Pregnancy update: 41 weeks

So, a March baby it is!

Technically, I'm just 40.4 weeks by ovulation/conception dates...but I thought I'd stick with my pattern of using LMP and posting on Tuesdays.

My belly feels like it's going to burst open. There's so much pressure everywhere that I can only walk at a leisurely amble. I set off intending to go at a nice clip, but I literally cannot! I've been having lots of crampy contractions over the past few weeks, definitely stronger than the normal practice contractions you have throughout pregnancy. I think the baby might have turned anterior, because tonight it feels like one smooth back all along my belly, and the movements are much more muted. I should give it a listen with my fetoscope; for me, that's the most accurate way to pin down where the baby is.

It's funny--no, it's NOT funny--how all of our careful plans for the birth of this baby and for my postpartum support have fallen apart. I was supposed to have around 3 straight weeks of help from my mom and then my mother-in-law. And the baby would be a few weeks old by time Eric left on his immersion trip...

Now, we're facing a dramatic upheaval in plans. My mother-in-law flies in from Alberta in less than two days, and still no baby in sight. Eric has lined up replacements for his trip, as it is pretty obvious at this point that he will not be going. Then, after his mom leaves, my mom won't be able to come until late March, leaving me with no postpartum help for a two-week period. Yikes!

I do have a wonderful circle of friends in town who repeatedly remind me that they are here for me, that they will take my children, bring me meals, do whatever it takes to support me during this time. I am so grateful for them. Now my job is to not try to do everything on my own, but to ask for and accept their help.

I never, ever imagined the possibility of still being pregnant and hosting my MIL. Now, don't get me wrong--I really, really like her. But I do not want anyone in my space until after the baby is here and especially when I am in labor! It's nothing against my MIL; I'd feel the same way with my mom and my own sisters. I am really protective of my space until the baby is born. So I am lining up friends who can host my MIL while I am laboring, if the baby doesn't arrive by tomorrow.

Besides these concerns--and of course the normal questions that arise unbidden in my mind: "what's up with this baby? why is it taking so long? at what point should I start to worry?"--I feel a deep sense of peace and calm. Poor Eric, on the other hand, has practically given himself an ulcer. He says he's been wound up so tight the last week or two that he feels like he's going to break. He keeps asking me, "are you sure you don't want to try walking/sex/spicy food/etc to see if it will bring labor on?" Now, I'm all about those things and more, but only for the sheer pleasure of doing them. Not to try to induce labor. If I'm going to take a walk, it's because I want to go outside and enjoy the fresh air. That's it. No ulterior motives. No wearing myself out trying yet another anecdotal method of inducing labor and driving myself crazy in the meantime.

Here's me, slightly disheveled after a brief morning nap (thanks to my friends who watched the kids!):

41 weeks from LMP/40.4 weeks from ovulation

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It's a boy!

Not mine though...sorry to tease you.

My youngest sister had her first baby today, a chubby 9 lb 2 oz boy! We were due within a day or so of each other. Of course we both thought I would go long before she would, given my history of early babies and her first-time status. She gave birth with the midwife practice at Mt Auburn Hospital in Cambridge and everything went as she had hoped for--a spontaneous, unmedicated birth with her husband, doula, and midwife present.

I'm so excited for her! Now let's see if my little one can get with the program and find the exit route.

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Supporting your own perineum

A blog reader recently asked a question about supporting your own perineum:

Reading the post regarding birth plans, I came across the part where you say "I catch my own babies and support my own perineum" and it confused me a little bit.  I am not a mother, never given birth.  I have witnessed a few births but I still have the question... What do you mean when you say you support your own perineum?  Can you explain to me exactly how you support it?  If this is too personal of a question, sorry!  I am just unfamiliar with this and would like to know what it is for future knowledge.  My husband and I are trying for our first and I have to say that I am scared of the birthing process.  Mainly because I am scared that I would tear.  So you mentioning this peaked my interest.

