Whose Blog Is This?
Log onto Squarespace
Archives
Thursday
Jun132013

Guest Post: 5 Reasons to Invest in Babywearing

Babywearing is the act of carrying your child around with you for great amount of time while being comfortable doing so. Some parents view this as an excess of attention. However, babywearing can have a great deal of personal and sociological practicality. There are many reasons why babywearing is an ideal form of raising your child, none of which has implications towards spoiling. In fact, babywearing can be greatly beneficial to solidifying the link between yourself and your child.

1. Comfort - From the moment the child exits the womb, he or she is going to need constant reassurance that everything is OK. This is a new world to him or her and having the presence of your body against the child's can help alleviate anxiety he or she may be experiencing. Since every circumstance is a new experience, the child needs that confirmation that you are present and will protect him or her from harm.

2. Ease of Feeding - For those who have babywearing clothing, breast feeding in a public place is so subtle that no one even realizes what is going on. Without having to fight straps or ties, you can cover your child while he or she feeds under the protection of a babywearing satchel. Since these are wrapped around your shoulders, your hands are free to go about your business while providing the support your baby needs. It's like having an extra set of hands holding your child.

3. Ease of Mind - There is a great relief of stress when you feel the weight of your child pressed against your body. Not only is it calming for your child, but it helps you calm down as well knowing your child is safe and secure. Some mothers have even mentioned how babywearing has eased some of the tension from separation anxiety. Children are not the only ones who can become anxious when away from the parent.

4. Less Fussy - Children that are snuggled against their mothers are inherently less fussy. This can be a benefit for instances while in public places such as movie theaters or restaurants. The less fussy your child is, the more everyone enjoys the situation. Although you may still need to cut the movie a bit short in order to deal with a dirty diaper, breast feeding during the movie or simply holding your child isn't as burdensome physically as it would be otherwise.

5. Hands-free - Being hands free whether you're in public or at home is a blessing to many parents. Babywearing can allow you to continue with most of your day-to-day activities without having to stop and care for your child. Although it may sound like it's a bit of a lazy approach to parenting, you are providing your child with the safety of being close to you while being able to complete various tasks.

You don't have to carry your child around with you until he or she is old enough to drive. However, the additional attention when he or she is between the infant and toddler stage can greatly improve the bond that many parents would be jealous over. As there are many ways you can carry a child in this fashion, comfort for yourself is not an issue. Isn't the prospect of starting off your relationship with your child strong a reason to investigate the possibility of babywearing?

Author Bio:

Rachel is an ex-babysitting pro as well as a professional writer and blogger. She is a graduate from Iowa State University and currently writes for www.babysitting.net. She welcomes questions/comments which can be sent to rachelthomas.author @ gmail.com.

Sunday
May262013

Colonization

I read a piece called “Cesarean Birth Linked to Childhood Obesity” that discussed the baby being introduced to the mom’s good bacteria as he is being born through the mom’s vagina. Theories about allergies, Type I Diabetes, and Celiac Disease have all been implicated in children not receiving their mother’s colonization from their good bacteria when going through the vagina.

Another a June 2012 study offers a detailed look at the early stages of the body's colonization by microbes. Babies born vaginally were colonized predominantly by Lactobacillus, whereas cesarean delivery babies were colonized by a mixture of potentially pathogenic bacteria typically found on the skin and in hospitals, such as Staphylococcus and Acinetobacter, suggesting babies born by CD were colonized with skin flora in lieu of traditionally vaginal type of bacterium.

There’s so much science here, I’m just going to leave it to the researchers. I know they are studying it, they are pcking apart vaginal and cesarean births, I suspect they are taking the different modes of transportation apart (via the nose, mouth, eyes, ears or a combo of any of the methods). I’m just wondering what we do know about it?

Do we add lines in our birth plans that ask for a swab of vaginal fluid if we have a cesarean so we can run it on our breast for our baby to colonize with it? I would ask for a large swab, not a q-tip sized one). Today it seems kind of gross smearing our juices on our breasts and the laying the baby on there to nuzzle. But, I don’t see it being too far in the future when it becomes the standard of care. Might we take a cloth and schmear it down the woman’s whoo haa and then rub on  the baby’s face and then clean the face off. Any of these ways seem doable to colonize the baby.

Is this far in our future? Already I hear about CMNs who swab for the mom and know that women ask for the ability to colonize their babies. Would I be doing this if it were me or Meghann? Absolutely.

What are your thoughts about this controversial experience with colonization?

Sunday
May192013

Oubli's Vaginal Tear

I was asked to share a different kind of birth scar story, different than the usual cesarean scar stories I share here. I welcomed her re-telling of her birth... and share it here with you all.

My Birth Scar

My pregnancy and birth were uneventful medically, textbook in every way - except the tear. In the standard lithotomy position in a hospital with a CNM guarding my perineum, my labia minora split horizontally in two as my child entered the world.

Cue the inept stitch work from a CNM who had too many patients and was in a huge hurry. Not enough stitches were used and days after I was discharge the too few that were there snapped while ambulating. Suffice it to say my labia didn't heal correctly, it didn't heal together, two pieces of flesh cleaving and fusing as it should have. A trip back to the CNM the next day and I was told, "There's nothing we can do, it's a purely cosmetic issue now - deal with it, you are wasting our time unless it's infected."

I hate my wound, for a long time I couldn't bear to look at it or touch it. It makes sex less enjoyable and sometimes uncomfortable (the skin flaps get grabbed by my DH and pulled inside during thrusting) and gynea exams just aren't as much fun as they used to be *snark*.

I call it a wound because I am still wounded by it, although it has healed. To add insult to injury I cannot get it repaired until after I am done child bearing, as plastic surgery on that delicate area has the same risks as Female Genital Mutilation.

Here's why I feel I need to be done childbearing beforehand - "[I]n nursing school I helped out at the delivery of a woman who'd had labiaplasty several years before, and holy shit. It sort of, um, shredded. One of the most horrific things I've seen in my career. It took them a really long time to sew everything back together, and I have a feeling she would have happily gone back to some slightly asymmetric or (gasp!) flappy labia if she could have."

http://jezebel.com/5402091/report-vaginal-plastic-surgery-has-same-risks-as-fgm

Other sources about vaginal rejuvenation or vaginoplasty, includes info about labiaplasties.

http://news.bbc.co.uk/2/hi/health/8352711.stm

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/co378.pdf?dmc=1&ts=20121129T0006283149

I fear that if I get it fixed before I am done child bearing it won't stretch properly, as scar tissue is inelastic and it may pop again creating a far more terrible tear in the same place. Even if I do not get it repaired I still worry about it tearing in the same place and becoming a vaginal wall tear. I never feared child birth before but this tear makes me rethink having more children.

4 years after the the initial tearing, it's hard to watch my birth video because of it, I resent my midwife for the lithotomy position, I resent my daughter (a bit) for causing it, I can't masturbate or have sex without touching/thinking about it (usually negatively), when I shave I have to be extra careful not to nick it as it protrudes further than the other side. Oh an did I mention that my stitches didn't completely dissolve, every few months I feel like I'm being stabbed from the inside out as bits of stitch work make their way to the surface and have to be delicately removed. I used to think my vulva was gorgeous and now it looks and feels sad all the time. My scar is still very much a wound that hasn't healed.

Sunday
May192013

How to Choose a Birth Doula

There are as many kinds of doulas as there are women who want one, so deciding how to choose one can really come down to personality. But, might there be other aspects of doula-dom that aren’t so individualistic? 

Education

It should be a given that your doula has taken a training course of some kind. I am not of the school that believes a certification makes a great doula (I am not a certified doula, either), but definitely a weekend workshop should have been had. Whether it’s DONA, CAPPA, toLabor or any of the other groups one might find (Radical Doula has a great list here), attending a training will have been infinitely helpful to your doula.

Experience

This doesn’t necessarily have to be hands-on experience since some of the best doulas I’ve met have been newbies, but there is a great deal of information out there that women can learn via books and videos. They can also learn at meetings where doulas gather to talk about cases. Watching videos of doulas, she can see what makes a good doula, how the woman touches the laboring mom, what kinds of suggestions she makes to her as the labor progresses and how to move about the room unobtrusively. I talk more about experience below in Referrals. Ask your doula-to-be how she’s come by her experience and these might be some of her answers.

Knowledge

This doesn’t have to be just book knowledge, but books cannot be overlooked when a doula is educating herself. What the doula reads and assimilates can help her practice immensely. Much of what I think a doula could do to up her knowledge is to read midwifery texts. Reading Heart & Hands and Ina May’s Guide to Childbirth are two really good books to read to get a feel for the rhythm of labor and delivery. The Birth Partner and The Ultimate “How to” Guide for Doulas are great doula books to read. I haven’t read Experienced Doula: Advanced Skills for Hospital Doulas, but the Amazon comments seem to recommend it. If it lives up to the title, it should be a good one.

Referrals

How do you know how the doula’s going to be interacting with the hospital staff? How will you know until you are in the throes of labor? The best way is through recommendations. This, of course, would mean your doula is experienced. This won’t work if your doula is brand new. But, not to knock new doulas (who might be awesome out of the gate), but I would really encourage at least a little bit of experience before venturing into a doula-client relationship. The question becomes, how can a doula get experience if women only hired experienced doulas? Most doulas start out helping friends and family, not being hired outright by strangers, so developing clientele, even if it is friends and family, is a great way to garner the recommendations she will need. This is sure to be my most controversial advice, but I do stick by getting referrals as a way to learn how a doula acts in labor and birth. You still might come up against a doula that isn’t a good fit in labor, but the likelihood would be less. How a doula interacts with the hospital staff can mean the difference between an awesome birth and a train wreck, so recommendations can’t be taken casually.

Asking the Right Questions

Knowing what kind of doula you want will help you here. Are you looking for a motherly-type doula? Or a take-charge doula? Do you want a doula to tell you what to do throughout your labor? Or do you want to lead the way? I know this can be a challenging question, but imagining yourself in labor can help you decide what type of woman you are and what you’re looking for in labor.

A good doula is able to mold herself into what you need, so if you change your mind in the middle of things, she should be able to move along with you.

So, what to ask?

- How many times will we meet? That answer should be at least twice during the pregnancy and once or twice afterwards; most meet with you twice afterwards.

-When do I call you? The answer should be “Whenever you want to.” Doulas should be available via phone, text, email throughout the pregnancy and then physically available from 37-38 weeks along. I say 37 or 38 because doulas have different beliefs about call-time. If you suspect you will go early (and not just because you hope you go early!) you might make sure you hire a doula who will come earlier.

- What If I have pre-term labor? Will you come? Most would if at all possible, but if you’re having pre-term issues, it would be good to ask the doula this question.

