Knowing what you don't know...

It comes up all the time in conversations about homebirth midwifery. The "what-ifs". "What if you have a complication?" "What if you need to transfer". Sometimes the answers are quite simple, like "No, a cord around the neck isn't automatically an emergency...it happens a lot in normal birth." Sometimes it is this hard to explain phenomenon of knowing what you don't know.

When you are blessed enough to witness women giving birth normally and get exposed to all the normal variations which occur in birth, you become quite comfortable with normal. The vast majority of homebirth midwives do not hesitate for a second to transfer someone who develops an obviously serious complication or who do not quickly resolve with a complication that is troubling. There is no desire to try to treat what is a medical issue at home...because we are not medical practitioners. We know our limitations and concede that when birth becomes a medical issue that a hospital is the best place for a woman to be.

Sometimes, knowing what you don't know comes up in other less obvious ways. A midwife may have a client who has social, emotional, or physical issues that the midwife may have no ability to understand. We may do our best to try to find a way to relate to this woman, but we may find that the best way to support her is to empathize without knowing. It is okay not to know what to say. It is okay to say "teach me".

I had a great compliment from the mother of a client recently. She thanked me for sharing a less than flattering fact about myself. She said that when she met me she had automatically put me on a pedestal because I was a midwife. She assumed I had to be practically perfect (my own Mary Poppins version of her words). She said that because I was willing to share my imperfections I suddenly became more human but no less special. I am not afraid to be human to my clients. I am not afraid to admit when I don't know. I am also not afraid to be off the pedestal and back down to servant status where I belong.

I realize that I don't know a LOT. When I know everything it will be time for me to retire...I have heard this and I believe it to be true. So, I keep on plugging.

Islands in the Stream

I have been singing this song for weeks, every since I heard it playing in the bathroom at Cracker Barrel when I was there having breakfast with my kids. It is a magic combination of Kenny Rogers and Dolly Parton singing the lyrics of the Gibb brothers (Bee Gees). It was a favorite song of mine from childhood. I was 9 or 10 and it spoke to me. The truth is, it still does. Especially the part that says "No more will you cry, Baby I will hurt you never, we start and end as one, in love forever" Very simple, yet encompasses so much. I can't help but relate it to pregnancy. We know the the mother/baby bond is strong and lasts a lifetime. In a perfect world, we would all be like islands in the stream, man, woman, and little baby islands who eventually break off and make their own islands.

Sadly, it is not always that simplistic. We have broken units...partners split, parents who abuse. We have mental and physical illness. Sometimes many of us have become our own little islands, nobody sailing away with us to another world. Some of us are surrounded by islands and but feel that we have nobody to teether ourselves to.

Good news,  we have legs and can walk...we can leave our locations and move. It is never too late to change our circumstances. I sometimes have women call to hire me who are ready to give birth at any moment. They are listening to their inner voice telling them that the the lack of satisfaction they feel with their current plans for birth is more than just a whim. It is more than just desire for an experience. It is a need deep within them that they can't ignore. I love these brave women. They do what I didn't always do when I was pregnant. They listen to that voice and respond. Amazingly, they find doors open for them. Location is just location. We can survive a bad birth or a c-section. Sometimes it isn't even a bad experience, it is just wasn't "right".  Our desire for better than that is not selfish or petty. When we listen to the primal woman inside us, the one we were designed to be we aren't lying to ourselves anymore.

Women are very good at creating community. The birth community often amazes me. So many of us broke away and anchored our islands to another who would understand and support us and just "get it". It is so incredible to see women from all different backgrounds and belief systems share a commonality with each other. We can be hard on each other for sure. People who are brave enough to drag their islands upstream are not always mild mannered! Still, when you share that community you have to be amazed that in this crazy world such a thing exists.

As we create these communities, we find better examples of families too. Women who anchor their babies to themselves, breastfeeding, co-sleeping...questioning the the status quo. I see families being lifted and supported by other families...imperfectly, but supported nevertheless.

Sail away with me...to another world....and we rely on each other ah ha

Coping with Labor...What NOT to do

There are all sorts of ways to approach labor. All sorts of settings in which to have your baby. While I most definitely may feel that there are optimal ways to approach birth, I am the first one to understand that where you are in each pregnancy is part of your own individual life story. I personally have given birth 8 times, 2 with epidurals and one with narcotics 5 completely natural, 1 was a stillbirth, 1 at home, 4 with a birth plan in the hospital. 1 with a licensed midwife, 3 with CNM's, 2 with OB's, 1 with a perinatologist. I have had L&D nurses who were lovely and one who I still hold a grudge against today. I had large episiotomies twice and 6 without a cut or tear.

