Wednesday, December 29, 2010


To me, the amniotic membranes are an amazing and beautiful thing. They embody the concept of strength in flexibilty. Being so incredibly thin and yet such a tough defender of the babe. Keeping the baby tucked inside; encompassing the salty, warm, nurturing environment of the womb. When I do vaginal exams during labor, and I feel that filmy, slippery membrane I am constantly in awe of its power. The veil at the doorway that separates our two worlds.

Working as a nurse in the hospital, I was constantly shocked at the often flippant way the membranes were regarded. So easily ruptured with little to no explanation to the mother as to why. Sometimes, even 'just done' and not even mentioned until after the break! Such a routine intervention, to the point of not really being considered an intervention.

As a midwife, I have used AROM (artificial rupture of membranes), but very sparingly. To me, it is a serious intervention and one that significantly impacts the babe's experience....a sudden, potentially jolting change. Don't get me wrong, sometimes it is an appropriate and helpful intervention. I just don't like the 'routine-ness' of it. When I have done it, it has been after careful consideration and thoughtful discussion with Mama and her partner. I have had several couples, after this discussion, decline the AROM. In my experience, the membranes most often release on their own, in their own time...and sometimes they don't release and the babe is born with them intact. I have caught 3 little ones this way. (see a previous post about the significance of this) I have had some Mama's who, from previous experience, have thought that the membranes had to be ruptured for the birth to happen...that they would hold things up and get in the way. A very popular question from family members when they feel things are 'taking too long' is "aren't you gonna break the bag?" This has become part of our culture of birth and cultures are a hard thing to overcome. Let's see if we can work on this one....

Monday, December 27, 2010

the shoulders

I have often been told that as a student, we all have a "hang up", a scenario that we fret over. For some it is a postpartum hemorrhage, a surprise vaginal breech, a serious baby resuscitation, etc. For me it was always a shoulder dystocia, a complication where the baby's shoulders become 'stuck' behind the mothers' pubic bone. It can be a potentially serious situation involving long term damage to both Mother and Baby. I have always been drawn to reading anything and everything that I could about this situation. Whenever I have been at conferences or gatherings of midwives, I was always present at discussions about 'shoulders'....always trying to suck up and store any tidbits of wisdom. As a student, I thought that I had had two cases and then I thought that I had another two cases as a midwife. The optimal part of those cases is that "I thought" I had had 4 shoulder dystocia's. My first clue to the error in my thinking should have been the number.....4 is a lot of these to have in a short period of time, as this is a relatively uncommon complication. Additionally, in all four situations the problem was resolved pretty quickly, less than 30 seconds, and with very mild intervention. You see, before Jenny's birth, I thought I had dealt with 'shoulders' before.....

Jenny was a first time mama, a sweet petite little lady with a supportive and tall, lanky husband. Her labor was nice....lots of moving and grooving, moaning and singing. She progressed nicely and at a good pace. Then she entered second stage and her nice progression stalled. She pushed and pushed and fought for every little gain. Finally, Jenny had worked her little one to crowning, and still the progress slowed. Of course, this second stage pattern is a classic 'warning sign' for shoulder dystocia, so I was mentally preparing for it. Running the drills in my head, telling the nurse to be ready with oxygen and to help with interventions. We were 'on alert' and ready. Then we were given the "turtle sign" from the babe...this is when the head emerges and then quickly retreats back into the perineum, like a turtle retreating into its shell. This is the ultimate and supremely classic sign of a shoulder dystocia, and I had never witnessed such a clear and obvious example of it!

Very quickly, we had Jenny get into McRoberts position, which for my previous 4 cases had worked like a charm. Absolutely no descent from baby. Very quickly we had Jenny move to the Gaskin (hands and knees)...again, absolutely no improvement. I passed my hands into Jenny's vagina to attempt and feel the baby's shoulders...I ran my fingers up the neck...and up and up...I could not feel the shoulders!!! They were so far back, that I could not feel them. This is when I realized that this was my first true shoulder dystocia and the tense set in. In certain situations I have experienced that time can simultaneously speed up and slow down...this happened on this night. My vision became crystallized and focused, like intense tunnel vision, the world became Jenny, her baby and her vagina...nothing else existed. In some ways, I switched to auto pilot...the drills, so long practiced and held in my mind, became my only thoughts. I worked through several maneuvers and could not get the shoulders down, could not find the arms. Jenny was amazing and followed my every direction to a tee and my nurse was fantastic...however, this baby would not budge. I had to remind myself to breathe...time ticked was not coming....after the failed attempts to free the shoulders, my hands took over. I reached deep inside Jenny, the baby held between my palms like a prayer...please Creator, help me, help this Mama and her Baby, please work through me, please, please...and then I finally found it, the baby's posterior arm. I was then able to both pull that arm out and rotate the baby like a corkscrew and with one final big push from Jenny, baby was free! What seemed to have been an eternity had lasted for three was stunned and needed a little encouragement, but came around nicely. He weighed in at 9# 13 oz....pretty big for a petite little Mama. Amazingly, somehow, Jenny's vagina and perineum were intact! Jenny and her husband were elated and Jenny's husband made a comment about how when he was born, he had gotten stuck and the doctor had to break his collar bone to get him out! (The nurse and I both had a little nervous laughter fit over that one later.) The new "little" babe wasted no time in locating his mothers' breast and then camped out there for hours, happily nursing away.

So, there was my biggest fear....faced and, at least for this time, conquered. Jenny loved her birth and remembers the nurse and I being very calm, focused and reassuring during the experience. I am eternally grateful for all the books I had read, all the midwives wisdom that I had soaked up and for the support of divinity in the room.....

