Author Archives: Gloria

Online(Zoom) Leadership Training

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“Leaders in Boys Protection” Project

A training program to unleash leaders in the worldwide push to eliminate male genital mutilation.
Start Date: Tuesday, January 11, 2022
Course Completion Date: Tuesday, March 15, 2022
Time: 7:00 to 8:30 p.m. (Pacific Standard)

This 10-week online training will be headed by Gloria Lemay, a midwifery educator, member of Nurses for the Rights of the Child, and Advisory Board member of Intact America. Gloria has led online courses for midwives and doulas for over 12 years. She is a passionate advocate for baby boys and their right to bodily integrity. She is active on social media as a spokesperson for the “intactivist” movement.

Who should be in this training?: If you have a desire to make a difference in child protection you are welcome to join this online training. You must be able to make a commitment to attend all 10 classes on Zoom once the course begins. If you have been stopped by societal pressure, embarrassment, sadness, anger, overwhelm, or other barriers to expressing your commitment to ending MGM, this will be a safe space to free yourself up and get in action again.

Bonus feature: We will have some special guest presenters who have had years of “on the ground” experience in advocating for baby boys.

What is the cost? There is no charge for the training.

What must I do to participate? Each participant will be asked to create a project of their own that will unleash their contribution to ending male genital mutilation. There will be homework in the course that will be posted on Google Classroom. At some point in the 10-week training, each participant will have an opportunity to present a talk on some aspect of their experience with speaking up for baby boys.

Intended Outcome of the Project

To unleash the expression of people in the intactivist movement at all levels of experience.
Expect unexpected results from coming together with other intactivists to inspire, collaborate and embrace the leadership in all of us!

Please contact me for more information on this project. waterbirthinwoman@gmail.com
Time of class: 7:00 to 8:30 p.m. Pacific Standard Time

WISE WOMAN WAY OF BIRTH DOULA TRAININGS (2023)

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We have one more Doula Training for 2023

Cost: $675 (Canadian)

taught by Gloria Lemay

Jessica Austin, with a Doula client.

Jessica Austin, with a Doula client.

This course will give you the skills to assist women giving birth at home or in hospital. Doula services are in demand. There is a pre-reading requirement. Please email waterbirthinwoman@gmail.com for further information and to register for the course.

The course will be on Zoom and assignments and tests will be on Google Classroom.
12 Classes 2 and a half hours long. In 2023, this will be the next available course.

Course Three: Saturday mornings (Pacific Time)
September 9 to November 11, 2023 (two week break, no classes on Nov 18 & 25).Class 11, Dec 2 and Class 12, Dec 9, 10:00 a.m. to 12:30 p.m. (Pacific)

Successful students will receive Wise Woman Way of Birth Doula Training certification.

OVERVIEW OF CLASS CONTENT
Class 1: Introductions, birth “politics” and Language
Class 2: Preventing Problems before the Birth: Nutrition. Prenatal Screening
Class 3: Types of “support” in birth: Midwife, Dr, Obstetrician, Doula — what are the differences? Comparison of home and hospital choices. Assisting your client in making a clear Birth Plan for the chosen place of birth.
Class 4: Anatomy and fetal positions, introduce the concept of “pain” and normalizing birth sensations through knowing the anatomy. Introduction to the concept of breech and twins as variations of positions.
Class 5: Medical Birth Phases and the “real” phases of birth and how to recognize them.
Class 6: Breastfeeding and early days postpartum and newborn care / Doula Role in these.
Class 7: Common Interventions and the Intervention Cascade. (Fetal monitoring, ultrasound, epidurals, Caesarean, vacuum, forceps, etc.)
Class 8: Preventing Birth Derailment in common scenarios and special situations: Induction for Postdates, augmenting a “slow” birth, a diagnosis of Low or High Amniotic Fluid Levels, Meconium, premature release of the membranes, vaginal birth after cesarean (VBAC).
Class 9: “Informed Choice”: what it *really* means and how to use it as a tool for your client vs a tool for enabling the institutional model of birth, more work on creating a Birth Plan with a client
Class 10: Business Basics: Finances, record keeping, professional practices, client confidentiality, and effective advertising. Structuring a plan for working with clients from interview through to completion.
Class 11: Comfort Measures, supporting Long Births, Helpful things to say, Water Birth.
Class 12: Staying calm when the baby comes: what to do if things change quickly and the doula is the most knowledgeable person present.,
Write Exam. Goal setting for next steps, further Resources.

