Where Do Birth Quest Clients Deliver?

Most Birth Quest clients deliver at Hackley, Gerber, Spectrum Health Butterworth, or home.

Here at Birth Quest, a lot of people ask Beth and I where we most often support birthing clients for their deliveries! Here is the answer with some reflections on each from a doula’s perspective:

1.) Mercy Health Hackley: Over 1/3 of our birth doula work is at Hackley. Beth and I were both born at Hackley and we both live less than a mile from the hospital, so this shouldn’t be a surprise. It also makes sense because we strive to serve our community and this is our community hospital! Being located near downtown Muskegon means there are some good food options, like Ryke’s Bakery, near-by. Design aspects we like about the hospital include having separate bathrooms in the hallway for visitors, a waiting room with an ice machine and being able to enter and leave the floor without having to pass through a security door. We’re not crazy about the separate Labor, Delivery & Recovery and Postpartum floors. Hackley is the only hospital on the lakeshore where midwives still deliver and I like how the nurses treat me like an equal. We’re curious to see the new labor and delivery unit that opens in summer of 2019.

2.) Spectrum Health Gerber Memorial: Many of our lakeshore clients travel to Fremont to have their babies at Gerber because of their reputation for supporting natural and patient-centered births. This support is backed up by Certified Nurse Midwives and their Perinatal Nurse Educator and blogger, Samantha Kauffman, who is both Hypnobirthing and Evidence Based Birth certified! Their Director of Clinical Nursing, Beth Coulier, and I worked together on the FIMR Case Review Team when I worked for Public Health – Muskegon County. She brings a lot of experience and compassion to Gerber and this is reflected in the quality of care her staff provides. Gerber gained a national reputation under the leadership of Dr. Tami Michele, who was innovative in overcoming an official ban in order to support trial of labor after cesarean (ToLAC) and vaginal birth after cesarean (VBAC). Dr. Michele currently works at the Butterworth campus. We like that birthing people can labor, deliver, and recover postpartum all on the same floor. Negatives include being located in a small town with few food options, especially late at night, having to be buzzed in and out of the unit by staff and not having visitor bathrooms on the unit. Although the staff are accommodating, it would be nice to have coffee, ice water and a fridge available without having to ask. You know, like a doula station? A doula can dream!

3.) Spectrum Health Butterworth: Although I would love to assist someone in the Natural Birthing Suites, we have not yet had the opportunity. When women we serve plan to deliver at Butterworth, it’s usually because they are high risk or planning a VBAC, making them ineligible for this option. In these circumstances, all of West Michigan is fortunate to have access to the state-of-the-art care provided there. There are pluses and minuses to being in such a large hospital. On the one hand, most of my clients have no idea who is going to be there when they deliver with a practice. On the other hand, when a woman’s care is transferred, there is a good chance that the care she seeks is available. Some of my favorite birth memories as a doula at Butterworth involve supporting women who want to do something that is met with staff discomfort and do it anyway!

4.) Home: There is nothing like the flexibility and comfort of home, even someone else’s home! Whether small or large, the gathering is always intimate, peaceful and festive. When present, I love spending time with other family members, friends and pets. There is never a struggle to support a natural birth plan, especially when it pertains to newborn interventions, at a home. Cost is the biggest barrier to home birth for those who desire it and fit the criteria. I also hope for a future with more diversity among midwives, to help increase access for all women.

Dimming the Lights: An Aid for Helping Labor Progress

Getting out of the bathtub at Spectrum Health Butterworth, after laboring under the light of LED flameless candles.

— By Beth Singleton, Birth Quest birth doula and photographer

I still remember my last labor like it was yesterday. Waking in the wee hours to discover I was in labor, only to have it stall during the daylight hours and then ramp back up after the sun set. When pushing, the room was dimly lit and to make things even darker, I had my face buried into the couch.

What is it about darkness that seems to ease and promote the progress of labor? A very common desire among laboring women, I thought it’d be a great idea to look into this.

The need for darkness is observed in nature.

If you’ve ever had the experience of witnessing a cat during labor, you probably noticed her need for a safe, dark place. When my cat had her kittens a few years back, that’s exactly what she did. In a box under my bed, our proud momma cat gave birth to her babies. This need stems from the mammalian brain, a commonality that affects cats, dogs, mice…and humans! I mean, we’re mammals, too, so regardless of the countless ways in which we’re nothing like our pets, the biological event of birth reaches deep to reveal that our needs are ultimately very similar.

