August 13, 2012

On July 26, 2012 I awoke at 4am to a strong rush. It got me out of bed and into the washroom. Another several minutes passed and another rush just as strong as the first one came. After several of these strong rushes I began to consider whether or not to have my husband take our 5 year old daughter in to daycare and send him off to work for the day. He works only minutes away, so he would be able to come home quickly if I needed him to.

Within about an hour (5am?) I saw a perfectly formed mucous plug on one of the soaker pads I’d sat on through a rush. Shortly thereafter I figured my membranes had ruptured spontaneously. The rushes continued to grow stronger and closer together and by about 6:45am I had contacted my doula, midwife and our daughter’s caregiver-doula to notify them of the onset of labour. My doula was at the lake 2.5 hours away so sent her a text message that my waters broke and that she should plan to come to Saskatoon today. Within half an hour she got another message to urge her to leave for the city ASAP!

My husband awoke around 5am and got the bed ready with waterproof layers and clean sheets, and started inflating and then filling the birthing pool we had for our planned home birth. While he was filling the birthing pool in our living room I was rushing every 5 minutes or less for about 30-45 seconds each time. I set up a comfortable stack of 4 pillows in front of 2 pillows and a soaker pad so that I could rush in a hands-and-knees/child’s pose position on the bed.  It was clear to me within a couple of hours that my husband would not be heading in to work that morning and that our daughter would stay home with us to see the birth as we had planned. Labour was quickly progressing and I was having really intense rushes.

By around 7am I had a strong, wet rush that left the soaker pad I was on filled with blood and a large clot. The next rush came and went with more blood loss.  I saved the soakers and had my husband contact our Midwife immediately to implore her to come to our home ASAP. He told her the situation, that there was a lot of blood, the baby is moving around and I’m fine other than that.

The Midwife arrived quickly, saw the soaked pads and asked if she could listen to the baby’s heart rate with her fetal stethoscope. The baby’s heart rate was reassuring and normal. She then asked me if I would let her do an internal exam to see how open my cervix was at that point. She mentioned that we would have to have a talk about transferring to the hospital because she was uncomfortable with the amount of blood loss. I consented to the internal exam and was 5cm dilated and 100% effaced.

I knew even before she arrived that we would probably be transferring to the hospital. I knew there was a significant amount of blood being lost, but felt strong and well otherwise. The baby’s movements were reassuring and I never felt weak or dizzy. I was prepared to transfer and accepted that it was necessary under the circumstances.

I prepared to leave with the Midwife while my husband stayed behind waiting for our daughter’s doula (her Grandma) to arrive at our home. We had planned to keep them at our home in case of a transfer to the hospital to await the birth announcement. The hospital procedures and routines can sometimes be chaotic and stressful and I didn’t want her to worry about me if things took a turn for the worst.

The car ride to the hospital was very uncomfortable. I couldn’t bear to sit properly in the front seat so I stayed on my knees facing the back of the passenger seat gripping on to the head-rest. I started out with the seat belt around my back but through the first rush I had in the car I released it. It felt far too restricting. The passage of time was hard for me to gauge. When it seemed like we should have been approaching the Royal University Hospital (RUH) I looked back to see that we had only traveled about 5 blocks!

I managed to walk the entire way down the stairs from my 3^rd story apartment, into and out of the car, and into the hospital, up the elevator and through the birthing unit. There was no wheelchair available at the old entrance when we arrived and I was thankful. I felt better walking through the rushes and leaning on whatever rail was around, or the Midwife herself to get through them. The rushes were intense and close together (every minute or 2?) but they didn’t seem to last 60 seconds. It seemed like they were only about 30-45 seconds long.

I knew that once we arrived at the birthing room I’d be consenting to continuous electronic fetal monitoring (EFM). The Midwife wanted to know how the baby was coping through labour and birth. His heart rate was normal and reassuring throughout the entire ordeal. Apparently his heart rate was extremely high as he was making the final descent through my pelvis and that caused the nurse to worry. I didn’t notice her or the calm reassurances my Midwife was giving her, my doula explained that bit to me after the birth.

