The Ina May Weekend

My work at the birth center is an integral part of my life.  In many ways, it does not seem right to call it work.  Midwifery is so much more than a profession; some refer to it as a calling.  It becomes a core part of your lifestyle and a defining part of your character.  I am proud to be a midwife and cannot imagine doing anything else.  Like many midwives of my generation, I was partially inspired by the work and writing of Ina May Gaskin.  She has been referred to as the Mother of Modern Midwifery and is the author of several groundbreaking books, including Spiritual Midwifery.  When I was pregnant with my first child, I found Spiritual Midwifery and it is part of why I chose the path of midwifery.

Recently, I was blessed to have the opportunity to meet and spend time with Ina May.  (I briefly mentioned this in my previous post titled, Powerful Weekend.)  A midwife friend, Samantha McCormick, who owns Baby Love Birth Center in Florida was hosting a screening of the new documentary Birth Story and Ina May came down to present it.  I was invited by my friend to join the fun and thanks to my generous boss, was able to make the trip.  And boy o boy was it worth it!  The documentary is amazing; funny, insightful, inspiring and truthful.  Luckily, there are  screenings all over the country, you can learn more at http://watch.birthstorymovie.com/  .  I highly recommend seeing it if at all possible.  You will laugh, you will cry and you will hopefully be inspired!

It is an intimidating thing to meet an icon, and I was more than a little nervous.   Sharing dinner with Ina May and several other wonderful midwives is an experience that I will never forget.  I found her to be warm and welcoming, with a wicked sense of humor.  I was somewhat nervous about coming off as a groupie, but was quickly reassured by Ina May's open, down to earth demeanor.  In hindsight, I am grateful and happily surprised that I was able to sit with this group of midwives and feel like an equal among peers.   This “work” is fulfilling and beautiful but it is also exhausting and demanding.  To have the opportunity to be in a circle of other midwives from around the country, including Ina May Gaskin, was a powerful way to re-charge my batteries. 

 

Powerful Weekend

This weekend, I was honored and blessed to have the opportunity to meet and spend time with several amazing midwives at an event in Florida.  One of whom was Ina May Gaskin.  It was truly a gift and I will be sharing part of my experience in an upcoming post, but I wanted to briefly discuss the content of these photographs.  As part of her presentation, Ina May brought parts of her Safe Motherhood Quilt. To stand up with her, and other midwives, to hold and bear witness to this powerful project was intense, moving and inspiring. As a midwife, I feel that guarding the health and safety of Mothers is an integral part of my duties. It is a responsibility that I take very seriously and physically holding this quilt resonated in my bones. Please take some time to learn about this project and visit the website atwww.rememberthemothers.org

Flight

Sometimes the universe likes to be funny while keeping us on our toes.

I was on call, there was no one in labor, but I was at the clinic enjoying lunch with my co-workers.  We were all  chatting about our weeks and just enjoying the company.  One of our midwives mentioned a movie she had just seen, "Flight" (which I have not seen) about an airline pilot who has to respond quickly to an emergency, preform some "superhuman" maneuvers and remain calm to manage the situation.  And that she thought it had some correlations to midwifery.  That sometimes, things are progressing calmly and normally when an emergency can arise and we must respond quickly and assertively, utilizing our skills and training to mange the situation.

Several hours later, a family had come in to the center, excited to be welcoming their first baby.  Mama was very tired as she had been in latent labor for a very long time, Dad was hanging in there and they had a fantastic doula with them.  We settled in for the work.  Amazingly, after all the hours and hours of early labor, once at the birth center her labor progressed remarkably fast.  She was a trooper and had a pretty intense ride for about an hour and half as she moved through transition.  Then her sweet little babe had some difficulty, letting us know through her heart rate.  She had several dips, with good recovery, but still she kept having the dips.  We changed Mama's position several times and gave her some oxygen.  I stilled the room, made direct eye contact with Mama and told her that she needed to pull out her Mama Bear and bring her baby to us.  Never underestimate the power of the "Mama Bear Instinct".  This Mama was so focused, so powerful and did amazing.  Her husband and her doula were fantastic.  We were all focused on this little baby and bringing her through safely.  Despite her courageous efforts, the babe was still not coming quite as fast as I liked and I called EMS for a transport.  This gave Mama an extra surge of energy and as the EMS crew arrived, the baby was birthed.  Baby girl was completely tangled up in her cord, it was looped all around her several times almost like a harness. After untangling her, she needed a little help to get started but then did wonderfully.  Thirty minutes later and all were tucked up in bed getting acquainted.

An hour or so after the birth, I was sitting at the desk working on all the paperwork.  The Dad came over to me, gifting me with extremely heartfelt words of gratitude.  We had a little discussion about how the birth had gone and then he says to me, "Have you seen that movie Flight?" Seriously, he said that to me!  I was so surprised, I thnk that I just sat there for a few seconds with my jaw hanging open.  He then proceeded to relay the same basic observations that my midwife colleague had made about the movie earlier that afternoon.  I guess I have a movie to go and rent....

Champagne

It was another three baby day...there is a joke at the birth center about my shifts and how they are always busy....

She was working on her first baby.  As such, she had been working for a while and was getting tired.  She asked to leave the birth center and go to the hospital.  Many Mama's ask this at some point in the process.  We support them through it, sometimes by distracting them as we did with this lovely Mama.  I checked her and she was 8cm, yay!  In the throws of transition, she still wanted to leave.  We loved her, distracted her some more and bought an hour...then she was ready at C/0.  She was so ecstatic to be at this place, that she (as a first time Mama) pushed her little one out in 16 minutes!  Each push was so powerful, she had decided she was done and wanted to have the little one in her arms.  She was at the point of crowning, I was talking to her about slowing down and simply breathing through the rest, when with the next contraction her beautiful baby girl just POPPED out into my hands!  She literally was crowning one second and the very next second a whole baby was in my hands and she was accompanied by a shower of birth fluids that anointed us all.  My nurse and I were so stunned, and we decided that it was just like the cork and fizz from a champagne bottle.  Baby girl was welcomed with the sounds of laughter and joy.

