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 16^th 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

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!  

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!  

 

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
  Enjoy!


Dena

A Wedding in the Blue City

    I just had a mad-wonderful three days in Jodhpur, in the heart of Rajasthan beside the Great Thar Desert.  Jodhpur is called the Blue City because for hundreds of years, the homes have been washed in Indigo to keep them cool and bug-free.  The city sits at the foot of a hill on which a giant 17th century fort sits, looking over everything in majestic glory. 

 

  A nice feature of Jodphur is that the streets of the Old City are so narrow and winding, that cars cannot get through.  Thus, a pedestrian has only the cows, motorcycles, and bikes to contend with

 

    Or, for a real blast, one can ride in a tuk-tuk and be the queen of the road.  You see, on India streets, the biggest thing wins, and everyone else must get out of its way.  There is no waiting and allowing pedestrians to pass first.  It has taken me a while to learn how to walk through the congested bazaars and not feel nearly run down by motorcycles and tuk-tuks racing through.  But I am getting the swing of it.  And after a day of walking about, hopping in one of these and racing through the streets myself is a blast. 

    As I tuk-tuk through the streets, there are so many sights, sounds, and smells all around me, I feel like I am on some exotic Disneyland ride.  Mr Toad's Wild India Ride.  I cannot describe the sheer volume of it all - there is nothing in America to compare it to.  A friend said, as we laughed at the absurd bedlam of our shared tuk-tuk ride, "India sure is lively!"  People say that when you leave India and go anywhere else, it seems like you have cotton covering your eyes, ears, and nose. Your sense experiences are that much duller, anywhere else in the world! 

Old Delhi Sights

     Yesterday I spent the entire day sightseeing in Old Delhi - an amazing and brain boggling experience!  Old Delhi is a vast maze of  bazaars and markets built in narrow passageways on the first floors of crumbling old buildings.   These buildings are a mish-mosh of architectural wonders from 600 years of Indian history.  The passages are filled with people, bike-rickshaws, sights, and smells.  Truly a bizarre bazzar!

Old Delhi also has majestic Moghul mosques, forts, and palaces.  Top that off with numerous Hindu and Jain temples filled with giant glittering alters to a vast array of dieties scattered everywhere, and you get an inkling of an idea.

   I took the Metro in the morning from my sister's house.  It was easy; the Metro is clean and convenient.  One brilliant feature is that every train has a "ladies car" where only ladies can be.  Since most of the metro riders are male, sittting with all women was lovely.  We could all look around and smile at each other without any wierd vibes.  

  I took a bike-rickshaw from the station to Jama Masjid.  Fun, swift, bone-rattling and white-knuckled way to go as the rickshaws just weave in and out of everything, passing pedestrians and cars with an inch or two on each side. 

 Jama Masjid, a mosque built in 1656, took my breath away.  The soaring, swooping architecture lifts my spirits right along with it.   I spent an hour here praying and taking in the beautiful, ancient energy of the place.  I paid 100 rupees to climb to the top of one of the minarets and take in the dizzying view.  The temples built at Burning Man each year borrow heavily from Islamic temple architecture.  In fact, I do believe that this year's Temple of Transition was  based on this very one!.  While the Burning Man temple lasts for one week, this mosque is going on 500 years.  Incredible. 

   I was told to find Karim's for lunch, in a tiny passage down a narrow bazaar.  After losing myself completely, kind people pointed me the way.  Karim's family has been cooking there since the 1700s, so the story goes.  It was a remarkably clean little enclave with white marble floors in the midst of filth and mayhem.  I ate the most delicious chicken lunch of my life.  Recharged, I hit the bazaar-wandering in earnest.

  I found the wedding bling market

the gem market, and the sari market where I was made to try on a sari that kept dropping in price...   

I found my way into a crumbling marble Shiva temple, and a beauitufl Jain temple which has a charity bird hospital attached.  

  I went to the Red Fort, a sprawling comlex from the Mughal Empire.  It was very busy with Indian families and groups touring.  Actually, I saw very few non-Indians all day.  Delhi is not a toursist destination for Westerners.  A funny thing happened at the Red Fort though.  All these people, especially small groups of nattily dressed young men, wanted to be photographed - with ME!   I was a rare, exotic creature to them.  I was happy to oblige since all day I had been snapping shots of people in the bazaar.  It seemed like a fair exchange.  

  Another wild ride on a bike-rickshaw through the spice market to the Metro,  and I came back to Amy and her precious baby just as the sun was setting.  What a day!  

