I was blessed to attend two amazing births with two amazing mamas in the last month or so. My mid March baby was born to a second time mother and was super polite and came ON her due date. This birth stands out for me, simply because it was so perfectly perfect. Labor was not too fast, not too slow, mama was in tune with her body, papa was great support. Textbook waterbirth. The only hiccup was that rather than papa catching the baby, he was holding the 2 year old who woke just in time to watch her baby sister come into this world.
This is what many people imagine homebirth looks like. Hands off, no intervention. This is what BIRTH should look like, regardless of where baby is born.
I recently heard that many people unfamiliar with homebirth are somewhat under the impression that families who choose homebirth, accept with a varying degree of conviction that their babies could die, and that they are okay with that. I think it is also a commonly held assumption that midwives don't DO anything at births. This is really farthest from the truth. Families who choose homebirth are not ever any more okay with their baby dying than any one else. They have however done an exceptional amount of homework and have looked at the risks involved in birthing anywhere and have made what they believe to be the best choices for themselves and their baby. Most of the time they choose a midwife who's philosophy and skill provides them with a safety net, and allows them to fully experience birth the way they have envisioned.
Fast forward to our mid April birth. Also second time mother, average length of labor, but this mother needed help. There were times when I had to be right in her face, encouraging and guiding her. There were times when I had to be hands-on-interventive. There were some anxiety provoking aspects to this birth as well. The reality is that babies let us know how they need to be born. Competent midwives understand this and are constantly evolving to be the kind of provider that women can trust if the crap-hits-the-fan. This doesn't happen frequently, but it does happen. I personally feel very proud that I was able to provide the care that this mother needed, to be a strong advocate for this family, and as you can see above, assist in another beautiful homebirth.
My training didn't end 8 years ago when I started attending births as a primary midwife. In fact I truly believe it had just begun. I consider myself blessed that I have so much access to information and training, incredible textbooks and instructors who believe in hands off birth, but also in being prepared. I also feel overwhelmingly blessed to be an apprentice to birth, at the feet of women, in service to them and their families. THIS is what a midwife provides.
January brought with it 4 moms due, 3 births and so much joy. Two snow storm babies, followed by quick labors and uncomplicated births, one big ole' boy and one sweet little Amish baby girl. One amazing Kentucky mother had also a very quick labor, with a posterior baby. What resilience and strength these women show me on a daily basis. Our last January mama had her sweet angel on the 8th of February. This birth was long, and ended with a transfer, but was not without it's own depth, joy and pure empowered birthing on the part of the family. Each baby that helped me welcome the new year, two boys and two girls, have shown me where my feet belong.
There was a good stretch of time after that rush where I was off call, and able to enjoy some family time. I celebrated my youngest son's Jaysun's 13th birthday. They grow so fast but I can remember very clearly his birth, my first homebirth, on that cold February day. My journey through pregnancy and birth with Jay was one that guided me ultimately to what true empowered birthing was. Even my postpartum transfer to the hospital with a heavy bleed and anemic condition made concrete for me the knowledge, trust and empowered language to navigate that space in a way that left me feeling strong, capable and also with an experience that allows me to sit in that space with women I serve and say "I know".
The new year also brought with it new clients, many new clients. Also plans for some time off late Sept through late November, for travel, training and to take the NARM exam. I have been blessed in so many ways, but especially with the abiding love and support that has allowed me to embark on this new journey in midwifery. I have also welcomed several new students into the practice. It is exciting to see the energy that is creating a new/old way of honoring women. We have plans for a local Birth Network
group and more community support. There was also quarterly training workshop in the Wiyama office, offering us time of learning and community.
Spring peeked around the corner and shared magical space with another perfect, sweet birth of a polite and graceful little girl. She came ON her due date, also a quick labor, and she and her mother are doing super. I truly live a charmed life. Sure I complain about the driving, weather and lack of sleep, but I couldn't imagine another thing I could do with so much joy, passion and confidence. I truly believe that I am doing my life's work.
This morning I attended a lovely, quick birth with an Amish couple who were having their 6th child. I have worked in religious communities before, and rarely am I not touched by the love and commitment in these families. It takes some getting used to in this hurry-up-cell-phone-facebook world, the lack of what we consider daily amenities.
