My excuse

I think so often about this blog, and sometimes, even about things I would love to post about. But, it is the same way with friends I haven't talked to in months: I think about them and want to call, but in that moment, I'm not free to gab away on the phone, so I put off calling until later, and then forget. So it is here with my blog.

I really do see a time when I will be able to be more devoted to keeping up with things here. I'm not sure when that will be, but definitely not for a few more weeks.

And, here is my big news that prompted me to come and post today.....

I finished my NARM PEP application tonight!!! Whew! All I have to do is get to the notary in the next day or two, and go get a passport photo of myself to send in along with it.

The sense of relief is enormous! Though, I know the next thing I will be worrying about once I get confirmation from NARM that my application was accepted will be the skills and written exams. But, for today, this week...all is well. :)

I'll be taking my exam August 20. It seems like eons away right now, but I know that it will be here in no time at all. I mean, we are just days away from March! That's shocking enough to me.

***
In the world of birth, we have been busy with prenatals, but our last birth was in early January. We have 6 mamas who could have their babies anytime now, though 5 of them could wait a few more weeks. From this point on through the summer, we have plenty of births to keep very busy.

***
I leave next week to The Trust Birth Conference. I can't really even say what I am most excited about. I sort of feel like even if all of the sessions were cancelled, it would still be wonderful: just getting to hang around with everyone attending and spend hours and hours chatting away about pregnancy and birth. But, the sessions are going to be pretty awesome, too, of course. I still feel giddy about it all.

Help save Waterbirth International!!!

Please pass the word on to anyone you know who may be willing to help.....

*****************
Waterbirth International may close doors. Here is a note from Barbara Harper of Waterbirth International

Barbara Harper wrote:.

I cannot yet imagine a world without the voice and work of Waterbirth
International - we get calls and emails every day from women who need help
convincing one hospital or another to let them labor or birth in water. If
we die - a big part of the movement dies. Waterbirth has shown us all that
women know how to give birth and babies know how to be born. Waterbirth
gave us "hands-off", sit back and let the baby out. I see waterbirth
mentioned on Blogs every single day, not to mention Baby Story on the TV. I
took Waterbirth International to ACOG two years in a row - and was the ONLY
booth showing birth films to obstetricians and especially to student
physicians. There were tears, laughter and outrage - just the thing to stir
up those young crop of doctors. I am finally realizing a life's dream.

But now I am faced with letting this dream go. Perhaps I have done enough.
Perhaps it is time to quit.

About 18 years ago, maybe it was longer, when Mothering Magazine was facing
bankruptcy Peggy did a heartfelt plea asking their readers to consider
ordering a Life-time subscription. I think the subscriptions were $1000 or
$1200, I can't remember now. I do remember that I couldn't imagine not
reading my Mothering. So, I bought two and gave one to my obstetrician's
office.

How can you help us stay open to take the next phone call? - to convince the
next obstetrician to incorporate waterbirth into his/her practice - to work
with the nurse midwives to install pools in their facilities? To educate an
entire hospital on the benefits of allowing women freedom of movement in the
water. How much is it worth to see waterbirth become the norm in the US,
like it is in the UK? I think we only need a few more years to make that
happen. Do women really want waterbirth to be an available choice in every
hospital? I think so.

Can you help us by getting the word out on blogs and lists? I had to let go
of all of the staff except one person to process orders. Miraculously, we
made payroll today, but we can't hang on much longer. We need a miracle.

If I need to call every single waterbirth parent personally, I will. I
don't want 25 years of work to end over a measly $200,000.

The work that we have done the last few years has been phenomenal. How God
arranged for me to teach in hospitals and medical schools around the planet
- Taiwan, Venezuela, Turkey, Mexico, Canada, Holland, Portugal, China,
Trinidad, Croatia - I'll never figure that out. I laugh out loud sometimes
when I get up in front of an audience of physicians in a medical school
overseas - who all want to hear about waterbirth and the incorporation of
Gentle Birth practices and principles into their routines.

Think about what you can do and call me if you want to chat or if you have
some great ideas on how we can quickly move into the black and keep
waterbirth alive and thriving.

We need your help. Barbara Harper needs your help. The waterbirth/gentle
birth movement needs your help.