  Today Amy and I are going to lunch with her friend who works in an NGO that aids traditional midwives in rural areas. Hmmm...that just happens to be right up my alley...    Then tonight I am taking an overnight train to Jodphur in Rajasthan.  I will stay there for a couple days and then return.  Blessings!

A Day in the Bazaar

     Amy and I spent all morning in baby-love land.  Okay, Ananya is the third cutest baby EVER, after Clarabel and Sophia.  I know I am saying this with a midwife's objective eye.  I helped Amy take a bath with her baby for the first time, instead of bathing her in a little pastic tub thingie.  Mother and baby loved it.

   Finally she had nursed enough for the meantime and we decided to go out to a craft bizarre to do a little browsing and shopping.  As soon as we were in a taxi, pulling out of Amy's quiet back streets onto the main road way, it was like, oh yeah, we are in India! My eyes were again working at warp speed to take in all the amazing sights flashing by us.  People pulling ridiculas loads on bikes, like ten mattresses piled on top of each other, little markets and stalls, crazily careening auto-rickshaws, food being cooked on the street, horns blaring.  The women are all so colorful and beautiful in their saris and salwars.

  My sister took us to a special bazaar that only the Indians know about.  It is not in the Lonely Planet guide. It is a government-regulated market, and it costs 20 rupees to enter (40 cents) so that keeps beggars and touts out.  All the stalls are run by the artisans themselves, with crafts and beautiful things from all the different parts of India.   Crowds of beautiful Indian families were there to shop. It was festive and colorful. Ananya happily slept in her Baby Bjorn as we walked around.
     My sister can look at things and say, these shirts are from Lucknow.  These things are from South India.  They make these in Kashmir.  She also has the ability to dicker and discuss in Hindi with the shopkeepers, which came in handy.  Everything was already very inexpensive but she bargained everythng down . Every time I was about to make a purchase, no doubt at the 'tourist' price, she walked up and spoke loudly in Hindi and suddenly 300 rupees were knocked off the price.   It was impressive, to say the least.  I am not much of a shopper, but it seems I will make an exception to that rule during my visit here.  And I will definitely do my big purchases with Amy-ma at my side. 

    Women do not breastfeed in public here so my sis is naviagating how to manage being out with her baby.  We found a quiet corner in the back of the food stalls where she nursed her discreetly and we ate corn roti and almond ice cream. My sister will probably become Delhi's first Lactivist.  She can be an example to the middle class professional women who do not breastfeed their babies.  Her friend told her that only the beggar women nurse their babies in public. 

      There are no big box stores in India.  None.  No walmart, no Target, no drugstore like Longs or grocery store like Safeway.  Everything is picked up at little markets and bizarres.  In a city of 9 million people, isn't that amazing?  That is one of the reasons that Delhi feels like a village - no strip malls!       What India does not have in 'things',  it makes up for it in charm and character.   I wonder how long they will keep the big box stores out....

that's all for now,
Dena

     

Passsage to India

I decided to come to India the day my sister's baby was born.  The preparations were a whirlwind;  expedited tourist visas, vaccinations, gathering baby things for her.  I would be coming alone, leaving my dear hubby and children safely having their Chico Christmas season without me.  Then all my November mamas supported my travel efforts by ALL three giving birth ahead of schedule,  within a crazy four days.   At that point, I got to move my trip up by almost a week!  
  In the days leading up to my departure I would start crying at random moments, just thinking about how excited I was.  Truth is, I have ALWAYS wanted to come visit India, but it had never seemed like the 'right time'.  First, we had no money, then we had babies, then we had no money AND babies, then we were buying a house...then.. then...then. 

    I hadn't flown overseas in more than a decade, since before Bella was born.  I was a bit anxious, but mostly just excited.  When you are used to traveling with kids, going on a trip by yourself is just ridiculasly easy!  I am tuning in with my old backpacker-adventurer self, who globe trotted in her early twenties, now twenty years ago!

  My travels all went smoothly, except for the fact that I did not really 'sleep' on those two overnight flights like I thought I would.  More like drifted in and out of half-sleep and watched a lot of good movies courtesy of Virgin Atlantic.

  I had an all-day stopover in London, which turned into a magical, wonderful day.  My friends,  Sonya Sophia, the EFT teacher and practitioner Goddess extraorinaire, and her British hubby Simon, picked me up and gave me a personal tour of the beautiful city.  Big Ben, Buckingham Palace, Harrods, and all the rest.  God, I love cities filled with five and six-hundred year old buildings.  They really knew how to build them back then.  We ended up at a swanky place called the OXO tower on the Thames and had the best meal ever with fabulas London views.  A three-course lunch that included a delicious bottle of wine and the most amazing bitter chocolate mousse that has ever passed these lips.  Lack of sleep, who cares!!

