Births that make me smile...

There are some births I have that I can’t help smiling throughout the entire labor. I had one of those births the other night. The mother came in with her second baby already in what I call fast and furious labor. She had a birth plan, requesting an unmedicated, non-intervention birth with skin to skin contact immediately after birth, delayed cord clamping, basically what as midwives we do anyway whenever possible. 

What I loved about her birth was that she was CLEAR about her needs. She verbalized, sometimes vehemently to her husband, her mother, the nurse, and me what she needed. She was not apologetic or polite. It was awesome!  When her mother kept talking, she asked her clearly to please stop talking. She and her husband were working through each contraction with a system that worked for them as a couple. He would say, relax your belly, relax your chest, relax your back, and she would breathe deeply and focus. At one point when he strayed from her side, she told him clearly I need you here. While these points of reference would not work for most women, it worked for her. Then when the nurse kept talking about IV placement, she told her, "I don’t care! Just do it."   I know from years of experience that when a women is clear about her needs, sometimes impolite that she will birth her baby. It makes me smile to myself and congratulate her in my mind.

When it came time to push, she loudly welcomed her baby into the world. Some people would call it screaming but I just thought to myself, "Yes, go for it!"  When someone is letting their air out through moaning and yelling I know it works because they are allowing the baby’s head to be born slowly. You can’t push as hard when you are letting all your air out through vocalizing.

After the birth she apologized to me for screaming and I told her, "No, you did great! That’s what I wanted."  We usually try to have women blow as the head is being born to minimize or prevent tearing, but yelling also works. No one said birth should be quiet! You are welcoming a new soul into this world. Celebrate it any way that works for you!

It was a beautiful birth, this mother embodied everything I know about childbirth. She was unrestricted and unencumbered and welcomed  her daughter with everything she had. 

With love,

Karen

What Does it Mean to be a Midwife in 2018?

What is a Midwife in 2018?

I am always saddened to discover that in 2018 many people do not know or understand what a midwife is or does! The term itself mid….wife means with…women.  I became a midwife over 30 years ago because I wanted to make a difference for women wherever they chose to birth their baby. At that time I was working at a large urban hospital with residents, obstetricians, and one midwife. The difference between the births that the midwife did and everyone else was so moving to me that I chose to follow her path.  Much has changed in the past three decades, but the principals of midwifery have not. Our commitment to support the mother and family unit, to encourage a woman to trust her own instincts and birth in whatever position/location that feels right for her while being surrounded by the people important to her has not. 

Today, there are over 12,000 women and a few men who are midwives in the United States. Certified Nurse Midwives (CNMs) are the most common type, but there are also Certified Midwives (CMs).  Both CNM’s and CM’s have graduate level midwifery degrees, have passed a national certification exam, and can prescribe medications and treatments. About 95% of the births done by midwives occur in hospitals, but another 5% safely birth at home or in birth centers.

Although midwives are best known for their role in pregnancy and birth, we also provide care for women from puberty through menopause. This can include routine gynecological care, birth control,  and  yearly visits after menopause.  Many women become so attached to their midwife that they follow the same person through all the stages of their life. I always say that once you see a midwife you will  be sold on the difference in your care.

Often I am asked to explain what the difference in birthing with a midwife vs a doctor might  be. Many people think it means they cannot have an epidural or drugs, which is not the case.  During pregnancy, my goal is to assist the mother in feeling healthy on all levels, physically, emotionally, mentally, and spiritually. There is so much more to birth than just the size of the baby and the mother’s pelvis. A woman's emotions, needs, past experiences, etc. are all major players in the birth process. I seek to educate her about her body, nutrition, exercise, and to understand her desires for the birth. I am there to support her in birthing in whatever way she feels is right for her. It is her birth, and I while I cannot control the course of labor, I can control that she feel supported during the process.  I believe that the only way to manage labor is to be present with the woman during the entire process. Pushing with a midwife can be different in that we encourage you to push in any position that works for you. We limit interventions to necessary medical problems, and rarely will cut an episiotomy.

Although most birth is normal, we recognize that sometimes there is intervention needed in the form of C/Section. I am grateful to work with a group of five Ob-Gyn’s and four other Certified Nurse-Midwives.  Just as there is always a midwife from our group on call, there is also a obstetrician available if we need them. In this way our patients are always cared for by members of our group that they have met before labor.

Suzanne Arms wrote this in the 70’s and I have strived in my 30 years of practice to practice with this philosophy. 