We had a trial run with this family in the wee hours of the 10th, The dad told me not to rush, that contractions were slow. We had to drive painstakingly slow up a mountain and back down the other side in pea soup thick fog at 20 miles an hour, and then back out again in a snow storm. We proved that inclement weather only really adds 20 minutes on to the drive. It was worth knowing.
This morning, after an amusing mix up with the phones (my cellular provider somehow mixed up calls, and the exact minute the papa was trying to call me to tell me his wife was in labor, another call from someone named Diane in Pennsylvania connected to my phone, but from the clients phone number, which popped up on my caller ID. She was looking for Kevin. At 2 in the morning.) The papa's call went directly to voice mail. He called my apprentice Haylea,who was sleeping at my house since we had gotten in late from a home visit last night, and she and I got it together and got out the door in 8 minutes. This time papa indicated that the mama was REALLY in labor, and since she has a history of precipitous labors, we were counting our blessings that we could see the stars in the sky, and the roads were clear and dry.
This time we learned that if we drive carefully but expeditiously on the mountain road, when there is NO other traffic we can cut 15 minutes off of the drive.
On the night of the trial run, we pulled up in front of the house, and it was dark out. I mean REALLY dark out. Can't see your hand in front of your face dark. I mumbled under my breath that I wish they had turned the porch light on... but before I even got the full sentence out of my mouth I looked at Haylea and said "Oh wait, they CAN'T turn the porch light on". We had a good giggle and Haylea dubbed that as the "quote of the day". This morning I was prepared for the dark, had even counted the number of stairs up to the front door the visit before. This time we carried all of the bags in at once. We did a quick assessment of the mama and baby and left her to do her beautiful labor dance. Having done this 5 times previously, she had it down to a science. She was focused and methodical. She walked, I mean POWER walked circles through her house, with each contraction, squeezing blocks of wood in her hands. When the contraction was over she would sit quietly in the rocking chair with her eyes closed. Not a sound came from her lips. The oil lamps were burning softly, there was a pot of coffee on the wood stove, and we set about making ready for birth.
We arrived at 3 am, were set up by 20 after. We simply sat quietly or chatted with the papa and this amazingly strong woman, this woman who had stacked firewood and washed sheets and blankets by hand and hung them on the line earlier in the day, walked and sat, walked and sat. I read, Haylea crocheted. We noticed as the time moved forward sleekly in the cold and dark night, that her walking and sitting became more frequent. It was too dark in the room to really see my watch, but Haylea noted that her contractions were now 3 crocheted rows apart and lasting about 5 laps. This is midwifery. Not watching the clock, watching the woman. Watching the miracle of birth unfold before our eyes. The couple was very sweet, and at about 6 am, the mama climbed onto her bed and said she wanted me in the room with her. Papa rubbed her lower back vigorously. She quietly began pushing on the bed. I washed up and put on my gloves, and gently, after about 15 good minutes of pushing, a sweet little boy worked his way out and up to his mother. He cried lustily immediately.
And then I realized... this was not just birth, this was life. An authentic life. Not by any clock, not by any rules or expectations of what it is *supposed* to look like. Her contractions went from 10 crocheted rows and 3 laps to baby in just over 3 hours, and it was perfect. I wanted to take pictures, because I love to look back at them and remember all of the sweet little details of every birth, but then I realized that pictures would have marred the perfection. No machines, no medications, not even any electronic note taking. Just a mama, a papa, a baby and patient, waiting, gentle hands.
(PS we did get the traditional baby weighing photo, with papa's permission, before we left. That is tradition.)
This last couple of weeks were unmercifully crazy. We were out of town at a state midwifery meeting, and were on call for two mothers. One right at her due date, another at 38 weeks. The mom who was due, was having her 9th child, and had fast labors. The other mama was a first timer, very sweet, very young newly wed. We made sure everyone knew we would need extra driving time, and to call early.
Our meeting ran late and we sat up kibitzing with other midwives until about 2 in the morning. Then we went to bed. At just after 5 am my phone rang. It only rang once, but in actuality two calls came through at precisely the same time (one went to voicemail). BOTH mothers were in labor. We threw our stuff in the car quickly and hit the road, again in the wee hours. Grabbed coffee at the drive through and then made the 2ish hour drive to the first mother's home. We arrived at about 7:30, assessed mother and baby, and got to making ready for birth. Mother sat on the edge of her sofa, breathing softly once or twice with each contraction. Between contractions we chatted as we had done for months in my office at prenatal visits. Once everything was ready, we slipped our shoes off and settled in to wait for baby. I listened to the baby again, and she sounded perfect. Now the waiting game.
