First

In a way, every birth is full of "firsts" because no two births are ever exactly alike. There are certain "bigger", though not more important, firsts: my first water birth, my first transfer, etc. Last week, as I mentioned, seemed to be full of more these kinds of firsts that usual- trial by fire. But, this is how we learn and I feel more competent and confident than I did previous to this group of births. I also, more fully know now, how to expect the unexpected.

One instance that I did not expect was a retained placenta. It was a particular long, hard labor...it seemed like hours of transition, talking the mom through each contraction. Once the baby was out, we waited for the placenta. And waited. And nipple stimulated. And waited. And squatted. And waited. And gave some pitocin. And waited. And catheterized. And waited. The placenta clearly was not coming. One of the unique things about the birth center is that one of our doctors lives upstairs. As you can imagine, this is very convenient and can save us from a hospital transfer. In this case, she performed a manual removal.

I'm not sure why the placenta did not fully separate from the wall of this particular uterus. It is possible that, due to the long labor, the uterus was just not contracting well. A manual removal is exactly what it sounds like: Once pain medication is administered (a removal can be very uncomfortable), the attending doctor places her hand in the uterus and peels back the remaining stubborn membranes. One midwife said the analogy used in school was like "turning the pages of a book". The placenta came out in-tact and all was well!

I tried to find a YouTube video or instructional animation that could show me what this procedure looked like from the inside but, couldn't. The diagram from Moon Dragon's Retained Placenta Guidelines at the top of this post should give you some idea.

What are some of your more memorable "firsts"?

Halloween!

OK, so Halloween has always been a conceptually important yet, anti-climatic holiday for me. I really like to think up (semi-obscure) Halloween costumes and tell everyone about them (and then usually end up doing nothing on Halloween)....Sometimes I am inspired by where I work. Case in point: when I worked at an auction house I dressed up like an ironic, ionic column. A few years ago while working at the Center for Reproductive Rights, I thought everyone should dress up like their favorite method of birth control (no one did). But last year, a good friend of mine from CRR opted for my idea of dressing up like "abstinence"- she looked amazing (all in white, with a halo and chastity belt).

Apparently, others in the reproductive rights fields have similar thoughts. Check out 'NYC Unrated and Unfiltered's list of pro-choice costumes. They're really good.

Just in case you're wondering, I'm not dressing up like a baby or a pregnant mom or a sperm this year. I was thinking more along the lines of a Moon Bear.

What will you be going as?

The break and back

Well, I'm back... and happy to be here.

My past week has looked like this:

Birth, class, class, sick, sick, class, class, birth, birth, apple picking, class, birth, birth, class, class. Punctuated with some long stretches of sleeping.

When it rains, it pours- recently this has been literal and figurative. The rainy October weather seems to have given me intense, double back-to-back births.

I feel like I earned most of my Birth Assistant "Badges" this past week. The last seven days have presented me with a few situations that helped me understand that I really will be able to handle being a midwife*. I am grateful to my wonderful families, my birth-assistants-in-training for being there and my incredible midwives who know how to beautifully take charge of a situation. I am also grateful to my sweet husband for putting up with phone calls in the middle of the night and listening to his semi- delirious wife unload all of her birth details in their full gory glory.

How has your past week been, friends?

I've got lots to share with you about what happened during my blog break.

* For example:
I can take fetal heart rates like a champ.
I can be surprisingly high functioning on little or no sleep.