Posts Tagged ‘home birth’

Homebirth: The Basics.

Monday, March 2nd, 2015

General Information

The Safety of Homebirth

Other

My Favorite Colorado Springs Midwives

So It Begins.

Monday, December 22nd, 2014
Image credit: knowyourmidwife.com

Image credit: knowyourmidwife.com

In November, The North American Registry of Midwives accepted my application into the PEP program.

That should really have about eleventy-one exclamation points behind it. After all, it is the ripening of a long-blossoming fruit. The result of  a dream hatched over seven years ago, when my youngest was just a baby. I called the midwife who had walked with me during my last two pregnancies, Merrie, and asked to meet with her in order to discuss becoming a midwife. In her wisdom, I remember that she said to me, “You don’t want to be a midwife,” and proceeded to tell me all the reasons why it was not something to just walk into.

It was at that meeting when I first heard the word, “doula.” A what-a? Her assistant at the time was one, and Merrie encouraged me to meet with her. She assured me that if I could hack it as a doula, then midwifery might become an option later. That is how I was born into the life of a birth professional. I took my training in the fall of 2007, when my youngest was only two months old. A lovely babysitter came with me, and I nursed him through sessions, and she played with him in between. I worked slowly through my training, taking the maximum amount of time CAPPA gave me to finish my certification, but it was worth it.

Through it, I gained experience outside my comfort zones. I learned that I can live on call, and work around my family.

Soon, it wasn’t enough. I wanted to teach. So, I trained through CAPPA (of course), under Desirre Andrews (who was a doula, lactation educator, and a dually-certified childbirth educator at the time), to become a childbirth educator. Teaching has always been at the heart of who I am. I often find myself teaching, even when it isn’t wanted or needed–a character trait I hope is being shaped into a far better tool than it has been in the past. At this point, it became obvious that I needed a place to teach, but not having a regular income, nor a family budget to pay for a place, I sought help from Desirre again. She had a lovely office and classroom space, and was wanting an educator to help her as she began to assist a midwife (the same one mentioned above, in fact). I approached her, and asked that she become my professional mentor, and allow me to work with her to grow, teach, learn, and have space and time to build Birth In Joy into whatever it needed to become.

I haven’t looked back since. It has been a wonderful working relationship, and I have been blessed with a treasured friend whom I feel is my “big sister.” Working with her has challenged my perceptions, my biases, my experience, my emotions, my mind, my heart, and my very character.

Soon, even that was no longer enough for me. I have always taken a light client load, because my family needed me to. So, I knew I wasn’t beginning to burn out. Far from it! My passion and love for this work has only grown, over the years. Thanks mostly to my fabulous, beautiful clients and students, who have shown me quite a cross-section of birthing women and the strength they each have in common. What a world we live in, and what a privilege to have walked with so many through such a sacred, intimate time in their lives!

Desirre declared to me, when she started assisting Merrie, that she only wanted to gain insight and skills she could use as a doula. She wasn’t going to become a midwife.

Ahem.

She is now a Certified Professional Midwife, registered in the state of Colorado. Ahhhh, life. We never really know, do we?

Except that I do know. Midwifery has always been my goal. My dream. What I want to be when I grow up.

So, as soon as Desirre became a preceptor with NARM this past September, I started my paperwork. Phase 1 has been accepted by NARM, and I am working on both Phase 2 and the 43 pages of skills I must master and prove. (No, shaking chicken bones and chanting are not on the skills exam. Just so you know.)

So it begins.

My journey to becoming a midwife. “With woman.”

I didn’t know I was ready until one day, I was.

What is your passion? What dreams are you pursuing?

Grace & Peace,
Tiffany

Book Review Friday: “Giving Birth” by Catherine Taylor

Friday, May 23rd, 2014

Giving BirthGiving Birth by Catherine Taylor
My rating: 5 of 5 stars

This is one of those books which I wish I would have taken notes throughout, to better enable me to review it accurately. Her tone, her writing style, and the content were all excellent.

Her writing style is accessible, honest, frank, and open–the way a good journalist’s should be. Her descriptions of the various women she meets, the places she goes, and the births she attends as an observer or doula are vivid without being wordy.