Guess what? This is the experience of a woman who later became a homebirth midwife! I would not be who I am without that varied experience. I am not judging your plan to need pain relief or that you decided half-way through that you can't do it naturally. I understand and get it.

Now for the truth...you don't need pain relief.

Your body was created with a master plan to support your through labor. YOU and your pain tolerance or lack thereof is capable of having an ecstatic birth. It is better for you, safer for your baby, and will support your mothering in the days following birth.

Read Sarah Buckley for the technical details. Her book Gentle Birth, Gentle Mothering is on my must read list for pregnant women.

How can you make sure that you set up an environment that will ensure a birth that you can cope with? Here are some tips:

• Don't become dependent on others, listen to your body's cues. If you feel like hanging upside down from a chin up bar in labor, GO FOR IT! (I hope someone does that while I am there)






• Listen to your body's cues (worth repeating)






• Eat a healthy diet, be in optimal shape. This reduces your risk for complications.






• Visit a chiropractor regularly during pregnancy, one who knows Webster is best






• Visit SpinningBabies.com and learn to be in tune with your baby's position. This is a neat thing to do while bonding with your baby and also helpful in preventing malpositions. This is not to say that a posterior baby should conjur up fear, it is just to say that babies generally like to come out in a certain way. Helping them with good body mechanics is a nice thing to do. The added benefit is that you will probably alliveate some of the aches and pains that surround pregnancy.






• Only invite people to your birth who are not afraid of birth and who fully support your decision to birth naturally. They should also be willing to leave the room when you need privacy. Party births only work for a handful of women. Birth in front of people who you would poop in front of.






• Hire a birth attendant who knows that YOU own your birth. Listen for cues like "we will let you" or "if you meet this requirement". Most women are very sensible about birth. They wouldn't put a baby or themselves in needless risk. This doesn't mean that you will agree about what is needless risk with your provider. They should have a level of respect for your beliefs. They may have reasonable requests, but it should be up for discussion if you feel differently.






• Make sure you have vocalized your wished before labor begins. Don't assume everyone understands.






• Don't allow others to place limitations or fear in your lap...even midwives or doctors.






• Ignore labor as long as you can. It is very tempting to get all excited over early labor. Call your midwife and check in, but try to go about your business. You don't want the pressure of people staring at you when it is still early. I like my clients to call when they need me, that means different things to different ladies. Don't wait to call because you are afraid of disturbing your midwife either. It is also okay to be wrong. Labor can be hard to judge, even for consumate professionals.






• Ignore the urge to push until it overtakes you. This will save you lots of energy. Nobody should be saying "your 10cm's; start pushing". It doesn't make your baby come faster and it may increase your risk of birth complications. Babies need time to rotate. When you feel as though you have no choice but to push because your body is already doing it, by all means go for it.






• Don't plan where you will give birth (e.g. in the water) that is NOT unhindered birth. Planning how your labor will go is a slippery slope. It leaves room for all kinds of dissapointment. Plan your postpartum babymoon instead. Plan for meals to come to the house, for helpers (family, postpartum doulas, friends) to clean and take care of your kids...that is much more helpful in the long run
  
  



• Don't idealize labor and birth...it is a very sexual, carnal, spiritual, and human process. It may not be camera worthy at all times...and that is perfectly okay. Have the candles, but don't be dissapointed if your baby is born on the staircase.



• Ease up on your partner. If male, he doesn't have a clue. I have seen some men support their wives as beautifully or better as any woman (some put me to shame)...but for the most part men are good rocks. They will stand by you and they will fix things. Not much to fix at birth, so be nice. They also generally don't want to read all the books and watch all the films. Be careful not to burn them out, wait until you have stumbled across gold before you ask them to read or watch. I love fathers at birth...but I feel it is unfair to ask a man to coach a woman in something that he really doesn't understand. I also really don't feel that anyone needs to coach a woman...so there you go.
  

So, to wrap up...YOU are expert in your own body. YOU are in charge at your birth. YOU will also be way to busy to police the actions of others, so don't invite those who you don't trust. Providers included. KNOW that you can do this. KNOW that you were created to do this. KNOW that any interference to the natural course of your labor will muck it up.

Can we overcome interventions and still have a good birth? YES! Can you bond with your baby if birth is not optimal? YES! That is another post...but come on. Lets shoot for the best and expect it. Best is not perfect. Just best.

