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 do....it 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 call.....it 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?....

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.

The "Rule" of Order

Birth workers will be familiar with this concept, I have heard it worded various ways but it boils down to this; first babies are hard and work their Mamas, second babies are fast and surprise their Mamas and third babies...well they are a wild card! Now, of course, these are not hard and fast "rules". There are first babes that come quick and second babes that take their time, or any combination of the above.

I was recently with a first time Mama, who was indeed working very hard for her little one. She had great support; her husband, her mother, her father and a friend. She labored strongly and had prepared well for the work. Her baby was OP (occiput posterior), so the work was hard and she had a lot of pain in her back. I had her do many things that, at the time, she did not want to do, and that were uncomfortable. We had her on all fours, with a rebozo wrapped around her belly and shook her. We had her rock on all fours and gave her "butt bumps". We had her walk the stairs in deep asymmetrical lunges. It was hard work, and while I knew that she did not like to do it, she did it all gracefully. Eventually, it worked, she told me later that she felt the moment her baby turned at the top of the stairs. Next, we got to the work of pushing, which she did beautifully. Twelve hours after the start of the journey, a sweet 8#13oz. baby boy was so joyously welcomed into the arms of his Mama and Dad.

A week later, I was seeing the new family for a postpartum check-up. They were doing amazingly, baby boy had already made up his lost weight (that all new babies lose) and was past his birth weight. Mama was healing well, and both she and Dad were adjusting to this new reality. After discussing all the technical details like how her bleeding was, how her perinuem was healing, how breastfeeding was working and checking her fundus, we talked about how the labor and birth had been for her. Did she have any questions, issues or concerns to address? She said that it had been hard but she felt supported. Then she said something that I will always cherish. She had been thinking about the experience and realized that while she would always love me, she would also always be mad at me.

Mad because of the things that I had had to have her do...walk the stairs, shake her belly, bump her bottom...all these things were not pleasant or easy for her to do. However, she also realized that they were necessary and was thankful that I had been there to help guide the process. She had felt the support and kindness through the sometimes firm instructions. As a midwife, it is sometimes required of you to be "mean", to ask for difficult things and actions. We have to be able to ask these things, to be tough yet loving, to balance the needs of the physical and emotional with strong compassion. Sometimes, we cannot be a friend. This Mama had told me this with a smile on her face and a twinkle in her eye...she knew this truth as well. She also said that she could not imagine having had a better midwife....and while I know that she would have felt the same for any of my other sister-midwives had it been they who attended her, it did make my heart flutter.

#100

This story has been a long time coming, and is one that has forever left me a gift of love. One of the lessons that has been most difficult to accept, is one that I knew going into this profession. It is this; not all births go well and not all outcomes are as expected. However, knowing this on an intellectual level and experiencing it on a visceral, feeling level are two very different things. As guardians of birth, it is our responsibility to create sacred, safe space for each birthing Mother, her baby and her family. This will look and feel differently for each family, but is no less important. As I sit down to write this piece, I have been blessed to attend the births of 142 babies. To be present at the threshold of life and hold that space as a midwife. Each and every birth has been special and each one has left me changed. Naturally, the births have changed me in different ways, some subtle and some not so subtle.


His Mama is so strong, beautiful in the work of labor. She works gracefully with the intensity of labor. His Dad is wonderful in his loving support, creating that amazing balance of strength and gentleness. Despite the hard work, we are having fun and the atmosphere is one of happy expectation. It is their first baby and all through the labor, I cannot but think how blessed this little soul will be to have these two parents. While all babies are a blessing and welcomed with love, there is something special about that first one, the unknown experience. One of my favorite things about this work, is being invited into this completely intimate time in the life of a family. While, no third person truly knows the inner workings of an intimate relationship, I feel that at births, I am blessed to catch a small glimpse of that secret space.



She was on the birth stool, in that crazy, beautiful time of crowning. His head would peak out at us and then retreat back to his Mother, preparing for his entry into our world. For me, this transition is nothing short of a miracle, every birth leaves me in awe of the power, wisdom and beauty of the design. This transition was smooth and gentle, his head slipping out between contractions. I felt his life, strong and determined, but I also felt something else. Something like a shadow and just knew, without knowing how, that he would need all that strength. Then, the rest of him was born, he was pink and breathing, his heart rate strong, so I gladly handed him up to the arms of his Mother and Father. We helped them all to the bed and tucked them in. Baby continued to have good color and breathe well, snuggled up to his Mother's chest. Her placenta was easily birthed, placed in a bag and laid next to them. The next 2 hours were of cautious watching, he was doing well, but there was something wrong. He was beautiful in that brand new baby way, but his face was asymmetrical and had some palsy. His precious little ears were small and off set. However, he was so content and peaceful snuggled up to Mama. His parents were in that euphoric place of discovery and there seemed no emergent reason to disturb that peace.




Eventually, though, it was time to take a good look at him. It became clear that he would need extra attention, that he would not be going home with Mama and Papa. I made phone calls, arrangements and kept his parents informed and supported. Between myself and the nurse, we took care of everyone, as best we could. Another midwife came in and they all embarked on the trip to the hospital NICU. It was incredibly difficult to stay behind while they left, I feel as though a piece of my heart will always be with them, but I was in no place to be of help...it had been a long shift.



