I'm your host Don Macintosh
00:00:49.33\00:00:50.86
and today I'm happy to
have Patti Barnes with us.
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Patti, welcome! Thank you Don
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So you are a certified midwife,
right? Professional midwife.
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And you've
delivered quite a few babies.
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How many is it now? Over 750
00:01:03.33\00:01:05.95
And today, I think we're going
to deliver another one today...
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so-to-speak, kind of
hypothetically here. Yes
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We have models
and different things.
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I think it's going
to be a great time.
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You have entitled this segment
or what we're talking about...
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"When to call for
help" Right? Right
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And I assume that has something
to do with the signs of labor.
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What are the signs of labor?
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Well, right before
labor most women have
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what they call "lightening. "
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Not thunder but lightening! Yes
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And is that like talking
about the heaviness or something
00:01:35.51\00:01:38.18
...I guess you're
going to explain it;
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you have a
graphic here! Yes - yes
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This is mostly with
the first-time mothers.
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The baby
settles into the pelvis.
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It's usually about
2-4 weeks before labor.
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And they'll feel that... Yes
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Braxton Hicks
contractions increase more,
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and that's
tightening of the uterus.
00:01:56.53\00:01:58.44
A bloody show which is
a pinkish glob of mucus
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as the cervix is dilating;
and starts thinning out.
00:02:03.11\00:02:07.73
And that's not a
couple of weeks before...
00:02:07.74\00:02:09.22
No, not always;
sometimes it can be.
00:02:09.25\00:02:14.05
Several soft bowel
movements and a burst of energy.
00:02:14.08\00:02:17.87
Now, every person can
vary; not everybody is alike.
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Again, the first mothers
- when it's the first baby,
00:02:21.53\00:02:25.41
you will see this more
because you could almost tell
00:02:25.44\00:02:29.70
when the baby has dropped. Okay
00:02:29.73\00:02:32.36
So they'll feel that
- they'll sense that.
00:02:32.37\00:02:33.99
You know, I guess
before I was born,
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my mother always tells
me that she got this real
00:02:36.22\00:02:38.15
burst of energy and she
cleaned the entire house!
00:02:38.18\00:02:40.41
Yes, it's like a
nesting syndrome.
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I see, nesting syndrome. Um hm
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But again, they'll say...
00:02:46.36\00:02:48.11
"Well you know, I feel
like I can breathe again"
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Because the baby has
dropped and again, they'll feel
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pressure on their bladder.
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So the beginning of pregnancy,
they have that pressure
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on the bladder, they
have to urinate often,
00:03:03.14\00:03:05.07
and then toward the
end, when the baby drops,
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they'll free
pressure on the bladder;
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they'll have to
urinate often again.
00:03:09.32\00:03:12.08
Did you bring any
pictures to show us?
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Yes I did bring a
picture to show you.
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This picture, the baby on the
left is what we call "engaged"
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So when the baby
drops into engagement,
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then she will feel
pressure on the bladder.
00:03:27.35\00:03:31.74
That's the "lightening" Yes
00:03:31.77\00:03:33.55
And next comes the thunder...
or next comes the delivery!
00:03:33.58\00:03:37.30
Well you know, many times,
as a nurse working in a hospital
00:03:37.33\00:03:41.48
I'd work there at the
front door triage in the
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emergency room;
people would come in
00:03:43.91\00:03:45.44
that thought they were having a
00:03:45.47\00:03:47.97
baby and many times they weren't
00:03:48.00\00:03:49.47
Sometimes they were...
many times they weren't.
00:03:49.51\00:03:51.29
What are the true and false,
00:03:51.32\00:03:53.98
or maybe the false
and true signs of labor?
00:03:54.01\00:03:56.00
Okay, well first of all,
the false labor begins with
00:03:56.03\00:04:02.24
usually you have the
irregular contractions...
00:04:02.27\00:04:05.51
So they're not... if it's
true, it's irregular, okay.
00:04:05.54\00:04:10.33
And they won't
intensify, in other words,
00:04:10.34\00:04:13.07
they stay the same;
they're not getting harder.
00:04:13.10\00:04:15.23
There's no change.
00:04:15.26\00:04:16.69
Contractions will
rarely exceed 60 seconds,
00:04:16.72\00:04:20.09
and they do not
get closer together.
00:04:20.12\00:04:23.16
...Mostly felt in
the front and high.
00:04:23.19\00:04:26.29
So up high.
Yes, and not lower...
00:04:26.32\00:04:29.36
And also, they may cease
with position change or activity
00:04:29.39\00:04:33.19
Hot baths or sleep
usually stops the contractions,
00:04:33.22\00:04:37.09
and that's a good indication...
00:04:37.12\00:04:39.42
And also you usually do
not lose the mucus plug,
00:04:39.43\00:04:43.07
you may but you may not,
most of the time you don't.
00:04:43.10\00:04:45.56
And minimal cervical
station if the doctor or midwife
00:04:45.59\00:04:50.39
checks your cervix and
she would see no change.
00:04:50.42\00:04:54.54
Okay, for
dilation or anything. Yes
00:04:54.57\00:04:57.02
Those are false
signs. What about true signs?
