The ICAN conference is a unique opportunity for speakers, as it brings both the consumer and the birth professional to learn and grow together. Rising cesarean rates worldwide have sparked rapid growth of ICAN, an all-volunteer, consumer-based organization working to improve maternal-child health.

ICAN’s Conference Committee is assembling an agenda that will appeal to consumers, birth professionals, and birth activists alike. Our goals for the conference are:

* Invoke passion, action and ability in women to change the current childbirth climate.
* Bridge the communication gap between care providers and pregnant women.
* Inform care providers and women of methods for avoiding a cesarean.
*  Encourage women to empower themselves for birth.

ICAN conference attendees and chapter leaders will return home energized to share their information with local moms, birth activists and the general public.  Speakers enjoy increased exposure to their ideas and their organizations and gain opportunities to market their books or products to a highly desirable audience.

If you have special expertise in topics related to pregnancy, birth and/or post-partum issues as it relates to cesarean prevention, cesarean recovery or VBAC support, please consider submitting a proposal following the guidelines in the application.  We want to meet you in St. Louis!

The submission deadline for speaker applications is September 30, 2010.

For additional information, please contact Ruthie Dicken, Speaker Chair, at speakers@ican-online.org

Overall, cesarean deliveries account for about a third of births in the U.S. While much attention has recently focused on women having repeat C-sections, researchers with the National Institutes of Health found that nearly one third of first-time moms delivered by cesarean.

Although several potential reasons were cited, including increased maternal weight and age, one factor stood out. From another article in the LA Times:

The study, released Monday by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, found C-section rates were twice as high after induction of labor compared with women undergoing spontaneous labor. Labor is often induced to speed up labor and delivery.

“Our study cannot directly say induction causes C-section, but it does provide some clue that either people may not be patient enough or something is going on that we’re not really sure about,” said the lead author, Dr. Jun Zhang.

The researchers note that lack of patience may be at issue:

The study showed, not surprisingly, that the major reason for undergoing a cesarean was due to the woman having a prior C-section. Still, almost half of the cesareans that took place after labor had started were due to “failure to progress,” and the study suggests that doctors aren’t acknowledging that labor takes time and doesn’t follow a predictable pattern in women, especially first-time mothers. A high proportion of these C-sections were performed before the women’s cervix had dilated to six centimeters, which is still considered an early stage of labor, and among women who had been in active labor for only two or three hours.

“As long as the maternal and fetal health are doing well in labor, they can wait longer and perhaps decrease the cesarean rate,” said Dr. S. Katherine Laughon, a co-author of the study.

Solutions? What ICAN has advocated for a long, long time:

For C-section rates to fall, more first-time mothers need to delivery vaginally, Zhang said, and more patients should undergo a trial of labor for VBAC, as was recommended recently by the American College of Obstetricians and Gynecologists.

I pushed for two hours, which isn’t too bad compared to the 43-hour marathon labor stories we hear. I was pretty vocal; mostly pissed that there was zero pain-relief from the epidural. I think the contractions were more painful because I had the expectation of pain relief, but since there was none, all I could think about was the pain.

The good part of the epidural not working is that I felt every bit of James leave my body, even his nose. It was pretty amazing. My doctor was yelling encouragement for me to push while he delivered James’s head with one hand and did perineal massage with the other. I felt an intense burning situation and then, holy cow, I had the strongest orgasm I had ever had. I faltered mid-push because, well, I had no expectation of having an orgasm during birth. Who does?? I was embarrassed-orgasms are for the bedroom, not the delivery room.

And she gives a shout-out to ICAN, too:

In closing, I offer a small bit of advice to all women: your body was made, among other things, to have children. You CAN do it, even if you think you can’t. If you prepare for childbirth, educate yourself on breathing and mechanisms to help you deal with the pain ahead of time, labor will be easier. Make this your mantra: “I CAN do it.” You can, you can! For more information on vaginal births after cesarean sections, please check out the International Cesarean Awareness Network.

Congrats, Jennifer! And thanks for sharing your story with the blogosphere…

Although antimicrobial prophylaxis to reduce postoperative maternal infections is already common practice for C-sections, clinicians need to stop waiting until after clamping the umbilical cord to administer them, according to the statement.

According to ACOG, research shows the following benefits:

*  Fewer wound infections (0.6% when given two hours before skin incision versus 1.4% within three hours after incision)
* Significantly lower endometriosis rates (1% when given 15 to 60 minutes before C-section versus 5% after clamping in one trial and 7.8% when given at incision versus 14.8% after clamping in another)
* Significantly lower total postoperative infection rates (4.5% when given 15 to 60 minutes before C-section versus 11.5% after clamping)

Although an additional small randomized trial showed no significant maternal benefit from preoperative antibiotics, it showed no harm.

