Birth workers will be familiar with this concept, I have heard it worded various ways but it boils down to this; first babies are hard and work their Mamas, second babies are fast and surprise their Mamas and third babies...well they are a wild card! Now, of course, these are not hard and fast "rules". There are first babes that come quick and second babes that take their time, or any combination of the above.
I was recently with a first time Mama, who was indeed working very hard for her little one. She had great support; her husband, her mother, her father and a friend. She labored strongly and had prepared well for the work. Her baby was OP (occiput posterior), so the work was hard and she had a lot of pain in her back. I had her do many things that, at the time, she did not want to do, and that were uncomfortable. We had her on all fours, with a rebozo wrapped around her belly and shook her. We had her rock on all fours and gave her "butt bumps". We had her walk the stairs in deep asymmetrical lunges. It was hard work, and while I knew that she did not like to do it, she did it all gracefully. Eventually, it worked, she told me later that she felt the moment her baby turned at the top of the stairs. Next, we got to the work of pushing, which she did beautifully. Twelve hours after the start of the journey, a sweet 8#13oz. baby boy was so joyously welcomed into the arms of his Mama and Dad.
A week later, I was seeing the new family for a postpartum check-up. They were doing amazingly, baby boy had already made up his lost weight (that all new babies lose) and was past his birth weight. Mama was healing well, and both she and Dad were adjusting to this new reality. After discussing all the technical details like how her bleeding was, how her perinuem was healing, how breastfeeding was working and checking her fundus, we talked about how the labor and birth had been for her. Did she have any questions, issues or concerns to address? She said that it had been hard but she felt supported. Then she said something that I will always cherish. She had been thinking about the experience and realized that while she would always love me, she would also always be mad at me.
Mad because of the things that I had had to have her do...walk the stairs, shake her belly, bump her bottom...all these things were not pleasant or easy for her to do. However, she also realized that they were necessary and was thankful that I had been there to help guide the process. She had felt the support and kindness through the sometimes firm instructions. As a midwife, it is sometimes required of you to be "mean", to ask for difficult things and actions. We have to be able to ask these things, to be tough yet loving, to balance the needs of the physical and emotional with strong compassion. Sometimes, we cannot be a friend. This Mama had told me this with a smile on her face and a twinkle in her eye...she knew this truth as well. She also said that she could not imagine having had a better midwife....and while I know that she would have felt the same for any of my other sister-midwives had it been they who attended her, it did make my heart flutter.
Saturday, December 31, 2011
Wednesday, November 30, 2011
#100
This story has been a long time coming, and is one that has forever left me a gift of love. One of the lessons that has been most difficult to accept, is one that I knew going into this profession. It is this; not all births go well and not all outcomes are as expected. However, knowing this on an intellectual level and experiencing it on a visceral, feeling level are two very different things. As guardians of birth, it is our responsibility to create sacred, safe space for each birthing Mother, her baby and her family. This will look and feel differently for each family, but is no less important. As I sit down to write this piece, I have been blessed to attend the births of 142 babies. To be present at the threshold of life and hold that space as a midwife. Each and every birth has been special and each one has left me changed. Naturally, the births have changed me in different ways, some subtle and some not so subtle.
His Mama is so strong, beautiful in the work of labor. She works gracefully with the intensity of labor. His Dad is wonderful in his loving support, creating that amazing balance of strength and gentleness. Despite the hard work, we are having fun and the atmosphere is one of happy expectation. It is their first baby and all through the labor, I cannot but think how blessed this little soul will be to have these two parents. While all babies are a blessing and welcomed with love, there is something special about that first one, the unknown experience. One of my favorite things about this work, is being invited into this completely intimate time in the life of a family. While, no third person truly knows the inner workings of an intimate relationship, I feel that at births, I am blessed to catch a small glimpse of that secret space.
She was on the birth stool, in that crazy, beautiful time of crowning. His head would peak out at us and then retreat back to his Mother, preparing for his entry into our world. For me, this transition is nothing short of a miracle, every birth leaves me in awe of the power, wisdom and beauty of the design. This transition was smooth and gentle, his head slipping out between contractions. I felt his life, strong and determined, but I also felt something else. Something like a shadow and just knew, without knowing how, that he would need all that strength. Then, the rest of him was born, he was pink and breathing, his heart rate strong, so I gladly handed him up to the arms of his Mother and Father. We helped them all to the bed and tucked them in. Baby continued to have good color and breathe well, snuggled up to his Mother's chest. Her placenta was easily birthed, placed in a bag and laid next to them. The next 2 hours were of cautious watching, he was doing well, but there was something wrong. He was beautiful in that brand new baby way, but his face was asymmetrical and had some palsy. His precious little ears were small and off set. However, he was so content and peaceful snuggled up to Mama. His parents were in that euphoric place of discovery and there seemed no emergent reason to disturb that peace.
Eventually, though, it was time to take a good look at him. It became clear that he would need extra attention, that he would not be going home with Mama and Papa. I made phone calls, arrangements and kept his parents informed and supported. Between myself and the nurse, we took care of everyone, as best we could. Another midwife came in and they all embarked on the trip to the hospital NICU. It was incredibly difficult to stay behind while they left, I feel as though a piece of my heart will always be with them, but I was in no place to be of help...it had been a long shift.
His journey has been hard fought and punctuated by multiple hospital stays and surgery. At one point, his parents took him home on hospice care, wanting to love him at home and not through the lens of the NICU. He is one of the most amazing humans, young or old that I have ever known, and he has surprised every expert at every opportunity. He was taken off hospice care, since he made it clear that he was not ready to leave us. His life is a lesson in love, perseverance and faith. His parents are testament to the strength of that love. His heart so perfectly filled and surrounded by love, but imperfectly shaped has now been mended and he is ready for the next step....to live and thrive! Ultimately, I am the blessed one to have been touched by this family and the lessons they have shared with me. I am thankful for any little part that I have been able to play in their story. And I am so excited, this spring to attend his first birthday!
His Mama is so strong, beautiful in the work of labor. She works gracefully with the intensity of labor. His Dad is wonderful in his loving support, creating that amazing balance of strength and gentleness. Despite the hard work, we are having fun and the atmosphere is one of happy expectation. It is their first baby and all through the labor, I cannot but think how blessed this little soul will be to have these two parents. While all babies are a blessing and welcomed with love, there is something special about that first one, the unknown experience. One of my favorite things about this work, is being invited into this completely intimate time in the life of a family. While, no third person truly knows the inner workings of an intimate relationship, I feel that at births, I am blessed to catch a small glimpse of that secret space.
She was on the birth stool, in that crazy, beautiful time of crowning. His head would peak out at us and then retreat back to his Mother, preparing for his entry into our world. For me, this transition is nothing short of a miracle, every birth leaves me in awe of the power, wisdom and beauty of the design. This transition was smooth and gentle, his head slipping out between contractions. I felt his life, strong and determined, but I also felt something else. Something like a shadow and just knew, without knowing how, that he would need all that strength. Then, the rest of him was born, he was pink and breathing, his heart rate strong, so I gladly handed him up to the arms of his Mother and Father. We helped them all to the bed and tucked them in. Baby continued to have good color and breathe well, snuggled up to his Mother's chest. Her placenta was easily birthed, placed in a bag and laid next to them. The next 2 hours were of cautious watching, he was doing well, but there was something wrong. He was beautiful in that brand new baby way, but his face was asymmetrical and had some palsy. His precious little ears were small and off set. However, he was so content and peaceful snuggled up to Mama. His parents were in that euphoric place of discovery and there seemed no emergent reason to disturb that peace.
Eventually, though, it was time to take a good look at him. It became clear that he would need extra attention, that he would not be going home with Mama and Papa. I made phone calls, arrangements and kept his parents informed and supported. Between myself and the nurse, we took care of everyone, as best we could. Another midwife came in and they all embarked on the trip to the hospital NICU. It was incredibly difficult to stay behind while they left, I feel as though a piece of my heart will always be with them, but I was in no place to be of help...it had been a long shift.
His journey has been hard fought and punctuated by multiple hospital stays and surgery. At one point, his parents took him home on hospice care, wanting to love him at home and not through the lens of the NICU. He is one of the most amazing humans, young or old that I have ever known, and he has surprised every expert at every opportunity. He was taken off hospice care, since he made it clear that he was not ready to leave us. His life is a lesson in love, perseverance and faith. His parents are testament to the strength of that love. His heart so perfectly filled and surrounded by love, but imperfectly shaped has now been mended and he is ready for the next step....to live and thrive! Ultimately, I am the blessed one to have been touched by this family and the lessons they have shared with me. I am thankful for any little part that I have been able to play in their story. And I am so excited, this spring to attend his first birthday!
Tuesday, November 29, 2011
Let's Get Along
I was recently lucky enough to attend the MANA/CAM Conference in Niagara Falls, Ontario. It was my first MANA conference and it was a lot of fun! It is an amazing experience to be surrounded by people that you share a passion with. To meet others walking on the same path. I was very proud to count myself in the company of so many great midwives, doulas and birth workers!
A heard a quote that was very powerful for me,
"All midwives need each other, and the women need all the midwives." -Judi Mentzer
This struck a particular chord with me. On paper and by training, I am a Certified Nurse Midwife or a CNM. In my heart, I am a Midwife, just simply a midwife. I do not feel that I am any better or worse of a midwife based on the initials placed after my name. Other midwives may have different initials, like CPM, RM, DEM, LM or any other number of options. To me, these are all midwives. One of my biggest frustrations in this profession is the "in-fighting" and the tearing down of eah other based on the initials we carry. How can we as birth workers expect to grow our numbers and support more women when we spend too much energy bickering amongst ourselves? Who needs the "establishment" to hold us down, when do such a good job of it on our own? Let's face it....women come in all stripes and persuasions....and they all deserve and need midwives...so midwives should also come in all stripes and persuasions!
I don't want to get too high on my soap box, but I do want to make my point. We have so many struggles facing our profession, let's just get out of our way, try to move forward from the divisions of the past and focus on the incredibly important task at hand....supporting, educating and empowering women!!
A heard a quote that was very powerful for me,
"All midwives need each other, and the women need all the midwives." -Judi Mentzer
This struck a particular chord with me. On paper and by training, I am a Certified Nurse Midwife or a CNM. In my heart, I am a Midwife, just simply a midwife. I do not feel that I am any better or worse of a midwife based on the initials placed after my name. Other midwives may have different initials, like CPM, RM, DEM, LM or any other number of options. To me, these are all midwives. One of my biggest frustrations in this profession is the "in-fighting" and the tearing down of eah other based on the initials we carry. How can we as birth workers expect to grow our numbers and support more women when we spend too much energy bickering amongst ourselves? Who needs the "establishment" to hold us down, when do such a good job of it on our own? Let's face it....women come in all stripes and persuasions....and they all deserve and need midwives...so midwives should also come in all stripes and persuasions!
I don't want to get too high on my soap box, but I do want to make my point. We have so many struggles facing our profession, let's just get out of our way, try to move forward from the divisions of the past and focus on the incredibly important task at hand....supporting, educating and empowering women!!
Wednesday, October 12, 2011
How Do You Know I'm in Labor?
