It is anticipation, flutters and quickening.
Life and growth and unparalleled beauty.
It is squeals and coos, wriggles and dimples.
Hanging scales with tiny feet peeking through.

It is knowledge and wisdom, training and practice.
Books and research, instinct and reason.
It is squatting and reaching, twisting and folding,
meeting a mother and her baby right here.

It is a never-off cell phone, interruptions at dinner.
Put off vacations, and birthdays on hold.
It is seizing the moment, because you’re not at a birth,
keeping scrubs in the car and bags packed and ready.

It is saying the hard things, in compassion and grace.
Holding hands and “I’m sorry,” grieving and loss.
It is sitting and waiting, listening and presence.
Letting grief take its course in her heart slowly breaking.

It is business and money, budgets and forms.
Paperwork piles, contracts, and records.
It is hiding the headaches and ignoring the numbers,
Trusting provision will come someday soon.

It is building a village, stone by stone every day.
Community, relationship, and opening doors.
It is connecting her with new like-minded others,
Helping her realize she is in no way alone.

It is hands and heart in equal measure.
Richness and fullness and life as reward.
It is working in joy, frustration, and love.
Being with woman is far more than a job.

What does midwifery care mean to you? 

A look back at one of our most popular blog posts of the past few years. Originally published May 18th, 2015. And still every bit as relevant!

A mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

 

One night, you are awakened from slumber at the beck and call of your compressed bladder. No, wait. That’s not it. There’s a crampy tightness that feels familiar. Where have you felt that before?

Menstrual cramps! It feels crampy. Weird. You decide to get up and move to the bathroom. After a few minutes, you get back and bed and feel more cramps. Hm. Weird.

Could this be it? It could be! This is it! You’re finally in early labor!

You know this because the contractions are coming, no matter what you do. You’ve had a big glass of water. You’ve gotten up to pee. You’ve had a snack. You’re content to let the rest of your house rest while you anticipate the birth day to come.

So you’re in early labor. Now what?

You think back to what your midwife told you, and you remember that she gave you several things to do during this slow building time.

1. Let Your Midwife Know. As soon as you know you’re definitely in labor, she’ll want to know. She or her assistant might swing by to check on you and baby, or just triage you over the phone, depending on what’s happening and your needs.
2. Rest. This is not the time to try and “get things moving” by taking a long walk, doing nipple stim, or anything else that is supposed to speed things along. This is the time to conserve energy. If you can talk through your contractions, you can sleep through them.
3. Eat & Drink. Whatever time your labor starts, eat normally. One good meal is often enough to sustain you through the work to come. No food is off-limits, though it’s wise to keep in mind that you may throw up, so avoiding choking hazards or harsh foods might be a good idea. Comfort foods are wholesome, nourishing, and encourage happy hormones. Also, keep drinking. Water, juices, herbal teas that you enjoy, smoothies, and broth are all great candidates. Whatever sounds good.
4. Do Life. There is no reason to put off that quick trip to the store to get milk and bread, or going to the movies. There is no reason to go out if you didn’t plan to, but just going about your day, doing your best to ignore what’s happening. At this point, it’s really no big deal, and it helps your progress if you can be content, happy, and moving.
5. Distract Yourself. Sometimes, especially when it’s your first baby, it’s so hard to keep your mind off your contractions. But the rule of thumb is that you must ignore them until they demand all of your attention, whether you like it or not. Conserving energy in early labor is paramount! Don’t use breathing or coping techniques from your classes yet either. They contribute to the sense of time, and can make you far more tired than you need to be. Instead, watch funny movies, go to the park, go out on a date with your partner, bake a birthday cake, start a slow cooker meal for after the birth, or call a friend to chat.

I like to tell people to “be in denial” about their labor until their labor gets all up in their face! Just take care of yourself, pretend like everything is normal, that nothing is going on, and let your body keep the secret just a little while longer. You will be shouting to the world in your own way soon enough, so save your breath. Smile. 

“To move into active labor, a woman must give up ideas of how she thought labor might be; in other words, she must surrender.” ~Elizabeth Davis in Heart & Hands

Open up to the path your labor has chosen, and surrender time.

Grace & Peace,
Tiff

As I was in the shower today, after two births in 24 hours–one in the hospital as a doula, the other at home as a student midwife–I was appreciating the perfect temperature of the water, the smell of my shampoo, and the utterly clean feeling I had when I stepped out onto the mat. I was positively luxuriating in my shower! I couldn’t help but compare it to the first shower I took after my babies were born. That first shower post-birth is simply divine.