The statement published by ACOG dismisses concerns about detrimental effects on the baby if antibiotics are given before the umbilical cord is clamped:

Concerns that exposure could have a negative impact on the baby by masking positive bacterial culture results or leading to antibiotic resistant infections are unfounded, the committee concluded.

Randomized trials have shown no difference in rates of neonatal sepsis overall or from resistant organisms or in rate of admission to a neonatal intensive care unit, although all were underpowered to analyze these secondary outcome measures.

In light of these recommendations, birthing women should discuss their concerns and wishes regarding antibiotics given before a cesarean with their care providers.

I was 41 weeks and 5 days along in my pregnancy when I had an OB appointment at Magee (though the OB will argue I was only 40 weeks and 6 days, but that’s another story).  Because I was so far along in my pregnancy and because I had limited fetal movement, they decided to do a non-stress test.  Eli failed, so they sent me downstairs for an ultrasound where the tech found extremely low amniotic fluid.  I was sent back upstairs to my OB’s office to discuss the results.  When the nurse invited me back to Dr. A’s office, I knew something was wrong.  When Dr. A walked in the room, she exclaimed, “So how does October 2nd sound for a birthday?”  My immediate response was, “Today?!?!”  She informed me that my placenta was getting “old” and not producing enough amniotic fluid.  I was to call my husband and then proceed downstairs to be admitted to Labor and Delivery.  Could I stop home and get my bags?, I asked.  No.  I needed to stay put.  My husband was a nervous wreck, sped the whole way from his office in Blawnox to our house, then rushed to Magee.

It turns out there was no need to rush, because when my husband arrived at Magee around 4pm, I was still sitting in the waiting room anxiously waiting to be admitted – all beds were full.  After pestering the admission lady (Dr. A said she wanted me on fetal monitors within the hour), I was admitted to triage around 4:30pm where we sat for 3 grueling hours until a bed opened up at 7:30pm.

Upon being admitted, they inserted an IV for fluids and started the pitocin drip.  I begged for food since I hadn’t eaten since breakfast at 8am.  The nurses adamantly told me no food, but thankfully Dr. A allowed me to order a full dinner – she said it was going to be a long labor and I would need my energy (and boy oh boy was she right).  Since my cervix was completely closed, Dr. A also decided to insert a foley bulb to essentially force my cervix to dilate to 5cm.  She tilted my bed back as far as it would go and I started to feel nauseous while at the same time I tried to keep myself from crying because the pain upon insertion was intense.

I labored like that throughout the night – hooked up to fetal monitors, an IV drip, and pitocin.  I was allowed to walk around, but all the wires would only allow me to move about 5 feet from the bed.  The nurses kept increasing my dose of pitocin, artificially making the contractions stronger and closer together.  Every time a nurse came in the room, she asked if I wanted an epidural, but I politely declined.  I wasn’t allowed to use the bathroom but instead had to use a bed pan.  Around 5am, I needed to relieve myself, but after I was done urinating, fluid still kept coming out and I knew my water had broken.  I told the nurse, but she didn’t believe me because she said there wasn’t enough fluid there.  I asked to be checked and a resident came in, confirming that my water had broken (and confirming that my amniotic fluid was, indeed, extremely low) and informing me that I had dilated to 5cm.  She tugged on the foley bulb and it came out.  Did I want an epidural now???  My husband had slept for maybe 45 minutes that night, but I didn’t get a wink.  I told them I could make it at least another 2 or 3 hours without pain relief, but they said it would certainly be much longer than that before my baby was born.  Considering I had been up for 22 hours at this point, I knew I didn’t have it in me to labor indefinitely, so I asked for the epidural.  And that’s when all hell broke loose.

The epidural went in just fine and brought some pain relief at first.  But an hour or two later, maybe more, I’m not sure…I started having complications.  It was at this point that I lost track of time and couldn’t focus on anything except my own body, so forgive me if the story from here on out seems a bit jumbled.  First my blood pressure started dropping, then the baby’s heart rate started dropping.  Alarms went off, nurses came running in, they gave me oxygen, they flipped me on my left side but that didn’t help.  So they flipped me on my right.  Eventually, somehow, they got the baby’s heart rate to come back up.  This scenario repeated itself at least 3, maybe 4 or 5 or 6 or more times over the course of the next 12 hours.  At some point, they even inserted an internal fetal monitor because it kept happening so often.