Saturday, December 18, 2010

the unkown milestone

This transition from student to midwife is a hefty load....of course it should be and I did not expect it to be easy. From the beginning, I had a feeling of floating around, with my feet way ahead of me or way behind. I was constantly attempting to catch up with them...or slow them down....just to get them underneath me. Recently, I hit a milestone that I had not expected or even thought about. After the last lovely birth, while writing the experience down in my midwife journal, I realized that I have now caught more babies as as midwife than as a student. This realization hit me profoundly and like a ton of bricks. I had not known that this moment would be so special and perhaps the surprise of it made it even more special. Sitting there, looking at my journal I shed a couple tears...of happiness of gratitude and of excitement. Since then, I have been able to have the feeling of my feet being right underneath me, strong and stable. Granted, I have many years of learning and growing ahead of me, and I am not going to get cocky about myself. However, I do finally feel like a 'real' midwife....which really means that I am very aware of my newness....but I am also aware of the strength and knowledge that I do have.

Tuesday, December 14, 2010

the 2X4 of birth humility....

Wake up call at 5am, two Mama's at the center, both first time Mama's whose water had broken in the night....Little did I know that I was destined to be hit over the head with the cosmic 2X4 of birth humility by one of these sweet ladies....

Molly is a lady that I had really liked during prenatal visits. She had come in at around 5am because her water had broken and she was GBS positive, so she needed some IV antibiotics. Her labor started after her water broke. My midwife sister had checked her cervix and found it be 1cm dilated and described it as pretty tight. Molly was having a very difficult time working with her contractions, which were about 1-2 minutes apart and lasted for about 30-45 seconds. This pattern is usually not very effective, difficult to work with and often associated with some dehydration. Molly was having a hard time drinking and had thrown up, so since she already had an IV for her antibiotics, I gave her some fluids. Additionally, even though she was so early in labor, we put her in the pool to try and calm things down and give her a break. These interventions did very little to give her any relief. Three hours after her first cervical exam, Molly was working very hard and requested another cervical exam. I was worried that she would not be very much more dilated and that would really disappoint her and I didn't want her to get discouraged. We talked about it, but Molly really wanted me to check her, so I agreed. I placed my fingers in her vagina and....bonk! head with just a little rim of cervix!! So, wham-o...the back of the head hit with the cosmic 2X4...silly, silly midwife!...never assume anything about birth! A tiny bit later and Molly started pushing, 31 minutes later and she had a gorgeous 9#1oz. baby boy in her arms!!!

Molly had been amazing and unlike some Mama's who have fast labors and then have a hard time afterwards, she was just so elated and very quickly had a little happy nurser snuggled up in bed with her.....

Friday, December 10, 2010


I have a strong faith and belief that birth is a natural process, that women are strong and babies are wise. That when a healthy women is nurtured and supported through the journey, she will most likely have a powerful and transformative birth experience. As a midwife, these beliefs are central to my philosophy. The catch to this faith is the "most likely" part of the equation.

My last several shifts have all involved the transfer of a woman in labor. I have become much more comfortable with the transfer process and much more trusting of my judgements in relation to the necessity of a transfer. However, that does not make them much easier in the moment. Midwives are sometimes referred to as 'guardians of birth' and this is a statement that I hold dear. As a guardian it is my job to, as much is possible, protect the mother and baby and to make difficult decisions when needed. Sometimes, in order to provide the safest care possible, that means a trip to the hospital. We have a saying about labor where I work, "its not birth center or bust". Meaning that our goal is a healthy mom and a healthy baby and for some families that means that we need the type of support that the hospital can give. Knowing this is beneficial, but in the moment, when I am supporting a woman and we have all been working very hard it doesn't make it any easier. When I have to look into her eyes and her partners eyes and tell them that the birth center birth thay have been planning and envisioning is not possible...that is a heart wrenching moment regardless of the facts. Ultimately, my goal needs to be the final outcome of a healthy Mom ready and able to care for her healthy baby and for them to grow together....and no single experience is worth that.

Wednesday, December 8, 2010

fast labors

Many times, I will hear women say that they hope for a very fast labor. This is deffinitely a situation where I will say "be careful what you ask for", just because it goes fast does not mean it goes easy. An example.....

Got a call from a second time Mama, Brenda. She sounds pretty hot and heavy over the phone, so I recommend that she hurry on in. About 20 minutes later, I am in the center, anxiously waiting for her. I think I hear sirens in the distance and think "Oh my gosh, she has had her babe in the car, down the street and here comes the ambulance!" I go outside to see if I can see anything.......low and behold....the siren I thought I heard was actually Brenda! She is in her car, in the parking lot and seriously cranking out contractions! With much ado and convincing, we (myself and her doula) coax her into the center. Her labor is loud and vocal, she is very confused about it being so fast. She has a lot of moving, using the swing, pacing and in and out of the birth essence she is trying to run away from her labor. Many, many times she states that she in not ready, that it can't be happening so fast, etc.... and all this very loudly! With much support and eye contact we are able to talk her through it and very quickly she is in the pool and crowning. THEN, as I am doing some perineal support, she takes my hand in hers and attempts to push the baby back up!! Saying, "it is just not time yet!" Of course, she was not able to stall very much and soon we had a happy 8# 40z boy to welcome to the world. Start to finish, her labor was less than 4 hours. After the birth, Brenda had a very difficult time accepting that her new little one had arrived and spent an hour processing before she could really enjoy him.

So, if a lady asks and hopes for a fast labor...remind her that through the process, we all have to pass certain mile markers and we can either pass them at regular pace or at 200mph...which can be very overwhelming and leaves little time to absorb the trip....

