Breech babies

Canada is doing a reversal on their cesarean-only protocols for breech babies.  Check out Rixa’s blog for more information on the policies and protocols.

Gloria Lemay has a great entry on her blog about hospital breech births. It’s true that breeches managed within a hospital setting are forceful and anything but natural / normal.  There’s usually a lot of manipulation, use of forceps and force to “deliver” these breech ones.  I think it’s fair to say that it’s not always a more gentle or safe option for those not wanting a cesarean. However, seeing a breech baby born by cesarean often involves vacuum or forceps and force as well.

Having attended a number of breech vaginal births, and having seen two babies not survive the experience, there is good reason to be fully informed about breech vaginal birth.  Baby’s position, mom’s position, the provider’s ability to allow baby to rotate and be born without force, and time for second stage are all huge factors that result in a safe birth.  I’m not going to parade around saying that breech birth is always safest when born vaginally or that there aren’t increased risks with breech vaginal births.  We see all the pretty pictures of successful births - nobody wants to talk about the complicated or agonizing outcomes. I believe that providers MUST know how to deal with breech presentations, what the risks are and how to know when to intervene.

I fundamentally believe that most breech vaginal birth is safe - but the risks have to be explicitly laid out.  We cannot assume that ALL breeches are safe at home, or that all women are good candidates for breech.  It’s best when we have knowledge of the breech presentation before the birth and couples can make informed choices based on evidence, provider’s skill level and experience, and their intuition.

I would NEVER belittle a woman for choosing a cesarean for her breech baby’s birth.  However, women aren’t currently being offered any choice or options in most situations.

Weighty issue

Many myths and judgements are thrown around regarding women of size and pregnancy/birth.  I’m so grateful to have in my area of the world a resource that is immediate to debunk misinformation on the topic:  http://plus-size-pregnancy.org/

Have you seen her blog?  It’s extremely informative and blissfully comprehensive regarding weight issues in the childbearing year.  (She also has great resources and information on VBACs…a concern especially for women-of-size because of fatphobia.)

I love, love, love this series she wrote on how waterbirth benefits women of size - despite women being told that they “can’t” have a waterbirth because of their weight.

Thanks for all you do, Well-Rounded Mama.  I adore you and appreciate all the work you do.

Segue to….

Pregorexia:  women who starve themselves or severely limit their food intake so as to not gain weight.

The Cochrane Database

The Cochrane.org online reference for pregnancy and childbirth-related issues (including breastfeeding).

 Childbirth Connection offers a thorough look at common practices and the evidence to support or dissuade use. 

Want to understand research and studies better?  You should know that a randomized-controlled trial is viewed as one of the best research tools available today.  This book will help the public understand what a study is saying (because we are vulnerable to just taking the summaries of studies and using one-liners to describe or report them, never looking at the whole study or who funded the study, which could be a source of bias) and allow you to comprehend results in an intelligent manner.

It’s easy to mis-use statistics and research using unfamiliar jargon and statistician-speak.  Most of the general public are not educated about statistics and the phrases that are used so it’s not too difficult to twist numbers and summaries.  (I can think of at least one infamous online blogger that does this on a regular basis in regards to the safety of out-of-hospital birth.)

The Brewer Diet

I’ve written about the confusion between gestational hypertension and pre-eclampsia before, but one thing that really stumps me is how we as midwives can keep touting the prevention of pre-eclampsia through The Brewer Diet.

The Brewer Diet is not, contrary to popular belief, evidence-based in regards to preventing pre-eclampsia.  Dr. Brewer’s “evidence” isn’t scientifically valid.   At the time that he recommended this diet to women, pregnant patients were still starving themselves (or taking diet medications) to avoid putting on “too much” weight.  Many women were smoking during pregnancy and more often they were not eating balanced meals.  One positive thing that Dr. Brewer brought to women was the idea that a well-balanced choice of foods (including fats) increased their health throughout the duration of the pregnancy.

