Perineal Tears, To Stitch Or Not To Stitch?

When it comes to discussing perineal tears, there seems to be so much misinformation, so let’s chat.

First of all, we must touch on the fact that there a several different degrees of tears.

An intact layout of the exterior genitalia, as a baby crowns.

First degree

Second degree

Third degree

Fourth degree

WHY do Tears Occur?

Sometimes tears are unavoidable, especially small tears. Some babies come out with such force and pressure, pulling the perineum tight in response, and can cause the skin to rip. In the moment, during a natural birth, will you feel it? Maybe, but you will probably be more focused on the fact that a child is emerging down your birth canal and about to come into the world to greet you, you won’t notice until afterwards, if you check, or if you go to pee and it burns on your perineum.

This study discusses how episiotomies, larger babies, an assisted vaginal delivery (with forceps or vacuum), an epidural, and induction, potentially being factors in tears.

This study reiterates how instrumental vaginal delivery can increase prevalence of tears, as well as length of transition (longer transitions were more so associated with tears, but we cannot help but wonder what caused those long transitions, but they don’t mention that).

Preventing Perineal Tears

  • STAY UPRIGHT, listen to your body and allow baby to descend naturally, without coached pushing or purple pushing, let FER take over
  • Gently apply a warm compress on your perineum as baby descends. If you can do this yourself entirely this is optimal. There’s no need to push on babies head, pull on your perineum, or enter your vagina like some providers do. As baby is naturally and successfully descending, simply place gentle pressure with a warm wash cloth (can add oil as well if desired) on the perineum
  • There is no indication the pre-labor stretching, massaging of the perineum, or kegels work to strengthen or loosen the perineum, so this is truly unnecessary. See a pelvic floor therapist if you are concerned about the firmness or lack thereof of your perineum during your pregnancy, a pelvic floor therapist may will have some good tips to protect those pelvic floor muscles!!

Can Perineal Tears be Managed Without Stitching?

There are many reasons why someone might want to avoid stitches. This includes the infamous “husband stitch,” prolonged healing, improper healing, lack of sterility, pain, swelling, pelvic floor impact, and more. Not to say that NOT getting stitches does not come with risks, because that choice does come with risks, too.

If you have a first degree or second degree tear, you may choose to heal naturally!

  • Comfrey root (found here), an herb that contains natural Allantoin (which also helps form the umbilical cord and the baby’s bladder in the womb), is an amazing all around healer and helps bind skin. Mixing this with warm, raw manuka honey (found here), turmeric (found here) and witch hazel (found here) can make a soothing, anti-bacterial, anti-fungal natural stitch to encourage your body to heal quickly on its own. Apply warm Nori wraps (found here) and/or gauze over the area to gently seal, and prevent mess and stickiness all over your underwear/postpartum pad.

Be sure to cleanse well with a peri bottle mix after every bathroom trip, and re-apply to prevent bacteria growth. This does not always work for every individual and even after making this choice, it’s very possible to decide to get stitches. Should you change your mind, you can always go to the local ER to request stitches. Or, you may decide to get stitches right away, that’s fine too!!

A common misconception is that a hospital transfer is required for stitches. Nope! If you have a midwife, she can stitch you, too!! And luckily, tear repair is not something that you have to absolutely rush to the ER for right away even if unassisted. You should give a hustle if you have a severe tear, but for a tiny tear, enjoy those golden hours with your babe and then go, and do not admit baby, then check out once you’ve been stitched. There’s no reason to be admitted for 48 hours for stitches, because they will dissolve in a few weeks anyways, but if you want to stay, you can do that too.

An example of perineal stitches:

Why I will not Attend a Hospital Birth as a Birthkeeper

One of my largest biases when it comes to birth is location.
I am very biased on where a woman delivers her child – so much so, I refuse to attend births in a facility setting. I have no problem admitting this and speaking on why.

I’m sure many of the main stream birth providers will be angry about this as many are trained to accept and assist all walks of life, and that’s okay!

I personally choose to acknowledge and respect my biases in respect for the women I serve and for myself. Bias is something I previously spoke on if you are interested in learning more about it.

I (Desirae) am personally really not about hospital birth. I’ve had 2 myself and I am aware of what they have to offer. I know that once you get there, you put your birth into someone else’s hands, and with this, I do not agree.
This is not empowering.
This is not biological.
This is a disservice.

Why Do I Stay Away from Hospital Births?

You could have a perfect hospital birth that goes just the way you want! Sure, I’ve seen it! The issue with that is you won’t know for sure until delivery day. Your provider might respect you but then again, they might not. They might feel like an episiotomy is needed (when it is not), and that will be happening no matter what you say because they write it off as “medically necessary.” Say “NO” all you want, it doesn’t always stop them. I’ve seen this happen as well.

