Wednesday, November 28, 2012

Taking Her Time

Sweet baby girl waited 42 weeks for her birthday, then couldn't wait to make in to the birth center for her birth!  Her Daddy called me after his wife had one hour of labor.  They live a bit away, so I told them to go ahead and come in.  He called me back an hour later, giddy with excitement, to tell me his daughter had just been born in the car.  I could feel his joy through the phone line and it was contagious.  Everyone was healthy and well.  The only bummer was for me....I had really wanted to be their midwife!

Saturday, November 24, 2012

Putting Yourself Out There

Putting yourself out there is very difficult.  I think it is important, but hard none the less.  As a birth who often struggles with the apparent lack of accountability in US maternity care, I feel that it is a duty to be open and transparent with my own stats.  In publicly posting my stats I knew full well that I was opening myself up to criticism.  My hope was the the criticism would be constructive, aid in my own introspection and help me to improve the care that I give.  For the most part this has been true.  I participate in a forum that is closed to the public and made up only of other birth workers, particularly but not solely, out of hospital workers.  I shared my stats blog post with the group.  I felt that I was prepared for some good discussion and mostly that is what I got.  Many of my numbers were questioned and "called out".  At first, it felt constructive and the discussion was valuable to me.  The very numbers that had troubled me, were the same ones that caused questions from the group.  Then, after a while it started to feel less and less productive and little more...hostile is not quite the right word but the closest that I can come up with.  This was most likely not the intent, and I am trying not to be overly sensitive about it all.  But it is not easy...I have a tendency toward being over sensitive and I know this about myself, so am constantly trying to balance my reactions.  I do not regret putting myself out there and am ultimately gratefull for the discussion.

One of the things that surprised me in the discussions was that most of the participants have never done their own stats.  I found this to be true with other people also, ones that I discussed my "project" with in person.  This surprises me.  How can we maintain standards and improve outcomes if we do not objectively look at our stats?  Before doing my numbers, I would have thought many outcomes were different.  Looking at them in black and white really puts things into perspective and has been invaluable to me.  As I said, this process is not necessarily comfortable and more than a little intimidating.

So, to further my process, I will delve into the "number" that caused the most concern in the forum group, postpartum hemorrhage (PPH);
Initially, I listed 33 PPH's, which worked out to be 16.5%.  That is a high rate!  I went back to really analyze the data.  After doing this, the number of PPH's that required intervention (medication) and/or caused symptoms (low BP, dizziness, etc) in the women was 12 which equals 6%.  Better, but still  high!  Where would this high rate come from?  The vast majority of our ladies are well nourished and healthy.  Our practice recommends nutritive herbs and 65-75grams of protien per day.  For the most part, births are physiologic with woman directed pushing, I practice immediate skin to skin care and baby led breastfeeding, third stage is physiologic and the cord is clamped after the birth of the placenta.  All of these factors should help to decrease the rate of PPH.  All throughout my training, I was taught that providers routinely underestimate the amount of blood loss.  Perhaps, I have over compensated for this and now over estimate.  Sometimes, especially when there appears to be a lot of blood loss, I will weigh the chux pads.  So for those cases I do know the actual amount.  I have two thoughts now; 1. if providers do routinely understimate blood loss, then it seems possible that the actual rate of PPH my be higher, and 2. is the current accepted definition of PPH (loss greater than or equal to 500cc) appropriate?  I have been very particular about noting any EBL over 500 as a PPH, the majority of my 33 were 600-800cc and caused no problems for the mother.  So, what is a midwife to do?  Well, it appears that this midwife will begin weighing ALL the chux after ALL the births and attempting to get a handle on the actual number of blood loss.  Stay tuned for results of my experiences in chux weighing..........

Finally, I would like to throw out a challenge; please keep records, please compile them on a regular basis, please use them to improve and strengthen your practice!!

Monday, November 12, 2012

Stats...200 Babies!

I can hardly believe that I have been blessed to catch 200 babies.  As I sit here writing this, I am overcome with gratitude.  Gratitude for all the families that have shared their births with me, gratitude for all of my teachers along the way, gratitude for my own amazing family and gratitude for the birth center itself.  Back in April of 2011, I reached the milestone of 100 babies and decided to calculate some personal stats.  It was very informative and I decided to go through the same process every 100 births.  The stats that I list are not for the birth center as a whole, but only the stats for the births I personally attended.  I have combined the results from 1-100 with the new 101-200 to give a total.  Here goes;

100 boys and 100 girls (what are the chances of that?!?), 5 of these were born en caul (2 girls and 3 boys)

There were 33 cases of PPH (16.5%), the vast majority being less than 1,000cc

There were 10 Shoulder Dystocia's (5%), however 3 were very mild and easily relieved by 1 position change

I performed AROM in 34 labors (17%), primarily this was done for augmentation of labor.

