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Birth Plan–specific about cord management and placenta

 

This birth plan was written for baby number three, after experiencing a traumatic birth where her second baby’s cord was cut before birth (causing life threatening injuries) and the active management of the placenta was prolonged and painful.

 

This birth plan is based on my previous birth experiences and our desire to achieve a spontaneous-onset labour, physiological birth and third stage (natural delivery with no drugs/ synthetic hormones).

Birth companion
Partner ‘E’, may be present at all times and able to take photographs. This is ‘E’s first baby so please feel free to explain and discuss the natural birth process with him, or any need to change plan in event of emergency or injury.

Labour

Walking, leaning over bed or ball. Use of shower and maybe bath/pool if labour is slow.
Minimal lighting and need for me to talk is appreciated.
Past labours have made me nauseous and vomit, so easy access to bag/ bowl or shower is appreciated.

Pain relief

Counter-massage on lower back and rocking – being able to lean forward or be on all-fours
I have a bulging disc in my spine (L5 S1) that can compress on sciatic nerve down left leg. I will assume positions to avoid pressure on disc during labour/delivery. If medical procedure required, please discuss anaesthetic – I have experienced several procedures where local was insufficient and required double-dose/ top ups.

Birthing pool
/ bath
Happy to use birth pool for labour, possibly for delivery (if it doesn’t affect having a natural third stage)

Monitoring
I would prefer intermittent hand-held devices to allow me to remain upright and mobile for pain relief/ spine.

Transition and delivery

Using an adjustable bed or in bath:

· I may need to rest on my side in a semi-upright position during transition, and then move into a raised kneeling/ all fours position for second stage.

· In the event of nuchal cord, please do not handle or cut. There may be a delay between delivering the head and contractions for delivering the shoulders, to allow time for rotation. If the cord is preventing delivery, please attempt ‘somersault technique’ first.

· We request delayed clamping of the cord – please discuss if there are any issues with the cord during delivery.

Assistance during delivery
Guidance is much appreciated to ease pushing and avoid tearing. Please allow for break in contractions between delivering head and shoulders. I may require assistance to move or lift right leg to deliver shoulders.
Please discuss suctioning if there is meconium stained liquor.

Third stage
Physiological third stage unless complications. Once the baby has established respiration and we have rested, we will commence breast feeding asap to support delivery of placenta.

Post-natal care of baby

We would like warming/ stimulation to be done via skin-to-skin contact with me and baby checks to be done next to me and/or with my partner – possibly after breast feeding.

I have signed consents for immunisations and Vit K.

Feeding the baby

Breast feeding only

Birth Story – Cutting the Nuchal Cord

Alex’s Birth Story – Cutting the Nuchal Cord

This is the birth story of my son Alex, who was born in an Australian hospital in 2004.

Alex was born with the umbilical cord around his neck (nuchal cord), which was cut before he was born.

Longer than your usual birth story, it includes information and links regarding the injuries sustained from pre-birth amputation from the placenta.  This birth story aims to raise awareness of the vital importance of keeping a baby’s cord intact during and after birth – to safely oxygenate the baby and avoid long-term damage.

When I arrived at hospital in labour to give birth to my second child Alex, I thought I was well prepared to have a safe, straightforward birth.

With my first baby I read many books about childbirth and had a ‘normal’ hospital birth without pain medication, where I was cared for by gentle midwives who were reasonably ‘hands off’.

The truth was I had no idea about routine interventions, cord management practices and their impact on the physiology and health of mothers and babies.

There were some differences with my second baby though. I had terrible heartburn and was persistently anaemic – I didn’t know at the time that antacids interfered with iron absorption, even supplements. I had grown much bigger with Alex (he was 2lbs bigger than my first, it turned out) and where I now lived  had a much larger, busier hospital.

Stretch and Sweep

It was Friday and I was (an estimated) 40 weeks + 6 days pregnant at my last antenatal appointment. Lying back, the midwife was palpating my baby when I mentioned my last baby was 7lb 10oz but suspected this baby was bigger.

“Oh yes,” she said, “this baby is WELL over 8lbs.”  *gulp!*

Back then I hadn’t heard of anyone having a baby bigger than 8lbs. Yes, I have learnt a lot since 2004!

