Saturday, March 05, 2011

Inga's birth story, part 2

Reflections on Inga's birth

Additional commentary on resuscitating the baby:
The midwives Penny and Holly watched the birth video while I was resting after the birth. I asked Penny if I reacted appropriately to Inga’s condition—was I too quick to do mouth-to-mouth? Should I have done anything else first? Should I have waited longer? She said I absolutely acted appropriately and that, frankly, Inga looked pretty darn scary for a while. Based on Inga's rapid loss of tone and color, the midwife suspects there was some kind of cord compression/restriction during the birth. Between my giving her mouth-to-mouth and the blood resuming circulation after the birth, Inga recovered quickly.

The other nurse-midwife Holly (who arrived after I was settled in bed) added that it was probably best that they weren’t there for the birth. I knew what to do and was able act quickly and calmly. She guessed it would have been more stressful for me had they been there and stepped in to intervene.

Was I scared? Not really--more focused on the situation at hand. I do remember thinking, as Inga was losing color and muscle tone, "I have NOT done all this work for nothing--come on, baby!" I knew it was serious, but I also knew that I had the appropriate knowledge and skills. I feel strongly that every pregnant woman should prepare herself for how to handle situations such as this, no matter where she is planning to give birth. Had I been planning a hospital birth, I seriously doubt I would have made it on time. And obviously, the midwife won't always make it on time either!

And as scary as the resuscitating part might seem, I'm glad to to be able to share it. It shows how to handle an emergency situation without losing calm.

I was very glad to be in a home setting in this situation. It's very unlikely that Inga's cord would have remained intact during a hospital resuscitation, which would have further compromised an already struggling baby. As it was, Inga was able to receive her full placental transfusion and make a quick recovery. 

Regarding the midwife not making it to the birth on time:
Not surprisingly, this didn't concern me at all. In fact, it hardly even registered that she wasn't going to make it. Now I didn't intentionally call Penny too late. In fact, when I called her the second time, I still wondered if it was way too early! She probably would have made it on time, had she not taken a shower after my second phone call. She told me, "I should have known not to get in the shower! After all, it was Rixa calling me!"

As you know from reading my blog, I planned an unassisted birth with Zari, so doing it on my own wasn't at all scary. Plus there's nothing that would have happened much differently had Penny been there. She would have checked heart tones, but otherwise everything else would have been the same. I know this, because Dio's birth that she attended was nearly identical to Inga's. With him, I pushed in the same position for about the same amount of time; I supported and caught the baby myself. Penny was just there to keep an eye on things.

Other thoughts:
I'd love to dispense with the practice of labeling our births. In my experience the line between a midwife-attended and an unassisted birth was so fluid as to be nearly irrelevant. Now that I've had a planned unassisted birth, a midwife-attended home birth, and an "accidental" or "surprise" unassisted birth, I can say that the labels don't really mean much at all.

There was an OB who was hoping to observe the birth, but he wasn't able to make it out. I know he had a busy call schedule on top of regular office hours. Too bad, though. Maybe next time?

The timing of this birth worked really well in the end. I was well-rested and fully recovered from the stomach bug. The day before I went into labor was incredibly relaxing, even languorous. As with my other two children, labor began at night and the birth happened during the day. And even the time of day of Inga's birth was perfect. It was a sunny morning and we were in an east-facing bedroom, so the light was beautiful. We got everything in order--barely--before I started pushing: house tidied, kids sent off, birth pool filled, etc. And my mother-in-law arrived the day after Inga was born. Couldn't have been better!

Someone asked why I chose not to have the kids present for the birth. It would have been way too distracting to have them underfoot, especially Dio. There was no question once labor started about wanting them around. I really liked the quiet time both before and after Inga was born, without the distraction of happy, noisy, energetic siblings. 

By the next day, the events of the labor and birth were already feeling surreal and dreamlike. Did I really go into labor and have a baby? Obviously yes, since I'm holding her right now! But it seems hard to believe that it really happened and that it's already over.

And finally, I am SO happy that we filmed this birth!


  1. Congratulations Rixa!
    I love your post and was captivated by your video. I am not one to typically watch these videos but your writing fascinates me and this post was just lovely to rea.

    I have two children both natural births but hospital births. The second was going to be a homebirth but preeclampsia ruled that out. perhaps my fascination is due to yearning for a similar experience to yours.
    just wondering - regarding neonatal resuscitation -which by the way was amazing to watch you perform in a calm way - if you could comment on the small risks at a homebirth of more aggressive resuscitation or ventilation was needed, say for meconium inhalation. did your course cover these issues? where did you take the course?
    I'll peek around in the archives to see if i can find any posts.
    Again, congratulations!

