Tuesday, January 25, 2011

Midwifery Apprenticeship

I’m very excited to announce the beginning of my midwifery apprenticeship.  I have partnered with Julie Hughes and Jen Anderson-Tarver at Mosaic Midwifery for the clinical portion of my midwifery studies.  I've been in prenatals for the last 2 weeks with these ladies and have had a wonderful time of getting acquainted (and re-acquainted) with the practice.  
Palpating and measuring bellies, listening to baby heartbeats, hearing so many unique stories and plans for homebirth - these are a few of my favorite things. I plan to spend the next 2 years hanging out with these lovely ladies and their clients while I finish my education and apprenticeship.  
If you’re interested in homebirth in Colorado and a fabulous midwifery team, please come visit Mosaic Midwifery!

Wednesday, April 28, 2010

Avoid Interference and Management and Prevent Hemorrhage

By Michel Odent

Over the years I have come to the conclusion that postpartum hemorrhages
are almost always related to inappropriate interference. Postpartum
hemorrhage would be extremely rare if a small number of simple rules was
understood and observed..

During the hour following birth, I remain as silent as possible and keep a
low profile. I either sit down in a corner behind mother and baby or
disappear, if there is an experienced doula present who has had a personal
experience of this situation. Minutes after birth many mothers are no longer
comfortable in an upright position. This is most likely the time when the
level of adrenaline is decreasing and when the mother feels the contractions
associated with the separation of the placenta. Then the birth attendant may
have to hold the baby for some seconds, in order for the mother to find a
comfortable position, almost always lying down on one side. After that there
is no excuse to interfere with the interaction between mother and baby.

I don't approach the cord and placenta for an hour. Clamping and cutting the
cord before the delivery of the placenta is a dangerous distraction.
Suggesting a position to the mother is another unneeded distraction. Her
position is the consequence of her level of adrenaline. When the level of
adrenaline is low and the mother feels the need to lie down, it would be
unkind and unphysiological to suggest an upright position.

It is only when an hour has passed after the birth-if the placenta is not
yet delivered-that I dare to disturb the mother in order to check that the
placenta is at least separated from the uterus. With the mother on her back,
I press the abdominal wall just above the pubic bone with my fingertips: if
the cord does not move, it means the placenta has separated. In practice,
the placenta is always either delivered or separated an hour after birth,
and bleeding is minimal, if the third stage has not been "managed." I have
never had to inject a uterotonic drug to control the bleeding.

An excerpt from "Putting an End to Women's Global Slaughter: Bleeding to Death," Midwifery Today, Issue 74

Saturday, March 20, 2010

Trusting Birth and Chiropractic Care

I had the amazing opportunity to attend the Trust Birth Conference in Redondo Beach, CA.  I went into the conference with a general belief that I do trust birth.  I came away from the conference having met some amazing women who not only trust birth, but who truly stand for the truth.  I'm still processing all that I heard and learned and what it means for me.  Meanwhile, here are a few of my favorite moments from the conference:

Dr. Jeanne Ohm opened the conference with information about trusting the process for natural birthing, chiropractic care in pregnancy and the "Dystocia Ride caused by mechanistic procedures".  She is doing an amazing work with women and families and I was sad to miss her other sessions.  My favorite comment was when she was referring to those that question why vaginal birth is preferred over elective cesarean.  She said, "Would you rather chew your food, or have a feeding tube?  Would you rather move your bowels or have a colostomy?"  She clarified the meaning of the Webster technique as not just the breech technique but rather, "specific chiropractic analysis and adjustment that reduces interference to the nerve system and facilitates biomechanical balance in pelvic structures, muscles and ligaments. This has been shown to reduce the effects of intrauterine constraint, allowing the baby to get into the best possible position for birth."
She also shared a story about chickens setting on their eggs and the "power of one" - how 1 hen taught the others the amazing ability she had as a mother to incubate her eggs.  Once she started doing it, they all wanted to do it.  We have this same power with our birth stories.

