What Makes Home Birth Safe?

Such a common question. What makes home birth safe? Is it actually safe? Of course it is! Here are a few of the most important things that make a home birth safe.

1) Licensed midwives are trained medical professionals. We are licensed and regulated through the Medical Board of California. We are experts in normal, natural birth and also trained for situations that veer from normal. Interventions are one of the things that often leads to complications such as infection and fetal.distress, for this and other reasons such as honoring birth, midwives offer little to no interventions unless medically indicated. Most births at home are uncomplicated and require little to no medical intervention, but when they do we are trained to manage such complications. Licensed midwives can administer IVs, antibiotics, oxygen, and anti-hemorrhagic meds. We are trained in neonatal resuscitation, suturing, and difficult deliveries such as shoulder dystocia. Having an experienced, licensed medical professional at your home birth makes it safe.

2) Birth is not a medical event. Yep. It’s not. When supported by the proper team and armed with her power, healthy low-risk women usually have uncomplicated, straightforward and beautiful births. One of the roles of a licensed midwife is is to ensure women planning a home birth are healthy and without other complications (such as high blood pressure, diabetes, obesity, placenta issues, etc). Women with these health risks may do best in the care of an OB for their birth. When women are healthy and without underlying health complications, home birth is a safe option.

3) When we need the hospital, we go. When a woman or baby need the care of an OB or NICU team, Sierra Vista is the place we go. Sierra Vista has many wonderful doctors that take care of my patients when we need their care, and for that I am very grateful.

I know home birth isn’t for everyone, Neither is hospital birth. I also know many people don’t understand why women have their babies at home and more importantly, if it is safe. From my years of experience, and that of thousands of other midwives, and millions of babies born at home for thousands of years (!!!) I know that home birth - with a licensed midwife - is safe and can be a wonderful experience to remember for a lifetime.

Enjoy these beautiful shots from a recent birth - including one of the newborn with a pulse oximeter measuring her oxygen level and heart rate. This is an example of a wonderful life-saving tool I use to keep home birth safe.

The Endurance of a Woman

I recently asked for the birth story of a wonderful client- the longest labor I’ve ever attended. Enjoy:

It all started Friday the 13th, I was 40weeks+6. I had an appointment with the midwife, Justine, that morning for a non stress test to make sure baby was still doing well in there. While there I was checked and was only 2cm and about 50% effaced. When my husband and I left we went straight to the beach to walk and see if we could get anything moving. We walked for about a half hour and came home. I took a nap and still nothing was happening so we decided to make dinner plans with my sister. Around 5 when getting ready for dinner I felt my first contraction that was starkly different from the Braxton Hicks I had been having. We went to dinner and they started coming in regular intervals and I began timing them. They were about 30 seconds long and coming around 5 minutes apart. I started to get excited that maybe the full moon was going to work some magic and finally bring me my baby. This pattern continued and around 7:15pm I texted Justine to let her know that things had started. Sense the contractions were still short and mild she had me monitor them some more and suggested I try and get some rest because if it was early labor I would need it. Around 9:30pm I took and shower and got ready for bed hoping for some more sleep before things got too bad. Around 11pm I had to get up because contractions were intensifying and I couldn’t lay down. We called Justine again around 1am and decided we would like her to come out and check on me. She checked me and I was still about 2cm but 90% effaced and babies head was very low. She left us to continue to labor and said we could set up the birth tub. The contractions were getting so intense it was causing me to throw up. When I finally got in the tub it was awesome, the contractions got more manageable and spread further apart. I was able to get some rest in there. As I continued to labor into the morning around 9am we decided to have Justine come back over and check the progress. Unfortunately when she checked I was only about 3cm. As the morning went on my contractions spread out again and were less painful so I took the opportunity to try and get as much rest as I could. All day I was able to rest and got 3 different naps in. I was able to eat a good amount and keep it down. Generally most of the day was spent lightly laboring. After dinner that night is when things started to ramp up again. I tried to lay down for bed around 10pm and couldn’t sleep because they were getting more intense. Saturday night was spent intensely laboring, using the tub and shower for relief. The contractions continued to stay about 45 seconds and 5-10 minutes apart. We called Justine again once Sunday morning came to update and she came out to check again. After the check I was still only about 4-4 1/2cm. She said it was time to really get this going. We grabbed the herbal tinctures and the breast pump. She also had some homeopathic remedies to get labor going. We went out for a walk, did a couple spinning babies moves, and continued to labor. After a few hours of these things I was checked again and was finally 6cm! I was so excited to be progressing so quickly. During this time laboring I found that I really liked getting my hips squeezed together for counter pressure during contractions and my husband and sister took turns doing that for me for nearly every single one of my contractions for hours. For me the only position I could handle was standing up leaning forward on a counter or my dresser and eventually my feet started to swell and hurt from being on them so much. I found a small amount of relief on the toilet or the birth stool. As the afternoon turned to night the other two midwives came out and I entered another dimension, or at least that’s how it felt. Things got insanely intense as I began to get closer. They continued to monitor the baby’s heart rate and I really was irritated by how much they were doing it but I never said anything because I knew they wouldn’t do it unless they needed to. At some point they told me they were afraid I was dehydrated and wanted to try for an iv. I had been having a hard time keeping liquids down and was fine with an iv. They tried twice but because I was so dehydrated and swollen they were unsuccessful. Around this time they had me taking some breaths with the oxygen mask, having me drink more water and gatoraid, and eat some honey for some energy. At this point I’m pretty sure I had already been pushing for a little while. They offered to break my water to really push things along. That was a very strange feeling and they realized at that point she had passed meconium. I don’t really remember a whole lot from when I was pushing but I remember I was not a fan pushing. I was fighting the feeling and wouldn’t let myself just go into the pushes. Justine was helping me know where to focus my energy with the pushes and I really didn’t like that either, but when she did that my pushing was better and making more progress so I was ok with her continuing to do that. I remember the room being so warm and I had my husband move a fan to my face. Everyone kept saying how close she was and how they could see her head when I pushed but I was convinced she wasn’t really that close and I would be pushing forever. I finally could feel how close she was and I knew it was almost over. I pushed so much and wanted to keep going but they had me stop and breath more oxygen. I knew with the next push I would have her head out. I pushed with everything I had and could feel her head making its way out, and after it came out the entire rest of her body launched out and I felt so much relief. After she was placed on my chest I couldn’t believe it. I was so exhausted that I kind of went into shock. It was crazy! That hour of skin to skin was amazing and it went by so fast. They had given me a shot of Pitocin to help me release the placenta. It was hanging on by a little bit and took a little while to come out but it came out just fine without pulling. After the hour we handed her off to my husband for some skin to skin while I got a few stitches. I had only one second degree tear on the inside. They numbed me and I just passed right out I was so exhausted. I woke up and they got me to the bathroom and got me all cleaned up and ready for bed. Around 3am they got us all tucked into bed and were ready to leave. Getting to sleep in our own bed was one of the best parts of the home birth. After just a few broken hours of sleep I woke up that morning elated and felt amazing! I was flooded with all those love hormones they tell you about and I was so happy! Even though the labor was 54 hours long, it was such a positive experience!

