Well, it's been 2 months since I checked in and updated you on how the tiny little girls are doing. During Thanksgiving week I had the privilege of visiting them when Mom and Grandma were there. The girls continued to amaze me with their resilience and progress. Olivia, the first born and smallest had graduated to a bassinet and weighed a whopping 3#5 oz.
Ava had grown to 4# 1 oz.
During this Christmas season when we thank God for sending His son as a helpless babe to live here and show us how to live,and for his gift of salvation to us, I thank Him for continuing to bless the lives of these two tiny girls and for the plan He has for their future.
May God bless each of you and your loved ones.
It had been an otherwise fairly uneventful twin pregnancy, with mom working full time, resting as she could, gaining adequate weight, and having evaluations with the high risk doctors to closely watch the growth of the babies and be alert for early signs of discordancy, or discrepancy in the size of the babies. As weeks 25 and 26 came around it became obvious that one tiny girl was slowing her growth and her sister was not. Mom was hospitalized in week 26, put on bed rest, given steroid injections to help mature her babies' tiny lungs, and daily fetal testing was done.
As the babies entered week 27, the smallest little girl began to reverse her blood flow back to the placenta, which signaled the need for an early delivery of both babies to improve their chances of survival. How do you prepare a mother for the birth of her babies 13 weeks early? A cesarean section was scheduled as the safest route for delivery of the tiny girls, family and friends arrived to support mom with their presence and prayers and two NICU teams were present for the birth.
As the skilled OB GYN lifted the first tiny baby girl Olivia, from the womb, she was held in warm towels as the umbilical cord continued to deliver blood and oxygen to her tiny body for 30 seconds. A tiny cry filled the room,then off to the radiant warmer where skilled neonatologists and practitioners cared for her. Nice and pink, with a small breathing tube placed in her trachea to support her breathing, Olivia was off to a good start. Weighing in at only 1 lb 6 oz (631gm), she has a lot of growing to do!
One minute later, the second baby girl, Ava, was delivered, raised a feisty cry, held, warmed, and to the second team of professionals at the second radiant warmer. Pink, flexing her little arms, small breathing tube placed in her trachea to assist breathing and rest her tiny body, Ava is off to a good start as well. Being the bigger of the two, she weighed in at 2 lb 1 oz (947 gm). both babies had little baggies pulled up over their little bodies to help keep them warm.
Being present and assisting the birth process is always a precious gift, but to hear two 27 week baby girls cry and be stabilized and off to the NICU (neonatal intensive care unit) is witnessing a modern day miracle!
"Before I formed you in the womb I knew you; Before you were born I sanctified you (set you apart)"...Jeremiah 1:5.
"For You formed my inward parts; You covered me in my mother's womb."
"I will praise You for I am fearfully and wonderfully made;" Psaml 139: 13,14.
Thank you Lord, for sharing these two precious miracles with us.
They wanted an unmedicated birth, unless a complication occurred that would require interventions and /or epidural anesthesia. Having read through "Natural Childbirth the Bradley Way" by Susan McCuthcheon, they were well prepared and trusted Mom's body to respond to the labor process and work with it to welcome their "surprise" baby into the world.
But, oh, the waiting game...Just with walking, Braxton Hicks contractions and daily activities in the ninth month of pregnancy her cervix had begun to thin and dilate until the 39th week found her 4 cm dilated and 90% effaced (thinned out). Thinking any day regular contractions or spontaneous rupture of the membranes would bring on labor, they waitied,,,
"To everything there is a season, and a time for every purpose under heaven: A time to be born"...Ecc.3:1 & 2a. Can a pregnant woman be 4 centimeters dilated and not be in active labor? Yes, she can, and when labor does come her body is very ready to work with it.
Finally after having her membranes swept in the office and going for a massage, contractions came stronger and more regular. Unlike the false labor, Braxton Hicks contractions, true labor makes you hand the phone back to your husband when the nurse-midwife is asking how often the contractions are coming.
Upon arriving at the hospital with that serious "this is the real thing" look, she was put to bed for initial fetal heart rate monitoring and having her cervix checked between contractions, was found to be 6-7 centimeters dilated. With a reassuring FHR strip, the monitors were removed for 40 minutes and intermittant EFM was done throughout the remainder of her labor. Sips of apple juice, water, and ice provided fluid intake and a reassuring FHR did not require IV fluids to be started. Mom was free to change positions during labor which assists the fetus in doing its work of turning, flexing its head and navigating its way through the birth canal.