Then another complication.  I started to feel dizzy, light-headed, like I was going to pass out.  I was slurring my speech.  I was talking crazy, saying I didn’t want to die.  I told my husband something was wrong.  Very wrong.  My nurse came in, then another nurse, then another…then a resident, then Dr. A, then finally an anesthesiologist.  Everyone was dumbfounded.  Dr. A held my hand and kept telling me that I was fine, I wasn’t going to die.  She also kept telling me I didn’t sound like myself and asked my husband if I had a history of psychiatric issues (ummm…no).  The nurses asked for a dose of epinephrine.  But that didn’t make sense, the anesthesiologist said…my blood pressure was fine.  But they gave me a shot of epi anyway.  Did I feel better now?  No.  Not at all.  They waited a bit.  Did I feel better now?  No.  Not all.  So they gave me another shot of epi.  How about now?  Did I feel better now?  NO!  NOT. AT. ALL.  Finally, the anesthesiologist said they should check my sugar.  The nurses argued but eventually conceded.  When they checked it, it was absurdly low – in the 40’s, I think?  I don’t know.  Like I said, I don’t remember all the details.  But whatever it was, it was so low that they were all shocked I was still conscious.  Dr. A gave me a glass of ginger ale.  Did I feel better now?  Yes, thank goodness!  (See…I TOLD YOU I’m not crazy!)

But alas, this was not the end of complications for me.  The nurses kept increasing my dose of pitocin – hey, I had an epidural and couldn’t feel the contractions, so why not, right?  My contractions were overlapping and I could now feel them in my upper abdomen.  They were so intense that I was panting and screaming and holding onto the bedrail.  The nurse got excited – maybe it’s time to push?  But someone (a resident?  Dr. A?  Like I said, the details are fuzzy) checked me and it was not even close to pushing time.  So they called the anesthesiologist and he gave me another dose of meds, but it didn’t help.  So he gave me another dose, but it still hurt.  So they finally turned the pitocin down.  Ahhh, relief.  For now.

Around 5:30pm (it was the next day now, October 3rd), Dr. A came in and checked me.  I was 8cm.  She said she had to go home – poor girl had been on call since I saw her for my regular OB appointment the day before at 1:30pm!  I complained to her that my back was killing me.  The pain was excruciating.  She said it must have been from lying in the same position for 13 hours – my stubborn child would only allow me to lay on my right side.  If I moved at all, boom!  His heart rate would drop instantly.  So Dr. A, my husband, and I talked at length about a “plan.”  As much as I did NOT want a c-section, I was exhausted in every sense of the word.  I was going on 34 hours without a wink of sleep.  I couldn’t do it much longer.  Ultimately, the decision was that Dr. B (they had to switch shifts) would check me in an hour.  If I had progressed further, I would continue to labor.  If I didn’t progress, I would go in for a c-section.

Well, they switched shifts, Dr. B came in at 6:30pm and checked me.  She said I was 6cm dilated.  SIX?!?!?!  Are you seriously f&*#ing kidding me?!?!?!  Wasn’t I just EIGHT an hour ago!?!?!?  She looked at me and said, very matter of factly, “It’s time for a c-section.”  I was depleted…physically, emotionally.  I was done.  I didn’t have the energy to argue.

So they wheeled me in for the c-section.  It was cold and the lights were bright and I was terrified.  Absolutely terrified.  They strapped my arms to the table and started prepping my naked body…preparing to cut my baby out of my womb.  But once they started cutting, I started screaming.  I could feel it.  I could feel everything.  The anesthesiologist kept asking me, “Pressure or pain?  Do you feel pressure or pain?”  PAIN, I screamed, PAIN!  The anesthesiologist kept saying I shouldn’t feel any pain, just pressure.  I kept screaming.  Finally, after the anesthesiologist kept insisting that I couldn’t feel anything, Dr. B yelled at him and told him, “Well every time I cut her, she keeps screaming!”  A curtain was drawn, so I couldn’t see anything, I couldn’t see when they were cutting me.  He gave me more drugs, but I still felt the surgery.  I felt every minute of it.  At some point, I heard Eli cry.  But I couldn’t even be happy about that because, in all honestly, I couldn’t focus on anything except my body, the pain, and trying to breathe.  As they sewed me up, I asked my husband to stay with me and I didn’t want to see the baby because I still felt like I couldn’t breathe.  Eventually, when they were done putting me back together, a nurse brought the baby over and my husband got to hold him.  I kept asking my husband to hold the baby up because I couldn’t see his face.  When the surgery was over, they put the baby in my arms and wheeled me back to my recovery room.  I was so exhausted and doped up on drugs that I remember asking the nurse to make sure the baby wasn’t going to fall.  I literally, physically, could not hold my own child.