Blessings,
Barbara
Barbara Harper, RN, CLD, CCE
Founder/Director
Waterbirth International
www.waterbirth.org
503-673-0026 -office (out of US or in Portland)
800-641-2229 - toll free
503-710-7975 - cell phone

We LOVE helping women get into Hot Water!!
And have been doing it for 24 years!!

******************

Homebirth Increasing in the UK!

http://www.nct.org.uk/media/pressrelease?prid=108

New National Statistics: Big increase in home births across UK<

Date: Friday, 14 December 2007

New National Statistics: Big increase in home births across UK

The National Childbirth Trust (NCT) welcomes the significant rise in the number of women in the UK giving birth at home, according to official new data provided by by the Office of National Statistics, The General Register Office for Scotland and the Northern Ireland Statistics and Research Agency and analysed by BirthChoiceUK (available at www.BirthChoiceUK.com).

Across the UK in 2006, 18,953 of all births (741,952) took place at home, compared with 17,277 in 2005. This is an encouraging rise of 9.7% overall, but still only represents 2.5% of all UK births.

The biggest increase - more than 10% - has been in England, where 16,923 women had a home birth.

Scotland shows the second highest rise in the number of home births (762) with an increase of 9.2%. Wales has fallen behind with the smallest increase in home births (1177) - 0.9% - despite having the fastest growing home birth rate in the UK for 2005.

Mary Newburn, Head of Policy Research, NCT, said; "It's very pleasing to see that home birth rates are on the increase, allowing women and their partners greater choice. However, many women around the UK still find it difficult to access a home birth. There is a lack of balanced information available to enable them to make an informed choice about where to have their baby. Low midwifery staffing levels mean that too often the option of a home birth is either not being offered or services end up being withdrawn at short notice."

Local administrative areas with highest and lowest home birth rates include:-

Highest	Lowest
West Somerset (England) - 14.2%	Middlesbrough (England) - 0.4% Blyth Valley (England) - 0.4%
East Lothian (Scotland) - 4.8%	Renfrewshire (Scotland) - 0.3% East Renfrewshire (Scotland) - 0.3%
Powys (Wales) - 10.7%	Conwy (Wales) - 0.9%

Government policy, as set out in Maternity Matters in England and the NICE Intrapartum Care Guideline, published by the Department of Health state that 'women should be offered the choice of planning birth at home, in a midwifery-led unit or a consultant-led unit.'

Mary Newburn continues;

"If the Government's choice guarantee for England is to be implemented by the end of 2009, considerable work must be done to increase access to home birth. We also welcome Keeping Childbirth Natural and Dynamic (KCND) in Scotland and the target for a 10% home birth rate in Wales as home birth initiatives."

At Your Cervix

Everyone, go check out the trailer for this new documentary.....

http://www.atyourcervixmovie.com/multimedia.html

An Iranian Waterbirth

If you haven't yet, go read Andrea Robertson's account of the recent Iranian waterbirth.

Reading stuff like this makes me really feel like there IS hope for birth.

Amniotomy

The latest from the Cochrane Review.

Breaking The Waters During Labor No Longer Recommended

17 Oct 2007

"We do not recommend that amniotomy, also known as breaking the waters, should be used routinely as part of standard labour management and care" says Cochrane Researcher Rebecca Smyth, after completing a systematic review of relevant research studies. "Women should be informed that it doesn't shorten the first or second stage of labour, it doesn't affect the woman's satisfaction with her childbirth experience, and doesn't result in the child being in better condition immediately after birth."

This Cochrane Systematic Review found that breaking the waters may be associated with a slightly (non-significantly) higher rate of Caesarean section. Breaking the waters may cause changes in the baby's heart rate.

The aim of breaking the waters is to speed up and strengthen contractions, with the intention of shortening labour. The membranes are punctured using a long handled hook, and it is thought that hormones in the amniotic fluid that flows out will stimulate contractions. In some centres, it is performed as a routine part of care for all women in labour -- in others it is used only for women with a clinical need to have their waters broken.

Ms Smyth came to these conclusions after she and colleagues had identified 14 relevant studies that involved almost 5,000 women. The overall quality of the studies was variable, making it difficult for the group to give firm recommendations about the use of amniotomy. There is a need for further research in this area.

