Life's Work

Life's Work: Ashley's Birth

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The photos and audio clips below are from a birth at Roots Community Birth Center on February 1, 2019. People in the room include: Ashley (who is giving birth); Ashley’s family members, including her mother, aunt, and cousin; Midwife Jahan Zuberi; Midwife Rebecca Polston; andBirth Assistant Britt Duncan.

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The back entrance leading up to the birth suites, beside the back entrance to the main office and clinic spaces.

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← Midwife Jahan describes Ashley's arrival at the birth center

In the birth suite kitchen, Midwife Jahan explained that Ashley left a message in the Roots online client portal and spoke to her over the phone before arriving to the birth center that morning after hours of laboring from home.

The birth suite includes a kitchen, a living/dining area, a bedroom with a toilet, shower, and bathtub, another half bathroom off of the hallway, and an additional room which is currently being redone.

← Midwife Jahan describes Ashley's arrival at the birth center

← Listening to baby's heart with a doppler

Fetal monitoring options available during childbirth include external and internal monitoring, performed continuously or intermittently (for example, 20 minutes of monitoring with 40minutes between). The handheld doppler is the most portable option, and certain models are waterproof, allowing monitoring while pregnant people labor in baths and showers as well. The midwives here perform fetal monitoring intermittently throughout labor.

← Midwife Jahan talks to Ashley about finding her rhythm and the building intensity of labor

← Ashley's labor music
← More labor music + sounds

← Ashley asks about Group B Strep treatment options

Group B Strep is a type of bacterial infection that can be found in pregnant people. The bacteria is normal, occurring in 25% of healthy adults with vaginas. When present late in pregnancy, there is a possibility that the infection can be passed on to the infant, which can be serious. Antibiotic treatment can be given to prevent this.

After taking more time to consider and review materials, Ashley decided to consent to antibiotic treatment for Group B Strep, which would occur every 4 hours throughout labor until her baby was born.

Midwife Rebecca Polston arrives and banters quietly with Ashley’s mother (not pictured) and aunt (pictured).

← Getting an IV

IVs can be given for a variety of reasons during labor, including in this case, providing antibiotic treatment for GBS positive laboring persons. Placing an IV can be a challenge during labor. In this case, small veins in Ashley’s forearms resulted in a few attempts before a successful IV was placed further up.

Because the purpose of Ashley’s IV was intermittent antibiotic treatment, her IV was “hep-locked” and detached. This meant that between doses, she was not hooked up to the IV line or attached to a pole and continued to have free range of motion.

← Midwife Rebecca responds to Ashley's, "I just feel weak."

After the grounding exercise Midwife Rebecca led Ashley through was complete, and the first dose of antibiotics was also, Ashley continued laboring in the bathtub. Her hep-locked IV was taped and not a problem to have in the water.

Getting into a warm tub of water during labor is an evidence-supported practice for managing pain, soothing aching muscles or joints, and inspiring a relaxed state of mind.Parents who practice some form of hydrotherapy during labor are more likely to delay or not request further medical pain relief.

← Midwife Rebecca asks Ashley when she last ate

Throughout Ashley’s labor she was fed and given to drink: oatmeal, oatmeal with honey, apple sauce, apple juice, water, coconut water, and Gatorade.

Evidence supports the right of low-risk laboring people to choose whether they would like to eat or drink during labor.

← Midwife Jahan pours hot water into the bathtub

Only a day after the extreme cold temperatures of the Polar Vortex had passed the pipes at the birth center were still cold, so boiling water was poured into the birthing tub to bring the water to a more comfortable temperature.

← Birth Assistant Britt performs a vitals check on Ashley

Ashley’s vitals and baby’s heart tones were checked regularly throughout labor, with the midwives and birth assistant working around her — not moving her from her position as much as possible.

This adjustable handle secured to the side of the bed provides a laboring parent a greater variety of ways to lean against and hold onto the side of the bathtub.

← Getting out of the bathtub and onto the toilet

After a few contractions in the bathroom, Ashley returned to the water. At her request, Midwife Jahan used a mesh net in the tub to catch any visible debris.

