Kim Pekin's Homebirth Midwifery Blog

MANA Conference 2009 and Taking the NARM Exam

2009-10-26T10:08:00.000-07:00

I'm trying to figure out where to start with writing about my trip to California. I could start with talking about my flight, or I could start with talking about checking in at the Conference, or I could start with how I even ended up going to California in the first place. There are so many places to start. I thought I could start with acknowledging how the first birth I ever went to started me on the journey to California, and then realized that it wasn't the first birth that started me on the path, but that it has been something that was within me at a very young age, perhaps something that has always been there, even before I used to pretend that all of my Barbies were pregnant and giving birth all the time...

So, then, I decided to skip all of the philosophical mushy stuff about why and how I ended up in California, in favor of just getting down to it.

Got to the airport REALLY early on Wednesday, October 21st. My friend Teri joined me on this trip to lend me moral support and to take a very well-deserved vacation from the Northern Virginia rat-race. Desiree Cripps, my friend and sister student midwife, was also testing at MANA, and she coincidentally booked herself on the same flight Teri and I were on. It was nice to spend that time with Desiree, and I think we helped each other stay sane by supporting each other and being there to get through the pre-test jitters and post-test crying.

Once we arrived in San Francisco, we got our rental car and decided to stop off for Chinese food on the way to Asilomar. Awesome Chinese food, by the way. It was nothing like the usual greasy, salty, buried in sauce Chinese food we have here in Virginia. They had dim sum, which I had never tried before. None of us knew what dim sum was, so we ended up ordering a couple of entrees off of the menu to share, but then when we saw the carts of dim sum going around the dining room, I think we all were wondering if we should have taken a chance and had the dim sum. Maybe next time!

After our lovely lunch, we began our almost 2 hour ride to Monterey. Northern California is so amazingly beautiful, so we didn’t mind the trip at all. In between oohing and ahhhing over the beautiful redwoods, Desiree and I did midwifery pop-quizzes for each other – name the components of the biophysical profile, explain physiological jaundice, review gestational diabetes testing steps, etc.

The Asilomar State Park in Pacific Grove is where the MANA conference was held this year. This beautiful park was such a relaxing back drop for such a high stress test as the NARM exam. The rooms were, well, not great, but they were OK once we bought a fan, some Lysol, and a scented candle. Just a little too musty and stuffy for our comfort. Once we got the air moving and worked on getting the mildew smell out of our room, it wasn’t half bad. The food was marginal, but hey, we didn’t have to cook, so it was AWESOME! Walking outside between sessions and mealtimes was one of my favorite memories of Asilomar. Always present in the background was the roaring sound of the ocean waves. It was just absolutely idyllic at Asilomar.

I only made it all the way to the beach once. One other time, I got close to the beach to watch the sunset, and there were a few other times when I saw the ocean at a distance. Teri spent quite a bit of time reading and people watching at the beach. I think she probably misses her time there, despite the dead seals.

After a good night’s sleep, I got ready for my big test day. I had wanted to have a watch to wear to help me keep time during the test, but I had forgotten to bring one. Then, when I got dressed, I found my watch was in my pants’ pocket! I had left it in there and had washed my pants with my watch still in the pocket. Fortunately, my watch is waterproof, so it was no worse for the wear! I saw finding the watch to be a good sign that the day would go well.

Another good sign was being seated at the breakfast table with Anne Frye (author of Holistic Midwifery Volumes I & II, Understanding Diagnostic Tests, and Healing Passage, amongst other things). I had referred to her books countless times in preparation for the test and in doing the modules for my school. Not only was Anne Frye at my table, but everywhere I looked I saw a famous midwife having breakfast in the dining hall with us. Being surrounded by so many wise women helped me to feel supported, and reminded me that all of us new midwives were there standing on the shoulders of the midwives who had gone before us. My realization was that this day was truly a rite of passage for us new midwives.

Desiree, Teri, and I walked to the testing room, and Teri snapped a few last pictures of us before we walked in to take our test. I arrived at the testing room and found my instructor, Shannon Anton (one of the co-founders of my school, National Midwifery Institute, and contributor to Heart and Hands), was helping Ida with administering the test that day. I gave her a hug and introduced myself. She said something like, “your work has been excellent,” which really boosted my confidence and helped me start the test from a good mental place.

Ida and Shannon handed out the tests and went over the test-taking rules. I sat there with my little pencil box, eraser, bottle of water, and Rescue Remedy in front of me, deciding to take a dose of Rescue Remedy as soon as I saw the test booklet! Someone, I think it was the president of MANA or NARM, came in and said a blessing for those of us taking the test, which was really beautiful.

Over all, the test wasn’t too bad. Most of the questions were scenarios, which was good and bad. On the one hand, as midwives, all that really matters is the decisions we make when faced with a particular situation. On the other hand, midwives aspire to provide holistic care to our clients, a two sentence passage to describe a scenario can’t adequately describe the entire situation, and individualized care means that a midwife might make one decision for one client and a different decision for another. The questions that fit into that category were the ones that made me the most crazy. For the most part, I felt I had prepared adequately for the exam. There were maybe 5 questions total where I really had no idea what the answer was, and another 40-45 questions where I had narrowed my choices down to two and had to decide between the two good answers.

As far as test preparation goes, I feel that doing the NMI program really helped me. The program guided me in my studies, encouraging me to explore my reference materials and really dig deep into the material. A lot of the questions in the Study Group Modules were scenario-based, so that in itself was good preparation. I also think using the NARM Written Test Specifications (found in the NARM CIB) as a study guide helped me focus my attention during the last weeks before the test. A lot of what I needed to know was qualitative rather than quantitative. Almost all of the questions were something like this, “Your client who is __ weeks pregnant calls you and says ____. What is the first thing you do?”

The test was long. We were given about 8 hours to complete it, with a 1 hour break for lunch between the two 4-hour testing sessions. My strategy for the test was to work through each question, keeping track on scratch paper which questions I wasn’t sure about. Then, after I made it through the entire test booklet, I went back to those questions and looked at them again. Each test session took me about 3 hours. I thought about going back through the entire test and re-checking my answers, but decided not to do it. My reasoning was that the first answer is usually your best answer, and that there was no way I could go back through all 175 questions in one hour.

Teri (thank GOD for Teri), had Fat Tire beer and Mike’s Hard Cider chilling for Desiree and me for after the test. Desiree and I had a little to drink, went through our emotional decompressing together, and moved on to enjoying the evening.

Off we went to dinner. Elizabeth Davis (my hero!) was there, so I introduced myself and gave her a hug. She was warm and kind, just as I thought she would be. She thanked me for my hard work at school and told me I was a great student (I was so thrilled to hear her say that!). Ina May Gaskin, Carol Leonard, Robbie Davis-Floyd, Anne Frye, so many famous people from the world of birth were there!

After dinner, we had a gathering where California midwives told stories of their work and of their struggle to practice. The stories were fascinating, but I was freezing cold, and couldn’t make it past about 11pm. Off to bed I went.

The next day, Friday, I listened to the keynote speakers. There was a wonderful midwife from Burkina, Faso, Sobonfu Some, who gave an outstanding address. She spoke of her people’s reverence for mothers and for their view of pregnant women as being beautiful. Next, I heard addresses from Jennie Joseph about midwifery’s ability to improve the rate of preterm birth. Her presentation has inspired me to think of ways to bring midwifery care to at-risk populations in my community. Still not sure how I would do that, but it is something on my list of things I want to do. Her presentation, combined with another one from a midwife serving aboriginal people in Australia really fueled a fire in me to serve people for whom midwifery care would ordinarily be out of reach.

I visited the exhibit hall next, where I met Suzanne Arms. Suzanne’s work has always inspired me. I also got to meet some of the suppliers we use in Peggy’s practice, as well as see other things that were available.

After lunch, I went to a session on the ethics of how we teach pelvic exams. I was stunned to find out that medical students frequently learn how to do pelvic exams by practicing on anesthetized, unconscious patients. The presenter has put together a movie that is in its final stages of production. She hopes to release it in 2010. It is called “At Your Cervix,” and it looks really interesting. Go to her website and watch the trailers. Very interesting and disturbing.

Next, I went to a session on Centering Pregnancy to learn how this concept of group prenatal care and community building could be used in a homebirth practice. I had been wanting to learn more about Centering Pregnancy, so it was good to discuss it in a group and hear feedback from other midwives, as well as hear how homebirth midwives have used it successfully in their practices. I think it is a great concept.

After dinner, I attended a movie night. I saw Birth of a Family, which was wonderful. I think I’m going to have to get a copy of that one. I also saw Le Primer Cri, a French film about birth in different cultures. It was interesting to see how birth is done in other cultures, but it was truly disturbing to see the “care” some women receive around the world. The film isn’t available in the United States yet, so I can’t say “watch it yourself and see what you think.”

Saturday, I got to see a great presentation by Eugene DeClercq about statistics surrounding birth in general, as well as midwifery and homebirth in particular. He is a great speaker, injecting humor into what would otherwise be a very dry and boring topic. The whole audience was captivated and he got a roaring standing ovation when he finished.

We decided to do some sightseeing for the rest of the day until we had to go to the airport. I was sad to leave the conference, but I felt like I really needed to seize the opportunity to explore Northern California. I was so torn! I felt like Asilomar was this safe little enclave of people who shared my beliefs about birth, where I could be free to say whatever I wanted to about birthing and not be judged or have people say to themselves, “oh, that Kim, she’s so radical.” Far from it! Compared to the community of midwives there, I was pretty mainstream! But, I couldn’t stay in this mini haven for midwifery forever, so off we went to explore California for the rest of the day.

We drove south along the coast on Highway 1 to Big Sur. WOW! The coastline, with its cliffs and rocks and crashing waves was just breathtaking. On the other side of the road were steep hills with colorful plants, farmland, and “happy California cows.” We saw the occasional hippie van along the way. The redwoods at Big Sur were impressive indeed. It seemed like the terrain changed every few miles. Mountains, then ocean, then redwoods, then more ocean, then farmland… there was so much variety.

Once we got to Big Sur, we turned around and headed back up the coast. We stopped off for some yummy Mexican food at a little hole in the wall cafe for lunch. Man, I wish we could get Mexican food that good here in Virginia!

Next, we headed to San Francisco. We went over the Golden Gate Bridge and stopped at Vista Point to take pictures of the bridge and the bay. We headed back over the bridge and went downtown to see the cable cars. Driving in San Francisco is INSANE by the way! I wasn’t sure what I was doing, so that made it ten times worse, but hey, we survived! After the cable cars, we made our way to Haight-Ashbury to see where all of the hippies were during the 60’s. Along the way, we saw a lot of interesting people we’ll never forget.

After all of our big adventures that day, we finally headed to the airport to wait for our flight home. Note to self; never fly overnight if you have trouble sleeping on an airplane. Total torture being in a seat made for a much taller person and trying not to touch the person next to you as you drift off. Anyway, we got home around 6am, got our bags, and headed home to our little town. My bed never felt so good!