Shortly after arriving in the recovery room, I started hemorrhaging.  A million doctors and nurses came in a flurry.  A resident – her name was Helen, I still wish I could meet her one day and thank her for her kindness – took care of me as I hemorrhaged on and off for the next 4 hours until she finally got the bleeding under control (I still, to this day, don’t know where Dr. B was??).  First she massaged my uterus (did I mention that was incredibly painful after just having had surgery on it?).  Then she gave me some medicine to make my uterus contract.  Then she massaged my uterus again.  The bleeding would stop for awhile, but then it would start again.  She kept saying my uterus was “boggy” and they couldn’t get the bleeding under control.  I kept asking what was going to happen – and they said they may have to do a D&C.  ANOTHER SURGERY?!?!?  Are you kidding me?!?!  At this point I was freaking out.  She said first she was going to try to remove the blood clots – manually.  Wasn’t that going to hurt?  Yes.  They said they could use my epidural for pain relief.  NO!, I barked.  That thing gave me nothing but trouble.  So they gave me morphine.  But the nurse pushed it too fast and it created a terrible pain in my arm (Could I please catch a break here?  Even my pain meds were causing me pain!).  Then she proceeded to do the most God awful thing I could have ever imagined – before I knew it, she was elbow deep inside my uterus, pulling out clots the size of baseballs.  All the while the nurses were trying to tell me to keep my legs open and that if I didn’t, they’d have to do a D&C.  I was told that I gave the most blood curdling screams anyone has ever heard – I’m sure I scared every other birthing mother on the floor that night out of their wits.  I’m not sure how long it took for her to remove all of the clots, but it felt like an eternity.  At one point, I made the mistake of opening my eyes – there was a mirror on the ceiling (intended for birthing mothers) and I saw the entire horrific scene…it looked like a crime scene.  I don’t think I’ll ever get that image out of my mind.

Somehow, eventually, Helen stopped the bleeding for good.  She brought the baby over to me and let me hold him.  And I kept saying, “It’s not fair.  It’s just not fair.  I’m so tired.  I’m soooo tired.  I just want to sleep.”  But she kept telling me, “You’re right, it’s not fair.  But you have a baby.  Look at your baby.  This is what you’re going through all of this for.”  And I started sobbing and kissing him all over his face and his eyes.  I had a baby.  I had a baby.

Around 2am (it was October 4th now), they finally sent me up to the postpartum unit.  I had a baby, but I was exhausted and depleted and doped up on drugs.  And though I swore I would never send my baby to the nursery in the hospital…I sent him to the nursery.  Because I had been up for 43 hours and I had just endured hell and I couldn’t keep my eyes open.  And so I spent the rest of the night in a morphine induced sleep.

And that is how my son was brought into this world.  And that is why I say the day my son was born was the worst day of my life.  I still can’t remember what he looked like in those first hours.  By the time they brought him to me the next morning (October 4th), he was bathed and fed and swaddled and had his hair combed.  He wasn’t the same baby that came out of my womb all messy and bloody and screaming the night before…I’ll never remember that baby, for his memory is forever lost on me.

Your weekly one-stop for highlights from the birth blogosphere. Visit weekly for the latest on childbirth, especially related to cesarean prevention, recovery, and VBAC. To nominate a blog post to be featured here, email me at blog@ican-online.org.

It’s summer and we’re a little slow around the blog lately…but there’s been plenty of good reading in the birth blogosphere. Here’s a sampling:

Patti Ramos posted two stunning images from one family’s cesarean to VBAC journey: This Woman’s Work…(video) and One Mother Two Births Two Years (photo). Informed Parenting wrote a thought-provoking post on birth trauma and violence.  Birthing Beautiful Ideas breaks down the VBAC scare tactic of large babies. Read all her posts on VBAC scare tactics here.  The Unnecessarian tells us what we learn from the growing number of news articles on obesity and the cesarean rate (hint: nothing!).

Ocean, my three year old son, and I came home Friday night from a fun evening of hanging out with Ocean’s cousins, Emma and Andrew.  We had all gone out for pizza and to the duck pond. I had felt pretty darn tired while we were out – I even had to ask Cecily to help me load Ocean into the car, which is normally something I can handle on my own just fine, but that night I felt especially beat. At any rate, when we got home, I went to the bathroom, and when I did I discovered my “mucus plug” had dislodged itself… oh boy! Behold the amazing mucus plug!  This is one of the first signs of labor coming– tho… I also knew it could be very misleading as well. For when I lost my mucus plug with Ocean, it was still about 4-5 days til I actually went into labor with him.

