know if it would work. My spirit and mind were totally exhausted and overwhelmed by then. Maybe I did the right thing. But I am sad. I cannot believe how terribly sad it makes me. I am starting to move through the feelings of utter failure, but the grief over being cut open is still strong, as is the loss of a vaginal birth, of finishing the experience, of being complete. Not to mention knowing that the possibility of ever having a home birth or even a vaginal delivery in the future is very compromised. I am surprised at the level of grief that I feel, but it is definitely there.
But, on to the good stuff. Within an hour of my decision, little Anna came to us. Her large head was turned the wrong way which explained the mystery of the ineffective pushing. They lowered the curtain at just the right moment so I could see her birth with my own eyes. Suddenly she was actually there, she was real! She cried just like in the movies. Cassie stayed with her at the table where they checked her out, and soon she was on my chest.
People said that any sadness or pain about your birth experience would disappear at the sight of your child. That is absolutely not true, but I do not ruminate on the grief and sadness. It immediately recedes to the corners of my mind at the sight of her. She is completely perfect and beautiful. I am in utter awe and deeply in love, on a cloud like never before. The bliss and joy is like they said it would be -- like nothing else.

As for the cesarean, I think of it as Cesarean Section Homebirth Style. My midwife says that homebirth is a state of mind, and I agree. I received excellent prenatal care which was compassionate and thorough. Every appointment lasted an hour, all of our questions were explored and concerns addressed thoroughly. Through those appointments and our excellent 6 week homebirth preparation class, we learned about every tool available to us at home and at the hospital. My fear of labor and delivery diminished over time and was replaced with confidence and respect. The folks in our class have kept in touch and encouraged each mama, holding her in love and light, as she brought her baby to the other side.

The memories of laboring at home bring me peace and joy. I hear the music and see the sky and sun and feel the soft breezes. I am very proud that I labored for 17 hours without intervention, mostly at home. Those were homebirth moments. My compassionate and dedicated partner was with me every single step of the way. She knew what to do thanks to her homebirth training. My beautiful and supportive friend, Theanna, got into the groove right away. My homebirth midwife was with us to the end guiding us in the ways of homebirth.

I don't see how I would have experienced all this if we had planned a hospital birth. We would have had perfunctory 15 minute prenatal appointments. I understand that many hospital oriented birth prep classes are cursory. We would probably have gone to the hospital early. I would have been given the epidural, pitocin and narcotics early. I may not have even known I had a choice. I would have missed the many hours of uninterrupted, quiet, natural labor at home. As it was, I was able to make informed choices at every turn with the help of my trusted birth team. I chose the epidural, I chose the narcotics, I chose pitocin and ultimately, I chose the cesarean, but only in the moments when I knew it was right for me and my baby. Those were also homebirth moments. I felt completely empowered through the entire process.

So that's my story. It's different than I expected it would be, but it's mine and it's perfect in its own way. And of course, most importantly, we got a beautiful baby girl out of the deal. Somehow we get to keep this little bundle of joy. She's ours! We're parents! The journey has just begun.