This got me on a train of thought I hadn’t really contemplated before.

Midwives, doulas, and postpartum mothers share a sisterhood in more than just birth. There are five things we all love after a birth, whether it was our own or one we attended.

1: Taking off the sweaty/goopy bra.
Taking off the bra at the end of the day is magnificent enough. Imagine peeling off a sweaty, potentially goopy and wet bra! Birthing a baby is hard work, and so is attending a birth. (Not on the same level, obviously, but we often get very physical, sweaty, and wet too) Oh, the glorious freedom of a bra slipped off and tossed aside!

2: That first shower.
Letting all the mess of birth wash down the drain. The sweat of hard work. The fluids, vernix, and blood of the birth. Even some of the heightened emotions are shared. They are on different scales but are sourced in the same hormones. And yes, birth professionals tend to get a little baptized with the birth fluids too. I cannot tell you how amazing it is to get into that warm shower and just feel clean again!

3: The first meal.
Whether it’s steak and eggs, sushi, fried chicken, gyros, cheese and crackers, bananas and peanut butter, smoothies, or a fistful of Cheetos, it doesn’t matter. No food tastes as good as post-birth food.

4: The first nap.
Most births happen in the wee hours before dawn, so everyone involved loses some sleep. Combine that with a hit of high-inducing oxytocin, endorphins, and adrenaline, and you have a perfectly natural sleeping potion circulating in your blood. The first nap post-birth is the best! Even if it’s interrupted by a hungry baby, or a text from a client (we’re usually still on call), it’s still lovely to sleep. Mostly because we are in bed. It’s all about the bed. And the cool side of the pillow.

5: Seeing your kids again.
There’s something about a family coming together again after the birth of a new baby. After you’ve come home from the hospital, or your kids were brought back home from Grandma’s, being together as a family with a new member to induct is just plain special. Some of my favorite post-birth memories, when my kids were born, were introducing them to their new tiny sibling. Now, walking in the door from the latest birth, and being greeted by four sets of arms hugging me, and four voices saying “Yay! Mommy!!!” is such a blessing.

What is your favorite thing after having a baby and/or attending a birth?

Grace & Peace,
Tiffany

We’ve all heard the horror stories. The homebirth turned cesarean. The induction gone wrong. The horrible hemorrhage. Cracked and bleeding nipples. Breastfeeding sabotaged by circumstances. And more. There is almost a compulsion to tell these stories, and we are often left feeling a little dazed as we walk away.

These are valid experiences, but hard to hear. Even harder is our response. Smiling and nodding seems shallow and awkward. What do you say in such situations when it doesn’t seem like there is anything right to say? None of us want to be trite, or offer mere platitudes, but what else is there?

Some advocate for setting firm boundaries and asking that only positive stories be shared. This may work among our own circle of acquaintance, where people know us and can understand where we are coming from. However, that often doesn’t feel right to do with someone we don’t know well or have only just met. It just feels wrong to hold up our hand and stop someone from telling their story.

I would like to offer another option.

Listen to their story.

Then, validate their experience. “Wow, that sounds like it was really hard for you.” A simple statement that honors the fact that they have shared part of their life with you.

Go a step further and ask them one question:

“If you could go back and change anything about your experience, what would it be?”

No one has likely asked them anything of the sort. More than likely, they have only been told “At least you have a healthy baby, and that’s all that really matters.”

Imagine what that one question could do for someone struggling with a traumatic experience. Someone who has told her story dozens of times, only finding those who could one-up her story, or who spoon fed her “healthy mom, healthy baby” platitudes.

Imagine being the first person to open up the door in the wall between this precious woman and her own healing. Perhaps no one has confirmed her struggle. Perhaps she has not been allowed to grieve what she lost. Perhaps she has been expected to get over it, no matter how much it hurt, or how few answers she has about her circumstances. Perhaps her experience has only ever been marginalized, even by well-intentioned loved ones who are simply uncomfortable with trauma.

Imagine what you could learn from hearing the answer to such a question. The information that may be between the lines of her answer that can help you confirm or change the decisions you yourself are making. Perhaps her story will be the means of preventing your own traumatic experience, and make you better equipped to handle unexpected outcomes.

Imagine being the means of turning horror into healing.