Those Smiling Eyes

She had been at the birth center all day.  I had been very busy.  While she labored, strongly and with the support of her husband and doula, two other babies had been born.  I had been able to spend time with her.  To sit and be in her space, to feel the rhythm of her birth song.  I would have liked to spend more time with her.  Thankfully she had a wonderful doula, a doula that I know and have worked with before, so I knew she was in good hands when I could not be with her.  Eventually, I was able to concentrate souly on her. 

It was now early evening, the birth center was quiet, the subtle energy of the previous two births was light in the air. Her body and baby were making the shift, moving from opening to pushing.  She was working, walking in the hallways with her husband.  I was also walking, from her space to other spaces and back again, it seemed that there needed to be a flow.  Being still in one place was not correct for this labor. On one of my passes, I noticed that she was ever so slightly grunting at the top of her rush.  I smiled at her husband, the time was coming.  Just a few minutes later, she was in the bathroom, on the toilet.  I went to be with her and low and behold, she had brought her sweet little one to a small crown!  On her face was the most glorious smile and the happiness was shining through her eyes to lite up the small room.  She continued to smile through each push and calmly welcomed her daughter earthside. 

It was a birth surrounded by smiles, laughter and love.  It was a birth that every Mama and Baby deserve, one that characterizes why we do what we do.  All the struggles that make the birth center possible are worth every effort in these moments.

YAY! Birth Centers!

Outcomes of Care in Birth Centers: Demonstration of a Durable Model Stapleton 2013 Journal of Midwifery & Women’s Health Wiley Online Library

This is the new "Birth Center Study".  It clearly proves (yet again) that the midwifery lead birth center model of care is fantastic!  This model of care increases good outcomes and decreases costs all in one smooth package!  Additionally, "my" birth center was one of the participating centers in the study.

The Great Chux Weighing Experiment

For the complete background on this issue, please refer back to two recent posts: "Stats....200 Babies" and " Putting Yourself Out There".  Briefly, back in November, I was lucky to catch my 200th little babe.  Afterward, I put together some statistics from those births.  Some were expected and some were not.   One thing that surprised me was the rate of PPH.  (Again, for the full story please read the posts mentioned above.)  Since that time, I have been weighing every chux after every birth, and I just baby #210.  So, I thought that I would post an update:

Birth #201: EBL 200cc (my guess was 150)

Birth #202: EBL 100cc (my guess was 100)

Birth #203: EBL 500cc (my guess was 400), this Mama had no negative symptoms so I did not call it a PPH because it was not more than 500...

Birth #204: EBL 200cc (my guess was 250)

Birth #205: EBL 150cc (my guess was 150)

Birth #206: EBL 150cc (my guess was 200)

Birth #207: EBL 900cc (my guess was 850), this was a second time Mama who had a precipitous birth, she did have some symptoms and received two different anti-hemorrhagic medications.  She stabilized and finished her recovery at the birth center before going home.

Birth #208: EBL 2500cc (this is not a typo!), this primip Mama lost 1900cc at the birth center and was transfered to the hospital where she lost an additional 600cc.  She had a long-ish labor of over 15 hours, and a long-ish second stage of 3 hours and 15 minutes, third stage was 20 min.  She had SROM'd 18 hours prior to the birth, had been afebrile and the fluid was clear.  Baby was term and weighed 7# 15.5oz.  Initially, with the placenta she lost 700cc, received a dose of IM pitocin and stabilized.  Then at 1 hour and 45 minutes PP, over the course of 15 minutes she lost another 1200cc.  During that time, she received an IM dose of methergine, cytotc rectally, an IV was started and a foley catheter was placed.  She was very symptomatic and an ambulance was called for transport.  Upon arrival to the L&D unit, she had stabilized.  She was taken to the OR and a 600cc clot was removed from her uterus.  Then she completely turned the corner and had a good recovery...after receiving 2 units of blood.  An obvious cause for her PPH was not identified, there was no hidden laceration, the placenta and membranes were intact.  She is a healthy 25 year old who had had a completely benign prenatal course.

Birth #209: EBL 100cc (my guess was 150)

Birth #210: EBL 950cc (my guess was 900), this primip Mama had a precipitous labor with a hard second stage.  Her little one had double compound hands and she really had to work him out.  Baby was term and weighed 8# 10oz.  She had PROM'd about an hour before her labor started, she had been afebrile and the fluid was clear.  She received an IM dose of pitocin, then had some more bleeding and an IV was started with pitocin in the bag and she was straight cathed (she was unable to urinate in a bed pan or to walk to the BR).  She then stabilized and finished her recovery at the birth center before going home.  She is a healthy 25 year old who had had a completely benign prenatal course.

So, yuck...three big PPH's out of those 10 births!  Now, hopefully I won't have another one for a long, long time.  I have noticed that these things usually happen in clusters, so I am hoping for that.  In general, our Mama's have good diets, we recommend 65-75gms of protein per day and have the ladies do dietary recalls for us.  We recommend nutritive pregnancy herbs and regular exercise.

What I did learn from this experiment is that my EBL "guessing skills" are just ok, with a range of 50-100cc's off.  I found it to be much easier to estimate the loss when it was lower.  Thoughts?.....