First, I should clarify that what I do is provide gentle counter-pressure against the baby's head wherever I feel too much burning/stinging, rather than touch or support the actual perineum.

Let me quote from Dio's birth story to illustrate:

The baby’s head descended rapidly. When I felt it hit my perineum, I slapped my right hand down to support my tissues while maintaining a death grip on Eric’s arm with my left hand. As I was doing this, this passage from Gloria Lemay’s article Midwife’s Guide to an Intact Perineum flashed through my mind: "The next distinct feeling is a burning, pins-and-needles feeling at the opening of the vagina. Many women describe this as a 'ring of fire' all around the vaginal opening. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This instinct should be followed. It seems to really help to have your own hands there."

...With each contraction, the head emerged more and more. I applied counterpressure to the head, varying the pressure between the front and back depending on where I felt more pressure and stinging. As much as crowning, and pushing in general, was wild and crazy and painful, it was amazingly cool to once again support my baby’s head as it emerged out of my body. There’s nothing like feeling your baby’s head come out, bit by bit, into the palm of your hand. Every woman deserves that experience.

Providing your own counter-pressure or perineal support isn't a fancy technique; it's a matter of following your body's cues. You cup your hand over the baby's head once it starts crowning and apply counter-pressure wherever it feels best to do so. Sometimes it will be in back towards the perineum; other times in front near the urethra/clitoris.

During Zari's birth, she seemed to take forever to be born. On the other hand, during Dio's birth I was doing everything I could to slow the pushing stage down. So the counter-pressure was especially useful for Dio's much faster pushing stage (20 minutes versus 2 hours).

If you want to do your own perineal support/counter-pressure, make sure those attending the birth know this and are prepared for it. Every provider has their own habitual practices--some routinely massage and stretch the perineum, others provide counter-pressure, others keep their hands off entirely. Be very clear that you want no one touching you or the baby as it is crowning and that you will be putting your hands on the baby's head instead.

It also helps to be in the right birth position so you can easily reach the baby's head. Variations on a low kneel or crouch work especially well.

"frog squat" from Sage Beginnings

A low kneel from Laura Shanley's Bornfree site

Sitting on the toilet also works; I did this while Zari's head crowned and emerged, then went down to a half-kneel/half-squat on the floor for the birth of her body.

I'd love links to photos or videos of women doing their own perineal support/counter-pressure!
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Women's history moment: engagement quilts

I slept and read books all day yesterday as I was recovering from the nasty stomach bug. While I was reading A History of the Wife by Marilyn Yalom, I came across a passage about engagement quilts. In her chapter on "Victorian Wives on Both Sides of the Atlantic," she writes:

During the engagement period, the making of a quilt by the bride's friends gave official recognition to the betrothal. Whether they lived in the South, the North, Midwest, or West, quilters participated in a utilitarian activity that had become, by the mid-nineteenth century, a communal ritual and a fine art. First they would make certain design decisions together, such as the size and color scheme. Then each woman would make a square or "block" and sign it with her name in ink or embroidery, before all the finished blocks were sewn together to make the quilt top. A quilt backing was stretched out on a frame, covered with cotton batting, which was then covered with the quilt top. Decorative stitching through the three layers held them in place. Referred to as "engagement quilts" or "bride's quilts," they were intended to last a lifetime and to be handed down to one's descendants. (p. 209)

I was struck by how similar this process was to the birth quilts I made for Dio and this new baby. It's fascinating to see how women's traditional practices become revived and reinvented--unknowingly, in my case.

And I can't leave out mention of this lovely birth quilt I linked to years ago...just because it's so beautiful.

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What's worse?

What's worse than a third sleepless night in a row?

A third sleepless night plus...

Puking 4 times

15+ trips to the bathroom for diarrhea

Fever and chills

Back to bed I go...

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Need sleep

Terrible sleep issues again...can't write much because I need to get to bed and if I started, I would probably say some very mean and irrational things because I am so tired and desperate.

