Home birth with midwife as safe as hospital birth

Updated Mon. Aug. 31 2009 12:51 PM ET
CTV.ca News Staff

Giving birth at home with a midwife present is as safe as a hospital delivery accompanied by a doctor, suggests a new Canadian study, which found home births were associated with fewer adverse outcomes for both mother and baby.

The study, published Monday in the Canadian Medical Association Journal, analyzed nearly 2,900 planned home births in British Columbia that were attended by regulated midwives, more than 4,700 planned hospital births attended by the same midwives and more than 5,300 hospital births attended by physicians.

The research found that women who had a planned home birth had a lower risk of having to undergo obstetric interventions such as electronic fetal monitoring, epidural, assisted vaginal delivery and caesarean section, and adverse outcomes such as hemorrhage and infection.
The babies born at home were also less likely to suffer birth trauma, require resuscitation at birth and less likely to have meconium aspiration, where they inhale a mixture of their feces and amniotic fluid.

The perinatal death rate per 1,000 births was also low across all three groups.
"The decision to plan a birth attended by a registered midwife at home versus in hospital was associated with very low and comparable rates of perinatal death," the authors said. "Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician."

The findings add to the ongoing debate about the safety of home births. According to the study, research from North America, the United Kingdom, Europe, Australia and New Zealand has not found a link between planned home births and an increased risk of complications.
However, the Canadian researchers say these studies are limited by problems such as incomplete data, non-representative sampling and the inclusion of unplanned home births.
A number of professional medical bodies, including the American, Australian and New Zealand Colleges of Obstetricians and Gynaecologists oppose home births, while the Royal College of Obstetrics and Gynaecologists in the U.K. supports home birth.

The Society of Obstetricians and Gynaecologists of Canada has recommended research into the safety of every birth setting, as is the case with this study.

The researchers say this study does not explain why home birth is linked to fewer complications -- for example, if environmental factors in the home reduce the risks.

The researchers also "do not underestimate the degree of self-selection that takes place in a population of women choosing home birth," which they speculate may be an important component for risk management.

But the findings will help other researchers who study the safety of home births.
"Our population rate of less than 1 perinatal death per 1,000 births may serve as a benchmark to other jurisdictions as they evaluate their home birth programs," the authors conclude.

MELISSA JOAN HART ON MYBESTBIRTH

Posted by Kim
Email received from Business of Being Born Facebook Group

Next week, we continue our celebrity webisode series with TV and film actress Melissa Joan Hart. We loved our interview with Melissa Joan because her two birth experiences mirror so many women that we hear from across the country.

Her first child was induced without any medical reason: “I was ready to just get my baby out and get my life going because I had been thinking about it for so long,” she said. What followed was a difficult labor that lasted 24 hours. It took several attempts before the epidural was administered correctly. Melissa’s doctor used a vacuum to assist. “There were three hours of pushing with my doctor saying, ‘One more push and you’re going for a C-section.’ I did whatever the doctors and nurses wanted me to do.” Melissa believes that her first son, Mason, just wasn’t ready to be born at the time she was induced. “I think he would have stayed in there another two weeks. I was mentally ready to have the baby, and because it was my first, I wanted to be done with it and have that experience,” she said.

When Melissa was pregnant with her second child, she wanted to do things differently. At a friend’s recommendation, Melissa enrolled in hypnobirthing classes where she learned relaxation and visualization techniques. “What I took away from hypnobirthing was the idea that you don’t have to be a good patient. You don’t have to do what the doctors and nurses tell you to do. They want to make it pain-free for you, and as easy as possible for them and for you. And they want to make you comfortable. But in hypnobirthing they teach you that birth is not a medical experience, and you have every right to bring the baby into the world however you want to, unless there’s an emergency.”

To hear how Melissa Joan’s second birth turned out, tune into mybestbirth.com next week! Melissa Joan’s story is being sponsored by our good friends at Milkalicious.

More Women Should Endure Labour Pains Says Leading UK Midwife

Posted by Kim
As written by Catharine Paddock, PhD for Medical News Today

A leading UK authority on midwifery told a Sunday newspaper that more women should experience the natural pains of labour unaided by epidurals and other pain-relieving medication because not only do these procedures carry greater medical risk but they interfere with the mother's ability to bond with her baby and deny her the opportunity to experience childbirth as a rite of passage.

According to an article in the Observer newspaper yesterday, Dr Denis Walsh, a senior midwife, published author on natural childbirth, and an associate professor in midwifery at Nottingham University, said that:

"In the west it has never been safer to have a baby, yet it appears that women have never been more frightened of the processes."

