Sarah, Student Midwife

World Breastfeeding Week!

2010-08-02T13:43:00.002-06:00

The video I made last year for my history class:

Also, tomorrow I'm speaking at the Breastfeeding Cafe, put on by the Utah Breastfeeding Coalition. It's at the SLC main library, and I'll be there August 3 at 10 am, but it goes every day from August 1-15, with all kinds of great presentations, discussions and of course, breastfeeding support.

Menstrual Cycle Chart

2010-07-09T14:13:00.002-06:00

So, I made this last week, with younger women in mind. I had this thought I would make it really cute and stylish, but it's fairly plain. Maybe I'll dipsy-dot-doodle it up later and add written instructions.
But, it's simply a Menstrual Cycle Chart for women who NOT trying to achieve or avoid pregnancy (ie, women who aren't sexually active, or are surgically sterilized, etc.). Notice how there's no spot for listing intercourse? Some of us just like to know what's going on!

Vaginal Exams, how?

2010-07-07T11:38:00.000-06:00

Gently. With respect. Only as needed. Duh.

The real issue is, cervices are not like the plastic rings or models we learned on. Not at all. Cervices are not uniform, they don't dilate in neat concentric circles and we don't use tiny centimeter rulers to measure them in labor.

But we like to act like it.

We give orderly assessments of the cervix, with lots of numbers: 50% effaced, 2 cm dilated, -3 station. This fits neatly on the chart, but does it really help mothers?

Painting of a cervix
Check Out Birthing From Within, and Pam's New Book, Labyrinth of Birth

Consider this from Pam England: "This shift from left- to right-brain, from conscious to unconscious, facilitates the surrender required in active labor. Without that shift, wherein mind and ego melt into the background, most women could not stand the intensity of active labor."
-Birthing From Within, p. 181

Now consider what many women in labor are prone to do with the string of numbers that result from a vaginal exam. Labor math. This is almost irresistible and goes something like: if I dilate about a cm an hour, and I'm at 2 cms now, I have 8 hours to go. Except I'm not completely effaced yet, so add 2 more hours for each 25% of effacement, and this is my first baby, so 2 hours of pushing, and that's...12 hours? 12 HOURS?!!! And thus the adrenals are stimulated.

Does that sound like a shift from left- to right-brain, from conscious to unconscious? True, active labor produces brain waves much like dreaming. And you can't do math or read in dreams.

So, I'm trying something new. Instead of announcing a set of numbers when I feel a cervix, I do something else. I describe it. "It's very soft and squishy, opening just like it's supposed to. I'd say it's open about like this." And then I show her with my fingers, a visual, tactile representation of her cervix. No numbers.

Thanks to Flickr user sylvar for this image / CC BY-ND 2.0

I'll let you know how it goes.

La Partera Gringa

2010-07-02T21:38:00.000-06:00

I had the chance recently to attend a birth where the family's first language was Spanish, and realized how rusty my Spanish has become. So, here, a list of words I learned/remembered that might be useful at a birth.

partera-midwife
bebé-baby
madre-mother
respira-breathe
dolores-pains/contractions
lo siento-I'm sorry
espira-breathe out (blow)
buena-good
mas-more
al baño-to the bathroom
empuje-push! This also means "shove" so is only for use if you really, really want a strong push.
el bebé que viene-the baby's coming!

Vaginal Exams, why?

2010-06-23T09:40:00.000-06:00

An interesting thing has been happening lately. I've developed an aversion to vaginal exams before labor. Not (only) for myself, but for clients. And why...why...well, that's really the question, isn't it?

Birthing Beautiful Ideas posted beautifully about cervical checks before labor being regarded as some sort of magic 8 ball, giving mysterious information that could, if you interpret it correctly, let you know when your labor will start. Unfortunately, I think that's true. And you know what? magic 8 balls are lousy at predicting the future. So are cervices.

Thanks to Flickr user Andres Rueda for this image / CC BY-ND 2.0

I like this post too, from Robin Elise Weiss, LCCE on The Myth of the Vaginal Exam. We really don't learn that much from prelabor checks, and even in labor, the cervix can do interesting things. It can reverse dilation, it can refuse to budge for hours during hard labor and then suddenly open like the stargate on SG1.

We can consult our magic 8 ball cervix, but that doesn't mean the information is that useful, especially before labor starts. And we all know the risks of repeated vaginal exams, right? Infection, infection, infection.

Next, Vaginal exams, if we're going to do them, how should they be done?

Solidarity

2010-06-19T12:21:00.004-06:00

Apologies for the lack of posts lately. I've been studying hard and attending lots of births, and some things (like housework and this blog) have fallen by the way. But a conversation with two other students this week got me thinking about midwife solidarity.

Midwives are, by nature, pretty cussed, independent and difficult women. I've hard organizing midwives described as "herding cats". Even the most gentle of us are stubborn and have strong beliefs.

And I'll be honest, I've seen and heard of my sister midwives doing or saying things that made me say to myself, "Are you serious? Really? That's nuts!" I'd be surprised if no one's ever thought that about me.

But this is a cry for solidarity. We are midwives, whether licensed or unlicensed, nurse or direct-entry, certified or not. Whether we rely on faith, or evidence, or tradition, we are midwives. And as Ben Franklin said, "We must all hang together, or assuredly we shall all hang separately."