00:04:57.05\00:04:59.00
Okay, with the true signs
we see that the contractions
00:04:59.89\00:05:06.94
turn into being more
regular and they intensify,
00:05:06.97\00:05:12.81
they'll get harder.
00:05:12.84\00:05:14.41
The contractions will
exceed 30 and then 60 seconds
00:05:14.44\00:05:18.74
and longer; they'll
grow closer together,
00:05:18.77\00:05:22.14
and not only will
they feel it in the back,
00:05:22.17\00:05:26.39
but also in the lower front.
00:05:26.40\00:05:28.07
So they really feel it just
coming... Okay, anything else?
00:05:28.10\00:05:31.55
They will not cease
with position change;
00:05:31.58\00:05:35.21
hot baths or sleep
will not stop them,
00:05:35.24\00:05:37.52
and that's a good indicator
- like if they call me,
00:05:37.55\00:05:42.08
and tell me that they believe
they're having true contractions
00:05:42.11\00:05:46.86
I will have them go take a
warm bath and try to go to sleep
00:05:46.89\00:05:51.63
and if they cannot...
Then you're on your way. Yes
00:05:51.66\00:05:56.00
Or they are on their way!
00:05:56.03\00:05:58.40
And of course,
when I check them,
00:05:58.43\00:06:00.23
the effacement and
dilation will change.
00:06:00.26\00:06:03.08
And we can see that, sure enough
they are starting to dilate.
00:06:03.09\00:06:07.87
Had there ever been
any times when someone
00:06:07.90\00:06:10.24
just has a baby without any
of these true or false signs?
00:06:10.27\00:06:12.90
No warning at
all... Well it's rare
00:06:12.93\00:06:15.77
I have had a couple of ladies
that just felt a little unusual,
00:06:15.80\00:06:23.28
and their cervix starts changing
and then they would feel
00:06:23.31\00:06:27.25
the heavy-duty contractions
around 8 centimeters
00:06:27.28\00:06:30.20
and that's pretty rare...
00:06:30.23\00:06:31.80
But then I've had only one;
she was a little Amish lady,
00:06:31.83\00:06:35.93
that she never felt anything.
00:06:35.96\00:06:38.80
It was the strangest thing.
00:06:38.83\00:06:40.65
She would just feel a
little funny in her stomach.
00:06:40.68\00:06:44.64
She would say, "I feel a little
00:06:44.67\00:06:45.96
stomach ache and
a little crampy. "
00:06:45.99\00:06:50.92
First of all, the first birth
she had, she went to the doctor,
00:06:50.95\00:06:54.17
in the hospital, and
she didn't make it in time.
00:06:54.20\00:06:56.77
Her husband flagged down
a police officer. Oh great!
00:06:56.80\00:07:00.23
And that was a first delivery
which they're usually longer.
00:07:00.26\00:07:02.70
The second one, I think she
00:07:02.73\00:07:05.85
had it on the lawn or somewhere.
00:07:05.88\00:07:07.75
She got a little
closer to the hospital...
00:07:07.78\00:07:10.49
But finally, the doctor said, we
need to just keep her at home.
00:07:10.52\00:07:15.16
And so we tried to get
there and she called me,
00:07:15.19\00:07:21.50
well actually, her
husband called and said...
00:07:21.53\00:07:23.33
"She feels a little funny"
00:07:23.34\00:07:25.63
I said, "I'm on my
way. " I'm out the door!
00:07:25.66\00:07:27.78
And I didn't get there in time.
00:07:27.81\00:07:31.03
But the husband called back and
my husband answered the phone,
00:07:31.04\00:07:33.65
and he said, "What do I
do... I see the baby's head!"
00:07:33.66\00:07:37.43
And my husband... He should know
00:07:37.46\00:07:40.49
at least how to talk them
through but he got so nervous,
00:07:40.52\00:07:42.85
he said, "I'll
pray for you brother!"
00:07:42.88\00:07:46.17
Oh no, so did you get
there in time that time? No
00:07:46.20\00:07:50.68
I would have like to talk
to that policeman afterwards.
00:07:50.71\00:07:52.84
What do you mean, he
flagged a policeman over and...
00:07:52.87\00:07:56.29
Police officers, they do
NOT like to deliver babies.
00:07:56.32\00:08:00.51
They really would prefer not to.
00:08:00.54\00:08:03.77
But anyways, yes, he ended
up delivering that baby also.
00:08:03.80\00:08:07.80
So finally, the doctor
said we need to just train
00:08:07.83\00:08:13.03
the husband what
to do. I can imagine!
00:08:13.04\00:08:16.79
So the police
officers don't like that.
00:08:16.82\00:08:18.82
Maybe they would have given
the lady a ticket for speeding
00:08:18.85\00:08:21.85
or having her baby too
fast but delivering the baby.
00:08:21.88\00:08:25.14
You know, in the hospital,
many times, they have the
00:08:25.15\00:08:28.69
ladies lay down
and different things,
00:08:28.72\00:08:29.98
I hear you talking
about moving around...
00:08:30.01\00:08:31.76
Is it okay, or is it good
for a lady to be laying on
00:08:31.77\00:08:34.30
their back during delivery?