Better health, however, does not necessarily mean a large reduction in pre-eclampsia.  This idea that if we just get women to consume 80 to 100 grams of protein a day (a feat that I would consider relatively difficult for many women, especially those vegetarians) they will have fewer complications is interesting to me.   One of the scariest maladies in pregnancy is pre-eclampsia.  As a midwife, it would be something that I view in a very, very serious light - next to shoulder dystocia, it’s one thing that really scares the pants off physicians, too.   If the solution to eliminating pre-eclampsia was as easy as increased protein in pregnancy we’d have it made and more women and babies would be alive today.

The Cochrane Database is without a doubt the one source of information that I wholeheartedly trust for evidence-based research.  Their pregnancy and childbirth database is extensive and should be referred to by those involved in women’s healthcare. Here is their summary about the benefits of increased protein intake in pregnancy

In a textbook specifically targeting triplet pregnancies, an excerpt about increased protein intake in pregnancy is discussed.  Of course, when dealing with multiple pregnancies we know that these women require a larger caloric intake.  Protein will naturally (hopefully) be a part of that.

Until we really understand what harm we might be doing with these very high protein diets, I think it’s wise to discuss protein in pregnancy, but to focus more on making it part of every meal or mid-meal snack and not on increasing a specific count of protein grams.This all goes back to the idea that until we know that something is beneficial in pregnancy, we need to examine why we do it or why we recommend it.  The thought that we should just do something because it’s what is normally done or that it “couldn’t hurt” is not a good rule to practice by (like bulb syringes, urine dips, etc).  We are constantly discovering courses of action and treatments that may actually be harmful for women and their babies (like the oversupplementation of iron in pregnancy) that we keep recommending.  Looking at the evidence and research is key for dealing with health-related issues.  As a provider, I would be woefully negligent to ignore such research and continue recommending things that have, at best, anecdotal promises.

Further discussion on the role of anemia in pregnancy and how lab values alone are creating a mass overuse of iron to the possible detriment of pregnancy outcomes is found in this post.  I’m interested to hear what other people have to think about these topics.    

Birth video

Sometimes I hesitate to post birth videos that are so romantic and calm and quiet and what we all deem to be “perfect with the woman in control”; simply because few women actually birth this way and it creates a feeling sometimes of “why can’t I birth like that?  there must be something wrong with me!”.  However, I wanted to post this birth video for the simple fact that the midwife in attendance is so respectful of this couple’s privacy, their need for quiet and calm, and a gentle entrance for their baby.

It’s very inspiring. 

Coastal birthing

This weekend a sweet little girl was born into her mother’s hands after a quick two hour active labor.  I was privileged to attend this birth and wanted to share it with you (with mom’s permission, of course).

 Check out the blog post announcing the arrival- at the end of the post you’ll find a tender video montage featuring the birth.

I was fortunate to witness a birth Friday, this one Saturday and then another one this morning.  Today’s birth was that of a first-time mom that pushed through most contractions in active labor.  The bearing down helped her with the pain (and sometimes it was involuntary), she said, and it definitely didn’t stop her from progressing or result in a swollen cervix.  

How fascinating to me is the body’s ability to do what it needs to do to birth babies safely.  I was - and am - deeply impressed. 

Unattended Birth Resources

A student midwife contacted me recently asking for more information about unattended birth and midwifery.  Specifically, she had questions about how a midwife would protect herself legally when working with a family that desired an unattended birth.

Care providers are always at risk for legal action.  No matter how many informed choice documents your clients sign, no matter how defensively you chart.  With that preface, here’s what I would offer someone interested in midwifery and unattended birth:

First, I suggest that midwives be exposed to as many unattended birth resources as possible.  I learned a great deal from my formal school education and apprenticeship but my most valuable insights into birth came from families who have had unattended births.  I cannot tell you the resistance and eventual sighs of relief that came over me when presented with information, beliefs and physiological evidence that proved contrary to what I had originally been taught or believed.  I am grateful for the women who patiently (and sometimes, not so kindly) gave me an education that was priceless.

My dear friend Linda offered the most gentle persuasion and discussion on the topic of normal, physiological, unhindered birth.  Her stance was not always about unattended, but it was clear to me that many of the minute hormonal balances during labor and birth were best served in an environment that was free from observation and judgment.  She was the first person to use the phrase “autonomous birth” on a regular basis (though Laura Shanley used it in her book, see below) - and these two words perfectly describe the type of birth that I feel is the safest and most normal.   Linda had a great blog (aptly titled “Autonomous Birth”) but has taken it down.  She’s working on a book (aren’t we all?) and I eagerly look forward to her wise words and thoughts in one collection.

