The joys of running....and birthing!

It's been a very, very long time since I've made a blog entry but I'm back!  Here's a little explanation of my latest entry.  I wrote this almost 2 years ago and within a few days of writing it, before I had a chance to post it, my laptop died!  I meant to re-write it but it just never happened.  I recently bought a new laptop and was able to recover the original document so here it is!  I hope you enjoy and I hope to post more often!

You Run? (Have a baby without medications?) You’re WEIRD!

OR

Why would you put yourself (your baby) in danger like that?

I’ve often compared childbirth to running but recently as I was struggling through a particularly difficult run I really gained a new appreciation for the similarities.  This epiphany took place during the “To Bone and Back Relay.”  For those of my friends that don’t live near me, a brief explanation (bear with me, locals).  Each year on the fourth Saturday in June, hundreds of runners gather for the To Bone and Back relay.  It starts at the office of the orthopedic surgeons that sponsor the run (get it…BONE, BACK, orthopedic surgeons…??) it then goes 20 miles up Sunnyside Road to a little farming town called Bone, Idaho (yes, there IS a town called Bone, Idaho) and then back again for a total of 40 miles. Teams of one to eight runners form to split up the five mile legs of the race. This year, I ran the seventh of eight legs.  The advantage of leg seven is it is all downhill (stay away from leg two, it’s all UP hill) the disadvantages are it is all desert with no shade and since it’s at the end of the race it is usually run in the afternoon when temperatures are approaching triple digits, oh, and it’s all downhill.

All morning I anticipated my run, I prepared by packing a small bag with sunscreen, water, PowerBars, extra socks, Band-Aids, flip flops for after the race, sunglasses and a CPR mask complete with “how to use” instructions.  I hydrated carefully so that I would be adequately hydrated but not over hydrated.  I ate light so I wouldn’t be nauseated during my five mile run.  When the big moment finally arrived my dear friends dropped me off at the starting point and the leg six runner passed the bone to me (yes, it’s really a bone-a fake bone but a bone nonetheless) and I was off.  I was excited, relaxed and felt great.  I had my iPod on with my preselected inspirational music and I had a firm plan for getting through the next five miles.  I had planned a run/walk regimen because I knew I would never get through running in that heat for that long.  I was actually amazed when I heard the voice in my ears tell me I’d reached one mile.  I was not tired, I was feeling amazing and I was every optimistic about the next four miles, this was nothing!

This is often how women begin their labor experience. They prepare ahead, packing items they will need before, during and after. They make a plan that they are sure will work well for them.  Early labor is often motivating and exciting.  Progressing a centimeter or two feels easy and the next six or seven centimeters feel like they should be a breeze.  The plan is easy to follow to the letter. 

As I approached mile two I began to see that I may need to alter my plan just a little.  The heat was getting to me, I think I may have gone out too fast in the first mile.  I could feel I was struggling but I was still determined to finish the next three miles. I began to walk a little more often than I’d planned but still maintained an acceptable pace.  I still felt motivated and excited.

Often as women progress through labor they begin to realize that although they are determined to stick to their plan, they may need to make some minor adjustments.  Maybe walking the halls isn’t as easy as they had envisioned and sitting on a birth ball or in a tub of warm water is more helpful. 

As I approached mid mile three I was beginning to doubt my ability to even finish.  I was hot, I was tired and uncomfortable.  It was as I approached mile four that our support vehicle pulled up next to me. Two friends jumped out and began to run alongside me.  They brought a bottle of water with them and handed it to me.  I was so grateful for that water!  I wondered how I would have completed the five mile run if I had not been allowed to eat or drink anything.  Such a physically taxing event requires food and drink.  I didn’t want a prime rib dinner or a large pizza but water and fruit were refreshing and gave me the energy I needed to complete the task at hand.

I’ve often wondered how we expect women to go through labor and not eat or drink.  Women in labor, also don’t want prime rib or pizza.  They usually want fluids and light snacks.  Now, the reason food and drink is generally withheld from women in labor is the risk of aspiration should she require a c-section or other emergency surgery.  As I was running, an ambulance passed me.  I later learned that there were at least two people treated for heat exhaustion and taken to the hospital.  This could have happened to me, I could have fallen and broken my leg and required surgery, yet the race organizers didn’t require that no one take foods or fluids in.  They also didn’t require that I run with an IV in my arm. 

