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What Goes into a Family-Centered Cesarean Birth Plan

By Connie Banack, CCCE, CPD, CLD, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

C-section birth plan basicsFamily-centered birth is used to describe a birth that is more family oriented, allowing the new family to experience their birth more fully. Many believe that this cannot apply to a surgical procedure. This is not true. Even with a Cesarean surgery, you can have a family-centered birth if you know your options and choose to apply them. Some of the options will be the same as for a vaginal birth. You may have to work harder to have a family-centered birth in the event of surgery, but planning ahead — even if you don’t foresee a Cesarean — can go a long way. Make a birth plan! They won’t know what is important to you unless you let them know, and a birth plan is actually a legal contract as it is providing your wishes in a document provided to your birth team.

Very few women would choose a Cesarean for their birth experience. However, it is important that every pregnant woman is aware of the procedures that surround a Cesarean section. This will give those who do birth by this process more choices and hopefully less fear.

A Word about Doulas

The continuous support of a doula has been found in numerous scientific trials to positively affect obstetric outcomes and the women’s satisfaction with their birth experiences. Many women and couples choose to have a doula because they want and need this extra assistance. During labor, an intense bond develops between the doula and the couple, and if a Cesarean becomes necessary, it is very distressing for the woman to have to choose only one person to be with her. Mothers will hire doulas even during a scheduled Cesarean birth to provide the consistent professional support a doula provides.

A 2001 article by Penny Simkin, “Doulas at Cesarean Birth,” details the benefits of a doula during a Cesarean, which include:

  • Doulas are familiar with Cesareans and do not find them upsetting.
  • The doula’s familiar presence can calm and reassure the mother who is likely to be very frightened and worried.
  • The doula can reassure the partner, who is also likely to be worried and frightened.
  • The doula can explain what is happening.
  • Once the baby is born, the partner usually goes to see the baby, leaving the mother’s side. The doula remains with the mother, tells her what the baby is doing, and helps the mother feel less alone.
  • The doula goes to recovery with the mother. If the partner has gone to the nursery with the baby, the mother still has a support person with her.
  • The doula does not get in the way or behave inappropriately.

Check with your doctor to see if your doula is allowed into the operating room and recovery to support you.

Birth Plan Preparation

In preparing a birth plan, each point needs to be discussed with your caregiver, even if he may not be at your birth. He will be able to tell you if what you would like is an option with him or at the hospital you have chosen. Start early and discuss a few points each prenatal visit rather than trying to cover every point in one or two visits. This will help you in providing more time for questions about each point and reduce confusion for both you and your caregiver.

Communication is vital in learning about philosophy, options, and rapport. A good way to communicate with your caregiver in putting together a birth plan that will be read and followed is through the “Who’s the Boss?” Method:

  1. Acknowledge provider’s expertise
  2. Add personal information
  3. Listen and consider
  4. Summarize
  5. Respond in appreciative and authoritative mode.


  • You: One of my friends was telling me about avoiding post-operative pain medications just after her baby was born, which made her fall asleep, and I wanted to get your professional opinion on the subject.
  • Doctor: Routinely, a pain medication is given to you after the baby is born to help you relax during the long suturing process, which can take up to an hour. It can make you sleepy or even relax you enough to put you to sleep. You can then wake up refreshed when you meet your new baby.
  • You: Is it possible to ask not to have this given?
  • Doctor: Absolutely.
  • You: OK. Thank you for discussing that with me. Now I understand, and I’ll think about what you said before I decide.

When writing your plan, start by introducing yourself through a prologue. This provides a familiar base on which to build a rapport with your nurses and attending caregiver. This is followed by your wishes, which have been discussed with your doctor prior to your birth. Point form is the most efficient way to list these, as you don’t want your birth team to become mired in your plan looking for a lost point. Wording is crucial in a birth plan. It can make all the difference between a supportive or hostile atmosphere during your birth. Yet it is also a legal document.

“The language ‘I do not consent’ may sound harsh but, in fact, is the only statement that has clear legal power so I encourage you to use it for things that you feel strongly about,” emphasizes Gretchen Humphries, editor of BirthTruth.org. “If someone does something to you after you state that you do not consent to it, legally they have committed assault and battery on you. Hospitals are well aware of this, but they assume you are not.”

Make your birth plan short, preferably one page long. Include only those points most important to you. Providing two plans, one for birth and one for your new baby, is an excellent way to ensure that both you and your baby are cared for as you wish. The birth plan stays with you, and the newborn plan goes with your baby if he not able to stay with you. Have several copies with you and give it to everyone involved in your Cesarean. And finally, after you have finished discussing the points with your caregiver, consider having him sign it. This helps ensure that it will be read and followed during your birth.

Basics of a Family-Centered Cesarean Birth Plan

  1. Prologue — Most nurses and doctors appreciate a prologue to a birth plan. A prologue introduces you to your birth team and can give insight into the choices you have made in the plan itself. For instance, parents who have had a former general anesthesia Cesarean experience could include this in the birth plan as an explanation as to why they are choosing an epidural for this birth.

We understand that there are times when a Cesarean delivery is in the best interests of the mother and infant. We also understand that Cesarean delivery, as a surgical procedure, is common and even routine in most maternity centers. However, we would ask that the staff respect that this individual surgery is a unique and never-to-be-repeated event in the life of our family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. We have already experienced the Cesarean delivery of our sons and, because of that, have certain requests and requirements to be taken into account.

  • Pre-operative Preparation — If an elective Cesarean is necessary, then you should request that you be able to begin labor naturally before the Cesarean is done. That is, you do not want a date and time preset; you wish for your baby to decide the day on which it is ready to be born to avoid any problems with prematurity and for both of you to reap the benefits of your hormones. It is also important for your benefit in both recovery and in establishing your breast milk. Labor signals your body to start producing breast milk about two to three days after your baby is born and this is thwarted when baby is removed surgically without labor, often prolonging the production of milk by several days. If a scheduled Cesarean must be performed, then you should request preoperative blood work and tests to be done on an outpatient basis, and hospital admission on the day of the birth not the night before. There are several preparation procedures that are done before you enter the operating room such as establishing an I.V. and giving a bolus of I.V. fluid, placing the epidural catheter and ensuring adequate anesthesia, inserting a urinary catheter, checking of vitals (blood pressure, heart rate, temperature), and checking fetal heart tones. There is no reason why you cannot have your partner and others there to comfort and support you during any of them. One procedure specifically, inserting the urinary catheter, can be quite uncomfortable and many mothers recommend delaying the insertion until after the epidural or intrathecal is in place.

I do not consent to placement of a urinary catheter until after regional anesthesia is in place, unless it has been discussed with me in advance.

  • Anesthesia — Women have three options for anesthetic during a Cesarean section: general anesthesia (mom is unconscious), epidural anesthesia, and intrathecal anesthesia (with both of the latter, mom is awake for the delivery). Please research each option, both for availability and benefits and risks of each to find which is right for you. What many women do not realize if they are awake is that medications are often given before, during, or just after the baby is born to relax the mother, but the postoperative medication especially often puts the mother to sleep. You will need to decide if you want this or not and include it in your birth plan if you want to avoid further pain medications during or after the surgery.

I do not consent to any pre-, peri-, or postoperative medication without prior verbal consent from myself, or my spouse if I am incapacitated. I wish to discuss the complete anesthesia protocol with the anesthesiologist prior to any medication administration. I desire postoperative analgesia to be administered via epidural before any use of systemic analgesics, sedatives, or tranquilizers. I have used this protocol in the past and was pleased with the results.