"More women should be prepared to withstand pain," he said, explaining that labour pain has a purpose, it is a "useful thing", with a number of benefits, including:

"Preparing a mother for the responsibility of nurturing a newborn baby."

He said nowadays hospital staff are too quick to offer pain relief, and argues that the 'epidural epidemic' should give way to yoga, hypnosis and birthing pools. Walsh criticizes the rising trend of pain free labour in a paper in Evidence Based Midwifery, a journal published by the Royal College of Midwives (RCM).

He said the number of women giving birth in the UK who have an epidural has nearly doubled from 17 per cent in 1989-1990 to 33 per cent in 2007 -2008. This was in spite of increased medical risks associated with epidurals, including a greater chance that the baby's head will be in the wrong place, lower rates of breastfeeding, and longer first and second stages of labour, he added.

Walsh told the Sunday paper that normal childbirth was receding in the face of a rising "antipathy to childbirth pain" that has grown in the last 20 years. Doctors and medical staff are more risk averse, and the idea of patients' rights have combined to create a situation where nearly all hospitals now offer epidurals "on demand" even though this may not be the best thing for mother and baby, he said.

Walsh supports an approach that he calls "working with pain" that he wants the NHS to adopt and move away from the idea that pain relief should be routine. Pain is a natural part of labour and such an approach would see women being offered yoga, hypnosis, massage and birthing pools as ways to work with and alleviate the pain, he said.

Walsh is of the view that there has been a shift toward viewing the pain and stress of labour as a negative thing rather than a natural process, a "rite of passage" in a woman's transition to motherhood.

According to Walsh, there is evidence than 1 in 5 women who are given epidurals don't need them, while recent research shows that normal labour helps a woman's brain prepare effectively for bonding in a way that is better than caesarean or pain-free birth.

Mary Newburn of the parenting charity National Childbirth Trust, told the Observer that Walsh's comments were timely. She said now that 93 per cent of births happen in hospital as opposed to at home has helped to fuel the "epidural culture". She said there should be more antenatal education and birth centres run by midwives.

But Sally Russell who co-founded the Netmums website described Walsh's comments as "absolute rubbish" and unhelpful to women who needed pain relief. She said women who for whatever reason can't go through normal birth will feel "stigmatized" by his comments and "made to feel they have let themselves down because there's such pressure to have a normal birth".

A senior obstetrician and gynaecologist at Birmingham Women's Hospital, Dr Justin Clark, agreed. He told the Observer that it was "wrong to suggest that modern women are somehow less stoical than in the past", and that Walsh was exaggerating the risks of epidurals. He said they were almost always a necessary and good thing, for instance if the woman gets tired or there are complications.

However, the general secretary of the RCM, Cathy Warwick, said there would be fewer epidurals if the NHS did more to support mothers in labour who ask for pain relief because they are anxious at not getting the one to one support they need from a midwife.

In 2005 the RCM launched a UK-wide Campaign for Normal Birth which aims to inspire and support normal birth practice among midwives and is underpinned by the RCM philosophy that pregnancy and birth are normal physiological processes, and that there should be a positive reduction in unnecessary medicalisation.

-- Evidence Based Midwifery

Birth Story - Griffin's Birth

Posted by Kim:

Below is the story of my second son, Griffin's, birth as written in my birth journal. Enjoy

2/11/05

Written by Mommy:

Well today is the big day! Hopefully our second little guy will be born on Uncle Will's Birthday! We scheduled our labor to be induced today because Griffin is growing at a healthy rate (possibly 3 lbs more than Connor's birth weight) and also this way our friends knew when to expect Connor to come over and play. It is a little bit difficult not to have family in the area.

** The decision to induce Griffin's birth is something I have regretted since. Convenience is not a good enough excuse, but I also remember being very tired of being pregnant. I only wish I had held out for my labor to start naturally, but I can't change that now. It is what it is. **

We weren't sure if you would be born today. At 5am we received a phone call from the birthplace saying that they were full with birthing mothers and we might not be able to come in, but call back at 8am to check. I could barely wait! At 7:58am I called and the girl who answered said we probably won't be coming in (why didn't I see this as a sign?). Then after waiting on hold for what seemed like 30 minutes, but was probably 3, she said "Can you com in at 8:30am?" I was so surprised it must be the closest feeling I have ever had to the surprise of natural childbirth. So we quickly got ready, packed Connor's bag, and umped in the car. Dad dropped me off at the hospital and said "OK call me when you're ready to have a baby. I'll be back to pick you up." Ha Ha, who is the funny guy? Dad then took Connor over to Aunt Kathy's house to play.

