OB vs. Midwife - Video

This completely describes my own experiences with OB care vs. my home birth midwife.

Mother's Love and Touch Saves Her Tiny Baby

As published on Growing Your Baby

An Australian mom who was told her baby had passed is speaking out about how she brought him back to life by cuddling him skin to skin.

When Jamie and Emily Ogg arrived on March 25 at 27 weeks gestation doctors gave little Jamie no chance of survival even though he weighed just over 2 lbs.

His twin sister Emily had survived but Jamie was declared dead by the doctor who delivered him after 20 minutes battling to get him to breathe.

He was handed to his mother Kate so she and her partner David could grieve and say her goodbyes.

The new mom placed him on her chest and after two hours of being spoken to, touched cuddled and held by his mum he began showing signs of life.

Kate spoke about the night to an Australian talk show... saying,

‘He wasn’t moving at all and we just started talking to him. We told him what his name was and that he had a sister.

‘We told him the things we wanted to do with him throughout his life.’

Jamie occasionally gasped for air, which doctors said was a reflex action.

She added: ‘After just five minutes I felt him move as if he were startled, then he started gasping more and more regularly.

‘I thought, “Oh my God, what’s going on?” A short time later he opened his eyes. It was a miracle.

‘I told my mum, who was there, that he was still alive. Then he held out his hand and grabbed my finger.

‘He opened his eyes and moved his head from side to side.’

‘I gave Jamie some breast milk on my finger, he took it and started regular breathing.

‘At that point the doctor came back. He got a stethoscope, listened to Jamie’s chest and just kept shaking his head.

‘He said, “I don’t believe it, I don’t believe it”.’

Kangaroo care, which is what the mom did, is one of the most significant ways to bond with a premature baby.  The warmth of the moms body paired with the soothing sounds of her heartbeat have been know to reduce anxiety, regulate breathing and help babies grow faster.  In this case Kate’s body acted link an incubator to keep the baby warm, which stabilized his heart rate and helped him to breathe.

Now the tiny baby is home from the hospital and doing well. The doctor who looked after the baby refused to be interviewed by the TV show.

Mom and baby Jamie appeared on Australian television show, Today Tonight.

Here's another publication of the story on Mail Online.

Planning and Meditating on Birth - Part 1

I was talking with my sister recently about birth choices, and I started wondering how much the decision of where to labor and give birth has an impact on the experience and the outcome. I told my sister that if I'd been in the hospital with my breech baby I probably still would have had the outcome of a healthy baby, but the experience would've been altogether different. The labor itself would have been different and I wouldn't have been so relaxed and comfortable. And then there's the issue of the surprise breech, which would have led to an emergency cesarean. Instead of recovering from a vaginal birth at home, I would have been recovering from abdominal surgery with 4 small children and a newborn. My fear of c-sections in general would have left me scarred emotionally, and I would've had a lot more to heal from than just the physical trauma from the surgery. I also would have ended up with a uterine scar that could impact future births.

I shared my home breech birth story with a group of my midwife's clients at her home. At the very same meeting another mother shared her hospital birth story, and it was a striking contrast to mine. She had a natural labor without interventions in the hospital and everything went smoothly. However, after the birth she noticed her baby was twitching. The doctors and nurses hadn't noticed it. It took the mother's eye and intuition to see that something was wrong. They determined that the baby had suffered a stroke sometime after the birth. Because they were in the hospital, the infant was able to immediately receive the medical care he needed. What was even more interesting to me was when she told us that she had considered planning a home birth, but whenever she thought about it she felt uneasy. She didn't know why she felt uneasy, but she followed her feelings and planned to have the baby in the hospital. She was exactly where she needed to be, and it was because she followed her feelings. I, on the other hand, had felt nothing but peace when I planned my home birth, and I was exactly where I needed to be.

I believe there are times when no matter which choice we make, we'll still have a positive outcome. Almost all babies would survive whether they were born at home or in the hospital, whether born vaginally or by c-section. Almost all mothers will survive birth regardless of where it takes place or under what circumstances. But the outcome is not the whole picture.

Rixa from Stand and Deliver has a great commentary post on her blog about the way people say that all that matters is a healthy mom and baby. "Health" in this sense usually means "alive".  

We all know that health is all-encompassing, and it doesn't simply imply survival alone. Health is physical, mental and emotional. When a woman has a traumatic birth experience under any circumstances, she is emotionally unhealthy. Trauma can lead to Post Traumatic Stress Disorder, and while it's not commonly associated with postpartum women, if the mother suffered trauma during the birth she is more prone to this state of disease. Trauma is not associated with specific birth events, but rather the woman's interpretation of them and her feelings of either being in control and respected or being out of control and disrespected. By definition the CDC considers cesarean section a "morbidity", which would imply that any woman who's recently had a c-section is physically unhealthy. We can see that there are many different situations under which a mother and baby can survive birth but still be unhealthy afterward.  Heather Armstrong wrote a beautiful, yet heart-wrenching post on The Unnecesarean about her own experiences with emotional and physical trauma regarding birth.