Rixa is an amazing writer who happened to recently obtain her doctorate (yay Rixa!), with her dissertation on unattended birth.  Her blog is thought-provoking, well-written and extremely informative.

 Laura Shanley is, quite possibly, the mother of the unattended birth movement.   With her book, Unassisted Childbirth, the term to describe the DIY birth was born.  When Laura wrote the book back in 1994 there were people having unattended births but certainly there was no open, public discussion about it (remember, the internet was still a wee baby at that point, many of us not having access to it the way we do now - and certainly there were few online resources for this type of dialogue).  Her website is full of information, stories, and amazing photographs of women.   All midwives should read these stories and learn why women choose this option of birthing.

Mothering.com has a great discussion forum - informative and comprehensive (if not, at times, overwhelming in content), including a great section specifically for unattended birth

Doing a search for “unassisted birth“, “unattended birth“, “freebirth“, “autonomous birth” turns up some great reads, both supportive and critical.

(Certainly, as midwives, we will see some erroneous information on the internet pertaining to advice, medical tests, procedures or the physiology of birth - the point isn’t necessarily that these women should know everything a midwife knows.  The point is that these women are truly assuming full responsibility for the outcome of their pregnancies and births.)

Books that have greatly influenced my views on unhindered, normal birth include:

Any book by Michel Odent.  

I remember in midwifery school one article by Odent really got me and my fellow student’s blood boiling.  What is interesting is at the time I was appalled that he could suggest a man (husband/partner) at birth might be obstructive or not helpful.  This was contrary to the types of homebirths that midwives were involved in - of course the father wanted to be there, of course the mother wanted him there.  Now, I view his writing on the subject in a much more realistic sense (the way it was intended) and know that he isn’t saying that men shouldn’t be at birth - he’s merely pointing out that the general mindset of most men and how they approach problems in life are often at odds with normal labor needs and processes. 

 

All of his books are necessary and important for student midwives and midwives to read.  He does have a tendency to have repetitive information in each of his books, but how could you not when there is so much that aligns various birth issues?  The Scientification of Love is one of my favorites. 

Sarah Buckley’s Gentle Birth, Gentle Mothering.  Finally available through Amazon.com, Sarah explores the delicate balance of hormones necessary for a smooth, safe birth.  I cannot say enough good things about this book.  While some people may not “get” the information on lotus birth and elimination communication, what she has to say about pregnancy, labor and birth is vital to our survival as conscious, aware beings.

The Power of Pleasurable Childbirth by Laurie Morgan.   Laurie Morgan was really my first not-so-gentle kick in the butt towards understanding and listening to unattended birth families.

Unassisted Homebirth: An Act of Love by Lynn Griesemer.  This is a great book that focuses on why some families choose to forgo a midwife or attendant for their births.  

 (I feel that no look at unhindered birth is complete without examining our common practices as midwives and evaluating current evidence and research.  Things like checking for a nuchal cord, suctioning babies, putting hats on babies immediately, doing vaginal exams, performing urine dips at every prenatal visit are all challenged by various research and physiological evidence.)

It is my belief that there should be a safe, intermediate option for families choosing an unattended birth and my skills and resources as a midwife could provide that.  It saddens me to hear of families transporting to the hospital for something that is minor and likely could have been helped with a call or visit from a willing midwife (meconium in the fluid, the feelings that transition brings, bleeding after birth).  Once in the hospital, a woman without any prenatal care that was laboring at home without an attendant or - heaven forbid! - birthed at home alone will not be treated well.  This belief system brings me to support - in theory and practice - families who desire an unattended birth.

I have a specific contract with those families that lays out my fees (per visit, prenatal or postpartum), being on-call for questions/support for the duration of the pregnancy and postpartum and additional fees for coming to the birth.  I was careful in creating this contract not to encourage those looking for a low-cost birth option towards an unattended birth but to provide a service for families to ensure that they have options locally.  I also include in my contract that I, as a midwife, have the right to suggest transport via phone and refuse to come should I deem the situation too risky for my attendance or needing more urgent medical attention. 