I went up to the birthplace and checked into room 2105. The first thing I do is change into the birthing skirt my friend Carri gave me as a present and a jog bra. Daddy arrived soon after and started shooting video right away. Now that he has become a video editor extraordinaire he looks at shooting video in a whole new light! My goal is to give birth to you by 6pm. We'll see how things go.

Written by Daddy:

Here's Daddy! Connor and I dropped Mommy off at 8:45am at LUH and told her to give us a call if she needed anything, its boys day out! Ha, not really. After dropping Mom off Connor went to visit Aunt Kathy for the day. Everyone was anxiously awaiting Connor's arrival for a day of cars and trains. I arrived at LUH at 9:15am to coach baby Griffin into the world. We're in room 2105 this year and we've got a much better view this time, we can see snow covered Long's Peak from our room. I started with casual photography and video to capture the scene. At 10:30am pitocin starts, the fun begins. So far so good, Dr Finnegan stopped by at 12:30pm, 3 to 4 cm dilated and he broke Mommy's bag of water at 12:45pm. While anxiously awaiting Griffin's arrival we listened to the Birth Day and U2 CDs we made and watched Old School. 2:30pm Epidural time. The epidural seems to have been slower to take effect, but by 3:15pm we seem to have a good block. Kim is about 7cm now. 4:10pm Dr Finnegan stops by and Kim is about 9cm dilated now.

Written by Mommy:

Our first nurse is Elaine and she is quite nice. She is from Alberta, Canada and we talked a lot about Toronto and how beautiful it is there. Elaine starts the pitocin around 10:30am and she said it will take about 3-5 minutes before my body will react to the iv. Unfortunately the contractions do not start as quickly as I had hoped, but there are a few.

Around 12:30pm Dr Finnegan stopped over and broke my bag of water. I am only dilated to about 3 1/2 or 4 cms, but he said this should really get my contractions going. Unfortunately this is not true, but I am definitely having more contractions than before. I work through the contractions while watching Old School. You can't help but laugh through the contractions.

Around 2:30pm I decide it is time to get up , use the bathroom and prepare for the epidural. For some reason I have to take a pepcid pill with an Alka Seltzer chaser. I don't remember doing that before, but then again, everything about your pregnancy, labor and birth has been totally different than Connor's. You are your own man. The Dr finally arrives after Elaine checks me and says that I am 7cm dilated. I am so surprised because the contractions at 7cms with you seem about 1/2 as bad as the contractions I had with Connor at 4cms, and they are in a totally different location. My contractions with you are at the top of my belly pushing you down. My goal is to deliver you by 6pm.

After getting the Epidural everything calms down. I am actually a little tired and feel like I could fall asleep. however, by 4:00pm I am completely dilated but you seem to be in a long sleep period and the contractions are not regular. Elaine is going to call Dr Finnegan and see what we should do. She thinks we should turn down the epidural and turn up the pitocin. So that is what we are going to do.

By 6pm the contractions are regular and I have regained a lot of feeling in my lower body because the Epidural has been turned off. At this time Elaine leaves and Suzy becomes our pushing coach. She and Daddy start to urge me on and hope that you will be born before Suzy has to leave at 7:00pm. For a while even Dr Finnegan was in the room to hold my leg. They kept telling me to push down and I thought that was what I was doing, but I guess not because you were not moving much.

Suzy leaves at 7:00pm and Joyce takes over and the pushing remains the same. Wither you are stuck or I am a terrible pusher. Unfortunately I think it is the latter of the two. Daddy is being so helpful because by now the Epidural has completely worn off and it is pretty painful. Because I don't seem to be pushing well I ask Joyce to get out the mirror so I can see what is going on myself. I figured if I could see your head maybe it would give me something to focus on. It seems to help a little, but by 8:00pm Dr Finnegan tells us we have a 1/2 hour until c-section. I almost lose it, but I am determined to push you out. I do not want a c-section. Daddy and Joyce cheer me on and Daddy says I am pushing well. Apparently I am using a lot more strength than I realized I had. I keep checking the time but I can see that you are moving. This is going to work.

Finally around 8:30pm they call the team in and you are going to be born. A few more pushed and your head comes out! This is amazing. I have to stop though because the cord is wrapped around your neck twice. Dr Finnegan clamps it and cuts it quickly. Unfortunately Daddy did not get to do the ceremonial cutting of the cord, but your health is most important. Now we're ready to push again. Just another push and you are out! Finally!! You were born at 8:43pm. It was a struggle, but I was determined.

