Wednesday, October 16, 2013

Four Births in Four Days

Four births in four days! As usual, each birth brought lessons and unexpected surprises.  Together as a group they are a lovely picture of what out of hospital birth can be and do.

Birth #1
A first time Mama.  Another one of my midwife sisters had been with this family through their labor, I was called in to assist because the birth center became very busy. By the time I arrived, she had been working for quite some time, her first stage of labor had been long at just over 24 hours.  Her second stage was also long at just minutes short of three hours. She was so brave, tough and dedicated to her birth.  I never heard her complain or falter...even through a difficult second stage that involved what I call "Birth Gymnastics", meaning multiple position changes, in every possible position imaginable.  Finally, as her darling baby began to crown, the reason for the hard work became apparent; her daughter was direct occiput posterior!  Mama worked hard but did eventually birth her lovely 9lb daughter, direct OP, to her loving arms.  Since I had not be present for most of her process, I inquired later about her labor pattern and contractions, wondering if the baby had given any clues to her position.  Apparently, other than a long labor, there had been no other signs.

Birth #2
A second time Mama came in in the early morning.  She had previously been to the birth center a couple days before and was sent home after her labor took a break.  This morning she was very nervous about it being another "false alarm".  She was laboring, but it did seem to still be in the early phase, so I suggested that she and her husband go out for some breakfast.  A while later, they returned, her labor was a little stronger but still not active.  They decided to go for a walk.  Her labor moved along slowly but surely, picking up little bits of steam here and there.  And then, the switch flipped!  After hours and hours of watchful waiting the baby decided to make his move and he did not fuss around. She had a beautiful waterbirth 13 hours after her first contraction of the day.

Birth #3
Another second time Mama who had also spent time in the birth center a day earlier and went home after her labor took a break.  She returned to birth center, clearly ready to birth her baby this time.  She had the look about her, the labor look.  When a woman is not really part of our reality, she seems to float above us and is so focused on her work.  After her round of stopping and starting, this time her whole process was completed in under four hours.  She had been nervous prenatally as with her first babe she had a serious postpartum hemorrhage and a fourth degree laceration.  I am happy to report that neither repeated themselves and she birthed a beautiful son with the sunrise.

Birth #4
Another first time Mama.  Her husband had called me that morning stating that her contractions had just become the 3-1-1 pattern.  Usually, with a first baby there is still some work to do at this point, so we discussed some coping techniques and support measures.  I asked him to call me back in one hour to check in.  When he called back, I did not need to hear his full "report" because I could hear his wife in the background and I told him to just get in the car and head over to the center.  When they arrived all I needed was one look to know that we would very soon be welcoming their child to the world.  Just under five hours from her first contraction she had her darling son snuggled in her arms.

All of these births had lessons within them.  What do you think some of those were?.....

Monday, September 2, 2013

Improve Birth Rally

Just had to share this photo of my darling daughter!We attended our local Rally to Improve Birth today and this is the sign she made; all by herself with no input from me.  She is another reason why I fight the fight every day doing what I do!

Saturday, August 31, 2013

Why Fight?

Sitting down to write this at the end of this week, I am exhausted.  Physically and emotionally exhausted.  I did not catch one baby or attend one woman in labor.  Yet, this week has left me drained and close to the edge.  Whether you may want it to be or not, whether you are aware of it or not being a midwife in this country is a political act.  In some ways, you must always be on guard.  Tonight, I am in a space of negativity and frustration mixed with triumph and pride.  I am hoping that writing about these things will help to alleviate my negativity.

I do not want to, nor should I go into details.  In brief, my birth center was the target of a "complaint" by a local hospital.  As a result, we were investigated.  Eventually, we were cleared of any wrong doing.  I was put on the hot seat for multiple hours on two different days, defending and explaining what we do at the center.  I feel triumphant that we eventually prevailed and proud of all my co-workers who supported me through the process.  I am also proud of myself and how I handled the pressure.  I am frustrated and angry that this process even had to happen.  It serves as a reminder that our struggle is far from over.  Midwifery is still under threat in our country.  ALL midwifery, not just homebirth midwives, but all midwives.  Why must we fight?  Why did I sit and endure this process?  Because the women and babies need us, we must fight for them.  We must never get complacent and become too comfortable. We must always fight the fight and stand up for women. Going to the birth center everyday is part of my resistance.  The hours that I put in, both at the sides of women and behind a desk, are my contribution.  I will continue to do my work and be on the front lines of this struggle. 

