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Monday
Oct242011

My First Homebirth (as a witness)

I remember my first homebirth. I was working at a busy birth center as an assistant to a group of CNMs and also working at another slower birth center, both in Orlando. I’d already attended over 200 hospital births, so the baby coming out of the vagina wasn’t the overall lesson of the experience, although it is always miraculous and wonderful. I’d been invited to attend this homebirth by a lovely CNM who wore a flower behind her ear anytime she left the house. I was asked to come along to help her if she needed it, but I ended up sitting quietly, watching all that went on with this mom’s labor.

The atmosphere was calm and quiet, despite there being her husband, a couple of friends and her first child, a toddler, running around the house. No desperation, no rush to do a vaginal exam when we arrived, no asking her to move here, or scoot there; the midwife met the woman where she was and shifted herself around the labor. I was pleasantly surprised.

Compared to the hospital, the energy in the room moved as if through thick, syrup-y air, a sort of slow motion, purposeful, advancements of arms and legs. Words, too, wafted around the room like sweet smelling smoke, curling it’s drifts… rising, then falling… eventually evaporating, but leaving the scent of intense focus, both from the mother as well as the midwife. I remember thinking everyone had that shimmery glow we see on the road during a baking summer car trip, trails of color that followed anyone that moved.

We arrived well into labor and after an initial lull when we arrived, it picked up again quickly, bringing her to delivery a couple of hours after our arrival. The baby tumbled out and into the midwife’s hands, which immediately brought him to where he’d just been, but this time, on the outside of mom’s body. His mother elatedly embraced him, a look I’d seen many, many times before, but this time it was… quieter? More peaceful? The midwife didn’t push a stethoscope to the baby’s chest or back, even under the blanket, but casually felt the cord and saw the baby doing just fine, leaving mom, dad and baby to get high within their own bubble of joy.

The rest of my time as a guest in this family’s home, I drifted in and out of my own ponderings of the difference between hospital, birth center and home births. They were distinctly different, each holding their own importance, but I wondered how anything outside the home could possibly mimic what I’d experienced that night.

So far, nothing has.

Monday
Aug082011

Dandy Commentary Continued

Continuing with what Birth a Miracle Services said in the post “Why state licensure is not the answer for midwifery,” the owners, Naomi Kilbreth and Haley Grant say: 

“A key componant (sic) of home birth is the mother taking responsibility for her birth. That means going to the hospital if she feels something is wrong, maintaining a healthy lifestyle, and being careful about which midwife she hires (ie. one that is well trained and experienced).” 

It is the woman’s responsibility to take care of herself and to hire the appropriate care provider, that’s certainly true. But once the provider is hired, the woman is depending on the provider, in this case, a midwife, to be her advisor, not her friend. 

Midwives do tend to be friendlier than many other providers. I stand first in line, guilty of this provider-as-friend attitude, both being one and applauding them. As time has passed, though, and through my own and others’ experiences, I see that a friendly provider isn’t nearly as important as a skilled one. I’m even guilty of encouraging women to choose a provider based on personality. 

“Most of us have very similar training, so I encourage you to picture yourself in a small room with the midwife –for 20 hours. If a quirk bugs you in the interview, it’s going to be greatly exaggerated when you’re in labor.” 

How’s that for advice on how to choose a midwife? groan of embarrassment 

While we had somewhat similar training, our levels of experience were vastly different. How is a newly pregnant woman supposed to gauge which experiences are great and which are useless in homebirth? While the birth junkie might learn about things like shoulder dystocia and hemorrhage and what a midwife should know when dealing with them, birth junkies are almost always born after their own babies’ births. It’s hard enough trying to teach women they have choices in childbirth; imagine the greater challenge of teaching them to be their own midwives! And that is exactly what BaMS is suggesting. 

“That means going to the hospital if she feels something is wrong….” 

Pardon?!? 

Do you women (BaMS) honestly believe women who hire midwives are supposed to “feel if something is wrong?” I know that most women hire midwives to let them know if something is wrong. Believing that women can “feel” a baby in trouble is cruel to the women whose babies died without their feeling one blip of concern. And it’s flat out wrong. Ask any midwife who’s overseeing a woman in labor, everything fine and then, during the next 15-minute fetal heart tone check, she finds the heart tones down in the 80’s. How long were they there? Sure, there are things to do to try and resolve the low heart tones, but seriously, shit happens in birth. And shit can happen fast. Having a midwife who knows what to do is crucial; her friendliness irrelevant. 

And it’s baffling to me how you think a woman in the middle of labor is supposed to take her contracting butt to the hospital. Drive? Call an ambulance? You make birth sound like a giant UC (unassisted childbirth). And terribly, terribly unappealing. 

(The great majority of) Women aren’t looking for a midwife to make every decision for her. They are not abdicating responsibility to a midwife who uses them like a marionette. Women look to midwives as counselors, as the experts in an area they don’t know much about. 

When hiring a plumber… or a car mechanic… most of us couldn’t care less how the job gets done, just that it gets done right. There are others who think the process is fascinating and learn, perhaps, to do it themselves. They might need help when learning… books, the Net or even talking to the technician. They might even go on to become the expert, inspiring other would-be plumbers as they snake the random toilet. 

Birth, in its crudest form, is like this. And a midwife knows more than the client. She is being hired to know more than the client! That isn’t the remotest commentary on her intelligence or the knowledge she does possess, but who wants to learn to be an expert in every trade or profession we utilize in our lives? I sure don’t! 

It’s great that women learn about the interventions and technology that might be (will be) used in their births. They can always learn more information… if that’s what they want to do. Homebirth women tend towards the information-heavy, that’s true. But should homebirth women have to learn everything in order to protect themselves from the midwife? Or shouldn’t there be a minimum standard they can count on so they’re able to relax during the pregnancy, labor, birth and postpartum period, trusting that the midwife really is looking out for her best interest (and that of her baby)? 

As many others have said, we go to all sorts of people assuming they have a certain level of competence… dentists, accountants, lawyers… even nurses, repair people and barbers… all carry with them the burden (if you will) of a minimum level of professionalism and knowledge. It should be the same for homebirth non-nurse midwives. 

I want women to trust midwives to act and react in their best interests… and the interests of their babies. I hate that I’m writing a “How to Interview a Homebirth Non-Nurse Midwife” piece. I shouldn’t have to!

Yet, with beliefs such as the one quoted at the top of the page, it’s more and more clear how critical that hand-out will be.

Sunday
Feb202011

Intensity Captured

I am privileged to see many, many birth photos and have taken more than my share of them over the last two-plus decades, but this picture was so amazing, I just had to share it with you.

Rebecka Regan tells Elliott's Birth Story in photos and words on her blog Elliott 365: A Photo Project.

Thank you, Rebecka, for letting me share this photo here. 

Thursday
Feb102011

Guest Post: HBAC Story from CNM's POV

I don't often do Guest Posts (not sure why, exactly), but this new blogger, Dena Moes, CNM, asked if she might share a story here. Dena is a certified nurse midwife in Chico, California, Yale-educated with a history of hospital care, but now a homebirth midwife. Her fledgling blog, The Midwife's Desk, offers an interesting perspective. 

Here's Dena.

This post has been written with permission from the family involved. Names have been changed to protect their privacyMy intent is to inspire others to think through their choices and question the current limits on a woman's freedoms after she has had a cesarean.

Before I share Hannah's journey from a cesarean to a homebirth VBAC (vaginal birth after cesarean), let me discuss the current climate regarding VBACs. When I moved to Chico in 2002 and joined a hospital nurse-midwifery practice, VBACs were being done in all three hospitals in our county. It was understood  that VBACs were safe, as long as the surgical incision was the low, vertical (sic) kind (which most in the US are). These scars are less likely to rupture than the up-and-down kind. I went out on maternity leave, had my baby, left that job, and then started attending homebirths two years later. I began hearing that VBACs were suddenly banned from all three hospitals. As in, NO MORE VBACs were allowed, period.  Even if you had had a previous VBAC, making you a very likely candidate for another successful VBAC, you were told by your care provider "No,  I wish you could have a VBAC, but my hands are tied. I am not allowed to attend VBACs anymore. We must schedule your cesarean." If you said "But wait! I just had a VBAC right here two years ago with no problems. Are you kidding? ", you were told "There is nothing I can do. It is up to the hospital, not me." OUCH. What happened?

What happened has to do with ACOG, the American College of OB/Gyns , a powerful trade group for OB doctors. They are so powerful that their recommendations, which put the interests of the doctors FIRST, become national health policy. American obstetricians have developed this habit of inducing most of their patients. Because using the induction drugs on VBAC women was found to increase the risk of a uterine rupture by a significant amount, they recommended that all sites where VBACs take place have an anesthesiologist in-house and ready, in the event of uterine rupture. Well, smaller hospitals like the ones in my county can't afford to pay for an anesthesiologist to sit around while a woman is in labor. VBACs were banned in hospitals all across America instead. The result of all these inductions, and all these VBAC bans, is that one in three women in America today goes in to have her baby, and comes out having had major abdominal surgery.

