The lovely Placenta...

I really do love keeping this blog, and have found it enlightening. However, I crave to hear the thoughts of those who bless me with their time to read it...so I have decided to periodically post some questions or topics to discuss. Let's start a place where we can share our experiences and thoughts!

So, I am and have always been fascinated by the placenta. It is such an interesting and important creation. Many cultures have very specific rituals and beliefs centered around the placenta. I would love to start a discussion about placenta's...please, post any thoughts, practices, beliefs that you have seen or heard about this amazing organ....is placenta encapsulation popular where you are?....

Here is a thought to start off the talk....Placentas may be the only "meat" that is vegetarian, as no animal is killed in their production!....

When Interventions Are a Good Thing

I firmly believe that each woman should be treated as an individual and that the concept of blanket interventions for all is ridiculous. Birth is a natural process and if we trust it, it will most often work for itself. Most of the time, my job is to be present and provide support...not to manage...but sometimes that is what I need to do....




Erika was working on her first baby. She had been in labor for hours, when early in the morning she started having a LOT of vomiting. After a few hours of this, she and her husband and mom came to the center....she was so exhausted physically, yet so strong in spirit. They had been working on keeping Erika hydrated, but with the amount of vomiting, this was nearly impossible. I started an IV and gave her some fluids...what a difference and she actually took a little nap, which was perfect. Then, she had more vomiting, followed by some more. At this point, she was still strong in spirit, however, her physical self was starting to struggle. I wrote her a prescription for Zofran, an anti-emetic, and her husband went to go pick it up. We also did some herbs and Rescue Remedy, but that Zofran sure hit the spot. Erika was able to "catch her breath" and go on to have a great natural birth, surrounded by love and support, on the birth stool and welcome her 7lb little girl.




This is an example of when certain "medical" interventions can really make the difference and allow a woman to carry on and move forward. Do I think all ladies need an IV or IV access? No. But, do I think we should have these options when needed? The intervention itself is not the problem, it is the over use of the intervention that creates the problem.

Love and Bubbles

I just have to say, that I love siblings at births! In my experience it is such a great way for the older child/children to feel that they are also part of this process...and there is nothing like the look on their sweet faces when they see the new little brother or sister for the first time....

I was recently with a family having their second child, their first is six years old and so smart and fun...Sam. Sam was amazing at his little sisters' birth. While his Mama was in the pool pushing, he diligently gave her sips of water between contractions, and took this job very seriously. Additionally, he would be sure to blow bubbles when she was having her contractions, it was great to welcome little babe to a room full of love and bubbles! Afterwards, he wanted to keep helping, so we employed him as our helper and he drained the birth pool with us. These births are so wonderful and such a family affair...as it should be. I wish that all women and their families could be blessed with this respect and openness for their births.....

Midwifing the Midwife

This calling is truly a blessing...to be included in and welcomed to such an intimate and special time for families is a gift. Seeing these women transform to mothers in those precious first moments and watching the awe in the faces of thier partners...these are times to be cherished. However, that is not always how it works out, despite all the best preperations and intentions. These are times when this calling can and will break your heart. The highest highs and the absolute lowest lows...these are wrapped up together in this calling...and we as the guardians of birth must be able to guide families through it all. We must also be able to nurture ourselves through these times and hold fast to our faith in the birth process....so, a question...who midwifes the midwife?

Fancy a Swim?

I love waterbirths, I have always loved them. My second child was born in the water and my first would have been if the hospital had "allowed" it, at least I was "allowed" to labor in the water. The funny thing about waterbirths is that they are wet ;) and there is a lot of water involved...splashing water, dripping water, sloshing water...you get the point. I have joked with the owner of our birth center that she should buy us wet suit tops so that we don't end up looking like contestants in a wet t-shirt concert....