 Late that evening I caught my flight to Delhi.  I already felt like I was in India just at the Heathrow gate.  There were only a handlful of non-Indians on the packed flight.  Food was Indian, and instructions were in English and Hindi.  I got all weepy for the last time ....no really, am I REALLY going to India?  Oh my, I really AM going to India NOW.

   I envsioned a bustling megapolis crazed scene at the airport.  Actually there is not a whole lot going on at the Indira Ghandi International Terminal.  Just a few flights a day, I think.  The vibe was way more like when I landed in the Soviet Union in the late eighties. They have built it, but not many have yet come.  Very chill, enormous buildings,  mostly empty.  I gathered my bags and headed outside. There, I saw a huge crowd of people packed around the exit, waiting for people.  It looked a bit...intimidating..  And there was Amy's driver waving at me, holding a sign that said 'Dena,  welcome'.  YES!  

   A few minutes later we were on my first Delhi road.  Oh SH*T!!!!!!    There are no lanes, there are bike-rickshaws, auto-rickshaws which are motorcycles with  tin-can bodies that can hold riders in it, trucks, cars, buses, people walking, more cars, and even a family riding on an elephant.  Yes, I saw an elephant walking along the freeway.  Everyone is swerving around the slower movers, and EVERYONE is constantly blowing their horns.   Everyone is driving on the 'wrong' side of the street, which is disorienting.  The steering wheels are on the 'wrong ' sides of the vehicles!  On the sides of these crazy roads, cows are sittings, packs of women in colorful saris are carrying big trays of things balanced on their heads, children are playing, little stands are selling things, lots of people are just standing around, and the horns are blaring...and on and on.   Did I mention the horns?


  Delhi is more like a sprawling collection of jumbly ancient villages connected by insane roadways than a cosmopolitan city, at least from what I have seen so far. Delhi has been a city since 2000 BC and there are bits of the architectural remains of each time period here and there and everywhere.  We took a walk in a park with beautiful Moghul tombs from the 1500s.  There are lots of trees, and lots of birds with strange screaming bird songs.  Parrots.  The sky is the smoggy color of LA skies circa 1975.  My sister's neighborhood Defense Colony is a quiet little back street zone. It feels peaceful and very old.  The cook comes in and prepares homemade Indian food in her kitchen every day.  yum!

  now I am holding a sleeping baby so Amy can get a bit of sleep.
Cheers!,
Dena

The Midwife Returns and the Revolution Unfolds

Dear readers,

 It has been three months since my last post... I have been offline and out of town for most of the summer.  This is by design, as I take time off midwifery during the summer so that the people known as My Family get my full attention.  We took a month long camping trip up to Oregon and Washington.  Spending time with my husband and kids in beautiful, natural places with no schedules, no interruptions, and no place to be but Here, Now means the world to me.  Being self-employed we happily trade income for quality time.  And what a time we had!  


We got into some hot water   (hot springs galore):

some white water:

and then the salty spray of the beautiful Pacific waters:

                 

Homebirth Photo Essay

    Greetings!  Today's post is short on words and long on lovely images.  Here are some photos of Toni Rae being welcomed into the world by parents Kristin and Chad, and big sister Charlie.   These are not labor photos but shots taken immediately after the birth, and then two hours later, during the newborn exam done on the bed with the family.  These pictures capture one of the benefits of homebirth - after the hard work of birth, the family is in its own comfy bed to relax and take in the joyous miracle of their new baby.  No strangers coming in and out, no machines beeping or nurses taking the baby to assess, wash, or "warm".  Just uninterrupted bonding time.  Enjoy!

Welcome Baby Toni!   She is placed right into her mother's arms, where she gives a good cry to open up her lungs.

Happy father embraces them both.  Note the bliss on Kristin's face as she admires her new daughter. That look of utter delight often accompanies the completion of natural childbirth, a combination of "yes, I did it!"  and "Oh!  What a love!"

Excited sister Charlie loved seeing her baby born!  She sat right beside me as the baby emerged.

Now a weepy Grandma takes a look... "did that really just happen?  Right here?"

Kristin responds to her baby's cues that she is ready to nurse.  This image shows how cozy the family is as the baby enjoys her peaceful first hours of life earthside.

After the initial cry, home-born babies are usually alert but relaxed, taking in their new environment from the warmth and safety of mother's chest

"Oooh...that is what those are for!"

"My turn!"

Giving the baby a thorough exam

includes weighing

and measuring

and footprints...

and finally a first diaper

Definitely a keeper!