Women in Chico who want a VBAC must either have a scheduled cesarean instead, or drive at least 100 miles to a larger urban hospital to have a VBAC. Or, they could find a homebirth midwife. Homebirth midwives put mothers and babies FIRST; not hospital rules, not malpractice insurers' rules, and not convenience for the midwife. (Cesareans are very convenient for the doctor - they last an hour, no one is groaning, grunting, or pooping, and the doctor even gets paid more than for a natural birth.) Hannah came to me about a year ago. She wanted a VBAC, and was considering her options carefully.  Her son had been born in NYC by cesarean after 30 hours of labor, but she felt that with more preparation and better support during labor, she could DO IT this time. Her husband Jason and the rest of her family were not particularly supportive of a homebirth. Hannah wanted me to do her prenatal care, and then she planned drive down to Berkeley, 3.5 hours away, to birth at a hospital where nurse-midwives attend VBACs. As her pregnancy progressed, Hannah became more clear that she actually wanted a homebirth. She educated herself and her family about homebirth, and finally her husband agreed. The Berkeley scenario was dropped, and we began to prepare in earnest.


We delved into the details of Hannah's previous birth. A big difference between hospital-based and home-based prenatal care is the attention homebirth midwives give to the position of the fetus. During the last two months of pregnancy, I pay careful attention to which way the fetus' back is lying, so we can be proactive about helping the baby into the best position for birth. This way, we are not surprised with a longer, more difficult labor due to posterior positioning of the baby. Hannah had started her first labor with her baby in the posterior position, and did not know it. Her doctor had never checked for that. Hannah and Jason had driven across the Brooklyn bridge at rush hour to get to the hospital, a major ordeal. When they got there and were checked, they were told to just go on back home, it was too early to be admitted to the labor floor. Well, Hannah was having the strong, painful contractions of back labor, and was not about to face another two hours of traffic. So she and Jason wandered the hospital, found an empty conference room, and spent the night there laboring away.

When they returned to the labor and delivery floor in the morning, more troubles arose. The "wrong" doctor was on that day, not the doctor Hannah had connected with and wanted. The nurse was kind and helpful, but then the doctor and the nurse "got into it with each other" and the doctor banished the nurse from Hannah's room!   Eventually Hannah pushed for three hours, all alone except for her exhausted husband and mother, with not even her nurse in the room to guide and support her. The doctor came in and out to watch for progress, and then took her in for the cesarean.  Afterwards, the doctor told her that surprise! the baby was posterior! Oh, well.

During her pregnancy I focused on four main areas of preparation.

1. Giving her undivided attention, love, and support so she could build trust in me and my assistants, and know that we will really, truly BE THERE for her. I imagined she would have another 30 hour labor, and mentally prepared myself to hang with that. If she needed to push for four, five, six hours, so be it.  

2. Fetal position! We used chiropractic care, specific exercises, and homeopathic pulsatilla to encourage that baby to rotate forward, not posterior. And she did.  

3. Healing the trauma from her previous birth. She wrote about her first birth and her deepest fears and we used Emotional Freedom Technique to address them. This technique uses the meridians and acupressure points of the Chinese Medicine system, to clear emotional trauma from the nervous system and tissues. Her biggest hidden fear was having to face her family and friends if her home VBAC "failed" and she ended up with another cesarean. She felt they would think "See? You should have just had the repeat cesarean. It would have been easier on everybody." She was so brave to stand up for what she wanted, outside the comfort zone of her intimate circle, while not knowing what the outcome would be.

4. Filling her with positive images, stories, and vibes to promote a sense of well-being and optimism about this birth.

Ten days after her "due date", I got the call at 4:30 am. "Hannah is having very strong, close contractions" Jason told me. I heard her moan in the background. I was on my way. I arrived a little after 5 am. Hannah was on her hands and knees in the kitchen, working with contractions every two minutes. This all had started just an hour ago. She had literally just woken up a hour ago. I could tell things were cooking along and readied my supplies. 45 minutes later, her water broke, and she had a strong urge to push. I checked her and she was completely dilated. We moved her to the rug in the living room where she pushed on her hands and knees for twenty minutes and gave birth to her eight and a half pound girl. She had been awake three hours, and I had been there for little more than an hour!

Well, talk about thrilled, shocked, and delighted! Jason and Hannah snuggled up with their baby and giggled and smooched while she nursed. "That was it?" they kept saying. "Really, that was it????" Her whole labor had lasted three hours and she had barely needed to push. Their eyes were shining with joy. They were both transformed by the experience. Jason was in absolute awe of his wife, so strong and powerful and looking gorgeous lying with their baby in the dawn light. They wouldn't have even made it, driving to Berkeley! It would have been a travesty for her to have had abdominal surgery instead of this experience! As we all ate bagels and eggs, I thought about her two births. Why are one woman's two births so different? Can love, support, and the comfort of one's own home REALLY make such a difference? What do you think?

Friday
Dec312010

Light Switch

“What was the light switch that turned you from a sheeple to a natural birth advocate?” was the question asked on my Navelgazing Midwife Facebook page. These were the answers. 

KS-R: Ina May's Guide to Childbirth. I don't remember why I bought it, but I’m glad I did. 

ABP: Getting pregnant with #1 and knowing I didn't want drugs and intervention pushed on me. 

CM: The birth of my second child. I went into labor with the attitude that the nurses had my best interests in mind and would do whatever possible to make sure I had a wonderful birth. It didn't happen like that at all. They bullied me, made it sound like I had no option except to lie in bed and labor, gave me Demerol against my wishes and overall extremely mean. I vowed never to go through that again and after hearing so many stories of how other women have gone through the same thing, I began my studies to become a doula. I had a beautiful birth with my third child and want to help women have the best birth possible. 

SD: I can tell you the exact moment actually. I had a doula friend in Des Moines, IA who had been talking to me about and also pushing me to take out-of-hospital birthing classes, even if I didn't follow any of her other advice. I picked a wonderful doula and childbirth educator and took her class. The first day of class, we did an exercise that is from Birthing From Within I believe. She asked us to draw what a C-Section looked like to us. I quickly drew a cold hospital table, with a Mom on it, with blood rushing out, a baby being yanked out and a terrible awful sad look on the Mom's face. Then I burst into tears. Loudly. I did NOT want my baby to be born into an environment that even remotely resembled that picture. It scared me so much! I went on to hire that woman to be our doula, had a birth center birth with a midwife, and haven't looked back since! 

KF: My births. First one, the typical American birth with all the drugs and complications. Second one, very low intervention with a midwife and we got a computer with internet access. There wasn't a lot of information available when I had my first baby in 1996. 

AC-M: Getting bulldozed in every aspect of my first birth definitely did it for me. I felt so powerless and helpless during the whole thing and even afterwards. I positively will not allow that to happen this time. 

EC: I am one of those people who reads everything I can get my hands on when I am faced with decisions. After my horribly mismanaged miscarriage, I started reading about options other than OBs. This lead me down the rabbit hole and I discovered I was far more "granola" than I thought I was. My previous thoughts of getting an epidural as soon as I got pregnant went out the window as I found out more about the cause/effect of interventions. 

JT: First baby--22 years ago--went to the see the OB after getting a positive home pregnancy test. He told me I could not be pregnant because I had not medically treated my endometriosis. I told him I used homeopathy and nutrition and he said "that doesn't work". I walked out and told my husband I could not have a hospital birth. I had never heard of homebirth, but found someone within a few weeks. 

EN: I saw The Business of Being Born. Ina May (Gaskin) is interviewed in that documentary, so I progressed to reading Spiritual Midwifery and never looked back. 

JD: looking at VBAC options while suffering secondary infertility; quickly found my options weren't options at all, ended up on the ICAN (International Cesarean Awareness Network) site and the rest is history. 

ALJ: Realizing that Dr. Stabby-Hands lied to me once I started researching the undeniable symptoms of the condition he diagnosed to justify our "emergency" c-section. 

SE: You were my light switch, Barb. 

Thank you!! 

LC: Getting yelled at by a nurse while purple pushing because I couldn't hold my breath long enough. Luckily my midwives with my 2nd and 3rd would never have dreamed of doing something like that. 

EWB: I was 13 and my pastor’s wife had just had a baby and she said to me "Emily, when you have a baby, don't go to the hospital - they won’t even let you eat while in labor." At 13 I couldn't believe the forced starvation. I followed her advice and never went to a hospital - motivated by food! 

JWP: There wasn't a one time thing. I went into birth wanting natural and ended up with an induction and c/s and I've just progressively gone from there. I've had 3 VBACs now and have learned even so much more after this 4th baby. I now want to become a CNM

CR: The fact that I hate hospitals with a passion and really didn't want to be subjected to someone telling me how I needed to have my baby. 

CS: When I was 13, I babysat for a La Leche League/natural birth/co-sleeping mama. Back in the 70s! It’s all Connie's fault! 

EG: I went to my sister in law's birth; she was induced and didn't even care about seeing her baby - she was just looking at the menu. When they asked if she wanted to hold him or have him cleaned off first - she chose the latter. It creeped me out how cold and unconnected it was. 