Shortly after arriving at the hospital I was surrounded by my husband, doula, Midwife, nurse, blood-work technician, and the Resident OB. I had another internal exam done by the Resident OB and was 6cm and 100% effaced. I had a heparin lock in my hand for quick IV access, blood-work done out of the other arm, and continuous EFM. All of this was a far cry from my original care plans but fortunately I progressed quickly and without further cause for concern! I raised the head of the hospital bed to a 60 degree angle and rushed on my knees on the bed facing the head of the bed. Once I couldn’t get out of the bed to use the bathroom anymore I stayed in this position until he was born. We were able to get the EFM to stay in place by wedging a pillow beneath it while I knelt and squatted facing the head of the bed.  

Our daughter and her Grandma arrived at the RUH but were asked to stay in the main mall or a waiting room. I was extremely loud breathing and moaning  “I’m OK, OK, OK it’s OK, OK…” though the rushes. As he was descending through my pelvis and I began pushing him down I changed into a loud roaring tiger! It felt great to transfer the strong sensations I was feeling into a deep roar. Everything was so intense and loud that I feared my daughter would be too concerned for me and be too much of a distraction when I needed to focus. As it turns out they heard me loud and clear from the waiting room anyway! It was amazing feeling his internal rotations as he descended and was born; a truly humbling experience.

Our son Samuel Alexander was born within 3 hours of arriving at the RUH after only 7.5 hours of unmedicated birthing (4am-11:30am). He weighed 7 lbs and 1.5 ounces. I only pushed him down for about an hour and was only told how to adjust my breathing as his head was born. No one had to tell me how or when to push. We waited until his umbilical cord finished pulsating before our daughter and my husband cut it together. I consented to an injection of synthetic oxytocin after the birth to prevent further blood loss. The placenta was delivered within about 20 minutes of the birth and without incident. I didn’t require a blood transfusion, sutures or anything more than some Acetaminophen and Ibuprofen for after-birth pains. I had a small first-degree tear on my perineum, and a second-degree tear inside my vagina but opted to heal naturally without stitches. I applied wet strips of Nori (seaweed) on the tear for about a week and a half postpartum and have healed well with many sitz baths and Nori applications.

I felt amazing after the birth! I was calm, grateful and completely at peace. I discovered that he was a boy and we were all thrilled! Words can’t describe the empowerment and joy I felt that day for having accomplished an unmedicated vaginal birth after caesarean (VBAC). I was lucid, focused and uninterrupted for the most part thanks to my caregivers. My Midwife respectfully adhered to as much of my care plan as she possibly could despite the transfer from a planned water birth at home to a hospital birth.

Because I suffered from postpartum depression and PTSD after the birth of my daughter by caesarean operation in 2006, I decided to prepare my son’s placenta for medicinal use postpartum. My doula cleaned and prepared it for me the day he was born. We were discharged healthy and happy the same day we arrived and were home before supper time. I had about an ounce of fresh placenta twice daily in a raspberry ice cream smoothie for 2 days. The rest of the placenta was made into a tincture. The tincture takes 6 weeks to reach full potency and can be used (by me exclusively) as a mood stabilizer and anti-stress/anti-anxiety remedy. Medicinal placenta stimulates milk production and my milk came in on day 2 postpartum. 

My doula is keen on placentas and has taken several courses in Midwifery skills, so she examined my placenta when we got home from the hospital. She noticed an extra part of the placenta attached to the main part, like an extra lobe. On that lobe there was clotted blood and some of the material had sloughed off in parts. We decided that was likely the part that caused the extra bleeding as it tore away from the cervix during dilation. It explains why there was so much blood, but never any signs of uterine rupture or placental abruption on other areas of the placenta.

 I am now almost fully healed 2 weeks postpartum and breastfeeding is going well. I adjusted to the postpartum hormonal fluctuations much better this time and didn’t even have the “baby blues.” I feel proud and energized by the birth of our son, and he is a healthy thriving baby.

My due date was January 4th, and slowly the days went by with no sign of labour. Honestly, every day felt like a month. I was trying to just trust the process, however it turned out to be, but as every day passed, I feared that we wouldn’t be able to have the home birth we planned.  On Wednesday, January 11, we went to the midwife to have a stress test done. Everything was fine, and the midwife told me that we had lots of time, and that I shouldn’t worry. It was a weird space of ..don’t worry you have lots of time.. but also we have to schedule more tests to be done to keep making sure everything is ok. I was feeling the pressure. Everyone around me was asking, “is she here yet”. My sisters would stop by everyday to see if I was in labour, and every time I went upstairs my mom would say.. so how are you feeling? I was going crazy. It’s all I could think about, so there were many times when I just had to find balance, and let go, and try to enjoy and appreciate the time before the baby arrived. A theme in my life has been to have patience and trust, and I think this was the beginning of Aurelia constantly teaching me this lesson. I know there will be many more times she’ll have to bring me back to this in the years to come.

