10 Rules for Avoiding Complications or Transfers During Labor:

It is human nature to immediately search for a solution when presented with a problem. Or, perhaps it is just the nature of birth workers and other people in proximity to a pregnant woman. I wish that I didn't have a list of examples of when women had their perfectly normal birth hijacked by well meaning people. Here is some food for thought. There are always exceptions, but don't assume that you are one of them. Also, keep in mind that you can do literally everything right and still have a complication. So, this list is not meant for you to feel guilty about. You can't change what already happened. It is a list of tips for prevention.

10 Rules for Avoiding Complications or Transfers During Labor:

1. Trust your provider, or find a new one. 

Don't think that you can choose the c-section king of the county and hire a good doula and all will be well.  It only will if you have your baby in the car on the way there. It is not too late to transfer most of the time. This goes for midwives too. Not every midwife is the right fit for every woman. If you don't trust your provider it is a big problem that could have affects on your ability to give birth and their ability to care safely for you. If you are supplementing your care, in routine situations, with another provider beware that this can cause a confusing "too many cooks in the kitchen" scenario. I see this in women who want midwife care but also want to see an OB "just in case". Why? If you aren't feeling safe with this provider and trust that she will consult as needed, just go with the OB.

2. Don't tell your family and friends what your actual due date is.

Avoid the unnecessary stress that having people breathing down your neck either in person, or through technology brings. It does affect you. My solution? Just give them a due month, or add a couple weeks. It is okay. They know not what they do.

3. Do not be tempted to put yourself into labor early. 

Just don't. It either won't work, or it will work enough to put you in a dysfunctional labor pattern that will tempt intervention. Be still and know that you will go into labor.

4. Do not let your (doula/herbalist/neighbor/online group) muck with your body. 

I know that people will not like this one. Too bad. Who are we kidding here? Intervention is intervention. If you don't trust your provider to give you good advice, find a new provider (see number #1). Herbs, oils, etc are INTERVENTION. Period. Intervention is fine when it is necessary, be sure that it is necessary. I have had alternative health providers cause transfers in completely healthy low-risk women by creating a complication. Don't let this be you.

5. Do not invite 50 people to your birth. 

This is not a party. This is physiology. It works best in the absence of pressure, in a dark, quiet, and safe place. There are absolutely exceptions. If you think can poop in front of all the people you can ignore this and invite away.

6. Don't keep things from your midwife or doctor.

If you ignored Rules #3 and #4, or "forgot" to disclose a bleeding disorder,  heart disease, etc, etc just admit it now. It's okay could keep you and your baby safe. While there are certain conditions that are incompatible at home,  know that midwives want you to have the birth that you desire. You would be surprised at how often we are able to find a way to work around risk factors to achieve a goal that accommodates your wishes and keeps you safe.

7. Don't expect your partner to be your coach. 

Be realistic. Most partners are going through their own stuff.  If they aren't up to it, ask someone else. There are partners out there who put doulas to shame but there are also some who need to be in a safe room until the baby is born. Know your person.

8. Don't have a coach. 

You don't need a coach, or even a method. You need to have things in place so that you can get out of your own way and have a baby. This is hard. "Coaching" implies things that do not help women labor. Most women do best with a quiet, supportive presence in a safe place. Explore this and come up with a plan that is best for your individual needs.

9. Be Realistic.

Understand that things happen, judgments are made, complications occur. It does not have to be your fault or the fault of anyone else. It is even okay if red flags where seen, changes were made, and it ended up being okay in the end. We cannot predict outcomes but we should always listen to warning signs. Sometimes everyone does their very best and it doesn't work out.

IF, someone really does you wrong send me their name and I will quietly "take care of it"

(wink, wink).

10. Don't over plan. 

Birth can be breathtaking. There are lots of pictures floating around with water, candles, and bikini tops. However, there are also lots of beautiful births that occur on toilets, floors, in closets, and doorways. There are beautiful births that occur in operating rooms after a stress-filled transfer from a planned homebirth. There are beautiful births that occur after a long, long labor, epidural, and everything medical in the world. I do not negate that some births can be traumatic but I notice that women are less traumatized when everyone was realistic, she had trust in her provider, and she and her partner felt part of the decision-making process (see #1).

Do not plan to give birth in water or any other place.  Don't worry too much about what positions you will be in, or what comfort measures you will use.