"There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle." --A. Einstein

Dr. Jeanne Ohm is a practicing DC in a family, wellness based practice since 1981.  She's the Producer and writer of the children's chiropractic song, "Power On!" and educational video, "Birth Trauma: A Modern Epidemic."  She's the Executive Coordinator for the International Chiropractic Pediatric Association (click to find a chiropractor in your area) and the Executive Editor of Pathways to Family Wellness Magazine.

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Friday, March 12, 2010

The "Volvo"

In my doula training 11 years ago, I had the rare opportunity of doing a cervical exam on the "volvo".  This was the term of endearment for the little blue box that contains a bunch of synthetic body parts that allows students like me to assess cervical dilitation, effacement, and fetal position, without having to practice on fellow students or poor pregnant mamas.  The term came from my facilitator's daughter who overheard her describing the teaching tool and mentioned the word vulva.  However, she thought her mom had said "volvo" and from that point on, this is how it was introduced.  It's an amazing tool and I have always wanted to practice on one again, but they are very expensive and I haven't know anyone else who has one - until the midwifery skills intensive in Redondo Beach.
It was a great session and I found that I was actually fairly accurate in my estimations, and even diagnosed a breech presentation.  So, once again, the "volvo" was the gateway to learning, and few crass midwifery jokes as well.  My favorite was when I offered a miner's cap to my classmate who was trying to "see" what was was happening in there. 
We also got to practice placing iv's on a fake arm, sutured "perineums" on a turkey leg, did blood draws, and finger pricks.  Unfortunately, for my classmate, the last 2 were on each other.
Overall, a fabulous learning opportunity, great practice, good laughs, and I met some amazing women from all over the states and Canada.

Wednesday, March 10, 2010

Yesterday We....

*took a picture of the twins in front of the house they were born in.

*left Provo 4 hours later than we planned.
*played in a "musical McDonalds playland".

*saw sheep.
*watched tons of movies in the van.

*brightened a very dark Las Vegas playground with the vibrance of our children's voices and their wonderful presence.  Ameena said, "We're making this park nice for everyone.  I'm going to blow some bubbles."

*drove through a blizzard.

*saw the coolest thing ever.....a spinning In-N-Out Burger sign. 

*drove through the Mojave desert.

*ate Chipotle.

*arrived in Hermosa Beach, CA at 10p at the home of wonderful new friends.

*were reminded countless times of the blessings in our lives.

Tuesday, March 09, 2010

Twin Birth Story (Repost)

I'm reposting this for reference for the story below.
There have been a few different versions of this story and I lost the original when I edited it for the Colorado Midwives' newsletter awhile back. So, this is my attempt to breathe some of the life and details back into it. But, it's a bit long. ;) Our love and thanks to so many friends and family who made this story what it is. Each year, I sit in disbelief and I remember this story and how blessed we are to have these girls.