EHS: I am so lucky because there was no aha moment. I was a little girl who studied things and questioned the status quo. I was also lucky to grow up sleeping in the handmade bed frame my mom was born in. So I was able to extrapolate that birth at home was normal. 

KF: What is really sad for me, having worked for many years as a doula, are those women that don't WANT the information that I was unable to get with my births. I'm just astounded. And when a mom says she wants a low or no intervention birth, proceeds to hire an OB who is the MOST intervention-minded, and I TELL HER and she doesn't switch - I don't get it! But it's not about me. I have to let those things go. 

RG: When I got pregnant, my friend gave me the Lamaze Guide to Giving Birth w/ Confidence. I was amazed that hospitals aren't set up to give women the best birth possible. That put me on the road to homebirth and now doula work! 

BJ: Endometriosis and figuring if I don't pass out in labor, it can't be as bad as a period. 

SS: Was born with it switched on. My mom had me at home after two hospital births. One a nightmare of medical pestering that has left her with serious urinary tract issues and another where she arrived intentionally just as she was about to push, and they insisted on separating her from her baby. I was a home birth. My sister was the first person to hold me (she was 10 at the time). I was born in my parent’s bedroom with the lights dimmed. 

I grew up with a healthy respect for things, since my mom told me our birth stories. She talked about the safety precautions the midwives took (apparently because of law, they had to hire an ambulance to wait in their driveway while I was being born), the feelings that she felt, what everything felt like, etc. 

I also grew up surrounded by animals and seeing animals give birth and care for their young. So my mental images of birth are of birth. When I asked my mother questions about "does it hurt", etc. her answers were honest according to my experiences in my births. That yes, there can be pain but that it's a different type of pain and that our bodies are strong and were born to give birth. 

AH-T: When I witnessed my nephew being held inside my sister in law because the nurse wouldn't deliver for "insurance purposes". I knew that I would never let someone tell me when I could or couldn't push or that I had to wait for some doctor to get there. 

Stories like that disgust me. 

NM: The booklist my OB insisted I read including “Spiritual Midwifery” & Immaculate Deception

Wow. Wow. Wow! Immaculate Deception, apparently, is a very difficult book to find. Even Suzanne Arms’ site only offers Immaculate Deception II. If you have a copy, hang on to it! 

PK: Pushing out a sunny side baby (my third baby and second Occiput Posterior) after 2 and 1/2 hours of pushing at my first homebirth. She was 8lbs 14oz. I realized that Natural Birth was the way to go after that, and felt I could do anything if I could birth a baby that size who was OP. My previous baby born at the hospital came after 2 hours of pushing (they had no clue she was sunny side up, duh...) and the help of the vacuum which was a b!tch because I had let the epidural wear off and I felt her being ripped out of me (I tore as a result also.) I've had a total of 3 homebirths now and at no time during any of them have I ever felt any kind of pain like the pain I felt when my OB pulled my second child out of me with that vacuum. I had the pleasure of seeing him at the hospital when my niece was born and telling him I'd had 2 more (larger) babies at home. 

TS: Believe it or not, it was an episode of A Baby Story that focused on Hypnobirthing

ACA: After having my first in the hospital. While I didn't end up like the many women who are forced into a c-section from being induced, etc., it was by the Grace of God and my God-given stubbornness (and my husband's refusal to allow the med staff to take control). 

I knew I would never have another hospital birth, but didn't know of other options, so I researched and found a home birth doctor who was great and the rest is history. I had baby 2 and 3 at home and am currently awaiting the birth of my twins who are due any day now and am having them at home. 

Life is good. 

NY: Caroline Ingalls, from Little House on the Prairie, says to Laura  concerning labor, "It's a good sort of pain." I was hooked!! 

NgM: How beautiful, all of you! 

I was a total sheeple with Tristan. I'd gained 70 lbs with him and did not want to repeat that, so when pregnant with Meghann, we'd just moved to Tacoma, WA, where I knew no one. The woman who registered me into the OB program at Ft. Lewis referred me to Marie Foxton, a prenatal and postpartum exercise instructor. Her studio happened to be really close to where we lived, so I went over there not too long after. 

Not only was Marie an exercise coach, she was also a Bradley instructor and LLL leader. Women in all stages of pregnancy and postpartum danced around the room, many with kids on their hips... and some even on the mom's boobs! I was fascinated. 

I took the pics of Tristan being born in to share... the blue drapes, the masks on everyone, the baby being taken across the room... and the women kindly oo'd and ah'd. Later, of course, I was astounded they'd been so kind. When I asked why no one said anything about how gross they were (to them), they smiled lovingly and said they trusted I would figure out the right way to birth for me... and they knew it wasn't going to be like that. 

They were right. I UC'd the next baby

KO: ‎@TS - YES!!! That was it for me too! I ordered HypnoBirthing the very next day. 

TC: I knew from the get go that being immobile wasn't going to work for a control freak like me. Little did I know that it was surrender that would bring my baby forth. 

CSM: I'm not sure… I was told throughout my childhood that I'd never be able to handle childbirth (I was a big baby if pain was involved) but somewhere along the way I realized things didn't hurt as much if I was the one in control. I knew I wanted an intervention-free birth long before I ever became pregnant. 

Ditto! I was told my whole life what a baby I was –and was-; but when it came to having babies, I was a lioness! It changed the way I saw myself forever. 

SP: Well, I had that "There is something not right about this" feeling after my first C section. I suppose reading Immaculate Deception and Spiritual Midwifery in the same week was what clinched it for me. Then after I had my first homebirth, it just seemed so simple that it was monstrous what I had been through to get there. 

TR: A completely unnecessary and very painful episiotomy at my second birth. I wasn't going to go through that again and I knew there had to be a different way. 

PNB: My first birth - Actually, I don't know that I was a sheep then either. I wanted a natural birth then, but for uneducated reasons. My first birth taught me to be educated. 

MPF: Educating myself, knowing our bodies are made to birth children, watching The Business of Being Born and knowing if I did try to have my baby in a hospital it would be a fight for natural vaginal child birth. 

KBH: There wasn't a total switch flip, as some of it had been there before, but I would have to say my long history of endometriosis really started it. How I was treated with that, being told at 17 to not expect to have children, going through medical menopause at 16, and taking two years and two miscarriages to conceive my first. I knew I may only get one shot and I wasn't going to be drugged or anything and miss it! After his birth, I only went deeper down the rabbit hole, and even more so after my second. 

LH: Reading every book I could get my hands on from the library and I came across Pushed by Jennifer Block. Haven't looked back since!! 

DV: Nine months of supporting one of my best friends during pregnancy (daddy is military and was out of state at the time) taught me a lot.  So did the 12 weeks of Bradley classes she asked me to attend with her.  But my light bulb moment was when mom acquiesced to amniotomy, which led down a path of intervention that included augmentation, pain meds which fractured her concentration, being tethered to an EFM and IV pole and all of the hassle of those entanglements, immediate cord clamping/cutting against mom's wishes - and the finale: a manual extraction of her placenta, because the care provider pulled too hard on the cord and it broke off.  It was like everything we were told, all the warnings we received, moved from hypothetical to 'this is actually happening.'

Watching other women experience pregnancy, labor and birth is no longer a remote landscape on the horizon that I catch a glimpse of once in a while and think, 'That's just some other country.'  Birth is in my own backyard now, and I exam every blade of grass.

M: I transfered care to a wonderful CNM, and when I asked her epidural or no, she told me that if I didn't decide in advance, I would have an epidural.  I wanted to have a choice, so I choose.  Now I'm a Bradley teacher, doula, and hopeful future natural OB.

KJ: I was never a sheeple.  Before my first birth, I knew that I wanted no drugs, no intervention.  My hubby wanted a hospital birth, and it wasn't worth arguing.  Over the last 13 years, I've had five babies, all birthed with no interventions, no drugs, all born in the hospital.  Each birth has gotten closer to ideal.  Each birth, I've learned a little more.  If I have a 6th (not likely, but possible), I'll birth at home, even though my hospital experiences have been good.  (I live in AZ, and I think, as a state, women are more "left alone" to do what they want to do, and less pushed, than in other locales.  That has been my experience, anyway!) 

HOWEVER, there was a light bulb moment for me, about being a natural birth advocate.

I'd always been rather laissez-faire about birthing:  to each her own.  I never encouraged ANYONE to do anything naturally;  I figured each woman had done her own research, and had just decided that they wanted an epidural (or whatever), in spite of their research.  Pretty much everyone in my circle knew I was a natural birther, and I figured if they wanted help, they would come to me.  It wasn't until a few years ago that I realized that most women DON'T do research and haven't come to their OWN conclusions;  they're just trusting the OB to do what's best, assuming that the OB is working towards the same goal that the mother is. 