How do you fight this fight?....

Saturday, August 3, 2013

The Hug

First of all, sorry for the long pause on new posts.  Summer has a way of keeping us busy while the time flies by.  Hopefully, I will be back on the wagon moving forward.

This story is simple, a simple unencumbered birth with a lovely couple an their supportive family.  Sometimes the most simple births can be among the most profound.  Rachel and Jon are a sweet, young couple expecting their first child.  They had done a lot of research and had found the birth center.  We are not at all close to where they live and they had to drive multiple hours to get to us.  It was a huge commitment for them to choose us.  They are not the first family who has made this choice and they probably will not be the last.  These families elicit two responses in my heart; first honor, that they choose to come to us and second, some sadness that they have to travel so far to get the care they deserve.  I had been able to have several prenatal visits with them.  They were polite, open and honest.  However, after each visit, I left the room wondering if I had managed to make a connection with them.  This is a tricky topic.  If I am being honest, I have to admit that it is not possible to make a strong connection with each and every family.  Sometimes the chemistry is just not there.  This is one reason why working in a group is nice, if I don't have the chemistry with a family one of my midwife-sisters probably will.  But I am human and I want to make those connections.  Most times I feel that I am successful in delving deeper, going that extra inch and making it.  With Rachel and Jon, I felt unsure and always questioned myself afterwards.

I was on call and the phone rang.  I was happy to hear the ring as it had been almost one month since attending a birth!  The birth center had been having babies, I had just been missing them.  I answered the phone and heard Jon's voice, he and Rachel were at a friends house who lived much closer to us and he thought it might be time to come in.  I agreed and they headed our way.  I was happy, I really enjoyed them.  And I was nervous, did they like me? I thought that they might prefer a different midwife.  I also felt silly, like a middle schooler, for even thinking that way.  They arrived and Rachel was indeed in good, strong labor and we settled in to the work.  Jon was loving and Rachel's mother and sisters were present and wonderful.  It was an atmosphere of love.  The birth was beautiful and simple.  A sweet little boy joined this incredibly loving family.  The recovery was uneventful and they prepared to leave.  That is when the magic happened.  As they were walking out to their car, I went to send them off.  Rachel turned to me and gave me the biggest hug.  Not a little, polite, quick formality.  But a deep, long, heartfelt squeeze and I knew that the connection had been there all along.  It was a hug that stayed with me and left a warm, fuzzy in my heart for the rest of the day.

Saturday, June 15, 2013

Reality Check

I have studied the history of midwifery and the history of birth, both in this country and around the world.  I have read many books and talked to many people.  I have been involved in birth since 2005 and began learning about it years before that.

Recently, I was attending a completely wonderful birth.  Actually, the night before, I dreamed that I was the midwife for this family.  So when they called me that morning I was not surprised.  They were welcoming their first child and were surrounded by family; sisters, mothers and even a sweet baby boy who was soon to be a cousin.  It was simply a beautiful, sweet experience.  The soon to be Mama and Daddy were doing wonderfully.  A little while into pushing, she reached inside herself to feel her baby's head for the first time.  I made a comment about the first physical touch and how lovely it is.  One of the soon to be Grandmothers then said, "We never got to do that with our babies since we were strapped down."

It hit me like a ton of bricks.  I know the history, I know that it was routine to strap women down during labor.  But this personal moment and revelation was so powerful.  This is why I do what I do, this is why we strive and struggle for the rights of women and their families to birth humanely.  We must always remember the past, so we can prevent it from happening again.