- When do I call you in labor? Again, the answer should be “Whenever you want to.” (I tell women, “If you think, ‘Should I call Barb?’ the answer is ‘YES!’”) Women need to be able to touch base with their doulas in early labor even if the doula is hours away from going to them. Through repeated phone calls, the doula and client can decide when the right time to get together will be. Depending on whether the doula is meeting you at your house or at the hospital depends on how far along in labor you will see each other. If you want a doula sooner than later (you think), mention that to the doula. Make sure she goes to the mother’s home before you find out in labor she’ll only meet you in the hospital.

Now, I have no qualms about a doula meeting you at the hospital instead of in your home. It’s what I do if I doula. I am uncomfortable laboring with a mom at home when she isn’t monitored, so only do monitrice work when a woman wants me to come to her home in early/ier labor. But, many doulas don’t have any issues with going to women’s homes and that’s fine, too. Just be sure you know what your doula will do before you get there.

Some answers you might hear include: When you can’t walk or talk through a contraction; When you feel you need me or When your contractions are less than 5 minutes apart. All of these are valid answers, none better than another.

- Who is your back-up? No matter how wonderful your doula, things happen and sometimes she won’t be able to make it to your birth. She or her kids might be sick. Someone in her family died. There might be another client in labor and she’s already committed to her (because the other woman went into labor first) or because her car broke down… all of these but the car have happened to me with clients over the last 30 years. It’s rare, but can happen. I have a couple of great (female) back-up doulas that are glad to meet with clients beforehand, but don’t have a monitrice back-up (yet). I am clear with monitrice clients that this might happen and I will refund them the difference if I have to send a doula instead of my going when she’s in labor. It’s best if your doula is able to connect you with her back-ups, even at least with a phone call so you know how to reach her/them if necessary.

- How do you see your role? This answer can be endless and this is when your own expectations come into play. Typical answers would be: As someone to soothe you when you’re in labor; To help you before, during and after the birth and As an educator to help you know your options in birth. It is important for a doula to be a teacher of some sort… not necessarily a childbirth educator, but have a teaching gene. She’s going to let you know your options in birth, help you learn how to communicate your wishes to the hospital staff and will probably help you get started breastfeeding (if that’s your choice). Will she help you with your birth plan? Most will help you with that, even if they start with a standard birth plan off the Internet. If she’s a good and experienced doula, she will help mold the template into your unique birth plan. (There’s nothing worse than presenting an Internet birth plan to the labor and delivery staff.)

During the interview, take note of the type of person she is. Is she direct and clear? Will that come across as bossy to the hospital staff? Or is that a trait you appreciate in a person? Is she meek and mild? Will she have the strength to guide you in labor when you need someone strong? Is she full of ideas for your comfort measures even now or is she only focused on labor? A doula who has information for you at the point you are in your pregnancy is a great doula! She will have loads of ideas in labor, too… and she isn’t afraid of sharing them with you. It also gives you a glimpse into her experiences.

- What kind of births have you seen? Has she been to VBACs? Twins? Cesareans? Moms with preeclampsia? Inductions? Natural/Unmedicated births? Moms who’ve hemorrhaged? Births with certified nurse midwives? Home births? Birth center births? Shoulder dystocias? The more complications she’s seen, the more births she’s been to –because they are generally rare and you have to go to a lot of births to see some of the more unusual ones. What does it matter if she’s seen complications? She’s not the one managing them, right? What it can tell you is that she will have acted/reacted in an emergency, helping her client through a crisis. This can be crucial to a woman’s postpartum adjustment period, how the complication went down at the time. Especially with cesareans since those are so common; it helps if the doula has gone through this with a client so she can guide you if you’re going to have one, too. Knowing the cesarean ritual helps the woman to prepare for what’s coming and can help her assimilate what happened postpartum. If she’s been to natural births, that lets you know she can work with a woman through the whole birth experience without medication… this is a totally different experience than when she has an epidural. Helping women through pain for hours and hours takes stamina and creativity. Then, working with women with epidurals, as different as it is from natural birth, takes a different type of creativity… does she work with peanut balls? Does she know the routine side effects of epidurals? Will she be comfortable sitting on her hands while the mom and dad sleep, sometimes for hours?

As you can see, there are many more ways to tell if you’re going to have a positive/good doula than just a personality mesh, although that can’t be overlooked either. After everything, do you and the doula get along? Does she look you in the eye? Does she include your partner in the discussion? Does she have ideas for him/her to help in labor, too? Is this someone you wouldn’t mind spending 20 hours with in a small room? If she irks you in any way, I’d say PASS on her and find another one. If she annoys you in the interview, how is she going to affect you when you’re tired, hungry and in pain? Find someone who will comfort you. You deserve to have the best doula for your pregnancy, birth and postpartum. I know she’s out there!

Sunday
May122013

Responsibility

Yet another home birth was deemed senseless. Joseph Thurgood-Gates was born in the hospital after a trying attempt to deliver him at home. The mom, Kate, had had two previous cesareans and the baby was also found to be breech about two weeks post-dates. The mother ignored not only the doctors who recommended she have a repeat cesarean, but even the midwife when she recommended (most likely) an NST at the hospital ten days post-dates. The coroner, Kim Parkinson, not only said they baby would have lived had he been taken care of in the hospital from the beginning of labor, but especially when the mother had a uterine rupture. She then commented, "To disregard the obstetrician's advice on the basis of a mantra founded in the uncertainty of statistical data obtained from the Internet is a dangerous course to follow."

When I commented, “The woman’s Internet “advisors” are just as guilty for this baby’s death,” a woman replied that no they aren’t, that we each make our own decisions.

So, who is responsible for the baby’s death? Is it the Internet for its anonymity and copious amounts of misinformation in the name of “telling the truth?” Is it the midwife who wrote in her notes that there are "’lots of political issues’ relating to home births?” Is it solely the mother’s because ultimately she made the decisions?

I bet those Internet advisors will find a way to incriminate anyone but themselves and the mother because mothers are rarely accused of doing anything wrong when it comes to home birth deaths. Even when it is their fault.

There are others culpable, though.

Entire websites are set up to convince women that medicine is evil, that doctors have nothing but dollars on their minds and that cesareans are the worst thing possible in a woman’s birth story. I could name five off the top of my head, but if I know them, then others do, too. There are a few that take the opposite stance, that home birth is evil and home birth midwives have nothing but popularity on their minds and that giving birth naturally is just for the experience. (I strive to be in the middle.) Neither is 100% correct, but desperate women cling to the fringes. Why is that? What are they looking for besides answers? Why do they look for the information they hope is true instead of balanced information? I’d need a psychology degree to answer those questions. It’s rather pitiful and sad, though, that they do… that there are women right now doing the exact same thing. And there are plenty of women out there validating their wishful thinking.

How many deaths and injuries need to occur before the Internet advisors start taking responsibility for their actions? Will they ever figure out the role they play in all of this? I would like to think so, but don’t hold out much hope for it. I don’t know how to get these women to own up to their behaviors, their advice to unsuspecting women who desperately want help over the wires.

Or how do we comfort the despairing woman? How do we help her so she doesn’t turn to the edge of sanity for information? Women can be so damaged; there has to be a way to help them before they go over the edge of sanity… the sanity of not taking medical advice from strangers.

Friday
May032013

Jason Collins Comes Out

 

I never write about sports, but this piece of information bears a short post.

Jason has become the first American to come out who plays a major team sport: NBA basketball. H’s a free agent at the moment, but has played for several NBA teams, including the Celtics. He’s gone to and won many competitions and has his share of awards.

Before Collins came out, before his trade to the Celtics and Wizards, he asked for the number 98 to honor Matthew Shepard who did a horrific death for being gay in 1998. Quite an honor and loud-spoken commentary.

Collins just came out on Monday… I just laid my hands on the Sports Illustrated story today… so it’s still early to see what lashing out there will be, if any at all. So far, things look good. Big names in all sports venues are rallying to his side, supporting his choice to come out now instead of later.

I just wanted to offer my support to Jason Collins for being himself… not necessarily brave or wondrous, but just for being himself. Thanks for coming out.

Thursday
May022013

AAP's New Home Birth Guidelines

The American Academy of Pediatrics came out with some guidelines for a safe home birth after first stating the safest place to deliver was in the hospital and in a birth center.

The guidelines, in bold italics, state; (my comments in afterwards):

- There should be no preexisting medical conditions.

This would rule out thyroid, heart, renal disease and more. Most home birth midwives wouldn’t have a problem with someone with thyroid disease, but would risk out for more serious diseases and conditions.

- There should be no diseases during pregnancy.

This would include not having women with diabetes in their practice. CPMs generally accept and keep women with diabetes as long as they aren’t on insulin. For the rest of the diseases of pregnancy, Preeclampsia, Pregnancy Induced Hypertension, HELLP Syndrome, etc., most midwives would risk out. There might be some midwives who wouldn’t recognize the lower levels of these issues and a few might not appreciate the gravity of the diseases, but most would.

- No one with twins, triplets or higher should deliver at home.  

We know this is one that is ignored too much.

- The baby needs to be vertex (no breech).

This one is also ignored too often, many/most midwives believing that breech is a variation of normal. It is not. The number one reason a midwife ends up arrested is because of a breech death. (This is my informal observation over the years.)

- The pregnancy should be at least 37 weeks, but no more than 41 weeks.

The 37-week limit is a common demarcation point although some midwives would deliver a woman under 37 weeks with specific clients, believing it’s okay to step out of the rule for special circumstances. This is one of the issues I have with CPMs; they don’t have hard lines, but find so much ambiguous. It’s part of what women want in a midwife, being seen as an individual, not a number, but there does come a time when hard lines should be drawn in the name of safety.

- The AAP says that labor needs to be spontaneous or induced as an outpatient.

Induced?! What were they thinking?

- Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board.

This means they recommend only Certified Nurse Midwives, not CPMs.

- There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.

This would include intubation, something the majority of home birth midwives do not do. However, even if one learns intubation, we don’t get a chance to practice it and it is a skill that requires constant practice in order not to injure the baby. It is a nuanced skill that nurses practice a lot and/or use more frequently than a home birth midwife would ever have the chance to do, mainly because most of the babies we see are from (or are supposed to be from) low-risk women. So the likelihood of ever being able to do this regularly is remote… something we might just have to scratch off the list of being able to do… keeping us from being 100% accepted by the AAP.

- A newborn infant who requires any resuscitation should be monitored frequently during the immediate postnatal period, and infants who receive extensive resuscitation (e.g., positive pressure ventilation for more than 30–60 seconds) should be transferred to a medical facility for close monitoring and evaluation.

30 – 60 seconds is too ambiguous and ambiguity is the hallmark of CPMs. I wish they had said 30 seconds and left it at that.

- Home birth mothers and caregivers also should take any infant with respiratory distress, continued cyanosis, or other signs of illness to a medical facility.