"Our evidence suggesting this lack of effect should be discussed with women in the antenatal period," says Smyth.

----------------------------
Article adapted by Medical News Today from original press release.

A totally rockin' breastfeeding article!!

Dr. Jack Newman and Edith Kernerman talk about breastfeeding and answer mothers' questions here.

A little long, but well worth the read. There were some really choice quotes from Dr. Newman in here!

Dr. John

If you have never read any of Dr. John Stevenson's writing, then here is a gem to start with.

Enjoy!!

Re-evaluating

I have been spending the last few days really considering what I want this blog to become.

I have such a hard-to-beat inclination to talk about what other midwives do/don't do in a critical way, mainly due to my own struggle to come to grips with the reality of maternity care, midwives included.

But, I don't want this blog to be about my judgement (that is what it is, essentially) of others. I want this blog to be about my own journey as a midwife and my own ideas. More "I" statements than "they" statements. LOL!

Often I feel compelled to post here about various topics because of an encounter with someone or something that I am in disagreement with. So, I will have to carefully check my tendencies to rant on and on about such things because I have been feeling like there is enough out there on the net and in books that bashes what others are doing. I want my blog to approach birth and midwifery from a positive light, spoken more from my heart and mind.

birth magazines

I'm not sure if Midwifery Today has changed, or if it is my perspective that has changed, but I can no longer devour each new edition that comes out and be left feeling excited and content.

I still love Midwifery Today, of course, and have great respect for their publication and recognize them as the great resource that they are. But lately, almost every article I read in each new edition makes me cringe at some point.

I know I have said it before, but it feels like the more I read other midwives' work or talk with other midwives, the more it has become glaringly obvious how far on the fringe I am in regards to my approach to birth.

I am tired of hearing midwives say that they trust birth and that birth is a normal and natural process, when they turn right around and start trying to convince everyone about how their interventions to 'help' the situation was natural because it only involved their hands (not a knife) and how midwives are needed to save birth, and so on. If birth works so well, then why do some midwives consider it dangerous to give birth with no trained professional?

I have to say....what is up with all of the bed births? Seriously! I'm not just talking about the birth pictures always featured on the inside back cover (which are almost always in bed, with lots of hands on the baby's crowning head and perineum), but about the birth stories themselves. I know that there are women who truly do choose to give birth laying down, and that is fine by me, but I am positive that they are in the very small minority. I think that more often than not, the bed becomes the chosen birth place because it is never presented to the woman as the least ideal place for giving birth (physiologically speaking). Though, again, I don't think that the birth pictures are a reflection of Midwifery Today's philosophy, but probably they print whichever pictures are received, and most of what they receive are bed births.

I am still a devoted reader of Midwifery Today, and I have been wanting to write an article to submit, as I don't think it is productive if all I do is complain about the situation. I have been brain-storming all night about which topic I should write about. Really, my issue I suppose lies more with the reality that I am facing: that the majority of midwives out there from what I can tell approach midwifery and birth very differently than I do. This is something that I am having a hard time coming to grips with, I suppose.

Elephant Suckling

"Elephant milk looks rather thin and watery but it is very nourishing and babies put on weight at a rate of 22-44 lb per month. They tend to suckle little and often."

From Eyewitness Books: Elepahant

Our mammal sisters have so much to teach us.

Perineums

Everyone has heard a story of a birth where the perineum was "tight" and just wouldn't stretch to allow the head to be fully born, and the midwife (or doctor) just had to either cut an episiotomy (it makes me wince to even consider) or massage it back around the baby's head.

Does this make biological sense? This makes as much sense as saying that a baby won't breath properly if not suctioned. ???? Um, no.

Any perineum that hasn't been mutilated by FGM will stretch as needed to birth a baby. Perhaps those women who have these so called 'tight' perineums need to be given more privacy, perineums unobserved, to give birth.

Sort of how our vaginas are soft and open up to our lover's touch but tense up when a stranger inserts a speculum.

conference fun

I really love going to conferences. Meeting new people, catching up with old friends, hearing speakers on hopefully amazing topics. It just makes me happy.