The trip to California was an amazing experience for me. I stepped over the threshold from student to midwife while I was there, although I know I’ll always be a student as I continue to stay open to learn from the experiences I encounter as a midwife. I also felt the sisterhood of midwives from around the world coming together to support and learn from each other. I got to meet some midwifery superheroes and had some unforgettable experiences while I was there. I hope I can take some of what I learned and bring it back to the women I serve here in Virginia.

Perinatal Birth Symposium

2009-10-07T19:25:00.000-07:00

What an amazing day! Today, at George Mason University, I was able to attend the Perinatal Birth Symposium. I was amazed at how many big names in birth were in attendance. I got to meet Robbie Davis-Floyd, Henci Goer, Shafia Monroe, Debra Pascali-Bonaro, and many other wonderful, passionate, brilliant women. I also got to see so many local midwives, doulas, and midwifery students. It felt like a family renuion!

My first stop, after checking in, was to catch the last half hour (I was running late) of the talk about Unassisted Childbirth, featuring Lynn Griesemer. I think midwives can learn a lot from listening to women who choose unassisted birth. There are reasons women choose to birth unassisted, and while it isn't a choice I would make, I think midwives, by listening to UC moms can improve our care. Just as midwifery clients choose midwifery over OB care so that they can feel empowered and respected, UC moms choose to UC because they feel they won't get that empowerment and respect from midwifery care. I disagree with some of the things that were said in the session, but overall thought it was good.

Second stop was to watch an audience-led performance of Birth: A Play, by Karen Brody. I had been wanting to see this play for a long time now, so it was great to be able to see it today. The cast included Robbie Davis-Floyd, Debra Pascali Bonaro, Vicki Elson, and several others. It was so great to see this play, and I could see how it would be such a powerful experience for teens and college students to learn about women's experiences of birth. So glad I got to see it.

Next, I went back to the Harris Theater to see Robbie Davis-Floyd speak about Birth Models that Work. I got to hear about how other countries, whose outcomes are much better than the US model, go about doing births. I am so used to seeing the American model that it was really helpful for me to think out of the box a bit to consider how we might go about integrating these other countries' models into our own. We have a lot to learn from how other countries manage normal labor and birth.

After this, I got to see Shafia Monroe speak about Birth as a Social Justice Issue. Shafia is so eloquent, and she helped me learn more about how race and racism affects birth outcomes. I also got a small taste of the heritage of midwifery amongst black women. Black midwives have a very different heritage than white midwives. For example, black midwives were not victims of the burning times (witch hunts). Black midwives practiced in Africa and in the US South as respected healers in their communities. I also got to learn about ICTC's Sistah Care Program, where girls age 13-17 learn basic midwifery skills and learn how to care for each other and for their community. I was so inspired that I feel like maybe I will pursue starting a Sistah Care Program here in Northern Virginia.

Next, I learned more about the legal aspects of birth and about informed choice. The discussion was facilitated by Tabare Depaep (Co-Chair of CIMS, doula, and lawyer) and Lisa Pratt (a law student at the University of D.C. who is active in supporting reproductive justice and VBAC rights). I came away from that one with a great idea for a project. I am going to put together a VBAC birth plan document with some very specific language to help VBAC moms get the birth they want. Tabare suggested having the doctors and nurses sign that they had read your birth plan. So, I plan to include the signature part, but also include a statement that the doctor will provide intrapartal care for the client at a hospital that will accomodate her wishes and respect her informed choice to have a VBAC.

After this discussion, I got to see Henci Goer's moving presentation about abuse of women in the hospital environment. Being a survivor of abuse myself, it helped me understand how I need to do some inner work to better serve women when we transfer to the hospital. Because of my own history of abuse, I find myself feeling very intimidated by the powerful male presence at a hospital birth, as well as feeling intimidated by the male-oriented medical model of care. Normally, I am very assertive, but I find myself losing my voice when I deal with doctors and feeling very much like I did when I was abused as a child. I fight it, but it is an ongoing challenge for me.

The last event I attended was a rountable discussion about birth practices and reproductive rights. The panel included Juliana Fehr, Robbie Davis-Floyd, Lisa Pratt, Debra Pascali Bonaro, Barbara Stratton (VBACtivist), Marjorie Brahms Signer (President of Virginia NOW), Shel Lyons (Birth Survey, CIMS, Mother's Rights Network), and Shafia Monroe, and was moderated by Jessica Clements. A lot of great ideas were discussed, but an empassioned plea from a woman in the audience got the panel to pull together a plan to move forward to begin work on legislation to protect the rights of childbearing women. A strategic planning committee was formed, and several members of the audience (myself included) volunteered to be a part of this strategic planning committee.

What an INSPIRING day I had! I feel so moved to do work to support mothers' choices. I wish everyone in the birthing community could have been there today.

And they think I'm a rebel! The fruit doesn't fall far from the tree!

2009-07-02T15:28:00.000-07:00

I just read my baby book. Yep, I know, when was the last time you did that? I was organizing my photo albums and noticed the remnants of my own baby book. My mom had given it to me a few years ago when she was in an organizing phase. Organizing her house means packing her car full of stuff she doesn't want anymore and unloading it at my house -- but I digress...

So, this baby book was quite a treasure trove. There was, of course, a lot of really great stuff in there about my growth and development as a toddler, which was a lot of fun to read. It was great to see my mom as a young mother, noting the same things I noted about my own kids' babyhoods. I can just see her in her psychedelic 1960's outfits, with her Sophia Loren eye makeup and bouffant hairdo, chasing little me around trying to get me to eat my pureed peas.

I was born in 1966, back at a time when most moms were knocked out for birth. The natural childbirth movement was just starting to gather momentum back then. Dr. Bradley had just published Husband Coached Childbirth the year before, but I don't think my mom had read it before my birth. She did, however, read Grantley Dick-Read's Childbirth Without Fear.

I was born at an Air Force hospital in Topeka, Kansas. My dad wasn't allowed in the room with my mom. My mother, having read Childbirth Without Fear, decided she wanted a natural childbirth. I, like many first babies, was late. According to my mom's calculations, I was 3 weeks late. She ended up being induced. Despite the induction, mom insisted on having no pain medication. She says she remembers the pain was like waves, and she would just visualize ocean waves during the contractions to get through it. She remembers a very nice nurse who was very comforting and maternal towards her during her labor. When mom started to push, the doctor had the nurse strap a face mask to her leg. It had trilene gas, a popular anesthetic at the time. The nurse said it would be there for her if she needed it, and she could just grab it and inhale if the pain became too much to bear. At the moment of crowning, when mom felt "the ring of fire," she grabbed the mask and inhaled, not knowing it wasn't going to get any worse than it was at that moment, and she was knocked out. When she came to, she remembers hearing me cry, and she thought I was a cat meowing.

When mom tells the story of my birth, she gets really angry, and rightly so. She made it all the way to the end and then took the drugs because she didn't know she was at the end. She never had any more children, so she missed her one chance to experience the moment of the birth of her child. As a woman who has experienced that moment for all 5 of my children, I really feel like my mom got ripped off.

I always thought that story was so sad, but I was so proud of my mom for trying hard for a natural birth back in those days. She was the only woman in the maternity ward who chose to breastfeed too. My mom was such a rebel. At the young age of 19, she knew already just how important natural birth and breastfeeding are. I am forever thankful for her choices and so proud of her for taking that path.

So, I was reading my baby book today and thinking about all that my mother went through when I was born, all of the challenges she faced. The baby book she had for me was part baby book/album and part baby care guide. It was really interesting to read what they had to say about birth, breastfeeding, and baby care. Here are some snippets I found particularly telling about the mindset surrounding birthing back in 1966:

"If you believe you are going into labor, do not eat any food until you speak with your doctor. Anesthetics are best tolerated on an empty stomach."

"After the doctor has examined you, he usually orders the nurse to give you an enema."

" 'Natural Childbirth' is a term that has been accepted by those mothers wishing to experience the birth of their babies without the aid of analgesia and anesthesia. Even those mothers, however, are frequently given a local anesthesia."

"When you recover from your anesthesia and delivery, you will, of course, be tired and so you may fall off into a natural sleep for three to four hours. Following this rest ... your first interest will be your baby and the nurse will bring him into your room as soon as you ask to see him."

"Most hospitals thoughtfully give the mother a bottle containing enough formula for 24 hours on her day of discharge from the hospital. This takes the pressure off the first day at home and makes the preparation of the first formula a pleasure rather than a hasty chore. You will be given a copy of the formula the baby has been receiving, and with the demonstration of formula preparation which you observed the day prior to discharge fresh in your mind, you will find that formula making is much easier than you may have anticipated."

"(Rooming in) requires special nursing routines and special regulations concerning visitors that most hospitals do not customarily allow."

"All normal newborns receive a 2 1/2% sugar water solution twelve hours after birth and at intervals during the following twelve hours. 24 hours after birth, the baby is put to the mother's breast for three to five minutes every four hours for one day. Feeding time is then gradually increased to the normal period of 20 minutes."

Regarding Infant Identification:
"Some hospitals expose the infant to enough ultra -violet light to sunburn his name on his skin. Others place a large piece of adhesive on the infant's back upon which his mother's name is recorded."

WOW. I knew it was bad then, but wow. My mom traversed some pretty high obstacles just to even breastfeed back then. I saw in my baby book that she remained in the hospital until June 1st, which was 6 days after I was born. I can't imagine not seeing my baby until 4 hours after the birth, nor can I imagine only being "allowed" to breastfeed my baby 24 hours after the birth, and then for only 3-5 minutes every 4 hours. Can you believe the stuff about the sugar water and not nursing for the first 24 hours??? The sunburn thing is absolutely barbaric!

My baby book was a real eye-opener in so many ways. It gave me a whole new respect for my mother's courage and determination in the face of a very well-established system of obstetrical care. I find it absolutely amazing that she was able to do as much as she did. In fact, I find it pretty amazing that anyone breastfed or had natural births back then. It is pretty mind-boggling to think of what a radical shift in philosophy the natural childbirth movement was back then. It makes my current efforts seem tame by comparison. Now, when people call me a radical or a rebel, I'll wear that label with pride and a little smile because I know I'm not nearly the rebel my mom's generation was. I aspire to be the rebel she was.

Birth As It Should Be

2009-06-24T19:38:00.000-07:00

I just got home from a lovely birth. It was as close to a "perfect" birth as it gets. It was the kind of birth where it would have been a shame for it to have happened in a hospital, where the medical machine just screws up a thing like this.

The woman I served today came to care early in her pregnancy. I had the pleasure of going to 8 of her 10 prenatal visits, and 7 of those 8 were in her home. I got to know her, her kids, her husband, her friends, and her home long before I showed up at her birth this afternoon. I became friends with her on Facebook, and we each learned even more about each other's lives. Her placenta is in my fridge right now awaiting encapsulation (a whole other blog post!).

This woman had a picture perfect pregnancy. She exercised and ate well throughout. She had a history of fast labors, so one of her greatest hopes for this birth was to be able to experience labor, to be more present and aware of what was happening during the birth. So, she hired a photographer to document her birth experience.