Postpartum Doula Certification(2023)

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We have heard such positive feedback about our Postpartum Doula Certification Course. We have put together a great course that will launch participants into action in this career.

The Wise Woman Way of Birth Postpartum Doula Training will be taught primarily by Candice Johnson. Candice is the owner/operator of Cherish Childbirth in Vancouver, BC. She has built her business over the past 10 years and is the “go to” woman when families are having problems in the early days of parenting. She has a broad education in Massage, Breast Feeding, Childbirth Education and Infant Massage. Candice has trained many postpartum doulas and is active in the Vancouver birth community. She is the mother of two boys who were both born at home and breastfed into toddlerhood.
Website: https://www.cherishchildbirth.com/
NEXT SCHEDULED COURSE FOR 2023:

6 live classes on Zoom, 2 and a half hours long.
Cost: $525 (Canadian)

2023
Final Course in 2023 dates: Wednesday, Sept 20 to October 25, 7:00 p.m. to 9:30 p.m. (Pacific)
6 Classes Live on Zoom, assignments and materials on Google Classroom.

Course Description:
This course will prepare you to be with families in the months after welcoming a baby. It includes all the aspects of the “fourth trimester” from practical feeding skills, to understanding the postpartum person’s body and how to support the family as a whole.
Our societal structures provide little care for new families. Having a trained eye and calm presence in a home in the early days is invaluable. Postpartum Doula care is proven to improve breastfeeding success, family bonding, and postpartum dis-ease disorders. Postpartum Doulas are in high demand!
The course will be on Zoom and assignments and tests will be on Google class room.
Successful students will receive Wise Woman Way of Birth Postpartum Doula Training certification.
Please email if you need more information or to register. waterbirthinwoman@gmail.com

Class ONE – The Fourth Trimester and the Role of the Postpartum Doula

Class TWO – Postpartum Healing – Physiology, Nutrition and Traditional Practice

Class THREE – Business for Postpartum Doulas and your Post Birth Bag

Class FOUR – Breastfeeding

Class FIVE – Alternative Feeding Methods, Twins/triplets, Newborn Intensive Care Unit

Class SIX – Newborn Care (including diapering and baby wearing).

Introducing Candice Johnson, the course instructor: Quote:
I have been living and breathing all things birth since I was asked to attend my first birth over 15 years ago. I feel a deep innate knowing of the undisturbed birth process. As an extension of my birth work I organically began supporting breastfeeding. I enjoyed my time with families postpartum but until I had my own babies I didn’t fully understand the importance of supporting someone through the postpartum period. Suddenly what I had always known, respected, and held space for I felt first hand. This sparked a passion for serving new families. I hope by sharing my knowledge of how to support the “fourth trimester” through doula education, much needed support can be brought to communities everywhere.
Candice Johnson, Birth and Postpartum Doula, Childbirth Educator, Breastfeeding Counsellor
— in Vancouver, British Columbia.

Is the baby breech?

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The baby can be breech or head down throughout the pregnancy and it’s of no real concern until 34 weeks gestation. At that point, the baby’s head is big enough and firm enough that it can be palpated and a reasonably good assessment can be made by a clinician. This is also the point in the pregnancy where it makes sense to take steps to encourage the breech baby (3% of all pregnancies) to turn to head down through Webster technique (chiropractic), knee/chest position, or external cephalic version by an obstetrician.

For birth workers, these are some of the things I’ve observed about pregnant women carrying the baby in a breech position. They are not 100% diagnostic but can alert you to look closer for breech position. If the only thing that is concerning in the final weeks of pregnancy is “What position is this baby in?”, it’s possible to have a “one swipe” ultrasound. An ultrasound technician can do a very brief scan and see where the baby’s spine, head and bum are. There’s no need to do a time consuming (prolonged ultrasound exposure) scan just for position. If the baby is breech, you’ll want to know where the placenta is located as well. If the baby is head down, the scan can stop and the parents can go celebrate.

