Thursday, October 29, 2015

A New Home

Hello All!
I am happy to share some big news with everyone. I am moving to new home and expanding my social media presence. Please check out my new website at as well as my new Facebook page at 'A Midwife on the Path' I look forward to seeing and hearing from everyone there!

Sunday, October 25, 2015

A Language Revolution

Language matters. Words, when spoken, have weight and a certain power. As birth workers we know this; the birthing person delivers the baby NOT the provider, midwives "catch" babies. The difference between "my care provider supported me through my VBAC" versus "my care provider allowed me to VBAC" is a very important one. As long as I have been involved in birth, I have felt very uneasy with the phrase "out of hospital birth". In my mind, it makes the hospital the norm and centralizes the focus on the hospital as the standard location for birth. This is wrong! If we plan to take back birth from the dominant physician based paradigm then we must move the focus from the hospital and put it back on the birthing family as the center of the process.

Recently, I attended the 2015 MANA Conference in Albuquerque, NM. One night, I attended a benefit dinner for FAM and I heard a phrase that struck a powerful cord within my heart and soul. This phrase has continued to grow in my subconscious and is taking root. I think that we need to start a language revolution and begin to use this phrase in place of "out of hospital birth". The history and philosophy of midwifery is based in the community; midwives view pregnancy and birth as a normal part of the life cycle. We see the Mother-Baby unit as a whole being in the context of their holistic framework. These things cannot be separated from the community; the entire family and the support circles that surround that family.

I work at a free standing birth center and as such my clients and midwives are often inadvertently left out of the conversation. Our current culture uses "home birth" and "hospital birth" and of course the above mentioned "out of hospital birth"...which often is only associated with homebirth. All of these terms fail to recognize birth center birth and maintain a marginalization of all the options. So, what is this phrase?....
Community Birthing
Community Birthing can encompass all the options that families may choose outside of the hospital. It does not utilize the hospital as the focus and therefor the norm. I plan to start using this term exclusively when referring to any birth that happens outside the hospital. No more "out of hospital" birth for me! What do you think? Care to join on this language revolution?....

Thursday, October 8, 2015

Why I Love Being a CNM.

Let me start off by saying that I am first and foremost a Midwife and I have learned that life often takes us to places we may never had anticipated. When I first decided to commit to this journey and become a midwife, I was absolutely going to become a CPM. I had zero interest in working in a hospital and never wanted to become a nurse.

Then I started to look for a preceptor and quickly became acquainted with this well known struggle! Eventually, I found an experienced homebirth midwife who would consider taking on an apprentice. However, I quickly realized that we had diametrically opposed philosophies, and that a relationship would not work. While I re-started the search for another apprenticeship opportunity, it also became clear that as a single mother to a young child keeping the schedule of an apprentice midwife would be nearly impossible. These factors caused me too look at other options. I started nursing pre-requisites at a local community college; reasoning that I would learn good information on A&P, microbiology, etc that could be useful as either a CPM or a CNM. I kept up the search for an apprenticeship and become involved in the local childbirth community. I still hoped, prayed and worked toward becoming a CPM. Then seemingly before I knew it, I was done with the pre-reqs and had to choose whether or not to apply to nursing school. I begrudgingly filled out the nursing school application. In my area of the country, in 2002, it was nearly impossible to get into a nursing program and it was common to spend a couple years on a wait list. I assumed that if I even got in, it would be on one of these wait lists.  To my complete shock and awe, I was accepted on the first try! After some serious contemplation, I decided to take this as a sign, made a HUGE leap of faith and went to nursing school.