Earlier I mentioned the friends that joined me on my run.  Oh, my dear sweet friends.  They meant well, they really did…but honestly if I would have had the energy, I may have inflicted bodily harm on them.  Their cheery “come, on, only a mile and a half to go” was not extremely helpful.    At that point I couldn’t think about a mile and a half, I could only think about the next step, then the next and the next.  One of my running buddies later apologized to me after her leg of the race. I handed off to her and by the time she was three and a half miles into her leg she was also struggling in the heat and realized that if someone told her “faster, only a mile and a half to go” she would have probably ripped their tounge out!

Often “supportive” family members mean well when mothers are in labor but are often very annoying! The grandmother that chooses this time to share the story of the eleven pound baby she delivered that “ripped me in two” or the mother that decides while her daughter is having a contraction is the right time to mention that her labors were much harder than what the daughter is now experiencing-well, they are truly risking their safety.  These comments do not belong in the labor room!

As I approached mile five and could finally see the hand off area, I began to feel hopeful.  I wish I could say I had a renewed burst of energy but truly, I didn’t.  I was still taking it one step at a time but the one step at a time no longer felt like it was a never ending journey.  I also wish I could say I felt great relief when I finished the run but I didn’t.  It took some time.  When I run at home and have a particularly tough run, I usually come into the house and drop to my hands and knees where I will breathe heavily and loudly until I can breathe easily.  Because I finished the race with nothing but asphalt, gravel and sagebrush in sight, I was not able to drop to my knees and feel comfortable.  I had to walk around slowly and my recovery took longer than when I am able to do what I need to do to get through it.

The end of labor is tough, pushing a baby out is hard work.  It is intense and it flippin’ HURTS!  Women need to be able to do what they need to do to get through it.  They need to be allowed to move around and change positions.  They shouldn’t be restricted to one position or one “way” of doing it.  They shouldn’t be yelled at and made to hold their breath while trying to struggle through the last few minutes (or sometimes hours) of labor.  No one should tell them they have to withdraw from the race because they aren’t running fast enough.  No one should tell them they should withdraw from the race because someone else is tired of waiting for them.  They should only be told to withdraw from the race when their health is truly in danger.

Once the five mile run was over I was sore and I was tired.  I didn’t earn a prize, I didn’t earn a medal, I didn’t earn fame-nor did I expect that I would when I signed up for this race. What I did earn was the satisfaction that I finished a very physically demanding challenge.  I set a goal and I reached it.  It inspired me that I can do other things that are difficult.  It gave me confidence that I could set bigger goals.  The fact that I ran five miles in the heat is very insignificant to most people.  Some people would tell me they’ve done better.  Some will tell me that it’s crazy that I run at all.  Some will tell me I’m “stupid” “crazy” or even worse-for running five miles.  So, it’s a good thing no one else’s opinion is important.

This holds true for women that choose to birth their babies without medications.  It’s not for everyone and no one expects it to be but for those women that choose to do so, they deserve respect and support, not criticism and hindrance.

Being "with woman"

“Tiene otro?”  She nods her head, she places her hands high on the wall and leans into it.  Standing behind her I place my hands on her hips and apply a firm, squeezing pressure.  She sways gently and moans softly.  The beautiful toddler giggles and runs back and forth between her mommy and the wall-as if playing a game of “London Bridges.”  Between my little bit of Spanish and her sister-in-law’s broken English we are able to communicate effectively. 

The contraction releases and she takes a deep cleansing breath and smiles, then begins to again pace back and forth across the floor, the little girl following her every step.  Baby sister is on her way but daddy can’t be here, he’s working out of town.  The mother to be has her sister-in-law and her cousin at her side helping her bring the new baby into the world. 

“La palota?”  “Si.” I help her balance on the large red ball.  This makes the toddler giggle.  I bring in a smaller version of the ball for her to sit on-just like Mommy.  I sit behind Mommy and rub her back.  This is not as comfortable as walking, she stands up and walks.  She leans on the wall again.  I resume the hip counter-pressures.  The little girl wants to help.  She places her hands on the outside of mommy’s knees and presses in-she giggles.  Baby sister is getting closer.  Mommy can feel her moving down.  Standing is no longer comfortable, she moves to the bed.   Her soft, gentle moans are becoming louder.  I encourage her to work with her body-don’t fight it, let the baby come.  Tears roll from her eyes.  The little girl is scared.  She leaves with the young cousin that has just arrived.  They will go play with toys in the waiting room and return to meet baby sister.  Rose comes in to help me talk to Mom in her native language. 

