Empowering Birth Blog

Sacred Mountain Midwifery

There is more news on the midwifery studies front.  I recently decided to attend Sacred Mountain Midwifery School in order to complete my didactic training as a midwife.  Over the past five years I have been reading midwifery texts and attending study groups and conferences, but when it was time to plan the completion of the PEP process for my CPM, I realized I wanted a concentrated review of all the skills I need to become a midwife, the things I have been studying on my own for the past few years.  I considered several programs and in the end chose Sacred Mountain Midwifery because I wanted extensive hands on experience (that is how I learn) and because I have been attending their yearly Women Helping Women Retreat and really enjoyed the teaching style of the co-founder Dr. Sarita Bennett (Ruth Ann is fabulous as well!).  In my search, I realized that I wanted to learn from a midwife who had been practicing for years and years (Sarita has almost thirty years of experience as a midwife) and (since my husband and I still plan to return to West Africa, hopefully Mali or Senegal) I wanted to learn from a midwife who practiced in a rural setting where immediate hospital transport was not always possible.  Sacred Mountain Midwifery seemed the perfect choice for me and after my first session there in October, I can hardly WAIT to go back.

Having a baby in May will make things a bit tricky.  I will be 38 and 1/2 weeks pregnant when I attend the May session and unless the baby comes early, I will most likely miss the June session.  My whole family will come for subsequent sessions and camp so that my husband can grab the baby if he/she is being fussy.  But it is a fabulous school and we are committed to working it out.  Anyone want to join me?  It isn't in the most practical location (a good four an a half hour drive from my house, a good bit winding through the mountains) but the setting is BREATH-TAKING and cell phones don't work (you can receive calls if you are on call and use their phone) which makes my weekends there a retreat as well as a learning experience.

Baby on the way!

It has been ages since I've blogged.  I took July and August off to focus on family, and then in September our family had some surprising news, and I didn't really feel like blogging until it was time to share the news.  You guessed it, we are expecting our fourth!  

Quite a surprise I must say.  I've been using Natural Family Planning, and apparently didn't realize the effects of possibly being close to Menopause (I am 37) and throwing my schedule off so drastically by attending births.  I hadn't had any real signs of Menopause, maybe a tiny variance in one cycle, but I know it can strike at any time.  It isn't like you get a notice in the mail announcing "Heads up Menopause is around the corner, expect cycle variations!"  When we had sex I had ZERO fertility signs, plus it was six days before the earliest I've ever ovulated.  I know NFP says seven days to be safe but I had been charting for quite awhile and never ovulated before day 19, and usually not until day 21, so I felt safe.  And six days should be ok, I mean sperm only lives 5 days (at best!).  But then I went to two crazy births, back to back, one of which was very long, and I noticed a shift in my cycle. This little person was determined to come into our lives, and we are excited to become a family of six!

Looking back, I think this baby has many lessons for me, the biggest being that I can't plan everything.  I had neatly planned out the completion of the PEP process and the latest date I would take my NARM exam (I had planned to take it by August of 2012).  I was also going to finish my Birthing From Within certification.  Now everything is up in the air, and that is ok.  While I can, I am plowing full speed ahead with the PEP process.  I have been on a roll with daytime births (five in a row!) and at 13 weeks on Wednesday, I am feeling like I am about ready to handle an all-nighter again.  Finishing up the PEP process will depend on whether or not families are willing to let me attend their birth with a newborn for part of their labor.  I am just not willing to be away from a newborn for any length of time until they are at least 9 months.  And of course I will be taking four months off (my last 4 weeks of pregnancy, and the first three months).  So I might not take the NARM exam until February of 2013, and that is ok.  It is good to be forced to be flexible, I am learning my lesson (smile).