Next time we have the urge to judge, to point fingers or to say, She's not like -me- let's think a little more deeply. We don't have to agree on every aspect of practice to agree that women deserve choices. A midwife for every woman means midwives as diverse as the world is wide. But we have to stand together, stand up for one another, and believe that what makes us midwives is the same.

Another Student Midwife Blog

2010-03-09T08:50:00.010-07:00

I just found this new blog: Journey of an Aspiring Midwife. Rachel's a student at Birthwise College in Maine and I love that she honors her spiritual journey, as well as the mental and physical aspects of becoming a midwife.

She writes: The Lord has directed my steps and my confidence in His plan for me grows with each breath. So beautiful. It's such a gift to find and meet fellow travelers on this walk that is so often so solitary.

And speaking of the spiritual aspect of this journey, this week has been ... not exactly hard, but not easy, either. I'm finding as I approach the midpoint of my studies, I've found fear. Not overwhelming fear, just the sort of pit you get in your stomach when you reach the top of a diving board ladder, a sense of ... look how far down it is. And questions arise. Small questions like Is 36 weeks or 37 weeks a good cutoff for homebirth? Do I have a favorite brand of prenatal supplement? and larger questions like, How will I know I'm ready to be independent? What if this life isn't for me? What if I make a horrible mistake?

A great teacher taught me once, Fear is the opposite of love. It will oppose it and pull you away from your best course, and God's plan for you. But the only antidote for fear is courage. Not turning away, but continuing to move forward.

So I'll take my little pause this week, be still and know that He is God. He is in control. My job is to walk to the edge of the light, and step into the dark. I can do that.

I think.

Thanks to flickr user bonnix (Scotty) for this image CC BY 2.0 for this image CC BY 2.0

In Praise of the Midhusbands

2010-02-09T09:38:00.000-07:00

We've come a long, long way together
through the hard times and the good.
I have to celebrate you, baby.
I have to praise you like I should.

This is the longest it's ever taken me to finish a post. I started this one in November of last year, around my anniversary. Some subjects are just too big, too huge and too important to do justice to in a blog post. But this is important.

Being the husband of a midwife is not an easy thing. This article in Mothering covers some of it. The missed birthdays and sleep, the interrupted lovemaking, the tears for someone else's experiences. I heard a midwife say that midwives have a higher than average divorce rate. I couldn't find any official statistics to that effect, but from what I can see, it's probably true. Part of it is the stress of the job, being on call, holding too much responsibility for any one person. Part of it is the tendency of midwives to be cussed, independent and not well-behaved women. It takes a lot of determination to stay married to a midwife. A lot of grit and love. A different kind of romance that will make a peanut butter sandwich and stay up until 1 while she sterilizes instruments after a birth because another one is coming soon.

I am married to a wonderful man. Without him, I would be less than half of who I am. It's not just that he's my other, kinder, stronger half. But he makes me better when I'm around him. His heart teaches mine to beat in rhythm. He's warm in the night when my feet are cold. He doesn't talk to strangers much, but he's my anchor. Making eye contact across the room gives me the strength to speak to anyone. I can lend my emotions to others because I know he'll hold me when I come home.

I love you, baby.

Pelvis in search of Doll

2010-01-25T13:07:00.000-07:00

Model pelvis has arrived. Need a doll. Must fit through pelvis.

Aisle of pink. Help!

When you grow up, you can be an astronaut, a bond girl, a teacher, a dependent teenager or a vampire. What, no midwife?

Talking dolls creep me out.

Too small.

Way too small. Triplets. Risked out.

Too scary!

Al...most...can't tell!

We may have a winner. Comes with a spare outfit and pacifier. Ironic, as he is destined to spend his life naked.

He fits!

There's a nice occiput presentation.

With sutures. Breech!

I shall call him Cletus. Cletus, my darling fetus.

Birth Control options (you wish you never heard of)

2010-01-16T12:15:00.000-07:00

Mild? No, it wasn't.
Spermicide? Yes, it was.
Most popular method of birth control from 1930 to 1960, when the pill arrived on the scene.
Ever wonder if the pill is any safer?
Or will our granddaughters look at it and say, Grandma, you didn't REALLY take artificial hormones, did you? Guh-rossss! Ew! Cancer!

Student Midwife Blogs

2010-01-11T08:50:00.000-07:00

I like to read blogs maybe more than I like to write in mine. Here's a few written by student midwives, too.

http://apprenticemidwife.blogspot.com/
Student in NC, studying through AAMI. Her pictures make me laugh every single time.

http://almostmidwife.blogspot.com/
Canadian student midwife

http://missionarymidwifemama.blogspot.com/
Apprenticing in Indonesia!

http://babycatcher33.livejournal.com/
Another Canadian student midwife

http://treasuredbirth.blogspot.com/
In Minnesota, one of my classmates at MCU

http://treesasbaliblog.blogspot.com/
This is not being updated anymore, but I thought it was so interesting--a student midwife's experience training in Bali

Gifts for the Student Midwife

2010-01-02T08:12:00.004-07:00

A couple things I got for Christmas and am really happy about, as well as some I wouldn't mind getting someday.

Mainly, I like this model because it's what one of my preceptors uses, and I've found it very convenient. You put it on the wrist, put the wrist at heart level and it starts. No rolling up sleeves to armpits. It's battery operated, quite accurate, and has NO TUBING. If you've ever had to untangle a stethoscope, a Doppler and a sphygmomanometer that got thrown in a bag together, you know. No tubing is a beautiful thing. I'm excited about mine (thanks, huz!).

