7 Steps to a Great Postpartum Period

Written by Aly Folin, CPM, LM, North Star Midwifery & Erin Stertz-Follett, CD(DONA), LCCE, HBCE, Flutterby Birth Services

Megan Crown Photography

Megan Crown Photography

 

“Postpartum [pohst-pahr-tuh m]: Adjective – Of or noting the period following childbirth; after delivery (origin: Neo-Latin, 1840-50).” Ah, yes. Postpartum. “The postpartum period.” “The time following birth.”

In the United States, there is little thought given to the concept of the postpartum period. Few families are afforded adequate leave from their jobs to tend to the needs of the mother and the baby. While the time of birth is celebrated, the time afterwards is not given much more than a moment’s thought. I (Erin) tell my doula families that “preparing for birth, but not for postpartum, is like preparing for the wedding but not the marriage.” Sometimes that is met with a bit of a dull thud. Understandable.

It’s not something we like to think about, necessarily… How things might be difficult in those first weeks and months; how we might need to ask for support when it’s outside of our comfort zone; how sleep deprivation will settle in; how baby might not latch on and nurse as well as we’d hoped; how our family lives way father away than we’d like. But it is important. So, SO important. Here are seven ways you can help to ensure that your postpartum period will be as wonderful as your birth!

1) Plan, plan, plan.

You planned your wedding. You planned your last vacation. You planned your birth. Don’t forget to plan for the postpartum period! Think about the following questions… Who will take care of meals, the dishes, the laundry, the other kids, and all of the other tasks associated with running your home while you rest and heal after baby is born? Who will bring you water and food while you snuggle skin-to-skin and nurse your newborn? What will you watch on Netflix so that you don’t go crazy lying around for a couple of weeks? Take advantage of the time your during pregnancy to determine what your plan will be so that you have the space and time you need to take that rest. You earned it! You did just take nine months to fully grow and give birth to another human being, after all! It is unreasonable to expect that you would be back to normal after just a few days. If you plan and take this time in the beginning, you will feel better so much faster and be back to your new normal fairly quickly. Mamas who don’t plan or have proper support are more prone to breast infections and nursing issues, longer postpartum bleeding, and generally being more run down. DONA has a wonderful Postpartum Planning Worksheet if you need help getting started!

2) Stay home (or close to it) for 2-3 weeks… and Rest.

Rest and nest. We know this sounds hard; especially for women who are used to being “on the go.” However, in those early days after your baby, it is essential that you rest and recoup. Physiologically speaking, you essentially have a placenta-sized scab on the inside of your uterus right after birth. When you get up and move around too much, you continually re-open that scab and do not have the time to heal. Also, think of your pelvic floor as a “sling” that has been opened and stretched to make room for a baby to emerge; it also needs time to come back to normal. Take the time to let your body recover! You will never have this sweet time with your baby again. Snuggle in bed, nurse, and watch TV or read a book. This concept becomes even more important when you are adding to your family. Once your older kids see you out of bed and out and about, they will expect you to be a full-time mommy again. Once you leave your nest, you can’t go back. It drives me (Aly) bonkers when I see moms with newborns out at Costco or the mall in those first few weeks after the birth. I feel bad for those moms being dragged out of their beds and into the world. Their bodies haven’t had time to recover. And the babies – they will have plenty of time to develop their immune systems, but those first few weeks isn’t the time to start exposing them to anything aside from the antibodies directly from your skin. For more on how to recover after birth, check out this wonderful summary: “A Guide to the Tender Loving Care of Yourself.”

3) Set boundaries.

This is tough. Really tough. There will naturally be many important people in your life that want to meet the baby once he/she arrives. Try setting up a visiting schedule each day (or every-other day) when people can come visit. Be “selfish.” Find a time that works for your own family and have an “open house” of sorts for several friends and family members to come at once (but not too many at once). Of course you want to show off your new baby, but if you can’t be topless in front of your visitors, then they really shouldn’t be over. Newborns will be newborns for several weeks; everyone will get a chance. Remember that baby belongs with you… not passed around from person to person.

When people do come to visit, put them to work – have them start a load of laundry, fold the clean clothes, or wash some dishes. Oh, and they definitely should not come unless they bring a meal! Our culture has things a wee bit backwards when it comes to taking care of new mamas. Hint: holding the baby while the mama “gets things done” isn’t the way to go! Ask your provider or doula for a note you can put on your front door that basically says, “If you aren’t here to help, you shouldn’t be here.” Or, a note that asks well-meaning family and friends to leave meals for you on the steps/porch. You just might be surprised how understanding folks can be when they know you have just given birth. Give yourself space and grace. They will too!

4) Practice good self-care.