Two years after our first beautiful homebirth, we were planning our second. I had a very normal and healthy pregnancy, just a bit tired and more aches and pains than the 1st time around, all to be expected when running around after a toddler.
Around 20 weeks, my midwife started getting “ambiguous” measurements when she measured my fundal height. “I could measure it here, or……here”, she said as she moved up a bit on my belly. Then, she and my doula friend Ranelle started to joke about twins, something that was never a possibility, nor was it funny, in my mind. Meanwhile, I also started getting comments from random people asking if I was having twins. Note to those of you addressing a pregnant woman – if you want said pregnant woman to ever speak to you again, never ever, even if you know it’s true, ask a woman if she is carrying more than 1 baby. It’s wrong.
During my 30 week appointment, my fundal height was no longer “ambiguous” but was measuring clearly at 34cm. My midwife felt “a lot of baby” and estimated the weight to be around 6 pounds if it was just one baby. But she estimated size based on the baby’s head to be around 4 pounds. We discussed the possibility that there were 2 babies in there, due to all the “little parts” she was feeling, and she suggested getting an ultrasound. Unfortunately, this was the one appointment (in both pregnancies) that my husband wasn’t able to attend and I was in complete shock. I called him from the car and said, “you’ll never believe what just happened.”
We got a second midwife’s opinion who suggested singleton pregnancy with polyhydramniosis (too much amniotic fluid) and confirmed the suggestion for an ultrasound. So, at 32 weeks, I reluctantly entered the ultrasound office concerned of all of the possibilities that could be causing the excess fluid, still convinced that there was only ONE baby in my belly. After a few normal questions, and about 3 minutes of scanning, the ultrasound tech asked, “Did you know you are having twins?”
WHAT?! My husband laughed, I cried.
I was completely overwhelmed. We have no history of twins in either of our families and though we joked about the possibility earlier on, I just “knew” it wasn’t possible. Ranelle had always prayed for twins for herself and at one point during my pregnancy had said, “Well, maybe God is giving you the twins”. I made some sort of desperate comment about how he would be making a horrible mistake if that was the case. She sweetly replied then, and many times since then, that God doesn’t make mistakes.
All I could think about was that I would have to give up my homebirth (and by the way how in the world were we going to take care of these babies!? but that's a whole other story). Homebirth is completely legal in Colorado and parents have the right to make the decision about where they have their babies, and who attends them (including having an "unassited" or unattended birth). The reason I thought I would have to give up my homebirth, is that we were not comfortable with an unassisted birth and due to the regulations for Colorado midwives, our midwife would not be able to attend us. Midwifery is regulated by DORA (Department of Regulatory Agencies) and the midwives have partnered with DORA to create statutes, rules, regulations, and policies regarding their practice. Included within the regulations, are also restrictions and in Colorado regarding twins, they read, "midwife shall refer mothers for evaluation by a qualified licensed health care provider and shall not continue as the care provider when a multiple gestation or a presentation other than vertex at the onset of labor are noted."

However, having been a hospital doula for 7 years, I couldn’t imagine how I was ever going to have a hospital birth. I had seen too much and my fear was too deep - I believed I would cause my own c-section.
We began to weigh our options. Do we still consider a homebirth? Isn’t delivering twins scary? Maybe we can talk the HMO staff into considering an “alternative” twin delivery in the hospital.
We talked with a very nice OB with one of the best reputations within the HMO who, after offering us an elective C-section, gave us statistics like "75% of twins born (in our hospital) are delivered by section" and "prolapsed cord and breech presentations are common and serious complications of delivering twin B." She delivers one set of twins a year, about average for all the other OB's. She said, “The doctors at our hospital like to think that they are prepared to do nothing and everything,” but she gave every indication that they would most likely do everything because "we’re not calm when twins come in and we don't sleep well when something goes wrong and we lose a baby or a mom. We really don't."
She suggested my husband do his own research using the resources available to him through the HMO as an employee. What he learned was that with as healthy as I and the twins were, the risk was not higher than a normal healthy singleton birth. We talked to many midwives who said that "if mom is eating right and babies are healthy, you should go to term." This coupled with the fact that we had no choice or control over which of more than 25 physicians would attend our birth, helped us come to our final conclusion.

Believing that home is a safer place to have healthy babies than the hospital, we began to believe that this was the safest place for the twins to be born!

So the question changed from “Isn’t delivering twins scary?” to "Who is more confident in their ability to assist vaginal birth of twin and breech babies?" Gabbe's Obstetrics and many of the studies supporting vaginal delivery of twins warned that the delivery should only be performed by someone well-versed and comfortable with external version and breech extraction. Our OB said that breech extractions were becoming more common with the increase in twin births, but most doctors still tend toward cesarean. And again, we had no control over which of the many HMO OB’s would actually be on-call for our birth and whether the one attending would be more comfortable with a breech extraction, or a c-section.
With all of the information we gathered regarding our choices and my growing anxiety around a hospital birth, we began to believe this wasn’t the best option for us. However, unassisted birth or asking a CO midwife to put her license on the line for our “underground” experience, didn’t really seem like a viable option for us either.

