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The plan was to deny I was in labor for as long as possible, but there was no denying when my water broke at 6am on Valentine’s Day! I went back to bed to act like I was sleeping and pray my husband would get as much sleep as possible. I was having some contractions, so I tried to relax my whole body during them like I had practiced for months. I was surprised by how badly they hurt and I thought, “I understand why women get epidurals,” even though I was fine with them at that time.

When James woke up, I told him what happened. We guessed the baby would be born in the wee hours of the next morning, on the baby’s due date. We went to Cracker Barrel for breakfast, and planned out some things we could do to take up time. James said the whole pregnancy that hoped not to have a son on Valentine’s Day, so we laughed about that possibility. Our midwife, Marilyn (you can visit our midwives’ website here) said to let us know when I needed someone. We talked again mid morning, when nothing serious was going on. At about that time, we unplugged/covered all the clocks in our house. We watched The Voice and straightened up around the house, and I finally got to eat my prepared “labor snacks.” My contractions were getting stronger all day. I tried to lay down to watch a movie we rented and do my practice relaxing technique. Laying down was the most painful position for me, so all that total body relaxation practice was a waste J. My back labor gave me the urge to be leaning forward during each contraction. I spent a lot of time leaning over an exercise ball on my knees. Contractions felt like back pain that wrapped around me, by the end they were more painful than I ever imagined.

About 5 pm I got to the point that I needed James’ undivided attention. At this point I guessed I was 5-6cm or so. I moved to my bed, still hands and knees leaning on pillows. We turned on my “labor music.” James rubbed my back and comforted me with his words, made me a smoothie and offered it to me between contractions, and began to fill up our birthing pool, that we rented from 9 Months and Beyond (They are fantastic! We’ve used them for other services as well). Our midwife, Bobbie, called at 6pm intending to say they were going to come on and try to get my labor started with some herbs. James told her my contractions were 3.5-4.5 minutes apart, the closest they ever were to each other. While he was on the phone, I had a contraction that I moaned through; she heard it and said they were going to come on to the house. About 7pm the tub was ready so I got in. It was awesome.

Looking back, this was my favorite part of my labor. I felt so thankful to the Lord for how things were going. I was thankful that my pregnancy lasted to full term, thankful that labor started and progressed on its own. I said, “Thank you baby for moving for your mommy,” every time I felt kicks, which was my entire labor, so reassuring! I said often, “Things are going so well; I am so thankful.” I told Jesus thank you between almost every contraction. “This is what I want,” I verbalized. James was encouraging me and offering me water. I ate half a hardboiled egg. Between contractions I was fine, and my contractions were pretty spaced out. During contractions I leaned over the side of the awesome pool, James poured water on my back, and I started having the urge to grab onto stuff. I kept grabbing onto a trashcan, and I was very vocal- James says it was a loud groan. I guessed I was 7 cm or so (but I was probably more). I was glad the midwives were on their way; I could tell I was really progressing.

Bobbie and Chelsea (their assistant) got here at 8pm. I was having a hard time looking at them, but I told them what I was feeling. Bobbie said she was fine not checking my cervix, I said, “Good, I don’t want you to.” She did listen to the baby and take my blood pressure, all while I was still in the tub. They started getting all their supplies ready. I heard them moving around, but I was very inward focused, I think I could hardly open my eyes. Bobbie reported to Marilyn. When Marilyn showed up I couldn’t understand a word she said, or hardly look at her. I made a sound that I have heard other woman make in labor, and I guessed I was in transition. I think Bobbie told me I had a 2 minute long contraction, and I said, “I thought they were long.” But they were never close together, which was awesome.

At 9pm I said, “I think the baby is in my birth canal.” They said, “Oh!” And Bobbie wanted to check my cervix. I said despairingly, “But I don’t want to be disappointed!” Marilyn said, “We don’t give disappointing news.” “Anything less than complete (10 cm) will be disappointing,” I replied. She checked and said all she could feel was the baby head (so I was complete), but she thought it may be asynclitic (coming down crooked). I said, “I don’t care, I am pushing.” I asked, “Does it feel like a boy head or a girl head?” She said, “It feels like a girl head!” and called the baby a girl from that moment on.