I found myself moved to nearly to tears several times (I’m not much of a crier, so “almost to tears” is saying a lot) throughout the book.

It’s picture of midwifery as a profession, from Certified Nurse-Midwives to direct-entry midwives is respectful and unbiased. She shares the reality of the political landscape all midwives must work in, the challenges they face, and the little triumphs on behalf of women and their babies.

Even if you are not into birth, I would recommend this book to every woman – whether you plan to have children, have children already, or plan to never have children. It can speak powerfully to any of us.

View all my reviews

Preparing For Birth Has Moved!

Monday, May 12th, 2014

We are still at the same address, but we have moved upstairs into a new, more spacious office suite. We are now in Suite 201, just at the top of the stairs. The very first door. We now have three midwives working out of this office, and five doulas, all of whom are a joy to work with. Classroom space is bigger, too, which excites me to no end!

As I grow in my business, I am learning so much, and I am grateful to be a part of Preparing For Birth as it grows to better serve our community with more options for women during the perinatal period. From Early Pregnancy classes, to Essentials for Childbirth, to Life With Baby, Pregnancy Fitness, and Breastfeeding classes, we really are covering a wider range of needs at an affordable price.

Stay tuned for more information!

Grace & Peace,
Tiffany

Doulas Benefit Care Providers, Too.

Monday, October 28th, 2013

Image credit: apperson.com/support

I’ve written a lot about the measurable benefits of trained labor support for women and their families, which is important. However, I believe firmly that doulas have great potential to benefit care providers and staff as well. As one more important piece of the birthing puzzle, doulas can either add to or detract from the big picture of any birth they attend.

When a doula is at her best, when she understands her role and her scope of practice, she brings freedom, communication, and peace to the place of birth.

Part of my Scope of Practice as a CAPPA-certified Labor Doula reads as follows:

During labor and birth, the labor doula provides the mother and her partner with physical, emotional, and informational support. She facilitates and promotes self-advocacy, informed choice, and effective communication between the family and care providers. She seeks to foster a cooperative, respectful, and positive atmosphere with all members of the birth team so that the mother can birth with confidence. (emphasis mine)

What does “effective communication” look like at a birth?

It looks like a bridge. A sturdy, well-built bridge that begins with openness, humility, and an extended hand from the doula to the staff member or care provider that does not interrupt their conversation with the client.

It’s remembering that the client chose her care providers just as much as she chose her doula.* That fact alone should elicit basic human respect from the doula toward those caring for her client. Period. Regardless if that respect is returned or not. Doulas do no one any good unless we do our best to leave those chips on our shoulders at home. We do best when we take the high road, and treat everyone on the birth team with dignity and respect.

Side note: respect doesn’t mean agreement or likeability. It simply means getting along, and choosing to work together toward a common goal: The safety and health (physical, mental, and emotional) of both mother and baby.

When a doula sees herself as an integral part of the birth team, and understands that everyone else there has their place (as long as her client chose them), there are a lot of benefits she has to offer to the care provider and staff she is working with.

Among those benefits:

  • Added perspective–Doulas can often get very creative when coming up with ways to help a labor progress effectively before medical interventions are truly needed. Care providers often appreciate suggestions that don’t interfere with safety, and that seem to help the mother.
  • Someone labor-sitting–Care providers are rarely available to labor sit as long as a doula can. Even home birth midwives may not have as much opportunity to do so, and usually arrive later in labor than a doula would. This means that a doula can fill in the provider and staff on what has been going on, what tricks have been tried, and things that may be relevant to improving her client’s care. The doula can often provide clarification where the mother’s or partner’s recollection is fuzzy. This helps the care provider have a more accurate picture of how labor is going.
  • Continuity of care for patient–This is one of the hardest things to provide as a care provider. Nurses, doctors, and hospital-based CNM’s change shifts–no matter what. Even home birth midwives may have to send a backup if two births are happening simultaneously. The doula provides one continuous thread of care, and we all know that this works out to better quality care in general. Also, can bond more quickly with the new people on shift, making her care easier for the staff and/or care provider, as they have to spend less time establishing trust.
  • Bridge of communication with patient–Doulas teach their clients to ask good questions, relevant to their own care, and how to understand the answers they’re given. This helps the client to build trust in her chosen provider, which makes caring for her easier for the care provider. A doula’s presence should facilitate togetherness at a birth, not a sense of “us vs. them.”
  • Extra set of hands–As much as care providers love to do hands-on care, many times they are simply not able to do so. Doctors, nurses, and even home birth midwives and their assistants, can easily get bogged down by charting, checking and setting up needed equipment, and (in hospitals) caring for other patients. This is as it should be, since the safety and health of the mother-baby dyad rests on their shoulders. Any non-clinical care they get to do is icing on the cake. Doulas have no such worries impeding their care. Non-clinical care is their only focus.Therefore, care providers are able to focus solely on their number one priority: the health and safety of mom and her baby.