  • During Surgery — It is the anesthesiologist who makes the decisions in the operating room. It is important that he reviews a copy of your birth plan and discusses it with you prior to your birth. Ensure you include in your birth plan who you would like to attend during and after your birth in the operating room. Some anesthesiologists allow only one person with you in the operating room; others allow two or more. Find out what your options are and prepare accordingly. If only one is allowed, one alternative may be having your partner be with you until the baby checks are completed and then have your doula or another support person come in when your partner leaves with baby, assuming baby is moving to the nursery. Routinely, your hands are strapped down to prevent tangling of the various cords to the medical equipment that is monitoring you and to prevent your arms from falling off the narrow boards they are placed on. You can ask to not have your hands strapped down, so as to better receive your baby when he is brought to you. Would you, and your partner, like to view the actual birth? Then make sure your obstetrician realizes this. Explain you would like the option of viewing the birth, either by lowering the screen or by positioning a mirror. Maybe your previous Cesarean is still a bit unreal, as you never have actually seen a baby leave your body — they tend to just appear from behind the green screen and be held up for a quick look before they disappear to be wrapped up and tested. Make sure that the operating room staff realizes that you would appreciate a verbal description of the birth as it occurs. You may have previously felt left out of your past Cesarean as your body and labor might have been discussed as though you weren’t there. Would you love to meet your new baby in his unclothed, naked newborn state — a wet, slippery baby? Request that the baby be placed on your chest with a warm blanket over you both. It would do a lot to make this surgical delivery a bit more natural for mother, father, and baby. And it may even resolve a few inner conflicts that are faced after the birth. In addition, ask that no screen be placed in the way as you will be able to see the baby as he emerges from your body immediately and even be placed on your chest for the baby checks and to cut the cord. Other options include taking pictures or videotaping the birth, having or even choosing background music to be played during the surgery, and your partner cutting the cord. What about that placenta? Most women who birth vaginally get to see it. If you would like to, too, make sure operating room staff knows you want to view the placenta. Make sure they realize the importance of this, and let them know not to just discard a part of you that you have carried for nine months as insignificant. You may like to take the placenta home, to plant under a tree, or even to eat (it reduces the incidence of postpartum depression), so please tell them to be sure to make suitable arrangements with you to see that this happens. If an emergency Cesarean is necessary, under general anesthetic, then you can have your baby given to your partner as soon as possible after birth and held by him (hopefully next to his naked chest – skin-to-skin contact) until you are awake and can be told of the baby’s sex and well-being by your partner. As with any surgery, there are risks and sometimes those risks can have drastic consequences. Some obstetricians remove the uterus to solve a problem like hemorrhage. Is this a concern for you? Many times, a hysterectomy can be avoided using other treatments. Have you considered the option of tubal ligation during the surgery? Many women have been asked on the operating table this question and have answered hastily only to regret it later. Make the decision before your surgery. Also, with any surgery, administration of blood products may be an option when there is excessive bleeding. Many have fears or religious considerations surrounding the dispensation of blood and blood products. Options may include banking your own blood or refusing blood products and building your own supply back to normal in the days following your birth. Finally, there are two methods to closing the uterus. Highly recommended is the double suturing method (suturing of both the inner wall and outer layer of the uterus) to further ensure scar integrity for subsequent pregnancies and labors. Closure of the skin layer can be done either with staples or with sutures. If either of these is preferable, note it on your birth plan as well.

I do not consent to having my arms strapped down unless I am physically unable to control them. I am familiar with surgical fields and understand the necessity of maintaining a sterile surgical field.

  • Infant Care — How about breastfeeding your baby straight away, rather than hours later? Let them know that you would like to feed your baby while you are being sutured, if you feel up to it, and you would like your baby to stay with you throughout the surgery and even during the recovery. Your baby should remain with you at all times, no disappearing off to the nursery with your partner. This simple routine can seriously affect your bonding with your child. If your baby must go to the nursery, then do send your partner and encourage skin-to-skin contact. Your baby will be much less stressed when with someone he recognizes, as baby will respond to your partner’s voice. Let them know that your partner would be delighted to hold his child within your view throughout these procedures, if you feel unable to participate in the bonding. Newborns are also subjected to various interventions, too — routine health checks using the APGAR assessment, vitamin K injection, eye ointment application, PKU test, weight and height measurements, a bath, and possibly Hepatitis B or other vaccinations. It is highly recommended you research each of these and make an informed decision on allowing, delaying, or not allowing these procedures. You can also ask that the procedures that are done right after baby’s birth be done while in your presence rather than in the nursery. If you are planning to breastfeed your baby, you may want to include in your birth plan that you would like your baby to avoid artificial nipples or supplements including water, sugar water, or formula. If there is a glucose or nutritional concern, ask that it be discussed with you before an action is taken.

We do not consent to the PKU test until after my milk is in. We believe that this will reduce the likelihood of an inadequate sample, making it less likely a retest will be needed.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

The Importance of Skin-to-Skin Contact

By Jack Newman, MD, & Teresa Pitman

Editor Rita Brhel doing Kangaroo Care with her premature daughterWe now have a multitude of studies that show mothers and babies should be together, skin-to-skin (baby naked, not wrapped in a blanket), the baby’s neck extended slightly so his head is in “sniffing position,” immediately after birth – and they should spend as much time together skin-to-skin as possible in the days that follow. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and normal, and the baby’s blood sugar levels are better.

Not only that – skin-to-skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s and studies show that the baby is much more likely to adjust to his new world, metabolically speaking, when he is skin-to-skin with the mother than if he is in that incubator.

We now know that this is true not only for the baby born at term and in good health but also for the premature baby. Skin-to-skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin-to-skin, and this helps reduce their need for oxygen and keeps them more stable in other ways as well.

From the point of view of breastfeeding, babies who are kept skin-to-skin with the mother immediately after birth for at least an hour are more likely to latch on without any help, and they are more likely to latch on well, especially if the mother did not receive medication during labor or birth. Putting mother and baby skin-to-skin can also be a valuable first step in solving any breastfeeding difficulties they are having.

There is no reason that the vast majority of babies cannot be skin-to-skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence. Of course, there is also no reason a baby cannot be back skin-to-skin with the mother immediately after the hospital routines are done.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, usually in response to the baby’s behaviors showing some interest in going to the breast, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other’s company. The mother and baby should not be left alone, however, especially if the mother has received medication. It is important that not only the mother’s partner but also a nurse, midwife, doula, or physician stay with them – occasionally, some babies do need medical help and someone qualified should be there “just in case.”

The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin-to-skin contact can also be done after Cesarean section, even while the mother is getting stitched up, unless there are medical reasons that prevent it.

Studies have shown that even premature babies as small as 1200 grams (2 pounds 10 ounces) are more stable metabolically, including the level of their blood sugars, and breathe better if they are skin-to-skin immediately after birth. The need for an intravenous infusion, oxygen therapy, or a nasogastric tube, for example, or all the preceding, does not preclude skin-to-skin contact. Skin-to-skin contact is quite compatible with other measures taken to keep the baby healthy.

Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin-to-skin with the mother immediately after birth. Indeed, in the premature baby, as in the full-term baby, skin-to-skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin-to-skin contact is still good and important for the baby and the mother for all the other reasons mentioned.

I have heard of a few cases where a mother had planned not to breastfeed but was still urged by hospital staff to hold her baby skin-to-skin. After doing this for a short period of time and seeing her baby gravitate to her breast, these mothers decided to breastfeed after all. The effects of this simple technique are powerful! In fact, one could say that skin-to-skin contact is even more important if the mother does not breastfeed so that the mother and baby have this special opportunity to “fall in love with each other.”

The Case for Skin-to-Skin Contact Between Mother and Baby, Whether Full-term or Premature
In summary, skin-to-skin contact immediately after birth that lasts for at least an hour has the several positive effects. These babies:

  • Are more likely to latch on, and to latch on well.
  • Have more stable and normal skin temperatures.
  • Have more stable and normal heart rates and blood pressures.
  • Have high blood sugars.
  • Are less likely to cry.
  • Are more likely to breastfeed exclusively longer.