Bright lights can make a laboring woman feel exposed.

Birth is a very private event for a woman. During such an intimate moment in her life, bright lights shining down can cause her to feel like she’s being observed or like she has no privacy. In nature, laboring animal mother’s will stop mid-labor if they think they are being watched in order to find safety. In a hospital setting, though, a woman can’t follow in the footsteps of her fellow mammal mothers and relocate if she feels like she isn’t safe.

Bright lights stimulate the neocortex of a laboring woman’s brain.

This increases brain activity during a time when labor progress relies on a woman’s primitive brain instincts. This stimulation can interfere with a woman’s ability to produce the hormones necessary for labor to progress and to help with pain. Some sources of bright light include:

• overhead lighting
• windows
• computers
• cell phones
• tablets
• televisions
• monitors

In particular, electronic devices affect the body’s ability to rest. Blue light, the light produced from items like cell phones and tablets, interferes with the production of sleep-promoting hormones. So even in a room where the lights are off, it’s important to consider the effect of having the television on or staring at a phone if relaxation is the goal.

How does darkness aid in relaxation?

When the lights go down and the room darkens, this signals to the brain that it’s time for rest. One of the hormones produced is melatonin. Also known as the “hormone of darkness”, melatonin promotes relaxation and sleep. When a laboring woman is better able to relax, she will probably rest better and more deeply between contractions. Her contractions might also be less painful if she isn’t holding so much tension in her body.

There are numerous ways to labor with the lights down low.

Whether laboring at home or in a hospital, there are several ways to create a dimly lit setting.
For a home birth, consider some of these ideas:

• night lights
• LED candles
• string lights
• votive and/or pillar candles
• dimmable lamp
• blackout curtains
indoor light projector

For a hospital birth, most of the above options aren’t as feasible. For example, a hospital probably isn’t going to permit burning candles; they will, however, allow LED candles. And items like string lights or lamps are bulky and may not be allowed, either. Night lights and indoor light projectors, on the other hand, are small and the room will likely have at least one outlet you can use to plug them in.

Sometimes, though, darkness isn’t the best option.

While it makes sense that many women desire to labor in darkness or a space that is dimly lit, there are
circumstances when the issue shouldn’t be pressed. Examples include:

• women who are afraid of the dark
• women who might become anxious if they feel the darkness would interfere with their care
• women with a history of trauma who feel safer with the lights on
• women who simply object to having the lights off

In the end, it all comes down to a woman’s preference.

Whether she chooses to labor with the lights on or off, the point is that she gets what helps her the
most. Ultimately, it’s the support she receives from those around her that will have the biggest impact
on her birth experience.

If you’ve already given birth, did you dim the lights? Why or why not?

We’d love to hear your feedback on this!

Muskegon Momma Shares her VBAC Birth Story

Adorable VBA1C baby!

My VBA1C Story.

So here it goes! I am a little late but I just finished up with school and having a newborn baby, and her being baby number two with a 5 year old boy at home has been quite the adjustment for me, but things are really coming along great and he is an amazing big brother to her!!! I had my amazing VBAC! I gotta say, my story is one of these stories you mommas trying for a VBAC MUST READ. I read stories like mine everyday during my pregnancy and they gave me so much encouragement. Because after what I had been through with my son, I honestly had a lot of doubt deep down. I was 17 when I got pregnant with him. I did not educate myself, I thought having a baby was nothin! I figured everyone else seemed to have a baby no problem, so why can’t I!? But as we all know birth can be very unpredictable. So as far as what happened with my son I will try to make a long story short, I went in for my last OB check up, which was a day before my due date and my blood pressure was extremely high so I got an ultra sound to check my fluids, everything seemed fine, but they did schedule me to be induced for June 13th. Hours after pitocin started I was making little progress even after they broke my water, ended up getting the epidural and after 24 hours of labor and 4 hours of pushing I ended up with a c-section. My son was posterior and was showing signs of stress. I just remember, after being told that I was going to be having a c-section, all I kept telling my sons father is “I feel like a failure, why can’t I do it!?” It was all very traumatizing. The anesthesiologist was a complete smart ass when came time to bring me in for the c-section, cuz I mean there was so much to joke about, right!? Afterward I was shaking so bad, I couldn’t hold my baby for nearly a half an hour after the c-section, not to mention I was so doped up on morphine and whatever else, I could barely function. I will say my son was absolutely perfect. 8 pounds 2 ounces and 21 ½ inches long, and very healthy. When the surgeon paid me a visit in the recovery room he informed be that I would HAVE to have the rest of my children a c-section in the future. I was highly upset. I was upset about the outcome of my birth, I felt everything had went wrong, and that I failed. Recovery was also very painful and lengthy!! But, my recent experience with my daughter was very healing. I feel empowered, strong, hopeful, blessed and so many other beautiful things that birth can possibly make you feel, but most importantly, I got my baby girl, who arrived healthy! And I was healthy! But enough rambling and on to the best part!