So, our midwife gave me some natural induction methods that we could try. She gave me verbena to make into a tea. The plan was that if the tea was working and I felt things moving along that night, that I would take a strong cocktail in the morning, and if nothing happened I would take the tea again until the end of the weekend, and the stronger cocktail on Monday, because two of the midwifes were off that weekend. We went from the appointment to home where I had the tea. I didn’t really feel much different that night, so I didn’t really think things would move along that quickly, but I tried not to dwell on it. The next morning Thursday January 12, [Dad] and I tried some other natural induction methods, and shortly after, I started having contractions around noon. I tried not to get too excited. We decided to do some cooking and listen to some Bob Marley while [Dad] continued to time my contractions. I had some spotting that started in the morning, but I phoned [our midwife] and she said not to worry, but to call her back if I notice that it’s getting heavier. I remember at one point looking outside and it was snowing. I think this was actually the first time I had seen the snow falling since winter had started.

Around 1 or 2 pm, we went downstairs to our living area, and I tried to get some rest even though the last thing I felt like doing was laying down. I felt like I needed to walk for every contraction, but I thought I’d try. As I was laying down and getting pretty relaxed, my water broke. I don’t think it fully broke but there was some gushing. I got up quickly and tried to get to the toilet. I didn’t make it. Around three we phoned our doula and she came 4 or 5. She helped soo much by giving me some hip presses, massaging, and reminding me to keep my groans low and jaw relaxed. I kept asking when I’d be able to go into the tub. I felt like I needed someone near me during the majority of my contractions so I was sure glad that we had a doula, or else it would have been a very draining day for [Dad] and we probably wouldn’t have been able to fill the tub ha. By six or seven we had tried calling the midwives for about three or four hours with no return calls. To reach the midwives you get the answering service and than they send a message to the midwives. Finally around 7 June arrived who said that they hadn’t
received any of the messages. They were not happy with their answering service. Luckily, we didn’t have any major problems, but I did think that maybe I would have to catch my own baby. When [a midwife] checked me I was about 6 cm dilated. Around 5 or 6 we decided to fill the tub, but ran out of hot water, so my mom, my sister, [doula], and [Dad] were boiling water on the stove and running up and down the stairs to try and fill the tub. I was so happy to get in there. [Dad] and [doula] would massage me, pour water over my back, feed me ice chips, gatorade, grapes. When things were getting tough I remembered the different phrases and things I read in Ina May’s books…keeping my jaw relaxed, allowing myself to open up, thinking was scary feeling wasn’t, My body is wise, the pain isn’t harming you, have faith in the universe…(I actually had these phrases posted all over my walls in preparation for the birth, along with candles, pictures, and music.) I remember that before a heavy contraction would come and I could really feel things progressing my body would give me a longer break in between contractions. In retrospect I find this really fascinating. I also couldn’t stay in one position for too long. I was either on my hands and knees, laying on my back with my arms over the edge, or leaning over the edge as [Dad] held me up, or moving my hips. It was nice to be able to let my body do what it needed to at the time.