So I am "due" end May (my third May baby, although this one might come in June) and I am using my good friend and fellow student midwife as my midwife (with preceptor present of course so it counts!).  I think it might have just been my husband and I (with a knowledgable friend nearby if needed) if I wasn't a student midwife and 110% committed to students.  We NEED more midwives in our area and I will be honored to be submitted as a "Continuity of Care" birth (at least 3 of the births attended by CPMs need to be women that have been seen by the student over the course of a pregnancy for at least 4 prenatal visits).  Oh and of COURSE we are having the baby at home.

Last week I attended the birth of a ten pound baby, no suturing needed!  I have been at quite a few births with nuchal hands (left or right hand up by the face), in fact, I have been wondering what is up since we are not the only ones seeing so many nuchal hands.  Each birth I attend blows me away and reminds me how incredibly amazing women and their partners are.  It fires me up that CPMs are legally authorized to attend home births in only 27 states.  Women NEED access to midwives and home birth should be an option, in EVERY state.

Well, my little one calls so I must run.  We are in the process of weaning (she is two and a half, and I have a hard time nursing while pregnant), down to three nursings a day.  So I need to help her work through the fact that we no longer nurse after nap...  I hope that IF I have any regular readers left, that all are well.

Peace

 

Why I Need to be a Midwife

Hello all, I thought I would share a piece that I just wrote about why I need to be a midwife...

Revised 7/24/10 After a week in New Mexico

Why Do I Want to be A Midwife?

Why do I want to be a midwife?  How many times have I thought or written about this, each time going a bit deeper, peeling the layers of an onion, one thin and translucent layer at a time.

On a trip to New Mexico, standing half in the hot sun at Ohkay Owingeh festival, watching the Dance of the Deer, I achieved clarity on what I had always known but had not yet spoken or written.  I need to be a midwife because it is my connection to that which is sacred.

I thought being a midwife was about empowering women, or about organizing in my community, the community of women, (rather then as an outsider, organizing in another community), or about creating peace on earth.  It is about all those things but there is something deeper.  Being a midwife is about following my bliss, connecting to the sacred, a connection I believe every individual must find in order to be fully alive.

During the three years I spent in West Africa, I felt as close to God as I had ever been.  I  initially thought I was called to West Africa because I was angry with “white culture,” but now I know it was God calling me to truly taste what is sacred, in order to make me hunger for it in the years to come.  I think cultures closer to the earth embrace the sacred in daily moments, moments which can be few and far between in the U.S.  So few and far between that I had to travel to Mali to really understand the sacred.  Admittedly I caught the sacred here and there, a Cathedral in Paris, a sunrise on the Gulf of Mexico, and in Gospel Music (which is why I continue to sing and feel unrooted when I am not singing).  But standing in the half sun in New Mexico, I acknowledged that I find the sacred in every birth.

But there is more.  At the Georgia O’Keeffe museum in Santa Fe I read, “Singing has always seemed to me the most perfect means of expression.... It is so spontaneous....Since I cannot sing I paint.” (Georgia O’Keeffee 1922).  And my soul said YES and because I cannot sing or paint, I will midwife.  I do sing, with my gospel choir, but I don’t think that anyone will hear my voice, and soar to the heights that I have soared in Mali at a drumming circle, or at a birth, or when I listen to Kirk Franklin.  But maybe, just maybe, if I can hold the sacred space when I midwife, then the family will connect to the sacred, and then in the U.S. our connection to the sacred will deepen, one family at a time, one birth at a time, and there will be healing.

I've Been Busy and I Can't Do it All

I have been sitting with the harder realities of the Birthing From Within Training, that there are some things I must leave in the underworld, and regular blog posts are part of what I must leave.

I am busy!  I have joined a regular study group so that when I begin formally apprenticing (when Nettie is bigger) I can focus on births rather then studying.  We are reading through Anne Frye's Volume II and meet twice a month.  