She begins to bear down.  “Muy bien.”  “NO PUEDO, NO PUEDO, NO PUEDO!”  “Si, se puede, meja, si, su puede.”  We see the top of baby’s head.  She will be beautiful and have a full head of dark black hair. She digs deep down and finds the last bit of strength she needs to bring her baby into the world.  Rose encourages her and helps me coach her.  The head slides out easily, the shoulders follow and the baby slides into my hands.  I immediately place her on mom’s tummy.  Rose has tears running down her face.  I have tears in my eyes.  Mommy has tears of relief and happiness.  Aunt and cousin have broad smiles and tears. Baby is crying vigorously. 

Happy Birthday, Baby.  Your sister is here to meet you.  The toddler crawls up on the bed with mommy and gently touches her sister-smiling and laughing in delight.  Daddy is on the phone.  Daddy asks his sister to please thank the midwife for helping his baby come safely into the world…..and I know I have done my job. 

Learning to Speak Fluent Midwifery

Two days ago I had an idea for my next blog entry, this morning I had a midwifery newsletter in my inbox with an article on the same subject I was thinking about so it must be important.  It’s the idea of learning to speak “midwifery.” 

The word “midwife” means “with woman.”  The very nature of the word implies a trust of birth and women’s bodies.

Tuesday evening I had the opportunity to hear two physicians discussing a birth.  Neither are physicians I work with nor are they even physicians that practice in Idaho Falls.  One asked the other how things were on the labor and delivery unit where they both practiced.  The female physician responded with “they just delivered the last one.”  The male physician then began to relate the experience he had with a woman giving birth earlier in the day. He shared with the female physician that she was a “primigravida that was 8 cm with a posterior baby.  I was about to do a Ceasarean but the nurse called and said that she might be making some progress.  I checked her awhile later and she was complete so I ‘let’ her push but I didn’t think she would make it but she did start to make some progress so I couldn’t do a C-section. Then she finally delivered-I couldn’t believe it.”  He appeared to be very upset about his inability to justify doing  a c-section because (the nerve of this woman) she was making progress. 

Several things about this conversation struck a nerve with me that caused me to bite my tongue.  First was the female physician’s response “they just delivered the last one.”  She took all credit and focus from the women giving birth and put the credit on the staff that “delivered” the babies.  The women giving birth were merely “jobs” for the staff to complete-another task to check off the list. 

The next thing that struck me was the attitude of the male physician toward the woman making “slow” progress.  There was no discussion of anything that was done to help turn this baby-only eagerness to cut the baby out.  He didn’t mention changing maternal position, he didn’t express any desire to have patience to let the baby come down on its own.  In fact, he seemed very disappointed that she had a vaginal birth instead of a surgical birth.   

I began to wonder how the same conversation would have gone between two practitioners that trust birth and trust women.   I imagine the female provider would have responded to the male provider’s initial question with something more like “the last mother in labor just gave birth.”  The discussion about the “primigravida” with “slow” progress may have been filled with excitement at the woman’s strength and power and trust in her ability to birth.  C-section would probably have not even been mentioned.  Instead of “I can’t believe she did it” the practitioners would have rejoiced in another successful birth with a healthy mom and a healthy baby. 

I absolutely love my job because to me, it’s more than just a job.  Pizzas are “delivered” in 30 minutes or less.  Births are a process to be trusted, celebrated and not rushed. 

To Each Her Own

As any reader of this blog knows, I am a huge fan of natural childbirth but even more than that, I am a fan of giving moms the birth experience they want.  I think there is something to be said for the feeling a woman gets when she conquers the challenge of an unmedicated birth.  It’s much like the “high” athletes get when they complete an extreme physical challenge.  Sometimes, however, athletes enjoy a nice drive through the scenery instead of a bike or a run.

Anna was pregnant with her third baby and desired an unmedicated childbirth.  Her two previous children had been born without the assistance of medications and she had done very well and thoroughly enjoyed the experience.  Anna came into the hospital in labor late on a summer evening.  She was handling the contractions very well and breathing through them.  We had discussed her plans many times in the office and had reviewed relaxation and breathing techniques.  I arrived at the hospital to see her shortly after she was admitted.  I walked into the room and very confidently she said “I have changed my mind, I want to have an epidural.”  She acknowledged that she was doing very well but just simply did not want to feel the pain of childbirth this time.  Her husband was present and he was very supportive.  We, of course, honored her wishes and called anesthesia and they promptly came and placed an epidural and Anna got some much needed rest.