Ok, so I found out I was pregnant March 1st of this year. I guess I wouldn’t say it was planned, but we weren’t necessarily trying to prevent it. At first I was just like ok, I guess I’m going to have another c-section, that really sucks. But then my stubborn bitch side kicked in and I was like wait, no, they can’t make me do s***! I mean they can’t really force me to have surgery, I’m not doing it, I refuse. Most people thought I was crazy and I heard a lot of “oh but you have to” and “you’re not allowed” but I was determined. I was also determined to breastfeed which I was unsuccessful with my son as well. (which has been going great as well ) But anyway, I told my midwives that I really wanted to have this one natural and they told me I better go in when time to push or the more safer route would be to go to Spectrum, so that is what I planned to do. But then I was actually talking to my stepmom and I was explaining to her that I really wanted to have this one natural and she told me to look into hiring a doula. I heard of a doula, but didn’t really know what they did or anything about them. And then a few different people referred me to Faith Groesbeck. What a real kind hearted, and genuinely beautiful soul she is. So explaining to Faith what I wanted as far as birth and telling her about my first experience she suggested I go to Gerber Hospital in Fremont. I made my appointment to meet with the VBAC supportive provider for the first time and when I got there I couldn’t meet with her because she was in delivery with one of her patients. I could have rescheduled but I wasn’t going to be able to meet with her until closer to the end of my pregnancy. I was a little frustrated, understanding that things happen and it wasn’t her fault, I just decided I would go to Hackley. It’s right down the street from my house, yes they are not as VBAC supportive as I would like, but I just kept in mind that they can’t force me to do anything and that I CAN DO THIS. And I did eventually accept that, if I HAD to, if there were extenuating circumstances that required me a c-section, than I would because my daughter and my safety was number 1. But unless it came to that, I was determined to have my VBAC, at Hackley Hospital. No matter the risks (because I did an extensive amount of research and there were risks, yes, but very unlikely considering my circumstances. I was not high risk.), the paperwork I had to sign or the attitude that was given, because honestly, no one’s attitude was going to be bigger than mine, and paperwork..??? Give it here!