Wonderful 2nd Baby

After having one baby the 2nd, 3rd, etc can come quite quickly! I do my best to help women prepare for a quick birth, especially by making sure they call me soon enough to make it to their birth! The last birth I attended right before Thanksgiving was for a momma having her second baby and it was quick! She did so well and was so powerful. But a quick birth can hit you like a train. It is still hard and sometimes more intense than a long labor. Regardless, she made it look easy and is a wonderful mother now to her two children. So grateful to serve this family!

Here are some sweet pics of her birth thanks to the amazing Bethany Joy https://www.bethanyjoymugg.com

Love the birth team shots and the joy captured after the birth! Which is your favorite??

Three In Five

Every midwife in this area has a different number of clients, some are busier than others, some have babies themselves, some grown children, and we are all balancing our lives and our midwifery practices. I love my practice, everyone in it, my clients, my partner midwife, my students, all of us together create the most wonderful midwifery practice I could have hoped for!

I have a medium sized practice I’d say. This allows me to have time to get to know each of my clients and their families, listen to them, plan with them and be there for them when they go into labor.

This week we were a part of three births in five days. One Wednesday morning , one later that night and then one Monday morning. They were all so different and all so so wonderful. Wednesday morning a sweet momma labored for a few hours before birthing her second son in a warm birth tub in her new home. Her husband supported her and they celebrated when they discovered they had another son. His birth was such a peaceful transition into the water and up into his mother’s arms. Such a beautiful morning.

Next, that same day a momma labored for her second time toward her first vaginal birth, her goal was to have a VBAC at the birth center. Fear, apprehension, hope, uncertainty, excitement - all emotions I’m sure most women seeking a VBAC feel as they approach what they hope to be their redemptive birth. When evening rolled around this momma knew it was time to head to the birth center. When she arrived her body was already starting to push her baby down. She quickly got into the birth tub and within minutes achieved her long hoped for goal and delivered her baby into her hands. She impressed all of us. Such a strong, driven momma who trusted the power of her body to deliver that baby boy without any help at all. Amazing.

Birth three. This one was a tough one! This momma went 13 days over her due date and labored quite a bit longer than her first home birth. After 12 hours of labor she pushed her second daughter out into the world in the a birth tub in her room. Her husband and mom cheered for her strength and perseverance through this difficult labor. She said this labor brought her to her brink - but the power of this woman, her strength and drive carried her to a victorious result. Her sweet little redheaded baby was more than worth all the work. Such a beautiful birth.

Am I lucky or what?! I am so blessed to be a midwife, I love it! I love all my clients and I am so grateful to witness these impressive women and their births. After three births in five days I’m tired but my happiness outweighs that for sure.

Triple VBAC/HBA3C whatever you want to call it, she did it.