Sunday, May 19, 2013


A little over a month ago I was approached by a great new organization, Future Midwives of America. It is great resource that is dedicated to helping students on the path of midwifery.  I am grateful that it is also a place that discusses both CNM and CPM as valid paths without trashing one or the other. They asked if I would be willing to be interviewed for the website.  I was floored...someone wanted to interview me?!? I said "sure" and then quickly became pretty nervous about the whole thing. Luckily, by the time the interview was scheduled I had been able to calm my shaky nerves. All in all, I think it went well, please check it out if you get a chance.  And then take some time to check out the rest of the website.

Tools Of My Trade #14

My Home Bookshelf
Book learning is indeed important, and is often how a woman begins on the path.  For me, it was Spiritual Midwifery that started the spark.  I have always been a devout book lover, so collecting them was nothing new.  I am always on the look out for a new addition to my collection.  As much as books have to offer, they are only part of the equation.  Through book learning we build the foundation but the most crucial skills and knowledge cannot be found within their pages.  By far the most important teachers are the women themselves; both the mothers and our teachers.  It is with them that we discover the authentic voice that is midwifery.  This does not diminish the importance of our beloved books as every practitioner requires a solid foundation upon which to build.

What books have been most instrumental for you on your journey?

Saturday, May 4, 2013

Not One

     Claire had been woken up, the morning she turned 37 weeks, by the sensation of her water breaking.  The fluid was clear and the baby was moving well.  At the beginning of her pregnancy she had tested positive for GBS (group beta strep) in her urine, so she and her husband came in for an evaluation and a dose of IV antibiotics.  When they arrived, Claire was not yet having contractions.  Everything checked out good; her waters had definitely ruptured, the fluid was clear, baby and Mama were both doing great.  I started an IV and gave her a dose of penicillin.  Since she was not yet in labor I did not do a vaginal exam.  Claire and her husband then went back home to have some breakfast.  Four hours later, they returned to the birth center.  Again, everything checked out good and I gave Claire her next dose of antibiotics.  Because she was GBS positive, we talked about encouraging her labor to start.  Claire and her husband both agreed that they would like to get proactive.  I sent them home again, this time with some herbs.  I did not do a vaginal exam.

     Another four hours passed, Claire and her husband returned, and they were joined by their 5 year old son and Claire's mother.  It was obvious that things had shifted and Claire was starting to labor.  She was in that sweet foggy stage of early labor, when women seem to be floating above the world, mildly aware of what is going on around them.  I gave her the next dose of medicine and we all settled in.  In a short time Claire shifted again, moving into the active phase of labor.  It was lovely to watch.  She was supported wonderfully by her family and she easily let go to the process.  She moved well, walking around with the contractions and swaying with her husband.  Eventually, she asked to get in the birth pool.  Very shortly after sinking down into the water she began grunting at the top of her contractions and then proceeded to birth her sweet 7lb 2oz. baby boy into the world.

    And all of this without one single vaginal exam!  Of course, I think that is awesome.  A couple hours after the birth, Claire and I were talking about it.  She asked why I never did one and I told her that besides the fact that her waters were ruptured, I didn't need to do one.  It was clear that her labor was progressing and I did not want to disrupt the flow of that progress.  Claire said that during her labor, she briefly wondered why I wasn't checking her cervix but then reasoned that I knew what I was doing and let the thought pass.  It is important to remember that there are so many ways, other than a vaginal exam, to assess labor progression.  Sharp eyes, clear ears and an open heart are just as valuable.  What are some of those other signs to watch for as a woman labors?

Sunday, April 28, 2013

The Ina May Weekend

My work at the birth center is an integral part of my life.  In many ways, it does not seem right to call it work.  Midwifery is so much more than a profession; some refer to it as a calling.  It becomes a core part of your lifestyle and a defining part of your character.  I am proud to be a midwife and cannot imagine doing anything else.  Like many midwives of my generation, I was partially inspired by the work and writing of Ina May Gaskin.  She has been referred to as the Mother of Modern Midwifery and is the author of several groundbreaking books, including Spiritual Midwifery.  When I was pregnant with my first child, I found Spiritual Midwifery and it is part of why I chose the path of midwifery.
Recently, I was blessed to have the opportunity to meet and spend time with Ina May.  (I briefly mentioned this in my previous post titled, Powerful Weekend.)  A midwife friend, Samantha McCormick, who owns Baby Love Birth Center in Florida was hosting a screening of the new documentary Birth Story and Ina May came down to present it.  I was invited by my friend to join the fun and thanks to my generous boss, was able to make the trip.  And boy o boy was it worth it!  The documentary is amazing; funny, insightful, inspiring and truthful.  Luckily, there are  screenings all over the country, you can learn more at  .  I highly recommend seeing it if at all possible.  You will laugh, you will cry and you will hopefully be inspired!