She is a great lady, with an awesome sense of humor. Her husband called me, she had told him not to, that it was not labor. He looked at her, curled up on the bathroom floor breathing through contractions, and made the phone call. I said that they should probably head on in...it was their third baby after all. Twenty minutes later, she walked through the door, clearly in labor and clearly well into her labor. She continued to be convinced that this was not, could not be labor and apologized for me having to come in. I just helped her walk back to the room, starting taking her vital signs and listening to her babe. Since she was positive for GBS, the nurse worked on starting an IV. She really did not like the needles, and in between contractions she argued..."are you sure it is time for that?"...."how do we know I am in labor"...."what if I don't need that IV yet?" Her husband, myself, the nurse and her doula all tried to reassure her that she was, in fact, in labor. Again, she argued, "but how do you know?" Finally, I said, "because we all have eyes!"
So, once the IV was started and she was a little more settled, I checked her cervix and low and behold!...she was definitely in labor and was actually in transition. We helped her into the birth pool and she finally began to accept that her labor was real. Less than one hour after arriving, she birthed her beautiful baby to the world.
Afterwards, we all talked about her reluctance to believe her labor. First, it had been very fast, less than four hours from start to finish. As I have discussed before, fast labors can be very difficult for women to process. Additionally, this Mama had her previous two babes in a hospital, where she was "ignored" until her cervical exam confirmed that she was "ready" and had been told not to push until a doctor arrived. So, her thoughts and feelings started to make some sense. Her husband told us that when he was getting her out of the of the house to come in, she was reluctant. He said to her, "remember that we aren't afraid to go to this place?" and she finally agreed to leave. While this may make me feel good about the care that my group gives and the style of our services...that our families trust us, it also makes me sad that women have these histories to overcome. I am by no means a "hospital hater", I am grateful to have the services available at a hospital when a woman and her baby need them. However, there must be, and in reality there IS a better way to care for pregnant women. A way that honors, empowers and uplifts while still guarding physical safety. They are not and need not be mutually exclusive!
So, once the IV was started and she was a little more settled, I checked her cervix and low and behold!...she was definitely in labor and was actually in transition. We helped her into the birth pool and she finally began to accept that her labor was real. Less than one hour after arriving, she birthed her beautiful baby to the world.
Afterwards, we all talked about her reluctance to believe her labor. First, it had been very fast, less than four hours from start to finish. As I have discussed before, fast labors can be very difficult for women to process. Additionally, this Mama had her previous two babes in a hospital, where she was "ignored" until her cervical exam confirmed that she was "ready" and had been told not to push until a doctor arrived. So, her thoughts and feelings started to make some sense. Her husband told us that when he was getting her out of the of the house to come in, she was reluctant. He said to her, "remember that we aren't afraid to go to this place?" and she finally agreed to leave. While this may make me feel good about the care that my group gives and the style of our services...that our families trust us, it also makes me sad that women have these histories to overcome. I am by no means a "hospital hater", I am grateful to have the services available at a hospital when a woman and her baby need them. However, there must be, and in reality there IS a better way to care for pregnant women. A way that honors, empowers and uplifts while still guarding physical safety. They are not and need not be mutually exclusive!
Tuesday, September 27, 2011
Guided Hands
I am by no means a superiorily experienced midwife, and as many of you know, still consider myself a "young-un". That being said, I do feel that I have built a strong foundation on which to grow my skills. I have been blessed with fantastic teachers and mentors, wonderful families to support and an amazing family of my own. I have recently had some experiences that truly reinforce, for myself, that this is my calling. I believe, that when a person finds their calling, and that when they are serving a higher purpose, there is a well of unconscious knowledge to tap into...
At a recent birth, I was literally at the end of my rope...I had done and tried everything to help this motherbaby. At that moment, of surrender, my hands just started doing. An obscure maneuver, from deep in a text book, that I had never done and only seen once years ago. My hands simply took over and did it....and wonderfully it worked! It was just the trick to help this sweet babe out. I didn't even fully realize what had happened until it was over. I believe that my hands were guided.
At another recent birth, after a beautiful labor and with a healthy, happy baby skin to skin...Mama truly started hemorrhaging...a lot, a dangerous lot. Her placenta had not yet been birthed and before I was able to consciously think, my hands just started to do, to enter her uterus and remove the placenta. This was of course, difficult and very painful for the Mama, however, it saved her life. I had never done this procedure before, only studied it and observed it, but in that moment, my hands knew exactly what to do. Again, I believe my hands were guided.
Of course, there is the acknowledgement that I have trained and studied for these situations, which I have done with dedication. Of course, there is the necessary ability to think quickly and remain calm. However, above all that, there are moments when I honestly believe and have felt something more than myself in the room. I am by no means special in this way and feel that this "well of knowledge" is present for all to dip into. I have seen many others experience this sensation. When have you felt/seen/experienced this? Do you even agree with me that it occurs? I would love to discuss this....
At a recent birth, I was literally at the end of my rope...I had done and tried everything to help this motherbaby. At that moment, of surrender, my hands just started doing. An obscure maneuver, from deep in a text book, that I had never done and only seen once years ago. My hands simply took over and did it....and wonderfully it worked! It was just the trick to help this sweet babe out. I didn't even fully realize what had happened until it was over. I believe that my hands were guided.
At another recent birth, after a beautiful labor and with a healthy, happy baby skin to skin...Mama truly started hemorrhaging...a lot, a dangerous lot. Her placenta had not yet been birthed and before I was able to consciously think, my hands just started to do, to enter her uterus and remove the placenta. This was of course, difficult and very painful for the Mama, however, it saved her life. I had never done this procedure before, only studied it and observed it, but in that moment, my hands knew exactly what to do. Again, I believe my hands were guided.
Of course, there is the acknowledgement that I have trained and studied for these situations, which I have done with dedication. Of course, there is the necessary ability to think quickly and remain calm. However, above all that, there are moments when I honestly believe and have felt something more than myself in the room. I am by no means special in this way and feel that this "well of knowledge" is present for all to dip into. I have seen many others experience this sensation. When have you felt/seen/experienced this? Do you even agree with me that it occurs? I would love to discuss this....
Friday, September 16, 2011
The Language of Labor
So, most of us are probably familiar with the term "the language of love". I firmly believe that there is also a "language of labor", a universal language that is shared by women during birth. I have had this belief for a long time, but recently had a birth that reinforced the feeling.
Marta was having her first child. She recently moved to the United States from Central America. When she first arrived, Marta spoke very little English. During her pregnancy, she was extremely proactive in learning English and from one prenatal visit to the next, her English skills flourished. Additionally, she had a great support system that included a couple good interpreters. When I got a phone call from Marta's family that she was in labor, I was so happy...I had really wanted to be her midwife. I speak some limited Spanish and am by no means fluent, but love the language and the culture. Marta arrived to the birth center, surrounded by rain, fog and her family. It was as if she was enveloped in a mist of soft, moist light. I only had to take one look at her to know that she was not far from birthing her little one. She had that aura, a vibration pulsating off her body. And, not surprisingly, remembered hardly any English. Yes, she had her family to help interpret, but honestly, we did not need them too much. We; Marta, myself, the nurse and my student, were able to speak the language of labor. The discourse that occurs through touch and look. She needed hands to hold, eyes to look into, and the comfort of closeness. Then there was the sound of crowning, that primal sound, the one that comes from our ancestral voice....that sound is universal and needs no translation. It is a sound that anyone in the room will feel in their bones. And then, the squishy, pink baby followed by the sounds of a Mother greeting her child for the first time. Marta had a gorgeous, chubby baby girl.
Many times, I feel that we do too much talking in labor...too much stimulating of the frontal lobe and pulling women out of their instinctual selves. Don't get me wrong, it is vital to be able to communicate. I am just proposing that we should be thoughtful in our use of verbal language around birth. That we should use language with a sincere purpose and weigh each word before speaking it. What are your thoughts and/or experiences with this?
Marta was having her first child. She recently moved to the United States from Central America. When she first arrived, Marta spoke very little English. During her pregnancy, she was extremely proactive in learning English and from one prenatal visit to the next, her English skills flourished. Additionally, she had a great support system that included a couple good interpreters. When I got a phone call from Marta's family that she was in labor, I was so happy...I had really wanted to be her midwife. I speak some limited Spanish and am by no means fluent, but love the language and the culture. Marta arrived to the birth center, surrounded by rain, fog and her family. It was as if she was enveloped in a mist of soft, moist light. I only had to take one look at her to know that she was not far from birthing her little one. She had that aura, a vibration pulsating off her body. And, not surprisingly, remembered hardly any English. Yes, she had her family to help interpret, but honestly, we did not need them too much. We; Marta, myself, the nurse and my student, were able to speak the language of labor. The discourse that occurs through touch and look. She needed hands to hold, eyes to look into, and the comfort of closeness. Then there was the sound of crowning, that primal sound, the one that comes from our ancestral voice....that sound is universal and needs no translation. It is a sound that anyone in the room will feel in their bones. And then, the squishy, pink baby followed by the sounds of a Mother greeting her child for the first time. Marta had a gorgeous, chubby baby girl.
Many times, I feel that we do too much talking in labor...too much stimulating of the frontal lobe and pulling women out of their instinctual selves. Don't get me wrong, it is vital to be able to communicate. I am just proposing that we should be thoughtful in our use of verbal language around birth. That we should use language with a sincere purpose and weigh each word before speaking it. What are your thoughts and/or experiences with this?
Sunday, September 4, 2011
Frustrated!!!
Well, this weekend was full of so much information, both good and bad! I was able to attend a conference....The American Association of Birth Centers 5th annual. Overall it was great, so wonderful to be surrounded by people who are also involved in the crazy wonderfullness that is a birth center! To know that we are not alone and that others are out there joined in the movement is fantastic and a great way to get the ole battery re-charged. There were great presentations on Anthropological Breastfeeding (so amazing!), new guidelines for STI's (good to be kept up to date), PROM and techniques for OP and labor dystocia. All in all wonderful information.
What was disturbing...the new data on Maternal and Infant Mortality!!! We as a country spend more money on health care and have some of the worst outcomes, and to make it worse, we keep getting worse not better!! We are slipping further and further down on the list every year, currently we are 41st for infant outcomes and 50th for maternal outcomes!! This is shameful and shocking. Additionally, if you are African American the outcomes are 4x worse! Here is a link to a recent report from Amnesty International
http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf
Before reading it, be prepared to be frustrated and saddened, and then hopefully moved to action. I will soon be moving that way....after the initial shock wears off. For now, I really needed to vent!
What was disturbing...the new data on Maternal and Infant Mortality!!! We as a country spend more money on health care and have some of the worst outcomes, and to make it worse, we keep getting worse not better!! We are slipping further and further down on the list every year, currently we are 41st for infant outcomes and 50th for maternal outcomes!! This is shameful and shocking. Additionally, if you are African American the outcomes are 4x worse! Here is a link to a recent report from Amnesty International
http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf
Before reading it, be prepared to be frustrated and saddened, and then hopefully moved to action. I will soon be moving that way....after the initial shock wears off. For now, I really needed to vent!
Wednesday, August 17, 2011
The Hose Wrangler
Now, I know that some of you may be thinking/wondering what type of hose I refer to. Well, let me just clarify that I mean hose in the literal, water your garden sense of the word. Working at a birth center has many, many benefits...I get to offer the type of midwifery care that I am passionate about, I get to build relationships with our families, my midwife sisters are fantastic and our whole staff is like a second family to me. However, like life and labor, it is not all a bed of roses. There is a lot of hands on, intensive cleaning work to be done....scrubbing floors and walls and birth stools, doing laundry, folding laundry, cleaning instruments and of course, hose wrangling.