← Midwife Jahan and Birth Assistant Britt address drinking more water

← Ashley asks about pain relief options and Birth Assistant Britt responds

← Midwife Jahan asks Ashley to describe her waves

The tightening and relaxing of the uterine muscles during labor, often called “contractions” are also often called “waves” or “rushes,” words that may feel more positive or produce less anxiety in birthing people.

← Midwife Jahan suggests a position change and provides options

The adjustable handles, previously on the sides of the birth tub, are placed under the water nearAshley’s feet by Birth Assistant Britt, so that Ashley can place her feet against them to both stabilize her position in the water and widen her pelvis.

← Birth Assistant Britt feeds Ashley oatmeal

Both Midwife Jahan and Birth Assistant Britt feed Ashley bites of oatmeal between waves.

← Midwife Jahan offers more options and Ashley decides where to labor next

← Intensity rises sitting on the toilet and so do encouraging words

Throughout her labor Ashley changes positions often — freedom of movement during labor, and particularly the use of active and upright labor and birthing positions, have been linked to shorter labors and less need for epidurals. Positions like this one, sitting on the toilet can encourage the descent of a baby and tap into the body’s natural response to open there.

← The sound of fanning and update on antibiotics

During labor a birthing parent can go from feeling hot to cold, or cold to hot quickly.

In the photo above, Ashley is still wearing a robe she asked for after getting out of the bathtub, just low and off of her shoulders. After expressing that she felt hot, BirthAssistant Britt then fanned Ashley with something she grabbed nearby.

Ashley decides to move from sitting on the toilet to sitting on the bed before getting her next dose of antibiotics.

← Birth Assistant Britt explains and starts using the rebozo

Birth Assistant Britt uses a rebozo to move Ashley’s hips, which can help relax the muscles around the pelvis and encourage better positioning of the baby. She also massages Ashley in this hands and knees position on the bed as labor continues to progress.

← Birth Assistant Britt massages Ashley

← Baby's heart tones and sounds of labor

The midwives ask for permission before every vaginal check Ashley receives. They also ask her to let them know when she’s ready for them to begin, and announce their touch just before she feels it. They communicate to her the information the vaginal check gave them about her labor during or after.

← Midwife Rebecca encourages Ashley into a position change

Midwife Rebecca watches the sacral movement of Ashley’s body for more information about how labor is progressing.

← Moving from the bed to the birth stool with encouragement

← Laboring through increased pressure in the squatting position

There are many ways a birthing parent can get into a squatting position during labor, including this supported squat over the birth stool, where in this case, Ashley is supported by her mother sitting on the bed behind her.

Ashley performs the lift and tuck motion that Midwife Rebecca (and Midwife Jahan at another time) recommend to help the baby descend past the pubic bone.

← Moving from the birth stool to the bathroom

← Midwife Rebecca requests permission to use a flashlight

← Midwife Rebecca brings mindfulness to tightness in the legs

← Ashley requests Nitrous Oxide

Nitrous Oxide, also called Laughing Gas, is one option for pain management during childbirth, but it’s better known for being used at the dentist. It is tasteless, odorless, and given through either a mouthpiece or a mask over the nose and mouth. It’s felt to be most useful when inhaled beginning about 30-45 seconds before a wave and then through to the end of that wave.

← Birth Assistant Britt explains how to use the Nitrous Oxide

← The sounds of using Nitrous Oxide

Midwife Rebecca goes under the bed to examine Ashley as she squats by the bed’s end.

← Practice pushing

While pushing might sound like it would be intuitive, many birthing parents learn and practice how to push productively through direction and coaching during this stage of labor.

← Practice pushing, pt. 2

← Midwife Rebecca describes beginning to see baby's head to Ashley

It is common in the pushing stage to begin to see the baby’s head (if the baby has descended head first) rocking out during a push and then sinking back out of sight between them.While this can be challenging for birthing parents who feel so close to done, it does encourage tissues to stretch, which may prevent tearing, to at least some degree.