Other than all of the morning sickness I had at the beginning of my pregnancy, it went really well. I had a little bit of preterm labor scare at about 25 weeks, but was most likely due to lack of water. After that I would have Braxton-Hicks here and there but nothing to get to excited about. I was very patient up until the last 3 weeks of course. The anticipation really started killing me. On Halloween though, I lost part of my mucus plug. I did feel some excitement because I knew my body was making changes, but my due date was in 10 days so I also knew that it didn’t necessarily mean anything. I could have been pregnant for another 10 days, or longer!! So I went about my week as normal, but was definitely trying to get last few things done around the house in case she decided to come a little early. I was supposed to go visit my grandma in Grand Rapids that Saturday but I called her Friday because I was having Braxton-Hicks very consistently and had a feeling the baby would be here soon so I wanted to spend my weekend doing the final last touches to the house and the kids room. So Friday morning I woke up feeling fine, I had sex about 11 am-ish I think it was and about noon I started having the Braxton-Hicks. I went to the grocery store, came home and was hanging out with my son for a bit. He was supposed to spend that whole weekend with his dad but I didn’t want him to because I knew when the baby came he was going to go with his dad for about a week or so so I could recover a bit (my kids have different fathers, so you’re not confused lol) I didn’t want him to go though because I was sad that it was my last little bit of time left with him being my only child. So I told his dad that he could go that night but I wanted him back Saturday if I could so that I could soak up the time with him. So anyway, my son went with his father that evening and I got this huge burst of energy and cleaned everything. I mean everything. I also cooked dinner and made brownies! Meanwhile the contractions were starting to be more consistent and somewhat uncomfortable, they weren’t anything unbearable. It was about 9 pm when I noticed they were at about 10 minutes apart. I was not concerned though because I was still in minimal amount of pain. At 10:30 I lost the rest of my mucus plug and then I thought, ok my body is making more changes, GREAT! I think I may have somewhat been in denial. As I’m communicating with a good friend of mine, she’s all like “baby time, you’re going to have her tonight watch” and I’m all like yeah right, I wish! Although I did feel she was going to come soon I just didn’t think it was going to be that night or anything in the near-near future. Lol. Anyway I decided that jusssst in cassse the baby came that night I decided I Should take a shower and do my eyebrows lol. So it was about midnight and my daughter’s father showed up, he works second shift and gets out of work at 11. I told him I wasn’t sure, but I thought labor may be on its way. Lol denial at its finest…and at 12:30 I crashed really hard, so I laid down. I woke up at 2am from the sharp pain of a contraction. It wasn’t anything excruciating, but enough to wake me out of my sleep. I sat up and just dealt with them as they were a little uncomfortable. I texted my grandma and told her I thought I might be in labor. She called me immediately and asked me how far apart my contractions were and I told her about 3-4 minutes apart. She told me to go in, I told her that i didn’t want to go in because they would send me home. Yeah my contractions were close together but I wasn’t in that much pain yet. You would think if you were in real labor you would be in a great deal of pain right? So I called a close friend of mine and asked her how much pain she was in when she decided to go in and she said she was in so much pain but they kept sending her home. So Brandon, (my daughter’s father) said we should go in, and here I am like no I just don’t really want to get sent home… but with him and my grandma hounding me I said okay, I’ll go in, but watch me get sent home. Right before I left my house the heat turned up a notch! It was about 2:45 when we arrived to the hospital and when I got out of my truck I knew then it was real labor because I couldn’t walk through the contractions anymore. I could still talk, and was breathing through them, but they had me hunched over. They got me checked in and the Nurse checked me and said “okay they will probably be keeping you but the Doctor will be coming in shortly to check you again, now I understand you had a c-section with your first” I told her I wasn’t having a c-section and she says “Well, do you know our policy here at Hackley on VBAC’s?” Of course I went in there with my diehard attitude and I said, I know you guys are going to try to make me have a c-section and its not going to happen. She says “Well we aren’t going to make you do anything, but we do have to let you know the risks” Her name was Lauren, She was awesome and I will never forget her. I won’t forget any of those residents there that night. I also reminded all of the residents that I did not want an epidural or any other form of pain medication. The Doctor that came in, his name was Dr. Thomas Duncan, and right away he checked me and told me that they were going to do what they could to help me have a successful VBAC and went through the ricks with me and that it was going to be either him or Dr. Gale-Butto that would be helping me deliver. So wait am I dilated though? I asked him. “Yes, you’re dilated to 9, your water is bulging and I can feel baby’s head” he says. I got scared. It was really happening, I was about to have this baby, SOON! I was in a good amount of pain by this time but was breathing through the contractions and felt I was doing okay. I was scared mainly of what was going to come when my water broke. As they moved me to the room where things were getting much more intense I suddenly felt the urge to push and my water broke. They wanted me to hold off a little bit because I tested positive for group b strep but its kind of hard to hold off when your body is taking over. At one point i asked if it was too late for the epidural, and Lauren the sweet nurse I will never forget, encouraged me that i was so close and she believed i could do it without, along with my daughter’s father and one of my Doulas Elizabeth (Unfortunately Faith was not able to make it due to important life events in which I do not hold against her for we were communication the entire time, and she was very encouraging as well) . You can do it they kept telling me. One of the other nurses came in and wanted to check me again but I refused firmly. I was in so much pain by this point, hands feeling in my vagina is the last thing I wanted! And besides when they checked me last i was at a 9, what do you need to check again for!! I thought. I told them I wanted to push when I felt ready and that I wanted to listen to my body. So after my water broke I could not fight the urge to push any longer. It was time to start working that baby out! I would say when I first started pushing I didn’t feel like anything was happening but i was in all this pain and i felt like I was trying my hardest. So after a number of pushes and feeling like it would never end I got fed up with the pain and decided I would take in that deep breath and push with all my might. The harder I worked, the sooner I could hold my baby girl in my arms. It’s truly amazing what you body can do. When she was crowning I reached down and felt all of hair and it was almost relieving and it made me so happy to just be able to touch her and know it was almost over. Unfortunately there is no picture of me touching her head, but Brandon, her father did say the look on my face was priceless and he will never forget it. What’s also crazy is pushing your baby out, and wanting the pain to end so badly, but having the doctors tell you to push, but don’t push so hard, because they were working her head out and her shoulders. Lol That took some control, but had I not listened I may have tore worse than I did. But after pushing for an hour and enduring that great amount of pain that I had no idea I could handle, my beautiful baby girl arrived at 6:12 am weighing 6 pounds 8 ounces and 19 inches long, HEALTHY and PERFECT. It was instant relief and all I could think about was how perfect and beautiful she was and that I DID IT. She came out eyes wide open and sucking on the back of her hand. She was ready to nurse and latched on right away, no problem! I feel like a momma lion!!! I knew I could do it, and the encouragement i received from those around me helped so much!!! I will never forget the residents that helped me deliver at Hackley hospital. I am truly blessed and I hope you mommas who are trying for a VBAC get some encouragement from this, you CAN do it!!