These are some signs that the baby could be breech at 34 weeks and beyond:

1 heart tones heard with fetoscope (not doppler) in upper segment (belly button level or higher).
2. Woman has feeling of a hard ball in her ribcage. Woman tends to squirm and press down on the top of her uterus when sitting.
3 head is slightly firmer than the bum on palpation after 35 weeks gestation age.
4. Abdomen has a more tight/taut sausage shape/quality than the usual round/squishy orange shape/quality.
5. Where are the baby hiccups felt? If high (woman’s belly button region), breech is suspected.
6. If the woman has had a previous breech birth, check carefully because a fibroid or a bicornate uterus (or other unusual anatomy) may predispose to carrying all her babies breech. (One woman I have worked with had 7 breech births. She had 2 uterii.)

I must admit that the best breech births that I have attended are the ones that were NOT diagnosed in advance. Women who have a surprise breech are spared all the worry, over-testing, over-lecturing and general misery that diagnosis of breech can bring.

Please let me know in the comments if you have any other tips or techniques for spotting those little beings who want to back into life. Thanks Gloria

Soothing words for birth

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When women start out on the path of birth work, they fear they won’t know what to say to the birthing woman. Quiet is more important than talking. A few words spoken at the right time can renew a woman’s sense of safety and resolve. Practicing saying soothing things out loud will make the words come easy when the time is right. Some things that might be appropriate to encourage a birthing mother:

“It’s safe to let go”
“You only have to do this one”
“Breathe right down into it, it’s safe to go there”
“Breathe oxygen down to your thighs, that’s it. . . breathe in oxygen and breathe out with loose lips.”
“What you’re doing is ancient. . . your mother, your grandmother and your great grandmothers all the way back have done this. They’re all proud of you tonight.”
“If you’re doing this well now, I know you’ll make it through. Each sensation brings you closer to holding your baby in your arms”.
“I’m so proud of you. You’re doing beautifully”.
“Let’s begin this birth anew. Just let your breath wash away the past 5 hours and let’s begin now at the beginning.”
“Breathe some good oxygen breaths for your baby.”
“There’s lots of room for the baby to come through”.
“You’re stretching beautifully. . there’s more space than you know”
“Just let the baby get itself born, you get out of the way”

Gloria Lemay, Vancouver BC Canada

Canadian midwife with client

SUA Single Umbilical Artery

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SINGLE ARTERY UMBILICAL CORD

About 30 years ago, a baby boy was born at home in a town about 90 minutes drive away from where I lived in Vancouver, BC. All was normal with the birth (first baby for the family). The baby was about 8 pounds and he seemed healthy.

I was taught to inspect every placenta carefully at some point in the hours after birth. One part of the placenta exam was to look at the cut end of the umbilical cord and make sure there were 3 little openings where the 2 arteries and one vein were. Remember, this was in the days pre-internet. Midwifery training was accessed by reading thick obstetric/midwifery text books in those days. This little boy’s umbilical cord had only 2 vessels. Oh no. Where was that third little opening for the second artery? I re-cut and peered at the end of the cord but, no, only two vessels. The only instructions in any of my textbooks about that possibility were to “call the pediatrician”. So, I did. At that time, we had a kind pediatrician who always took calls from home birth attendants. When I told him the situation, he said “Hmmmmm, I don’t know what that means. Could you go in to Children’s Hospital to the library and look it up?” I didn’t like to leave the family’s home without knowing for sure that the baby would be okay and I had that 90 mins between their home and the hospital library. I decided to call a friend who was a long time hospital nurse. She didn’t know either but thought it might have something to do with the heart. The baby wasn’t showing any signs of blueness around the mouth and was a keen breast feeder so, I didn’t see or hear any heart problem indicators. After a few hours, I headed back to town and went straight to the Hospital Library.

Vein larger than the 2 arteries

In those pre-computer days, the hospital Librarian was a God-send. She was very helpful and looked up a bunch of articles for me but they really didn’t tell me much more than “it could mean a kidney problem”. I was feeling frustrated but, then, got an idea. I could find the pathology department in the hospital and speak to a person who had seen babies with kidney problems and maybe get some useful help.