I had 5 cases of retained placenta. (At our center, per state regulations, the cut off for retained placenta is 30min.)

I performed 1 manual removal of a placenta at the center secondary to hemorrhage, also for that birth I performed bi-manual compression while en route to hospital.  I had 1 cord evulsion, found 1 true knot in a cord and had 1 labial hematoma.  The hematoma was not severe and resolved on its own.

I have performed 7 episiotomies (3.5%). Two of which extended to fourth degree lacerations. All were done for significant fetal heart rate decelerations during crowning.

Intact perineums = 75, first degree lacs = 59 (about half requiring repair), second degree lacs = 56, third degree lacs = 7 and fourth degree lacs = 3

8 newborns were transferred to the hospital; 6 for TTN, 1 for congenital pneumonia and 1 with severe anomolies.

17 women were transferred PP; 5 for retained placenta's, 3 related to PPH's and 9 for repairs of extensive lacerations.

My water birth rate is 36.3% (for 21 of my catches, water birth was not an option per the site)
Birth positions: semi-reclining = 35, hands and knees = 58, birth stool = 36, McRobert's = 29, squatting = 21, side lying = 18, standing = 3

Additionally, something that I did not keep track of for the first 100 births, was my rate of intrapartum transfer.  I have since started keeping track of those numbers. Since April of 2011 through November 8 of this year, I have transferred 24 Mama's that were in labor, none of them were emergent.  (These 24 are not included in the above numbers.)  Of those ladies transferred, 11 required a cesarean section.

So, there it is in a little nutshell.  It really is an experience to go back and look through these numbers.  In reviewing my birth logs, I get to re-visit these births and families.  Overall, I feel good about my outcomes and am glad to share them. 

Sitting on My Hands

Right now, literally, I am precepting a wonderful new midwife.  She is guiding a lovely first time Mom through second stage.  I am down the hall, well within hearing distance (don't worry though, the Mom cannot hear my typing ;)), trying very hard not to be over her shoulder.  We have worked together for years, we both started here at the birth center as nurses.  She is more than capable, she is fantastic, she is doing a great job.  I am going crazy out here.  I have precepted many students by now, and find that role easier and easier.  With a student, I am still ultimately "in charge" and am always present in the birth room.  This is different and new for me.  She is a midwife, on her orientation and needs to be completely independent...she need to know that I am here, but that she can do this all on her own.    Wish me luck on my process of sitting on my hands.....

Saturday, October 13, 2012

And what is this?.....placenta?!?....

So, as I work at an out of hospital setting, it is logical to assume that I believe in natural, physiologic birth.  I believe strongly, that most of the time, if well supported a woman and her baby will safely navigate the birth process together.  However, sometimes this is not the case.  If you are a reader of this blog, you will have already read some of my stories that discuss less than optimal situations.  Fortunately, by the grace of the divine, my learned skill, years of training, the amazing nurses,  our healthy low risk population and a sprinkling of luck I have not had a "bad outcome".  I also know that, if one works in this realm long enough, it is more and more likely to happen.  My reasons for sharing this story are complex and I have thought long and hard about whether or not to do so.  In the end, I have decided to share it.  Not to tout the "crazy" things that may happen in an out of hospital setting. But to highlight that even in an out of hospital setting, when a trained and skilled provider is present, many unexpected high risk scenarios can be handled safely and well.

 At our center, we do not require that Mama's get any ultrasounds.  We believe that ultrasound is a tool, to be utilized thoughtfully.  I will say that a majority of our clients do get one ultrasound, the traditional 20 week anatomy scan, but it is optional.  If something comes up during the course of a clients care, for example: bleeding, her fundal height measuring too big or too small, we will request that she get an ultrasound.  Other clients may get an early ultrasound to establish a due date if we don't have accurate menstrual or ovulation information.  And if a Mama goes into her 41st week we will use the ultrasound to get an AFI (amniotic fluid index) level. ***I do realize that there is controversy around the use of AFI to assess fetal and placental status, but in our community it is the standard of care so we include it our assessment.*** Recently, I attended a birth that caused me to seriously question my stance on ultrasound...

Sue and her husband are open, intelligent people with a beautiful family.  She is very involved in the local birth community as a doula and educator. They are preparing to welcome a new child to their family.  She has been rumbly for a day or so and we decide to have her come in and check things out.  She arrives with her husband, children and a friend/doula.  She is in labor, but it is still a little early.  My student checks her cervix and finds it to be about 3cm.  We all decide that Sue and her family will go home and return when her labor has picked up.  My student goes home to sleep and I go lay down in our midwife sleep room.  About two hours later my phone rings and it is Sue's husband, I can hear Sue in the background and tell him that they should just head in.