Excerpted from The Latch and Other Keys to Breastfeeding Success by Newman, J., and Pitman, T. (2006) Amarillo, TX: Hale Publishing. (pp. 9-12) www.ibreastfeeding.com

Heal Thyself through Birth Storytelling

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Healing through our birth storiesIn preparing the Spring 2009 issue of The Attached Family, I asked a number of women to tell their birth stories who were too uncomfortable in doing so. They were still working through emotions of disappointment, fear, and sometimes guilt surrounding their baby’s birth – even years afterward.

It is obvious that emotional healing is a process, similar in many ways to grieving over the death of a loved one. In fact, the emotional healing process after a traumatic birth is a type of grief: You are grieving over a loss – having to settle for a labor and/or childbirth that may be very different than you imagined it, the loss of your expected recovery or early attachment period with your baby, even the loss of a healthy baby. For some women, the loss may not be so obvious – perhaps you didn’t get to hold your baby after your birth, or you had an I.V. or catheter or couldn’t walk around during your labor as much as you wanted to. Not all losses have to be catastrophic or major to cause a feeling of grief.

“Shock is a normal psychological and physiological response to an unknown, intense or perceived biologically-threatening situation,” according to Pam England, author of Birthing from Within, in her article, “Birth Shock,” on BirthingFromWithin.com. “Labor, even normal labor, qualifies for all of those categories. So birth shock is a completely normal response to either normal or complicated births and postpartum; it occurs in home births and hospitals births.”

Dr. Elizabeth Kübler-Ross was a doctor who spent time studying the emotions patients in Swiss hospitals go through when they learn they have a terminal illness. She wrote On Death and Dying in 1969, where she identified seven stages of grief people typically go through as they work through the emotional impact of the loss of their dreams for their life. Commonly referred to as the Grief Cycle, these stages are common with all forms of loss – such as the loss of a job or pet, and theoretically could be applied to the emotions surrounding a disappointing birth experience.

“Grief is a process of physical, emotional, social, and cognitive reactions to loss,” according to Lori Godin, a licensed marriage and family therapist in San Jose, California (ModernLife.org). “The grieving process is often a hard one to work through. It requires patience with ourselves and with other. Although responses to loss are as diverse as the people experiencing it, patterns or stages that are commonly experienced have emerged.”

The Grief Cycle

The Grief Cycle is often condensed to five stages: denial, anger, bargaining, depression, and acceptance. The original Grief Cycle created by Kübler-Ross includes actually seven stages, which are outlined on ChangingMinds.org:

  1. ShockSymptoms: At first, the person may appear to have no reaction at all, or may nod and appear to accept the news without being troubled by it. The person may need to be told several times before they understand it, which is indicative by a physical reaction such as paling of the skin, shortness of breath, and physical freezing. Treatment: The person should be sat down and given something to hold onto. Show them sympathy and acceptance. Prevention: While there is no prevention of the Grief Cycle, the reactions of the Shock Stage may be lessened some by telling the person the news in a private, safe place with the company of trusted friends or family.
  2. DenialSymptoms: The person pretends that nothing has happened, including denying any evidence that would prove the news to be real. Treatment: Show sympathy by letting the person know that you, too, find it unfair. This will help the person feel safe to become angry about the situation, which opens up their ability to deal with their emotions.
  3. AngerSymptoms: The person may swing suddenly and explosively into anger, as she asks “why me?” She may freely blame people, places, and events – anything that may have been involved in the situation. Treatment: Allow them to feel angry and don’t deny their feelings, much as attachment parents do with their toddlers’ tantrums. However, should the anger become destructive, remind the person of appropriate and inappropriate behavior and help her to reframe her anger into useful channels such as problem areas, tasks, hobbies, and other ways to move forward. Prevention: Again, while the Anger Stage cannot be prevented and is essential to move through the Grief Cycle, you should be aware of your reactions when faced with another person’s anger. Do not turn it into an argument, as this could push the person back into denial or cause future problems. Support and accept their anger, and let them be angry at you, especially if the person’s “why me?” turns into “why not you?”
  4. Bargaining Symptoms: The person feels hopeful that the situation is reversible. She seeks in vain for ways to avoid the situation. Treatment: While you can help the person seek out practical alternatives, do not offer the person any false hope. Offer new opportunities for personal growth.
  5. DepressionSymptoms: The person finally feels the inevitability of the situation and reluctantly accepts it. This can be a deep depression full of despair and hopelessness. Depression can present in many ways, from tearfulness to sleeping all the time to loss of joy in hobbies. As they turn into themselves, they turn away from any possible solution or person who can help them. Treatment: Show sympathy and acceptance. Your presence, while it may not be acknowledged, can be comforting to the person. Professional counseling may be needed to help the person recognize their depression and then find a way out of depression.
  6. TestingSymptoms: The person begins to experiment with activities to find ways out of the depression. Treatment: The support of friends, family, and sometimes professional counselors can help tremendously during this stage. Give the person as much control over the situation as possible, as you help them try different solutions.
  7. AcceptanceSymptoms: The person feels ready and actively involved in moving on with her life. The person takes ownership for their actions and emotions. They start doing things and taking note of the results, and then changing their actions in response. They appear increasingly happier and more content. Treatment: Help the person to establish themselves in their new position on life. Congratulate them on getting through the emotional healing process, and celebrate the transition of their transition.

“Knowing these stages can sometimes help in coping with the process of grief and recognizing that there is a light at the end of the tunnel,” Godlin continues. “It should be noted that although most people experience all of the following stages, they do not experience them with the same duration or in the same order or with the same intensity. It is a very unique process.”

The Grief Cycle in a Birth Story

For this exercise, I am referring to my daughter’s birth story, “The Story of Rachel,” in the Birth Stories section. Try dissecting this story and see if you can identify any of the stages of the Grief Cycle.

Here’s what I came up with:

  1. Shock – “My first thought was that I had lost the baby, but as soon as I stood up, I felt a kick. I couldn’t grasp that she was still alive when it was clear from the blood that things were not at all OK.”
  2. Denial – “I had no idea was he was trying to tell me — I thought the drugs would work, the pregnancy would last until my baby was term, my baby wouldn’t need any sort of NICU care.”
  3. Bargaining – “I braved each contraction, with the help of my dad and a nurse as my coaches since I had never been through childbirth classes, with the expectation that the drugs would work.”
  4. Depression – “It was devastating to hear the doctors say there was nothing more they could do to stop labor and that my baby’s well-being was left to fate.”

Note that I did not appear to go through all the stages. As Godlin mentioned, not everyone goes through every stage of the Grief Cycle, or through in the same order. In addition, some women may grieve their births immediately, while others may wait. Some may think they have accepted the circumstances surrounding their child’s birth but then find a trigger in another’s birth story or when a close friend or sister becomes pregnant for the first time. Many women don’t grieve until they’re pregnant again, or even just considering whether or not they want more children.

What my birth story doesn’t tell you is, I didn’t feel angry until I was pregnant with my second daughter, Emily, and then especially after her Cesarean.  As far as the testing and acceptance stages go, while I believe I’ve accepted the way my birth progressed with Rachel, I’m still bouncing in and out of acceptance and anger with Emily’s birth. Because the two births were only a year apart, it’s difficult to sort out exactly which emotions go with which birth and it’s very possible the two’s Grief Cycles have enmeshed with one another.

Why Birth Storytelling is Needed

Everyone’s birth story is unique unto itself, and every person sees disappointments, fear, and guilt in their own way. This is why it is sometimes difficult to find empathy or sympathy from others, and why it can be useful to use the telling and retelling of our birth story as therapy in working through the Grief Cycle. In the article, “Emotional Recovery from a Cesarean,” on Plus-Size-Pregnancy.org, we learn that many women who suffer from emotional trauma following a Cesarean birth often then feel additional isolation and hurt by friends and family who have difficulty understanding the need to mourn a birth when the baby and mother are ultimately healthy.