I was a bit nervous going to Pathology because I was afraid I’d see dead bodies but, no, the place was clean as could be. The Pathologist was glad to see me and have someone to talk to. (I think that’s a lonely job). I told him what was going on and the first question he asked was “How much did the baby weigh?” He then told me that babies with kidney problems tend to be very small so he doubted my finding that there were only two vessels in the umbilical cord of an 8 lb. baby. He suggested that I should bring the placenta in so he could take a look. I wasn’t relishing the 90 minute drive back and forth again but I was more than willing to be wrong about my count of the vessels if it meant I could relax about the baby.

One vein, two arteries

I returned to the family home, got the placenta from the fridge and drove it back to show the pathologist. He cut the end of the cord on his marble slab and peered at it and then said “Well, I see what you mean. There are just two but can you see that the vein, which is usually larger than the arteries, and the one other vessel are both about the same size? I think what happened here is that the two vessels grew together. If the baby is pee-ing normally and eating well, I don’t think you have anything to worry about.” He then proceeded to reach up on to his shelf and bring down a copy of a thick text book entitled “The Human Placenta”. He told me that it was a fascinating book by a pathologist who had been a veterinarian before he pursued pathology. When I expressed amazement that there was enough to say about the placenta that it could fill a whole book of its own, he said that a lot of the information was comparing the human placenta to that of zebras, gorillas, and other wild animals. Somehow, I’ve never been tempted to buy the book. . . I like to keep my placenta knowledge on a “need to know” basis.

That little boy did just fine and he’s a big man now. That’s the only 2 Vessel cord I’ve ever encountered in 1500 plus births, so it’s very rare (and, in this case, not even a real finding).
I hope this story is informative and reassuring to parents/practitioners about SUA (single umbilical artery) diagnoses in babies with normal growth.
Gloria Lemay, Vancouver BC Canada

From www.midwifethinking.com
A great blog

HOW BIRTH STORIES GET JUMBLED

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I wanted to share this memory with you, Ted. I don’t know if you remember this incident but I’ve told it to so many people and it always makes me laugh so I thought you might enjoy this trip down memory lane.

Many years ago, when we both had young kids and you were married to Karen, I bumped into you in the parking lot of the “7-11” on West Fourth Ave. We exchanged small talk for a while and, all of a sudden, you got a strange look on your face and blurted out the following, unforgettable (to me) sentence: “Gloria, is it true you were a topless dancer in China?” I couldn’t fathom how that thought could ever enter someone’s head. I’ve been accused of many things in my life but that was pretty far-fetched—I had never been to the Orient, I had never been to the local nude beach, none of what you said made any sense at all. But, somewhere in there, I started thinking “How could this husband of another birth attendant have gotten this idea in his head?”

Then, I remembered a birth that I had called Karen out to one evening. It was the second vaginal birth for the woman. When Karen arrived at the home, I went through the woman’s chart with her. The only surgery the birthing woman had ever had was a breast augmentation. She was a Caucasian woman who was married to a Japanese man. I explained to Karen that the couple had met in Japan and the first child had been born in a Japanese hospital, completely natural birth. The woman had been in Japan because she had taken a job as a hostess in a nightclub in Japan. japanese fan

Now, they were living in Vancouver and having their second child. The baby was born just after midnight and I sent Karen home soon after.

I’m guessing that what happened is that she crawled into bed with you, Ted, and you must have asked her “how did the birth go?” There wasn’t much to tell except that bit about her previous breast augmentation surgery so perhaps Karen told you about that. Somehow, in your sleepy state, that got changed into “Gloria Lemay was a topless dancer in China”.

Once I had retraced the strange pathway of that statement, I said to you: “You know, Ted, that’s not true about me BUT it’s way more interesting than my real life. Will you, please, spread that rumour about me!”

Thanks for the special moments and laughs that knowing you has added to my life. I love you and your dear family.

