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   The bill will fix  outdated regulations concerning nurse-midwives in California that will enable myself and others to provide our expert services without these legal barriers.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 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,



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.  

Wednesday, November 5, 2014

A Poem for Mothers


“Where have I come from, where did you pick me up?” the baby asked
its mother.
She answered, half crying, half laughing, and clasping the
baby to her breast-
“You were hidden in my heart as its desire, my darling.
You were in the dolls of my childhood’s games; and when with
clay I made the image of my god every morning, I made the unmade
you then.
You were enshrined with our household deity, in his worship
I worshipped you.
In all my hopes and my loves, in my life, in the life of my
mother you have lived.
In the lap of the deathless Spirit who rules our home you have
been nursed for ages.
When in girlhood my heart was opening its petals, you hovered
as a fragrance about it.
Your tender softness bloomed in my youthful limbs, like a glow
in the sky before the sunrise.
Heaven’s first darling, twain-born with the morning light, you
have floated down the stream of the world’s life, and at last you
have stranded on my heart.
As I gaze on your face, mystery overwhelms me; you who belong
to all have become mine.
For fear of losing you I hold you tight to my breast. What
magic has snared the world’s treasure in these slender arms of

Rabindranath Tagore(India (and Bengal)'s first Nobel laureate)

Saturday, August 16, 2014

Special Announcement: I am back in Chico!

Dear Clients and Readers,

  We have returned from our voyage to India and beyond, and I am now available for midwifery services.  Feel free to call me at 530-828-9435 for information.

Thank you,


Tuesday, July 31, 2012

In a Mother's Words; A Home VBAC Story

 Here is a guest post by Chico mother Michelle Burdette

In Praise of Midwives: A joyful HBAC experience

Avery Marie Burdette was born on November 16th in the comfort of her own home. Her father lovingly supported me through labor and was able to see his daughter’s first breath. Dena Moes and her assistant Amber guided me along the journey and delivered Avery on their knees on my bedroom floor. I feel so blessed to have had this experience and were it not for Dena and the option of home birth, I would have had to undergo a repeat cesarean section.

I distinctly remember sitting in the doctor’s office after viewing my first ultrasound and discussing my birthing options. The doctor stated that I could not have a VBAC in the hospital due to regulations. He then stated that there was one OB/GYN in town that would sometimes “let” his patients labor until it was too late for a C-section, but he would generally end up doing a C-section in most cases.

I did not like any of these options! I felt trapped, like I had no choice but to go ahead with a scheduled C-section. I saw this doctor a few more times and was very depressed about the actual birth my child was going to have. You see, I did not get to experience my first daughter’s birth at all. I had an emergency C-section for footling breech presentation. I did not get to see her until an hour after her birth. Her father was able to hold her soon after she was born, but it pains me to know that no one familiar to her was there when she was born. I wanted this birth to be different, and now I was being told that due to a policy, I could not have the birth I wanted.

During a family get-together, I was discussing this situation with my cousin’s wife. She told me that they were planning on having a home birth and gave me reading material. I told her that I did not think home birthing was for me, but thanked her for the information. One of the articles she gave me was written by Dena Moes, CNM. The article was all about VBAC’s at home and I was inspired by the strength of her experience and her conviction. I was overjoyed to learn that she was a midwife in Chico and that there was another way for me to give birth.

I read everything I could get my hands on and discovered so much information that I wish I had known before giving birth to my first child. Who knew that Pitocin could be so problematic? I had no idea that I could have any say in my birth outside a “birth plan”. My husband and I met with Dena and were given the great news that I would be a good candidate for a home birth after C-section (HBAC). We were very nervous because this was outside the norm of what all of our friends and relatives had chosen. My family was nervous about birthing at home and worried that something catastrophic might occur. My husband and I looked at all of the statistics and were far more worried about birthing in a hospital setting. When we told people that we had decided to have our baby at home, people said things like: “you are so brave”, and “Aren’t you worried?”. Only a few people voiced their support.

We met with Dena throughout our pregnancy and with each meeting felt so blessed to be getting a home experience. We would meet in Dena’s office and there was a flannel sheet on a comfy table with a real pillow! There were no metal stirrups for your feet, no hospital gowns and no one pushed me to get testing done due to my advanced age of 37. I felt comfortable and like pregnancy and birth were natural, not fraught with peril. It was a gentle and holistic experience. We also attended a child birth class taught by Serra Wells that supported home birth as a viable choice. It was so helpful to meet others who had chosen home birth.

The day before my daughter was born I went to my regularly scheduled appointment with Dena and she informed me that the contractions I was feeling were the real deal and that we would be having our baby soon. There was no sense of emergency, just warmth and excitement radiating from Dena and Amber. This was so reassuring that I was able to enter labor with joy and confidence. Dena and Amber were very supportive throughout labor and the birth of our daughter. They helped guide me through the final stages of labor and calmly helped our baby into the world. Avery took a little bit to breathe, but Dena cleared her lungs and gave her a little puff and she cried her first little cry. With a home birth, the umbilical cord remains attached to the baby and the placenta until all of the blood has returned to the baby. This allowed Avery to remain at my feet receiving oxygenated blood rather than whisked off to a table in a delivery room. I was able to hold my baby right away and experience all of her first moments. This was so incredible for me as I did not get to be with my first daughter until she was an hour old.