So, I sent out a probing email to a few of my midwifery mentors asking them what suggestions or ideas they might have to help us have the natural birth and holistic care for our newborns that we were hoping for. What followed, was nothing short of a miracle. I learned that in many states, unlike Colorado, the regulations did include vaginal breech and multiple gestation. Some of these include Tennessee, Texas, and Utah.
I put out a call to my natural birth community and the flood of emails and phone calls of support was absolutely amazing. We began pursuing The Farm in Tennessee, due to their amazing statistics regarding normal vaginal birth at their birth center, and were amazed to find that those numbers included twins and breech babies! I spoke with Ina May and she was encouraging and supportive but couldn’t confirm a place for us until one of her other twin mamas gave birth. With the help of our Colorado midwife, we were put in touch with her mentor and midwife in Texas. She was happy to accept us as her clients and we continued to move closer in our plans to leave Colorado.
A couple of days later, a doula in Austin heard of our story and suggested a wonderful and experienced midwife in Utah, even closer to home. After we interviewed each other, she invited us to come on out. Simultaneously, the Texas midwife had a freak and debilitating horse accident and called to let us know that she was sorry, but she wouldn’t be able to help us with our birth after all.
From there, a cascade of people knowing people pulled everything together, including a double-wide trailer with 3 bedrooms, minimally furnished by new friends, and air-conditioning – all for just the basic cost of utilities. In a matter of 4 weeks, we made the temporary move to Utah.

The first couple of weeks went by pretty quickly. Caleb went to work each day using the wifi connection at the Borders coffee shop in the next town over, about 10 minutes away. Malachi and I spent our days playing in the park, exploring the town, visiting our favorite natural foods store, and playing in our “yard”, with “Goldie” the dog on the other side of the fence. In the evenings we would pick Caleb up from “work” and go for a walk on the trail, take a swim, or explore the town. We took many weekend trips visiting Bridle falls, Strawberry Reservoir, and Salt Lake City and the temple.

About 2 weeks in, our support plan kicked in. We had rotating family members and friends start coming in to help take care of Malachi. The first shift was our sweet sister and brother-in-law. They were a welcome encouragement and new energy to help entertain Malachi. Then, our Colorado midwife and her family joined us as labor support and their daughter was a fun playmate for Malachi. Then, my mom arrived as Brigitte and Andrei had to head back to Colorado. We always had loving support by our side which made our double wide in a strange town, feel more like home. Though, one by one, they were all running out of time to stay, as my pregnancy continued on and on. My mom approached me with 1 day left before she would have to leave with tears in her eyes.
After a month in Utah and 41 weeks of pregnancy, we had tried almost every “natural” thing to get labor started. When I asked the midwife to check me, she found that I was walking around at 5cm. So, at 5:30p I had her strip my membranes, a big decision for a person who touts no interventions. Her instructions were for us to call her once I was in a "contraction pattern". Right, like that hasn’t been going on for months. So, we headed out for a short walk, a little doubtful. But, it worked like a charm, and by 7p I was having contractions 5 minutes apart, increasing in intensity. When I requested that Malachi and Caleb fill the birth tub, Caleb said, “If you want the tub, I’m calling the midwife”. Reluctantly, I agreed.
The midwife team came flying in the door about 15 minutes later, and there they sat for the next few hours. Caleb and Malachi were so sweet, and Mo was concerned with how much each “traction hurting, mommy”. Around 10p, when he was losing steam, I had my mom take him for a van ride to help him to sleep.
At 11:41p I started pushing on my knees in the birth tub. And, at 12:16 a.m. Acacia was born in the water, in the caul. They broke her bag and passed her to me. My midwife held my belly so that Baby B wouldn't turn in any funky positions. I held Acacia in amazement and before I could imagine how much time had gone by, my midwife said that Baby B was ready whenever I was ready to push. “What, are you serious?!” While holding Acacia, I pushed in semi-sitting position and at 12:26 a.m. Ameena was born in the water, in the caul. It took 2 people to break her bag. We had to stimulate her some, they cleared her mouth with a bulb syringe and she began breathing. Once I knew she was ok, I leaned back in my husband’s arms and wept. And as we held our girls, I felt the weight of the previous 9 weeks lifting……until all 3 kids started crying at the same time. The girls weighed 7# and 7#1 oz, and latched right away. I had minimal blood loss but could barely walk without constant support of my very empty belly. My mom flew home the next day and my mother-in-law flew in to help us return our double wide to its’ previously vacant state and make the two-day trip home. Thirty six hours after they were born, we were packed up and on the road. We made a few stops along the way, including many truck stops (with babies in slings trying to avoid gaulkers and germs), one or two postpartum breakdowns on my part (sorry Karen!), ice cream cones, and an overnight stay in Wyoming.
We made it safely back to a beautiful Colorado welcome from our sweet family and friends.
And, my dear friend Ranelle, you were right.....God doesn’t make mistakes.