It is an intimidating thing to meet an icon, and I was more than a little nervous.   Sharing dinner with Ina May and several other wonderful midwives is an experience that I will never forget.  I found her to be warm and welcoming, with a wicked sense of humor.  I was somewhat nervous about coming off as a groupie, but was quickly reassured by Ina May's open, down to earth demeanor.  In hindsight, I am grateful and happily surprised that I was able to sit with this group of midwives and feel like an equal among peers.   This “work” is fulfilling and beautiful but it is also exhausting and demanding.  To have the opportunity to be in a circle of other midwives from around the country, including Ina May Gaskin, was a powerful way to re-charge my batteries. 


Monday, April 22, 2013

Powerful Weekend

This weekend, I was honored and blessed to have the opportunity to meet and spend time with several amazing midwives at an event in Florida.  One of whom was Ina May Gaskin.  It was truly a gift and I will be sharing part of my experience in an upcoming post, but I wanted to briefly discuss the content of these photographs.  As part of her presentation, Ina May brought parts of her Safe Motherhood Quilt. To stand up with her, and other midwives, to hold and bear witness to this powerful project was intense, moving and inspiring. As a midwife, I feel that guarding the health and safety of Mothers is an integral part of my duties. It is a responsibility that I take very seriously and physically holding this quilt resonated in my bones. Please take some time to learn about this project and visit the website

Saturday, April 13, 2013


Sometimes the universe likes to be funny while keeping us on our toes.

I was on call, there was no one in labor, but I was at the clinic enjoying lunch with my co-workers.  We were all  chatting about our weeks and just enjoying the company.  One of our midwives mentioned a movie she had just seen, "Flight" (which I have not seen) about an airline pilot who has to respond quickly to an emergency, preform some "superhuman" maneuvers and remain calm to manage the situation.  And that she thought it had some correlations to midwifery.  That sometimes, things are progressing calmly and normally when an emergency can arise and we must respond quickly and assertively, utilizing our skills and training to mange the situation.

Several hours later, a family had come in to the center, excited to be welcoming their first baby.  Mama was very tired as she had been in latent labor for a very long time, Dad was hanging in there and they had a fantastic doula with them.  We settled in for the work.  Amazingly, after all the hours and hours of early labor, once at the birth center her labor progressed remarkably fast.  She was a trooper and had a pretty intense ride for about an hour and half as she moved through transition.  Then her sweet little babe had some difficulty, letting us know through her heart rate.  She had several dips, with good recovery, but still she kept having the dips.  We changed Mama's position several times and gave her some oxygen.  I stilled the room, made direct eye contact with Mama and told her that she needed to pull out her Mama Bear and bring her baby to us.  Never underestimate the power of the "Mama Bear Instinct".  This Mama was so focused, so powerful and did amazing.  Her husband and her doula were fantastic.  We were all focused on this little baby and bringing her through safely.  Despite her courageous efforts, the babe was still not coming quite as fast as I liked and I called EMS for a transport.  This gave Mama an extra surge of energy and as the EMS crew arrived, the baby was birthed.  Baby girl was completely tangled up in her cord, it was looped all around her several times almost like a harness. After untangling her, she needed a little help to get started but then did wonderfully.  Thirty minutes later and all were tucked up in bed getting acquainted.

An hour or so after the birth, I was sitting at the desk working on all the paperwork.  The Dad came over to me, gifting me with extremely heartfelt words of gratitude.  We had a little discussion about how the birth had gone and then he says to me, "Have you seen that movie Flight?" Seriously, he said that to me!  I was so surprised, I thnk that I just sat there for a few seconds with my jaw hanging open.  He then proceeded to relay the same basic observations that my midwife colleague had made about the movie earlier that afternoon.  I guess I have a movie to go and rent....