When they arrive, it is clear that Sue is ready to begin pushing.  The family gets settled and I listen to the baby's heartbeat, a strong and steady 140bpm.  Many times when a multiparous woman starts to push, I will not check her cervix, however, this time I felt that I should.  Sue layed down on the bed and I checked her cervix, which was completely dilated and effaced, the baby head was at 0 station.  However, there was also something else presenting, a soft, spongy, "tissuey" something from about 12 o'clock to 3 o'clock.  It takes me a moment to realize what this is that I am feeling.....placenta!!!!  Everything that happened next seemed to take forever, but in reality happened extremely quickly.  I looked at Sue and calmly (hopefully) told her the situation and that she would need to pull out her inner Mama Bear and birth her babe quickly.  I called for help and then set up one of our birth stools.  I had calculated in my head the time it would take to get Sue to the hospital v. how long it would take her as a multip to just push out her babe and decided it would be quicker to just do it. (Had she been a primip I never would have attempted this!)

Sue got on the birth stool with her husband behind her, I will never forget the look on her face.  She was preparing to fight for her baby and would not accept anything other than winning.  It was powerful and exactly what we needed.  With the next contraction, she pushed the babe to +2, the waters broke and the baby had a low heart rate.  We all breathed, gathered our focus and prepared for the next contraction.  Thankfully, it came quickly and with one more mighty push the babe was born!  She was beautiful and still, had a good heart rate but needed some resuscitation.  I worked on her, Mama and Daddy talked to her and she came around to join us in the world.  The placenta was birthed very soon after that, with a chunk sheared off but still attached to the membranes, and otherwise normal.  I helped Sue, her husband and the new babe get into bed and settled.  Then my help arrived! Basically, as soon as I saw my nurses I left the room and collapsed in the hallway, my legs just buckled out under me and I started to cry.  I remember repeating over and over again that they were both well and thanking the creator.

During the course of her prenatal care, Sue had declined any ultrasounds.  Her pregnancy had progressed normally and was a healthy one.  She never had any signs, like vaginal bleeding, that would suggest she had a partial placental previa.  In the initial days after this birth, I felt strongly that as a center, we needed to change our policy on ultrasound and begin requiring them.  Then, through talking with other midwives, processing the birth and visiting with Sue and her family, I began to slowly shift back to my original thinking.  Birth work will continually keep you on your toes, will cause you to question your beliefs and require that you are always learning and adapting.  Each birth will give you new insights into the process...information to gain and information to discard.

Monday, September 24, 2012

Tidbits and Snippets

Just some tidbits and snippets from recent births.....

In case you were ever AquaDoula birth pool will in fact hold a 5'11" full term pregnant Mama and her 6'6" husband! It will look like a soup of belly and long legs but it will work.

It is possible for a woman, experiencing a shoulder dystopia in the pool, to levitate herself out of the water and onto the floor.

Being blessed to catch the little brother or sister for a soon to be big sibling who you also caught is pretty fantastic.

Giving birth to your baby on the same day as your wedding anniversary is sweet.

When your answering service calls you at 2am and tells you that Ryan Reynolds in on the phone for you, it is probably just a soon to be Daddy who has similar name and not actually Ryan Reynolds.

Most of the time, nuchal cords are not a problem, but when they are they are a BIG problem.

A Mama can have an extremely difficult second stage, work and work and work for hours, require an episiotomy and then look at you afterward and say "That wasn't as bad as I thought it was gonna be" with a huge smile on her face.

Birth...never dull around here!

Saturday, September 1, 2012

A Banner Crop

Wow, all I can say is wow!  This past week at the birth center, we had a record setting amount of births.  One day, we had 5 babes in seven hours, then just one day later we had 5 babes in six hours, another baby was born a few hours later and the next night 3 babes were born back to back! It was intense and sometimes a blur of activity.  However, it served to highlight the amazing group of people that make up the birth center and I am so proud to be part of it! It was all hands on deck and the hands worked beautifully together.  Members of our administrative team were scrubbing toilets and doing laundry, staff members came in on their day off, it was a fantastic display of teamwork.  Every Mama had a birth room and no-one was turned away.