Disaster or Adventure?!

We chose ADVENTURE!  What an amazing day!
We awoke yesterday morning at 3a to embark on our first major family road trip in 4.5 years (a story all of it's own), and we've never done it with all 4 kids for more than 3 hours.  So, we loaded the last of our stuff and all of the kiddos at 3:45am.  They were all so excited for our trip to the beach, and off we went.  With joy brimming in our little van, I was determined not to be the usual road-trip-hater that I have been since child-hood.  I even took the first driving shift.  I was excited about our first real road trip, our destination, the midwifery skills lab, the conference, meeting far away peers and fellow-students, seeing old friends, and the fun ahead with the family.
Caleb was just settling into rest as I turned onto I-70 off of C-470 and there is was in flashing lights, "I-70 CLOSED at Glenwood Canyon, due to a rock-slide."  Of course, here we go.  "I told you to check the roads", I said as I slugged Caleb in the arm.  Don't worry, I lightened up and we began to discuss our options.  We came to the quick realization that our plans had just changed pretty drastically and that this would result in a longer day of travel, with less progress toward our destination, and resulting drama from all parties involved.  But, we made the best of it and decided to head toward Steamboat instead of Leadville since it was the more adventurous, "road less traveled".  We made numerous stops for potty breaks, McDonalds playplace while Caleb did a little work for Freespeech, potty breaks, map-check, snacks, potty breaks, etc.  The kids did an AMAZING job and were mostly happy for the entire day.  At one point in our trip, Caleb went in to the gas station to ask the locals about our new route.  He was in there for what seemed like forever.  He finally came out and said, "Well, are you ready for more adventure?"  The first time I saw this look on my husband was on our honeymoon when we decided to take a spontaneous trip up to Norway from Finland to see the arctic ocean.  It was full of adventure, but not lacking in frustration, and many lessons learned (like, if you relax and laugh at the things that happen when you're spontaneous, it's a lot more fun and makes for a great story for years to come).
So, we forged on, with happy hearts.  Around 9a, we stopped in Craig (Caleb's birth town) to play/work at the McDonalds.  I got the kids dressed in the bathroom and let them play for about 45 minutes.  I was about at my fast food/germy play-place limit when Caleb came in with the news.  "Did you figure out a hotel option for tonight?", I asked.  "No, but guess what?!"  and he shared that our new route would allow us to visit Provo with just an additional 30 minutes added to our trip.  Well, who can resist that!?  So, we jumped back in the car and headed back down the road.  We ended up spending about 12 hours traveling yesterday and today will probably be about the same.  But, we were able to priceline a fabulous Residence Inn room with room for all of us, and complimentary dinner in addition to breakfast for the low price of $60! 
Thank you Lord for diverting our original plan.  We've had an amazing, blessed time and today, we get to start our day by showing the girls the little place they were born in and share their story with them.

Tuesday, March 02, 2010

Observing the Future

"As one went to Europe to see the living past, so one must visit Southern California to observe the future." ~Alison Lurie

We'll be leaving in just 5 days on our road trip to California to attend a Midwifery Skills Intensive and the Trust Birth Conference.  As a student in a distance program, I'm especially looking forward to the time with my fellow students, amazing midwives, and phenomenal speakers, including Dr. Sarah J. Buckley.  It will be a great launch into the next phase of my education and continue to rouse the hope I have for the future of midwifery in our community. 

So, stay tuned for amusing road-trip stories, insights from the skills lab and conference, and entertaining picutres of Caleb chasing our 4 adventurous children on the beach, and trying to get a little work done himself....poolside.