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)  

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        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?

Special Delivery: A Homebirth after a Previous Stillbirth

This post is written with permission from the family involved.  My intent is to inspire others to think through their choices and have courage.  Deep thanks are given to Rachel and her family.


   Eight years ago, Rachel was twenty-two years old, in a troubled marriage, and pregnant.  Young, poor, and in a challenging life situation, Rachel did her best to take care of herself and eagerly awaited her baby.  She used hospital-based midwives for her care, and had a normal pregnancy.  Two weeks before her due date, her water broke.  She called her midwives who advised her to come over to the hospital to be checked.  She showered, got dressed, and came to the hospital.  When she arrived, the heart beat of the baby could not be found.  The baby had died.  Rachel labored heroically and gave birth naturally after many hours to her stillborn son David.  The cause of his death was never found, and the diagnosis of "unexplained stillbirth" was given to him. 

    The birth of David changed Rachel's life.  She describes the changes as positive, because she used her grief as a catalyst for transformation.  She began a profound spiritual journey,  left her unhealthy marriage, and basically started a new life, listening deeply into her heart to find what was good and true for her.  Rachel says "I believe that David and I had an agreement, made many lifetimes ago, that in this lifetime our time together would only last as long as it did.  For whatever reason, that was what was meant for us.  If it weren't for him, I would not be the person I am now."

"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? 

Happy Holidays; Birth in a Barn

    I have always enjoyed working on Christmas;  welcoming a new babe into the world seems the perfect Christmas gift for me.  The years I spent working as a labor and delivery nurse or hospital midwife, I gladly took the Christmas shift.  Growing up Jewish, and marrying a Buddhist, Christmas is not a big family event for us.  Rather, Thanksgiving is the time our family gets together.  But the story of Christmas does touch my heart deeply;   it reminds me to pay attention to this truth :  each baby born is a holy child.