You can press charges, but good luck with that…

I’m not about secondary trauma either, I’ll pass. You literally couldn’t pay me to watch a woman endure the abuse that occurs during many hospital births. I will not stand next to a woman while a doctor reaches in to check her cervix when she is begging them to please not. I do not care to experience a woman being told “You must get the epidural or we will simply take you back for a cesarean”.

What a disruption to her birth energy! No thank you. That is NOT what I’m about to wake up for at 2 AM to go witness. I’d rather sleep. “Why is she there in the first place?”, is all that comes to mind.

When a law suit is drawn up over the abusive malpractice, I’d be dragged into it. Again, no thank you. I already know how those outcomes go.

I am not about trying to negotiate with a medically minded provider over their poor choices. It’s a waste of time trying to speak to someone with a “God complex” that feels they are most knowledgeable, I’ve done it. Their main goal (for most) is “keep my license” not, “follow mama’s birth plan”. Birth plans are nothing shy of a request during a hospital birth. Keeping licensure will always trump a mothers desires.

I do not attend births as a means of living. I do this on the side to assist women who feel empowered and trust in their body and baby. I only assist those who see birth for the spiritual and natural process that it is. I’m not about defending a birthing mother who does not trust her body enough to stay home. If she has fear, that means she has more research to do. Research is the answer. Not a hospital birth.

I always mention how insane it is that low risk women flock to hospitals to birth their young. Going to a place of emergency for a natural bodily function? Where’s the sense in that? Should I be showing up at a hospital so I can take a poop? I mean, I might get a hemorrhoid or get a tear in my anus. I should go there just to “be safe”, right?

I have no desire to support someone who doesn’t trust in their body’s ability. If you have fear, you need more knowledge, not more unnecessary assistance.

There are birth attendants and doulas that will attend those medically minded hospital births. There are many women who will attend hospital births and don’t mind watching the activity that occurs there.

I am not one.

I Love Home Birth

There is definitely a provider for everyone and I feel that is glorious! As for me, I support the small crowd of women who are empowered and see home birth as the only logical option.

Sometimes there are complications in the birth process, I get that, but let’s get back to the numbers… less than 5%. I feel hospital births happen out of fear. Fear from the birthing woman or her partner. It could also be because that is what the birthing mama was conditioned to believe was necessary!

Fear has no place in a soon-to-be mama’s heart. If she has fear, that is ok and normal by all means! She just needs more research. Not a hospital birth.

Hospitals have zero place in low risk births. If mama can’t trust herself at home, I can not assist her. & that’s ok! Ask someone else.

*I will also note that in the case of emergency, I would transfer with my clients. I will never put my desires above her emergency needs. I do know when to pull the plug and have zero problem doing so. I would go into that facility and defend her like a guard dog, as if my life depended on it. I’d literally push a medical doctor out of the way and run into the hall demanding a new one if mama and I did not agree with their practice. My passion runs deep. My past experiences would be set aside for her. In a true emergency, a hospital birth is the best bet. It can save lives, I will not deny. I’m simply saying that if a low risk mama doesn’t trust her body and baby enough, or realizing the safest place for a healthy birth is at home, I can not assist her; I am not the best fit.

-Desirae

Supine Hypotensive Syndrome: An Epidural Blackout

Imagine the horror as you welcome an epidural, relief, into your body after a long stretch of contractions (and having to hold a specific position for several minutes while the anesthesiologist placed a needle the size of your face into your spine), only to instantly start blacking out while you hear rapid, loud beeping in the background. The nurses faces start to get fuzzy and you notice your breathing getting slow and short, but you cannot seem to force your body to take a deep breath to help your oxygen flow…

This horror is not an allergic reaction.
This is not a labor complication.
Your body is not broken.

This is Supine Hypotensive Syndrome.

What is Supine Hypotensive Syndrome?

SHS is defined as a sudden drop of blood pressure in a pregnant woman when she lies on her back, due to Caval Compression (compression of the abdominal aorta – the main artery in the abdominal cavity – and the inferior vena cava.)

The only cure to this is to GET OFF YOUR BACK and GET INTO A DIFFERENT POSITION!

Have you experienced dizziness, nausea, shortness of breath, even fainting/unconsciousness when you lay on your back while pregnant? Has a doctor ever talked to you about why?

Position Matters!

Have you ever been told your body isn’t capable of birth?
What if it wasn’t your body, but instead your epidural restricting you to only laying on your back?
Or, what if it was the need to be monitored in the bed, on your back, every 20 minutes?
Did you push for a certain amount of time, only to become absolutely exhausted because it was so hard to breathe?
Did you/your baby’s heart rate drop so rapidly after the epidural that your birth resulted in a cesarean?
ALL of these ‘complications‘, and many others, could have simply been fixed by allowing you to move and change positions.

