Sometimes, Babies Die. {trigger warning, stillbirth}

As a Doula, I’ve had the opportunity to attend all kinds of births. But the call I NEVER want to receive, the call every parent and birth worker dreads, is the call about fetal demise. 

Because sometimes, the universe is cruel. 

Sometimes, babies die. 

And there’s nothing you can do about it. You can cry, you can scream, you can question your reason for life. As a birth worker, when faced with this call, you have to be strong. You have to hold it together for this family who may have needed you before, but DESPERATELY needs you now. You have to walk them through the loss of their child. The child who will never take a first breath. 

Last week, I had to do just this. Pictures included below, sensitive material. 

Also included below is a link to the gofundme page we established to help cover memorial and burial costs. If you can’t donate, spreading the word is so helpful. Thank you.

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Two weeks ago, on a lazy Monday, as I was relaxing at home with my family, a local midwife who I work closely with reached out to me. She had a mother who had been planning a home birth after years of infertility. She was finally pregnant with their miracle baby. However, just days shy of 37 weeks, she had discovered that her daughter was no longer living. She and her husband were headed to the hospital to begin an induction, and they were requesting the presence of a Doula. I went. 

There was certainly emotion in the room, but I was amazed at the composure of the parents. They were brave, and they clung tightly to their faith in this intense time of grief. There was a lot of quiet resting and reflection as we waited for the induction medication to establish an active labor pattern.

The induction lasted for days. Monday and Tuesday were long, but relaxed. Many friends, family members, and pastors came by to offer condolences, prayers, and to lighten spirits. The distraction of visitors was welcome, and it helped break up some of the time. We also spent a lot of time walking, squatting, and using a birth ball. Wednesday morning things got much more intense once the Pitocin was introduced. Mama was so worn out and tired, she was considering tapping out for a c-section by Wednesday night. 2 doses of cervadil, 3 doses of Cytotec, and 15 hours of Pitocin over the course of several days had worn her down. Contractions had been intense all day, and she was shaking from pain and exhaustion. Through it all, she remained ever graceful and at peace with her situation. At one point she said to me, “There are times when I feel like I am about to fly into a million pieces, but then a wave of warm calm rushes over me, and I feel so lifted up. I know my God has a plan in all of this, and I now we will come through this.” Internal exam on Wednesday night revealed that she was only 2 cm dilated. Pitocin was turned off, and she hopped into the tub to rest. I sat there and talked with her and held her as she cried. We talked over her options, and at that point I expressed that her feelings were valid, and she needed to make choices based on her physical and emotional health, and that she shouldn’t feel guilty for whatever choices needed to be made She was at the end of her rope, reaching that place of desperation. After about an hour in the tub, she was calm, and we agreed to one night of rest and then a re-evaluation of her desires in the morning.

In the morning, after a very restless night, she was still feeling tired and that a c-section was preferable to more pitocin. Her OB urged her to wait just a few more hours, and her husband and I told her we were all-hands-on-deck for whatever she chose. They ruptured her water, and she opted for an epidural so pitocin could be started again without the intense pain. Within an hour she was sleeping peacefully, dilated to “a loose 3″. A little after noon, they began the pitocin again, and that’s when everything changed. At 2:15 pm it was discovered that she was fully dilated and ready to push, so they called in the team and broke down the bed. She pushed from 2:23 from 2:35, when her beautiful daughter was born. The baby that will never take a breath is a sight I pray none of you ever have to experience. As beautiful as she was, there was also a somber mask of death that flooded the room. It was a beautiful still birthday. Baby Astrid was 5 lbs 9 oz, and 19″ long. There was no visible cause of death, which shocked us all. She was like a little doll, perfect and pale. 

Before I post her photos, I want to include the link to a gofundme page that we have set up to help offset funeral and memorial costs. This is a tragedy no one should have to endure, but they handled it with such incredible grace. I have never seen two stronger people, and it was absolutely an honor to be invited into that space and walk through this experience with them. There is also a memorial website currently up at www.astridsorensen.com. 

Introducing Astrid Katherine Sorensen. Stillborn, but still born. 