00:08:34.33\00:08:35.62
Well we encourage being
in the upright position.
00:08:35.65\00:08:40.04
You know, in Exodus 1:15-18,
it talks about the Hebrews
00:08:40.07\00:08:45.71
having their
babies quicker and easier,
00:08:45.74\00:08:48.94
and they were
sitting on birthing stools...
00:08:48.97\00:08:51.11
Birthing stools... Um hm
00:08:51.14\00:08:52.56
And we do see that once
00:08:52.59\00:08:56.14
they are sitting in
an upright position,
00:08:56.18\00:08:59.57
they have their babies;
it opens their pelvis wider,
00:08:59.61\00:09:04.23
and they have them
quicker and easier.
00:09:04.26\00:09:07.14
I brought a
birthing stool with me.
00:09:07.17\00:09:09.26
So this is an actual
birthing stool here. Um hm
00:09:09.27\00:09:12.00
And I guess this is
probably after the birth
00:09:12.03\00:09:14.72
...this baby is on
this, but we should take
00:09:14.75\00:09:17.02
the baby off and
then which way do they...
00:09:17.05\00:09:18.80
Oh, I think it's pretty
obvious which way they sit. Yes!
00:09:18.83\00:09:21.48
They'd sit on
the birthing stool...
00:09:21.51\00:09:23.55
Back is right
here, and there are...
00:09:23.59\00:09:24.94
We try to put some back support,
00:09:24.97\00:09:26.29
you know,
pillows behind her back.
00:09:26.32\00:09:29.05
And this is up on
the bed, or this is...
00:09:29.06\00:09:31.05
No, we cover the floor.
It's on the floor... Um hm
00:09:31.08\00:09:34.52
And it's like almost a squatting
position but with support.
00:09:34.55\00:09:39.46
It opens their
pelvis and the reason
00:09:39.49\00:09:43.60
why I end up getting
this is because I notice that
00:09:43.63\00:09:47.03
a lot of ladies
when they are at home,
00:09:47.06\00:09:49.39
they like the upright position,
00:09:49.42\00:09:54.16
and I have a hard time getting
them out of the bathroom,
00:09:54.19\00:09:56.43
and I didn't want to
have any babies on the toilet.
00:09:56.46\00:10:02.66
Or in the
toilet; one of the two!
00:10:02.69\00:10:04.99
Did your husband
build this for you?
00:10:05.02\00:10:06.72
No, I bought this. Okay
00:10:06.75\00:10:08.71
And so many of the
babies that you've delivered,
00:10:08.74\00:10:12.82
this has been the
stool that they've used...
00:10:12.85\00:10:14.91
in the 700 and... how
many babies is it now?
00:10:14.94\00:10:18.00
Over 750 and not all of
them on the birthing stool,
00:10:18.03\00:10:23.03
but a lot of them.
00:10:23.06\00:10:24.47
And the reason for
that again is because
00:10:24.50\00:10:26.36
that's kind of a
natural position to be pushing,
00:10:26.39\00:10:29.67
and all those different things.
00:10:29.70\00:10:31.20
Yes, the gravity
is in their favor.
00:10:31.23\00:10:33.63
GRAVITY is in their favor.
00:10:33.66\00:10:36.88
Isn't that what they
call it when you're pregnant
00:10:36.91\00:10:39.07
"gravid" or
something like that? Gravida
00:10:39.10\00:10:40.48
Gravida! But that's a
little different than this...
00:10:41.12\00:10:42.70
this is actually
the force of gravity.
00:10:42.73\00:10:46.18
Well, you've written a
book about some of this
00:10:46.21\00:10:48.74
haven't you? Yes, it's
"The Ministry of Midwifery"
00:10:48.77\00:10:52.41
And, didn't you just
finish that recently?
00:10:52.44\00:10:55.39
Yes, I just finished it.
00:10:55.42\00:10:57.10
Oh great, well we're looking...
00:10:57.13\00:10:58.74
And are the things that
we're talking about today,
00:10:58.77\00:11:00.81
are they covered in that book?
00:11:00.84\00:11:01.91
Yes, that's all in the book.
00:11:01.94\00:11:03.56
Great, I know that
some people are saying...
00:11:03.57\00:11:05.32
"I'm not going to be
able to remember all that"
00:11:05.35\00:11:07.17
but at least
they'll have a resource.
00:11:07.20\00:11:09.32
We're talking to Patti Barnes;
00:11:09.35\00:11:11.12
she's a certified
professional midwife,
00:11:11.15\00:11:15.10
and she has a lot of wisdom
from delivering 750 babies.
00:11:15.13\00:11:21.38
When we come back, we're going
to actually walk through a birth
00:11:21.41\00:11:26.43
and talk through it.
00:11:26.46\00:11:28.46
You're going to learn a
lot of interesting things,
00:11:28.49\00:11:30.64
and we hope
that you can join us.
00:11:30.67\00:11:33.61
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Welcome back, we've been
talking with Patti Barnes
00:12:36.94\00:12:39.80
She is a certified
professional midwife,
00:12:39.83\00:12:41.93
and we're talking about home
deliveries, or deliveries right?