I expected pushing to be the best part of labor. I anticipated pain relief. Many women don’t appear to be in any pain when pushing. So I started pushing and I was shocked and dismayed, “It hurts!!!” I would instantly have the same back pain I felt all day. I was so upset; this was the most difficult part of labor. Bobbie tried encouraging me, “come on now push, 1, 2, 3…” I interrupted, “Please don’t count!” She said, “ok.”  I got out of the tub at their suggestion, hoping it would make my pushing more effective. I tried a few different positions (squatting, leaning) but stuck with leaning over the exercise ball as I had in the morning. The midwives basically let me figure out the pushing thing, which I am so thankful for. Looking back it was so sweet how well I was taken care of, even though this was by far the most difficult part of labor. I was SO HOT. I kept saying despairingly, “I am HOT!” James took at book and fanned me ferociously. Between contractions he would give me water. Bobbie asked if we had any massage oil — we only had vegetable, so Chelsea got some vegetable oil and rubbed my back. It was AWESOME J. This is when I started crying out, “I can’t DO this!”  After I got over my despair that pushing was painful, I just worked through contractions and pushed a bit only as much as I felt like it, I am sure it was not very effective. I basically was laboring down. No one told me what to do, I just did what I felt like, and they supported me. At some point I felt downward progress. I began to realize that although initially pushing caused me the back pain of a contraction, if I pushed past that point I could feel the baby moving down. The progress cancelled out the pain, and I finally got determined and pushed with all my might.

I said, “I must be crowning.” I wasn’t crowning, but the baby was starting to stretch my skin. Bobbie said, “Why don’t you either get in bed so we can see to try to prevent you from tearing, or if you want a water birth, you need to get back in the tub.” I was indecisive. Marilyn said, “You better go ahead and move.” So I got in the tub. I felt a lot of the baby’s head and I was shocked to feel a ton of hair. They showed me in the mirror once, but I couldn’t focus on it, I was too busy pushing. I Pushed for 1 contraction, and then said, “I am just SO excited to have this baby!!” I pushed the next contraction and felt the ring of fire. I felt like I was going to split in 2, and it was very scary; I screamed. James says this was obviously the most painful part, but I can’t even remember it anymore.

Then my baby was born at 10:49pm. I lifted her up to my chest with Bobbie’s assistance. There was so much vernix (looks like white cheesy stuff on the baby) and a full head of hair! Someone said, “what is it?” I said, “I don’t care I just want to see it breath! James, what is it?” I was staring at her face. He said, “It’s a girl,” with some uncertainty. I said, “It’s a girl?!?” I verified. We were both shocked (we think we would have been just as shocked to have a boy). I kept crying, “My baby, my baby!” I started checking her out, feeling the cord pulse, seeing if she had a tongue tie, checking her tone, etc.

Every few minutes I would check the cord. We wanted it to stop pulsing before it was clamped and cut. Well, even after 10 minutes or so it was still pulsing. Bobbie asked if we could go ahead and clamp and cut so I could get out of the tub to keep an eye on my bleeding. I was totally fine with that. I cut the cord, and then we handed the baby off to James, who held her skin to skin. That is the most touching mental picture I have, my husband holding his daughter for the first time. She looked so tiny in his arms.

Leila Esther was 7#8oz, 19 inches long. She had a tiny bit of capit (swelling) at birth that was not centered on her head, but it was gone in an hour. I had a 1^st degree laceration that needed no suturing. Although I technically pushed for 2 hours, I had no swelling and no pain after delivery. I have had more soreness and pain from nursing (from a bad latch and bad posture) than I did in recovering from giving birth. I attribute all of these things to me being able to just listen to my body, my birth went so smoothly. Everything was so healthy and normal.