I love water birth. The amazing look of relief that seeps into a woman's face as she sinks down into the warm water. The calm, alert babies opening up to their new world. I do not, however, enjoy the draining and filling of birth pools, particularly when it comes to the management of the hoses. They are heavy, cumbersome and always kinked or kinking. (Inevitably, this task is taking place at 3 am which does not help.) Recently, while knee deep in this process, I somehow, very gracefully I'm sure, managed to get all caught up in the hose and trip flat on my face. Luckily, no one was present to witness my injury, I guess now the secret is out.
I must admit that when the birth bug first bit me, I was caught up in the romance of it all. Now, some years down the line, I am still a devout "birth junkie" but the romance has worn off and evolved, much like a new relationship, into a deeper understanding and respect for all that being "with woman" entails.
I love water birth. The amazing look of relief that seeps into a woman's face as she sinks down into the warm water. The calm, alert babies opening up to their new world. I do not, however, enjoy the draining and filling of birth pools, particularly when it comes to the management of the hoses. They are heavy, cumbersome and always kinked or kinking. (Inevitably, this task is taking place at 3 am which does not help.) Recently, while knee deep in this process, I somehow, very gracefully I'm sure, managed to get all caught up in the hose and trip flat on my face. Luckily, no one was present to witness my injury, I guess now the secret is out.
I must admit that when the birth bug first bit me, I was caught up in the romance of it all. Now, some years down the line, I am still a devout "birth junkie" but the romance has worn off and evolved, much like a new relationship, into a deeper understanding and respect for all that being "with woman" entails.
Monday, August 8, 2011
Vacation
It should come as no surprise that this profession is hard...sometimes very hard. It can be exhausting both emotionally and physically. I am basically a baby midwife, and am comfortable saying that. One of my continual lessons, is how to maintain this path while still maintaining my personal health and the well being of my family. Balance is always an issue. If you have read this blog, you will know that it is a topic I often write about....it seems to be one of my "things". So, last week I had vacation. Unfortunately, it was not an exciting one, more like a stay-cation and let's get the kids ready to start school. But, I was away from the birth center for the week....and I actually stayed away...which was pretty hard for me! It was good to be away and spend good time with my family and I am now glad to be back with the Mama's...
Monday, July 18, 2011
Normal Birth?...part 2...
I think that the first issue I would like to tackle is birth trauma. Unfortunately, this happens all too often and is not relegated only to the hospital setting. The idea that I ponder about the creation of birth trauma is exactly why/how does it happen? Clearly, there are myriad reasons and individual situations and I don't mean to water the issue down to one cause.....but, having worked in the birth field for years, both in and out of the hospital, I have seen and heard many woman's stories. To go back to the first part of this question, the birth story....
It was the two day postpartum visit. Both Mama and Baby were doing well, babe was happily nursing and Papa was ecstatic. We went through all of the "nuts and bolts" business....physical assessments, etc. and all was well. Then, we sat and talked about the birth. I was worried that it may have been difficult for them, so many things had happened, particularly with the baby resuscitation. So, when I asked, "How do you feel about your birth?" I was pleasantly surprised to see the big smile grow across Mama's face and hear her say, "It was amazing and wonderful!" We talked about everything that had happened, they asked thoughtful questions and it was clear that they had a realistic understanding of what had happened. Finally, Papa said, "We knew that serious things were happening, but you and the nurse were so calm and really knew what you were doing, so we felt safe and it was never scary." There was not one ounce of trauma to be found! I include the Papa's statement NOT to "toot my own horn" but to illustrate what I think is a crucial component to the creation of birth trauma......
How the birth is handled, how the family is treated, management of the "background" noise, followed by open and transparent discourse between care provider and client....I think that these have much more to do with birth trauma than what actually happens. Of course, there are major exceptions, sometimes, no matter how much care and thought are involved, the outcome can be so devastating that trauma is inevitable. As women we have to start educating ourselves and each other about our options and we have to demand thoughtful, compassionate care. All options for birthing need to be universally discussed and available to all. It is time that we stood together and began to create the atmosphere for this change......
It was the two day postpartum visit. Both Mama and Baby were doing well, babe was happily nursing and Papa was ecstatic. We went through all of the "nuts and bolts" business....physical assessments, etc. and all was well. Then, we sat and talked about the birth. I was worried that it may have been difficult for them, so many things had happened, particularly with the baby resuscitation. So, when I asked, "How do you feel about your birth?" I was pleasantly surprised to see the big smile grow across Mama's face and hear her say, "It was amazing and wonderful!" We talked about everything that had happened, they asked thoughtful questions and it was clear that they had a realistic understanding of what had happened. Finally, Papa said, "We knew that serious things were happening, but you and the nurse were so calm and really knew what you were doing, so we felt safe and it was never scary." There was not one ounce of trauma to be found! I include the Papa's statement NOT to "toot my own horn" but to illustrate what I think is a crucial component to the creation of birth trauma......
How the birth is handled, how the family is treated, management of the "background" noise, followed by open and transparent discourse between care provider and client....I think that these have much more to do with birth trauma than what actually happens. Of course, there are major exceptions, sometimes, no matter how much care and thought are involved, the outcome can be so devastating that trauma is inevitable. As women we have to start educating ourselves and each other about our options and we have to demand thoughtful, compassionate care. All options for birthing need to be universally discussed and available to all. It is time that we stood together and began to create the atmosphere for this change......
Thursday, July 14, 2011
Normal Birth?...part 1....
What is normal birth? I often ask this question. Often times a normal birth may include many things that are not "normal" but that happen. Here is an example...
She was a sweet first time Mama, her man was supportive and loving, her Mother was present and wonderful. She labored beautifully, was in the pool and started to push all on her own, instinctively and with strength. Soon the babe was crowning, and crowning, and crowning and crowning..my senses prickled up a bit...and crowning, then with one push the head emerged and quickly retreated back into the perineum. With speed, we moved her out of the pool to her hands and knees on the floor, babes head was still tightly squished up against the perineum...with some help and effort, one minute after first emerging, he was out! He was not fully with us, his cord was pulsing strongly but he was purple and not breathing. We stroked him and spoke to him, his Dad loved on him, eventually we had to use the ambu bag and give him some breaths. Immediately, he turned pink and began to cry...of course, the BEST sound in the world. We moved the new family to the bed, baby boy skin to skin on Mama with Dad curled up next to them and a radiant Grandma at the bedside. One of my favorite times of a birth...the afterglow. The nurse and I were busy trying to strike that balance between invisible and present. I was ever so gently holding the umbilical cord, feeling the pulse of life, when something felt off...there was a "loosening" feeling and a gush of bright red blood. However, for some reason I knew it was not the normal cord lengthening and placental separation gush. I immediately felt up the cord, into her vagina and felt a partial cord evulsion!! I grasped the cord and crimped it off, while asking the nurse to hand me a clamp. I clamped the cord and took a deep breath for myself. A few minutes later, her placenta emerged all intact, thick and healthy. Again the new family was the picture of beauty, baby was crawling on Mama finding his prize of the breast. Then a little while later, Mama started to bleed and pass clots and bleed and pass clots....with some vigorous massage, herbs and finally medications, the bleeding eased up. Finally, all were well and healthy, basking in that afterglow.
This birth was "normal", so what does normal mean? As a midwife, I must always guard the birth process; help to create and hold a space that is calm, centered and uninhibited. The vast majority of the time I am not needed...but in those times when I am, I REALLY am.
This birth made me think of two things: 1) unassisted birth and 2) birth trauma. I will follow up with my initial thoughts and my follow up with this lovely family, but what are your thoughts? How do you feel about unassisted birth? How does birth trauma happen and what can we do to lessen it?
She was a sweet first time Mama, her man was supportive and loving, her Mother was present and wonderful. She labored beautifully, was in the pool and started to push all on her own, instinctively and with strength. Soon the babe was crowning, and crowning, and crowning and crowning..my senses prickled up a bit...and crowning, then with one push the head emerged and quickly retreated back into the perineum. With speed, we moved her out of the pool to her hands and knees on the floor, babes head was still tightly squished up against the perineum...with some help and effort, one minute after first emerging, he was out! He was not fully with us, his cord was pulsing strongly but he was purple and not breathing. We stroked him and spoke to him, his Dad loved on him, eventually we had to use the ambu bag and give him some breaths. Immediately, he turned pink and began to cry...of course, the BEST sound in the world. We moved the new family to the bed, baby boy skin to skin on Mama with Dad curled up next to them and a radiant Grandma at the bedside. One of my favorite times of a birth...the afterglow. The nurse and I were busy trying to strike that balance between invisible and present. I was ever so gently holding the umbilical cord, feeling the pulse of life, when something felt off...there was a "loosening" feeling and a gush of bright red blood. However, for some reason I knew it was not the normal cord lengthening and placental separation gush. I immediately felt up the cord, into her vagina and felt a partial cord evulsion!! I grasped the cord and crimped it off, while asking the nurse to hand me a clamp. I clamped the cord and took a deep breath for myself. A few minutes later, her placenta emerged all intact, thick and healthy. Again the new family was the picture of beauty, baby was crawling on Mama finding his prize of the breast. Then a little while later, Mama started to bleed and pass clots and bleed and pass clots....with some vigorous massage, herbs and finally medications, the bleeding eased up. Finally, all were well and healthy, basking in that afterglow.
This birth was "normal", so what does normal mean? As a midwife, I must always guard the birth process; help to create and hold a space that is calm, centered and uninhibited. The vast majority of the time I am not needed...but in those times when I am, I REALLY am.
This birth made me think of two things: 1) unassisted birth and 2) birth trauma. I will follow up with my initial thoughts and my follow up with this lovely family, but what are your thoughts? How do you feel about unassisted birth? How does birth trauma happen and what can we do to lessen it?
Thursday, July 7, 2011
And Tantrum Makes Three....
It was a good to have a baby...I had two lovely first time Mama's working on their little ones. The sun was shining, the flowers were out and the sky was sapphire blue. Day time births are less common and so seem somehow different and rare to me.....
Andrea's water had broken the day before, early in the morning. It was well over 24 hours later and her labor was flirting around the edges....not quite ready to take off, and Andrea was on the verge of losing her steam. She came in with her Mom, Susan, who was such a great support. Andrea's husband is in the military and is deployed overseas, which of course was difficult for her. We did an NST (non stress test) and her babe looked good. We decided to try and help her labor along. We sat down and had a good talk about how she was feeling, about letting go of wanting/missing her husband and letting her labor happen and I gave her an herbal tincture. Then I sent Andrea and her Mom out to get some lunch and to go for a nice walk.
Meanwhile, another Mama, Ellen was ready to come in with her husband. She was laboring beautifully, really letting her body go with the flow and opening up to it. Her husband was great and just followed her lead. It is so wonderful to see couples at this time, working well together and being present to see the love they share.
