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Category Archives: Birth

April is Cesarean Awareness Month

Many bloggers have written incredible posts about the shocking cesarean rate, VBAC support, and resources for healing.

I’m not going to try to repeat what they have already so eloquently written.

I want to talk about the idea of family-centered cesarean birth.

I don’t attend many cesareans.  The ones I’ve attended lately are so vastly different from the ones 5 or 6 years ago.  Those involved babies sent to nurseries while mom was in recovery–sometimes alone.  Waiting family members snapped pictures of this new life while mom caught only a quick glimpse in the operating room.

Now, I witness something astoundingly different.  It is much more common to witness births in the operating room involving skin-to-skin contact, sometimes delayed cord clamping, moms with arms unstrapped, and recovery together as a family.  Baby is often held skin-to-skin with dad when not on mom’s chest.  Doulas are more frequently allowed to accompany the family for the cesarean.

Recently, one of my couples experienced a cesarean birth.  After pushing for hours in every position imaginable, their posterior baby (with a 15 inch head, mind you!) was born by cesarean.  Their medical team gave us all the time we needed to try every trick I knew.  The couple was disappointed but they remained empowered throughout their birth experience.

They won’t be showing up for the 18 month cry.

I want to share a few of the pictures from their cesarean birth.  The obstetrician called in to perform the cesarean was Dr. Danielle Harris.  She immediately agreed to their wishes for delayed cord clamping and skin-to-skin.  The family physician who had supported them through the birth was Dr. Keith Stafford.  You know him on this blog as Dr. Polo Shirt.

Dr. Harris hands baby to Dr. Stafford who places him directly onto mom’s chest.  He doesn’t dry the baby first or take a detour to the warmer first.

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Dad steps in to help mom hold their son.  Mom’s arm is free to touch her baby.

Here’s hoping that more babies who must be born by cesarean will experience a gentle welcome like this one.

Huge thanks to my clients for permitting me to share a little of their birth experience.

April is a happening month

Just a sampling of some local events:

April 6:  Movie Day at the Hughes Main Library.  Watch “Born in the USA” and learn about birth choice in SC.  I’ll represent the doula perspective on the Q&A panel after the event.  10.00 donation suggested.

April 8:  The Spartanburg Babywearing Group meets at Labors of Love.  11am

April 10:  Greenville Cloth Diaper Group has a monthly meeting at the Taylors branch library.  10am.

April 11:  EarthFest at Greenville Tech’s Barton Campus.  I’ll be there working a table for Upstate BirthNetwork.  Stop by and say hello between 10am-2pm!

April 11:  Prenatal Yoga at I Love Natural Baby.  5pm

April 12:  Parent and Toddler Yoga at I Love Natural Baby.  10am

April 12:  Parent and Baby Yoga at I Love Natural Baby.  10:45am.

April 13:  Come hear the sexy-voiced Michel Odent, MD speak about birth.  Sponsored by the Bellies to Babies Foundation and the SC Birth Coalition.  Info here.

April 13:  Cloth Diaper 101.  A free class to introduce you to cloth diapers!

April 15:  La Leche League of Greenville meets at I Love Natural Baby.  7pm.  Other meetings throughout the upstate.  Check http://www.llli.org to find the meeting closest to you!

April 20:  Thrive:  A Conscious Health Experience in Clemson.  Looks like such a fun day full of exhibits, kids yoga, and special speakers.  10am-4pm.

April 20:  The Great Cloth Diaper Change is happening at I Love Natural Baby.  Come break the record with your baby!

April 23:  Meet the Midwives event at Greenville Midwifery Care.  6-8pm.  Registration is online through our home page on website or you can email to GMCmidwife@ghs.org.

April 27:  Blessingways:  A Gathering of New and Expectant Families.  April is Cesarean Awareness Month.  Join the discussion.  2pm.

April 28:  The Fair Exchange.  This is the third year that I’ve organized this amazing event to raise $$ for a cause.  This year, we’re raising money for the SC Birth Coalition as they lobby to protect birth choices in SC.  Stop by and shop gently used baby clothes, cloth diapers, babywearing products, etc and buy some raffle tickets for fantastic prizes.

This month, I’m teaching three Hypnobabies series and will attend two births, two postpartums, three prenatals, and meet with a few new couples for the first time.

I thought this was a part time job?  I love it so.

Extraordinary Nurses

Many families worry about which nurse they will get during their birth.  The nurse is a wildcard.  We can pick our midwife or doctor.  We can pick our doula, our birth photographer, our childbirth educator.  We can pick our hospital.  We don’t get a choice in our nurse(s).