I know that the above benefits are really more indirectly beneficial to the care provider. However, when there is benefit to the birthing woman, there is benefit to her care provider as well. The patient load of most OB’s is such that it can be extremely difficult for them to individualize care. After all, the care provider has as little time, per appointment, to get to know their patient as the patient has to get to know them.

Therefore, if there is any way for a doula to help build bridges, encourage their client to ask good questions, and utilize whatever time they have with their care provider, it enables and empowers the care provider to do what they want to do most: Provide evidence-based, individualized, humane care to their patients. This results in good feedback for them, and encourages them to be more open to the next client asking questions or wanting something different than the basic standard of care.

In short, the presence of a doula can mean heightened communication, empowerment, and a positive experience for everyone on the birth team, not just the mother.

*I understand that many women only have very limited, or no choice, when it comes to their care provider, due to geography, local/state laws, financial constraints, or other factors. Still – they ultimately still have chosen their care provider, rather than birthing unassisted at home. Therefore, they are placing some modicum of trust in that care provider. I appreciate feedback on this.*

Care providers: How often do you work with doulas? What do you appreciate most about good doulas? What tips might you offer to doulas who are still learning, or who need to understand your perspective better? What ideas do you have to foster better relationships between clinical and non-clinical professionals?

Thanks for reading!

Grace & Peace,
Tiffany

Birthy Weekend Links

Saturday, September 7th, 2013

This weekend is coming up fast! What plans do you have? I have family coming in for a five-day visit, I’m on call for a midwife, and I’m trying to put together some bouquets for my sister’s upcoming wedding. In the meantime, here are a few things worth reading this weekend.

Interested in reading more? “Like” my Facebook page, since I tend to share a lot more of these on my Facebook page, almost daily!

Happy weekending to you!

Grace & Peace,
Tiffany

Top 10 Things I’d Do If I Were Pregnant Again

Tuesday, April 10th, 2012

Image from decalsground.com

We all have things we’d like to hit the rewind button for. Today, I thought I’d share the top ten things I’d do differently if I were to miraculously find myself pregnant again. Why not? It’s not something I’ve shared before on this blog. I don’t often get very personal, but I’d like my readers to see me as a real person, who has made real decisions about birth.

So, without further ado, and in no particular order:

The Top 10 Things I’d Do If I Were Pregnant Again:

Image from richmondmidwife.com

1) Have a water birth.

The first time I’d heard of water birth was at our group tour of the birth center where DS #1 was born. In answer to another mom’s question, the midwife leading the tour said something like “No, we don’t do water births here, because we don’t think babies were meant to be born that way.” They did allow moms to labor in tubs, and I tried it. My labor practically stopped. I didn’t know then that if you get in the tub too early, the water can slow/stop your labor. I never thought twice about it all the time I was birthing my four children. Now that I have seen several water births, I would definitely choose to have a pool set up in my house for that purpose.

2) Have my placenta encapsulated.
This is an option I had no earthly idea about when I was having children. I think it could really have helped me with a whole slew of issues. I never struggled with baby blues or a PPMD, but I did have pretty roller-coaster-y emotions in the immediate postpartum days. Also, I have never been able to say that my milk supply was abundant, and I think the reassurance of the placenta pills’ ability to boost supply would have been a welcome comfort to me.

3) I would take a comprehensive, independent childbirth class.
Since I am a certified childbirth educator, I don’t think I’d actually take a full course, but I would probably take a refresher workshop of some kind, just to see if there is any new information out that would be important for me to know, and to give my husband a chance to internalize information he has heard at random since I became a doula. There is always room to grow, and I think we would both benefit from additional education.