Saturday, December 4, 2010

a day in the life #2....

So, if you were able to read the previous post, I said that I would be writing about two different shifts. For both of these shifts, I was basically at the center for 24 hours. However, they were both very different in how they played out.

Phone call at midwife sister has been at the center for a couple few hours and caught one baby, another Mama will be having her baby soon. Additionally, another one of my midwife sisters is ill and, if possible, I need to cover her clinic schedule. Oh, and we had a Mama whose water broke the afternoon before and I'll need to check in with her and hopefully be with her in labor...sounds like a busy day....

While I was on my way in, my phone rang and it was the midwife who had called me earlier. Apparently, she had 'pocket dialed' me and I was able to hear her and a Mama in what sounded like the bathroom, having a baby! I listened for a little bit and then hung up the phone. A while later, the midwife called me back and we laughed about it. We decided that I should stop at Starbucks...since I had time now...and get some treats. With the type day of I had ahead of me, a little morning treat seemed in order.

When I arrived at the center, there were two lovely Mama's and their two new little boys all snuggled up and warm. I checked in with both of them and the nurse who was helping to care for them. Then, I went over to the clinic to prepare the charts of the clients that I would need to try and see for our sick colleague. It was a full day, with a lot of clients who all needed some sort of lab work...gearing up for a busy day.

At 8 o'clock, I got a call from Sue, the Mama whose water had broken the afternoon before. She was doing well, having some contractions but not really in active labor. We had given her some instructions for trying to get her labor started which she had tried. Our policy at the center, is that if a woman's water breaks, and the fluid is clear, she needs to be in active labor within 24 hours. Sue's time would be up at 2pm. Since it was now 8am and not much was happening, I decided that she needed to come in. We decided that she would arrive at around 9:30. I would not be able to cover the clinic day.....I saw the first three clients and then we had some serious shuffling to do. Which, thankfully, because we have amazing staff, we were able to do.

Sue and her husband arrived right at 9:30. She was having contractions but they were pretty short and pretty far apart. Her little one sounded great, the fluid was clear and her vital signs were perfect....we just needed some labor! I checked her cervix and it was only opened a slight little bit. We did a lot of talking about the chances of her being in active labor by 2pm and the probability of needing to go to the hospital. Clearly, this was not a fun conversation and we all had frustration and disappointment to work through. We decided that we would still try some tricks and hope for the best. We did some herbal tinctures, some walking, and used the breast pump. We were able to get some more contractions going, but they weren't enough to change her cervix. Finally, we made the tough decision to head over to the hospital. Luckily, I was able to call the midwifery group who works there an they were able to accept her.

Sue and her husband decided to use one of our on-call doula's to come over to the hospital to help support them. While I was there with them waiting for the doula to arrive. I got a call from the center to let me know that another Mama had been sent over from the clinic! She had come in for her 40 week appointment and been found to have extremely high blood pressure and was transferred to a physician. I spent several hours at the hospital going between the two families, answering questions and offering support.

Eventually, I made it back to the center. (Both of the hospital mama's had been settled in.) I very quickly ate some food, as my last food had been that long ago Starbucks treat! Then I went over to the clinic to help with the end of the day. Very glamorous stuff like taking out trash, doing laundry and cleaning speculum's. I started getting phone calls from two other Mama's, both having their first babes. They would be coming in sometime, but not quite yet. I decided to try and leave the center for a bit. A friend of mine was having a "journal club", which means a bunch of nurses getting together and reviewing an article from a medical journal. I really wanted to go and visit with friends I haven't seen in I went for it. It was a nice break and I was able to stay for a little while before heading back to the center.....

Kelly, was one of the first time Mama's who had been in early labor and talking with me over the phone. It was time for her to come in. She arrived with her husband and doula around 9pm. She was doing good, her baby sounded great...but her blood pressure was a touch high. Low enough to stay at the center, but high enough for me to need to monitor it closely. Her cervix was 5cm and we all got ready to work this baby out. Kelly worked very hard, spent time in the pool, in the bed and walking the hall. A few hours later she was 7cm, but her blood pressure had gone up just a touch more. I decided that we would need to re-check her blood pressure in 2 hours. Over those 2 hours, Kelly worked hard, she had some difficult stretches but we were able to talk her through them. Unfortunately, when we re-checked her blood pressure the third time it was very high and it warranted a transfer to the hospital. Now we had 3 Mama's over there! Argh!

Just before Kelly had to go to the hospital, the other first time Mama I had been talking with had come in! Nicole came in did not appear to be in labor, she was so calm. Initially, I felt bad for having them come in when it looked like they would need to go back home. However, as birth is so humbling, I was proven very wrong. Nicole was 7cm dilated! After I checked her cervix she literally, rolled over on to her side, in bed, pulled the covers up and went to sleep! About an hour later, she opened her eyes and asked if she could get in the pool. I said "yes" and asked if she was still having contractions, to which she replied "sure". She stepped into the pool, rested her head on her arms on the pool side and.....feel asleep! Again, some time later she opened her eyes and said she needed to go to the bathroom and that she was hot in the pool and wanted to lay down again. Sure thing! Once again, curled up on her side, appearing to be asleep....Nicole started grunting every couple minutes. I asked her if I could check her cervix and she was 9cm! I asked her to wait just a bit to really start pushing and she said "ok" and went back to sleep. Then, 15 minutes later, she opened her eyes and said, "I really want to start pushing and do you have a birth stool?" Wow! We set up the birth stool and 14 minutes later Nicole had a pink little baby boy in her arms! Amazing, amazing!......

Then it was 6am and time for me to go home. What a strange, hectic, wonderful shift! Of the many things that pregnancy and labor teaches me, one is to never, ever take anything for granted or to make assumptions. It seems that the more I learn...the less I know....