Here is a snippet of these births.  I was pretty tired if I do say so myself.  We had just had the two big 5 baby days and I was hoping for a little lull in activity....but, we had two Mama's who were almost 42 weeks.  The first one was pregnant with her second babe, she was so tired and ready to have her little one.  We had used a cervical balloon earlier in the week, and it had done some good and started some labor but the it stalled out.  She had decided to try castor oil and it was working.  She arrived to the center with contractions and was 5cm.  The contractions were sporadic and could have been more intense.  We had a long discussion about options and she and her husband opted to do some herbs and then AROM (artificial rupture of membranes).  These interventions worked and her labor picked up.  Then things stalled again, her contractions were in a coupling pattern, Mama was becoming frustrated.  Additionally, the location of the babes heart beat was OP presentation was happening.  I did what I refer to as "labor acrobatics"......rebozo shaking, the hands and knees bump and duck walking, just twenty minutes later her babe turned and she gave birth very shortly after that.  We were all enjoying this new little one when I got another call.....
Mama #2, she was having her second baby, her water had just broken and she was cranking out labor.  Of course, I said "get on over here!".  She came in, labored beautifully in the water and not long after started to push.  Her babes beautiful head emerged....and then stopped, a shoulder dystocia was occurring.  I told her to get out of the pool, which she did in amazingly fast speed, we got her on her hands and knees and with a little help the babe was born.  Then we settled everyone in the bed, gave them lots of TLC after the stress of the birth and they were recovering nicely.  And phone rang.....
It was the other Mama who was almost 42 weeks.  She had been doing some herbs and was now in good labor and ready to head in.  She arrived with her husband and Mother, they made a great team.  It was her first baby and she labored so gracefully.  In a very short time, she was ready to push.  She was in the pool, and soon the babe was almost crowning.  Then, she started to have some bleeding, at the same time, Mama said she felt something happen.  The blood kept coming, the heart tones were strong and steady.  I had her get out of the pool, as the baby crowned the bleeding stopped and shortly she gave birth to her gorgeous little one.  We placed babe skin to skin, Dad curled up next to them and we waited for the placenta.  She had some more bleeding but no placenta, so we gave her a shot of pitocin. Then her placenta came....along with a huge 500cc blood clot! I think that at the very end she had a small placental abruption.  Thank goodness, baby didn't have any trouble and both were well.
So, that was just one snippet from this week.  Of the 14 births that happened, I was blessed to be present for 8 of them.  I am still processing them and looking forward to seeing the families in their postpartum visits.  And now I am ready for a HUGE nap!

Monday, July 16, 2012

9cm for 6 hours!?!?......

This birth recently happened, and I love how it points out some differences between the midwifery model and the medical model..... A client, Sara, called, she was having her first baby and had been in early labor for several hours. She was one week past her due date. Sara reported regular contractions every 3-4 minutes, good fetal movement and did not think her water had broken, but had had some bloody show. Excellent! I tell them to head on in. In the meantime, it got busy! I had to call in my back up midwife. She is fantastic, I love working with her and her presence in labor. She is also a brand new "baby midwife". When Sara arrived, she walked in the door and my first thought was "Oh darn, it is too early for her to be here!" She was calm, smiling and talkative and her contractions were now every 8-10 minutes and "mild". I took her back to the birth room, checked her vital signs, listened to baby and checked her cervix. She was 9cm/100%effaced/+1 station!!! I had another Mama who also very close to birthing, so I went to be with her while my midwife-partner stayed with Sara. Four hours later, the other Mama had birthed and Sara was still pregnant. Her contractions were still mild and spaced out. Her vital signs were good, the baby was doing great, so there seemed no reason to rush things. About an hour later, Sara got frustrated and asked for an exam. We discussed AROM (artificial rupture of membranes) and Sara and her husband asked for that as well. My midwife-partner checked her and found the exam un-changed from the previous one. However, this time she noted that the baby was in the OP (posterior)position, which can make birth more difficult. So, we did not AROM, instead we did lots of good positions and activities to help turn the baby to the anterior position. About an hour later, Sara's contractions changed dramatically. They became stronger and very regular, she began to have the urge to push. A while later, while standing next to the birth pool, Sara and her husband welcomed their beautiful son to the world. Would this birth have progressed so "naturally" in a hospital setting? Of course, it is impossible to say for sure, but it seems unlikely. Most likely, she would have had her waters ruptured, which may have "locked" the babe in that tough position, leading to a much harder birth. In the midwifery model, there was nothing wrong, so no reason to intervene until the Mother desired it. The interventions to turn the baby were appropriate and very successful. All in all it was a grand birth!

Tuesday, June 12, 2012

Tools of My Trade #13

The Washing Machine and the Dryer
This may seem to be a funny tool, however, it is crucial.  Working at a birth center means doing a lot of cleaning...scrubbing toilets, washing dishes, mopping the floor, doing laundry.  Our washer seems to always be running, with laundry from births and the clinic, it is a busy machine.  Sometimes, when people new on the path of midiwfery, approach me with stars in their eyes about working at a birth center, I tell them about the laundry.  It is not all about catching the babies, it is about all the background work that makes it possible.

Sunday, June 10, 2012

Tools of My Trade #12

Listening to the Babes
Fetoscopes, pinard horns and dopplers all are ways that we can listen into the world of the baby.  They can give us insights and clues...if we truly listen.  There is more to listening than counting the rate and noting the rhythm of the heartbeat.  The subtle changes that can occur in labor, the overall atmosphere of the womb, locating the placenta.  Truly listening requires skill and patience both gathered through experience and time. 