A midwife cannot just create such a contract and have that be her source of support for unattended birth families.  The midwife really needs to believe that unattended birth is a valid and necessary choice for some women.  She has to be able to feel comfortable sitting in another room while a woman is birthing her baby in privacy.  She has to be able to honor a woman’s desire for no fetal heart tone monitoring during labor.  It takes a process and journey to get to this point (and I’m willing to admit I am still on this journey, but I do feel fine attending women how they desire).  If a midwife is not completely comfortable with the idea of unattended birth, she should be willing to admit what her limitations are and not overestimate her comfort level.  To do so will mislead the parents and likely cause conflict should certain situations arise.

These births are not my births.  I definitely have certain choices, plans and options I would want if I was birthing a baby.  My clients are not asking for what I would want for my baby.  This is their baby.  This is their birth.  They have the right to ask for the care that they feel is necessary and no more.  They are in charge of the process and decision making.  I am in charge of my own boundaries as a professional.  Honesty is key in all instances not only from the midwife but also from the birthing family - this creates an atmosphere of trust and respect, important for normal birth. 

Given full information and options, I trust that parents have a stronger desire for a safe outcome of this process than I do.  They love their baby and want their baby.  It is rare and unusual the mother that claims the experience of birth is more important than the outcome and health of them or their baby.

I make myself available because I believe in CHOICE.  I am firmly pro-choice in reproductive health, including childbirth.  I do not think that my role at a birth always makes the birth safer - and recognize that my attendance at some labors/births could actually impede the normal process.

I’d love to hear from students or practicing  midwives about how they view unattended birth and the role of the community midwife in response to the growing trend of this practice.  I also would love to discuss how the internet has made unattended birth more public, and if certain situations, internet communities or beliefs create competitiveness within this population that may not be safe. 

 (Please note:  I use the term “unattended birth” to describe a birth without any care provider in attendance.  I have been to “unassisted births” in which the mother gives birth on her own, in her own way, without any help from me or my assistant.  I see both of these terms as separate from each other, even though the most accepted term for an unattended birth is unassisted.) 

Sarah Buckley teleseminar

Rixa posted information on a teleseminar featuring Sarah Buckley, MD, author of Gentle Birth, Gentle Mothering.  I’m excited to “attend”!

Dr. Buckley has greatly influenced the way I attend births as a midwife - and restored my pride in the beautiful design of our bodies. 

The Millbank Report: Evidence for the Modern Maternity sCare

Has anyone read Childbirth Connection?  They’re a fabulous organization that is focused on evidence-based research as it relates to childbearing.  It’s a necessary resource for any birthworker, but proves powerful for consumers of modern maternity care.

A wonderful new midwife in my community sent me the link to Childbirth Connection’s Millbank Report - a report entitled “Evidence Based Maternity Care: What It Is and What It Can Achieve” (link opens to pdf).

Please download this important  work, read it, share it with as many women and birthworkers as you can.  It’s become obvious that the current standard of care for pregnant women and babies in the US is not yielding safe results.

What is stopping providers from practicing evidence-based care?   How can consumers change this?  How do providers turn their practices around?

What a Lovely Name

Came across this awesome baby name generator - for those parents who are struggling with what to call your little bundle of joy.

 

(I was disappointed only by the fact that I couldn’t choose three of my favorite tags - intelligent, independent and funny - at once.  The system said I had too many tags at once and not enough names that fit them all.  Who knew?  I thought for sure “Pamela” would be there!)

Important information on umbilical cords

I’ve written on umbilical cord issues before, but it’s nice to have more information on this topic for parents and providers.  I hear stories all the time of babies that were “strangled” by their umbilical cords and by deaths that were attributed only to nuchal cords (cords around the neck).

