To VBAC or Not to VBAC...

There is so much controversy surrounding VBAC (Vaginal Birth After Cesarean) lately.  Cesareans are the #1 most frequently performed surgical procedure in the US, and the cost of surgical intervention is more than twice the cost for a vaginal birth in the hospital.  As of 2010, the C/S rate in the United States is at 32 percent nationally with a variance of 22-38% on a state by state basis, the rates having risen as much as 50% in the last 10 years.  The World Health Organisation states that a safe and valid number should be somewhere around 15%. The maternal mortality rate as of 2011 is 12.7% ranking the US 50th world wide, a number which has doubled in the last 25 years.  The infant mortality rate in the US is 7%, ranking the US 34th worldwide, and this number has risen in the last decade.  The premature birth rate in the United States is 12% which ranks the United States a whopping 131st world wide.  C-section rates are higher among the poor and ethnic minority populations, mostly because they don't know better.  What these numbers prove is that a rising Cesarean rate is not improving the lives of mothers and babies, actually quite the opposite appears to be the case.  It is also violent and damaging to a women's psyche.  Along with our soaring rate of intervention in birth, including the ridiculous rate of surgical intervention, postpartum depression and psychosis has become an epidemic.

Fewer and fewer providers are allowing trials of labor (TOL) for women who have previously had a surgical birth.  The American College of Obstetriticians and Gynecologists (ACOG) themselves endorses TOL and VBAC, stating that the risks of repeat surgery are greater than the risks of complications occurring because of the uterine scar, but again and again I hear from women who cannot find providers who will all them to attempt a vaginal birth in the hospital.  Sadly, even midwives are becoming rigid about this.  Many nurse midwives practicing in the hospital cannot or will not encourage or assist women with VBACs, especially if they have had more than one Cesarean   I believe in homebirth and ultimately unassisted birth, I believe in the strength and power of women, and the body's miraculous ability to heal, but I am sad and frustrated that women are being FORCED to choose between homebirths and surgery, when they may not feel 100% safe at home.  Of course I deeply believe that most women can give birth vaginally, and that most women experiencing low risk pregnancies CAN have their babies at home, but not everyone WANTS to have their baby at home.  Homebirth has to be an option that parents come to on their own, rather than it being forced upon them.

If you injure your back or blow out your knee, you are urged to take the necessary steps to encourage healing, and eventually you are expected to use those parts again in the proper way. If you have heart surgery, brain surgery, bowel surgery, we don't just automatically assume that these organs are now defective and stop trying to live, no, we are encouraged to create healthy attitudes and lifestyles and HEAL.  If the body can heal a back or knee or brain or heart, and those parts can be used again, for walking, twisting, lifting, thinking, pumping etc. it stands to reason that the uterine muscle will work properly too.  We heal.  We just do.  It makes sense for surgeons who are performing Cesareans to be diligent in closing the incision with the  expectation that the organ will heal and be able to be used again, in a normal fashion.  Am I naive in thinking that this should be true?

So the question really is how committed are you to birthing your baby vaginally?  Are you willing to stand up for yourself in the face of adversity, invest in a birth team who are going to support you and believe in you?  Are you willing to say NO?  Studies show that VBAC is safer for both mother and baby.  The long term effects of natural birth over interventive birth, and specifically surgical birth are overwhelming.  We do what we do, we breathe, we make an intricate chemical exchange in our lungs that is amazing.  We eat, and think, and breathe, and pump and filter and gestate and give birth.  It is what we do.

The chemical actions that occurs in mother and baby during pregnancy and birth happen the way they do for a reason.  There is rarely an accident or malfunction that isn't caused by interfering.  Normal birth happens.  It happens when you are young, old, fat, thin, happy, sad, tall, short, married or not.  It happens.  It happens best when it is left alone. Homebirth is a safe option for women experiencing an uncomplicated pregnancy.  VBAC is as safe as running a marathon on a knee that has been surgically repaired.  The only difference is that the marathon runner gets patted on the back for pushing through adversity and overcoming the dysfunction.

To the doctors I say; women experiencing labor with a scar on their uterus need time.  Blown out knees may heal quickly, but learning to walk, and run on it takes time to figure out.   Stop rushing women into surgery.  Stop supporting a broken health care system by damaging the uterus's of more than a third of women, you cannot honestly believe that one out of 3 women are defective.  Stop spending so much time convincing yourselves and the women who trust you that they are broken.  Women, stop believing you are broken. Our doctors and surgeons can save our lives, and that of our babies, when things go awry. However, just like we don't rush out and get a colostomy, the first time one might get constipated, women should not be having their uterus's cut unless there is a true indication for surgery.  Fear should NEVER be an indication for surgery.

What it means to be a midwife...