First and foremost: Sleep when your baby sleeps. Cliché? Maybe. But every mom who has been there before you will say this… and for good reason! You never know the next time your baby will have a nice long stretch of sleep, so don’t worry about cleaning the house or writing thank you notes; those can wait! If your baby isn’t one that sleeps longer than an hour or two at a stretch, then strategize with your partner on how you can get a few uninterrupted hours in a row (pro tip: you might need ear plugs). Approach parenting like the team you are, and take shifts. When you are ready to leave the house more, book that massage (or have your partner book it for you)! Better yet, find a massage therapist who will come to you. See your chiropractor. Take a nice, long soak in an herbal bath. As experienced moms, we can’t stress this enough: Take breaks!… Short ones if you have to, and longer ones if you can get them.

5) Hire a postpartum doula.

Yes! There is such a thing as postpartum doulas… And they’re awesome! They can provide support and encouragement in those first few weeks postpartum. They do light house cleaning, make meals, run errands, hold the baby so you can nap, help you navigate breastfeeding… whatever you need! If you don’t have familial support, a postpartum doula is essential! Your provider or doula should be able to provide you a list of local postpartum doulas.

6) Give yourself grace.

Lower your own expectations. Give yourself some slack. Sometimes this may be the most difficult step of them all. Women, by nature, are harder on ourselves that we should be. The “Mommy Wars,” trying to please everyone, and wanting to live up to our own mothers’ (or friends’) examples or expectations… It’s a lot for any mom, but especially a new one! It doesn’t matter what the house looks like. It doesn’t matter that you are getting take-out food 4-5 times per week. What really matters is that sweet new person you get to snuggle… and taking care of yourself. There will be plenty of time to worry about the other stuff, but those first days and weeks with your new babe are irreplaceable.

7) Know when additional help is needed… and where to find it.

Sometimes the postpartum time comes with postpartum depression. This is more than the typical adjustment time and associated “Baby Blues,” which generally dissipate within two weeks after birth. 10-15% of new moms are diagnosed with true postpartum depression, and it may begin anytime in the first year of baby’s life. Partners are often the ones who notice depression first – their partners are just not the same, and it is more than just the sleep deprivation or expected struggles that come with being a new parent. Thankfully, there are lots of resources. Here are a few for our local folks, and know that you can always contact your provider too:

Pregnancy and Postpartum Support Minnesota

HCMC’s Mother Baby Program

Postpartum Counseling Center

Consider joining a new mom’s group or a MOMS Club in your area! Sometimes getting out and being around other new moms who are traveling the same road that you are can be extremely comforting. You just may make a few new lifelong friends!

If you need additional help with breastfeeding, talk to your provider or doula. Don’t wait until things are so bad that you feel like giving up. It is normal to need help! Seek out the guidance of an IBCLC (International Board Certified Lactation Consultant) who can help assess and set you on the right path. For you locals, Flutterby offers lactation services; and there are many other awesome lactation pros in the Twin Cities.

Bottom line? You only have this baby, and this postpartum period, once. Be good to yourself. Turn over some control to others (good practice for parenting in general). Allow your body time to heal. Snuggle your baby; they are only this little for a short time. Ask for help. Remember that this too shall pass.

Happy Birthing!

Aly and Erin

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Photo Credit: Megan Crown Photography

Ten Things Women Say in Labor (that are totally normal!)

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Brittany-19Written by Aly Folin, CPM, LM, North Star Midwifery & Erin Stertz-Follett, CD(DONA), Flutterby Birth Services

After attending many births, it is safe to say that we as midwives and doulas have heard just about everything you can imagine come out of the mouths of the beautiful, strong laboring women before us. These are instinctual, common things to say in the midst of this transformative moment in your life. Sure, we might occasionally think, “Wow, I’ve never heard that before!” But, generally speaking, here are the words and phrases that we as birth attendants most often hear, along with tips for what these may mean and what partners can do in response!

1) “I can’t do this anymore!”/”When is this going to be over?”
What this might mean: There are really two distinct transitions in labor – The transition from “early” to “active” labor; and “Transition,” which is the when the cervix is finishing its opening. Labor can be described as a “staircase,” with each step up becoming more intense. It can take a laboring woman by surprise and may take some adjusting, mentally and physically.

What you can do: Help her stay calm, focused, and breathing through the contractions. Often this feeling passes quickly as she adjusts to the new level of intensity. Remind her that she can do anything for one minute at a time, and that she will receive breaks in between each contraction.

2) “I CAN do it.”
What this might mean: In short, it means that she believes in herself, has educated herself on birth, and has built a wonderful support team! We see women all the time that are surrounded with loving support and skilled, caregiving providers who are confident and working with their labors.

What you can do: Keep giving your partner your attention and reminder that yes, she can do it, that she IS doing it. If she strays from this path, have her repeat with you, “I CAN do it.” Tell her you are amazed by her, that she is strong. Keep affirming her work in bringing this baby forth.

3) “Don’t touch me!”
What this might mean: Labor is full of big, new sensations that can require all of a laboring woman’s focus. As labor moves along, she goes more inward. If touched at the wrong moment, it can distract her from her work. She may love that foot massage one moment and want all hands off at the next.

