My Visit with Abigail (midwife for Eva's birth)

I had a great visit with Abigail. She was so open and easy to talk to and she filled in most of the blanks I had about Eva's birth, and about childbirth in general.

She was running a little late so she gave me my chart to flip through, which was fun and interesting, and it gave me some time to make notes.

Here are some details of our discussion:

When my water broke during my labour with Eva, it was bright red with a tinge of green. I would have thought that would be alarming since bleeding can indicate placental abruption. So I was curious to know whether she was alarmed, since I didn't sense any concern about it. She explained that assuming the bleeding doesn't continue (and it didn't in my case) and especially if it's not accompanied by non-labour-related pain (which mine wasn't), it would be considered 'bloody show' and quite normal. The green was meconium (Eva poop) but it was thin and not a big problem. Probably by the time I got to the hospital and saw her my waters were clear or just tinged with thin mec and so there was no need for alarm.

I arrived at the hospital at 9am at 5cms, and by 4pm I was 6-7cms and my contractions were spacing out. She consulted with the OB on call and they started a pitocin drip. She said the hospital standards are to set up 5mu in a 500mL IV and set the drip at 1mu. Twenty to thirty minutes later if no change had been noted the drip would have been upped to 3mu, and so on. My records weren't clear about exactly how much I was given, but as I recall it didn't take much before things really got moving. The doctor's notes were that fetal heart tones were normal, reactive with variations, it was an average sized baby, my pelvis was adequate, baby was vertex occiput anterior, head not moulded and no caput (scalp swelling). His assessment was uterine dystocia and he recommended augmentation and analgesia as necessary. In retrospect Abigail still felt like it was absolutely the right call.

Eva was born 4 hours later. I pushed for 20 minutes. The placenta was came along spontaneously 8 minutes after Eva did. Abigail gave me 5mu pitocin 1 minute after that. She gave me the pit because I had been given pit during labour. Blood loss was within the normal range. Eva had apgar scores of 8 and 9 (or possibly 9 and 9). She weighed 3621g/8lbs. I had a second degree tear. Eva received an IM shot of vitamin K. Micah was born after 9 minutes of pushing. Sari gave me 5mu pitocin 1 minute after he was born. The placenta was born 3 minutes after that. She gave me the pitocin because she prefers to be proactive vs reactive. Blood loss was in the normal range. Micah had apgar scores of 9 and 9. He weighed 4089g/9lbs. I had a small labial tear. I recall Sari saying that it wouldn't have needed any stitches except that it was bleeding. Micah received an IM shot of 5mu of vitamin K.

I asked about using doppler to monitor fetal heart tones and she felt like it is the best way to go during labour. She said it's hard to hear with a fetoscope and really listen for variations while mom is labouring. She felt like intermittent auscultation monitoring about every 15-20 minutes gives a good feel for how baby is doing. I learned that not only is it concerning if baby's heart rate decreases dramatically, but also if heart rate is not variable. A flat heart rate could indicate that baby is conserving energy because of distress.

I mentioned that my blood loss with both kids was in the normal range (<500mL). Risk factors for post partum hemmorhage are: previous PPH, prolonged rupture of membranes, fast labour, large baby. I am planning to decline postpartum pitocin injection with this birth- as long as there is no substantial blood loss- and I asked Abigail her opinion of that. She thought that considering how quickly the placenta came along after my babies and that my previous blood loss was in the normal range, it would probably be fine to decline.

I asked about being GBS positive. She brought up something I hadn't considered. In her opinion it's harder on the baby to receive antibiotics as a newborn than it would be to receive them via the placenta while in utero. Ok, now I'm praying even harder that I'm GBS negative.

I asked about the WinRho/Rhogam shot as it relates to delayed cord clamping and she said that many birth attendants prefer to clamp on the early side with an Rh- mother because they want to make sure they can get a good enough size and quality sample of cord blood to send to the lab. Abigail said that she has experience in finding/using just the right vessel to access in the placenta so that even with delayed clamping she doesn't have a problem getting a good sample. Interesting. Also if this next baby's placenta comes along as quickly after baby there should be no problem getting a good quality blood sample. She didn't see any risk to the baby or to me related to delaying the cord clamp. As far as declining the prenatal WinRho/Rhogam shot, she wasn't too enthusiastic about passing it by. I look forward to reading the book I ordered so I can make the best informed decision about this. I hope I get it before we leave to go home to Mexico, because already my 28 week shot is pushed out to at least 33 weeks which is when I get back.