Since she had this history of fast labors, I knew I needed to act quickly once I heard she might be in labor. I got the call this morning from Peggy that the woman was showing some signs of early labor, so I asked my husband to stay home from work in case I needed to leave in a hurry. I followed her updates on Facebook, made sure I got everything done I needed to get done before leaving home, and waited for the call to leave for the birth. Finally about 8 hours after the first call from Peggy, I got the call from her that our lady's water had broken. Yay!!! Time to go! I practically didn't let Peggy finish her sentences as we wrapped up the call.

I arrived at the house to find our mama just hanging out and making Lego creations with her kids. She said the contractions were about every 5 minutes but were still light. I checked the position of the baby, running my hands along her tummy, feeling her baby's body with my hands instead of looking at it on an ultrasound machine. I listened to her baby's heartbeat with my Doppler through a contraction and afterwards, and was assured that all was well with her baby. Since her membranes had ruptured, I didn't want to do a vaginal exam unless the mom asked for it. No sense in risking infection. In fact, we never did a single vaginal exam during the labor at all. I checked mom's blood pressure, pulse, and temperature. Picture perfect.

Peggy and I worked on getting the supplies ready for the birth. The mom had taken great care to be sure that she had gathered the supplies we requested. I set up the heating pad with blankets and an outfit to keep warm for the baby. I put some water in the crockpot to heat in case we had time to do warm compresses. We got a tray ready with supplies we might need in a hurry. Meanwhile, the mom spent time with her family, chatting, eating, drinking labor aide, and contracting every few minutes. The photographer, friend, and grandmother arrived. Peggy and I charted and spent time talking on the couch, checking on our mama from time to time.

After a short while, the contractions had built in intensity enough that the mom wanted to retreat to her "birth nest." We knew birth was imminent and didn't leave her side. Once she got up to her bedroom, she knelt by the side of her bed, and we knew we were moments away from meeting this new life face to face. After a few gentle pushes, the mom reached down to feel her baby's head emerge, and in another push, the shoulders and rest of the baby slid out of her body and into our waiting hands. The baby, a beautiful vernix covered boy, opened his eyes and looked at his mother right away. He made quiet sounds to let the world know he was breathing, and he pinked up right away.

The baby's cord stayed intact until it was done pulsing, giving him a nice bolus of cord blood. He stayed in his mama's arms for a long time. He stayed there nuzzled up to his mom's breast and soon started nursing. He transitioned into the world, surrounded by the love of family and the caring hands of his midwives and his mother.

The photographer captured the beauty of these first moments of this baby's life. I heard the camera in the background as she caught special moments that can never be replayed -- crowning of the baby's head as it was born, mom receiving her baby into her arms, baby meeting his older brothers, dad cutting the cord, midwives weighing him for the first time...

It was a birth as it should be. It was beautiful and sacred. It the type of birth that could only happen at home.

I feel honored to have served this family today. I had an opportunity to see something today that only rarely happens in America. I saw a beautiful, natural birth, free of unnecessary interventions, allowed to unfold in its own time and space. I can never thank this woman enough for including me at this special moment in her life. It is the type of birth that fills me with hope and reminds me of why I chose this unpredictable life I live.

Making the choice -- Are you a good candidate for a hospital birth?

2009-03-12T11:15:00.000-07:00

I was just reading Gloria Lemay's blog post "Are You A Good Candidate For A Hospital Birth?" and it really got me thinking about how to reach more people and help them understand what their choices really are. I think if first-time moms really understood what the hospital birth experience is all about, they would think twice. At least, that's the idealistic part of me who thinks that. Some moms are content to not think, and some moms know both perspectives and choose the path more well-traveled by their peers. There is such social pressure to conform, especially when your family says things like "choosing homebirth is a selfish choice" (yes, I just heard that from someone!).

Here's Gloria Lemay's list of questions for her blog post "Are You A Good Candidate For A Hospital Birth?":

Must not be scared of needles.
Must not be claustrophobic or uncomfortable in confined spaces.
Must be able to go for long periods of time without eating or drinking.
Must be happy to share a bathroom with others.
Must enjoy sleeping on a mattress covered with plastic.
Must not have a rebellious or questioning nature.
Must accept the possibility of contracting antibiotic-resistant infections.
Must be confident with caregivers who are overtired and overworked.
Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
Must like and trust electronic equipment.
Must be comfortable with cesarean rate of 30%.
Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
Must realize that someone you have never met before will likely receive your baby.
Must realize that the written birth plan will be ignored.
Must be willing to have fluorescent lights turned on at all hours.
Must be capable of birthing without making loud noises.
Must look good in a flimsy blue gown that is open up the back.
Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.

Do women know that this is what they are choosing when they choose hospital birth? Are they so afraid of the process of birth that they're willing to give their safety and their birth experience up to a system that promises the worst outcome for them and their babies than every other industrialized nation? What motivates women to make this choice?

I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that's a good place for me to start as I look for answers.

With my first baby, I wanted the best possible care, which to me meant the most expensive care -- an obstetrician. I thought midwives were somehow "less than," and that homebirth was dangerous. The Internet didn't exist for me in 1989, so the ability to make a truly informed choice was very limited. I'd have to say my pre-conceived notions about midwives and my uninfomed opinions about homebirth and about obstetricians drove me to seek a hospital birth with an OBGYN.

With my second baby, I just did as I had done with the first. I thought I had been pretty happy with my first birth experience (since I didn't know any better), so I went back for more of the same. My second birth was a tough Pitocin augmented persistent posterior birth. Being restricted to lying on my back or my side made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.

So, now fearful of birth, I chose a birth I felt I could better control -- scheduled induction at 39 weeks with an epidural at 1cm. Not much pain, but instead of feeling in control, I felt totally out of control. I had no sensation, which meant no feedback on how my labor was progressing. I felt disconnected from the experience. I was totally at the mercy of what the doc felt my progress was. It was horrible.

The turning point for me, the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. It was through listening to the experiences of other mothers that I learned doctors don't know everything. Finally hearing that this was the experience of so many other mothers, caused me to question whether my choice to give birth with an OB in the hospital was the best choice for me. They helped me to see that it was not my body that had failed me. The clincher for me was when I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, "Kim, tell me you are NOT having a natural birth." I nearly ran away screaming!

I'm an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don't consider myself to be one to bury my head in the sand when it comes to making important decisions. What could have helped me to know the truth sooner? Maybe if I had seen Gloria Lemay's blog back in 1989, or maybe if I had seen the Business of Being Born back then, maybe those things could have helped me to know the truth about giving birth in the hospital.

I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way or just one woman at a time. Reading Gloria Lemay's blog post has re-energized my determination to keep fighting the good fight. Speaking of which, I sent a copy of The Business of Being Born to my sister-in-law. She's newly pregnant and needs to know the truth. I think I'll send her a link to Gloria Lemay's blog post too.

Homebirth Video for Peggy Franklin's Client

2009-01-23T22:10:00.001-08:00

Check out this great video from Aimee Fairman's blog. This movie is made about a client of Peggy's, and I think it was really well done. It is such a great representation of what we do and how we do it.

QuickTime | Flash | iPod | Ogg

by: vPIP	Embed (copy & paste):	close

Virginia HB 2163 and HB 2167 Seeking to Limit Scope of Practice for Licensed Midwives Serving Women Seeking VBAC

2009-01-19T15:40:00.001-08:00

Delegate Matt Lohr of Harrisonburg, Virginia recently introduced two bills (HB 2163 and HB 2167)seeking to limit the rights of Virginia women seeking homebirth with a licensed midwife after a prior cesarean section. I recently wrote to Delegate Lohr to ask him to pull both bills. Here is a copy of the letters we have exchanged. They're shown below with the newest one first. My original email to Delegate Lohr is at the end. I hope others will be moved to write to Delegate Lohr at DelMLohr@house.virginia.gov and let them know what they think of these bills.

1/19/ 2009 My letter in response to Delegate Lohr's letter to me

Dear Delegate Lohr:

Thank you so much for taking the time to answer my letter. And, thank you for supporting midwives and homebirth. I would like to take a few moments to respond to some of the points in your letter, as it appears more clarification might be helpful.

Midwives DO practice safely, regardless of any legislation in place (or not in place) to regulate their practice. Time after time, studies have continued to prove both the safety of homebirth and the improved outcomes associated with midwifery care. Midwives were practicing safely in Virginia before the CPM credential was recognized, and they continue to provide evidence-based care and have excellent outcomes now after the passage of the law that allowed for the licensing of Certified Professional Midwives here in Virginia.

VBAC is NOT a procedure. It is a physiologic outcome to a normal pregnancy. This is an important point. Repeat cesarean section IS a procedure, one which carries greater risks to both mother and baby than a normal vaginal birth. I contend that it is repeat cesarean section that should be looked at more closely, and not vaginal birth (with or without prior cesarean section). When serving a woman seeking a vaginal birth after cesarean section, midwives in Virginia disclose the risks associated with both vaginal birth and cesarean birth after prior cesarean section. Consumers use this information, in addition to their own research, when making their informed choice to have a normal vaginal birth at home rather than being forced into having a repeat cesarean section at their local hospitals.

I urge you to consider the options women face with their pregnancy after a prior cesarean section. The two choices are either a vaginal birth or a repeat cesarean birth. That’s it. The bottom line is that cesarean is more dangerous for mothers than vaginal birth, regardless of whether the mother has had a previous cesarean birth. Many hospitals in Virginia have NO-VBAC policies, forcing mothers seeking hospital birth to either have a more dangerous repeat cesarean section or seek a safe vaginal homebirth. If licensed midwives will be unable to legally provide care to women seeking vaginal birth after cesarean section, many will choose to birth unassisted, with friends, or with an unlicensed midwife.

Limiting Medicaid funding to not cover VBAC for Virginia women is discriminatory towards low-income women, who are already at greater risk just by being low income. These women especially would benefit from the extensive nutritional counseling and one-on-one support of a licensed midwife. Outcomes for poor women are greatly improved through midwifery care. So, by denying their right to receive the same care options as other U.S. residents (mandated by Federal Medicaid Law, I believe), Virginia would be unfairly discriminating against an at-risk population by denying them the care they need and rightly deserve.

I agree that there are some procedures that are very risky and that those procedures are best left in the hands of obstetricians, who are trained in the pathology of pregnancy and in the management of high-risk obstetrical care. Cesarean sections, for example, are best left in their hands. However, for women seeking normal vaginal birth, the evidence shows that homebirth with a qualified midwife is as safe or safer than hospital birth with an obstetrician.

Thank you for your help in protecting the interests of Virginia mothers and babies.

Sincerely,
Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com

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1/19/2009 Delegate Lohr's response to my email on 1/16/2009

Dear Kim,

Thanks for contacting my office regarding the proposed midwife legislation.