Saturday, June 9, 2012

Tools of My Trade #11

The Herb Garden
At our birth center, we have a gorgeous herb garden.  It is filled with many herbs that are beneficial for pregnancy, labor and birth, postpartum and breastfeeding.  We use many complimentary healing modalities with our clients and the use of herbs is one of them.  We recommend herbal teas, tinctures and salves for a variety of reasons.  What are some of your favorite herbs for a woman's childbearing year?...

Wednesday, June 6, 2012


Typically (if there is such a thing), I am able to spend time with each Mama in labor.  To sit with her, support her, just be present.  However, every once in a while, there will be a shift that is just soooo busy. In hindsight, I think that I get one of these about every three months....which is interesting because it seems as though the babies on these shifts also come in three's.

It had been a busy shift during the day.  Nothing to do with labor....a beautiful 2 day postpartum visit, a visit to the hospital to sit with a family who had been transferred the day before.  Multitudes of phone calls; a Mama with mastitis, a Mama who had fallen and hit her belly, a Mama at 34 weeks who thought her water might have broken, a Mama struggling with postpartum depression.  When the sun set, I was already tired and then the labors started!

Jill came in first, with her husband and her grandmother, to have her first baby.  After much work, they all welcomed a beautiful baby girl....who was so blessed to have her great-grandmother witness her entrance!  Then, Mary came in, laboring with her third baby and surrounded by family members and her husband.  The sex of the baby was a surprise.  Their other two children are boys....when this sweet one was born, Daddy peeked under the blanket, gave a sly smile and announced "It's a Girl!"  The hoopla that erupted in the room was contagious.  At first I thought, well they are really excited about having a girl now...then it came out that this little one was the eighth grandchild and the first girl!  That explained the level of the hoopla.  Finally, Sue came in to work on the birth of her second child, she was with her husband.  Not long after arriving, they welcomed thier chubby, yummy daughter to the world.  Three births in three hours....there is that number three again!

Wednesday, May 16, 2012

Tools of My Trade #10

The Birth Stool
We actually have several birth stools at our center, this one just happens to be my favorite.  It is pretty low to the ground, so really helps to approximate a squat position.  There are handles on the underside so a woman can really get into the work.  It is hand crafted and made of a beautiful warm wood.  Underneath it we place a small mattress pad, some towels and a round mirror.  Depending on the light in the room (some mama's prefer it dimly lit and others want it a bit brighter), we may use a little flashlight as well.  The stool can be placed almost the bathroom, in the hallway, most often we are in one of the birth rooms.

Monday, May 14, 2012

Tools of My Trade #9

The Coffee and Tea Station
Once upon a time, in a horrible turn of events, the fancy coffee maker was like defcon 5 at the center.  Thankfully, we had a french press to save the day!  What can I say, the coffee is midwives, nurses, staff and family members as well.  We all know that birth happens around the clock and sometimes we need a little extra help to stay in the groove.  Of course, we also drink a lot of water and eat healthy well balanced meals ;)

Tools of My Trade #8

Blood Work and Blood Pressure
The stories the body tell and share.  I absolutely believe in "high touch/low tech" care and am blessed to work in a setting that, for the most part, accomplishes that goal.  That being said, there are some crucial pieces of information and care that come from these tools.  With these tubes, needles, cotton balls, cuffs and stethoscope we can get valuable insight into a piece of the whole and have a more complete, holistic picture.

Tools of My Trade #7

Teaching Tools and Nursing Pillows
As a midwife, one of my passions is client education.  In the Midwifery Model of Care, women are considered equal partners in their care, capable of making truly informed decisions about their care and choices.  I truly value and cherish the time I get to spend with women and their families in discussions; educating and empowering them, and in turn learning from them as well.  However, some of the most ardent "students" are the big brothers and big sisters....many a visit has involved a Mama using the nursing pillow to breastfeed her new babe, while the big sibling eagerly watches how the new babe negotiated the twists and turns of the pelvis.

Sunday, May 6, 2012

Tools of My Trade #6

Oh, the Hose!
I definitely have a love hate relationship with this hose!  I absolutely love our birth pools, they are amazing for women in labor, and fantastic for birth.  I do not, however, enjoy the management of the hose.  Our pools are stand alone, with no internal plumbing.  This is good for the prevention of bacterial growth and the ability to clean them properly between each woman.  It is not good for those of us that have to drain and then re-fill the pools.  This particular hose is the "dirty" hose and is used to drain the water out, so it is connected to a lovely sump pump.  Now, don't be fooled by the mild look of the hose and pump.  The sump pump can be temperamental and moody, the hose itself loves to get tangled in your feet and legs, all in all it is a tricky business....especially at 0200 in the morning!

Wednesday, May 2, 2012


There are moments; moments that envelope, define and articulate this work.....

