Saturday, April 19, 2014

There’s a placenta in our freezer...

There’s a placenta in our freezer and my husband doesn’t know. He would freak out and then insist I bleach the whole refrigerator and freezer and I would never hear the end of it.

One of my clients had a scheduled C-section last week. There were multiple medical problems on board, not the least being that she had bariatric surgery earlier that year, lost over 150 pounds and then got pregnant. She had one complication after another after that. She was very nauseated the entire pregnancy, had bleeding on and off into the 8th month, remained anemic and had dizziness throughout, causing her to fall several times a week.

Bariatric surgery essentially reduces the size of the stomach making it almost impossible to eat large quantities of food. There are several surgery options ranging from restricting the stomach with rubber bands or a sleeve, to stapling or sewing a part of the organ off. In this case Megan could hardly eat at all which served the purpose of losing the weight, but in the process her body became depleted of much needed nutrients. Her hair started falling out, she couldn’t maintain enough red blood cells and became dangerously anemic and by 7 months, her baby’s growth all but stopped.

The doctors considered inducing labor so that the baby could be born 6 weeks early and begin to get nutrients pumped into him via IV after birth. There were tests to see if her hormone levels were mimicking labor which would let them know that preterm labor was a possibility. She tried liquid diet supplements like Ensure which didn’t help much, even when she could keep it down. This was baby #4 so it wasn’t possible for her to rest much during the day. At night joint pain became unbearable, probably caused by the extreme anemia and vitamin deficiencies. A chiropractor was able to help a bit and had some good suggestions as far as nutrition. Megan tried yoga and meditation.

Then the day before she would hit the 39-week mark her water broke at about 3 a.m. She called me, not believing that she was capable of doing that without medical intervention. She had never been allowed to let the bag of water break spontaneously with the other 3 births. I congratulated her and for the hundredth time told her that her body really can do this and she is stronger than she thinks!
I had sent her this quote the week before:
Promise me you’ll always remember:
You are braver than you believe,
Stronger than you seem,
And smarter than you think!
~ Christopher Robin to Winnie the Pooh

I told her to let her doctor know, who in turn wanted her to come in immediately. I met her at the hospital triage wing of the labor and delivery floor. Like a mini emergency room, the nurses there can decide if a mom is in early labor and can be sent home without setting up a whole birthing suite or, if it is active labor (4 centimeters or more with contractions coming about every 5 minutes) they can have her transfer to a proper labor room, at this hospital with a large tub, birth ball, etc.

They first confirmed that the water bag had broken with a test strip. Then they Velcro-ed on the monitors in order to watch the baby’s heartbeat -- which was great -- and the rushes, or contractions – there weren’t any. We hung out and visited while her husband snored away on a lounge chair. Breakfast was served, then later lunch while we continued to flip the channels on the TV suspended in a corner of the room. Later that afternoon the official neonatal team of doctors descended on our room. They explained that they had hoped contractions would start on their own but since they had not and we were at about 12 hours out, they were hoping to talk about some options for birth. She could get Pitocin through an IV or in conjunction with a cervix softener like prostaglandin or Cervidil also called Prepidil or Dinoprostone. Or they could do a C-section, which they would suggest since she had one previously.

 

As a doula it wasn’t my place to push her in either direction. I had done my best at our prenatal visits to extol the obvious benefits of vaginal delivery and try to realistically enumerate the very risks of surgery, but at this point Megan was so sick and undernourished and anemic that she could not imagine summoning up the strength to endure labor. It was a catch-22. She had thought the stomach surgery would solve all of her weight issues, not knowing the havoc it could wreck on a body, much less a pregnant one. She chose the Cesarean route.

 

She woke up her sleeping beauty in the chair and asked him if he would want to go into the OR with her. He had not planned on that. It had never even occurred to him. It sounded overwhelming. What if he fainted? There’d be a lot of blood, right? What if he had to leave? He was working himself up to a panic attack. I got out my phone and found some photos of C-sections that I had posted on my blog. I pointed out that there is a huge drape that separates us from the actual operation. That it is bright in there but relatively quiet. That is takes only about ½ hour and that he can go over to the warmer and be with his baby and then bring him over to Megan and get to know him when he has been wrapped up. He studied the pictures and finally said he could do that.

 

While the nurses prepped Megan, Dad and I put on sterile ‘bunny’ suits to cover our street clothes. We donned our blue shower caps and masks and put blue booties on over our shoes. Megan walked down to the operating room with the nurses and we waited in the room until they would call us. Dad quickly fell back to sleep. He had been doing nights all these months with their other 3 children to let Megan rest and regain her health, so I didn’t grudge him these naps.

 

Finally we went back too and were given our posts on two little swivel chairs that had been placed by Megan’s head. She had already gotten the epidural and was excited about finally seeing this baby. They were already starting the surgery when we came in and baby was ‘born’ 15 minutes later. He came out with a loud cry – a good sign since he was so little. He weighed in at 6 pounds and 10 ounces, a miracle really considering all of the problems with this pregnancy.

 

Joe did really well, too. I checked in with him several times and told him he was doing great. Then I went with him over to the warmer where he reached out to his little boy who promptly grabbed his finger. Joe started sobbing, so overwhelmed with it all. The nurse wrapped baby up and Joe proudly carried his son back to his wife.

 

In the recovery room baby Abel latched on immediately, another miracle since I had assumed he would act more like a sleepy preemie, but he didn’t. He nursed at both breasts before falling into a peaceful sleep on Megan’s chest.

 

Her recovery is going well. I did a final postpartum visit with her two days later. I had suggested she ask for a belly band, or pregnancy belt which would both hold in her sagging tummy (which was profoundly out of shape after the weight loss) and help put her muscles back in place while she healed from the C-section. They had already delivered it from the hospital pharmacy before she left the hospital and she was again able to eat, though only miniscule portions. 


I also referred her to a nutritionist. I personally think they are grossly underused. Nutritionists have a wealth of information and can suggest numerous options for regaining your health. I am a vegan, though I was vegetarian throughout all of my 4 pregnancies, and when I began becoming concerned about the sugar that was showing up in my urine I worked with my midwife and a nutritionist to figure out how I could manage my diet without medications. I learned volumes from her. She never once suggested I needed to eat meat and completely understood my choices. After having 5 babies

--- one birthing suite birth, two home births and twins born on The Farm (see Twin Birth story) -- my sugars no longer seemed to be able to be tamed by my diet alone, so I went back to a nutritionist and learned how to further manage without meds. I am still insulin/Metformin-free today at 61 years old.

 

As a doula it is hard to work with women who apparently give up like Megan and simply opt for a C-section. I do not respect her any less, though. She is not where I am at. She may share my views someday, but she also might not. I also could not imagine how sick she felt during this pregnancy, nor how stressed and worried she must have been. My role here was to listen and show love and simply be there with her.

 

And when Joe first balked at the idea of bringing the placenta home, Megan patiently explained the value of encapsulating it and the benefits it could afford her. He got more grossed out by the minute and then flatly refused to carry “THAT THING” home on the bus in a red hazardous materials bag. She begged, she pleaded. Finally from across the recovery room, I offered. I knew how much it meant to her. She could collect it in a couple of weeks and I would get to see her baby again that way. We were all happy, then.

 Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!






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