Throughout the year, legislators meet with hundreds of constituents about issues of importance. Some of those concerns warrant possible legislation. The medical community met with me this year about incidents involving midwives and the safety of mothers and children. I have always supported midwives and greatly appreciate the work they do. I do not support shutting their practices down. This is not a bill to bash midwives. It is a bill to make sure that their practices are done safely.

The first bill I introduced was just a requirement that midwives have full disclosure with patients about their practices and associated risks. This is not directly stated in the code, which is why I introduced the bill. After visiting with the midwife lobby last week…who by the way were great folks…I actually decided to strike this bill because this process already takes place. I found out that part of their licensure process requires that they do this. That bill will be stricken from the docket. I was glad to see that this important step was already being done.

The second bill will be amended. The new amendment will narrow down the scope of the bill. To deter midwives from taking on very high risk deliveries, the original bill said they would be denied funding if they chose to do this. Some procedures are very risky and in my opinion they should be done in hospitals with medical doctors. I met with the midwives lobby last week at length and had very positive discussions. The new bill will only apply to the VBAC procedure (Vaginal birth after C-section). This procedure is deemed unsafe and risky by the medical association. Now, a midwife would only be denied funding if they conduct a VBAC delivery. All other high risk deliveries will remain in place. I am all for choice, but in my opinion certain choices deemed “very risky like a VBAC” should not be taking place in homes with a midwife.

Midwives provide a great service to our society, but I do have concerns over them attempting very delicate and complex procedures that place mother and baby in dangerous situations. I appreciate your opinions on this matter.

Sincerely,

Delegate Matt Lohr
26th House District of Virginia
Room 526
Richmond, VA 23219
(804) 698-1026

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1/16/2009 My initial email to Delegate Lohr about these bills

Dear Delegate Lohr:

As a citizen of the Commonwealth of Virginia, a midwifery student, and mother of 7 children (2 born at home with a Certified Professional Midwife), I urge you to pull HB 2163 and HB 2167 from the docket and to work to help INCREASE access to midwives rather than restrict it. Homebirth with CPMs is as safe or safer than hospital birth. With the outrageously high c-section rates in Virginia hospitals, more than 1 in 3 mothers are having surgical births now, and each of those mothers who have had c-sections are finding it nearly impossible to find a health care provider to support their informed choice to have a vaginal birth (VBAC) for their future births. These women, being very well-informed as to the safety of VBAC, are increasingly finding support for their informed choice through the support of CPMs and are choosing to have their babies safely born at home.

Further, these bills seek to restrict access to CPM care for low-income people. A homebirth with a CPM costs around $3000, and that includes all of the prenatal care, the birth, and care for mother and baby through 6 weeks postpartum. An uncomplicated vaginal birth in the hospital easily costs at least 3 times as much money, and a c-section costs much more. Legislators committed to reforming health care, cutting costs, and improving outcomes support CPM care as a way to meet those important goals.

Midwives and the clients they serve care very deeply about preserving the rights of women to continue to receive evidence-based care and to receive support for their informed choice of homebirth. Please do all that you can to help us increase access to CPM care.

Sincerely,

Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com

Miami Maternity Center Raided

2009-01-06T08:06:00.000-08:00

Don't the cops have more important things to do in Miami? On Christmas Eve, "a team consisting of 12 FDA Special Agents, 6 Miami Dade Police Department Detectives, 2 DOH Investigators and 2 Medicaid Fraud Control Unit Investigators" raided the Miami Maternity Center following a 10 month investigation by the ULA (Unlicensed Activities Unit) who alleges "The ULA investigation disclosed that the pills being manufactured at MMC were from the dehydrated, placentas of various birth mothers. The organs would be ground up all together inside of a coffee grinder and placed into gelatin capsules by MMC staff members. The ULA investigation also disclosed that as many as 10 to 15 placentas at a time were being placed in layers inside of the MMC dehydration machine creating a cross contamination hazard." The law enforcement officials seized all of the MMC's patient records since 2006, computers, frozen placentas, dehydrated placentas, dehydrator machine, grinding device, prescription pads, billing records and all potential biohazard items.

OK, I understand why they wouldn't want the MMC to comingle placentas, but A 10 MONTH INVESTIGATION AND A RAID? Don't they have something better to do? Couldn't they just do an inspection of the center, check out how they do the dehydrating and encapsulating process, and be done with the whole thing? I'm not an expert in this, but wouldn't the dehydration process kill any blood-borne pathogens in the placentas? I would think the health risks involved in comingling the placentas would be negligible (if there were any health risks at all) Why do they need all of the patient records? What about HIPAA? If I were a client there, regardless of whether I had my placenta processed by them, I would be furious that the feds had my medical records!

For those of you new to the idea, some women choose to dehydrate and encapsulate their placentas. Ingesting placenta is thought to help with postpartum depression, increase milk supply, and even help with menopausal symptoms. If you go to http://placentabenefits.info/index.asp you can learn more about encapsulation and the benefits of doing so.

New Year's Resolution for Homebirth

2008-12-31T13:28:00.000-08:00

I pretty much think New Year's Resolutions are hokey, but sometimes I think taking the time to formulate some general goals can serve as a "sanity check" be sure the things you are doing are moving you in the right direction. Considering the work I do as a student midwife, I feel that what I do supports my goal of helping more and more mothers give birth naturally and in a family-centered way.

However, I can do more. The women I serve come to us -- not the other way around. I would like to do more outreach to people who might not have considered a homebirth or midwifery care. How can I do more to spread the word about homebirth midwifery in my community? One of my resolutions is to do more community outreach to help more people know that homebirth midwifery is one of the choices available to them.

Another resolution I have is to work towards building bridges to the local medical community. Sometimes, admittedly not very often, we have to transfer care to a physician or to the hospital staff. I would like to do something to help our local doctors, nurses, and EMS understand the CPM credential and why our clients choose to give birth naturally at home. It can be very difficult for people to have to transfer care when their heart is set on having their baby at home. I don't want them to have to deal with explaining their choices to uninformed hospital staff at the same time as having to deal with the loss of their homebirth dream. We do our best to make the transition as smooth as possible, but it would be a much smoother transition if the medical community were better informed.

Lastly, I resolve to keep my mind and heart receptive to every woman I help, and to learn as much as I can from the women I serve and work with. Peggy, Tierney, Aimee, and Desiree have such a great amount of wisdom, and I am so fortunate to be able to work with them all. I learn so much when we're together, and the women we serve are such a blessing to us. Each birth, each prenatal appointment, each childbirth class helps me to grow as a midwife, and I am so thankful to have such a treasure to learn from. My task, which can be a challenge at times, is to continue to stay open and humble and just let the learning happen.

First Catch!

2008-12-10T23:58:00.000-08:00

Well, I finally got my first catch! Completely unplanned and by surprise, but my first catch nonetheless!!! I arrived at a birth tonight thinking I had several hours to go. I went upstairs to check on the mom and set up supplies for the birth. I found her sitting on the toilet and wanting to push. So, I said, "OK, well let me get some gloves and I'll be right back." So, I got my gloves on (darned packages are so hard to open when you need them quickly!), and told my laboring mama that she probably would want to get off of the toilet to give birth, so she slid off and onto her knees right beside the toilet. She grabbed me around my neck, and I reached below her to feel her baby's head right on her perineum. The dad said, "what do you need me to do?" I said, "get towels!" Just then, her membranes ruptured and amniotic fluid went everywhere. Next thing I knew, she was pushing the head out, and I was saying things I've heard Peggy say so many times at births, "that's it, nice and slow, just like that..." and out came the head. I reached behind to see if I felt a cord around the baby's neck and to see where the shoulders were. All clear with the cord! The anterior shoulder came under the mom's pubic bone, and I lifted gently to get the posterior shoulder born, then plop right into my hands! Wow! What a rush! I'm so excited that I got to catch my first baby!!!

About a minute later, I looked back at Peggy, who was smiling at what she saw. I knew what to do, but I was so unprepared mentally for what had just happened that it was a huge relief to see her smiling face in the doorway. We worked together to help the mom get to the bed (much more comfortable than the bathroom floor) to deliver the placenta and to nurse the baby.

Dad had filled the tub just before the birth, in anticipation of a water birth. So, instead of laboring in the tub, we helped the mom and baby get in and enjoy a nice postpartum bath by candlelight. It was good for them to have that quite time alone, especially after such a quick birth that took everyone by surprise.

I've always felt a special bond with this particular mama. Her first child was born the same day and year as my last child, so she's extra special to me. I am so happy she was my first catch!

An awesome waterbirth!

2008-12-07T17:45:00.000-08:00

Last night, I had the honor of being a part of a beautiful birth for a lovely couple. It was one of those "that's why I do this work" moments for me. In my blog, I try to protect the identity of the people I serve, so I am not using their names in this birth story.

I met this couple last spring at Peggy's Homebirth Meetup. I instantly felt a connection with them. I think they had been together for a long time as a couple, and had plans to eventually marry. She had recently become pregnant, and he had proposed to her the night before the meetup. They very excited about the baby and were really looking forward to having their baby at home. Over the next few months, I got to know them both pretty well through their prenatal visits and through my childbirth classes. They asked me to be at their birth, telling me they felt really connected to me and that they wanted to share the birth with me.

I'd been anxiously awaiting the call from Peggy. The due date passed, and then another week went by. Finally, some irregular contractions and bloody show. Not active labor yet, but definitely getting ready for the big day. Yesterday, after a few days of toying with active labor, I sat with them and we talked about what they were thinking and feeling about their labor, and the woman said that she was feeling discouraged and really wanted to do something to get labor going before they ended up having yet another sleepless night. After discussing some natural labor stimulation options, they decided to start nipple stimulation later that afternoon, and that if it didn't do the trick, they wanted to try castor oil.

Our study group was working on learning how to suture yesterday. Once we finished the suturing practice, we decided to watch the new birth movie "Orgasmic Birth." It wasn't what I expected, but I did enjoy it. I think I'll have to do a whole separate blog post on it, but I mention it in this birth story because it reminded me of how beautiful it is when a man and a woman work together during their birth. I knew it was just the thing I needed to see before I headed off to go help at this birth.

After the movie, Peggy and I called our laboring couple. They had tried nipple stimulation and had found it to be really effective at getting strong, regular contractions. When I arrived at their house, the husband greeted me at my car, saying that his wife had just had "a breakdown" and said she wanted us to be there. He looked out the window right then and saw my car's headlights, so the timing couldn't have been better!

I greeted his wife, and by her expression, she seemed to be in early active labor. She was serious during contractions, but she was coping really well, and between contractions she was pretty sociable. She wanted to see how far she was dilated, so I did a cervix check and she was about 4cm. Her contractions were moderately strong, but she wanted to make sure she was having stronger contractions that wouldn't fade if she got in the pool. So, we tried some homeopathics and some herbal tinctures a few times. The contractions got much stronger and our laboring mama got in the pool.

It didn't feel right to me, especially after watching Orgasmic Birth, for the husband to be sitting outside of the pool. I really thought, especially considering the depth of love these two people had for each other, that they needed to be in the pool together. So, I suggested he get in the pool and support her there. They cuddled and worked together beautifully. She wanted him to really experience the birth with her, so being together in the pool worked well for them.

