Works of Wonder – Vida Health Communications, 2000, $395

3 birth stories (unmedicated, induction with narcotic, epidural); then “Stages of Labor” section, then sections on all the interventions. Then a cesarean birth story.

www.vida-health.com/product_detail.php?selected_product=0025&selected_category=0019&uid=1136405683

Paula and Chris – normal vaginal birth. Narrated by Chris… he’s sweet.

Older caucasian couple,

First ctx in morning, off and on (shows him doing counterpressure) so went to movie, then hung out. She’s waiting for ctx, he gets her water

When 8 or 9 minutes apart, hot shower to relax. She says it’s great, and that standing feels better.

Called m/w, couldn’t talk during ctx, good not to have too many expectations

At hospital, with nurse-midwife and nurse (shows putting monitor on)

How’s labor? “Not that bad, and really awful at the same time”

Midwife swaying with her, has button saying birth is normal.

Paula’s labor slowed down after we got to hospital. Used downtime to talk about how they would work with ctx as labor gets harder… shows lunging, birth ball, vocalization, mom asks them to shut up during ctx. Shower on birthing ball.

Water broke, ctx got harder, but still 7 minutes apart

Warm rice sock with lavender, music, ice chips, m/w talks about the benefits of squatting position on the ball. Hand massage and foot massage. Mom relaxed / crashed out looking

After 5 or 6 hours, mom asks for cervical exam, 100%, and 5cm

M/w helped her understand labor was active now, and would speed up

Walking in hallway – can tell from her face that ctx are longer and stronger… transition.

Paula asked for music, then asked to turn off… hard to figure out how to help

Vocalization, massage, lots of hands-on quiet support from nurse and m/w

M/w reassuring her

Lying on side with eyes closed… looks relaxed, but then says “I can not push this baby out.” M/W reinforces that she has everything she needs to do it

By the time m/w examined her again, almost ready to push… OKs bearing down if urge, tells her that if it hurts, don’t force it – you’re not ready

m/w says “who am I to interfere with something that’s working”

Paula still wearing normal looking shirt

On squat bar, vocalizing. Then hands and knees. Baby at +2 station. Semi-sitting with sheet over squat bar. M/w explains perineal massage, and why she’s doing it.

Mom says “I don’t think I can do this.” They bring mirror over. (perineal views in mirror)

After every ctx Paula would re-group and get ready for the next one

She’s on her side, they encourage her to touch baby’s head.

Spontaneous pushing… no counting

Perineal view, bloody baby, Paula lifts it up onto her chest.

Shows cord cutting.

Dad talks about how proud he was to be a father, and even more proud to be Paula’s husband… during labor, we had every emotion we could have…. I feel lucky my son has the mother he has

Breastfeeding

Janelle’s summary: Nice normal birth. Sweet couple. She works reasonably hard, but never suffering. Great caregivers. Good modeling of a variety of comfort techniques.

Lourdes and Jonathan, induction

She’s from Honduras; Jonathan’s mother with them too, and doula (hired by friends as gift for baby shower)

Water leaking all night, but then fluid was greenish from meconium. Induction. Nurse explains Pitocin. She’s smiling, walking the hallways with IV pole and monitor

During ctx, Jonathan and doula come close, and are quieter with her

Doula says we’ll walk, and your body will tell you when to stop for a ctx

Rocking chair (doula explains why it’s good)

More pitocin, then she can’t talk through ctx, but still smiling between ctx

Joke about diapering the cat

Italian ice. Relaxed and chatty between ctx.

Slow dancing – again, doula explains why it’s good

As ctx got closer together, she says she needed more help. They’re stroking, cool cloths in ice water, doula modeling how to focus on outbreath

She said dr didn’t do a lot of exams, but did come often to check on her

Standing. Leaning over chair. Hip squeeze.

Paula says it helped to do breathing – gave her something to focus on

Grimacing during ctx

After 6 or 7 hours, on her side in hospital gown, talks to dr about medication

Doctor talks about a shot of narcotics to take the edge off, so can doze in between ctx – doesn’t take the whole pain away

The last option is an epidural

Doula suggests getting her cervix checked… if you’ve got a long ways to go and need to rest, epidural may be good. If you’re almost there, and feeling like you can handle it, maybe we don’t need it

7 cm – doula reinforces that is fabulous

Decides on narcotics

Standing up, slow dancing, doula rubbing back, then zoned on husband’s shoulder

A couple hours later, some pressure. Exam: 9.5 cm with lip

Then on toilet, pushing… with monitor on “It’s amazing how my body knew what to do”

Semi-sitting – felt good to push and have something to do… they talk about needing to suction because of meconium

Pushing on her own – no counting

Perineal view, nice head, internal monitor, bloody baby

Couldn’t hold right away, but didn’t have to wait long

They bare mom’s chest, and put baby on, mom weeping

“Nothing I have ever done in my life made me feel so good, so happy”

Mother-in-law tells her she’s wonderful…. Lourdes says she’ll have another one

Jonathan kisses her

Janelle’s summary: likeable people, good doula, lots of explanations of what’s going on, nice relaxed pacing, etc. Good.