00:12:41.96\00:12:45.23
Tell us a little bit
about delivery itself.
00:12:45.26\00:12:48.05
Okay, first of all in a normal
delivery, before labor begins,
00:12:48.08\00:12:56.83
we have what they
call "cardinal moves"
00:12:56.86\00:13:00.50
As the baby moves
down into the pelvis,
00:13:00.53\00:13:02.96
it starts to
rotate, and as you can see,
00:13:02.99\00:13:08.93
the cervix is thinning and
the baby's head is starting to
00:13:08.96\00:13:13.99
rotate internally.
00:13:14.02\00:13:17.35
Labor is continuing and the
cervix is starting to dilate,
00:13:17.38\00:13:20.93
and the water, the
amniotic fluid in front of
00:13:20.96\00:13:25.95
the baby's head is bulging
and the baby continues to rotate
00:13:25.98\00:13:31.45
until the head or the face
is looking down at the rectum
00:13:31.48\00:13:36.77
because that's
the normal position
00:13:36.80\00:13:38.88
of the way the baby
is supposed to come out.
00:13:38.91\00:13:41.38
And the water is
broken at this point?
00:13:41.41\00:13:42.93
Yes, usually it is.
00:13:42.96\00:13:44.97
This crowning
of the baby's head,
00:13:45.00\00:13:49.04
and then when the head
comes out beyond the pubic bone,
00:13:49.07\00:13:54.32
it's looking down at
the rectum, face down.
00:13:54.33\00:13:58.83
And then, externally,
it needs to rotate for the
00:13:58.86\00:14:03.41
shoulders to come through.
00:14:03.42\00:14:04.91
This is external the rotation.
00:14:04.94\00:14:09.02
And, at that point in time,
when the baby rotates that way,
00:14:09.05\00:14:12.43
we check for cord and
then we suction the baby.
00:14:12.46\00:14:15.87
And the anterior shoulder
usually will come first,
00:14:15.90\00:14:19.54
and then the posterior.
00:14:19.57\00:14:21.43
And then, of course,
after the baby comes out,
00:14:21.46\00:14:24.73
then the
expulsion of the placenta.
00:14:24.76\00:14:27.62
The placenta will come out
and then the uterus will start
00:14:27.65\00:14:32.28
contracting going
back to it's normal size
00:14:32.31\00:14:35.89
which is called
"uterine involution"
00:14:35.92\00:14:38.41
So that it stops the bleeding
00:14:38.44\00:14:40.08
and all those
different kind of things. Yes
00:14:40.11\00:14:41.60
If it doesn't
contract, you'd have problems
00:14:41.63\00:14:44.22
with bleeding.
Right, you definitely would.
00:14:44.26\00:14:45.75
So these are called what again?
"The cardinal moves" Um hm
00:14:45.78\00:14:48.05
When the baby comes
down into the pelvis,
00:14:48.77\00:14:50.83
it rotates and the
pelvis is greatly influenced
00:14:50.86\00:14:57.04
in pregnancy.
What happens to it?
00:14:57.07\00:15:01.22
Well the hormones,
progesterone and relaxing will
00:15:01.26\00:15:06.95
cause the sacroiliac joints of
the pelvis to be more flexible.
00:15:06.98\00:15:14.24
And show us where those
joints you are talking about.
00:15:14.27\00:15:15.90
Okay, as the baby comes
down, joints on either side...
00:15:15.93\00:15:19.71
Right here... these
joints in here. Um hm
00:15:19.74\00:15:22.15
The pelvis will
open up like this.
00:15:22.16\00:15:24.13
Okay, so you're talking
about these joints right here.
00:15:24.14\00:15:26.75
Yes, on each side,
and the sacrum will
00:15:26.78\00:15:30.40
move out of the way.
00:15:30.43\00:15:31.68
Okay so it's like the
sacrum here moves out of the way
00:15:31.71\00:15:35.74
like how again?
00:15:35.77\00:15:36.98
Um hm, will move
out of the way...
00:15:37.01\00:15:38.40
And the last little coccyx
joint will move out of the way.
00:15:38.43\00:15:43.23
The symphysis pubis joint
here... There in the front
00:15:43.26\00:15:47.42
Yes, that will...
Relaxes as well. Yes
00:15:47.45\00:15:51.10
Is that why they
call it "relaxin?" Yes
00:15:51.13\00:15:55.16
It's not
supposed to be this open,
00:15:55.19\00:15:56.76
but this pelvis
had too many babies...
00:15:56.79\00:15:59.86
It's supposed to be
together a little more.
00:15:59.89\00:16:01.60
I see... So this then
just normally happens,
00:16:01.63\00:16:05.58
you don't have to take a
medicine for this or anything;
00:16:05.61\00:16:07.18
it just relaxes and
it's doing it on its own...
00:16:07.21\00:16:09.18
The pelvis opens up
as the baby comes down
00:16:09.19\00:16:12.56
through the pelvis.
00:16:12.59\00:16:13.79
It opens up this
way and then the sacrum,
00:16:13.80\00:16:16.92
and then the coccyx;
now it moves out of the way.