The midwife offered to ‘sweep the membranes’ and I had to ask her what this was. She reassured me it was a simple procedure for women over 40 weeks. “I can’t leave you waiting around this like forever.”

It turns out sweeping the membranes to induce labour can be painful and unpleasant. It certainly was for me.

I was physically uncomfortable from the moment the ‘sweep’ was done – a ‘crampy’ ache began in my lower back and cervix and remained constant. I couldn’t sit or lie down comfortably…so I spent the next two days, Saturday and Sunday, pacing up and down my street in the cold, to try to ease my discomfort or make something of it.

I felt so uncomfortable I was sure labour was imminent and walking would ‘bring it on’. Labour didn’t begin though. I just had the constant cramping, which was painful like a contraction but did not progress into labour. All the walking just made me overtired and I realised if labour started while I was this exhausted I’d be in trouble!

By Sunday lunchtime I had begun to leak amniotic fluid. I called the hospital and was asked to go in for a check up.

“Your membranes are leaking fluid; you’ll need to come in tomorrow night if labour hasn’t started.” The monitoring showed Alex’s heart rate was in the 160s with good variability.

By Sunday night the cramping eased up (thankfully) and I slept surprisingly well for a heavily-pregnant woman.

Labour day – 41 weeks, 2 days

I awoke at 5.00am Monday with a hot, sharp contraction radiating right through to my back.

Woohoo! Real labour!

I was so happy the cramping had finished and the real thing had begun!

It wasn’t long until I couldn’t lie down anymore. I told my husband Paul I was in labour, so he had breakfast and started watching a movie so he wouldn’t get too bored during the early stages.

I was able to eat some toast but by 9am the contractions were regular and I needed my daughter to be collected so I could relax, as well as prepare to leave for hospital at any time.

Contractions were about 5 to 7 minutes apart, but getting looong and strong. I laboured undisturbed at home until midday when I realised I probably didn’t have much longer to go.

Leaving home for hospital

We only lived 2 blocks from the hospital, but it was slow getting there because my contractions were now quite close together. I had to stop for contractions at the front door, on the way to the car, at the car door, as soon as I sat down…you get the drift!

As soon as we pulled up at the hospital I jumped out of the car. I didn’t plan on having another contraction sitting or on my back if I could help it!

I kept my head down to avoid the stares and slowly made my way up to the birth suite, contracting in the lobby, hanging onto the walls in the corridor, horrifying people in the lift!…. Then when I got to the entry of the birth suite the contractions were so strong I couldn’t ring the bell! They were super strong and took a bit of recovering in between.

Thankfully Paul turned up (after parking the car), rang the bell and soon I was in a consultation room. The midwife on-duty asked me to get on the (narrow) observation bed for monitoring. Why are the consultation beds so narrow in maternity wards, unfair really!? 

This was the first time during this labour I began to feel a bit off-balance.

The midwife was quite insistent I get on the bed for monitoring and also have a cervical exam to be admitted. This hadn’t happened at all with my first hospital birth. I have pre-existing sciatica that is especially painful during pregnancy, which is why I labour standing up and give birth on my knees.

I wanted to explain this to the midwife but I began to throw up during contractions and struggled to talk at all.  When the midwife could see I wasn’t about to comply with her request, she set up the monitor next to a recliner chair and asked me to sit there. Being in this chair was just like the car; coping was difficult and I felt stressed during and after the contractions.

[Progress Report states: Fetal Heart Rate 142 bpm, contractions every 3-4 mins & mother requesting vaginal exam.] Except I declined the exam.

Admitted into birth suite

I was barely talking by now, fully in the zone. Just after 1.00pm I was freed from the monitoring and admitted into a birth suite. It was a sunny winter day and the room seemed very bright compared with the consultation room and hallway.

The midwife asked if I wanted to play some music, saying some women liked this. But my labour was well advanced by now and I wasn’t in the mood for music.

I was able to laugh about being too far along to like anything, and say “no thanks, but I would love a mat on the floor to give birth“.

I stood next the bed, swaying my hips and feeling quite positive that labour might be over soon. Paul was applying counter pressure to my lower back, being careful not to press against the bulging disc in my spine that causes my sciatica *ouch*.

When Paul talks about my labour he says I hardly made a sound. But I was vocalising loudly by now, something tells me he must have been expecting me to be much louder!

