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 http://amidwifeonthepath.com/ as well as my new Facebook page at 'A Midwife on the Path' I look forward to seeing and hearing from everyone there!
Thursday, October 29, 2015
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?....
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;
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.
Wednesday, September 16, 2015
#NursesUnite
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
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.
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.
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
Choices
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.
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
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 bedside...you 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
- 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
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?....
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?....
Sunday, December 28, 2014
Stats....300 Babies!
300 Babies! Once again, I am honored and humbled to be in this position serving women and their families. I am eternally grateful for my own family who make it possible for me to do what I love; particularly my amazing husband who is my rock and my own Mother who is my biggest cheerleader and the best Grandma ever! I am also thankful for the birth center, it is a labor love and passion to work at and keep a birth center open, and I am thankful for each and every person who has worked with us in the past and present.
I have kept a detailed birth log since starting as a student midwife. I am committed to maintaining this personal tradition for a few reasons. I love periodically reading back through the birth stories, especially during trying times to remind me why I struggle and fight. I am a writer of sorts and it has now become a part of my process after each birth. And the reason I started keeping the logs in the first place, to have a record of my own outcome statistics. I cannot speak highly enough of this point, as midwives it is our duty to keep these records. Through these records we can objectively look at our outcomes to ensure that our practice is indeed providing the best care. Transparency is critical. I openly share my outcomes, some of which are difficult to share, in the hopes to inspire others and to keep myself honest. I will gladly discuss my outcomes, if the discussion is respectful and from a place of true constructive criticism.
Also, I work in a group practice, please know that these statistics are my own personal outcomes for the births that I have attended and are NOT from my birth center as a while. As a practice, we also diligently maintain and review our outcomes and participate in the national birth center data collection database, Perinatal Data Set or PDR.
Without further delay, here we go;
148 girls and 152 boys; 6 of these sweet ones were born en caul
Postpartum Hemorrhage: my overall rate is 16%, this is high and I have spent a lot of energy into looking at these numbers. (Please see the discussion from "Stats...200 Babies" and the follow up "The Great Chux Weighing Experiment") For births 201-300 I have been weighing each and every Chux pad and recording the actual EBL down to the ml. What I discovered is that for the first 200 births, I was over estimating EBL. Also, I have been more thoughtful about what actually constitutes a PPH. One woman may lose 700ml but not require any anti-hemorrhagic medications and not develop any symptoms of high blood loss. On paper, she technically has a PPH, but did she really? I would love to discuss this question....
Shoulder Dystocia: overall rate of 6%. This is another outcome that seems very high! However, in looking back, the vast majority were mild and under 60 seconds from birth of head to birth of the body. Some practitioners may not even consider those as dystocias. In looking at each birth, if I only
included times greater that 60 seconds and births that required more than one maneuver to relieve,
then my overall rate would be 2.3% which is much more appropriate. I think that I have been too quick to "label" these births. Again, would love a discussion on this topic.....
I preformed AROM in 13% of labors and it was always done as augmentation and with informed consent after discussion with the woman and her family.
I have had 6 retained placentas. In my birth center, per state regulations we have a time limit of 30 minutes for the birth of the placenta.
I have done a manual removal of the placenta twice, both times were for active heavy bleeding related to partial separation. I have had 4 cord avulsions, only one was severe and required newborn
transport. I have found one true knot in an umbilical cord. I have had one labial hematoma, which
resolved on its own and did not require transport.
My episiotomy rate is 3%. All of the episiotomies were done due to significant fetal heart decelerations with crowning. Approximately, one third of them extended to third or fourth degree lacerations.
Lacerations; intact = 102, first degree = 87, second degree = 95, third degree = 12, fourth degree = 4. For the vast majority of the third and fourth degree lacerations, they were either as a result of episiotomy or the birth happened on the birth stool. I have recently been actively working against birth stool birth for this reason, and that I have noticed higher blood loss. I still use the birth stool in second stage, but as birth approaches I encourage the woman to change positions.
My water birth rate is 37%.
Birth positions (I have rounded these rates up or down to the nearest whole number); hands and knees = 30%, semi-reclining = 17%, birth stool = 17%, McRoberts =14%, squatting = 11%, side lying = 9%, standing = 1.5% and supine = 0.3%.
I have transported 12 newborns; 7 for Transient Tachypnea, 2 for anomalies, 1 for congenital pneumonia and 1 for pneumothorax.