Inducing Labor Naturally {what works and what doesn't}

Once women hit the 39th week of pregnancy, many are eager to meet their babies and may try all the various old wives tales to "induce" labor naturally. Before we begin, I feel like I need to make a disclaimer: if you are in any way putting anything into your body to try and start labor, it's considered an intervention, and isn't actually "natural". Walking, squats, and sexual activity are considered natural, because those are things you could do at any point in your pregnancy without causing labor. Waiting for spontaneous labor to start greatly reduces your risks of complications and medical interventions, however, there is no harm in trying some of these once you are full term {defined by the ACOG as 39 weeks pregnant}. But it is important to note- none of these things will work until your body and baby are ready. I realize that the end of pregnancy seems to take forever, I've been there myself. But as I and many others will tell you, it's over before you know it. But enough about all that- let's talk about these wives tales and what makes them work {or not}.

WALKING
If you are at the end of your pregnancy, there is no doubt in my mind that at least one person has said to you "are you walking?", "walk that baby out," or something to that effect. By the last week, you feel somewhat like a planet with legs, so walking probably doesn't seem too appealing. When walking is recommended, no one means you need to take up power walking. A relaxed 30-60 minute stroll around your neighborhood daily should be enough. Even walking around the mall or through Target {which is an absolute must if you live in South Florida like me and the outside will try to kill you with heat} for 45 minutes can help greatly.
How does it work?
Staying in an upright position helps your baby's head engage against your cervix. As you walk around, your baby's head will rub against your cervix, which can cause dilation, and will release oxytocin, which can bring on labor contractions. Working with gravity is the key with walking- you are helping baby move into the right position. Walking can be exhausting for a hugely pregnant person, so try not to overdo it. You don't want to wear yourself out prematurely.
Once you are in labor, walking during labor is encouraged to keep things moving in the right direction.

SEX
Oh, that's right. I'm going here. Small disclaimer here: there's no reason NOT to have sex during pregnancy unless your doctor has expressly put you on pelvic rest, or your water has broken. If neither of those things apply to you, go to town. There are several ways sex and intimacy can help get things going, and I'll start with the most obvious.
Orgasm
A female orgasm stimulates the abdominal and vaginal muscles, and releases a flood of oxytocin. This combination can bring on some pretty intense contractions, and the more intense the orgasm, the more intense the stimuli. Same goes for the amount of orgasms in a row, the more the better.
Sperm
There is a protein contained in male ejaculate, called prostaglandin. This helps the cervix to ripen, soften and dilate. There is not enough to cause an actual induction of labor, but if the cervix is already beginning to dilate and efface, the semen helps it along. During a medical induction, if the cervix is not yet favorable, a drug called Cervadil is often used to help speed the process. This drug is essentially synthetic prostaglandin {some say it's derived from pig semen, but I have yet to see a credible study done on that particular claim}, it is much more concentrated than a natural placement of male ejaculate, but it has the same purpose.
Oxytocin
During any sort of intimate activity, whether it's cuddling or full intercourse, oxytocin {the love hormone} will be released into your system. This hormone is known as the labor hormone, it's what fuels contractions and then assists in breastfeeding once baby has arrived. Any release of oxytocin is good for your body, and especially good for helping move labor along.
Cervical Irritation
Often, sex can 'irritate' the cervix, which can cause uterine contractions to begin. Typically, those contractions caused by irritation alone will peter off if left alone, but if you encourage them, they could possibly turn into the real deal. But of course, this will only work when your body is ready.

ACUPRESSURE & ACUPUNCTURE
These methods rely on pinpointing certain pressure points and nerve bundles in your body to cause another area of your body {in this case, your uterus} to respond.
Acupuncture should only be done with a trained professional in a sterile environment.
Acupressure is more relaxed, and can be done at home. Some of the main acupressure points for inducing labor are LI 4, SP 6, UB67, UB60 and Kl 1. More information about acupressure techniques for inducing labor can be found in this article.

CASTOR OIL
This is a widely-debated method of induction, and before I go any further, I need to say this.
DO NOT ATTEMPT TO USE CASTOR OIL TO BRING ON LABOR UNTIL YOU ARE WELL PAST YOUR DUE DATE AND YOUR DOCTOR HAS APPROVED IT.
Now that I've shouted that warning, we can proceed.
Castor oil is a bowel stimulant. It's pretty gross to choke down, but mixing it with something, like OJ or a chocolate milkshake, can help. It works by causing bowel contractions and diarrhea, which then irritates the uterus and may cause uterine contractions as well. It does work for some people, but there are side effects, such as severe diarrhea, nausea and possibly dehydration. Castor oil should only be attempted if your cervix is already at least 1.5 cm dilated and you are beyond your due date, as the contractions it may cause are intense and could put your body and baby in distress. If your cervix is not favorable, and your body experiences contractions before it's fully ready, this could cause your baby to be distressed and affect their health. It can also be extremely painful, as well as generally uncomfortable thanks to the diarrhea and nausea.
There are many success stories out there about castor oil, but there are just as many horror stories and "all I got was awful diarrhea and nausea, no real contractions" stories. Always check with your doctor before attempting to use castor oil to induce your labor, and make sure you are past your due date and your cervix is favorable {did I stress that enough? I think I did}.