P.S. The 3 Mama's at the hospital all had vaginal births and healthy babes....

Friday, December 3, 2010

a day in the life....#1

Recently, I have been at the center for several 24 hour shifts. We are always scheduled for 24 hours, but usually are not there for the whole time, thankfully. I am writing about these two in particular because they were very different and exemplify the diversity of labor and birth....

Phone rings at 5am...time to get in to the center...a Mama is cooking. I arrive to be with Beth (names are always changed ;)) and her husband who are having their third baby. She is sitting on the ball, leaning over the bed working with her body and her baby. One of the old midwife sayings is, "first babies are hard work, second babies come fast and third babies are a wild card"...or some variation of that. So, I was prepared for that wild card effect with Beth. While we were all supporting Beth, my phone rang. Another Mama, Christie, who is having her second baby calls in labor...actually it was her husband who was on the phone, which usually means we are serious. They arrive shortly after their call.

Now, I have 2 Mama's working on their babies. Christie and her husband had a lot of great support...both of their Mothers, sisters and friends...and they were in the smallest room. Beth and her husband were on the other side of the center, just the two of them in our biggest room. Between the nurse and myself, we were able to be with both women and things went big concern was that they would both their babies at the same time! Luckily, that was not the case....

Beth's beautiful babe arrived first. When it came time to push, she had a difficult time...she did not want to do it. She remembered pushing her other children out and said that this time it hurt more and felt different. So, I did a vaginal exam and found that her babe was a little asynclitic, meaning a little "crooked", so I had her stand at the bedside and use the birth stick to "hang" and stretch out her abdomen for several contractions and the baby was able to right himself. After that, we had to do some talking through it and some coaxing through it and some laughing through it but in the end, Beth decided it was time to meet her new little one. He was born so sweetly and started crying as soon as his head came out...even before his shoulders were born! After her last baby, Beth had some heavy bleeding, so I gave her a little shot of pitocin and she had very minimal bleeding. The three of them, tucked into bed, babe nursing wonderfully and finished their recovery.

Next up was Christie. She had quite the audience with all the family members and friends present, but it was perfect for her and they were all amazing. Somehow, despite the crowd it didn't feel like a 'show' at all. She was in the pool and laboring beautifully. She started pushing on her own and soon was crowning. The baby's head emerged, but then stopped we quickly got Christie out of the pool and to the bed....all the movement was good because then her babe came right out. Christie had also had a lot of bleeding with her last babe so she got some pitocin as well and also hardly bleed. Christie and her husband are both brunettes, their oldest daughter is a cute little red head, so we were all curious about this new little girl's hair.....and it is red as well! They too, tucked into bed with a sweet nursing baby and finished their recovery.

Shortly after Christie's birth, another Mama and her family came to the center. Amy was a first time Mom and working hard, but well with her labor. She also had a large support network with her...multiple sisters (with their husbands and children), her mother and father. So, at this point the center seems to be busting at the seams...all three birth rooms full and two large family groups....somehow it worked out well. Then, a couple hours later, I get a phone call from another first time Mom, Jill. She is in labor and almost ready to head in! The birthday juices were flowing that day! Beth is almost ready to go home, so we set up our overflow recovery room and set her up there. Then we very quickly clean the room she had birthed in to get ready for Jill. Whew...a whirlwind of activity...such is birth!

So, eventually, Beth and Christie and their families all headed home...with a new addition each of course. The two first time mama's, Amy and Jill, remained to work on their little ones. As is normal, they both had some hard work to do. Again, between the nurse and myself we were able to be with each of them and offer support and guidance.

Jill's birth dance progressed beautifully. She spent most of her time in the birth pool and it was a joy to be present with her and her husband. They are funny, sweet people who worked so well together. They have been together for a long time and this pregnancy was a long time coming and you could tell they had such a great foundation of partnership. Jill welcomed her 8# cuddly, sweet baby girl to the world while squatting in the birth pool. We helped her to the bed, and the three of them all tucked in with a nursing little one and recovered wonderfully!

Amy's birth dance was more difficult and slow. She was an amazingly strong lady who worked so passionately for her baby. Her husband and family were wonderful and supported her through the whole process. Unfortunately, her labor just got stuck...we did multiple position changes and walking mixed with resting, herbs to encourage things and just could not move past the 7cm mark. After 16 hours at the center (and many hours before that at home) and a Mama who was exhausted we had to make the decision to transfer to the hospital. These situations are so hard and emotional for everyone involved. After several more hours at the hospital Amy and her husband were blessed with a healthy baby born via cesarean section.

So, if that seems like a jam packed, exciting and exhausting shift.....that's because it was! At the end, even though I was so tired, I was also so thankful for what I do. Ultimately, I feel blessed to be able to join these families during this most intimate event and to help support them through the transition.

Friday, November 26, 2010

Divinity in the Room

To be with birth is to be with Divinity. To hold this sacred space and to welcome this new soul to the world is a true blessing. I have a belief that if every adult human could be present for a healthy, supported and planned natural birth, we could be many steps closer to peace. Is it possible to sit in that space and not recognize the glory, honor, courage, compassion and integrity of each precious being, both old and new? Perhaps, since I come from a personal background of a deep faith, this belief is pre-disposed in me. But I find it hard to believe that a person could be in that space and not be moved on some level......

The Divinity of a partner offering love and support through the wiping of a brow with a cool towel and gentle touches. The Divinity of supporters joining in the woman's birth song to lend her strength. The Divinity of the "second wind"; that well of fortitude that a woman is somehow miraculously able to dip from when she has exhausted all other energy sources. The Divinity of the power that can pour out of a woman's head, heart, muscles and very soul as she works to birth....