I’ve seen, many times, a baby with central cyanosis receive blow-by oxygen for extended periods of time. “The baby just needs to nurse!” is what so many midwives believe. Annoying. That the baby does transition eventually reinforces their actions, but what of the babies that do have problems that need to be watched by an NICU staff? What happens to them? They are delayed and delayed going in.

- All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored.

This is always done in my experience.

- A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.

Something that cannot be done for many midwives whether because of legalities or hostilities in the community.

- AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests.

While many home birth families refuse Vitamin K and Erythromycin eye ointment, midwives who can, do carry it for those that want it. When a midwife can’t do something, like the Hep B vaccine, she would send the baby to the pediatrician to have it done. Same with the bili checks; blood work is done via the pediatrician, so it isn’t ignored, just that we don’t typically do that lab test. There are home bili tests, but they aren’t as accurate as blood tests. In my experience, even with the home tests, if there is a question, the midwife would send the baby in to be checked by the pediatrician.

- The baby needs to be monitored every 30 minutes for the first two hours and consider transitional care to be 4-8 hours postpartum.

Midwives at home monitor more frequently in my experience. Not a complete newborn exam every 30 minutes but absolutely doing vitals. Most midwives stay at least 3-4 hours postpartum. Now maybe we should stay a minimum of 4 hours?

- If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening.

This would be something I would hope all midwives do, but I know too many don’t even test for GBS in the pregnancy, much less treat with antibiotics in labor. This must change. I worry how may babies have to die of GBS before home birth midwives get the connection between testing and a live baby. Then there’s the LGA babies that need to be tested for glucose levels, but midwives often merely go by symptoms and even then don’t test. I would like to see glucose monitoring of newborns become more common.

- Comprehensive documentation and follow-up with the child’s primary health care provider is essential. They want to have the baby see  a pediatrician within 24 hours after the birth and again 48 hours after that first visit.

A variation of this is done by most midwives. Some will say the baby needs to be seen within the first three days and others within the first two weeks. I err on the side of caution and liked my clients to see the Pediatrician within the first three days. AAP takes a much more conservative take and wants the babies seen much sooner and more often,

As I’ve read through the articles about the new guidelines, there have been some comments from CPMs saying they are glad for the guidelines because all CPMs do them already. As you read above, that isn’t true at all. There are specific items on the list, namely risking out for diabetes, intubation and vaccinations, that most (if not the great majority of) CPMs do not do. These need to be known and if we want to win the hearts of the AAP (and the public), we might consider adding stringent limits with diseases and intubation into our repertoire. And many midwives are wont to limit their clients to normal, vertex, singleton mothers and babies, instead being led by clients and their needs, not adhering to what is proven safe for those wanting a home birth. It’s frustrating when midwives take these high/er risk women and things go wrong. It makes all midwives look careless and ignorant of risk. If we were able to adhere to strict standards, perhaps CPMs might finally be included in the professionals’ recommendations. I don’t see that happening any time soon.

When we get standards from others such as this and we’re able to compare the requests with the realities, it is perfect for giving the CPM areas where she needs to increase her education and skills training. I’m often asked what exactly do I think midwives need to learn and this post is perfect for that. Tops is learning to adhere to the Standards of Care of not step out of the boundaries just because the midwife feels sorry for the mother. There is nothing mentioned in this piece about malpractice insurance and that should be a requirement, too. I can see, with increased education and skills training and standardized education (not the haphazard methods there are now to become a CPM) and malpractice insurance, CPMs finding a more accepted place in states. But there are still too many challenges that don’t fit the exacting standards of ACOG or AAP. I hope we midwives strive for what their looking for, not minimize their requests. It is in our self-care that we will be able to garner more and more respect. With respect, we get laws on our sides, Medicaid payments, all states with CPM laws and a great reputation. It’s time we had a great reputation.

Sunday
Apr282013

Nursing School Worries

I’ve had several women come to me lately telling me they are entering nursing school, but are worried about losing their natural/home birthing mindsets. While I haven’t gone to nursing school myself, I have talked many women through and wanted to share some of my thoughts about how to keep centered even while moving into the medicalized world of nursing and hospital care.

The biggest concern seems to be having to do extraneous things that have nothing to do with midwifery… orthopedics, cardiology, geriatrics, psychiatry… all seemingly so far from birth work, but in reality, have everything to do with birth –if you just look with a soft-focus lens.

Everything you do in nursing school (and nursing in general) has something to do with midwifery, even if they seem so far away.

Why would you need cardiology in birth work? Part of the job of a midwife is to determine if mom has a heart murmur or not. Heart murmurs can be indicative of underlying cardiac conditions that need to be addressed by specialists. Also, listening to newborn hearts is a crucial part of immediate postpartum care. If you’ve listened to a thousand hearts, most of which are normal, you are able to quickly determine if there is an abnormality in the heart you are listening to. As an apprentice midwife (out of hospital apprentice), you don’t get the chance to listen to the wide variety of hearts that you do in nursing school. It’s a distinct advantage to be able to hear so many hearts.

What would geriatrics have to do with midwifery? Besides listening to the heart advantages, there is also the ability to work with folks with depression, orthopedic issues (more on that in a moment), chronic pain and family dynamics… all aspects that have to do with the care of women in the childbearing year and beyond.

Orthopedics? What in the world does that have to do with birth? One of the first things a midwife does with a new baby is check his or her clavicles to see if they are broken. Knowing what a break feels like as well as how to refer out if necessary or even how to fix it can be crucial for a midwife. Plus there are other physical conditions a newborn can have that a midwife needs to be aware of: hip dysplasia, club foot or femur fractures can all be a part of what might happen in birth.

Time in psychiatry is infinitely helpful because midwifery is all about the psychology of things. Getting to know a family, deciphering whether there is abuse in the family or not, understanding eating disorders and more are all covered in the psych portion of nursing school, something that isn’t typically covered in non-nurse midwifery education. It’s something we pick up along the way. I learned a lot from my own years in therapy.

So, putting the positive spin on nursing school can help keep your eye on the prize of the nursing degree.

What of possibly losing the idealism of out-of-hospital or natural birth? Won’t nursing school ruin the belief that birth is normal?

I always find that question so interesting. If you have the belief and there is nothing to counter it, you’ll stick with the belief. If, however, you have information that shows otherwise and you change your viewpoint, then that is the perception you’re supposed to have. If there is nothing to change your point of view, then you will stick with it. But, nursing school does change perceptions because there is new information, why wouldn’t it? Does it make you not believe in natural birth anymore? Not in my experience. It widens your attitude towards birth, eventually bringing the two (or more) positions into alignment. Is there a way to be a nurse and still believe in home birth? Absolutely! There are plenty of nurses who have their babies at home. They are probably more discerning about whom they choose to oversee their births, but they do believe in their abilities to be safe while birthing at home.

You know you’re going to learn new information. Why wouldn’t you want it to blend with your already strong knowledge of birth? Do you really feel you will be brainwashed? Or might your beliefs be questioned. Now, that isn’t such a bad thing. We should be able to stand strong in our beliefs even as someone stands in front of us showing us counter-proof. If we shift, we are brilliant humans, using all the information at hand and developing a new mindset. There is nothing wrong with that.

Will you see things that make you crazy? Absolutely. Will you want to reach out and stop people from doing things that you know to be dangerous or bad? You bet. Will you do it? Or will you stand there and learn. You will learn. Even when someone does something that you think to be dangerous, you must sit still and learn because there really might be another way to do what you’re watching. And even if you say to yourself, “I will NEVER do that to a woman,” put the skill in the file drawer because you never know when you might need to do just the thing you’re finding abhorrent. I remember learning how to do controlled cord traction. My mind screamed at me to stop; it was a horrible thing to do with a placenta. But, I sucked it up and learned. Was I ever glad when I had to get a placenta out from a hemorrhaging mom. I never thought I’d use the skill, but thankfully, I paid attention and learned anyway. I’ve learned there can be a reason to use any skill you acquire along the way, no matter how awful it seems at the time.

And that’s the way it is with nursing school. Even with all the things you think you’ll never need to practice home birth midwifery, you are wrong; you will utilize every extra skill and piece of education that comes out of nursing school. Midwifery school, even more so. But that’s a different post.

I hope this helps those wondering about nursing school and having concerns or second thoughts. I hope you’ve found some peace about the possibilities that await you in a place completely foreign from anything you’ve ever known. What an adventure! I only wish I had gone that route when I was your age. But now I get to share my old lady wisdom with you all who might go on to be awesome nurses and possibly certified nurse midwives. I am all the way behind you. Go for it!

Friday
Apr262013

Women Get High From Epidurals?

Really? This is what, in part, an article by Judy Slome Cohain, originally published in the Autumn 2010 Midwifery Today, says. From what I understand, Cohain is a Certified Nurse Midwife, making her comments/beliefs even more confounding.

“They get a little buzz and feel a bit tingly high from the relief of pain and the fentanyl and smile from the high. It seems a shame that they are unaware that they could get that high by learning how to find the place inside themselves that releases it naturally, or by surrounding themselves with other high people. Also, if the woman feels the fentanyl high, then the baby must be getting it also….”

Her interpretation of what women are feeling is bizarre. It isn’t that they are high, they are relieved! Is the baby relieved? Probably from the stress hormones’ minimization.

The really long article waxes poetic about unmedicated birth, saying,

“The biggest lesson I’ve learned from 25 years of assisting births is that there are no two people on earth alike. Each woman is a completely unique entity with different tastes, needs and desires. By enabling a woman to birth at home—or in any place she chooses—where she can find the position, place, smells, atmosphere and surroundings she needs to birth, she can birth practically without pain. I am not only referring to people who meditate and do hours of yoga every day. I’m talking about Mrs. Couch Potato, too. I could describe hundreds of women who did not feel much pain during birth.”

I haven’t been a midwife for 25 years, but I can surely tell you that there were plenty of women who felt a great deal of pain in their home births. Some so much, they transferred to the hospital for pain relief; not many, but a few. Pain is one major reason first time moms transfer to the hospital.

Cohain also says,

“The task of labor is to breathe and relax for 30 seconds of contraction. This can easily be accomplished by the most unimaginative person by walking slowly and counting 10 slow breathes. An imaginative person can connect to the place in her body where she can release her natural endorphins and get a natural high. She can surround herself with a few people who love her and get a contact group love surge. She can connect to her power or whatever power she wants to let flow through her—it’s much like the energy you get watching a great concert, or a shooting star, or a child take his first step. As this energy flows through her she can imagine herself powerful and giving life force to others, praying for the health of sick people she may know. She can kneel down in soft, green grass and suck in nature’s bounties. It can be tiring, but the longest it will last at significant strength is 12 hours.”

30-second long contractions are in early labor and that is typically the least uncomfortable time, but for some, it is still painful if the baby isn’t in a great position. And the longest hard labor lasts is twelve hours? She must have some speedy women giving birth around her.