And I'm just a tad bit stressed out about the fact that my husband is leaving the country in a week. He's bringing a group of students to the US Virgin Islands over spring break as part of a travel writing course he's teaching. We thought the baby would be several weeks old by that point. Now I'm facing the possibility of having a baby only a few days old and no husband around. My MIL is coming that week but I am not sure I can handle it on my own, even with her help.

And let's not even mention all the ridiculous theories various people have suggested for why I'm still pregnant. I'm too stressed/not stressed enough/purposely withholding labor/caused it because of my diet.

Whatever.

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Bamboo wrap-style carrier on sale!

I saw this Earth Mom and Baby's Panda Pocket wrap-style Carrier on clearance at Baby Steals for $39.99 (normally $89.98) and wanted to pass the news along. Price last until they are sold out, which will probably happen some time today.

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Pregnancy update: 40 weeks

Today is the first time I’ve ever reached my “due date” in 3 pregnancies. To be really technical, I won’t actually be 40 weeks for another few days, since I have a 27-28 day cycle with a short luteal phase (I ovulate around day 16-17)…but who cares, anyway?

We had a "due date date” tonight after we put the kids to bed. There’s not much going on in our town, no good restaurants or shows right now, so we just stayed in. I rented a video—the latest Twilight, since I felt like something fluffy—and we ate popcorn. Eric was totally rooting for Team Jacob. "Enough with the weepy, moronic, emotionally abusive relationship," he said.

I don’t feel all that much different than last week. Sleep has been so-so, but that’s the reality of being at the end of pregnancy. Zari was really helpful today and let me sleep during Dio’s naptime. She played quietly by herself, helped herself to an apple, and stayed out of the room until I woke up.

I’ve already started working through my postpartum reading list. Last night, I started reading The Year My Son and I Were Born by Kathryn Soper and stayed up way too late. Then I woke up early this morning and couldn’t get back to sleep, so I finished the rest of the book before everyone else woke up. The writing itself is okay, but the story is so powerful. I cried through about half of the book, and I’m not usually the crying type.

Then this afternoon I read Free-Range Kids start to finish. Fantastic book, fast read. After Dio woke up from his nap, I brought the kids outside to play and myself outside to read--putting free-range into action, right? It was right around freezing and overcast, not really the best weather, but the kids didn’t care. It’s amazing how they can amuse themselves with puddles of water and broken tree branches.

If I don’t have the baby tonight, I’m bringing the car into the shop tomorrow. Great timing, eh? I’m pretty sure we have a fuel line leak, since our mileage has plummeted suddenly from 600+ miles/tank to less than 350. I’m borrowing a friend’s car for the day so I can go to my midwife’s appointment, and we’re hoping it the car will be fixed by the end of the day.

40 weeks pregnant

 I love this photo because it shows Dio's silly side.

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Birth Around the World: Vertical Birth

I recently added a vertical/upright birth button to the left sidebar. Clicking on it will bring you to a list of posts mentioning upright birth.

I also wanted to bring your attention to several articles and links about vertical birth.

First, read The Unnecesarean's fabulous article about the Vertical Birth Movement in Latin America. From Venezuela to Peru, from Ecuador to Mexico, hospitals and childbirth advocates are starting to adopt vertical birth as a way to increase safety and as a fundamental human rights issue.

Next, Susana of Spirit-Led Birth that birthing in an upright position liberated her from pain:

Once I learned that women can birth while sitting, standing, or on all fours I was liberated! From the bed and from pain! My first two births, (which were hospital births) were conducted in a bed. For the rest of my 5 births I never once laid in a bed. During my first homebirth I went to lie in bed, out of habit I guess, and as soon as I laid down I felt pain so I got out the bed and never got back in!

She includes a link to a Spanish-language video called "Humanized Birth: Retrieving the Vertical Position." Lots of lovely upright births!



Finally, Sage Beginnings has photo illustrations of various birthing positions. These pictures, taken in a variety of birth locations, are so much more helpful than the line drawings found in many birth books!