While Anna rested I went and assisted with a c-section on another patient.  When I was finished I came back to check on Anna.  She was still very comfortable but feeling some pelvic pressure so we checked her and her baby was ready to come.  Anna asked for a mirror so she could watch the baby’s birth.  We positioned the mirror and she watched as the baby eased out into the world.  The full head of black hair, the cute little ears, the adorable button nose-they all slipped out easily as I sat there with my hands folded in my lap.  Then the shoulders began to gently slide out so I placed my hands on the baby’s head, as the shoulders slid out I encouraged Anna to reach for her baby.  She reached down and lifted the baby the rest of the way out of her body and up to her chest.  The baby began to cry vigorously and tears ran down mommy and daddy’s face as well.  A beautiful, healthy baby girl. 

Many times mothers that originally planned an unmedicated birth and then change their mind feel guilty and they often apologize to me.  I try to reassure them that they do not need to apologize to me at all-it is their body, their birth experience, not mine.  Anna had no guilt.  When the birth was over she told me that she was very happy with her decision.  She enjoyed watching the birth and participating and based on her past experience she didn’t believe she could have done that with the pain she would have been feeling. 

This was truly a successful birth in terms of giving the mother the experience she wanted-even though there was a change of plans…and giving moms the experience they want is what it is all about!

The Little Midwife

Every time I think my job can’t get better, it does! 

This afternoon I had the opportunity to catch a darling baby boy, but this time, I had help!  This mama had lots and lots of family support.  Daddy was there, the grandmas were there and the big sister was there.  We’ll call big sister “Sarah.”  Sarah is six years old and she was SO excited to finally meet her new baby brother. Every time I would walk into the room she would ask me if it was time yet.  At one point she saw a little bit of blood on my glove after an exam and was a little worried.  The grandmas were amazing and promptly reassured her that it was OK and perfectly normal. It quickly became obvious to me that the mom and the grandmas had already done a great job of preparing Sarah for what she might see during a birth.  Her mom asked me if it was OK with me if she stayed in the room for the birth.  I always feel like I’ve failed a little if they have to ask me something like that-it’s THEIR experience, not mine.  I told mom that I was supportive of whatever they wanted. 

Finally the time was here to meet the new baby brother!  As mom pushed, Sarah became very interested in the process.  She was fascinated with seeing the top of her baby brother’s head as he was about to be born. Sarah started out standing next to her dad, daddy was more nervous than Sarah.  At one point, Sarah said to her dad “daddy, you’re shivering!  Stop shivering, it’s going to be OK.”   She progressively moved from the head of mom’s bed to my side.  I asked mom if it was OK if Sarah helped me catch the baby-she said it was so we asked Sarah if she wanted to help. She eagerly said “YES!”  In no time at all we had her outfitted with gloves and a gown so she wouldn’t get her “I’m a BIG Sister” t-shirt messy.  I gave Sarah instructions that I would help guide the head out and once the shoulders were out it was her job to “catch” the rest of the body with me.  As the head began to emerge Sarah was very “hands on” I gently supported the perineum and Sarah’s hands were right next to mine the whole time.  Then, two contractions later the baby boy was born.  Sarah did exactly as we’d discussed and she caught the baby’s lower body and together we put baby on mom’s tummy.  She was SO excited and asked so many very good questions.  She wanted to know everything there was to know about babies!  Once the baby was on mommy’s tummy Sarah wanted to take her gloves off and climb up next to them-which she did!  She touched the baby and talked to him-she took ownership of him!! 

Sarah’s midwifery skills didn’t stop with the birth.  The nurse rubbed mom’s tummy and checked her bleeding.  Five minutes later I looked over to see Sarah sitting on the bed next to mommy, pulling up her gown and rubbing on her belly!  Once mommy and baby were all stable, Sarah and I both signed the birth certificate.

I’m sure some people think I’m weird or crazy but that’s OK, Sarah will never forget this experience-and I’m sure her kindergarten teacher will get a kick out of “Show and Tell” this week!

The Amazing Melding of Midwivery and Medicine

Several weeks ago I caught six babies in a row in which mom used no medications, no interventions-they “went natural.”  I was amazed at each and every one of these amazing, strong women.  Over the past 24 hours I have been amazed by three more amazing women.