After a few hours, she started gently pushing. Her membranes were still intact, so as the head started to be born, it was really amazing to see the amniotic sack in front of the head. It was the first time I ever saw a baby born in the caul. She took pushing really slowly. I think she was surprised by the stretching sensations and was a little fearful of pushing through it, but she stretched beautifully and slowly. There were moments in between contractions where she would reach down and touch her baby's head and say, "oh honey, there's our baby" or "oh this is so amazing," or something like that. Her husband and she would feel the baby together, and it was beautiful to see the love in their eyes. It was, as Aimee put it "truly exceptional."

As the baby was born, it burst through the amniotic sack. The dad lifted her up and put her on his wife's chest, and the three of them just fell in love with each other as a new family. I don't think there was a dry eye in the room. Of course, Peggy, Aimee, and I sprang into action to do our job of making sure all was well, but in between checking on mom and baby I know I just watched for moments here and there and soaked up the emotion in the room. There were a few times I felt tears of joy stinging at my eyes even today, the day after the birth.

The mom and dad had chosen not to find out the baby's gender before the birth, and as we always do, we made sure they were the ones to decide when to look to see for themselves. While they were holding their baby, they said things like, "what do you think, boy or girl" and "honey, do you want to look and see yet." After about 10 minutes, they decided to take a peek and saw that they had a beautiful baby girl. They were overjoyed, and the tears flowed again!

Dad cut the cord a while later, and mom birthed a nice healthy placenta when she got out of the pool. The baby nursed right away! We did our usual postpartum watch, made some food for them, got the laundry started, and cleaned up after the birth. At about 6am, we packed up our stuff and left this new family to sleep in their bed and enjoy their first day as a family together.

What a BEAUTIFUL BIRTH!

Craniosacral Therapy

2008-11-09T13:46:00.000-08:00

Yesterday, at Peggy's Homebirth Meetup, I met a really nice Chiropractor, Dr. Lisa Przybysz, who taught us about craniosacral therapy and chiropractic for pregnant women and babies. It was great to see first-hand what I had just read in the latest copy of Midwifery Today. Here is part of that article from the Midwifery Today website:

Craniosacral Therapy in the Midwifery Model of Care
by Kara Maia Spencer

How can the gentle touch of craniosacral therapy (CST) prevent and heal birth trauma? This relaxing bodywork is growing in popularity among midwives, doulas and childbirth professionals as a modality complementary to holistic maternity care. Mothers are seeking out craniosacral therapists as well, to assist themselves and their babies in achieving optimal health in the childbearing year.

Craniosacral therapy is a gentle, non-invasive and powerful hands-on therapy that benefits whole body health, treats a multitude of conditions and is effective for infants, children and adults. Though the craniosacral therapist uses a very light touch, the bodywork is deeply transformative and healing—physically, emotionally, mentally and spiritually.

The soft, hands-on bodywork techniques of the craniosacral therapist are non-invasive and serve to relieve pain and dysfunction in the body. The body’s physical release of myofascial restriction facilitates the innate potential for increased wellness and a peaceful consciousness.

The craniosacral system develops shortly after conception, when the first cell divides in the womb and forms the primal midline that becomes our spine. From that moment onward, the health of all our systems is organized around the midline—the spine. Our bones, joints and muscles should be balanced to be healthy, but like a tree that has grown twisted due to the wind, our spines and connective tissues can be affected by tension, trauma and injury throughout life—beginning with the prenatal and birth experiences.

Craniosacral therapy is a gentle way to relieve restrictions in the body to increase the capacity of the individual’s nervous system for health, harmony and well-being. The body naturally seeks homeostasis—and craniosacral therapy facilitates this balancing. When an individual experiences restriction or trauma, whether through a challenging birth or an injury or emotional shock to the nervous system, the body alters its priority from actualization to survival mode. The sooner that trauma, shock and restriction are released from the body, the easier and faster the healing process.

Craniosacral therapy is wonderful for all ages and conditions—from those with severe conditions to those looking for preventive health care. In an ideal world, all pregnant women and infants would receive craniosacral therapy to promote healthy births, babies and families, thus saving on health care costs in the long run!

What Is Craniosacral Therapy?

The craniosacral system (CSS) consists of the brain and spinal cord, the three membranes that completely surround it, the craniosacral fluid within the membranes and the fascial connections to the bones of the cranium, cervical vertebrae and sacrum. The dura mater is the tough outer membrane that connects to the cranium and sacrum and contains the entire fluid craniosacral system. The CSS has a slow, gentle rhythm that resonates throughout the entire body.

Through gentle soft tissue release, the practitioner works with the craniosacral rhythm to release tension in the fascia and balance the ligaments, muscles and bones. The craniosacral rhythm can be felt as a result of subtle palpation through contact with the cranium, spine, and sacrum—as well as throughout the entire body. If there is not movement or expression of the craniosacral rhythm and tide throughout the body’s tissues, then restriction, dysfunction and pain settle into the body.

The craniosacral therapist assesses the body for restrictions and uses a very light touch to encourage expansion, mobility and healing. Craniosacral therapy effectively creates deep change through gentle touch by addressing issues at the core of the body’s health. During craniosacral therapy the practitioner uses no more pressure than 5 gm (the amount needed to hold a nickel) to assess, resolve and prevent restrictions in the body. The treatment is deeply relaxing and recipients often experience a sense of timelessness or “stillpoint.”

Unique from other systems of the body, the CSS actually slows down and enters into stillpoints. These rests are a therapeutic time of revitalization for the CSS—similar to rebooting a computer. After facilitating a craniosacral stillpoint, the individual’s CSS functions more strongly and is better coordinated; the body is using its own innate ability to heal.

Regular craniosacral therapy sessions can help to maintain health, well-being and immunity, as well as to ward off depression, musculoskeletal dysfunction and stress. Craniosacral therapy is recommended for pregnant and postpartum women and new babies—as well as for women of all ages and in all stages of life.

Juliana Fehr's book and some odd coincidences!

2008-09-07T14:29:00.000-07:00

I recently had the wonderful good fortune of meeting and speaking with Juliana Fehr at last month's Loudoun Birth Matters meeting. I had a really nice conversation with her and she suggested I read her book, Diary of a Midwife. She said her mother had suggested she write a book, and this book is based on the letters she wrote to her mom about her early years as a midwife.

I found a copy of this book at a used book website and have been chipping away at it bit by bit. What a wonderful book! Juliana has such amazing insight into birth and life in general. I've really enjoyed the reading. I'm about 2/3 of the way through it and I just read a really touching passage about the death of her mother. I just wanted to reach out and give Juliana a big hug after that today.

While I was reading this book, I noticed something peculiar about the particular copy I had. The bookseller had acquired this book from the Meriden Public Library in Meriden, Connecticut. That library is quite close to where my dad used to live. Also, and this was the really big thing for me, it was stamped "Meriden Public Library March 8, 1999." That day in 1999 was the day my daughter Elizabeth was born. It was her birth that started me down the path towards eventually becoming an advocate for natural birth, breastfeeding, attachment parenting, and now my career as a midwife. It was with Elizabeth's birth that I healed many of my old wounds from my first two births, and I discovered my inner strength to persevere with breastfeeding.

Shortly after her birth, I joined La Leche League, which started a chain of events that brought me to choose to give birth at home when I gave birth to Charlie. Giving birth to Charlie at home gave me the courage to finish my La Leche League Leader Accreditation and become the Coordinator of Leader Accreditation for Virginia and West Virginia.

My involvement in La Leche League encouraged me to start my business, Natural Family Boutique, which was a home party business. My vision for the business was that it would be like a La Leche League Meeting with products to support lifestyle choices many LLL Members make. My goal was to provide mother to mother support (like LLL) in a home party format. I planned that moms would share their challenges and solutions and products that helped them along the way.

What I didn't plan on was how my work with NFB would encourage me to take on even greater challenges. When I saw an NFB Sales Consultant become more confident in her parenting because NFB somehow validated her choices, I knew the power of women supporting women. I saw women choose homebirths who had never even considered the idea before their involvement with NFB. I saw women blossom as mothers, confident in their choices and empowered by their support network. When my business failed last year, I found myself with this gaping hole in my life, and I knew it could only be filled by helping women in the same way I had seen NFB help them.

My business started declining due to the economy while I was pregnant with Justin. When I found out I was pregnant, I decided to have a homebirth again, and I chose Peggy Franklin as my midwife. As my pregnancy progressed, I started to see homebirth midwifery as something I might be able to do myself, and I admired Peggy so much and thought if my life changed to the point where I could pursue midwifery I would really like to work with her as my teacher.

A few months after Justin was born, my business went through difficulties from which it would never recover. I felt such grief at the prospect of closing my business, but the thought of the opportunities it presented encouraged me. I could finally pursue midwifery! So, I made an appointment to speak with Peggy about working with her as an apprentice. Thankfully, Peggy accepted me into an apprenticeship and with that news I enrolled in National Midwifery Institute's program. Now, a year into the program, with 12 births under my belt, and a sense that I am doing my life's work, I meet Juliana and learn about her book. Pretty amazing.

God works in my life in ways I don't necessarily understand at the time. If you would have told me 9 years ago that I would be studying to be a homebirth midwife, I would have thought you were nuts! But, God, as usual, had a plan for my life I wasn't aware of. I didn't understand it then, but in hindsight, I feel comforted to know that he has been there for me all along, guiding me along my path.

The bittersweet job of midwifery

2008-08-22T19:37:00.000-07:00

I had a great day Tuesday helping at prenatals! I just had to post about it! One of the most bittersweet things about helping families through midwifery is the 6-week postpartum appointment.

I love seeing these beautiful babies thriving on breastmilk and love from mom and dad. It is so great to see these babies and remember that just 6 short weeks ago we didn't even know who they were or what they looked like! In such a short time, they each develop their own personality and show glimpses of what they'll be like as they get older.

The moms and dads go through an amazing transformation, especially the first-time moms and dads. By 6 weeks, they've managed to figure out their baby's cries and how to make her smile. Their relationship has deepened to include the joy they share of parenting their new baby. It is such a wonderful thing to behold!!!

I feel gratified to know I had some small part in this whole huge thing. As a student, I'm not nearly as involved in their lives as my preceptor is, but I have developed relationships of my own with these families. Even if my only role were to be as a witness to this life-changing event, I would still feel so honored to be a part of it.

The first 6-week appointment was for a couple who ended up transporting and having a c-section. While you would think their birth experience was horrible, it was absolutely beautiful, and the mom thought so too. In her words, she got to experience just about every kind of birth all in one -- the best that homebirth had to offer for labor, a smooth hospital transport, a respectful hospital staff, and a c-section after all available alternatives had been explored. She was happy with her birth experience, mainly because every decision was made only when it was clear that it was the best thing to do given the circumstances at the time. Because she was an active participant in all of the decision making, she felt at ease with the decisions that were made.