The Divinity that I have felt, moving through my heart and hands at birth. Honestly, I have been taught such humility in response. I have, in times of great stress and need, felt the support of Divinity working through breathe and massage and speak life into a tiny little baby...a deep knowing of when to stop "pushing" a woman and her baby....a sudden need to have a woman get out of the water, for no apparent reason, but then to have the reason become clear. In these circumstances, I truly feel unable to take full credit for these actions. Yes, I have trained and observed and prepared for these situations, but ultimately, they are not completely in my control....this has been a hard lesson and one that I will most likely be continually working on. I must constantly be on the lookout...the often spoken of 'eyes of a hawk', and open to the power of the mother and the power of Divinity.....

Monday, November 15, 2010

careful what you ask for

So...if anyone actually reads this will remember that recently I have been complaining about not catching any babies recently. Well, I should have known better.....last shift was literally busy with mama's for 24 hours! I was able to help three Mama's have thier little ones....two girls and a boy. Also, I was with a sweet mama who ended uo having to go to the hosoital after a long, long journey.

And actually...I was loving all of it....

Sunday, November 7, 2010

a long time coming, part 2

Please be sure to scroll down and read part 1 before starting part 2

OK, here I sit, ready to attempt to finish this story. Armed with coffee and a scone...I need comfort for this one.

I made my way back to Dad and little baby girl. On the walk over, I had tried to pull myself together, I didn't want to be a mess for the Dad. Baby girl was doing great, sleeping on Daddy. I did my best to explain to him what had happened. He was understandably upset, but soothed by the fact that she had been stable and resting when I left. We loaded baby into her car seat, gathered some stuff in a diaper bag and started the walk over to the hospital.

My phone rang and for some reason, it made my heart sink. I answered it and a voice I didn't know was on the other end....a nurse from the hospital...very urgently telling me that the husband needs to be there now! I turn to him, there holding his new daughter and worried for his wife, to tell him this. How do you do that? How do you tell someone this kind of news? How in a way to offer support and not crush? I cannot remember exactly what I said to him, but I remember him asking me what was wrong, what was going on? All I could tell him was that I didn't know and that we should hurry.

By the time we got to the hospital, she was back in the operating room. Dad, baby and I went to the waiting room and waited and agonized and waited. We held hands, we held baby, we held our seemed and eternity. Finally, the doc came for us....Mama was ok, she had lost a lot of blood, had transfusions, but was stable now and in the ICU. We rushed to where she was. She was so, so pale...but, thankfully alive and even awake. I will never forget the looks on her and her husbands faces as we entered the room. It was one of those times where you feel like an intruder in the intimacy. Somehow, I mangaed to talk the ICU nurse into letting me unwrap baby and put her skin to skin on Mama's chest...that was magical and mama was so relieved. Shortly after that, I had to leave. Other family members had arrived to help give support and I was just about at my limit.

When I got back to the center, I basically collapsed. The adrenaline that had been keeping me going wore off and I just folded into the floor. What had happened? Why did this happen? What could I have done differently? What sign did I miss? Had I done enough for them...could I have been more? It has taken a while for me to fully process this birth...and truthfully it is something that I still have to work on. Mama did recover, it took a long time, but she did. In the end, it was discovered that she had a placental implantation problem, placenta increta. There was nothing that could have been done to prevent her outcome, it is an extremely rare case. She is truly lucky to be alive. Eventually, she had to have a hysterectomy as her placenta had taken over the uterus. I try to focus on the fact that she is alive, that her husband still has his wife and that her daughter will grow up with a mother. Despite knowing the facts, I still am haunted by this experience and still struggle with doubt. I also try to focus on and remember that the birth had been beautiful, that she was blessed with that experince and will always have those memories....

Saturday, November 6, 2010

a long time coming, part 1

I have been trying to write this for a long time, and am just now feeling able. This birth story is from a while ago, and was during my intense time of trial by fire earlier this year.

The labor was amazing. A beautiful primip, working in harmony with her body. A loving, supportive husband, present in the moments. The birth was sweet, a lovely little dark haired girl welcomed into the world with trust and love. Enjoying the time of golden bliss and a babe who latched herself to her Mamma's breast. It is after these births that I just want the placenta to come on out, so I can exit the room and leave this new family to themselves. To explore this new creature and count all the fingers and toes, marvel at the smell of the head and just get to know each other in private.

Unfortunately this placenta had other thoughts. I was watching closely for the signs of placental separation and could find none. No lengthening of the cord, no little gush of blood, no change in uterine shape and Mamma had no cramps...not even after a lovely nursing babe. I gave her some medicine and asked her to close her eyes, breathe deeply, relax and talk to her placenta. It had done an amazing job and helped nurture and create this beautiful baby girl, but now its job was done and it was time to let go. Still nothing. I used my finger to follow the cord up through the vagina and to the cervix, to feel if the placenta was there.....nothing. Next, I tried some light downward cord traction, again nothing. During all this, Mama and baby are doing great. However, now we are 30 minutes out from the birth and this third stage has veered off the course of normal. I make the decision to transfer to the hospital. We are sad to do this...Mama will be separated from babe and Dad, but it is needed......

