I have been in another state, for almost 5 weeks now, visiting my sweet sister-in-law, Dawn, so I can be here with her when she has her baby. She went into labor and had her baby last night, finally at 42 weeks. She was amazing, had a very short active labor, and a very long pushing stage which ended up needing intervening, and ended in a huge laceration to her bottom. She is at the hospital right now getting stitches, for a tear I felt was outside my scope to repair. I am heartsore. This is not what I came here (planet earth, not necessarily to Dawn's house) for. Babies are supposed to find their way out. I KNOW in my brain that I am supposed to be at these births, that these families invite me to be part of their sacred space not only for the genuine servants heart I possess, but also my skill set. I try VERY hard to be as unobtrusive as I can be at births, encouraging moms to do things their way, call the shots, own their bodies and birth their babies in their power. This is the midwife that I was called to be. There are only a handful of pictures of me at birth, because I am committed to being the servant in the background, the one holding the space so the family can bloom in their own natural way. My clients have started taking photos during the baby exam, and I'm ok with these photos, and they seem to be sentimental for the families.

I have had to intervene in one way or another in the last 4 births, at the end. What is the universe trying to show me? Each time it was almost spiritual how my hands knew what to do before my brain did. Tonight I am grieving. I went into this birth with an expectation, which is never something I do, and I am disappointed. If I'm disappointed, how is my SIL feeling? Did I let her down? Does she feel like she owned her birth, birthed in her power, or was I the midwife who swept in and saved the day, or worse, intervened when I might have had my own motivations or fear.  I remember my brain saying "This baby is not coming out like this" after 2 hours of very vigorous, exhausting pushing.  Was that my connection to spirit that shared that nugget with me, or was it my ego-let-me-help-this-along?  I guess only I have the answer to this question, but it certainly would be easier if someone would just hand me the golden ticket, with the answer on it.  I'm tired, and just cant seem to quite get my physical or emotional feet under me.

I am not sure why I am having such a difficult time this time around, maybe it is because it is family.  Maybe it is because I had such an impact on Dawn as a young woman, that she has gone on to be a doula and trained as a midwife's assistant.  She has asked me several times if she can come apprentice to me.  I wanted perfection for her.  I know that she asked me to be here because she trusts me, my heart AND my hands, but I wanted perfection for her, AND a break from my streak of needing to help these babies out.

The last three births... a nuchal hand, shoulder dystocia, and non descent with a non-flexed fetal head and baby in crisis, needed immediate intervention. This one was different, it required a thought process, a seeing this out to the end, process.  I could see she was exhausted and baby was becoming tired too.  I could see that no matter where or how hard or in what position she pushed, the baby was NOT making descent.  I also trust Dawn's sense of trust in the process, and feel like if she thought I was just trying to hurry things along, she would have said no.  She was tired, and in pain.  She was pushing like mad every 3 minutes for 2 hours.  Uncontrollable, gut wrenching, reverse vomiting pushing... for 2 hours.  As I process this, with my apprentice, with my friend, they both said that my actions probably saved this mom's birth.  What would have happened if she had pushed another 10 minutes or 2 hours like that.  Would she have become so exhausted she couldn't push any longer?  Exhausted mama's, babies and uterus's have a tendency to bleed.  This was one of Dawn's fears going into this homebirth.  If I had left it alone, not directed her to push on her back, with me assisting, would she not have torn?  These are unknowns.  These are questions I will never have an answer to.  But I wish I did.  I wish I could unravel the mysteries of the universe.  Two of the three previous births, also had significant tears to their perineums, even though they pushed in the positions they chose, and I gently coached them to go slowly and breathe their babies out, they still tore.  I know I know the truth of this as it applies to me.  I know that my truth is just that, mine.  Her disappointment may or may not have anything to do with me at all, if it even exists.  I know spirit will reveal to me the truth.  I am just tired.  Tired of crying when I get home from a birth because I couldn't protect, fix or change a situation.  I know I need to let go and let these things work themselves out.  And I will... when I am done crying and have some rest... I will.

Third Time's the Charm...

I just attended a mama who had her 3rd baby with me.  It is amazing to see the family grow and change, the babies so full of personality and charm.  While things are similar with most every birth, every birth is also quite unique, and these three births, although they were to the same mother, with babies in the same size range, the births were very different!