By behavior I would never have guessed that this mother was in labor. She didn't look uncomfortable or even working much with her contractions, and she was very social. 8 minutes after I slipped my shoes off, mama drops to one knee beside the couch and grunts. Her water breaks. There was meconium in the fluid and A LOT of it. I listened for baby again, and could not find heart tones no mater where I listened. Just as a wee bit of anxiety started to creep up in my chest, fter about half a minute of listening, the mama sort of croaked my name, and I looked down to see the baby's entire head out. I quietly asked Haylea who was sitting on the birth stool charting, for a towel and she handed it to me without even looking. She assumed it was for the fluid on the floor. She glanced up at me to ask what heart tones were, just in time to see the whole baby slide out. Baby number 1... check.
We cleaned up, did the newborn exam, made plans to see mama the next morning, and dashed out the door. We were there 2 and a half hours total.
We had been keeping up with the other mama via text, and knew she was truly in labor, so we grabbed breakfast and coffee and went directly to mama #2. We walked in the door at about 11am. Her water had broken on the commode just as we pulled in the driveway. Again, I did a quick assessment of mother and baby and we got to the work of setting up, which was more complicated this time because we had to set up the birth pool as well. In about an hour or so we got everything set up, listening to baby every 20 minutes or so. We could tell this sweet girl was really beginning to be uncomfortable, but still, she had the softest demeanor, no sounds of distress did she utter.
She got into the pool, and was instantly soothed. We don't call the birth pool the aquadural for nothing! She began whistling through her contractions. Not a song, just a long slow whistle with each breath. We listened to baby and gently encouraged mama, loving the energy in the room. This sweet couple were newly married and very young. The sister of the papa had just had had a homebirth herself and was there since early in the morning, just praying with them and doing whatever they needed. She was an amazing doula. Just a sweet, sweet family.
Before long the mama's whistles started going up in pitch at the peak of the contractions, and I was noticing a bit of a dip in the baby's heart rate with them as well. I asked if I could check her, and she said yes. I was surprised to find that the baby was nearly crowning. How this mama had no gut wrenching urge to push I cannot figure out. We discussed pushing, she tried it on for size a little bit, and then she decided she wanted to get out and go to the bathroom.
On the way back from the bathroom she stopped and sat on the birth stool for a contraction. She was so comfortable there, she just stayed. She started pushing all on her own. This awesome, first time mama, who had really only labored about 8 hours total, pushed about 15 minutes in earnest. She was a little afraid of tearing, and was holding back a little. I tried to coax her back into the pool, but she didn't want to move. Finally the urge overtook her and she got to the business of pushing our her baby boy. She was amazing!
At 1:30pm on November second, the second November baby slid into the world. He too came out bawling and was just perfect. Baby #2, check! The mama experienced a pretty significant laceration which bled a good deal. We ended up transporting her to the hospital for a repair and fluids. Overall, it was a beautiful birth and an awesome learning experience for us, in transferring to a different hospital than we normally use, and the chaos that ensued when we showed up with the mother and NOT the baby. But in the end the hospital has become an incredible ally for us.
So the rest of the week was back and forth, an hour out and an hour back, twice a day to the mama who was admitted to the hospital, and then to the first baby who had developed jaundice and needed frequent bilirubin checks. It was exhausting, BUT, I feel like I have a family there. Not just a family in the sense that all of my clients become family, but I had actually grown quite close to both sets of parents of the young couple, and in the hospital staff who were amazing.
Oh yeah. We never did meet the papa of the first baby until the 24 hour visit.
We had 3 clients on our calendar for the months of July/August. Not a super heavy load, the days ticked by and no one had a baby we were really starting to sweat (sweat in the sense that we were going to have overlaps, not that they were over due). Two of our summer clients were VBAC's (one due in late July, and one due in mid August) and one was a first time mom (due mid August). We had grown quite close to them over the previous months.
Mom #1 8/07/13 VBAC
This mom worked so hard during her pregnancy to be healthy, even though she has had a terrible relationship with food, her body and birth in the past. She ate well, stayed active and went nearly two weeks over due. Unfortunately after 3 days of labor, 2 days with membranes ruptured (spontaneously), getting all the way to complete, with NO urge to push, this mama ended up transferring to the hospital and having another C-Section. My heart just broke for her. She cried, and we cried with her. Portly Baby #1 was born in the early morning hours weighing in at 9lbs 15.5 ounces. I say even though she didn't get her vaginal birth, she is still a rockstar!