Again, my preceptor has one of these and I sort of want one for home use, as well as midwifery. I wish I'd had it when my little ones were littler. It's a thermometer you wipe across the temporal artery (temple) rather than inserting it anywhere. I know! LIKE STAR TREK MEDICAL BAY!
Really, the huge thing about this is you can take a client's temperature without them having to hold something in their mouth, so they can continue talking. And you can take a baby's temperature while they sleep or cuddle with mom-don't even have to peel an arm away to get axial access. Taking a baby's temp while they nurse is a good thing.

Waterbirth. Pants. Really, any kind of waterproof running/athletic pants will do, but the huz said this brand was good. No more wringing out your pants while you drain the birth pool! Wheee!

Paired with a cool T-shirt about ovaries and you're good to go.

Next year I'll try to post a list BEFORE Christmas. Happy New Year, everyone!

T-shirts are awesome

2009-11-21T11:33:00.000-07:00

Vaginas Are Awesome T-shirt

2009-11-15T10:02:00.002-07:00

So, I saw this T-shirt this weekend, and I nearly bought it for work. Positive, uplifting messages for mommas in labor: Your Body is Awesome! Right?

The huz convinced me it might be inappropriate outside of work, and further, people like mistake me for a lesbian. I offered to buy him one, too, but alas, they only seem to come in women's.

What do you think? Awesome? I need your input!

Maternal Mortality, or What is Going On?

2009-11-11T10:04:00.002-07:00

I read this BBC news article and thought they did a good job putting the maternal mortality problem in perspective. Trust the Brits to keep us Americans honest. We're doing better than third world countries, but for spending as much as we do, our rates of maternal death during or after giving birth are the worst. So what's going on?

Thanks to Flickr user innocenteyez for this image / CC BY-ND 2.0

One of the most disturbing parts of this all (besides women are dying and we don't really know why) is the issue racial disparities. Even when controlled for education and income levels, black women are dying much more often than caucasians, Asians and Latinas. If you aren't a statistician, that means that Michelle Obama or Oprah have a greater risk of dying in childbirth than I do, simply because of the color of their skin. And if that seems wrong, you've got it right. It is wrong.

So what can we do about this? The International Center for Traditional Childbearing is working to train midwives of color to help explore and combat these numbers. Midwives of color are rare, and obstetricians of color are even more so. I would really like to see some answers here. Why is this happening?

Thanks to Flickr user Tammra for this image / CC BY-ND 2.0

One theory is that because Americans intervene in normal childbirth more than many other countries, which has led us to a 32% Cesarean rate, we might be actually seeing iatrogenic deaths. A sobering thought: Hazards of Cesarean Birth.

One of my favorite midwives and writers on the topic of maternal deaths is a pioneer in the homebirth field. You can read Ina May Gaskin's writing in this area and see what you think.

In lieu of content

2009-10-14T21:20:00.004-06:00

a comic of stick figures:

From xkcd.

It is pretty neat.

Pelvic Muscles Model

2009-10-10T03:43:00.000-06:00

To study up on the pelvic muscles, I made a model out of felt, yarn and a box lid.

The box lid represents the bony pelvis. The top is the pubis (pubic bone) and the bottom is the tailbone, or coccyx.

The three strings/ribbons represent the sphincters: yellow=urethra, pink=vagina, brown=anus. I just put them in there to hold the space. You can see in the first picture the superficial muscles: ischiocavernosus (the white diagonal), urethral sphincter (white curvy part), superficial transverse (big blue, clearly labeled), and external anal sphincter (green).

Once you peel away the superficial layer, you can see the deeper layer with the red pubovaginalis, puborectalis and pubococcygeus. These are the kegel muscles, very good idea to strengthen these if you have a vagina and like to use it. Prevents urinary incontinence and, I'm told, adds sensation for your lover.

And the deepest level, you can see the iliococcygeus (green) and ischiococcygeus (blue). And that's it!

Holistic Adventures: Sprouts Day 4

2009-10-09T14:15:00.001-06:00

Wow, sprouts! The wheat are much greener today. Adzuki beans are definitely showing little white tendrils.

I took the wheat sprouts out and shared them with my kids for a snack. They are good, crunchy and green-tasting. The kids were tickled to be eating "whole plants".

Not as good as I remember alfalfa sprouts tasting, though. Anyone know where I can get alfalfa seeds?

Holistic Adventures: Green Drink

2009-10-08T22:15:00.000-06:00

I made my green drink from parsley, spinach and cranberry juice mix (all juice, but not all cranberry).

fresh parsley (about 1 oz), containing

1 g fiber
47% RDA Vitamin A
62% RDA Vitamin C
10% RDA Iron
4% RDA Calcium

fresh spinach (about 6 oz) containing

4 g fiber
220% RDA Vitamin A
80% RDA Vitamin C
30% RDA Iron
16% RDA Calcium

Langer’s Cranberry Plus juice (1 cup) containing

20% RDA Vitamin A
100% RDA Vitamin C
10% RDA Calcium

Everyone knows cranberry juice and spinach are good for you. Man, can you believe the nutritionals on fresh spinach? No wonder Popeye was so buff. But I was surprised what I learned about parsley. It is supposed to be anticarcinogenic (prevent cancer), purify the blood and stimulate the digestive system (which is why it became commonly used as a garnish!). Good on ya, parsley.

So, total in the final product:

5 g fiber
287% RDA Vitamin A
142% RDA Vitamin C
40% RDA Iron
30% RDA Calcium

I bet with some yogurt in there, we could have topped the 50% mark on iron and calcium. Hm.