“Jenny” was one of the first moms that I saw for every one of her prenatal visits-from first to last!  Jenny was pregnant with her second baby. With Jenny’s first baby she labored for some time before having a c-section.  Many times during her pregnancy we discussed her options to attempt a vaginal delivery or schedule a repeat c-section, this was a difficult decision for her.  In the end, Jenny decided to wait and see if she went into labor on her own.  As her due date approached without contractions the thought of a scheduled c-section was becoming more desirable.  The experience of laboring for such a long time only to end up with a c-section was quite traumatic for Jenny-and an experience she didn’t want to repeat.  The day before her due date her cervix was still closed, long and firm so after much discussion,  we scheduled a c-section for the next day.  I assisted the doctor with the c-section and Jenny had one of the most beautiful baby girls I have ever seen!  I was again amazed at a strong woman who educated herself on her birth options and made a decision that worked best for her! 

“Maria” is a woman I had only met one time early in her pregnancy.  She had met my “partner in crime,” Susan, several times during her pregnancy but when complications developed her care was transferred to the physicians so she could get the level of care that she and her baby needed.  Maria’s complications worsened and it became necessary to induce her labor.  After many hours of labor and quite some time of pushing as well as an attempted vacuum assisted delivery it was determined by her physician that the safest route of delivery would be a c-section.  I was lucky enough to be in the right place at the right time and had the honor of assisting with the birth of Maria’s baby girl.  As soon as I saw her I was convinced the reason she wouldn’t come out was a very scientific diagnosis that I refer to as “cheek dystocia.” This sweet little girl had the chubbiest cheeks I have EVER seen.  What a cute, sweet little (big!) thing!!  What a strong woman to endure the treatments that were necessary to treat the complications of her pregnancy, to try so hard to push her baby out and then to be so brave in undergoing surgery to bring her baby into the world in the safest way possible.

“Tina” is a woman that began her care with a physician but I was so lucky to “inherit” her when her physician retired from OB practice.  Tina is such a sweetheart.  She is always smiling and I always look forward to seeing her.  When it came time for Tina to have her baby, the little princess had plans of her own.  Apparently, when it was time for her to make her grand entrance, she wasn’t quite ready. Her mama worked so hard to urge her out into the world.  She worked at it and worked at it and worked at it.  I was amazed at the strength this woman had after hours and hours of pushing she still kept at it.  Finally, there came a time when her drive and determination began to outlast her physical strength. This little princess was SO close but just needed a little extra help coming out.  I called one of my physician colleagues (at 4 am no less!) who, without complaint, came in to help us out!  With just a little assistance from a modern medical device, this woman was able to dig deep inside herself and find that last little bit of strength that she didn’t even know she had to push the guest of honor out to the party!  Tina said over and over that she felt like a “wimp.”  Wow! She was the farthest thing from a “wimp!” She pushed for over three hours-her strength and endurance is amazing!!!! 

So, women of the world, whether you “go natural” or utilize modern medicine in some form or another-you are amazing!!!  I am so grateful everyday to have the great honor to work with such amazing women!!!!! 

Tim McGraw, My Pedicure and the Demise of a Long Sleeve T-Shirt

The sun was bright and warm. The sand cushioned my freshly pedicured, bare feet.  The breeze gently lifted my hair away from my face.  I was enjoying a long walk along the beach accompanied only by the rolling waves and a man with a goatee and a sweet southern twang that introduced himself only as "Tim."  He was about to sing to me. I could her the strum of his guitar.  It became louder and louder, it was as if I could feel the vibration on my cheek.  Then, just as quickly as it all started, it all ended and I realized the vibration was not the musical work of a very hot southern man but, yet the ringing of my phone under my pillow.  I tried hard to simultaneously hold my eyes open and focus on the screen (as if I didn't know who was calling).  Just as I thought "L&D  208-557-2729."  I fumbled with the phone as I struggled in my state of semi-consciousness to recall which button on the screen to touch to connect with the person on the other end of the line. Ah, yes, I remember now, "Answer" that's the right one.  "Hello?"  "Hi" the all too chipper voice on the other end of the phone greets, "you have a patient here she is 39 weeks 4 days, contracting, she is 4 centimeters and she's worried that maybe she came in a little too early."  Four centimeters?  How many is that again?  How many weeks does she need to be? When does she need to come to the hospital? So many questions that my mind can't really sort out right now.  I take a deep breath, turn on the lamp next to the bed and open my eyes, hoping it will help me think.  "Ok have her walk for an hour and see if she changes if she doesn't and wants to go home for awhile she can, if she wants to stay, let me know." 

