Tools of My Trade, #1

Way "back in the day" before I started my journey
to midwifery, I was known to play and work with photography. Somehow, along the
way, I misplaced the photography bug. I had been concerned that it was gone
forever. However, much to my happy surprise, it has begun to re-surface. I am
going to be trying out an inspiration through the pages of this blog. The
inspiration is this....a photo essay, of sorts, to highlight some of the Tools
of My Trade. I decided to start the essay of with one of the tools that I always
have with me, ready and willing to serve my Mama's and their families, My
Hands....

These hands caress, stroke and sometimes cajole

These hands inspect, delve and palpate

These hands are sometimes soft and other times are hard

These hands support and elevate

These hands act as guides...to babies on their way out, to women as they become mothers

These hands repair and cultivate

With these hands, I honor and act with grace, for all the women....

Midwife Pride

Here I sit at my kitchen table, sipping a mocha and watching the snow fall outside. Lately, I have been heavy thinking on the topic of pride. It is a subject that I often ponder from time to time. Clearly, too much pride can be a bad thing. However, pride can also be an important trait. I was recently involved in a Facebook discussion about the definition of a midwife. The author had proposed that a midwife is a good friend who assists a woman in finding her own path through birth (I am seriously paraphrasing). The focus of the quote was the "friend" part. This lead to some interesting points and people arguing for and against the simple "friend theory". One poster pointed out that midwives are much more than friends and hold a lot of responsibility. Another poster argued that all the responsibility lies with the Mama and that the concept of the midwife holding responsibility over her was insulting. These discussions have re-kindled a strong passion that I have regarding midwifery and I will try to explain it here. I apologize for the large soap box that I am about to climb onto.....

First, I am extremely proud to be a Midwife. I have dedicated years of my life to the study of midwifery and continually strive to continue my learning. To me, it is both a profession and a calling, in the true sense of both words. A profession because it involves, study, skill acquisition, continued education and recognized standards. A calling because it requires dedication, an appreciation of the beauty of the process and a genuine love of MotherBaby. Historically and traditionally, as midwives we have seriously down played our role and knowledge base, in favor of giving all of the credit to MotherBaby. In my opinion, this has been a mistake, and has allowed for the devaluing and oppression of our work. Now, I must make something absolutely clear, I strongly believe that MotherBaby deserves vast amounts of glory for their work. One of my crucial roles as a midwife is to support them through the process and allow the Mother to be born along with the baby, through empowerment and strength. Keeping this in mind, we as midwives also deserve a lot of credit for facilitating this process. We are highly trained and have a vast knowledge base, acquired through both "book" learning and experience.

While I may be a type of friend to my clients, I am also much, much more. I do hold some responsibility for their well being, I have been hired to guard their health and safety, to watch over and monitor their progress and intervene when needed. Is this responsibility shared? Absolutely! Do I hold power over MotherBaby like some kind of overlord? Absolutely not! Do I sometimes have to tell women things that they do not want to hear and make recommendations that they will not like? Yes. Think of a Mama, in the thick of a protracted labor with a babe in a "bad" position. Do I have to ask her to do things; like sumo-walk the stairs, spend time on her hands and knees and other various things that she may not like in the moment? Yes. Or a Mama who has developed a complication during the course of her pregnancy that makes it safer for her baby to be born at a hospital....will I tell the truth and recommend this transfer? Yes. Or a Mama who is bleeding heavily after the birth...will I act quickly and decisively to stop that bleeding? Yes. These decisions and interventions involve a level of responsibility. A responsibility that I as a trained midwife, who has been chosen by a family, take very seriously.

I strongly believe that we as women and midwives must claim this power and take credit for our skill. We must work and fight for the recognition we have earned. We must educate the public on our skills and be proud of our profession and not be afraid to also take some of the credit. Just as we share responsibility with our clients, we can also share credit. Let's step out of the shadows and into the light of our awesome work! Let's claim our power, just as we encourage MotherBaby to do, and be proud of the skills and knowledge that we bring to this calling!

The Serenade

Well, if have been reading this blog, you know that I feel blessed by my "job". My co-workers are fantastic and our clients and their families are wonderful. I recently had an experience that reminded me how awesome our collaborating providers are. We work very closely with a particular pediatric group, they see clients out of one of our auxiliary spaces and many of families choose them as providers.

I was at the hospital visiting with a family that had had to transfer during their labor. I walked into the room to find a happy, healthy Mom with a beautiful dark haired baby girl nursing away. The proud Daddy at their side. We were chatting, discussing the transfer and marveling at how great the baby was breastfeeding. After a short time, another visitor arrived...one of the pediatricians from the above mentioned group. In addition to being a great physician, he is also an avid guitar player. We had recently had a huge snow storm and it was freezing outside, so he could not leave his guitar in the car and brought it in with him. Of course, one thing lead to another and before he did the baby exam, we were gifted with a song! How many people can say that their pediatrician serenaded the baby before examining them? Truly, we are blessed to be surrounded by such wonderful people.

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!