Milca and Sondra - epidural

African American

At my last prenatal, I had a feeling I was in labor… 3 cm dilated

Decided to admit me b/c I was already there, and I live 2 bus rides from the hospital

My sister was going to be with me, but she was taking exams at school – then she gets stuck in traffic

At 5 cm, with nurse, and dr. holding her hand. On IV. Doctor says they’ll switch her from side to side

She says she did try other positions, but just liked lying on her side…. Didn’t like to be touched, but did like people to talk to her and explain what was happening

6 cm – she’d planned to wait for her sister before epidural… asks if epidural will affect baby, they explain that it does not, and that baby will be alert… mom decides to get epidural, dr says she understands

She has epidural inserted… shows nurse helping her through ctx… only kind of shows insertion. Dr gives test dose

Sister arrives – young… apologizes for being late, and tells her she should have called earlier.

Milca is chatting and relaxed now with epidural

Sondra helps her through 4 or 5 ctx till epidural working – Sondra says “don’t cry… I wish I could do this for you”  Says best thing Sondra did for her was make her laugh

Doctor still there

Looking at baby clothes together

Monitor shows ctx have slowed down – Pitocin. Nurse says it can make ctx more painful, “but that’s why you have the epidural”

As nearing pushing, asks for epidural to be turned down. Without the pain meds, I started getting cranky again

Fully dilated… working again to cope with ctx

Pushing took a lot of work, but it didn’t feel painful… high pitched noises

Semi-sitting, nurse and sister holding legs up, cheering her on

Perineal view, very bloody baby, up onto her gowned chest. Breastfeeding.

“As soon as I held her, it was like the pain I went through never happened… there’s not much I would change about how he came into the world. “

Janelle’s summary: good job of showing a mom who needed extra support, and epidural being that extra support for her…

How the end of pregnancy begins (Stages of Labor section)

Shows animation… talks about baby releasing hormones, and shows ripening due to prostaglandins. Talks about back ache, cramps, soft bms, queasiness, nesting

Encourages moms to take good care of themselves

Indications of early labor: bloody show, leaking fluid, irregular ctx

Shows animation of mucus plug / bloody show – may be days before labor

Shows fluid leaking… talks about SROM only starting 11% of labor – call HCP, will want to know time, amount, color, odor

Irregular ctx – she gets up and leans over. He rubs back…. May have for several days… then ctx get longer, stronger, closer together

Screen says “Pure Positive Power” – ctx are surges that power labor – may be hard to think of them as positive, and needed to move labor along.

Remember, even when very strong, ctx come and go. Relax between. As they get longer and stronger, sign that labor is working its best

Shows illustration of labor pattern (bell curves of ctx). When come every five minutes, may last 40 – 60 seconds. Notice the time there is to regather between ctx.

Then 1 – 3 minutes apart and very strong – but probably only 20 ctx like this

Each labor has its own pace – may start slowly or move quickly

Early labor can last a day or more – stay at home – slow dance position, squatting by couch. When ctx are 5 minutes apart, last at least 30 seconds, hard to talk through, active labor. In active labor, will need to use techniques more

Sitting on birth ball, breathing, massage, slow dance, holding hands, visualize how well your body is doing, m/w coaching her through, focal point taped to dad’s chest

Animation of first stage, second stage, third stage

Animation of baby engaging into pelvis (lightening), pelvic station, effacement and dilation, rotation to anterior

Shows mom on side, bearing down (working hard)

Animation of baby’s descent and birth

Non-perineal view of birth (from mom’s POV) Wet, but fairly clean and “normal” looking baby put up on her chest

Then animation of posterior baby

Intervention chapters:

Induction / augmentation. IV fluids. Fetal monitoring. Interventions to relieve back labor pain: positions, heat packs, massage, intradermal water blocks shown. Narcotic analgesics: increase pain tolerance, and allow more relaxation in between – do not take away pain.

Epidural: does show movement; says to delay to active labor; shows cleaning, shows mom having ctx while getting it administered, does not show insertion on mom, does show animation; explains that medicine goes through catheter, shows taping down, talks about bp checks, monitoring, IV fluids, bladder catheter (shows bag of urine), says labor may slow down and may need Pitocin. “Well managed, an epidural is a great relief for some moms. May not be effective / may be patchy, decreased bp, longer labor, maternal fever which makes it likely baby will need to be evaluated for infection, higher risk of forceps, ve, c-s, headache, backache, very rare long-term complications.

Then episiotomy, forceps and ve

A Cesarean Birth Story – Teri and Ryan

One in five babies. (OUT OF DATE L statistic… now 29%)

May be scheduled in advance, but may come after long hours of labor, even after trying many alternatives

Baby not descending with pushes – superb pushing. 30 hours in hospital, 3 hours of pushing, FHR not recovering – to prevent further fetal distress, need c-s

Shaved, antacids, temperature, pulse, blood pressure, catheter. Epidural. Dad scrubs and preps. They show her draped and with belly washed. Monitor, bp monitor, oxygen mask

Show her cut abdomen with tools stretching flesh back

Animation of incisions.

Shows baby being pulled out of her belly (can’t see incision at this time)

Baby active alert, they hold it where she can see it. Mom cries.

They take baby to warmer, dad goes with. They check baby – healthy in every way

Ryan holds him so Teri can look at him – they say repair takes 45 minutes, talk about mom experiencing shakiness or nausea – can have meds, but make drowsy

Mom is bare-chested, holding baby and breastfeeding.

Talks a little about recovery – getting up to walk

Mentions possibility of VBAC

Feelings of disappointment can be natural, but it can also be a positive fulfilling birth