The contractions began to ‘double peak’ and I remember thinking they were like every contraction I’d ever had…and the pain rolled into one!…but then all of a sudden I knew the baby was coming!

I dropped to my knees on the mat, with my chest upright and arms braced on the end of the bed. It was just after 2.00pm.

Second stage

I was still wearing underwear and asked for them to be ripped off. I was asked to stand up and take them off, but there was no way I was moving. The midwives cut them off with scissors thankfully.

Baby Alex descended out of the cervix and it felt very quick. The pressure was enormous and I began to bear down during the contractions.

The attending midwife crouched next to me on the mat and said the ‘waters’ were bulging. I couldn’t stand the pressure and asked her to break them for me. I hadn’t asked for an intervention like that before, but she told me it was better if she didn’t.

The membranes ruptured naturally at 2.13pm, and I felt the warmth gush down my legs. What a relief! [The notes state the liquor was clear.] But the relief was short-lived, because this pressure was quickly followed by my son’s head. Argh, he felt huge!

The stretching with Alex was very intense and seemed to happen quite slowly. I focused on not pushing too hard – but waiting for a contraction with his head half out was the worst ‘ring of fire’ ever!

The contraction came and the rest of his head was born. A part of me knew I had just experienced one of the moment painful moments of my life, but it was over!

With his head out, I was waiting for the next contraction.  With my first baby there was a slightly-longer break in contractions once her head was born. The midwives had reassured me this was normal last time, so I wasn’t worried about waiting a few moments for Alex to be born.

 [Notes state: mother commenced short controlled pushing - head on view @ 2.18pm, FHR 92]

Nuchal cord

The midwife performed a vaginal exam and announced the cord was around my baby’s neck (a nuchal cord).

She began to push her fingers further inside me and try to loosen the cord by pulling on it. She then informed everyone the cord was tight and looped twice around his neck.

At first the manipulation of the cord at his neck just felt intrusive, but before long the midwife was actually pushing her hand inside me to reach the cord and create some ‘slack’. Leaning forward on my knees, I couldn’t see what was happening behind me.  I could feel a hand moving inside me, pushing, and it became excruciatingly painful.

It hurt so badly I felt like I couldn’t breathe. I heard a surgical instrument and started to panic.

“Why am I being cut!” I asked another midwife in view.

She reassured me this wasn’t happening but I couldn’t believe I wasn’t tearing or being cut. The examination and attempts to reach the cord were excrutiating having just birthed the head – pain was radiating throughout the vaginal, perineal and rectal area.

I have no doubt that shock and adrenalin from this unexpected intervention caused my contractions to stop dead.

So now I have lost the urge and ability to push out my baby – all I want to do is stand up and get away from the midwife. But I feel trapped. I’m mute.

All this happened immediately after his head was born. The midwife didn’t wait to see if my son could rotate and deliver normally. She intervened as soon as she saw the nuchal cord.

“I can’t unloop the cord. I’m going to have to cut it.”

The noise and feeling of surgical instruments was actually the cord being doubled clamped in order to ligate the cord.

Alex was only half born when he was amputated from the placenta – cut off from his organ that provided him oxygen, transfered accumlated wastes and contained the blood supply for his transition at birth.

What the evidence says about nuchal cords

It was years after Alex’s birth before I found an article about safely managing a nuchal cord – it clearly stated to leave it alone.

I read the worst thing you can do with a nuchal cord is cut it. I learnt nuchal cords are common and that babies can still be born with a tight nuchal cord. In water the babies gently loop through the cord or curl out of their mother’s body (instead of straight out). On land the birth attendant or mother can support the baby to curl or ‘somersault’ out if the cord is tight or not long enough. (1)

I understand the midwife responded to the presentation of a double nuchal cord based on her training, experience and work practices. Obstetric, nursing and midwifery textbooks are full of unevaluated recommendations to unloop or cut nuchal cords. But they are not accompanied by any references to scientific evidence to support these interventions. Instead, scientific literature contains case studies of catastrophic birth injuries and recommendations by medical researchers and practitioners to leave the cord intact before and after the baby is born.

With a baby half-way out of me I was extremely vulnerable to the actions of others. And, growing up on a farm where the cords of other mammals were NEVER clamped to ensure the birth was safe, I had no idea that birth attendants would amputate a human baby from the placenta before birth.