It’s infuriating to think that, isn’t it? I get it, because I have been there.

Final Thoughts

Doctors don’t talk about this, they likely don’t even know about it actually because their textbooks won’t tell them this, but I will. Even if they did know, would they say anything? Would they make the effort to roll you onto your side or encourage you to move around, if they knew it could allow you to have a birth that didn’t leave you with trauma? Or is it prime and optimal to have you lying on your back in stirrups for their convenience? They are well-trained surgeons so whats another cesarean to them?

And yes, YOU CAN move into a different position with an epidural. Ask for the lowest dose possible, and ask exactly what medication they are using for your epidural. Are you comfortable with Fentanyl, for example? A WALKING epidural can allow for much more movement, and quicker leg function and healing post-birth, too.

Have your support team help you get onto your hands and knees. You may put a ball or a stack of pillows in front of a bed placed in seated position, face the back portion of the bed, hold the ball or stack of pillows and rest comfortably on that, while still allowing gravity to do its job on your pelvis. Using a peanut ball in between your legs as you lay on your side can be optimal as well, as it keeps your pelvis open and ready for baby.

Take control of your birth with education, one step at a time!

IATROGENIC CARE; Your Body did not Fail – The Medical Establishment Did

IATROGENIC : “induced inadvertently by a physician, surgeon, medical treatment, or diagnostic procedure. ”

When a mother tells me about her previous complication during labor/delivery, I like to keep in mind that sometimes complications naturally arise. It’s an undeniable fact. More often than not though, these complications are induced by the provider; also an undeniable fact.

It’s no surprise that after a woman is given Pitocin, her baby’s heart rate tanks. This often ends in an emergency cesarean. Pitocin use often results in a c-section. A mother’s body starts failing to respond to labor after having fentanyl injected into her spine. No surprise! To numb the body and expect all to be well is not logical thinking.

A woman’s blood pressure is off the charts after being given Pitocin. Now her and baby’s life are at risk due to an unnecessary induction. No surprise here, either.

A woman’s cervix starts to swell and backtracks in regards to dilation after multiple unnecessary cervical exams. No surprise there. Vaginal checks can irritate the cervix and interfere with labor.

I could go on. All of these complications occur after hands interject into a natural bodily process. Then you are left with a complication that needs addressed. It quickly can turn into an emergency, all due to unnecessary interventions.

The worst part is that after it’s all said and done, providers claim they saved the day. That they saved the woman and baby’s life.
Yet, in truth, they caused the unnecessary emergency.

Most complications that happen during labor in a facility are iatrogenic. Caused by the provider who many trust to keep them safe. We have one of the worst infant mortality rates in all of the developed countries, according to the CDC. We are failing mothers and infants. It’s time for people to wake up, research, and realize what is going on here.

To find more information about iatrogenic care in the delivery room, see the latest research here:

The Surrogacy Experience

Surrogacy has really taken off recently. In the most popular surrogacy group on Facebook, there are over 13,000 members eagerly asking questions, commenting and either completing or beginning their surrogacy journey as an intended parent or as a surrogate, gestational or traditional. It seems more and more I see my timeline popping up with friends going through surrogacy, that I really never expected to.

I have people reach out to me daily asking about my surrogacy experience and honestly, answering is becoming exhausting, time consuming and draining, so I will put it here for the world to see and it will find the people it’s meant to find and if you’re looking for answers and perspectives, here they are. Please read in full before reaching out to me with questions. It’s long but it’s necessary if you feel you are wanting to make an informed decision on whether surrogacy is right for you. If you are contemplating egg donation, please see our egg donation article for my perspective on that here.

Preparing for Surrogacy

You must know that the process going into surrogacy is a hurry up and wait game. Whether you go through an agency or independent, you can expect to be waiting at minimum 6 months before even starting to get pregnant; some women wait much longer – even years. So do not go into this expecting to get pregnant or get a paycheck quickly, by any means.

Before you even get into the nitty gritty, check if your state even allows surrogacy. The ability to be a surrogate depends on the state YOU live in, not the parents. For example, in New York, surrogacy is not permissible or legal. There are ways to get around it, but it’s a gamble for you and the parents legally. For a state by state guide, learn more here.

Types of Surrogacy

There are different types of surrogacy, so you must decide which route you will take.

Traditional surrogacy involves using your own egg, so you would be biologically related to any baby you carry. This may involve home insemination, in clinic insemination, IUI or the full IVF process, extracting your eggs, creating an embryo or multiple embryos, and transferring the embryo(s) into your uterus.