Ashley came to me 10 weeks into her pregnancy in hopes—high, high hopes—that she could have a home birth after three prior c-sections. Ashley wanted this home birth so fiercely. I went away from our first meeting wanting to support her 100% but was torn by what my license would allow and what responsibility I was taking upon myself if I became her midwife. After discussing with my colleagues and referring to the CA medical board details regarding VBAC, I decided that—although other providers may not—I was going to be Ashley’s midwife and support her goal of having a VBAC. We made plans of what we would do this time to make it happen for her; she discussed with me what happened in her previous labors and what she wished would have happened. I also recommend things to do differently this time. We made lots of plans. We discussed what could potentially lead her to another surgical birth. But because she wanted her vaginal birth so badly, Ashley focused on the details of her home birth. She knew that another transfer to the hospital was possible, I felt like it was likely, but she put the '“what-if” to the side and went for her VBAC.

Not many thought she could do it. No one thought I should do it. Ashley nor I wanted her VBAC to prove anyone wrong. Ashley wanted it for many reasons. She wanted a good, positive birth experience, she wanted to end on a high note, this being her last child and birth, she knew her body could birth vaginally. And me, I wanted to support her, thats my job and my passion! I support women, I want them to have the birth of their hopes and dreams. I want them to feel supported and fulfilled as women and I’ll do what I can to help make that happen.

ACOG (American College of Gynecology) recommends women wanting a VBAC have their “trial of labors'“ in a hospital. VBACs are occurring more often in hospitals but are still pretty uncommon. No doctor I know would do a VBAC in the hospital after two or more c-sections. Many women seeking a VBAC are told they can’t labor if they go overdue or if their baby is “too big”. Women who have successful VBACs have lower rates of hemorrhage, thromboembolism (blood clot), infection, and a shorter recovery period. Mothers who have a VBAC will avoid the risk of hysterectomy, bowel or bladder injury, blood transfusion, infection and placental complications such as placenta previa and accreta that accompany c-section. (*) Uterine rupture is the top concern for all medical professionals when discussing the risks of a VBAC. Uterine rupture can be fatal for both mother and child. The risk of this occurring for Ashley was as low as .09% and as high as 3.7%, according to ACOG. As a doctor in our community so bluntly assimilated “You attempting this VBAC at home is like driving to LA without a seatbelt on, you’ll most likely be fine, but you may die in a horrible accident.”

That is not how I felt about this birth. Ashley and I knew the risk and didn’t feel like it was more than what we could handle. As her midwife I took extra precaution to ensure Ashley and her soon-to-be born baby were healthy and tolerating labor well throughout the entire experience. Ashely labored for 26 hours at home, with the support of her doula, husband and daughter. She dilated perfectly, her baby’s heart rate was healthy and strong throughout labor, not one deceleration. At 8cm though things started to take a turn. In Ashley’s previous labor she progressed to 8 cm after around 40 hours of labor. Her body started to push prematurely, her baby was in a posterior (sunny-side-up) position and would not come down all resulting in another c-section. This time when her body started pushing again at 8cm, with still 2 cm of cervix in the way of her baby being born a bit of panic from all attending started to stir. (If she would have pushed her cervix could have swelled shut and labor would have not progressed toward birth) This is when a technique from Spinning Babies came to mind and literally saved the day.

I had Ashely do the Open Knees- Chest position to help her stop pushing. Ashely did NOT like this position, later she told me it was so uncomfortable and felt un-natural. She was such a trooper, she kept that position for 25 minutes while her doula (shout out to her doula Hannah!) and I took turns holding her hips off the bed with the Rebozzo. In this position she was able to fight the urge to push a little better, because her baby’s head was no longer pushing so intensely on her cervix. After those 25 minutes of Ashley working so hard to let her body dilate and let baby come down a little more before starting to push, I checked her cervix and I was hopeful that the amount of cervix left could by pushed past with a little help. Shortly after Ashley started actively pushing we could see her sweet baby’s head, and what felt like just minutes for me, her baby girl emerged from her body. Ashley’s husband reached down and pulled their baby the rest of the way out and they embraced her together for the first time. “I PUSHED HER OUT OF MY VAGINA!” was one of the first and most memorable things Ashley proclaimed after the birth. Such an accomplishment, such a wonderful and victorious birth to be a part of.

She did it! VBACs are possible and they can be very healing and triumphant. They can be hard, I’d say they usually are hard! And sometimes, for whatever reason an attempted VBAC results in a repeat c-section. No matter what kind of birth a woman wants I hope she can find a team of people to support her in her desires and wishes. Also, I LOVE Spinning Babies. If you are a birth worker or pregnant and don’t know Spinning Babies, please take time to learn about it.

Here is a link to Ashley’s birth story!

Books

Currently I am in the middle of reading way too many books. A few pages here and there is all I really fit in most days. I don’t know the precise reason but it could be a combination of: trying to find me time while being a Mom to three kids including a new baby, running my home birth practice, trying to continue my education, fuel my love of reading and keep up with new resources for my pregnant clients….among many other things. (silly emoji face)

A book I really want to check out and am curious if anyone has it or has read it is The Mama Natural Week By Week Guide to Pregnancy and Childbirth by Genevieve Howland, 2017. I’ve heard good things about it and have seen a bit of the content online. I am going to order it on Amazing Amazon and follow up to let you know how it is. But it looks like its a great up-to-date guide to pregnancy and birth. Most of the “What to Expect” books are fear based and don’t have good natural options for most pregnancy things like so I definitely feel that a book like this can be a valuable read to all pregnant mommas out there.