  2. I have loved reading about your birth, watching the birth and especially the part of resuscitation. I cried and held my breath even though I KNEW everything was okay. laughing!

    I wish everyone would realize that they *do* need to prepare to birth on their own whether they are planning a hospital birth or a homebirth with a midwife, because there is NEVER a guarantee that you will make it to the hospital or that your attendants will make it to your house. :) This is something I always stress to the families I work with!

    Congratulations! Enjoy your babymoon!

  3. This is incredible. I'm grateful for your putting this information out there. After my hospital birth (which was wonderful, really), I've decided that I want to birth at home. I honestly had never thought of the need to be trained in neonatal resuscitation. I'm so glad you were. Inga is beautiful. And I'm glad you alerted me to knowing that I should be too. Thank you.

  4. The whole birth was really amazing. You are a champ. Most people probably would not have been that calm but your knowledge and confidence really shined through. Blessings to your family. I just delievered my first baby at home last year, and so looking forward to the next home birth (as hard as it can be).

    Have you ever considered becoming a midwife?
    Where would the average mom go to get neonatal resuscitation training?

  5. Rixa
    As usual, you have outdone yourself! Inga's birth was beautiful. Get the Maple Leaf diaper out! Time for another photo op!

    all love

  6. I have to say I was amazed at how calm you were the entire time! Good job! And congratulations again! Inga is just perfect!

  7. This has to be the most educational birth story I have ever read. Thank you.

  8. It is true that if the midwives were there, they would have jumped in and interfered. Which would have been appropriate in most cases. However, since you knew what to do, you were able to stay calm and do exactly what needed to be done! Great job!

  9. i am so confused as to why you think you did so much better than the midwives would have done? you did not towel her or give any sort of stimulation, and you waited far too long to give her breaths. you are so very lucky. truthfully, i am horribly jealous that your baby lived while mine died in my arms. i think you should think carefully about what advice you give pregnant woman. i listened to all your advice my whole pregnancy and my daughter died...

  10. Just wanted to say that I really appreciated you posting your birth videos! As I prepare for baby number two to arrive it has really helped calm some of my "what if" anxiety by seeing you react so quickly without any panic or craziness. I can only hope that if god forbid something happens at this birth I can be as prepared and fast acting as you. I'm sure somewhere down the line someone will be posting about how watching your videos helped them in a similar situation!

  11. I was impressed by your calm during labor and delivery. I was going to suggest that maybe you share this video with the OB who was hoping to watch your birth. It won't be as good as being there in person, but he/she's probably not seen many births like yours!

  12. Liz - my heart goes out to you and your daughter. I'm sure you know this, but Rixa is only sharing her experience. I'm so very sorry for your loss.

    Rixa - well done on all accounts. You've made me think twice about neonatal resuscitation. I was certified in CPR many years ago and take it for granted that my skills would still serve me. I definitely need a review. I would've panicked.

  13. Rixa, I think you did great. From the video I watched it did look like some transient cord compression sice she was pink initially maybe some extra fluid. There was no need to panic no frank blood, she was ok then decompensated for a brief moment before you reacted appropriately. I prob. would have been a little more aggressive with the stimulation and reached for the bulb syringe, nut thats the l&d NICU nurse in me. My 2 homebirths were land side it makes me wish for 1 more to try a water birth. Simply lovely. Liz sorry for your loss but abruptions happen in the hospital as well and end in demise or worse life long vegitative states. Birth is powerful and there are no givens at any location. As Rixa said a hospital birth would have lead to a quick cord cutting further harming a baby thats decompensating. We RN's are quick to bag and give o2 but that was avoided with a great outcome and a calm birth.So glad you put this out there so examples of a peaceful resucitation can be seen.

  14. By the looks of it, Inga lost tone and color because her airway was not clear. The movement she was making with her arms before she lost color was a movement a newborn makes when she is trying to get a breath, but cant because of a blocked airway. Watching the video, I wanted you to towel off her mouth and nose first with that towel sitting there. The breaths probably would have been unnecessary if her airway was clear (the breaths did however lead her to cough several times to clear her airway). You said you learned NRP so you knew what to to do, but the first step in NRP is dry, stimulate and clear the airway which comes before PPV (breaths). Good job staying calm, but next time (let's hope there isn't a next time!) clearing the airway is usually sufficient in resus, especially with a baby that was born with good tone and making efforts to take a breath like Inga was. She sure didn't look like a baby with cord compression to me, since usually those babies have already lost tone when they are born, not after. Just my two cents from someone who has been doing NRP for 10 years. Anyway, good job keeping your cool and doing what you had to get her going.