During the whole time to call the ambulance, get loaded up, the trip over to the hospital and getting in to her room, mama was great. The doc came in and evaluated her, the decision was made to attempt a manual removal of the placenta. This tough, tough Mama decided not to go to the operating room for sedation during the procedure and opted for IV pain medication, in the hopes that this would be quick and she could get back over with her husband and baby sooner. Everything is ready, all the personnel are present and the manual removal is attempted. I am with the Mama, by her head, explaining everything to her and giving her support. It is difficult to convey what happened after this...many things happened at once...when the doc attempted to get the placenta, it did not want to come and there was a lot of blood, followed by more blood and still more. I stayed with Mama, talking softly into her ear, reminding her of her gorgeous little girl, telling her she would be ok, that she was well taken care of...which she was. This went on for what seemed an eternity and through the amazing work of the doc and nurses, Mama was stabilized. During all of this, Dad was back with baby, wondering what was going on with his wife. As soon as I could, I called and updated everyone and then headed over to meet them. The plan was to get Dad and baby and bring them over to Mama, who would need to recover at the hospital. Plans don't always go as we would like...

As I am sitting here and writing this story, tears are streaming down my checks and I must take a break before I can finish the telling. I apologize for the two part post, but I must...

Thursday, November 4, 2010


So, another shift with no babies..hopefully I will be getting slammed on my next one....within reason please. I did however, get a lot of phone calls throughout the babies + much disturbed sleep = cranky midwife!

Saturday, October 30, 2010


OK, I haven't caught a baby is a couple weeks now....starting to feel the itch. I know, I know, be careful what you ask for, but I really hope that on my next shift, there is some action. So, I put it out there. Probably my next post will be about how crazy busy I was....

Sunday, October 17, 2010

a girl and a boy

Early morning phone call...round two. My new midwife colleague called at 5:00am and I did not even wake up! I finally figured out why...I am just like Pavlov's dog...I had not yet set her ring to the "birth center" ring...which will instantly wake me from a dead sleep. I heard the regular ring in my sleep and just blew it off. Anyway, I was happy to be going in to assist a woman who I have known and worked with as a nurse.

The birth was beautiful, number two for Mama, and accordingly smooth and easy...from my perspective...Mama might have other reflections of course. A sweet little (big, almost 9lbs) baby girl arrived around 9:30, born in the caul and a little unsure of her new surroundings. With some attention and encouragement she came around and latched onto the breast and proceeded to stay there for an hour! Just before time to go home, she started to breathe very fast, everything else looked little babe, no other signs of distress, just breathing very fast. Eventually, I called an NNP (neonatal nurse practitioner) at the hospital and she said we should bring her in. The whole time my gut was telling me this babe was fine....but I had called the NNP, so felt like I had to follow her advice. So, instead of a nice cozy trip home to tuck into bed, baby girl was tucked into the transport isolette and we all climbed into the back of an ambulance. As soon as the NNP saw little miss, she sent them all straight home, thank goodness. My gut was right all the while. I have been feeling bad about the whole hospital detour, but am trying to file it under the 'better safe than sorry' group. The Mama was nothing but gracious about the process and thanked me for making sure her baby was ok....but I still have the lingering guilt about not listening to the gut-voice....

Back to the center....adrenaline long gone and HUNGRY. Eat some food and dive into paperwork...always paperwork. When I envisioned my midwifery path, I must admit, that I had not thought about the mundane stuff like piles of paperwork....

Just about done and get a call from another second time Mama, she is starting labor but talking and laughing with me on the phone, so not quite time yet. Another call a couple hours later, but she doesn't want to come in yet...then 15 minutes later her Mom calls and says she thinks its time. She gets to the center about 30 minuts later....and a good boy was born 29 minutes later. A nice water birth with Papa in the pool as well.

And then, of course, more paperwork....but, in truth, I will take all the paperwork in the world to be able to do what I do.....

Monday, October 11, 2010

Where's the climax??

In almost all ways, my job is ideal. I am blessed to serve women and thier families outside of the hospital. I am able to develop relationships with these families over time. I help support anf guide women through childbirth....and can specialize in hands and knees waterbirth by candle light! I get to do all of this AND have a predictable schedule that allows me quality time with my family.....

However, that doesn't mean there are no hitches! Being with a woman and her family for hours and hours is tiring, requires intense focus, makes everybody sweaty and is all consuming....but sooooo worth all the work, especially when that little one enters the world. Sometimes, in my job, I am with a woman for hours and hours...and then it is time for me to go home and pass her care on to the next midwife. While I am always grateful for the relief, it can be difficult to leave. Recently, I had the realization that it is a little like sex....but with no orgasm!!! All the build up and then no release> That is frustrating!!! I am trying to learn how to deal with these times of the perverbial "blue balls".......any suggestions???

Tuesday, October 5, 2010

The Big 30

Last night, I hit the big 3-0....thirty babies caught as an actual midwife! I was looking back at my birth log this afternoon...after I woke up...from being at the birth center until 2:00 am. 19 of the babes have been boys and 11 have been girls, 13 have been first time Mama's and 17 have had babes before. During this time, I have also supported several families who ended up having thier babes by cesarean section...5 of those stories...all healthy and happy...3 girls and 2 boys. If, in my short and young career, I have started to learn anything it is that you can never assume anything about women, birth or babies...they will always surprise you at every chance.

I have the utmost gratitude and respect for the families that have allowed me to share in thier journies. I am continually in awe of the process....

Sunday, October 3, 2010

radio silence

Trial by fire....I have heard the term often. This summer, I had my own trial by fire....initiation to becoming a midwife. It was long and difficult. There were times when I felt so awful that I wanted to of the jokes that I have with my mentor is that it would be so much easier to open up a bakery. (Basically, I had a lot of dreams about cupcakes, pastries, and cakes.)

I spent many hours grappling with the question of how not to own every aspect of the birthing journey for the woman and her baby. As I have written before, it is not difficult for me to remove my own ego when things go well. It is when things don't go so well, that I begin to place all the blame on my own shoulders.