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Postpartum reading suggestions

I need some good books to read after this baby is born. I felt so good after Dio was born that I had a hard time making myself lie down and rest. But give me a good book, and I can stay in bed for hours! I need some reading suggestions--fiction, non-fiction, fluffy, serious. Anything really, as long as it's well-written, throught-provoking, and/or entertaining.

I've already ILL'd a stack of books and made my way through a few of them, but I need lots, lots more. So please send me your recommendations!

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Make hay while the sun shines, Rixa style

We've had an unusually warm spell the past few days. True to form, I've taken advantage of it to strip the antique washstand & mirror that we're turning into our bathroom vanity. It's a beautiful piece of furniture, but the shellac was worn off in several places.  It would look blotchy if I just put another coat of shellac on top. So I suited up with a dual-canister respirator, heavy-duty rubber gloves that are supposed to be impermeable to any chemical substance, and an old Army surplus shirt (which barely snapped over my belly). I wish I had a picture, because it was quite the sight.

I finished the last of the washstand today. If the baby stays put for a few more days, then I can apply the new finish (a wipe-on polyurethane for moisture protection).

Or the baby could decide to be born right away and I'll just not have a bathroom sink for another month or so. I'd be okay with that too.

My friends joke that I'll be doing a home improvement project while I'm in labor, pausing for the contractions and only stopping for good once I'm starting to push.

Probably not too far from the truth. 

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MamAmor: handcrafted birthing and breastfeeding dolls

At this year's Lamaze/ICEA conference in Milwaukee, I saw these gorgeous, handcrafted, colorful MamAmor dolls and fell in love.

I'd been looking for a "birthday present" for Zari when the new baby is born. I chatted with Adriana, the creator and owner of MamAmor, about ordering a doll. She does both ready-made and custom dolls. You can specify eye & skin color; hair color, texture, and length; type of clothing (nursing dress, skirt & shirt, pants, etc) and several different accessories, including glasses, hand bags, scarves, jackets, and ring slings.

Each mama-baby pair takes 12+ hours to make from start to finish. Adriana has detailed the doll-making process at It takes more than Vitamin "L". She uses yummy materials--environmentally friendly, often organic, and local if possible.

For Zari's doll, I requested medium brown skin, blue eyes, and long strawberry blond hair with lots of color & texture variation. I asked for a nursing dress--something "beautiful and colorful"--as well as a ring sling. While Adriana was making the doll, she sent me 4 choices for the nursing dress. Zari immediately picked the green.

Two weeks ago, this package arrived from Alberta, where Adriana lives, works, and makes her dolls. Zari was so excited! I told her she could open it and play with it for a day, then we had to wrap it back up. She could open it again when the new baby was born.

She immediately arranged the mama and baby dolls into this or that position, narrating as she went.

Look at the amazing hair! It's made of alpaca, merino, and cotton wools:

MamAmor dolls are designed to go through pregnancy...

 birth... 

 and breastfeeding. 

 

Adriana also makes VBAC dolls that can give birth either vaginally or through an opening in the abdomen.

Thanks to the strategic placement of snaps, the mama doll can nurse and cuddle her baby with no outside "help". The baby's mouth fastens to the breast, and the mama's arms snap together to hold the baby securely.

The baby comes with a detachable umbilical cord and placenta, diaper, and receiving blanket.

Of course I had to make several extra blankets for the baby doll at Zari's request! You can see the multiple layers of blankets in this picture.

 I love the Zen expression on the mama's face.

 A tiny ring sling carries the baby securely. 

Making extra baby blankets wasn't enough--Zari requested another dress, too! She pulled out just about every fabric in my stash, wanting a whole wardrobe full of dresses. I told her one was enough for now! I made this one with a matching blanket. Like the original dress, it has nursing slits in the front of the bodice.

The MamAmor doll was definitely worth saving up for--a great use for Zari's birthday & Christmas money from grandparents & great-grandparents. Now we're just waiting until she can open her present again on the day the baby is born!