Sunday, March 24, 2013


It was another three baby day...there is a joke at the birth center about my shifts and how they are always busy....

She was working on her first baby.  As such, she had been working for a while and was getting tired.  She asked to leave the birth center and go to the hospital.  Many Mama's ask this at some point in the process.  We support them through it, sometimes by distracting them as we did with this lovely Mama.  I checked her and she was 8cm, yay!  In the throws of transition, she still wanted to leave.  We loved her, distracted her some more and bought an hour...then she was ready at C/0.  She was so ecstatic to be at this place, that she (as a first time Mama) pushed her little one out in 16 minutes!  Each push was so powerful, she had decided she was done and wanted to have the little one in her arms.  She was at the point of crowning, I was talking to her about slowing down and simply breathing through the rest, when with the next contraction her beautiful baby girl just POPPED out into my hands!  She literally was crowning one second and the very next second a whole baby was in my hands and she was accompanied by a shower of birth fluids that anointed us all.  My nurse and I were so stunned, and we decided that it was just like the cork and fizz from a champagne bottle.  Baby girl was welcomed with the sounds of laughter and joy.

Saturday, March 2, 2013

Those Smiling Eyes

She had been at the birth center all day.  I had been very busy.  While she labored, strongly and with the support of her husband and doula, two other babies had been born.  I had been able to spend time with her.  To sit and be in her space, to feel the rhythm of her birth song.  I would have liked to spend more time with her.  Thankfully she had a wonderful doula, a doula that I know and have worked with before, so I knew she was in good hands when I could not be with her.  Eventually, I was able to concentrate souly on her. 

It was now early evening, the birth center was quiet, the subtle energy of the previous two births was light in the air. Her body and baby were making the shift, moving from opening to pushing.  She was working, walking in the hallways with her husband.  I was also walking, from her space to other spaces and back again, it seemed that there needed to be a flow.  Being still in one place was not correct for this labor. On one of my passes, I noticed that she was ever so slightly grunting at the top of her rush.  I smiled at her husband, the time was coming.  Just a few minutes later, she was in the bathroom, on the toilet.  I went to be with her and low and behold, she had brought her sweet little one to a small crown!  On her face was the most glorious smile and the happiness was shining through her eyes to lite up the small room.  She continued to smile through each push and calmly welcomed her daughter earthside. 

It was a birth surrounded by smiles, laughter and love.  It was a birth that every Mama and Baby deserve, one that characterizes why we do what we do.  All the struggles that make the birth center possible are worth every effort in these moments.

Friday, February 1, 2013

YAY! Birth Centers!

Outcomes of Care in Birth Centers: Demonstration of a Durable Model Stapleton 2013 Journal of Midwifery & Women’s Health Wiley Online Library

This is the new "Birth Center Study".  It clearly proves (yet again) that the midwifery lead birth center model of care is fantastic!  This model of care increases good outcomes and decreases costs all in one smooth package!  Additionally, "my" birth center was one of the participating centers in the study.

Sunday, January 20, 2013

The Great Chux Weighing Experiment

For the complete background on this issue, please refer back to two recent posts: "Stats....200 Babies" and " Putting Yourself Out There".  Briefly, back in November, I was lucky to catch my 200th little babe.  Afterward, I put together some statistics from those births.  Some were expected and some were not.   One thing that surprised me was the rate of PPH.  (Again, for the full story please read the posts mentioned above.)  Since that time, I have been weighing every chux after every birth, and I just baby #210.  So, I thought that I would post an update:

Birth #201: EBL 200cc (my guess was 150)

Birth #202: EBL 100cc (my guess was 100)

Birth #203: EBL 500cc (my guess was 400), this Mama had no negative symptoms so I did not call it a PPH because it was not more than 500...