I’m so happy that nearly all the nurses I’ve worked with in the last few years have been amazing.  Occasionally, one nurse really stands out and shapes the birth in extraordinary ways.  Like Beth two years ago.

This time, I’m bragging on Mona.  I adore Mona at Greer Hospital.  She’s been a rockstar for many of my clients.  Mona played a big role in this birth.   And she caught the baby before Dr. Polo Shirt could arrive at this birth.

So I knew I could relax when I saw Mona walk into the birthing room.

monaWhat made her support so extraordinary at this birth?

  • She kept interactions with the mama at an absolute minimum.  Mama stayed in the tub and the door to the bathroom remained closed 99% of the time.
  • She used a handheld doppler for quick listens to the baby’s heartrate while mom was in the tub.  She also used a handheld monitor while mom was pushing.  My client didn’t have anything strapped around her belly.
  • She ran interference when the doctor preferred that the mom get out of the tub sooner rather than later.
  • She stalled when another nurse prompted that the mom needed a hep-lock.  The mama never did get that hep-lock.
  • She applied hot compresses on mom’s perineum when baby was crowning.
  • She patiently and quietly guided this first-time mom and then called the doctor in a few minutes before the baby was born.
  • After the birth, she didn’t fuss with the baby or try to talk to the mother.  She stepped back.  After an hour, she still didn’t fuss with the baby or suggest taking her.  In fact, when I left, mama was breastfeeding her baby and blissfully devouring her own lunch tray.

I love this nurse.  She is a strong and quiet presence.  If you give birth at Greer Memorial and Mona walks into the room, relax.  You’re in very good hands.

(Also, I hope she doesn’t kill me for blogging about her!)

SC Lay Midwife Act–Bill 3731

You may have heard that SC is going backwards again.  Not surprising, really.  But for a conservative state, I’m surprised at the movements lately to squeeze in more governmental control.

Enter Bill 3731, the SC Lay Midwife Act.

What the heck is a “lay midwife?”

I’ve attended over 100 births as a doula.  If I decided, “Hey, I think I know a decent bit about childbirth.  Why do the OBs and midwives get paid the big bucks?  I think I’ll start catching the babies.”  That.  That would be a lay midwife.  I would be a person without training hanging up my shingle. (*see footnote)

When I first read this bill, I thought the legislature’s intention was to criminalize, well, lay midwives (i.e. people who were DIY babycatching).

Surely they could not mean SC Licensed Midwives.

Then I read on.

Now, I realize it may be difficult for a layperson (pun intended) to understand the in’s and out’s of midwifery with it’s many acronyms and differences state-to-state.  Let me break it down.

To apply the misnomer “lay midwife” to our licensed midwives is offensive.  Simply that.  And clearly the bill understands this offense as it belittles midwives and the families they serve by requiring a name tag (!):  A lay midwife shall wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the lay midwife’s name and the words ‘Lay Midwife.

Do you see the absurdity of this?  These midwives are attending births primarily in homes.  They have spent hours with the families they serve prior to the birth.  Name tag?

Back to this lay midwife term.  The bill defines lay midwife as a “midwife who may have had little formal training or recognized professional education in midwifery, who learned by accompanying doctors or midwives attending home births.”

Does that apply to SC Licensed Midwives?  In the 1930’s, the state embarked on formal training of midwives.  There were thousands of midwives practicing in rural areas, equipped by the SC government.  In the 1970’s, a move (eerily similar to this one) ended government support of midwives.  The people of SC reacted in protest and a new licensure program developed in the early 1980’s.  This licensing process is still in place and ain’t broken.  DHEC sets standards and regulations for midwives.  Their outcomes are public information.  Nobody is hiding anything.

A layperson can go to the DHEC website to view more information than s/he would ever want to know about regulations, current care providers, reporting, and more.

“Little formal training?”  Licensed midwives must complete a formal education program approved by DHEC and finish an intensive clinical apprenticeship.  Typically the preceptor-apprenticeship ratio is 1:1 or 1:2.  It cannot be more than 1:3. The apprenticeship generally takes 2-3 years.  Then the applicant completes an examination.  Once licensed, there are continuing education requirements and peer review processes.  And, of course, there are fees, fees, fees.

Calling Licensed Midwives “lay” would be the equivalent of suddenly calling all Licensed Builders in the state “lay” and requiring citizens to hire structural engineers to build their deck.