00:16:16.95\00:16:19.99
Do that again and point that
00:16:20.43\00:16:22.14
towards the camera
there in the middle.
00:16:22.17\00:16:23.62
How would you do that again?
00:16:23.66\00:16:24.93
Okay, as the baby comes down
00:16:24.96\00:16:26.20
it opens up this
way, and then sacrum,
00:16:26.23\00:16:31.48
and then the last little
joint here, back out of the way.
00:16:31.51\00:16:35.84
Wonderful!
00:16:35.87\00:16:38.73
I take it you've
done this before,
00:16:38.76\00:16:40.63
and shown this many times.
00:16:40.66\00:16:42.12
Yes... This is
your teaching pelvis.
00:16:42.15\00:16:47.39
Well, you've told me
that you want to show me
00:16:47.42\00:16:50.41
the entire process here
of delivery as well. Okay
00:16:50.44\00:16:54.60
And so, we've brought
some different things here,
00:16:54.63\00:16:56.25
and we have some time
to work through this here.
00:16:56.26\00:17:01.41
What's going to
be best for me to do?
00:17:01.44\00:17:03.27
You just tell me
what to do here. All right
00:17:03.30\00:17:07.44
Now you've already
delivered babies, remember?
00:17:07.47\00:17:10.14
Right, yeah, but I've
usually had most of the
00:17:10.17\00:17:12.00
people here with me, you know;
I didn't just have the pelvis.
00:17:12.03\00:17:15.29
ha, ha, ha... All right.
00:17:15.32\00:17:17.04
Well as the baby is coming down,
00:17:17.07\00:17:18.55
Okay, let's turn it this
way so everybody can see this.
00:17:18.58\00:17:21.33
As the baby is coming down...
00:17:21.36\00:17:25.23
The best
position... Where is lightening?
00:17:25.26\00:17:26.78
Okay, it's when
the baby is engaged...
00:17:26.79\00:17:30.01
Right there... that what you
00:17:30.02\00:17:33.11
called a little bit
earlier "lightening" huh.
00:17:33.14\00:17:34.97
And as the baby is moving
down into the pelvic cavity,
00:17:35.01\00:17:39.34
it begins to rotate and
the head will rotate internally
00:17:39.35\00:17:43.14
as it starts to crown
to look down at the rectum.
00:17:43.17\00:17:47.27
Okay, so the back of
the head is going to be
00:17:47.30\00:17:49.48
what you see
here. Yes... Crowning
00:17:49.51\00:17:53.14
The baby comes through the
pelvis... Through the pelvis
00:17:53.17\00:17:59.42
All right, and this
is all opening up... Yes
00:17:59.45\00:18:02.66
Then it turns this way?
00:18:02.69\00:18:03.91
Yes, but you
don't... I don't turn it. No
00:18:03.94\00:18:06.74
If I turn it, that
could be a problem.
00:18:06.77\00:18:07.96
Now when it's coming out,
00:18:08.00\00:18:08.98
do I check for
anything as it's coming out?
00:18:09.02\00:18:10.81
Yes, you do...
What I was going to say
00:18:10.84\00:18:14.35
is if it doesn't
rotate, if it stays this way,
00:18:14.38\00:18:17.56
it should indicate to
me that the baby could have
00:18:17.59\00:18:22.59
what they call
"shoulder dystocia"
00:18:22.62\00:18:24.20
The shoulder stuck
behind the pubic bone.
00:18:24.23\00:18:26.16
Okay, so what do you do then?
00:18:26.19\00:18:28.01
Well, the baby
always needs to rotate;
00:18:28.04\00:18:30.35
in other words,
rotate the shoulders this way
00:18:30.38\00:18:34.12
so that the baby can come out,
00:18:34.15\00:18:37.56
but if it doesn't, we
do different maneuvers like
00:18:37.59\00:18:39.86
we'll turn the mother
over on her hands and knees
00:18:39.89\00:18:43.23
to open the pelvis up wider.
00:18:43.26\00:18:45.57
Or we'll go in
this way and get a hold
00:18:45.60\00:18:51.39
underneath the armpit
and just try to rotate it
00:18:51.42\00:18:54.83
counterclockwise.
00:18:54.86\00:18:56.40
Now is the shoulder this
way so that it is right there
00:18:56.43\00:18:59.14
where the pubic symphysis
is, so it can open up...
00:18:59.17\00:19:01.35
is that why it's there?
00:19:01.38\00:19:03.02
Well, yes it does open it
up, but it needs to rotate
00:19:03.05\00:19:07.64
sideways so that the
anterior shoulder should come
00:19:07.67\00:19:11.52
through first. Oh okay
00:19:11.55\00:19:12.82
And then the
posterior, but at this point,
00:19:12.85\00:19:14.52
you should be just
supporting the baby's head.
00:19:14.55\00:19:16.45
Support... okay, you
tell me what to do. Okay
00:19:16.48\00:19:18.54
Support the baby's head...
00:19:18.57\00:19:19.86
Immediately check for
the cord around it's neck.
00:19:19.89\00:19:22.09
Okay and why do we do that?