Immediately after you are born they take you to the warmer and Daddy heads over to inspect. Of course he says you have Connor's hands and feet. The nurses clean you off as I deliver the placenta, thankfully with only one push. You are not crying like I wold like and it seems like you are grunting a little too. After they let me hold you for a short time, but then the nurses and Daddy take you down to the nursery to check everything out. I am worried because I don't know if everything is alright.

While you are in the nursery I called Aunt Lisa & Uncle Tony, Grandma & Grandpa King, and Aunt Kathy to tell them the good news! I don't even know what your statistics are yet! I am guessing that you weigh about 7 pounds.

Finally Daddy returns from the nursery with your stats. You are 8lbs 1oz!! I can't believe it. No wonder I had trouble pushing. You are 21" long and your head circumference is 13 3/4 " (75% on the charts). I can't believe it! Now I am so glad that you were induced, if you were much bigger I don't think I would have been able to deliver you! You are 3lbs 7oz bigger than Connor was when he was born.

The Dr decided that you should spend the night in the nursery just to be safe. So after a while Daddy and I head down to the nursery so I can nurse you. I am so happy when you latch right on and eat like a little piggy! I love it!! Daddy and I stay and cuddle you until midnight. We love you so much! We're just happy that you are healthy. Daddy then goes home so he can catch some Zs and pick Connor up in the morning. I nurse you again during the night and at 6am the NICU nurse Erika brings you down to our room. I am not going to let you out of my sight from now on.

Griffin on the left Connor on the right, same Pooh Bear (two totally different babies)

Birth Story - Kim's First Birth

Posted by Kim:

I have been promising my birth stories and after an aggravating, sweaty search for my birth journal I finally found it and will transcribe the words from the actual birth experience. I have been looking for a week and I was starting to get a little sick to my stomach because I thought I had the journal out since we have been in our new house, frankly I felt a little taste of vomit in the back of my throat for every day that went by and I couldn't find it. Never the less, I was successful and without any more pointless details about my search I will get to the story!!!

Look at this picture? If you ever wonder why we "invented" BINSI this is why. To say the least I am not looking like I am ready for the challenges of labor and birth. I look like someone stuffed into a sausage casing. Thank goodness I wore BINSI for my second birth

October 20, 2002

written by Paul (Daddy)

Today is the big day! We arrived at the hospital around 12:15pm to begin inducing the baby. We are inducing the baby because the baby is a little bit smaller than expected, but the baby is healthy [original due date 11/16/02]. The Doctor believes at this point the baby will grow better on the outside than inside [had an amnio the previous week and lungs are developed].

Our first nurse is Polly and she has been wonderful. Our room number is 2010, pretty ironic since today is 10/20, we think it might be a sign that the baby will be born today (so naive we were). Also the Bills are beating the Dolphins 20-10, coincidence? The first thing Polly does is put Kim on the fetal monitor for about an hour while going through the formality of admission paperwork. During the course of conversation we find out that Polly is from Elmira, NY and that Kim and Polly share the same birthday. It seem that everyone has a NY connection.

At approximately 1:30pm Dr Finnegan arrives applies prostin gel to begin inducing the baby. Kim is about 1cm dilated, so we have a ways to go, but almost immediately after the gel is applied, Kim starts to feel cramping. We are also starting to see contractions on the external probe, a good sign. Kim describes the pain as similar to menstral cramps she used to have.

Since our arrival we've been catching up on our NFL action. Unfortunately the hospital does not have the NFL ticket, so we didn't get to watch the Bills today, Kim and baby are disappointed. Dr Finnegan says the head is in position for delivery and that the baby's head is looking in the direction of the football game, must be a football fan!

Amy Jones arrives around 2pm to visit us. Shortly after Amy arrives we go for a walk outside around the hospital. It was a short walk, but it felt good.

The Bills won today 23-10, so maybe its a sign that we're not having a baby today.

After a shift change, a new nurse Kelly, our friends Mark and Becky visit bearing gifts. Becky brought a sleezy sex mag (Cosmo), a baby Magazine (Martha Stewart) and Fortune with an article on Super Dads for me.

Dr Finnegan returned around 7pm to check on Kim's progress. Contractions are still occuring and the baby looks good, so the Dr will not give another dose of prostin gel tonight. Our progress indicates the baby may not come until Tuesday, but he'll re-evaluate on Monday morning.