This bill will end the licensing of midwives in SC.  It calls for direct supervision of “lay midwives” by obstetricians.  Obstetricians and licensed midwives practice in different environments and under vastly different models of care.  Don’t let the wording fool you, this bill would end legal midwifery for out of hospital birth in SC.  This supervision wording is merely a smokescreen.

What will happen if there are no licensed midwives in SC?  There will always be families who don’t want a medical birth.  There will always be families who choose homebirth.  And there will, I trust, always be midwives who will serve them.  But these midwives will do so under the threat of criminalization.

There are many other issues associated with this bill:

  • Financial considerations:  a homebirth with a licensed midwife typically costs less than 4000.  An uncomplicated vaginal birth at the hospital may cost 10,000.  Medicaid reimburses licensed midwives.
  • Freedom:  this bill removes access to professional midwives.  It will destroy an entire profession in our state; a profession recognized world-wide.  If you care about freedom, this bill is one to fight.
  • Safety:  I would need to write an entire post to discuss this one!  This bill is not about the safety of mothers and babies.

So now, what will you do dear layperson?  I saw a few weeks ago how a rapid response from citizens pressured the sponsors of a homeschool bill to remove their support.  We can make that happen here, too.

Keep up to date on talking points, petitions, and information at the SC Friends of Midwives website.

Write, email, call the members of the 3M committee.  Let them know you  oppose this bill.  You don’t need to write or say anything fancy.  I think numbers are more important at this stage.

Please help SC families who want access to licensed midwives and protect our freedom to choose where and with whom to birth.

*There are many wise and experienced midwives who choose not to license.  Some have called them “lay midwife.”  I do not because I think the whole term “lay midwife” is oxymoronic.  This bill isn’t addressing these unlicensed midwives anyhoo.  It is addressing SC licensed midwives.

February, be gentle

Such a busy month!  It isn’t all work-related.  I’m also busy socializing my homeschooler.  Heh heh.

I have an invitation for YOU to fill up your calendar space with a few choice selections:

“Now What”:  a class about the first six weeks postpartum.  20.00/couple/student.  Feb. 5.

Greenville Babywearing Meeting:  noon.  Bring your lunch if you’re on a work break.  Feb. 6.

Clemson Babywearing Meeting:  new time this month!  Free gathering to play and discuss babywearing (or anything else that you fancy).  Feb. 7

Spartanburg Babywearing Meeting:  Feb. 11 at 11.

“Sleeping Like a Baby“:  a class about *yawn* newborn sleep.  20.00/couple/student.  Feb. 12

Greenville Cloth Diaper Group:  a group for families who plan to or are cloth diapering.  Topic and discussion.  Free!  Taylors Library at 10am.  Feb. 13.

Cloth Diaper 101:  a free introduction to cloth diapering led by the savvy Jessica.  Dads are encouraged to attend.  Feb. 16.

Blessingway:  I’m so excited about this month’s gathering!  Please come to hear Norie’s birth story.  This first time mama had a peaceful hospital birth.  And the Puppy Nanny will be there to talk about pets and babies.  Free!  Babies and kids are welcome.  Feb. 23

“Having a Baby without Breaking the Bank”:  a class about creating a smart and green registry, DIY items, and saving $$.  20.00/couple/student.  Feb. 19.

New Member Picnic:  I’m hosting this one!  A picnic and playtime at Lake Conestee for new members of the Greenville Attachment Parent Meetup Group.  Join the AP group to find out more.  Expectant moms are welcome.  Feb. 19

Organic Nutrition for Pregnancy and Lactation:  taught by midwife, Grace Hannon.  FREE!  Feb. 21

Anderson Babywearing Group:  Feb. 25 at 6:30pm.

“Parenting the First Year”:  a class about introducing solids, child development, age appropriateness, and more.  20.00/couple/student.  Feb. 26

Water Birth and Other Comfort Measures for Labor and Birth:  another free workshop taught by midwife, Grace Hannon. Feb. 28.

*Also check the schedules for your closest La Leche League!

Coming UP:  

Registration is open for my March/April Hypnobabies Class.  This series will meet from 6pm-9pm on Tuesdays beginning March 12.  Contact me ASAP for information!  j_byers@bellsouth.net

Oh!  And due to a client birthing early, I have a doula space which has opened up for late February or March.  I also have space available in May and June.  Let me know if you’d like to sit down for a free consult.

The March space is taken!  🙂

Goodbye 2012

I like stats.