Mom #2 8/17/13 Primip.
Got the call from this mom about 8 in the morning that she had been having regular contractions since about 5am. She too was nearly 2 weeks passed her due date. We popped over, as she was nearly walking distance from both mine and Haylea's houses. She also had a friend there who was her doula. We set up, got the pool filled and mama got in to the pool. She had a stellar labor, record breaking speed. about 1pm she was feeling some urge to push, so she got out of the pool to go to the bathroom and sat on the birth stool to rest. Her water broke, there, and almost immediately she started to swell. I cannot for the life of me make sense of it, but in the next couple of hours her poor anatomy swelled and swelled, and we again, had to transfer to the hospital, again mother required a C-section. Words cannot convey. She was very understanding, but disappointed. Baby #2 born at abut 6pm, weighing in at 9lbs 6oz. Again, a rockstar!
Mom #3 8/22/13 VBAC
This mom is a young woman I met from Eastern Kentucky. She traveled the nearly 3 hours to me (one way) for all of her prenatal care,except for two visits. She was also passed her due date, and coming in to my office for a prenatal visit. The transmission blew out in their new-to-them fresh off the lot minivan, stranding them here. Staying in a hotel, waiting for the car to be repaired she went in to labor. The hotel room was entirely too small to set up the birth pool so we decided to have the baby here at my office. Let me say right off the bat, THAT rocked ALL THE SOCKS! I was able to sleep in my own bed, eat my own food and it all worked out so perfectly. The labor was long and slow, about 24 hours of latent labor, with very little sleep to be had, mostly for her. When Active labor kicked in, she only had 3 hours of it. She was tired, but super in tune with everything, and the truest example of a mother in *labor land*. She pushed actively for about 15 minutes. She pushed a 9lb 11 oz baby (boy) out of her vagina. August was a ROCKSTAR month. Oh... and nary a tear. She recovered on the futon in my office, I took the papa to get their vehicle and the went home to begin a new life as a family of 4.
Each time I am blessed to serve women in this sacred way my capacity for love and joy becomes greater. I can triumph with them, cry with them, and try to be what they need, when they need it. I love the men who love the women who have their babies with us. I am forever changed by each and every birth. Tiny little footprints on my heart.
I just attended a mama who had her 3rd baby with me. It is amazing to see the family grow and change, the babies so full of personality and charm. While things are similar with most every birth, every birth is also quite unique, and these three births, although they were to the same mother, with babies in the same size range, the births were very different!
Denise has herself been a student midwife, and now holds a bachelors degree in holistic health care. The first birth I attended with her occurred in Massachusetts, outside of Boston. I flew up close to her due date, and stayed for a week. She usually carries her babies to 41 weeks, so we were sweating it a little when 41 week mark came and went, worried that I would have to extend my trip and buy a new plane ticket, but labor came at 41 weeks and 2 days.
Denise had invited two of her friends from midwifery class to attend, as assistants/doulas and it was actually the first birth I ever attended with the help of an assistant (which was bliss, and I have never attended one alone since). This was her fourth child, first homebirth. Her labor started slow and easy, progressed in a textbook manner, she felt pushy, climbed on the bed and pushed a couple of times and out slid a beautiful baby girl (if you ask her son, who was around 4 at the time, he will tell you that she just JUMPED out of his mom's crotch). The only thing even slightly out of the ordinary was her partner Pete, who was slightly squeamish passed out shortly after the placenta delivered. I still give him a hard time about that. The birth was perfectly textbook, about 12 hours from start to finish. Lovely, normal postpartum, lovely normal newborn in the 7ish lb range.
About 4 months after after that sweet baby girl, Nova, was born, Denise and her family moved south to the city I lived in, with plans that when her baby was older, she would begin to attend births with me. Denise and I had been great friends for a long time prior to that birth, I think we knew each other when we were planning the births of our now 10 year-olds. Before she could get Nova weaned and be ready to work with me, she became pregnant again.