After the Dr leaves Kim, Amy and I watch Monsters Inc. After the movie I run home to pick up a few things and get some food. As Day 1 comes to a close Kelly is relieved by Missy who will be our nurse throughout the night. I think we were both very anxious for the baby to arrive and with the news it may be Tuesday before baby comes is disappointing. The hospital and nurses are great but I think we'd both like to be home with our new baby!

October 21, 2002

Day 2 starts early with Missy coming in to take vitals every couple of hours, with a pelvic exam around 5am to check Baby T's progress and prepare for Dr Finnegan's first visit. After the prep work for the Dr visit Kim heads for the shower to freshen up. I slept on the sofa bed in the room. It was nive to stay in the hospital, but the comfort could be improved.

written by Kim:

Dr Finnegan stopped by around 8am or so, just before breakfast arrived. I was very hungary and wanted to eat, but didn't get a chance. The cramping from last night's gel had pretty much worn off so he decided to start with gel again today, not pitocin. Dr Finnegan checks my progress and I am 3cm dilated and about 80% effaced. He applies the gel and it seems to instantly spin me into labor. Our nurse today is Stacie and she says that the gel may be enough. I may not need pitocin.

Stacie constantly monitors my progress and I feel the contractions come on strong. They are approximately 2 minutes apart and 45 seconds in length. Stacie checks my progress and vital signs. She can not believe it, I have not dilated that much, but I am 100% effaced. She is going to call Dr Finnegan, it may be time to break my bag of water.

Around 9:15am Dr Finnegan breaks my bag of water and the contractions start to get stronger. He thinks we may have a baby by 4:30pm today. Mean while, throughout the whole labor process Paul has been wonderful! He hasn't even had a chance to shower or anything. He just sits by my side, counts my breathing and holds my hand. After Dr Dinnegan broke my bag of water he had to put the internal fetal monitors on me to check the baby's heart rate and my contractions. For some reason my contractions were not showing up on the monitor. I find this very odd because I know I am having them. The pacement of these monitors restricts where I can go, but that's ok because it seems like lying on my right side makes me feel best any way. Every time I move I throw up! I feel sea-sick.

The contractions keep coming and they are getting stronger. Nurse Char comes in to relieve Stacie so she can go to lunch. Char suggests I try some different positions, maybe this will help. I try sitting in the glider chair, but the rocking really makes me nauseous. Then I try to stand up and lean forward on the bed while Paul rubs my back. While Paul's massage feels great the standing and swaying makes me sick to my stomach again. So I just opt to sit on the bed. The baby's heart rate is best if I just lay on my right side so this is what I do.

The pain is really starting to get intense now. Epidural is running through my mind, but I can do this, I can endure! I will wait until Dr Finnegan comes over on his lunch to check my progress.

Around 12:30pm Dr Finnegan stops in to check my progress. I am only 4cm dilated! 1 cm? How can that be? I don't htink I can do this too much longer [this is where a doula would have intervened]. Stacie said I may need to get pitocin to regulate my contractions. this will probably make them more intense, regular and closer together. UGH!! Call for the epidural. I need it now.

We hear Dr Schneden is the doctor on call and I am nercous about this, but all the nurses say he is the best. At 1pm he starts the process and it takes about 30 minutes to complete, well it would have taken only 20 minutes if he wasn't so concerned about deleting a message on his beeper. By this point I could have picked up his beeper and slammed it on the floor inro 1000 little pieces. But eventually it is placed and the medicine starts to work.

It is amazing what a difference the epidural makes. I can hardly believe it, and I think Paul is pretty amazed too! The break in the action allows him to take a shower. I guess he doesn't want to be in his pajamas when the baby is born.

Around 1:15pm Paul calls Amy to give her an update. Very shortly Amy calls back. She got our message when she was in her car because she was already on her way to the hospital. She was just too excited to stay ay work. It works out well because Paul hasn't had anything for lunch and he asks Amy to stop by Wendy's and pick him up his favorite #2 combo.

Amy arrives around 2pm and Paul goes to eat lunch (switching of the guard)! I tell Amy all about the day and we are chatting when Stacie comes in to check my progress. She can't believe it, I am dilated to 10cm and I can start pushing! It is 2:30pm now and Amy runs out to get Paul and let him know we are going to start pushing. Paul runs into the room he can hardly believe it. In a little over an hour I went from 4cm to 10cm. Stacie says maybe th eepidural helped me to relax.

