Saturday, April 23, 2016

What is Haibun?


  

   Today I attended Wordspring, a writer's conference at Butte College.  I took a workshop on cross-genre writing from author Gabrielle Myers, where we looked at the intersection of poetry and prose.  17th century Japanese poet Basho combined prose with Haiku, and called it Haibun. The form includes segment of prose followed by a 17-syllable poem, which is Haiku.  It often was used to describe travel scenes and experiences.  We each gave it a whirl.  Here is mine, a travel scene from my life, that happens daily at 8am.


       Reminders start a half hour before. "Fifteen minutes!" I lie. She is coiled, cobra-like, all seventy-two pounds of her crouched at her mirror, liquid liner in her hand. I yell to be heard over  the squeak of a Youtube make-up tutorial. Fifteen minutes later I call five minutes, then "Now!"  I pass her lunch, gather homework, fill water bottle, find socks.  Now, now, now, I beg. Combat boots are zipped.

      We emerge into the morning. "Forgot something!" she sings, dashes in again. My frazzle meter rises. Too many minutes later, she climbs into the car next to me. Belts click, door closes, we are off, late again.

  Annoyed, mad with love
I glance sideways at this girl.
Who will she become?



         Tee Hee.  After writing so much about our India adventures, it feels fresh to write about something, well, ordinary and close to home.

Haibun is easy and fun... try it!  Tip: most haiku are three lines:  Five syllable-seven-syllable-five syllable.  Feel free to post yours in the comments below.   



Tuesday, March 8, 2016

Sacred Ways Midwifery is Currently Closed

    While International Womens' Day dawns clear and pink-tinged, I announce with a deep sigh, that by decree of the California Board of Nursing, Sacred Ways Midwifery is closed. Please do not call inquiring about home birth services.


     I have served the mothers and babies of the Chico area for twelve wonderful years. I have had 100% healthy babies born under my care, and many families I have served have become like my own family.  It has been a gorgeous, love-filled, and profoundly meaningful way to make a living.  I have been honored to serve you.

   My nursing license has been placed on probation for the next three years, as a disciplinary action for charges related to two VBAC women I cared for in 2009. There was no lawsuit - but some local doctors wrote a letter of complaint to the Board of Nursing , and this is the result.  The conditions of my probation make it impossible to continue my work as an autonomous home birth midwife.  

   In witnessing hundreds of births, I have learned that one hallmark of women is Resilience, and I get to discover what next amazing work I am meant to do. In the meantime, you will see me at Wal-Mart, where I will be your cashier! (Just kidding!)

  There is still home birth available in Chico, just not with nurse-midwives.  There are two licensed midwives, Paula Emigh LM and Katarra Shaw LM who are working in the area.  It is within their regulations to attend VBACs, by the way.
Good luck, and blessings,

Dena



Saturday, January 23, 2016

Midwife Sisters


    
      "A midwife must have a deep love for other women.  She knows that all women, including herself, are sometimes as elemental as the weather and the tides, and that they need each other’s help and understanding.  The true sisterhood of all women is not an abstract idea to her.”
                                                                                -Ina May Gaskin,
                                                                                Spiritual Midwifery, 3rd addition


             :The true sisterhood of all women" is a concept that resonated deeply with me when I first read Spiritual Midwifery, twenty four years ago.  I was single and living in NYC, far from my California home.  My sisters/girlfriends were my family.   And they still are.  Over my twenty years involved in midwifery, I have seen that sisterhood is indeed a core value of the profession.  This sisterhood is one essential piece that I love about being a midwife.  Midwives train each other, help each other, advise each other, and just plain love on each other.  Because there are just some things that only a sister midwife can understand.   There is an unspoken code among midwives, that if a sister midwife asks for help, you must do your best to help her. We treat each other the same way we treat our mothers and babies;  with respect and integrity.

    I just want to take a moment to tell about midwives who have been instrumental  along my journey.  The story of my career is interwoven with powerful midwife sisters.  When I was a student midwife at Yale School of Nursing, I trained in a midwife-run labor unit at North Central Bronx Hospital.  My preceptor, Lynn Chapman Stern CNM, was a feisty, snarky, tall blonde who had previously travelled the world by motorcycle.  Lynn made working twelve hour night shifts where I would deliver up to four babies a shift, fun.  Her clear words of advice for gently delivering the head, shoulders, body of each baby, whispered in my head for years after our time together.

        When I wanted to study home birth, Rondi Anderson CNM let me come catch all the Amish babies in her rural Pennsylvania practice for a summer.  She attended nine Amish home births a month, so in a summer I got to catch 25 babies.  She arranged for me to live on a farm with an Amish family. Hippie artsy Yale student living with kind, simple Amish family - I treasure the memories.  I would drive through the cornfields to get to births, passing folks on horse-and-buggy, with Beastie Boys blasting on my car stereo.  And of course, being a part of twenty five peaceful, uncomplicated Amish births planted the seed of Trusting Birth indelibly into my being. 