Fast forward many years, trials, tribulations, a new marriage, joys and sorrows, a new baby, a few more years and I came out re-birthed as a Certified Nurse Midwife. In hindsight, which is of course always 20/20, everything worked out perfectly and as it needed to. I am thankful for everything that being a nurse taught me and I am proud to be able to call myself one. When I started this path, I had starry, rose colored glasses and was high on the idea of birth and babies. I had no idea how much I would also fall in love with full scope women's health care. I appreciate that, in many years, when the realities of being on call will become difficult I can choose to still serve women, just in a different capacity. Additionally, the security of being able to practice in any state or even internationally is comforting.  The past few weeks, and these cases, have exemplified why I love being a CNM and why I love working in a free standing birth center;
  • A sweet first time pregnant person at term calls to report that she thinks her water broke. A couple hours later I have her come in to the center and confirm that, indeed, the bag of waters has broken. We do an US to confirm that baby is cephalic (yes, I also did Leopolds and knew that babe was head down, but in these cases we also use the US) this way I did not do an internal, cervical exam. Because she is not in labor, we also do a Non-Stress Test or NST and the baby looks gorgeous. After a good discussion on all the risks and benefits and answering all their questions, she and her husband go home with some herbs to try and encourage labor to start. Several hours later, they call in a great labor pattern. When they arrive to the center, it is clear that she is in active labor and is entering transition, I do not do an internal cervical exam. We labor. A little while later, while in the birth pool she begins to spontaneously push and shortly thereafter gives birth to a beautiful baby. She never, during the entire course of her pregnancy, labor or birth had an internal cervical exam and I love that! 
  • Recently, one of my midwife sisters had a client in for a Well-Woman exam who wanted a photograph of her cervix. We were excited and made that happen, it didn't even phase us.
  • I have collected a pap smear while a toddler was latched and nursing and placed an IUD with the entire family present.
  • A few weeks ago, I had a couple come in for a Preconception Counseling visit. The client has a long and difficult history with some past drug use and mental health issues. She has felt judged and mistreated, "labeled", in traditional medical systems and practices. I was able to sit with her, spend a lot time and make her feel safe and comfortable. It was very likely her first ever positive experience with a health care provider. And she is now on track to plan a healthy and much wanted pregnancy.
  • A little while back, we had a client present for an annual well woman exam. Her physical exam lead us to do some blood tests to assess her thyroid function. These came back abnormal and we referred to a specialist. She was quickly diagnosed with thyroid cancer and had surgery to remove her thyroid, luckily the cancer had been caught early and there was no spreading of it to other organs or systems. She is now home and healthy with her sweet family.
  • There were two families at the center who had given birth and there were two families at the center in labor. The midwife on call received a phone call; a serious family emergency with one of her own children. I immediately sent her out to go to the hospital to be with her family. The other midwives in our group quickly stepped in and provided care to these families. This process was seamless and incredibly quick, the families did not even realize what had happened.
  • I have provided care to a woman who had never been sexually active, then met a wonderful man and counseled her on contraception and safe sex practices. Before their wedding I placed an IUD as they no longer needed to consider "safe sex" but contraception only. Then after they had been married and were ready to start a family, counseled them on preconception planning and removed her IUD. They then came to our center for their pregnancy and birth.
  • For the past year and a half, I have been providing care to a client with a significant history of abuse. She desires children some day. With time, care and the absence of any type of pressure we have worked up from our first meeting which had to take place out of the clinic to her being able to come into an exam room and have a partial physical exam. With the same care and patience, I have faith that we will be able to work up to a full exam.
All of these stories and many more make me grateful that my path took unexpected twists and turns, leading me to my current position. I truly appreciate every stage and aspect of being with all the ways that women need me.

Wednesday, September 16, 2015


I am a midwife and that is how I introduce myself. However, I am also a nurse and am a Certified Nurse Midwife. Here I am with two of my "doctor" stethoscopes, one for Mom and one for Baby. Not pictured here are my fetoscope and Pinard horn.

Sunday, September 13, 2015

A Poem for New Midwives

A dear colleague of mine is starting on the path of becoming a midwife. Last night, some midwife-sisters gathered to wish her well and share encouragement. I quickly jotted down some words; through my sleep and today, they have expanded and I share them here with her but also with all folks who are starting on this road.

Births will be glorious.
Births will be ferocious.

Babies will be welcomed through joy, laughter, gratitude and prayer.
Babies will be welcomed through weeping, sorrow, heartbreak and prayer.

Families will be wondrous.
Families will be tumultuous.

There will be unfathomable beauty. 
There will also be blood, urine, amniotic fluid, mucous, poop, sweat and tears.

Being 'with woman' is all engrossing; it requires tenacity, intellect, passion and grace.
Be mindful and feed your soul as well, do not become consumed.

Being 'with woman' is all rewarding; it will give you peace, community, strength and pride.
Be humble and remain rooted, do not become boastful.