It’s important to remember a few things about umbilical cords around the neck:

  • Intrauterine babies do not breathe.  Having something around their neck is very different from us having something around our neck.  We forget that intrauterine beings have a very different physiological process than we extra-uterine beings do.
  • Umbilical cords, when moms are healthy, are strong, super-durable and very, very resilient (the article below describes, in fabulous detail, all the protective mechanisms built-in to protect our babies)
  • Cords that are around a baby’s neck rarely cause an issue - the uterus and placenta (and therefore the cord insertion site) follow the baby down the birth canal.  It’s not like the baby is bungee-jumping to be born.  Many times with a short, tight cord labor is not typical (usually contractions are spaced farther apart than you’d expect, but are strong enough to dilate the cervix) and has no complications aside from variable decelerations in the heart rate which are typically not an issue.
  • There is no need to remove a cord from around a baby’s neck before the body is born.
    • If the cord is tight, holding the head close to the moms body and allowing the baby to “somersault out” is helpful.  Cutting the cord before the body arrives effectively “suffocates” a baby and makes them more likely to have a difficult transition.
    • Removing - or even checking for - nuchal cords with the birth of the head is often painful for the mother and unnecessary.  Unwrapping baby after the birth of the body is easy to do.
  • Cords around the neck prevent cord prolapse (when the cord slips in front of, or alongside, the baby’s head before birth)
  • Babies who are more active have longer umbilical cords. The stretching of the cord accommodates those busy little babies - and there are bound to be some wraps from these active ones.

Hopefully this information, from a perinatal pathology website, will offer some new insight about umbilical cords and their design for those interested.

I’m fascinated and so impressed by the creation, design and function of both the placenta and the umbilical cord.

(pictures above are not from my own practice, just found online. I’ve seen numerous true knots in cords, one cord with TWO true knots and endless cord wraps of various types including a five time nuchal cord wrap!)

I’m still here. Really.

Things have been a bit crazy over the past couple weeks, had two more births to first-time moms, one cesarean after five hours of pushing, one baby born at home into her father’s hands.

The two births were days apart.  I must say that they were vastly different in so many ways, not just the place of birth.  I am always crushed when we transport - and when there is a cesarean after trying so hard at home.  Still, in the end, I firmly believe that my heart lies in the outcome:  healthy mom, healthy baby.   If things go well and baby is born at home, it’s icing on the cake.

Homebirth is not the goal.

As it is with becoming a midwife.  Sometimes we can be so focused on the end result (to be a practicing midwife) that we lose sight of the journey to becoming that midwife.  The journey, just like labor, can be long, hard, filled with unexpected pain and joy, empowering and full of personal growth.  When we forget to honor the journey we arrive at the goal completely blind to who we are, how we interact with others, and full of arrogant ego that hurts us over and over.

The process to birthing a baby, whether at home naturally, in the hospital with medications, or by cesarean, is important.  What is even more important is that women feel empowered through information and individual decision making during this journey.  That they are given the freedom and resources to make CHOICES about their care, and that of their babies.  That their decisions and wishes are honored and those who attend them work hard to make the experience one that is woman and family-centered rather than routine and clinical.

The same applies to the path of midwifery.  There are bumps in the road to becoming a midwife, for sure.  It’s hard to open yourself up and believe that if you let go of our idea of “control” things often flow so much more smoothly than when we hold onto the reigns so tightly. It’s just like labor.  Letting go of the “goal” of natural/home birth is necessary to receive all the gifts that the journey has to offer.  Many times the end result (just like with a transport) is not what we had originally intended, but the process by which we got there helps us with the change in plans.

Birth and life journeys have little we can control.  The more we recognize that it’s the path, not the goal, that offers us benefits, the easier life is.

~*~*~*~*~*~

Edited to add:  I am seeking a new apprentice.  For many reasons, mainly my lack of preparation, interviewing process and communication around it, I lost my apprentice.  I’m taking awhile looking for this new one and appreciate feedback if you or anyone you know is interested.  Feel free to email me at pamela.midwife at gmail dot com

third baby syndrome

Those within the birth community often speak of the “third baby syndrome” (another link to discussion about it found here).   Women who are pregnant with their third baby have two previous experiences that they draw comparisons from.  In fact, women expect that this third pregnancy will mirror at least one of the other two.

It’s not really the case.