Denise has herself been a student midwife, and now holds a bachelors degree in holistic health care.  The first birth I attended with her occurred in Massachusetts, outside of Boston.  I flew up close to her due date, and stayed for a week.  She usually carries her babies to 41 weeks, so we were sweating it a little when 41 week mark came and went, worried that I would have to extend my trip and buy a new plane ticket, but labor came at 41 weeks and 2 days.

Denise had invited two of her friends from midwifery class to attend, as assistants/doulas and it was actually the first birth I ever attended with the help of an assistant (which was bliss, and I have never attended one alone since).  This was her fourth child, first homebirth.  Her labor started slow and easy, progressed in a textbook manner, she felt pushy, climbed on the bed and pushed a couple of times and out slid a beautiful baby girl (if you ask her son, who was around 4 at the time, he will tell you that she just JUMPED out of his mom's crotch).  The only thing even slightly out of the ordinary was her partner Pete, who was slightly squeamish  passed out shortly after the placenta delivered.  I still give him a hard time about that.  The birth was perfectly textbook, about 12 hours from start to finish.  Lovely, normal postpartum, lovely normal newborn in the 7ish lb range.

About 4 months after after that sweet baby girl, Nova, was born, Denise and her family moved south to the city I lived in, with plans that when her baby was older, she would begin to attend births with me.  Denise and I had been great friends for a long time prior to that birth, I think we knew each other when we were planning the births of our now 10 year-olds.  Before she could get Nova weaned and be ready to work with me, she became pregnant again.


At precisely 40 weeks, a little earlier than Denise's norm, labor began.  We expected things to progress along the same lines.  While the early and middle parts of the labor went very much the same way as the first, transition this time was hard.  Denise spent hours at 9 centimeters.  I have no real understanding of exactly why it happened, but it was hard.  Hard for her, hour after hour, being told "I know it hurts" and "No, I don't know why it is taking so long, but you both are fine".  Hard for me to see my dear friend suffering, knowing there was little I could do to help her, but to trust birth and trust her strength. She never gave in, she kept fighting the hard transition fight, until finally, after 6 hours of incredibly intense end stage labor, with a roar and two hard, unexpected, spontaneous, pushes, another sweet baby girl was born, caught by her mother's own loving hands.  This baby DID actually jump right out of her crotch.  I didn't even have time to put on gloves.  She had a very short cord, and I suspect this was the reason for the slow descent, but we will never really know.  Lola was almost a carbon copy of her sister, a bit heavier, but they could literally pass for twins at birth.

This last birth was an exercise of shooting from the hip.  This was a surprise pregnancy, She has moved, and I have since relocated my midwifery practice to Southern West Virginia, so we have a considerable distance between us. Denise is nearly 40 and not was feeling as fit or healthy as she has in the past.  Certain health issues created minor hiccups in the course of prenatal care, and all along, Denise considered the strong possibility that she might have this baby in the hospital.  Part of it being realistic, and I think part of it was her fear of transition.  The stars aligned, and I found myself nearby during the holidays.  Denise was still not 100% committed, but willing to see what happens, the plans were made for me to hang out, and for Denise, her partner and her beautiful 19 year old daughter Amber to rock this last birth out.  The thought of Amber catching the baby made us all excited and proud, proud of the deep trust that this young woman has now in birth and the power of love and life.

The labor began at 41 weeks and change, and was relatively quick, judging by her earlier patterns.  About 4 hours of active labor, and about 6 pushes, and handsome little David slipped into the world, with a blonde fauxhawke and looking as adorable as his older sisters.  Things got a wee bit hairy at the end, but the family performed amazingly.  Over all, this birth was perfect.  A perfect end to an era of creating wonderful little people to populate the earth with their wit and wisdom, the wisdom passed on to them through their mother and father, their loving brothers and sister, their connectedness as a family.  I am proud and honored to have been a part of the creation and evolution of this family.

I love you Denise and Pete  You are great parents.

Our First Birth in WV...

I met J. and C. through another midwife who practices about 2 hours from me.  I spoke with J. online many times before they finally came into care.  J. was receiving care from a local OB, and was having a normal uncomplicated pregnancy.  This was her second child, and she wanted a low tech, intervention free birth.  They spoke with several previous clients, and did lots of homework before actually committing to care.  C is a surgeon in a local hospital, so he had lots of questions. Finally they called and set up the appointment, and transferred care completely.

J is a sweet, soft spoken southern belle, certified as an elementary school teacher, but currently teaching their only child at home.  They both asked lots of questions at prenatals, and maintained a healthy lifestyle throughout the rest of the pregnancy, to ensure a great birth.  Their little boy was quite possibly the smartest two year old I have ever met.  There is much to be said for genes.