It is hard to describe labor. Primarily it was painful and joyful. It was more excruciating than I could have imagined. But I was only in serious pain for a few hours, and only every 5 minutes or so, and between those I was fine. For a few days I felt scared of labor, but in review it wasn’t that bad, and I already look forward to having another baby (in a few years!). My labor was exactly what I wanted. If everything went well, as it does most of the time, I wanted to be left alone and let things go as normal. Labor is normally a healthy process and a healthy labor only needs monitoring. I was empowered and in charge of my labor. It was by far one of the greatest days of my life. Thinking back on it makes me weep as I remember with joy how my beautiful daughter came into the world, how I was so supported and empowered. “Can’t help falling in Love” by Ingrid Michaelson played in the background while I became a mother to my Valentine’s Day baby; I am floored by the love that is drawn out daily as I get to know this little one.

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I stumbled on a great discovery while researching breastfeeding premature babies. I was shocked to read that hands-on pumping from day 1 can double a woman’s milk supply!

This 10 minute video by Jane Morton, MD from Stanford Medicine describes the research results and describes the “how to.”

In summary:

1. Massage first, as if doing a self-breast exam.
2. Double pump (with a good, electric pump).
3. When the milk spray has nearly stopped take off shields and massage breasts again. Find areas of hardness and massage out.
4. Then use hand expression or single pump while massaging, alternating right and left side. Pay particular attention to outside of breast. Watch for sprays, and learn what works the best for you.

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The Harris family welcomed 6 babies at once, born at 26 weeks. Mrs. Harris pumped breastmilk 6 months for her sextuplets. 12 times a day, every 2 hours, day and night. Her husband cleaned and set up the equipment while she slept. 50 bottles of milk a day. More than she needed!

The Masche sextupletes were breastfed for 8 months. Jenny said, “It was something I was determined to do all along, but it proved to be a huge challenge initially. I had pretty bad post-partum depression. Had it not been for my mom and sister, I don’t know how I would have been able to keep the breastfeeding going through that period. I was so grateful for their encouragement. They didn’t let me give up on it.”

The breastfeeding dyad requires 2 person participation for success. When the baby is unable to do his part, or anytime mom and baby are separated, a breastpump must substitute. For success, you must trick your body into believing that you have a healthy baby. You want to mimic the conditions that occur if your baby was able to come to the breast.To build up your milk supply:

1. Start pumping early

2. Pump at least 8-12 times a day, for 10-15 minutes (each side).

3. Aim for at least 100 minutes/day

How can you acheive such frequent pumping?

Quality Support is particularly important! Both moms of sextupletes cited support as a significant factor for acheiving such extreme breastfeeding.  Mrs. Harris’ husband cleaned and prepared the equipment for her during the night. She set an alarm, and when she woke up to pump, everything was ready. He would also store the milk she had collected. Her husband’s support made this gift to her children possible.

Use a Great Pump. Double pumping (both breasts at once) has shown to improve milk supply. It also cuts the time spent pumping in half. I recommend renting a top quality pump. If you are going to invest the time, make sure your pump is effective! Money spent on breastpumps is now tax deductible. (Go USA!)

Go hands off. You can write a blog, read a book, or surf the internet. This may make those 100+ minutes of pumping a day more bearable. Buy a bustier (like this) and get your hands and mind off of pumping! There are also bra-hacks online for hands-free pumping. Thanks to Babytool Kit, a former NICU mom, for giving me that idea, and mentioning some other good ones.

Diligence pays off. Keep a pumping log and keep up the frequency! Persistent pumping will ensure more milk and easier breastfeeding in the months to come.

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Moms of babies in the NICU have a lot on their plate. Many are recovering from surgery, or on a Magnesium IV drip because of high blood pressure. Most have lost sleep and now have additional anxiety from separation. It would seem that adding the additional requirement of pumping breastmilk every 2-3 hours would add further stress on already taxed mothers.

I have found the opposite to be true, at least while still in the hospital. When a mom pumps breastmilk, she is caring for the child in a way no one else can. She fills a special need for her baby. The frustration that comes from handing your child over to a medical team, the concern over the weebit’s health and safety, the helplessness of the parents, all can be channeled into something tangible and productive: Pumping breastmilk.