For more information/to purchase:

• Visit MamAmor for more information about ready-made ($135 and up) and custom dolls ($145 and up). 
• Some ready-made dolls and accessories are available here. 
• You can also browse MamAmor's Facebook page for hundreds of photographs of the dolls she has made. There's also a giveaway for the 5,000th person to "like" MamAmor on Facebook!

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Belly picture: 39 weeks

39.1 weeks...

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Upcoming reviews

I have a wonderful lineup of products and books to review. We'll see how many I can get to before the baby is born!

• MamAmor birth & breastfeeding dolls
• Mother & child needle felted wool dolls from The Mermaid's Muse and MamaGoddess
• Bright Star all-in-one diaper
• Green Body Basics Naturally Effective Deodorant

Books:

• Memoirs of a Singing Birth by Elena Skoko
• Birth Movement: How to Use the Birth Sling, Squat Bar, Birth Ball, and Positions for Your Low-to-No Intervention Hospital Birth by Jun-Nicole Matsushita of Birth Movement
• Impact of Birthing Practices on Breastfeeding by Linda J. Smith
• Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers by Nancy Mohrbacher and Kathleen Kendall-Tackett 

As always, I would love your suggestions for books, products, and DVDs to review!
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Pregnancy update: 39 weeks

I feel fairly well-rested the past few days, for which I am incredibly thankful. I've been able to fall asleep and get back to sleep quickly when I wake up. I had a few narcoleptic moments recently, though. On Saturday I fell asleep at a birthday party that Zari and Dio were at (it was at a good friend's house and their couch was in a sunny place and I knew they wouldn't mind!). The kicker was at church this Sunday. I was so tired that I laid down right on the pew and slept all through Sunday school. My sister said, "good thing you don't care about social conventions."

Several people have commented that my belly looks different or that I've dropped, although I have never noticed "dropping" during any of my pregnancies. But I am starting to feel like I look huge (for me). When I see my side profile in the mirror, I do a double-take. I'll see if I can get a belly picture tomorrow.

I've gained somewhere between 18-24 lbs this pregnancy (I don't know my exact pre-pregnancy weight since I was in France and didn't have a scale). Pretty similar to my other two pregnancy gains of 26 lbs each time. I haven't seen any new stretch marks this pregnancy, but I also haven't been looking that closely either.

Other than the normal late-pregnancy pelvic looseness, I feel pretty good. Baby is still hanging out ROT, maybe a bit ROP at times because I feel a lot of movement in front. My midwife said the baby's head is tucked in super tight. I still have a hard time envisioning how all the parts fit together into an actual baby! I love seeing the belly mapping drawings like this one. This baby is active during the day and pretty calm at night. No complaints with that, since I've had so many sleep challenges the past few months.

We're supposed to have an unseasonably warm spell of 60 F (15 C) in a few days. If the baby can wait until then, I'd like to strip and refinish--outside and with a respirator of course!--the antique washstand & mirror that will become our bathroom vanity. Otherwise we might not have a bathroom sink for quite a while...

I also wanted to share pictures of a Blessingway tree I received in the mail, along with a pack of beads and their meanings from a group of friends at The Gift of Giving Life project. Some of the women include Felice of TGOGL, Sheridan of Enjoy Birth, Heather of Women in the Scriptures, and Buscanda of Birth Faith. Zari helped me hang the beads on the bonsai tree last night. I added a few beads of my own from Dio's Blessingway and from beads I sent to other women for their Blessingways.

Dio is fascinated with the beads

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Last midwife's visit?

I had a visit with my midwife today. While I was there, two of her clients went into labor. So she headed out in one direction and her midwife partner in another. We didn't even finish our entire visit. I joked that maybe I'd go into labor tonight and add to the Valentine's Day fun.