The outcome matters. The experience matters. The emotional, mental and physical well-being of mother and baby matter. How can expectant parents plan for birth with all of these variables in mind? How can they make decisions about their baby's upcoming birth hoping for the best experience and the best outcomes?  


Click here for part 2...

Advocating For Evidence-Based Health Care

I found this on Science and Sensibility: Understanding Evidence-Based Healthcare: A Foundation for Action

This includes maternity care, but it's much bigger than that.  The Consumers United for Evidence-Based Healthcare (CUE) is a group that helps educate and advocate for improve healthcare in the US.

‎"We’re only going to get evidence-based healthcare in this country through consumer activism." 

-Kay Dickerson, director of Consumers United for Evidence-Based Healthcare.

High Tech vs High Touch

I found a really great post at the Midwife Next Door: "Thank you for touching me": the conflict between high-tech and high touch care.

I didn't realize that many prenatal care providers don't use touch anymore in the care they give to expecting women. Most care providers these days use ultrasound to check for fetal heart tones, fetal position, size, and overall well-being. Did you know that there's a technique care providers can use that's called Leopold's Maneuver that can check all of these things, and they only need to use their hands?

My obstetrician, his nurse-practitioner, and my midwife all use Leopold's Maneuver. I didn't have more than one ultrasound in each pregnancy, because my care provider was able to determine the baby's well-being with their hands. Not only was it extremely simple and helpful, but it's also comforting to have high touch care like that. I definitely prefer it over the cold jelly and hard probe of the ultrasound machine.

There is some question about the safety of ultrasounds. We don't know how safe ultrasonography is on a developing fetus, as no long-term studies have been done. Ultrasound machines are not regulated, and the wave frequency has not been tested for safety. We don't have any evidence against it, but we also have no evidence to support its routine use during pregnancy. Ultrasounds in the last trimester of pregnancy are also unreliable in determining a baby's size. The estimation can be off by a full pound, more or less. With these questions in mind, wouldn't you prefer to use a proven hands-on technique rather than an unproven technology?

I'll leave you with an excerpt from the post by the Midwife Next Door:

"Women in labor need hands-on care. It’s known that women who have a female birth companion with them during labor have fewer c-sections and faster births, with fewer epidurals needed. Why is this? I believe it’s because a machine can never replace a human, even if it is more accurate in certain assessments. A machine may be able to tell me that this woman is only 3 centimeters dilated, but my eyes and ears tell me that she looks and acts as if she’s in transition, and guess what? Most of the time, my eyes and ears don’t lie, and we have a baby within the hour.

"In our push to improve birth outcomes, we continue to move farther away from the hands-on, low-tech models of countries with exemplary birth statistics, such as the Netherlands, England, and other countries where midwife-attended births are the norm. Instead of looking for new machines to meet this goal, why not look to the example of cultures who are working within the midwifery model of care that is already meeting this goal?"

Great Post on Group B Strep

Sheridan at Enjoy Birth has written a great blog post about Group B Strep: Group B Strep - Why Should I Care? It's full of resources so you can educate yourself and make an informed choice in your prenatal care.

Kangaroo Care

Human Nature

Mother's Touch

by Ashley Montagu

Human kids and kangaroo kids have more in common than you might think. By studying marsupial mothering, researchers are gaining valuable new insights into the needs of vulnerable newborns.

A human body is not a finished product. The newborn elephant and the newborn fallow deer can run with the herd shortly after they are born. A six-week-old seal navigates the seas by itself. Human beings, however, can't even crawl until they are 8 to 10 months old; they can't walk or talk until they're about 14 months old. Why are human beings born more immature and why do they stay immature longer than any other animal?

Like the newborn marsupial that crawls over its mother's damp fur to her pouch, there to spend up to six months completing its development, the human newborn is only half-formed. It could be said that a child's birth is not an end of gestation but a bridge between growth within the womb and growth outside it. The elephant, deer, seal and human all have long gestation periods – ranging from an average period of 630 days for the elephant to about 266 days for humans. Yet only humans are born so immature, their growth divided into a period inside the womb (uterogestation) and a period outside the womb (exterogestation). It appears that if babies weren't born when they are, they couldn't be born at all.

At birth, the brain of the average seven-pound infant weighs roughly 380 grams. To be as talented and capable as a newborn elephant, deer or seal, the human infant would need the 825-gram brain of a one-year old. Clearly, infants can't wait until they've grown a brain that big before being born – their heads would be too large to fit through the mother's birth canal. They must be born with the biggest possible brain that still allows them to get out and then do the rest of their brain-growing after birth.

As Professor John Bostock of the University of Queensland, Australia, suggested, what I call the period of exterogestation is over when a child can crawl on all fours. Amazingly, the average time for this achievement is 266 days – exactly the same length as the average pregnancy.

Two-stage gestation might have been an adaptation to several important changes during the early evolution of the human species. The move from the forest to the open plains demanded an erect posture and a bigger brain. The pelvic outlet grew smaller while the brain grew larger.

If this two-stage theory of gestation is sound, then we are not adequately meeting the needs of infants. We fail to give attention to gestation outside the womb.