  15. To Anon above-
    With primary apnea (a baby born without tone and color) rubbing the baby and clearing the airway will often work to stimulate breathing. With secondary apnea, where the baby loses tone and color, stimulation will not work. The baby needs PPV/ rescue breaths. Stimulation is really irrelevant in these cases.
    -also a NICU nurse

  16. Rixa, I'm happy that Inga is ok, but it seems that those with more expertise don't agree that this was a minor complication that was handled perfectly with your NRP education. It is very lucky that all worked out okay.

    I homebirthed my second baby but this event has made up my mind that I'll go back to hospital birth for the third.

    What a strange feeling to come full circle from being afraid of hospital birth from my first negative experience, to having a great uncomplicated homebirth, to feeling more afraid of homebirth than hospital birth. Never thought I'd change my mind...

  17. From an interested reader, not a healthcare professional, or mother, this is what I've gotten from reading Rixa's posts:

    - She never says she did better than the midwives would have. She simply quotes one of the CNMs as saying that it probably would have been more stressful for Rixa to have them step in and do what she did herself.
    - it seems that there's disagreement among the professionals in the comments over what "the right thing" to do was. Perhaps some of them could link to the latest guidelines on neonatal resuscitation that they use in their practice?
    - I have never read Rixa giving prescriptive advice on this site. She is not a healthcare professional.

    If Rixa feels like responding to these comments (mine and others') I'll read her responses with interest; if not, I'll do my own research and discuss with relevant healthcare professionals if necessary. I'm very glad that both Rixa and Inga are doing well.

  18. Why dont we all quit stressing out the new mother and just be grateful she shared her very private moments with the world? there are a zillion what-ifs when it comes to life and birth, and death is also one of those what ifs. They baby was still on the cord and still recieving oxygen from the cord, not fully transitioned to breathing. Yes in the hospital they would have cut her cord immediately and started their own versions of resuscitation that might have seemed more vigorous or what not, given the hospitsl protocol. Do you wish that we only got to see "perfect" births, perfect videos? Sometimes newborns do this. Rixa and her husband have done nothing to warrant this ridiculous hind sight nit picking. Her baby is fine. They have 911, they have training, and they had midwives right at the doorstep. Im not sure what anyone's point is but you are lucky Rixa isnt a shrinking violet and that you got to see not only a labor and birth but another part of birth which is the baby earthside, needing a little puff or two. I really do not know what anyone's point is.

    Rixa-- you're awesome.

  19. Another thing-- good grief it is nice to hear of another mother who does NOT want little kids climbing all over her and chattering, crying, etc when she is giving birth.
    I know lots of home birthers share the experience with the other kids, but know that historically, this would NOT be the norm, and that women would be in a circle of women, protecting her space, so that she may accomplish this most arduous of human tasks in a manner that was most conducive to her peace and concentration.

    I do not know how people can sit at home on their computers and judge such a lovely family and beautiful brave woman. Shall we also ask her why there was no Anya, no candles, no henna'd hands?

    Blech on everyone. You're all lucky she doesnt throw her laptop into the birthpool and never blog again.

  20. "You're all lucky she doesn't throw her laptop into the birthpool and never blog again."

    I laughed so hard at this that it almost woke Inga up!

    Maybe after Inga was born I should have turned on my Enya, lit my candles, painted my hands with henna, then dried Inga off with towels, then cleared her airway, then got out of the birth pool, and only finally THEN given her mouth-to-mouth.

  21. Enya! Why did I say Anya? hahaha, shows how much of that stuff I listen to.

    I'm glad you laughed. If you wake up that little smooshy tiny angel, tell her its Joy's fault and give her a lil' kiss from her "cousins" in Michigan.


  22. Hi, this is Apollo's mom. Wow, what a story! You were awesome. So calm and clear headed. MY blood pressure was up just watching the video and I KNEW it ended okay. Once again, like Apollo's birth, I think the key is being educated. Then when the time comes, you stay calm and do what needs to be done. End of story. Thanks for sharing.

  23. Hi Rixa, Wanted to add my congratulations on your new little daughter. I love the name and am so happy for all of you.

    Lennon put your birth video on her FB page and I commented that you looked like you were ready for a Sports Illustrated Swimsuit Edition photoshoot. You must do a blog post on how to look beautiful while birthing a baby. Love you, Gloria

  24. Thanks for responding to my question about having the kids present. I hope you didn't take the comment as a criticism, as others appear to have. I admire you're confidence in knowing exactly what you need and going for it. I feel that I'm being pulled in two directions about this right now, so the opinion of someone that I greatly respect in these matters means a lot. I can only hope I can make the decision that is right for me when the time comes.