I have transported 27 women after the birth; 16 for laceration repairs, 5 related to PPH and 6 for retained placenta.
So there it all is. In the next couple days, I will post an update with my outcomes for transfers in labor, those births are not included in these numbers. I am ready and open for discussion...
**Update on 12/31/14**
I have just finished compiling my outcomes for the Ladies that I have transferred. At my birth center, when transfers are necessary, we work with some amazing OB's and are very lucky to have them. One of them actually does vaginal breech births! Also, once a client has transferred, we are no longer involved in the clinical management of their care.
Here goes: 39 women have been transferred by me to the hospital in labor. The primary reason was failure to progress or arrest of dilation. We do not have time limits on progress and our ladies are not on any type of clock. The decision to transfer for this reason is one based on how she and baby are handling the labor and is one made in conjunction with the entire family. They are not typically quick decisions and have a lot of thought behind them. The other major reason for these transfers was the presence of meconium in the waters. Per our state regulations, we are required to transfer for this reason unless "birth is imminent". Of those women who transferred, 18 had cesarean sections and one gave birth via Forceps assisted delivery. This gives me a c/section rate of 5.3%.
I have kept a detailed birth log since starting as a student midwife. I am committed to maintaining this personal tradition for a few reasons. I love periodically reading back through the birth stories, especially during trying times to remind me why I struggle and fight. I am a writer of sorts and it has now become a part of my process after each birth. And the reason I started keeping the logs in the first place, to have a record of my own outcome statistics. I cannot speak highly enough of this point, as midwives it is our duty to keep these records. Through these records we can objectively look at our outcomes to ensure that our practice is indeed providing the best care. Transparency is critical. I openly share my outcomes, some of which are difficult to share, in the hopes to inspire others and to keep myself honest. I will gladly discuss my outcomes, if the discussion is respectful and from a place of true constructive criticism.
Also, I work in a group practice, please know that these statistics are my own personal outcomes for the births that I have attended and are NOT from my birth center as a while. As a practice, we also diligently maintain and review our outcomes and participate in the national birth center data collection database, Perinatal Data Set or PDR.
Without further delay, here we go;
148 girls and 152 boys; 6 of these sweet ones were born en caul
Postpartum Hemorrhage: my overall rate is 16%, this is high and I have spent a lot of energy into looking at these numbers. (Please see the discussion from "Stats...200 Babies" and the follow up "The Great Chux Weighing Experiment") For births 201-300 I have been weighing each and every Chux pad and recording the actual EBL down to the ml. What I discovered is that for the first 200 births, I was over estimating EBL. Also, I have been more thoughtful about what actually constitutes a PPH. One woman may lose 700ml but not require any anti-hemorrhagic medications and not develop any symptoms of high blood loss. On paper, she technically has a PPH, but did she really? I would love to discuss this question....
Shoulder Dystocia: overall rate of 6%. This is another outcome that seems very high! However, in looking back, the vast majority were mild and under 60 seconds from birth of head to birth of the body. Some practitioners may not even consider those as dystocias. In looking at each birth, if I only
included times greater that 60 seconds and births that required more than one maneuver to relieve,
then my overall rate would be 2.3% which is much more appropriate. I think that I have been too quick to "label" these births. Again, would love a discussion on this topic.....
I preformed AROM in 13% of labors and it was always done as augmentation and with informed consent after discussion with the woman and her family.
I have had 6 retained placentas. In my birth center, per state regulations we have a time limit of 30 minutes for the birth of the placenta.
I have done a manual removal of the placenta twice, both times were for active heavy bleeding related to partial separation. I have had 4 cord avulsions, only one was severe and required newborn
transport. I have found one true knot in an umbilical cord. I have had one labial hematoma, which
resolved on its own and did not require transport.
My episiotomy rate is 3%. All of the episiotomies were done due to significant fetal heart decelerations with crowning. Approximately, one third of them extended to third or fourth degree lacerations.
Lacerations; intact = 102, first degree = 87, second degree = 95, third degree = 12, fourth degree = 4. For the vast majority of the third and fourth degree lacerations, they were either as a result of episiotomy or the birth happened on the birth stool. I have recently been actively working against birth stool birth for this reason, and that I have noticed higher blood loss. I still use the birth stool in second stage, but as birth approaches I encourage the woman to change positions.
My water birth rate is 37%.