I turn the light out and wrap myself in the warm comforter.  I hope Tim waited for me.  I drift back to sleep but I can't seem to find Tim, he must not understand the life of a midwife-remind me to discuss this with him next time I see him.  An hour and a half later the phone rings again, this time I don't have as much trouble answering it.  "She's six centimeters now with bulging membranes."  I get out of bed and briefly consider just wearing my pajamas in to the hospital but then reconsider.  I put clothes on (a black short sleeve tshirt that says "I'm not a Gynecologist but I'll take a look" over a long sleeve white tshirt and jeans)  and slip sandals on my feet so I can show off my cute pink nails with the white flowers on the big toes. I walk out into the dark and get into the car.  As I back out of the driveway Tim McGraw comes on the radio "ah, there you are" I say right out loud.  I drive to the hospital singing like a karaoke queen the whole way there..."and it felt good on my lips!" 

Once I arrive at the hospital I change into scrubs (but make the mistake of leaving the long sleeve white tshirt on) and take a few minutes to read through the patient's chart-considering I have never met her-she's always seen the other midwife for prenatal care. I finish reviewing her prenatal record and I'm headed into the room when I see the call light pop on above the door.  I go in just in time to hear the nurse say "can you send Natalie in?"  I announce my arrival and I see the patient standing next to the bed and a large puddle of fluid on the bed-her water had just broke.  Just then she said, in broken English "I need to go to da bathroom."  Then with speed impressive for any human being, let alone a woman at 39 plus week pregnant, she ran into the bathroom.  Now, this ain't my first rodeo so I know better than just to assume she's going to empty her bladder in there so I follow her in.  She sits there for approximately 60 seconds with no results.  She then gets up and walks back to the bed, just as she sits down she jumps back up and runs to the bathroom again.  This time she makes soft grunting noises as she sits in the bathroom.  Between my little bit of Spanish and her little bit of English I am able to convey to her that the sensation she is feeling is the baby's head, but if she's more comfortable pushing on the toilet, I'm OK with that.  We realize that we need to make her more comfortable so we pad the pipes behind the toilet with pillows so she can lean back on them while she pushes.

OK, so we are going to have a baby in the bathroom.  We get the nursery nurse, Anna (who thankfully speaks Spanish) and we pull the cart with our equipment into the bathroom.  Anna looks at me like I'm crazy because I'm on my knees in front of the toilet wearing sterile gloves with my hands in the toilet (OK, not in the water) supporting the crowning head.  Now, in her defense, I probably am crazy. I ask Anna to please tell her that once the head is out she'll need to stand up because there is simply not room for the rest of the baby to come out while on the toilet. The mama says she understands this.  One contraction later the mama gently pushes the head out.  For anyone that's ever had a baby without medication-you know how intense this part is.  Once the head was out she had a bit of a hard time maintaining control.  Although she did stand up, she was having a hard time remaining standing and kept trying to sit-a few times right on the baby's head!  I could see this wasn't working so we helped mama to her hands and knees on a sheet on the bathroom floor. By this time we had noticed that there was meconium stained fluid (we hadn't noticed this before because her water broke on a green sheet!) so we had called for the respiratory therapist.  Soon after moving her to hands and knees she pushed the baby into my hands. The sweet, seven pound, six ounce baby girl cried right away!  The respiratory therapist arrived about this time-all I can say is the look on his face was priceless when he saw us all in the bathroom!  The baby was a little bit pale so she was handed over to the nursery nurse and the respiratory therapist, they took her to the warmer to check her out. 

We helped mama get up so we could get her into bed to deliver the placenta and make any needed repairs.  As we walked from the bathroom out into the room she looked over to the warmer and I realized this was the first time she'd seen her baby so I said "do you want to go see her?"  She did.  So, with the umbillical cord in my hand I walked her over to the warmer to see, touch and kiss her baby.  I wish I would have had a picture of the RT's face when he saw me holding the umbillical cord that was still attached to the placenta that was still inside the mama! 

We had such a FUN time with this delivery. I had to throw my shirt away because it was covered with blood, I got blood on my cute toes and my sandals while I walked mama to the warmer to see the baby, and as a special treat, my dear friend Roz-who was also the labor nurse, was kind enough to model the position in which the mama gave birth!

Even the mama had a great time!  When I saw her the next day she laughed about her baby being born on the bathroom floor-I told her whatever works for her works for me!  That's the beauty of being a midwife-I let the mama make the rules!