When Stars Align (and Evidence-Based Care is normal)
By: Andrea Shandri, M.Ed, CD(DONA), CCCE
Mercy Medical Center, Des Moines, Iowa
Amanda McClannahan holds daughter for the first time.
Although a statement typically reserved for pure-luck instances, “when stars align” is a phrase that makes us think of a lucky, blissfully decadent, once-in-a-lifetime occurrence, with little chance of naturally happening again. As a birth worker, there are many examples I could think of that fall under this ….what’s the word….phenomenon… of star-aligning events, when enough prayers are said, or when the lucky get luckier. Lack of intervention during a highly medicalized event, spontaneous start of labor when the induction date is set, or complete belief in a woman’s body to birth a baby on her own, by her own power, are events that many of us dream of seeing.
Daughter Emily bonds with mom Amanda following Cesarean birth
To think of the things a birth worker (specifically a doula) would love to see on a regular basis is easy: start with the natural process of labor and identify those critical elements that allow the process of birthing both a baby and a mom to not only happen, but flourish. For many doulas and birth workers, those critical elements typically include waiting for labor to start on its own, delayed cord clamping, immediate skin to skin, and breastfeeding. But what if labor doesn’t start on it’s own? What if a Cesarean birth is the only viable option a mom has? Do the processes of bonding and elemental birth that help a mom and baby flourish get disregarded?
The stars aligned today.
Those evidence-based elements of birth that we know are safe, combined with an inspirational care team, created an astronomically unpopular, yet so incredibly important, birth experience.
Amanda McClannahan holds her daughter for the first time following Cesarean birth
A woman was treated with dignity and respect. She was valued and felt she had a say in determining the course of her birth. Although for many reasons she felt forced into a repeat Cesarean, she knew she could still have a say on some elements that were critically important and valuable to her and that would lead her to feel more involved in the birth of her baby and help ensure a healthier postpartum recovery. Amanda wanted to be a participant in her birth (to see her baby born) and she wanted to hold her and nurse her immediately (skin-to-skin) after birth. She valued these and knew these were important elements for both her and her baby. Most of all, she knew they were still possible to have, even in the event of a cesarean birth. However, Amanda also knew that, sadly, she wouldn’t be automatically offered these critical element, despite the fact that they are supported by evidence. She knew policy and protocol many times override evidence-based practice. So what’d she do? She worked hard to learn her options. She interviewed multiple care providers to determine which one would respect her desire for a family centered cesarean. She trusted her intuition, prayed, and even changed her surgery date based on the provider who agreed to support her wishes for this birth. On the morning of the scheduled Cesarean, feeling overwhelming anxiety, she trusted herself, reminding herself of the abhorrent birth of her first daughter, and asked for what she wanted.
“Honestly, I just wanted to hold my baby. With my last pregnancy, not being able to hold my daughter for four hours affected me greatly, even to this day. No baby, no matter how they are brought into this world, shouldn’t be ripped away from their mothers- the only thing they know- for hours on end unless it’s a true medical emergency.”
The stars aligned and she got everything she wanted.
Family Centered Cesarean made possible in part with the cooperation and support of nurse Lauren
With the help of Dr. Massey with West Des Moines OBGYN, Dr. Touney with Mercy anesthesiology, and nurse Lauren, Amanda experienced a fundamentally different birth with her first cesarean, and one that not many mothers have gotten to experience in Des Moines (if at all). This approach to a cesarean birth supports both physiologic and emotional importance of birth experiences. Family Centered Cesareans value the mom and partner in the process of the birth of their baby. Amanda was “allowed” to: see the birth of her baby (surgery techs dropped the sterile surgical drape), have delayed cord clamping (beneficial to any baby just born), have immediate skin to skin on the operating table (temperature, blood pressure, and hormone regulation) and breastfeed while she was being sutured.