How have you handled horror stories in the past? How might you handle them in the future?

Grace & Peace,
Tiffany

Yes, it almost sounds like a Dr. Seuss-ism – “Would you rather be a passenger or a driver?” Most of us would rather be the driver, I would venture.

In every other aspect of our lives, we exercise informed consent. We want to be involved, in control, and overseeing every detail. Take for example the research we do in buying our next car, cell phone, or home. Think about how much we invest in knowing our stuff, so we can avoid the sales pitch and just get exactly what we want because we desire to make a responsible informed decision.

Yet, when it comes to our health care–prenatal care in particular–we often content ourselves with being a passenger. We readily abdicate responsibility for our health by laying down our questions and concerns to take the word of a stranger. We leave our right to informed consent in the waiting room.

Why is that?

“But, they’ve gone to medical school for a million years! What do I know?” Of course, their expertise is invaluable. Their advice is often sound. While they have an intimate knowledge of the human body and its various pathologies, they do not have an intimate knowledge of your body in particular. Its quirks and signals that are all too familiar to you.

What many fail to realize is that, no matter which role we choose to play in our health care, the consequences of any and all decisions are carried by the patient. By you and me. For the physician, it is out of sight, out of mind, not because they are inhumane, but because they are human.

When it comes to prenatal care in particular, we see a unique dilemma, because the health care we receive has more to do with a physiologic process, rather than pathology or disease. This isn’t a broken femur, a tumor, or a chronic illness. It is not even a parasite, in spite of the tongue-in-cheek proclamations of many. It is something our bodies do naturally, without a lot of help. It is a process more in need of general oversight, rather than active management.

Pregnant or not, it is imperative to understand that the practitioner is hired for his or her advice. It is up to the patient to decide what to do with it. We have many options.

1. Follow the advice without question.
2. Question the advice, decide what to do.

• What are the benefits?
• What are the risks?
• What are my alternatives?
• How does this advice apply to my personal case?
• What happens next if it doesn’t work?

3. Get a second opinion.
4. Discard the advice in favor of an alternative outside traditional medicine.
5. And more…

Medical decisions are rarely black and white.

The key is to remember who it is that carries the weight of the risks. It is ultimately the patient. There are many factors that play into the reasoning behind your doctor’s recommendations–not all of which are health-related. (That’s another post for another day, however.)

In the end, all you have to do is decide which set of risks you are most willing to live with. That is true informed consent.

Only the driver can decide that. Not the passenger.

In which seat will you choose to sit?

Thanks for reading.

Our best to you,
Desirre & Tiffany

Why take childbirth classes anyway? You and baby are made for this process, so what is the big deal?  You go into labor, have many contractions, eventually become fully dilated and push out a baby. Bam. It’s nature! Right?

Not quite, I’m afraid.

In a perfect world, women would grow up around pregnancy, labor, birth and postpartum to soak it all in. Younger girls would assist the mother, participating in many aspects of her care, and would then gain valuable in-person true life experiences that give her encouragement, education, and confidence going into her own pregnancies, births, and postpartum times. Aunties, grandmothers, daughters, cousins, and friends all would participate in this womanly art of birth. If this were still the case, it would put the need for childbirth classes to an end.

Sadly, women in our culture are all too often discouraged, educated with fear, and lack confidence about all things related to pregnancy, labor, birth and early postpartum. It is a mystery to most women as they grow up, and very few have regular access to normal birth. Indeed, the body of a woman isn’t something that is expanded on widely in health classes, or talked about with any raw clarity. The female body, and what it can do, is shrouded in mystery from puberty to the end of life. So, we need good childbirth classes because women have been giving birth in a vacuum for a long time, and have lost the knowledge they once would have grown up with.

Women and babies deserve better. Women and babies deserve to have positive, foundational knowledge to pass down to the next generation. Women and babies deserve the care that can come when the veil is torn, and the mystery becomes clear.

Women learn in community. Quilting bees, canning day, and wash day didn’t really go away. It’s merely been replaced by play dates, mom groups, and social media. Childbirth classes are one more great way to bring women together over a common goal so that they can learn from each other. It serves the purpose of re-integrating the knowledge of generations of birthing women into the modern world.

A good childbirth class will help a woman and her partner to:

A mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

Almost three years ago, I packed up my four children and drove to Oregon to help care for my father. His melanoma had metastasized to his spinal fluid, and everything that could be thrown at it to kill it, had been. There was nothing left, but to wait. Probably only weeks were left.