Blending it up made it very foamy, and you can really smell the parsley.

It tastes…very green. Sweet, and a little crunchy—that might mean I didn’t blend it enough, I’m not sure. Not bad, but I’ll be honest, it was crunchy enough I didn’t finish it. Maybe it’s an acquired taste.

Holistic Adventures: Sprouts Day 3

2009-10-08T17:15:00.001-06:00

Well, the white beans smelled a little funky this morning, and the sesame seeds were doing a whole lot of nothing, so I emptied those out, and moved the wheat berries to the bigger jar. The wheat are just starting to put out little white sprouts.

Nothing yet on the adzuki beans. They don't smell bad like the white beans did, but they have a definite "beany" smell.

Holistic Adventures: Sprouts Day 2

2009-10-07T14:15:00.002-06:00

Well, I forgot that soaking beans and seeds makes them SWELL. I think I need to empty about half of the beans and wheat berries out of their jars. Other than that, they seem to be doing well.

Lab skills!

2009-10-06T15:47:00.000-06:00

I'm doing skills labs this week, learning a lot at the MCU conference. See you in a bit!

Holistic Adventures: Sprouts Day 1

2009-10-06T09:15:00.000-06:00

It's time for sprouting! Did you know sprouting seeds, grains or nuts makes them more nutritious? I didn't know that before this week. I have fond memories of my mother sprouting alfalfa in a mason jar by the sink, but you know, alfalfa seeds are not as easy to find as they used to be! I found already sprouted alfalfa at the grocery store, but neither they nor the health food store had any unsprouted alfalfa. But, I did get some wheat berries, adzuki beans and white beans. I have some sesame seeds, which seem like they might sprout, so I'll try them too. I don't know if they'll all sprout, but we'll see!

Rinse, cover and soak overnight!

Holistic Adventures: Yogurt, Whey and Cream Cheese

2009-10-05T14:06:00.000-06:00

If you're wondering where I'm getting all these holistic recipes, it's from a book called Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats. And no, I don't know what a diet dictocrat is. But the cookbook also includes lots of information about how traditional foods are in many ways healthier than current, highly processed diets.

So, today's plan is to make yogurt, then strain out the whey and make cream cheese out of it. I like cream cheese on my bagels. Making yogurt is not hard. You need some cultures or already made yogurt, and some milk. Warm it up, keep it warm for 6-12 hours and it turns into yogurt. I have a yogurt maker (a lovely gift) so I set that overnight and it was good to go, but you can do it in a pan of water in your oven, too.

Morning time! Cover a strainer with cheesecloth (so that's where it gets its name!) and pour the yogurt in. Some of the whey strains out quickly.

Some takes a while.

After a few hours, gather the cheesecloth into a little bag and hang it over something to let the last of the whey strain out.

See my knot tying skills? I'm like a mad boy scout with string.

After a couple hours of that, you have a few cups of whey (very nutritive, I'm told, and excellent for making bread) and some yummy, super creamy cream cheese.

Holistic Adventures: Potassium Broth

2009-10-04T10:16:00.000-06:00

This broth is for helping people who are sick or recovering from illness. I bet it's great for stress, say...from not sleeping several nights in a row while you attend births. I made mine from celery, parsley (not very perky parsley), onions, potatoes (home grown!), and carrots.

Cut it all up, peel the potatoes and PUT THE PEELS IN, and simmer for half an hour.

Strained, it has a pretty amber color. It has a nice flavor, not too strong.

Labor Induction and the Knowing-Doing Gap

2009-10-03T18:02:00.005-06:00

Elective induction of labor is one of the most common, and arguably one of the most dangerous practices going on in obstetrics today. But surely midwives aren't part of that. Are we?

Thanks for use of this photo by Flickr user zoutedrop/ / CC BY 2.0

Actually, according to the BMJ study of CPM-attended births, we are. Midwife clients were experiencing induction of labor 9.6% of the time (click on table 3). Now, some of those were likely after transfer out of midwifery care, and many likely for legitimate reasons. But nearly 10% induction rate doesn't sound that far behind the 21-44% the hospitals are reporting.

There are two problems with knowing when to recommend inducing labor. One is what I call the knowing-doing gap. Alright, I didn't call it that first--there's a book by that name. But basically, the gap between knowing what we should do, and actually doing it when faced with the situation. It's not as easy as we like to think. In my family we use the quote, "If ye know these things, happy are ye if ye do them!" It's easy to know the right thing, but far harder to do it when faced with an exhausted, 41-week mother who is crying because she really thought she'd have her baby by now.

The other trouble is the vagueness of most reasons we use in determining whether to induce labor. How late is too late? How big is too big? How ripe is ripe enough? Even the usually obvious reasons for inducing are called into question. Because womens' bodies and babies are so individual and situations vary so much, it's very much a guessing game. Lamaze has a new video out, helping women try to navigate this, because it's one of their 6 Healthy Birth Practices.

According to A Guide to Effective Care in Pregnancy and Childbirth (a great reference that is available free online), "The decision to bring pregnancy to an end before spontaneous onset of labor is one of the most drastic ways of intervening in the natural process of pregnancy and childbirth" (p. 375).

Just because an induction doesn't involve Pitocin doesn't make it any less a drastic intervention with serious risks to mother and baby. Despite what ACOG may say, induction is not to be taken lightly, or commonly. As midwives, we must question ourselves any time we're faced with the decision to end a pregnancy early.