I was never asked to consent to being examined for nuchal cord, nor given time to consent before the cord was cut. It is vitally important that a birthing woman is informed prior to any procedure and asked to consent. It is also the law.

Cord already cut, baby not yet born

Once the cord was cut there was immediate panic by the midwives for him to be born. I started to push without a contraction but I was shocked to realise his body didn’t budge at all. I tried to push again but there was no strength without a contraction and baby still didn’t move.

The midwife explained I needed to rush and asked me to push again. All I could reply was “I can’t, I have to wait.”

The room became very quiet. I stared straight ahead and mentally tried to block out what had just happened. I felt like my pelvis needed to open wider so Paul helped me to raise my right knee up and out. The seconds felt like a lifetime and I wasn’t sure how long it had been since my son’s cord had been clamped…but thankfully the urge to push returned.

With the first push I felt Alex turn – his shoulders hadn’t rotated yet which is why he didn’t move before! I then pushed as hard as I could and his shoulders ‘exploded’ out of me. Ouch.

I remember the midwife telling me she was injecting me with something but I didn’t feel it [syntometrine].

Response at birth

Alex was born at 2.24pm.

He was a big baby and a tight fit in the birth canal.

Given the fetal heart rate recordings, it is fair to assume the cord around his neck was not tight during labour. The monitoring didn’t show up any problems with Alex’s blood flow during contractions.  But the cord had tighten significantly by the time his head ‘delivered’ – before the shoulders.

When the cord was tight it was compressed and being a big baby, his body was compressed too. The umbilical cord was clamped during this compression and resulted in significant blood loss being inflicted on my baby.

It had been an intense three hours of active labour - with my other babies I have felt immediately happy and relieved after giving birth. Not so with Alex.

Paul clearly remembers our baby ‘dropping’ straight out of me, being picked up by the midwives and instantly raced to the bed in front of us.

The midwives ‘flopped’ Alex outstretched onto the bed. Paul joined me and together we watched, stunned, while the midwives began to resuscitate our limp, watercoloured-grey baby.

I tried to reassure myself and Paul – who had his hand clasped over his mouth – that newborns don’t always start breathing straight away.

At the time, I didn’t know that compression from the nuchal cord may have already blocked the flow of oxygenated blood to Alex even before the midwife clamped the cord. I didn’t know the need to resuscitate him was caused by the ‘management’ of the nuchal cord.

His resuscitation was due to him being depressed by the tight cord and then the clamping, which prevented any chance of him receiving the placental blood transfusion that normally occurs in the minutes after birth with an intact cord.

Simply unlooping my son’s cord after he was born would have facilitated a safer transition and possible ‘auto-resuscitation’ by restoring his blood volume,  perfusing all his organs with adequate blood, including his lungs, and supported his transition to breathing.

My baby was most likely suffering from a low blood volume - administration of oxygen does not fix this. Studies of blood volume have shown that a nuchal cord can result in a blood loss of between 30-50% with immediate cord clamping.

My baby’s blood was trapped inside the placenta, only to be later discarded. (An engorged placenta can also complicate the separation of the placenta from the uterus and increases the mothers’ risk of haemorrhage.) (2)(3)

Watching the resuscitation

I watched my pale baby being worked on by the midwives. I saw his floppy arms and legs flailing as the towel was rubbed vigorously over his body.

I saw the thick black meconium streaked down the inside of his legs (the baby’s first bowel movement).

I remember thinking “please don’t let my baby die; I just worked really hard to get him”. It felt like such a long time before his colour began to change.

[His notes state that he took 3 and half minutes to establish regular respiration - his resuscitation included tactile stimulation, suction and oxygen, IPPR bag and mask.]

The situation seemed to be stressful for the midwives too; the delay in him being born after the cord was clamped had raised the stakes of a poor outcome.

Once he began to breathe, Alex he was moved to the other side of the room and worked on by more people, where I could no longer see him.

Alex’s first Apgar score was 4 (at 1 minute) and then only 6 (by 5 minutes).

[Alex's birth records state:
"
Head did not rotate, therefore traction applied to deliver shoulders as colour fetal head becoming cyanosed in appearance. Shoulders emerging transverse and were rotated to AP just prior to birth shoulders. Cord around neck loosely and pulled down. Blood taken for cord gases."