I am lucky enough to live within a reasonable driving distance of the Gentle Birth World Congress conference which happened this last weekend. Though I only registered for the neonatal resuscitation training during a pre-conference session, I ended up spending Thursday through Sunday there, just hanging out, talking with people, walking around the free baby expo, and seeing the (free) birth and breastfeeding videos. I drove lots and lots of miles to make it happen, but it was fun and totally worth it! I say that even though I didn't actually attend any of the conference sessions. lol!

It just makes me even more excited about the Trust Birth Conference happenings!

breastfeeding again

I am just blown away. Seriously! What is up with the pervasive amount of mis-information about breastfeeding???? Even from alternative health care practitioners......

In the last few days, I have talked with 2 different moms.

First mom's baby is about a month old. At 2 weeks old, she took her baby to the 'breastfeeding clinic' class that takes place twice a week at our local hospital. The lactation consultants there (called lactation specialists on their website, so probably not IBCLCs) determined that because she didn't gain much after nursing (leisurely) for 20 minutes, that the mother's supply was inadequate. Baby was fine otherwise, good output (wet/poopy diapers) thriving in all other aspects, not loosing weight, etc. They sent her home with formula (!!), a nipple shield (not surprising) and a SNS (which they didn't show her how to use at all). When I hear crap like this, I just want to throw up. Oh my. :( She had never tried the SNS because she had no idea how to use it. Of course, she could have gone back and asked for help, but why the hell would you give a mom (who you believe to have a low supply) a SNS without showing her HOW to use it????

This breastfeeding clinic consists of stripping baby down, weighing baby, nursing baby, then weighing baby. Then being told that you either have enough milk or don't. Total nonsense. That coupled with their love of handing out nipple shields like there is no tomorrow, and, I admit it, I have a very strong dislike of the class.

The second mom has a week old baby, and was having horrible sore nipples. Her midwife suggested giving her nipples a rest for a few days, and just pump or hand express milk and gave her a syringe feeder to feed her baby. Then, at a week, when it was apparent that the baby wasn't gaining, and was still loosing weight, she suggested she supplement with goat's milk. :( I can't be the only one who sees problems with this advice. It's the latch! It's the latch!! A poor latch will of course cause sore nipples. It will also lead to the baby not getting as much milk, and, because the breasts aren't being effectively drained, to a low milk supply. Which is where the mom is at now. Her supply is low, her baby is still losing weight. :( While I understand that you want to give mom a break from the horrible pain of sore nipples, stopping nursing is a very poor solution. It too will more often than not lead to low supply. Fixing the latch is the best solution for both mom and baby.

She took her baby in to see a naturopath doctor (who also happens to attend homebirths) and he told her that because she never experienced any physical breast changes (tenderness, growth, etc.) during pregnancy, she would never make enough milk. He suggested that it was perhaps because she had a lot of stress going on in her life during her pregnancy. What the....???? There have been studies that have shown that prenatal breast changes are NOT associated with milk supply at all. And, the bit about stress? In my opinion, a large number of women have a lot of stress during pregnancy. It seems that so much transitions and life changes suddenly occur when a woman is pregnant: moving, job changes, financial worries, and so on. If stress caused us to not make milk that easily, low milk supply would be a true problem for numerous women. Well, I guess low milk supply IS a common breastfeeding problem, but that is because of a whole other set of reasons (scheduled feedings, supplementing, poor latch, etc.).

It feels like there are so many factors that really undermine breastfeeding in our culture. Can I at least have hope that it won't last forever? Because I do, I really do.

Birth Philosophy

I have been spending lots of free time looking at all different midwives' websites while preparing to start creating my own website. What has struck me more than anything is the similarity of all of the 'philosophies'. I know from experience that many (most?) people assume that a midwife is a midwife is a midwife. Of course, that is not the case at all. But, when you ask midwives about their birth philosophies, they almost all include some talk about birth being natural, birth working best left alone, their role is to support the woman/family, about promoting calm/gentle birth, etc.

You will never see a midwife say that she believes birth works, but only if she does "X" (perineal support/massage, vaginal exams, hat on baby right after birth, test your glucose levels prenatally, and so on).