Discovering the first "clip-clop, clip-clop" of a tiny heartbeat.
Words shared to build a relationship.
The glorious, squishy rolling of a babe in the womb.
The reach of a hand, looking for comfort.
Ripples made from the breathing of a woman in the water of the birth pool.
Tears of hard work and joy glistening in the eye lashes.
The soft, fresh curve of a baby's ear.
The look of awe in the faces of new parents as they embrace thier baby.
Wide, surprised eyes as a woman feels the first latch of her baby.
Laughter shared over the happiness and discovery of the new "normal". 
Being witness to the growing confidence in new parents....

Listening to, and supporting a woman through postpartum depression.
Being present and available through the struggles of loss.
Discussions about difficult findings.

All of these moments and many, many more are the vocabulary of midwifery.....

Tuesday, May 1, 2012

Tools of My Trade #5

A Baby Scale
Here we have a few things...all important to my trade.  A baby scale, a baby hat, our pretty personal birth certificate, a baby stethoscope and thermometer.  You can also see our "NST machine" the electronic fetal monitor...that we never use in labor, only during pregnancy and infrequently at that.  Some nice lotion for our hands, since we wash, wash, wash them all the time.  The last baby that I caught, weighed in at 8#13oz of deliciousness!

Thursday, April 26, 2012

Tools of My Trade #4

The Birth Room
Since I work in a birth center, we have "set up" rooms, there are three in total.  This room is called the Tent room and was inspired by the book The Red Tent.  One of the biggest tools in each room is the pool, I love our birth pools.  (they are AquaDoulas)  We keep them filled and ready, so that whenever a Mama comes in, it will be ready for her.  Each room also has a bed...very few births actually happen in the bed, but they are where the new families get to know each other afterwards.  Sometimes, when the center is empty, late at night, I can go into a room and feel the echoes of the births that have past.  It fills me with a warm glow, I like knowing this and connecting with this current.  These walls are rich with history.

Tuesday, April 24, 2012

Tools of my Trade #3

Speculums, Clamps, Tenaculums, Scissors
These instruments are hard and cold, shiny and clanky.  These instruments are also tools of my trade.  As a clinician, I appreciate them...use them for pap smears, rupture of membrane evaluations, placement of IUD's...all valuable and necessary tasks.  As a woman, I strongly dislike them, they are harsh, invasive and downright uncomfortable.  So, I am left as a female clinician, attempting to make them as palatable as possible.  I use them with respect and always, always, always with permission.

Sunday, April 22, 2012

Tools of My Trade, #2

Baby Blankets
These baby blankets have helped to welcome countless a new babe to the world.
They are warm, fluffy and soft.  Many of them have been brought in, from home, by our own
nurses, midwives and other staff.  They have been well loved and cared for.  Others have
been purchased especially for the center.  These blankets are kept, folded, between two
heating pads.  As the birth time approaches, we turn on the pads, and thus have warm,
soft and fluffy blankets for the babes.  All of our babes are kept skin to skin with thier
mothers, so these baby blankets are placed over the babe and mother together.
Enveloping them in warmth and freshness.

Thursday, April 12, 2012

Tools of My Trade, #1

Way "back in the day" before I started my journey
to midwifery, I was known to play and work with photography. Somehow, along the
way, I misplaced the photography bug. I had been concerned that it was gone
forever. However, much to my happy surprise, it has begun to re-surface. I am
going to be trying out an inspiration through the pages of this blog. The
inspiration is this....a photo essay, of sorts, to highlight some of the Tools
of My Trade. I decided to start the essay of with one of the tools that I always
have with me, ready and willing to serve my Mama's and their families, My
These hands caress, stroke and sometimes cajole
These hands inspect, delve and palpate
These hands are sometimes soft and other times are hard
These hands support and elevate
These hands act as babies on their way out, to women as they become mothers
These hands repair and cultivate
With these hands, I honor and act with grace, for all the women....

Thursday, February 23, 2012

Midwife Pride

Here I sit at my kitchen table, sipping a mocha and watching the snow fall outside. Lately, I have been heavy thinking on the topic of pride. It is a subject that I often ponder from time to time. Clearly, too much pride can be a bad thing. However, pride can also be an important trait. I was recently involved in a Facebook discussion about the definition of a midwife. The author had proposed that a midwife is a good friend who assists a woman in finding her own path through birth (I am seriously paraphrasing). The focus of the quote was the "friend" part. This lead to some interesting points and people arguing for and against the simple "friend theory". One poster pointed out that midwives are much more than friends and hold a lot of responsibility. Another poster argued that all the responsibility lies with the Mama and that the concept of the midwife holding responsibility over her was insulting. These discussions have re-kindled a strong passion that I have regarding midwifery and I will try to explain it here. I apologize for the large soap box that I am about to climb onto.....