The galvanizing light bulb moment, though, was about two years ago, talking to a friend who had a HORRIBLE, HORRIBLE vacuum vaginal birth with 4th degree tears, very alone, very confused, very unsupported.  She had wanted a natural birth, and didn't know what steps to take to help that happen, and assumed her OB was on her "side".  He wasn't.  She ended up with PTSD.  I didn't know her well at the time, but afterwards, in tears, I asked her if she would have allowed me to be present at her birth, to add support and to help her with decisions.  She then burst into tears and said, "I was hoping you'd ask!"

I realized that I had been so "live and let live" about the whole thing that I had missed countless opportunities to HELP other women achieve the birth they wanted.  Instantly, I felt the weight of guilt and grief for the mothers who might have wanted my assistance, but were afraid to ask, for all those lost births.  I'm not the "afraid to ask" kind, so it never occurred to me that women might WANT some help and direction and support, but not ask for it.

Duh.

I'm now doing the prerequisite reading to become a DONA doula, and have switched my modus operandi regarding birth and birth issues to be a much more active, vocal one.

C: My mom wanted a natural birth in 1987, at age 21, unmarried, deep south. she had her first c-section, because of 'failure to progress'. the next baby was also a c-section, and he was given up for adoption. then third c-section was in 1994 (I was seven), a miscarriage in early 1995 (I remember that day), fourth c in 1997, fifth c in 1998, sixth in 2000, and the final c was in 2005 with the only OB in town willing to preform a seventh c-section instead of a full hysterectomy and abortion. she still has her uterus, but pretty horrible endometriosis.

When I was twelve I saw a video of my aunt's accidental UC (midwife stuck in traffic and arrived to deliver the placenta).

I am grateful that my mom was always so open with me about everything baby, and that their history has taught me so much so young.

I am grateful for the lessons that I learned in my own birth experience. That while homebirth was the right choice for me, the hospital is not the enemy, they are sometimes supportive. I choose a kick-ass CPM,who labor sat for the long, slow 48 hours, and transferred for heavy meconium and who guarded the space in the L and D room while I worked through my acquired fear of hospital birth and taught me how to birth a baby.

L: My mom had 3 natural births which she always shared were very painful.  When I first got pregnant I was scared of labor, but knew that I absolutely did not want a c-section (lady at work had one).  I checked out a ton of books at the library, but the one I read first was The Thinking Woman's Guide to a Better Birth.  Then I was trying to figure out what kind of birthing classes to take and Amazon reviews ended up convinced me to try hypnosis, even though at first I thought it was way too hokey.  I ended up doing Hypnobabies Home study and became completely sold on natural birth and was excited.  I switched to a CNM/birth center at 6 months pregnant (fortunately it was a cheaper option thus I was able to convince my husband), and had a wonderful birth experience. With my second I was super excited about giving birth again, and this time chose a CPM but wanted the birth center again.  Unfortunately I ended with a c-section the second time around.  It really sucked. 

My one piece of unsolicited advice to every new mom is to interview their care provider.  No one listens though.

A: For me, it was watching The Business of Being Born.  In fact, I can tell you the exact moment in that movie when the switch flipped.  My friend (a natural birth advocate and survivor of a traumatic birth) took me to see it at a film festival and at first, I was quite skeptical and huffing about certain points, yet interested. 

But when they started describing the cascade of interventions, it clicked me for me.  I thought my hospital birth was awesome (and it was exactly what I needed/wanted at the time) but the third degree tear that took literally months to recover from (couldn't have sex for 6 months, it didn't stop hurting for another 3) was the worst part. 

As I watched the movie, I realized that a lot of the circumstances in the hospital conspired to create a bigger and more painful tear and that there were things I could do to help prevent or at least lessen future tears, I wanted to know more. 

I dug a scrap of paper out of my purse and started scribbling questions furiously and as soon as we left, bombarded my friend with them.  It's been almost 3 years since that night and I have devoured and learned and sucked up tons of knowledge.  I went on to have a beautiful, successful home birth with my son (second baby) and am now pregnant and planning a birth center birth for my third baby.

D: My 16 week IUFD when I was not told I could have an induction rather than a D&E, and when I asked about what happened to my child's remains I was told by the OB, "you don't want to know" so then I called the hospital after the procedure. The nurse on the other end of the line didn't know how to deal with me and when I asked what happened to my CJ's remains she first asked, "what did your doctor say," and then stated, "yes, you don't want to know." Then she coldly stated with annoyance, "they went out with the medical waste."

All along I had the right to ask for the remains, had the right to ask for an induction, had the right to have sonogram photos of CJ, but I was nervous and never spoke up for myself.

I began reading online and came across a few blogs (obgynkenobi led to atyourcervix who led to you....and other midwife blogs).

When I got a positive screen for t-18 with my 6th pregnancy, I had already begun reading your blog regularly. You had photos of Dr. Biter with a patient who had an OP baby who was having decels and he didn't do a c-section but had her move. In my labor, my OP baby was having decels that went down to 80. I recalled your photos at that moment and resolved in my head to do something, instead of staying on my left side, I argued with the nurse and sat up. Heartrate jumped immediately to 120. I have written you about this birth, I complied after that and the nurse was horrible, and that experience really changed me. I had a midwife for the next baby (my last one) and I have bloggers to thank really. Funny....

Very humbled, Dawn. Thank you.

Thank you… all of you. And feel free to add your own story. We’re all listening. 

Tristan's birth, 1982 (notice the nurse not wearing gloves). 

Me, in labor with Meghann (my UC baby), 1984   

Thursday
Dec092010

What to Wear to a Funeral

My friend and former client ( that I midwife’d for for two of her babies) Silvia Frank’s funeral is Saturday, December 11, 2010 (details below) and the decision about what to wear to a funeral seems to come up more often as those around me have died. The American (Western?) tradition is to wear black, whereas in other cultures, white is the appropriate/accustomed color. 

When Silvia was laboring with her second youngest of five daughters, I arrived wearing black leggings and a black dress kinda thing; the thought being, “Birth can be messy and you can’t see wet/blood/poop/anything on black, so good choice, Barb!” Half-way through her active labor (I can see her even now), inbetween contractions, she, in a silky red nightie (see picture below), looked up at me and said, “Don’t you ever wear black to a birth again.” Oh how I wished I’d had a change of clothes! Later she expounded by telling me how she thought of me in lots of colors, that she could never think of one time when I’d worn all black clothes. I’ve never worn all black to a birth again. 

So, as I sadly prepare for her funeral, I keep smiling thinking, “I’ll be damned if I wear all black!” Reminding her oldest daughter of Silvia’s admonition, telling her I wasn’t going to be wearing black, she said she would not be wearing black either, that she would be wearing her mom’s favorite color - orange. I dug around my closet and found an orange top and will wear that color as well. (If you’re attending, perhaps you, too, might wear something orange in her memory!) 

Choosing what to wear in mourning is absolutely a personal decision, best made by the mourner him/herself. For me, I don’t think I will ever be able to wear all black again… funerals or births… equally pious and blessed events. 

For those wanting to donate funds to the five girls, ages 3 to 17, here is the information: 

Routing#: 322274527
Acct#: 1020018003
"Frank Girls"

Funeral Information:

Viewing and Funeral, Saturday, December 11th, from 12 P.M. to 4 P.M. (I don't know the exact time of the service; her page has been removed from Facebook... very sad, indeed. When I find out the time, I will post it.)

McWane Family Funeral Home
www.mcwanefamily.com/
350 North San Jacinto Street
Hemet, CA 92543-3110
(951) 658-9497

Sunday
Nov282010

Thoughts on “When a Homebirth Doesn’t Happen”

Maryn Leister wrote a beautiful article in Indie Birth, “When a Homebirth Doesn’t Happen.” 

“There is a Higher consciousness that serves us all, and to act like we KNOW how things need to turn out is just plain arrogant and egotistical. Who’s to say that a woman needs or should have a certain kind of birth? How is that respecting the path that she walks? It is not my job or my goal to affect change on anybody’s path. We each have our own to walk, and our own lessons and trials and triumphs.” 

It’s a lovely self-reflection about a midwife’s desire for her clients to have their babies at home and the subsequent feelings in both midwife and mom if the birth moves into the hospital. At the beginning of the piece, Maryn says: 

“I’d like to approach the delicate subject of transports to the hospital from home; mainly for my own reflection and processing. I say ‘delicate’ because for many (midwives and mamas alike), a transport conveys the ‘failure’ of someone or something. In the past, I’ve been the midwife that, I’ll admit, has heard other midwives’ transport stories and thought indignantly, ‘You transported for THAT?’” 

I’ve found that, with time, all midwives eventually come up against this reality check. It really is pretty easy to second-guess another midwife’s actions, especially when not a midwife yourself. But when the woman and baby are in your charge, the scenario can look entirely different. I believe it would be a fairly immature midwife to not look at this issue with a brilliantly bright light and a daringly sober attitude several times over a career. 

Through the years, I’ve revised my Statement of Purpose as a midwife when the situations led me to do so. At the moment, my Statement of Purpose is: 

My main role as your midwife is to keep you and your baby alive. However that unfolds, I am here to serve you.