The human infant is almost as immature as the infant opossum or kangaroo, but whereas the marsupial infant enjoys the protection of its mother's pouch, the human infant has no such advantage.

The symbiotic relationship maintained by mother and fetus throughout pregnancy should not end at birth; indeed, it is naturally designed to become more intense during exterogestation. The mother who is equipped to give sustenance and shelter inside the womb is equipped to do so outside the womb, at least as efficiently as the marsupial mother.

The warmth with which the mother enfolds her child while breast-feeding is psychologically analogous to the pouch enclosing a suckling marsupial. However, little marsupials, with free access to their mother's breast, suckle when they wish; human infants are generally suckled when their mothers think they should be. Children are therefore in a much more dependent, indeed more hazardous, state than marsupials; they should be nursed on demand, rather than by the clock.

When the human mother breast-feeds her child, the pair make eye contact vital to the psychological development of the child. The mother lovingly coos, talks and sings to the child, cuddling, kissing and caressing it. As important as breast-feeding itself are its associated sensory stimuli – the sights, sounds, smells, taste and warm feelings that comprise the enfolding love that ought to be the birthright of every child.

Several studies show that early deprivation of maternal care leads, in many animals, to failure of both individual and social development. The human infant is in many ways more dependent on such sociopsychological care, not merely because it is born in such an immature state, but because becoming a competent human being is much more complicated than becoming a competent baboon.

"Hope is better than nothing"

Women in Charge blog wrote this. It really touched my heart, and I want to pass it on to my readers:

Hope is better than nothing

by Maria Iorillo

I keep thinking about Sara from Uganda. She runs a 15-bed clinic along with 2 other midwives. She receives $5 per delivery. Some women come for prenatal care and not too many people come postpartum. Once a healthy baby is born, most of her clients feel they don't need to return.

Sara came all the way to Washington, DC to represent the Ugandan Midwifery Association at the Symposium to Strengthen Midwifery. She received a scholarship to attend Women Deliver. The UMA has over 2000 midwives and was started in 1948 when the government tried to make midwives retire at 55. You can imagine what the midwives said to that! So they formed an organization to better represent themselves to the powers that be. Sara says the UMA is the best midwifery organization in the world.

When the Symposium was almost over, Sara was discouraged and asked me what would happen on the ground. On my last day with Sara, we were walking from store after I had bought chocolate for her to take home to her children. She was hopeful, particularly because I had just made a blog for her that morning. She wants to use the blog to tell the stories of maternal death in Uganda. She wants to post about the midwifery meetings they will have. She has a new vehicle for communication. She is going home with SOMETHING already in her pocket. She says that hope is better than nothing. She says that she has a new friend, she has a blog, and that she knows that she is not forgotten. That the women of Uganda are not forgotten. Sara decided to call her blog, Women for Survival.

Women for Survival

I keep thinking about Sara and our fast friendship. I am thinking about our partnership and how one-on-one we can help each other strengthen midwifery. I know so well how the Bay Area's midwifery community has grown simply because of the one-on-one support we give each other. Why can't we do that across the global? I guess I'm saying there's no reason why not.

Thoughts About Labor Support and Unassisted Birth

I've been thinking a lot lately about unassisted childbirth. I must admit that the idea is becoming more appealing to me the more I think about it, and I'm starting to consider this as an option for my next baby's birth.

Don't worry, I'm not pregnant again... yet. We want another baby, but we're not trying to conceive at this time. I'm always thinking and planning for the future.

My childbirth experiences have been a journey. I feel I've been on this road, and I keep growing and learning as I go. My journey from fully medicated birth to unmedicated birth in the hospital, then to birth at home, has been a progression for me. I'm always wanting to find something better and more fulfilling, and possibly more challenging as I go.

I like challenging. It stretches me, helps me grow.

"When you're through changing, you're through." -Bruce Barton

What's the next step? Is it freebirth?

Don't get me wrong. I'm not going to put myself or my baby at risk just because I enjoy a good challenge. I don't make any big decisions without doing my homework and knowing all the ins and outs, exactly what I'm getting myself into.

I also believe in divine personal inspiration, and I'll pray about my options and move forward with what I feel is right and best for my family. I prayed about home birth with my last baby and felt such overwhelming peace that I knew that's what I should do.

Right now I'm researching and considering my options, and I'll pray about them when a decision is needed.

I'm all about labor support. I'm a doula. I DO labor support. I feel it's important to have the right support for birth. But what is the right support? I think it can be different for each birth.

When it comes to unmedicated, natural, spontaneous birth without unnecessary interventions, I've always felt that with the right support and care I can do anything. I love my doula and midwife who each worked with my husband to provide encouragement, comfort measures, and a level head to help me through what's always been for me a somewhat long process of labor and birth.

At one point during active labor with my planned home birth I found myself alone. My midwife was in the other room. She had left my husband and I alone because I was coping well with his support and she was respecting our private space. My husband had to go to the bathroom, and just as he was gone a strong contraction hit.

I had been depending on my husband's support, and it suddenly occurred to me that I was alone! Panic hit, fear set in, and I experienced the worst pain of the entire birth experience. It's the only part of Liam's birth that I consider to have been actually, truly painful. Even transition was nothing compared to the pain I felt at that moment.