At precisely 40 weeks, a little earlier than Denise's norm, labor began. We expected things to progress along the same lines. While the early and middle parts of the labor went very much the same way as the first, transition this time was hard. Denise spent hours at 9 centimeters. I have no real understanding of exactly why it happened, but it was hard. Hard for her, hour after hour, being told "I know it hurts" and "No, I don't know why it is taking so long, but you both are fine". Hard for me to see my dear friend suffering, knowing there was little I could do to help her, but to trust birth and trust her strength. She never gave in, she kept fighting the hard transition fight, until finally, after 6 hours of incredibly intense end stage labor, with a roar and two hard, unexpected, spontaneous, pushes, another sweet baby girl was born, caught by her mother's own loving hands. This baby DID actually jump right out of her crotch. I didn't even have time to put on gloves. She had a very short cord, and I suspect this was the reason for the slow descent, but we will never really know. Lola was almost a carbon copy of her sister, a bit heavier, but they could literally pass for twins at birth.
This last birth was an exercise of shooting from the hip. This was a surprise pregnancy, She has moved, and I have since relocated my midwifery practice to Southern West Virginia, so we have a considerable distance between us. Denise is nearly 40 and not was feeling as fit or healthy as she has in the past. Certain health issues created minor hiccups in the course of prenatal care, and all along, Denise considered the strong possibility that she might have this baby in the hospital. Part of it being realistic, and I think part of it was her fear of transition. The stars aligned, and I found myself nearby during the holidays. Denise was still not 100% committed, but willing to see what happens, the plans were made for me to hang out, and for Denise, her partner and her beautiful 19 year old daughter Amber to rock this last birth out. The thought of Amber catching the baby made us all excited and proud, proud of the deep trust that this young woman has now in birth and the power of love and life.
The labor began at 41 weeks and change, and was relatively quick, judging by her earlier patterns. About 4 hours of active labor, and about 6 pushes, and handsome little David slipped into the world, with a blonde fauxhawke and looking as adorable as his older sisters. Things got a wee bit hairy at the end, but the family performed amazingly. Over all, this birth was perfect. A perfect end to an era of creating wonderful little people to populate the earth with their wit and wisdom, the wisdom passed on to them through their mother and father, their loving brothers and sister, their connectedness as a family. I am proud and honored to have been a part of the creation and evolution of this family.
I love you Denise and Pete You are great parents.
I met J. and C. through another midwife who practices about 2 hours from me. I spoke with J. online many times before they finally came into care. J. was receiving care from a local OB, and was having a normal uncomplicated pregnancy. This was her second child, and she wanted a low tech, intervention free birth. They spoke with several previous clients, and did lots of homework before actually committing to care. C is a surgeon in a local hospital, so he had lots of questions. Finally they called and set up the appointment, and transferred care completely.
J is a sweet, soft spoken southern belle, certified as an elementary school teacher, but currently teaching their only child at home. They both asked lots of questions at prenatals, and maintained a healthy lifestyle throughout the rest of the pregnancy, to ensure a great birth. Their little boy was quite possibly the smartest two year old I have ever met. There is much to be said for genes.
The afternoon her labor began I had just pulled into the parking lot of a community pool where my daughter was having a end of summer pool party with her softball team. It was about 4pm. J. texted me that her contractions were mild but regular and she would stay in touch. We texted and talked a few more times throughout the evening, and then bedtime rolled around. I laid down and tried to sleep, but it just wouldn't come. I realized much too late that I am in the wrong profession for someone who is as sleep sensitive as I am. I got another text that her contractions were 5 minutes apart and getting stronger, so I got up and showered. I called her when I got out of the shower, around midnight, to check in and see if she wanted me to come. Her mouth was saying no, but she sounded like she was working hard, and I had an hour drive, so I made the call to go ahead and go. Haylea was still up in the northern part of the state, and had to have her toddler into the doctor in the am, so I didn't even bother calling her. I texted Sandra, and she met me at the house and we left together.
We got to J's home around 1:30am. I got in and said my hello's and took a set of vitals. Listened to the baby and he sounded perfect. She asked me to check her, and the exam showed her to be 3-4cms dilated and about 80% effaced. She said she was tired and wanted to try to sleep. Sandra and I went into the other room they had set up for us, with a coffee pot and sleeping space, should we need it. We made a pot of coffee and chatted quietly in the other room. Every 5 minutes, I heard J softly moan through her contractions. I went in a couple of times to check on her and listen to the baby. At one point, not to much later, I heard them up rummaging around so I peeked in and saw that she was getting into the bathtub. It was about 3:30am.