The Little School that Could

   Many of us in the homebirthing community embrace alternative education for our young ones.   If we folks are conscious about choosing how and where we give birth, it  makes sense that we will also  consider how to school our young.  Waldorf education, homeschooling, and unschooling are some examples of these kinds of choices.  My first daughter was born in Santa Cruz, California, and when she was a wee nursling tucked in my sling, I saw Rahima Baldwin speak about Waldorf education and the young child.   It was music to my ears - an approach to education that seemed like homebirth midwifery for the child's mind and heart!   Rahima Baldwin, by the way, had been a foremother of American homebirth midwifery and wrote Special Delivery, a classic homebirth book .  Then she became a Waldorf educator, and her book You Are Your Child's First Teacher is one I recommend to new parents.  I knew what I wanted for my children.
    Waldorf education weaves art, music, handwork such as knitting and crochet, reverence for nature, and movement into reading and math.  Waldorf classrooms are softly colorful, lessons are poetic, all materials are natural such as wood or wool with NO plastic, and all the children sing and learn music, including string instruments starting in third grade.  "Accept the children with reverence, educate them with love, send them forth in freedom"  says Rudolf Steiner, Waldorf founder.  All subjects are introduced when developmentally appropriate, and the wonder and magic of childhood is nourished and left intact.  
   We moved to Chico in 2002 when Clarabel was two.  Lo, and behold, Chico had a fledging Waldorf Charter School!  Charter means public and tuition free, not private.  Open to everyone, by lottery.  The school was tiny, just one kindergarten class, but it would grow by one class each year until it was K-8.  Clarabel started kindergarten there when it was K-2.  There were about 50 students.  Over the next several years the school slowy grew and blossomed into a beautiful community of families and teachers.  We moved three times as we grew.  The final move was last year into a closed-down Blue Shield Call Center that was built to look like an Ivy League campus on the outside, and was an ugly cavern on the inside.    We transformed it into a beautiful school, tore up the asphalt parking lot,  and built a playground with our own hands.  Then we had to double our school size in one year to fill and pay for this giant new space. Now we had 350 kids, and a year of growing pains as we adjusted to so much change. 
      Then, this year, we almost lost our charter.  I won't get into the details of the politics that led to this, but our charter was denied renewel by our original authorizing agency.  So we wrote a new charter and took it to the Chico Unified school board for approval.  Over the last several months we have worked hard to raise community awareness about our school, align our curriculum more closely to the standardized tests that are considered the "bottom line" to determine a school's success, and waited to see if our school would stay open.   Last night, the board voted.  After two hours of tense discussion, it was looking pretty bleak.   The first motion of the vote was to CLOSE the school!   It was quickly seconded.  Then, by a miracle, one board member stood up and talked to her peers about looking beyond test scores, to other aspects of what an education is.  She moved to give us our charter, and the motion was carried, three to two.  It was incredibly emotional.  Teachers, parents, children, all crying together with joy and relief that our blessed school would stay open.  It felt like that moment of relief when we finally meet a baby, after a long, complicated labor.  Bravo Blue Oak School, a beautiful, joy-filled school for our children, now for many years to come!

The Midwife in Hot Water

   In the midst of a busy birthing season, I have been harboring a secret fantasy;  zipping off to a hot springs resort for some solo relaxation time.  These days my practice is so full that someone is due as soon as someone else gives birth - no time off for me until July, when I don't deliver babies.  Except last week, when a tiny miracle unfolded for me.  Instead of the one expected birth, I attend two in two days - someone went a couple weeks early!  As I rolled out of bed in the dark of night  to attend this birth, I realized - hey!  I'm going to be off-call this weekend!   I was fried, but I would be free.
    Friday afternoon, I popped my little bag of snacks and my little bag of clothes into my car, and I was off on a weekend retreat to Harbin Hot Springs .  Its funny how in the midst of raising a family, even the act of tossing ONE bag in the car for a trip seems so light and carefree.  My hubby and the girls would have a great weekend here in town, and everyone would appreciate a happier, de-stressed Mom!  I had known for a while I was in need of a break because everything was starting to feel heavy - the responsibilities of work, keeping house, the cooking, and the kids' activities, and on and on.  I believe in BALANCE as a guiding principle in my life - when things are big and heavy in one direction, we need to swing a little in the other direction.  Some carefree bliss was in order.
   So what did I do during this weekend away?  Relaxed profoundly.  Soaked and soaked and soaked in the hot pools.  Sunbathed.  Received a knockout massage and a Watsu treatment.  Got away from cell phones, computers, and cameras which are all NOT allowed at Harbin.  Ahhhh....a midwife not checking her cell phone every half hour, how bizarre.  I ate meals in the restaurant - organic and delicious, and had spiritual, uplifting conversations with fellow weekend Harbin-ites.  For a mother to take 48 hours off cooking and tending to others - it is amazing!  I read an inspiring book called A Woman's Worth by Marianne Williamson