I’ve been to births that sound like what Cohain describes above, but they were the unusual, not the typical. I’ve also been to hospital births that were just as ethereal as these home births she describes. Has she not?

“Watching a woman get an epidural reminds me of watching a teenager have a bad drug trip. Birth is not a terribly painful process in the comfort of home, although going to the hospital doubles it.”

It makes me very uncomfortable to read such statements. Sure, staying in the bed without movement can be more painful, but more and more hospitals are “allowing” women to move around in labor, even as they are tethered to monitors and an IV. Saying that birth isn’t a “terribly painful process” at home discounts all those women for whom birth is terribly painful.

Cohain even attacks the verbiage used around epidurals, although, as far as I know, she gets even that wrong. She says,

“Although the euphemism, ‘She took an epidural’ is universally used, no woman can take an epidural. She has to be given it.”

In my 30 years of experience with epidurals, the woman got an epidural, she didn’t take one. Have you all heard of taking one?

There is great detail about a woman in a hospital bed and getting an epidural, including the erroneous information that says,

“The anesthesiologist takes a large gauge needle on a 5 or 10 cc syringe and starts digging into the laboring woman’s back. The hole has to be large enough to fit the drug-bringing canula which goes in 4 inches, or 10 cm, in and up her spine. Blood flows down her back in a half-centimeter stream from the hole. It hurts to be stuck.”

First, the woman gets a shot of lidocaine so she doesn’t feel the needle going into her spine. The doctor also doesn’t “dig” into the woman’s back; he knows precisely where he’s going. While it does sting like a bee sting for the lidocaine poke, the insertion of the needle and then canula are typically felt as a lot of pressure, not pain.

At one point, she says that Bupivacaine is an opioid, which it is not.

And her belief that women get high from epidurals is laughable if she weren’t so serious. Accusing women of wanting to get high in birth is downright rude; women are wanting to have pain-free births and have that option in a free world.

It’s sad to me that Cohain doesn’t seem to have seen some beautiful hospital births, that the only lovely births she’s seen have been home births. I’ve seen some hospital births that were more wonderful than some home births.

I’m tempted to write a birth story where a woman starts out at home then transfers to the hospital for an epidural, words billowing melodiously. It could happen.

Sunday
Apr072013

Judging Birth Stories

I asked this on my Navelgazing Midwife Facebook Page "When you tell your birth story, do you feel judged?" and while I knew the answer, it was still enlightening to hear what women had to say.

TJ: I sometimes feel judged as a midwife because my birth experiences weren't 'midwifery enough', but fortunately many women I care for don't ask.

MS: I don’t tell my story because nobody cares to listen to other peoples stories.

NgM: I don’t find that true at all. People love hearing others’ birth stories.

HS: Always. And crazily enough, it depends on who I'm telling it to what ~type~ of judgment I feel.

EB: It hasn't occurred to me to care.

AF: I love to share my stories.

The first one is a thriller full of tension and drama, and honestly, Hallmark movies don't get nearly the ratings of The Walking Dead.

The second one is pretty boring with the exception of the kid peeing on the OB as he was held up for me to see. That's about the only part I share often. Humor sells too.

Do I tell them often? Nope. I don't get asked much now, and I didn't get asked much when they were young either. The average person is not interested.

The people who think birth is supposed to be this amazing transformational experience don't think much of my stories because they aren't about magic moments and soft focus pictures. I'm not interested in rewriting my experience to fit their favorite narrative.

CF: You know what's funny? I actually had a pain-free, intervention-free birth (thanks Hypnobabies) and was too embarrassed to share my story for awhile. The moms I knew seemed to enjoy sharing their stories, which they were overwhelmingly not happy with, but they didn't seem receptive to hear about enjoying my pregnancy and having fun while giving birth. I almost ended up feeling like I was apologizing for having the kind of birth I did. It took my best friend helping me to understand that women wouldn't know this kind of birth was even possible unless it women shared those experiences. I was so scared of women feeling like I was saying their experience was less than mine if I shared, but that wasn't ever what I was trying to get across. So I've found myself carefully framing my story to make sure they still feel validated and heard and that they know I truly believe that each story is unique and worth celebrating.

SBN: Yep. With both - the epidural-first-time-mom-not-quite-my-own-advocate and my non-meds one that was serene and minimal. You can't win.

HS: Seeing an interesting trend on this thread.....It appears a lot of moms who've had positive experiences (whether natural, augmented, or surgical) feel reluctant to share their stories. So many women love to share their horror stories of birth, either their own or someone else's, that hearing a happy one is almost taken in offense.

CK: It's a rock and a hard place when you want to vbac. Especially when you want to vbac with no epidural. Have you ever been on magnesium sulfate? That is some nasty stuff, and a huge game changer when your plan for pain management includes lots of movement and a tub.

EC: No, however I don't share much in mixed company because so many people have negative stories. Mine are both mainly positive and I think that can annoy people. Same thing when I share about my breastfeeding success. So I guess it is a kind of judgment, or maybe they are afraid that they are being judged by me (they're not!)?

HMD: Certainly. People think, "how boring..."

LSA: It depends on who it is I'm telling it to.

SSC: My first pregnancy was really enjoyable but the birth was awful and my second pregnancy was not as enjoyable but the birth was wonderful. I find that you just can't win. I frame telling stories about both based on the audience.

HMD: Mine was neither happy and exciting, nor terrifying and dangerous. But it was anti-climatical to the pregnancy. I should write that up, with pictures.

AF: You should go with the narrative: "My pregnancy nearly killed us, the c-section saved our lives.".

I think that's fairly accurate.

CK: Yes. My first had heart issues, so he was born via c-section. My second was a vbac attempt +preeclampsia +OP +failed induction. I feel like I’m being judged when I talk about it, but I know a lot of it comes from my own negative feelings about both births.

DH: I always feel bad for mothers with pre-e that really puts them between a rock and a hard place.

AF: Pre-e puts you into a high risk pregnancy which can usually be managed effectively by an experienced HCP. I don't see the "rock and hard place" unless a woman has a problem with managing a serious condition properly.

AS: No. The only people I tell my story to are friends, family, and coworkers, and none of them are judgmental

MF: Yes - but it never matters - for it hurts more not to tell people about Finley (her baby that died). And with Toni-joi's I am the one that judges the choices I made.

APH: No, but it's not something that comes up these days. My baby is 17!

SM: Often. I don't care much. I still share.

DRS: I had a c-section because of breech position with my daughter, and felt judged before I (had the) birth, with all the advice on how to flip her, being 4'10", it was unlikely. With my son I fought hard for a VBAC and had a hospital delivery, went into labor naturally, but had an epidural, he aspirated meconium so was in the NICU for 5 days. After that experience I could care less about judgment since I fought hard to do my bet for him and he is now EBF and healthy!

EEC: Well, I had C-Sections, so yes.

SWM: It depends who I tell it to....

MM: Every time.

EG: No, but I try to frame the stories for the audiences. I've had an induction-epidural hospital birth, a narcotic hospital birth and then two homebirths. I can relate to almost everyone!

JB: I no longer tell my story, bits and pieces yes, but not the whole thing. I no longer share it because my trauma has grown into love for myself and my journey. Am I still pissed about parts of it? Sometimes. When I did share my story a lot I felt my own self judgment the most. When I hear other birth stories, as I have learned to love my own, I have learned to love and accept their stories. Before I processed my journey, I judged others as harshly as I judged myself.

GS: Yes.

LSL: After my first Hypnobabies birth I wanted to tell everyone how awesome and comfortable it was. I was laughed at and made fun of by main stream mom friends and got the attitude from my natural birthing friends that I wasn't one of them since it wasn't a painful experience. I had another pain-free hands-off  Hypnobabies birth a few years later and I still don't share that story unless I know someone well.

SB: Yes and no. Those people who hate homebirth or are anti-midwife judge me for having di/di full term twins at home. Everyone else thinks it is great, including me and my family.

NgM: Here I am talking about not judging and my first thought about your birth, SB, is “No way!” I don’t hate home births nor am I anti-midwife, yet I still question your smarts in birthing di/di twins at home. I wonder if you’ll change that viewpoint over the years as I did my UC birth. How much judgment was in that comment? Bad, Barb… but being honest.

TR: Yes all the time. I had an emergency c-section and our baby had to be resuscitated. Since then I've had 4 more sections. I just don't offer that info anymore.

KS: I've come to peace with my first birth that led to a c section, the other 2 I feel went exactly as they were meant to, and the interventions that happened were needed - I managed the timing of them and never felt out of control. I don't feel judged at all when telling my stories.

AB: A lot of people think that I'm insane for homebirthing.

LA: Knee jerk: uh, no. Thoughtful answer: it depends on who I am talking to. I never feel judged about my hospital birth, my unassisted home births (some planned, some not) tend to leave jaw drops from most, and inspire horror from most medical professionals.

KDK: No. But I generally don't share in a judgmental atmosphere and I'm confident and unapologetic about all my births from my C-section to my storybook VBAC. Usually I get FAR more judgment surrounding the number of births I've had vs. the kind of births I've had.

RAJ: Yep.

AN: I find that the only people who really ask are the types that want to judge. I had an uneventful unmedicated hospital birth so it usually passes without judgment from either the NCB camp or the mainstream camp.

EWC: Yes frequently, especially my first.

SC: I only tell if people ask. The only people who ask are the ones who either really love me or really love births, or both, so no, no judgment. I do sometimes mention to others (especially mamas expecting their first) that I had a really easy, short labor and delivery... I leave it at that unless they ask, but I think it's nice to hear positive, non-scary stories, since people mostly hear the bad stuff.

MH: I don't share my birth stories mostly. Very few know them.

KS: Yup.

MM: Not in real life, but on the Internet in most birth related groups I often feel like I need to add a disclaimer about why my inductions were 'necessary'. The judgment doesn't bother me (it's people on the Internet for goodness sake) but I do hate that I find myself trying to justify irrelevant aspects of the events that gave me my three beautiful sons.

HH: There is nothing better to start the conversation with "I've had 5 sections." to be judged.

DH: At times, yes, (depending on who I tell it to) - like I was stupid for taking such risks (VBAC and attempted VBAC that ended rather dramatically - but safely - in a cesarean). One person, a dad, actually, asked me, "So, you had an emergency c-section?" I told him, "That depends on who you ask." I'm not sure he knew what to think.

LW: Yes, in the best way possible! Judged as a WINNER!

AMJ: Yep. Homebirthers seem to think I shouldn't have transferred (for prolonged first stage/swelling cervix/length of time since waters breaking), and non-homebirthers seem to think I should have just been in hospital all along….

TP: I think you showed courage and common sense.

MC: I'm judged more as an activist because I was a failed induction c/s... like the attitude is "who are you to be on a soap box when you did this"

ST: Yep.

BR: Always.