According to the article, some people don’t understand the scope of a Cesarean, thinking it’s more or less interchangeable with vaginal birth; others come from an age where interventions during birth, such as putting women out of consciousness or giving them massive episiotomies, were the norm. Some people may disregard a woman’s grief because they don’t want anything to overshadow their own joy of the new baby. Some people may be unable to feel empathy because they have unresolved issues from their own birth experiences, even seemingly normal ones, or because they happy with their interventions, even a Cesarean, and don’t understand why you wouldn’t feel the same way.

The article goes on to acknowledge the power of birth storytelling in emotional healing. In fact, the author, who is identified only as KMom, stresses that telling the birth story is crucial in starting the healing process: “This is one of the most difficult steps for some women, but it really is very important in getting the healing started.  If you can’t name what happened to you, then you can’t fully understand it or begin to make it different next time.  Name the problem, talk about what happened, then retell your story over and over and over. “

Healing Through Our Birth Stories

With the internet, it’s easier now to find ways of telling your birth story. You can share it on the API Forum, where parents are always ready to give support. You can submit your story to be included on The Attached Family online. API Leaders through your local support group, or a resource leader contact, would be happy to listen to your birth story. Some API Support Groups host special meetings specifically for women to share their birth stories. If you’d like to be more personal, write your story in a journal or on your computer where no one else can see it but yourself. Tell your story to a trusted, impartial friend or family member.

Only share what you feel like sharing, and don’t feel pressure to share all of it at once. Many women develop their stories, or parts of their stories, over time. They may remember points of their births that they hadn’t before, or are able to see it in a different perspective. You can start by writing about your pregnancy and work slowly forward in your story, or you can start at your recovery and work slowly backward. For some women, the story just falls together on its own from start to finish. For others, the story comes in little bits and may jump around.

KMom shares that it’s not enough to tell a birth story only once, that retelling it many times with different focuses is needed to be able to start processing the emotions that come with it. Lynn Madsen, author of Rebounding from Childbirth, suggests writing the birth story in two layers, resting between the layers to give time to reflect:

  1. Write down the concrete details you can remember: who, what, where, when, the sensory details, etc.
  2. Write down what was going on inside of you: where was your mind, were you aware of the baby, what did you say to yourself, how were you feeling, etc.

It is in this second layer of your birth story that you will begin facing and processing the disappointment, fear, guilt, and other emotions surrounding your birth experience. This is daunting work for most people, as KMom explains: “Some of the hardest work you will do is accessing your deepest feelings about your child’s birth.  Often, it is very difficult to do this.  People don’t like to go through pain, and facing unpleasant or difficult feelings is painful.  Feelings about birth tend to be very intense, especially the deeper you go.  Often they bring up life issues which can be even more intense.”

“It is completely normal to wish to avoid pain, but if you suppress your feelings and don’t really feel them fully, they become stronger.  Often they will present in your life again and again, each time stronger and more insistent, and sometimes in more destructive ways.  Although facing the feelings may be very difficult or feel very threatening, in the long run it is what frees you,” she continues.

Some women feel they don’t need to deal with their emotions because the experience is behind them, or because their experiences may not be as traumatic as someone else’s. But Madsen explains: “Every feeling about birth matters, no matter how long that feelings lasts, no matter how unreasonable, irrational, or out of proportion it seems.  Any feeling, no matter how strong, is easier to live with once it is named. …A woman may believe she is going to die as the feeling rolls through her, but she won’t.  The trick is to sit with the feeling until this intensity, this sensation of death passes, and light is perceived at the end of the tunnel.”

Telling the birth story, and working through the emotions surrounding a disappointing birth, is essential before a woman decides to have another baby. It is also important for women who are certain they are done having children, because their emotions may be clouding their judgment. Even if a woman is past her childbearing years, naming these emotions and working through them is needed for closure, or else, these emotions will return over and over again throughout their lives at different points and in different situations, until they are finally resolved in some way.

Get the Most Benefit Out of Your Birth Story

In developing your birth story, KMom gives several helpful tips to more fully understand the emotions you may be feeling:

  • Learn exactly what happens during the procedure you went through, whether it was a Cesarean, episiotomy, or another intervention. Search for an article on the Internet, or watch a video. Realize that you’ll likely find this distressing at first, but it really does help you to understand your emotions if you know what physically happened to you.
  • Request a copy of your medical records. Find out what really happened during your birth experience and the reasons for the interventions.  You need to understand the complexities of what happened and if there was anything you could’ve done to prevent what happened. You may feel anger and sadness as you read through your records, especially if you find unkind remarks or misinterpretations by your provider, but you can discover a lot of the behind-the-scenes reasons for why your labor and childbirth went the direction that it did.
  • Listen to your partner’s view of the birth and discuss it. Your partner’s version may be different than yours, and he may be able to offer insight. Realize that he may be working through his own emotional healing process, so understand if he is reluctant or if he tells his story in a brief way that lacks a lot of emotion and details, and ask probing questions gently.
  • Activate your anger. Unexpressed anger can destroy a person, but expressed anger opens up the healing process. It doesn’t matter whether you feel its reasonable anger or not. Women often feel angry at their health care providers or their spouses, but they can be angry toward anyone. But many women also don’t want to acknowledge that they’re angry. A good way to vent your anger is to write a letter addressed to the person with whom you’re angry – although you won’t send it – and let your anger erupt or pour out over the page.
  • Express emotions through the arts. Draw, paint, sing, write a poem, create a sculpture, even out of play dough, or write a children’s story from your baby’s point of view – do whatever your creative tendency is.
  • Acknowledge the emotional power of anniversaries. Your baby’s conception, expected due date, birthday, and other anniversaries can be both joyful times for you as well as times that bring about hard feelings toward your birth experience. Allow yourself to grieve during these anniversaries, which paradoxically, will allow you to work through the feelings and then enjoy the celebration. Otherwise, you’ll spend the day concentrating on your grief instead.
  • Share your experience with others who understand. Join a support group or seek out a mentor, such as through the International Cesarean Awareness Network, ICAN-Online.org; Sidelines National High Risk Pregnancy Support Network, Sidelines.org; Birth Trauma Association, BirthTraumaAssociation.org.uk; SOLACE, SolaceForMothers.org; and Birthrites: Healing After Cesarean, Birthrites.org. Find support through the API Forum or at a local API Support Group. Talk with a trusted friend, listen to or read other women’s birth stories, or especially if your birth was traumatic, seek out professional counseling with a therapist who specializes in birth issues.
  • Reframe the experience to focus on the positive — and on your baby. Give yourself credit for your courage and emotional strength. Think about the positive reinforcement you would give to another woman in your situation. Focus on the aspects of your birth where you did well, and give yourself credit for being mature enough to work through your emotions and to use the experience as a time for personal growth. Remember that you made the choices you made at the time because you believed them to be the best for your baby.
  • Practice self forgiveness. Forgive yourself for your choices, whether it was going along with whatever the doctor said or whatever it is that is making you angry. Tell yourself that you did the best with the knowledge that you had at the time, because that is truly the best that anyone can do.
  • Rewrite your birth in the way you wanted it to go. This is a very effective way to heal, but should be done only after you have written the birth story as it has gone and you have learned as much as you can about how the birth really went, which means looking at your medical records. Recreate your birth story with as much or as little detail as you want. Also, some women may need to rewrite their birth story over and over in order to feel a complete emotional release.
  • Tell your birth story to your child. When you’re ready, hold your child while he is asleep and whisper to him first your birth story and then your recreated birth story, what you wished had been different. Some women feel more comfortable practicing this exercise first without their child present, or by holding their child’s favorite toy, to first release strong emotions like sorrow and rage. This is especially true if there is any anger felt toward the child.
  • Create ceremonies. Some women gather friends together for a birth storytelling circle. Others write their birth stories or letters to those they are angry with and then burn the paper. Some have placental burials, affirmation declarations, or other rituals where they can either give themselves positive reinforcement or express anger in a healthy way toward others.
  • Find activities that help release your emotions, tension, and stress. Exercise, good nutrition, mediation, and massage are especially helpful, as are your hobbies or even chores if you are able to channel your strong emotions into them.