Second midwife reported:
"Maternal contractions slowed in second stage. Cord loosely around neck. Baby white and flaccid at delivery. Cord cut and clamped. Active resus commenced - aspiration of airwards attended. HR 120 babe not breathing. Bag and mask at 6 lit/per min - babe slow to respond, flaccid, HR 126 irregular respirations, vigorous drying of babe and lower body covered to maintain temp. Babe took 3 1/2 minutes to establish regular respiration with flaccid tone. Apgars 4+6+9. Babe passed mec at delivery. Bruised face from delivery. Cord cut and clamped. Contact with both mum and dad."]

No mention of the pre-birth cutting of a tight nuchal cord!?!

The events of my son’s birth are not captured in his birth records. When my son’s condition was reported to the doctors, there is a good chance they didn’t know he had a tight nuchal cord and was at risk of hypovolemia. Does this explain why he wasn’t checked or treated for anaemia?

Placental birth

I didn’t give birth to the placenta. After a short, spontaneous and natural labour, the pre-birth cord clamping had ‘terminated’ my attempt at natural birth and ‘pathologised’ the third stage of labour.

While other staff continued to work on Alex, I was asked to get on the bed for active management of the placenta.

I remember my backside was hurting so much I didn’t want to lie down! The midwife placed a metal dish between my legs and started to take the clamp off the cord attached to me still.  I looked away at this stage to watch the staff working on Alex.

It was years later I realised what the midwife was doing – and why I am SO glad I looked away at this point. She was unclamping the cord to drain the excess blood out of the placenta – MY SON’S BLOOD! – before she began applying traction on the cord. I feel absolutely sick thinking and writing about this.

The midwife began to roll her fist into my stomach, pushing in quite deeply. The “active management” felt rather rough. The cord was pulled on pretty hard for quite a while, in between pushing down on the uterus.

“The delivery of the placenta must be completed before the uterus, under the influence of large amounts of oxytocin, contracts sufficiently to trap the placenta behind the closing cervix. Once the injection is given, the placenta must be delivered within 10 minutes to prevent this happening.” (4)

The obstetric discharge summary says the third stage took nearly half an hour.

Having your uterus pummelled after giving birth feels awful. I was starting to get really sick of this woman hurting me, especially because I didn’t understand why. I felt so shocked, weak and passive. I wasn’t talking or asking questions, things were just happening to me and around me.

9lbs 10oz – without placental transfusion

I heard the staff weigh Alex and announce he was 9lbs 10oz with a big head! I agreed with that!

If Alex had even a minute or so of placental transfusion at birth, he probably would have weighed around 10lbs. In case you’re wondering, I was tested and didn’t have GD. His father is 6ft 4 and was a big baby too.

The buzz in the room indicated they thought he was large and their discussion turned to testing him for low blood sugar. “He’s sure to be hypoglycaemic.”

Alex was tested and did have low blood sugar levels, but not necessarily because of his size. Low blood volume from cutting the cord is invariably linked to low blood sugar.

“The source of neonatal blood glucose is liver glycogen stores; a deficient blood flow through the liver results in deficient conversion of glycogen to glucose, and lower blood glucose levels”. (5)

Ragged membranes

When the midwife was able to ‘remove’ the placenta, she inspected it in front of me.

The membranes had torn in several places and she informed me they could still be inside my uterus. A quick vaginal inspection showed I had a small tear but I quickly told the midwife I didn’t want to be stitched. I couldn’t stand the idea of being handled anymore.

The midwife told me I was brave to birth like that without any drugs. She patted me on the leg and announced to the room that I “was a tough one”.

First moments with Alex

Baby Alex was placed, tightly wrapped, on the bed next to me. All I could see was his scrunched up face.

I gazed at him, feeling more shock than awe. He didn’t open his eyes and he even looked a bit strange to me.

Where were my feelings of recognition, my connection?

We were together for a very short time before he was checked and the staff noticed his nostrils were flaring.

They quickly picked him up again and explained he was having trouble breathing and needed to go to the Special Care Nursery. And he was gone.

My minute with Alex before he was taken for treatment for respiratory distress

Special Care

Alex’s discharge summary states he required treatment for hypoglycaemia and transient Respiratory Distress Syndrome due to meconium stained liquor.