KW: Nope and I'm especially proud of my unassisted birth.

MB: I couldn't care less if someone else wants to judge me!

ALB: Yep.

NgM: I remember the first time I felt judged. It was by my future Bradley class (a group of us were in an exercise class together) and I had just told my hospital birth story, showing the pics and everything. It wasn’t right away, but when I realized these were natural birthing women, I asked how they could stay quiet about my birth and they said they knew I would eventually figure out the error of my ways if I hung out long enough. I was so embarrassed. I’m angry that I felt that way now; one should never be ashamed of one’s birth story.

I was totally judged for my Unassisted Birth (no more than by myself nowadays), thought I was crazy for doing what I did. (I concur.) The third birth (a car birth) was always told with such humor, no one could possibly judge any part of it, even though I wasn’t home birthing (membranes ruptured seven days before labor started… oh, is there judgment there!?). I also didn’t care what anyone thought, so wouldn’t have noticed judgment if there was any.

What can we do about judgments with birth stories? Is there a way to change the culture from one of “How could you do that?” to one of “How great that you did that!” – no matter what kind of birth it was.

Notice how many women said they judged themselves. What kind of culture exists that causes a woman to second-guess her birth? Why can’t the birth stand alone, without a comparison or contrast? Is there a way each of us can phrase comments that don’t make it sound like we are judging? Can we just state: “from here on out, there will be no judging and the assumption is there is no judging” so we can just go on, women feeling safe to tell their stories? That’s what I’d like to see.

And then there’s the compulsion to judge women’s births. We need to nip that urge, too, before it smears its ugly self all over a woman’s story. How do we re-program ourselves to not think, “She shouldn’t have x, y, z, but should have a, b, c instead.” Is it human nature to judge? I’d love to ask a sociologist! But, even if it is inborn, there are ways to de-program those thoughts so we don’t hurt those we’re talking and listening to.

Can we just listen with an open heart? Hearing the woman’s story for what it is? This is what I propose. That we suspend our thoughts and judgments so we are able to listen, really hear, what the person is saying as she tells her story. So many of us know what it feels like to be judged, imagine what it would be like if we all took the time to be in the moment with the story, not second-guessing or re-creating it with our own prejudices. Wouldn’t that be awesome? I say we all start doing this now and encourage those around you to do the same. Judgments suck, all the way around. So let’s eliminate them and allow women and their births to just Be. As they are. Beautiful and powerful and awe-inspiring, no matter how they unfolded. Or difficult and painful and achingly sad… if that is how the birth went. Allow the experience to be what it is, no matter what. What kind of world might we create if we were all able to let go of our judgmental selves? I believe a rather nice one.

Saturday
Apr062013

Eliott's Birth Story

This is my part of Eliott's story:

Eliott was born at 9:27pm on March 18, 2013, the midwife Lauren doing the delivery. As he was born, his cord was clamped, then cut, and Lauren placed him in the blanket I was holding. I started to put him in the isolette… a habit… but then immediately said, “I’m going to hold him” and walked to the rocker and proceeded to hold him for the next hour, rocking him the whole time. 

When I got him, he was so warm from Meghann’s body and I held him close until the only warmth left to feel was my own. Then I held him closer, wanting to keep him warm. I looked at him, described his body to Meghann and Brian and they chose not to see him at the time. Meghann ended up not holding or looking at him, but Brian did see his body, from the neck down. No one but me saw the head, which, to me, looked like a bunny. Meghann said she wanted to think of him as a bunny, not as a deformed baby. I understood. Brian held his son after I’d been holding him a little over an hour. 

Before he did, I went and got a warm washcloth to clean Eliott of the little bit of blood there was on him. It felt ritualistic to me, bathing the dead. I gently washed his little arms, his back and then his long, thin legs. I wrapped him in the ultra-soft blue and brown blanket Meghann brought for him. He was ready for Brian to hold him. Brian sat on the end of Meghann’s bed, crying softly over his son. It was a tender and precious few moments. 

Then the Pastor and his wife came in… family friends… and then Brian’s mom and sister arrived and then Linda, Meghann’s “cousin” came in. As soon as everyone was assembled, the Pastor said some beautiful words about Eliott’s birth and death and how he would forever have an impact on us. After that, Linda continued with a lovely prayer, referencing Meghann’s grandmother who’d passed and whose name (Jacoba) was reflected in Eliott’s middle name of Jacob. Most of us cried through the lovely sentiments. 

After the prayer, the Pastor and his wife left, the rest of us spending time together, my holding Eliott again until I passed him off to Brian’s mom, so she could hold her grandson, too. 

It was a long time before Brian was ready to see his baby and when he did, I set Eliott up so you could see his body, but not anything from the neck up. His body was perfect; it was his head that wasn’t normal. Brian, Jenny (his sister) and Linda came in and I introduced them to the sweet baby. After a moment, I excused myself, as did Linda, so Brian and Jenny could have some time alone with the baby. Jenny came out, too, giving Brian some time with his son. 

After they were finished, I did the newborn procedures with Grace, the RN, in a room off the patient room. We weighed Eliott and he weighed 1.7 ounces and was 5 ¼ inches long. Very tiny. We did foot and handprints on a Memento Birth/Death Certificate and then Grace did a Plaster of Paris of his hands and feet. The whole time, I talked to him and let him know how loved he was and I moved him when he needed to be moved and did the footprints myself. I also got a thumbprint of Meghann and Brian on the paper. Their thumbprints were much bigger than Eliott’s feet. 

Grace gave Meghann and Brian many gifts from an organization that gives clothes and toys to grieving parents. Meghann decided on one knitted sock to put Eliott in before he left them and wrap him in a white blanket. Up until that point, I’d wrapped him in the beautiful brown and blue blanket Meghann had for him… soft as could be. Meghann and Brian also had a bracelet that had Eliott’s name as well as a little stuffed penguin that I kept wrapped in the blanket while we all held him. I had put the blanket he was born into away so we could take it. I also took the cord clamp he had on for awhile. Meghann’s keeping the bracelet, penguin and blanket as well. 

I left about 4 hours after the birth, leaving Meghann and Brian alone for the first time since we got there that morning. They were ready to be alone with Eliott and I was ready to go lay down.

It was a beautiful birth. I loved holding my grandson, looking at his bunny face and perfect body. It was such a privilege to be with him as long as I was able. 

I’m at peace today. Feeling better than in the last week. I will miss sweet Eliott, but am glad to have the experience behind us. It was something no mother should ever have to go through.

Saturday
Apr062013

Eliott's Story

This is from my daughter Meghann: 

We are sad to share that we have lost our baby boy. He was born sleeping Monday, March 18 and weighed 1.7 ounces and was 5.25 inches long. We named him Eliott Jacob and feel blessed for the short time we had him.

What was supposed to be a fun ultrasound to find out the gender turned out to be quite stressful as the baby was not cooperating. We left the appointment knowing we were probably having a boy, but would need to come back in a week to confirm. The reality was, our baby had lots of problems. After talking with our midwife, seeing a maternal fetal medicine specialist for a level 2 ultrasound and talking with a genetic counselor, we learned that our baby likely had a chromosomal abnormality of trisomy 13 or trisomy 18. The physical signs of this were an omphalocele with the stomach and intestines growing outside the body and exencephaly with the brain growing outside the body because no skull developed. We could clearly see this on the ultrasound and almost didn't need someone to tell us that the brain abnormality was "not compatible with life."

We had no genetic testing done with this pregnancy or Gabriella's as we are Christians and knew in our hearts that termination was never an option for us. When we got the first phone call with bad news, we decided that night that we could handle whatever our baby had. We could definitely love a child with Down's Syndrome or one with physical abnormalities. We knew that no matter what, if our baby lived, he would be loved and well cared for.

The harsh reality was that our baby would not live. He had a 0% chance of being alive outside of my body. The specialist said my young, healthy body was keeping him alive when he normally would have been an early miscarriage. With his brain abnormality, there was no chance of him making it through labor and the birth canal alive. We were told that he may live a few more weeks or maybe even to 35 weeks. With my previous c-section and the need to induce labor to get him out regardless of whether we decided to end the pregnancy early or wait until he passed naturally, we chose sooner  rather than later because the risk to me increased with each passing week as my uterus grew. I was already 16 weeks by ultrasound calculations and 17 weeks by my last period. And if I made it to the third trimester, an induction wouldn't even be possible because of my c-section. We also wanted to minimize any pain for our precious angel and knew that prolonging his life would only bring more pain. What an impossible choice that no family should ever be faced with.

My induction started Monday morning with my first dose of Cytotec being inserted around 10 a.m. By noon I had an epidural because the contractions were already strong. My water broke around 3 p.m. and Eliott Jacob was born at 9:27 p.m. into my mom's arms. Our room was soon filled with his loving family who wanted to meet him and say goodbye.

In retrospect, I knew something was a bit off the whole pregnancy. I had an odd sense of hesitation when it came to sharing the news, but with Gabriella I wanted to shout it from the rooftops at 5 weeks. Our dating ultrasound pushed our due date back a week but I knew when we got pregnant and got a positive test before it would have been possible based on the new date. I also wasn't showing at all. Nothing more than a tiny bit of bloat. I could still zip and button my size 6 skinny jeans. The bad news was devastating, but almost not a surprise. I guess a mother's intuition is right.

We decided not to do an amnio or any other testing while Eliott was still alive as the results wouldn't have changed the fact that his brain abnormality was fatal and that we would still try for more children in the future. We did send my amniotic fluid and placenta to be tested and will likely get results in about a week that will tell us if there was a chromosomal problem.

We know our family is not complete, and we will try again eventually- maybe when Gabriella decides to wean as I'd rather not be nursing and pregnant again. This whole experience has been surreal. It is something I never would have imagined as a possibility in my life. But I have faith that we are coming out from this storm stronger than we entered and know that we will be just fine. The love and support from my amazing husband, our care providers, family, friends and total strangers swells my heart with joy.

Meghann

Wednesday
Mar202013

Doulo

PS: It's important to know this family was a dear friend of our family and they invited Zack into their space. It isn't that Zack is my usual back-up. My back-up doulas are all women.

I know, you think it’s a typo, but it isn’t. It’s not doulA, but doulO. What’s the difference? 

Those of us in the birth world know what a doula is… a support person for women in labor and birth… and there are postpartum doulas as well. The doula provides a great deal of information and knowledge to the birthing couple, doesn’t make decisions for them, but reminds them of the birth plan they’d created when they were pregnant. Doulas also provide physical comfort to the birthing mom (and often her partner as well), getting her water and ice chips, providing cool or warm washcloths as needed and pressing on her back and giving counterpressure to help alleviate the back pain that can be relentless in a posterior labor.

But what happens when the doula isn’t a woman? He becomes a doulo.