RASPBERRY LEAF TEA
This is commonly thought to help induce labor, but that's a common misconception. Raspberry Leaf helps to strengthen and tone the uterus, which in turn can help labor be more smooth when the time comes. It is not meant to actually jump-start your labor. Another common mistake is thinking any raspberry tea will do this- it needs to be organic red raspberry LEAF tea. Not just any raspberry flavored tea.

EVENING PRIMROSE OIL
This is the same concept as the raspberry leaf tea. EPO is not meant to kick start your labor, merely help it along when it's time. Inserting a gel capsule of EPO vaginally in the evening can help your cervix to ripen, making it ready to dilate when the time comes. EPO can be taken orally as well, for the same reasons.

SPICY FOOD
This trick works much like castor oil- the spicy food is meant to irritate your bowels, which in turn could irritate your uterus. If spicy food is already part of your diet, or you don't usually experience tummy troubles after eating a spicy meal, this method likely won't do anything at all on that level. However, often, your body will release prostaglandins during the digestion of spicy foods, so at the very least, you can enjoy a nice meal out without worrying about dishes, and you get some prostaglandin cervical and uterine preparation.

NIPPLE STIMULATION
Nipple stimulation is often one of the first suggested ways to get labor started, or to augment a slow labor. Stimulating your nipples releases a flood of oxytocin {oh hey, thought I forgot about good old oxytocin, did ya? Nope!} and causes your uterus to contract. If you plan to breastfeed, the same thing will happen post-delivery, and those contractions will help shrink the uterus down to size and tuck everything back where it once was before you grew a whole other person. Rolling your nipples between your fingers is a gentle way to get things moving, but for more pressure, use a breast pump. Don't pump for more than 20 minutes at a time, and rest for a bit between the 20 minutes intervals. You don't want to wear out your nipples before baby even arrives, and you want to ensure that you are pacing your contractions. Too much nipple stimulation could cause them to become too strong or close together too quickly.

PINEAPPLE
Some say eating fresh pineapple is a great way to jump start your labor. On a scientific level, this is correct.  A raw pineapple has enzymes that have the potential to cause uterine contractions. However, you'd have to eat roughly 5-8 raw pineapples in one sitting to get enough to actually start your labor. I don't know about you, but that's a lot of pineapple for one sitting!

CIMICIFUGA AND CAULOPHYLLUM
Also known as Black and Blue Cohosh, these herbs have been used to help induce labor by midwives and herbalists throughout the ages. Always consult a professional before using either of these herbs in any dosage during pregnancy. They work best when taken together, black cohosh stimulates the contractions while blue relaxes the uterus and helps establish a pattern. Taken alone, blue cohosh can help stop Braxton Hicks and prodromal labor. There are several recipes online involving these herbs, but I will stress again, do not use these in any dosage without the supervision of your care provider and a professional herbalist.


I said it in the first paragraph, and I'll say it again here at the end for the spirit of continuity. These wives tales to induce labor work for some people, and some tricks work better than others. But they will not work for anyone unless your body is 100% ready. You can do everything on this list 10 times over, but if your body is not ready, you won't get the results you want. The most surefire method to start labor is being patient. No one has ever been pregnant forever, you will go into labor and birth your baby. Wait it out, especially if you are a first time mom. Most first time labors don't start until well past the due date, and remember- your due date is not an expiration date. It's merely an estimate. Your baby will come when they are ready, and waiting for spontaneous labor is beneficial to both you and your baby.

Be smart, and be safe. Happy birthing.

Maternity Session: Baby Zeke

This week I had the beautiful honor of shooting a sunrise maternity session with clients of mine who are very dear to my heart. The weather was perfect, and this couple simply glowed with love.
I absolutely had to share some of the magic here. Enjoy.

Inducing Labor- the pros and cons

As the due date approaches, something strange happens. The pregnancy that seemed to fly by so quickly suddenly drags. Days seem to stretch on forever, and it seems as though baby will never arrive. Taking into account that most first time mothers will gestate well past the estimated due date, this time of limbo can be particularly frustrating. An option that is often presented to mothers who have reached term (redefined by the ACOG to be 39 weeks as of 2013) is a medical induction. There are many methods of induction, which I will tackle in a later discussion. Today we are talking about induction as a whole, and the pros and cons.