Prepare yourself. Be mindful.  Learn to relax your body. Learn to let go. Find a way to immerse yourself in nature. Don't push fears away, explore the things that trouble you during pregnancy. Clear the air. Have a back-up plan. Don't place pressure on yourself to 'make something happen' when you should be going along for the ride.

It will be beautiful and if, for some reason, it is not you will deal with that later. Finding your ability to trust this process that is bigger than you is the stuff that life is made of.

Allow the power of birth with all its mysteries and lessons to unfold.

I believe in you.

Yesterday, Today, and Tomorrow.

I am no Beyonce, but I know lemonade. In fact, I am in the process of whipping up a batch right now. It is still a little sour, but think about sitting down with me anyway. THIS is who I am right now. THIS is my life, and just because it isn't currently the stuff of a fairytale ending, it is no less valid. How often do we share the struggle that we are in rather than the one that we overcame? Indulge me. Let me do it. Forgive the self-centered, sad, and bitter place that I am in. It might be worth it. I am really good at oversharing. Let me do it while I am making lemonade and not drinking out of a paper bag in front of a check cashing store.

Today, I am a woman who has a mind flooded with questions. I am grappling with a sense of bewilderment over my circumstances. Today, I have no idea which one of the many ideas that I have will be the one that works. Today, I am living in an upside down world where the one thing that made sense for years and years is not what I am doing. Today, I am just sick of trying to rebuild..

I had a personal tragedy in January 2014. It is a story that I might not ever publicly tell and certainly not today. At the time, I had a thriving homebirth practice, my profession was not the problem, my personal life was. My profession was my safe place. I could have the whole world falling apart at home and rock a birth. I could feel like a failure as a mother and woman and feel like a good midwife. This tragedy rocked me off of my axis and instinctually, I knew that I had to leave that place to survive and rebuild a safe world for my kids. It wasn't neat and clean, it was messy and filled with regrets. It meant leaving things behind and maybe even creating problems for others. Yet, I had to.

Arizona. A birth center! A steady paycheck! Regular hours! The West beckoned me. It felt familiar; I was from there. I even had family there. From the time that I landed in the bright sunshine at Sky Harbor, to meeting all of the beautiful women who would become my clients and co-workers, it felt right. More than right, it felt like I had done something right to be given this opportunity and I didn't take it for granted for a second. I couldn't. As single mom, a CPM, and a woman walking away from everything that she had known for 17 years; I had to be on my game. There were minor rough patches. Overall, I thrived in a setting where I could put aside my own ego and be part of a team of midwives focused on good care. It was easy, because as a midwife, birth is never about me. It is about the women I serve. I happily worked extra hours and gave up time off. I spent hours on the phone talking over our clients on two hours of sleep. I loved it.

 A year later, I was inexplicably feeling tension, but I was determined to ride it out. I remember saying, "I love and need this job. I am not going anywhere." It wasn't about my work performance, it seemed personal, so I put my head down and showed up. I poured myself into the relationships with the clients and my co-workers, all of whom I adored. I made efforts with the people who didn't like me. It seemed to pass. I received a raise and a glowing yearly review without a single criticism. I thought I was okay. I planned to be there for years and years. Maybe even decades.

Another year passed and again, I found myself in the midst of a situation with tensions that I couldn't rationalize. I was determined to be part of a solution and to handle the issues that had come up respectfully and purposefully. As part of a team, I participated in carefully preparing what we hoped to be a fair and solution based proposal. However, before we could present it the sky fell in.

I was not a strong as I would like to relate to you. I remember quietly pleading, "Please don't do this." I remember being backed into the proverbial corner crying in front of people who did not seem to be sorry to see me go. You know how sometimes you cry when you really want to go all Jerry McGuire on people? Yeah, that was me. I was told that I was replaceable. I saw this perfect thing that we had crumble. Devastation isn't a good enough descriptor of how I felt.