Birth #204: EBL 200cc (my guess was 250)

Birth #205: EBL 150cc (my guess was 150)

Birth #206: EBL 150cc (my guess was 200)

Birth #207: EBL 900cc (my guess was 850), this was a second time Mama who had a precipitous birth, she did have some symptoms and received two different anti-hemorrhagic medications.  She stabilized and finished her recovery at the birth center before going home.

Birth #208: EBL 2500cc (this is not a typo!), this primip Mama lost 1900cc at the birth center and was transfered to the hospital where she lost an additional 600cc.  She had a long-ish labor of over 15 hours, and a long-ish second stage of 3 hours and 15 minutes, third stage was 20 min.  She had SROM'd 18 hours prior to the birth, had been afebrile and the fluid was clear.  Baby was term and weighed 7# 15.5oz.  Initially, with the placenta she lost 700cc, received a dose of IM pitocin and stabilized.  Then at 1 hour and 45 minutes PP, over the course of 15 minutes she lost another 1200cc.  During that time, she received an IM dose of methergine, cytotc rectally, an IV was started and a foley catheter was placed.  She was very symptomatic and an ambulance was called for transport.  Upon arrival to the L&D unit, she had stabilized.  She was taken to the OR and a 600cc clot was removed from her uterus.  Then she completely turned the corner and had a good recovery...after receiving 2 units of blood.  An obvious cause for her PPH was not identified, there was no hidden laceration, the placenta and membranes were intact.  She is a healthy 25 year old who had had a completely benign prenatal course.

Birth #209: EBL 100cc (my guess was 150)

Birth #210: EBL 950cc (my guess was 900), this primip Mama had a precipitous labor with a hard second stage.  Her little one had double compound hands and she really had to work him out.  Baby was term and weighed 8# 10oz.  She had PROM'd about an hour before her labor started, she had been afebrile and the fluid was clear.  She received an IM dose of pitocin, then had some more bleeding and an IV was started with pitocin in the bag and she was straight cathed (she was unable to urinate in a bed pan or to walk to the BR).  She then stabilized and finished her recovery at the birth center before going home.  She is a healthy 25 year old who had had a completely benign prenatal course.

So, yuck...three big PPH's out of those 10 births!  Now, hopefully I won't have another one for a long, long time.  I have noticed that these things usually happen in clusters, so I am hoping for that.  In general, our Mama's have good diets, we recommend 65-75gms of protein per day and have the ladies do dietary recalls for us.  We recommend nutritive pregnancy herbs and regular exercise.

What I did learn from this experiment is that my EBL "guessing skills" are just ok, with a range of 50-100cc's off.  I found it to be much easier to estimate the loss when it was lower.  Thoughts?.....

Wednesday, January 9, 2013


Ask and you shall receive....

Kim is preparing to welcome her second child.  The room is full of love. Represented by friends and family members, the seams are bursting with it. Smiles are everywhere to be found.  Kim and her family had been at the birth center earlier in the day.  She was in early labor and had gone home to rest.  Now they were all back and eagerly awaiting the baby's debut.  Kim was in the pool, gracefully laboring.  Her husband was at the side of the pool, a strong reassuring force and source of support and comfort for Kim.  He was a true Papa Bear.  Kim began to push and soon she was crowning, then the head was born, pink and healthy.  But then, babe was held up, he seemed "caught", but not by his shoulders.  I calmly and firmly told Kim that she needed to get out of the pool.  The very next thing I knew, Kim literally rose up out of the water and over the side to the floor.  It happened so quickly that I was left behind, still crouching over the edge.  Hurriedly, I went to her and discovered the problem.  Babe had two tight loops of cord around his neck.  He was still pink, but wanted to be born.  The loops were so tight that they could not be uncoiled and I really did not want to clamp and cut them.  So, I asked for quiet in the room, which I instantly got and told Kim to focus.  We took a breathe together and I told her to push out her babe. With her push I guided the baby's head in toward her thigh and his body came out.  He was still wrapped up, so before she got off her hands and knees, I unwound him.  Soon the room was filled with the squeals of new life and joyous welcome.

How had Kim levitated out of the pool?  Her husband had literally, in one scoop, given me exactly what I asked for...Kim out of the pool!