An induction can seem like a beacon of warm light to an impatient mother, beckoning her to the end of her pregnancy and birth of her child. It seems like the perfect solution- you can set a date, there is no guesswork involved {a la "was that just pee or my water breaking?", "are these contractions real?" "is it time to go in!?"}, and you can schedule your time around your induction. You can make sure family and friends are there and available, and you can pick the day you want, avoiding those pesky holidays or other family birthdays. If you have older children, you can pre-arrange childcare and make sure everyone is ready for the arrival of the new baby. You can make sure you are well rested the night before your induction {HA! who can actually sleep when you know you are meeting your baby soon!?} and have all the essentials ready to go. All of this seems wonderful, right? It's the perfect answer to your impatient, super-pregnant prayers!

But wait. There's more.

Induction is the artificial stimulation of labor, and with anything artificial, there are side effects. The most common method of induction is Pitocin, which is a synthetic form of Oxytocin which your body naturally produces during spontaneous labor. This drug causes your uterus to contract and essentially forces baby out. Labor by induction is more painful than spontaneous labor because your body has not had appropriate time to establish a contraction rhythm. The Pitocin quickly gets things moving and puts your body into high gear, often before it is prepared. This can have many effects on the body, and on your baby. Common side effects of an induction are fetal distress, 'failure to progress' resulting in cesarean, umbilical prolapse, premature birth, hemorrhage, and of course, the cascade of interventions. I will also be talking about the cascade of interventions as it applies to all types of labor at another time, but induction is a major leaping point for that cascade. The greatest risk of an induction is a cesarean birth- being medically induced doubles your likelihood of undergoing a surgical birth.

In some cases, an induction is medically advised. Situations such as preeclampsia, IUGR, previous post-term stillbirths, severe gestational diabetes, a gestational period of longer than 42.5 weeks, or a pre-existing medical condition of the mother or fetus are all reasons an OB may request an induction of labor. In those cases, induction can be the best choice for both mother and baby. It is always best to weight your personal pros and cons and discuss your medical needs with your doctor.

However, there is an instance where induction may be recommended but the grounds are not founded: the big baby. Often, women will be induced prior to the due date because "the ultrasound showed that the baby was huge". First, ultrasound measurements are notoriously inaccurate in late pregnancy. The weight estimates can be off by as much as 2 lbs. Many women are induced, expecting a huge 8 1/2 lb baby {that's actually a pretty average size} and then when baby arrives they are shocked to find he is in the 6-7 1/2 lb range. Second, the pelvis is not one single solid bone; it is designed to shift and open up, allowing baby passage. I've seen a tiny 5'3" woman birth a 10 lb 4 oz baby like it was nothing. The 'big baby' needing medical intervention for birth is a myth. Nine times out of ten, your body will not gestate a baby too large to pass through your birth canal naturally and without intervention.

Elective inductions are discouraged by the ACOG, due to the high volume of risks for both mother and baby. If it's not medically necessary, it is best to wait for spontaneous labor. Sabine Droste, MD, professor of Obstetrics and Gynecology at the University of Wisconsin-Madison says, "Induction is a medical procedure that carries risks, so it should be reserved for medical reasons only."

Along with the aforementioned risks, induction also usually goes hand-in-hand with an epidural. Because an induction is not natural, spontaneous labor, the body doesn't handle it as well and pain medication is usually required. The epidural brings with it a whole host of additional risks and side effects, most common being the labor stalls and often will be transferred to a cesarean. Other side effects include needing a vacuum or forceps assisted birth, difficulty breastfeeding, continued pain at the injection site, spinal headaches, loss of consciousness, and, most rare, paralysis.

Another thing to be aware of is that induced labors are notoriously longer than spontaneous labor. Inductions, on average, take 2-3 days, especially for first time mothers who are not yet 40 weeks. A few women get lucky and wind up with 8-12 hour inductions, but the truth is, the vast majority aren't that lucky.

While there are many, many cases of successful inductions, it is wise to be aware that approximately 50% of inductions do end in cesarean birth.  There are certainly pros to an induction, in that you have the luxury of choosing your labor day{s} and can plan around it. There are enormous risks though, and it is best if you are fully aware of all that an induction entails before choosing one. It is up to you, your partner, and your doctor to weigh your pros and cons and decide if a medical induction is the right choice for you.