There was a time this summer, where I felt that if a woman was in labor and I touched her, she broke. I knew that on one level this was silly, but on many other levels, I had trouble working through this. Almost every babe was posterior, labors were long and dysfunctional, several women ended up needing of which was an emergency with a stressful ambulance ride and all that entails. On the good side, all of the Mama's and babes were well and healthy at the end. On the negative side, it left my confidence shaken and my heart very heavy.

In the midst of all of was too difficult to sit in front of the computer and re-hash the experiences. So, here I am, apologizing for the long absence and offering my explanation. Also, I am offering a pledge to not disappear again for such a long radio silence......

Thursday, July 22, 2010

thanks babes

Thanks to all the babies...all the babies that I have had the privilege to help care for. From the tiny preemies with the translucent skin to the post date wonders and their crackly skin. Every baby that I have ever seen has helped me to be able to recognize a baby with a problem. Every baby that has needed a little help to get started has increased my skill level in this area. On behalf of myself and all of the future babies that these hands will care for....thank you!

Sunday, July 4, 2010

in the tool kit

The first item that should always go in the tool kit of a midwife is HUMILITY and lots of it. After that, there are several things that we should keep on hand at all times.....

soothing words and touch
a change of clothes and toothbrush
humor and a couple good jokes
strong hands
a warrior heart
sharp senses

As I have newly been traveling down this path with women, one of the other things that I have had to cultivate is my 'inner drill sargent'. This is one item that I really have to foster and work on as it does not come as naturally to me and it is a crucial skill in midwifery. One of my favorite sayings is that "birth is made to work if no one shows up" and as a midwife, this is a truth that I hold dear. For the vast majority of births...I should not be needed, I should sit on my hands and observe and support. However, sometimes a Mama and babe need help and when this happens, a midwife must be able to take charge of the room and make things happen. These are the times that we are called upon and must act quickly.

Thursday, June 17, 2010

Almost on the staircase and more thoughts...

Luckily, I was already at the birth center...waiting for another Mama who ended up never coming in. Got a call from a Dad saying his wife's water just broke and she sounds "serious", since this is baby #2, I say get on in here! The weather was wet and rainy and it was the middle of the night. I meet them in the parking lot, wet all around us...the rain was crazy, and Mama says "the baby is here!" as we walk up the steps, I 'o-so subtly' reach behind her and 'goose' her while feeling for a little baby head...not quite yet, but there is the tell-tale bulge. Barely making it to the birth room, pants off to reveal a lovely crown, Dad says "she wants a water birth" and I say we don't really have time to climb in the pool...and then the babe is born into her Daddy's (with a little back-up from me) waiting hands. So great!

So, when I am blessed to be present at a birth such as this one, I have absolutely no problem giving all the glory to the Mama. I am constantly awed by the tremendous power of women as they work to bring forth these new lives. My ego really has nothing to do with it....they are the wondrous ones. Then, why is it, that when a Mama has a really difficult path and maybe needs to go to the hospital....that I feel such ownership of the process? When the outcome is not ideal, I have a very tough time getting my ego out of the way. Is this normal...will it eventually become easier to remove my ego from all situations? However, is that the proper goal? I guess I come back around tot he original thought....what is the balance point for being present and supportive while maintaining my own self?....

Wednesday, June 9, 2010


This morning I sit at my little desk, looking out the window to my green backyard. While I sit here and sip my coffee, many thoughts run through my mind. How do I invest myself in the birth process without owning the process. This has been struggle for me, there seems to be a balance, one that I have not yet been able to manage. Does one ever totally manage it? I need to be present, invested and supportive...yet, keep some sort of distance...everything is not up to me or my 'fault'. If a Mama needs to transfer to the hospital it doesn't mean that I have failed, or that she has failed...we don't have control over everything.

Sunday, June 6, 2010

Morning Babe

Woke to a phone call this morning....a primip (first time Mama) is pushing....whew, jumped out of bed, ran through the shower, threw on some clothes and out the door, all in 15 minutes. That is midwife adrenalin for ya!

Got to the birth center in just enough time. Mama sitting on the birth stool with a bulging bag of waters crowning. Through the bag and the waters, I can see specks of vernix floating in the clear fluid. I can also see lovely dark hairs dancing and swirling, suspended in the waters, dancing in tune with the Mama and her birth rushes. For a moment, I am transfixed by the beauty. Then with a grand grunt from Mama, I am pulled back and place my hand on the babe's head...expecting the bag to break and flood me with a wave...but it doesn't budge. Instead, I apply some mild downward pressure and the babe is birthed, bag and all, into my hands. After working him out of his bag....up to Mama and Papa he went.

When a babe is born in thier amniotic sac, it is called being "born in the caul" and it has been ascribed many meanings by many different cultures. I have read several of these meanings and have found them all to be positive. The common associations are that this child will be a leader of their people, they will have the 'sixth sight', they will never perish by drowning, etc. (I would love to hear of any other known associations.) I think that we have many more of these babies at the birth center because we do not routinely break the bag of waters. Which then leads me to wonder...are we, by fostering gentle, honored birth, fostering a generation of visionary leaders?....

Tuesday, June 1, 2010

up to bat...

As a child, I was fostered in the heartland, the midwest of the country. I came from a family of father, my aunts and uncle and my cousins. I remember admiring all of the medals and trophies that my cousins were able to earn and display. I often felt like I did not fit into this family tradition, I was the only one who did not excel in this pursuit.....