So while I was excited to see a new sign that labor was near, I wasn’t sure what to think exactly – for I had just been through a false labor a couple weeks prior. I felt like the only thing that would make me believe labor was actually happening was if, well… labor was actually happening.  But it was exciting enough to call my friend Mindy and to call my husband, and let them know, but I didn’t even bother the midwife or anyone else.

So I got Ocean into bed, and I pulled out my “what to expect when you’re expecting” book. I had him read his own book that night next to me while I brushed up on the topic of mucus plugs and bloody show. It was kind of nice to have us read our own books together in bed for once. Then I read him one book and shut off the light, and we quickly fell asleep.

I think I woke up around 1am… I was having some contractions, but at the time I wasn’t sure if that was what woke me up or if it was just one of my usual “night wakings”… I went to the bathroom and again discovered more mucusy/bloody show goodness. I noticed my contractions were a bit more “crampy” feeling – almost painful, but not quite. “Annoying” might be a better description than “painful.”

They were “annoying” enough that I finally decided to call the midwife at about 1:30am. I told her about the mucus plug and about my contractions. I hadn’t been up long enough to really time them and get a sense for them, but I figured I’d call her just in case this was enough information to go on. Turns out it wasn’t. She said, in a nice way, “I wish you had timed them before calling…” I felt bad – like I hadn’t done my homework or something. Ah well. I talked with her for about 10 minutes – noting to her when I was having them. They were only lasting about 30 seconds each, and I was able to talk through them with a bit of ease. With that information we figured – well, it might be EARLY labor, but probably not ACTIVE labor yet– as usually you think of active labor when the contractions last for at least a minute and they’re so intense you just can’t talk through them. So she told me to call her back if they start lengthening,  and if they get more painful. I was fine with that proposal, and we hung up.

I puttered around the house, trying to tidy things up a little– just in case I were to have some visitors that night – and at some point, maybe 2am, I realized my contractions were getting in the way of my tidying. They were definitely more annoying – though still not super painful. I called my sister Kathy – I figured at least if it is early labor then she wouldn’t feel too bad about coming out, and she could probably just sleep in the guest room while I waited for this whole “active” labor thing to start. She answered the phone, and was on her way… it was about 2am.

While I waited for Kathy, I walked around and tidied up more (isn’t that what everyone does when they’re in labor?) but eventually I had to stop and only deal with my contractions. I laid down on the daybed in the playroom and worked through them. I still wasn’t entirely convinced they were “painful enough” to call the midwife, which is really rather silly in retrospect. Of course they were. At some point it felt like it had been a while since I had called Kathy, and so I called my friend Ann in case Kathy had gotten delayed somehow.

Ann is my neighbor and happens to be someone I went to grade school with as a child – she and I met in kindergarten – when I was only 4 years old. We hadn’t been in touch with each other since sixth grade, but we  reconnected over Facebook just a few weeks ago. We realized that not only do we both live in Cazenovia now, but we actually live on the same street in Cazenovia – to boot, only about 6 or 7 houses down from each  other! So we’ve been hanging out a bit since then, reconnecting and becoming friends, and in all of this reconnecting, she offered to come help with the labor somehow. So I had planned to call her when I felt like it was actually happening, and it seemed the time had come, so I called her and told her I needed her now. She headed right over.

In the meantime, I set up a little “camp” for myself in the back bathroom. I had been feeling nauseous and thought it’d be a good idea to be near a toilet.  Between a contraction, I used that brief time to quickly lay out a bunch of towels out on the floor and I made a pseudo-pillow for myself out of a stack of towels as well. I turned on the little space heater, laid down on my left side just in time for my next contraction. Then I just “dealt” with my oncoming contractions. I would have gotten an actual pillow and the “right” towels – a stack I had gotten specifically for the labor – but it was all I had to just even set up this little space as it was.

I think Kathy and Ann arrived around the same time. Kathy, I think, got there first. I told her right away to call the midwife – as by then, sprawled on the bathroom floor, I was convinced this was definitely “real” labor, timing or no timing…for the contractions were actually giving me the shakes all over, and I couldn’t talk or even handle anyone touching me during them. I would have called her the midwife before that, but it was all my energy just setting up my little labor-space in the bathroom.