Birth positions (I have rounded these rates up or down to the nearest whole number); hands and knees = 30%, semi-reclining = 17%, birth stool = 17%, McRoberts =14%, squatting = 11%, side lying = 9%, standing = 1.5% and supine = 0.3%.
I have transported 12 newborns; 7 for Transient Tachypnea, 2 for anomalies, 1 for congenital pneumonia and 1 for pneumothorax.
I have transported 27 women after the birth; 16 for laceration repairs, 5 related to PPH and 6 for retained placenta.
So there it all is. In the next couple days, I will post an update with my outcomes for transfers in labor, those births are not included in these numbers. I am ready and open for discussion...
**Update on 12/31/14**
I have just finished compiling my outcomes for the Ladies that I have transferred. At my birth center, when transfers are necessary, we work with some amazing OB's and are very lucky to have them. One of them actually does vaginal breech births! Also, once a client has transferred, we are no longer involved in the clinical management of their care.
Here goes: 39 women have been transferred by me to the hospital in labor. The primary reason was failure to progress or arrest of dilation. We do not have time limits on progress and our ladies are not on any type of clock. The decision to transfer for this reason is one based on how she and baby are handling the labor and is one made in conjunction with the entire family. They are not typically quick decisions and have a lot of thought behind them. The other major reason for these transfers was the presence of meconium in the waters. Per our state regulations, we are required to transfer for this reason unless "birth is imminent". Of those women who transferred, 18 had cesarean sections and one gave birth via Forceps assisted delivery. This gives me a c/section rate of 5.3%.
Monday, November 17, 2014
Aquarium Nets and Naked Men
Or, Laughing
Through Transition. Every birth, every woman, every family and every baby are
different. Some birth songs are fierce, some are soft, some songs are shy and
some are boisterous. Each one is unique. The wonderful Ina May Gaskin has noted
that the cervix and the mouth/jaw/throat are intimately connected during labor.
If we can relax the throat and mouth it can often have a positive impact on the
cervix. Nothing relaxes the throat better than a good laugh. As a midwife, I have seen this principle in action many times. I
recently had the pleasure to attend a birth where laughter was the best
medicine.
The couple
was beautiful; connected, strong and confident in each other. The picture they
painted was blissful. They worked through the labor together, walking around
the center, bouncing on the birth ball and finally while she was in the birth
pool.
I have to
give some background now. At our birth center, we have a class called the 34
Week Midwife Chat. It is required for all of our families and covers things
like when to call the midwife, what to expect when you get to the birth center,
labor, birth and postpartum processes and transfer protocols. Talking about
transfers is always a heavy conversation. So after we cover those, we like to
end on a positive note and talk about
the “Rules” at the birth center. The Rules are a little silly and are intended
to make the class attendees giggle. Examples include; No naked people other
than women in labor and newborn babies, No pot smoking at the center and No
pets (dogs, cats, ferrets or iguanas) allowed. All the rules were created in response to actual situations….
So, this
woman is in the birth pool, transition is imminent and her husband asks me to
share the reasons why we have the “no naked people” rule. There are two stories, both are true and may
or may not have happened at our center. They both involve the male partners of
a woman in labor. (There are other stories that involve other people but I will
save those)
Story One
(for our protection): A woman is in the birth pool, the midwife is kneeling in
front of her, face to face with her. Behind the midwife the soon to be Dad is
very excited and asks, “Is it time for me to get in the pool too?” The midwife
replies that sure he can get in now. Remember that her back is to him as he
prepares to get in the water. The next thing the midwife knows, the very naked
man is literally stepping over her to join his wife in the pool….she literally
got an “eyeful” so to speak.
Story Two
(for your protection): A woman and her husband are in the birth pool. They are
both naked. Often, in the second stage of labor women will pass stool, this is
completely normal and actually a wonderful sign that everything is progressing
normally. When this happens, we use a little aquarium fish net to discreetly
scoop “things” out of the water. Well, a nurse thought she saw something in
need of scooping at the bottom of the pool and used the fish net to try and
retrieve it. Let’s just say that it was not what she thought it was. It was
actually something firmly attached to the soon to be Dad and not something in
need of retrieval.
These
stories had the woman laughing and laughing, right on through transition. I
think her husband knew that laughter would help her through this part of labor
and wisely asked me to tell these stories. And shortly thereafter we all
welcomed a sweet water baby earthside.