Hospital Triage and the 20-Minute Strip

One of the things I loved about working for Public Health – Muskegon County was the opportunities for continuing education. Now that I’m self-employed, a smaller budget forces me to be more judicious while I also must work around being on-call. Nevertheless, 2016 is already turning out to be a great year for learning.

In January, I had the pleasure of attending the Michigan Affiliate of the American College of Nurse Midwives (ACNM) conference on physiologic birth in Kalamazoo. In April, I took a road trip with my kids and a friend to Alabama for the International Cesarean Awareness Network (ICAN) conference. Both of these provided chances to network and connect with people making a difference for birthing women in my state and across the country. Webinars are convenient, but nothing compares to getting to hang out in-person with inspiring individuals.

I would like to share some of what I learned from each of these trainings, to plant seeds of inspiration in expectant women and birth professionals everywhere. To do this, I’ll be sharing a series of blogs, highlighting the “pearls of wisdom” I learned from so many experts in the field of childbirth.

One of the speakers at the ACNM conference was Lisa Kane Low, PhD, CNM, FACNM, FAAN, who spoke on “Promoting Physiologic Birth to Reduce Primary Cesareans.” She introduced me to birthtools.org, an ACNM website that contains 3 quality improvement (QI) bundles for reducing primary cesareans: intermittent auscultation as a standard for low-risk women, comfort & coping and promoting spontaneous labor progress.

For those of you who aren’t familiar, Rebecca Dekker of Evidence Based Birth has a great article on what intermittent auscultation is, why it should be the standard of care for low-risk women and how to get it. Basically, intermittent auscultation is checking the baby’s heartbeat every so often through a fetal stethoscope, as opposed to through an electronic fetal monitor.

Listening to Dr. Kane Low speak, I couldn’t help but wonder about the mandatory “strip” in triage. For those who are unfamiliar, most hospitals put women who arrive in labor in an area called triage in which they are monitored to check on the baby’s health and the progress of labor. After a designated time period of being attached to an electronic fetal monitor, if the baby is responding well, the mother is either admitted or discharged home based upon how much she has progressed.

I have my own story to tell about triage. With my first baby, I had been laboring for about 22 ½ hours at home when I arrived in the hospital via the longest cab ride of my life. When I get to the maternity floor, they take their time, asking questions, entering information in the computer, pretty much ignoring the fact that I’m in labor. Finally, they assign me to triage. For the first time in my labor, I was confined to a bed, told to lie on my back, and had monitors strapped to me. Eventually, a nurse checked me and announced that I was completely effaced and dilated to an 8. Finally, they believed me that I was in labor! I couldn’t wait to get out of that room, off the bed, and get those uncomfortable monitors off of me!

So, I asked the presenter what evidence there is for this triage protocol. Her answer? “Data does not support the 20 min. strip in triage.” What?!? She went on to say that the only reason this remains standard practice is due to tradition.

Look, I understand that many women present to the hospital thinking that they are in labor, only to be sent home. However, for women like myself, arriving in active labor and being subjected to this practice that has no evidence to uphold a tradition? There is hope for change, though. The Alternative Birth Center at Providence Hospital in Southfield, MI, has ditched the 20 min. triage strips with great outcomes – way to go Providence!