As Maryn and others have also experienced, the feelings of failure, of being a not-good-enough midwife have splashed about my ankles and calves. I’ve even had times when the guilty waters have, tsunami-like, threatened to take me under the waves. But, I force myself to remain in a place that does not include self-pity. There’s a difference between wishing things were different and beating one’s self up; the former can be productive if processed correctly –the latter is wasted energy. 

I’ve had my share of transfers (going to the hospital in a non-emergent fashion) and transports (going to the hospital in an ambulance) and I think with all but the clearest of reasons (i.e. placental abruption and posterior face presentation are two that come immediately to mind) I have wondered “Could I have done anything more?” There have even been a couple of births that haunt me, wishing I would have done things differently. While it might be a woman’s path to be in the hospital, perhaps if I had <fill-in-the-blank>, it might not have been in her cards in quite the same way. Blessedly, no mothers or babies were lost in the process, but I do believe at least a couple of women have been (cesarean)-scarred by my decision to move to the hospital. My heart aches with that belief. 

When I became licensed as a midwife in 2005, I’d had many years of experience as a doula and a few as a midwife in a birth center and even fewer as an assistant and then primary in the homebirth setting. During my homebirth apprenticeship, experienced homebirth midwives would say, over and over, homebirth was a different animal than hospital and birth center births. Really, all I could tell was it was a lot slower and gave the woman a ton of one-on-one care, especially compared to the high-volume Casa de Nacimiento birth center. I mean, wasn’t birth birth? Didn’t all women labor the same, birth from the same body part and have the same needs? It was even easier in the more relaxed settings because women didn’t have to struggle with The Establishment over her autonomy. I grew tired of their repetition… “Homebirth is different.” For goodness sake, most of them didn’t have nearly the number of births under their belts that I had. 

But they were right. Homebirth is a different animal than birth center and hospital birth. (I thought it would be a bitter taste in my mouth to say that, but it actually came out easily.) 

Now that I’m five years into being a Licensed Midwife, I feel I am just now coming into my own as a homebirth practitioner. I know that probably sounds ghastly, especially to past clients. I don’t mean I was a bad midwife before, but feel I am now a more mature midwife… less skittish than I’ve been in the past. All those years of erring on the side of extreme conservatism; was that really necessary? I’ve not heard other midwives speak about this learning curve, so I’m left wondering if this is a solitary experience… these feelings of previous inadequacy. (If you have written about this topic or know someone who has, please point me in the direction; I’d love to hear from others.) 

I don’t believe this was a technical lacking in my education or training. It is more of an intuitional process that can’t be taught… that place of balance between trusting all of my capabilities implicitly and knowing the exact moment to hand over the reigns to a medical professional. I’m not sure if this perfection is ever achieved, but I know I could have come a lot closer to the mark. 

I know this sounds crazy, but it is now that I wish I could apprentice with an experienced homebirth midwife. It is now that I know what I’m watching for in a domiciliary experience. I’m finally (I think) more balanced in my knowledge of all births, homebirth included. That doesn’t mean I still don’t have slews of things to learn, by any stretch of the imagination. It doesn’t mean I won’t still waver on the cusp of uncertainty. What an apprenticeship would do is validate my decision-making skills, allow me to say, “I did know everything to do after all,” or show me my blind spots, forcing me to acknowledge “I hadn’t thought of that; I will remember next time.” 

I would be more patient in an apprenticeship now. In the early 2000’s, I couldn’t wait to be on my own, really believing I didn’t have all that much to learn… perhaps how to do longer prenatals or organizing a birth kit… but not so much about birth itself. I wonder if I wasn’t arrogant even. I might have been at times, but think I was simply naïve more than anything else. 

Maryn says that even as she brings up the topic of transports…: 

“… I am trying to prove something, or maybe it’s to disprove something. That my transports (or lack of) somehow indicates my worth as a midwife. As if I am in control of the outcome, as if these births I attend are all about ME and how skilled, intuitive (substitute your favorite midwife attribute here) I am. These 2 transports, the most recent in particular, have shown me how ridiculous this mindset is. And how if I (or any midwife) operates under that notion, birth becomes ego-centric and also totally disempowering to the woman.”  

To me, midwives are in control of at least some of the transports. If they (I) don’t have certain skills, then some situations can be out of the scope of practice for the midwife… and a transport becomes (almost) inevitable (unless she sallies forth, trusting the knowledge is there and will pour out of her brain into her hands). While the outcome itself might not be in my hands, by making certain decisions, the selection of outcomes narrows. By making the decision to transport, I have removed the option of having a homebirth and, in all likelihood, thrust the woman into the pool of an uncontrollable cesarean rate. 

I have said, more times than I can count, “Who knows why your baby needed to be born in the hospital/by cesarean.” I’ve toddled along, counseling women after their complicated births, helping them to reframe their experiences into some (possibly) pre-destined ordeal. With Maryn’s unwitting help, it is this attitude I am questioning. Perhaps by believing birth is already written even before labor begins… by believing in fate… might not that absolve the midwife from any culpability? Isn’t that the selfish and egotistical notion? Might the midwife not accepting her role in the outcome be the disempowering factor in the mother’s attempts to make sense of it all? Might this attitude not be a subtle way to blame the victim for her own circumstances? 

I agree; it isn’t All About Me when it comes to a woman’s birth or her transport to the hospital because of a complication, but I feel there must be room for the client to ask, “What could you have done differently?” I mean, the woman hired me as a consultant in her birth, didn’t she? Even women who want autonomy, if they’ve chosen to have a midwife at their births, they (often) look to the midwife to make the ultimate decision to transfer/transport. If we/I can accept that our/my actions might have pulled the laboring mom down the path towards Intervention World, perhaps that creates the space for women to find their power surrounding their births. Perhaps this acknowledgement is the tipping point between a woman’s self-flagellation and the ability to retain/regain her sense of self-confidence… an attitude that, most assuredly, spills over into her mothering. 

None of this is meant as a recommendation for making the midwife the scapegoat in a transfer/transport… something I have seen happen before. But, as with all things, a balance of responsibility allows room for learning, explaining and even asking for forgiveness if that is appropriate. 

Just writing this, I have uncovered places where I now want/am ready to accept responsibility for my actions and apologize for them. I know it can’t fix the outcome, but it can, at least, acknowledge their own niggling questions about their births, letting them know their births were an integral part of my continued education as a homebirth midwife. Not many pregnant/birthing women would purposefully want a midwife learning on her, but, in a way, aren’t we always learning by caring for women? If I could do some of those births differently, I would. The fatalistic part of me says we chose each other; me to learn… they to teach.

But I can’t help but wonder, is that my justifying all over again?

(photo by Nova Bella DeLovely)

 

Tuesday
Nov232010

Comment to “Ummm… not so much”

I was asked to remove the blog owner's name, she thinking her blog was private. Therefore, you will not be able to read the post I'm referring to. However, I'm leaving what I have because it's a great discussion even without the entire piece. She wrote “Ummm… not so much” about an article she read about a homebirth, how the article reaffirmed her decision to birth in the hospital. 

“One of her (the woman in the article she read) reasons was hey its the way people did it back in the day it must be the right way to do it. Well people also used the bathroom outside and took baths in the creek but we don't those things anymore right? What is so bad about having the baby in the hospital? I had a wonderful dr and labor and delivery nurse and I knew if there was a problem, I was in the right place. There was also the issue of her child being home for the birth. This lady was sitting on the toilet screaming having a baby while her child is coming in and out trying to figure out what is going on. At least take the child to a babysitter!”  

It’s so interesting reading others’ take on what many of us find pretty typical, if not downright normal. When moms or family members worry what the kids will think, I remind them that kids usually do better than grandparents… they don’t have the preconceived brainwashing they do. You know, no decades of watching fake-births in movies and on tv; to them, it’s not that big of a deal. 

Regarding the peeing in the woods analogy, I always find that so gross. Birth isn’t an elimination function… it’s the bringing forth of a life. And sure, there are advancements we can and should embrace, even in birth. For goodness’ sake, it’s a rare woman who wouldn’t accept medications for hemorrhage or blood products. And I can’t imagine any woman not wanting anesthesia for a cesarean, but when we mechanize the simplicity that is the majority of birth, that’s where the complaints come in. 

The analogy of hospitalizing a woman, putting monitors on and in her, people wandering in and out, measuring blood pressure and pulse… and penis size? while having sex with one’s mate… that’s what normal birth foisted into the hospital setting is like. An absurd picture, isn’t it? 

The blogger goes on: 

“Midwives can't give pain meds and u have to footprint ur child on ur own, they don't do it. They never mentioned going to get the baby checked out by a pediatrician; she just said they cut the cord and then she ate breakfast at the table with her expanded family and then they sat outside watching the other child play. What?? What about all those tests they give when the baby is born? What about height and weight? This article was a little disturbing to me. I understand this may be more comfortable for the mom but what about the safety of the baby? What if something went wrong?” 

Actually, dear blogger, if a woman wants pain medication in labor, she does need to be in the hospital because they are so patently unsafe she and the baby must be monitored. Even something as simple (simple?) as a sedative needs constant attention. Nothing given for pain is benign. Nothing. 