I love this quote from a NICU mom, read her story here.

“Each time I sat down to pump, or each time I leaked onto my bra and blouse, I was reminded that I had a baby who was counting on me for not just love and care, but for the nourishment that only a mother can give. This made me really enjoy the pumping sessions, just as a mother enjoys feeding her newborn directly from the breast.”

Recently I came into work and was assigned a mom who delivered her 32 week old baby 20 hours before, due to serious blood pressure problems. She was not yet able to see her baby, as she was on a Magnesium drip (to prevent seizures), and had to be closely monitored. That separation is heart breaking. She had not yet pumped. She had been told she just needed to rest, and she could start later. I explained pumping as soon as possible will help her milk supply in the months to come. She agreed, so I brought in a pump.

Her attitude was completely transformed. She had been resting all day, but after pumping she felt renewed energy. Although she had hardly laid eyes on her baby, and had never touched him, she felt like a mom. She was able to provide the most important ingredient of her baby’s health- breastmilk.

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by Stacey Lynn Photography

It is a special honor for me to work with Mom’s with premature babies. These woman have a journey more difficult than I can imagine. As a woman’s labor and delivery nurse, my major focus for them after delivery is to get that baby as much breastmilk as possible. Breastmilk makes the difference in life and death for some preemies; the difference between sickness and health for many preemies; and the difference between optimal outcomes, and suboptimal outcomes for 99% of babies. Breastfeeding a premature baby is extremely challanging, and extremely important.Research indicates that later milk volume is impacted by how soon after birth mom begins to stimulate her breasts. Thus pumping promptly after birth promotes milk production for preemies, or any baby who is separated from mom after birth. Anytime a baby cannot be skin-to-skin on mom directly after birth, the natural breastfeeding process is interrupted. The mom’s body needs a signal to produce milk. Thus, pumping promptly mimics the natural process, and signals the body to start producing for the preemie.

Pumping soon after birth speaks volumes to the body about breastfeeding intentions. Literally, it will cause an increase in volume as long as she breastfeeds. Research studies vary on the window of time crucial for starting to pump. Some say 4 hours, some up to 8. I say pumping cannot be initiated too early, but mom and baby can suffer it is started too late. I get my moms to pump as soon as possible after delivery. After a vaginal delivery it is easy to pump before 30 minutes after birth, and after a C-section 30 minutes after the end of surgery.

Mom and the support team may have to press this issue to ensure prompt pumping. If an preterm delivery is expected, talk it up before hand about how important it is to you to pump right after delivery. You may even be able to get a pump in the room before the delivery happens. Husbands and doulas are great for making it happen after delivery. It may take annoying a nurse, but there is no reason a woman cannot pump soon after delivery. Pumping does not take much effort, it does not even require a mom to be awake. If my mom is too tired to stay alert, I will set everything up for her, and even hold the pumping equipment to her while she sleeps.

by Stacey Lynn Photography

Step 1 for providing breastmilk to any baby separated from mom: Pump Promptly.

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Frequently the water is broken with hopes to signal to the woman’s body to start labor.

The Cochrane Collaboration, who strives to recommend the best care based on the best evidence, supports the use of breaking water plus Pitocin to induce labor, when medically necessary.

Medical indications for induction:

• 41+ week pregnancy
• pregnancy-caused high blood pressure
• infection in the uterus
• growth restriction for baby
• maternal health problems like uncontrollable diabetes.

During a medical induction, it is hoped that breaking the water will signal to the body to begin labor. However, once those flood gates are opened, there is no going back! You are fully committed to deliver, even if that means via Cesarean Surgery.

Alternatively, if Pitocin alone (or another drug) is used to induce labor, there is no commitment to delivery. Consider 2 scenarios I have seen play out in Labor and Delivery:

When you went to the OB today, she measured your belly and asked for an ultrasound. Just in the last month your baby fell off the growth curve. With the diagnosis of Growth Restriction, your OB explains although you are early, in this situation it is better for the baby to be out than in. Continuing with the pregnancy will result in further stunted growth. Worried, you head to the hospital to start your induction.