Andrea came back from her outing and had good news....she was able to call her husband and he was going to be able to be on the phone, on speaker, to be "with" her during the birth! It was great...somewhere from a ship, somewhere in the world...he was at least able to be present with us. Her labor was picking up a little bit, but still not too strong. We decided to try the breast pump and after a "round" of that.....she kicked into serious gear. After an hour of serious, consistent contractions I checked her cervix for the very first time since her water breaking and she was 4cm....great news! She got in the pool and we all settled in for the work. She talked to her husband a lot and despite the distance the love was so palpable in the room. Literally, 30 minutes later, Andrea said she had to push! A quick cervical check...she was C/+1 and after 24 minutes of beautiful, instinctual pushing a beautiful baby girl was welcomed to the world.
Not long after that birth, Ellen was ready to welcome her sweet babe. Ellen was complete...but not ready to push...instead she paced and paced, unable to relax. She did not like the sensations and seemed to try and run away from them. She was fidgety and had a lot of trouble getting into the work of pushing. I have seen other ladies do this and eventually they stop "running" away and get into it. Just over an hour later, Ellen was getting frustrated....her energy was spilling over and she was busy trying to contain it. I felt that she needed to have a "melt down", let the energy go and move forward....and then it happened. Ellen threw a temper tantrum; seriously stomping around the room, crossing her arms, pouting her lips and kicking things!...in true three year old style!! She was saying things like wanting to the hospital, this "sucks", whose dumb idea was this, etc. I was actually happy and trying not to laugh, this needed to happen...and after she calmed down, Ellen sat on the birth stool and gracefully with strength pushed out her gorgeous baby girl.
Every birth is a gift and teaches me new things. These births were very different but had one thing in common: a true and genuine love between a man and a woman, that was supportive and strong. One was witnessed in person and the other was felt from a distance but both were amazing.
Andrea's water had broken the day before, early in the morning. It was well over 24 hours later and her labor was flirting around the edges....not quite ready to take off, and Andrea was on the verge of losing her steam. She came in with her Mom, Susan, who was such a great support. Andrea's husband is in the military and is deployed overseas, which of course was difficult for her. We did an NST (non stress test) and her babe looked good. We decided to try and help her labor along. We sat down and had a good talk about how she was feeling, about letting go of wanting/missing her husband and letting her labor happen and I gave her an herbal tincture. Then I sent Andrea and her Mom out to get some lunch and to go for a nice walk.
Meanwhile, another Mama, Ellen was ready to come in with her husband. She was laboring beautifully, really letting her body go with the flow and opening up to it. Her husband was great and just followed her lead. It is so wonderful to see couples at this time, working well together and being present to see the love they share.
Andrea came back from her outing and had good news....she was able to call her husband and he was going to be able to be on the phone, on speaker, to be "with" her during the birth! It was great...somewhere from a ship, somewhere in the world...he was at least able to be present with us. Her labor was picking up a little bit, but still not too strong. We decided to try the breast pump and after a "round" of that.....she kicked into serious gear. After an hour of serious, consistent contractions I checked her cervix for the very first time since her water breaking and she was 4cm....great news! She got in the pool and we all settled in for the work. She talked to her husband a lot and despite the distance the love was so palpable in the room. Literally, 30 minutes later, Andrea said she had to push! A quick cervical check...she was C/+1 and after 24 minutes of beautiful, instinctual pushing a beautiful baby girl was welcomed to the world.
Not long after that birth, Ellen was ready to welcome her sweet babe. Ellen was complete...but not ready to push...instead she paced and paced, unable to relax. She did not like the sensations and seemed to try and run away from them. She was fidgety and had a lot of trouble getting into the work of pushing. I have seen other ladies do this and eventually they stop "running" away and get into it. Just over an hour later, Ellen was getting frustrated....her energy was spilling over and she was busy trying to contain it. I felt that she needed to have a "melt down", let the energy go and move forward....and then it happened. Ellen threw a temper tantrum; seriously stomping around the room, crossing her arms, pouting her lips and kicking things!...in true three year old style!! She was saying things like wanting to the hospital, this "sucks", whose dumb idea was this, etc. I was actually happy and trying not to laugh, this needed to happen...and after she calmed down, Ellen sat on the birth stool and gracefully with strength pushed out her gorgeous baby girl.
Every birth is a gift and teaches me new things. These births were very different but had one thing in common: a true and genuine love between a man and a woman, that was supportive and strong. One was witnessed in person and the other was felt from a distance but both were amazing.
Wednesday, June 29, 2011
Midwives are a Strange Breed
Through the years, I have met many midwives. Though we are all unique individuals for sure, we do seem to share some commonalities. We are empathetic, intelligent, kind, sincere, independent, clear headed...and maybe a little "twisted" ;)
I recently had a conversation with one Mama that included suggestions on natural personal lubricants for sex and positions to try, how to entertain a three year old when nursing the one month old, the best organic diaper creams and the importance of nutrition.
Also, I have noted many statements that midwives routinely say that are pretty twisted:
"You're having a lot more pain? That is good news."
"You're leaking bloody mucous from your vagina? How wonderful!"
"You just threw up all over the bedroom? Good progress."
"You feel like you just sat on a campfire? Yes, it does feel like that, and great work."
Other things that midwives might "enjoy".....
Sitting in a dark room, behind a naked sweaty woman who is on all fours and realizing that she is pooping on your hand. Being drenched, and I mean drenched, in amniotic fluid as you kneel on the floor in front of a woman on a stool. Using a fish net to fish many things other than fish out of a pool. Driving home after a long night at work, looking in the rear view mirror and realizing that you have meconium on your face.....
So, you see, midwives are definitely a certain breed...and potentially a strange one at that! And I wouldn't have it any other way!!
I recently had a conversation with one Mama that included suggestions on natural personal lubricants for sex and positions to try, how to entertain a three year old when nursing the one month old, the best organic diaper creams and the importance of nutrition.
Also, I have noted many statements that midwives routinely say that are pretty twisted:
"You're having a lot more pain? That is good news."
"You're leaking bloody mucous from your vagina? How wonderful!"
"You just threw up all over the bedroom? Good progress."
"You feel like you just sat on a campfire? Yes, it does feel like that, and great work."
Other things that midwives might "enjoy".....
Sitting in a dark room, behind a naked sweaty woman who is on all fours and realizing that she is pooping on your hand. Being drenched, and I mean drenched, in amniotic fluid as you kneel on the floor in front of a woman on a stool. Using a fish net to fish many things other than fish out of a pool. Driving home after a long night at work, looking in the rear view mirror and realizing that you have meconium on your face.....
So, you see, midwives are definitely a certain breed...and potentially a strange one at that! And I wouldn't have it any other way!!
Monday, June 20, 2011
The lovely Placenta...
I really do love keeping this blog, and have found it enlightening. However, I crave to hear the thoughts of those who bless me with their time to read it...so I have decided to periodically post some questions or topics to discuss. Let's start a place where we can share our experiences and thoughts!
So, I am and have always been fascinated by the placenta. It is such an interesting and important creation. Many cultures have very specific rituals and beliefs centered around the placenta. I would love to start a discussion about placenta's...please, post any thoughts, practices, beliefs that you have seen or heard about this amazing organ....is placenta encapsulation popular where you are?....
Here is a thought to start off the talk....Placentas may be the only "meat" that is vegetarian, as no animal is killed in their production!....
So, I am and have always been fascinated by the placenta. It is such an interesting and important creation. Many cultures have very specific rituals and beliefs centered around the placenta. I would love to start a discussion about placenta's...please, post any thoughts, practices, beliefs that you have seen or heard about this amazing organ....is placenta encapsulation popular where you are?....
Here is a thought to start off the talk....Placentas may be the only "meat" that is vegetarian, as no animal is killed in their production!....
Monday, June 13, 2011
When Interventions Are a Good Thing
I firmly believe that each woman should be treated as an individual and that the concept of blanket interventions for all is ridiculous. Birth is a natural process and if we trust it, it will most often work for itself. Most of the time, my job is to be present and provide support...not to manage...but sometimes that is what I need to do....
Erika was working on her first baby. She had been in labor for hours, when early in the morning she started having a LOT of vomiting. After a few hours of this, she and her husband and mom came to the center....she was so exhausted physically, yet so strong in spirit. They had been working on keeping Erika hydrated, but with the amount of vomiting, this was nearly impossible. I started an IV and gave her some fluids...what a difference and she actually took a little nap, which was perfect. Then, she had more vomiting, followed by some more. At this point, she was still strong in spirit, however, her physical self was starting to struggle. I wrote her a prescription for Zofran, an anti-emetic, and her husband went to go pick it up. We also did some herbs and Rescue Remedy, but that Zofran sure hit the spot. Erika was able to "catch her breath" and go on to have a great natural birth, surrounded by love and support, on the birth stool and welcome her 7lb little girl.
This is an example of when certain "medical" interventions can really make the difference and allow a woman to carry on and move forward. Do I think all ladies need an IV or IV access? No. But, do I think we should have these options when needed? The intervention itself is not the problem, it is the over use of the intervention that creates the problem.
Erika was working on her first baby. She had been in labor for hours, when early in the morning she started having a LOT of vomiting. After a few hours of this, she and her husband and mom came to the center....she was so exhausted physically, yet so strong in spirit. They had been working on keeping Erika hydrated, but with the amount of vomiting, this was nearly impossible. I started an IV and gave her some fluids...what a difference and she actually took a little nap, which was perfect. Then, she had more vomiting, followed by some more. At this point, she was still strong in spirit, however, her physical self was starting to struggle. I wrote her a prescription for Zofran, an anti-emetic, and her husband went to go pick it up. We also did some herbs and Rescue Remedy, but that Zofran sure hit the spot. Erika was able to "catch her breath" and go on to have a great natural birth, surrounded by love and support, on the birth stool and welcome her 7lb little girl.
This is an example of when certain "medical" interventions can really make the difference and allow a woman to carry on and move forward. Do I think all ladies need an IV or IV access? No. But, do I think we should have these options when needed? The intervention itself is not the problem, it is the over use of the intervention that creates the problem.
Love and Bubbles
I just have to say, that I love siblings at births! In my experience it is such a great way for the older child/children to feel that they are also part of this process...and there is nothing like the look on their sweet faces when they see the new little brother or sister for the first time....
I was recently with a family having their second child, their first is six years old and so smart and fun...Sam. Sam was amazing at his little sisters' birth. While his Mama was in the pool pushing, he diligently gave her sips of water between contractions, and took this job very seriously. Additionally, he would be sure to blow bubbles when she was having her contractions, it was great to welcome little babe to a room full of love and bubbles! Afterwards, he wanted to keep helping, so we employed him as our helper and he drained the birth pool with us. These births are so wonderful and such a family affair...as it should be. I wish that all women and their families could be blessed with this respect and openness for their births.....
I was recently with a family having their second child, their first is six years old and so smart and fun...Sam. Sam was amazing at his little sisters' birth. While his Mama was in the pool pushing, he diligently gave her sips of water between contractions, and took this job very seriously. Additionally, he would be sure to blow bubbles when she was having her contractions, it was great to welcome little babe to a room full of love and bubbles! Afterwards, he wanted to keep helping, so we employed him as our helper and he drained the birth pool with us. These births are so wonderful and such a family affair...as it should be. I wish that all women and their families could be blessed with this respect and openness for their births.....