One more thing. If I found out that I had to birth at the hospital, for some medical reason, I would definitely take a full, comprehensive course. Since I have never birthed at a hospital, I would really need to fully equip myself for the big differences I would face.

4) I would take a breastfeeding class.
Breastfeeding, for me, though a beautiful experience, was a struggle. I never had cracked, bleeding nipples. I never had to overcome hospital “booby traps,” because I never birthed in a hospital. I had the full support of my husband, my friends, and my mother.

Still, I was never able to meet my breastfeeding goals. When I look back, I know it was simply a lack of basic knowledge of how breastfeeding works. I hadn’t even read a book about it. I think that, if I were pregnant now, that is the first class I would sign up for, and would make sure I had the phone number to some good lactation support.

Image from portlandplacentaservices.com

5) I would make placenta prints.
Before I had it encapsulated, of course. I would frame them and hang them in my living room. They’re gorgeous when done correctly.

6) I would exercise.
Now that I have started trying to take care of my body, and can see the immediate benefits to my emotions, my confidence, and my overall well-being, this is something I would do during pregnancy. Though I did eat well, I never officially exercised with any of my kids, except for the occasional walk with a friend. I know that if I kept up a good exercise routine, I would probably enjoy my pregnancy more.

7) I would try a few different baby-wearing carriers.
For all four of my babies, I had a trusty ring-sling. One was a hand-me-down, and one was custom-made for me by a dear friend. I loved my ring sling, but there were some definite downsides to it. I had no idea there were any other carriers out there that would be properly supportive of my babies (Snugli’s and others like them are not ergonomically correct for a developing baby). So, if I were pregnant again, I’d hook up with the local “baby-wearing lady” in town, and try something new.

Image from hottopic.com

8) I would YouTube/Facebook/Tweet my birth.
I wasn’t on any kind of social media during my other pregnancies, but this time, all my friends would be hearing from me regularly! I’d probably try to facebook/tweet pictures and thoughts as I labor, and be able to announce my little one’s arrival as soon as he got here!

9) I would have professional prenatal photos taken.
This is something I really wish I had done before. I look at all the adorable baby bump photos around me, and sigh a little, wishing I had done the same.

10) I would have a professional photographer at my birth.
There is nothing as powerful as positive birth images. Images that reflect the intimacy, the intensity, the power, the strength, and the sacredness of birth.

There, that about covers it. I can come up with a few more, but I’ll leave that up to you! What would you do if you were pregnant again? If you’re already pregnant, what kinds of things are important to you? What are you doing to enjoy your pregnancy this time around?

Grace & Peace,
Tiffany

Interviewing Your Home Birth Midwife

Thursday, September 22nd, 2011

Interview Questions

  •  Why are you a midwife?
  •  What is your training? Are you certified? If yes, with whom and why? If no, why not?
  •  Are you licensed in the state of _____?
  •  What is your scope of practice?
  •  Are there any circumstances (physical, emotional, and/or spiritual) would you not take a woman as a patient?
  •  When would you risk out a patient?
  •  What is your style of practice (laid back, hands on, managing)?
  •  How much time will be spent with me during each appointment? Do you come to my home or do I come to your office?
  •  At what intervals will you see me during pregnancy?
  •  What can I expect at a prenatal visit?
  •  What routine tests are utilized during pregnancy? What if I decline these tests?
  •  What herbs or supplements do you like your patients taking during pregnancy?
  • At what point in labor do you normally arrive?
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water?
  • What does your cord clamping protocol look like?
  •  What do you do in the event a complication arises during labor or birth?
  • When would you transfer a patient?
  • What percentage of your patients do you transfer to the hospital? Cesarean rate?
  •  How are post-dates (post-42 weeks) handled in your practice?
  •  Do you ever encourage induction by pharmaceutical, herbal, AROM or other natural means? If yes, please describe.
  • What does postpartum care look like for me and my baby?
  • Do you have a midwifery student or an assistant that attends births with you? If so, what is her role?
  •  Who would attend me if you are ill, had an emergency or are at another birth?
  •  Briefly please describe the types of births you are most and least experienced with.
  • What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why? What is your perception of the role of a doula at a home birth?
  • Do you have a back-up physician?
  • What do your fees cover?
  • Do you take any insurances?
  • Should I take childbirth education classes? Do you recommend any? What do you cover?