Here is what I’m reading now (not sure anyone cares but I’m just having fun blogging):

Rediscovering Birth by Sheila Kitzinger. Its a great source of info about birth traditions across time, cultures and the countries. You read about the mythologies of pregnancy and birth over time and how the care for pregnant women has evolved with both OBs and Midwives. It really is a great book.

Also reading

The Gift of Giving Life by Felice Austin. This takes a highly spiritual outlook on pregnancy and birth targeted toward Christian women. It focuses on how pregnancy and birth are not to be feared but treasured as joyful experiences to us closer to God as a woman and as a family. I thoroughly enjoy the reminder this book has brought to me about the spiritual beauty of birth.

And

Hold On To Your Kids by Gordon Neufield. A great read about how kids need to have a strong unbreakable attachment to their parents to combat the strong pull and often negative influence and effect peers have on our kids.

Also,

The Book of Mormon. I read this as much as possible to keep my relationship with Christ and God intact and strong. These strong relationships really help me balance all the balls I juggle on a daily basis.

Lastly,

The Gender Games. This one is just for fun. I think I’m on the third book. Its post-apocalyptic, there are two communities/cities, one is Patriarchal, run by men, the other Matriarchal. Both inhabit men and women, but the societies are completely different, and of course, they’re at war with each other. It’s kinda like a Hunger Game and Divergent type story. Pretty entertaining.

UPDATE (1/4/19)

So, The Mama Natural Week By Week Guide to Pregnancy and Childbirth by Genevieve Howland, 2017 is sooooo good. Its a complete guide on how to have a healthy, safe, and informed pregnancy and birth. It guides you to choose the right provider for you, birth location, etc. It talks nutrition, exercise, baby development week by week, and much more. I recommend CHUCKING OUT all “What to Expect” books and buy this Mama Natural book, you wont regret it!

Baby Rylee

A handful of you know that 5 years ago I thought I'd be giving birth to a baby girl named Riley, to our happy surprise, Parker was born instead. A week ago Rylee (spelled differently this time) was finally born.

A fast an furious series of events led to the wonderful birth of my third baby on June 2nd. Contractions started at 4:18pm every 2 minutes and they were stronger than I'd ever felt. Each one brought my baby closer, and each one shook my entire body. I knew that they were so strong because things were going quick. Luckily my midwife, Tiffany, showed up quickly after my labor started, I was able to get in the tub and labor for a bit in there. Floating face down on my belly was the most comfortable position during the contractions for some reason. Shortly after getting into the birth tub the urge to push overtook. It felt like the pain of the contractions lifted when I pushed and as my baby quickly shifted down my body. I told Tiffany the baby moved down. With my hand I felt my cervix fully dilate with one push and my bag of water popped with the touch of my finger. During the next push my baby's head was born. I remember feeling the soft wet hair in my palm, I rubbed the sweet head several times before pushing again.

The rest of the baby didn't come so quickly, after asking for help Tiffany eased the baby out and found the umbilical cord wrapped holding the baby down a bit. After unwrapping the cord, baby squeaked and cried, along with many of us in the room. I felt my baby's body and quickly learned I had a little girl in my arms. I announced it and everyone cheered with excitement. 

My husband brought in our kiddos, who were napping in the next room. They were slow to wake up but were very excited to finally meet the baby that grew in mommy's belly. It was such a special experience to have my mom and sister in-law, husband, and my two midwives there with me for the birth. Baby Rylee weighed 7#14, my biggest baby yet. And she is perfect. 

A Strong Heart

Sometimes I have pregnant women come to me who want to birth their babies in their homes but  have some kind of medical condition that increases their risk of complications. I've had women come to me with twins, breech babies, previous cesarean section, bleeding disorders, diabetes, high blood pressure and more. With most of these, according to the restrictions of my license, I have to find them an OB that will provide them care in the hospital. For some of these women it is safer for them to birth in the hospital. 

Last year a wonderful couple came to me wanting a home birth and this particular mom-to-be has a bicornuate uterus.  Her uterus is heart-shaped with a partial septum in the middle starting at the top. In my years as a midwife I have not had any clients--that I know of-- that have had a bicornuate uterus. I wanted to be able to provide the opportunity for this couple to have the birth they'd always hoped for--only if it was safe of course. 

I had the couple see an OB  (Dr. Safarik) that specializes in treating high risk pregnant women. He gave her an ultrasound and cleared her to continue in my care. He educated the couple on their increased risk of preterm birth, incompetent cervix (cervix won't dilate) and miscarriage. He also told them that many women can have normal, natural births often without even knowing they have a heart shaped womb. This information definitely didn't ensure this momma would have a successful home birth. We weren't sure if she would carry to term, if her baby would grow un-inhibited, if she would have a normal labor... but this didn't stop her. We made a plan to cautiously proceed together towards her home birth. As time passed, her pregnancy progressed without any complications and her ultrasound showed her beautiful baby growing normally. Finally she passed the "pre-term window" of pregnancy and our hope grew toward her having a successful birth. 