Option #1:
After finding you dilated 1-2 cm, the nurse starts you on Pitocin, and keeps turning up the dose for a few hours. Your OB comes in and checks your cervix, no change. She tells you she wants to break your water, to hopefully get things kicking. You agree. 12 hours later, you have a temp, and you are only 3 cm dilated. Your OB comes in and explained the induction just didn’t work. We need to get the baby out. We don’t want you to get infected. You consent to a Cesarean Section.

Or Option #2:
After finding you dilated 1-2 cm, the nurse starts you on Pitocin, and keeps turning up the dose for a few hours. Your OB comes in and checks your cervix, No change. She tells you she wants to break your water, to hopefully get things kicking. You decline. You ask her, If the induction fails today, can we turn the Pitocin off and try again tomorrow? She agrees. You have no progress, and the Pitocin is turned off, and you sleep through the night. In the morning you try again with the Pitocin.

This is just an example of how having your water broken commits you to delivery. Sometimes during a medical induction delivery can’t wait another day, and sometimes it can. It is at least something to discuss with your healthcare provider. Together you must weigh the pros and cons of opening those flood gates.

Does breaking the water speed up labor?

If the water provides such benefit, why do people have their water broken artificially?

3 main reasons:

1. Speed up Labor
2. Induce Labor
3. Use internal monitors

The Cochrane Collaboration is a network that advocates for evidence based practice by reviewing research studies and publishing recommendations. Independent from all companies, they hold to the highest standard of evidence, and now work closely with the World Health organization. Cochrane reviewed 14 research studies about amniotomy, or breaking of water, which involved 4893 women. Upon reviewing, they declare:

“Evidence does not support the routine breaking the waters for women in spontaneous labour. The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged.”

According to the highest level of evidence, breaking water does not speed up labor.

by B&M Photography

Even if it did, Why does labor need to be sped up? Does this help mom? Help baby? Increase chances of a vaginal delivery? Or just help the doctor get home for dinner, or get the midwife in bed on time? There are no proven benefits to breaking water in spontaneous labor, only risks.

I overheard a story of one mama, and I was so proud! She came in to the hospital at 37 weeks pregnant contracting. She was dilated to 5 centimeters when her contractions stalled out and she didn’t not dilate any more for 4 hours. Many times this is when she or someone else would suggest breaking her water. Maybe it would help get her back in labor.

Although I am sure she was ready to have a baby, she did not want any intervention, so she went home! Smart woman! She can go home, sleep in her own bed, eat her own food, relax in her own tub!

In 10% of labor the water breaks before contractions start. That’s cool, it is a natural process. For the other 90% Rushing Water has no proven benefit. However, keeping the water intact supports good blood flow to the baby by providing a cushion, prevents infection by maintaining a barrier, and comforts the mother by allowing her to labor around a water balloon.

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Who could get away with this?? Love it!

Just as a (REAL) water bed is more comfortable than sleeping on a boulder, laboring with a water balloon is more comfortable than around a hard skull.

As labor advances, part of the water balloon gets trapped below the babies head. That means the head is not pushing on the cervix, a water balloon is. As you can imagine, the balloon provides a gentler pressure than a skull. There is a major difference in going through labor with the water intact and the water broken. This difference is easily observed in laboring women. Having your water balloon popped will cause a more painful labor, the water balloon provides a cushion to labor around.

If a woman is going to avoid pain medicine, the water balloon is one of her greatest aids. I have seen many women get close to fully dilated unmedicated, and decide she wants her water broken, thinking it may speed things up. So the doctor comes and breaks her water, and she still has a few hours, now in the most intense part of labor, without a cushion. The water balloon is designed to cushion while being flexible enough to fit through small spaces! It is a help, not a hindrance to labor. So don’t let anyone burst your bubble!

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Marvelously, a baby is knit together in the womb within a protective garment, the water balloon, aka, a Hazmat suit. Just as a Hazmat suit provides an air tight barrier against toxins and contaminants, the Water Balloon contributes the primary mode of protection against infection. Dirt and grime can cover the outside of the suit, while purity remains inside.