Healing is Possible

When a woman is in the midst of feeling the emotional trauma from a disappointing birth experience, it can seem like her former, happy self has gone away forever and a depressed, angry person has taken place. Healing takes time and effort, but it is well worth it in the end. Unhealed emotions from a traumatic birth experience can take their toll not only on the relationships within a family, but also on the future children (or decision whether to have more children) and on the woman.

Sharing your story through an API Support Group, the API Forum, or by submission to The Attached Family online “Birth Stories” section can be a great start to healing through your birth story – as well as helping others heal from their traumatic births.

In her Plus-Size-Pregnancy.org article, KMom explains: “Reading other women’s stories of recovery after a [traumatic birth] can be very healing.  Sometimes, confronting women’s pain or our own can be distressing, but it is running away from or avoiding the pain that prolongs it. Dealing with the pain when you are ready can be very revealing about general life issues, can help you heal many ways emotionally, and can help you face your fears and prepare for future pregnancies and births.  Remember, ‘The other side of fear is freedom.’”

For More Information

  • Birthing as a Healing Experience by Lois Halzel Freedman
  • Ended Beginnings by Claudia Panuthos & Catherine Romeo
  • Rebounding from Childbirth by Lynn Madsen
  • Silent Knife by Nancy Cohen Wainer & Lois Estner
  • Transformation Through Childbirth by Claudia Panuthos
  • Trust Your Body! Trust Your Baby! by Andrea Frank Henkart

Be Prepared for These Common Childbirth Interventions

By Amber Lewis, staff writer for The Attached Family publications

Common Childbirth Interventions“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.”
~ Gloria Steinem, Ms. Magazine, April 1981

Most pregnant women will tell you they have a plan for their labor, but just as parents cannot imagine how their children will turn out as they grow and mature, soon-to-be mothers cannot be guaranteed a perfect birth. Labor experiences are as varied and vast as the types of people who go through them and the children those experiences bring into the world. There are just as many emotions involved in this miraculous experience, and while many births are happy and uncomplicated, others can be deeply disappointing for the parents.

This leads to the question: What to do when childbirth does not go as it was planned to? Continue reading Be Prepared for These Common Childbirth Interventions

Luke’s Birth

By Jeannette Freeman, leader of API of Southeast Texas

Jeannette's family
Jeannette’s family

Editor’s Note: Attachment Parenting International does not advocate unassisted birth of any sort. We believe the safest birthing environment for every baby, whether at home or in a hospital or birthing center, is with assistance from a midwife, obstetrician, or another accredited birthing assistant. The following article has been published to give this mother a voice in telling her birth story only, without any endorsement of her decisions made regarding her child’s birth.

Luke Elliot was born Friday, Sept. 21, at 5:43 p.m., shortly before sunset and the beginning of the Day of Atonement (Yom Kippur). My “due date” had been the previous Saturday, and I really wanted him to be born before the next Sabbath, as I was tired of everyone at church being surprised that he hadn’t arrived yet.

My original due date had been off by two months, and some of the mother hens of the congregation, namely those who birthed in the 1950s and ’60s, were more than a little anxious about my unassisted pregnancy and planned unassisted birth. It had gotten to the point when my husband, Mark, and I decided to visit an obstetrician to calm everyone’s nerves. The doctor refused to touch me unless I was willing to submit to a vaginal exam and whatever else he deemed necessary. I refused.

The morning of Luke’s birth, Mark, my two-year-old daughter Audrey, and I spent over an hour picking up branches and leaves from our front yard after Hurricane Humberto  our first hurricane experience  had hit the week previous. After I put Audrey down for her nap, I commented to Mark, “We may have started something,” referring to the yard work and my now-present uterine contractions. When Audrey awoke at 2:45 p.m., my labor became active. There was no stopping now!

It was a rather surreal labor, as I chose different positions, consulted two different birthing books, gave instructions to my husband, and practiced a variety of vocalizations to figure out what did and did not work for me, mindful than some noises might startle my daughter.

Our bathroom  truly a one-person room  became my center of command. For awhile, I labored on the toilet, leaning on a pillow resting on a TV tray table. For awhile, I labored on my hands and knees. My butt was in the bathroom and my torso in the hallway. Between contractions, I was leaning forward on two large couch pillows with my butt up in the air to slow progress down a bit. This was entirely different from Audrey’s labor that lasted so long I was literally out of energy before it was over. It was during this period that Audrey insisted that her father get her a pillow of her own to lie on. Now, when I leaned forward on my pillows during contractions, she did too. I wish I had a picture of that!

I consulted a book to determine if I had entered the transition stage yet. I had. I then read that after transition, there was often a release of endorphins. I felt that rush, than had two more contractions that felt like they were still part of transition before my body moved onto the pushing stage. During the pushing stage, I hung on the bathroom door.

A little bit into the pushing stage, I reached into my vagina to feel Luke’s head. This is something I had never considered doing, but it was exhilarating to touch the little person I had been waiting for months to see.

By this time, my husband and daughter were sitting outside the bathroom door and watching. A few more pushes and Luke’s head crowned. I took my time, knowing that he would come out eventually and that I didn’t want to tear. Soon, he was part way out. I got a hold of him and realized I could catch him myself, so I did. I was ecstatic. I held my boy for a few long moments and then exclaimed, “We did it!”

When I looked at the umbilical cord, it was already white and ready to cut. This was a good thing, as it was rather short. I suspected it would be, as it was with Audrey, and it was rather awkward to hold Luke. My husband did the honors. I balked at the smell of the rubbing alcohol he used to clean his pocketknife. It was offensive to my senses and out of place.

Mmy boy’s head smelled aseptic. It wasn’t a hospital-like, chemically created aseptic smell but a natural cleanness from his time in the womb. It surprised me until I thought about how the womb was indeed a sterile place.

I sat on the floor in the mess for a few minutes and then crawled into the tub while my husband cleaned up. Then, my husband took Luke and Audrey into the library. I ended up birthing the placenta on the toilet. I knew it was coming and I tried to get to the tub. I wanted to check the placenta to make sure it was complete. I did fish it out of the toilet later and put it in a big bowl. I looked at it later but gave up trying to figure out if it was all there. Instead, I put it in a bag to send out with the trash.

Less than an hour after Luke’s birth, I was standing in my shower thinking, “Wow! This is great. Showering in my own shower. Never leaving home to birth my own baby. This is the way to do it. So much more relaxed and peaceful than the hospital.”

Audrey had big plans for her new brother. She had Dad read a book to him, and brought him a block to play with and a pair of her shoes to wear. Mark enjoyed this time of the three of them bonding while I cleaned myself up.

I have no intention of leaving my home to birth again. It was an amazingly empowering event that, three months later, I still ponder with awe.

I began my journey towards an unhindered birth with the belief that my Maker created my body to birth and that He created it perfectly. Planning an unhindered birth was my way of “putting my money where my mouth was.” I’m glad I did.

Audrey’s Birth

By Jeannette Freeman, leader of API of Southeast Texas

Jeannette and Audrey
Jeannette and Audrey

On Monday morning, August 1, I woke up with my first contraction at 5:30 a.m. I had another at 6:30 a.m., 7 a.m., and then periodically throughout the day. I was able to continue my usual activities, but by the time bedtime rolled around, I couldn’t ignore the contractions any longer. I tried to get comfortable. I tried everything I could think of. Even took a bath. No luck. I didn’t sleep at all. However, I did everything I could to conserve my energy, knowing I would need it.

Finally, at about 4:30 a.m. on Tuesday, I couldn’t take it any longer and had Mark call the nurse-midwife. I didn’t know how far I’d dilated, but I figured I was at least somewhat along. My water hadn’t broke yet, either, but that isn’t a good indicator of how dilated you are.