His journey has been hard fought and punctuated by multiple hospital stays and surgery. At one point, his parents took him home on hospice care, wanting to love him at home and not through the lens of the NICU. He is one of the most amazing humans, young or old that I have ever known, and he has surprised every expert at every opportunity. He was taken off hospice care, since he made it clear that he was not ready to leave us. His life is a lesson in love, perseverance and faith. His parents are testament to the strength of that love. His heart so perfectly filled and surrounded by love, but imperfectly shaped has now been mended and he is ready for the next step....to live and thrive! Ultimately, I am the blessed one to have been touched by this family and the lessons they have shared with me. I am thankful for any little part that I have been able to play in their story. And I am so excited, this spring to attend his first birthday!

Let's Get Along

I was recently lucky enough to attend the MANA/CAM Conference in Niagara Falls, Ontario. It was my first MANA conference and it was a lot of fun! It is an amazing experience to be surrounded by people that you share a passion with. To meet others walking on the same path. I was very proud to count myself in the company of so many great midwives, doulas and birth workers!

A heard a quote that was very powerful for me,

"All midwives need each other, and the women need all the midwives." -Judi Mentzer

This struck a particular chord with me. On paper and by training, I am a Certified Nurse Midwife or a CNM. In my heart, I am a Midwife, just simply a midwife. I do not feel that I am any better or worse of a midwife based on the initials placed after my name. Other midwives may have different initials, like CPM, RM, DEM, LM or any other number of options. To me, these are all midwives. One of my biggest frustrations in this profession is the "in-fighting" and the tearing down of eah other based on the initials we carry. How can we as birth workers expect to grow our numbers and support more women when we spend too much energy bickering amongst ourselves? Who needs the "establishment" to hold us down, when do such a good job of it on our own? Let's face it....women come in all stripes and persuasions....and they all deserve and need midwives...so midwives should also come in all stripes and persuasions!

I don't want to get too high on my soap box, but I do want to make my point. We have so many struggles facing our profession, let's just get out of our way, try to move forward from the divisions of the past and focus on the incredibly important task at hand....supporting, educating and empowering women!!

How Do You Know I'm in Labor?

She is a great lady, with an awesome sense of humor. Her husband called me, she had told him not to, that it was not labor. He looked at her, curled up on the bathroom floor breathing through contractions, and made the phone call. I said that they should probably head on in...it was their third baby after all. Twenty minutes later, she walked through the door, clearly in labor and clearly well into her labor. She continued to be convinced that this was not, could not be labor and apologized for me having to come in. I just helped her walk back to the room, starting taking her vital signs and listening to her babe. Since she was positive for GBS, the nurse worked on starting an IV. She really did not like the needles, and in between contractions she argued..."are you sure it is time for that?"...."how do we know I am in labor"...."what if I don't need that IV yet?" Her husband, myself, the nurse and her doula all tried to reassure her that she was, in fact, in labor. Again, she argued, "but how do you know?" Finally, I said, "because we all have eyes!"

So, once the IV was started and she was a little more settled, I checked her cervix and low and behold!...she was definitely in labor and was actually in transition. We helped her into the birth pool and she finally began to accept that her labor was real. Less than one hour after arriving, she birthed her beautiful baby to the world.

Afterwards, we all talked about her reluctance to believe her labor. First, it had been very fast, less than four hours from start to finish. As I have discussed before, fast labors can be very difficult for women to process. Additionally, this Mama had her previous two babes in a hospital, where she was "ignored" until her cervical exam confirmed that she was "ready" and had been told not to push until a doctor arrived. So, her thoughts and feelings started to make some sense. Her husband told us that when he was getting her out of the of the house to come in, she was reluctant. He said to her, "remember that we aren't afraid to go to this place?" and she finally agreed to leave. While this may make me feel good about the care that my group gives and the style of our services...that our families trust us, it also makes me sad that women have these histories to overcome. I am by no means a "hospital hater", I am grateful to have the services available at a hospital when a woman and her baby need them. However, there must be, and in reality there IS a better way to care for pregnant women. A way that honors, empowers and uplifts while still guarding physical safety. They are not and need not be mutually exclusive!

Guided Hands

I am by no means a superiorily experienced midwife, and as many of you know, still consider myself a "young-un". That being said, I do feel that I have built a strong foundation on which to grow my skills. I have been blessed with fantastic teachers and mentors, wonderful families to support and an amazing family of my own. I have recently had some experiences that truly reinforce, for myself, that this is my calling. I believe, that when a person finds their calling, and that when they are serving a higher purpose, there is a well of unconscious knowledge to tap into...


At a recent birth, I was literally at the end of my rope...I had done and tried everything to help this motherbaby. At that moment, of surrender, my hands just started doing. An obscure maneuver, from deep in a text book, that I had never done and only seen once years ago. My hands simply took over and did it....and wonderfully it worked! It was just the trick to help this sweet babe out. I didn't even fully realize what had happened until it was over. I believe that my hands were guided.

At another recent birth, after a beautiful labor and with a healthy, happy baby skin to skin...Mama truly started hemorrhaging...a lot, a dangerous lot. Her placenta had not yet been birthed and before I was able to consciously think, my hands just started to do, to enter her uterus and remove the placenta. This was of course, difficult and very painful for the Mama, however, it saved her life. I had never done this procedure before, only studied it and observed it, but in that moment, my hands knew exactly what to do. Again, I believe my hands were guided.

Of course, there is the acknowledgement that I have trained and studied for these situations, which I have done with dedication. Of course, there is the necessary ability to think quickly and remain calm. However, above all that, there are moments when I honestly believe and have felt something more than myself in the room. I am by no means special in this way and feel that this "well of knowledge" is present for all to dip into. I have seen many others experience this sensation. When have you felt/seen/experienced this? Do you even agree with me that it occurs? I would love to discuss this....