Firsts in 2012:

  • First dad to leave me in the dust on the drive to the hospital.  You know who you are, J.S.
  • First missed births.  I missed one due to dengue fever and one because I was away for the weekend (she birthed early).  I’m ever indebted to Angie and Laura for doula-ing in my place.
  • First time supporting back-to-back births.
  • First hospital waterbirth.
  • First time driving 1000 miles for a birth (which I missed, so that’s three missed births this year.  Painful.).

I am excited to see what 2013 has in store for me!  My doula availability is booking quickly and my first Hypnobabies class is filled to maximum capacity.  And how could it not be an amazing year with this adorable pumpkin as the first baby I snuggled in the new year?  He also peed on me three times.  I’m sure it is a sign of good things to come.

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I have only one resolution.  I will not miss any births.

When you pass through the waters

I’m reading Michel Odent’s book, Water and Sexuality.  If you aren’t familiar with Odent, he is a French surgeon who began to explore birth as a midwife.  He noticed women were drawn to and influenced by water during birth.  You don’t need to be around birth long before you notice that phenomenon.

He is also incredibly provocative.

He tosses about Japanese tradition, Greek mythology, sexual theory, and futuristic aquatic adaptation.  In the same chapter.

Like I said, provocative.

IMG_2686In terms of waterbirth, he describes how women are drawn to the water and will sometimes enter the tub before it is barely filled.  In Odent’s observations, the presence of water “releases the brakes” on birth; inhibitions melt and the neo-cortex turns off.

I started thinking about a question I ask all my clients:  If you could birth your baby anywhere in the world, without worrying about logistics or safety, where would your fantasy birth take place?

I knew many women included water in their answer but I decided to find out how many.  I pulled my last 50 client files and went through each one of them.

38 out of 50 said they wanted to birth either in water or near water.

Some of the answers were creative and specific.  Here are a few:

  • A cottage by the ocean in a rain storm
  • Floating on a bamboo raft in Hawaii
  • In a tree house over the ocean in Fiji
  • By Bull Sluice on the Chattooga River in the daytime
  • On a blanket at the ocean in Italy
  • In a Swiss Alps cottage with the sound of water

Three women mentioned dolphins and four mentioned mangoes.  Is there some symbolism in those images?

My favorite was a woman who would birth at a coral reef at night.  Probably the scariest place I could imagine but for her it was a peaceful, safe haven.

Only 12 did not involve water.  So what did those 12 answer?

  1. At home in bed near a fire.  Dim lights.
  2. At home with candles
  3. At home in the living room.
  4. Home
  5. At home in bed.
  6. At home beside the fireplace.
  7. Somewhere comfortable and private
  8. Hospital (interesting, at her birth she spent much of her time in the hospital shower)
  9. Mountain top
  10. Outside
  11. and 12.  No answer

I don’t have a big revelation in these numbers.  I’m not surprised by them.  Personally, it’s difficult for me to imagine having a “land birth.”  At my first birth, when the midwife said the tub was ready, I stripped my clothes off in a room full of people and almost dove headfirst into the aquadoula.  The tub created a boundary around me, it gave a physical space that was mine.

Not everyone wants to immerse in water, certainly.  Still, ocean sounds, waterfalls, and thunderstorms resonate in many of these fantasy births.  We grow our babies in water, we dream vividly of it in pregnancy, and it may release the brakes in our births.

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Doulas and the Long Labor

Have you attended a long labor yet?  By long, I mean, a birth requiring labor support for more than 24 hours.  And really, 24 hours sounds lovely compared with some of the lengths I’ve attended.

I will do just about anything to prevent a long labor.  But it has taken years to find ways to recognize the signs that a long birth is on the horizon and to keep the mom engaged in the follow-through.

Recognition:

In my experience, long births are tricksters.  The waves are coming closer together.  Mom is releasing adrenaline and the tell-tale signs of transition appear.  She may even feel little urges to push at the peaks of the waves.  The doula often thinks, “This is it!” and transports to the hospital  or calls the midwife only to find out mom is 2cm.  In a little while, the waves space out.

This repeat building toward transition and then puttering out is one sign of the long labor.  At one birth I attended, the couple went to the hospital three times because of this pattern.

Another sign may be that the waves are short.  Perhaps less than a minute long.  While I have attended one or two births that were characterized by consistently short waves the entire labor, this pattern is unusual.  Or perhaps, the waves are at first long and then later they last less than a minute.

The mom may complain of back pain.