Most midwives do footprint, but it’s a memorabilia sort of thing since there is no chance your baby will be mixed up with another baby… something that can (and has) happen in the hospital. 

We do all the routine tests and administer the state required treatments -if the parents consent to them. Many (most?) of us also do the Newborn Screen which is done about day three postpartum.

Most midwives do recommend the baby be seen by a care provider, usually a pediatrician, within the first few days after a birth. We are able to keep a mom and baby safe through the passage of birth, but we are not specialists in complications of either. If there are any signs of a problem, they are referred (if not transported immediately) to a specialist (obstetrician/pediatrician). 

However, we do postpartum visits, checking mom and baby several times after the birth. My own rhythm is 24 and 72 hours, then two and six weeks postpartum. This is more observation than hospital birthing women get; once they are released from the hospital (24 hours or so postpartum), they are not seen again for six weeks. 

It seems the mom in the original article (that she does not name) was demonstrating the simplicity that is homebirth… that it was as easy as cutting the cord and then sitting down to eat her breakfast. But, I promise you, the midwife was doing much more than just scrambling eggs and buttering toast. 

We do examine the baby, head to toe and side to side. We weigh the baby (see the scale picture below) and measure him/her. How can anyone not want to know those basic facts? Besides, the weight is necessary for the birth certificate, which, in my state, I get to complete and file for the family, too. 

We watch the baby during the postpartum period, usually two to three hours, which is what happens in the hospital, too. We make sure mom is nursing well, that her bleeding is under control, that the baby’s breathing well and adjusting to the outside world nicely. We’re taking her blood pressure, both their temperatures, helping mom to the bathroom, helping her to shower, cleaning the room/bed, making the house so that you cannot even tell a birth occurred there. We start the laundry and make sure someone will be with her at all times for the next day or so. 

And if something goes wrong, we immediately attend to it and/or move into the hospital setting where, we absolutely acknowledge, they are the specialists in complications. We do carry medications to stop bleeding/hemorrhages, but if it continues and needs more help, we don’t hesitate to get the mom to the hospital. Why would we wait? As midwives, our most outstanding job is to keep the mom and baby alive. No “experience” is worth dying for. 

And having a homebirth is not just about “the experience” or to brag about natural birth. For most of us, it is to eliminate the massive amounts of technology shoved onto (and into!) women during birth. While the judicious use of technology is a great thing, the indiscriminate use is what’s abhorrent. When birth is going along swimmingly normal and the wonders of science are required (or highly encouraged) hospital policy, each intervention (continuous fetal monitoring, IV, remaining in bed, no food or drink, pain medications, etc.) carries with it enormous risks. In remaining at home, those risks are avoided and birth can continue unhindered by the commands of impersonal, faceless bureaucrats. 

So while you may still scrunch up your face at not ever wanting a homebirth… and you have that right, of course… I felt it was important to clear up a few misconceptions mentioned in your blog post. (I wanted to leave a comment, but the settings are not set to Name/URL, so couldn’t; decided to write here instead!)

Sarah (lifting) and me weighing Katelynn Belle.

(photo by Nova Bella DeLovely)

Sunday
Nov212010

The Hospital Tour

Written & directed by me, Barbara E. Herrera, LM, CPM; animation completed by Sarah M. Hubbard.

Friday
Nov192010

Comment for "Home Birth Plan"

Note: As I am set to publish this, Emma sounds like she might be in labor. She’s having a breech homebirth, so I’m eager to watch along her process. Much of this post becomes irrelevant for her and wasn’t a critique at all of her birth plan, but I wanted to offer other thoughts and ideas; now they can sit out there for others to read. 

Sending love, Emma! 

I read “Home Birth Plan” on the Ramblings of a kajira blog today and wanted to make a few comments. Blogger has been irking me no end not automatically allowing Name/URL as a commenter’s option, so I’ll just chat with Emma here in my blog! 

Emma, the author of the blog, is a kajira… a slave in the Gorean style of Dominance/submission, what many would classify as kink, but others find it a lifestyle choice instead. Her D/s world is irrelevant to her birth plan (on the outside, anyway), but when you go to her site, you’ll have questions; thought I’d give you a head start. Oh, and lowercase “i”s instead of the capital I is a sign of submission, not a typo. 

Emma! I’m so excited for you having a homebirth. I love that you have Jake as such a vital part of your needs and desires. That speaks well for your relationship. 

There’re a couple of things I wanted to mention about your birth plan, clarifications, really. I know you have a midwife and she’s obviously guiding you along nicely, but thought I’d point out a couple of things that caught my eye. 

- I'll need antibiotics for GBS. Once the series is done, i'd like the IB removed.

When antibiotics are given in labor, they are given every 4-6 hours (depending on the antibiotic) until delivery. But, inbetween infusion times, the tubing can all be set aside and you capped off with a saline lock. You’ll still have the IV threaded in your vein (no needle, of course), but you will be able to move around fine, shower and such without a problem. 

Have you talked to your midwife about doing the Hibiclens wash instead of the IV antibiotics? It is what many homebirth clients do and is what most of my clients choose to do as well. It is easy and the research is very positive about the efficacy of its treating/”washing” GBS so the baby isn’t infected as s/he goes over the perineum. If you want the list of studies and my protocol for the Hibiclens, email me and I’ll send it right over. (Navel gazing Mid wife at g mail dot com)

- No episiotomy, i'd prefer natural tearing. - and if a tear does happen, PLEASE use a topical numbing agent to stitch it.

It is extremely rare for a midwife to do an episiotomy. I’ve done two in 15 years! (and might not even do those again if it were today) Hopefully, that will ease your mind. And not sure why you are asking for a topical numbing agent. Instead of injectable lidocaine? Many of us will put the topical on for a minute or two, letting it numb the area a little and then use the injectable lidocaine to really numb the area. I cannot imagine suturing with just the topical lidocaine. Owie, zowie! 

There are midwives that suture without meds, but they almost always will suture immediately after the birth when the birth hormones are raging high and the perineum is still pretty numb from pushing. It’s a philosophical discussion about when to suture, but I find that suturing that close to the birth doesn’t allow mom and baby an uninterrupted time to see and feel and smell each other. When moms are being sutured, it isn’t unusual for her to be so distracted she cannot hold the baby or, if she can hold the baby, have a difficult time nursing. I’d rather wait awhile (45-60 min or so) and let mom and baby settle in before suturing. 

Each midwife does have her own style and preferences, though, so this is a great question for your own midwife. 

- Regarding being told what to do versus listening to your own body as well as Jake, I think you’re going to find that exactly as you picture it. When everything is going great, the usually tact is to be gently encouraging. It is when guidance is needed that a midwife will step in. (It’s what you’re hiring her for, right?)

- Vitamin K shot is not needed, but eye drops after a couple hours are fine if required due to the GBS positive factor. I want that bonding period first though, and if eye drops aren't required, i'd like to skip them.

Actually, there are times the Vitamin K shot is needed (in my and others’ opinion). If there is bruising at birth or if there’s been some trauma to the baby as s/he is being born… shoulder dystocia for example… or if there is a caput (neither of which a breech baby will have). However, it is very common for a breech baby to have bruising on the butt, swelling and/or bruising on the genitals or if any manipulations need to be done, on that body part. As a midwife, I would encourage my clients to seriously consider getting the Vitamin K shot for a breech birth. 

Regarding the Erythromycin eye ointment, it is given for chlamydia and gonorrhea, not GBS, if that helps your decision. 

According to the 2005 Sanford Guide to Antimicrobial Therapy, the ophthalmic ointment is indicated for use in all newborns for the prevention of a bacterial eye infection known as ophthalmia neonatorum due to Neisseria gonorrhoeae and Chlamydia trachomatis."

- Baby will need hep B vaccine AND hbig immuglobulin at birth with in 12 hours of delivery....

It’s so interesting you don’t want the Vitamin K or the erythromycin, but you do want the HepB injection. If moms pick and choose, it is very often the other way around. If, however, you are in a high-risk category, ignore this comment.

- Mom will need Rhogham. She's RH negative - baby is most likely positive. 

Not sure why you think the baby is most likely positive, but care providers almost always (should!!) test the baby right after the birth and then you can get the RhoGam® (aka Anti-D) if the baby is positive. (And yes, readers, I am aware not all mothers choose the RhoGam® even if their babies are negative.) Even in a homebirth, labs can come get the blood stat and let the midwife know so she can get you the RhoGam® before 72 hours postpartum. There are even home tests to determine what type the baby has. 

I’ve poked around and can’t find a percentage of babies that are positive to moms who are negative; do you have a site I can check out? I did find that 85% of Caucasians have Rh positive blood, so maybe that’s what you are going by? 

And do you know if the dad is Rh positive or negative? If he’s negative, then you don’t need a shot at all! 

(For the geeks in us, I came across this interesting (cool!) site that scientifically explains the Rh factors in more depth –and reminds us providers it isn’t just a case of positive and negative, but there are variations on the negatives we need to be aware of. Plus, MoonDragon has a great explanation of the variants of Rh negatives [Kell, Duffy, etc.])