“Childbirth is an experience in a woman’s life that holds the power to transform her Forever.  Passing through these powerful gates –Each in her own way-Remembering All the generations of mothers Who walk with her She is alone- Yet not alone.”

Love,

Karen

The strength you find...

CJ Lewis wrote,  "A strong woman knows she has strength enough for the journey, but a woman of strength knows it is in the journey where she will become strong!"

A good friend, also a midwife, gave me this quote on a plaque. It resonates with me in so many ways.  It is about accepting that yes, life can be hard sometimes. It is about knowing that in the challenges the universe presents we can choose to grow stronger or we can wallow in our own self-doubt and judgments.

For all the pregnant woman I am blessed to be connected to the message is clear. Women have the strength, they were born to birth and mother their children, it is in their genes;  but it is in accepting the challenges along the way that they truly grow strong. Carrying, nurturing, and birthing a baby requires great strength and endurance but even if a woman perceives herself as not strong she will have her baby. However if she embraces the entire journey and accepts that it will have ups and downs, that it may not be a straight line, she will be empowered  and transformed by the birth.

I have raised four children and lost one more. Each birth taught me something different.  Each child in their formative years and on into adulthood has also challenged me. For example, each one of my children was very different with different needs, personalities, and strengths. I learned that when my girls came to me with a problem, they wanted me to “fix it.”  My boys just wanted me to listen. My teenage son stopped me dead in mid sentence when he said to me “I don’t want you to fix it. I just want you to listen.” I recognized that when I allowed my eldest child to decide on her own, she would always go in the right direction. I also found that my eldest son would never choose the way I hoped so, therefore, needed more forceful direction if it was an issue of safety. My second daughter was so difficult at 3 that I read every book on child development. It convinced me her behavior was very normal and she ultimately morphed into the easiest child at 4 and ½ and stayed that way all through school. Finally, I learned that sometimes if you try to push your children too hard, they will just push back harder. You have to let go and allow them to learn their own lessons. When my youngest son was in high school I could not get him to take grades seriously, so I said to him I cannot want this more than you want it for yourself.  He told me that was the most important thing I said to him.

In some ways each experience has made me the strong woman I am. When there were health issues, I learned that the more “experts” you spoke to, the more you could make an informed decision. When there were no clear answers, I learned to let go and trust there was a reason. I have taken these lessons and embraced them to enable me to give the support to pregnant women and new mothers that possibly someone without the same challenges would not be able to give.

I always say birth is not easy because motherhood is not easy!  Birth requires great strength but motherhood asks for 100 times that strength in accepting that our children will teach us the lessons we need to learn; and that it is not always easy but it is incredibly fulfilling. We continue to grow with each stage and through the journey, we are transformed into mother and eventually wise woman.

Love,

Karen

Birth Plans...

Detailed Birth Plans

I often wonder what is it about detailed birth plans that make labor and birth so difficult? In my 30 years as a midwife, I have never seen this document improve the quality of care or the outcome of birth.  In fact, it is always the reverse. It  seems the more detail in the plan, the  less likely someone is to birth without intervention.  

So the question is WHY? As a yoga teacher, I would assume that writing your positive intentions  down on a piece  of paper would be beneficial. After all, I often talk in my prenatal classes about affirmations and writing down positive thoughts, successful outcomes. Smart  intelligent women research birth plans on the internet and in good faith print them to reinforce their wishes to their provider.  Possibly one of the reasons this backfires is because the scripts on the internet microanalyze every facet of labor and birth, giving women scenarios to worry about they never thought to consider. The other issue is that women are encouraged to write birth plans rather than talk to their providers about what their views are on intervention and promoting natural  birth.

When my patients ask me if they need a birth plan, my response is usually, “No, because there is nothing you could want that I  would not normally do."  I tell them that while I cannot control how labor goes, I can control that they be supported throughout the process.  I also want them to share with me their views and visions for their birth. For example, whether they are definitely planning an epidural, whether they are going to wait and see, or whether they think they absolutely do not want an epidural.  This helps me guide them in labor.  If a woman tells me she  is absolutely sure she wants one, then I know to suggest the optimal time to take  it.  If she tells me she would prefer not taking one, then if she is progressing quickly but suddenly feels anxious (usually signifying transition is coming), I know to tell her to wait just 10 more contractions and then reevaluate. However, I also tell them that even if they are absolutely sure they don’t want one, I will encourage it if I believe it is in their best interest.  My suggestion is always to visualize the way they would like labor to go, to see it flowing and easeful, and then to accept there may be  detours along the way. 