The second 6-week appointment was for a woman whose sheer determination was the deciding factor on whether she would birth at home. She didn't have health insurance, and she and her husband could not afford a hospital birth, so she was determined to have her baby at home unless it became a situation where her baby's or her health was in danger. She had a great labor up until the time to push. Then, after 6 grueling hours of pushing, there came a point where we had to make a decision about whether we were going to be able to continue at home. When we told her this, her attitude became very serious, and she stood up on the bed and squatted deeply and pushed with all her might. Progress, finally! She moved to the floor where she continued to squat while pushing. Soon after, her baby was born! If she had been giving birth in a hospital, she surely would have ended up with a c-section, but at home we were able to help her find a way to make her vaginal birth happen.

The third 6-week postpartum visit was from a mom who ended up transporting and having a vaginal birth in the hospital. It wasn't what she had originally planned, but she was at peace with how it all happened. The truly amazing thing about this woman was her transformation into being a mother. The moment her baby was born, her life completely changed in ways she never could have imagined. Up until that time, her dogs were her life. Now, with her beautiful son in her arms, her priorities instantly changed, and now her baby boy is everything to her. It was such a beautiful thing to see her completely changed by motherhood.

Each of the three 6-week appointments were for women whose births were more challenging than most. Each met the challenge in different ways, and each ended up with a different outcome. Although they didn't all end up having their babies at home, they did end up happy with the birth experience they had. Each woman felt that she was in charge of her birth, she directed the outcome. I think as midwives that is one of the greatest gifts of our profession.

So, what is the bittersweet part of the 6-week postpartum appointments? Having to say goodbye to these women is so very hard! The memory of working with each of them is on my heart forever, and I have a hard time accepting that I may never see them again. I'll probably never get updates about how they or their babies are doing, and that's really a sad thing for me. I hope it isn't always like that. I hope they do keep in touch. Just a quick email now and again would mean the world to me! Of course, they will go on with their lives, which is how it should be. And, I'll go on with my life. But, from time to time, I know I'll remember things about them and I'll wonder how they are doing. Bittersweet.

Homebirth is Green!

2008-08-13T00:06:00.000-07:00

I pretty much figured that homebirth was a "green" choice, but I didn't have any information to back up my hunch. Well, now I have! Natural Life Magazine has a great article in their July/August 2008 issue called "Green Birthing: The Triple Bottom Line." They bring up a number of very good points:
Think Globally; Act Locally -- Not a new idea, of course, but as the author of the article pointed out, "your midwife will probably be local and will, in turn, support other local businesses with her dollars. A small, one to three person team of midwives may have a wide scope of complementary allied health professionals that they can refer you to for true whole woman care. Visiting chiropractors, naturopaths, homeopaths, body workers and herbalists in your local neighborhood help keep your community thriving and vibrant with out-of-the-box modalities and thinking."
C-Sections Aren't Green -- "Surgical birth and hospital procedures require more people power, more drugs and more equipment, cost more and produce more waste than a vaginal birth at home."
Hospital Birth Uses More Resources Than Homebirth -- A lot of resources go into a hospital birth! Think about all that goes into the typical hospital birth. As the author stated, we need to consider "all the “stuff” of the typical hospital birth: the amount of electricity used to run the monitors, the resources needed to keep each and every room running on hospital floors, the waste produced and materials needed to make catheters, anesthesia needs, surgical instruments, shields, blood product equipment...the list is substantial!"
Homebirths Use Small Amounts of Disposable Products -- Yes, we use chux pads, gloves, gauze, umbilical cord clamps, and a few other disposable odds and ends. Some midwives buy or make their own reusable chux pads, and some mothers may choose lotus birth (which would mean no umbilical cord clamps). Midwives also make use of reusable towels and washcloths. And, as a way to give back to the earth, many homebirthing families choose to bury their placenta under a new tree rather than incinerate it as the hospital would. Likewise, the birth pool can be drained into the yard, again giving back to the earth.
Homebirth Encourages Breastfeeding -- Breastfeeding is the greenest way to feed your baby! There are no bottles to wash, no manufacturing process to support, no cattle to graze -- just you, your breasts, and your baby.

Vaccines -- lots to think about

2008-08-11T21:28:00.000-07:00

I just returned from the Loudoun Birth Matters meeting. Dr. Will Sonak, a chiropractor from Sterling, was the guest speaker, and he was really wonderful. He was very well-informed, and his presentation was clear and easy to listen to. He tried to provide a balanced approach to the vaccine debate, but he was very upfront about his choice not to vaccinate his own kids.

Over the years, I've read a lot about vaccine safety, but it has all been bits and pieces. It was really nice to see it all put together in a 60 minute presentation. Some points he made really make you think about whether to vaccinate:

Vaccines contain all sorts of things -- not just the vaccine. They have cells from aborted human embryos, aluminum, mercury, animal cells (an issue for vegetarians), antibiotics, MSG, formaldehyde, and many other things. Of course, the pro-vaccine people say that these are in trace amounts, but it makes me think of the brownie story. This is the story where the kids want to watch PG-13 movies, and they're trying to convince their dad that it is OK because there is only a little bit of violence and sex. So, the dad makes brownies. He uses the finest ingredients -- the best chocolate, etc., but there is only one drawback; he adds a little bit of dog poop to them -- just a little bit. He tells his kids that he's sure he's mixed the poop in really well, so they probably won't even notice it. He says if they will eat the brownies, they can go to the PG-13 movie. Similar situation with the vaccines! The questionable ingredients are "just trace amounts," but who wants that stuff floating around in their newborn's body? Not me!
Risk vs. benefit -- deaths from infectious diseases, including the diseases vaccines seek to protect us from, were already in steep decline before the introduction of vaccines. Nowadays, illnesses that would have killed us in the past are largely treatable. Of course, you wouldn't want your child to get these diseases at all, but the risk of a 2 month old getting something like polio or hepatitis B is practically zero. So, why risk introducing those chemicals into the body of a child whose immune system is just at the very beginning of development? Is there any harm in waiting?
SIDS -- I knew that there was some controversy about vaccines and SIDS, but I didn't know about this. Apparently, in Japan, the government raised their DPT vaccination age from 2 months to 2 years. The SIDS rate plummeted. As immunization rates increased in the late 1970's Japan, the infant mortality rate likewise increased.
Autism -- Again, I knew about the possible connection to autism, but I wasn't aware of this particular story. The Amish, who do not vaccinate their children, have a very low rate of autism amongst their population. They are about as close as we have to a control group here in the USA! The Amish of Lancaster County, Pennsylvania should have about 100 or so autistic people if you make your estimate based upon the rate of autism for the rest of the US population (now at about 1 in 150). However, the article showed only three people with autism -- one was adopted from China (and was most likely vaccinated there), the second one came from a progressive Amish family who vaccinated, and the third one was the only one for whom vaccines had not been introduced. Makes you wonder!

There was plenty more in Dr. Sonak's presentation, but those were a couple of gems I came away with. I still struggle with the vaccine issue with my own children, but I'm feeling more and more comfortable with not continuing to vaccinate my kids. Justin, who will be two in a week, has never had a single vaccine. I had considered starting to vaccinate him now that he is older, but after tonight's talk, I'm in no rush.

Why I want to be a Homebirth Midwife

2008-08-03T20:12:00.000-07:00

Today was a perfect example of why I want to be a homebirth midwife! I love my life as a student midwife and I am so looking forward to when I am a homebirth midwife working on my own. I still have a lot to learn, and each birth teaches me so very much. I don't think I'll ever be done learning about birth! Every family is different, every birth challenges me in new ways, and every baby is unique.

This morning, I got called by my preceptor to get a "heads up" that one of her clients was going into labor. Her membranes had ruptured, but nothing was really happening yet. This was her third baby, and her second one had come very fast, so I was a little anxious about not going to her right away, but as always, my preceptor's decision was spot on.

So, I got myself ready to go. I had my cell phone by my side all day, waiting for her to call me. Finally, about 4pm, I got the call that the client was ready for us to come. I excitedly got myself out the door and on my way to her house.

As we arrived, we heard the sounds of labor that let us know that the baby was coming very soon. We got the supplies ready to go, and did a quick assessment of heart tones and blood pressure, and prepared for a quick birth.

The woman had difficulty finding her strength during pushing, so my preceptor suggested I sit on the bed and have her squat in front of me while she held onto me for support. Perfect position for her! She pushed with such might and made low pushing sounds in her throat. In between pushes, I hugged her and whispered words of encouragement in her ear. I could feel her body melt between contractions. The words and the hugs seemed to really relax her. All the while, my preceptor was helping her control the birth of the baby's head so she wouldn't tear.

The baby was born. A big, beautiful, healthy baby girl! Her mama scooped her up in her arms and snuggled her at her breast. The baby latched on right away, and there she stayed for pretty much the whole time we stayed afterwards.

The mother was so happy with her birth, and she kept praising our efforts to help her. I felt so gratified and so humbled, all at the same time, to have been part of such a sacred moment in this woman's life. Somehow, I knew what to do for her, and it made a difference. What could be more wonderful than to have been part of this? These are the moments I live for as a student midwife! What a beautiful day!

Wanting Everyone to Have a Homebirth

2008-07-29T19:30:00.000-07:00

I just read a really sad blog. The woman writing it was using her blog as a pregnancy journal. She decided late in her pregnancy that she wanted to have a homebirth, so she consulted with a midwife to see if she was low risk. The woman has hyperthyroidism and has been on thyroid medications during this pregnancy. She went to her OB and told him of her decision to pursue homebirth, but that she wanted to make sure she was low risk. He disagreed with her decision and said she was too high risk for homebirth.

My first instinct? The doctor is just saying that because he doesn't want you to leave his care and he has a bias against homebirth.

So, I picked up Heart and Hands and checked out hyperthyroidism. Sure enough, it is a contraindication to homebirth, especially if the woman has been taking thyroid medication. DARN! I really had wanted to post a "go for it" encouragement on this woman's blog, but I just can't do it.

It is so hard sometimes to see women have to choose a hospital birth with an OB when they really want a home birth. I think one thing that makes it especially difficult is that there are so many women out there who are truly low risk and who would be great homebirth candidates, but end up going with the hospital birth because they are either misinformed, uninformed, or just plain scared. To see a woman who really wants it to not get it is tough for me.

I think one of my greatest fears throughout both of my homebirth pregnancies was that I would be risked out at some point. It didn't happen, but the fear was always there. I would get really nervous at my prenatal appointments, thinking, "OK, this is it. Today is the day I get risked out." I especially had that fear with my last pregnancy. I was older (40) and obese, but otherwise in excellent health. Plus, I had already given birth vaginally to four other children. I kept thinking I was going to end up with a hospital birth, and would leave every prenatal appointment with a sense of relief that I had somehow managed to squeak by again!

I would have been so sad to have been risked out! I know the pain this woman is going through! I wish there was some way her prospective midwife could wave a magic wand and make her low risk. Maybe there is some way for her to have a homebirth. Maybe there are things she could do to get herself well enough to still have a homebirth. I really don't know, but I sure do hope so.