First off, I cannot tell you the number of third time moms that are convinced that they are having twins because the early expansion of their belly is so great compared to previous pregnancies.  It’s a common theory, really, among women pregnant with their third.

Then there’s the train of thought regarding labor and birth…that there are these two other experiences and, even if those were different, we have a need to expect this labor/birth to resemble one of those.

It’s natural, of course, to think these things.  And I would never tell a woman that she was wrong or that her intuition is off simply because it’s her third pregnancy.  I just think there is something magically surprising about the third pregnancy/labor/birth/baby.  It often catches us by surprise.

I attended the swift, sweet homebirth of a third baby yesterday.  I have attended the previous two births at home and always find attending births with siblings that I’ve seen born so special.   The first and the second births, while relatively normal and uncomplicated, were anything but easy for this  mom.  She was hesitant about believing this next birth could be different in a very positive way.  Still, she was open.

She started labor at around 1am and by 6am she was holding her sweet 7lb baby boy in her arms.  Labor was very different for her -  more manageable and active until the last couple contractions as he was born in the caul (in his bag of water).

Anyway, we all have the possibility to experience a different pregnancy, different labor and different birth with each baby (and each baby is different so why wouldn’t this change?).  I think being open to the specific journey that a baby will bring is so important.  Still, like most humans do, it’s hard not to compare experiences either with ourselves or with another person.

hands on birth

a beautiful, sweet baby boy was born at 9.50 last night, with his right hand presenting up above his ear - waving his hello as he came into this world.

the first-time mother had so much support from all her female family members.  so many loving, warm hands on this mother.  this birth was one of those that was a group effort from all involved.  it was lovely to witness.  the strength of these women, including the grandmother who had birthed at home and her sister who is pregnant and also planning a homebirth.

we did end up transporting because of a third degree tear, compliments of baby’s eager greeting.  supportive doc met us at the hospital, did a beautiful job repairing her and now I trust she is at home snuggling with her baby boy in bed.

seeing second-generation homebirthers is so affirming.

University Presentation

For the third (or fourth?) year in a row I’ve been asked to do a presentation at a local private university on the homebirth side of birth rituals in the US.   It’s specifically for a class that looks at comparisons between Japanese and US traditions regarding birth, marriage and death.

I created a video montage for the presentation last year and I will use it again tomorrow.

A few years ago I did a presentation that was similar for a medical anthropology class. These presentations are always interesting and good experience for further conference presentations.

baby boy

A sweet baby boy, 8lbs 4oz, was born just past midnight this morning in the water.  It was her third baby, her second homebirth.   I’m so excited to see those older siblings (who slept right through the birth, like many kids do!) with this new babe!

Transitions

So much is going on, I can barely form sentences that will allow readable segues.  For ease of understanding, I shall employ my favorite structure (bullet listing!):