A gestational carrier is just that – a carrier. You are simply hosting the embryo(s) and they are not directly biologically related to you, though, if you are carrying for a cousin, sister, daughter or any other relative, they will be distantly related to you, of course. This involves the second half of IVF and we will go in depth with that explanation in a bit.

The Legal Side

Once you’ve decided whether you want to be a gestational carrier or a traditional surrogate, you will pursue an agency. Typically agencies do not aide traditional surrogates as they are legally more complex and involved. There are TONS of agencies to choose from; vet them wisely. Ask questions about how they support you through the process, what process steps they handle prior to you getting matched with parents, if they can match you with parents that fit your values and birth plan, how compensation is handled, and if you are 10-99d for the compensation you receive (if so you must save at least 15% of your compensation for the following tax year, or you will be investigated by the IRS).

Some values that are important to consider in surrogacy are:

  1. Compensation: What is the compensation amount to make it worth it for you to dedicate your body for a minimum of 10 months, sometimes over a year if transfers fail, you have to do mock cycles, you have an early loss, etc? What about lost wages if you have to miss work for appointments, or quit your job all together? What will be your transfer fee? What about if you have to have a hysterectomy from birth complications?
  2. Embryo Transfer: This is one that really stirs the surrogacy community up, but let me make it clear that transferring multiple embryos to increase likelihood of pregnancy is no longer evidence based. It sounds like it makes sense at first, but it is not backed by science. It just increases your risk of multiples, and there are some theories that transferring a lower grade embryo with a higher grade embryo makes a pregnancy LESS likely to occur or sustain. Multiples occurred through IVF increase the interventions pushed in pregnancy and birth and enhances your risks for pre-term labor, placental complications, pain, rupture and more. If your Reproductive Endocrinologist recommends transferring two or more, run away. You should always transfer ONE for yours and baby’s safety. Transferring two or more, to “save money”, is NOT worth it.Also, how many separate transfers are you willing to do before you have the option to drop the contract? The standard is three, but it’s absolutely your choice. It can be very taxing on your body and may require out of state travel and lots of time away from your own family.
  3. Termination: Under what circumstances are you willing to terminate?  None? Any? Parents choice? Specific birth defects? Multiples? You absolutely must know what your stance is on this and put it in the contract.
  4. Parental Involvement and Contact: How involved do you want the parents to be? Would you like someone local that can attend every appointment? Or do you prefer someone to give you space through the pregnancy and update them via text or call after each appointment? Can  you tolerate communicating via translator if your parental match is foreign?  Are you comfortable with them being present through the entire birth, or are you more private?
  5. Birth plan: Do you want someone that is okay with a natural birth? Home  birth? Birth center? Hospital? Who will your provider be? Are you okay with being induced if requested? Would you agree to a scheduled cesarean? What  are your limitations on intervention? At what stage of labor do you plan to go to the hospital? Who will be present in the room if you need a cesarean and only one person can go with you? What happens if the parents don’t make it to the birth? Who will cut the cord? Who do the baby/babies go to immediately? Would you like a doula present? A birth photographer? If so, who covers those costs? Will you share a room after birth? Who gets the placenta(s)?
  6. Providing Breast Milk: Are you willing and able to provide breastmilk?What will be your charge per oz? Will you do it for free? How long are you willing to provide for?

There are certainly other factors to consider as well that your lawyer will discuss with you in building contracts, but those are the main, important factors.

The Evaluation Stage

Now, let’s move on to the evaluation stage! In this stage you will be required to attend several appointments, gas and time coming from your own pocket. This involves a medical evaluation of your reproductive organs and general health at a Reproductive clinic, an approval from your OBGYN for clearance of pregnancy, a psychological evaluation for you and your partner, a background check, and a blood draw to screen for diseases, drugs, hormones and nutrient levels.

You will need to get a hysteroscopy during the medical evaluation, in which they insert a catheter into your uterus and fill a balloon with saline to examine you for cysts, endometrial tissue abnormalities, and uterine shape to check for optimal conception and pregnancy chances. It’s not really painful but definitely feels odd and you may experience period like cramps and bloating after. You will need a recent healthy, normal Pap smear and pelvic examination from your OBGYN for pregnancy clearance. If you are not immune to specific “preventable diseases” some reproductive clinics may require you to be immunized before proceeding. If you have any drugs in your system, you will be denied point blank, for obvious reasons.

During the psychological evaluation you will need to take a test that’s about 300 questions long, it tests for psychotic and sociopathic tendencies and how risky of a person you are. It’s all multiple choice and true or false, and based on your own opinions, so don’t worry, you don’t need to study. Then you will meet with the psychologist where she or he will chat with you about your surrogacy motives, family psychological well-being, how safe your home is, how your birth and previous pregnancy experience was, how you feel about different surrogacy scenarios and what you would do in those situations, and they will gauge your partner’s well-being and how supportive they are of the surrogacy. Your partner must be completely on board. If you don’t have a partner, you must have great support, such as your parents, reliable childcare or someone else that can be there when you call, as needed.