I learned two things from that experience:

1. The Fear-Tension-Pain syndrome is REAL. When we experience fear our muscles invariably get tense, which causes pain. This is definitely true in labor and birth, and I experienced it first-hand in stark contrast to the rest of my otherwise relaxed and peaceful labor.
2. I have had the belief that I can only handle natural labor if I have support from others. Whether my belief was true or not, it was real and it affected me completely in that moment.

I've reflected on that experience a lot since then. What about women who experience spontaneous precipitous labor and have no support, but still have an amazing and beautiful birth? What about those who plan unassisted birth and handle it just fine without any outside support (other than that of their partner)? Why would I only be able to handle labor well with support, if others could handle it just as well on their own?

If I plan an unassisted birth I would still have my husband's support so I wouldn't be completely alone. Do I actually need the support of a doula and/or midwife or others in order to have a beautiful birth experience?

Thoughts on Preterm Labor & Birth

This is a topic I've thought a lot about over the past few months. A friend of mine was experiencing contractions at 34 weeks gestation. She went into the hospital and underwent some tests. It was confirmed that she was actually in labor. It was also discovered that she had a urinary tract infection that triggered her body to start contracting. She was given antibiotics to resolve the UTI and was told that her labor would subside as a result.

I wonder how often an underlying infection is the cause for preterm labor?

When there's an infection, the pregnant woman's body has a defense mechanism to protect the baby from the infection: start labor to try and get the baby out.

It doesn't matter if it's 40 weeks into the pregnancy, or 20. The woman's body is designed to protect the baby.

Infections can be tricky things. A woman can have a UTI and not realize it because the symptoms can be subtle. I think many women in our culture are so busy that they're not tuned in to their body's signals. If we slow down, take care of ourselves and pay attention to how we feel, we can often sense when there is a problem and catch it before it becomes serious.

There are ways to prevent preterm labor, and scientists are feverishly trying to pinpoint them, particularly because preterm labor is becoming more common in this country. The United States recently received a "D" on the March of Dimes 2009 Premature Birth Report Card, and it's important that we do something to change the trend of preterm labor and birth. One study found that a woman's DNA can predispose her to preterm labor, but there are other factors as well.

For one thing, you can do your best to stay healthy and low-risk through proper nutrition and exercise. This can help you avoid an infection that could trigger early labor. Proper nutrition can also help avoid preeclampsia and toximia, which are often culprits for prompting early induction resulting in possible preterm babies.

One thing I personally believe would make a big difference is for women to tune in with their bodies. Take some time each day to check in with yourself. How are you feeling? Do you have energy, or are you struggling to get things done? What did you eat, and how did that affect how you were feeling? Did you drink plenty of clear fluids? Did you do something for you today? Are you happy? Do you have an overall feeling of well-being, or does it feel like something may be out of balance? Often, how you feel emotionally can be a signal of how things are going in your body, and a woman's intuition can really clue her in to some possible problems. I'm a true believer in intuition, and I've personally been working on listening more closely to my intuition and acting on even the smallest promptings I feel. I'm finding my life goes a little smoother and I'm better able to handle things when I pay attention to what my body and my feelings are trying to tell me.

This process of checking in with yourself can take as little or as much time as you have. It can be 2 minutes, or 2 hours. It can involve deep, focused breathing and meditation, or just a quick mental checklist. Find what works for you, and try it.

What do you think? Does any of this seem to fit together, or am I way out there?

Experiences With Both Doctor and Midwife

by Nicole

"When my husband a I got pregnant with our first child we already had plans to use a midwife. It was something I had wanted to do for years because I don't like the hustle and bustle of hospitals with the possibility of going through several different nursing staff during shift changes and I also had a horrible experience with a spinal tap. When I was getting my tap done the doctor said don't worry its like an epidural (which I had never had one, so at the time it didn't mean anything to me). Well after the tap I ended up with a spinal migraine that left me incapacitated for about a week. The words of the doctor stuck with me... If the tap has similar side effects as an epidural and I was in my room in complete darkness for a week what would I do if I had an epidural for labor and I experienced the same thing? What about my baby and the bonding? It knew that an epidural was out of the question for me. So that is how I ended up wanting to use a midwife.

"I found my midwife through the place we took the Bradley birth classes. I see my midwife for all my prenatal care and I see a doctor for some of my prenatal visits as well. The reasons why I see both is one, being that if things don't go as planned for my home birth I would somewhat know who would be helping deliver my baby and two, is pretty much because it seems to make everyone I know feel better about my decision even though it shouldn't matter. The funny thing is that when you tell people that you see a doctor as a back up it makes them feel at ease even though my doctor really doesn't know me at all.

"From my experience seeing both my midwife and my doctor are 2 totally different things. With my midwife she gave me the time and patience and respect I was looking for. Every prenatal appointment we had was at least an hour long. She really cared about what was happening to my body physically and emotionally. She even wanted to make sure my husband was doing well during my pregnancy. She cared about us as a whole. Even though I felt very educated on pregnancy and child birth my midwife had so much information and real experiences to share that it was better than any reading I could have done. I learned so much from her.