STORY FROM A STRAGGLER

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STORY FROM A STRAGGLER

This story was told to me by a young man who came, on his own, to a birth film night that I hosted in Vancouver, BC. It was strange to have a 19-ish year old man in a room full of women. He said he had come because he saw the event advertised in a local paper and he thought it might be important in his future to know about birth. After the films ended, people milled about for a while chatting but, then, everyone dispersed except for him. He seemed to be loitering around. I wasn’t afraid to be alone in a building with him—he had such a pleasant way of being. As I packed up my gear and replaced things in the room, he said “Gloria, I’ve stayed behind because I want to tell you a story.” I was all ears. This is the story that the straggler recounted that night.

“My mother was born at home in Berlin, Germany. In Germany, it’s different from here. When someone has an apartment they stay in it their whole lives and sometimes pass it down through generations. It’s not like here where people move around a lot. In the old days, when my grandmother felt it was time to give birth, she would knock on her bedroom wall and that was a signal for her neighbor to come over and assist her with the birth. My grandmother did the same for her neighbor when the roles were reversed. So, my mother was born in my grandmother’s bed. Family Bed They were very close mother and daughter but my mother ended up falling in love with a Canadian and moved to Canada after she was married. She would take every vacation opportunity to fly back to Germany and be with my grandmother.

One day we got the news that grandmother had cancer and was dying. The doctors gave her six months to live. My mother took a leave of absence from her work and flew to Germany to be with her mother through this passage. The night that my grandmother died, my mother was holding my grandmother in her arms in the same bed and bedroom that my mother had been born in.”

That young man’s story has stayed with me. I’m so glad he came to my event and that he felt it was important to share with me. The more I ponder on this story, the more I think about him and I wonder if he has had children of his own. I think that, because he was the son and grandson of those two women, is why I felt so safe with him. Love Gloria
p.s. thanks for your encouragement to tell these stories, Babz Covington and Carla Hartley. I love you both so much. Please share your stories, too.

LITTLE THINGS MEAN A LOT

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I wanted to write this story down because it is one I can’t forget.

I was walking back to my car after a late night downtown meeting and I was accompanied by Peter and Molly, old friends. Molly was someone I really admired and she had two young children. As we were walking along together, Molly said: “Gloria, I don’t think I’ve ever told you what an incredible difference you made to me.” My ears perked right up, I love to be acknowledged, but I couldn’t remember anything special that I had done for Molly.

She said, “Remember that day we bumped into each other on the street when I was hugely pregnant with Caroline, my second daughter? We hadn’t seen much of each other during my pregnancy and I was working with two registered midwives and planning a homebirth.End of Pregnancy

My mother had come out from Eastern Canada to help the family at the end of my pregnancy and it seemed to be taking forever for the baby to come. I was worried that my mom might be really scared to see me birthing and I had a feeling she didn’t like the idea that, this time, I would have the baby at home. I didn’t even want to talk to her about the idea I had of having a waterbirth. Everything else about the birth was going smoothly but I had this nagging fear about my mom’s reactions. Well, Gloria, you listened to everything I said and then you said “Oh, do you know what? I have the most amazing video of waterbirth that you just have to watch. Everyone who sees it has a lovely smooth birth, you’re going to love it”. (The video was Barbara Harper’s “Birth Into Being”). You went to your car trunk and presented me with the vhs tape. I took it home and we watched it that evening. My mom watched it with us and said at the end “Why don’t you get one of those water tubs and do it that way, Molly!” All my worries were gone and the next morning my birth process started. The birth was everything we wanted. Afterwards my Mom said “Honey, that is the most beautiful thing that has ever happened in my whole life. I’m so glad I came out to Vancouver and got here on time to be present to the miracle.”
My Mom returned home to Eastern Canada. She was a widow and she liked to live in her own home alone. A few months after Caroline was born, we got the terrible news that my mother had taken a fall down a flight of stairs and she died. The grief was terrible. Amidst all the grieving I had this sense of peace that my Mom had been present to a miracle and that we had shared a profound experience. I don’t know if it would have unfolded that way if you hadn’t run to your car and lent us that video.”

Only two remain undilated.


Only two remain undilated.

