at home in orland (#2)

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runs 20 minutes


This birth features the second homebirth experience for Valerie Bates and her husband, Todd Cotier.  Valerie and Todd are both from Maine.  Todd is a mechanic and Valerie, a stay-at-home Mom (for now!).  They have three children, Austin, Cooper and Penelope.  Family is an important centerpiece of their life.

Val and Todd had a homebirth with their second child, Cooper, in November of 2008, which is featured in two other films in the At Home in Maine series:  “At Home in Orland” and “At Home in Maine, Part III.”

With both homebirths, Valerie and Todd were assisted by Andrea Mietkiewicz, CPM and Evelyn Conrad, CD of Clear Light Holistic Midwives of Old Town, Maine.

Valerie is almost two weeks “overdue” when she and Todd meet with Andrea for a prenatal visit at Andrea’s home/office.  The film presents a natural holistic model for how this midwifery practice addresses their client’s concerns, focusing on the “mind-body” connection.

Several days after this visit, Valerie has a very fast labor and births her daughter Penelope in the birth tub!

Though Valerie’s birth with Penelope is normal, Valerie begins to bleed heavily post-partum.  The film shows how midwives are trained to address these kinds of complications.

From Andrea Mietkiewicz of Clear Light Holistic Midwives:
Postpartum hemorrhage is defined of blood loss of greater than 500ml.  This happens in 5 – 13% of all women after birth.  The causes may be prolonged or fast, forceful labor and delivery, retained placental fragments, lacerations, or clotting difficulties.  The bleeding may come all at once, or a slow trickle that accumulates over time.  Any woman who has had a postpartum hemorrhage in the past is at risk for recurrence.

There are times when an injection of pitocin is given after the birth and before the placenta is delivered, when uterine contractions are not strong and/or there is a steady trickle of blood, more than normal.   If the placenta does not detach, it is manually removed.  The uterus is massaged to stimulate contractions.  If a woman continues to bleed heavily despite these treatments, it may be wise to transport to the hospital for evaluation.  A blood count is often done to establish a baseline measurement, and to evaluate the mother for anemia.   Methergin tablets, a long-acting pitocin, are often prescribed to keep the uterus firm.  Methergine is not on the list of approved medicines for a CPM to carry and administer according to Maine law.

Prenatal care offers an opportunity to attempt to prevent postpartum hemorrhage.  Hemoglobin levels are checked several times to make sure the mother is not anemic.  Foods high in iron are recommended, along with floradix or a whole food iron supplement , nettle and raspberry leaf tea, extra calcium and magnesium, and vitamin K.  All midwives are trained to treat postpartum hemorrhage should it occur.  The same emergency measures are performed regardless of place of birth, home or hospital.

During the birth you have just viewed, the placenta delivered quickly. The membranes were fragile and they shredded during the rapid, intense birth.  Pieces of membrane remained inside, preventing her uterus from contracting completely.   The mother had more than the normal amount of vaginal bleeding.  She was treated with pitocin and uterine massage.  The uterus remained boggy, and attempts to manually express clots were unsuccessful. She was transported to the hospital by private car where a doctor manually removed pieces of membrane and clots by reaching up into her uterus and scooping them out.  Given her birth history, we decided that she would be best served by doing this in the hospital.  She was given an injection of  methergin after the procedure, and agreed to stay overnight in the hospital to be monitored.  She was discharged early the next morning.

This mother had her first birth in the hospital, had a postpartum hemorrhage.  Hospitals usually give 10u of pitocin IV over the first hour after delivery.  The body carries memories, and it looks for this stimuation in subsequent births.  In her second birth the placenta was retained despite pitocin injection to bring strong contractions, and it was manually removed.  After the first hour bleeding was still more than normal.  We transported to have this evaluated.  Baseline labwork was done, and she was sent home with oral methergine tablets to take over the next two days.

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