I really do look forward to your upcoming birth, Emma. I know there are now many of us sending you birth vibes and anticipate seeing your precious baby. Thank you for being so out there.

Wednesday
Nov172010

Love Letter

In my email today. Just in time, too.

"Hi, Barb.  You don’t know me. We’ve only communicated a couple of times, and by email or blog comments at that.  But you changed my life. 

I had a hospital birth with my first child – a great hospital birth, honestly, even knowing what I know now.  At the time, I chose family practice OB care and a hospital delivery as not just the safest option, but the ONLY safe option for delivering my baby.  Through a combination of lucky factors, I ended up with a low-intervention OB (who had apprenticed with midwives!), a baby-friendly hospital, and a quick labor with few interventions outside of an epidural, IV, and continuous fetal monitoring. But when my sister-in-law chose to deliver her first child at home, I knew I had only two choices; I could either get on board with her decision, or I could remove myself emotionally from her pregnancy and birth. It’s not OK to be constantly dogging someone’s pregnancy with doubts and fears, and I wasn’t going to do that. 

In my homebirth research, I found your blog, and I read it avidly, and I started to question some of my assumptions.  Between your blog and lots of other research, I learned that the incidence of birth complications that can’t be resolved outside of a hospital AND that come on very quickly with no warning is, actually, incredibly low. Like, you’re probably at a greater risk when you drive to the hospital.  (Further research and some NTSC number-crunching showed that yes, for the majority of Americans, you take on a greater risk of substantial complications by driving to the hospital for a low-risk delivery than you do by delivering at home; the likelihood that you’ll get into an accident while driving distracted for 20+ miles is higher than the risk of a problem developing at home that can’t be fixed by a transfer.)  I emailed you and told you my birth story, and you said “Oh hell yes, when you asked for the epidural, you were in transition, 4 cm or no 4 cm.  You were right there. You could have done it.”  And after talking to my husband and realizing the degree to which he HATES hospitals, I decided that if I could ever get pregnant again, I would deliver at a birth center, with midwives. 

I did get pregnant again.  (After two more miscarriages, totaling four.)  My pregnancy was completely textbook and uncomplicated, modulo a couple of borderlike GDM screens and some preterm contractions that were stopped pretty easily.  At 39w2d, my prodromal labor started amping up and regulating, and after some discussions with the midwife, we decided it was time to head to the birth center. . . 

. . . and then I got the call.  For the first time ever in my midwives’ practicing history? The birth center was full. FULL.  No room at the inn.  We could either drive to another birth center 40 minutes away, with strengthening contractions that I was feeling largely in my sacroiliac joints and a history of precipitous labor, or we could do this at home.  After some quick discussion, we decided to convert to homebirth.  My husband and my doula scrubbed out our giant tub and tidied the hell out of my master bedroom, my mother bought plastic tablecloths and triple-wrapped the mattress, the neighbors brought over a plate of sandwiches, and we sent my daughter over to her best friend’s house. 

I am so glad we didn’t go to the birth center.  My contractions were kinda strong but irregular, and the midwives advised amniotomy (I was having a LOT of ligament pain and couldn’t really walk or change position very easily, and the thought of doing that for hours was very exhausting).  They broke my water at 6 cm, which threw me basically instantly into transition; after 25 minutes I got in the tub, where I instantly began to feel pushy, but my midwives didn’t want me to deliver in the water because I’m heavy enough that in the case of a dystocia or other emergency they couldn’t lift me without risking their own health, so I tried to hide it. (HA.)  But after 20 or 30 minutes in the tub, I had a contraction that I just took a deep breath and bellowed through for 90 unbroken seconds without changing pitch or tone, or pausing, or taking a breath, and they said “Yeah that’s your last contraction in the tub.” I said “I will fucking CUT you if you make me get out of this tub” but they did anyway – my doula had to count me down like a recalcitrant toddler – and got me onto the bed to push.  That was at 3 PM.  My son was born at 3:08, after I just hollered him out of my body. 6 lbs 12 oz of amazing miracle; 78 minutes since the amniotomy. 

It was so lovely. It was so peaceful.  When we were done, we were home. . . he was born in the same bed where he was conceived.  I had very little blood loss, no tearing, and his apgars were 8 and 10.  I’m still not in love with unmedicated labor, but it was worth it to stay out of the hospital.  And my GOD I felt good afterwards. 

Without your blog, without your passionate advocacy, would I have had the courage to deliver at home? Maybe. Probably, even; I had a lot of other resources on the web.  But it was definitely an easier decision to make having read your accumulated wisdom, in large part because you tell it like it is and don’t shy away from the risks.  

My son is ten days old, sleeping on my shoulder as I type this, tummy full of milk.  He’s been out of the house a handful of times already, but every time, it was by my choice. I could have kept him here, at home, in my arms, since the instant he was born.  He is my second and last baby. . . I am so grateful to have had this gift of having him at home.  Thank you, thank you, thank you. 

--Kathryn"

Thank YOU, Kathryn! You were the salve I needed today. Bless you and your family. Enjoy your BabyMoon.

Thursday
Nov042010

Diamond Marks the Spot

One of my clients has three fabulous birth stories; each unique and very, very amusing.

1. During labor, beginning to push, mom said, "It's burning" and the midwife (I was assisting/observing) kindly offered to put ice on her perineum. The mom's eyes flew open and she said emphatically, "Something's on fire!" Right next to me (how did I miss it?!), a down comforter had been tossed onto a candle and was aflame. The midwife jumped off the bed, grabbed the comforter and dashed across the small room, burning feathers flying and tossed it into the blow-up fishy pool, popping the top ring of the pool. The twelve or so folks in the room (great, tight family) all laughed at the crazy turn of events. Mom hollered, "Shut up! Shut up! I'm trying to push!" We all stifled our laughter and mom had the baby not long after. Twenty minutes or so after the birth, mom started laughing and we all could finally let the tension go. The next morning, when one of her brothers came to see the baby, he looked in the still-filled pool with the floating singed feathers and said, "So, did you have a duck?"

2. I was really sick with Disseminated Coccidiomycosis, had a DVT and a separate blood clot in my leg. At her 40+ week prenatal, the baby's heart tones were very low. After moving her around, spicing things up with juice and watching the kid for awhile, I decided we needed a better look, so drove the 40 miles or so to a midwife-friendly hospital. A six-hour NST showed the baby's heart rate never going over 115 or so... averaging about 105-110. Even so, the OB, apparently from some alternate universe, said the baby was fine, to go home and have a great homebirth. So we drove back, talked for a couple of hours about the baby, keeping an open mind about place of delivery and by that time, I was so exhausted, I couldn't possibly drive the 30+ miles home. I was put up in a spare bedroom and set my phone to wake me in two hours to check the baby. Right before the alarm went off, dad came in and told me mom started having contractions. 45 minutes later, the baby was born. If I'd have gone home, I would have missed the birth. Isn't fate great sometimes?

3. Mom, very nervous about how fast this baby might come. At a prenatal, I left all my equipment, showed them how to help the baby breathe if they needed to do that before I got there and checked in with mom fairly often. I finally got the call that contractions had started and immediately left for her house. I called my then-apprentice to also get to her house... we were off and running. I had to drive across the county on a two-lane road and at 3:30pm, the traffic was at a near standstill. I was talking to my apprentice on the phone who got to the house amazingly fast and when she got in the house, mom was on the floor, baby's head in her pants. My apprentice helped her get her pants off and the baby was born... there on the floor, marking the carpet with a bright red, later brown stain. Dad and I arrived together, the baby and mom were great... all was well.

But, mom was a tad miffed about the carpet stain that, even with peroxide, just never really disappeared. She was mostly miffed that her husband wouldn't pull the carpet up and lay down the wood floors... like the ones he laid for a living.

Finally, after years of waiting, dad yanked up that old carpet and put down the lovely wood. He loved the story of his third baby being born on the floor... hated taking up the special section of the rug... he designed a way to honor his son's birth with the wood.

He took a red piece of wood, made it into a diamond shape and inlaid the piece into the final design.

Now, that is love right there.

Tuesday
Nov022010

"Homebirth Awareness Week"

While Homebirth Awareness Week is almost over in Australia, I came across this beautiful post entitled "Homebirth Awareness Week" and wanted to share at least a few lines of it.

Lauren, of the owlet blog, poetically says (in part):

I am aware that homebirth is an amazing, life changing, completely normal, everyday miracle kind of thing.

I am aware that I am extremely lucky to have a home to birth in.

I am aware that many women around the world do not have the same luxury I do. The best they can hope for is to avoid trauma and infection and that someone might get them a glass of water or gently rub their back.

I am aware that I am lucky to have a care provider who will just be with me and leave me to birth in my own time.

I am aware that my right to have the birth that I want, with the care provider I want, is on tenterhooks (sic).

and she beautiful ends the piece with:

I am not brave. I am not a hippie. I am not built for birthing more than any other woman. But I am aware.