A couple of hours later, I was 8 cm. The last five hours are such a blur to us. I remember times when I would start thinking that I couldn’t do this anymore, but I was very aware, and knew that I didn’t want to be in this space, so I would try to bring my thoughts back, and just let myself do my moaning, and [my doula] was always very good at noticing this and bringing me back. A couple of days later, [Dad] told me that my moans reminded him of sacred muslim prayers, which I think is absolutely beautiful but definitely isn’t the way I remembered it being. haha  [My midwife] came around midnight. I was definitely in my own zone, but I was happy to see her. A little while later she told me that I could try pushing if I felt like it so I did. I didn’t really feel an overwhelming feeling to push, but I just couldn’t take the pain anymore, and thought that I would try to see what it felt like, and than I didn’t want to stop. I thought I would like pushing better than the contractions, but it was actually the scariest part for me. I kept thinking that I was tearing, because I could feel the burning, but everyone told me that it was
just my skin stretching. It felt like everything was going to come apart. After pushing for a couple of contractions, they wanted me to get up to go to the bathroom. I remember saying that I didn’t want to, but they said it would make room for the baby. Really, I think they knew that this would get things progressing faster, walking, and the sitting position on the toilet. I went, and it was just [Dad] and I in the bathroom. I had a contraction, and [Dad] says, that he saw my body open up and a head starting to come through. [My secondary midwife] came in and said, ”[Primary midwife] you better come here”. [She] came and said, “this is the one place you cannot have your baby,” so they helped me walk back to the tub. I had a couple of more contractions and at one point they asked if I wanted to feel the head. I will always remember this. I felt a head… and I felt hair! They pointed the flashlight and I got to see it! I didn’t push for very long, and I remember feeling her moving down, and the head come out. I knew that maybe I should let her come out gradually, and a little slower, but I just wanted her to come out, so I kept pushing and out she came, and [the midwife] put her right on my chest. I remember saying “oh my God” and feeling overcome with an unexplainable joy. I remember seeing [Dad's] face. He was smiling from ear to ear, and blinking his eyes, in the way that he does when gets teary and than I saw that she was a girl!!!! I don’t know why, but I kept feeling like we were having a boy, and I was so surprised to see that it was a little
girl. They were trying to get her to have a good cry, to expel the mucous. Because I pushed her out so fast, she didn’t have time for this to happen naturally. She had good color, she cried a bit but not the scream they were looking for. After the imbilical cord was finished pulsing they let [Dad] cut it, and they gave her to [him] and he put her on his chest while the tried to get her to cry to get the mucous out. After, I delivered the placenta, they took me to our bed where [Dad] and Aurelia were laying. I absolutely loved seeing [him] with our little girl. I layed down while they stitched me up. I had second degree tearing. She wasn’t expelling the mucous, and so they used a machine thing to get some of it out. After I was stitched up, I got to nurse her, and she had her first bowel movement shortly after.  Aurelia Moon Trifa was born at 1:20 am, January 13th. She weighed 8lbs 5oz, and was 21 inches long.

We had Aurelia picked out as our girl name, but as we were laying in bed and I was nursing her, [Dad] thought of moon as the middle name. When I asked him about it later, he said that she had moon energy… powerful but still.

I arrived at the hospital at 3:15am and waited for about 10 minutes on the fourth floor just outside of the labour and delivery unit at the RUH when Mom and Elyse arrived together on a stretcher with the paramedics. Once they got Mom on to a hospital bed they explained to the nurse that Elyse was born at about 2:10am and had an APGAR of 10 by the time they arrived (shortly after she was born). The umbilical cord was cut about 5-10 minutes after birth and the placenta was bagged and transported with them to the hospital.

I held Elyse while Mom explained her medical history and answered questions for her charts, and then Elyse was placed under a warming lamp because she was quite cold by then (5:25am). Mom unfortunately received many stitches for multiple first to third degree tears. Elyse was weighed shortly afterward and determined to be: 7 pounds 2 ounces, 52.5 cm long, 34 cm head, 31.5 cm chest. All of the usual newborn routines and screening procedures were performed on Elyse. She was obviously a healthy term baby, just a bit cold from the transportation. No information was passed on to Mom and Dad about the condition of the placenta, so we assume that it checked out OK.

Mom had bled about a litre or more after the birth, so she was given IV fluids, Sintocinon, Fentanyl for pain relief during suturing and antibiotics to prevent infection. She also had two oral doses of Ibuprophen for pain relief after suturing. The nurse checked her uterus by pressing the fundus and had said that it was good and hard upon arrival. She was very calm, reassuring and helpful throughout her shift which ended around 7am that morning. I left around 6:45am and returned later that day to check on them. Breastfeeding had not been established when I left, because Elyse was too sleepy and uninterested in it at the time.