00:19:22.12\00:19:23.14
We're checking now -
You're saying this cord... Yes
00:19:23.17\00:19:25.78
And it could be down
there around... It could be
00:19:25.81\00:19:27.80
What do you do if it is?
00:19:27.83\00:19:29.11
Well, we have several
and it's usually no problem.
00:19:29.14\00:19:32.18
We just loosen it over the
head, or over the shoulders.
00:19:32.21\00:19:35.81
And push it back in.
00:19:35.84\00:19:36.83
And we just lift it up and let
her push the baby right through
00:19:36.86\00:19:41.38
And if you DON'T
do that, what happens?
00:19:41.41\00:19:42.66
Well if it's too tight
and you cannot do that,
00:19:42.69\00:19:44.56
then we just clamp in
two places and cut in-between
00:19:44.59\00:19:48.58
...You know,
clamp it off in 2 places
00:19:48.59\00:19:51.26
and then cut it
off the baby's neck.
00:19:51.30\00:19:53.18
Now you do that though
only if the... If it's too tight
00:19:53.22\00:19:55.07
If it's too tight and if
the baby's mouth is outside?
00:19:55.99\00:19:58.47
Oh yes, when it's out you check,
00:19:58.50\00:20:01.92
you could feel around the neck,
00:20:01.95\00:20:04.63
and then you suction
the baby at this point.
00:20:04.66\00:20:06.90
Okay, take this and you
told me that I need to push
00:20:06.93\00:20:09.27
it in like this
first, right? Yes
00:20:09.30\00:20:11.50
I had to do it first
before instead of afterwards,
00:20:11.51\00:20:14.82
or I'll get a big
squirt... All right
00:20:14.83\00:20:17.81
Rinse out the
mouth and then the nose.
00:20:17.84\00:20:19.00
And the nose too... Yes
00:20:19.03\00:20:20.79
All right... I'm suctioning
the mouth and the nose.
00:20:20.82\00:20:25.52
All right, I got it. Okay
00:20:25.55\00:20:28.38
How did I do? You did great!
00:20:28.41\00:20:30.56
I think so. All right
00:20:30.57\00:20:34.09
Okay, now she's pushing...
she's pushing the baby out
00:20:34.12\00:20:39.44
All right, at this
point... How do I hold it?
00:20:39.47\00:20:42.59
Just like that...
Just like this? Uh huh
00:20:42.62\00:20:44.83
When do I give it a
spanking like they normally...
00:20:44.84\00:20:47.48
Well you don't.
You don't have too?
00:20:47.51\00:20:49.08
We don't, usually it
will come out crying,
00:20:49.11\00:20:52.33
or you could stimulate it by
rubbing the back, massaging it.
00:20:52.34\00:20:55.09
Do I need to suction it again?
00:20:56.08\00:20:57.28
If it's mucousy, you
could suction it again.
00:20:57.31\00:20:59.44
You say "it," "the little
one," or how do you say...
00:20:59.47\00:21:02.27
"The little baby"
The little baby - okay
00:21:02.30\00:21:04.38
And I suction
again... Now isn't it slippery
00:21:04.39\00:21:06.65
with all that stuff on it. Yes
00:21:06.68\00:21:08.15
So I have to be careful. Yes
00:21:08.18\00:21:09.56
How do you usually
hold it, like this?
00:21:09.57\00:21:10.94
Yes... Like that, okay
00:21:10.97\00:21:12.55
And I'm suctioning again...
00:21:12.58\00:21:14.18
Oh wait a minute, I'm
supposed to do it like this,
00:21:14.21\00:21:16.30
and then the nose again. Right
00:21:16.33\00:21:18.25
This baby has it's eyes opened
being delivered, is that normal?
00:21:18.28\00:21:21.55
Yes, that's normal. Okay
00:21:21.58\00:21:23.69
And then what do I do?
00:21:23.72\00:21:25.59
It's still
hooked up there somehow.
00:21:25.60\00:21:28.39
Yes, usually I let the
mother nurse the baby...
00:21:28.42\00:21:31.26
If the cord stops pulsating, you
can go ahead and clamp it off.
00:21:31.27\00:21:34.55
Okay, so wait for the
cord to stop pulsating.
00:21:34.58\00:21:38.24
Let me ask about this cord,
00:21:38.27\00:21:39.39
it looks like you
have a blue cord in there,
00:21:39.42\00:21:41.34
and then a red cord.
00:21:41.35\00:21:42.40
How many cords
are there in there,
00:21:42.43\00:21:43.63
and how many
vessels are there in there?
00:21:43.66\00:21:45.05
There are 3, 2
arteries and 1 vein.
00:21:45.08\00:21:48.90
All right, let me just have you
00:21:48.91\00:21:51.84
hold this... Okay,
and I'll hold the baby.
00:21:51.88\00:21:53.16
And so I take this clamp...
this is the clamp, right? Right
00:21:53.20\00:21:57.02
And I put it right there...
I'm not going to clamp it
00:21:57.05\00:21:58.28
because I probably won't
be able to undo it. Go ahead
00:21:58.31\00:22:00.43
I CAN clamp it? Um hm
00:22:00.44\00:22:02.41
Well thank you.