P.S. We buy our aquarium nets from a local pet supply store. One of my nurses was getting some and the cashier (a young man) asked her why she was buying so many. She politely told him that he really didn't want to know. He persisted and she finally told him, in full detail, what the nets were for. He very seriously replied, "You're right, I didn't want to know that."
Friday, November 14, 2014
Our Government in Action?....
I recently attended the national American Association of Birth Centers (AABC) conference in Washington DC. Part of the conference was a Lobby Day, where attendees visited their state representatives in person to educate them on birth centers and issues that we face. It was a great experience, myself and the owner of our birth center were able to meet with one congressional representative and both of our Senators. We had prepared packets of information about us specifically as well as the materials that the AABC had put together on birth centers in general. We did have an experience, however, that I believe is a lovely metaphor for the dysfunction in our current government.....
We first visited with a Congressman. After we checked in I realized that I had accidently left the extra copies of one of our documents at the hotel. I asked the Intern at the desk if it would be possible to get two copies of this one sided, standard sized page. He was very polite and said that he could. This Intern looked to be in his early to mid twenties, was dressed very professionally and I assume that as a White House Congressional Intern is either in the process of, or has just finished a high level of college education. For the next 20 minutes, in my peripheral vision, while waiting for my appointment I watched him attempting to make me two copies. He went back and forth between a copy machine and fax machine and eventually had another Intern come help him. Between the two of them, the confusion seemed to increase. Eventually, he approached me very apologetically to say that he was only able to make me 1 copy. Now, in my opinion being able to only make one copy is kinda worse than not being able to make any.....I graciously took my one copy and thanked him for his effort.
Next, we went to the office of one of our Senators. This office also had Interns, this time they were female but also appeared to be in their early to mid twenties and I assume also are/were in process of upper level education. After checking in for our appointment, I asked if it would be possible to get one copy of my document. I was very politely informed that the Senators office does not make copies for the public.
So, there ya go. One group wanted to help me and tried and was only able in the end to partially help me. The other group just wouldn't help me. What do you think? Does that sum it up nicely?
We first visited with a Congressman. After we checked in I realized that I had accidently left the extra copies of one of our documents at the hotel. I asked the Intern at the desk if it would be possible to get two copies of this one sided, standard sized page. He was very polite and said that he could. This Intern looked to be in his early to mid twenties, was dressed very professionally and I assume that as a White House Congressional Intern is either in the process of, or has just finished a high level of college education. For the next 20 minutes, in my peripheral vision, while waiting for my appointment I watched him attempting to make me two copies. He went back and forth between a copy machine and fax machine and eventually had another Intern come help him. Between the two of them, the confusion seemed to increase. Eventually, he approached me very apologetically to say that he was only able to make me 1 copy. Now, in my opinion being able to only make one copy is kinda worse than not being able to make any.....I graciously took my one copy and thanked him for his effort.
Next, we went to the office of one of our Senators. This office also had Interns, this time they were female but also appeared to be in their early to mid twenties and I assume also are/were in process of upper level education. After checking in for our appointment, I asked if it would be possible to get one copy of my document. I was very politely informed that the Senators office does not make copies for the public.
So, there ya go. One group wanted to help me and tried and was only able in the end to partially help me. The other group just wouldn't help me. What do you think? Does that sum it up nicely?
Tuesday, August 26, 2014
#LifeOfAMidwife:Struggles
This life is not for the faint of heart that is for sure! Here are some examples of issues often not talked about....
My low beam headlights are out, they have been out. I have been driving at night with the high beams. When will I be able to make it to a garage to have them fixed? Good question!
My oil needs to be changed, see above....
My daughter had her first day of third grade last week, I was not able to drop her off or pick her up. Daddy and Grandma were there, but I was not.
I think I have friends...somewhere out there in the regular world. It has just been a while since we have seen each other.
At my birth center, we have to fight everyday to stay open. Insurance companies don't want to pay us, hospitals are threatened by us and can make life very difficult. The relevant government agencies don't support us and seem to actually hurt us.
My bank account is sad. I make significantly less money than my peers who work at hospitals and don't even get me started on student loan debt.
I wish that I could serve more women and that getting paid didn't matter, but it does. I have a family to support as well.
And yet, to me I have the best "job" possible. I don't want to whine too much, after all, I made a very conscious decision to follow this path and answer this calling. I believe that there are much more important things in life than wealth, however, that does not mean that the struggle doesn't get exhausting sometimes. Why should supporting women and their families be so hard?.....