A few days before her due date she started having contractions and quickly was in full blown labor. I went to her home cautiously early at which point she was already progressed to 5 centimeters! She was coping well, although contractions were close together and intense. Shortly after I arrived their wonderful doula came to offer her support and expertise. Within a few hours the momma was 10 centimeters and ready to birth. This powerful warrior woman pushed out her baby within an hour--her husband and my assisting midwife caught the baby together and delivered her to the arms of her mother. They quickly discovered they had a daughter and were overjoyed.

What an amazing birth!! What a powerful woman and amazingly strong heart shaped uterus. Thank goodness she put fear and doubt aside enough to pursue her desire to have an unimpeded and natural birth.  I'm so grateful I was able to support this family and witness such a wonderful birth. I hope this woman and her experience can give others faith and hope to pursue their birth plans. I hope women can find midwives, doulas and doctors that support them and help them have memorable and safe births. 

Spinning a Posterior Baby

This week I had the pleasure of attending a mom having her second baby. All births are unique and special and this one was no different. My client, Q, dilated fairly quickly to 10cm and tried to push but baby wasn't moving--with about 3 inches to go down the birth canal. I could tell by feeling the bones on baby's head that he was in a posterior or "sunny-side-up" position. Some babies come out just fine in this position--in-fact both of mine did--but in many cases babies need to be in the anterior position to be born vaginally. 

So if Q would have pushed for much longer than she had, about 30 min, baby would not have come down and she would have become exhausted. So this is what we (the amazing doula and I) did. We had Q do 10 lunges, 3 side-lying releases and to top it off, 3 forward leaning inversions. After the third inversion Q squatted on the couch she had inverted off of and had an immediate inner urge to push, so she did! I could see baby boy's head right away as she gave into that urge. A few pushes later we saw his head emerge in the anterior presentation and her husband caught their sweet and fat little baby boy. 

What happened here is the lunges and side-lying release helped loosen any tense ligaments or muscles and created extra space in the pelvis for baby to move down. What I feel was the real game changer that brought baby into the right position was the forward leaning inversions. In a nutshell, this maneuver is like downward dog off of a couch, with bum up in the air and hands on the ground. This position hangs the baby down and allows the baby's head to lift off of the cervix only a tiny bit but that tiny bit creates just enough space for their heads to spin into the right position. It truly was amazing to witness and see this easy position change result in a positive vaginal home-birth experience!  So grateful I was able to be a part of this birth and use these valuable techniques to help baby be born. 

Congrats to Q and her family :)

More info about posterior babies: https://spinningbabies.com/learn-more/baby-positions/posterior/

OB Collaboration

This morning I participated in one of the most exciting meetings for the progress of midwifery care on the Central Coast! Tiffany Dietrich, LM , Alia Clark, Student Midwife and I met with a team of three Obstetricians and two L&D delivery nurses at the Santa Lucia Birth Center to establish the beginning of our collaborative care with Sierra Vista Regional Medical Center. What does this all mean?? These OBs, Dr. Bruce Monroy, Dr. Danny Lickness, and Dr. Angelina Malari are 3 of the 4 new hospitalist OBs available at Sierra Vista hospital at all times. On the occasion that a licensed midwife like me has to bring a patient into the hospital for some medical help in labor we will be assigned one of the doctors, who already know who we are, and we know them and they will gladly support us and our clients care. This is so exciting!! The doctors and nursed were excited to see the birth center, ask us questions about or practices and the services we offer to our clients. 

A huge gap is being bridged here. This is progress. In the small, often conservative town of San Luis Obispo, this is progressive movement toward more fluid and inclusive healthcare for all pregnant women. 

Thank you to the professionals that visited today, we look forward to working with you. 

For more info: https://www.sierravistaregional.com/our-services/birth-center/ob-hospitalist

Sometimes We Gotta Go

We all have an idea of what our birth will be like. Some of us make a "Birth Plan". We write it down for our providers to see all the things we want and don't want done to us and our soon to be born baby. Sometimes we just talk through the options with our provider and make a verbal plan. I think its important to have a plan. A plan means you've taken the time to educate yourself and decide what it is you want. Do you want pain meds offered? Do you want to squat while you birth? Do you want to have delayed cord clamping? These are all questions I hope you've been asked or asked yourself before your birth. But we all know this simple yet hard to handle truth about plans: THEY CHANGE.

Change can be hard to deal with, especially in the often stressful situation that is labor and birth.  I think there are a couple ways to help prepare and deal with the possibility that your birth plan just may change. 

1. Have a provider you trust. Whether its an OB or midwife I wish all women could have a provider in their pregnancy that they trust. You trust them to be honest with you about your care and your options, meaning they let you make actual choices about your care. They don't pressure you to do anything your not comfortable with. They focus on you and your desire for your care.
2. You keep an open mind. If you never think your plan will change, and therefore don't prepare for it, the change will be a hard pill to swallow. Taking time to talk about possible outcomes, how your plans would change and what would be done to ensure that best possible outcome is crucial. Other ways to help with an open mind are exercising, meditating or taking yoga, and eating healthy. These simple lifestyle choices help lower stress on the body and release endorphins to help deal with potentially stressful situations. 