Since she was up and running a bath, Sandra and I decided to go ahead and fill the birth pool, and set up our equipment. Her bathtub was a spacious jetted garden tub, but had a sliding glass door which offered NO access to mom and baby, so we decided the pool was the better option. We got the pool inflated, and went to attach the hoses and found that every single fixture on their upstairs level was too small to fit any of my hose attachments. Frustrated but motivated, Sandra and I set to work filling the pool with pots, stopping every 15 to 20 minutes to take a listen to the baby. J and C were such an awesome team, working together during her suddenly very intense contractions.
Around 4:30 we got enough water into the pool that she could move over, and in the process of getting out of the bathtub, her water broke. She got into the pool, and was immediately in transition. I have never seen a woman have such an intense transition. Sandra continued to work on filling the pool, while I offered what support I could. It seemed as though nothing we did helped her in any way. Her husband, who was a larger man, was working hard to do counter pressure on her back, while she clutched and grabbed at his clothing, screaming with the peak of each contraction. Each contraction seemed to be more intense, and she was having a lot of pain in her sacrum and lower back.
I was sitting on the birth ball beside the pool, gently encouraging her through every contraction, while her husband struggled to do counter pressure on her back leaning over the pool and reaching around behind her. while she grabbed his shirt and pulled on him, trembling and screeching the whole time. In hindsight it was quite comical, but at the moment, it made everyone anxious, her pain was so intense, and there was a very real chance that she might actually pull her fully clothed, very large husband into the pool with her, on top of her! I listened to the baby after every other contraction, knowing she was very close, as the heart tones were very low, just above the pubic bone. I tried to encourage her to reach inside and feel the baby's head, she was adamant that she was hours from finishing and it was just too hard.
At one point, around quarter after 5, J. looked me dead in the eye, and serious as a heart attack said "I can only do this for 15 more minutes". I remember thinking, "Or what"? but what I said was "One at a time honey, one contraction at a time". Luckily for all of us her baby was born EXACTLY 15 minutes later. I guess she was serious. Baby Cameron was born into his father's hands smooth as silk. Baby was pink and happy, mama hardly bled at all. Perfect birth in my eyes, but hard, hard work in hers.
Every birth I attend humbles me. Every woman who births her baby in her power and on her own terms shows me how strong we really are, but also how fragile. I am never cocky, for I know at any moment, no matter how much I trust birth and believe in women's power and strength, it can change. I know that birth is as safe as life gets. We can never be fully prepared for the unexpected tragedies that occur in our lives, but we can soften our hearts and be of humble spirit, listening to the wisdom of God in every thing. We can't be prepared for every little hiccup that might occur along the way, but we can be flexible enough to change our minds about what exactly constitutes perfection, about what brings us to our knees before our creator, and trust that there is a bigger picture, a larger destiny than we can see.
Oh... and we ended up bailing that pool with the same pots we filled it with.
There is so much controversy surrounding VBAC (Vaginal Birth After Cesarean) lately. Cesareans are the #1 most frequently performed surgical procedure in the US, and the cost of surgical intervention is more than twice the cost for a vaginal birth in the hospital. As of 2010, the C/S rate in the United States is at 32 percent nationally with a variance of 22-38% on a state by state basis, the rates having risen as much as 50% in the last 10 years. The World Health Organisation states that a safe and valid number should be somewhere around 15%. The maternal mortality rate as of 2011 is 12.7% ranking the US 50th world wide, a number which has doubled in the last 25 years. The infant mortality rate in the US is 7%, ranking the US 34th worldwide, and this number has risen in the last decade. The premature birth rate in the United States is 12% which ranks the United States a whopping 131st world wide. C-section rates are higher among the poor and ethnic minority populations, mostly because they don't know better. What these numbers prove is that a rising Cesarean rate is not improving the lives of mothers and babies, actually quite the opposite appears to be the case. It is also violent and damaging to a women's psyche. Along with our soaring rate of intervention in birth, including the ridiculous rate of surgical intervention, postpartum depression and psychosis has become an epidemic.