The afternoon her labor began I had just pulled into the parking lot of a community pool where my daughter was having a end of summer pool party with her softball team.  It was about 4pm.  J. texted me that her contractions were mild but regular and she would stay in touch.  We texted and talked a few more times throughout the evening, and then bedtime rolled around.  I laid down and tried to sleep, but it just wouldn't come.  I realized much too late that I am in the wrong profession for someone who is as sleep sensitive as I am.  I got another text that her contractions were 5 minutes apart and getting stronger, so I got up and showered.  I called her when I got out of the shower, around midnight, to check in and see if she wanted me to come.  Her mouth was saying no, but she sounded like she was working hard, and I had an hour drive, so I made the call to go ahead and go. Haylea was still up in the northern part of the state, and had to have her toddler into the doctor in the am, so I didn't even bother calling her.  I texted Sandra, and she met me at the house and we left together.

We got to J's home around 1:30am.  I got in and said my hello's and took a set of vitals.  Listened to the baby and he sounded perfect.  She asked me to check her, and the exam showed her to be 3-4cms dilated and about 80% effaced.  She said she was tired and wanted to try to sleep. Sandra and I went into the other room they had set up for us, with a coffee pot and sleeping space, should we need it.  We made a pot of coffee and chatted quietly in the other room.  Every 5 minutes, I heard J softly moan through her contractions.  I went in a couple of times to check on her and listen to the baby.  At one point, not to much later, I heard them up rummaging around so I peeked in and saw that she was getting into the bathtub.  It was about 3:30am.

Since she was up and running a bath, Sandra and I decided to go ahead and fill the birth pool, and set up our equipment.  Her bathtub was a spacious jetted garden tub, but had a sliding glass door which offered NO access to mom and baby, so we decided the pool was the better option.  We got the pool inflated, and went to attach the hoses and found that every single fixture on their upstairs level was too small to fit any of my hose attachments.  Frustrated but motivated, Sandra and I set to work filling the pool with pots, stopping every 15 to 20 minutes to take a listen to the baby.  J and C were such an awesome team, working together during her suddenly very intense contractions.

Around 4:30 we got enough water into the pool that she could move over, and in the process of getting out of the bathtub, her water broke.  She got into the pool, and was immediately in transition.  I have never seen a woman have such an intense transition.  Sandra continued to work on filling the pool, while I offered what support I could. It seemed as though nothing we did helped her in any way.  Her husband, who was a larger man, was working hard to do counter pressure on her back, while she clutched and grabbed at his clothing, screaming with the peak of each contraction.  Each contraction seemed to be more intense, and she was having a lot of pain in her sacrum and lower back.

I was sitting on the birth ball beside the pool, gently encouraging her through every contraction, while her husband struggled to do counter pressure on her back leaning over the pool and reaching around behind her. while she grabbed his shirt and pulled on him, trembling and screeching the whole time.  In hindsight it was quite comical, but at the moment, it made everyone anxious, her pain was so intense, and there was a very real chance that she might actually pull her fully clothed, very large husband into the pool with her, on top of her!  I listened to the baby after every other contraction, knowing she was very close, as the heart tones were very low, just above the pubic bone.  I tried to encourage her to reach inside and feel the baby's head, she was adamant that she was hours from finishing and it was just too hard.

At one point, around quarter after 5, J. looked me dead in the eye, and serious as a heart attack said "I can only do this for 15 more minutes".  I remember thinking, "Or what"? but what I said was "One at a time honey, one contraction at a time".  Luckily for all of us her baby was born EXACTLY 15 minutes later.  I guess she was serious.  Baby Cameron was born into his father's hands smooth as silk.  Baby was pink and happy, mama hardly bled at all.  Perfect birth in my eyes, but hard, hard work in hers.

Every birth I attend humbles me.  Every woman who births her baby in her power and on her own terms shows me how strong we really are, but also how fragile.  I am never cocky, for I know at any moment, no matter how much I trust birth and believe in women's power and strength, it can change.  I know that birth is as safe as life gets.  We can never be fully prepared for the unexpected tragedies that occur in our lives, but we can soften our hearts and be of humble spirit, listening to the wisdom of God in every thing.  We can't be prepared for every little hiccup that might occur along the way, but we can be flexible enough to change our minds about what exactly constitutes perfection, about what brings us to our knees before our creator, and trust that there is a bigger picture, a larger destiny than we can see.

Oh... and we ended up bailing that pool with the same pots we filled it with.

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.