It is so easy to be disappointed when our birth plan changes. I believe having a midwife or doctor your trust and keeping an open mind will really help optimize your birth no matter how it ends up. In the end all providers strive for the same thing. We want you and your baby to be healthy after the birth. Ideally happy too but that does take a back seat when your health is on the line. The happiness comes from proper prepping and support from your provider throughout. 

I had a momma whose birth plans recently changed after 50, yes 50, hours of labor. She worked so hard to progress, and would have done anything to succeed at home. But after that long, hard labor we had to go to the hospital to get some help. Luckily her sweet and chunky baby was born happy and screaming but her plans definitely changed and disappointment set in.  I am so proud of the way she handled everything and knew that we made the right decisions for her baby. Thats what moms do right? We put our desires after the wellbeing of our kids. It will take time for her to deal with the loss of her homebirth but with support from me, her family, la leche leauge and other fourth trimester groups i can only hope she will find joy in her birth. 

Having a baby and being a mom is hard work. And it starts even before we meet these little cute people. I hope all women can have providers they trust and prepare for the unplanned. xoxo

Above all odds

I had the pleasure of providing care for a woman having her first baby with a strong family history of preeclampsia- her mother, sister and grandmother all developed it in their first pregnancies. When preeclampsia sets in, high blood pressure endangers the woman and her baby as seizures are bound to happen until the blood pressure is stabilized with a medication given by a doctor and the baby is delivered; the exact cause of which is still unknown.

Family history can be a big indicator in what a woman's pregnancy and birth will be like. I've seen it time and again when a woman's mother had gestational diabetes, went past her due date in her pregnancies or had her water break to start her labors and the woman's labors simply followed just as her mother's births.  

This client of mine sustained normal blood pressure and health throughout her entire pregnancy. Diet? Exercise? A safe and low stress environment? Something more? I cant say what exact thing enabled this woman to overcome the odds of her family's history of this illness but I am so grateful for whatever it was!! She delivered a beautiful baby girl in her home this morning and I could not be more proud and in awe of the strength of this woman. I look forward to caring for her and her baby and for her babies in the future!      

Love them!!!

Welcome Londyn

I was so lucky to be a part of the birth of baby Londyn a couple weeks ago. I was covering another midwife's practice and her client Nikita was overdue and ready to go! Her labor progressed very smoothly and quickly and she had a wonderful home birth with the support of her husband.  Nikita showed her strength and became a powerful mother as she brought her chunky adorable baby earth side, it was a honor to witness. 

Thank you Nikita for allowing me to be a part of welcoming Londyn into your family!

Welcome Carmella!

I had the honor of being part of a wonderful birth last Friday. My client RM was preparing to have her second baby. Her first was born at a birth center, she had a wonderful and quick first birth experience and delivered a 10 pound baby. We knew this baby would be a nice healthy size too and we expected this labor to be just as quick if not quicker. One thing RM did not hope for was to go 2 entire weeks past her due date this time! 

Her due date came, on a Thursday, and she alerted me of some bloody show she noticed around 6 in the morning. She wasn't having an strong contractions but felt like she was having some Braxton hicks every now and then. I met her at the birth center later that day and we decided things felt a little early still. I recommended rest, but she wanted to walk and get this thing going! (I always empathize with my clients when they feel DONE and just flat out ready to have their baby when their due date rolls around-because I've been there!)

OK, so RM went on a walk with her hubby and then to bed when the contractions were not strong enough to indicate labor was quite kicking in yet. Friday early morning RM requested a home visit, still her body was not quite in labor but she wanted it so bad. I recommended rest and reassured her she would indeed go into labor when her body and baby were ready. Later that day she notified me contractions were picking up again, about every 6-10 minutes and not super strong yet. I recommended some abdominal lift and tucks (thank you SPINNING BABIES!!!) to help encourage her baby to drop and allow contractions to become efficient. This was about 3 in the after noon when she started these abdominal lifts. She called me around 4 report that after doing 10 lifts with 10 contractions her contractions changed and were now right on top of each other  and that she was feeling lots of pressure. YAY! At 5pm her husband called to tell. me they were both ready for me to be there. I got to their home in Los Osos around 6 and labor was in full swing; RM was in her birth tub being supported by her husband and her parents and her daughter were in the room as well. RM was focused and working hard during her contractions to relax and breathe deep, and her hubby and mom would offer her encouragement and water in-between contractions. What a dream team! 

I set up all my midwifery gear and before long RM started to push, and within 30 minutes of pushing her sweet little girl was born in the water, at 7:09pm. RM pulled Carmella up and she was pink and chubby and perfect. 

Prodromal or false labor or pre-labor contractions can be hard and discouraging. In the case of this labor, it could have been days or longer before little Carmella engaged enough to start active labor. I'm so grateful for the information and different techniques offered through Spinning Babies to help mom's just like this progress and push through the hard and confusing stages of labor and birth. 