Control

2008-07-28T13:21:00.000-07:00

Why does it seem that so much about birth has to do with who controls what? When I went on my friend's hospital tour at Inova Fair Oaks Hospital last week, some of the most irritating things about the hospital environment had to do with control. The hospital staff seems to have this great need to control every aspect of the birth and hospital stay of the mother and baby. They have rules about just about everything!

There are rules about the birth tub -- you can stay in it for labor, but not for the birth, and definitely not at all if your membranes have ruptured!
There are rules about the hours that your loved ones can be with you -- partner 24/7, grandparents can stay until midnight, children until 8pm, etc.
Rules about bathing your baby -- the baby is considered a biohazard, so it must be scrubbed with soap and water 3-4 hours after the birth.
Rules about whether your baby can go home in the car seat you brought with you -- don't even get me started about the car seat test!
Rules about whether you can even take your baby home from the hospital -- can't take the baby home if you don't have a car seat.
Rules about doulas -- some hospitals don't even allow them!
Rules about what you can eat and drink -- pretty much nothing, although your labor partner should eat and drink frequently to keep his strength up. Hmmm... who's the one laboring?
Rules about the Vitamin K and Erythromycin ointment -- they look at you like you just grew a third eye if you even question it.
Rules about how many people can be in the room -- no more than five plus the laboring woman. But, there can be as many hospital staff members as the hospital wants.
Rules about having to have an IV -- must have it unless your doctor "allows" you to opt for a hep-lock instead.

Yeesh! All of those rules! How does the presence of these rules affect a laboring woman? My thought is that just having someone else calling the shots on things you may or may not care about, puts you in the position of having to answer to someone other than yourself. The woman gives up her power and her responsibility to think for herself because the institution has a rule for every decision she would normally have to make for herself. Giving up this power and responsibility puts her in a position of being under the control of the hospital and doctor for her birth. She's already accepted the hospital and doctor as the decision makers, so how could she have the gumption to question the decisions they make for her? Birth becomes something that is done to her, rather than by her.

When listening to women talk about their hospital births, how often do you hear something like this: "I'm not sure why, but they did ____ to me. I'm sure they had their reasons." Something like that would just not fly in midwifery care! In midwifery, the woman takes part in just about every decision made. She becomes informed about the options available, the risks vs. benefits of the tests she decides to do (or not do), and makes a decision based upon this informed choice. This, I feel, is the cornerstone of midwifery care.

Are there rules for homebirth? Sure, I suppose so. Some midwives don't do breech births or twin births at home. Of course, the woman has the option to seek out another midwife who would be willing to help her with a breech or twin birth. But, for the most part, midwives are pretty open to the mother doing whatever she feels is the right thing. Eat and drink in labor? Absolutely. In fact, most midwives insist upon it. Get in the water after membranes have ruptured? Sure, why not? Have your loved ones with you 24/7? Absolutely. Skip the bath? It's your baby, why not? If someone is worried about disease, they can wash themselves after they touch the baby! Car seat? Yes, but we're not going to do the car seat test! Ultrasounds? If you want them, you can get them, but that's up to you.

The point is that you have as much control in a homebirth as you want to have. If you want to catch your own baby, go for it, but if you want the midwife to do it, she will. You have choices in your birth. Your midwife might guide you, and she might point you to information to help you make decisions about your care, but you have the control to make the choices you want to make.

The Right to Choose -- HOMEBIRTH!

2008-07-24T20:53:00.000-07:00

I've been stewing about the AMA trying to outlaw homebirth. The very idea of this is ludicrous, especially in a country where women have the right to legal abortion. Why is it that women can choose to abort their babies, but they shouldn't be able to give birth wherever they choose?

All the studies point to homebirth being as safe or safer than hospital birth for low risk women. But, let's say, for the sake of argument, that this isn't true. Let's say the risk of death for a homebirth baby is 50% (which, of course, would be horrible if it were true). The risk of death for an aborted baby is 100%! Women in the USA are able to legally have abortions, so why shouldn't women have the right to choose to give birth wherever they want?

Here's something to think about. If the AMA wants women to give birth in the safest environment possible, then they should support homebirth for low risk women. After all, more and more hospitals are outlawing VBAC (vaginal birth after cesarean), requiring repeat cesareans. Cesarean surgery is more dangerous than VBAC, so since it is becoming nearly impossible for women who have had c-sections to have a VBAC in the hospital, the safest place for a woman with a prior c-section to give birth would be at HOME!

How can the AMA even think to try to outlaw homebirth? There are plenty of people in the US who choose homebirth for religious reasons. And, people can always choose to make decisions for themselves against medical advice. It is preposterous to even propose trying to outlaw homebirth!

Show me a study that shows hospital birth to be safer than homebirth for low risk women. SHOW ME THE STUDIES! They don't exist. But, there are plenty of studies out there proving what midwives have known for years: homebirth is as safe or safer than hospital birth for low risk women.

The Car Seat Test

2008-07-23T21:57:00.000-07:00

I just went on a hospital tour at Fair Oaks hospital. One of my dear friends is going to give birth there, and she asked me to help her as a doula, so she wanted me to go on the tour with her. In general, I think Fair Oaks is a decent hospital. Of course, my feeling is that hospitals are for sick people and that healthy moms and babies shouldn't give birth there, but I also feel that women need to be supported in their choice of birthplace and care provider, even if their choices aren't the same as mine. My friend would love to have a home birth, but with 2 out of 5 pregnancies (including the last one) ending in preeclampsia, she felt better about not getting her heart set on a home birth and just going to the hospital for her 6th baby. She had planned a home birth for her 5th baby, but ended up transfering to the hospital at the last minute because of preeclampsia.

So, I went on this tour, and it was pretty standard fare. I heard the usual hospital policies -- must be hooked up to an IV (or at least a hep-lock if the doctor agrees to it), no water birth (but you can labor there), no food or water (of course, your labor partners should eat and drink because they'll get tired -- like the laboring mom won't?), etc. Then, the lady running the tour threw a new one at me. She said that if your baby weighed less than 5 pounds, 8 ounces, your baby would have to pass a car seat test. Car seat test, what's that? She said those babies will be strapped into a car seat, be hooked up to heart and breathing monitors, and left there for 90 minutes. No matter how much the baby cries, the baby is left in the car seat. If the baby has any concerning episodes with regards to heart or lung function, the parents will be required to purchase a "car bed" for their baby before they are "allowed" to take their baby home.

My comments on this? I asked her what they do if the baby starts crying or wants to nurse, and she said that they make sure you feed the baby before they do the test so they won't have to nurse again for the 90 minutes. I said that breastfed babies frequently need to nurse more often than that, and that 90 minutes is an awfully long time to separate a newborn from his mother -- nursing or not! Her response was a shrug and a comment about it being "hospital policy."

So, I got home and did a Google search on "car bed." I wanted to see what one of these looked like and I also wanted to see if I could find any information about the benefits of using one. Guess what -- they're not better than a regular car seat! According to a study published in June of 2007 in The Journal of Pediatrics:

"Twenty-eight percent of the infants had at least 1 event during testing, with 9.2% having an event only in the car seat, 13.2% in the bed only, and 5.9% having an event in both. There was no difference between the 2 carrier types in the percentage of infants who required intervention from a nurse during testing. Lower gestational age was associated with events in both devices.

The authors conclude that all VLBW infants are at risk of apnea, bradycardia, or desaturation at discharge regardless of carrying device."

OK, so once again, non-evidence-based theories are being used as the basis of hospital policy. It pains me to think of the number of babies subjected to this absolutely unnecessary test. Common sense would dictate that if you have a low birth weight baby, and if having your low birth weight baby ride in a car seat or car bed might result in apnea or bradycardia, it would be prudent to have someone sit in the back seat with the baby and monitor the baby for any concerning episodes. Once home from the hospital, it would also be a good idea to avoid car rides until the baby reaches a weight where this issue isn't such a concern. This truly seems to me to be common sense, and most likely, the mother would instinctively want to watch over her very small baby in the car anyway.

The name of my business!

2008-07-21T20:41:00.000-07:00

I finally decided on a name for my business! My homebirth midwifery business will be called "Gentle Homebirth Services, LLC." Why did I choose this name? I think it says everything that I think homebirth midwifery is all about.

First of all, take the word "Gentle." The very first book I ever read about birth was Dr. Frederick Leboyer's classic "Birth Without Violence" It shaped every choice I ever made about my own births. I had the good fortune of reading this book when I was pregnant with my first child, so I always carried with me the knowledge that babies do experience birth and that those early experiences really do matter to them. I think it is because of this that Karen Strange's class was so inspirational to me. To me, homebirth is the most gentle way for a person to be welcomed to the world.

Homebirth -- of course, this goes without saying, but my practice will support homebirth, so having that in the name seemed to make sense.

Services -- I chose the plural because I see the work of a midwife as a combination of many services we offer to the birthing family. We are counselors, nutritionists, lactation consultants, childbirth educators, and parenting educators, as well as specialist attendants for pregnancy, birth, postpartum, and newborns.

The name isn't fancy, new-age-y, or cutesy. I'm not any of those things. But I do offer women a gentle and safe way to welcome babies into their families at home.

My Story

2008-04-03T18:36:00.001-07:00

I published this story on the Natural Family Boutique website back in 2005 (before Justin was born), but since NFB is no longer in business, and I don't want to lose this story, I thought it made sense to post it here. Enjoy!

I come from an unbroken line of breastfeeding mothers. My mother nursed me; her mother nursed her, etc. For me, breastfeeding was never a choice - formula feeding was a choice some women made if they were unable to nurse. At least, that is what my experience had been during my childhood. I grew up unaware that most Americans saw things the other way around.

I first learned of LLL in 1980, when my Aunt visited us. I was 14. She would nurse her toddler while we would sit and talk about mothering. I had always been fascinated by the whole pregnancy/birth/lactation process, and wanted to be an obstetrician "when I grew up." I considered my time with Aunt to be part research for my future career and part fun "girl time." She told me how being a member of LLL helped her develop a network of like-minded friends who supported her decision to nurse. This was the first time I ever realized there was such a thing as a decision to nurse.

When I became pregnant with my first child, Erik, in 1989, I read everything I could get my hands on about pregnancy and birth. Breastfeeding was something I just took for granted. I assumed that it would all just come naturally. I was working full-time until 2 days before he was born. I bought a breast pump, and thought I would be able to just pump a few bottles every day for him. I had no idea what I was in for.

When Erik was born, I left the hospital 19 hours after his birth. I had nursed him only twice while I was in the hospital. He had been very sleepy and uninterested in nursing during his first day. The day after we got home, he woke up and I had no idea how to take care of him. My mother lived 1000 miles away, and my only support was from people who had never breastfed a baby. They told me to put him on a strict schedule or he would be totally spoiled. I didn't trust my instincts because I felt so overwhelmed by the experience. I figured that since I was an only child and had never been around a newborn, these other "experienced" mothers must have known what they were talking about.