Holistic Adventures

2009-10-03T09:28:00.004-06:00

Well, it wasn't the flu, and I recovered quickly. It's amazing what drinking more fluids and getting more sleep can do for a body.

Also, I'm in a class called Holistic Health this term at MCU, and so I decided to try some of this stuff. I should stop and explain here that there are many different kinds of midwifery students (and midwives, for that matter). There are sweet baby sniffers, woman power hippies, researching evidence students, and natural living gals. I'm not a natural living gal. I eat fast food (sometimes). My kids watch TV and except for a brief run at cloth diapering, wore plastic diapers. I have a garden, but it's not organic. I'm just not that gal. I love those gals. But I'm not them.

For the sake of learning, though, I thought I'd give some of this holistic stuff a try (and of course, share the process with you, loving reader!). I'm sprouting some sprouts, making my own cream cheese, yogurt and whey, maybe some sourdough, a couple nutritive broths (mmmm), and a green drink. Should be fuuuun.

Sick

2009-09-26T20:16:00.001-06:00

I think I may have influenza, but it's not dire.

Pandemic home care instructions

Learn from my pain. And fever. And whining.

I'm gonna drink some juice and take a nap.

Hey, I know her!

2009-09-14T20:38:00.000-06:00

My friend and teacher Andrea Lythgoe is now writing for Lamaze International's blog, Sense and Sensibility. Go, read what she has to say. She is a fantastic teacher about understanding research.

Homebirth Studies?

2009-09-12T09:47:00.000-06:00

I mentioned a study about the safety of homebirths on my Facebook and got the response, "I'm so glad someone's studying that!" And really, a lot of people are studying it. Here are a few of the recent studies on homebirth with midwives:
CPMS in North America (2005)
the entire nation of the Netherlands (2009)
British Columbia, Canada (2009)
Report of Utah Licensed Direct-Entry Midwives, (2007-2008)

Sorry for the post slowdown lately, been studying up a storm and writing, too. More on the writing later this weekend. Or next week.

What it's like

2009-09-06T19:45:00.003-06:00

"Wow! You're studying to be a midwife? That's awesome! What's it like?"

It's hard to explain to people what it's like studying midwifery, assisting amazing, experienced midwives, learning all kinds of new things that aren't appropriate to discuss at dinner.

It's like exploring new fantastic lands,
having unbelieveable adventures,
falling in love over and over again....

...all while trying not to fall on your face too often.

Yeah. It's kind of like that.

Tell me about yourself!

2009-09-04T15:40:00.001-06:00

I've shared about my life, but I'm curious about you, my readers. Who are you? How did you find my blog and why do you read?

Answer in comments below or take the poll.

Thanks!

Birth Day

2009-09-01T22:26:00.001-06:00

Today's post is guest written by Joyce from Muum's Musings. She's a talented gardener, writer and amazing woman. She also happens to be my mother.

When my first child was born, I had some trouble recovering from the C-section. She was healthy, but I ended up with a bladder infection and was traumatized by the surgery. I hadn’t spent a lot of time in hospitals and remember feeling like they had ‘broken’ my body by cutting it open. It was upsetting, and I hurt, and I was tired. It took me probably 6 months to feel good again after that. *** and I were also upset because we had wanted to have a large family, and a Cesarean would limit that desire, too. But those feelings (which were a big deal to me at the time!) were minimized by the immense protective feeling of love I had for my firstborn. It was overwhelming to think that I was responsible for her care and well being. I loved her and wanted to do my very best for her, even though I didn’t really know what to do, often! I remember a moment in the hospital, in pain, having trouble walking, having to drag myself to the bathroom to pump my breasts because the nurses wouldn’t let me nurse her because I was on an antibiotic (!dumb reason) and thinking, it was all worth it to have her.

So, my initial experiences in motherhood were .. intense.

Our first child was two weeks late! This added to the personal discomfort of that last month (six weeks!), compounded by the heat and humidity of central Florida, where we were living in a horrible apartment with no a/c. For the rest of my pregnancies, I negotiated the due date with my doctor, based on the fact that I think my body runs at a slower rate than normal.

I remember lying in bed and moaning, ‘I’ll be pregnant forever!’ this child will never be born’, and truly believing it.

My water broke one fine day, and off we went to the Navy hospital (a WW 2 relic, with covered walkways between the buildings. A new hospital was being built while we were there.)

I remember thinking, “well, now they can’t send me home, we will HAVE this baby!”

As they put me in a bed, and all the paperwork was completed, a funny thing happened- my labor did NOT start. So we sat. And played cards. No, I couldn’t get up and walk around, and, by the way, I was ‘too small’ to have what looked like a large baby, they informed me. And if I hadn’t started labor by noon, they would do a C-sec because they can’t wait any longer because of the risks of infection (my water had broken about 6 am that morning) . My lack of knowledge cost me here. Although I had attended birth classes and prenatal classes with my husband, nobody told me that it is ok to wait – 48 hours? – I think, after the water breaks and things would be ok.

We did end up with a Cesarean. We were upset. I was upset, because my husband couldn’t come into surgery because he had not gone to a C-sec preparation class. I felt very alone, and very vulnerable. A spinal anesthesia was administered, and I remember lying there, and hearing the baby’s mew-like cry, (Did they tell me it was a girl?) and then I was unconscious.

I woke up in recovery with violent cold shakes, something else I was not prepared for. The nurses brought warm blankets, and I was so grateful. Soon my husband came in to be with me, and to say that the baby was a girl, and she was fine.