"As for my doctor it is exactly what I try to avoid. It's chaotic and busy and I spend most of my time waiting. I usually end up waiting for at least 15 to 20 minutes before I get to go in a room. Then the nurse sees me first. She weighs me, takes my B.P. and a urine sample. The nurse asks me the usual questions. What meds are you on? Do you have any cramping, bleeding or abnormal discharge? Then she leaves and I wait in the room some more to see my doctor. When my doctor comes in she asks the same cramping, bleeding, discharge question that the nurse already asked me and she asks me how I'm feeling and if I have any questions. Then she measures my uterus and we listen the the baby's heart beat. Then that's it. I get about 5 to 7 minutes with my doctor and I'm on my way.

"I feel somewhat satisfied how the appointments go because I get everything else I want and need from my midwife. I do feel the sense of being rushed while I'm there and feel there is such a lack of personal touch. I also feel like the only information I would get from my doctor is if I brought in a list of questions. (which they wouldn't have that much time to answer anyway) I cant imagine not having a midwife who spends the time to help me learn and prepare as much as possible. I feel like there is so much information women don't get from their doctors unless the woman pursues it.

"I'm not against doctors or hospital births because I feel its important for a woman to do what's comfortable for her. From my experience I think too many women just trust their doctors and do whatever they say and that is not always the best way to go through pregnancy, labor, and delivery. I feel so many women may not being getting the opportunity to learn about birth and pregnancy and what their rights or choices or options actually are.

"I have an amazing relationship with my midwife. I consider my midwife to be a part of my family. She was there for me in all aspects of the most important time of our lives, not only for the pregnancy, labor and delivery but even for questions after the baby was born. I remember calling her a 12am in tears because I was having trouble nursing. I don't know anyone that can call their doctor at that time for that kind of question let alone even calling their doc at all. I tried calling my doctor once before for a question about my child. My daughter had a diaper rash we couldn't clear up. I just wanted to know if there were other creams or natural ways to help other than what we were already doing. Well when I called the nurse took my call and said "I can't give you suggestions without seeing it you need to make an appointment". So I called my midwife, she gave me two suggestions, I tried one and in 2 days the rash was gone.

"Everything I had imagined on how I would want my midwife to be and how I pictured my labor and delivery came true. It was the best experience I have ever had. I am pregnant with my second child right now and due February 7th. Again I see my wonderful midwife and I see the same doctor as well for the prenatals. I love seeing my midwife and love the interaction she has with my first daughter that she helped bring into this world. I am really looking forward to having another home birth with her again."

Home Birth Transfer Under a Midwife's Care - Emily's story

by Emily

"With my first son, I was twenty weeks pregnant before I found a homebirth midwife, an LM (Licensed Midwife) educated in Washington State. Previously, I had been seeing a group of midwives and OB's who were affiliated with my local hospitals birth center. Every time I went there, I was weighed, measured, and told my BP was too high. It would take several checks before it would come down. The first time I had an appointment with my MW, she had me weigh myself in the bathroom down the hall, then trusted me to tell her, and my BP was lower than it had been my whole pregnancy. I knew I'd found "the one."

"She was great during my labor. I had several family members there, but she didn't mind at all. When my water broke at 10 cm it was stained with meconium and my boys heart rate dropped significantly. We ended up transferring to the hospital. Her assistant rode in the back of her subaru with me, assuring me it would be fine.

"My MW ended up seamlessly taking over the role of doula once we got to the room. She would give suggestions for positions to push, and thought that having me push with every other contraction would help with the baby's HB. It helped immensely. She even whispered in my ear that the OB was looking at using the vacuum and to make my pushes really count. I can't imagine pushing for 2 1/2 hours without her there. After my Samuel was born, she stayed and helped me breastfeed. She and her assistants went back to my house with my mom and sisters and cleaned up my house.

"With my second son, we were able to rent a birth tub through her, though we didn't use it much. She had some great herbal remedies for when my blood pressure began to creep up a bit. She was fabulous during my labor when I had a OP(occiput posterior) baby, and my labor dragged on and on. I felt like I had put my whole self in her hands. And she took wonderful care of me. Sometimes people talk about not relying on anything but their own bodies during labor, but I never feel like that, I feel like I need some one with me who knows what they are doing, because I'm 22 and don't know anything but what I've read in books!

"When Matthew was born, I was standing up against the headboard of my bed and birthed his big body over an intact perineum. He came out and was floppy and white. My MW was amazing, immediately called 911 and began administering oxygen. His heart rate was strong and steady but he was reluctant to come around. I'd almost say it was like he passed out as he was born. He perked up just as they arrived. She had it under control, even when the EMT's arrived and completely ignored her authority and essentially "stole" my perfectly healthy son and transported him to the ER for an hour. The next day she went and gave them a lecture on home birth and her role versus theirs. She was awesome.

"She was a great mixture of professional and warm. She was like a doctor, in the way that she was full of information and had such a direct and strong way about her, but she was a midwife at heart, warm and willing to be leaned on."