Mom was supported in a dimly lit labor/delivery/recovery room by her husband's kind and encouraging presence, her mom, one sister, mother-in-law and nurse-midwife. Her sister-in-law waited nearby and other relatives waited outside of the room. When a laboring woman's body is not altered by the effects of pain medication or an epidural, it knows how to self-direct pushing. The work of labor/pushing is off set by the wonderful breaks of rest between contractions.
Shortly after midnight a vigorous baby boy was welcomed into the world and placed on his mother's chest. Welcome to the world Henry! God has a special plan for you and has blessed you with a wonderful mommy and daddy.
The phone rang around 8am, "I think my water is leaking..."At 38weeks, 4 days, we had been waiting for signs of labor to start, regular contractions every 4-5 minutes for several hours, or leaking of fluid from the vagina that could not be stopped with Kegal contractions. Since she was Group B strep positive and would need to receive antibiotics in labor to protect her unborn from Group B Strep illness, we decided to have her pack her bags, eat a light breakfast, and head to the hospital in another 2 hours. Oh, did I forget to mention she was 3-4 centimeters dilated at her last exam in the office?! Needing to leave their 4 year old daughter with relatives, the time passed quickly.
Upon arriving at the hospital, she was noted to be grossly ruptured, which only between 2.7-17% of women are prior to regular contractions. After interviewing questions were answered, the electronic fetal monitoring was on and found to be reassuring, blood was drawn, an IV of Lactated Ringers solution was started along with the first dose of Penicillin. Low dose Pitocin was started to bring the contractions to a regular interval of every 2-3 minutes. Mom and dad had accomplished natural childbirth 4 years earlier and were anxious to have an unmedicated birth with this baby too. A calm labor room with low lighting, position changes from rocking chair to standing to birthing ball to standing and leaning over the birthing ball while receiving very warm wet towels on her low back and buttocks helped this mother to move gracefully through the active stage of labor. Her Nurse-Midwife and husband encouraged her in her relaxing and conserving her energy for the second stage of labor (10 cm to delivery of the baby).
A little frown came across mom's forehead as she said, "I think I'm going to need something to help ease the pain." Before making a decision on pain relief I asked to check her. "You're 9+ centimeters now, Soon you'll be able to push the baby out." That was all mom needed to hear. With the next contraction came that unmistakable urge to push. The room was prepared to receive the new baby and 11 minutes from the first urge to push, a sweet baby girl with lots of black hair was born, handed to her mother, and let us all hear thast she was an unmedicated infant...with great lungs!
Natural childbirth is almost a lost art now, with the modern advances of epidurals, but on occasion I am still privileged to witness the event, and am always honored and blessed by being part of this miracle of life.
She was almost one week past her due date, that magical date arrived at by adding 40 weeks to the last menstrual period, when she awoke to a feeling of her bag of waters leaking. Still feeling her baby move and not noticing any unusual color to the leaking, she waited for labor to start and called her Nurse-Midwife to discuss how long to wait at home before going to the hospital. Having had an uneventful pregnancy course, we decided to give a few hours and see if nature would take it's course.
A few hours later the contractions were only about 20 minutes apart, so it was time to head to the hospital to get labor picked up, first by walking around, then with the addition of low dose Pitocin through an IV drip. Walking, rocking back and forth, and sitting on the birthing ball passed the time of early labor moving into the active stage of labor.
Her husband was very attentive and encouraging as labor contractions began to come closer together. Lite kisses on her forehead gave her that sense of being cared for and feeling his strength and safety. The Nurse-Midwife offered suggestions for position changes and later a little rest in the bed. The RN and student nurse offered their support with breathing and relaxation too, bringing an additional freshness into the room.
Soft classical music had been selected by the patient and brought from home to create a more home like environment for labor....and we waited...now nearly 4 centimeters dilated and 90% effaced, the contractions became stronger and harder to deal with. With mom becoming tired from being up most of the night before, a decision was made to have an epidural for pain relief.
Most of the time epidurals provide fairly quick pain relief to the laboring mother, but this time relief would not come. Breathing and relaxation techniques were called into play as we encouraged and supported our patient and requested the epidural to be placed a second time an hour later.
As pain relief came the mother-to-be continued to dilate to 10 centimeters and labor down. The second stage of labor (from 10 centimeters to delivery of the baby) often takes an hour or two or a little longer in a first time mother and is usually well tolerated by the fetus. This little fellow, however gave interesting signs of slowing his heart rate in response to contractions when on mother's right side or in a mid sitting up position.