I am birth assisting, one birth a month (sometimes two) until Nettie is bigger. I've started to count my births as part of NARM's PEP process.  I attended a beautiful birth a week and a half ago.  The mom had very supportive and loving friends but the mom noted that when her friends surrounded her, she looked to them to take her pain away.  After more then a day and a half of supported labor, she tried laboring alone.  The shift was dramatic.  Before laboring alone, the mom played the role of the patient, hobbling to the bathroom, supported by others, looking to us, rather then within, for guidance.  When the mom labored alone, she found the strength to walk down the hall into the office, grab a chair to support herself, and carry it back to her bedroom to labor.  She arranged chux pads neatly under her to catch fluids and labored peacefully, diving into and befriending the pain. The mom noted after the birth that she felt so much more grounded when laboring alone.

I have been spending a lot of my free time (not much of this with little kids) helping re-organize a midwifery organization with the hope that we will pursue legislative efforts in our state.  NOT because I need a license but because women should have REAL choice when it comes to birth and because I believe we would have more student midwives if it was legal for CPMs to practice in our area.

With a group of neighbors, I started a small, neighborhood, Montessori co-op pre-school.  Tons of fun and a lot of work but so good to know that my kids have a group of neighbors they know and love and can be with when I am at a birth.

So that is what I've been up to.  I plan to blog once a month, twice if possible, but I can't promise much more at the moment.

Moving Slowly

Our new neighbors our wonderful and are doing a lot of neat things, many of which resonate with my own passions.  I learned today that one of them is helping a midwife friend set up a non-profit in Malawi.  The non-profit, The African Mothers Health Initiative works to create an environment in which women are free to experience and appreciate the birth process and motherhood as one of the great joys of human existence.  The midwife who started the non-profit has a blog, Babycatcher which I will be adding to my reads.  

I just finished reading Monique and the Mango Rains and have been reminiscing on my almost three years in Mali.  Yesterday I felt the deep ache of yearning that sneaks in regularly now that I have an infant again and am not attending births.  It has been almost a year since my last birth.  I vomited regularly during my pregnancy with Nettie and after a beautiful December birth (during which I barely succeeded in concealing my regular trips to the bathroom to get sick), I decided to stop attending births until my baby was out and bigger. I have another birth in December and will slowly start to attend again but sometimes it is hard to push away the thoughts, "I want to be a midwife right now!"  The senior apprentices were all aglow with stories of births at prenatals yesterday and my ache was palpable.  There is so much to do and yet what I must do right now is mother, that IS enough.  In order to move myself into the moment, I attended a late night yoga class, late for this mom of a little one who is waking several times to nurse at night.  Ah, yoga.  There is nothing like yoga to bring you back to the present moment, to nudge you back into balance.  I try to move slowly.

But Babycatcher's recent post gave me a taste of my distant future.

Looking for Student Midwife

I am posting this for a friend:

Hello Midwives and aspiring midwives,
I am just letting everyone know that we have a student opening for Feb 2009 here at the Northern New Mexico Midwifery Center. For more information about our program see the attached flyer and visit our websites: www.midwiferycenter.org and www.taosbirth.blogspot.com Please feel free to pass along to anyone you feel may be interested.

Back to Prenatals!

Nettie is three months!  We sold our house and are living with friends (by the time we had sold our house, all of the houses on the market in our price range that fit our family's needs had sold). Life in a small one bedroom apartment with a family of five is challenging but we are lucky to have friends who had space for us when we needed it and sharing the duty of cooking meals is a bonus.  Thankfully our friends have a huge yard so when quarters are tight I send the kids swiftly out the door.

This morning I dropped off Fen at the babysitter and headed a few blocks down the road to attend prenatals with my midwife.  It has been awhile and the doppler felt a bit clumsy in my hands. I had trouble counting the fetal heart-tones with my watch (adding the seconds up is a bit much for my tired brain) and my midwife suggested I buy a watch with a sweep hand (now why didn't I think of that!). Interestingly enough, if I just listen with my ear, I am often right on the mark.  Nettie slept happily on my back during most of the morning.