The Baby Belongs to the Mother...

The other day, I held a baby. It was quite amazing. She was 6 months old and beautiful. She and her twin sister are crawling. Her mother was happy to let me hold her, in fact, she seemed to be relieved to have someone else hold her for a minute. As I held her, the thought occurred to me that despite being around mother's and babies quite a bit I rarely hold any for any longer than it takes to do a quick newborn exam or to take a picture. I love babies as much as the next gal, but I don't really believe that I have rights to babies. I love looking at them where they belong, in the arms of their mothers. Besides, I had my chance to hold seven of my babies all I wanted.

Among most midwives is the fundamental belief that to separate a mother and her newborn is to deny them the full benefits of maternal infant bonding. Even those pictures that I mention make me wince just a little...I love having that memory, but I don't want to send the message that the baby wasn't with its mother. In my work, I go to great lengths to avoid separation at all. In the first hours after birth I all but require that the baby stay with her mother. I don't cut the cord, don't do exams, don't suggest that Dad or Grandma hold the baby. The mother and baby require each other. At some point mom wants to get up and go to the bathroom or shower which presents the perfect opportunity to give baby to Dad. When she comes back, she wants to eat something...then the midwife can do the newborn exam (if desired). She can get a quick picture (better yet with mom and baby) and hand baby back off to mom who is done eating. It all works well and Mom is never without her baby for more than a brief period of time. She never has to ask for her baby back.

I have to confess that one little guy (currently on my facebook profile pic) made my heart skip a beat with his chubby little cheeks and sweet face. I held him just a hair longer than the other babies I have caught. I didn't mean to, I was tired and he was wonderful to look at. His mom didn't mind, but it goes to show that no matter how strong our convictions are, it can be easy to fall prey and forget why we are there...to help. The best help a mother can have is to have people around who can take care of everything while she holds her baby.

Just a midwife...

I often joke that my favorite births are the ones in which I am merely the head of the clean-up crew. It is better that way. I prefer that any day over the births where I have to use my "skills".

I like to do all of my talking in the prenatal period, that is when we should talk. We should ask questions and answer them, provide opportunities for education, support the woman and her family, and familiarize our self with her dreams and intuitions.

At birth, the talking should pretty much be to the minimum. Mom leads and baby guides. When we disrupt that process we risk complication. Hands off doesn't mean that we ignore warning signs or are complacent, it means that we understand that babies and mothers are better left to work their magic alone without the midwife interfering.

The best midwives are thrilled with how unnecessary they usually are to the actual birth process. The best birth stories are the ones who merely give a shout out to the midwife.

So, while yes I do rely on the clinical to help paint a picture and I search for opportunities to educate myself so that I am prepared for the times when I am needed, I strive to be more or less just a midwife. The gal in the background. A member of the clean-up crew.

What a homebirth midwife does

Because I am so used to being involved in providing homebirth care, sometimes it is hard for me to think back to the times when I really didn't understand a thing about what homebirth was about. I remember when I was pregnant with my daughter and preparing for my first homebirth that I thought I shouldn't bother my midwife if I was having preterm contractions! I went to the hospital instead and just told her about it at our next prenatal visit. I am sure she was exasperated with me, but I have clients do just the same sort of thing. So in order to clear up any confusion, I thought I would write a little post about it. Remember, I don't require much...this is what I offer.

Here is what I do as a homebirth midwife, your midwife may offer different services...

• complete prenatal care
  
• nutritional counseling
• a little massage, craniosacral work, and myofascial release
• well-woman care
• newborn exam
  
• provide emotional/physical/and informational support
  
• referrals to local resources
• proof of pregnancy letters
• Placenta encapsulation and prints
  
• sign and file birth certificates
• blood tests, paps, GBS, and newborn metabolic (PKU) testing
• Clean-up after the birth (for the most part) including the starting the laundry
• In-home postpartum visits
  
• good old-fashioned mama love

What I DON'T do:

• Ultrasound
• C-section
  
• Tell you what position to get in to push
• Count while your pushing
• Clean your windows or your car

Reasons why I love my fetoscope...

I have a love affair with my cheapo fetoscope here's why:

1. It is cheap enough to send home with a mom
   
2. The tubing is long enough to reach a mom's ears so she can have a listen
3. It is just the baby instead of a reproduction
4. There is no exposure to ultrasound
5. Everything in the room slows down for just a minute while we focus
6. It doesn't make a bit of noise
   
7. It helps me to confirm a baby's position
8. I feel more connected to the baby
9. I like kickin' it old school