It is a shame my son’s condition at birth and respiratory distress were not recognised as insufficient blood volume (hypovolemia) from prematurely cutting his cord. Instead it was attributed to his size and meconium stained amniotic fluid – except the liquor was clear. The meconium was probably passed during the second stage after the cord was clamped.

I read an article by a doctor recently that describes what may have happened to Alex during his birth, (although my baby was not this critical, he still had a good heart rate and did improve upon resuscitation):


“The most frequent cause of fetal distress is cord compression (cord around the neck, knot in the cord) that impedes cord venous flow and congests the placenta with a large amount of oxygenated blood. At birth, this child is not only hypoxic but hypovolemic. The clinical appearance is a flaccid, limp, pallid child with a very slow heartbeat. Immediate clamping in the panicked rush to resuscitation leaves the newborn with insufficient blood volume to perfuse either the lungs or the brain adequately. Ventilation fails to improve the Apgar score while a placenta engorged with oxygenated blood is discarded.” (6)

Alex’s continued respiratory distress was most likely due to insufficient perfusion of his lungs and low blood volume that risked organ damage, including the brain. He needed his blood that lay to waste in the placenta. The blood loss from clamping a tight nuchal cord can also cause low body iron levels – which are associated with damage to long-term brain development:
“Iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.” RCOG paper 2009 (7)

[Special Care Notes -

Baby came to SCN for observation following delivery. Baby Large for Gestational Age (LGA) 4.380kg. Observations Temp 36.2, Heart Rate 102, RR 19 SaO2 92% Nasal flare and rib retraction. Baby slightly cyanosed. Meconium present on legs. At 5.00pm his O2 sats were 96%, ten minutes later he had slight central cyanosis. (There are downward arrow next to the sats, but my doesn't show the actual percentages. Under the warmer his temp was 36.5.)]

Alone in the birth suite

Paul and I were left alone in the birth suite. I had a shower and was surprised at how much blood I kept losing. While getting dressed I had to change my pad and underwear three times because I was bleeding through before I could get dressed.

I got back into the bed feeling completely spent, with no baby.

My mother arrived to visit with my daughter and I was happy to see them. But it felt strange because there was no baby to introduce them to.

I was relocated to the maternity ward, where I had more family and friends come to visit. They asked me about the birth and I could feel my body start to tremble as I told them it went fine until they found the cord around his neck and ‘had to cut it’.

Nobody said much about it, I don’t think any of us really understood what had happened or the ramifications.

Special Care Nursery

At 7.00pm I was informed I could see Alex in the Special Care Nursery. It was nearly four hours since I had seen him, for that brief time on the bed.

The hospital was quieter now and he was the only baby in the SCN.

The nurse there was an older woman and she seemed really nice. She sat me down and handed Alex to me, who was still bundled up in a lot of blankets.

She explained that Alex needed to be given formula but that I was welcome to breastfeed him first. There didn’t seem to be any choice in the matter, I was just told the formula was medically necessary. The nurse asked if I knew how to breastfeed and I replied yes, I was confident after 3 years experience with my last baby.

Alex was bundled up in so many blankets it was hard to align him to my chest. I tried to unravel the top of the blankets a tiny bit but the nurse reached over and closed them up again. “He is very cold, you must keep him warm.”

The lights in the room were so bright and I still hadn’t seen my baby’s eyes. I asked if Alex had opened his eyes yet and the nurse said no. He was approaching 5 hours old!

Feeding Alex – watch out for the nipple pincher!

I turned my back to the nurse slightly and opened my shirt. I didn’t want to rush the feed; I wanted to see if I could stimulate some instinctive behaviour in my baby. Up until now the only movement I had seen were his nostrils flaring earlier.

I started by gently brushing my nipple on his cheek, near his nose and mouth. He began to stir and open his mouth. I kept stimulating him and I could feel my spirits lifting as he rooted for the nipple. *Yay, he can move more than just his nostrils*

But all of a sudden the nurse bent over the top of my chair, pinched and stretched out my nipple and forcibly pushed my baby’s head onto it.

Talk about ruin the first special moment I’d had with my baby!