I met a beautiful couple.  The mom had had three cesareans and one vaginal birth and was hoping to have a second vaginal birth despite the fact that her doctors are eager to schedule her fourth cesarean.  I wish them all my luck on their journey and feel blessed to enter the lives of so many people as they birth their babies and watch them grow.  If you have had three cesareans, home birth is really your only choice around here.  There is a doctor who will attend VBACs after two cesareans but if you have had three, you are pretty much on your own.

Are you in labor?

So the second question my friend's birth brought up is when are you in labor?  My friend noted that she was a bit confused as to when her midwife wanted her to slow down labor and when she was supposed to follow her labor instinct, which included choosing positions that would speed up labor.  So deciding when to slow down labor and when to let it run its course probably depends a lot on answering the question, "Are you in labor?"  The midwife seemed to think my friend was in active labor because she was 4 centimeters dilated and requested that my friend stay at the hospital because things could happen very quickly (she was sent home 24 hours later and returned the next day to birth her baby).  There is, however, a lot more to labor then dilating.  How strong are the contractions, how effaced are you, how ripe is your cervix?   Again I have to reference the tape on Prolonged Labor by Diane E. Barnes, CNM and Gertrude L. Welsh, CNM, NP from "Midwifery Today's Clinical Tape Package".  In order avoid improperly labeling a labor as prolonged, the midwives take a good hard look at whether a mom is in labor.  They look for adequate contractions (your uterus should feel as hard as your forehead during a contraction) and cervical change (softening, ripening, change in the position within the pelvis as well as dilation).  They look carefully for other reasons, such as lack of rest/nourishment/hydration, infections (especially UTI) and build-up of lactic acid in the uterus, that might cause contractions but don't indicate labor.  The midwives warn against starting the labor clock until there are adequate contractions AND cervical change in order to avoid labeling a labor prolonged when it hasn't even begun.   I think it is even more important to be careful about noting when labor starts if your client is going to give birth in the hospital. 

My friend began to experience regular contractions on Tuesday morning and had her baby on Friday morning (72 hours later), but did she really have a 72 hour labor?  Did the clock start on Tuesday or did it start when the contractions started to really pick up despite the wine/rest/hot bath?  If you start the clock later, perhaps mom won't feel as though she has been in labor forever.  And was it the fact that it was a pre-term labor the reason the midwife was less clear about when it was ok for my friend to assume positions that would speed things along?  Until it was determined that there was no turning back, why speed things along?

And wouldn't it be nice if caregivers were better at explaining prodromal labor and didn't tell their client's that there will be a baby around the corner just because mom is 80% effaced and 3 centimeters dilated (a mom can hang out like that for days, even weeks).  Babies come when they come.  There are times when we would all love to know when they will come but that is knowledge we can't have.

So much to think about!  So much to learn!

Premature Labor?

My friend just had a 72 hour labor.  WOW, 72 hours, now there is a number that could get a mom really discouraged.  It was preterm labor (35 and 1/2 weeks) and her midwife offered morphine to help her rest (which would mean staying at the hospital), I suggested home, rest, hot bath, and wine.  So this birth has gotten me thinking about two things.  One, when is a mom in labor, and two, what is a good way for mom to get rest/slow down contractions.  I don't think I am ambitious enough to tackle both in one blog post so let's start with helping mom rest/slowing down labor.

In Spiritual Midwifery, Ina May writes:

"If there is no bloody show and there is no or very little dilation of the cervix (less than 1 cm), give the mother a full glass of water followed by a glass of wine.  Alcohol is a depressant, and it suppresses the release of oxytocin from the pituitary gland.  It works well for stopping labor in the third trimester.  Alcohol should not be given in the first two trimesters to inhibit labor because of possible damage to the developing baby.  The woman should stay in bed and everything should be as nice and quiet around her as possible."1

Now my friend was 4 centimeters dilated, not one, but the midwife was offering morphine so my thought was, if wine works (and there is no history of alcoholism in the family), why not?  And the wine was indeed a tremendous help.  It slowed down my friend's contractions, helped her manage a long labor, and possibly helped keep the baby in her an extra two plus days, which got the baby a lot closer to 36 weeks.