Remember that you are not alone.
There is a history of ancestral knowledge behind you.
There is a circle of support around you in the now.
There is a place for you at the table in the future...and the view is glorious!

This post was recently republished on Birth Wisdom, a resource for maternal health advocates by Birth Institute. Want to become a midwife? Check out the Birth Institute Holistic Midwifery program

Sunday, August 9, 2015

Obstetric Violence (trigger warning)

We sat at her kitchen table drinking coffee. The sky was a clear blue with a gentle breeze. As often happens, when women hear that I am midwife, she wanted to share her birth stories with me. When this happens, I try to listen attentively and remain open to their sharing. Her children are 50 and 51, yes born very close together, 11 months apart to be exact. As she tells her stories, she becomes visibly upset and even agitated. For her, these things happened yesterday. In my experience, this is a crucial part of dealing with birth trauma; it always feels so current, the pain is often just below the surface. She is angry and confused, still not understanding the things that happened to her. She remembers very little, just snapshots really. She was "drugged" and felt out of her body, something "cold and hard" was placed inside her to "pull" out her children. She was treated "like an animal" there was no compassion. The next day, she had bruises and abrasions on her wrists. For years afterwards, she would wake in the night terrified and feeling as though she were dying.  She still deals with pain "down there" all these decades later. She asks me; "Do you know what happened to me?"
Do I tell her? Do I tell her about 'Twilight Sleep', women being strapped down to tables, episiotomies and forceps and the assembly line that was a labor and delivery unit? I ask her; "Do you want to hear my answers?" She responds that she does. So, I tell her, I tell her everything that likely happened to her. She is calm and quiet for a time, occasionally nodding to herself. Eventually she says, "Now at least I finally know that I am not crazy."  We two women looked at each other with silent tears on our cheeks and finished our coffee.

This is the truth behind the history of obstetrics in this country. This is the reality of what the knowledge is based upon. This is where "they are coming from" and we can never forget. Have we struggled, fought and toiled to make great strides to improve the care given to women during birth? Yes! Are we done? Hell No! This is why we must continue. Just because things are much better now does not mean that the work is done. I share this story so that we don't forget, so that the new advocates and activists remember the history, know the past and never forget where they came from.

Tuesday, May 12, 2015

#LifeOfAMidwife: Birth Happens

Birth Happens! Sometimes it happens so quickly that you barely have time to catch the sweet baby, let alone make it all the way inside the birth center! This handsome babe kept his parents in suspense, with a couple trips to the center with "false" alarms but then when he decided to make his move for real we didn't even get through the front door and only made it to the top of the stairwell. Both baby and Mama were fantastic and healthy, the baby was even born en caul. We quickly moved inside after the birth and they had a lovely postpartum recovery. This is a picture that I took later of the "aftermath" of the quick, beautiful birth. Then I had A LOT of scrubbing to do.

Saturday, May 2, 2015

What is The Worth of a Midwife?

This is a question that I often find myself contemplating. What is my worth as a midwife?  I wish to be able to give my knowledge and support to every person who would want it.  The reality is that that is not really possible. This is a fine line we walk as midwives. We wish to serve all but realistically we simply cannot. Here are some of my thoughts on the issue of why it is important to be “paid” in some way. I spend hours, days, weeks, months, years serving at the feet of my clients. I do so, willingly and with respect, but that does not make it easy. I do not expect to live a life of luxury, in fact, my life is pretty minimalist but I do expect and dare I say deserve to be able to provide the necessities for myself and my family.

·         Balance: work-life balance is a serious issue. In order for me to be the best midwife possible, both clinically and emotionally, I need a balance. Quality time off to spend with my own family, to practice self-care and to simply relax and have fun. I am no good to anyone if I run myself into the ground by working too much.

·         Energy exchange: providing quality midwifery care is energy intensive. Being open, available and supportive while at the same time monitoring the health of each client requires focus, time and strict attention to many details. This energy output deserves to be reciprocated in some way; this does not have to be monetary however, in our current society this is how the exchange of energy is most often handled.  Believe me, I see the value in a barter/trade system for goods and services but in the current culture I can’t make my car payment (and I need a car to be able to get to my clients) within that framework.