We drove into the hospital, went to the triage area, and they checked me out. I was only two centimeters dilated. They had me walk the halls for an hour, from 6:30 to 7:30 a.m. During that time, my contractions went from just being in the front of my abdomen, to going almost all the way around my lower abdomen and back. That’s commonly called “back labor” and was more intense then the previous labor. I also lost my mucus plug. However, I figured out that the contractions were most easily handled if I walked through them.

They checked me again. No changes. I had the option to go home or stay at the hospital. I had no desire to be in the hospital any longer than necessary, so we left. We stopped at McDonald’s to get breakfast.

The morning and early afternoon were spent with a heating pad strapped to my lower back and attached to an extension cord. I lied on my bed between contractions; during the contractions, I would stand up and walk around the bed. Then, I would lie back down. I wanted some stress balls to squeeze but didn’t have any. I instead used two stuffed animals. At about 1:30 p.m., my water broke. It didn’t all come out at once. We called the nurse-midwife, and at some point, we headed to the hospital.

We got there at around 5 p.m. They put me on the monitor for 20 minutes, and then we went to walk the halls. They had a large labor pool, and when we came back from walking, I got into the pool and stayed there for the duration of the first stage of labor. I rested my chin on a pile of towels on edge of the pool and knelt the entire time in the pool. I had the lights dimmed but with no music or background noise. I just went with my body and followed its cues, with a lot of pelvic rocking and loud vocalizations. Finally, at 8:40 p.m., I was fully dilated and got out of the pool for the pushing stage.

Through all of this, I was trying to conserve energy but was slowly losing energy. I hadn’t eaten since 11 a.m., so I was running on empty. The only thing I would have done differently would be making sure that I kept eating every couple hours up until going to the hospital, even if I didn’t particularly feel like it. At first, I was kneeling on the bed, then I tried lying on my side to conserve energy, but that wasn’t very comfortable at all. My midwife then suggested that I try squatting. She said it would require more energy, but that she thought the baby could be born in about 30 minutes. This was at 10:09 p.m.

I don’t think she realized how little energy I had at that point, because it was two more hours before Audrey arrived. My body definitely had slowed down. The contractions were farther apart and did not last as long. My midwife suggested an I.V. After awhile, I could feel my blood sugar level going down and I agreed to the I.V. After that boost of energy, the pace picked up a bit and it wasn’t too long before my daughter, Audrey, was born at 12:14 a.m. on August 3. Her cord was so short that my husband, Mark, had to cut it before I could even hold her. My midwife was concerned that my body wouldn’t expel the placenta naturally and that I would hemorrhage, so she had Pitocin ready if necessary to encourage it along. But the placenta came out by itself five minutes after Audrey.

We were in the delivery room about one-and-a-half hours before they moved us to our postpartum room. From then on, it was a standard hospital stay. We were discharged Thursday morning at 11 a.m., 35 hours after Audrey’s arrival.

The Story of Emily Fran

By Rita Brhel, editor of The Attached Family publications


Emily Fran was born at 8:27 a.m. on Tuesday, October 23, at 19 inches long and six pounds, 12 ounces. I waited a long time to write her birth story. Emily was more than a year old when I finally decided to sit down and put it on paper. The reason is because my pregnancy with her was rather bittersweet: I had been happy to be pregnant again, but stressed by the fact that my previous pregnancy had ended in a dangerous condition that had formed for no known medical reason. I didn’t want to put another baby in a life-threatening situation, but with none of my questions answered from the previous pregnancy, I didn’t see how this pregnancy could be any different.

Emily is our second child, our second daughter. Unlike her sister Rachel, my pregnancy with her was never threatened with anything more than my extreme fear that something may go wrong and that Emily would be born early. But Emily was no less a miracle child. She didn’t survive against all odds, but she was my hope…a wonderful, beautiful gift from God that helped me heal and taught me about faith.

Emily didn’t come when my husband Mike and I were planning for a second child — in fact, I found out I was pregnant only a week after Rachel came off the last of her medicines for apnea of prematurity; Rachel was nine months old.

Through my mother’s OB/GYN office, I found a very experienced specialist who was able to answer all of my questions of what exactly went wrong with my first pregnancy. Terry Foote, MD, had more than 30 years of experience; in fact, he delivered my brother John and shared the office with the doctor who had delivered me when I was born. He helped me come to terms with what had happened with my first pregnancy and what had to happen with this pregnancy. I learned that the placental abruption most certainly had its root in a fluke in how the placenta had developed and that the threatened miscarriage was the sign of this, but that the real reason for the abruption was undiagnosed pre-eclampsia. The fact that I suffered no edema, not even swollen ankles, during Emily’s pregnancy and that my blood pressure never rose supported this theory. The premature labor and birth with Rachel was likely the only one I would ever experience.

However, the fact that I had such a difficult time delivering a three-and-a-half pound baby with my first pregnancy was troubling. I have a narrow pelvis, meaning that my bones along the birth canal are misshapen so that I cannot deliver a baby larger than four pounds. I would have to have a Cesarean section; a vaginal delivery is impossible for a full-term baby.

The night before my scheduled C-section, I couldn’t sleep at all. I was nervous for the surgery, having never gone through one before — anxious for myself, for Emily, for Rachel. Mike got me up at 5 a.m. on October 23, at 39 weeks gestation, and drove me from our home in Sutton, Nebraska, to Mary Lanning Memorial Hospital in Hastings, Nebraska, the same hospital where I had been born 26 years earlier.

The surgery wasn’t pleasant, and there were some complications for both Emily and I, so I couldn’t hold her anymore than I had held Rachel when she was born. A nurse held her up for me to see for a couple minutes before I had to be put to sleep to finish the surgery.

Unbeknownst to my doctor, I had become anemic during the last month of my pregnancy and with a hemorrhage during the surgery, I had lost a lot of blood. My iron level had dipped down to 5, when the normal is 12 to 16. I also had a spinal fluid leak due to the spinal injection for the narcotic-anesthetic for the C-section.

Emily had low blood sugar when she was born, but more than that, her poor nose had apparently been smashed up against my pelvis since she turned head-down in utero. The newborn doctor used a naso-gastric tube to open up one nostril to make sure she could breathe through both sides of her nose.

Editor’s Note: Read the rest of this story in “Pregnancy & Birth” section of TheAttachedFamily.com with the article, “Sibling Spacing: One Year Apart, Too Close or Just Right?” or click here.

The Story of Rachel

By Rita Brhel, editor of The Attached Family publications



Editor’s Note:

This birth story goes along with the article of how I came to Attachment Parenting through my premature daughter’s birth. Find the article, “AP from a Preemie Mom’s Perspective,” in the “Your AP Stories” section of TheAttachedFamily.com or by clicking here.


As my second trimester came to a close at the end of May, with the summer promising to be very hot, I began to wonder how big I would get and how exactly I’d be able to do my busy, active journalism job as my pregnancy progressed. While I was starting to get a little nervous about my due date, August 13, and was sad that I’d miss my usual summer activities of water-skiing and canoeing, I still felt good. Besides some swelling in my ankles, the pregnancy seemed to be going along just fine.

The morning of Tuesday, June 6, everything changed. Pregnancy was no longer nearly as fun or as full of promise for a healthy baby. I woke up at 5:30 a.m. in a pool of blood. My first thought was that I had lost the baby, but as soon as I stood up, I felt a kick. I couldn’t grasp that she was still alive when it was clear from the blood that things were not at all OK.

Fifteen minutes later, my husband Mike had driven me to the clinic in Hartington, Nebraska — only 10 miles away, but the ride seemed like an eternity. The doctor hooked me up to the ultrasound and contraction reader, found the baby’s heartbeat and said everything was going to be OK. However, I would need to go to the hospital to stop the labor that had begun. I was also given the first of two painful steroid shots to quicken my baby’s lung maturity.