At this point you should know that I wasn’t at all concerned that the midwife might not have enough time to get here even though she lived over an hour away.  Seriously I was still more worried about her coming too early.  See, my first labor with Ocean was 43 hours long – and that’s only counting “Active” labor!  It was crazy. Now I know they say your second labor is shorter than your first typically, so I was prepared/braced for a “normal” labor of like 24 hours. Even something like an 8 or 10 hour labor would have been a blessing – and of course  that would be plenty of time for the midwife to get here – since I had just begun labor a couple of hours earlier. Oh how happy I am that I was wrong in estimating how long this labor would be…

Well, at this point it was a little after 3am…and now the midwife was on her way, and Kathy and Ann asked what they could do to help. Since I didn’t really want them touching me (no massaging or rubbing or anything), nor did I even want them talking to me (no “you’re doing great…” cheers) I really just wanted to be alone for the most part, so I sent them off to blow up this kiddie pool I had bought to possibly do a water birth in. I should have blown it up days earlier, but I figured since my labor would probably be 20 some odd hours, that should be enough time to get it blown up and filled up for the delivery. So they went off to deal with that project and periodically walked by the bathroom to check on me. They said later that I looked so calm and quiet in there that they assumed I had fallen asleep on the floor.

Not quite.

So there I was in the bathroom. I was laying on my left side facing away from the door. It was the most comfortable position for some reason. When a contraction would come on, I would say – either outloud quietly or in my head – “OPEN ….OPEN… OPEN” and I’d visualize in my head the contraction opening up the passage for the baby to come through. Sometimes I’d hold perfectly still through the contraction – on purpose, almost just to see if I could – and sometimes with that I’d start shaking all over my body – like a shiver when you’re cold only way more shaky. Those contractions are very powerful. Interestingly I found that the amount of pain I had while holding still was pretty much the same as when I moved around during it, and somehow holding still was actually more calming to me – and it definitely conserved more energy at least. This is probably why my sister and friend had thought I had fallen asleep – I was just holding so still during them and trying to relax myself as much as possible. I went deep into my head, visualizing an opening and repeating “open open open” to myself.

Sometimes during some contractions I’d pull up/open one of my legs with my arm. I’d say OPEN…and just in a sense “wish” that by this opening of my legs up and pulling upward in that way, I was somehow encouraging the baby to come through my legs – sort of like – “Here – I’ll make some room for you – just come out this way….”

It was during this time that I somehow got the impression that I wanted to push the baby out. I was so focused on opening and visualizing that I started to feel like I wanted to REALLY help the baby get out and thus I wanted to just start bearing down and pushing him out.

Intellectually I thought to myself – “No…no… it’s WAAAY too early to start any kind of pushing… “ for I knew that if you push when it’s too early, you could possibly be making things worse…thinking of people who pushed prematurely only to swell up their cervix and make it even harder/longer to get the baby out.

But boy, I really wanted to. I mean, I could tell I didn’t have to push…it wasn’t like my body was demanding it in an unstoppable way…. but the desire was definitely there.

My mind drifted to this farm nearby. I had just been there a few days earlier and had learned that a new calf had been born. I asked my friend, the farmer, about how the cow gave birth – what was her labor like? He said it was really fast – that he had left her alone for a little bit to go up to the house to get something, and when he  came back, there she was – licking her newborn. I thought to myself at the time, “see- she just wanted to be left alone, given some privacy, so she could finish it up….”

So there…laying on the floor debating with myself whether or not to push, I thought, “Well, what would the cow do? Would the cow start pushing?” I thought – the cow would DEFINITLY start pushing. She wasn’t going to wait for the farmer midwife to arrive back to check her to tell her it was OK to push, she would just fricking push. So – I put my reservations aside and gave myself permission to do whatever felt right even if it seemed to make no sense. For how could I be in the push phase – I had only been in labor a couple of hours!

But I thought of the cow, and every time I got a contraction, I’d feel this point where I’d want to push right along with it, and so I did. After doing this a couple times, I felt down by my vagina to see if perhaps anything was actually happening down there. I felt a lot of mucusy gook, which I wasn’t quite sure what to make of… “was that just coming out anyway? Was it coming out as a result of the pushing?” I wiped it off on a towel and kept going.

I would get a contraction, and about 10-15 seconds into it, I’d, in a sense, “hear my turn” being called, and I would step up and start pushing/bearing down as hard as I could, whatever felt best… It was like one of those songs like “row row row your boat” – where the contraction would start the song, and I’d chime in a bit after it started with my own part, for there would be a definite spot in the contraction where I’d feel it was “my turn.”

After a few of these “melodies” I felt again at my vagina during the break between contractions to see if anything was happening. And one time – I ventured in a little with my finger (I know – gross!) and OH MY GOD – there was actually something solid in my vagina – the baby was RIGHT there – he made it past my cervix, into the vagina, and, wow – we really were in the “push phase” of labor after all!  The cow was right….