All right, right there.
00:22:02.44\00:22:04.86
And then I take one
of these, I suppose,
00:22:04.89\00:22:08.01
and I put it right here? Yes
00:22:08.04\00:22:09.89
Okay, and then I can
clamp it. You can clamp it.
00:22:09.92\00:22:12.25
And then, let's just
pretend these are scissors,
00:22:12.28\00:22:14.71
is this what I'm
supposed to do? Right
00:22:14.74\00:22:16.25
Cut right between...
And I cut right there. Yes
00:22:16.28\00:22:18.52
Okay, cut... And
let's pretend that we
00:22:18.55\00:22:21.41
took it off and then
you... The baby nurses
00:22:21.44\00:22:24.68
And then what happens next?
00:22:24.71\00:22:26.12
Now you get a hold of the
cord because you're waiting
00:22:26.15\00:22:28.22
for the placenta to detach.
00:22:28.23\00:22:30.22
Okay, we're waiting for this...
the placenta is this up here
00:22:30.25\00:22:33.51
to detach from the uterus.
00:22:33.54\00:22:35.50
And as the baby nurses,
it causes Oxytocin to release
00:22:35.53\00:22:43.99
a natural Oxytocin and
the Oxytocin will encourage
00:22:44.02\00:22:48.71
the contractions and
as the uterus contracts,
00:22:48.74\00:22:51.72
it starts bringing
the uterus down to size,
00:22:51.75\00:22:54.33
it's called uterine involution,
and it detaches the placenta
00:22:54.36\00:22:57.92
from the uterine wall.
00:22:57.95\00:22:59.77
So actually the baby triggers
that... it's amazing isn't it?
00:22:59.80\00:23:03.12
The baby triggers that, okay.
00:23:03.15\00:23:04.97
Now what we do is
like a cord traction,
00:23:05.00\00:23:08.60
wrap it around your finger.
Wrap it around the finger...
00:23:08.63\00:23:10.19
You know, like have
you ever been fishing?
00:23:10.79\00:23:14.46
Okay, just put some
cord traction on it,
00:23:14.49\00:23:17.24
pull it a little bit.
00:23:17.27\00:23:18.62
Okay, you can feel
that it's tight right? Right
00:23:18.65\00:23:21.51
Okay, well as
the uterus contracts,
00:23:21.54\00:23:23.69
and it releases, you'll feel it.
00:23:23.70\00:23:26.00
And I just take up a
little bit more slack then.
00:23:26.03\00:23:27.84
Yes, you'll see
that it's loosening,
00:23:27.85\00:23:31.03
and you'll see a little
gush of blood. All right
00:23:31.06\00:23:33.66
And then you will
have her push it out.
00:23:33.69\00:23:37.03
Okay, so as
she's pushing it out,
00:23:37.06\00:23:39.10
what we do at this point,
when you see the placenta,
00:23:39.13\00:23:43.06
is I'll take and twist it right
here, just to wrap the membranes
00:23:43.09\00:23:50.80
all around the placenta
because I want to get every bit
00:23:50.83\00:23:54.57
of the placenta out, I
don't want to leave it...
00:23:54.60\00:23:56.11
And then once it comes out,
00:23:56.14\00:23:57.45
do you check it to
make sure it's all out?
00:23:57.48\00:23:59.26
Yes, I check every bit of
it because I want to make sure
00:23:59.29\00:24:01.92
I didn't even leave one little
00:24:01.95\00:24:03.57
piece of placenta
inside the uterus.
00:24:03.60\00:24:05.84
Now I remember
from nursing school,
00:24:05.87\00:24:07.36
they have 13 places.
Is that right or not,
00:24:07.39\00:24:09.91
maybe I'm wrong.
What do you call it?
00:24:09.94\00:24:11.63
I don't remember, but there are
00:24:11.66\00:24:12.64
different places it's hooked in,
00:24:12.67\00:24:13.95
and then do you
checkup as well in the uterus
00:24:13.98\00:24:16.28
to make sure it's
all out of there too,
00:24:16.31\00:24:17.59
or do you just do it
by checking the placenta?
00:24:17.62\00:24:19.78
Well, we could usually
see if everything is here.
00:24:19.81\00:24:22.96
This is the maternal
side of the placenta;
00:24:22.99\00:24:25.44
this is the side that is
attached to the mother...
00:24:25.47\00:24:28.41
And all these little
pieces are called "cotyledons"
00:24:28.44\00:24:32.41
and they fit like a puzzle.
00:24:32.44\00:24:34.70
And we can see
that they're all there,
00:24:34.73\00:24:36.82
and then on this
side, the shiny side,
00:24:36.85\00:24:40.02
this side is
attached to the baby.
00:24:40.05\00:24:43.67
Okay, and we make sure that
00:24:43.70\00:24:46.95
the veins end before
the edge of the placenta,
00:24:46.98\00:24:50.43
so we know that it's all there.
00:24:50.46\00:24:52.54
Now if the veins run off
the edge, we can know that
00:24:52.57\00:24:56.33
something is left
up inside the uterus.