My partner Zack recently became a doulo for a client of mine, Amanda, when I was too sick to attend the birth. My client’s labor was days long and my previous client and Amanda’s Hypnobabies instructor Rachel came to work with Amanda and Kevin in the early parts of her sleepless and painful posterior labor. Rachel helped Amanda with positions and comfort techniques as she knew all too well how to do, but nothing turned the kid Amanda’s pain was unrelenting.

After a day of labor, Amanda had a non-stress test at the hospital and there, they found her to be 1cm and sent her home saying labor might be starting in the next day or so. To Amanda, labor pain had already begun. For any of you who’ve had a posterior labor before, you know exactly what she’s talking about when she describes the pain as a chisel to her back.

Having worked so hard during the pregnancy for a home, vaginal birth, as time passed and the prospect of a hospital birth grew closer, Amanda had increments of acknowledging that her dreamt for birth was soon just a memory.

On day two, Amanda was getting so tired and I encouraged her to have a beer or a glass of wine and to take a warm bath and then get some sleep. She tried, but neither the alcohol nor the bath relieved her fatigue or pain. She used a heating pad on her back, but even that was barely any relief.

During all this time, she was visited by her home birth midwife and she kept her appointments for NSTs, always learning she was 1cm and still not in labor yet. The baby sounded awesome each check (and mom had a doppler so listened periodically herself) and her other vitals were fine. Her membranes had not broken; she was, for all intents and purposes, not in labor at all. Even though she had so much pain and contractions every four to eight minutes apart, depending on when you counted.

The fourth day of no sleep, Amanda had abandoned any hope of having a home birth, knowing she was going to have a hospital birth, with an epidural, because she had had enough of the suffering. (There is pain in birth, but there should be no suffering. If there is suffering, that’s what an epidural is for.) She really had given up the reality of having a home birth before the fourth day, but it was at that time she was able to verbalize it to the rest of us.

She gathered her belongings and headed to the hospital, begging for an epidural. After an NST and a vaginal exam, the doctor sent her home with a prescription to take 50 mgs. of Benadryl to help her sleep. It did nothing but make her groggy and it difficult to cope with the back pain. Another trip to L&D several hours later, for more help with the pain, she was sent home this time with an Ambien; she didn’t take it knowing it would just make her groggy again. Instead she went home and cried because they kept sending her home. She was now 2 cm.

Then the last time she trekked to the  hospital, they kept her. She was then 3 cm – the magic number the CNM said. Within 45 minutes, Amanda had an epidural that subtly diminished her back pain. I say subtly because the back pain broke through the epidural four times and the anesthesiologist had to come give boluses to stop the horrible pain from coming back again. The PCA did nothing to aid the discomfort, only the boluses.

Right before her last trip to L&D was when Zack took the case. He went to Amanda and Kevin’s and helped press on Amanda’s back, something Kevin had been doing even as he tried to sleep. Zack went over to give Kevin some time to nap, but he said he had his second wind (or fifth?) and was okay. Both the laboring partners were too tired to know what to do next since they’d been sent home yet again so recently, so Zack called me and I listened to Amanda in pain and said it was time to go to the hospital and NOT let them send her home. I gave her the words to use so they wouldn’t send her home again, even if she wasn’t “the magic number.” I told her to tell them she was not going home without a baby. That she was in excruciating pain and needed relief. I told her to tell them she hasn’t slept in days and she is not exaggerating, but telling the truth (and she was… not even naps between contractions were possible). They got off the couch and got in the car and went to the hospital, Zack behind them in his truck.

At the hospital, Zack introduced himself as the doula and the nurses kept saying they had never seen a male doula before. It was Kevin who coined the term “Doulo” and it stuck with Zack during the labor and birth. One of the nurses in triage was very confused about his being a doula and Zack off-handedly said it was okay, he’d had a baby himself. She, of course, thought he meant he was a father, but Zack tried to clear it up saying he had had the baby himself. She didn’t believe him that he’d been born a woman. Talk about a confusing moment! The topic never came up again during the labor, but it sure will during Amanda’s birth story over the years.

When I asked Zack what kind of doula things did he do he ran down the litany of chores one does while doula-ing: fetching water, ice chips, hot and cold washcloths, changing the chux on the bed (something not all doulas do; it isn’t in the standard doula repertoire), helping move Amanda’s totally numb legs to change positions in bed, rubbing her back when needed and keeping the room comfortable, atmospherically and physically. That all sounded doula-like to me!

I’ve asked Amanda how Zack was as a doula and here’s what she had to say:

"Zack really was incredible. In a birth story that could not have gone more haywire if it tried, at least without becoming a tragic story, Zack was really our knight in shining armor. By the time Thursday rolled around, which was day 3 of labor and day 4 of no sleep and little food, Kevin and Icould not really think straight any more. We were running on fumes and willpower alone. But, Zack came in and started giving us direction that we really needed, taking over massaging my back, which was by then black-and-blue because the massaging had been my only source of distraction from the back pain for days at that point, reminding Kevin what he was doing (Kevin was trying to do 4 to 5 things all at once and had been for days, poor guy), and even calling you at the appropriate times to help convince us it was really time to do certain things, like head to the hospital for the third and final time and, of course, to help make clear the reality that a cesarean was necessary by Friday (day 4 of labor) morning.

Kevin was an amazing birth partner and was doing everything I asked and more without complaint. But, by Thursday (Laboring Day 3) we were both made a bit crazy by this whole experience and Zack really brought that element of "sanity" that we needed. He really stepped up for us by handling all of the "to dos" of a Doula (doulo, in his case), but it was the moments of quiet emotional support he provided that I will forever remember.

On Laboring Day 3, while on the couch and just before our final trek to the hospital, Zack had taken over massaging my back and during one of my contractions he said, "You can do this, if you want. But, you do not have to. NO ONE will judge you for going to the hospital." While I knew that, I needed to hear it. I was holding out for this birth that we had planned LONG after I had already reached a 'breaking' point of knowing that it would probably not happen for us with that pain and drained of all our energy, all because I wanted to have this wonderfully powerful natural/home birth story to share. But, it would not have happened safely and it would not have brought me the wonder I was seeking to have caused Giovanni any harm by trying to stick it out for the sake of that story.

Zack (along with you and Kevin) made it okay for me to let go of the home/natural birth story that I hopelessly clung to and finally go to the hospital and demand that they take me. The other moment I will forever remember was on Laboring Day 4 (Friday), when I was stuck at 5 cm for 6 or 7 hours and we were slowly making the decision to have a cesarean after the Dr. & CNM both said that they did not believe I would have a safe vaginal delivery and that now was the time to make this call, before something started to go wrong for either Giovanni or I (I was not thinking at the time how we BOTH had been laboring for 4 days by that point). I was a wreck - crying over both the home birth and the natural birth story that we had lost at that point and realizing that in that next moment we were about to lose the vaginal birth story we had hoped for too, Zack came over to me, grabbed my hand, leaned over the bed bar close to me and whispered, "I know that you are upset and you have every right to be. But, you can deal with this later, and you will. But, right now, you are about to meet your son. Be here." It took me a few moments of looking into both Kevin's eyes, Zack's, and back to Kevin's again to know that Zack was right and that, while I needed to give myself the time to grieve at some point, RIGHT THEN was not it. It was time to shift gears and be ready to meet my son. And, I really needed to hear that because that moment of meeting Giovanni was so magical and I believe that I would have regretted being stuck in my selfish spiral of what I had 'given up' during those days of labor delivery rather than being present to experience howwonderful that moment of meeting Giovanni really was.

And, it was magical - despite being in the hospital, despite having had an epidural and several other interventions at that point, and despite being in the O.R. when I met him, it really was magical. And, I appreciate Zack for knowing what I needed to bring me back into that moment. Those are the things that I will forever remember and forever thank Zack for bringing to our L&D story. Things that we may have or may not have come to on our own, but they happened when they did and when they needed to because of him. And, I will be forever grateful that things went so 'wrong' so that we could still have an amazing birth story - just one involving a rare "Doulo" instead of the birth story that we *thought* we would have."

I have to say, I’m so proud of him! I mean, I taught him how to be a doula over the years… his watching me when women came to our home to labor way back in the 80’s, reading my blog for eons, listening to birth stories ad infinitum and being around my clients for the last 27 years… and he did assist me with my last few midwifery clients (and was the best assistant I ever had), but he still added his own personality when it came time for him to doulo for someone all by himself. No woman could have any better doula than my man.

Sunday
Mar172013

Scathing Commentary About Oregon's OOH Births

Here is a link to commentary by Judith Rooks, CNM, also a CDC-trained epidemiologist, regarding the status of out-of-hospital births in Oregon in 2012. The statistics themselves are horrid, but her commentary is what I want to highlight.

She says:

"But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting."

"Many of them" she says. Not a few. Not some. Many.

To those who make comments about babies dying in the hospital, she addresses you, too:

"There are very few term IP (intrapartum) fetal deaths in the hospital. Most fetuses in prolonged distress are delivered by cesarean section. Estimated rate of IP fetal deaths is 0.1-0.3 from the authoritative literature, based on studies in Canada and Europe. Data on all term fetal deaths cannot be substituted for IP fetal deaths."

She also points out that while she removed one baby from the stats that had congenital anomalies, those babies are not removed from the hospital statistics.

I'd love to see Judith Rooks have a national job doing this for all 50 states and the District of Columbia. Think we could gather enough money to hire her?

Monday
Mar112013

OT: How E2L is Going

My, my, food is such a difficult thing for me. You would think I’d be able to stick to something as healthy and fulfilling as E2L, but I have been struggling in ways it’s embarrassing to admit. I’ve lost a few more pounds (down 25 now), but nothing like the 10 pounds a month I should be losing. I’ve been on the diet now three months today. I guess 25 pounds isn’t anything to sneeze at, I just wish it was more. If I didn’t eat SAD food, I would definitely be losing more, but I am totally addicted to it. sigh

I only eat SAD foods once every other day or so, but that’s enough to keep me fat. You would think with how much I have cut out of my diet I would lose like crazy, but I must have the metabolism of a sloth in order to still stay this size on the diet I’m on.

So, let’s not whine, okay? I am doing well enough in other ways. I was feeling really weird for a few days, missed a birth for it and everything (writing about that, too), but figured out it was my thyroid medication and I’ve since fixed it. Dang, that thyroid does some crazy things to a person.

I’ll try and do better. It helps when I write here even though it is boring as crap to read about someone’s diet woes. I laugh when I see people writing out their exact menu because the only one really interested in what you’re eating is yourself. I’ll try to save you all from that yawn of blogging about my food choices.