·         Time spent studying: I spent years of my life dedicated to learning my craft and I continue to spend a good amount of time staying current and continuing to learn. To go to midwifery school, I had to take out student loans and those need to be paid. Now, is there a big problem with our current educational system that saddles people like me with huge debt? Absolutely! Do I still have these payments to make? Yes.

·         Time away from my own family: to me, this one of the biggest ironies of midwifery. Midwives strive to support families in all that we do, we fight for people to be able to have the best choices and care available. We are focused on helping to foster strong, healthy families and yet we’re often doing so at the expense of time away from our own children and family. If I am going to be away from my own family and children, I need to be bringing something back with me, like; food for the table, helping to provide the roof over our heads, clothes for my family, the ability to have some fun as a family every so often, etc.

·         Marginalization of women: this is a big one for me. Historically speaking, women have been marginalized in our culture. While we are in a much better place now than we were, say 100 years ago, we are still marginalized. Our work is often undervalued and under paid. Midwifery is a classic example of traditional “women’s work” that is undervalued and overlooked. As a midwife, I am also a woman and I need to be able to provide for my own family. Again, in our current system, that is done through the exchange of money. Are my clients also in this marginalized group? Yes. And is there a huge problem in our current health care system in regards to access? Absolutely! We as women need to stand up and demand better. We as women need to stop “taking it” and subvert the dominant paradigm. Through my work, I hope to be working towards this goal by empowering and fostering strength in my clients and their families. The other side of the coin is the reality that I must also function in our current currency driven society.

OK, there are some of my current thoughts on the topic of “giving it away”. What are your thoughts?....

This post was recently republished on Birth Wisdom, a resource for maternal health advocates by Birth Institute. Want to become a midwife? Check out the Birth Institute Holistic Midwifery program. 

Thursday, February 5, 2015


I have some soap boxes to get on today. There is a lot of "doctor or hospital blaming" that can happen in the natural childbirth community. Some of it is deserved and some of it is not. What is becoming clear to me is that for any real change to happen, the women must stand up and demand it! Money talks and if women start taking their money to where they will get the care they want and deserve, change will eventually happen. One of my pet peeves is that many people seem to spend more time researching which TV to buy than on where and with who they will give birth. To this end, here are some of my thoughts.

In order for a person to have the optimal birth experience for themselves, it is CRITICAL to choose your care provider and birth setting accordingly. If you desire a natural, physiologic birth you need to hire a provider who aligns with that desire and then works in a setting that supports the process. If you would like an epidural, choose a hospital that has 24/7 anesthesia available. Research these issues; be sure that your provider and birth setting truly have and offer what you are looking for. Ask around in your community; what is the cesarean section rate at the local hospital, what is the epidural rate? Ask your provider how they feel about your wishes; are they supportive or dismissive? It is not unusual in the current culture to experience the "bait and switch" of having a provider say one thing early on and then start to change their tune as the pregnancy progresses. If you want a physiologic birth then the first step is to be in an environment, surrounded by people, that will facilitate natural birth. When a birthing person is well supported, they will feel comfortable and can more easily relax. This will in turn increase the release of endorphins and decrease the release of stress hormones; it will hurt less and progress more effectively.  Planning a natural, un-medicated birth in a hospital that has a very high epidural rate may be like fighting an uphill battle as they may not be equipped to support the process. Birth should not be a battle, you should not have to go in ready for a fight. You should be welcomed with compassion and support.

Another point to be made: you have hired your provider, if the relationship is not going well do not be afraid to change providers! Prenatal appointments should make you feel supported and comfortable. You should have time to ask questions and those questions should be treated thoughtfully and fully answered. Going to care should not be a battle that you have to gear up for...if it is, leave and find a new provider.

Don't forget about the postpartum period. Many first time families have a tendency to only focus on the birth itself. Really, that is only the beginning. Think about how you want those first few precious hours to go. Uninterrupted skin to skin time is crucial for long term breastfeeding success, does the birth setting you choose support skin to skin care? Will the baby be left in the room with you or will they be removed to a nursery for an exam and observation? What types of routine procedures are done? Research these issues, ask questions and be persistent. These are reasonable questions and should be easy to answer. This is your baby and you have every right to know these things.

Essentially, here is my truth: Be Honest about what you want, Research your options and Choose a provider and setting that will truly support you.