Remembering this makes me so mad. She had no right to touch me like that and there was no cause for the interference. The nurses actions were so rough she caused a ‘crack’ in my nipple. Unfortunately I have heard from other women with similar experiences at this hospital – the nipple pincher is either still at large, or it is standard practice there!!

Alex hadn’t latched when his face was smooshed into my breast (surprised?) so I hunched over him so the nurse couldn’t see him and let him attach himself a few seconds later.

Alex wasn’t able to feed for very long before he fell asleep. I left the nursery in disgust knowing he was being fed formula and feeling terrible I couldn’t just take him with me. My nipple hurt too!

[SCN notes: Blood sugar levels 2.7 mmol. Took 30mls formula. BF both sides with assistance]

Thankfully it was only another hour before Alex was able to leave the SCN and room-in with me. He was wheeled in to my room at the end of the ward, in a clear plastic tub. I was told I must used the ‘tub’ to move Alex around and to keep him warm at all costs.

He looked pale but seemed content. Finally we were alone.

Alex – day 2 after birth

Sneaking my own baby

Near my room, at the end of the ward, was a small waiting room.

At 9.00pm the room was barely lit, only by the soft corridor lights. I picked up Alex out of his ‘tub’ and walked to the doorway to check if there were any nurses around. Sneaking off with my own baby, I went into the waiting room and sat down on one of the couches not visible from the hallway. Still wrapped, I held Alex out in front of me and spoke to him. “Hello baby!”

He instantly opened his eyes and looked straight at me – his eyes were blue! We saw each other for the first time nearly six hours after he was born.

Hospital stay

We ended up staying at the hospital for two days.

I had heavy bleeding and needed assistance to remove the ‘ragged’ membranes.

(In fact, the heavy bleeding persisted for over 12 weeks. I required an internal ultrasound at 10 weeks which didn’t find any cause for the prolonged post-partum bleeding. Turns out active management is not always so great for maternal blood loss!)

When the nurse removed the ragged membranes I began to tremble again, like I had when talking to my family about Alex’s birth. Only this time the trembling turned into intense shaking. I didn’t know why it was happening and felt embarassed. I wasn’t in physical pain but I now think it was a reaction to the trauma of the birth.

But now that Alex was rooming-in with me I felt so much better. He slept in my arms and on my chest, healing me.

Alex breast fed very regularly, but he was weak and couldn’t nurse for very long. His strength and ability to feed slowly improved over time. I’m pretty sure he vomited up most of that formula he was given the first night to ‘treat’ his hypoglycaemia, which meant I didn’t sleep a wink in case he choked. He seemed to ‘spit’ it up for hours.

I don’t know how digesting infant formula in the first hours of his life while suffering from low blood volume was good for him. A blood transfusion, colostrum and his mother’s body heat would have been a much better start, considering what his birth injuries were.

Once we were home I was able to continue bonding with my baby. In the warmth of home I got to see and touch his skin, carry him and breastfeed him almost constantly until he gained enough strength to feed more vigorously. He grew into a gorgeous toddler and was adored by his parents, big sister, grand-parents and extended family.

Alex as a toddler

The aftermath

In the weeks and months following his birth, thinking about Alex’s birth still caused me to start shaking, so I tried to push it out of my mind. I knew I never wanted to give birth again and my husband arranged a vascectomy soon after Alex was born.

Alex’s physical development was impressive. He sat, crawled, stood and walked at a much younger age than his big sister. I thought his birth experience was completely behind us, until by age 3 it was clear he had developed disruptive and compulsive behaviours (constantly running off, breaking his toys). I also discovered it was difficult for him to concentrate and learn to read and write in preparation for school. His parents and sister all did very well academically in primary school, so I hoped starting school might develop his interest.

After a year at primary school Alex was referred to a paediatrician based on my concerns and his school. He speaks in incomplete sentences, is testing well below the expected levels and has difficulty behaving appropriately in formal learning environments.

Alex has been diagnosed severely autistic, with anxiety and learning delay.

Alex, school age

There are passionate debates about the causes of autism – and about the optimal time of umbilical cord clamping.

While I do not believe that cord clamping (or vaccines!) cause autism, I recognise that studies of children with autism do not measure for premature amputation from the placenta, altered blood volumes and reduced stem cells. I have also read studies where the need for resuscitation at birth was associated with lower IQ scores by school age.