Sunday, June 12, 2011
Midwifing the Midwife
This calling is truly a blessing...to be included in and welcomed to such an intimate and special time for families is a gift. Seeing these women transform to mothers in those precious first moments and watching the awe in the faces of thier partners...these are times to be cherished. However, that is not always how it works out, despite all the best preperations and intentions. These are times when this calling can and will break your heart. The highest highs and the absolute lowest lows...these are wrapped up together in this calling...and we as the guardians of birth must be able to guide families through it all. We must also be able to nurture ourselves through these times and hold fast to our faith in the birth process....so, a question...who midwifes the midwife?
Tuesday, May 24, 2011
Fancy a Swim?
I love waterbirths, I have always loved them. My second child was born in the water and my first would have been if the hospital had "allowed" it, at least I was "allowed" to labor in the water. The funny thing about waterbirths is that they are wet ;) and there is a lot of water involved...splashing water, dripping water, sloshing water...you get the point. I have joked with the owner of our birth center that she should buy us wet suit tops so that we don't end up looking like contestants in a wet t-shirt concert....
It was her second baby and she was doing beautifully. Her husband was great and she had a fabulous doula. As her labor progressed, she moved into the pool and soon after her husband joined her. This if course, raised the water level pretty high, so I was on bucket brigade and removed some of the water. She started pushing while on her hands and knees, then she moved to squatting, followed by leaning back into her husbands arms. With each move she got a little bit further away from me...and I leaned a little bit more over the side of the pool. Then as her babe started to crown, she pushed her legs against the sides of the pool, pinned her husband against the back of the pool and sat on the pool bottom. Now, I am a pretty hands off midwife, especially in the water, but I do like to feel for cords and make sure it is ok for Mama to bring/pull her babe up out of the water. (Also, it can be a little difficult for a baby to emerge when its Mama is sitting.) So, I ended up basically in the pool from the waist up, gently lifting/encouraging Mama to squat and make room for baby. Her son was very soon born and was welcomed into the loving arms of both Mama and Papa. I looked like a drowned cat and was literally dripping all over the floor...my hair was wet, my shirt was soaked (along with my bra), my pants were wet and the water dripped down into my shoes. And we all laughed. I love waterbirths!
It was her second baby and she was doing beautifully. Her husband was great and she had a fabulous doula. As her labor progressed, she moved into the pool and soon after her husband joined her. This if course, raised the water level pretty high, so I was on bucket brigade and removed some of the water. She started pushing while on her hands and knees, then she moved to squatting, followed by leaning back into her husbands arms. With each move she got a little bit further away from me...and I leaned a little bit more over the side of the pool. Then as her babe started to crown, she pushed her legs against the sides of the pool, pinned her husband against the back of the pool and sat on the pool bottom. Now, I am a pretty hands off midwife, especially in the water, but I do like to feel for cords and make sure it is ok for Mama to bring/pull her babe up out of the water. (Also, it can be a little difficult for a baby to emerge when its Mama is sitting.) So, I ended up basically in the pool from the waist up, gently lifting/encouraging Mama to squat and make room for baby. Her son was very soon born and was welcomed into the loving arms of both Mama and Papa. I looked like a drowned cat and was literally dripping all over the floor...my hair was wet, my shirt was soaked (along with my bra), my pants were wet and the water dripped down into my shoes. And we all laughed. I love waterbirths!
Wednesday, May 4, 2011
You say frenectomy, I say frenotomy
So, being a midwife is not only all about labor and birth. I am blessed to work in a practice that also provides newborn care for the first two weeks, and I love it!!
Recently, I have learned how to perform frenotomy's. These are done when a baby is "tongue tied" and they cannot stick out their tongues...which can make nursing very difficult indeed. Being tongue tied happens when the frenulum (little piece of skin) that anchors the tongue to the base of the mouth is too tight or extends too far. In the frenotomy, this little piece of skin is clipped. It seems scary and yes, is a little intimidating...especially to have scissors in a newborns little mouth. However, it is very easy, the babies tolerate it well and it hardly bleeds. This is a topic near and dear to my heart. My sweet firstborn was tongue tied and I was not able to find anyone to clip it for me, I was not yet a nurse and had no idea how to do it myself. Together, we endured weeks of very difficult breastfeeding with a couple bouts of mastitis thrown in for fun. Eventually, we were able to work through it, but I would never want a Mama to have to deal with that...when it can be so easily fixed.
This week, I saw two Mama's struggling with these tight frenulum's. They were both working with lactation consultants who recommended an assessment for frenotomy. Both had seriously beat up nipples and were in a lot of pain and their babies were not gaining enough weight. The procedures went great and both babies were immediately put to breast....and the look of relieved surprise on the faces of the Mamas was priceless..."oh, this is how it is supposed to feel?!?" The baby that came in earlier in the week is already gaining weight!
These times are when this "job" is truly rewarding!
Recently, I have learned how to perform frenotomy's. These are done when a baby is "tongue tied" and they cannot stick out their tongues...which can make nursing very difficult indeed. Being tongue tied happens when the frenulum (little piece of skin) that anchors the tongue to the base of the mouth is too tight or extends too far. In the frenotomy, this little piece of skin is clipped. It seems scary and yes, is a little intimidating...especially to have scissors in a newborns little mouth. However, it is very easy, the babies tolerate it well and it hardly bleeds. This is a topic near and dear to my heart. My sweet firstborn was tongue tied and I was not able to find anyone to clip it for me, I was not yet a nurse and had no idea how to do it myself. Together, we endured weeks of very difficult breastfeeding with a couple bouts of mastitis thrown in for fun. Eventually, we were able to work through it, but I would never want a Mama to have to deal with that...when it can be so easily fixed.
This week, I saw two Mama's struggling with these tight frenulum's. They were both working with lactation consultants who recommended an assessment for frenotomy. Both had seriously beat up nipples and were in a lot of pain and their babies were not gaining enough weight. The procedures went great and both babies were immediately put to breast....and the look of relieved surprise on the faces of the Mamas was priceless..."oh, this is how it is supposed to feel?!?" The baby that came in earlier in the week is already gaining weight!
These times are when this "job" is truly rewarding!
Sunday, May 1, 2011
WTHeck??...
I was very happy to get a call from this awesome family. They were expecting their first baby. We met at the center and she did seem to be in a great labor pattern. She spent a little time getting settled in, going to the bathroom, being in the room. Her vital signs were stable and the babe sounded good. Then came time for a cervical exam. I gently eased my fingers into her vagina and easily found her cervix, which was lovely and soft, opened to 6cm. Then, it became confusing...what is this presenting part? It feels so soft...are these the sutures?..What am I feeling...then something floated into my fingers....are these fingers?....no!...this is a foot!!
I have often heard providers describe finding a breech presentation by internal exam, and they have all talked about a certain level of confusion. How you try to somehow make sense of what you are finding, and try to make it fit into being a head. That is exactly what I did in this situation. Additionally, for some reason, I had not as I usually do, done Leopold's yet on this beautiful belly. When I did do Leopold's after the exam, it was not a clear case...had I not felt that little foot, I would not have suspected.
Then came the most difficult part...telling this family that their sweet little one was breech, that she was in active labor and that her only option at this point was a cesarean section at the hospital. We all cried a bit, but then this great family was able to switch gears and quickly just focus on the fact that their babe was soon to arrive. I was in awe of their strength and grateful for their grace.
I work in a large urban setting and providers willing to do vaginal breech births are rare. We are blessed to work with one such great physician. However, he will only do "scheduled" vaginal breech births....breeches that are found during prenatal care. In these cases, we can send a family to him, he will do an evaluation and discuss all the pros and cons about vaginal breech and cesarean section, give truly informed consent and follow the family's decision. He will also offer to preform an external version, if he feels it is a safe option. We have had a couple babes born with us after he completed a successful version. Unfortunately, for this Mama, we did not discover her breech baby early enough....
I have often heard providers describe finding a breech presentation by internal exam, and they have all talked about a certain level of confusion. How you try to somehow make sense of what you are finding, and try to make it fit into being a head. That is exactly what I did in this situation. Additionally, for some reason, I had not as I usually do, done Leopold's yet on this beautiful belly. When I did do Leopold's after the exam, it was not a clear case...had I not felt that little foot, I would not have suspected.
Then came the most difficult part...telling this family that their sweet little one was breech, that she was in active labor and that her only option at this point was a cesarean section at the hospital. We all cried a bit, but then this great family was able to switch gears and quickly just focus on the fact that their babe was soon to arrive. I was in awe of their strength and grateful for their grace.
I work in a large urban setting and providers willing to do vaginal breech births are rare. We are blessed to work with one such great physician. However, he will only do "scheduled" vaginal breech births....breeches that are found during prenatal care. In these cases, we can send a family to him, he will do an evaluation and discuss all the pros and cons about vaginal breech and cesarean section, give truly informed consent and follow the family's decision. He will also offer to preform an external version, if he feels it is a safe option. We have had a couple babes born with us after he completed a successful version. Unfortunately, for this Mama, we did not discover her breech baby early enough....
Saturday, April 23, 2011
Action!
The night sky was inky and the air was apple crisp on my checks. I was pacing. There was student midwife with me and she joined in. The room was ready, I had hastily gotten all the tasks done. So, now I was outside on the breezeway, pacing in the night. It was her second baby and I didn't know if they were gonna make it in. They had said the drive was about 10 minutes, by now it had been 20. I anxiously watched the street for car headlights turning my way. Finally, I saw them, and I took a nice long breath, they had made it.
The car door opened and I heard the Mama...the unmistakable sounds that mean a baby is just about to crown. She stepped out of the car and grabbed onto the gate, fell down to her knees and groaned. I quickly and gently felt between her legs...we had a few minutes, maybe. "Your baby is very close. We can have her here or we can go inside. Do you want to try and walk inside?" She says that she would like to walk inside, the next moment, she is sprinting across the breezeway with myself, the student midwife, and her husband trying to catch up.
Once inside, she returned to her hands and knees, groaning and full of power. We must have been quite the sight, she was crawling down the hallway, we were trying to get her clothes off, the baby was working her way down and out. I told her that she could stop crawling and have her baby where she was, however, she was determined to have her daughter in the room that she had loved during her prenatal care and classes. The instant she crawled into the bed, her sweet little girl arrived and all were well. A few minutes later, the nurse arrived and came in the room laughing. She said that the hallway looked like a movie scene...with clothes strewn about, socks, pants, underwear, etc. leading to the bedroom. We all laughed together. These moments are so special and sweet, I am honored to be a part of them.
The car door opened and I heard the Mama...the unmistakable sounds that mean a baby is just about to crown. She stepped out of the car and grabbed onto the gate, fell down to her knees and groaned. I quickly and gently felt between her legs...we had a few minutes, maybe. "Your baby is very close. We can have her here or we can go inside. Do you want to try and walk inside?" She says that she would like to walk inside, the next moment, she is sprinting across the breezeway with myself, the student midwife, and her husband trying to catch up.
Once inside, she returned to her hands and knees, groaning and full of power. We must have been quite the sight, she was crawling down the hallway, we were trying to get her clothes off, the baby was working her way down and out. I told her that she could stop crawling and have her baby where she was, however, she was determined to have her daughter in the room that she had loved during her prenatal care and classes. The instant she crawled into the bed, her sweet little girl arrived and all were well. A few minutes later, the nurse arrived and came in the room laughing. She said that the hallway looked like a movie scene...with clothes strewn about, socks, pants, underwear, etc. leading to the bedroom. We all laughed together. These moments are so special and sweet, I am honored to be a part of them.