So, when pondering about how I can word my own philosophy on birth, I am struck with the fact that I am just restating the same old lines. However, the more that I read/hear/talk with other midwives, the more I feel very much like the odd ball. How can there be this disconnect?

Practice Philosophy

My practice philosophy has been on my mind lots lately. Not just my general, overall philosophy, because I feel very sure of that. I support women in their informed choices, birth unfolds best left alone, and essentially, I do want to be what is termed a 'hands-off' midwife.

But, I have been thinking more and more about the lovely details. Different situations, how I would react in various circumstances. How much nutritional counseling do I want to offer? Which pregnancy/birth/breastfeeding books do I want to give to all clients? How will I approach clients who have failed to hold up their agreed upon payments? Will I use a doppler prenatally if clients choose it?

I need to start writing all of this down. It is, of course, one of my assignments for school (to create a thorough Principles of Practice), but I would want to do it anyways. Getting computer time for it seems so scare. I have been considering hand writing it all, and then typing it up later.

Another thing I have really been wanting to get started is a website. There is no rush, as I am not taking clients of my own for a little while still, but it is something that gets me all excited! The main thing holding me back is the fact that I must choose a domain name. I have a very hard time with such things. It is right up there with the name of my future practice. I have NO idea. I am hoping that the right name will just 'appear'. Maybe the universe will send it to me in my dreams. I can dream, right?

Baby girl born unassisted

I got word today that the sweet couple for whom we were on call as back-up for their UC had their baby girl early this morning. :) So very sweet. I knew it would go perfectly and they wouldn't need us.

Apprentices

It feels more and more like so many midwives do not show fair amounts of respect to their apprentices. I hear more and more of apprentices who are made to the grunt work, asked to do all sorts of things (not midwifery related), and aren't paid.

I don't mean to say that it is unreasonable for apprentices to do ALL aspects of midwifery, including the grunt work; of course, she should do her best to help the midwives as much as is reasonable and to experience all the work involved in being a midwife. But it often seems like the apprentice is treated with little regard.

I understand, too, that not all midwives can afford to pay their apprentices, and that the midwives are offering a huge amount of learning to the apprentice. But, there does come a point where the apprentice is quite valuable to the midwife, not just a bystander watching to learn. At this point, it does seem only fair to give the apprentice some sort of pay, even if it is $20 per birth. It isn't so much about the money as it is the act.

I feel extremely blessed to be working with a midwife who respects and values me as much as I respect and value her. She does pay me a very generous amount to assist her at births, more now that I am acting as the primary midwife during prenatal and antenatal care. For this, I am grateful beyond words. Because of my experience, I fully intend to do the same for my future apprentices.

I am just tired of hearing about midwives who are asked (more often, expected!) to organize the midwife's (personal) files, run (personal) errands for her. Midwives and apprentices both have so much value and ought to have mutual respect and admiration.

Aunt Orlene

Granny midwife Orlean Puckett.

I just cannot even fathom losing 24 of my own babies.

nipple shield fun

Our local hospital has a breastfeeding class twice a week, consisting of everyone undressing their babies, weighing their babies, nursing their babies, then weighing the babies again. This is to make sure they 'have enough milk'. The lactation consultants (most of whom are IBCLCs) seem to hand out nipple shields like there is no tomorrow.

These 2 facts make somewhat despise the this 'class'. I have yet to see a mom go there and come away with helpful, sane information. It really just makes me want to pull my hair out in frustration! It makes it even harder when clients go there for help, without ever calling us to tell us they are having problems, even after repeatedly telling them to PLEASE call us if they need anything.

Back to nipple shields. I am sure that there are some rare cases where they can be a true blessing, but they are so hugely overused and, in my opinion, really are a danger to the success of breastfeeding. I have emailed with Dr. Jack Newman regarding nipple shields in the past, and here is some of what he had to say:

"No, a nipple shield is not better than a bottle. With the bottle, the milk supply is maintained and the chances of getting the baby to latch on are good. With the nipple shield the milk supply decreases, and that makes it more difficult to get the baby to latch on. I am appalled by the wide spread use of nipple shields by anyone, but particularly lactation consultants."

Dr. Newman totally rocks.

I just wish them shields weren't handed out like candy everywhere. :(