Congratulations RM! You are a strong and powerful woman and you have accomplished so much for your family by bringing Carmella earth-side. Thank you for letting me be a part of this journey with you! xoxo

To have an epidural or to not...that is the question!

For some it is any easy choice, either for or against getting an epidural as a means of pain relief during labor and birth. For others it is not so easy. Some women choose to wait and see how the labor goes and they decide in the moment whether or not they need the epidural. Others spend some time researching the pros and cons and make a decision and plan before labor and birth start. 

There is no RIGHT or WRONG way to do it. Everyone has their own reasons for the kind of pain relief they seek during labor and birth. I do feel like its so important to know what the options of pain relief are and what the costs and benefits of each are as well. 

An epidural is widely known as the best method of pain relief during labor and birth. Nearly 60% of women use one for their birth. Have you ever wondered--what is an epidural? Well, just incase, it is an anesthesia placed in the epidural space, right next to your spinal cord. The epidural space is about 4mm wide ___ about the size of that line I just typed... and thats where the needle and medication need to be placed. After the needle is in the right place a small catheter replaces the needle. This only takes about 10 minutes. Once you have an epidural you'll most likely have a bladder catheter, a blood pressure cuff and continuous fetal monitoring. Although there are such things as "walking epidurals", they aren't super common so you'll most likely be confined to you bed for numerous hours once the epidural is in. 

Woah. Lots of info. 

Ok, so why do women want epidurals. Lets name the reasons: Typically provides complete pain relief. When it works, it works well. You can sleep and relax through labor. It can allow a tense woman to relax and her labor to move along. 

Thats all pretty straight forward I think. Sounds pretty good right?

Ok. So then why not? Some women don't want them because: For some it doesn't work well or at all. Side effects can be serious and possibly long lasting. They want to be able to move during their labor and birth. They don't want to lay in bed. It makes them feel trapped/stuck. They don't want the baby to get the drugs. Other interventions are more likely.

OK. Not so straight forward. May need a few facts to back that info up right...? Here:

Epidural fail rate is 12% (6). Often the anesthesiologist can fix the problem but not always.

Possible side effects: for you- Anxiety, nausea, vomiting, chills, fever (2), fluid overload from IV, increased vaginal tearing, temporary urinary incontinence, nerve injury, muscle weakness, dangerous drop in blood pressure, long term back problems (7), spinal headache (7), seizures, heart attack or respiratory distress. For baby- drops in heart rate (distress), low oxygen to baby, injury from forceps or vacuum, low muscle tone (limp when born), more likely to need NICU stay. 

Statistically epidurals do increase the chances of a cesarean (3). Babies are less likely able to do their normal rotation down the birth canal (1). Babies are more likely to be stressed out--their heart rates drop (4/5)--leading to emergency surgery. 

From the manufacturer's packaging of bupivacaine, the most common epidural drug: "Local anesthetics rapidly cross the placenta and...can cause varying degrees of maternal, fetal, and neonatal toxicity...Adverse reactions in the parturient [woman], fetus, and neonate involve alterations of the nervous system [brain damage], peripheral vascular tone [blood vessel damage], and cardiac function." 

Other interventions such as a need for pitocin (1), episiotomy--being cut from vagina to anus (yup I said anus)--or forceps or vacuum extraction (3). 

Movement in labor is a key component to helping the baby move down, rotate and dilate the cervix the way it is all meant to happen. 

The choice is yours or course. Epidural or not, home birth, hospital birth, circumcise, vaccinate... these are all choices we get to make. I know so many women that love using epidurals for their birth and I support them in their choice! For some women, it is what they need to have the birth they want. The purpose of this blog is to help women know more about the choices they make. I want all women to have good and memorable birth experiences. Thanks for reading :)

(1) Howell, CJ (2000)     (2) Lieberman, E. et al. (1997)    (3) Thorp, JA and Breedlove, G. (1996)   (4) Ramin, SM et al. (1995)  (5) Thorp, JA et al (1993)       (6) Pan, PH et al. (2004)   (7) MacArthur, C. Lewis, M., and Knox, EG. (1992)

Take Charge

No surprise to most of you, I love hearing the exciting news when a woman is pregnant. The best though is when I learn of a woman, friend or not, that had been trying for sometime to conceive and finally is pregnant! We all know people that have struggled with infertility.  Toni Weschler wrote a book, Taking Charge of Your Fertility, to help women understand their bodies and achieve or prevent pregnancy.  Of all the women I know that have successfully used this book, it took as long as 6 months to get pregnant, and as short as 1 month! 

Taking Charge of Your Fertility has information it in that I want to yell off my roof top! I want every woman of childbearing age to have as much control of her fertility as she can - whether you want to prevent a pregnancy or get pregnant. It's time for women to take charge of their fertility! Understand when you are the most fertile, understand when is the best time to get pregnant, and NO it is not just 14 days after you have your period. That is just an average. Most women ovulate between 11 and 21 days after their period starts. You can know exactly the day you ovulate just by tracking a couple very simple parts of your every day life. 
Basically, you can predict your ovulation every month by tracking your temperature right when you wake up in the morning (basal temperature) along with your cervical fluid (most people call this discharge). You can know if your hormones are stable enough to maintain a pregnancy. You can know if you have an anovulatory (no ovulation) month. You can know you're pregnant before a pregnancy test does.