Fewer and fewer providers are allowing trials of labor (TOL) for women who have previously had a surgical birth. The American College of Obstetriticians and Gynecologists (ACOG) themselves endorses TOL and VBAC, stating that the risks of repeat surgery are greater than the risks of complications occurring because of the uterine scar, but again and again I hear from women who cannot find providers who will all them to attempt a vaginal birth in the hospital. Sadly, even midwives are becoming rigid about this. Many nurse midwives practicing in the hospital cannot or will not encourage or assist women with VBACs, especially if they have had more than one Cesarean I believe in homebirth and ultimately unassisted birth, I believe in the strength and power of women, and the body's miraculous ability to heal, but I am sad and frustrated that women are being FORCED to choose between homebirths and surgery, when they may not feel 100% safe at home. Of course I deeply believe that most women can give birth vaginally, and that most women experiencing low risk pregnancies CAN have their babies at home, but not everyone WANTS to have their baby at home. Homebirth has to be an option that parents come to on their own, rather than it being forced upon them.
If you injure your back or blow out your knee, you are urged to take the necessary steps to encourage healing, and eventually you are expected to use those parts again in the proper way. If you have heart surgery, brain surgery, bowel surgery, we don't just automatically assume that these organs are now defective and stop trying to live, no, we are encouraged to create healthy attitudes and lifestyles and HEAL. If the body can heal a back or knee or brain or heart, and those parts can be used again, for walking, twisting, lifting, thinking, pumping etc. it stands to reason that the uterine muscle will work properly too. We heal. We just do. It makes sense for surgeons who are performing Cesareans to be diligent in closing the incision with the expectation that the organ will heal and be able to be used again, in a normal fashion. Am I naive in thinking that this should be true?
So the question really is how committed are you to birthing your baby vaginally? Are you willing to stand up for yourself in the face of adversity, invest in a birth team who are going to support you and believe in you? Are you willing to say NO? Studies show that VBAC is safer for both mother and baby. The long term effects of natural birth over interventive birth, and specifically surgical birth are overwhelming. We do what we do, we breathe, we make an intricate chemical exchange in our lungs that is amazing. We eat, and think, and breathe, and pump and filter and gestate and give birth. It is what we do.
The chemical actions that occurs in mother and baby during pregnancy and birth happen the way they do for a reason. There is rarely an accident or malfunction that isn't caused by interfering. Normal birth happens. It happens when you are young, old, fat, thin, happy, sad, tall, short, married or not. It happens. It happens best when it is left alone. Homebirth is a safe option for women experiencing an uncomplicated pregnancy. VBAC is as safe as running a marathon on a knee that has been surgically repaired. The only difference is that the marathon runner gets patted on the back for pushing through adversity and overcoming the dysfunction.
To the doctors I say; women experiencing labor with a scar on their uterus need time. Blown out knees may heal quickly, but learning to walk, and run on it takes time to figure out. Stop rushing women into surgery. Stop supporting a broken health care system by damaging the uterus's of more than a third of women, you cannot honestly believe that one out of 3 women are defective. Stop spending so much time convincing yourselves and the women who trust you that they are broken. Women, stop believing you are broken. Our doctors and surgeons can save our lives, and that of our babies, when things go awry. However, just like we don't rush out and get a colostomy, the first time one might get constipated, women should not be having their uterus's cut unless there is a true indication for surgery. Fear should NEVER be an indication for surgery.
Sunday, November 18, 2012
There are times when I couldn't imagine any better job in the entire universe. I love what I do, and I couldn't possibly NOT do it. I've tried. Many who are interested in midwifery have romantic notions about what the job entails, and many people who are using midwives for their homebirths hardly understand exactly the level of commitment involved. So, this is for the women who may want to work in the birth field, and the families with whom we celebrate the changes in their lives.
Let me start by saying I rarely take more than 3 clients a month, 4 would be a busy month for me, because of not only the time commitment involved, but the emotional investment as well. Prenatal visits with me rarely run under an hour, and there is often a deep emotional connection to not only the pregnant mama, but to the entire family. I try to group prenatal visits on the same day or days of the week, and do them in my office, because the driving involved in home prenatal visits with a practice area as large as mine means that I would spend more hours in the car than I do with my clients, even with a more local clientele I would still spend hours in the car weekly. 3-4 clients a month, every month means I could see as many as 20 women a week, for monthly, bi-weekly or weekly prenatal visits. This does not include initial interviews, 37 week home visits, any emergencies that may arise, trips to the health food store to purchase herbs and supplies for remedies and teas, meeting with other professionals in the area to help provide a network of care, hours spent charting, documenting to keep everything up to date, and hours studying and researching in order to keep myself and my clients abreast of changing trends in evidence based maternity care, and holistic care for the entire family.