When I arrived at 2pm I found them all asleep in their room, so I returned again around 3pm and stayed until 4pm. Mom was breastfeeding well, and Elyse was spitting up a bit of mucous and milk, but other than that seemed to be thriving. I suggested that Mom try breastfeeding her in a more upright position, like the video we watched prenatally on baby-led breastfeeding, because many women find that that position helps babies who have reflux and problems with latching on correctly. Physically Mom seemed better than before. When she arrived at the RUH she was quite pale and had passed out at home after the birth. She also had a wave of dizziness and felt faint shortly after Dad and Big Sister arrived to see her (around 5:20am). By 3pm she was doing great considering the unexpected ordeal that she had experienced earlier that morning. They had few questions at the time, and were doing well so I left around 4pm to pick up my daughter from daycare. We are planning an in-home visit in a week at their home.

As surprised as I was by how fast Elyse was born after their first call to notify me, I knew that Mom and Dad were as well prepared as anyone could be for the experience of an unattended surprise home birth. Big Sister helped them by collecting towels and letting the paramedics in the house. She was delighted and proud of her baby sister. She wanted Elyse to leave with her when she had to go to school later that day, and was happy to tell everyone that Elyse had splashed into the toilet and made a big mess. What a birth story for her to tell!

Maureen was in touch with us throughout this day and ready to arrive whenever we needed her. At this point, she was on her way. She arrived shortly after my waters were broken. She reminded me of my birth plan throughout, but, unfortunately my stubborn streak got in the way and I chose to have an epidural. The epidural stopped labor. The contractions continued, but it took the remainder of the night to actually dilate the final centimetre. Liam was not in the proper position yet, and we needed to wait for him to move before we started to push. Maureen was very helpful in reminding us of different relief techniques. (Apparently, even when you think you are prepared, usually you aren’t) She helped with massages and made sure Jordan, my husband, could get rest. When it came time to push, she made sure the doctor had compresses to
help soothe. All in all, she was there to make everything more comfortable. At 10:32 a.m. Liam was born. He weighed 8 lbs, 14 oz. and is the greatest gift we could ever ask
for. Maureen made sure we were all feeling okay and recommended some good foods to eat to get my strength back. She checked in with us after and we were welcome to call with questions.

Doulas are amazing! They have skills and services that are so helpful to expecting parents and new parents, no matter what your birth plan and birth story entail. They offer so much advice to those who have no clue! I’m so happy that we could share Liam’s birth with Maureen, and look forward to sharing baby #2!

- Shelby, Jordan and Liam

Breastfeeding:

• Breastfeeding Center
  (306) 655-4806
  Provides support in the community for pregnant and breastfeeding mothers
• Saskatoon Breastfeeding Matters
  (306) 655-4331
  Education and community events in support of breastfeeding
• La Leche League
  (306) 655-4805
  Mother to mother support, monthly meetings and resource library on childcare and breastfeeding
• Breastfeeding education classes
  (306) 655-4820
  One evening class about breastfeeding

Nutrition:

• Babyfood making workshops
  (306) 655-5311
  Make baby food from scratch and learn about feeding your baby solid foods
• Food for Thought
  (306) 655-4826
  Assists pre/postnatal women and their children to achieve improved health. With a focus on cooking low-cost nutritious food, women come together and have an opportunity to share ideas, make friends, and talk about their lives. Childcare and transportation provided.
• CHEP
  (306) 655-4575
  Good food box, community gardening, collective kitchens
• Saskatoon Food Bank
  (306) 664-6565
  Food hampers, cooking classes, clothing depot
• Friendship Inn
  (306) 242-5122
  Soup kitchen that provides nutritious meals daily as well as social support and crisis counselling for individuals and families

Childcare:

• Early Learning and Childcare
  (306) 933-6071
  List of licensed childcare facilities
• Maggies Teen Parent Childcare
  (306) 665-5721
  Committed to support teen parents finish high school
• Millie’s Early Learning Center
  (306) 683-8354
  Childcare for infants and toddlers of students of Nutana collegiate
• Student Childcare Services
  (306) 683-8383
  Childcare for infants and toddlers of students of Mount Royal collegiate. Variety of parent programs offered.