You also must be at least 21 years old, not be on any type of government financial assistance (food stamps, WIC, or any variety of that), have had at least one healthy, complication-free and term pregnancy and be raising said child. People who have had gestational diabetes, pre-eclampsia, antenatal depression, pre-term delivery, hyperemesis gravidarum, placenta accreta, or any other complication may not qualify.

The Contract

Once you have gotten through all that, now it is time to start contracts. Contracts can take several months for some matches, and as little as a couple weeks for others. Have your lawyer go over EVERY SINGLE DETAIL and ASK QUESTIONS. ADVOCATE for yourself, or you may regret it. Remember all those values we mentioned before and include them ALL. It doesn’t matter if you are “being complicated,” the lawyers are making thousands off this contract and it’s so worth it to protect yourself. Take your time, don’t feel rushed by this part. You will need to have your contract notarized and if you are married, your spouse will need to sign as well, in most states.

The Pregnancy

Now, we move forward into the process of getting pregnant! Are you exhausted yet?? LOL

You may have a mock cycle to see how your body responds to medications, or may be put on birth control to syncopate your cycle with the Intended Mother’s if doing a fresh transfer. The medication protocol is different per every clinic, and sometimes different per each individual, so it’s truly hard to gauge what your specific cycle will look like. It is EXTREMELY rare that a clinic allows a natural cycle so do not hang on those hopes going into it.

The medications you may be put on include:

Birth Control (this may be the mini pill or something stronger)

Lupron (this is an ovulation suppressor and is self-injected into your abdomen)

Estrogen (this may be oral or self-injected)

Progesterone (there are many forms, PIO, or progesterone in oil is the most common and effective, and is injected into your upper buttocks or your thigh, you may be on this for 2 months or more once transfer occurs. There is also oral progesterone and vaginal suppositories and those may be used in combination with progesterone in oil or solitary.)

PLEASE research the side effects of these medications before proceeding, they can have life long effects and include but are not limited to, dizziness, fainting, vaginal bleeding, painful and sore knots at injection site, allergic reaction, nausea, vomiting, migraines, sore breasts, infertility and cancer of the breasts, cervix and ovaries. Progesterone supplementation can lead to placental complications and those complications are common in the surrogacy world.

I also strongly encourage you to look into birth trauma and primal memories of infants, but that’s a subject for a different day. Surrogacy is not victimless and not solely a positive gift, no matter the relationship between the surrogate and parents. Moving forward…

My Surrogacy Story

This is my personal story and perspective of my surrogacy, after sharing that informational bit. Take it and do with it as you will!

Taylor’s Story:

I had always envisioned myself one day carrying a child for someone that couldn’t, I was not actively pursuing, it wasn’t something I was necessarily looking to do right away at the time, but I was open to it and researching it and did talk to a couple women that were connected to me by a friend that had her babies via surrogate. Between these first conversations I realized what was important to me.

I met a woman that was the sweetest soul, her story touched my heart. I spoke with her about my intentions and knowledge for the pregnancy and birth, and she communicated that there was trust and free reign, that she agreed with how I felt about interventions, that it was my body to make informed and safe choices with, that she believed in the natural lifestyle, she was raised naturally and her business seemed to jive with exactly what she was saying. I thought we connected very well, that I had found my soul sister. We talked for months and months, and I even drastically lowered my compensation to almost nothing because I truly thought this was a lifelong bond and connection, as it should be, and as it was portrayed from her that it would be. The monthly compensation wouldn’t even pay my rent by itself, if that gives you any idea of how low it was. But I was okay with it because I felt that she truly respected and appreciated me, and that’s all I wanted, to bless a loving pair of souls with a beautiful little baby, it was never about money for me. I bring up the low compensation because when you’re a surrogate, at least in my experience, apparently it’s justifiable that the parents treat you however they want because they pay you so well. I beg to differ.

I went through every check of the process with flying colors. I responded to the medications with ease, was injecting myself daily but pushing through.

We transferred two embryos and both of them implanted, that evening I felt the actual implantation and remember pointing out the exact spots of the implantation to the mother, it was pretty cool to be so in tune to my body at that time. We got a positive pregnancy test just 3 days later. I flew home the day after.