Wednesday, April 20, 2011
and Beyond
Well, it has most definitely been an amazing year with women! I started my blog in May, but I had started catchin' babies in April. As this anniversary has been approaching, I have been wondering what to do with this blog. I have loved keeping it, and am surprised (very happily) that a few others actually read it. It has been therapeutic, fun and in a real way has helped to foster my growth. The introspection involved is much appreciated...though not always easy to accept. After some thought, though not much because it was an easy decision, I have decided to keep the blog going. I have no idea how to change my url without loosing the content and followers, so I will keep the original name. This may be an homage to this first year and how special it has been and to the hopes of many more amazing years to come.
Monday, April 18, 2011
Stats..the first 100!
Wow, again, it seems hard to believe that I have reached this milestone! I have compiled a rough group of stats from these births, but I do have some disclaimers. First, these births are only the ones that I was able to "catch". So, these do not include Mama's that I labor sat with and then passed to my midwife sisters. Second, these do not include Mama's that I had to transfer to the hospital before the birth...which would include both vaginal births and cesarean sections. In putting these numbers together, this is an area that I realize I have unfortunately missed. In the future, I plan to also keep track of those births as well. Also, the first 40 births were done as a student and 21 of those ocurred in a hospital. Well, here goes:
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
Saturday, April 16, 2011
A Milestone
All I can say is, WOW! I have reached a big milestone recently. I was blessed to catch baby #100! It seems somewhat surreal, but wonderful. I can realize how much I have learned and grown...I can also realize how much more I have to learn. Currently, I am in the process of putting together some stats about these births...boys v girls, birth positions, water v land births, etc and will be sharing them. But, I couldn't wait to share the news of my Big 100.
Thursday, April 14, 2011
AWOL...
Wow, how time does fly!! I must apologize for my long absence...and offer an explanation. While I was on the long path to midwifery, my dear husband was amazingly supportive...and actually my biggest cheerleader on those inevitable road bumps. He truly made it possible for me to complete the journey, without too much guilt about the time taken from my family. It was a long road, several years in fact. I feel that it many ways loving, supportive midwife-husbands are the unsung heroes of our service to women, as they are often left to pick up the slack at our own homes. So, several months ago, when my husband started talking about running for a local elected office in city government....I, of course, wanted to be supportive. This is something that he has considered doing for years, but was always busy being my cheerleader. Now that I have finished the formal education part of my path, it only seems fair to "pay it forward" and give him the same support in return. So, long story short, I have become a committed member of the campaign...and the official treasurer (which is actually quite hilarious if you know anything about me and numbers). We have been canvassing in our community, attending forums, taping TV spots, and stuffing envelopes! It is a process that we are all learning together and it has been an adventure. The whole family is involved and it has been a great way to spend time together. The election is coming up and I feel that we have a good shot and if he doesn't win, it will not be from lack of heart or effort. Clearly, this has kept me very busy indeed! I have continued to work with women and their families, catching babies and all that entails....I just haven't had any time to sit and share my experiences...which I have truly missed doing! Don't worry, I have been keeping my birth journal and have some great storied to share..... Stay tuned for some good, juicy midwife tales.....
Thursday, February 17, 2011
its always something
Clinic is never dull! Last week, we had a day of SROM (spontaneous rupture of membranes) checks...when a Mama thinks her water may have broken, so she comes in for us to verify one way or the other. Something was in the air, and tricking ladies into thinking their water broke, cause none of them were. I had one lady tell me she never thought that hearing she had peed her pants would be good news! Ah, pregnancy and the sheer glamour of it.
Today, I wrote my first prescription for the NuvaRing! I know, kinda silly. Our client population doesn't usually vote for hormonal based contraception like the "pill" or "patch" or "ring", instead we do A LOT of IUD's, Natural Family Planning and diaphragms. But for this Mama is was just the right fit. We all had a chuckle that I had to look up how to write out the script.
Palpating a glorious 37 week belly and finding the baby to be breech...argh! Supporting the family through this discovery, encouraging and educating about the options...positional interventions, acupuncture, external version. And talking about what happens if these things don't work. We are blessed to have an OB in our area who does vaginal breech births and I am eternally grateful to be able to send these Mama's his way.
Meeting all the soon to be big brothers and sisters. Having them help "check their baby" by holding the doppler and having them palpate that crazy belly. Meeting soon to be grandparents and reassuring them that the birth center is "legit" and alleviating their worries.
Having to tell a Mama that she has Gestational Hypertension and can't have her babe with us. Comforting her and her family, explaining why this means she "risks out" and what that all entails. Answering her questions and giving her lots of TLC.
never, never dull
Today, I wrote my first prescription for the NuvaRing! I know, kinda silly. Our client population doesn't usually vote for hormonal based contraception like the "pill" or "patch" or "ring", instead we do A LOT of IUD's, Natural Family Planning and diaphragms. But for this Mama is was just the right fit. We all had a chuckle that I had to look up how to write out the script.
Palpating a glorious 37 week belly and finding the baby to be breech...argh! Supporting the family through this discovery, encouraging and educating about the options...positional interventions, acupuncture, external version. And talking about what happens if these things don't work. We are blessed to have an OB in our area who does vaginal breech births and I am eternally grateful to be able to send these Mama's his way.
Meeting all the soon to be big brothers and sisters. Having them help "check their baby" by holding the doppler and having them palpate that crazy belly. Meeting soon to be grandparents and reassuring them that the birth center is "legit" and alleviating their worries.
Having to tell a Mama that she has Gestational Hypertension and can't have her babe with us. Comforting her and her family, explaining why this means she "risks out" and what that all entails. Answering her questions and giving her lots of TLC.
never, never dull
Monday, February 14, 2011
argh...
Call shift induced insomnia is so lame!!! I had a lot of trouble with this months ago, but had managed to mostly cope with it....until last night!! I was a rare evening when I actually didn't get many phone calls and therefore could have slept.....ah, well I gues that it comes with the territory....
Sunday, February 13, 2011
the sunny side
I had been at the birth center alllll day and was TIRED. (We had had two gorgeous little ones in the morning, more about those births later as they were both difficult.) Since the previous births had been tough...I had had some serious adrenaline highs and then crashes...which makes for a tired that is a little more intense. The nurse was also on the same boat.
It was the typical labor of a first time Mama. Her first stage took almost 15 hours, but had progressed at a nice steady pace and flow. Mama's spirits had remained intact and positive throughout. She came to the center at the appropriate time and labored well. Being with her definitely helped to wake us up...along with some super caffeine charged tea that the nurse compared to crack! (And it was quite effective.) Mama had a mild urge to push so I checked her cervix; barely a rim of cervix and a bulging bag of waters at +2 station, with a baby head close behind. In my exhaustion, I offered to AROM, in my mind I wanted to speed things up....something I am not proud of! Wisely, Mama declined. Then, a short time later while sitting on the toilet, her water spontaneously ruptured and she was ready to push for real. Her second stage was 39 minutes, a couple of times the baby heart tones dipped a touch so we changed positions with good results and ended up semi-reclining in the bed. Then there was a lovely crown, followed by the birth of a direct OP baby! The nurse said, "I thought something looked funny and then realised it was because the baby was looking up at me!" Her labor had progressed so nicely, she never had any of the classic "OP labor" symptoms...it was amazing. I have heard of this happening, but had just never seen it myself. So, it does happen! Believe me, I have experienced, many times, the classic "OP labor" and all of the associated dysfunctions and extra pain. And then, there is this one that just kinda snuck up on us. I could see why they are sometimes called "sunny side up" cause that sweet little sunny baby face was lookin right up at us!
It was the typical labor of a first time Mama. Her first stage took almost 15 hours, but had progressed at a nice steady pace and flow. Mama's spirits had remained intact and positive throughout. She came to the center at the appropriate time and labored well. Being with her definitely helped to wake us up...along with some super caffeine charged tea that the nurse compared to crack! (And it was quite effective.) Mama had a mild urge to push so I checked her cervix; barely a rim of cervix and a bulging bag of waters at +2 station, with a baby head close behind. In my exhaustion, I offered to AROM, in my mind I wanted to speed things up....something I am not proud of! Wisely, Mama declined. Then, a short time later while sitting on the toilet, her water spontaneously ruptured and she was ready to push for real. Her second stage was 39 minutes, a couple of times the baby heart tones dipped a touch so we changed positions with good results and ended up semi-reclining in the bed. Then there was a lovely crown, followed by the birth of a direct OP baby! The nurse said, "I thought something looked funny and then realised it was because the baby was looking up at me!" Her labor had progressed so nicely, she never had any of the classic "OP labor" symptoms...it was amazing. I have heard of this happening, but had just never seen it myself. So, it does happen! Believe me, I have experienced, many times, the classic "OP labor" and all of the associated dysfunctions and extra pain. And then, there is this one that just kinda snuck up on us. I could see why they are sometimes called "sunny side up" cause that sweet little sunny baby face was lookin right up at us!
Wednesday, February 9, 2011
never a dull moment...
Of course, its not only about catchin babies. I have to admit that I do have the "baby catching bug" and it was originally what brought me to midwifery. However, I definitely love the rest of my job as well.
Clinic days are often fast and never boring. I love meeting with our families for thier prenatal visits. I am blessed to be in a practice where I am able to spend time and get to know our clients. Meeting families for thier very first visit and welcoming them to our practice. The postpartum visits for the new families...the 2 day, the 1 week and the 6 week...being witness to the transformation of the mothers and fathers and family. Preconception visits to help women plan a healthy pregnancy from the very beginning. Well woman and contraception visits to help women learn about and take control of thier health and fertility. How can I not love this work? never a dull moment and always fulfilling....sometimes exhausting!...but worth every minute of it!
Clinic days are often fast and never boring. I love meeting with our families for thier prenatal visits. I am blessed to be in a practice where I am able to spend time and get to know our clients. Meeting families for thier very first visit and welcoming them to our practice. The postpartum visits for the new families...the 2 day, the 1 week and the 6 week...being witness to the transformation of the mothers and fathers and family. Preconception visits to help women plan a healthy pregnancy from the very beginning. Well woman and contraception visits to help women learn about and take control of thier health and fertility. How can I not love this work? never a dull moment and always fulfilling....sometimes exhausting!...but worth every minute of it!
Thursday, February 3, 2011
epiphany
The labor can best be described as full of grace. The Mama was focused and serene in her power, her husband was loving. She progressed steadily and evenly, spending time in the pool, walking, on the birth ball and in the bathroom. While on the toilet, she started pushing and we were witness to a shining crowning bag of water, which eventually broke on its own.
At some point during the second stage, the baby had some difficult moments. It was a time when I had to pull out the "inner drill sargent" and strongly coach mama through some intense directed pushing and position changes. Baby was talking and telling us that the birth time needed to come sooner rather than later. It is interesting to me how, in times of stress like these, the mind can compartmentalize different thought trains. In my heart, I knew that this mama and this baby could do this and that we were safe in pushing through. I also knew that 6 months ago, I would have "called it" and taken them to the hospital. This was an epiphany for me and one that I have been pondering for days. During some of my musings I have been fearful that I was "cowgirling" it...felling too cocky and being unsafe. Other times, I have been proud of myself for staying the course and helping them through. I spent time discussing all these feelings with my fellow midwives. It is a fine line and one that, now, I feel I did not cross in this situation.