   When my family moved to Chico twelve years ago, I met the only home birth midwife working here at the time - Diane Lawrence.  Paula Emigh,  the midwife of Birthdance Midwifery, was her apprentice.  Diane welcomed me to the community with open arms.  She showed me her office and even gave me the complete inventory of her supply closet so I would know what to order for mine.  My friend Cynthia Banks CNM sent me all the paperwork from her home birth practice in San Franscisco, to model mine after.  Paula and I both began attending home births on our own here around the same time.There has never been a sense of competition between us, but there has always been backup and support.  The one time in ten years that two of my clients gave birth at once, Paula came and saved the day.

     A couple years into my practice, a young student midwife landed on my doorstep with tears in her eyes.  Jessica Mairs LM had relocated her family to Grass Valley for an apprenticeship that  immediately fell through.  Although I was unsure that I was ready, I became a preceptor for her school and trained her for the next two years.  Now she has a thriving practice in Grass Valley, Sierra Homebirth.  When I hear about Jessica, the awesome midwife, I can't help but feel a little rush of pride.  A couple years ago Katarra Shaw LM joined the Chico scene with a third home birth practice.  She and I have shown up to assist at births for each other when needed.  And here we all are together, celebrating a wedding last year. 

The Midwives of Chico - aren't we something...?

   Paula, Katarra, and I have been working together with the Chico Birth Network. Our mission has been to create better communication and collaboration with Enloe Hospital.  We have made great strides in the last two years of meetings, building bridges to benefit the families of Chico when transfer of care from home to hospital is needed.  We also meet every couple months along with our assistants and students, to peer review complicated and unusual cases.  We tell the stories, listen, learn, and advise each other.  And  feast on the most deluxe potluck brunches ever. 
    
Finally ,Yelena Kolodgi CNM and Kavita Noble CNM , Bay Area home birth midwives have given me hours of support and invaluable advice as I have nagivated my bureaucratic proceedings with the Board of Nursing. The above link directs you to Stand By Your Midwives for more info on legal issues faced by California home birth CNMs.  My beloved friend from nursing school Sarah Shealy CNM flew up from LA for the day on her birthday to attend a Nursing Board meeting and speak up for home birth CNMs.    

These wonderful women, along with my assistants over the years, Serra Wells and Amber Eandi, show me again and again, that this term "sistering" that is buzzing around the web is no joke.  I will even take it further.  Here's what i think:   Women are the weavers of the cosmic web that actually holds the world together. 

Here's to you, ladies.

   

Friday, December 18, 2015

Happy Holidays !

   December has been a beautiful month for home births.   I love my job because I am always meeting new friends. 
Here are my two latest new buddies:




     Babies born in the Christmas season remind me that we are all precious, we are all miracles, we are all Children of God, if you will.   Every birth reminds me of the holiness of each human life.  May we all work together to bring Peace to ALL children around the world, and bring HEALING to our planet, the Mother of us all!

Okay, and on a lighter note, check out these Holiday Cookies for the Midwife who has Everything, baked by new Mom Ninette Daniele, whose son is in my arms in the above picture:





See you in 2016!

warmly,    Dena


Monday, August 31, 2015

September 2015 Update

Dear Friends,

     Thank you for your support while I have navigated a complicated legal situation between myself and the California Board of Nursing. In helping me, you help the cause of womens rights during pregnancy and birth, and keep access to health care options for the families of Chico California.

     There is still not a “final outcome” to this journey, but I do have some updates I would like to share. First of all, the donations I received from the Chico benefit concert in May and the Gofundme website have covered my legal expenses and the fines I am to pay the Board of Nursing. My family and I are deeply grateful for the relief of such a stressful financial burden.


  But beyond that, this outpouring of support has  rejuvenated my strength and my spirit.  Over the summer I spent a few weeks camping with my family.  I had quiet hours to sit by a rushing creek under green old growth trees in Oregon.  I finally had time to take in what a tremendous showing the Chico community made, when I reached out for help.

   I thought about the benefit concert - the hundreds of people who came out and donated and celebrated with me.  I thought of the 126 people who made online donations to my cause.  126!   I remembered the sight of our crew of mamas, babies either strapped on or else still inside round swelling bellies, working all day to put on a party full of flowers , art, music, food, drinks, and silent auction.   I know it was not for me, in an ego or personal sort of way.  It was for me because of I am Chico's home birth nurse-midwife.  It was a showing of love for myself and also for  the families I have cared for over the last ten years. 

