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"


Sunday, April 1, 2012

Two Equinox Babies; Part 1

    I was blessed to attend two sweet births last week, within the three days around the spring equinox.  Both families were repeat customers of mine.  Their darling toddlers know that I helped them into the world as well.   I will share these beautiful birth stories in two posts.   
    Vanessa went first...she called me at 3:30 am on March 19th.  I rolled out of bed and was off.  She was having her third baby so I knew there was not a lot of time to spare.  I arrived at her house where she was laboring in the tub, her husband Adam by her side.  She has quick, intense labors, and goes deeply inward during the process.  I peaked in on her, and then went to set up my equipment for the birth.  Her two daughters were asleep in their beds and her mother was making a quiche in the kitchen.
     A half hour later she got out of the tub,  and I noticed some red bleeding .   It was a small amount, but noticeable.  Vanessa had had a marginal placenta previa (the edge of the placenta was located over the cervix) at the beginning of her pregnancy and had some bleeding from it at 18 weeks.  The placenta moved out of the way of the cervix as the pregnancy progressed, which we had confirmed by ultrasound recently.   I put my doppler on her belly to listen to her baby's heart rate and it was low, in the 60s, and then climbed back up to normal, 120s.   Hmmmm, I wondered if the ultrasound was incorrect and the placenta margin was being exposed as the cervix opened.  The more common reason for some bleeding and a drop in the heart rate is that the cervix is opening quickly and the baby is suddenly moving into the birth canal.   We listened again through a contraction and heard the heart rate drop down again for a minute or so.  Adam looked at me.  "Should I call 911?"  "Okay" I answered, not convinced this was an emergency but playing it safe.
   Vanessa flipped over to her hands and knees and we continued to listen to the baby, whose heart rate soon returned to normal.  The bleeding  stopped.   The heart rate dropped a little bit during the next few contractions, and then didn't drop at all.  When the paramedics arrived, they peaked into the room where Vanessa was laboring on her hands and knees on the bed while we listened to the baby's heart rate.  The head paramedic assessed the goings-on in the room, and said to me, "I see you have everything under control, just come out here in the hallway and tell me what is going on."  I was pleased with his respectful, hands-off attitude.  I stepped out of the room and gave him report; what had happened and how my concern was quickly diminishing.  He had a student paramedic with him from the community college, who was taking all this in like a sponge takes spilled milk.  "Look,"  our head paramedic said, " I can see you are making sure mother and baby are safe.  Why don't we just wait on standby in the other room while you monitor the baby a little longer, just in case."  "That sounds fine", I agreed, delighted they had not insisted on touching Vanessa, coming into her labor room, or anything.  So they hung out watching Grandma make the quiche for a half hour, then had Vanessa and Adam sign a form, and left.
   The moment they left the house, Vanessa felt an urge to push.   She put her hand over her yoni and pushed against her baby's head as it was born.  Then, pink and squawking, Baby Jackson slipped into this world and was placed on his mama's chest. His apgar scores were perfect 10s at one minute and five minutes. (meaning, he was full of oxygen and energy and vital life force)  Vanessa was thrilled and relieved, and told us later she hadn't been afraid, and hardly noticed the paramedics' visit, she was so deep in her labor.  Adam felt reassured by their presence at first , and then was relieved when they left.  I was grateful to know we have respectful, timely emergency services available to help if we need them, that are also willing to just step aside when we don't.  I called the 911 dispatcher to tell the news of the healthy birth and praise our paramedic team.  The dispatcher sounded excited, like she had heard all about this case, and promised to tell the paramedics right away.  The quiche was delicious - goat cheese and spinach.  The two older children , Kayla and Addie, woke up at their usual time and were delighted to find a new baby brother Mama's arms.   Happy Equinox!  


Sunday, February 26, 2012

Maui and the waterbirth of Matson

  Aloha readers!

   The midwife is back, after an extended winter of travels.   I had just recovered from my travels in India, when it was time to attend Jenny and Chad's beautiful birth.  (see video below!) Then we set off on a major family camping expedition to Maui.  The Moes Family Band played at a music fesitval, Maui Mystic Island,  at the end of January.   We stayed for two more weeks, camping and exploring the wonders of the tropics.   Here we are playing our set at sunset on the beach.

   Some YouTube footage will be coming  soon.

    Speaking of YouTube, my January clients Jenny and Chad made this lovely birth video!

The Waterbirth of Matson     http://www.youtube.com/watch?v=1GYBoqyMaNE