I begin pushing and it is really nice because it is only Paul, Amy, Stacie and me. The cameras are ready for action and the pushing begins. Soon the warmer comes into the room with our nursery nurse Brenda and Kristi the tech is present as well. A few contractions come, so they tell me, but they don't want me to push because the baby is too close. I have been pushing lying on my right side Stacie is counting and holding my left leg. Amy is cheering me on, but I think Paul is so excited and overwhelmed he forgets about me. He doesn't count, I think he is speechless. Finally Dr Finnegan arrives and he says we need to push him out now or we may need to use the vacuum because the baby's heart rate is going down. Just as he says that I push as hard as I can and out comes the abby. For what seems like an eternity I think "What is it? Boy or Girl?" Finally Dr Finnegan says it is a BOY! I can't believe it, I was so sure it was a girl. Paul was glowing with pride!! It was the cutest thing I have ever seen. Connor was 4 pounds 10 ounces and 18 inches long.

After Connor was born they laid him on my belly and cleaned him off. We had a short time together, but then they took him to the warmer so the nurse could check him out. Of course at this point the only person paying attention to me was Dr Finnegan [again a place where a doula would have made a major difference]. Dr Finnegan said I better get use to it. I don't mind my boy is healthy and beautiful!!!

Connor was induced 5 weeks early due to low in-utero fetal movement. We had been sent to Denver for an amnio and his lungs looked developed and the Dr there said I could either have the baby now or wait a week on bed rest and then induce the labor. Upon Dr Finnegan's recommendation we decided to induce sooner than later (the day of my planned baby shower actually).

While typing these words out I felt tears of joy coming to my eyes thinking about the birth of my first son. While at the same time I feel tears of pain stinging my eyes for the naive choices we made, the lack of knowledge I feel I had going into the birth (we did take a childbirth class), and some mourning for the birth experience I did not get to have, but had been planning all along. I have often wondered why we didn't listen to our friend Chuck when he said "Get a Doula. It's the best investment you will make." While hindsight is 20/20 and I can't change anything about Connor's birth there is a feeling of loss and sadness that I did not accomplish the natural birth I had been wanting. I really think we made the choices we had to at the time and as Carri always says, I have to embrace Connor's story because that is HIS birth story and in the end we have a happy healthy 6 year old now who I adore and is truly one of the lights of my world!

Little did I know that Connor's birth was going to be the easy part. The next two weeks were to be the hardest weeks of my life!

To Be Continued.......

Birth Story - Elaine & Greg's Birth

Posted by Kim:

I was lucky enough to be hired as the doula for another wonderful couple and I was honored to be present at the birth of little baby boy Nikolai! It was an amazing experience and has made me even more passionate about being a doula! To be honest it was only the second completely natural birth I have ever seen, the birth of Carri's third son being the first.

It was interesting because Elaine had a few instances of stalled labor as my previous client did. On Monday evening Greg called me to let me know that Elaine had stopped in to see her doctor that afternoon and she was dilated to almost 4 cm and 100% effaced. The doctor said she could check into the hospital then if she wanted to, but they chose to head home and relax to prepare there instead. This was great news seeing as though Elaine mentioned that she had not really had any major contractions, just what felt like some annoying menstrual cramps. Remembering what a marathon Gina's birth was I began to mentally prepare myself for labor and went to bed early anticipating a call from them that night (again, silly new doula). No calls. I ask them to stay in close touch just so I would know how they were feeling. So we talked Tuesday morning and everything was back to normal.

On Tuesday they ended up coming into the hospital again because they were concerned that they really hadn't felt the baby move at all that day. Luckily the nurses monitored the baby and everything was fine. So they went home and Elaine rested, ate and prepared for pending labor.

Around 12:15am on Thursday morning Greg called me again and said that Elaine's contractions were coming on very regular and they were going to head into the hospital and wanted me to meet them there around 1am. So I jumped out of bed, hit the shower (I had some hot water this time) and was in Boulder by 1am. It was a very interesting drive however because the Old Stage fire was raging and literaly lit up the entire sky. I had never been so close to a brush fire like that and actually felt a little guilty that we have had such a dry winter, I guess I better hope for some snow (hard for me to do). In addition to the fire there was also a major accident on the Diagonal Hwy and as I approached I just kept praying that it was not Greg and Elaine, luckily they took 287.