Although she was fine, we spent 8 days in the hospital (the maternity wing was one side of a barracks-like building, with the other side full of hysterectomy patients! That was fun, though), while I recovered from a bladder infection/ UTI.

It is a good thing babies are tougher than they look. We didn’t know how to get her to stop crying (she didn’t like the hot humid weather, either), we didn’t know how to put on a diaper – the cloth ones we were using looked like an askew boat on her little body. My mother came to help out the day after I got home from the hospital (or so, a day or two), and helped out with that first bath (a disaster!) and fixed the diaper/boat problem, too. I remember basically sleeping and feeding the baby the two weeks my mother was there, and not much else. It was wonderful to have her there, caring for us.

*** = my dad

I know, I'm pretty lucky, huh? That was my birth, and it was 32 years ago. Mom went on to VBAC 3 times and then have her last via Cesarean for breech. She continually teaches me how to be brave and kind and how to love fiercely, like mothers do.

Normalizing Normal Birth, Part One

2009-08-31T06:36:00.000-06:00

Thanks for use of this photo by Flickr user molly_darling / CC BY-ND 2.0

“You had a baby at home? But you’re so…”

People usually trail off at that point, leaving me unsure of what I am so…

Smart? Boring? Conservative? Liberal? Normal?

I think it’s normal. I seem so normal. But finding out I’ve had a baby at home with a midwife makes people step back and reassess. Because in our culture, normal birth is not normal. Clearly, my colored hair, average clothes and pathetically common soda habit must be some kind of ruse, a cover for my abnormal childbirth behavior. I seem so normal.

And the truth is, I am normal. I’m a pretty average woman, although I’ve been blessed with some extraordinary circumstances in my life. I have my babies the normal way, without unnecessary drugs and interventions, without surgery unless the situation becomes life-threatening. What’s so strange about that?

Except it is. We know it is. Few births happen out of hospital. In the US, close to a third of births involve major abdominal surgery, so many that many people believe cesarean birth is actually safer than normal birth, and don’t even count the “minor” surgical procedure of episiotomies that are performed with ridiculous, heedless regularity, like some sort of Western female circumcision rite. Most births occur in hospitals, are monitored, induced and anesthetized beyond the needs of normal birth, making birth in the US more dangerous than in most developed countries. That’s not normal.

So how do we bring normal birth back into cultural normalcy and make it not only accepted, but expected? How does this change happen?

First Day of Apprenticeship

2009-08-29T06:58:00.000-06:00

Yesterday was my first day apprenticing (although I did some 4 or 5 years ago). I plan to work with more than one group of midwives, but this group is excellent so I'm starting here.

This is my watch. I remembered my preceptor was very specific that apprentices need to wear watches with a second hand for births and prenatals. Waterproof=a good idea.

Nervous. Elevator.

We had two prenatal and one postpartum visit. I got to help with some things (checking urine, checking blood pressure) and watch others (blood draws!). The clients were all very patient and lovely, but of course I can't post pictures of them. Don't be silly. Privacy!

I studied and filled out MANA statistic forms between clients--we had a couple cancellations, so it was a slower morning than expected, but a good one!

You can see more about where I'm apprenticing at: www.BetterBirth.com. The midwives there are fantastic, and great teachers.

3 Ways to Save Money as a Midwifery Student

2009-08-27T07:29:00.000-06:00

Thanks for use of this photo by Flickr user tracy_olson/ / CC BY-SA 2.0

Learning to be a midwife isn't easy, but it also isn't free. Whether you're doing PEP or a MEAC program, you have tuition, workshop fees, equipment and textbooks to buy. But, you can ease the pain, pinch your pennies here and there.

1. Go low-tech
Especially as a student, learn to use a stethoscope for labor FHR checks, rather than a doppler, or make your own baby scale sling (I've seen an awesome one--I'll see if I can duplicate it and post a pattern). See if you can barter for the things you need rather than paying top dollar for the machines that go ping. We're midwives, right? Let's act like it.

2. Get it used
Books are the obvious thing here--you can save hundreds of dollars on books shopping around online for used or discounted copies, but you'd be amazed the kinds of stuff you can find on Ebay. One word of caution, do your research before you buy! I've seen many "dopplers" for sale on Ebay that are not professional grade, or even very well built.

3. Get it free
Cheap is good, but free is better. Google books has several common textbooks are on "limited preview" which means you can read a few pages and search them online, totally free. And a few books (like Guide to Effective Care in Pregnancy and Childbirth) are actually totally free to download.

Don't forget to use your local library. I mean, not just checking books and videos out (although definitely, don't miss that!) but really USE it. Ask your librarian about interlibrary loan. Some libraries even have access to research databases. For example, the Salt Lake County library system allows you access to EBSCO and several other databases, even from home! If you live near a college of university (or, bestill my heart, a medical school), find out if you can use their research facilities without checking materials out. They have periodical journals that will save you hundreds of dollars! Just bring some dimes for the copy machines.

If you have the type of family or friends who feel it's alright to "make a list" for your birthday or Christmas, you can ask for supplies or books as gifts--just be specific! Your aunt may not know the difference between Holistic Midwifery and Spiritual Midwifery.

What other ways have you found to trim the fat from your midwifery study expenses?