Susan's Thoughts on Midwives

"I love my midwife who provided care during my last pregnancy during home visits. My body was faster than she was so I caught my own baby, but she was there for the placenta.

"That being said, it is very important for women to understand that their midwife may not be able to make it in time for a planned homebirth, which could be deadly for the baby and the mother. My experience taught me that it would be best to choose a midwife who works within a group practice so that the odds are that someone will be able to get there in time for the L&D (Labor & Delivery). This was not an option for me as the only midwife who would attend a HBAC (Home Birth After Cesarean) in my area is the one that I hired. I didn't feel comfy planning a hospital VBAC (Vaginal Birth After Cesarean), but I had confidence that if there was a reason to transfer that my midwife would be able to provide continuity of care. As it turned out, if I had transfered to hospital I would have been surrounded by strangers with a low VBAC rate so I stuck it out at home. I was blessed that I was in the majority of women who are able to birth without any intervention, but am acutely aware that we are lucky that there were no problems.

"Having a midwife is not a silver bullet, and although every woman deserves her choice of care provider, the fact is that some women will always be safer in the care of an OB. I have learned that autonomy of choice is sacred, and that choosing a cesarean is just as valid as choosing a UC (Unassisted Childbirth). It's just the risks that are skewed. My personal experience with midwifery care drove home the fact that it is more important to support whatever choice that the mother makes than to try and convince her that one way is better than the other based on my personal opinion. Midwives have taught me to support women and their choices."

Different Midwives, Different Experiences - Part 2

How I Met My (home birth) Midwife

by Kaitlin Rose

"The first time I met my (home birth) midwife, I didn't actually meet her that night.

"We were sitting next to each other listening to Suzanne Arms (a natural childbirth advocate) speak. At one point, Suzanne asked us to find a stranger sitting near us to do an exercise with. Since my fiance was sitting to my right, I turned to my left, only to be staring at the back of a bun. The woman to my left had turned to her left, so I was forced to look elsewhere.

"It was that event where I was first made away that home birth was a viable option. I thanked Suzanne afterward as we were about to leave and she pointed out that one of the two midwives in the area who performed home births was sitting next to me. I gasped - those kinds of things really get to me. I love strong coincidences.

"Turns out, I had another link to this woman.

"I hired my doula before hiring my midwife. She teaches a natural childbirth class where I lived, and Eric and I decided we'd like to hire her as our doula within just a few classes.

"Her first birth was at a local hospital, but her second was at home with the midwife whom I was sitting next to. Another connection. This intrigued me.

"In the back of my mind, I knew she was who would be delivering our baby into the world in our home before I ever spoke to her on the phone or had her over for an interview. I had a feeling - much like the "feeling" that I was going to have a natural, uncomplicated, safe and beautiful home birth.

"I couldn't have been more right about the connection I, and my fiance for that matter, felt to our midwife. I felt like I'd known her for years when we met. There was an instant kinship and likability all around.

"During my labor, she blended into the walls, but her presence was such a source of strength and comfort. She let me labor - she let me trust my own process. It was great. She knew just when to appear, such as when she asked how much I had eaten and suggested Eric make me a protein shake. We had talked about that in prior visits and had all necessary essentials stocked and ready.

"When it came to "the moment" - the spontaneous moment I felt like pushing, suddenly, there she was, coaching me on.

"She has delivered over 1,000 babies into her hands. I trusted her, grew to love her, and can't imagine anyone else as my midwife. I'll travel back to Kalamazoo or fly her to where ever I am to ensure she is there."

Kaitlin is a home birth mom who has launched a website all about bringing birth home.

Different Midwives, Different Experiences - Part 1

Even among midwives, experiences can vary greatly depending on the individual and the practices they ascribe to. Kaitlin is a home birth mom who has launched a website all about bringing birth home.

My Experience with Certified Nurse Midwives

by Kaitlin Rose

"I chose to see a group of midwives working at a hospital as well as my home birth midwife for prenatal care (it was a women's service center within the hospital). There were a total of 17 midwives that rotated and were on call for deliveries. Patients could not choose one midwife, they got whoever was on call.

"My very first appointment, the midwife I saw that day said, hi and told me to lay down flat on my back. She set up some things on a little tray and told me, "put your legs up, I'm going to put my fingers inside of you now to check things out." Just like that. No "how are you today," "is this your first pregnancy," "how are you feeling, any morning sickness?" Nothing.

"When that was over, she pulled up my shirt, squirted some jelly on my skin and started checking for the babies heartbeat. All of this was done in complete silence. Uncomfortable. All of a sudden, I heard a little galloping sound come out of the speaker...she pulled away, wrote something down and started cleaning up. I said, "what was that?" in TEARS, and she said, "oh, that was your babies heartbeat." She walked toward the door to leave and I started crying. I was alone. My fiance was working. That was my first time hearing my little girl's heartbeat, first pregnancy... that woman ruined it.

"Every appointment after that was basically the same with a different "midwife" (I don't even like calling them that). My name was called, I stepped on the scale, I waited for the midwife, I was told to lay back, jelly, heartbeat, wipe up, reschedule, goodbye. I hated it.