Because I was only 30 weeks along in my pregnancy, it was decided that I would need to go to the Avera McKennan Hospital in Sioux Falls, South Dakota, a hospital that specializes in high-risk pregnancies and has a Level III Neonatal Intensive Care Unit, or NICU, a nursery that is able to handle the youngest and sickest babies, basically any baby born before 32 weeks gestation. It was a long ambulance ride up there, one and a half hours away from Hartington. Mike followed the ambulance in the car; I distracted myself from the contractions that were coming every 10 minutes by chatting with the paramedics.

Once I got to the hospital, the perinatalogist determined that I had a placental abruption, a dangerous complication in which the placenta prematurely separates from the uterus, causing the mother to hemorrhage and the baby’s oxygen and nutrient supply to diminish. I also had effaced nearly 100 percent, signaling that labor had been going on silently for longer than just that morning, most likely caused by an incompetent, or weak, cervix. Luckily, dilation had not begun, I was stable, the baby showed no signs of distress and my water had not broken. There was hope.

I was placed on strict bed rest — not even able to go to the bathroom, shut the curtains, or turn on the TV — and put on a powerful dose of magnesium sulfate, a drug that effectively stopped labor but left my body wrecked. The first dose of medicine, put through my I.V., felt like fire running through my veins. I was extremely weak and dizzy, and had to be on oxygen. My heart rate, blood pressure, blood-oxygen levels, urine output and temperature were checked every hour by the nurse; my medicine level checked every four hours by a blood draw; and I could only eat a liquid diet. I still cannot eat Jello to this day. But it worked; I had stopped bleeding and I felt less than four contractions an hour, not enough to cause labor to progress.

The ultimate goal was to delay labor long enough so that my baby wouldn’t be born until the steroids had time to work, at least 24 hours past the second injection. The hope would be that I could stay on bed rest at the hospital until at least 32 weeks, when the survival rate of premature babies jumps up to about 98 percent and complications were less likely and less severe. The survival rate for a 30-weeker was 90 percent but complications were more common and their severity higher.

At one point during my hospital stay, a neonatalogist visited my bedside to give me an overview of the NICU. I had no idea was he was trying to tell me — I thought the drugs would work, the pregnancy would last until my baby was term, my baby wouldn’t need any sort of NICU care. I had never even heard of the NICU before then, and when he asked me if I had any questions, I just stared at him blankly … even though my mind was racing with them.

Thursday, June 8, was the day of truth … in my mind. That was the day I was to be taken off the magnesium sulfate and put on the pill form of procardia, a drug created for heart patients, with the hope that it would keep labor-progressing contractions at bay. Unfortunately, Mike had to return to work on Friday, so I begged for my dad to come and stay with me, instead.

Thursday was a good day. Friday was not. My contractions came back early Friday morning, June 9, with all the intensity they had on Tuesday. At 11 a.m. Friday, I was put back on a magnesium sulfate I.V. with a double dose of the procardia pill and an injection of terbutaline, another anti-labor drug that gave me the shakes. I braved each contraction, with the help of my dad and a nurse as my coaches since I had never been through childbirth classes, with the expectation that the drugs would work. But when the perinatalogist checked my cervix at about 3 p.m., he found that I was 7 centimeters dilated and far beyond the point of halting labor. I had also started hemorrhaging again, and birth was the only sure way that neither me nor my baby would die. It was devastating to hear the doctors say there was nothing more they could do to stop labor and that my baby’s well-being was left to fate.

I was immediately wheeled down to the next floor to prepare for delivery. I was given an epidural, not only for my pain relief and to help keep me and my baby calm, but also to ensure that an emergency C-section would be possible. If the baby showed any signs of distress, it was expected that I would undergo a C-section immediately.

Mike got to the hospital just as soon as the anesthesia started working, but although he had missed most of the labor, he was right in on the action during birth. My time to push came so quickly that he didn’t even have time to scrub in. Wearing a pair of shorts and a sweaty shirt, he helped hold my leg and my hand, telling me how great of a job I was doing.

I had been pushing for 40 minutes when we ran into a snag. The baby was starting to show signs of distress, a slowing heart rate. I was put back on oxygen to help my baby out, but the doctor advised me he’d have to help her out in his own way. He decided to try an episiotomy, but said that if the baby didn’t come out with one pushing cycle, we’d have to do a C-section. After all that work, and especially an episiotomy already done, I did not want that C-section. And, luckily, I didn’t have to have one.

At 10:17 p.m., a little girl with blond hair was born measuring 16 inches long and weighing three pounds, seven ounces, about a pound more than the neonatalogists were hoping.

The Long Wait for William

By Amy McGovern, co-leader of API of Norman, Oklahoma

Amy's family
Amy’s family

I woke up on a Sunday wondering, again, if this was the day my husband, Andy, and I would get to meet William. After church, I tried to rest but kept waking up with repeated mild cramps. A phone call to my mom confirmed the start of labor. Contractions were ten minutes apart. Excited, we took the dog for a walk to speed labor along, but we had to stop because the contractions began to hurt. We tried to play a board game as a distraction, but I had a lot of trouble concentrating because the contractions were really hurting now. I was completely unprepared for how much they would hurt given how mild they had been earlier! And everyone I knew had very mild labors, so I did not expect it.

By the time the contractions were five minutes apart, I was convinced he was coming any minute! I quickly ate, and we dropped off the dog at our neighbors. As we drove to the hospital 45 minutes away, I called both our parents to tell them what was happening. The contractions hurt so much that I still thought William would arrive in the car, but both moms said I was talking too much for that to happen.

When we arrived at the hospital, they said I was only at two centimeters dilated. They were about to send me home but I vomited. The nurse told me that I was not very far along, and she was not convinced labor would keep going on its own. She sent us off to walk for an hour and then come back for a re-check. We started to make laps, but the area was small and we quickly got bored. We pulled out our board game, and Andy made me walk laps after every turn. We played until I was gasping from the contractions coming every three to four minutes. All that pain had to be worth at least a few centimeters, but I had only dilated one more centimeter. It was about midnight and they were preparing to send us home about midnight, when the heart monitor showed a sudden drop and I was quickly admitted. They offered me some pain medication, and the nurse told me that it would help me to dilate if I could relax. I slept for only a few hours.


Twenty-one hours into labor, the Monday morning obstetrician said I was only at four centimeters, so she broke my water. I asked for an epidural, because the contractions hurt far more than I had anticipated. I demanded that my epidural be a “walking one” without really knowing what that meant. First, they broke my water and the obstetrician said, “Oh, my favorite color.” I asked what she meant, and she said it was meconium.

When the anesthesiologist gave me the epidural, I started to relax. Then, all of a sudden, the room was filled with doctors and nurses! I was a bit loopy from the medicine and did not know what was wrong. The nurse and the obstetrician kept repositioning me, and I finally ended up on my knees before they were happy. It turned out that the epidural made William’s heart rate drop. Once he was back to normal, I was allowed up but was monitored wirelessly.

Determined to get William here quickly, we went for a walk by the nursery, which helped motivate me for the upcoming pushing. I knew it would be hard, and I wanted to see all those newborns whose moms had succeeded. We walked for a long time and stopped for a grape popsicle in the afternoon. Worn out, I walked back to my room to eat  stopping once to leak water all over the floor. Apparently, William shifted!

After some rest and another exam that showed I was at seven centimeters, I tried to get up to go to the bathroom. No one had told me that if you lie down, the epidural would go to your legs. I started to fall as I tried to get out of bed but the nurses and Andy caught me. Frustrated, I ended up in bed waiting for ten centimeters. Sometime in this time period, a nurse came in and gasped, “She’s cyanotic! She has asthma, aren’t you worried?” The other nurse just laughed and said, “No, that’s the grape popsicles!”

Finally, around 8:30 p.m., the obstetrician on-call came in, examined me, and told me that I was at ten centimeters. I was at last allowed to push! However, I didn’t feel any urge to push, so they put me on Pitocin. I was too exhausted to really argue. All I knew is that I wanted William to get here soon.