    Your response to my call for help has re-inspired me.  I see how important my services are to the people in my community, and how much Chico values home birth midwifery.  I won't give up!  I will to continue to stand up for the rights of women and babies to have safe, gentle home birth experiences.    I thought I would close my business this fall, because I was feeling exhausted and defeated.  But thanks to all of you, I have changed my mind, and am still helping families.  Just last night, with the bright Super Moon shining on us through the sliding glass door, I welcomed a beautiful baby boy into the world.

    Statewide, there are  positive steps being taken improve the situation for nurse-midwives in home birth practice.    AB 1306 has been tabled for the year, but it unanimously passed the State Assembly, and will be on the ballot again in 2016. 

   In the Superior Court of California, a judge ruled that the Board of Nursing must allow nurse-midwife Yelena Kolodgi to continue her home birth practice while on nursing license probation. This took a year-long battle to get her back to work after her probation began, but hopefully sets a precedent for other midwives (such as myself) placed on probation.

Thank you for standing with me, and with Chico California mothers and babies.

Warmly,


Dena Moes RN MSN CNM

Wednesday, April 15, 2015

Clouds and Sliver Linings

Dear friends and supporters,

    First, the Cloud.
     Some of you may already know, and for some this may be new information.   This summer I face a legal proceeding between myself and the California Board of Nursing, in regards to a complaint made by a few local Ob/Gyn doctors back in 2010. 



The Silver Linings:
 1.   The California Nurse-Midwife Association has sponsored a bill that may be passed THIS YEAR to remove the physician supervision requirement for certified nurse-midwives in all settings;  home, birth center, and hospital.   The bill will fix  outdated regulations concerning nurse-midwives in California that will enable myself and others to provide our expert services without these legal barriers.

PLEASE SUPPORT AB 1306!   Go to www.MidwivesPASS1306.com to learn more and get involved.

Yesterday I spent the day lobbying for the passage of this bill in Sacramento.  I was touched to hear that my own personal case has served to inspire the timely authoring of this legislation, that will improve access to midwives for women all across the state.  A silver lining, for sure.  

2.  The beautiful babies keep on coming.    Here is one of the five beauties I was honored to welcome into the world last month!  This is Opal: 

3.  The support I am receiving from all directions has been profound and beautiful.  My home birth families, sister midwives, local filmmaker Skyler Andrew, and Elena Tonetti and her organization Birth into Being, with its nonprofit Sentient Circle, for starters.  Please visit my gofundme site here



With love and blessings,

Dena

   

Tuesday, December 2, 2014

A Tale of Two Cords

Dear Readers,

       Over the years I have been very careful to avoid criticism of our local hospitals in my words, and in my blog.  I am grateful to have safe hospitals nearby for those times when we need them.   My intention with this post is to bring to light an issue that is important , and needs to change.  Remaining silent in order to avoid sounding critical does not actually serve mothers and babies.  
     This post is  about  the baby's umbilical cord;   when and why it is clamped and cut, and the implications of that choice for the baby.  I will briefly discuss how my own management of the cord has evolved over the years, give some links to latest research, and then illustrate some important points with a story.
     I was trained in 1995 in a busy public hospital in the Bronx.  My preceptor taught me to always check for a cord around the neck once the head was born, and then "reduce" it,  meaning pull it over the baby's head, or clamp and cut it if it was so tight that I could not.  If option B happened, then we had to hurry to deliver the rest of the baby quickly as the baby's oxygen had just been cut off.  The cord, mind you, is what delivers oxygenated blood to the baby from the placenta in utero, during the birth, and if the cord is left alone, for several minutes postpartum.  During my studies I also learned about the myriad benefits of delayed cord clamping for the baby.  For a detailed explanation of those, please read this . Then I learned that in the hospital, when a baby is born compromised, and not able to start breathing on her own, the cord is cut right away so the baby can be rushed across the room to be resuscitated on the warming bed.
       When I began attending births at home many years later, I quickly realized that home born babies have this brilliant advantage:  If the baby is born compromised and not breathing, the cord is left intact, delivering oxygen to the baby just as it did in utero. The midwives resuscitate the baby right there beside the mother.  The first time I did this, I was amazed at the difference that I saw.  In the hospital, distressed babies are blue or grey in color as they lie on the warming bed, their lifelines severed so that the nurses can work on the other side of the room.  At home, our little non-breathing baby was pink instead of blue, getting her oxygen from both the cord and our ambu-bag until she perked up and could start breathing on her own. 
     Around that time, an article was  published in the ACNM  Journal, questioning the act of even checking for a cord around the neck in the first place.  The  study interviewed midwives in the U.S. and midwives in  New Zealand, comparing  various practices.  Lo and behold, New Zealand midwives don't ever check for a cord, and U.S. midwives always do.  And guess which babies do better?  Neither;  the outcomes are the same.  
       My third year of homebirth practice, I attended a waterbirth for a VBAC (Vaginal Birth After a Cesarean) mama. The head was born in the water, I reached in and checked for the cord, and sure enough there was a very tight cord around the neck.   I realized that  I couldn't possibly clamp and cut it with her in the birthing tub like that, so I just let it be.  That baby was fine.  Better than fine.  He was born, I unwrapped the cord from around his neck, lifted him out of the water and gave his back a little rub, and placed him in his mama's arms, pink and perfect.  I have never cut a tight cord since. It was an "A-ha!" moment.  You don't have to cut a tight cord.  Soon after, I studied detailed intructions on  "The Sumersault Maneuver"  by which the baby's  body can be  sumersaulted past the head to accomodate a tight cord during birth. .  Over the years I have attended births with the cord wrapped once, twice, even four times around the neck, without it ever being a problem for the baby.   And I am always grateful for that lifeline if the baby needs extra help breathing. 
    There has been a lot of research lately to confirm what homebirth midwives already know; babies that need resuscitation do better if the cord is intact.  Read about this promising study of preemies here.  Read about this beneficial practice in the developing world here   Also, there are efforts to develop technologies (like a lightweight board that can be placed beside the mother Wow wow. We use a plastic cutting board at home.)  so that our State of the Art, first-world hospitals can cease cutting cords to rush babies across the room. Read about a pilot program for that here.

