After re-reading yesterday's post about the unusual placenta, I realized that a big picture of a placenta as the first image seen on my blog is NOT a modest photograph and may very well be hard to look at by many people, especially if you're not expecting it.  I am sorry for that oversight and submit this entry as a space filler until my creative writing juices get flowing again.  Let it also serve as a warning about the photographs that follow this entry.  They are graphic images of a placenta being examined after it was released by the mother's body.  There is blood visible on the placenta but no people showing in the photos. 

Exodus 1:17 - But the midwives feared God....

We recently attended a birth which had interesting conditions of the placenta.  Here are some pictures of a circumvallate placenta with velamentous insertion of the cord.

In 99% of pregnancies, the umbilical cord inserts on the placental mass. The insertion site may vary from the center of the fetal surface to the border of the placenta. The term velamentous insertion describes the condition in which the umbilical cord inserts on the amniotic membranes rather than on the placental mass. Therefore, a segment of the umbilical vessels runs between the amnion and the chorion of the amniotic sac, losing the protection of the Wharton's jelly.

The incidence of this condition is about 1.1% in singleton pregnancies The most significant problem arising from a velamentous insertion of the umbilical cord is vasa previa, a  condition in which the velamentous umbilical vessels traverse the fetal membranes in the lower uterine segment below the presenting part of the baby. In 6% of singleton pregnancies with a velamentous insertion, vasa previa is a coexisting condition. These unprotected vessels may rupture at any time during pregnancy, causing fetal exsanguination and death. Although spontaneous rupture has been reported before labor and with or without intact membranes, this accident occurs most often during amniotomy. (Quintero, Sepulveda, Romero, et. al.)

This same placenta is a circumvallate placenta in which the amniotic membranes double back for a short distance over the fetal surface. This decreases the surface area of the placenta reducing delivery of oxygen and nutrients which may lead to fetal growth retardation  and/or fetal loss.

In this birth, we were not aware of the placental conditions until after the baby and placenta were born.  The birth proceeded smoothly and baby was born gently, without drugs of any kind and no forceful pushing during the second stage of labor.  The bag of waters ruptured spontaneously a few minutes before the head emerged.  There was no blood in the amniotic fluid and the velamentous vessels were intact upon postpartum examination. The baby was born with high apgar scores, vigorously nursed immediately after birth and has since grown into a vibrant toddler. 

This birth accentuates the need for natural childbirth with a watchful birth attendant.  This labor was longer than the mother's previous births which would tempt some birth attendants to artificially break the bag of waters.  Had we done so, we would have seriously risked rupturing the velamentous vessels and losing the baby.

But if we hope for that we see not, then do we with patience wait for it.  Romans 8:25

In April 2007 I met Erika, who became my student and apprentice in midwifery.  Through the course of the year we have grown in friendship through our time together in prenatal appointments, births, labor-false alarms, postpartum cares and of course...during our ritual "post-birth-breakfast-at-the-diner" discussions. 

"Post-birth-breakfast-at-the-diner" is a tradition passed down from Alice Skenandore which has become a favorite time of mine with Erika in the past year.  After each birth, we traditionally drive closer to home and meet at whatever little diner is on the way which catches our eye.  Sometimes its taco bell at  3:00 a.m., sometimes Denny's at ten in the morning...other times its a 24-hour truck stop or family restaurant in a little town. 

What I enjoy most about our breakfasts is the opportunity to unwind together before we head home to our respective duties and family needs.  We laugh together about silly things seen along the road; we share our stories of family life and child rearing and listen to each others' challenges and trials of day to day life.  Sometimes we talk about the birth we just attended...but not usually;  its a time of decompressing and letting our hair down before regrouping with our families. 

Four days ago, Erika left for Texas where she will spend the next three months attending births in a busy birth center.   I am going to miss those breakfasts with her immensely!  She is recording her adventure in a blog entitled "Student Midwife".  I sure hope that we can continue to help each other unwind after births during her stay in Texas...if only by blogging and email! 

Here is a really nice picture of Erika while she was here.  She looks so natural in her role as midwife here doesn't she?