Now you’d think I’d call for my sister and Ann at this point, but – well, I know this sounds nuts, but I didn’t WANT to. I felt like I was onto something here, and was making progress, and I didn’t want to stop or interrupt any of it to explain what the heck I was doing or what was happening. I didn’t even know if I could explain what was happening, I was so involved with it at that point. I just wanted to DO it. So I kept right on going. I kept singing that melody with my body – pushing when it was my turn to push, now fully confident that my pushes were doing something. Knowing that each push was doing something somehow made them a little less painful.  With each one, I’d feel with my hand what was happening “down there”… and was excited to feel how each push was pushing him a little closer and closer to the exit. Eventually I could feel him emerging – and as he would come out a little bit, and then receed back in…. and at some point I realized he was still in his water sack – that is, the water hadn’t broken yet at all. Feeling him with my hand, it felt like a tight water balloon was emerging from me.

At this point, it was probably about 4:30am. I was pushing pushing pushing, and the head was almost all the way out, so I knew I had to be careful at this point – for if I went to rough or too fast with a push I could very well damage myself and create a rip.  So I would push and feel carefully with my hand what was happening – how open I was, where the baby’s head was, etc. I even tried to push gentley around the opening with my fingers to ease the head out – using kind of a counter-pressure on it.  It was very tricky – considering I couldn’t even see anything down there past my big belly, and I could barely reach it as it was. I’d push a little, feel a little, push a little… then the contraction would end, and I’d take my little break and wait for the “song” to begin again in a few moments.

Finally, with a push, the head came through completely, and I knew this was the end of the road. Somehow I could tell I had just one more push and the baby would be here. I needed someone to catch him. “HELLLLLLLP!!” I called for Ann and Kathy. I heard them both running from the other room, and I sort of smiled to myself knowing they were in for a BIG shock when they’d arrive. “HOLY SHIT” was what I heard Kathy say…and she’s not one to swear very often!   I told her I needed her to get in there and catch the baby, for I was going to push it out shortly. Kathy didn’t hesitate for a moment and got right in there and kneeled down and gently held the baby’s head. Ann got on the phone to 911 and whipped out her camera. Amazingly Ann took pictures AND relayed all the info from 911 to Kathy. It was nutty. I have no idea how she did that.  At some point when Kathy touched the baby or maybe as I pushed him out, the bag of water finally broke, and I heard and felt the gush of it while the baby slid right out in the stream. I remember telling Kathy not to pull the baby – I was afraid she thought she should pull him out or something, but she didn’t of course. She was extremely gentle.

Once he was out, I told Kathy to just put him on my stomach and cover him with a towel. DONE. Now where’s that midwife?

Ann, in the meantime was still on the phone with 911 and still relaying any instructions from them to Kathy – how to make sure the baby was breathing, etc. Kathy wiped his nose and mouth, and cleared any mucus from there. He was breathing fine…he had let out a little “squak” upon emerging and was now quietly resting on my belly, taking it all in. I was quietly resting on my back – taking it all in as well. Kathy mentioned later to me that anytime I spoke, the baby would raise his eyes up at me – as if he recognized my voice in particular, which, yea, he probably did.

A few moments later the 911 folks arrived – two very nice men – and started checking my blood pressure and things like that. They wrote on clipboards and joked with Kathy and Ann. It was clear that all was well – they could see that both baby and I were fine, and we knew the midwife would be there any second now. We made it clear to them we did not want to go to the hospital, which I think surprised them, but they were fine with that since everything was looking good and the midwife arrived shortly after them.

To be perfectly honest, I felt like she arrived at the perfect time. I was still laying on the floor, Forest on my belly, still contracting a little – for the placenta still needed to be delivered as well. She helped me with all of that. She clamped off the cord and cut it, helped me do my final push to get the placenta out, and she massaged my belly to get my uterus to tighten up.  I liked that she was there for all the “cleanup” but that she was out of the way for the whole delivery.  I know that sounds rather crazy, but what can I say?  I am a do-it-yourself kind of person.

After all the cleanup, I got up and took a quick shower in the tub next to where I had just given birth– I looked like a giant bloody mucusy mess from the waist down. Kathy and Ann took turns holding baby Forest while I got cleaned up.

I was beaming the whole time in the shower… Can I say – I’ve never been prouder of myself in my life. I did it. I did it.. I did it! I wanted to do a little dance.  I was also just SO incredibly relieved that it was all over… the wait was over…the wondering if everything would be OK was over… and best of all -the pain – oh the pain of labor was over.  And it didn’t last for two days this time…it was only about 3 hours!  I felt like I had won the lottery!

The rest of the night/morning was spent bonding with Forest and doing some procedural things with the midwife – like weighing him, measuring him, etc. I nursed him a little and he latched on great. He was so calm  and alert – barely cried at all the whole morning. I myself felt fantastic  –and the midwife happily reported I had only one very very minor tear from the whole thing, and not enough to warrant any stitches or anything. All that careful pushing paid off…phew.