The other thing we discussed was vitamin K. Hemorrhagic disease of the newborn comes on quickly and can in rare cases cause severe brain damage. In fact, one of her colleagues has a baby who ended up nearly brain dead as a result of this disease. I had read that there had been a study linking vitamin K administration to childhood leukemia, and she said that there were a number of studies done after that one. None of them were able to reproduce the results and therefore that study is now considered invalid. I just did a Google search and found a recently released joint position statement of the Fetus and Newborn Committee, Canadian Paediatric Society (CPS), and the Committee on Child and Adolescent Health, College of Family Physicians of Canada. It mentions that the study linking vit k to cancer had been discredited, and strongly recommends an IM shot within the first 6 hours of life.

I was leaning away from giving this shot but now I'm leaning back toward it. It really bothers me that the routine administration of this shot kind of assumes that God forgot to take care of something somewhere along the way. Seems to me he would have made sure that baby has exactly what it needs when it's born. But maybe it's not about the baby missing something by design, maybe it has something to do with the food or air or water that we mothers are exposed to or choose to ingest which causes there to be a deficiency or imbalance. That wouldn't be so surprising.

I asked how she felt about the idea of not doing any cervical checks during labour. It was not a big deal to her. I think many or most mothers like to hear about their progress. She does often like to check right before pushing to make sure there's not a cervical lip. I saw first hand at Tara's birth that a birth can go very smoothly without a check at prior to pushing. She thought that a check would also give the birth attendant time to prepare him or herself for the imminent birth. Again, with Tara, it was pretty clear that birth was imminent. But of course that's only one birth. My plan is to hold off pushing until my body absolutely won't take no for an answer, and I plan to catch the baby myself (or perhaps Andrew will!) so I think that declining exams during our upcoming birth is a fairly reasonable request. Again assuming things move along smoothly.

We talked about Micah's birth a little and she described it as a "textbook 2nd birth". She said in many cases the third is very much like the second, though it does happen that it is much harder than the first. I had heard anecdotes about the third birth being kind of a wild card so while I am hoping and planning for a beautifully smooth birth I recognize that things don't always go as we hope and plan and I accept that. I am grateful to have expertise and resources available should they be needed.

See my comment on the previous post for followup thoughts about my big bump.

Doctor Visit

I saw Dr. Lopez today. All is well. Blood pressure 100/60, heart rate 67, no edema, reflexes good. He palpated and listened for the heartbeat with a pinard horn (see photo)! Baby's was running at 158. Was head up and pointing to my right today.

I asked what he thought of my birth plan and he said again that it's all good and whatever I want is good with him. But then something else we talked about made me realize that he hasn't actually looked at it yet. Once I get back from Canada we'll have a meeting with him, the doula and the two pediatricians we would like to have on call, and work through any concerns.

He wrote me letters confirming my weeks gestation and health in case the airline requires them. And that's it til I get back!

Today I also had a terrific conversation with Abigail, our midwife for Eva's birth. Still four and a half years later she remembers so much about us and the birth itself! She is going to request the hospital records so we can go through all the details of Eva's birth. I think it will be so interesting!! We did talk a little about it. Suctioning is not something she does routinely so she probably didn't suction Eva and cord cutting is not something she rushes so it probably didn't happen until a little while after Eva was born. I'm so pleased to know that Eva got her full complement of blood! Andrew and I were talking about the kids' births the other day and while he doesn't remember a lot of the details he does remember noticing just how gentle both Abigail and Sari were with the babies. Makes me feel so happy to know they were treated so gently and respectfully. I have been so blessed!!

Another interesting thing is that she is on the committee for the birth centre that is going up in south Winnipeg. I gave her my email and asked her to keep me in the loop. They will definitely need a childbirth educator so there's an employment opportunity! ;)