"When I started seeing my home birth midwife at home... oh my god. The difference was breathtaking. She CARED! I remember the second time she came over I just had an appointment at the women's center the day before and she asked me what position my baby was in. I said, "I don't know, no one has ever felt my baby or belly before." She was in shock. Her hands on my skin felt simply amazing...and she told me what position my little girl was in by such swift motions.

"The very last time I went in for an appointment at the women's center, I got the midwife from the first appointment. It was okay - my fiance was with me for support and he always asked a LOT of questions (he basically initiated a lot of conversation at those appointments because I didn't want to talk to them). He asked that midwife a lot of questions that day and we walked out thankful, GRATEFUL, that we weren't even going to risk the CHANCE of her delivering our child into the world.

"Here's what she had to say:

1. I saw you signed the water birth consent form. I don't do water births. So, you can labor there, but when it comes to delivering your baby, you're going to have to get out (that's verbatim - I could never forget it).

2. I usually always do episiotomies. It's just safer for mom. I've seen women just fall apart down there and it's hard to put them back together (I was pregnant while she was saying this mind you - nice mental images of birth, huh?).

3. You can labor in almost any position you want... I don't know, there's not a lot of room... but laying on your back to deliver your baby is best for you, and for me. It's really hard to deliver babies when women are squatting. I almost always make them turn around.

"I was 36 weeks at this appointment and refused to schedule another, walking out of there feeling SO bad for the women who were patients there. I was, in fact, absolutely furious."

Stay tuned for Part 2!

Types of Midwives

What is a Midwife?

The word midwife means "with woman". A midwife attends prenatal care visits and is present at the birth of your child. She is also there during the post-partum period to provide care as well as advice for mom and baby.

There are three main types of midwives:

Certified Nurse Midwife (CNM)
Trained nurses with additional study in midwifery. Can attend births in hospitals or birthing centers. In some states CNM's also attend home birth. Services are generally covered by insurance, depending on your plan and limitations within it. Is accountable to the hospitals and birthing centers at which they work, and must follow all birth procedures outlined by the AMA, supervising doctors and hospitals.

Certified Professional Midwife (CPM)
A midwife who has passed the North American Registry of Midwives (NARM) competency test and is awarded the CPM Certificate. Only attends out-of-hospital births. Services are sometimes covered by insurance, and many CPM's may be willing to negotiate costs and possibly trade for their services. Depending on individual state laws, CPM's can be licensed and certified with the state, and must follow state laws and guidelines regarding birth procedures, and in some states they have been banned. Sometimes midwives are certified through the state they practice in, and can be referred to as Licensed Midwives (LM).

Direct Entry Midwife
An independent practitioner who has learned the skill of midwifery through study, apprenticeship, a midwifery school or college that is not a nursing program. Only attends out-of-hospital births. Services are almost never covered by insurance, but many DEM's are willing to negotiate costs and possibly trade for their services. DEM's may be licensed or unlicensed. Check with the laws where you live, and make sure you find out your midwife's qualifications when making your choice. If a DEM is unlicensed, it can allow more flexibility in birth procedures because they are not constrained by state guidelines, but it also means she has no legal protection from the state. DEM's are outlawed in some states. DEM's are sometimes also referred to as Lay Midwives.

Certification and licensing are separate. Certification is done through NARM and granted by them. Licensing is handled on a per state basis, and each state has its own licensing laws regarding midwives. A midwife can be certified by NARM and not licensed in her state, and depending on the state laws, a midwife may be licensed but not certified.

In my state Licensed midwives are referred to as LDEM's (Licensed Direct Entry Midwives), and they have received their CPM designation from NARM and registered their licensure with the state. Unlicensed midwives in my state may be referred to as DEM or Traditional Midwife (an uncertified, unlicensed midwife with unspecified training).

How to find a midwife:

First, find out if your state licenses midwives! Then visit MANA, Midwives Alliance of North America.

If there's more than one midwife in your area, you have lots of options! Interviewing perspective midwives is a great way to narrow down your choice and find the best one for you. Birth is all about choice, right down to your care provider. Keep in mind that each midwife is different, and it's important to find the one that is best for you. Some midwives will be more natural-minded and some will lean more on medical interventions, so ask lots of questions and find the one who will fit your needs and desires for birth. Be sure to ask your midwife about her experience, training and/or qualifications to determine if you feel she has what you are looking for.

My own midwife is unlicensed, but she received her midwifery education through an accredited midwifery college and has over 15 years of experience working in home birth midwifery, and also attends hospital births as a doula. I felt her experience and training were sufficient for what I wanted, and the certification was simply a piece of paper when it came to the question of her qualifications. Each midwife is different, and each state has its own laws governing midwives, so please choose carefully.

The Midwifery Model of Care

"The doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease."

- Thomas Alva Edison

For me, this statement embodies the midwifery model of care.

Midwives generally approach birth from the perspective that if it's not broken, don't fix it. Midwives help women approach pregnancy in a holistic fashion: taking into account diet, lifestyle, personal and emotional well-being, and more in helping a pregnant woman stay healthy and low-risk and avoid complications rather than expect them and react to them.