Ocean…where was Ocean during all this? Asleep. Ocean slept through the whole ordeal. Even when the ambulance people arrived, he kept right on sleeping – for their arrival was probably the noisiest part of the night. At about 8am, Ocean wandered out of his room to find me. I was in the guest bedroom snuggled up with Forest. I told Ocean I had the baby while he was sleeping – and I invited him up on the bed to meet him. I unwrapped Forest a bit to show Ocean what he looked like, and Ocean immediately went for his foot and started to gently tickle him, saying “coochie, coochie coooooo…” I just about died from cuteness overload. Ocean gave him some kisses and tickled his feet some more. It was a perfect little first meeting….

Photo credit: Birgit Amadori

Have you contacted your local hospitals and OB providers yet to ask about their practices in light of ACOG’s new VBAC recommendations?

Stephanie Windgardner in Sioux City, Iowa has. She shares:

My [OB] office previously stated the ACOG guidelines as why I could not try for a VBAC with my next child. Since the guidelines changed, I emailed to see if their standard of care was going to change along with them. Here is my email to them, their reply, and after what they replied, I felt the need to reply back to them- just want to get awareness out there that in my city (Sioux City, Iowa) and the tri-state area of Nebraska, Iowa, and South Dakota, that there are two hospitals, and two OB offices, none of which will “allow” or attend VBAC. I will be going to Omaha or Sioux Falls when I have my next child likely, so that I can have a chance at VBAC! This is a good hour and a half drive for me.

Here is part of Stephanie’s first email to her OB’s office:

After a lot of research and other opinions, I have decided I want to pursue a VBAC with my next child. I am not pregnant yet, but my husband and I plan to begin trying to conceive early next year.

After the release recently of the new ACOG guidelines, I was curious if the physicians in your office would be taking on VBAC patients. I see on your website your practice seems to follow all of the ACOG guidelines, and refer to them for more information.

I really appreciate any information you can give me. If VBAC is not an option…then I want to seek out other options before my yearly check up this fall, so that I can become familiar with a new doctor.

Thank you for your time.

Stephanie Winegardner

And here is her OB office’s reply:

Good afternoon Stephanie, we hope your having a great day.  I wanted to let you know that our office and the two hospitals in town do not do VBAC’s.  I am very sorry that you had a horrible experience with your last child and we would be more then glad to see you but you would have to have another c-section.

If we can be of any more help, please let us know.

Thanks

Unsatisfied with this response, Stephanie wrote one more email, asking her OB’s office why they won’t be changing their standard of care in line with ACOG’s new guidelines. As of today, she has not heard anything back.

Kudos to Stephanie for taking a mother-sized step toward better maternity care in he community. If you have contacted your hospitals or OB practices since ACOG’s recommendations, share your stories with us!

To find out what hospital policies are in your area, check ICAN’s VBAC Policy Database.

Your weekly one-stop for highlights from the birth blogosphere. Visit weekly for the latest on childbirth, especially related to cesarean prevention, recovery, and VBAC. To nominate a blog post to be featured here, email me at blog@ican-online.org.

How is it possible the summer is flying by so fast???

The National Advocates of Pregnant Women posted on their blog this week that the Appellate Division of the Superior Court of New Jersey has ruled in favor of  a mother who gave birth to a healthy baby vaginally but had the baby removed from her custody for refusing a cesarean.  Check the blog post for all the details. ICAN is one of many organizations who signed an amicus brief in support of the mother’s case.

Childbirth Today linked to a nifty handout from Childbirth Connection comparing the 2004 ACOG VBAC practice bulletin with the  new one released last month.

Kelli Haywood at Birth True recently presented a Cesarean Awareness Radio Documentary on a local radio station in Kentucky. Listen to the documentary here.

Indie Birth posted some thought-provoking questions on what’s really keeping women from home birth. These questions would be good to ask yourself no matter where you decide to give birth.

Your weekly one-stop for highlights from the birth blogosphere. Visit weekly for the latest on childbirth, especially related to cesarean prevention, recovery, and VBAC. To nominate a blog post to be featured here, email me at blog@ican-online.org.

Birthing Beautiful Ideas is on a roll, with another great post this week, this time on the pros and cons of birth plans.

Molly at Citizens for Midwifery shares a thoughtful reflection on why it’s important to care about birth, even if many birthing women don’t seem to.

Kathleen Kendall-Tackett takes on the question of whether telling women not to breastfeed overnight is good advice in combating postpartum depression on Science & Sensibility.

Finally, Patti Ramos posted this beautiful picture of the birth of a father.