Points to ponder afterward:

  • Did you feel immediately comfortable and heard at the interview?
  • Was MW willing to answer questions in detail without being annoyed?
  • Are you comfortable with her scope of practice?
  • Are her expectations of you reasonable?
  • Are your expectations of her reasonable?
  • Are you able to take full responsibility for your decisions with this midwife?

All Rights Reserved Desirre Andrews Preparing For Birth 2011

Affording the Birth You Want

Monday, February 1st, 2010

Many times over I have heard something similar to “If only my insurance would cover the childbirth class, doula, that provider or birth location. Then I could have the birth I really want for me and my baby.” That statement sadly says to me that women are settling for a provider, birth location, type of birth even that would not otherwise be chosen.  Even so far as having a repeat cesarean because the insurance covered location or provider does not “allow” VBAC.

So practically how is someone going to get the desired provider, location or birth? First think of appealing to the insurance company to add a specific location (even home) or provider (even a  home birth provider) to the plan. This may or may not come to fruition, but unless the process is undertaken it isn’t even a possibility. Second, think outside the insurance box.  Be creative. I am a believer that almost 100% of the time there is a way. It may not be easy, simple, or lack stress but likely possible.

Here are some of my ideas for paying for the birth location, care provider, education, or doula support really desired.

Ask for family, friends, co-workers to donate to fund(s) in lieu of routine shower gifts (you will likely not use most of that “stuff” anyway no matter how much you think you will).

Trimming Down = Money Savings

  • Satellite/Cable tv – Lower or cancel service.
  • Cell phone – lower minutes, negotiate new fee structure, change plans.
  • Household utilities – Lower thermostat, take short showers, heat or cold proof home.
  • House phone – Get rid of all extras on phone that you don’t need or go VoIP. Even set-up answering machine.
  • Food – Grocery shop sales only (no impulse buying), use coupons, eat at home, brown bag to work, no more fancy coffee drinks.
  • Entertainment – Get Netflix instead of going out to the movies, visit with friends or family in their homes or yours.
  • Shopping – Cut back on extras you do not need to live.
  • Vehicle – Car pool whenever possible, only run multiple errands together, walk if possible, use public transportation is available.
  • Housing – Move to a lower rent area or to a smaller home. Even consider moving in with family to maximize savings.

Extra Cashflow

  • Sell any unneeded items via yard sale or something akin to Craig’s List. This can apply to second vehicle as well.
  • Take on a second job that can be done from home or even with a multi-level company.
  • Ask husband or partner to temporarily take on a second job.
  • Do you gourmet cook,  write, musically talented, sew, knit, paint or craft? You may be able to sell your creations or services.

Miscellaneous

  • Barter
  • Ask for payment plan.
  • Look for less expensive supplies such as a “fishy pool” versus renting an AquaDoula.
  • Choose a birth center or a home birth as the cost is significantly less than even a no-intervention natural hospital birth. Also your prenatal care is included in the fee unlike a planned hospital delivery.
  • Hire a training doula. Often a lower fee.
  • Start a savings account before you are pregnant.
  • Plan ahead and pay down any existing debt prior to getting pregnant or in early pregnancy.

I hope some “light bulb” moments are had and there is encouragement in the ideas. There is almost always a way.

If I have left anything off the lists, please feel free to leave a comment and I will add.

Increasing your opportunity for a vaginal birth in a cesarean stricken culture.

Tuesday, August 4th, 2009

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

  • Take the ICAN webinar on cesarean prevention.
  • Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
  • Interview both midwives and OB’s.
  • Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
  • Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
  • Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
  • Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
  • Turn off your TV – stop watching the dramatic birth shows.  They are not real.
  • Use mobility in labor.
  • Drink and snack in labor.
  • Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
  • Say no the the epidural completely or at the earliest at 6 cm’s dilated.
  • Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
  • Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
  • Study yourself for what comforts, assures, and adds to your feeling of safety.
  • Eat healthy and exercise during pregnancy.
  • Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
  • For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
  • Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.