When I reached Elaine's room Greg told me that their contractions were very intense at home, in the car, up the elevator, but as soon as she got into the hospital room they literally ended. Elaine placed the intensity of the contractions at only a 2 on a scale of 10. In addition to the lack kof contractions she also had an elevated temperature so the doctor wanted to monitor Elaine closely and she received an IV of fluids as they were thinking the elevated temperature was possibly due to dehydration. This was hard for Elaine to accept because she felt like she had been drinking tons of water, but as she received the fluid her temperature did go down. Just prior to going into the hospital Elaine had been taking a hot bath so I asked the nurse if that could have effected her body temperature and she said it wouldn't really have effected her overall body temperature, and especially for this length of time. Good to know. So I headed home around 4am and Greg and Elaine were released shortly after. I called Carri later that morning to talk with her about what was going on and her thoughts about the stalled labor again and she said that the contractions Elaine was experiencing could actually have been caused by the dehydration. Again, good to know I will keep that in my knowledge bank.

But the real fun was just about to start because Friday morning around 4:30am Greg called and said that they had been laboring since about 9:00pm Thursday night and they were ready to have me come over. Remembering Gina's labor I didn't freak out, I took a quick shower, gathered my doula bag and personal items and headed out ready for a long day (again, silly new doula). When I arrived at the house Elaine's car was running in the driveway so I figured we would soon be heading to the hospital. Elaine was in her bed and Greg was being an amazing coach. While I could tell the contractions were intense for Elaine she seemed to be handling then amazing. SHe breathed through them as Greg was reminding her to take deep belly breaths and I tried to help her relaxed her hands and face. It was interesting because Greg told me that she was also experiencing significant discomfort in her back but when I tried to apply the same massage and pain relief that I used on Gina this was of no comfort to Elaine. Again, I had to remind myself that this was a completely different person so what works on one may not work on the other. Greg and I began talking about when to go to the hospital and seeing as though she had been laboring for quite a while and the intensity of the contractions were so strong we decided that it was time to go. However, getting Elaine to the car was my biggest fear because she was obviously feeling so much intensity and handling them seemingly so well in the bed that I hated to move her, get her to the hospital and have the contractions slow, but I knew we had to go. So step by step and in between each contraction we headed to the car we eventually reached the Boulder Foothills Hospital around 6:15am.

Greg said that one of his funniest memories of this experience was our trip from the car into the hospital. He had gotten a wheelchair for Elaine and I had made myself in charge of carrying all of our gear. So he said as we were walking down the hall he looked over at me and couldn't help but laugh because all he saw was me carrying 18 bags and a pillow. I told him not to worry that it was my job to take care of the things that he should not occupy his mind with. He should be worrying only about Elaine. So we then named me the Doula Sherpa! : D

When we got to our room Elaine settled in bed and the intensity remained and I think we were all thankful for that. The nurse was wonderful and asked Elaine if she would like to get up and walk, take a bath or try some different positions. She said as soon as she checks her she could do whatever she wanted. Much to all of our surprise, when the nurse checked Elaine she was 10cm dilated and the nurse said she would be able to push whenever soon. The only thing standing in the way of her and the baby was the bulging bag of water. Because Elaine had been experiencing a lot of discomfort in her back I suggested she get on her knees and lean on the birth ball. I told her that this would relieve some of the discomfort and would also be a great position to start pushing once her water broke. It seemed to help for while, but the doctor came in and we all discussed if she should break the bag of water for Elaine or if she should wait for it to happen naturally. It was decided that the doctor would break the water so Elaine could start the pushing phase of labor. By 7:00am her bag of water was broken and the urge to push was rushing over her and by 8:05am little baby Nikolai was born. Elaine was a wonderful pusher and having the nurse use her fingers to help Elaine feel where to push really seemed to help! It was beautiful and amazing, again I felt blessed to be there.

After Nikolai was born the placenta would not expel itself naturally, even after several minutes of nursing (Nikolai was a natural). So they finally decided Elaine needed to receive some pitocin to encourage the placenta to come out. Unfortunately when it did there were pieces of the placenta left behind and the doctor tried a manual extraction to remove the remaining pieces before Elaine bled too much. This however was ineffective and Elaine eventually had to have a spinal epidural and a D & C. Not the ending we anticipated after a healthy pregnancy and beautiful natural childbirth, but medically necessary.

This was another learning experience for me (although I can't think of a birth that won't be a learning experience). I was impressed with the nurses and doctor at Boulder Community Hospital and I was thankful we were there, but I was most impressed and awed by how Elaine breathed through her contractions and how great a coach Greg was. This may sound a little corny, but I could truly see how deep their love is for one another and what an amazing family Nikolai was being born into. It was truly a blessings. Elaine's recover has been more difficult than we would have hoped, but ultimately the most important thing is that there is a very healthy baby and a healthy recovering Mom and ecstatic Dad!