There are times when I couldn't imagine any better job in the entire universe.  I love what I do, and I couldn't possibly NOT do it.  I've tried.  Many who are interested in midwifery have romantic notions about what the job entails, and many people who are using midwives for their homebirths hardly understand exactly the level of commitment involved.  So, this is for the women who may want to work in the birth field, and the families with whom we celebrate the changes in their lives.

Let me start by saying I rarely take more than 3 clients a month, 4 would be a busy month for me, because of not only the time commitment involved, but the emotional investment as well.  Prenatal visits with me rarely run under an hour, and there is often a deep emotional connection to not only the pregnant mama, but to the entire family.  I try to group prenatal visits on the same day or days of the week, and do them in my office, because the driving involved in home prenatal visits with a practice area as large as mine means that I would spend more hours in the car than I do with my clients, even with a more local clientele  I would still spend hours in the car weekly.  3-4 clients a month, every month means I could see as many as 20 women a week, for monthly, bi-weekly or weekly prenatal visits.  This does not include initial interviews, 37 week home visits, any emergencies that may arise, trips to the health food store to purchase herbs and supplies for remedies and teas, meeting with other professionals in the area to help provide a network of care, hours spent charting, documenting to keep everything up to date, and hours studying and researching in order to keep myself and my clients abreast of changing trends in evidence based maternity care, and holistic care for the entire family.

There is the call to labor at 3 in the morning, while you are grocery shopping, teaching a class or in church.  There are births that last 2 hours and births that last for two days.  There is the incredible investment you have to make in your own health as the provider, to ensure that you are up to the task of assisting at birth AND that you aren't making situations where mom's and babies could get sick. Next factor in the texts, Facebook messages and phone calls at all hours of the day and night.  Please don't think I am for one second complaining, I am not at all.  I say this with heartfelt affection and commitment to the families that I serve.  I love them all, and make the commitment because it is what I have been called to do.  I have missed children's birthdays and important anniversaries, Thanksgiving, Christmas & Easter with my family, to help bring sweet, sweet babies into the world.  Even if I plan a week or two off *call* for family time, I STILL have to be available for prenatal care and attention to clients immediate needs.  I am in it for the long haul, and my family whole heartedly supports me in this endeavor, even if it means that every penny of what I earn goes back in to supporting my work.

I have recently been privy to some conversations and attitudes regarding doula's and midwives which indicates a level of ignorance with regards to the emotional, social and economic commitment made by these women.  It is frustrating to hear someone say... "Maybe you can find a student midwife who will attend your unassisted birth, since you can't afford a midwife" or "maybe you can find a free doula who needs some births for her certification".  I am insulted FOR these women. It is incredibly dangerous to ask a birth professional to provide care that is outside her scope of practice and unfair to ask a birth professional to attend in a manner that is either too great a commitment for the investment you are willing to make.

It is important that doulas, childbirth educators, apprentice midwives, midwives, lactation workers and other birth helpers are shown the respect appropriate to the level of commitment involved in the work.  We all have poured our heart and soul into what we do, and a lot of time, energy and money into education and training, that is ongoing.  We are professionals who are committed to you on a level you will not see in the medical model, so take heed.  We are professionals.  We deserve to be paid for our time, energy and expertise.  We deserve to be compensated for the commitment that our families makes so that we can be available 24/7 sometimes for days at a time.  We deserve the courtesy of down time, holding non urgent business for the work day.  Birth workers deserve to be recognized for the commitment to the families they serve, and compensated for the work that they do.  You can't put a price on love, but knowing that the gas bill is paid goes a long way toward helping YOUR birth professional be more available to do what she does and what she loves.

Because we love what we do, there is always a way to make an equitable exchange.  Ask, you might be surprised what the answer is.  I personally LOVE to barter, because it means we can both do what we are good at and show exceptional value in that service above what money can provide.   If society continues to devalue the women who are weaving the fabric of love around birthing families, too soon these amazing women will not be able to make the same investment in the community that does not support them.  I have known quite a few birth professionals who have retired because the commitment required was greater than the community's investment.  What you invest in becomes your reality.  Invest in love.

I'll Catch Your Baby in a Gas Station Bathroom, or What you NEED to Have a Homebirth...

I'll Catch Your Baby in a Gas Station Bathroom, or What you NEED to Have a Homebirth...Often times I am puzzled by the things that people think about when they are presented with the idea of birthing at home.  Is my house clean enough, is it large enough, is it accommodating, close enough to a hospital etc.

One thing I have to constantly remind people is that babies come out.  One of the best things is that they come out when mama is relaxed and feeling safe in her environment.  Whatever it is that makes you feel safe, warm and supported, THAT is what you want/need for your homebirth.  It doesn't matter that your house is small, or even an apartment.  It is your HOME and that is the perfect place to birth.