Speaking of, though, I’ve been trying several recipes and have found a couple that are really good… one I just made today that is awesome. Susan Voisin has a great website called the Fat Free Vegan Kitchen and on there she has some really great recipes. Today’s came from there and I wanted to share it. It was the Smoky Refried Bean Soup; yummy! I also tried her Macaroni & Cheese and it was awful. I mean, inedible. Won’t be trying that one again. I’ve made these Sunny Bean Burgers and like them lots. I was eating them plain, but decided I wanted some bread (why I’m not losing so fast? Haha!) and got those thin bun thingies and use one with the bean burger. Yum! I definitely like having substance with my meal as opposed to just salad and veggies. They seem so insignificant. Yet are supposed to be the mainstay of the E2L Plan! Where’s my mind-shift? Can I buy one?

Friday
Feb222013

MediCal for California Licensed Midwives?

On the California Association of Midwives website, it says:

Please support our efforts to make midwifery care accessible to all California families. Under our current legislation California Licensed Midwives are not eligible to be Medi-Cal providers unless we have physician supervision. This is something we have been unable to obtain since we got licensure in 1997. Although we function as primary care providers, not having physician supervision often impedes our ability to obtain important lab work, medications, oxygen, and ultrasounds for our clients. This year the California Association of Midwives is introducing new legislation to remove the “physician supervision”, which will better serve midwives, physicians, and most importantly - the families we care for. This will allow us to readily obtain everything our clients need as well as allow all families access to the highly personalized care and excellent outcomes that midwives provide.

Here are several things you personally can do:

If you've used midwifery care follow this link to have a postcard sent to your local legislators: http://form.jotform.us/form/30215615467148

Go visit your local legislators. To find out how contact Melissa Lang-Lytle at: camregion10@gmail.com

Let us know if you have any personal connections with your local legislators. Follow this link to find out who they are: http://www.californiamidwives.org/californialegislators

Forward this information to your families and anyone else willing support our cause.

On behalf of all California families, thank you for the difference your actions will make!

Constance Rock, LM, CPM

President, California Association of Midwives

I have several thoughts about this. First, remember I am a California Licensed Midwife, so my thoughts should have some weight in this subject, too.

First, there is no alternative to physician supervision given. For all the years I was practicing, we talked about moving the supervision to collaborative care, allowing midwives to go to OBs without the OB being responsible for the outcome, yet allowing for better care for the clients. I see none of that in this statement. What happened to that desire? Are midwives wanting complete autonomy? I don’t believe that’s appropriate. Here’s why.

Too many midwives take the women’s care lightly. They accept and do breeches and twins, VBAmC and women with the lower limits of high blood pressure. They accept and minimize the issues with LGA/macrosomic babies (including myself). They spread the length of pregnancy past the 42nd week. The LMs stretch the realm of normal until they are outside the parameters of normal and they justify it by using the “Trust Birth” mantra. I’ve seen how midwives allow women to push for far longer than 5-6 hours before transporting. I’ve seen how midwives hide bloody chux pads from EMS so they have an Estimated Blood Loss less than a hemorrhage. Even me, not transporting soon enough with a postpartum hemorrhage (and I know others who’ve done the same). 

(Know that I know better now and would never do the things I did when practicing.)

Perhaps it’s because midwives cannot stay within the limits of normal that they don’t get to do MediCal births? Or work without Supervision? If the midwives didn’t brag about their low transport rate as a medal of honor to try and get clients, the essence of safety might be in the forefront and doctors and legislators not so worried about loosening the tight regulations that bind us now.

There are alternative ways to be able to get the medications we need, the oxygen, the ultrasounds without eliminating physician supervision. Simply make a rule within each of the organizations that it’s legal for us to get the supplies. If that requires a law, then focus on that instead of the supervision aspect.

I do acknowledge that getting physician supervision isn’t ever going to happen in California, so I am for the movement toward physician collaboration in the language of the law. I know it would make things infinitely easier to take care of our clients. They would be able to get medications for STIs, urinary tract infections and GBS during the pregnancy. As it stands, the client has to find an OB, establish care, pay for it (making the choice between using her insurance for the doctor or midwife) and lie to the physician, not telling him she’s really having a midwife and home birth. That’s just unfair to the client to have to go through. Plus it doesn’t allow a discussion between midwife and doctor, the midwife asking questions before even sending a mom in… perhaps she doesn’t even need to go in at all. If there was collaboration, everybody wins: the doctor helping a client while not being the primary care provider and ultimately responsible for the outcome… the midwife being able to give higher quality care to her clients… and the clients who get the best of both worlds; midwifery and obstetric care.

Why can’t this be the request of the California Association of Midwives?

Then there’s the issue of the postcards being sent to legislators. Why aren’t women sending the forms themselves? I can see unscrupulous midwives taking their entire client list and sending a postcard for them even though the woman didn’t fill out the form herself. Why aren’t they having women send them themselves? I am very confused about this strategy and wonder if it’s even going to be accepted as a valid count of constituents or the postcards tossed into the garbage.

Lastly, I would love to see the statistics proving the “excellent outcomes that midwives provide.” What are the mortality rates of mothers and babies? California collects this information every year (for the last 4 years), so where are the numbers for the public to see? Is midwifery care as safe as CAM is claiming? I wonder.

I’d like to see this request changed to something more middle-of-the road, something that serves women more than the midwives. They say the changes will benefit the women, but I see it as taking much more care of the Licensed Midwives than the moms themselves. Our focus should be the women completely. If midwives stayed within the ranges of normal, it might be a totally different thing, but too many do not and it’s because of this I feel asking for what they are requesting is too much. Change it to collaborative and I am totally on board.

Sunday
Feb172013

Becoming a Monitrice

I’ve been asked more and more how one becomes a Monitrice, so I thought it good to write a post instead of continuing to answer in private. For those who don’t know, a monitrice is a doula with additional midwifery skills. I am a monitrice and doula, but as a monitrice, I go to mom’s home while she’s in early labor and monitor her and baby until the woman is ready to go to the hospital or I think birth is becoming more imminent. Or if I detect a problem with either mom or baby.

Here, a doula wanting to be a monitrice asks me questions:

Does a monitrice have to be a midwife?

Being a monitrice is more than a doula with a doppler. There are several skills needed and also the need for midwifery/obstetric training in order to be a skilled monitrice.

When the monitrice goes to the laboring mom’s home, she’ll not only monitor vitals and listen to fetal heart tones, she will also be on the lookout for signs of labor not progressing normally or even more dramatic, watching if something is wrong with either the mother or baby. And if there is, she needs to know what to do… change mom’s position or call 911… or something inbetween.

This knowledge comes with time and experience with laboring women. I believe that would include midwives, midwifery assistants or experienced apprentices who do hands-on co-care and L&D nurses. It’s not that the skills can’t be taught, but it takes a lot of on-the-job learning to be able to catch the nuances that can occur while mom labors at home.

Or can a monitrice truly be a separate professional goal?

I believe it can be a separate goal, but still apprenticing with a home birth midwife for a year or two would be necessary. I just don’t think a doula can jump in and be responsible for the lives of two people without having the experience doing it. Even experienced doulas, I think, would need at least some home birth experience.

If that’s all it takes, finding a midwife to apprentice with would be all that’s needed, right?

What’s hard about that is midwives might be wary of hiring an apprentice that isn’t eventually going to be a midwife. Apprenticeship is pretty much a linear generational experience; one teaches another teaches another teaches another. To teach the skills and nuances of midwifery to someone who’s leaving, possibly even becoming competition (monitrice jobs are not nearly as common as doula jobs), isn’t so appealing. I’d love to hear from midwives about whether they would be willing to teach a woman midwifery skills so she could branch off to be a monitrice. Would she ask that the monitrice apprentice pay her to learn?

What training and/or amount of experience would make this a safe option?

I believe it would take at least a year or even two of home birth midwifery training before a woman was ready to be a monitrice. She really would need to be familiar with the pace of home birth (it’s much slower than hospital birth) and understand how women labor out of the bed, which most doulas don’t often see, at least for extended amounts of time with untethered women.

With the apprenticeship comes learning the nuances of deciphering fetal heart tones. It can take years to learn what to do with them completely, but here I believe experienced doulas might have the edge over completely green women, that is if they have paid attention to the fetal heart monitor in the hospital. If the doula hears the heart tones going down, does she know to turn the mom on her side before the nurse even comes into the room to do just that? Has she listened to the machine and watched how the nurses responded over the years?

How experienced is experienced for a doula? I think that can best be served in numbers versus months or years. I’d say at least 100-150 births would give a decent idea of the rhythms of fetal heart tones. I still believe the monitrice-to-be needs home birth experience because hearing a deep deceleration in the home setting is treated much differently than a decel in the hospital.

What is the legality of working as a monitrice-doula without a midwifery license?

This is certainly going to depend on where you live and the midwifery laws. My own personal belief is I think monitrices need to be Licensed &/or Certified Professional Midwives, Certified Nurse Midwives or Registered Nurses, but I also acknowledge that many licensed women have no desire to do anything but midwifery or nursing work. It takes a specific type of person who is okay with abdicating responsibility mid-stream… as a matter of course, not only if there’s an emergency. In fact, some of the midwives in my area that do do monitrice work will only be with the women while they labor at home, abandoning the woman to labor alone or with another person as doula in the hospital. Can you tell how foul I think that is? Where’s the continuity of care?

Listening to fetal heart tones isn’t the part that’s practicing midwifery… it’s interpreting them that is. When I was a doula and occasionally had a mom laboring at home for an extended period of time, I would sometimes listen to fetal heart tones to see how the baby was faring. I didn’t interpret the heart tones; I would tell the mom that between 120-160 was normal and then tell her what the heart tones were when I took them. She interpreted them, not me. But this shows you how ignorant I was at the time. Fetal heart tones are not read on a one time reading every couple of hours, but more frequently and before, during and after a few contractions. (Even as a midwife, I was remiss in doing this too much.) So much can happen during labor to the baby, just listening for the heart tones, inbetween contractions, once an hour just isn’t enough. Once labor kicks into higher gear, every 15 minutes really is necessary and listening before, through and after the contraction simply should be done. And of course, there is the interpreting part. We are back to that experience thing.

I want to help my clients keep safe and wonder if there aren’t skills I could learn that would help them. Perhaps palpating the uterus or checking cervical dilation could help them more than if I didn’t do the skills?

Palpating the uterus takes longer to learn than interpreting fetal heart tones. Your hands, literally, have to “see” what is beneath the flesh, muscle, fascia, etc. And only in touching dozens of bellies hundreds of times can your hands begin to see what is where. Of all midwifery skills, I think palpating is one of the most difficult to learn well.

Learning to do vaginal exams isn’t as challenging, but still takes time to learn. Once you’re able to find the cervix and use your two fingers inside it, there is still the subjective aspect of the skill. Only with time do you learn what is six is six for the others also checking dilation.

Or, perhaps the answer is that, because I don't have these skills, I shouldn't be assisting women in their homes? That by virtue of being there, I am taking responsibility for something that I don't have the skills to be responsible for? And that I should only be meeting women at the hospital?