My low beam headlights are out, they have been out. I have been driving at night with the high beams. When will I be able to make it to a garage to have them fixed? Good question!
My oil needs to be changed, see above....
My daughter had her first day of third grade last week, I was not able to drop her off or pick her up. Daddy and Grandma were there, but I was not.
I think I have friends...somewhere out there in the regular world. It has just been a while since we have seen each other.
At my birth center, we have to fight everyday to stay open. Insurance companies don't want to pay us, hospitals are threatened by us and can make life very difficult. The relevant government agencies don't support us and seem to actually hurt us.
My bank account is sad. I make significantly less money than my peers who work at hospitals and don't even get me started on student loan debt.
I wish that I could serve more women and that getting paid didn't matter, but it does. I have a family to support as well.
And yet, to me I have the best "job" possible. I don't want to whine too much, after all, I made a very conscious decision to follow this path and answer this calling. I believe that there are much more important things in life than wealth, however, that does not mean that the struggle doesn't get exhausting sometimes. Why should supporting women and their families be so hard?.....
Tuesday, June 17, 2014
#LifeOfAMidwife: Fluidity
The phone rang, I am hopeful that it is a woman in labor. It has been a couple weeks since I was able to catch a baby, and I feel the urge tickling in my fingers.
I can tell instantly from her voice that this is not the reason for her call. She is early in her pregnancy and experiencing spotting, she is nervous and concerned. We talk. I offer her reassurance and comfort; based on her symptoms this could be nothing or it could be everything. After our discussion, we hang up the phone with plans for her to call me with any needs or changes in her symptoms.
Mere moments later, the phone rings again. This time it is a Mama in labor. Her man is the caller and I can hear her in the background working with her labor. We talk. It is still a little early in the process, so I offer reassurance and comfort. We review labor patterns, I encourage good hydration, eating a light meal and movement. We hang up the phone with plans for them to touch bases with me soon.
Another call, the first Mama. Her bleeding has increased, she is crying, she has questions. We talk. I offer her comfort and a shoulder to cry on; I tell her that now her symptoms are likely a miscarriage happening. Based on those symptoms and the timing of her pregnancy, I recommend that she go the hospital for an evaluation, she agrees.
A short while later and the phone is ringing again. The laboring Mama is ready to come in. When they arrive, she is beautiful, alight in that sweaty glow of labor. She and her man are working together in such a sweet way. She progresses well and has a sublime waterbirth to welcome her babe Earthside. It is a birth that feeds the soul of the world. They are then snuggled up in bed, safe and warm.
A final call, the other sweet Mama is now home from the hospital. She has indeed lost her baby, she is heartbroken. We talk, mostly I listen. There are no magic words for these experiences, the only healing is through time. Having someone to listen and simply be present is the support we can give. We then schedule an appointment for her to come in, so we can give her more love and help her through this process.
This is the life of a midwife.....
I can tell instantly from her voice that this is not the reason for her call. She is early in her pregnancy and experiencing spotting, she is nervous and concerned. We talk. I offer her reassurance and comfort; based on her symptoms this could be nothing or it could be everything. After our discussion, we hang up the phone with plans for her to call me with any needs or changes in her symptoms.
Mere moments later, the phone rings again. This time it is a Mama in labor. Her man is the caller and I can hear her in the background working with her labor. We talk. It is still a little early in the process, so I offer reassurance and comfort. We review labor patterns, I encourage good hydration, eating a light meal and movement. We hang up the phone with plans for them to touch bases with me soon.
Another call, the first Mama. Her bleeding has increased, she is crying, she has questions. We talk. I offer her comfort and a shoulder to cry on; I tell her that now her symptoms are likely a miscarriage happening. Based on those symptoms and the timing of her pregnancy, I recommend that she go the hospital for an evaluation, she agrees.
A short while later and the phone is ringing again. The laboring Mama is ready to come in. When they arrive, she is beautiful, alight in that sweaty glow of labor. She and her man are working together in such a sweet way. She progresses well and has a sublime waterbirth to welcome her babe Earthside. It is a birth that feeds the soul of the world. They are then snuggled up in bed, safe and warm.
A final call, the other sweet Mama is now home from the hospital. She has indeed lost her baby, she is heartbroken. We talk, mostly I listen. There are no magic words for these experiences, the only healing is through time. Having someone to listen and simply be present is the support we can give. We then schedule an appointment for her to come in, so we can give her more love and help her through this process.