This isn't to say that midwives are ill-equipped to handle problems. They are trained to know what to watch for, and when transfer of care may be needed if something is beyond their scope of practice. Even home birth midwives come to a birth equipped with knowledge as well as tools in case there is a need for it. I was a little surprised when I was in labor with my planned home birth and my midwife showed up with an oxygen tank along with her other tools. She set it aside and never needed to use it, but it was there just in case.

Birth is a natural process, not inherently dangerous

Yes, there are complications that can come up in birth, and there are times when medical intervention is definitely needed. The majority of the time, however, no such intervention is warranted.

According to Grantly Dick-Read in his book "Childbirth Without Fear" 95% of all births are low-risk and require no medical intervention whatsoever.

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events.

The Midwives Model of Care includes:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• minimizing technological interventions and;
• identifying and referring women who require obstetrical attention
  

The application of this model has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

The Midwives Model of Care definition above is Copyright © 1996-2001, Midwifery Task Force, All Rights Reserved.

I've written many times before about midwives. Here is an older blog post that might be of interest:
Differences Between Physician and Midwife - My Personal Reflections

In the coming weeks I will be posting a series of blog posts about midwives, along with some personal experiences and advice from some of my friends. If you have any questions or comments, or would like to share your own experience, please feel free to post a comment below.

The Perineum's Vital Role in Female Health and Birth

"You know that thong of tissue that keeps your tongue anchored to the floor of your mouth? It’s your frenum. And the translucent cartilage between your nostrils is your septum. And the flesh that stretches like a hammock between your vagina and your rectum is your perineum, and you and it are going to have a special relationship in the childbearing year.

"You will want to be on good terms with this most tender of tissues. You will want to get to know it well. You will want to become, in fact, your perineum’s pal."

My Perineum, My Pal

This is an informative article which explains the function and importance of the perineum in female health and childbirth, as well as detailed ways you can strengthen your perineum, prepare yourself for birth and take care of yourself postpartum. This is information I believe every woman should know.

I also found a video all about incontinence (bladder control) problems during pregnancy. It's really interesting, and it explains why it happens and what you can do to minimize such problems:

Habi-it Pelvic Floor Video

Women Seek Humanistic Care in Pregnancy, Labor & Birth

"Women are not seeking “designer” births. They are looking for humanistic care during pregnancy, labor and birth and are increasingly having difficulty finding that in many hospitals."

Media out of focus on Midwifery - The New Haven Register

Baby Wearing, Kangaroo Care, Baby Carriers, Wraps and Slings

When I started having kids almost 10 years ago I bought a baby carrier with buckles and straps that can hold the baby either in front or on the back. It worked pretty well, but it wasn't very comfortable with the stiffness of the harness, and I didn't like how my baby's legs always stuck out of the leg holes at the bottom and often got cold (especially in the winter) even if they were covered up.

When I was pregnant with my daughter, my fourth child, some friends threw me a baby shower because it was my first baby girl. My favorite gift of all was my Maya Wrap baby sling! Compared to the carrier with the buckles and straps, this baby sling is so easy to use and very comfortable! I can carry my baby in a variety of positions and use it until my child weighs 35 pounds. I like to go on walks with my kids often, and it was so easy to just slip my little girl into the sling and go! She was always the most content when she was in the sling, and would often simply fall asleep as I walked. I used the sling until I was too big with my next pregnancy (when my daughter was about a year old) and couldn't comfortably wear it anymore. Now that I have a new baby, I am using my wonderful baby sling again, and loving it! My favorite thing about using the sling is that it saves my arms from fatigue and keeps the baby snug and secure against me. It's also machine washable and takes up very little space to store it.

I recently started looking up more websites about slings and wraps and refreshing my memory on how to use it, and I decided to share some of these sites with you.

• The Baby Wearer - This is a fantastic site with all kinds of information about every kind of baby carrier out there, including product reviews, instructions, and more! Whether you are new to baby wearing, or an expert, this is a great resource.
• Baby Sling Sewing Instructions - This shows how to make a Maya Wrap baby sling.
  
• Sewing and Improvising Baby Carriers - This is on The Baby Wearer. If you are handy at sewing, or would like to make even a no-sew baby sling, this has a whole list of links to helpful websites.
• No Sew Ring Sling - This has simple instructions on how to make a ring sling that requires no sewing!

My Maya Wrap is a ring sling that incorporates metal rings with fabric threaded through for a secure sling with no bulk. I can fold up my sling and fit it into a purse or diaper bag. There are lots of other types of wraps and slings available to choose from. I would recommend checking out The Baby Wearer if you want to see what types there are and which one would best fit your needs. Since I got my baby sling I have not gone back to using my old baby carrier, not even once!

This photo to the right is of the first time I put my daughter in the sling, and I soon learned that it was much too low to wear comfortably. I learned how to cinch up the fabric to wear her higher so we were both much more comfortable.

If you have a favorite baby carrier, please let me know, and I would be happy to post about it!

For more information about baby wearing:
Mothering Magazine: Hold Me Close: The Many Advantages to Wearing Your Baby