 

When a worker enters a dangerous situation, where hazardous materials are present, his health and life depend on the integrity of the Hazmat suit. Although not many women birth babies around such toxins (I hope!), defense against disease is essential in every childbirth. Infection is no laughing matter. For the mom the results are minor: antibiotic therapy. For the baby, however, the results can be dire. Infection is linked to cerebral palsy, hypotension, need for resuscitation at delivery, low Apgar scores, and neonatal seizures. The risk for infection increases with the time the water has been broken.

 

It is no wonder that in the hospital, where cervical checks are routinely done every 1-2 hours, they put a time limit on how long a woman can labor with her water broken. Typically if a woman has not delivered within 24 hours, a doctor will perform a C-section. Some doctors don’t even allow that amount of time. I have seen multiple Cesarean surgeries performed because the mom showed signs of infection, like a fever. Infection can be dire and prevention should be taken seriously.

Keeping that that Hazmat suit whole, or not letting a healthcare provider break your water, can help guard your sterile, clean baby from bacteria and toxins during labor. Breaking the water is like making a hole in the Hazmat suit. That hole doesn’t do much damage if nothing reaches in and touches the baby or uterus. However, each cervical exam, bacteria that normally lives in the lower vagina is carried up into the uterus. If labor takes a while, and that bacteria is given time to grow, an infection will result. The Water Hazmat suit your baby grew in shields him from Hazardous Material in the natural environment.

The design is Marvelous. In meditating on the function of the Water Balloon, I am stumped to find everyday metaphors. We have not yet invented something so innovative and flawless as the design of how the Lord protects children growing in the womb. Truly every child is fearfully and wonderfully made.

The take away:
1. Defend the water balloon, as it guards your baby from infection!
2. After the water breaks, limit cervical checks!

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Chicken Fight by Green.thumbs

Chicken fighting was intense. Our favorite arena was the ocean, where the waves and sand provided additional challenge. My brother formed “The Bottom Base,” while I composed “The Apex Attack” on his shoulders. We met every challenging duo with reckless bravery. The goal: remain as a unit as you destroy the combo you face. Tear them apart. Make them separate. I still remember the feat of my brother. We would begin to loose it. My balance would shift as I precariously began to fall off his shoulders into the waves. As we toppled into the water, my brother would go under, manage to get his balance under me, stand up, and re-enter the match! Ahh, good memories!!

Chicken fighting was fun! We never chicken fought on land, however, this activity was specifically designated to water. Why? Somethings are fun to do in water, that are dumb to do on land. Water cushions. Water creates a low-impact environment. It is hard to get hurt in water (if only we could avoid those blasted jelly fish). Water is also the preferred setting for cannonballs. 🙂

In the womb, the baby is happy, swimming in a tough balloon of water. This water balloon provides a low impact environment, where it is difficult for the weebit to be hurt by collisions, jerks, shakes, or smashes. The mom can fall down a flight of stairs, be black and blue, and the child will be unaffected. (Someone should invent cars that provide the safety of water for impact reduction!) Outside force is absorbed in the water, and cannot do harm to the baby.

During labor contractions tightly squeeze the little one. This squeeze prepares the bambino to live outside the womb. The water, again, cushions the smash of the contraction. When the water balloon is busted, the cord, which transfers oxygen and nutrients to the baby, often times gets compressed. The cord may get between the child’s bones and the rock hard uterus. When the cord is squeezed, blood cannot flow from mama to baby, and vice versa. This causes a drop in the baby’s heart rate. Although usually tots recover from this easily, and are born healthy, I have seen women have C-sections because of these drops in the baby’s heart rate.

When in a water balloon pool, the baby and the cord are not as affected by contractions. The water protects the little one from impact, and guards the cord from being compressed by contractions. Thus, the water promotes the best blood flow possible for the little tyke. The water assists in protecting the baby and cord, so let your baby keep swimming, and don’t drain the pool prematurely.