This is the life of a midwife.....
Tuesday, June 3, 2014
#LifeOfAMidwife
I have to admit that I am pretty much out of the "hashtag" loop, but I couldn't resist....
I have been having a lot of random thoughts lately, so I decided to just list them all together as things that you experience, say and feel as a midwife. Perhaps it will become a little series. Hope you enjoy installment #1 :)
I have been having a lot of random thoughts lately, so I decided to just list them all together as things that you experience, say and feel as a midwife. Perhaps it will become a little series. Hope you enjoy installment #1 :)
- Midwives talk about sex a lot; sex to conceive, sex to not conceive, sex during pregnancy, sex after pregnancy, sex during menopause...I think you get the idea here. I recently had one of these sex conversations with a pregnant couple. They were concerned that recently after sex, she had a "long but mild" contraction. We then had a discussion all about oxytocin and orgasm and I said that besides just having sex, they must have had really good sex! Oh boy, the bright red blush x 2 that happened in that room; priceless.
- When you are at home and doing laundry, you have to wonder "Is this blood or meconium or amniotic fluid or adult stool or...." You get the point.
- Speaking of body fluids, there is nothing quit like being showered, sprayed, anointed, and getting soaked through your clothes with amniotic fluid during the birth process. I have had amniotic fluid in places I don't care to mention!
- Experiencing the honor of having the soon to be Mama, who is working so hard, place her head on your shoulder, or place her head forehead to forehead with yours, to have her lean on your shoulders, to have her clasp your hand in hers, or to be there for her when she opens her eyes looking for comfort and strength. Time can stop in these moments and leave you breathless.
Wednesday, May 14, 2014
We Had Prepared
We had prepared everything for her transfer. Her sweet baby was apparently very contented to remain nestled up in her warm womb. All measurable signs and tests were done and everything pointed to a happy, healthy babe. Mama and her family were hanging in there, anxious to meet this little one, but willing to be patient....
Every birth center has regulations to deal with and work within, we are no exception. I agree with many of our regulations; no Mama's with hypertensive disorders, no twins, no Mama's with major preexisting medical conditions like epilepsy or severe heart diseases to name a few. And then there are regulations that I do not agree with; no Mama having their sixth or more baby and no VBAC's. These examples are by no means a complete list of our regulations, just the first that pop into my head. Our regs were originally written in the early 1980's and can be very restrictive. We struggle with some of them to even remain open to serve our families. Part of the reason why there are so few birth centers in my state (mine, one on the other side of the state and one in the process of opening) is the restrictiveness of these regulations....and we seem powerless to change them. There is no desire on the part of the state to re-open them. It would literally take an act of (state) congress to make this happen and unfortunately the care of Mama's and Babies falls to the bottom of the priority list when budgets are tight. This is so wrong and is such a travesty, but it is the reality that we currently have to function in. So, we struggle on, we make personal sacrifices and we fight the fights so we can be here to care for our families. And sometimes we have to make decisions based on these regulations that we may not agree with. However, my goal is to remain open and to serve as many families as possible so I must "follow the rules" and walk the line.
We had prepared everything for her transfer, the very next day she was scheduled for an induction as she would be two weeks past her "due" date. The reports had been given, the records has been shared and all was set. Then in the last possible hours, blessedly, her babe decided to make the move. The birth was beautiful; a wonderful messy mix of strength, perseverance, radiance and sweaty work. Then I got to make one of my favorite phone calls; to the provider who was going to do her induction, and cancel it!
Every birth center has regulations to deal with and work within, we are no exception. I agree with many of our regulations; no Mama's with hypertensive disorders, no twins, no Mama's with major preexisting medical conditions like epilepsy or severe heart diseases to name a few. And then there are regulations that I do not agree with; no Mama having their sixth or more baby and no VBAC's. These examples are by no means a complete list of our regulations, just the first that pop into my head. Our regs were originally written in the early 1980's and can be very restrictive. We struggle with some of them to even remain open to serve our families. Part of the reason why there are so few birth centers in my state (mine, one on the other side of the state and one in the process of opening) is the restrictiveness of these regulations....and we seem powerless to change them. There is no desire on the part of the state to re-open them. It would literally take an act of (state) congress to make this happen and unfortunately the care of Mama's and Babies falls to the bottom of the priority list when budgets are tight. This is so wrong and is such a travesty, but it is the reality that we currently have to function in. So, we struggle on, we make personal sacrifices and we fight the fights so we can be here to care for our families. And sometimes we have to make decisions based on these regulations that we may not agree with. However, my goal is to remain open and to serve as many families as possible so I must "follow the rules" and walk the line.