The final sign is instinct.  I have learned to pay close attention to flashes of memory or insight that come during birth.  I remember once I arrived at a birth and when I greeted the mom, immediately a memory of a former student popped into my consciousness.  I dismissed it.  What followed?  I was completely tricked by a birth that lasted over 50 hours.  Guess what?  The birth was almost identical to that former student from two years before.  Was this some magical power?  No, of course not.  My instincts probably picked up on subtle clues prenatally when I felt baby’s position.  Instinct is a powerful assistant.  When we listen.

Reasons:

Most of the time, long labors happen because of baby’s position.  The top two are:

Posterior–baby is facing mom’s belly.

Asynclitic–baby’s head is tilted toward her shoulder.

It may also be that baby is still high in the pelvis (not engaged), baby’s chin is not tucked, or baby’s hands are up.

Prevention:

Until recently, I tended to be a little bit tentative when encouraging techniques to reposition a baby.  I didn’t want to ask the mom to do something that would increase her discomfort and I wanted to trust birth, all that jazz.  A doula is meant to soothe and help with discomfort; not make things more intense!  But an ounce of prevention…

There are many techniques in the doula playbook.  They have names like:

  • The Miles Circuit
  • The Rotisserie
  • The Abdominal Lift and Tuck
  • Walcher’s Trochanter
  • Rebozo
  • Psoas Resolution
  • Open Knee-Chest

Sometimes it is hit or miss to find the one manuever that works for this labor.  Please remember to remain balanced during this process of elimination so that the birth team rotates rest and nourishment with the calisthenics.

Which brings me to:

I believe a long labor was avoided with one of my clients.  I recognized the signs:  waves varied from long and close together to short and spaced.  Over the course of about 9 hours, I rotated rest, nourishment, techniques.

The techniques that I thought should work, didn’t.

I encouraged the couple to have some private time and I sat in my car thinking it through.  I wrote down what I knew about this birth and what we had tried.  When the couple was refreshed and rested, I decided to try the Pelvic Floor Release.

I don’t use this technique often.

After a nice bath and rest, I asked the mom to give it a try.  With dad and I supporting her, she began.  She completed three waves on her right side and then we switched to the left.  Around the second wave on her left side, I heard the change.  Her waves became powerful and long.

We followed the Pelvic Floor Release with the Rotisserie but I’m not sure it was necessary.  Within an hour, we were on our way to the hospital where she 8cm!

Conclusion:

From now on, I will arrive at births with techniques a-flyin’.  Perhaps I’ll carry a clipboard and wear a whistle.

No!  These manuevers are still interventions.  We should practice watchfulness and instinctual awareness.  IF they are needed, we should keep our tone positive and tread oh-so-carefully into the birth space.

However, we should not be afraid to move from gentle support to a more firm encouragement.  We’ve seen the result of a long labor and we want to avoid that if possible for our clients.

 

Graduates

I’ve been slack about posting pictures of my Hypnobabies students.  I add the pictures to this page but I forget to highlight them here.

Look at these adorable Hypnobabies!

This picture is from a recent class reunion.  One baby boy was not able to make it for the photo shoot.

Want some stats?

  • 100% of the babies were born without complications
  • 100% of the mamas gave birth without medication
  • 1 baby was born with a family practice physician at a hospital
  • 1 baby was born with midwives at a birth center
  • 1 baby was VBAC at home with a family practice physician
  • 2 babies were born at home with midwives
  • 4 of the babies were born in the water.
  • None of the mamas needed sutures
  • And THIS childbirth educator was not the least bit surprised by these stats!

Email me about classes beginning Oct. 16 and Jan. 27. ( j_byers@bellsouth.net)

 

When Birth is Difficult

I’ve attended three challenging births in the last 8 months.

Two were first time moms –hospital births lasting over 40 hours of active labor.  These were caused by the baby trying to come in a funky position.

One was a homebirth that wasn’t long but was hard because of several factors.

All three women birthed healthy babies without an epidural.

When birth is hard, the support team is usually the deciding factor in the outcome.  When the challenging births come, the doula is necessary.

At a recent interview, I was asked, “What do you like to do most at births?”  Without hesitation, I answered, “Nothing.”

It is a rare job interview that “nothing” is the appropriate response.

See, when I’m not needed, that means the birth is easy.  I deeply want my clients to enjoy butter births.  My clients want that, too!

But the challenging births are what doulas prepare for.

I want to share Keren’s birth story.  It was beautiful.  And tough.  Spiritual and amazing.

The photos are stunning.  Especially when her husband catches their son!

(Hypnobabies students:  Use your BOP before reading.)

Go read!