You Are All My Babies

    When I was pregnant with my first baby, I had been a midwife for years already and was in absolute bliss to be finally having my OWN baby.  I loved my baby so much that my pregnancy was marked by fits of joyous laughter for no "reason", and a deep joy that came with me everywhere I went.  (once the nausea had passed, of course)  I glowed.   In my ninth month, my husband took me to San Fransisco to see a very holy Tibetan Buddhist teacher, who was staying with a friend of his.  This teacher, the Venerable Khenpo Palden Sherab, was performing sacred ceremonies for generating peace and awakening for hundreds of people.  Because he was staying with our friend, I was given a private audience with him.  Here is information on this holy man:   http://www.dharmafellowship.org/biographies/contemporarymasters/khenchen-palden-sherab.htm

  Khenpo Palden blessed me and my ripe belly, and then he gave me an instruction, which I have held in my heart as my path ever since.   He told me I must love ALL BEINGS as if they were my precious baby.   This is a nearly impossible task, but I am trying. When I remember, my heart is filled with compassion, and anger, hatred, and judgement melt away.   It is the perfect instruction for a midwife, isn't it?  And he didn't even "know" that is what I am! 

The First Breaths of Life

     It seems my clients like being written about on their midwife's blog.  I had no idea when I started this a couple months ago that folks would be so open to my writing about them.  Talia and Mishu are my most recent new parents and they have graciously agreed to let me tell about their story.  So here it goes...

  Talia and Mishu came to me a little less than 2 years ago, nine months pregnant.  With tears in her eyes, lovely red-headed Talia requested that I take her on in the eleventh hour.  She explained how over the nine months of pregnancy, she slowly realized she should be having a homebirth.  She had been seeing the hospital midwives and but now REALLY wanted a homebirth after all.   Mishu was a recently graduated nurse, and they were prepared to do whatever was needed for birth at home .  We went for it.   Talia rocked her first birth with twenty-four hours of early labor and then a straightforward active labor the following night.  She did great and little Livia happily came into this world.

    For her second pregnancy, Talia came to me from the get-go.  Mishu has become a very well-respected RN at our local hospital.  (I love it when local RNs choose to birth at home!)   Right around her due date, the 1st of March, she had some bouts of contractions during the night that went away at dawn.  This happened a few nights in a row.  Then, on Wednesday, they didn't go away at dawn.  Talia had irregular mild contractions throughout the day, and in the evening they got a bit stronger, although still not strong.    I had checked her in the afternoon and  she was barely 1 cm open with the baby's head high.  That evening, my assistant Amber went over to check in on her, and she texted me updates such as "No need to rush over here, not that much going on.  Contractions, but irregular. Baby's heart tones sound great."   Well, around 9 pm a little voice deep inside me said "Go over there now".   I went.   When I was approaching her street, Amber texted me "Water broke, gush of clear fluid."  Oh yeah, it was time.
     Talia was sitting in her bathroom on the pot, cranky about how the contractions felt but still chatty and not really looking like she was deep into labor.  About fifteen minutes later she stood up to wash her hands, turned a deep red color and p*u*s*h*e*d.   "Talia, hold on there a second"  I said, running to peel off my street clothes and throw on my baby-catching clothes.  With my shirt half on, I heard Amber say "Dena, I see the head!"   Sure enough the head was crowning.   Talia was on her hands and knees in her small bathroom.  I climbed behind her, half in the shower, and Mishu and I together put our hands on the head as it was slowly born.   The little face was pink and she was making little movements.  Hello dear!   Then we waited for the next contraction.  And waited.  And waited.  It was a few minutes but it felt long.  These dang irregular contractions!  I had Mishu reach down and rub her belly.  I had Talia crawl a few feet into the bedroom to give me more space to work.