• La Leche League
  http://www.lllc.ca/chapter-group/saskatoon
  (306) 655-4805

• The Birthing Site is a great local website:
  http://www.thebirthingsite.com

• Berry Breast Support offers breastfeeding support by phone or appointment.
  Call Fred (yes, Fred is a lady).
  Mother’s Melody is her retail store located at 248 3rd Ave South, Saskatoon
  (the new location of Birth Rhythms)

  Email: mothersmelody@gmail.com, fred.berry@usask.ca
  (306) 612-2297 http://www.facebook.com/theberrybreastsupport

• Cravings maternity and baby store has a M-F breastfeeding support person,
  Martha available for drop-in visitors:
  http://www.shopcravings.ca/home
  (306) 477-8200

• Saskatoon Breastfeeding Support Clinic
  http://www.saskatoonhealthregion.ca/your_health/ps_bf_support_services.htm
  (306) 655-4777

• Caitlin is a La Leche League leader and postpartum doula:
  http://wisewomencare.wordpress.com

• Birth Rhythms has developed a new pregnancy and parenting health centre which includes breastfeeding classes and birth trauma counselling sessions:
  www.birthrhythms.ca

• Living Skies Living Milk
  (306) 612-2297

• www.saskmom.com
• Facebook Group: Human Milk 4 human Babies-Saskatchewan.
  A non-profit breastmilk sharing group.

• Breast pump rentals in Saskatoon:
  Pink tree
  (306) 665-6544.
  Located at 701 2nd Ave North, Saskatoon.

  Cravings
  (306) 477-8200

• http://www.lowmilksupply.org

• www.kellymom.com

• www.nbci.ca

• www.askdrsears.com

• www.babyledweaning.com

• www.kangaroomothercare.com

• www.naturalchild.org

• www.diaperfreebaby.org

• Saskatoon Attachment Parenting Group:

  Email Erica at: ericabird@shaw.ca
  or call Natasha at (306) 249-3853

  Described as “a learning and discussion group for parents interested in attachment parenting, breastfeeding, co-sleeping and baby-wearing.”
  They meet the 3rd Friday of each month at 10:00am at the Augustana Lutheran Church on the corner of Broadway and 7th St East, Saskatoon.
  They are not a religious group.

• SHR Breastfeeding Professionals:

  Linda Wright RN, BSN, IBCLC
  (306) 655-1883

  Brenda Corman IBCLC
  (306) 934-1013

UNICEF and the WHO developed a video to educate care providers about the benefits of early breastfeeding initiation:

The above video was designed to improve newborn survival rates in developing countries, but the importance of early breastfeeding initiation rings true in developed nations as well. When watching the video pay attention to all of the normal physiological processes that the baby goes through while self-attaching. It’s immune system is strengthened by skin-to-skin contact; the smell of amniotic fluid on its hands reminds it of the smell of colostrum (the first milk) and leads it directly to the nipple; its feet kick at the uterus causing uterine contractions which aid in the expulsion of the placenta.

It is important for the mother to be in a comfortable position during the breast crawl or baby-led attachment. Many women prefer to be reclined at about a 45 degree angle, well supported by pillows at her back. Others prefer to sit upright, and a few choose to lay flat with just a pillow beneath the head. The baby should be supported mainly on the bum, not the head and upper body since their rooting reflexes are strong; they will turn their head in the direction of touch applied to their face. Let the baby lead the way, just support it so that it doesn’t roll off!

Another excellent website full of helpful videos about a good latch and breastfeeding basics is: International Breastfeeding Centre

For more information about breastfeeding visit:

• http://www.lllc.ca
• http://www.lowmilksupply.org/index.shtml
• http://www.kellymom.com
• http://www.askdrsears.com/topics/breastfeeding
• http://www.breastfeeding.com

Some of the best ways to prevent birth complications due to malpresentation of the fetus is to: practice good posture, eat nutritious foods, exercise regularly and avoid reclining positions for long periods of time in late pregnancy. If the baby is not in an optimal position for birth (head down, facing your back) these simple techniques can sometimes encourage it to move into a better position. Other options include chiropractic care, acupuncture and manual external version. Each of these options should only be done under care of a licensed health professional with specialized skills in treating pregnant women. Babies who stay in a breech position or any other position that’s
not optimal despite your best efforts should be left where they are. No one can tell for sure where the baby is in relation to its umbilical cord or placenta, and babies are intelligent and self-preserving. Continuing to attempt aggressive therapies to turn a persistent baby can result in serious complications.

For more information visit http://www.spinningbabies.com/more-info/for-pregnancy and http://www.homebirth.org.uk/ofp.htm