We had prepared everything for her transfer, the very next day she was scheduled for an induction as she would be two weeks past her "due" date. The reports had been given, the records has been shared and all was set. Then in the last possible hours, blessedly, her babe decided to make the move. The birth was beautiful; a wonderful messy mix of strength, perseverance, radiance and sweaty work. Then I got to make one of my favorite phone calls; to the provider who was going to do her induction, and cancel it!
Thursday, March 20, 2014
Midwifery Today
Wow! I am very excited to share that two articles of mine were accepted for publication in the magazine Midwifery Today. For me, this is a huge honor. As fledgling nurse and then midwife, this publication was a powerful source of inspiration for me. There are no electronic links to the articles in this magazine, but you can learn about this organization at their website http://www.midwiferytoday.com/
If you are interested, you can order single copies of the magazine, my articles appear in the current issue #109, Spring 2014. Of course, you can also subscribe to receive the magazine regularly. (And as a disclaimer, I received no payment for my articles nor any percentage of sales.)
If you are interested, you can order single copies of the magazine, my articles appear in the current issue #109, Spring 2014. Of course, you can also subscribe to receive the magazine regularly. (And as a disclaimer, I received no payment for my articles nor any percentage of sales.)
Sunday, February 16, 2014
Midwife Love
Midwife Love may sound silly or cliché, but it is the best description of how I feel right now. I am in love with my midwife-sisters! We are such a diverse and beautiful group of people. Through midwifery, I have had the opportunity to meet women that I otherwise never would have. And many of these women are now dear friends. This weekend, I am a town across the state and had the opportunity to visit one such friend who has recently opened a free standing birth center. She did a portion of her clinicals with us and I am so proud to have played a part in her growth as a midwife. The women and babies here are blessed to have her and her center. I can't wait to hear about their growth and success.
In particular, I am eternally grateful for my midwife-sisters at the birth center. They are a source of strength, humor, support and knowledge. Don't get me wrong, we can also disagree and challenge each other....but what is love without a little challenge. Being able to disagree and then come to a mutual understanding is a hallmark of love; we don't change each other but make each other stronger. We don't mimic each other or think that we all have to make the same choices. There is great power in our differences.
Recently, I had an experience that really hit this home for me. It was early morning, I was at the center to be in the clinic. I was in the kitchen making my (very necessary and much loved) cup of coffee. The on call midwife was there for a Mama in labor and the midwife who had been on call the day before was at the hospital as she had had to transfer another Mama. The previous midwife had had "one of those shifts"; long and tough, she had been up for 24 hours before the transfer. She returned from the hospital (after the birth and a healthy MotherBaby outcome) and was exhausted. The first thing that happened when she walked in was a lovely and much needed group hug. The three of us just put our arms around each other and took some breaths, it was simple and took only a few moments but was powerful. These seemingly small moments are among the ones that keep us going in the hard moments. And for these moments, I am eternally grateful.
In particular, I am eternally grateful for my midwife-sisters at the birth center. They are a source of strength, humor, support and knowledge. Don't get me wrong, we can also disagree and challenge each other....but what is love without a little challenge. Being able to disagree and then come to a mutual understanding is a hallmark of love; we don't change each other but make each other stronger. We don't mimic each other or think that we all have to make the same choices. There is great power in our differences.
Recently, I had an experience that really hit this home for me. It was early morning, I was at the center to be in the clinic. I was in the kitchen making my (very necessary and much loved) cup of coffee. The on call midwife was there for a Mama in labor and the midwife who had been on call the day before was at the hospital as she had had to transfer another Mama. The previous midwife had had "one of those shifts"; long and tough, she had been up for 24 hours before the transfer. She returned from the hospital (after the birth and a healthy MotherBaby outcome) and was exhausted. The first thing that happened when she walked in was a lovely and much needed group hug. The three of us just put our arms around each other and took some breaths, it was simple and took only a few moments but was powerful. These seemingly small moments are among the ones that keep us going in the hard moments. And for these moments, I am eternally grateful.
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