First, I am extremely proud to be a Midwife. I have dedicated years of my life to the study of midwifery and continually strive to continue my learning. To me, it is both a profession and a calling, in the true sense of both words. A profession because it involves, study, skill acquisition, continued education and recognized standards. A calling because it requires dedication, an appreciation of the beauty of the process and a genuine love of MotherBaby. Historically and traditionally, as midwives we have seriously down played our role and knowledge base, in favor of giving all of the credit to MotherBaby. In my opinion, this has been a mistake, and has allowed for the devaluing and oppression of our work. Now, I must make something absolutely clear, I strongly believe that MotherBaby deserves vast amounts of glory for their work. One of my crucial roles as a midwife is to support them through the process and allow the Mother to be born along with the baby, through empowerment and strength. Keeping this in mind, we as midwives also deserve a lot of credit for facilitating this process. We are highly trained and have a vast knowledge base, acquired through both "book" learning and experience.

While I may be a type of friend to my clients, I am also much, much more. I do hold some responsibility for their well being, I have been hired to guard their health and safety, to watch over and monitor their progress and intervene when needed. Is this responsibility shared? Absolutely! Do I hold power over MotherBaby like some kind of overlord? Absolutely not! Do I sometimes have to tell women things that they do not want to hear and make recommendations that they will not like? Yes. Think of a Mama, in the thick of a protracted labor with a babe in a "bad" position. Do I have to ask her to do things; like sumo-walk the stairs, spend time on her hands and knees and other various things that she may not like in the moment? Yes. Or a Mama who has developed a complication during the course of her pregnancy that makes it safer for her baby to be born at a hospital....will I tell the truth and recommend this transfer? Yes. Or a Mama who is bleeding heavily after the birth...will I act quickly and decisively to stop that bleeding? Yes. These decisions and interventions involve a level of responsibility. A responsibility that I as a trained midwife, who has been chosen by a family, take very seriously.

I strongly believe that we as women and midwives must claim this power and take credit for our skill. We must work and fight for the recognition we have earned. We must educate the public on our skills and be proud of our profession and not be afraid to also take some of the credit. Just as we share responsibility with our clients, we can also share credit. Let's step out of the shadows and into the light of our awesome work! Let's claim our power, just as we encourage MotherBaby to do, and be proud of the skills and knowledge that we bring to this calling!

Wednesday, February 8, 2012

The Serenade

Well, if have been reading this blog, you know that I feel blessed by my "job". My co-workers are fantastic and our clients and their families are wonderful. I recently had an experience that reminded me how awesome our collaborating providers are. We work very closely with a particular pediatric group, they see clients out of one of our auxiliary spaces and many of families choose them as providers.

I was at the hospital visiting with a family that had had to transfer during their labor. I walked into the room to find a happy, healthy Mom with a beautiful dark haired baby girl nursing away. The proud Daddy at their side. We were chatting, discussing the transfer and marveling at how great the baby was breastfeeding. After a short time, another visitor of the pediatricians from the above mentioned group. In addition to being a great physician, he is also an avid guitar player. We had recently had a huge snow storm and it was freezing outside, so he could not leave his guitar in the car and brought it in with him. Of course, one thing lead to another and before he did the baby exam, we were gifted with a song! How many people can say that their pediatrician serenaded the baby before examining them? Truly, we are blessed to be surrounded by such wonderful people.

Saturday, January 21, 2012

So, you want to be a midwife?....

This profession is definitely an adventure, and is never dull. It requires strength, both physically and mentally. At the birth center where I work, we take 24 hour call shifts 1-2 times a week. These are our "labor" shifts and I generally look forward to them. The following is an example of a recent call shift that I had. A day in the life of a birth center midwife....

I woke up at 6:00am, got my three children up and ready for school. I also get report from the midwife who had been on call before me, and one of our Mama's, Sue, had started labor last night and her water broke at 11:30pm. The fluid was clear, baby was moving great, and her GBS (group beta strep) test had been negative, so she was laboring at home with her husband and family. At 7:30, I get a call from a sweet first time Mama, Carrie, whose water just broke. She is not yet having any contractions, the fluid is clear and her baby is moving well. Since her GBS test had been positive, we plan to meet at the birth center, so I can give her some IV antibiotics. She arrives in high spirits and is excited that her baby will be coming soon. I start her IV and the antibiotics, take her vital signs and listen to her baby. Both she and babe are doing great. Since her water is broken and she is not in labor, I do not do a cervical exam. She decides to wait on starting any herbs to start labor as she feels confident that things will progress well. We make plans to meet again in four hours for her next dose of antibiotics.