I'm reminded of a recent client, who when she found out she was going to have to move into a much smaller apartment, was DISTRAUGHT over the whole thing, thinking that she would have to scrap her plans for a homebirth.  I said to her "Sweetie, I'll come catch your baby in a gas station bathroom if that is where you want to give birth... Is your apartment bigger than a gas station bathroom?"  What you need to know about space for a homebirth is that it needs to be a place you feel safe.  I personally prefer running water and electricity, but the reality is that babies come out, they come out in cars, on trains, in grocery stores, in ambulances, in cold hospital rooms and operating rooms, with harsh lights and cold metal.  They come out.  They come out best when you feel safe and comforted.  Babies need very little, and it is a little known secret that mama's and babies are PERFECT dance partners when they are left to figure it all out, unhindered and together.

The rest is just fluff.  The dishes in the sink will wait, or they will get washed.  The laundry in the dryer will wait, or it will get folded.  The rest of it will keep.  Trust yourself, trust your body and your baby, and do what women have been doing for eons, in caves, in plywood and tarp shacks, in huts and hovels.  All that baby needs is you.

Angels Among Us...

With a heavy heart I offer sincerest prayers and loving thoughts to the family of Scarlett and Chris G.  Their sweet baby girl, Sofie was born still at 36 weeks, on August 29th at 11:31pm, due to a cord complication.  All of the families and babies who come through my doors, find themselves in my heart forever.  This family is no exception.  Sofie will be missed by her loving parents, 4 older brothers and many other friends and family, a few of whom I was privileged to meet.  Much love to you all.

Sweet Baby's Breath

One of the most amazing things about being a midwife, aside from the obvious sweet little babies and glowing mama's is the constant filling of my own heart as my truth is honored again and again.  I trust birth, in my heart of hearts I believe birth is as safe as life gets, more so when it is unhindered.  I had the honor to witness one of the sweetest couples working together as an amazing team, birthing their little boy through the wee hours of the morning.  When I think about this birth I am reminded that things do not always go as planned, no one can plan for the intensity of the moment or the hoses not connecting right, but what we an plan for is the heart and soul, the hand holding, the sweat wiping, the encouraging and the triumph of that moment when the mama realized she has climbed the mountain, and can stand at the peak and survey all of creation.  I also smile when I think about filling and then bailing a birth pool with pots and bowls, and a good hearted assistant to help out.  I am blessed daily to be in the lives of these amazing families, birthing their babies through whatever life throws at them, and the women with whom I share this journey as caretakers and space keepers.

Summertime...

It has been a wonderful summer here in Bluefield so far.  I have been on call for 5 weeks and experienced birth with my first family here in West Virginia.  What a wonderful family to work with.  I'm still on call, awaiting another little one sometime in the next couple of weeks.  I have been hard at work cranking out Informed Choice documents and handouts for my families, education and information are so, so important during this time. If there is something you wanted to know but were afraid to ask, now is the time.  Chances are if I don't already have an IC Document or Handout about it, it is in the works.  Feel free to offer suggestions as to the types of things YOU would like to know.

I have officially started working with Haylea Musick as an apprentice, and Sandra Rose as birth assistant.  These ladies will be deeply involved in every aspect of Wiyama Midwifery.  They will be at prenatal visits so everyone has the opportunity to get to know them personally.  I will add Sandra to the About the Providers page as soon as I can.

If you are looking for a health & nutrition coach or for personalized hypnosis Denise Borgeson is here for those needs as well.  Feel free to call me and ask about her services and I can forward you on to her.

Website Up and Active...

Website up and active...It was quite the process to get my domain transferred over, and get my website tweaked and to my liking.  I know there may still be some editing to be done, so please be patient with me.  I am really pleased with how it has all come together.  I'm especially excited to put the first new birth announcement up!  I officially go on call on Monday for my first birth since relocating Wiyama to Bluefield.  I might even venture to say I am more excited than the mama is!  I have to send out a special THANK YOU to my family, who has been super supportive through the move and helping to create a work space for where my homebirth families can come for classes and prenatal care and feel at home.  My 14 year old, Kody, stripped the paint off of the walls in my office so it could be repainted. <3

The long and short of it is that I finally feel like I am home.  This is a good feeling.

Roll Out of Wiyama's New Website...

Welcome to Wiyama Midwifery's new home on the web.  Pull up a chair and make yourself comfortable.  Here you will find lots of information about Wiyama, as well as articles and news, birth announcements, and a shopping page custom made for homebirthing families.  Moving Wiyama Midwifery to Bluefield was quite the undertaking, but a brand new location, new office, and new clients have me feeling so excited to begin serving the families of Southern West Virginia.  Updates to this blog will be posted on my Wiyama's facebook page.  Please add yourself to that page if you are interested in receiveing blog updates!  Feel free to email me any feedback you might have!