This is what I do. As a monitrice, I go to their homes. As a doula. I meet them in the hospital. I cannot, in good conscious, be at their home with mom in labor and not monitor her and the baby. I know too much. I know many doulas don’t have any problem going to the home in labor and staying with them for an extended period of time, especially with VBACs, but I just don’t feel it’s safe without monitoring. Do I think doulas should never go to a mom’s home? I think that’s up to each individual doula, but I tend to find the more a doula knows, they less likely she is to hang out at home for a long time because she knows monitoring is so important. The laboring woman’s blood pressure could climb precipitously. The baby could be stressed or the mom could develop a fever, which affects the baby, too. There are infinite hidden variables that monitoring can uncover. As I said, I know too much.

I would love to take a monitrice apprentice, but the women who have approached me rethought the idea when they realized the legalities of taking care of a woman in labor. Would it be practicing midwifery without a license? Probably. I try to think of how it could be a gray area, but it wouldn’t be, at least here in California. A monitrice without a license would be at risk for prosecution if anything untoward occurred.  In other states, the issue might be different.

There is only one online place to study the monitrice occupation. That’s through Birth Arts International and it’s a $1250, year-long program. I’d love to see the program to better be able to comment on it, but the outline for it looks comprehensive. Even so, I still believe an apprenticeship has to happen.

I wish there were more monitrices out there. I’d love to see the profession grow. Maybe I should start a monitrice organization to gather together the monitrices out there. Not sure if I have the energy for that, but would love it if someone did, me or someone else.

To the woman asking these questions, I think you have your answer now, yes? Do let me decide what you choose to do and I will add an addendum to the post.

Does the prospect of being a monitrice intrigue you? Do you want to try this profession? What do you think of the legalities? What about doulas who go to mom’s homes, good or bad idea? I’d love to hear your opinions.

 

Photo by Nova Bella Conte

Sunday
Feb172013

Hernia

So, I have a hernia, an incisional hernia that burst through my former Open Roux en Y Gastric Bypass (which was in 2001) scar. The outer scar goes from just above my belly button to about 3 inches below my sternum. The hernia, an opening in the layers of my abdomen, is small, about 2 inches in diameter, but when I saw the surgeon, she said she’d rather see humongous ones than small ones because small ones can constrict more than large ones. Great, of course I get a small one. 

I sat up in bed and the hernia burst through the tissues and I was in enormous pain. It took all day to get the intestine back into my abdominal wall, but I finally did. If they stay out and constrict, it’s emergency surgery time. I didn’t/don’t want that! 

I spent the time waiting to see the surgeon sitting still. Thank goodness I had no babies due. The hernia only popped out one more time, but I was able to get it back inside my belly without a problem.

I saw the surgeon last week and she was awesome. She explained the whole hernia experience to me, what happened, what’s coming down the pike (surgery) and recovery after surgery.

Regarding surgery, before I saw the doc, I’d gone online and checked out surgeons’ sites and saw that almost all of them required their hernia patients to have a BMI of 30 or less. Oh, criminy. That would be about 130 pounds from now! While I am on the Eat to Live Diet Plan, I just don’t think I can wait to lose 130 pounds before I have surgery. They do that so they can do the surgery with a laparoscope instead of an open procedure (with a long incision). The more incisions you have in your belly, they more complicated your insides become… adhesions and more possibilities for incisional hernias. This doc was great and told me that even if I didn’t lose any more weight than the 20 I’ve already lost, she would still be able to do the surgery laparoscopically. There would always be the risk of having to revert to an open surgery, but she felt comfortable with the laparoscope. Even so, it’s best if I lose some weight, so we put the surgery off ‘til June, so I can try to lose about 40-50 more pounds. (Wouldn’t that be awesome? Sounds great to me!) I want the surgery to be as safe as possible.

So, what about working? I have one client due now and will attend her birth, but I am having to pass off the rest of my spring and summer clients. Bummer all around. I have a binder to hold in the hernia as I do the upcoming birth, but the surgeon told me that binders don’t always work, so no lifting anything above ten pounds until surgery. Afterwards, no lifting anything more than twenty pounds for six weeks. That’s a long time! I’ll have to be creative at the upcoming birth. I can do it, though.

I did really well not getting a hernia after the gastric bypass. About 50%-70% of patients get one within the first couple of years post-open gastric bypass. I went 12 years! Pretty good.

Now, the goal is to keep the hernia inside as much as possible so I don’t have to have an emergency surgery between now and June.

During the surgery, the doc will put a large mesh over the hole in my abdominal wall and she’ll staple it there. I might feel the staples until they disappear (3 months or so post-op). It’s outpatient surgery, too, so that’s great. She said I’d feel like crap for a few days, but then will feel fine unless the staples hurt on the inside, which is rare. We talked about the risk of a seroma and she told me if I get one to NOT let anyone try and reduce it with a needle, to just let it disappear on its own. She said the needle, no matter how sterile, introduces bacteria into the mesh and the mesh gets infected most of the time and that’s a huge mess if that happens. No aspiration of seroma; check. 

Otherwise, everything sounds surgery-straightforward. I just need to keep myself as safe as possible during the surgery. 

Isn’t this fun?

Wednesday
Feb132013

OT: What's Hard About E2L

While I am glad I am doing Eat to Live and it is the easiest plan I’ve ever done, there are definitely hard parts.

The first two days, I cried almost inconsolably. I really wanted to eat my old food choices. I couldn’t attribute it to anything but detoxing, if there is such a thing. It was more likely mourning. Who knew how addicted to the SAD (Standard American Diet) diet one could be?

Is there an addiction to food? We have to eat to live, so how could someone have an addiction to something we are required to do at least three times a day? I’m learning that I have serious feelings about food. Well (laughing), it isn’t like this is new information. I have been in therapy much of the last 30 years and food has always been a popular topic of discussion.

I don’t know what other word to use with regards to my compulsions to eat and my mourning about not eating the SAD diet except addicted. And in dieting circles, it’s a common word used. Even the term abstinence is used, as if one can abstain from eating? No, it’s abstaining from the foods that cause the distress… distress with Morning Glory muffins, peanut butter toast and luscious casseroles dripping with cheese. It almost makes me cry just seeing the foods on paper! Is that addiction? I think so.

In the book Eat to Live, it tells about the 6-Week Plan. I am almost to Week 5 (on Thursday). The 6-Week Plan is the most restrictive, limiting lots of yummy natural foods like potatoes, cooked carrots and eggs. The whole program gets looser with time, but always limits SAD foods, fats and animal products. I’ll be doing the 6-Week Plan for a lot longer than six weeks because I have so much weight to lose.

Supposedly, one eventually gets to a place where SAD foods become repulsive and the cravings are for lettuce and green beans. I can’t imagine, in my wildest imagination, getting to that place. If I was 20, maybe, but after 50 years of eating out and having regular food, it just seems far-fetched. I’ll be sure to let you know if I start craving lettuce, though.

I used to be a food writer. I participated in the writing of Vegetarian Walt Disney World and Greater Orlando in 1998 (nom de plume, gardenia) and I love fine dining. It’s going to be interesting seeing what chefs can come up with without oils. Not that I’m eating fine dining right now. In fact, eating out would be a dangerous proposition. I ate breakfast with a friend and didn’t make a wise choice, eating a wonderful quesadilla with pesto and artichoke hearts. I felt sick the rest of the day, but much of that was regret at my choice. I am trying not to beat myself up when I go off program, but it’s hard. 

So these are some of the difficulties I’m experiencing as I eat differently. I know that while some challenges resolve themselves, there will probably be new ones on the horizon. I’m glad I’m writing so I can talk about them. Thanks for listening!

Tuesday
Feb122013

OT: Eat to Live

This is my blog and it is midwifery oriented, but there's something going on in my life that I want to blog about and it's just going to have to be here. At least it will make the site more active again!

And it is relevant to midwifery.

I am fat. Very, very fat. As I've gotten bigger, it's gotten harder to doula more than once a month because it is really hard on my body. While I am at the birth, I am totally mobile and active, but afterwards, it takes days to recover. This is so hard to admit, but so important to talk about, especially for fat doulas who continue gaining weight. I am the fattest doula I know, in real life or otherwise.

I am damn tired of being fat. It can't be good for me, not just physically, but also emotionally. It has caused me to limit my interactions outside of the house, so much so that I get anxious even leaving the house. I am so sick of that!

So, Zack and I were channel-surfing in December and I stopped on PBS with Dr. Joel Fuhrman talking about Eat to Live, a diet/program that focuses on vegetables and fruits as its base for health. It isn't vegetarian/vegan, but certainly could be depending on how one does the program.

I've been doing Eat to Live (E2L) for a month now and am already down 19 pounds. In a month! Before those 19 pounds gone, when I walked down stairs, I had to go one step at a time, sideways. Now, I can walk down stairs normally and that small change alone has been really cool. Otherwise, I haven't felt much different. My skirts are getting longer, showing that my belly or butt is getting smaller. I think it's stomach, which is great; less chance of recurring diabetes.

I have no health problems at the moment. Hemoglobin A1c is a normal 5.9 (although I will find out the most recent one in a couple of weeks), Blood Pressure is normal. Kidney & Liver labs are all normal (my kidneys are doing so well I've gone from Stage 3 Kidney Disease to Stage 2!). Lipid panel is all normal, but my HDL could be higher. So many of those who start E2L are really sick and have that motivation. Mine is fat and a desire to continue with my healthy labs.

I've been on diets my whole life. I was on Phen-Fen in 1996 and lost 111 pounds. I had a gastric bypass in 2001 and lost 190 pounds. Blessedly, I never got up to my fattest, but I sure did damage to my GB weight loss. The idea of another diet is depressing, which is why E2L is something more for me.

I have not had a second of hunger. It takes almost zero discipline to do this except for choosing the foods to eat. I never did well with structured plans... failed miserably with Weight Watchers, Overeaters Anonymous, the Lean Cuisine Diet... anything that made me measure or eat smaller portions failed. This gal wants to eat and the E2L allows me to do that, even though the choices are not the typical Standard American Diet (SAD).

Don't get me wrong. I miss my peanut butter toast, cheese and casseroles, but I am enjoying walking down the stairs better. I know I will never be able to go back to eating the old way and that has created mourning in my heart (food addiction, anyone?), but I cannot be this fat anymore.

The main focus for me is Gabriella. My 17-month old granddaughter. I want to play with her, run around with her and enjoy her life as a toddler and growing kid. I want to be alive to see her find a loving partner one day. I want to see my other grandbabies that aren't even here yet.

I can do this. I have to do this.

So, I'm going to write about my journey on E2L here. I will continue to put OT in the title so those who couldn't care less can pass it by. I do, however, know I will intertwine the weight loss with doula/monitrice work. I eventually want to take 2-3 clients a month... and look forward to do that.

Those who continue reading, welcome!