I do think the events of my son’s birth have had an impact on his young brain, his ability to learn and to express himself.

For anyone who feels profound regret about their child’s birth, you know how I feel when I admit to wishful thinking, wishing I could go back and change what happened.

While I cannot change what happened to my son, maybe my story can help others be aware of the trauma that can be caused by cord cutting, and the importance of the cord being left intact while their baby is born and transitions to life outside the womb.

I believe that outcomes for mothers and babies would be much improved if it was standard practice that any person who clamps a cord, particularly before placental transfusion and the baby establishing respiration, is individually responsible and liable for the resulting injuries.

Maybe then they’ll put the clamps down?

Please see Cord around the neck – what parents and practitioners should know for more information

LINKS
Nuchal cord management and nurse-midwifery practice – Mercer et al. (2005)
Nuchal cords: sharing the evidence with parents – Reed et al. (2009)
Neonatal transitional physiology: a new paradigm – Mercer & Skovgaard (2002)

REFERENCES

(1) Reed, R. Barnes, M. and Allan, J. (2009), ‘Nuchal cords: sharing the evidence with parents’, British Journal of Midwifery, February 2009, Vol 17 (2): 106-109.
Found at: http://www.box.net/shared/o0iyhgve7g
(2) Cashmore J. Usher RH. (1973) Hypovolemia resulting from a tight nuchal cord at birth. Pediatr. Res: 7:339.
(3) Shah P, Riphagen S, Beyene J, Perlman M. (2004) ‘Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy’. Arch Dis Child Fetal Neonatal (Ed 2004): 89,152-155.
(4) Robertson, A. (2009), ‘Obstetric interventions explained’, Preparing for Birth: Mothers. Birth International: NSW, p39.
(5) Hankins GDV, Koeh S, Gei AF. (2002)Neonatal Organ System Injury in Acute Birth Asphyxia Sufficient to Result in Neonatal Encephalopathy’. Obstetrics & Gynaecology, Vol. 99 (Part 1): 688-691
(6) Morley, G. (2002) The Physiology and Iatrogenic Pathology of the Third Stage of Labor Found at: http://naturalsolutionsradio.com/blog/natural-solutions-radio/physiology-and-iatrogenic-pathology-third-stage-labor
(7) Royal College of Obstetricians and Gynaecologists, Scientific Advisory Committee Opinion Paper, Clamping of the Umbilical Cord and Placental Transfusion. 14 May 2009. Found at: http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SACPaper14ClampingUmbilicalCord09.pdf

Additional article:
Iffy L., Varadi V., Papp E. ‘Untoward neonatal sequelae deriving from cutting of the umbilical cord before delivery’, Med Law. 2001;20:627-634.

Birth Trauma

BIRTH TRAUMA – RESOURCES & ARTICLES

May 13, 2011

When Birth Is Trauma is an excellent guest post by Elizabeth Ford on the Australian website MidwifeThinking blog , which explores the issue of birth trauma, post partum depression and post traumatic stress disorder.

Rather than birth trauma necessarily being associated with interventions or an ‘unrealistic’ expectation of childbirth, research is showing trauma can be linked to feelings of powerlessness, lack of control and autonomy, and being mistreated or ignored by caregivers.

Ford writes:

“Women don’t seem necessarily to be traumatised by the events of birth not happening as they expected, but may be affected when they do not receive the care they expect.”

Click here to access full article…

Birth trauma can be particularly difficult for women to experience and cope with in our society, when the emphasis is on the ‘outcome’ of birth (mother and baby alive and/or healthy) despite how significant the process and experience of childbirth is for a woman and her transition to motherhood.

There are many online forums, blogs and articles about birth trauma and women’s stories. Here is another great article that compares the trauma of a mid-air scare with birth trauma, and how society supports some traumatised people but silences others.

RESOURCES:

Information page with links to Australian pages/services: Healing from Pregnancy and Birth Trauma Australia

Website: Solace for Mothers – Healing After Traumatic Childbirth (international)

Discussion: Global Movement to Reduce Disrespectful and Abusive Treatment of Women during Childbirth

Discussion: What Feminists Should Know About Birth Rape (blog post by US Birth Activist Jennifer Zimmerman)

Discussion:  Obstetric Violence (blog post by NZ midwife Sarah Stewart)

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