 

Then, just 6dpt…

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About 5 weeks go by and my pregnancy tests have just been getting darker and darker and my HCG is through the roof. A little nausea and sickness has started to show itself, but I didn’t think much of it. I went to my first ultrasound of the pregnancy and I remember the tech asking me how many embryos I had transferred as she turned the screen to me to show me two distinct sacs with little beans growing in them.

As the days passed after this appointment and my HCG kept spiking, my little bit of nausea turned into violent all day sickness, barely keeping water down, fainting spells, and basically bed ridden. Turns out, the medications used for surrogacy and IVF can stimulate H Pylori overgrowth and cause Hyperemesis Gravidarum.

And then things got worse again… Had my first and only ER trip at 14 weeks because I started to faint again, and felt like I was dying this time. My body was so depleted. My BP was very low and my heart rate was 150 resting, obviously my body was in dehydration survival mode. My husband quickly whisked me to the hospital and they were able to replenish my fluids and check on the babies but they also found placenta previa. Handling my sickness was a challenge between the parents and I because they weren’t comfortable with CBD oil, or prescription meds. I was at a loss.

There were also payment complications with bills. Somehow my moms FSA account got charged from that hospital bill, payment plans in my name were discussed, but in the end it all got paid, after a very stressful few days for everyone. So be aware this can happen! This is why it’s important to have an escrow account.

Finally, around 17 weeks, I came out of the horrible sickness I was experiencing. Around 20 weeks the placenta previa cleared on its own.
At 24 weeks the parents came down again, this time for a little bit longer, and I was forced into a high risk MFM appointment, for absolutely no reason, where they did almost a two hour long ultrasound that was very painful. If anything, those high risk appointments are WHY women lose babies because of how stressful they are. The doctor there put it in the mother’s head that an induction must be done at 38 weeks for twins or else they could die. Couldn’t give any statistical or scientific back up for this, she said it just is what it is. On our two hour car ride trip back to my house, I explained how inaccurate that is and even found studies that negated what the doctor said.

For the remainder of my pregnancy, this would be an issue that continuously came up – the doctors wanting to schedule an induction. At this point, I felt I was the only one truly advocating for the health of the babies, and that no one understood how dangerous this was and started to shut down emotionally. After all, lung development continues well up to 40 weeks and beyond, why would we want to risk them having poor breathing and spending time in the NICU?

For the rest of the pregnancy it was almost nothing but a hassle, and dealing with people watching me in surrogate groups on social media. Anything I would post in private surrogate only groups were immediately sent to the parents, so I didn’t even have a safe place to express my feelings anymore. Things were taken out of context and made the parents feel concerned with my emotional well-being and state of mind. Even someone I thought was a good friend sent screenshots of text messages of me venting, which caused a major wedge in the surrogate-intended parent relationship that never needed to be there.

As “induction day” drew nearer, tensions were high, speaking terms were non-existent, and I was gathering the necessary tools and speaking with legal people in preparation for a court battle, if need be. I cancelled the induction appt.

At the same time, the OBs office was also giving me a hard time, refusing to even see me if I wasn’t going to be induced, which is completely unethical and from what I read up on, actually illegal. I forced my way into the office and demanded an on the spot appointment because I wasn’t about to be accused of breaching contract just because I didn’t have my weekly appointment. I allowed the weekly NST, as usual, and the chart immediately picked up back to back contractions, and a hard time picking up baby A (the boys) heart rate. The OB asked me to just do an hour of monitoring in the hospital to be safe.

Monitoring at the hospital still showed contractions back to back, though I wasn’t feeling a thing so I assumed it was at best early labor, I could see them and they were nice and strong and steady. But I wanted to go home.

About mid point of monitoring, I got up and had to go to the restroom pretty badly. I felt a lot of pressure. My water gushed out with a pop and was a heavy flow, there was no mistaking, but I was still doing great. They came back in to hook me up and I let them know my water had broken and she asked to check me to see where I was at and I agreed to one check, I was 7cm. Well, guess go time is soon then, I thought. The OB came in quickly and announced that I needed an epidural, and with a calm and collected face (still having no contractions), I told her absolutely not and signed a non consent for pain medication form. My beautiful doula friend came to support me at this point. I asked them to call the mother and when she got there, things got really obnoxious with them trying to force the epidural.

Basically telling me I either get it or I’m having a c section right now. I asked the doctor to place it without running it, so if there was an emergency, it was quick easy access. I thought this was a good compromise that I could live with.

While they were preparing the anesthesiologist, I entered transition and was in my zone. On the floor, on all fours, full on growling though contractions in a true animalistic state. It was the most powerful feeling that I will never forget. Toe curling, full body coursing, back to back intense pressure. Like a hug from a large person that’s just way too tight, but is warm and familiar.