His decline was gradual, over the course of about three and a half months. During that time, I discovered another purpose to my doula training and work.

The end of life is much like the beginning. It is mainly about waiting, comfort and support. There isn’t anyone who can do the dying work, except the dying. Those in attendance find themselves with not much to do but wait. At the most, we bring comfort through physical touch, slow conversations, and just quietly being present. It is so much like waiting while a woman labors. The main difference being that we are on the wrong side of the veil. We do not get to see our loved one birthed into the next life. It is all darkness on this side.

I have never been so grateful for my training as a doula. Everything I learned is very nearly directly applicable to the dying process. Here are 5 things I learned while doulaing my dying father.

1. Pain can be a normal part of the process.
Granted, the pain of death was not something I believe that we were ever designed for. It is often pathological, but it is also a natural part of dying. As in labor, it is a signal that something needs to change. Perhaps a massage will alleviate it. Perhaps a dose of morphine will help the man laboring to die to rest a little easier. Pain also allows and invites loved ones to minister to the dying simply by being present, holding a hand, or stroking the hair.

2. The same comfort measures used in labor often work well for the dying.
Massage. Gate control. Supporting the five senses. Medication. Acupressure. Essential oils. Music. Bathing. Hydration. Light snacking to their level of hunger if it exists at all. The dying, much like the laboring woman, do not need much food if any. It’s important to follow their lead. All these techniques we learn in our doula training are applicable to the dying one. Of course, some causes of death render certain massage strokes unbearable, much like transition may do in a laboring woman. It’s all about trying different things, and allowing the dying to accept or refuse it without taking it personally.

3. Holding space is the foundation for dignity.
We know as doulas that a mother’s pain level, or even the kind of birth she has will have little bearing on how satisfied she is with her experience. What matters most to her is that she is the decision maker and that she feels supported throughout the process. We as doulas hold the space for that to happen. We are constantly directing attention back to the laboring mother: “How do you feel about adding Pitocin to the plan? Would you like time to talk about it?” It’s the same with the dying. They often struggle to decide, and just need the space to settle in with what they want. This gives them the dignity they deserve as a human being while they go through an undignified, and often painful process.

4. Writing an end-of-life plan is much like writing a birth plan.
It’s written before the active dying really begins, much like a birth plan is written prenatally. It outlines the dying person’s desires, wishes, and medical decisions ahead of time, so that if and when they become incapable of decision-making, those who are caring for him can use it as a guide to know what he would most likely want to do. Unlike a birth plan, it is a legal document, and only power-of-attorney can override it. The principle is the same, though. And as a doula, upholding these desires came naturally to me.

5. Dying doesn’t look at all like what is portrayed in the media.
Birth in the media is always an emergency, there is a lot of screaming and hating of husbands, and demanding of drugs. It’s almost never clinically accurate or true to life. It is the same with death in the media. Death in the movies is always grand or gory or like watching someone fall asleep. Watching my father die was none of those things. There is no way to portray the sights, smells, sounds, or the heaviness of the room where the dying man lies. There are as many ways to die as there are to give birth. As beautiful as Dad’s final moments were, as dignified and peaceful as it was, I found death itself to be ugly. Just as I find birth to be beautiful, in spite of the “mess” and the pain and the noise and the smells. Death and birth are studies in contradiction. They are each a paradox. And both are sacred.

I loved being with my dad while he lay dying. I felt honored, privileged, and blessed to witness a man’s leaving of this world to enter the next. For Dad, to live was Christ, and his death was gain. Every time I enter the sacred birthing space of another woman, I am reminded of the gravity of life, and how important it is to have dignity at both birth and death. As a doula, I now know that I have the skill and compassion I need for either. If I weren’t a doula, or pursuing midwifery, I think I would want to be a hospice nurse. But that is an entirely different post for a different day.

Thanks for sticking with me. I know this is a tough subject, but it’s close to my heart, and it was time to write about it. How have you experienced death or birth in your life? Have you seen both? Are there other parallels you noticed?

Grace & Peace,
Tiffany

Thank you.

Thank you for choosing me to walk with you, whatever your journey.

Thank you for asking questions.

Thank you for learning and growing, and letting me be a part of that.

Thank you for sharing your strength, dignity, and unique experiences with me.

You are amazing. You are the reason I love this work.

Grace & Peace,
Tiffany