    A contraction came, Talia pushed, and the baby was born.  She was floppy like a rag doll and a mottled purple and white color.  She was not grimacing or sneezing or trying to breathe.  I quickly dried her with a warm flannel blanket and rubbed her up to stimulate her.  While doing so I placed my fingers on the skin where her  umbilical cord inserts and felt a normal heart beat.  "Good heart beat" I said.  But still no effort to breathe at all.  And limp.  Amber had the oxygen tank and ambu bag ready.   I had recently taken the neonatal resuscitation training of Karen Strange CPM, who is the pre-eminent authority on resuscitation in the home birth setting.  She talks about mouth-to-mouth breathing as an initial alternative to ambu-bag and oxygen tank.  For more info, see her website  www.newbornbreath.com 
       I lifted the baby to my face, placed my mouth firmly over her nose and open mouth, and carefully, slowly gave the baby an "inflation breath."  With mouth-to-mouth,  I can literally feel her lungs' alveoli inflate, and her lungs expand to take in oxygen.  I am so connected to the baby's life force.  A newborn baby's alveoli must inflate so she can take in oxygen through her lungs.  In the womb, the alveoli are collapsed and the lungs are filled with water.  That is why the baby's  first, big breaths are so important.  I pulled her away a bit to look at her.  She opened her eyes and looked at me.  But didn't breathe. "Okay baby, lets breathe"  I said, and gave her four more mouth-to-mouth breaths.  By the fourth, I felt her suck in on her own, she mewed, and then gave a good cry.  She turned a rosy pink from head to toe, and her arms and legs bent into normal position.  She was breathing fine.  Her heart rate was fine.  Her tone was strong.  She was a little more than a minute old.  I had been working on the baby right beside Talia, with the cord intact and pulsing away, providing oxygen to the baby even while she wasn't breathing.  In the hospital, if the baby is not breathing, they cut the cord right away and take the baby across the room to work on her.  At home we leave the cord, which is still  bringing oxygen to the baby via the placenta for several minutes,  and work on the baby beside the mother. I would like to see hospitals learn to do things that way - it is definitely to the baby's advantage.

   The baby was now warm, pink, and perfect in Talia's arms.   She was letting us know all about it.  Talia stood to get into bed and the placenta plopped into a bowl I had at the ready.  She hardly bled a drop.   Within two hours, and baby had eaten,  been cuddled skin to skin with both her Mom and Dad, Talia had been up and showered, and we were all eating blueberry birthday cake.  The baby was strong and alert and weighed in at 9 lbs!

Here she is after being checked out thoroughly by her midwives.  That is yours truly holding her lovely footprints, her first mark on the world.

   Today when I called to check in on the family, Mishu told me they have decided to name their baby Adina, partially in honor of their midwife, who provided her with her first breath of life.   I am the one deeply honored, and so grateful to all my teachers and mentors, and supportive, wonderful assistants.  Most of all, I am grateful to all the moms and babies I have served over the years, who have truly been my real teachers. 
 

Full Moon Baby

  I am just back from a welcoming a 9 lb baby boy into the world this afterrnoon, and some post-birth weariness is setting in.  My client lives out in the almond orchards south of Chico.  She and her husband own 500 acres of almond trees, which surround their home.  They are all in bloom right now - trees covered in pale white-pink flowers as far as the eye can see.

    Last night  I went to check on her because her water had broken, and I needed to take her temperature and listen to the baby's heartbeat.  I drove out by the light of a bright full moon, as the dark rainclouds parted like curtains around her.   Mother and baby were fine, so we all got a good nights sleep and labor began this morning.  When I arrived this morning, my client was running a mild fever.  This was concerning because with waters broken, it could indicate an infection brewing, which could affect the baby.  It was mild enough to not necessitate transferring to the hospital - yet. 

  My plan was to hydrate her really well, and have the baby soon before the condition worsened.   A phone call to my OB consultant, Dr Fischbein down in LA (bless his heart, dedicated supporter of midwives) gave me the confidence I needed to hold to my plan.  I started an IV and gave her a large bag of IV fluids, which worked like a charm.  When the bag was almost all run in, this Momma turned to me out of her laborland far away place and said. "Take my temp again NOW.  I feel BETTER!"  Sure enough the fever was gone.

  An hour later she squatted on a big pile of towels on the floor and in two or three roaring pushes, out came a 9 lb baby boy.   The baby breathed right away, but took several minutes to really "transition" into his outside-the-womb life.   He just seemed a bit pale and his heart rate was a little lower than usual,   Hmmm.  We watched him carefully, gently massaged and stimulated him, and gave him a little oxygen "blow-by" (holding the oxygen tubing close to his face so he is breathing more oxygen-rich air).  I considered bringing him in to the hospital to be checked out .  But after a thorough assessment and exam,  he just pulled his little self together, and was pink as a piggy, with strong tone and normal vital signs.   By then, he was about a half-hour old.  Whew, little guy!  