I did things the way everyone, including my son's pediatrician recommended. I put him on a schedule and let him cry when he wanted to nurse more frequently than every 3 hours. He gained weight very slowly and cried all of the time. About a week after he was born, I had cracked and bleeding nipples. After another week of me crying every time he nursed, I gave up and began formula feeding. I felt like a failure as a mother and as a woman. This, after all, was supposed to be something that just comes naturally. I felt defective and depressed.

On formula, Erik developed essentially the same as every other child I knew. He was constantly on antibiotics for ear infections. He ate solids early (4 months). He spent a great deal of time being cared for by other people. I felt that my role as his mother could be adequately filled by anyone who loved him. In other words, I felt that I offered little that was uniquely my own.

When Erik was 18 months old, I conceived my daughter, Lauren. I was determined that things would go differently this time. I read "The Womanly Art of Breastfeeding" for the first time about a month before she was born. It opened my eyes to a whole different way of thinking. Unfortunately, it was not enough. Things went fairly well for the first 6 weeks despite some early setbacks. Lauren was in the hospital until she was 5 days old due to jaundice. I came to the hospital every 3 hours around the clock to nurse her until her release.

When Lauren was 6 weeks old, I developed a stomach ulcer and my doctor put me on medication that he said was incompatible with breastfeeding. Later, I found out that it would have been completely harmless. I met with a lactation consultant and rented a hospital grade breast pump. The doctor decided I should pump and dump and feed Lauren bottles of formula. I had great difficulty pumping milk. I was very discouraged by the small amount I was able to express when I pumped. After about 3 weeks, I was given the green light to breastfeed Lauren. But, Lauren had become accustomed to using bottles and would become frustrated when she would try to nurse. She cried constantly and so did I. The lactation consultant decided that I should use a Supplemental Nursing System to encourage Lauren to nurse. We tried it for a few days and gave up. Lauren was no longer nursing at all by 3 months. Once again, I felt that I had failed.

My husband and I divorced three years later. A year after that, I re-married. My husband, Barry had two children from his previous marriage. His son, Jonathan, was 6 months older than my son, and his daughter, Nicole, was 6 months older than my daughter. About a year after we married, I began having baby cravings. Our blended family was doing very well, and our marriage was fantastic. I realized that I wanted to have a child with Barry and share the experience of raising our child together. After some initial problems with infertility, we conceived Elizabeth in 1998.

This time, I knew exactly what was ahead of me. I knew I really needed to prepare. I read "The Womanly Art of Breastfeeding" about 10 times cover to cover. I also read as many other breastfeeding books as I could find. My husband, whose children were bottle-fed, did not understand my nearly obsessive need to prepare myself for breastfeeding.

When Elizabeth was born, my husband marveled at my devotion to nursing her. I was completely determined to be a successful nursing couple. Elizabeth roomed in with me full time at the hospital. I woke her to nurse every two hours during the day if she was sleepy. I ignored the poor breastfeeding advice of an obstetrician who said I should give her bottles of artificial baby milk until my milk came in. I turned a deaf ear to all advice from anyone who had not nursed a baby. When Elizabeth was jaundiced, I slept next to her in the living room where her light therapy unit was set up. I nursed her with the light cuff on every two hours for the duration of her treatment.

At 2 weeks postpartum, I developed mastitis and a very high fever. I read in the "Womanly Art" that the best remedy for a breast infection was frequent nursing and rest. My husband stayed home and took care of Elizabeth and me while I recovered. He brought her to me every 2 hours to nurse, and then cared for her himself so I could get as much bed-rest as possible. He made sure I had everything I needed to get me through this difficult time.

Barry quickly became my biggest support and my strongest advocate. He defended my right to breastfeed everywhere and quickly shot down the arguments from people who were ignorant of the benefits of breastfeeding. He thanked me nearly every day for nursing our daughter.

When Elizabeth was about 6 weeks old, I joined La Leche League. The first meeting was like a whole new world had opened for me. Before joining, I felt like I was the only woman in my community who was nursing her child. I never saw women nurse in public. Finally, at La Leche League, I saw mothers who also nursed their children. I wish I had joined La Leche League when I was pregnant with my first child. Being a member of La Leche League and attending the monthly meetings have truly shaped how I raise all of my children, not just Elizabeth. I learned about toddler nursing, tandem nursing, pumping, misinformed doctors offering poor breastfeeding advice, nursing strikes, weaning, etc., from the experiences of my friends. I now know that what I went through is very common. I didn't fail at nursing; I just had the unfortunate experience of dealing with the expectations of a bottle-feeding society. This culture is what has made it so difficult for many of us who want to breastfeed our children.

Breastfeeding Elizabeth caused me to question many things that I had at one time accepted blindly. When I became pregnant with my fourth child, I was more open to alternatives to a hospital birth. I researched the risks vs. benefits of various common obstetrical interventions, took Bradley classes, and planned a home birth with a midwife.

Charlie's birth was an incredibly beautiful family event. Birthing at home, with my body's own wisdom, helped heal the pain I had carried with me from my other births and failed breastfeeding attempts. Finally, I did not feel defective! My body knew all along how to give birth, just as it knew all along how to nourish and nurture my babies through breastfeeding.

As I write, Charlie, who is now nearly 4 years old, is still nursing. Of course, I know that our nursing days are nearly done. He's nursing once or twice a week instead of once or twice an hour now. It is a bittersweet time for me. I am saddened by the thought of this journey coming to completion, but I feel great joy when I reflect upon all that we experienced through breastfeeding. Breastfeeding has been so much more than providing milk for my child. It is about learning to listen to my child's needs, and learning to trust my ability to meet those needs, perfectly. The lessons I've learned have made breastfeeding the greatest parenting class I could have ever taken.

Take a moment

2008-04-03T16:48:00.000-07:00

Man, what a day yesterday was! I had my Neonatal Resuscitation class, which was taught by Karen Strange. She is an amazing woman! I learned so much about birth, not just about NNR, and it has forever changed how I will approach birthing.

Big words there! Yes, "forever changed." Karen spoke so eloquently on birth from the baby's perspective. It reminded me a lot of Birth Without Violence by Frederick Leboyer. I read that book years ago and was moved by the words of Dr. Leboyer. I knew that when I gave birth, I would do so in a non-violent manner.

Of course, hospital birth is anything but non-violent, but since I didn't know I had alternatives, I ended up going down that path for my first three births. Then, when I chose to have homebirths with midwives for my last two births, I felt I had finally found the non-violent birth I had always sought. By comparison to hospital birth, my homebirths were very much non-violent, and by comparison to other home births, I'd say my homebirths were very calm experiences. However, Karen opened my eyes to things even midwives could do more gently.

"Just take a moment." Karen said something that considering the ordeal the baby has gone through -- navigating the planes of the pelvis, being squeezed by contractions, experiencing periods of hypoxia, going from darkness to light, feeling gravity for the first time, hearing the squeals of excited family members ... can't we just take a moment to get our bearings? Why do we need to rush in and rub the baby with towels, suction the mouth and nose with a bulb syringe, clamp and cut the cord, and shove a breast in his mouth?

Karen says we carry a cellular memory of our birth, and because of our own unresolved issues and fears surrounding our entry into the world, we project this onto the babies we care for. Maybe she's right, or maybe it is just that this is the only experience of birth we've ever seen or been trained to handle. Regardless, her words hit home with me and made me think a lot about what we do as midwives and what we COULD do as midwives.

Rather than rush to get to the finish line, why not "just take a moment." Let the mother claim her baby when she's ready, rather than handing her the child as soon as it arrives. Let the mother and baby set the pace. In almost all cases, there is no reason to rush. The baby will breathe on his own, and if he does have trouble, you're able to step in and help him. Maybe he just needs to "take a moment" to catch his breath, so to speak.

There's plenty more to write about here, but for now, I'll leave you with this thought... take a moment.

Pregnant ... Again???

2006-03-25T18:16:00.000-08:00

Yes, again! Last December, in the middle of our holiday rush, I found out that we’re expecting a new person in our family this coming August. At the age of 40, I really thought my baby days were over, but God had another plan for our family.

It is interesting to see people’s reactions to the news. Some people just shake their heads in disbelief, while others have been bubbling over with joy for us. Usually the people who were most happy for us were the ones who truly found parenting to be a joy rather than a burden.

I think that love of parenting is one of the biggest benefits of attachment parenting. Parenting becomes an extension of yourself and an expression of your love for your child when you practice the principles of attachment parenting. But, “detachment” style parenting makes parenting into a job, another thing on your list of things you need to do.

Of course, adding another child to the family does add a lot to that list of things I need to do. But, I’m thrilled to know that I’ll have yet another chance to wear my baby in my sling. I’m looking forward to the nights of having a little nursling snuggled in close to me in my bed. I do worry about getting everything done though. After all, we already have a very full life. But, I had the same fears with each of my other children, and somehow, it always worked itself out. Likewise, after a few months, we’ll get into our routine, and we’ll wonder how we ever lived our lives without this new little person!

I have an opportunity few moms have. I have the joy of being able to welcome a seventh child into our family. These days, a large family isn’t a common thing, and I am lucky to be able to do it.

Reflections on Attachment Parenting

2005-06-20T18:41:00.000-07:00

I look at my beautiful children, and I am struck by the essence of why attachment parenting makes perfect sense. Each child is an individual, with his own strengths, weaknesses, needs, and gifts. Attachment parenting embraces these differences amongst children, and challenges you, as a parent, to respond according to your child’s needs — not according to a schedule or to some predetermined babytraining method.

I have six children — four by birth, and two by marriage. Each one of my six kids is very different from the other. Their personalities, likes, dislikes, temperaments — all very different for each child. What works for one, may not work for another. I am amazed at how even though these children share the same gene pools (overlapping in interesting ways because of our blended family), each child is so completely different from the others.

Each of my children responded to different ways of comforting when they were babies. Elizabeth loved to nurse, sometimes for an hour at a time. Lauren loved to be held and rocked while she held my thumb (had to hold the thumb or it didn’t work). Erik loved to be upright and patted on the back while he rested against my shoulder. Charlie was always happiest in the sling.

Now that they’re older, I’ve been able to see the results of responding to them as individuals through attachment parenting. Four of our six kids are teenagers now. Jonathan is 16, Erik is 15, Nikki is 14, and Lauren is 13. Each one of them is very self-confident and honest. They know that home is a safe place for them to express their opinions, and they know that we trust their judgment to make good decisions for themselves. We respect our children, and they, in turn, respect us. I think this is the reason we don’t have a lot of the “teenager issues” many other families have.

I wonder what the future will hold. In two years, we’ll start sending kids to college. One by one, they’ll each go off into the world and begin their lives as adults. I’ll miss them terribly! But, I am thrilled for them that they will be starting this new chapter of their lives. I’m looking forward to seeing the path their lives will take. And, when the time is right, I’m really excited to work on Attachment GRAND-Parenting! In the meantime, I’ll continue to watch them grow, and help them on their journey to adulthood — Attachment Parenting style, of course!