Most importantly, I feel that as a society we are not encouraging women to trust their intuition, their bodies, and their ability to birth. I encourage women to prepare for birth through prenatal yoga, meditation, breathing, and childbirth classes.  Katie and I started Spiral Path Yoga to give women the information and support they need to fully enjoy and embrace their pregnancies and transitions to motherhood. Both in and out of the office, I work to support and help as many women as I can experience positive, healthy pregnancies and prepare for birth. If a woman tells me she still feels the need to write a birth plan, I suggest she write down on paper her WISHES, a POSITIVE document of what she would like her labor and birth to be as opposed to writing down all the things she doesn't want. 

Suzanne Arms wrote in the 70’s, “Childbirth is an experience in a woman’s life that holds the power to transform her forever. Passing through these powerful gates –Each in her own way—Remembering all the generations of mothers Who walk with her. She is alone—Yet not alone.”

The IN-Between

The IN-Between

I had a busy call this Monday, helping and supporting 5 women birthing their babies. As busy as I was, I had time to sit with my mothers, to be in their space, and observe the quiet. Sometimes the most meditative moments I have in a week come when I sit with a mother in the throes of labor. Women rock, they moan, they breathe, and then…there is quiet. The space between contractions when women gather their strength and prepare, for the next contraction, for the next phase of their lives.

The IN-BETWEEN… the space in-between contractions, in-between being a pregnant woman and a mother, in-between being a couple and parents; these are important transitions and require contemplative space.

It is incredibly important to respect this time. All too often I see visitors, care providers, support people chattering and talking in a manner that is not supportive to the laboring women. She needs the quiet to draw upon all her reserves, her incredible mama strength. She needs to know that she is the most important and only focus of everyone in the room. Only then can she use her intuition to move in a manner that allows her to birth her baby. 

When I was a young midwife in training, I was told by a preceptor that when you enter a laboring woman’s room, you must leave your own issues, moods, concerns outside so that you can support her energy in a positive manner. I have found this to be true over and over. There are times when a woman is stalled in labor and I have asked a particular “support person or persons” to step out and she will spontaneously become fully dilated and birth her baby.

I love observing a woman as she proceeds with her “labor dance,” rocking and moving, looking completely inward with the quiet only broken by her own sounding, or requests for support or nourishment. I know she gathers her courage, her strength, maybe acknowledges her fear during the in-between one contraction and the next. For me, this time of stillness, of being with women in all their power gives me joy but also insight into my own intuition, my soul knowing and sometimes the strength to continue to the next laboring women and the next…

Supporting Birth

My primary goal as a midwife is to support women to birth their babies in whichever way it feels right for them. I am often known to say that I cannot control how your birth progresses, but I can control that you feel supported during the process. Sometimes being an advocate for birthing women can be challenging. There are times when I don’t agree with their detailed birth plans and unwillingness to accept my very experienced advice.  Most of the time I end up being right with my suggestions and the birth ends up in the exact way I anticipated, usually with the mother learning to surrender to a greater force and let go of her detailed birth plan.

However, and I would say thankfully, I often find myself surprised in her adherence to her plan and the revelation that it works! This week I had 10 births and 8 progressed as I anticipated and 2 did not. One mother came in birthing her first child at full dilatation and informed me she would only push if she felt like she needed to.  I thought to myself, ok we’ll see, but to my humility 3 hours laters with minimal pushing, she was crowning and 4 hours later birthed her baby without ever breaking a sweat. It was awesome and made me realize once again that we really don’t understand all the component parts of birth. There is the physical, clearly. The shape of the mother’s pelvis, the size of the baby, the position of  the baby, the diameter of the baby’s head, etc.  But there is the emotional and mental component of birth that propels labor or inhibits it. I have observed after 30 years of birthing babies that women rarely deliver their babies on high holy days or holidays. There is a strong emotional component which we cannot treat with an herb or a medication. Women do birth as they live. 

The second labor surprise came from a woman also birthing her first baby.  She arrived at 9 cm dilated and also did not feel she needed to push. She was moving with her body, rocking, squatting, lunging with each contraction. I thought, great, let her be, she will get to fully dilated and start spontaneously pushing. Wrong again. When she actually started pushing, she became so agitated, she completely kicked her sympathetic nervous system into action and we could not get her to focus or breathe. End result:  She got an epidural at 10 cm as a last resort.  It worked and after 1 more hour of pushing she delivered her baby.

I love observing  women in their power demanding their caregivers respect their wishes.  I love watching women succeed in their strength, and as always I am always humbled by their power.