There is the call to labor at 3 in the morning, while you are grocery shopping, teaching a class or in church. There are births that last 2 hours and births that last for two days. There is the incredible investment you have to make in your own health as the provider, to ensure that you are up to the task of assisting at birth AND that you aren't making situations where mom's and babies could get sick. Next factor in the texts, Facebook messages and phone calls at all hours of the day and night. Please don't think I am for one second complaining, I am not at all. I say this with heartfelt affection and commitment to the families that I serve. I love them all, and make the commitment because it is what I have been called to do. I have missed children's birthdays and important anniversaries, Thanksgiving, Christmas & Easter with my family, to help bring sweet, sweet babies into the world. Even if I plan a week or two off *call* for family time, I STILL have to be available for prenatal care and attention to clients immediate needs. I am in it for the long haul, and my family whole heartedly supports me in this endeavor, even if it means that every penny of what I earn goes back in to supporting my work.
I have recently been privy to some conversations and attitudes regarding doula's and midwives which indicates a level of ignorance with regards to the emotional, social and economic commitment made by these women. It is frustrating to hear someone say... "Maybe you can find a student midwife who will attend your unassisted birth, since you can't afford a midwife" or "maybe you can find a free doula who needs some births for her certification". I am insulted FOR these women. It is incredibly dangerous to ask a birth professional to provide care that is outside her scope of practice and unfair to ask a birth professional to attend in a manner that is either too great a commitment for the investment you are willing to make.
It is important that doulas, childbirth educators, apprentice midwives, midwives, lactation workers and other birth helpers are shown the respect appropriate to the level of commitment involved in the work. We all have poured our heart and soul into what we do, and a lot of time, energy and money into education and training, that is ongoing. We are professionals who are committed to you on a level you will not see in the medical model, so take heed. We are professionals. We deserve to be paid for our time, energy and expertise. We deserve to be compensated for the commitment that our families makes so that we can be available 24/7 sometimes for days at a time. We deserve the courtesy of down time, holding non urgent business for the work day. Birth workers deserve to be recognized for the commitment to the families they serve, and compensated for the work that they do. You can't put a price on love, but knowing that the gas bill is paid goes a long way toward helping YOUR birth professional be more available to do what she does and what she loves.
Because we love what we do, there is always a way to make an equitable exchange. Ask, you might be surprised what the answer is. I personally LOVE to barter, because it means we can both do what we are good at and show exceptional value in that service above what money can provide. If society continues to devalue the women who are weaving the fabric of love around birthing families, too soon these amazing women will not be able to make the same investment in the community that does not support them. I have known quite a few birth professionals who have retired because the commitment required was greater than the community's investment. What you invest in becomes your reality. Invest in love.
Often times I am puzzled by the things that people think about when they are presented with the idea of birthing at home. Is my house clean enough, is it large enough, is it accommodating, close enough to a hospital etc.
One thing I have to constantly remind people is that babies come out. One of the best things is that they come out when mama is relaxed and feeling safe in her environment. Whatever it is that makes you feel safe, warm and supported, THAT is what you want/need for your homebirth. It doesn't matter that your house is small, or even an apartment. It is your HOME and that is the perfect place to birth.
I'm reminded of a recent client, who when she found out she was going to have to move into a much smaller apartment, was DISTRAUGHT over the whole thing, thinking that she would have to scrap her plans for a homebirth. I said to her "Sweetie, I'll come catch your baby in a gas station bathroom if that is where you want to give birth... Is your apartment bigger than a gas station bathroom?" What you need to know about space for a homebirth is that it needs to be a place you feel safe. I personally prefer running water and electricity, but the reality is that babies come out, they come out in cars, on trains, in grocery stores, in ambulances, in cold hospital rooms and operating rooms, with harsh lights and cold metal. They come out. They come out best when you feel safe and comforted. Babies need very little, and it is a little known secret that mama's and babies are PERFECT dance partners when they are left to figure it all out, unhindered and together.
The rest is just fluff. The dishes in the sink will wait, or they will get washed. The laundry in the dryer will wait, or it will get folded. The rest of it will keep. Trust yourself, trust your body and your baby, and do what women have been doing for eons, in caves, in plywood and tarp shacks, in huts and hovels. All that baby needs is you.