Baby Emily enters the world
As Amanda’s doula, I encouraged her to not only research what she wanted to happen, but also have the trust in herself to ask for those things while being prepped for surgery. Amanda and her husband were confident in their requests and verbalized them to their nurse, Lauren. She not only listened, but encouraged the requests! She validated and shared in their desires. Lauren was the first star that was aligning. The second star of the morning, Dr. Massey, not only agreed to do Amanda’s c-section earlier in the week, but also agreed to let Amanda’s husband videotape the surgery. Not only that, she agreed happily to hold baby in the sterile field while the umbilical cord stopped pulsing. Dr. Tourney (anesthesiologist), the third star that aligned, agreed wholeheartedly to allow Amanda to hold her baby after the NICU team checked her out, but also keep her skin to skin and initiate breastfeeding. During the surgery, I made sure to beam ecstatically through my face mask, hoping that my body language would signal my complete and utter shock that this gentle Cesarean was even occurring. Dr. Tourney mentioned, “This never happens.” I replied, “I know. You’re changing lives.” It was true, and I still don’t know if he fully understood what the impact of his support truly means.
Amanda McClannahan watches as her daughter is born
This monumental composition of factors hold so much importance to Amanda and her husband, more than anyone will ever understand. The difference in the postpartum experience this time around that Amanda will feel over the next few weeks is undeniable…her perceptions about her birth experience are so much more positive than the birth with her first daughter, and that’s what I’m most concerned with as a doula.
So the stars aligned. Amanda participated fully in her birth instead of just experiencing it.
The big question here is, why did Amanda’s experience have to be a star- aligning event?
Amanda’s care team was quick to mention that this only happened because “the stars aligned”… each care provider “happened to be working that day”, because otherwise no other partners in either the OB practice or anesthesiology practice would “agree to do these things”.
But why do the stars have to align for a mom to hold and smell her baby? Why do the stars have to align so perfectly to allow a baby to breastfeed undisturbed minutes after birth? Why are normal, physiological functions so easily dismissed or less valued in a cesarean, leaving moms to agonize over being told no after asking for these evidence-based practices? Without Amanda’s determination, she could’ve been left alone on the operating table, while her baby was removed from the room for ‘medical observation’, and not given a chance to breastfeed for hours.
Amanda was the reason her stars aligned, “Even though having a repeat c-section wasn’t ideal, my c-section was picture perfect in the terms of getting exactly what I wanted. I knew this was an answer to prayer that I had prayed for nine months. All that was important to me was a healthy baby, no matter the delivery, and that I would be able to hold her immediately. This shouldn’t be such a dramatic request, it should be part of standard protocol. Hopefully, someday it will be.”
Daughter Emily nurses for the first time, still in the OR
For astronomically beautiful events to take place, stars have to align just once. Cosmic shift
happens much like tidal waves that start from a small wind. What butterfly effects will this Family Centered Cesarean have? How many moms will ask their care providers to be treated as the one birthing, worthy of attention, after reading this article?
Be a part of the cosmic shift. The voice of the consumer is an extremely powerful tool when it comes to promoting change. Share this article and make sure to tag your own local provides, but also those mentioned here (West Des Moines OBGYN and Mercy Medical Center) to say thank you for providing evidence-based care. We’d love for these providers (and others) to see what an impactt their family-centered care is making. Every time a page is tagged on FB they get a notification – a way that they’ll see that folks want this type of care and that they [might be] willing to switch to a provider who supports it. Let’s show these providers what an impact the care they provided is making. Events like these do not have to be star-aligning events. If we persist, if we are vocal and if we question “protocol”, we can change the birthing environment for many.
I know you can make the stars align for you too.
Watch Amanda’s full birth video
The Birth of Emily McClannahan from Andrea Shandri on Vimeo.
Andrea Shandri, M.Ed, CD(DONA), CCCE, is a certified doula, certified childbirth educator, and birth photographer. She is the owner of Iowa Doula Agency and Blessings Photography & Birth Services, LLC.
For more information on how a doula can help encourage evidence-based birth practices, please follow Iowa Birth Organization and ICAN of Central Iowa on Facebook, or write to Andrea at: firstname.lastname@example.org.