I'll be 39 weeks tomorrow. If this baby were Zari, it would have been born almost a week ago. And if it were Dio, it would be born tomorrow. After having two babies come "early," I have a bit more of an expectation that this baby will also be born shy of 40 weeks. And so does almost everyone who knows me. I am getting really tired of people asking me, "So how are you feeling?" Umm, tired but otherwise just the same as last time you asked!

My next midwife's visit is scheduled for Wednesday of next week (40.1 weeks). Will I go that long? Who knows...

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Breastfeeding history moment: Mormon handcart pioneers

In 1900, Danish artist CCA Christensen painted "The Handcart Company." From 1856 to 1860, around 3,000 Mormon (LDS) pioneers crossed the Great Plains on foot, pulling handcarts behind them for 1,400 miles. (Incidentally, the handcart companies departed from Iowa City, where I did my PhD. The town has a Mormon Handcart Park and holds an annual celebration honoring the pioneers.)

In this painting, you see a woman nursing her baby uncovered in mixed company. She is sitting on the left side of the painting near the wagon. Her dress is unbuttoned, exposing the breast. While this painting is not necessarily a snapshot of breastfeeding norms in the mid-1800s, it does reveal cultural attitudes towards nursing in public around the turn of the 20th century.

Full painting:

 Zooming in:

Full zoom:

I wish I had a better quality image of the mother & child. If anyone had access to it, please send it my way.

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Breastfeeding 101: Latching on a newborn

I took this short video when Dio was about 10 days old. In it, you will see

• a baby showing very obvious signs of hunger
• a cross-cradle hold that transitions to a cradle hold once he is latched on well
• me explaining the basics of an asymmetrical latch
• the suck-pause-swallow sequence of a nice, deep latch
• and some other things incidental to breastfeeding, like me taking out the nursing pad before we begin!

Also viewable in HD.

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Draw how you feel

I haven't read a lot of parenting books. But I really like Siblings Without Rivalry and How to Talk So Kids Will Listen & Listen So Kids Will Talk, both by Adele Faber and Elaine Mazlish. Their writing style is a bit contrived and hokey, but their advice is spot-on. One of their suggestions in helping young children deal with their feelings without hurting other people is having them draw how they feel. Drawing gives children a creative outlet for feelings of anger, fear, frustration, or sadness. It also validates their emotions.

I tried this the other week with Zari. She and Dio were sitting at the kitchen island eating pretzel sticks. I think Dio grabbed Zari's pretzel and broke it. She got very very mad at him and was gearing up for a temper tantrum. I quickly diverted her anger away from Dio by saying, "Zari, run get a piece of paper and draw how mad you feel!" She disappeared into the dining room and came out a few minutes later with this:

She explained the scene to me. You can see the island, Dio's step-stool, Dio holding the pretzel, and Zari looking quite unhappy with Dio. Her anger was successfully defused, I had acknowledged how upset she was by looking at and talking about the picture, and best of yet, Dio emerged without being hit or pushed.

Success!

What are some of your favorite parenting books or tips?

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Implementing skin-to-skin in a hospital

Alethea, a labor & delivery nurse in a small community hospital, wrote this guest post about how to implement skin-to-skin in a hospital. Sometimes a big change in policy starts with just one nurse's efforts! 


If you would like to get in touch with Alethea, please leave your email address in the comments or send me an email, which I will forward on to her. She is more than happy to answer your questions.

As expectant mothers near the end of pregnancy, they begin to prepare themselves mentally and physically for the upcoming birth of their baby. While imagining what labor and birth might be like for them, they often daydream about holding their baby in their arms for the first time, immediately after birth. It is instinctive for new mothers to want to hold their babies close, nourish them, and keep them safe and warm.

In recent years, studies have shown what mothers have known in their hearts since the beginning of time: that skin-to-skin contact immediately following birth is best for mothers and their healthy babies. Healthy newborns placed skin-to-skin on their mother have a surprisingly easy time adjusting to life outside the womb. Skin-to-skin contact helps keep babies warm. Babies also cry less, have more stable blood sugar levels, sleep more, experience less pain from painful procedures, and are interested in breastfeeding sooner than newborns who are separated from their mothers.