← Confident pushing with family encouragement

As her pushing progresses, changes include: the lowering tone of Ashley’s voice, letting out less breath as she pushes, pulling her legs back and rounding her body as she pushes, and her family becomes more vocal with their encouragement, motivating her even more.

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← Baby's heart tones during pushing

The baby’s head no longer disappears between pushes. Laboring parents are often encouraged to reach down and touch their baby’s head at this point, which Ashley did just before the doppler is used.

← Confident pushing with family encouragement, pt. 2

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It is not uncommon for a baby to be born in stages like this needing separate pushes — possibly minutes apart — head first, shoulders through next, and the rest of the body after.

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This baby is born “encaul,” meaning still inside the intact amniotic sac. Here, the baby’s facial features can be seen pressed up against the inside of the amniotic sac lining, and below, their fingers can be seen stretching it away from his face.

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← Ashley's final push to birth to her baby

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Once born, baby is transferred immediately to Ashley’s chest, and covered with a blanket to stay warm and bond with Ashley as the next stage of labor arrives.

← The birth of the placenta

The birthing parent’s work continues after childbirth as the the placenta is born. They still feel waves and need to push to get the placenta through the birthing canal.

In Ashley’s case, the placenta is still attached to the baby through the umbilical cord, which she has chosen to delay clamping and cutting.

← Birth Assistant Britt places an ice pack for Ashley

Cold ice packs applied to the perineal area after childbirth can help reduce swelling and pain. Birthing parents can continue this practice at home as well, creating DIY ice packs to place externally and provide relief.

← Ashley talks to her baby and asks about the first bath and Midwife Rebecca responds

Ashley chose to delay clamping and cutting of her baby’s umbilical cord. Delayed cord clamping allows blood circulating in the placenta to transfer to the baby’s body. Clamping is considered delayed when it happens after one minute after birth, however, it can take several minutes for an umbilical cord to go from thick, blue-purple, and pulsing (transferring blood) to white and limp (no longer transferring blood).

← Ashley reflects with her family and Birth Assistant Britt explains and performs fundal massage

Fundal massage, or uterine massage, is not so much a massage as much as purposeful pressure applied to the abdomen after childbirth to stimulate the uterus and reduce bleeding (preventing postpartum hemorrhage). It is often described as uncomfortable, and birthing people are encouraged to breathe mindfully through this important check as they would their waves.

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Birth Assistant Britt shows Ashley her placenta, describing how the baby grew inside the attached amniotic sac, and pointing out the smooth side where vessels form the “tree of life” pattern into the umbilical cord.

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After giving the family some space (with intermittent visits for fundal massage, stitching, breastfeeding assistance, etc.) the Roots team re-enters to perform a newborn examination.

On the topic of stitching, perineal tearing is common during childbirth, especially for first-time birthing parents. There are several degrees of tearing that can happen, requiring various levels of treatment. There are also ways to address the possibility of tearing, including perineal massage to stretch tissues. The practice of episiotomy (cutting of the perineal area to prevent tearing) is not supported by evidence for the vast majority of birthing people.

← Midwife Jahan begins the newborn examination in Ashley's arms

The newborn examination took place in Ashley’s arms and beside her on the bed.

← Midwife Jahan measures the baby

← Baby's birth weight is weighed and recorded

← Baby is given a Vitamin K shot

The Vitamin K shot is an injection given to babies within the first six hours of life to prevent Vitamin K deficiency. While rare, the potential impact of Vitamin K deficiency in newborns is life-threatening bleeding. The three main options parents have in addressing Vitamin K for their newborns are: consenting to the Vitamin K shot, choosing an oral Vitamin K regimen, or declining both.

Ashley’s family warmed the car while she dressed herself and baby. After a final fundal massage/uterine check, the family leaves the birth center to begin the next chapter of their life at home.

Ashley arrived at RootsCommunity Birth Center on February 1, 2019 at about 7:00am. She and her family left the birth center for home on February 2 at about 4:30 am. She is encouraged to call with questions if needed, is advised on particular things to call and alert the midwives to right away if she or baby experiences them, and will be visited by a birth attendant at home within the next three days.

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