In the end, a happy and healthy mama and dad took home a happy and healthy baby....which is always the goal of course. It is crucial to learn from experience, but to not let that experience get the best you...always a balancing act....
At some point during the second stage, the baby had some difficult moments. It was a time when I had to pull out the "inner drill sargent" and strongly coach mama through some intense directed pushing and position changes. Baby was talking and telling us that the birth time needed to come sooner rather than later. It is interesting to me how, in times of stress like these, the mind can compartmentalize different thought trains. In my heart, I knew that this mama and this baby could do this and that we were safe in pushing through. I also knew that 6 months ago, I would have "called it" and taken them to the hospital. This was an epiphany for me and one that I have been pondering for days. During some of my musings I have been fearful that I was "cowgirling" it...felling too cocky and being unsafe. Other times, I have been proud of myself for staying the course and helping them through. I spent time discussing all these feelings with my fellow midwives. It is a fine line and one that, now, I feel I did not cross in this situation.
In the end, a happy and healthy mama and dad took home a happy and healthy baby....which is always the goal of course. It is crucial to learn from experience, but to not let that experience get the best you...always a balancing act....
Saturday, January 29, 2011
sweet squishies
Whew, two sweet squishy babes early this morning. One girl and one boy...and a nice way to get out of the land of negative....
But my mind does still wander, this time to the babes. How do we welcome our new generation to this earth? I can't hope but believe that when newborns are welcomed in love, respect, beauty and strength, it leaves an impression. That they are starting off on the "right" foot. Clearly, empowered birth will not change all of the world's woes....but it could go along way toward starting. Ensuring empowered birth is much more than fostering the few months of pregnancy, the hours involved in the birth and the postpartum time. Empowered birth requires that young boys and girls are nurtured and grown in environments that honor and respect thier bodies and that has they grow to young men and women they respect each other. That girls are raised hearing strong, positive stories about the power and wisdom of thier bodies. An environment that honors birth, is one that honors women and children...and when we honor women and children we honor all life. And that! is a start toward ending the woes of the world!
Ok, so there is one of my 'waxing philosphic' moments. I guess that is what sweet squishy babies do to me.....
But my mind does still wander, this time to the babes. How do we welcome our new generation to this earth? I can't hope but believe that when newborns are welcomed in love, respect, beauty and strength, it leaves an impression. That they are starting off on the "right" foot. Clearly, empowered birth will not change all of the world's woes....but it could go along way toward starting. Ensuring empowered birth is much more than fostering the few months of pregnancy, the hours involved in the birth and the postpartum time. Empowered birth requires that young boys and girls are nurtured and grown in environments that honor and respect thier bodies and that has they grow to young men and women they respect each other. That girls are raised hearing strong, positive stories about the power and wisdom of thier bodies. An environment that honors birth, is one that honors women and children...and when we honor women and children we honor all life. And that! is a start toward ending the woes of the world!
Ok, so there is one of my 'waxing philosphic' moments. I guess that is what sweet squishy babies do to me.....
Friday, January 28, 2011
a little rant
We have been sooooo quiet! I know, I know...don't rock the boat or jinx anything, but it is getting ridiculous. My fingers are getting a serious itch. I have drained and filled, due to lack of use, too many birth pools. All of this 'free time' has lead my mind to wander.....
Recently, I had an orientation (kinda like an open house for the center) with a lot of great attendees. It was a good crowd, with lots of good questions and interaction. At the end of these sessions, I always stick around for people to speak with me privately if need be. A very nice couple approached me and as she started to tell me her story/ask her question, she started to cry. She is early in her prgnancy and has had some spotting. The "care" she has been receiving from her care provider (an OB doc who she has been seeing her whole adult life) sounds less than stellar. Don't get me wrong, it sounds like all the clinical bases have been covered...but the emotional ones have been abandoned. My initial instinct was to reach out and touch her, give a hug, a tissue and some comfort....which I did, even though I didn't really know her. Then we all talked through her experience, I answered questions as best I could, and held her hand. We spent all of 5 minutes together and at the end she said that I "had given her more care and compassion" than her doctor ever had! Me, who is basically a complete stranger!
This is so disheartening. How can we empower women to demand and get the care they deserve? This story is so common in our culture....we need to encourage and foster change. Don't get me wrong, I am not bashing doctors...there are fantastic, kind doctors out there; just like there are not so great midwives out there. It's just that, all too often, as "patients" women will accept horrible care as "normal". Aarrgghh!
Whew, I have to pull out of the negative, or I could go on and on down that road! Clearly, I need to catch some sweet, squishy babies and get back in the positive zone. Hopefully tonight!!
Recently, I had an orientation (kinda like an open house for the center) with a lot of great attendees. It was a good crowd, with lots of good questions and interaction. At the end of these sessions, I always stick around for people to speak with me privately if need be. A very nice couple approached me and as she started to tell me her story/ask her question, she started to cry. She is early in her prgnancy and has had some spotting. The "care" she has been receiving from her care provider (an OB doc who she has been seeing her whole adult life) sounds less than stellar. Don't get me wrong, it sounds like all the clinical bases have been covered...but the emotional ones have been abandoned. My initial instinct was to reach out and touch her, give a hug, a tissue and some comfort....which I did, even though I didn't really know her. Then we all talked through her experience, I answered questions as best I could, and held her hand. We spent all of 5 minutes together and at the end she said that I "had given her more care and compassion" than her doctor ever had! Me, who is basically a complete stranger!
This is so disheartening. How can we empower women to demand and get the care they deserve? This story is so common in our culture....we need to encourage and foster change. Don't get me wrong, I am not bashing doctors...there are fantastic, kind doctors out there; just like there are not so great midwives out there. It's just that, all too often, as "patients" women will accept horrible care as "normal". Aarrgghh!
Whew, I have to pull out of the negative, or I could go on and on down that road! Clearly, I need to catch some sweet, squishy babies and get back in the positive zone. Hopefully tonight!!
Sunday, January 23, 2011
breathe, two, three, breathe, two, three...
One and two and three... release
One and two and three... release
One and two and three... release
One and two and three...release
Inflation breaths....come on inflation....come on inflation....I can hear the words as spoken by my NRP teacher....all is so quiet...except the mantra...one and two and three...release
The labor had been so sweet, such a natural, instinctual process in a Mama who was strong and a partner who was so supportive...
Come on baby...come on baby...join us here...we are here for you...come on baby...
Breathe, two, three...Breathe, two three...Breathe two, three....
Heart rate is up now....join us little one...all is well and you are loved...
The room is so quiet, everything is in slow motion and at light speed, all at once. Just before birth, the waters had ruptured and there was meconium. The nurse and I got everything ready. The little one had been great in labor, so we weren't too worried, but being prepared is always good. As he slid out of his Mama and into my hands, I knew he needed help...dried, stimulated and no response....heart rate 80-90....
A breath!!! That was a breath from the little one, tentative but a breath!!! The arms and legs begin to flex, color starts to flood in...another breath, much stronger this time and then...the best sound in the world, a CRY!!!...Everyone in the room takes a collective breath and baby is handed up to the loving arms of Mom and Dad, the recovery goes easy as pie afterward. All of this happened in about 1-2 minutes....but seemed to last at least 1 year.
This is why we have trained and trained and trained and sat through hours of classes...this situation, to make the difference at these times. In the moment, my hands took over and I just did the drill, there was clarity in the steps and my focus was amazingly sharp. Afterward, is of course a different story, when out of the room I was shaking and tearing up from adrenaline overload. I give thanks and gratitude to all of my teachers along the way....thanks that through their guidance I was able to be there when this baby and family needed me...able to be the midwife.
One and two and three... release
One and two and three... release
One and two and three...release
Inflation breaths....come on inflation....come on inflation....I can hear the words as spoken by my NRP teacher....all is so quiet...except the mantra...one and two and three...release
The labor had been so sweet, such a natural, instinctual process in a Mama who was strong and a partner who was so supportive...
Come on baby...come on baby...join us here...we are here for you...come on baby...
Breathe, two, three...Breathe, two three...Breathe two, three....
Heart rate is up now....join us little one...all is well and you are loved...
The room is so quiet, everything is in slow motion and at light speed, all at once. Just before birth, the waters had ruptured and there was meconium. The nurse and I got everything ready. The little one had been great in labor, so we weren't too worried, but being prepared is always good. As he slid out of his Mama and into my hands, I knew he needed help...dried, stimulated and no response....heart rate 80-90....
A breath!!! That was a breath from the little one, tentative but a breath!!! The arms and legs begin to flex, color starts to flood in...another breath, much stronger this time and then...the best sound in the world, a CRY!!!...Everyone in the room takes a collective breath and baby is handed up to the loving arms of Mom and Dad, the recovery goes easy as pie afterward. All of this happened in about 1-2 minutes....but seemed to last at least 1 year.
This is why we have trained and trained and trained and sat through hours of classes...this situation, to make the difference at these times. In the moment, my hands took over and I just did the drill, there was clarity in the steps and my focus was amazingly sharp. Afterward, is of course a different story, when out of the room I was shaking and tearing up from adrenaline overload. I give thanks and gratitude to all of my teachers along the way....thanks that through their guidance I was able to be there when this baby and family needed me...able to be the midwife.
Thursday, January 20, 2011
conference day
I was able to spend yesterday at conference, which was fabulous, for several reasons. First, I love learning and studying...I know, I know...but, if I am being honest, I am a complete nerd. Going to conferences is one way that I can get my batteries re-charged and it is always great to share stories and experiences with others. Second, there were several of my past fellow nursing co-workers in attendance and it was great to see them!
I went to the conference because I have been working on our policy/procedure for hypertension and that was one of the main foci. Before I finalized my information, I wanted to make sure that it was all up to date and correct. At the risk of sounding snotty....all my stuff was/is right on...so that was a nice ego boost.
The presenter was great, a nurse with oodles of experience and knowledge. In the middle of the event, surrounded by nurses and other midwives, NNP's and NICU nurses. I had a big realization....I love nurses, I am proud to be a nurse and of the work I did as one....but I don't ever want to work as one again. And, I hope that I am always blessed to work out of the hospital as well.
I went to the conference because I have been working on our policy/procedure for hypertension and that was one of the main foci. Before I finalized my information, I wanted to make sure that it was all up to date and correct. At the risk of sounding snotty....all my stuff was/is right on...so that was a nice ego boost.
The presenter was great, a nurse with oodles of experience and knowledge. In the middle of the event, surrounded by nurses and other midwives, NNP's and NICU nurses. I had a big realization....I love nurses, I am proud to be a nurse and of the work I did as one....but I don't ever want to work as one again. And, I hope that I am always blessed to work out of the hospital as well.
Sunday, January 16, 2011
how long is too long?
We had all been working very hard for a very long time....
Susan was having her first baby. She had a long first stage, but not really much longer than a lot of Mama's who are having their first. She had a good support system, had been able to keep up with food and fluids, and was hanging in there. The she was ready to push. And she pushed and she pushed and she pushed. Susan fought for every little centimeter of descent. But, there was descent...just at a slow, slow pace. Two times during her second stage, we stopped pushing to discuss if we should transfer to the hospital. Susan really wanted to stay, her vital signs were good, her baby sounded great and her husband was comfortable with Susan's desire. I have never seen a Mama push so hard for so long....