I was on a softball team in grade school. In my head, I wanted to be great at reality, that was not the case. Not that I was awful, just not great....and in my heart of hearts, I didn't enjoy it. Everytime I was up to bat or in the outfield, I was terrified. As I got older and tried to find my sports niche...volleyball, basketball, etc. I would hear other people talk about a calm that they felt when they were "up to bat". A quiet that would descend upon their brain and allow the world to melt away, creating an exquisite focus. I never experienced this when "up to bat", on the contrary, I would be overwhelmed with worries and pressure. Eventually, I was able to accept that I was not an athlete and be happy with my other strengths, but I always wondered about that exquisite focus.....

Earlier this year, I was on myself for the first time. My phone rang and a Mama was in labor. I rushed to the birth center. I must admit that my nerves got away from me....I was literally pacing and going over the cardinal movements of birth in my head. I set up the room that the Mama wanted and double checked, ok...triple checked all of the equipment. After that, more pacing and running through drills in my head. Then, the Mama and her husband arrived at the birth center......and suddenly the world melted away, my brain was calm and I felt the exquisite focus. It was a magical moment for me and I knew this would be wonderful...I had found my niche. And the Mama and babe were glorious.

Saturday, May 22, 2010

Ina May

Well, what can I say other than Ina May? She is in town now and I was able to see her twice. Once at the Colorado Midwives Association conference and then again at an open Parent's Night. We are all so blessed to have her knowledge, humor, passion and compassion in this world. She is so was a great 'battery charging' opportunity. It is always good to remember her Sphincter Laws:
They are shy
They don't obey orders
They do respond to praise
They open better when owner's mouth and jaw are relaxed and open
They open well when owner is smiling or laughing

These rules appear so simple, yet in our culture they are so easily forgotten.

Yesterday was actually the third time that I have had the pleasure to meet and hear Ina May. The first time was at a Midwifery Today conference. It was when I was taking my first tentative steps on this path and it was remarkable. The second time was also at a Midwifery Today conference and I had just finished nursing school and was getting ready to enter midwifery school. It too, was amazing. (And at that conference I had the fun chance to 'boogey' with her at the evening festivities....that was a blast...and she has some moves on her!) So, yesterday I meet her again, this time as a new midwife. I had to have a little 'groupie' moment and tell her my (very brief) story and of my previous times in her precense. She was gracious and congratulated me on my path...what a treat!

Thursday, May 20, 2010

waking up....

Attempting to go to bed when on call.....somewhat tricky. It takes a bit longer to fall asleep...was that the phone?....did it make a noise? it still on and the battery charged?....better check it again. Ah, finally asleep and the dreams start....a Mama calls and says her water broke and there is a foot in her vagina...another Mama calls and says she is having trouble sleeping....another calls to ask if she can still wear panty hose. Then, beepbeepbeepbeep the alarm jolts me awake.....o my gosh!!! what calls did I miss?...did something happen to my phone in the night? it on and the battery charged?.....yes, all is well and there were truly no calls all night...or was there? Something about a baby needing panty hose when the water breaks???

Tuesday, May 18, 2010

one lesson...

Just a quick observation...when you will be doing IUD's, don't wear black pants due to the sterile glove powder. Don't wear white due to drops of betadine, don't wear long, loose can imagine. Actually, there is probably no perfect clothing choice when doing IUD's. But the most important thing is to remember to clean up after yourself and not leave your mess for someone, a great forgiving and understanding, someone to clean up.....

Sunday, May 16, 2010


Just a flutter, soft and warm
A glimmer in your father's eyes
A squishy print in your mother's soul
Deep, deep down in the dark, cool place...restful and serene
Present for only a flash and yet so bright that the mark will forever burn

Thinking of my little lost one today. How such a tiny sprout can be so profoundly missed is one mystery of life. Or as a woman...perhaps not a mystery at all. When I lost my babe, she (I have always thought of her as a girl-though will never know for sure) almost took me with her, literally. I felt her tugging at my heartstrings and as I was bleeding and bleeding and being taken to the operating room part of me wanted to go with stay with my little one and keep her close. Letting her go was torturous, but in the end, I am always grateful that I was able to remain.

Since I have started on this path, I have had to help other women through similar experiences and it never gets easy. How can we soothe, how can we support and aid one another to the other side of the grief? It is a process that I will continually learn. When all is said and done...what I needed was a hand, a shoulder and to know that someone was there...this is what I strive to give all the Mama's that I have been with and that I will be with as they cross this bridge....

Saturday, May 15, 2010

Here I sit at home. My husband is working on fix-it projects, repairing much loved and therefore broken toys. Our daughter is nestled in bed. Dinner is warm in our bellies. I cherish these quiet times around the house.

I have the weekend off from the birth center...and I miss it. It seems to be a catch-22. I am thankful to be here at home...but I am also often wondering what is going on in my other world. All those Mama's that I saw this past week who are due any day now. How are they? Are their wombs rumbly and their little ones wiggley? Now that the sun has gone down are they starting to brew?.....

Friday, May 14, 2010

the beginning....

Let's see, how to start? I have recently completed a very long journey, so you might say that this beginning is really just the ending of the previous trip. My new beginning was initiated when I graduated from midwifery school and was somehow blessed with an amazing job....

It hardly seems real for me to say, out loud, that I am a midwife and that I work at a free standing birth center serving women and their families. I am still working on 'owning' that has been so long in the coming. So long I had been a student, and frankly had become very comfortable with that position. It is a nice place to be...observing, learning, growing, doing...without the full responsibility. As I have started this process of owning and inhabiting this new reality, I have often thought of starting a journal. I have wanted to save all of the thoughts and expereinces that have been surfacing and floating in my mind. Which leads me to this blog. It is my first, and honestly, I really have no idea what I am doing. If you have any interest in following along with me, I plan to document this first year as a new midwife and it should be an interesting ride......