  • My ‘old apprentice’ put in her application for her state license yesterday.  She passed her NARM exam a couple months ago (I knew she would!).  She is doing what every new midwife does:  setting up her supplies and marketing materials for her practice.  I’m so happy for her.  Genuinely thrilled - and pleased that there is a strong supporter of unhindered birth in my community that can help take call when I need some self-nurturing.
  • I miss her a great deal, too.  Not too long after our last birth together she went out of the country on vacation.  I didn’t see her much at all until recently.  It was hard seeing her for the first time since that last birth and last real contact.  I got emotional and cried.  I miss her so much.  I’m grateful she lives close by, but there is something about working together that keeps you in each others lives in a way that never has to be worked at.  I’m committed to working at our relationship and maintaining it.  She means so much to me.
  •  My ‘new apprentice’ has started with me and is full of enthusiasm and excitement.  This makes me even more grateful for my time off because I need the outlook, focus and energy to move her into my practice.  I am excited about her meeting all of our families. There is such a gift with apprentices - not only do they learn but we, as preceptors, learn so much from them.
  • I’m still deeply indebted to my first apprentice that endured a rough apprenticeship experience with me because of my inability to recognize my limitations and lack of communication skills.  I appreciate what she gave to me and am grateful for what she sacrificed for our families.
  • I’m interested in using this new pump to empty some water in birth pools to add more hot water.  I have a huge submersible pump that I bring to births to empty the pool after the birth, but due to cross-contamination issues I cannot use this pump to empty some water to heat the pool back up again during a labor.  This small, inexpensive item seems to be just what we need to remove some water from the pool to add more hot water.  Experiences?
  • I’m getting addicted to quackwatch.com - it’s hard being a homebirth midwife and not really believing in aromatherapy (it’s healing properties, not emotional effects) or flower essences, crystals, reiki, etc.  I will say that I am a firm believer in acupuncture, most chiropractic and homeopathy.  Talking with my apprentice today I realize that there are quite a few things that I’m just not sold on that is presented as solid treatment within the alternative healthcare professions.   Ah, well, we all have our things.
  • I’m still in love.  Very much so.  He is kicking my butt to get me to write more.  He is supportive and encouraging of my practice.  His kids are amazing.  My daughter loves him (and so do my ex’s girls!) and his kids.
  • I’m knitting now that it’s getting cooler.  The weather is cloudier, raining more often and the temps are well below 70′.  I’ve been knitting hats like mad and my apprentice would like me to teach her.  So I will likely be knitting some baby hats at births again.
  • I’m interested to hear from midwives or doulas about how they market their practice.  Where do most of your new clients come from?
  • I’m back on LiveJournal and loving that.  I don’t discuss my midwifery life there - just my juicy personal stuff.  Are you on LJ?
  • TV played a big role in my downtime last month.  I am devoted to:  Mad Men, Weeds, Dexter (new season starting soon!!!), Shear Genius, Project Runway, Top Design and America’s Next Top Model (though the ANTM seasons are getting sillier and sillier).
  • I am blessed to maintain contact with my former clients…or blessed that they maintain contact with me.  If you’re one of them, please keep sending those emails and pictures!  It’s so appreciated!

Baby girl

It was their fourth girl, I was honored to have been the midwife at all the births.

While her mom was working hard, the 5 year old and I looked through old photo albums - viewing her birth and her older sister’s birth pictures.  Then, while mom was squatting to push, she sat and held my hand or held my arm as we watched at her mom’s feet.

As a midwife, when I arrive to a home of a family that I’ve known for so long it feels so awesome.  The 5 year old was awake as I came through the door this morning, exclaiming, “Oh! It’s PAMELAAAA!” while greeting me with a huge hug.

So many kids I see, born at home, growing older and witnessing the births of their younger siblings.  Such affirmation of how normal birth is, how it’s not “scary” and how we can do it if people support us and believe in us.  Seeds of trust are planted in these girls right now and they will continue to blossom until they birth their own babies.

At a birth…

Didn’t make it through the *entire* month of September without a birth.

Waiting on a baby, fourth homebirth, fourth baby for this family that I’ve been at.  Just hanging out, thinking about pulling out my embroidery while mom takes solace in the shower.

I have so much to write about but lately have lacked the motivation.  I’ve had such a great time sleeping in, going to bed late, spending time with friends and watching trash TV.  It’s been great to be off call for births and now I’m refreshed and ready to get back into this incredible life!  (Due to some serious financial issues I wasn’t able to get away for my time off, but this weekend I am spending some time on a friend’s boat…with cell phone coverage.)

Can I just add how fortunate I am to have a boyfriend that respects and loves what I do?  He is remarkable and amazing - and I deserve every bit of goodness he brings!

The Other Side of the Glass - Important Messages for Fathers…and the rest of us.

Please pass this on:

This video is geared towards fathers, has many father’s experiences, but it is a vital message for us all.

It is so very important. We will not change this world without changing how we treat babies at the moment of birth.

Please, hands off those babies that are making the transition well. Give them time. No towels, no hats, no suctioning.

Let them emerge.  Guard the sacredness of the immediate postpartum period by not touching, handling or talking to the mother or baby unless absolutely necessary.

(If you are a birthworker in any way - doula, childbirth educator, midwife, nurse, physician - and you have not yet taken Karen Strange’s Neonatal Resuscitation course PLEASE DO SO AS SOON AS POSSIBLE.  We need to stand united for the baby’s experience at birth.  I challenge all midwives to remove bulb syringes from their birth kits!)