  25. random thought - did you keep looking behind you because you were afraid you were pooping?

    I was worried about that when pushing time came. I knew no matter what, I did not want my husband dealing with helping me with that.

    Is it wrong that I don't want an unassisted birth for mainly that reason... I want a hired hand, someone other than my romantic partner there to deal with that in case it happens.

    It never has happened to me but it didn't stop me from checking the water too...

    and watching Inga's little struggle will only solidify most opinions. UCers will be glad you were left alone to do what you knew to do.

    anti-homebirthers will say you are lucky she is not dead

    I don't know how it will affect those on the fence.

    for me... Thank you for showing us a beautiful tender moment that you handled with grace.

  26. I just went back and watched my favorite parts again - when you birth and then pull her little body up out of the water, give her a few breaths, and then chase the assistant out of the room with a few well-chosen words. I loved it! What I can't figure out is how she missed seeing the tension that was building up in you as she bustled around. It was very, very obvious from watching the video.

    I dreamed about you and Inga the first night after I watched your post. I think it affected me more deeply than I realized at the time. I found myself wishing that I could do it all one more time just so I could experience again the bliss you just experienced. What is particularly interesting to me is that I was/am pretty sure that that door was/is firmly closed. Hmmmm....

    Rixa, Inga is beautiful, and so are you. I tried to explain to Jon last night what the emotions of giving birth are. I felt so incredibly vulnerable, and yet so very powerful! My very favorite moment of all in birth is the burst of release as the baby's body slides out of my own, and then pulling that slippery, floppy, brand-new baby up onto my chest for the first time. Your video captured all of that perfectly. Thank you once again for sharing that with me/us. I feel so very honored that you did.

  27. I have been saying for a while that I should learn CPR for infants (and adults), but watching your video has given me the kick in thepants I need to get it down. Since I planned a mid-wife assisted birth the first time (and will again) I kind of just left that up to her. But, you are so right that surprises do happen and I anyone could have a quick birth and not have time for the midwife to arrive.

    As you was reading the possible reasons for Inga's troubles I was thinking, "In a hospital this would have been turned into an emergency. Cord cut, and baby being resussed with a bag(?) instead of mother's breath." Inga is so fortunate to have you for her mother. :)

  28. Good grief, please forgive my typos. I've got blurry eyes from allergies. Blech!

  29. As a nurse I think I can agree that in the hospital the cord would have been cut right away and she would have been bagged with a similar outcome. I do agree that that airway might have been an wiping her mouth or suction might have been useful , but it's easy to say in hindsight. I think the thing that was the best for the baby , though was to keep her attached to the cord. So much research is coming out now that shows how important that is. And this is something that is rarely done at the hospital.

    That said...I think Rixa did great. For me personally , I wouldn't want to be the one resescitating my baby...not what I want or know if I could do at the time with just giving birth. It does make me want to brush up on my NRP skills...just in case...never know when you'll need them:)

  30. Congratulations Rixa! She's beautiful!

    I absolutely loved reading about and especially viewing your labor and birth. Thank you so much for your sharing your experience and your insight.

  31. Rixa,

    Thanks so much for sharing this. It was truly scary to watch, but you handled it beautifully. I hope the buzz around this doesn't affect your baby moon and you're able to keep your focus on your squishy new babe and your family.

    I think it's intimidating for people to see a baby 'crash' like that. Like Housefairy said, mostly it's the 'perfect' homebirths that get shared. As an OB nurse and practitioner of NRP, I know that the good thing about NRP is that it almost always works. It's not like CPR which rarely does.

  32. Rixa, congrats again, thanks for sharing. you did an amazing job and there never seemed to be any doubt that she would be fine. As someone who has seen every sort of homebirth. The baby was obviously alive and you did just the right thing to give warm moist breaths. Beautiful.

  33. My question is, why not clear her airway? Some times just clearing the airway will give enough stimulation to breath. I would also have provided more stimulation to breath. Sometimes just stimulating is enough to have babies get with the program.

  34. I can't believe people have the gall to critique someone's birth story!! Seriously people what are you thinking?!

    Rixa wonderful job and thanks for sharing. I hope people can learn to keep their mouths shut when appropriate.

  35. I don't think it is so much gall as reflection. I always reflect on what I did and what I could have done. I think Rixa does the same. At least that is what I got out of her post.

  36. Wow, so amazing. Thank YOU for sharing so much with us! I hope the OB who missed out will watch your videos. :) Which I also hope to do when I'm not at work. Best wishes!