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Now let me tell you, trying to sit still through transition with nurses holding you down while they place a needle in your spine is outrageous and gross. A needle that I didn’t even want. A needle that served me no purpose. I was at the finish line, let Birth happen for goodness sake.

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And, wouldn’t you know it, they ran the damn medication anyways without permission. My body instantly reacted very badly. At first I started to go numb, then I felt my body go weak, tingly, my vision went blurry, now black and in and out of consciousness. I was shaking profusely. All I could think in my head was don’t pass out or they will cut you, don’t die for this, you have your own baby at home. My BP tanked to 70/30.

Tons of nurses rushed in to try to stabilize me. All of this for a medication that I was refusing. I should have kicked them in the face. I should have been stronger. In this test, I surely failed. The strength that I am for other women, I couldn’t even be for myself. I was ashamed.

They pulled the epidural and I regained myself and started to regain feeling and immediately went straight to the best part, when the babies came from womb to earth. I didn’t have all my feeling back for when the boy came, I was still a bit limp in my legs so I gave a little effort of push for him. With the girl I had my body back and FER completely took over when she was ready! She took her sweet time, coming 45 minutes after the baby boy, descending and my body taking a nice little break in between them, but she flew on out when she was ready with minimal efforts on my part!

The parents and I shared a room the first night and the babies were discharged before I was. I was able to make it home just in time for my baby boy’s third birthday party on the 7th! My son’s birthday is July 3rd and the twins is July 5th.

Because  of misunderstandings, the parents and I didn’t talk from about 3 weeks postpartum to about 4-5 months postpartum, in which we fought about bills and all the complicated crap that happened in the surrogacy.  It all surrounded expectations that weren’t met and hurt feelings.

If you ask me if I would ever do surrogacy again, the answer is no. I wouldn’t even go back and re-do the surrogacy I had. I would have never chosen to pursue it, knowing what I know, now. I think it is one of the least natural and most emotionally complex things you can do. I would only ever do it for my siblings, if needed. It aged me immensely, caused an array of health issues that who knows when I will fully recover from and has a lasting emotional impact. Not because of the bonding with the babies, I didn’t feel sadness when they were given to their parents, but the sadness that the surrogacy was everything I didn’t want. The birth wasn’t even breezy, though short, it too, was stressful. There are some that have beautiful, heart warming stories about their surrogacy and go on to have many journeys, and I wish I did too, but alas, there are two sides to surrogacy, and I’m here to share that it isn’t all rainbows and butterflies.

It has been a year since I had the twins, and my, oh my, how things have changed. I have not spoken to the mother in several months, even prior to my son’s cancer diagnosis in April. Needless to say I am so disappointed that she did not even care enough to reach out when my son was diagnosed, when mine or his birthday came around, or even at all on the twins’ birthday. It is such a shame to give someone so much love and happiness into their world without any gratitude. But I am generally at peace with it, I cannot make other people be good people out of pure desire, they have to choose to do so on their own.

Thanks for reading. Feel free to reach out with anything I did not answer here..

How To Have A Gentle C-Section

When you picture a cesarean, what words come to mind first?

Cold. Quiet. Bright. Scary. Scrubs. Scalpel. Shaky. Drugged Up. Curtain. No Skin to Skin. Sore. Inactive. 

But wait! Ending up with a C-Section, whether by emergency or by choice, does not mean that you have to miss out on being an active participant in your birth!

What is a Gentle C-Section?

While a gentle cesarean is not going to do much to change the postpartum recovery, it is still a major surgery, it can reduce the trauma or disappointment you may experience, if a c-section was not in your expected birth plan. And even if it was, how neat is it to have a more active and informed surgery, right?!

A gentle cesarean is something that should absolutely be discussed with your provider prior to you going into labor, whether you are planning to deliver at home or planning a scheduled c-section, everyone needs to be on board and knowledgable about your intentions in the event of a cesarean happening! OB/GYNs that do not routinely do cesareans need to be informed on their role during the cesarean and what things will be different, which will not be much on their part honestly – just a little extra time and flexibility. If you have a doula, she can aide you in advocating for your gentle cesarean, as you will be numb, but if not make sure your partner or support person is fully informed on what exactly it is that you are aiming for.

What Makes a Gentle C-Section Different?

First things first, you will still be prepped like every cesarean mama would be; you will need to sanitize your body to prevent your opening from becoming infected, and everyone coming into the room will be scrubbed up from head to toe to keep germs to a minimum. You will be given a form of pain medication in your spine to numb you; your best bet is to ask for a spinal block instead of the epidural or general anesthesia. This will be a shorter lived pain medication (about two hours) that will get you well through the surgery, but not linger as long as the epidural and generally does not have as many side effects.