Birth Story - Kim's First Birth as a Doula!

Posted by Kim:

Well bringing in the new year was VERY exciting this year. I was not with my family when the clock struck twelve, instead I was helping a family be born! Since Friday night I had been in touch with Gina and Steve as their contractions began. The first call from Steve was received on Friday night at 10:30pm just as my husband Paul and I were sitting down to see the new 007 movie! Things were pretty much under control at that time, however I expected to hear from them later that night, but no news (silly new doula). Saturday morning I called at 9am to see how things were going and Gina's contractions had slowed throughout the night, but things kicked in again a little early Saturday morning, but were light. On Sunday morning I heard from Gina and Steve again and contractions started early and they wanted me to come over. I headed over around 9am (after picking up a heating pad) and worked with Gina as her contractions remained 5 minutes apart. Unfortunately they started to fade again so we walked the stairs, I encourage them to be together and kiss, we took a walk together, but nothing seemed to help. So after a while I went home and Gina enjoyed her mother and sister's company for the rest of the day.

On Monday Steve and Gina went to see their doctor and found out that she was 3cm dilated and 80% effaced. Good news that her contractions were actually doing something for her.

On Tuesday morning around 4:15 am Steve called again and asked if I would be willing to come over and help Gina as her contractions were back, but Steve was going to go into work. When I arrived Gina was laboring hard and we worked through the contractions. She sat on the fit ball and once the sun came up we went for a walk. Today however she wasn't able to walk through the contractions as on Sunday. We had to stop, I rubbed her back and she was cool and calm through each one. I was so impressed with how she was able to close her eyes, go into herself as each wave passed through her. Steve returned home from work around 10am, just as Gina's contractions were slowing in time and intensity AGAIN. Poor thing, how many days of labor can one person take? So I suggested she rest as much as possible and call me if she needs me. So once again I headed home expecting to hear from them again soon.

And I did..... It wasn't as soon as I thought, but after a fun evening of taking the boys Dave and Busters, Steve called me around 12:15 am Wednesday morning and said that Gina had been laboring and the intensity of the contractions seems like it had changed. After getting up and getting dressed (couldn't shower because the pilot on the hot water heater was out NICE...) I headed over to their house once again. I arrived around 1am and Steve immediately went to bed to rest. Gina and I spent some time together talked through the waves of contractions and I spent a lot of time rubbing her back, this seemed to be a continuous ache for her. While trying to remain completely confident and in control for Gina, on the inside I was worried that she could be progressing and we were close to birth and I didn't want to catch a baby. Gina kept asking me when we should go to the hospital and I reassured her that we could go any time, and we should especially go when she no longer instinctively felt safe at home. So around 3am and after a call to the hospital confirming that we could come home after being checked if we chose to, we decided to head out.

We arrived at the hospital about 20 minutes later and by 4am they checked Gina and confirmed that she had progressed to 5 cm and was about 100% effaced. This was good news so we decided to stay. Gina continued to labor and we all hoped that the contractions were making her progress, but again by 10am ish her contractions started to slow and become less intense. After talking with the doctor (she wanted to start pitocin right away) Gina and Steve agreed that we would wait until noon and see if she has progressed. At noon they checked her and she was only 6cm. So the doctor broke her water and this definitely brought on active labor. Gina continued to labor and was my hero because she was really handling it well considering the new level of intensity.

Around 6pm Gina decided to have another check and she was only 7cm. This was very discouraging for Gina and frankly after 5 days of labor she was really starting to get exhausted. So she and Steve decided it was time to consider the epidural. We all hoped the epidural would help her relax enough to dilate quicker. Once the epidural was placed there was instant relief and Gina felt much better and could even get a little rest. Unfortunately it did not help her dilate faster however. At 9pm she was 8cm, 11pm 9cm, 1am 9 1/2cm and by 1:40am she was fully dilated and ready to push. This was an exciting moment, but I tried not to get too excited because I knew from experience that there was still a lot of work to be done. I just didn't know how true this was, because it wasn't for 5 more hours before little baby girl Jordyn joined the world at 9 lbs 1 oz and 22 inches. As always it was amazing wonderful and euphoric. Looking at Gina's face it was like the last 28 hours (or 6 days for that matter) hadn't even happened! What a honor to be there. I can't wait for my next birth! I learned so much and it even allowed me to let go of some of the figurative pain I have been going through since Griffin's birth. Its like anything with parenting, you just can't make plans or if you do they have to be written in pencil because they are sure to change!