Having passed meconium earlier in the evening, an amnioinfusion had been started to thin the meconium and help protect the baby from trying to swallow the fluid after birth. Mother was encouraged in gentle bearing down efforts or mild pushing as we watched baby's response to the final leg of his journey. As baby continued to show signs of mild stress with labor it was decided to be in the best interest of mother and baby to stop the Pitocin, rest mom, and request the physician to come and assist the birth with a vacuum.
A little while later and two pulls, a vigorous baby boy entered the world, wide eyed and very unhappy about being removed from his safe place for the past 9 months.
Yes, I witnessed a miracle of a team effort in the birth of a baby boy on Mother's Day, May 9, 2010 with proud grandparents in Korea and Romania, all celebrating a new life on the same day in different countries. Welcome to the world, little man. You are so loved!
In that process called labor, mental distractions are the friend of a new mother to be. Sometimes women will use the focal point of an ultrasound picture of their unborn, a photo or computer shot of the children at home, meditation, praise music, repeat scriptures or songs in their mind, or play games.
At a recent induction of labor for medical reasons, I was privileged to witness my patient sitting up in the rocking chair, calm and smiling while using her Eee PC to communicate about her day in labor with family and friends on her facebook page. While attached to a Pitocin drip to stimulate labor contractions and external fetal monitoring to watch the baby's response to labor, the rocking chair and Eee PC activities took her outside of the walls of the labor and delivery suite. Although she was planning to have an epidural and presently was dilated to 4cm and 90% effaced, the preparatory time of fluid bolus with Ringer's Lactate to help prevent the occasional hypotension (drop in blood pressure) following an epidural were being spent rocking and communicating. Just one more reason to facebook, I say!
Once the epidural was in place, mom and dad could rest a little and mom could comfortably "labor down" as the baby maneuvered down the birth canal and the cervix released its hold on the baby's head.
Feeling some pressure and discomfort, mom was checked again, found to be 10 dilated ,and the room and radiant warmer were prepared for the new life. Just two pushes later (not the norm), a beautiful dark haired baby was welcomed into the world. At 9lb 1oz, we were reassured that the right decision had been made to deliver this sweet child.
As for Eee PCs and facebook...You guessed it...the proud mom and dad had their first family photo going out to friends and family before midnight.
What a great time to be alive, enjoy the profession of Nurse-Midwife, witness the miracle of birth and the blessings of sharing that miracle with others. Welcome baby girl!
"I will praise thee for I am fearfully and wonderfully made..." Psalm 139:16.
The month of March has brought new changes to the North Park OB GYN practice in the Hixson/ Chattanooga,Tennessee area. Along with the welcome addition of a second Certified Nurse-Midwife, we are also offering another professional option for our patients through the addition of a Nurse Practitioner. Dr. Jones and I are pleased to introduce our two new partners in women's health: Lori Clemmons,CNM and Karen Tinsely, FNP.
Lori Clemmons is a Certified Nurse-Midwife with a solid background in labor and delivery and OB management. Nurse-Midwives honor the normalcy of women's life cycle events and allow for watchful waiting and non-intervention in normal processes. Lori has a strong passion for empowering women in their health care decisions and labor and delivery experiences. While focusing on health promotion during routine gynecologic visits, preconception, prenatal visits, teen care, reproduction and pre and postmenopausal care, midwives spend more time with their patients, and make every attempt to support them in their choices for pain relief during active labor and delivery. Midwives endorse a philosophy of care that encourages active involvement of the patient in health care decisions, inclusion of family members for support of the women they serve and provision for appropriate collaboration of other health care providers when necessary.
Karen Tinsley is a Family Nurse Practitioner who has spent most of her nursing career working with women in the Public Health community, meeting needs of well-women exams, preconception counseling and contraception. She is an advocate for women's health and makes prevention, wellness, and patient education a priority. Karen believes women deserve to have their health concerns acknowledged and addressed by an understanding and compassionate provider.
Thank you ladies for the contributions you bring to the office and to Lori for sharing call and continuing to provide women with a Nurse-Midwifery choice for labor and delivery. I look forward to many years together in meeting the needs of women throughout the life cycle.
Most of the time babies born in the United States are born healthy. Most of the time being a Nurse-Midwife is a fun, happy job, serving the needs of women, helping to keep them in good health or pointing the way to better health and wellness. But there is that awful 3% of the time when two or three babies out of 100 are born with a major birth defect. Then the best of words sound empty and a profound sadness fills the room.