Molly (not her real name) only told me this story when the baby in this story was about 12 years old. You never know what the ripples in the pond of your actions might be. Love Gloria

A Doula’s Experience with Breech

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After a birth, it helps to get a perspective on what could have/ should have/ might have been different in order to learn and grow. Every birth story is different. Gloria

A DOULA WRITES:
The family had a super healthy (first) pregnancy, with opportunities
galore; access to acupuncture, chiropractics, yoga, watsu, massage,
walking, biking, good rest and healthy food (they are both vegan and
eat really well). They chose not to have any ultra sounds and had
her first internal exam at 40 weeks, at her request. She was quite
anxious about having internal exams, learned that it is possible to go
through pregnancy and birth without any fingers up her vagina and
decided that would be best for her. She asked for the exam at 40 weeks
because she felt it would be better to have a ‘practice’ exam in a non
labour situation to see what it would be like just in case she wanted
to have one in labour.

Throughout her pregnancy her various health care professionals
palpated her belly and were sure the head was down. I don’t touch
bellies, I just pay attention to how women are carrying and moving and
what they are saying, and it seemed like a vertex presentation to me
as well. At 39 weeks, her chiropractor and her midwives noticed a
difference, but figured maybe the head was engaged. On her due date
she had an appointment with one of her midwives, who is quite new to
midwifery and she basically freaked out from feeling what she thought
were hands presenting and told the family they must go for an ultra
sound the following morning at 8am. The family was left quite worried.
I asked what she felt about the baby’s position. She said she had been
feeling flutters down below, and figured it was simply mild
contractions. I also asked if she was feeling pressure up in her ribs,
or if she was pushing down on her belly in discomfort, and she said
she had been feeling that way all week. I told her not to worry and
offered to join her for the ultra sound in the am.

Later that night I received a call that labour had started, she had
been contracting since her midwife appointment, but thought it was due
to the internal exam. The contractions were building, so she called
the midwives and they told her to go straight to the hospital for an
ultra sound and one of the midwives would meet them there. The ultra
sound indicated baby was breech and the OB on call was one of the only
in the city who was open to vaginal breech births, although he clearly
stated he was not interested in any marathons and she would have 6
hours to labour (no pressure!) The midwife assured them he was good at
what he does, but he was known to have no bedside manner. That was
pretty clear, but they didn’t care.

At this point their midwife said they could go home to grab their
stuff and take a pause. She was well aware that this was a total game
change from their water birth at home plan, so taking a moment at home
seemed an important part of their birth experience. They called to
let me know the baby was in fact in a breech presentation and that
they were heading home to get their stuff. I was pleasantly surprised
they were encouraged to go home, and told them to keep me posted and
take their time. I said I would meet them back at the hospital when
they returned.

We met at the hospital at 9:45. The midwife did a very gentle and slow
internal exam and found her cervix was 4 cm and stretchy. They had her
on the monitors after that. I asked if she could be on hands and
knees, but they couldn’t get the heart rate as clear, so that was
ruled out. She was laying on her side and after 10 minutes on the
monitor we heard major dips in the heart rate over and over, tried
getting her on her other side and baby was still dipping quite a bit.
The midwife was concerned of a cord prolapse, so the nurse came in and
did a very different internal exam, got right in there fast and
vigorously and felt bulging membranes and what she thought was a cord.
Suddenly two nurses had their hands inside of her, it was terrible.
They said they were trying to push the baby up off of the cord.
breech presentations

You can imagine how intense this was for the mother to be. The room
filled with nurses and it was announced that she would have an
emergency cesarean birth. They wouldn’t let her partner go with her,
this was also terrible. The midwife wouldn’t take no for an answer and
got her scrubs on to accompany her. I stayed with her partner. He was
a mess. We found the only nurse on the floor and asked if she could
keep us updated and I asked if there was any way her partner could go
in. They were waiting for the doctor to come (this whole time with the
nurses hands inside of her…) the doctor would do one more check to
make sure the cesarean was necessary. The nurse grabbed scrubs for the father
and he got changed, but just as he was going to go in the doctor
arrived.

I later found out instead of determining whether a cesarean was
necessary, he yelled at the midwife for having let them go home. One
of the nurses spoke up and suggested they instead focus on the task
at hand and he determined the cord was not presenting, but a foot was,
and her cervix was 8cm dilated. They went ahead and gave her general
and she heard the OB yelling at her midwife as she went under. Her
partner and I waited in the hallway, he made a comment that being the
dad waiting in the hallway while his baby was born felt like we time
warped to the 1950’s.