I am a labor and delivery nurse in a small community hospital. We attend the deliveries of 350-450 births per year. I began recognizing that it was not a part of our culture to support immediate skin-to-skin contact with new moms and babies. Often, doing as they were trained to do, nurses would whisk the baby over the warmer, clean her up, weigh her, measure her, administer baby meds, etc while the placenta was being delivered and the physician was repairing the mom’s perineum if needed. Often, I then witnessed the baby being wrapped up in multiple layers of blankets, with only his face visible to finally meet his mother mother for the first time 15-20 minutes after birth. My colleagues and I were simply task-oriented; we did not recognize what we were denying these moms and babies. We were all trained under a medical model of obstetrical care, and we were simply trying to get our jobs done as efficiently as possible. Ah, but old dogs can be taught new tricks (or ancient tricks that they just didn’t know yet)!

When I was first training as a labor and delivery nurse, I worked in a large urban city hospital that had both midwifery-model care delivered by certified nurse midwives, as well as medical-model care delivered by physicians. (Granted, some midwives seemed to function under the medical model and some physicians seemed more midwifery-model oriented, but that is another story.) In my training and subsequent employment, I witnessed the beauty and the benefits of providing immediate skin-to-skin contact between moms and babies, as it was strongly supported by the midwives with whom I worked. I feel so blessed to have had the midwifery model of care as a part of my training. Many moms and babies have benefited from what I learned from those midwives (and some physicians).

So, how did we go about changing the culture of our little community hospital? It all seems to be a bit of a blur, and I might be getting some of the details out of order. My apologies to my colleagues if that is the case! Taking into consideration that the predominate culture of our department has always been doing what is best for moms and babies, I think this particular change started with leading by example. When I attended a birth as the baby nurse (we always have two nurses attend every delivery, one for mom and one for baby), I began to put babies skin to skin with their moms. When I was the labor nurse, I urged the baby nurse to get the baby skin to skin as soon as possible, asking them to leave all the non-urgent admission tasks for me to complete later. If the baby was brought to mom all wrapped up, I would simply unwrap the baby and get him skin to skin with his mom. We began to have discussions at the nurse’s station about which of our nursing tasks can wait (most of them), and we talked about how easy it really is to do those tasks that could not wait right on the mom’s chest. For those nurses who felt they did not have time to come back later to do admission procedures on my babies, I volunteered to do everything myself. And slowly the culture started to shift.

In 2007, AWHONN published an article, Skin-to-skin Contact: Giving Birth Back to Mothers and Babies (PDF). I printed up copies of the article and left them around the department, requesting that all the nurses read it. I sent copies to the recovery room staff and anesthesiologist. Over time, I began to notice more nurses starting to incorporate skin-to-skin into their routine practices. We were gaining momentum.

Over the past couple of years, the nursing staff and physicians I work with have successfully integrated immediate skin-to-skin contact as a standard of care for healthy babies born by vaginal birth. Because we strongly believe in the importance of providing safe, quality, family centered maternity care, we are always looking for ways to improve the services we provide the new families in our community. So why stop what we now know is the right thing to do with just vaginal births?

We all know that when cesarean birth becomes necessary, it often brings an unexpected and unwelcome separation of the mother from her newborn baby. Even when cesarean births are planned, I can’t imagine the longing so many mothers must have felt during the time they are separated from their babies. It is not uncommon for it to take between 40 minutes to over an hour be reunited with their baby. (Side note: because we are a very small hospital, we do not staff our own operating room or recovery room.) As we witnessed the gentle transition to life outside the womb with infants placed skin to skin with their mothers after vaginal birth, I began to wonder why we could not also support this amazing time for healthy moms and their babies born by cesarean.