So a few days after my friend's birth, I was listening to the tape on Prolonged Labor by Diane E. Barnes, CNM and Gertrude L. Welsh, CNM, NP from "Midwifery Today's Clinical Tape Package" and the CNMs were discussing ways to help mom sleep when she is faced with a potentially long labor or just really needs some rest.  Instead of morphine, they recommend 50mg of Vistaril and 1000 mg of Tylenol.  If the mom's contractions are more painful, they suggest giving a Tylenol #3 (with codeine) in addition to two regular Tylenol). Apparently the midwives have had success promoting the Tylenol/Vistaril combination to hospital doctors as an alternative to morphine.   Among other things, lack of rest, nourishment and hydration can also encourage pre-term contractions, so before tackling the problem of how to help mom rest/slow down those contractions, you should ask mom are you hydrated/how much rest have you had/what have you been eating, etc. etc.?

Which brings me to another thought.  One of the midwives on the tape noted that she didn't believe in Braxton-Hicks contractions before 36 weeks.  She felt that contractions before 36 weeks were due to an irritable uterus or a sign of potential preterm labor.  What an interesting way to think about uterine contractions.  If there is no such thing as Braxton-Hicks contractions before 36 weeks, then if you experienced contractions before 36 weeks, you might think to yourself, I need to hydrate/rest/nourish myself.  If Braxton-Hicks contractions can be experienced before 36 weeks, you might think to yourself, oh, there goes my uterus again.

In any case, my friend said no to the morphine, returned home after laboring in the hospital for a while, took a few hot baths, rested, had a glass or two of wine, and these things seemed to slow her labor down, keep baby inside for a few more days, and gave her the energy she needed to birth her baby when the time came.  I should add that my Midwifery Tape on Prolonged Labor did not recommend wine due to fetal alcohol syndrome, but if Ina May recommends it, alcoholism doesn't run in the family, and you are in your third trimester, I can't help but think it seems like a good idea.  A mom I know who is German mentioned that a glass of wine or beer is a common recommendation for moms in early labor.  What do you think?  Oh, and if you have Spiritual Midwifery, there is a great birth story on page 70 of a mom who uses wine to stop pre-term labor.

Post to be continued....

1 Ina May Gaskin, Spiritual Midwifery, Fourth Edition (Summertown, TN:Book Publishing Company, 2002) 425.

RN?

I am toying with the idea of pursuing an RN.  There is an accelerated program at Johns Hopkins for people who have an advanced degree.  If I could get in, I could complete my studies in only 13.5 months! I've been thinking a lot about how to add to my knowledge base while the kids are young and I don't want to be an apprentice that is continuously on call.  Since six months at Maternidad La Luz is not a realistic option for a mom of three, I was thinking an RN (specialize in labor and delivery of course) might be another way to increase my knowledge of birth (become adept at putting in IVs etc. etc.) until the kids are all in school full-time.  Another benefit of an RN would be to better understand birth in hospitals, with the future goal of having necessary transports go more smoothly, and to better understand the current system of obstetrical care so that I can successfully communicate necessary reforms to the medical community.  An organizer at heart, I have always felt that I would become involved in organizing for better births on some level in the future.  As an RN (as well as CPM of course!), will the medical community be better able to hear me?

I have to admit, I think the RN idea was planted in my head after reading Navelgazing Midwife's blog entry written after reflecting on The Business of Being Born.  After my initial reading I thought, good post, but didn't realize that the post would end up marinating in my head.

And finally, I wanted to include a link to another blog I found (thanks for linking to me!).  So check out Bellies and Babies! Some day I will have to update the blog links on my menu, make my blog more exciting, etc. etc. etc., but for the moment, I am just grabbing a minute here and there to write!