I have often had the feeling of treading a fine line. The line between hard work and pushing a woman to give and do just a little bit more when she can. Many women in labor, at a certain point, feel that they cannot continue the work. However, most of the time, this feeling means that they are just about done and will soon have their babes to cuddle. I am continually in awe of the power reserve that women are able to plug into at these moments. The fine line comes into play when a woman may be truly reaching her physical and emotional limit and can venture into the land of suffering. Hard work vs suffering....the distinction can many times be difficult to distinguish.
Susan's birth was one of these difficult times. She was actively involved in her care and the decision to continue with the work, but it was so very hard. Eventually, Susan gave birth to her baby and both were healthy. Susan felt empowered and was happy to have been able to birth her baby the way she did. However, when I saw Susan during her postpartum care, and I saw the multiple petechial bruises on her face and shoulders....a result of her extreme pushing effort over a sustained time, I definitely questioned my decisions. Had I pushed her too far? Had she truly suffered? It was Susan who then reassured me that she was still secure in her birth and confident in her own power as a mother who fought for her baby.
This balancing act is one that midwives must continually maintain. It is one that I am continually monitoring and debating when I am with a woman. Most of the time the line is pretty clear...it is those times when the line is blurry that we must be ever vigilant.
Susan was having her first baby. She had a long first stage, but not really much longer than a lot of Mama's who are having their first. She had a good support system, had been able to keep up with food and fluids, and was hanging in there. The she was ready to push. And she pushed and she pushed and she pushed. Susan fought for every little centimeter of descent. But, there was descent...just at a slow, slow pace. Two times during her second stage, we stopped pushing to discuss if we should transfer to the hospital. Susan really wanted to stay, her vital signs were good, her baby sounded great and her husband was comfortable with Susan's desire. I have never seen a Mama push so hard for so long....
I have often had the feeling of treading a fine line. The line between hard work and pushing a woman to give and do just a little bit more when she can. Many women in labor, at a certain point, feel that they cannot continue the work. However, most of the time, this feeling means that they are just about done and will soon have their babes to cuddle. I am continually in awe of the power reserve that women are able to plug into at these moments. The fine line comes into play when a woman may be truly reaching her physical and emotional limit and can venture into the land of suffering. Hard work vs suffering....the distinction can many times be difficult to distinguish.
Susan's birth was one of these difficult times. She was actively involved in her care and the decision to continue with the work, but it was so very hard. Eventually, Susan gave birth to her baby and both were healthy. Susan felt empowered and was happy to have been able to birth her baby the way she did. However, when I saw Susan during her postpartum care, and I saw the multiple petechial bruises on her face and shoulders....a result of her extreme pushing effort over a sustained time, I definitely questioned my decisions. Had I pushed her too far? Had she truly suffered? It was Susan who then reassured me that she was still secure in her birth and confident in her own power as a mother who fought for her baby.
This balancing act is one that midwives must continually maintain. It is one that I am continually monitoring and debating when I am with a woman. Most of the time the line is pretty clear...it is those times when the line is blurry that we must be ever vigilant.
Sunday, January 9, 2011
thinking back
Today has been a day full of snow and reflection. Snow often brings me to points of reflection. My thoughts have been wondering to memories of my own births and pregnancies...so very different from each other...for many reasons. I have had three pregnancies and two births. My first pregnancy was almost 13 years ago, boy that is scary to say...I have a 13 year old!! How does that happen?
When I was pregnant with my son, I knew nothing of what I was heading into. The pregnancy was a surprise but welcomed. However, I seemed to know two things, strongly and instinctually. I knew that I had to have a midwife and that I had to breastfeed my baby. In hindsight this is amazing to me...where did this knowledge come from? I had never consciously heard of midwives and I had never been around mothers who breastfed. Somehow, I just knew of these things in my bones...maybe some crazy genetic memory. I was blessed to find a great group of CNM's. I had a difficult pregnancy that involved a serious car accident, bed rest and PUPP's(a difficult skin rash). The labor and birth continued with the pattern and were also difficult. My son was direct OP (posterior or sunny side up) and acynclitic. It took four hours and every ounce of determination and strength in my body to work him out. Afterwards, we had a tough time with breastfeeding, including a tongue-tied baby and a full blown case of mastitis. Looking back now, it is almost comical, at the time it was almost tragic.
My next pregnancy was tragic. (I have written about it before in the post titled 'Just a Flutter'.) It was a desired and planned pregnancy...that was not meant to be. Near the end of my first trimester, the pregnancy presented itself to be ectopic. The baby was lost and I was very nearly lost as well. It was devastating and is something that I still work through.
My last pregnancy was also planned and desired. It also had its share of tough issues, including pretty serious morning sickness, that had me loosing weight. The birth however, was glorious. My daughter was born at home, in a pool in our bedroom. I was surrounded by friends and family and had a great midwife. It was empowering and humbling.
Although my two births were so very different, they did share some aspects. They were both drug free and I had supportive people around me. Additionally, I had a similar experience during both. In the depths of labor, that point where you feel that you cannot possibly do or give more, I had the sensation of being in a great line of women. I could see them flowing through time, all behind me, and feel them supporting me and offering strength. This experience during my first birth was also the moment that I knew, deep inside my being, that I would become a midwife myself. So, here I am, on a snowy winter day contemplating these memories. I sit here as a midwife...the journey has been a long and twisty one...but so worth the effort. I also know that it is a journey that will never end, it will always grow and expand, like the never ending line of women flowing through time....
When I was pregnant with my son, I knew nothing of what I was heading into. The pregnancy was a surprise but welcomed. However, I seemed to know two things, strongly and instinctually. I knew that I had to have a midwife and that I had to breastfeed my baby. In hindsight this is amazing to me...where did this knowledge come from? I had never consciously heard of midwives and I had never been around mothers who breastfed. Somehow, I just knew of these things in my bones...maybe some crazy genetic memory. I was blessed to find a great group of CNM's. I had a difficult pregnancy that involved a serious car accident, bed rest and PUPP's(a difficult skin rash). The labor and birth continued with the pattern and were also difficult. My son was direct OP (posterior or sunny side up) and acynclitic. It took four hours and every ounce of determination and strength in my body to work him out. Afterwards, we had a tough time with breastfeeding, including a tongue-tied baby and a full blown case of mastitis. Looking back now, it is almost comical, at the time it was almost tragic.
My next pregnancy was tragic. (I have written about it before in the post titled 'Just a Flutter'.) It was a desired and planned pregnancy...that was not meant to be. Near the end of my first trimester, the pregnancy presented itself to be ectopic. The baby was lost and I was very nearly lost as well. It was devastating and is something that I still work through.
My last pregnancy was also planned and desired. It also had its share of tough issues, including pretty serious morning sickness, that had me loosing weight. The birth however, was glorious. My daughter was born at home, in a pool in our bedroom. I was surrounded by friends and family and had a great midwife. It was empowering and humbling.
Although my two births were so very different, they did share some aspects. They were both drug free and I had supportive people around me. Additionally, I had a similar experience during both. In the depths of labor, that point where you feel that you cannot possibly do or give more, I had the sensation of being in a great line of women. I could see them flowing through time, all behind me, and feel them supporting me and offering strength. This experience during my first birth was also the moment that I knew, deep inside my being, that I would become a midwife myself. So, here I am, on a snowy winter day contemplating these memories. I sit here as a midwife...the journey has been a long and twisty one...but so worth the effort. I also know that it is a journey that will never end, it will always grow and expand, like the never ending line of women flowing through time....
Tuesday, January 4, 2011
the eyes
Laura is a very sweet first time Mama. I had been able to see her several times during her prenatal care and really liked her and her husband, Tim. She had been on our "labor radar" for several days as she had been experiencing pretty difficult prodromal contractions. She had been up through the night for the last three nights and was very exhausted. The physical toll was also starting to weigh on her emotionally and she was definitely loosing her steam. We had tried all of our usual tricks to help ladies get some rest through these situations...and just couldn't get her any relief.
Finally, as a last resort, I called in a prescription of Ambien for her. She was able to take that and eventually get some sort of sleep during the day. Later that evening she called me and really wanted to come in and be evaluated. I was concerned about Laura and her ability to cope with hard labor after the long, long latent labor trip she had been on. When we met, she looked tired, with purple shadows under her eyes. I hoped to check her cervix and have really good news to share. Unfortunately, it wasn't as good as I had hoped...but not horrible either. We decided to spend some time and re-check her in a couple hours. Then, literally 15 minutes later her water broke. It was like a switch went off in her tired body and she was flooded with energy. Her contractions steadily picked up and she started to smile and shine. I think the knowing that it was now really happening, that the "teasing" was over had given her a strong, hardy second wind. Never underestimate the power reserves of a Mama.
Eventually, Laura was in the birth pool and cranking away in solid active labor. She was on her knees, with her arms and head resting in her husband's lap. It was very peaceful with the flicker of candles and some gentle music playing. Suddenly, with a strong contraction, she opened her eyes and locked them with mine. The look was one of strength and vulnerability, beauty and necessity. She needed me to join her on the ride, together we climbed the hill, made it across the peak and came down the other side. In between contractions, she would close her eyes and just breath. The next wave would start, we would again lock eyes and traverse the mountain together. Without words, I knew that she needed me to be there, that when she opened her eyes, I had to be there waiting to walk with her. We did this all through transition, on and on, I was truly with her, intimately on the journey. I knew, as she did, when it was time to push. Five hours after her water had broken, Laura brought her gorgeous, 6# 9oz., daughter to the world.
I will never forget this labor. I feel that I was completely "with woman" as we worked so closely together and I was honored to support this family.
Finally, as a last resort, I called in a prescription of Ambien for her. She was able to take that and eventually get some sort of sleep during the day. Later that evening she called me and really wanted to come in and be evaluated. I was concerned about Laura and her ability to cope with hard labor after the long, long latent labor trip she had been on. When we met, she looked tired, with purple shadows under her eyes. I hoped to check her cervix and have really good news to share. Unfortunately, it wasn't as good as I had hoped...but not horrible either. We decided to spend some time and re-check her in a couple hours. Then, literally 15 minutes later her water broke. It was like a switch went off in her tired body and she was flooded with energy. Her contractions steadily picked up and she started to smile and shine. I think the knowing that it was now really happening, that the "teasing" was over had given her a strong, hardy second wind. Never underestimate the power reserves of a Mama.
Eventually, Laura was in the birth pool and cranking away in solid active labor. She was on her knees, with her arms and head resting in her husband's lap. It was very peaceful with the flicker of candles and some gentle music playing. Suddenly, with a strong contraction, she opened her eyes and locked them with mine. The look was one of strength and vulnerability, beauty and necessity. She needed me to join her on the ride, together we climbed the hill, made it across the peak and came down the other side. In between contractions, she would close her eyes and just breath. The next wave would start, we would again lock eyes and traverse the mountain together. Without words, I knew that she needed me to be there, that when she opened her eyes, I had to be there waiting to walk with her. We did this all through transition, on and on, I was truly with her, intimately on the journey. I knew, as she did, when it was time to push. Five hours after her water had broken, Laura brought her gorgeous, 6# 9oz., daughter to the world.
I will never forget this labor. I feel that I was completely "with woman" as we worked so closely together and I was honored to support this family.
Subscribe to:
Posts (Atom)