Our department was looking for a quality improvement goal for the upcoming year. At our staff meeting in November 2010, I suggested we begin to offer and support skin-to-skin contact in the operating room. We had already tried, with inconsistent success, to bring babies back to PACU (a recovery room that is staffed with different staff than the LD unit) to breastfeed. (Again, another story as to why that hasn’t been very successful.) So why not just prevent the separation in the first place and keep the babies with mom in the OR?


My colleagues were all on board and we set a very ambitious goal of providing skin-to-skin contact in the OR for 75% of our cesarean-born babies within 3 months of beginning the initiative. I am excited to report that after two months into our initiative we have supported immediate skin-to-skin with 53% of cesarean-born babies at our hospital. We do have a little ways to go, but it is absolutely worth celebrating that over half of babies born by cesarean are now getting to spend this valuable time with their mothers.

Prior to beginning the initiative, we did a little ground work. I spoke to the head of anesthesia about our plan. While some of his colleagues were not as enthusiastic about it as I had hoped, we got the go-ahead to move forward on a case-by-case basis. As the anesthesiologists have all been able to witness the beauty of this time, they are now all very supportive (or at least not negative) about it! We also decided to clearly define the criteria for both mom and babies to participate in the initiative (stable vital signs, no O2 requirement or respiratory distress for baby, no nausea/vomiting for mom, mom wants to participate, etc). We got the full support of the Neonatal Nurse Practitioners who attend all cesareans and let the pediatricians know that the babies would not be coming back to labor and delivery for their first admission exam as soon as they previously had been. We were all set to begin on December 1st, 2010.

Just a few days before Christmas, I was working with a first-time laboring mom and her partner. Kelly was in the middle of a medically indicated induction, and was hoping for a vaginal birth with minimal intervention. As the day progressed and despite that fact that she had been working extremely hard for many hours, she experienced very little cervical change. She was exhausted and disheartened by the news. At that point she decided to receive an epidural. After many more hours, and despite exhausting all other options, there was still no cervical change. Kelly and her physician agreed that a cesarean birth was necessary. As I was preparing her for this change in plan, I let her know that there was a good possibility that at least one part of her birth plan would not be disturbed. All went as planned. Both Kelly and and her baby Simone did very well and met our defined criteria. Not only did we place Kelly and baby Simone skin to skin in the OR for nearly 30 minutes, Simone even breastfed briefly in the OR!

When she later sent me copies of the photos I took of this special time with their camera, Kelly said:

It was incredibly meaningful to have Simone with me immediately after her birth. That very special moment of togetherness is what so many mothers look forward to, and I did, too: After 9 months of pregnancy and the effort of labor, it felt like a huge reward to finally touch our baby, to face her and have her in my arms. A cesarean birth really enforces a distance between mom and child, but the opportunity to embrace Simone right away really did help me overcome those feelings of alienation. It allowed me to be one of the first to welcome her into the world, which is, I think, a mother's right--certainly it's something I think all moms hope for.

Pictures of Kelly and Simone in the OR:

 

 

 

 

Cindy, a LD RN, loves witnessing the bonding and connectedness that skin-to-skin in the OR promotes. “It makes it so much more real,” she commented. Kristi (RN) added that “it makes the surgical birth experience so much more personal and meaningful.” As a Birthing From Within mentor as well as and LD nurse, I know in my heart that cesarean birth is still a sacred time for new families. All births, cesarean or vaginal, represent not only the birth of a baby, but also the birth of a mother, a father and a family. My hope is that supporting ways to make cesarean birth feel less clinical and more sacred will save a lot of heartache, feelings of disconnectedness, and feelings of loss over an unexpected and often unwished-for outcome. Allowing moms and babies to connect immediately after any birth is the right thing to do, and I feel it is my job to protect this sacred time.

I believe that with a little time, patience and education, all LD departments can do what we are now doing to support skin-to-skin for all mothers and babies. If you are interested in learning more about how you too can bring skin-to-skin in the OR in your hospital, please don’t hesitate to contact me. (Send Rixa an email, and she will forward it on to me.)

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