  37. You got lucky. Pure and simple luck.

  38. To anonymous above me,

    So did everyone else who had a live, healthy baby, no matter where or how or with whom they planned to birth.

  39. To Keldie above:
    No when you have a well trained person with you that helps to handle a crisis, it is not luck but preparation, knowledge and experience that save babies who need help.
    Rixa got lucky and I am happy for her and her family,but just think if the cord who have been a tad bit shorter that it already was Rixa would have had a harder time giving mounth to mounth and precious seconds would have been lost...So was it up to luck that the cord was just long enough???yes! it had nothing to do with how prepared she was!!
    The only reason woman defend UC is because they are holding their healthy babies in their arms, trust me when your baby dies while you are UCing you change your mind on the whole thing!

  40. I think Rixa did great; it was just a moment that the baby wasn't doing well, the cord was still pumping, so simmer down!

    It is true that any of us who have healthy babies are not "lucky" but blessed, and we should rejoice with those who do and try to console those who don't, but not try to second guess their choices. And those with sadness, don't try to destroy another's joy; it won't help you.

    When I first watched this video, before all the criticism started, my thought was something like "See how calm and resourceful a woman can be when her baby needs her!" That is how I still feel.

    Susan Peterson

  41. This video was inspiring to me. My husband and I watched it together. Although it was obviously a complication, it is common and minor when someone such as yourself is calm and collected and so obviously prepared! You did amazing and reacted in a normal way, in my opinion. I had never thought about taking a resuscitation class before, but now my husband and I both realize the need for one, as babies commonly need a bit of help. Thanks for your strength!

  42. Rixa, thanks for sharing your video! I have had a lovely homebirth and a nice enough hospital birth, and I totally give you high fives for knowing your stuff and keeping your cool. Your experience has renewed my commitment to learning neonatal resuscitation -- my babies come fast and hard and I am aware that I may very well end up with a surprise unassisted birth one of these days despite my best planning. I want to be ready no matter what happens to take care of my children as well as I can. I am pregnant right now and I'm going to go look up a class this very moment.

  43. Rixa, thank you for sharing Inga's birth story. Beautiful!

  44. You got it all figured out!
    Blue floppy and unresponsive babies are the norm! this is how they are all born!absoutly normal.
    Then my daugthers must be super human because they pinked up seconds after birth..
    But you now what if you are trying to make Igna situation seem very normal, there are many more who werent so lucky and died!

  45. Rixa,
    I am an L&D nurse x almost 10 yrs and I think you did what any NRP educated person would-followed your instincts! Yes, we are educated to follow the NRP protocol/algorithm exactly, but as any of us who have participated in a resusitation know sometimes you just do what your gut tells you regardless of "where" you are in the NRP steps. Interestingly also is the trend in the new NRP guidelines to use blended air (room air is 21% oxygen) in resucitations instead of 100% oxygen. Obviously worked well with Inga:) Often all babies need is the pressure rather than the oxygen. Also the point of Inga already being in secondary apnea is a valid one. You had already passed the point in the algorithm for stimulation, etc. Great job! An unplanned unassisted birth could happen to anyone, so as you said being prepared is a good thing. Congratulations!

  46. Thank you for sharing your videos of Inga's birth. My 13 yo daughter was wanting to see her only sister (she has 4 brothers!) be born, but was still a bit uncomfortable with the unknown and the thought of nudity involved. Watching your video helped her see that you really don't see everything and that it is a beautiful, gentle event. Now she is excited to attend the birth in just a couple more weeks. :) Thank you! :)

  47. Babies die in hospitals; babies die at home. Sometimes there is a reason. Sometimes someone screwed up. BUT usually it's a combination of factors no one can control... but everyone wants to blame someone. Sometimes doctors act like every baby is save-able, but that's just not true.

    The point here, to me, is that UNPLANNED unassisted birth can happen to ANYONE. I know that many moms and dads who are having their 6th, 7th, 8th babies get instructed by their OB's on emergency birth just because many times these moms just can't make it to the hossy 2 or 3 hours away because they go so darn fast. (Their OB's are usually not supportive of UC or even homebirth... they've just had enough moms barely make it or not make it in ar all.)

    It is SO true that in an emergency you go with your gut. If you don't follow the 'steps' just right, well, so it goes. I know I have had to deal with a choking toddler two times and neither time did I do it 'right', but both times what I did got the job done.

    My second birth was a planned homebirth. She came during an ice storm. The assistant midwife lived 3 blocks away and walked over with ice spikes on her shoes. We were that close to an unassisted birth, on accident, and we would not have been prepared.

    Thank you, Rixa, for sharing.


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