Insist on a small, low transverse scar that is to be double sutured. If this is a repeat c-section, make sure they remove built up scar tissue before suturing, so you are less likely to experience placenta accreta on your scar tissue in future pregnancies. This will increase your likelihood of a successful VBAC, if that is potentially a future desire of yours. Babies can squeeze out of a hole the size of a bagel, trust me, they do not need to cut you from hip to hip.

Leave the shawl down or ask for a transparent sheet to go in between you and the OB/GYN operating, so that you can see everything happening! Ask the OB/GYN or a nurse to talk you through the procedure and everything that is going on to help keep you fully engaged in your baby’s entrance.

Music may play during the birth to encourage a loving and soft environment. If possible, you can request that the temperature be warmed and the lights reduced just for a few minutes as baby emerges. Of course, when the OB/GYN is opening and stitching you back up, you will want them to have full visual. Have monitors turned silent and away from your face so you can be relaxed and at peace.

Allow baby’s head to be pulled to the top of the opening and turned towards you, to emerge slowly and gently. If possible, you or your partner can do this part, and still deliver your own baby! They can still do the breast crawl this way or just be pulled up to your chest for skin to skin. Delayed cord clamping should absolutely still be an option and you can almost always keep your placenta. They should allow the placenta a few moments to attempt to detach naturally, before pulling or manually removing, and it should be removed gently as to not cause any damage to your uterus.

Simply have them place the placenta in a bowl or container next to your bed for delayed cord clamping and keeping the placenta. It should not be allowed to go to pathology, except for a small sliver, if they absolutely must test.

Baby should remain skin to skin with you or your partner while you are stitched back up. After they stitch you, be sure to ask for them to swab your vagina for vaginal seeding, this provides baby with probiotics and healthy culture from your vagina that they would normally get passing through the birth canal. Baby should not be washed, especially with soap! Rub their vernix and any other fluids into their skin.

If baby must be separated from you for any reason, have someone else provide skin to skin, or at minimum stay with them, especially if you are declining vaccinations, or eye ointment.

Check out this video as an example of a gentle cesarean:

 

 

Are Doulas Only for Home Births?

The simple answer is NO! Doulas are great for everyone, regardless of your birth plan!

Regardless of where you deliver, a Doula is a great person to have on your team. Doulas are proven to play a large roll in birth outcome; just by having her knowledge and voice present to advocate and protect you.

Impact of Doulas on Healthy Birth Outcomes – NCBI

It is no secret that providers often suggest options during your pregnancy/birth that are not beneficial or are proven harmful. Having a Doula during your pregnancy, birth, and postpartum can help you make more healthy choices. Part of a Doula’s job is to share factual based information with you surrounding everything pregnancy, birth, and postpartum so that you can make a healthy choice for your growing family.

First do no Harm – Interventions During Labor and Maternal Satisfaction: A Descriptive Cross-Sectional Study – NCBI

Having her voice in the room could be the change in your birth outcome! For example: You have stated that you do not desire Pitocin during labor. You are in labor and it is taking a while to progress fully. Providers are known to hook up Pitocin to your IV without warning or consent (because you signed over rights for them treat as they see fit). If you have a Doula she would catch this slick action and make you aware. “Hey mama, the nurse is trying to hook up a Pitocin drip. Are you okay with this?”

When provider’s choices of care action are the 3rd leading cause of death and our maternal and infant mortality rates are the highest out of all developed countries, it may be in you and your infant’s best interest to have a Doula during pregnancy and present during labor!

Continuous Support for Women During Childbirth – NCBI

Especially for women in the following categories. These women are proven to have an increased chance of adverse birth outcomes:

  1. Socially disadvantaged women
  2. Low income women
  3. Unmarried women
  4. Primiparous (First time moms)
  5. Giving birth in a hospital without a companion
  6. Those who experience language/cultural barriers
  7. Hispanic and women of color

How Doula Care can Advance the Goals of the Affordable Care Act: A Snapshot from New York City – NCBI

If you are having a medication free hospital birth, a Doula would be great to have in your corner; seeing to it that your plan comes to be if at all possible. She can help you avoid pharmaceutical means of pain management by providing counter pressure and rebozo use.

If you have a planned cesarean, a Doula would be beneficial to have with you! She could update you on each step; giving you assurance and comfort that all is well while making sure your desires are advocated for and met.

If you are having a home birth, a Doula is great to have as well. She can help with other kiddos, getting you water/snacks, help starting dinner, assist in pain management techniques, and far more!

Regardless of social class, ethnicity, multiparous or primiparous, or desired birth plan, a Doula is for you!

Be sure to keep in mind that Doulas are not one size fits all, they are not equal. There is not a single Doula that is for everyone but there is a Doula out there for everyone who desires one! Be sure the one you choose is a good fit for you and your needs!