The doctor left me with two labor nurses and Andy. I tried to push when they told me. One of them helped me to stand up, and I tried to use the squatting bar. The nurse got very excited when she could see William’s hair. I was pushing as hard as I could but no other progress happened. I kept thinking, “If I push hard, his birthday will be today!”

After about an hour and a half of pushing, the doctor came back, watched me push, and said, “You are not pushing right,” and left. I wanted to shout at him, “How many babies have you pushed out? I’m doing the best I can!” but he was already gone. Besides, I was really too tired to do anything else.

After three hours of pushing with no further progress, the nurses called the doctor back in and he examined me again. He told me that I had to have a Caesarean section. By this time, it was 11:30 p.m. I was so exhausted that I barely had any energy to move, but I argued with him that there had to be another way. We finally agreed together that William needed to get here soon, for his sake and mine. As we made the decision, the doctor turned off the Pitocin drip, and the contractions immediately stopped.


Around midnight, as the night dissolved into Tuesday, the nurses wheeled me in the OR. I told the nurses that Andy did not like the sight of blood so they whisked him away while they prepped me. However, I was terrified and began to shake uncontrollably, but the kind nurses held my hand and told me it was just hormones. I joked that the extra anesthesia didn’t work, because I could still wiggle my toes.

Andy finally was allowed in when surgery started. I felt a lot of pulling and tugging, and the nurse and anesthesiologist narrated for me. Finally, they pulled William out, but he didn’t cry. I kept asking, “Why isn’t he crying? Is he ok? What is wrong?” They kept reassuring me that he was fine and he was being cleaned out. The Neonatal Intensive Care Unit (NICU) team was there, and I suddenly heard a loud wail. I was so relieved! Shortly after that, the NICU team announced, “We are all set! Congratulations!” and they left.

The doctor told Andy that William had been turned 90 degrees and had gotten stuck. Looking back now, I wonder if the reason labor hurt so much was that it was back labor? Apparently this was the doctor’s way of apologizing for telling me that I wasn’t pushing right: by telling me it wasn’t my fault.

The nurses finally held William up for me to see, since I was still being sewed up, and asked me to name him. I was so exhausted and relieved that I started to cry. Andy told them proudly, “William Robin.”

Around 2 a.m., I was wheeled into the very cold recovery room. We called our parents, and my mom tried to talk my dad into coming right then but he told her that he needed to sleep before driving for eight hours. She stayed up the rest of the night researching Caesarean sections, and he drove them up later that morning.

Around 3 a.m., a nurse appeared and said, “It says on your chart you are breastfeeding. Is that right?” She came back with William and said, “Ok, here you go! Twenty minutes on each side!” I had no idea what to do, so she helped to get him latched on and she left. I sleepily watched him for 20 minutes, and she came back to make sure I switched sides. Afterwards, they took him to the nursery. Around 4 a.m., they unhooked me and wheeled me upstairs. Exhausted from labor and surgery, I feel asleep quickly.

Around 7 or 8 a.m., I woke up with a start and demanded my baby now! Andy brought him in, and I finally got to examine him carefully from head to toe. He was wonderful – our sweet William Robin!

The Rocky Arrival of My Twins

By Pam Stone, co-leader of API of Merrimack Valley, New Hampshire

Pam's twin sons
Pam’s twin sons

On a Wednesday afternoon, several weeks before my twins were due when I was on bedrest in the Maternity part of the hospital, I started having contractions about five minutes apart. My doctor was out of town, so his midwife came to check on me. I had dilated some, but she wasn’t certain whether I was going into active labor or if it could be stopped, so I was transferred to Labor and Delivery. Thankfully, my doula, Joan, happened to be visiting at the time and she was able to go with me. I don’t know what we would have done without her.

The fabulous nurses in Maternity allowed my husband and daughter, Greg and Sophia, to keep the room here so that we didn’t have to move our things and they could continue to spend the nights. The covering doctor did not suggest doing anything more to stop the labor since I was beyond 34 weeks. He wanted to wait to see if I was going to go into active labor. So, we were waiting patiently when all of a sudden, I developed unbearable headache and stomach pain like I had never experienced. I was vomiting frequently. Greg was tending to Sophia until his mom could arrive to help, and Joan and the labor nurses were there to give me strength. It didn’t seem long before I was begging for an epidural  not for the contractions, but rather to stop the pain in my head and stomach.

I don’t remember much from around this time, but I know that my lab results came back indicating severe preeclampsia, and the situation suddenly became very crazy. They started me on several medicines, including magnesium sulfate to avoid seizures. I remember the doctor saying that if I were to progress quickly, we could still do a vaginal birth, but that we couldn’t let things go for too long. He said that the best way to stop the preeclampsia was to deliver the babies, Nico and Kian. He broke Nico’s water, and I was given an epidural.

For a short time, things seemed to be back on track. Then, just as quickly, Kian started showing distress at every contraction. The doctor recommended an emergency Caesarean section, and in what seemed like an instant, we were in the operating room and the boys were here! Nico Dennis was born at 10:28 p.m., weighing four pounds, six ounces and measuring 16 inches long. Kian Albert was born two minutes later, weighing four pounds, four ounces and measuring 17 inches long.

Nico did well from the start, scoring 9 out of 10 on his Apgar. Kian struggled a bit. He wasn’t breathing and only scored a 1 or 2 on his first Apgar. I remember someone commenting that it was good that they got him out when they did. Within a couple of minutes he was OK, and he scored a 9 out of 10 on his five-minute Apgar. I was allowed a quick kiss before they were whisked away to the Neonatal Intensive Care Unit (NICU). Greg went with them.

Back in my labor and delivery room, I wasn’t feeling well. I wanted to go see the babies, but I was too unstable. The side effects of the magnesium sulfate, along with the after-effects of the anesthesia, left me in rough shape. I stayed in my room during the night.

I was able to see the boys twice, for about 10 minutes each, on Thursday. I began pumping milk for them. I was achy and tired and had blurry vision, but I was OK. Then, my stomach became distended and my suture line looked swollen. I began running a fever. I was started on two I.V. antibiotics. That was the beginning of the next downturn, which started Friday morning. The nurses suspected I had a case of hospital-acquired C. difficile, a bacteria that causes intestinal illness, and put me on contact precautions, meaning that everyone who came into the room had to wear gloves and gowns and I couldn’t go to the NICU to see Nico and Kian. It was a very hard day, but Greg kept me updated on Nico and Kian, who were doing marvelously.

The initial C. difficile test came back negative, and I was told that if my fever stayed away for 24 hours, I could go to the NICU again. But before we had time to celebrate, the final C. difficile results came back positive. Nobody was really sure what to do, and there wasn’t an Infection Control doctor in the hospital because it was the weekend. They wouldn’t let me see go to the NICU on Saturday and wouldn’t let me send up any milk for the boys, either. I also wasn’t able to hug, kiss, or even touch Greg and Sophia.

We were told I’d need more antibiotics for ten days. I was still suffering from the side effects of the magnesium sulfate, and adding the C. difficile on top of it was miserable. I cried a lot.

By Sunday morning, I was already feeling a little better. My body was starting to win the battle against the C. difficile, and the effects of the magnesium sulfate were wearing off. I called to talk to the NICU, and they had been able to reach Infection Control during the night. I was going to be able to see my babies! I could breastfeed directly and could send up milk. I was so relieved.

The Labor and Delivery department needed my room, so I moved back to Maternity early on Sunday morning. Finally, my doctor visited on Sunday and removed the contact precautions. Good hand-washing hygiene would do. My platelet count was recovering, so they could at long last remove the epidural catheter, and my doctor began treating the massive rash that had broken out due to an allergic drug reaction. I was allowed to hug my family, and spent several hours in the NICU visiting Nico and Kian. They were fabulous. I met with a lactation consultant and was able to breastfeed them both. Things were beginning to turn around.

Nico and Kian still battled the many challenges that many premature infants face, but today, they are home and are doing well.