I decide to stay at the birth center. One of the less glamorous sides of being a midwife is the paperwork. There always seems to be some sort of charting to is a never ending process. I get a call from Sue's husband, he just wants to check in. She labored through the night, then had a nice nap through the morning and is now starting to labor again. We talk about making sure that she gets enough fluids and eats well. They will check in again later. A little while later, Carrie returns for her next dose of antibiotics. She and baby are still doing great and she is now starting to have some cramps. Again, she declines any herbs for labor stimulation and heads back home to go to her prenatal yoga class.

I go over to the clinic to see if anyone needs anything....and, of course there is always something. The day before, one of our ladies had presented to her prenatal appointment, at 39 weeks, and had very high blood pressure. She felt great and denied having any symptoms of a problem, however, due to her pressures we drew blood work and ordered urine tests. Today her tests had come back abnormal and we had to diagnose her with mild preeclampsia. This condition, at her gestation in pregnancy, requires immediate induction of labor. Needless to say, this was difficult news for me to deliver and for her to receive, she and I, and her husband, spent a long time on the phone discussing the situation. I called the physician who would take care of her and gave him report, then called the labor deck at the hospital and faxed all of her records to them. By this time, Carrie had returned for her third dose of IV antibiotics. At this point, she decided that she would like to try some herbs to encourage labor along. She and her baby continued to look great, so I gave her the herbs and instructions and she returned home.

A little while after Carrie left, I get a call from Sue's husband and they sound ready to come in. Sue's labor had really intensified over the last few hours and she was eager to be evaluated. They arrive to the center, take time to settle in, and I check them out. Sue and the baby are doing good and she is 3-4cm dilated. They settle in for the work of labor. I call in our student midwife and we all get down to business. Sue's labor pattern and her problems with persistent back pain, lead us to think that her baby may be posterior, so we get to work to encourage the little one to turn around....

By now, it is time for Carrie's next dose of antibiotics and she arrives. She and her husband are excited and looking forward to meeting their little one. Carrie seems a little more reserved, is reporting "stronger cramps" and is having trouble standing still. I call in my nurse to come help so that both Mama's can have continuous support. Again, Carrie and baby are doing great. I do her first cervical exam and discover that she is 5/80/0! Since she is not really contracting yet, we all decide to try a little nipple stimulation...which works like magic and her labor takes off. Meanwhile, Sue has progressed to 5cm as well. They are both laboring well. Between myself, our student and the nurse, we support and monitor both families. Then......

I get a phone is a second time Mama, Doris, and she is ready to come in! Here we go! I call my "second call" midwife to give her a heads up to be on stand by and we all get ready. Doris arrives and is rocking out labor, she and baby are doing great and they settle in. Since she is a second time mom, I stay with her while the student and the nurse continue working with Carrie and Sue. About an hour after arriving, Doris and her husband welcome their amazing new son to the world! It was a gorgeous water birth at 0035.

Meanwhile, Carrie has really kicked in to high gear and now its her turn to rock out labor. The nurse comes to be with Doris and I go to be with Carrie and her husband. I check Carrie's cervix and she is 8/90/0...and it has only been about an hour since her first exam! About 15 minutes later, Carrie starts to grunt and push spontaneously. She is sitting on the bed and I ask her where she wants to have her baby....she climbs into the pool, along with her husband, and 11 minutes later at, 0121, welcomes her gorgeous baby girl to the world. After they are all snuggled into bed and stable, I go to check on Sue.

She is working really hard. She has spent hours walking the stairs, sitting backwards on the toilet, rocking on her hands and knees and been squatting in the sling. She has been eating and drinking well to keep her strength up. Still her little one is posterior and still her cervix is 5cm. We have tried herbs to help her relax and she is now starting to become exhausted. We; myself, Doris, her husband and the student, have a long talk. Together, we decide that it would be best to go to the hospital at this point. It is a tough decision, but it is right one at this time. I call the midwives who work at the hospital and they are happy to take care of her. We pack up and all head over to the hospital. As we are driving over, my phone rings.......another first time Mama, Samantha, is in labor and almost ready to come in!!!!! I call my nurse and tell her, she starts getting a room ready. I have just enough time to get Sue settled and comfortable, when the phone rings again and Samantha now needs to head in. I literally run back to the birth center.....

Samantha and her family arrive and with one look, it is clear that she will be having her baby sooner rather than later. The student checks her cervix and she is complete! We all take a deep breath and settle in. A short time later, while on the birth stool, Samantha welcomes her sweet baby girl to the world!

It is now 5am and I am blissfully and completely worn out! I call the midwife who is on call next and she heads in to take over....thank goodness! So, you want to be a midwife?....

Monday, January 2, 2012

Happy New Year

Wow, we have officially entered 2012! I want to wish everyone a Happy and Prosperous New Year.

This spring will mark my Two Year anniversary as a midwife, and I am eternally thankful for the experience. It is surely one wild ride, but one I wouldn't trade. I look forward to catching my first baby of 2012 and continuing my journey on this awesome path.