  By one hour of life, the little one was nursing away like a champ, and remained pink and in excellent shape.  We were brought Mexican food from my favorite taqueria and while he nursed, the happy parents and midwives sat around feasting on chile rellenos and tacos, and reviewing the incredible events of the day.  A final exam of the baby revealed a fully present, pink, alert healthy babe, and the proud mama didn't even need stitches!

  We packed up our bags, reviewed the detailed baby-care instructions, and were home by dinner time.   I will go back in the morning to check on mother and babe.  Good night!

Special Delivery 2; Homebirth after a Cesarean

     This post has been written with permission from the family involved.  Names have been changed to protect their privacy.  My intent is to inspire others to think through their choices and question the current limits on a woman's freedoms after she has had a cesarean.


     Before I share Hannah's journey from a cesarean to a homebirth VBAC (vaginal birth after cesarean), let me discuss the current climate regarding VBACs.  When I moved to Chico in 2002 and joined a hospital nurse-midwifery practice, VBACs were being done in all three hospitals in our county. It was understood  that VBACs were safe, as long as the surgical incision was the low, horizontal kind (which most in the US are).  These scars are less likely to rupture than the up-and-down kind.  I went out on maternity leave, had my baby, left that job, and then started attending homebirths two years later.  I began hearing that VBACs were suddenly banned from all three hospitals.   As in, NO MORE VBACs were allowed, period.  Even if you had had a previous VBAC, making you a very likely candidate for another successful VBAC, you were told by your care provider "No,  I wish you could have a VBAC, but my hands are tied.  I am not allowed to attend VBACs anymore. We must schedule your cesarean."  If you said "But wait!  I just had a VBAC right here two years ago with no problems.  Are you kidding? ", you were told " There is nothing I can do.  It is up to the hospital, not me. ."  OUCH.  What happened?
      What happened has to do with ACOG, the American College of OB/Gyns , a powerful trade group for OB doctors.  They are so powerful that their recommendations, which put the interests of the doctors FIRST, become national health policy.  American obstetricians have developed this habit of inducing most of their patients. Because using the induction drugs on VBAC women was found to increase the risk of a uterine rupture by a significant amount, they recommended that all sites where VBACs take place have an anesthesiologist in-house and ready, in the event of uterine rupture.  Well, smaller hospitals like the ones in my county can't afford to pay for an anesthesiologist to sit around while a woman is in labor.  VBACs were banned in hospitals all across America instead. The result of all these inductions, and all these VBAC bans, is that one in three women in America today goes in to have her baby, and comes out having had major abdominal surgery. 
     Women in Chico who want a VBAC must either have a scheduled cesarean instead, or drive at least 100 miles to a larger urban hospital to have a VBAC.  Or, they could find a homebirth midwife.  Homebirth midwives put mothers and babies FIRST;  not hospital rules, not malpractice insurers' rules, and not convenience for the midwife.  (Cesareans are very convenient for the doctor - they last an hour, no one is groaning, grunting, or pooping, and the doctor even gets paid more than for a natural birth)  

---

        Hannah came to me about a year ago.  She wanted a VBAC, and was considering her options carefully.  Her son had been born in NYC by cesarean after 30 hours of labor, but she felt that with more preparation and better support during labor, she could DO IT this time.  Her husband Jason and the rest of her family were not particularly supportive of a homebirth.  Hannah wanted me to do her prenatal care, and then she planned drive down to Berkeley, 3.5 hours away, to birth at a hospital where nurse-midwives attend VBACs.  As her pregnancy progressed, Hannah became more clear that she actually wanted a homebirth.  She educated herself and her family about homebirth, and finally her husband agreed.  The Berkeley scenario was dropped, and we began to prepare in earnest.
   We delved into the details of Hannah's previous birth.  A big difference between hospital-based and home-based prenatal care is the attention homebirth midwives give to the position of the fetus.  During the last two months of pregnancy, I pay careful attention to which way the fetus' back is lying, so we can be proactive about helping the baby into the best position for birth.  This way, we are not surprised with a longer, more difficult labor due to posterior positioning of the baby.   Hannah had started her first labor with her baby in the posterior position, and did not know it.  Her doctor had never checked for that.  Hannah and Jason had driven across the Brooklyn bridge at rush hour to get to the hospital, a major ordeal.  When they got there and were checked, they were told to just go on back home, it was too early to be admitted to the labor floor.  Well, Hannah was having the strong, painful contractions of back labor, and was not about to face another two hours of traffic.  So she and Jason wandered the hospital, found an empty conference room, and spent the night there laboring away.  
    When they returned to the labor and delivery floor in the morning, more troubles arose.  The "wrong" doctor was on that day, not the doctor Hannah had connected with and wanted.  The nurse was kind and helpful, but then the doctor and the nurse "got into it with each other" and the doctor banished the nurse from Hannah's room!   Eventually Hannah pushed for three hours, all alone except for her exhausted husband and mother, with not even her nurse in the room to guide and support her.  The doctor came in and out to watch for progress, and then took her in for the cesarean.  Afterwards, the doctor told her that surprise! the baby was posterior!   Oh, well.
      During her pregnancy I focused on four main areas of preparation. 1.  Giving her undivided attention, love, and support so she could build trust in me and my assistants, and know that we will really, truly BE THERE for her.  I imagined she would have another 30 hour labor, and mentally prepared myself to hang with that.  If she needed to push for four, five,six hours, so be it.   2.  Fetal position!  We used chiropractic care, specific exercises, and homeopathic pulsatilla to encourage that baby to rotate forward, not posterior.  And she did   3.  Healing the trauma from her previous birth.  She wrote about her first birth and her deepest fears and we used Emotional Freedom Technique to address them.  This technique uses the meridians and acupressure points of the Chinese Medicine system, to clear emotional trauma from the nervous system and tissues.  Her biggest hidden fear was having to face her family and friends if her home VBAC "failed" and she ended up with another cesarean.   She felt they would think  "See?  You should have just had the repeat cesarean.  It would have been easier on everybody."  She was so brave to stand up for what she wanted, outside the comfort zone of her intimate circle, while not knowing what the outcome would be. 4. Filling her with positive images, stories, and vibes to promote a sense of well-being and optimism about this birth. 