Crafty Cells

2009-08-25T08:46:00.000-06:00

This has inspired me:

Plush Cell Model - More DIY How To Projects

I'm in anatomy this fall, so maybe I'll try to make a plush human ovum or embryo. A little more detailed thank this one. Don't worry, if I do, I'll post pictures.

The Birth Survey

2009-08-23T06:54:00.000-06:00

Thanks for use of this photo by Flickr user molly_darling / CC BY-ND 2.0

You may have noticed, along with cleaning up my sidebar (there are some new things coming there!) I now have a banner for The Birth Survey at the bottom of the page. It's not a paid advertisement, just something I want to publicize. The Birth Survey is collecting information about birth experiences with different care providers and at different locations (home, birth centers and hospitals) so women can make more informed choices about where and with whom to have their babies. I think this is such a valuable tool, so please, use it!

There's also a Lamaze Webinar on September 15 about the survey and how it helps increase transparency in maternity care--always a good thing. And there's CEUs to be had!

Don't Force It

2009-08-20T15:48:00.000-06:00

You've all seen this before, right? Men v. Women, simple v. complex. And really, in a lot of ways it's true.

Especially in at least one way: sex. For most men, most of the time, it's a simple equation. Flip the switch, the light turns on, they are ready to go. For women...the time of day, the temperature and humidity of the room, scents, the right words, the right kind of touch, the right feelings. All the little knobs and dials have to be in the right place, and it usually just takes some time for everything to get in the groove and start working.

Women are complex, hormonal creatures, and the same kind of chemical perfection that can lead to a screaming, mind-blowing orgasm is required for another uniquely female, hormonally orchestrated event: labor.

And so, when some small piece of the hormone cocktail isn't quite in place, we can't tell what it is, and things don't quite work. Labor stalls or never gets really going and there is a great temptation to force it. Or sometimes we look at our calendars and say, the baby is due! It's time to make it come out!

Thanks for use of this photo by Flickr user valeriebb / CC BY-SA 2.0
That's one reason induction of labor isn't such a good idea. You're forcing it. And that can lead to all kinds of problems. Increased anesthesia. Fetal distress. Surgical births. Preterm babies. Postpartum hemorrhage.

Women aren't broken. They're just women. Complex. Beautiful. Exactly the way they should be.

New ACOG Guidelines for Induction Out

2009-08-17T21:33:00.003-06:00

First, let me say, Look! There's only one entry on the page now. Much cleaner. You can still get to things you may have missed using the archive feature (scroll down and look to your right) or click "Older Posts" at the bottom.

So, ACOG has released new guidelines for inducing labor and Henci Goer is tellin' it like it is re: Misoprostol over at the Lamaze blog. I find it really stunning. Just stunning. More about induction later, I promise.

And here, something else I found today:

41 Countries Doing Better than the United States in Infant Mortality

Korea, South
Cuba
Man, Isle of
Italy
Taiwan
San Marino
Greece
Monaco
Ireland
Canada
Jersey
New Zealand
United Kingdom
Gibraltar
Portugal
Netherlands
Luxembourg
Guernsey
Liechtenstein
Australia
Belgium
Austria
Denmark
Slovenia
Macau
Israel
Spain
Switzerland
Andorra
Germany
Czech Republic
Malta
Norway
Anguilla
Finland
France
Iceland
Hong Kong
Japan
Sweden
Singapore

From: 2008 Infant Mortality Rates

3, no 4! Short Things

2009-08-14T20:06:00.001-06:00

1- BetterBirth's clinical training program is having a 50% off tuition special right now. Go see. These are a great group of midwives I've worked with before and hope to work with again. Fantastic teachers, AND their clinical program sets you up in an apartment right by the birth suites.

2- Great instructional short on sterile gloving from a midwifery program in Australia.

3- I stumbled on this collection of pictures (and a few videos) of newborns (normal and abnormal conditions) from Stanford School of Medicine. Very useful! The "warning graphic content" just means there are pictures of breasts in the breastfeeding section and some shots of naked baby genitalia. The videos of circumcision are not for the faint of heart, though.

4- And finally, I'm signed up for NRP in October at a local hospital--if anyone in my area wants to come with, I'd love the company.

Coming soon: doing birth research

The Myth of Balance

2009-08-11T12:33:00.001-06:00

I've been thinking lately, about balance. How do I, mother of three, wife and lover, intelligent person, church volunteer, writer, teacher and student, fit in the role of midwife to my teeming schedule, not to mention the brainspace?

I painted this a few years ago when I was trying to wrap my head around being pregnant with my third child, with a toddler in one hand and an increasingly frustrated (see that hand on her hip!) preschooler in the other. Plus writing, helping, teaching, learning--I needed more hands and felt precariously balanced on the pedestal of "doing it right".

A dear friend noted that I'd painted myself as a Hindu goddess, who, I learned, is a fighter with ten arms. Her name is Durga and I enjoyed reading about her, especially the bit: "Durga manifests fearlessness and patience, and never loses her sense of humor, even during spiritual battles of epic proportion." She's sometimes called "the invincible." Inspiring, no? And she isn't balancing. She's dancing.

Thanks for use of this photo by Flickr user jessicatesty / CC BY 2.0

So how do I balance? I don't suppose I really will. I'm not a goddess. I will fall sometimes, and run out of hands to do everything. But hopefully I'll get back up and dance again.

How to Memorize Medical Terms

2009-08-07T09:23:00.001-06:00

Thanks for image from Flickr user adrianclarkmbbs / CC BY-ND 2.0

So, I'm taking medical terminology right now, and it's sort of painfully addictive, the learning and memorization of words for things I have only an as-yet-tenuous knowledge of. But, since I'm nearly done, I thought I'd post my tips.