Dena and Amber remained with us for several hours after Avery was born, unobtrusively checking us to make sure we were both doing fine. A defining moment occurred when Dena was helping me after I took a shower. I was still a bit unsteady and she actually dried my legs off for me. I can’t imagine a hospital setting where a doctor would deliver your baby, fix you breakfast and then dry your legs after a shower! I was so pleased that Dena and Amber would be back to visit us several more times in the week following Avery’s birth. I did not feel alone or abandoned as I had after the birth of my first child. I owe a great deal of thanks to Dena for allowing me to trust my body and the process of birth despite a prior C-Section. Our home birth was a beautiful and powerful experience. My husband and I are very grateful to Dena for providing women the opportunity to birth at home and to have a natural birth after a C-Section.
Thanks Dena and Amber! Michelle Burdette and Family

Monday, June 25, 2012

Epic Birth Journey and the Midwife's Bag of Tricks

   The longest day of the year was celebrated in high style at Sacred Ways Homebirth, with one of the longest home births of the year.  Much congratulations and love to Ajay and Walker, who have given me permission to inspire others with their heroic journey into parenthood.  
    There is usually a big difference between the labor of a first time mother (primip) and that of a second or third or fourth time mother (multip).  Once you have given birth to a baby, the next one is remarkably faster and easier.  This spring my assistant Amber and I attended several multip births where we arrived, set up, hung out for an hour or so, and the baby came out.  Lovely, beautiful births;  happy families; midwife home for dinner.  Then came our first-time mama Ajay's birth.
   Ajay began her labor on Sunday afternoon.  Contractions were 10 or 15 minutes apart and Ajay did exactly what was best for her;  carried on with her day alternating between activity and rest.  She tried to "rest" at bedtime, but by then they were a consistent 10 minutes apart.  By 2 am she was uncomfortable and in a regular labor pattern, and made the call to us.  When we arrived I could see that her contractions were strong and in a good labor pattern, but that she had a way to go.  She asked if I would check her cervix, but I procrastinated and put her in the birth tub instead.  I had a hunch she was a small amount dilated, and I didn't want her to get hung up about that.  (Midwife trick #1)
    The birthing tub was just the thing for her.  She relaxed beautifully between the contractions, and moved through the water during them.  Walker got in the tub and held her.  It was dark, with candles lit.  We gave them privacy;  they got sensual and snuggly. (Midwife trick #2)  The contractions got stronger and closer;  a sign that the labor was progressing well.  At 6 am she got out of the tub and I checked her - 7 cms!   An hour later she felt "some pressure"  and wanted to get back in the tub one more time before pushing.  Two more hours of hard labor went by.  We checked again and found  - 8 cms.  That is only one centimeter more in three hours- ugh.  Ajay's progress had stalled.  I could feel that the baby's head was not down against the cervix because the bulging bag of water was in the way.  We decided to break it, which would bring the baby's head down and hopefully help finish the dilating.  (Midwife trick #3).
    With her waters broken, Ajay walked around and worked with the intense sensations.  I could tell she was losing steam.  We fed her miso soup, a whole bottle of Recharge, and put her back in the tub.  She was so tired, she started saying things like "I can't do this anymore.  This isn't working.  The baby won't come".  I knew that the baby could come.  She had in her favor:  1. The baby in an excellent position, NOT posterior.  2. an excellent labor pattern of strong, long contractions.  3. She had stayed well hydrated.  4.  The baby was doing great;  perfect heart tones, clear fluid, and movement.   But I needed to change her mindset, because I could feel that emotionally I was losing her.  I told her we would not make her do this forever, but let's give it one more hour to get to complete dilation.  I gave her a homeopathic remedy, caullophylum.  (Midwife trick # 4) Then I gave her affirmations to say with me, instead of  "I can't."  They were something like "I am allowing body to open.  My cervix is opening now."  I said it with her, Amber said it with her, Walker said it with her.  As she repeated the words, she relaxed and became centered again.  It worked.  (Midwife trick #5).  At noon there was just an anterior lip of cervix remaining.  I had her push mightily while I lifted the rim of cervix up and over the baby's head.  (Midwife trick #6) 
     Ajay is a strong woman, an Enloe  nurse I might add!  She munched some chocolate covered almonds (Midwife trick #7), downed another bottle of Recharge,  sat on the birth stool, and pushed.  She felt the pressure and she pushed and pushed and pushed.  She got up and pushed on the toilet, (Midwife trick #8) tried several different positions including standing lunges (Midwife Trick #9), and pushed and pushed and pushed.  The baby did not really budge.  At all.  After two hours.   In the hospital, this would be called "arrest of descent"  and a cesarean would be done for the baby "not fitting through".  Hmmmm.   I sorted through all the files of past births in my brain, to find one last trick.  I remembered a birth many years ago.  "Ajay, "  I said.  "Stop pushing now.  Let's have you take a break and just stand in the shower for a little while" (Midwife trick #10)  Ajay enjoyed the hot water coursing over her, and I guess she grabbed something and squatted during her contractions because after ten or so minutes alone in the shower she yelled " Something is bulging in my butt!"  Eureka - that something would be the baby!   I popped my head in, saw that progress had been made, and kept her in there another ten minutes.
     Back on the birth stool, we could see the baby's head peeking through.  The baby had come down through the bones, and was almost here.  With each push now, progress was made, although it was still slow.  We heard a deep drop in the baby's heart rate for the first time. We heard it again.  It recovered, but I told Ajay that it was time to just have the baby now.  Finally, finally, the head came through, the baby slipped right about, and Ajay's nine pound baby arrived.  He was dusky and his  breathing was labored, so we rubbed him up, talked to him, and let the pulsing intact cord keep providing him oxygen. (Midwife trick # 11) We gave him blow-by oxygen and his color turned a rosy pink (Midwife trick #12)  Once it stopped pulsing we cut the cord to take him in the steamy bathroom with the hot shower running full blast.  The hot vapor did the trick, and his breathing was easy and regular by the time he was ten minutes old  (Midwife trick #13). 
        Then Mom, Dad and Baby cuddled into bed.  Chicken enchilada casserole was warmed, and things were quietly tidied while bliss and bonding occurred in the family bed. 