00:24:56.36\00:24:58.90
Okay, and then we
check the amniotic sac.
00:24:58.93\00:25:01.47
This is what the baby was in.
00:25:01.50\00:25:03.01
There are 2
layers; the amniotic sac,
00:25:03.04\00:25:04.86
the amnion and the chorion.
00:25:04.89\00:25:07.09
And we hold it up to
see that it's all there.
00:25:07.12\00:25:10.93
Because you don't want to
any of that in there as well.
00:25:10.96\00:25:13.18
It might have infection or
something if it's left in there
00:25:13.22\00:25:15.41
Well even just a little
piece of membrane that's left in
00:25:15.57\00:25:20.53
where the placenta side was,
could cause a major hemorrhage
00:25:20.56\00:25:23.15
or even an infection.
00:25:23.18\00:25:24.60
So that's really important...
00:25:24.63\00:25:26.18
the afterbirth is as important
00:25:26.21\00:25:28.68
as the birth... in
terms of your work. Yes
00:25:28.71\00:25:31.23
So then what's happening
with the baby right now?
00:25:31.26\00:25:33.37
What do you do
next with the baby?
00:25:33.38\00:25:35.05
Well, I let the baby nurse,
00:25:35.08\00:25:36.66
and the parents
bond with their baby.
00:25:36.69\00:25:39.33
The most important thing
is to make sure that the baby
00:25:39.36\00:25:42.37
has good color and is nursing
well and the baby is warm.
00:25:42.40\00:25:50.55
So you cover it up
with a warm blanket.
00:25:50.56\00:25:52.15
We have a warm
blanket... we have a warm cap
00:25:52.16\00:25:54.59
we put on its head,
and we make sure that
00:25:54.62\00:25:59.34
the mother is not bleeding
also as well, not a whole lot.
00:25:59.37\00:26:04.26
Okay, so then... I've
heard this expression used
00:26:04.29\00:26:07.52
"Apgar scores"
When do you do that?
00:26:07.55\00:26:09.46
Right when the baby is born.
00:26:09.49\00:26:10.99
And you have like a
little chart or something? Yeah
00:26:11.02\00:26:12.64
It's 1 minute and
then at 5 minutes again.
00:26:12.67\00:26:16.54
What are you
checking on the Apgar score?
00:26:16.57\00:26:17.65
We're checking the fetal
heart tones, the respirations,
00:26:17.68\00:26:22.03
the color of the baby;
is the baby well-flexed
00:26:22.04\00:26:27.12
or is it limp... you know.
00:26:27.15\00:26:29.75
Do you let the dad in the room?
00:26:29.78\00:26:31.52
Do I let the dad in the room?
00:26:31.55\00:26:33.46
I encourage the dad to
help with the delivery.
00:26:33.49\00:26:35.54
With the delivery... is
that why you had me do this?
00:26:35.57\00:26:37.31
Um hm... Okay, that's great!
00:26:37.34\00:26:42.30
How long does this whole
process normally take then?
00:26:42.33\00:26:44.94
The delivery itself?
00:26:44.97\00:26:46.59
Labor and delivery or just...
00:26:46.62\00:26:48.54
Not labor and delivery,
but the delivery itself.
00:26:48.57\00:26:50.82
When it starts coming down,
00:26:50.85\00:26:52.26
the cardinal
moves when they start.
00:26:52.29\00:26:54.06
Well, it's different for...
Different for different people.
00:26:54.09\00:26:56.66
Yes... if it's your first
baby, it could be 8-16 hours,
00:26:56.69\00:27:05.55
but then again, I've had some
primips or first-time mothers
00:27:05.58\00:27:10.86
surprise me with
5-hour deliveries.
00:27:10.89\00:27:13.70
I'm talking about labor
and delivery, I'm sorry.
00:27:13.73\00:27:17.90
The pushing stage, just
when the mother is pushing
00:27:17.93\00:27:22.08
the baby out...
for the first mother
00:27:22.11\00:27:25.23
it could take 2-4 hours.
00:27:25.24\00:27:27.21
BEAUTIFUL isn't it!
00:27:27.24\00:27:28.50
Every time you see this it's a
miracle for you, is that right?
00:27:28.51\00:27:30.98
It's a miracle!
00:27:31.01\00:27:32.39
We've been
talking with Patti Barnes
00:27:32.42\00:27:35.37
She is a certified
professional midwife.
00:27:35.40\00:27:37.17
She has
delivered over 750 babies.
00:27:37.20\00:27:39.57
She has written a
new book entitled...
00:27:39.60\00:27:42.72
"The Ministry of Midwifery"
00:27:42.75\00:27:44.72
And really, it's a
beautiful thing to see
00:27:44.75\00:27:47.73
a new life come into the
world and be a part of it.
00:27:47.74\00:27:50.21
And it's wonderful
to have people that know
00:27:50.24\00:27:51.92
what they're
doing that can help us,
00:27:51.95\00:27:53.65
and help that little one
have life right from the very
00:27:53.68\00:27:56.97
beginning that
hopefully, as a result...
00:27:57.00\00:27:59.13
will last for a lifetime!
00:27:59.16\00:28:01.31