Baby was born at 10:45pm and dad held him for the first time in the
hallway at 11:10 pm. Apgars 8 & 9, and he was 5lbs 11 oz.

Mom and baby were moved to the recovery room and dad right away took
off his shirt and gave baby skin to skin cuddles until mom was ready.
At 12:45am the nurse said baby’s sugar was low and suggested formula
or glucose water. I asked mom if she was ready to try breastfeeding or
if she wanted me to get on the phone and call her friend who had
offered expressed breast milk if they needed. The nurses were outraged at this
suggestion, said they couldn’t allow it and so she did her best to
try breastfeeding. An hour later they did the sugar test again and it
was way up. The midwife and nurse were both in disbelief (the sugar
level raised from 1.9 to 3.7 in one hour!) The midwife commented how
interesting it was that they had no trouble believing the low number.
I told them it must have been the skin to skin contact with mom and
some colostrum that did the trick. Once they were settled and resting, I
drove home with their placenta and made them some quick prints and a
smoothie. They were happy to have had some of their birth wishes
granted.

Today the family is doing quite well. They are breastfeeding, resting,
eating well, have lots of support and are processing their unexpected birth
experience a little bit each day.

QUESTIONS:
– Could we have avoided those low decels if she could have been up on
her hands and knees?
– What happened when that nurse felt bulging membranes? Did she cause the membranes to release?
Or is it possible to feel a prolapsed cord through the bag?
– Could a baby with apgars 8 & 9 have been in such distress moments
before? (or was it that they were worried baby couldn’t handle two
more centimeters as well as pushing?)
– Was this the only way it could have happened? In general it felt to
me like everything happened as it had to, except those few questions
above that leave me feeling a bit curious.

I have never attended a cesarean birth (I have been a doula for four years).

Any way in which we can learn together from this story would be great.
Comments and feedback are very welcome.

Ruby

Gloria’s thoughts

    Dear Ruby, It’s getting to be hopeless to have a primip give birth vaginally to a breech.
    You must be traumatized/grieving about all this. Thank goodness you were able to give them some measure of getting their wishes met.:

    When the adrenalin gets going at a breech birth, they basically find reasons to head to the surgical setting. The cord wasn’t causing problems so, in hindsight, the heart tones were fine.

    Don’t know what the nurse doing the exam was intending but I would hope she was being careful NOT to rupture that membrane with a breech. Did she break the water bag? You would have seen amniotic fluid with clear poop coming out of the woman’s vulva after that exam if the membranes released.FOOTLING BREECH

    As far as diagnosing a prolapsed cord through the membranes with a footling breech, it might be possible because the bag is thin but it’s highly unlikely and, we know in this case (again, good hindsight), it wasn’t there.

    Apgars of 8 and 9 indicate a healthy, well grown term baby (again, golden hindsight). We do know that monitoring increases the risk of cesareans without any evidence that it is helpful in improving health.

    From what that dr with no bedside manner said, the woman wasn’t going to be given much of a chance to give birth vaginally. Since she hadn’t had previous uterine surgery, it would have been nice if someone with the skill to do a cephalic version had been there when she was first at the hospital. The baby presenting by the feet is the easiest to turn, especially if the baby is small and it’s early in the birth process. To be fair, a first birth with feet presenting is not a good vaginal birth risk to take. Luckily it is a rare situation to have so the numbers should be very low.
    footbreech

    If the caregiver is palpating bellies and listening with a fetoscope (instead of doppler) in the prenatal period, the caregiver should be picking up when it’s breech at 36 weeks gestation (if in doubt, the woman can have a one-swipe quickie ultrasound to double-check). At that point, if it’s discovered, there’s time/space to get baby turned to head down. As I said, a footling breech is easiest to get turned. Frank breech is a more optimal position for safe vaginal birth of breech but not for turning baby to cephalic. Querying rib pain, listening in the 4 quadrants with a regular fetoscope (and finding the true fetal heartbeat low in the pregnant belly) and observing the shape of the pregnant belly are your best tools for early diagnosis.
    Thanks for being there for this family. Gloria