  With that twinkle in her eyes and glow of her grin, would you guess Ajay had just labored for 24 hours?   Would you guess it took her 6 hours of labor to get from 7 cms to 10 cms?   If she had planned a hospital birth, she would be in surgical recovery, instead of here.  This is why home birth is important.  The truth is, women are stronger than one would ever believe.  Birth works, folks.   Now I am off call for a month, for family time.  Happy Summer!  

Tuesday, June 12, 2012

Emotional Freedom Workshop at the ACNM Conference

    I was blessed to attend the ACNM (American College of Nurse-Midwives) conference and annual meeting last week in Long Beach, CA.  Not only did I attend, but I was a presenter.   My offering was a four-hour workshop entitled Healing Trauma for Mothers, Families, and Midwives with EFT (Emotional Freedom Technique).
    Twenty-two midwives signed up for my workshop.  Many were directors of large practices, university faculty midwives, and pioneers in the midwife movement.  I was humbled and deeply moved by the honor of teaching this energy healing work to them.   I created a healing, sacred circle for these powerful midwives, complete with an alter in the center.  The workshop was experiential.  We learned about EFT, and then practiced healing each other.  Several of my sister midwives experienced profound healing.  It was beautiful to witness these women, who give so much of their lives in service to mothers and babies, take care of their own emotional well-being.  Here they all are, at the end of the workshop:

     Aren't happy, emotionally tended midwives beautiful?

    Two summers ago, I had the opportunity to study EFT with an internationally acclaimed EFT trainer named Sonia Sophia Illig   ...    Sonia's Website here   .  EFT is both a talking and a physical / energy therapy.  As you talk about your emotions, you "tap" on acupuncture points in a relaxing, beautiful series of movements.  This combination of reviewing your trauma and the emotions around it verbally, and tapping on the points, actually releases the trauma from the nervous system and tissues.  It is easy to learn and do, and results occur quickly.  Emotional pain is diminished  and a person feels lighter, more clear, and free.

    I use EFT in my midwife practice when painful emotions and past traumas are identified during  prenatal visits.  It is so empowering to be able to heal emotional pain, right there, in the office. Before I knew EFT I would listen compassionately to women's stories and feel frustrated that I couldn't do something to fix it other than offer referrals to therapists and healers.  Now I say, I can help you heal this;  lets do some EFT on this.  All VBAC clients must do at least one session with me. (See my other VBAC posts for more on this).
      The workshop at the ACNM conference really became about healing the healer.  Self-care for midwives is vital; we carry so much responsibility and often take difficult births or outcomes personally.  Midwives tend to burn out, and have health problems and divorce rates at record numbers.  There are little to no professional avenues to process the trauma midwives experience, and it was amazing to bring that to the American College of Nurse-Midwives.  
   A neat thing about EFT is that you can use it on yourself, and then easily use it to help others.  When you are healing others, you get healed as well.   Here is what one attendee said about my workshop:

  "Hi Dena,
I really appreciated the EFT learning session, which you offered at the ACNM conference 2012. It was wonderful. I'm a CNM who offers Home birth and Birth Center births and always love to learn alternative modalities to offer to our mama's. Attending your workshop gave me new tools for my clients but, also for all of the Midwives and staff who I work with. What a wonderful healing opportunity we now have to offer to the healers themselves.
Within days of your workshop, I was able to offer the healing modality to one of my pregnant clients. She tearfully thanked me for the comfort it provided and planned to use it at home as well, to continue with her self healing.
How empowering, I thought. Love it.
Thank you for bringing this loving modality to us.
Blessings, Lorri
 PS, you can use this as you see fit. Good luck. hugs

Lorri Walker, RNC, NP, CNM
Founder & Director
South Coast Midwifery & Women's Health Care"