It had started out as a spontaneous labor, a few weeks early, but with high expectations of a normal labor and delivery for a low risk mother having her second baby. The prenatal course had been uneventful, with a second ultrasound to take another look at the fetus’s heart, which had turned out fine. No other comments or recommendations had been made, and now it appeared we would soon welcome this sweet child. Once mom arrived at the hospital her labor moved along quickly, an epidural choice was made by mom to relieve the intense discomfort from her rapidly progressing labor. Shortly thereafter she was fully dilated to 10 cm. Now that she was comfortable, a time of rest was given while we waited. When mom could assist her contractions with pushing, we worked together, expecting her baby to descend through the birth canal, as her first had done. We worked and waited an appropriate time, but no descent. The physician was consulted and the decision was made to deliver the baby by cesarean section.
An air of expectation filled the operating room as mom, dad, and nurse-midwife waited patiently for the physician and expert OR team to deliver this loved and longed for baby. As her little head was delivered and sweet face appeared the remainder of the baby did not follow effortlessly. It seemed to take more effort to get this baby removed from the womb, as if she sensed she would not do well on the outside. Then we saw that her little tummy was much larger than usual, and had prevented her descent for an expected vaginal birth.
A team of neonatal intensive care personnel worked expertly on this little life, and assisted the heart rate and breathing. Prayers were made for the baby and family and we waited…an expert team of perinatologists worked on, tested, and consulted on how to try to save this baby’s life, but an unusual childhood cancer would claim it two days later. What do you say to parents who were only given two days with their child?
Most infants with birth defects are born to couples without known risk factors, often having other normal children and no history of genetic problems. Many times there is no explanation of what went wrong.
The grief process includes:
1. Shock and denial-“This can’t be happening to me/us”
2. Anger- “Why me? Why us? Why now?”
3. Bargaining with God.
4. Depression and loneliness.
5. Acceptance and hope in the future.
Each one walks that path differently and will find a way to go forward.
Believing that a loving God knew your child before it was born (Jeremiah 31:3) eases some of that pain, but doesn’t fill your empty arms. There will be days when people laughing and smiling around you will seem insensitive to your pain, but each day will bring with it the promise of a new day, new opportunities, another day to heal from the inside out, and one day closer to seeing your baby again and raising her in heaven.
Psalms 30:5 promises …”Weeping may endure for a night, but joy comes in the morning."
Isaiah 65:17-20a “For behold , I create new heavens and a new earth; And the former shall not be remembered or come to mind.
But be glad and rejoice forever in what I create; For behold I create Jerusalem as a rejoicing, And her people a joy.
I will rejoice in Jerusalem and joy in My people; The voice or weeping shall no longer be heard in her, Nor the voice of crying.
No more shall an infant from there live but a few days…”
In this most interesting profession of Nurse-Midwifery, one of the most common myths is "you only see pregnant women and deliver babies at home."...Nothing could be further from the truth. Last week in a typical day at the office my patients ranged in age from 14 years with heavy, painful periods, to 78 years old with gyn problems accelerated by the absence of hormone therapy after menopause. With some return OB patients in between, it was a most excellent day. Since women are not "one size fits all", their needs are varied and I feel privileged to contribute to their health care. For over 16 years I have delivered babies in a hospital setting, and feel comfortable supporting women in their choice of labor and delivery experiences. Not needing a lot of intervention, but having it available if needed, makes a hospital setting a agood choice for a lot of women. So, no, Nurse-Midwives do not only see OB patients, but a whole range of women's health needs as well. Until next time, do your best to stay healthy in these cold winter months and consider a Nurse-Midwife for your health care needs.
A little frown came across mom's forehead as she said, "I think I'm going to need something to help ease the pain." Before making a decision on pain relief I asked to check her. "You're 9+ centimeters now, Soon you'll be able to push the baby out." That was all mom needed to hear. With the next contraction came that unmistakable urge to push. The room was prepared to receive the new baby and 11 minutes from the first urge to push, a sweet baby girl with lots of black hair was born, handed to her mother, and let us all hear thast she was an unmedicated infant...with great lungs!
Lori Clemmons is a Certified Nurse-Midwife with a solid background in labor and delivery and OB management. Nurse-Midwives honor the normalcy of women's life cycle events and allow for watchful waiting and non-intervention in normal processes. Lori has a strong passion for empowering women in their health care decisions and labor and delivery experiences. While focusing on health promotion during routine gynecologic visits, preconception, prenatal visits, teen care, reproduction and pre and postmenopausal care, midwives spend more time with their patients, and make every attempt to support them in their choices for pain relief during active labor and delivery. Midwives endorse a philosophy of care that encourages active involvement of the patient in health care decisions, inclusion of family members for support of the women they serve and provision for appropriate collaboration of other health care providers when necessary.