Please take a moment and read the entire poem. And let Lauren know how much you enjoyed her prose. Here awareness is lovely.

Saturday
Nov012008

Ink Birth

As this beautiful birth unfolds, I will share some thoughts. The story will wait, however, until mom writes her own story.

NOTE: The birth pictures are extremely graphic. Amazingly so.   

Danielle and Craig. Danielle depended on Craig throughout labor and the birth... they were so wonderful to witness. 

Danielle had a great deal of back pain and loved having pressure on each side of her spine. The baby was anterior when I did vaginal exams, so the pain was a mystery (probably a rotating/wiggling head).

I love this picture! Danielle is 5 feet even, so floated in a very small amount of water as well as was able to stretch out in the Aqua Doula. I "saw" this picture before taking it. She looks so beautiful - high! 

 Sipping soup. 

Craig "with" Danielle. During the times that Danielle wasn't (physically) touched, she was adoringly touched

We watched the baby's head eeking out slowly. I love this picture because her labia look like a vessel (which it is!) pouring life's liquid (which it is!).

As these photos unfold, watch how the labia "tightens" around the head. Mom did not have any perineal tears and the only touching that was done was by mom herself. During the birth, she said she was afraid of tearing, so Donna (my apprentice) encouraged her to touch when she needed to, that her body would guide her. Look! It did! 

 In labor-land... high, high, high!

(The photos are in chronological order... she moved around at the beginning of pushing, but eventually settled on hands and knees.) 

 

 

 Watch as you can "see" the head through the labia.

 

During a push.

 Inbetween pushes... note how the head recedes somewhat.

 

Curls!

 

 

 See the bubble that popped? How cool is that?

 

 

 See how the labia is now wrapped around the baby's head? Our bodies are so great.

 

 The birth of the head.

After this photo, the baby tried to breathe and Donna was there to catch since dad didn't want to (in the moment). As a mentor, it is my responsibility to assist, not photograph, so the next photos come after the birth.

 She's still so high!

 The new mom and dad.

 Zoey Irene, 6 pounds 6 ounces... exactly what both of her parents weighed when they were born! 

 Using the cord bander - it puts a tiny rubber band on the umbilical stump. Much more comfortable than the standard plastic clamps.

 Welcome to the Earth, Zoey! 

  

Famous Tattoo Artist Craig Driscoll holding his beautiful 2 hour old daughter Zoey Irene. Mama Danielle was showering.

I'll be taking family photos tomorrow and will post those when completed.

I loved this birth! I look forward to sharing the details - after mom shares hers. 

Monday
Aug252008

I'm Offensive...

... and oh, so proud!

I don't know about y'all, but when I find a blockade, I love to knock them down. See a warning about a site? Gotta know what's so dang bad (good? juicy!) about it!

American Prayer was sent to me this morning. Not just because I am (obviously) voting for Obama, but because Dr. Wonderful is in this star-studded video! 3/4 of the way through, after the homeless vet, right after Woopi Goldberg, Dr. Wonderful is holding a baby. He's also writing a book about birth (in the vein of "Babycatcher") and was supposed to be on an episode of Scrubs, but had a baby that night. That man's connected!

The issue of birth trauma (something that needs a label put on it if I ever heard one) came up over the weekend in two different types of articles. The first addresses birth trauma directly, the second, indirectly.

GUERILLA MOTHERING: Mama’s baby drama doesn’t have to cause trauma says,

"The Wall Street Journal recently ran an article about Post Traumatic Stress Disorder in new mothers. Evidently, traumatic hospital births with a lot of medical interventions are leaving moms severely emotionally scarred. Imagine that! Someone comes into your hospital room, you’re already half-naked, scared, and in pain, and tells you that the baby you’ve carried and dreamed of for so long might die if they don’t do a certain procedure right away-and even then, no guarantees you’re going home with your little one. Yeah, I’d call that a little traumatic."

And...

"...he was born out of my numbed-to-the-point-of-paralysis body after a long night of drugs, having my water broken, and lying around practically tied to a hospital bed, as nervous as though a firing squad was waiting for me on the other side of labor. The very moment he was born, I held my arms out for him, desperate to hold him — but the Dr. took him away immediately to be examined on the other side of the room. I still tear up, just thinking about it, seven years and two additional births later. Is that a sign of trauma?"

And after her third, a homebirth,

"There he was. Healthy, serene, perfect. There is a photo of me, smiling, holding him in my arms, immediately after he was born. I had finally outrun those birth demons, and what a prize.

"It was the most beautiful thing I have ever done, and it truly changed my life. I went on to change careers, write a book, visit a monastery for a week, play roller derby — all kinds of things that I still think are not as cool as having a homebirth, but I would perhaps not have had the confidence to do, had I not named and claimed the birth of my third miracle child. That is the total opposite of trauma, without a doubt."

What's so sad to me is that she had to swing all the way to a homebirth to find the birth that empowered her the most. I am so frustrated, knowing Dr. Wonderful births, watching/hearing, over and over, the birthrape, birth trauma and birth abuse that happens in hospitals when it simply doesn't have to be that way. Keeping women and babies safe (the whole explosive reason/explanation for the massive amounts of technology and "inconvenience" to women in hospitals) just doesn't have to be so damned dramatic/traumatic! If I hadn't seen there could be other ways, I would never believe there could be other ways. But, I have - and there can.

Should We Push for Better Birth on Television as Well?, a blog post by the Massachussetts Friends of Midwives talks about how birth on tv is incredibly over-dramatized and how helpful it would be to see a variety of midwives in a variety of birth situations so women could see how birth can (and should!) be.

I wrote one of the most profound sentences in the comments section (if I do say so myself):

TRUE natural birth needs an agent.

The article speaks about the over-dramatization of birth shows, yet sings the praises of House of Babies, a show about a birth center in Miami, Florida. While the births are unmedicated and, compared to hospital births, the women are permitted free movement, the actual births are almost always in the lithotomy position (not flat on the back, but close to it) - even in the birth tub.

Shari Daniels trained and worked in El Paso where, for the most part, women birth on their backs. In fact, unless a woman precip'd, she delivered on her back. Easily 99% of the time. While on House of Babies it might seem the women are on their backs for good camera angles, I can hear the imploring of the midwives in almost the same words, English or Spanish, as the midwives in El Paso. I have long felt we are products of our training and experiences; it isn't unusual for Shari to nudge birth along at the end since it seems to work just fine. The urgency is just as palpable on House of Babies as it is on Babies: Special Delivery.

I wonder if I'd want a camera watching a birth I was doing. Talk about being judged for actions! Am I ashamed of what I do? Not at all. But I don't know if I could take the amount of scrutiny I know would happen. I wonder how many midwives would/could want Discovery cameras in their birth arenas.

I assisted at a birth once and the client permitted a camera woman who was photographing Rites of Passages in our culture. She not only took photos of that birth (and I purposefully took none), but also of a Bris of another midwife's client. The photographer, an intern for our San Diego paper, disappeared with the photos - never to be heard from again. I'm a tad wary of bringing in an outsider anymore.

Plus, watching Mindy's birth (Psalm and Zoya) be massacred on Discovery Health, it's hard to trust the media at all!

But, how do women get to see natural births? Is it really only through edited YouTube videos? How does the slow unfolding of birth get portrayed... the mundane-ness, the down-and-dirty boring reality of it all?

(And I don't mean I am bored. I mean that many labors plod along and that is perfectly normal and wonderful. It's one reason why I LOVE the Labor Day Birth Day on Discovery Health; one gets to see births in real time - and how many births really are drugged and end in cesareans. Natural birth can be hypnotizing in its contracting, moaning repetition.)

If women saw birth on its undramatic terms, would women be so afraid of the pain? I don't think so. Even the unmedicated women in hospitals are confined to beds; no wonder they scream! The women on House of Babies moan, but don't often holler.

If our culture could get the taboo issues regarding sexual expression and childbirth out of the way, labor would look much more delicious than painful. Reminding women that sex looks scary to the uninitiated (kids, for example), but really is a delightful journey that sometimes includes moaning and hollering. So, too, can birth be the same. I think our repressed society struggles with the sounds, smells and similarities of birth and sex, hence medicating, covering up with non-descript gowns and mechanizing the whole experience so we don't have to be reminded that our genitals are involved.

Hmmm... where did that come from?

Food for thought, though.

True natural birth does need an agent. Wonder who she is.

Tuesday
Mar112008

First Breath


Tuesday
Mar112008

Wait No More


Tuesday
Mar112008

Three Generations Embrace


Wednesday
Mar052008

Baby Today


The mama in the horsey photo down a couple of posts had her baby last night. This is her the same day (2 days ago). It was wonderful!

A beautiful autonomous waterbirth. She delivered her daughter into her hands alone. It really was so lovely to witness.

I have more pictures of her in the garden and with the animals; I'll publish some once I get them edited.

7 pound 2 ounce baby girl born at 1:04am.

Fabulous!

Tuesday
Dec252007

Christmas Eve Baby

2 year old little girl with her mama who's 20 minutes away from having her 5th girl.