Break it down

Use a trick

Sing it

Digital Flashcards

Birth Wars?

2009-08-05T10:07:00.000-06:00

This week there's a new Jennifer Block article out, examining the "homebirth debate". I wish it wasn't such a conflict, but many doctors and insurance companies seem stuck on the status quo, ignoring the fact that it isn't working. They continue to promote this idea that homebirths are unsafe when the statistics speak for themselves.

Thanks to Flickr user innocenteyez for this image / CC BY-ND 2.0

Homebirths are safe, midwives are experts in normal birth and hospitals are hurting women and babies by overusing technology, surgeries and drugs. It's not that these things aren't useful and good in their place, but 31% of women do not need major abdominal surgery to give birth, 50+% of labors do not need to be induced or augmented and 98% of births do not need to take place in the hospital.

These things don't need to happen.

Moms for Moses

2009-08-04T12:13:00.000-06:00

If you haven't read the story yet of Moses Goodrich and his many milk mothers, you should. What a wonderful example of a community supporting breastfeeding families under the most painful of situations.

How to Score an Apprenticeship

2009-08-03T08:13:00.000-06:00

This is the question most student midwives ask, worry and wonder about. How do I find someone to take me on as an apprentice?

So, here are my top 4 tips on how to score an awesome apprenticeship, or at least get your foot in the door.

Thanks to Flickr user pointnshoot for this image / CC BY 2.0

Bring food. I'm only half-kidding, here. Midwives are usually busy women, and it seems like very few carve out a lunch hour on their clinic days. But if you call and ask if you can bring her lunch (or even breakfast before her first appointment) and talk to her about apprenticeship, it's like she gets to kill two birds with one stone. Ask what she likes. Burgers? Sushi? Homemade soup? Bring it to her. And show how much you understand the midwife lifestyle by including a "if you have a birth, don't worry about it, we can reschedule." She'll appreciate it.
Emphasize the skills you have. This can be anything from having your NRP and CPR cert done already to a list of the workshops or classes you've completed, but focus on what you can do to help her. What do you know how to do? Even if you're a complete novice, have you answered phones in an office before? Are you bilingual? A whiz at filing? You're asking her to help you--show her how you can help her, too.
Be honest about the skills you don't have. She knows you're a student, that's the point of this all. If she asks if you have done something you haven't before, or don't even know what it is, cop to it right up front because you sure don't want to get caught later in a lie that could put you, her and a client in a bad situation. If you don't want to keep saying, "I don't know how to do that" tell her (truthfully) what experience you do have. "I've seen it done a couple times, but was never taught how to do it myself" or "I've read about that, and would love to learn how."
Ask good questions. Everybody likes to talk about themselves and what they're doing, PLUS asking thoughtful questions about the midwife and her practice shows her you a) care about what she thinks of things, b) are trying to see if you'd be a good fit for her practice and c) are the kind of student who thinks things out and asks good questions. If you think you'll get nervous, here are a couple questions to get you started:

"How did you get started midwifing?"
"What do you feel is the most important thing I can learn from my time with you?"
"When in labor do clients usually call you?"

That's what I've got. What's worked for you?

World Breastfeeding Week

2009-07-31T16:19:00.000-06:00

Augst 1-7 is World Breastfeeding Week and I'm celebrating all the mommas and babies today with a project I've been working on for school. Hope you enjoy!

Links to flickr users in the order they appear:
timtom.ch, jinglejammer, benklocek, khym54, haabet, best love poem, until we can do better, Bryce Edwards, hdptcar, jessicafm, -mrsraggle-, christyscherrer, babasteve, Joe Shlabotnik, ODHD, littleREDelf

Quotes taken from:

And the soundtrack is also a Creative Commons licensed piece
How Lucky I Am, mixed by Pitx

Midwives and Preterm Birth: There is a Difference!

2009-07-28T06:25:00.000-06:00

Well, I got so curious about yesterday's issue of premature birth in the US that I emailed Ken Johnson, the lead epidemiologist on the landmark BMJ study of planned homebirths attended by CPMs, and he let me know that they also noticed the difference, and although it wasn't included in the original study, they have published on the web their findings on lower prematurity rates among midwife clients. It's a pdf, easy to download and share! Their ongoing research can be found at: http://understandingbirthbetter.com.

The upshot is, yes, CPM clients have lower rates of preterm birth than similar populations in the general population (measured by the National Institute of Health): "the premature birth rate for the NIH non-Hispanic white births in hospital was 11.3%, more than double the rate for the women cared for by Certified Professional Midwives (CPMs)."

12.7% Prematurity: Are You Serious?

2009-07-27T11:42:00.000-06:00

Thanks to flickr user Scott & Justine fromWyo for this image CC BY 2.0

According to this week's Time magazine, 12.7% of live births in the United States are now premature. That's one in eight babies!

And of course preterm (before 37 weeks gestation) birth puts the preemie at risk for all kinds of complications their first year, and ultimately death.

Overall, the statistics say we're lagging behind the rest of the developed world in infant mortality (that's how many babies die in their first year of life). And why? No one seems to know, exactly.

But my real question is, can midwives help? Many of these women are high-risk before they even become pregnant, but simple, low-risk interventions like social and nutritional support are actually some of the most effective, it seems.

Can midwives make the difference in preventing preterm birth? How?