Saturday, January 17, 2015

Nitrous. Yes, No or Don't Know?

****I do not want this to become a discussion on the safety of nitrous. The evidence is strong and overwhelming on the safety; it has been used for decades with no documented concerns for women or babies. I am wanting to have a discussion about the philosophy of using something like nitrous.****

Several months ago my birth center started offering Nitrous Oxide (N2O) for the use of pain management in labor. This is something that I had been wanting to do for several years. I have been reading about it and researching it for quite some time. The first time I proposed this to the other midwives, it was not popular and was basically 'voted' down. A year or so passed, we had some changes in midwives and I presented the idea again. This time the response was very positive and we decided to go for it. I then did all the necessary things; staff training and education, ordering the equipment, letting our families know complete with educational handouts and consent forms, and all the other technical requirements. And in September of 2014 we rolled it out.

Prior to this, I had never seen N2O used. I was simply passionate about it as a safe option for women. As a midwife, I am committed to ensuring that women have options and are presented those options with true informed consent. I spoke with several people; other midwives, experts in the field and women and felt that it should be an option. At the time there was no other facility in our entire state offering N2O. Since then, one of our local hospitals has started offering it as well. I am very happy about that as it only increases access and choice to the women of my community.

Now that we have been using it, I have several observations from experience. There are things that I really like about it and others that I don't. Overall though I really like this option and am very glad that we have it available. I know for a fact that it has helped to prevent several transfers from our center to the hospital and that is a huge success to me. We have also used it to prevent a transfer postpartum for a laceration repair in a woman with severe anxiety about the process. Here is a little break down of my thoughts so far;

Things That I Like
  • The woman is in complete control.
  • It can be used in the birth pool, sitting on the birth ball, in the bathroom on the toilet, standing at the get the point.
  • It can become a sort of focal point that helps her to focus on her breathing.
  • It really seems to decrease anxiety
  • It can be used at anytime during labor
  • It can be used for other indications; laceration repair, third stage, IUD insertions
  • If she does not like it for any reason, she simply stops using it and the effects wear off within minutes
Things That I Don't Like
  • The machine is cumbersome and takes up a good amount of space
  • The scavenging vacuum is loud, it becomes a 'white' noise but is still there
  • The mask can seem claustrophobic
  • It can be distracting for some women to figure out the timing, making it harder to focus on her breathing
Clearly, N2O is not for everyone and sometimes it just does not offer any benefit for an individual woman. It does not take the pain away and so the expectations have to be appropriate. What I have noticed in the social media forums is that there is a definite bias in some of the "natural childbirth" communities against N2O. Bias that using N2O is not "natural birth". That it is a type of cop out or that only women who don't have good enough midwives, support persons or who are not properly prepared would need it. To me, this smacks of judgment, which is something I think that we all as humans need to be very careful of. Judgment runs rampant in our current birth culture and this is just another example of that. So, what do you think? Have you used N2O yourself or have you had clients use it? I would love a positive, open discussion about all thoughts.

Thursday, January 1, 2015

Elemental My Dear

This work, the work of being With Woman, is elemental.

Conception is a spark, bright and warm, in the watery depths of the Mother. A spark fed by the eternal breath of the Creator.

The baby grows and develops in the dark, rich soil of the womb fed by the running waters of the Mother's blood.

Labor is a force of nature! It requires the passion of fire, the gentleness of water, the calm of air and the strength of earth. And let's not forget the Spirit, ever present and supporting.

As a midwife, the element that I most often channel is that of water. I am never exactly the same midwife for every woman. I am always myself (guided by Spirit) and bring with me my fundamental knowledge (supported by the Earth), have passion and compassion for my families and the work (fueled by Fire) and my critical thinking skills (through the lens of Air). However, it is as water that I enter each birth space. Each woman has her own song, her own path and will need me to adjust to her. Water takes the shape of the space it fills and that is how I enter; filling the space as needed. Water is soft, gently supporting and caressing, warm or cool depending on the need. Water is strong, clearing away obstacles and creating new paths. Water is quiet, whispering in your ear. Water is
booming, commanding attention when necessary. Water is my midwife elemental energy.

Midwives and Doulas out there...what is your birth element and why?....