     Ten days after her "due date",  I got the call at 4:30 am.  "Hannah is having very strong, close contractions"  Jason told me.  I heard her moan in the background.  I was on my way.  I arrived a little after 5 am.  Hannah was on her hands and knees in the kitchen, working with contractions every two minutes.  This all had started just an hour ago. She had literally just woken up a hour ago.  I could tell things were cooking along and readied my supplies.  45 minutes later, her water broke, and she had a strong urge to push.  I checked her and she was completely dilated.  We moved her to the rug in the living room where she pushed on her hands and knees for twenty minutes and gave birth to her eight and a half pound girl.  She had been awake three hours, and I had been there for little more than an hour!
     Well, talk about thrilled, shocked, and delighted!  Jason and Hannah snuggled up with their baby and giggled and smooched while she nursed.  "That was it? " they kept saying.  "Really, that was it????"  Her whole labor had lasted three hours and she had barely needed to push.  Their eyes were shining with joy.  They were both transformed by the experience. Jason was in absolute awe of his wife, so strong and powerful and looking gorgeous lying with their baby in the dawn light.  They wouldn't have even made it, driving to Berkeley!  It would have been a travesty for her to have had abdominal surgery instead of this experience!  As we all ate bagels and eggs, I thought about her two births.  Why are one woman's two births so different?  Can love, support, and the comfort of one's own home REALLY make such a difference?  What do you think?

"zee hormones of love are zee hormones of birth"

    When I was a nursing student back in the early nineties, I had the great fortune to spend a couple days with Michel Odent, .  He is the French obstetrician who revolutionized birth in his country and helped spread the ideas of undisturbed birth, waterbirth, and peri-natal psychology worldwide.   In the 1970s, he was tired of seeing so many births in his hospital ending in forceps deliveries or cesareans.  Clearly, the standard procedure of the time, the take-a laboring woman -and -strap her to a table on her back-and -drug her heavily- and pull the baby out with forceps- method was not optimizing the birth for mother or baby!  He redesigned the labor rooms to be like private, dark warm caves, with a tub of warm water and a bed on the floor in the corner.  He instructed the midwives to  just sit, rocking and knitting.  When a woman came in, in labor, she was given complete freedom to do whatever she wanted.  Most women gave birth in upright positions in the corner of the room or in the tubs.  He coined the term "fetus ejection reflex" to describe the spontaneous, powerful reflex that occurs when a women feels her own urge and pushes her baby out without a cheering squad to yell "push" and count, and tell her how to do it.  No one told these laboring women ANYTHING.  Just nods and smiles of reassurance.  The result of this experiment? 

We are Mammals

   Today I want to write about something truly obvious, but often forgotten.  We, the tech-savy, brilliant, analytical, adapted to extreme-comfort living,  humans,  are actually MAMMALS.  Mammals, yes,  same as our dogs, cats, horses, and yes, apes.   In so much of life, the fact that we are mammals does not play a real significant role.  Attorneys, computer experts, managers of companies or businesses, salespeople, etc do not need to remember they are mammals in order to do their best work.  Midwives, however, do.