Let me quote from these articles :
"When babies aren’t breathing at birth, doctors typically have to cut their umbilical cords and whisk them away from their mothers in an urgent attempt to resuscitate them. The intervention saves lives, but it’s a trade-off. These babies lose nutrient-rich cord blood that can help prevent brain damage and other complications."

“There is no expense and no equipment needed. All the attendant has to do is pause, let the baby breathe and then clamp the cord,”

   I was inspired to write this post by a beautiful birth I attended this week.  Here is the Story, as promised.  Thank you Mary for allowing me to share this.

A Tale of Two Cords.

     For Mary's first birth three years ago, her plan for a home birth changed when she went post dates and we discovered low fluid levels around the baby.  We went in for an induction to her local hospital, and with a little medication she went into labor.  Mary did a tremendous job laboring all night in the shower and on her birth ball.  My assistant and I served as her doula.  In the morning she was close to delivery.  She pushed for a few hours, and fortunately the baby's heart rate sounded terrific the whole time, showing the staff that he was tolerating the labor well.  We got very close to birthing time.  The doctor came in.  The baby's head was born, and there was a cord around the neck.  The doctor clamped and cut it.  Then, everything stopped for a few minutes.  Contractions, pushing, everything.  I felt this terrible sinking feeling when the doctor cut that cord, but now nothing could be done but wait.  Several minutes went by, baby half out, oxygen cut off.   Finally the baby came, grey and limp and in poor shape.  He was rushed off to the NICU .  $64,000 and five days of pokes, pricks, IV's and oxygen masks later, the baby was discharged home, healthy.  Mary said the nurses kept reminding her how wonderful it was, that they saved her baby.  I never said a word to her about that cord, but she knew that that was why her baby had gotten so sick.  "They saved my baby from a mistake the doctor had made, and expected me to be grateful for it.  And I was, but it was really hard." 
    This week, Mary had her second baby, at home, under my care.  She went into labor just after her due date, and her labor progressed quickly.  Her water broke as she approached the final stage of birth, and once again she had scant fluid with meconium.  There wasn't time to transport for this, so we readied ourselves to help the baby at home.  Mary gave birth on soft towels on the bedroom floor.  The head was born, and the little one spit out a mouthful of meconium (which landed on my nose but you didn't need to know that).  I reached a finger in to check the shoulders and felt a tight cord around the neck.  I withdrew my finger and let it be.  Just like last time, it took a little while for the baby's body to come.  Mary got up to a kneeling lunge, and the body slowly emerged.  The baby sumersaulted himself , I unwrapped the cord, and then just watched.  The baby looked around, waved his little fingers about, and then opened his mouth a took a deep breath.  His color went from purple to cotton candy pink.  The cord pulsed away.  This all happened in that silent, timeless moment we call the first minute after birth.  It was my first home birth since my year off in India and I felt honored to witness the perfect design, the perfect physiology, that is the miracle of birth. 
   
    
   Folks, don't all our babies here in Butte County deserve this beneficial care, not just the ones born at home?  I think so.  I know so.  Perhaps we can begin bringing awareness to our medical community that it is time to update their practices.  Let's not just stand by shaking our heads.  Some ideas: 

1.  write a letter to the nurse-manager of your local hospital, including copies of these articles I have linked to.
2.  Bring copies of these referenced articles to your next visit with your OB or hospital midwife, and ask to discuss these issues with them.
3. Join the Chico Birth Network, to promote safe and gentle birth;  contact me for info.  I welcome your ideas and input.