Education is power! Time to take charge. Knowing your own body, is underrated. 

If you have questions please ask. Otherwise check out Taking Charge of Your Fertility. You can buy it on Amazon and a bunch of other places. Its awesome. 

Of course this is not a one size fits all method. IVF is a wonderful advancement in medicine, BUT I am a huge believer in this method of tracking your cycle to achieve pregnancy. It works. And I think its a bummer when IVF is used as a first means of intervention. 

Welcome Dandy

Five days after her due date, Baby Dandeliana was born on Sept 9th at home into her dad's hands. Here is her story, (with permission):

At first, Dandy's mother was planning to have an unassisted birth. She came to me with questions and concerns, mostly from members of her family, about the safety of birth at home. She had her three babies in the hospital, one via cesarean section, and desired to have a different experience with her fourth. She ultimately decided it was the best decision for her, and her entire family for her to receive prenatal care and to have me attend her birth. 

The birth was definitely hard work for momma, as all births are, but so rewarding and personal. The couple was able to have at the birth the mother, sisters and grandmother from her husband's family, while her mother and other family members watched and encouraged her via FaceTime. It was a very supportive group of women that helped make the mother comfortable and at ease. 

She dilated quickly to seven cm and was pushing shortly after that. The father of the baby wanted to catch her as she was born. I guided him and ensured mom and baby were doing well and dad did a wonderful job. He was the first to touch and hold his little girl and immediately passed her to mom after the birth. The other three children appeared minutes later and greeted their new sister. It was a very sweet moment when their elderly grandmother remarked about how special she felt to be able to attend the birth of her great grandbaby. 

After all was done, at one of her postpartum visits, Dandy's mom expressed her happiness with how everything turned out. I was honored to be a part of this woman's experience bringing her fourth baby into the world into the safety of her home. 

Spinning Babies World Conference

I had the pleasure of being able to attend the very first Spinning Babies World Conference. 

Spinning Babies is an organization created by a midwife in Minnesota. It focuses on the importance of the position of the baby during pregnancy to help optimize labor and birth. Balance, Gravity and Movement in pregnancy will lead to optimal position of the baby. 

Gravity is exactly what it sounds like and in pregnancy and labor and birth we should let it help our babies get into the right position. Head down is great, but there is more to it. The mother's body is designed to birth in the upright position! 

Movement of the hips, legs and entire body in pregnancy, labor and birth are used to relax muscles and open the pelvis into a larger diameter as the baby moves down. 

 How do we obtain balance in pregnancy? And what does that mean? Balance, according to Spinning Babies means "not too tight and not too loose". It is obtained by doing multiple things such as exercising, having good posture (also avoiding bad posture), taking time for yourself to reduce stress and mentally relax, and doing certain daily stretches to soften and lengthen the muscles supporting the uterus. 

It is crucial to do all we can to help our babies be in the best position throughout pregnancy. Also, there are techniques that Gail teaches to help babies move into the right position in labor. (Although, it is not a great idea to just wait til labor to try these out!) When babies are breech, posterior, high in the pelvis, etc, there are different positions and maneuvers that can be done to help baby move down and into the correct/easiest position. 

There were dozens of speakers at the conference. Gail is truly a visionary. She is teaching OBs in the hospitals in Minnesota to deliver vaginal breeches-in the hospitals!! Its amazing and ground breaking work that excites me just to know about! There was an OB from Germany that is publishing a study about the diameters of the pelvis and how they change when the mother changes into the hands and knees position-directly related to breech birth in the hands and knees position.

Another speaker I loved was a midwife and craniosacral theraptist, Deb E. McLaughlin. She taught about 4 different complaints in pregnancy, how to diagnose and then how to treat them. I am so happy and excited to have the tools now to treat pubic bone pain! I don't know many women that do not suffer from pubic bone pain, especially near the end of pregnancy. Also I now am confident to help diagnose and treat sacral pain and pressure, pendulous bellies and round ligament pain.

I could go on and on. 

I am so grateful I had the opportunity to attend this conference, to meet dozens of wonderfully talented, passionate and experienced doulas, midwives and other educators. Now I hope to bless the lives of my clients and friends with the knowledge and skills I've gained!

To learn more please check out SpinningBabies.com

Welcome Penny

I had the honor to be a part of a birth in mid-May. I will let Penny's mom, my friend Brianna tell her story. Check out her blog post:

http://cameronandbriannajensen.blogspot.com/2016/06/penelopes-birth-story.html

Lots to learn

Women's bodies are not as mysterious as we think they are, most of the time.  As women it is so important for us to know our bodies, starting with anatomy and most importantly it's functions. When am I most fertile? Can I get pregnant on my period? What is this discharge coming out of me? We have all asked ourselves this, or at least have a friend that has. The information is out there. Lets learn it, if we haven't, and make sure to teach our daughters. 

http://www.huffingtonpost.ca/ruth-miller/girls-sex-ed_b_7531704.html

justine