It was her second baby and she was doing beautifully. Her husband was great and she had a fabulous doula. As her labor progressed, she moved into the pool and soon after her husband joined her. This if course, raised the water level pretty high, so I was on bucket brigade and removed some of the water. She started pushing while on her hands and knees, then she moved to squatting, followed by leaning back into her husbands arms. With each move she got a little bit further away from me...and I leaned a little bit more over the side of the pool. Then as her babe started to crown, she pushed her legs against the sides of the pool, pinned her husband against the back of the pool and sat on the pool bottom. Now, I am a pretty hands off midwife, especially in the water, but I do like to feel for cords and make sure it is ok for Mama to bring/pull her babe up out of the water. (Also, it can be a little difficult for a baby to emerge when its Mama is sitting.) So, I ended up basically in the pool from the waist up, gently lifting/encouraging Mama to squat and make room for baby. Her son was very soon born and was welcomed into the loving arms of both Mama and Papa. I looked like a drowned cat and was literally dripping all over the floor...my hair was wet, my shirt was soaked (along with my bra), my pants were wet and the water dripped down into my shoes. And we all laughed. I love waterbirths!

You say frenectomy, I say frenotomy

So, being a midwife is not only all about labor and birth. I am blessed to work in a practice that also provides newborn care for the first two weeks, and I love it!!

Recently, I have learned how to perform frenotomy's. These are done when a baby is "tongue tied" and they cannot stick out their tongues...which can make nursing very difficult indeed. Being tongue tied happens when the frenulum (little piece of skin) that anchors the tongue to the base of the mouth is too tight or extends too far. In the frenotomy, this little piece of skin is clipped. It seems scary and yes, is a little intimidating...especially to have scissors in a newborns little mouth. However, it is very easy, the babies tolerate it well and it hardly bleeds. This is a topic near and dear to my heart. My sweet firstborn was tongue tied and I was not able to find anyone to clip it for me, I was not yet a nurse and had no idea how to do it myself. Together, we endured weeks of very difficult breastfeeding with a couple bouts of mastitis thrown in for fun. Eventually, we were able to work through it, but I would never want a Mama to have to deal with that...when it can be so easily fixed.

This week, I saw two Mama's struggling with these tight frenulum's. They were both working with lactation consultants who recommended an assessment for frenotomy. Both had seriously beat up nipples and were in a lot of pain and their babies were not gaining enough weight. The procedures went great and both babies were immediately put to breast....and the look of relieved surprise on the faces of the Mamas was priceless..."oh, this is how it is supposed to feel?!?" The baby that came in earlier in the week is already gaining weight!

These times are when this "job" is truly rewarding!

WTHeck??...

I was very happy to get a call from this awesome family. They were expecting their first baby. We met at the center and she did seem to be in a great labor pattern. She spent a little time getting settled in, going to the bathroom, being in the room. Her vital signs were stable and the babe sounded good. Then came time for a cervical exam. I gently eased my fingers into her vagina and easily found her cervix, which was lovely and soft, opened to 6cm. Then, it became confusing...what is this presenting part? It feels so soft...are these the sutures?..What am I feeling...then something floated into my fingers....are these fingers?....no!...this is a foot!!

I have often heard providers describe finding a breech presentation by internal exam, and they have all talked about a certain level of confusion. How you try to somehow make sense of what you are finding, and try to make it fit into being a head. That is exactly what I did in this situation. Additionally, for some reason, I had not as I usually do, done Leopold's yet on this beautiful belly. When I did do Leopold's after the exam, it was not a clear case...had I not felt that little foot, I would not have suspected.

Then came the most difficult part...telling this family that their sweet little one was breech, that she was in active labor and that her only option at this point was a cesarean section at the hospital. We all cried a bit, but then this great family was able to switch gears and quickly just focus on the fact that their babe was soon to arrive. I was in awe of their strength and grateful for their grace.

I work in a large urban setting and providers willing to do vaginal breech births are rare. We are blessed to work with one such great physician. However, he will only do "scheduled" vaginal breech births....breeches that are found during prenatal care. In these cases, we can send a family to him, he will do an evaluation and discuss all the pros and cons about vaginal breech and cesarean section, give truly informed consent and follow the family's decision. He will also offer to preform an external version, if he feels it is a safe option. We have had a couple babes born with us after he completed a successful version. Unfortunately, for this Mama, we did not discover her breech baby early enough....