 I had one month to get a job before my checking account was empty. Here is the thing about being a CPM in a state where you have only lived for 2 years while working 60-70 hours a week at a birth center: there is no job for you. I scrambled to start a practice. I had a website up and running in a matter of hours. I had glowing reviews from past clients. What I was missing was an income. I had started a business before. I knew that it would take a good year to be able to pay myself, but I didn't have that luxury.  I didn't have another income. I had a boyfriend and we had just started living together and sharing household expenses, but not a checking account. I worried that said boyfriend was going to run for the hills after the independent and gainfully employed woman he fell in love with turned into a jobless wreck.  I panicked because I was at the tail end of digging myself out of the debt that my divorce, business, and move had left me in; I had no savings. I had to get a job. Here is another thing about being a CPM: your credential doesn't translate in the work force. Outside of homebirth and birth centers, being a CPM is a tough sale. I took a position were I was told that, "maybe you could get a CNA" and was trained by a medical assistant on how to fold robes.

Don't get me wrong, I was grateful for the work and anyone who knows me knows that I will happily and without complaint, catch a baby, chart, suture, and then go clean the mama's toilet and start some laundry. I am not too good for folding robes. However, it was the fact that I had gone from a job where I specialized in complex decision making and now was only allowed to answer phones and perform other menial tasks. I had gone from being trusted with what mattered most to people to being trusted only with things like collecting the mail. Worse, I found out that the person whose position that I was supposed to be taking, was not leaving after all. Worse, that person seemed to be hell bent on making my life miserable.  Worse, I was moved to a corner in a file room isolated from the rest of the office because I had no place. Worse, I found out that I am too old to master in the art of handling mean girls. I was having babies and cleaning toilets when those girls were perfecting their skills. I don't know the secret handshake. I am the guy in the corner (literally) wondering when this will pass.

I tried pathetically to be proactive. I hung inspirational quotes in front of my computer monitor and looked at them to keep going. I took to finding little undone things that I could help people with to make their life easier. I showed up early. I cleaned shelves and organized things. I found solace in the patients, I understood them and they understood me and it was nice. Outside of work, I started classes  to get a nursing degree and give my future self the security that I was currently lacking. I fell into a rhythm and routine. I counted my blessings. I restored relationships with my kids. I let myself feel safe with my partner.

I thought that work would improve and I would have a job for years to come. It did not seem to improve. I started getting sick all the time. I was miserably exhausted and burning myself out trying to "make things better." I started to jump when people spoke to me and winced when I realized that this was going to be complaint number 3, 4, or 5 for that day. I had to take breaks from my desk to cry in the parking lot. Then, I arrived to work one day, still running a fever after being out from the flu for two days and was told that it wasn't "working out." And just like that, I was packing up my things in front of people who didn't seem to be sorry to see me go. Fired, for the first time in my life.

Yesterday, I wondered why a woman who had caught over 350 babies and was good at what she did was trying to drive for Uber. Yesterday, I lamented for the millionth time why I wasn't still working at the job I loved and was good at, the job I moved 2,500 miles to take. Yesterday, I felt guilty that the few close friends that I have are forced to listen to me struggle for six months straight. Yesterday, I got my unemployment debit card in the mail. Yesterday, I showed up for my class and took an exam and studied for finals. Yesterday, I looked at the face of my new granddaughter on my phone and knew that it would be awhile before I could afford to go see her. Yesterday, I had panic attacks and night sweats as I fought away the lies, the uncertainty, and the shame.

I am still a midwife, that will never change. I am grateful for the former clients who have found me and asked me to care for them during their pregnancies. I am grateful that, because of their trust in me,  I am able to hold on to what I know. I am able to focus on them and not me. I am working on things that will allow me to do what I am good at while continuing to work on having that security that I need. However, it is hard to build a business with no funding.  I have to wait for the word of mouth and the little opportunities. It is hard to ask a man, who is making sure that you have a roof over your head, for more. The business ideas are good. College, even the repetitive stuff, is good. Underneath this current pain, I am still me. I am the person who can build a business and can give excellent care. These hurts do not define me, even if they delay me.

Today, I wish I had a neat little explanation for what has transpired in my life, a nice little object lesson for my readers. Today, I am holding on to snatches of hope that come in the form of ideas for the future. Today, I am grateful that I have enough mental clarity to write this, even if it is a bit risky. Today, I am making lemonade. It is still a little sour, but don't let that stop you from coming over and sitting down with me. I am good at making lemonade. I will keep working on this batch until it is ready to pour over ice and sip on while sitting in the shade somewhere.

Tomorrow, I will wake up. Tomorrow, I will hike through the mountains and contemplate and find the good. Tomorrow, I will start again.