What you can do: Don’t take it personally! It is all she can manage right now, and this too will pass. Help her get through by staying close and helping her to remember to breathe and release tension with only your words. A little goes a long way. Don’t forget to remind her that she is doing great!

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4) “I am hot… I am cold.”
What this might mean: There are huge hormonal fluctuations in labor that often lead to women feeling overheated or very cold. Because of this, you may first spend all your time warming a mom up, and then during the next contraction, she throws off all the blankets and is roasting!

What you can do: Don’t worry; it is normal! It does not mean that she is running a fever (but feel free to ask your provider if you are concerned). Just go with whatever she needs in the moment. Heated rice sock? Check! Icy-cold washcloths? No problem, babe! Need the heat turned up when it’s already 80 degrees outside? Ok!

5) “I don’t know what I want to do.”
What this might mean: Sometimes as women are getting closer to that final transition, they get more agitated and indecisive. No position or comfort measure is helping any more, or they are just too inwardly focused to make up their minds (understandably so!).

What you can do: Again, remind her to breathe and help her stay calm during the contractions. Ask your doula or midwife to suggest some position changes that help moms when they are in this place in labor. If she wants to do something, but is having a hard time making a choice, take the lead and ask her to try a new position or technique for at least three contractions.

6) “It feels like I have to poop.”
What this might mean: Poop? Yes, poop. As midwives and doulas, we get very excited (quietly) when we hear this! It often means the mom is feeling the baby’s head descend and put pressure against the nerve between her vaginal canal and her butt, making her feel like she has to poop. This usually means things are getting closer and she may be pushing soon!

What you can do: Say, “YAY!” What?! No, really. Please don’t say, “GROSS!” Since you now know that this sensation is good and it means baby is closer to arriving, celebrate with her! Midwives and nurses/birth assistants are very quick to clean up anything that does come out. Be sure mom doesn’t feel self-conscious and remind her that she is close to meeting her baby!

7) “Baby’s coming!”
What this might mean: Typically is means that baby is about to be born! Occasionally, women use this saying in general during their labor to express their overall excitement and anticipation of baby’s arrival.

What you can do: If you are unsure if she means this literally, ask her to clarify. If so, get your midwife or the nurse – baby is coming and you should get ready to help catch!

8) [Insert favorite curse word(s) here]
What this might mean: In actuality, it is surprising how little women swear in labor. The way the media depicts it, you would think that women are cursing up a storm and telling their partners all kinds of terrible things. But in reality, it is usually a moment here or there where some choice words or phrases will come out.

What you can do: Nod your head “yes.” Give her an “Mmmm hmmm.” Show her that you understand that she is feeling an intensity like she never has felt before. Maybe curse words are a part of her everyday language, and you won’t even notice! Doulas and midwives love when moms curse, as again, it typically means that things are moving along.

9) “This is fun!” (What?! Yes, really… Women say this).
What this might mean: Ok, we’ll admit. This isn’t the most-heard phrase in labor. But it has been said; most often by moms who are “high” on the hormonal cocktail of birth. They have drunk the Kool-Aid. They are all in. I (Erin) hear women say this who are well supported and who value humor and laughter in their birthing time. Moms who use hypnosis for childbirth techniques are the most common purveyors of this phrase.

What you can do: Enjoy it! Your partner is a Certified Rock Star!

Brittany-2210) Nothing at all.
What this might mean: Women deep into active labor will become very internally focused. Sometimes the way that helps them get through their contractions is to moan or stay quiet. Every woman is different and will cope differently.

What you can do: Don’t worry if she isn’t talking to you – it just means she is working really hard to stay focused. Stay present physically, she will reengage when she can.

Any and all of the above are so, so normal for women to say in the heat of labor! The main thing you can do as a support person is to respond to her needs the best you can in the moment and stay present as she works hard. Don’t take anything she might say personally. Always tell her she is doing great and how amazing she is! If this feels overwhelming to do on your own, hire a doula! She will help you know what to say in the moment and help you support your partner through this wonderful journey.

Happy Birthing!
Aly & Erin

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Photo Credit: Megan Crown Photography

7 Steps to Getting the Birth You Want

While it is true that I am a midwife that loves out-of-hospital birth, and loves getting to see how amazing women in labor can be on a daily basis, I understand that it may not be the right choice for everyone. I see beautiful births happen everywhere: at home, at birth centers and in the hospital… even in operating rooms! I passionately believe that every woman, no matter where they choose to give birth, should be treated with respect and honor during one of life’s most transformative moments.

What I want most for you is to know what your choices are, and to understand the potential impact those choices have on your birth experience. There is nothing I dislike more than hearing someone say they had a terrible birth experience and they wish they had found me before they had their baby! Informed consent, evidence-based information, and shared decision-making are crucial for a confident birth.

So what IS most important to you about your birth? Jot down some thoughts about the kind of birth you envision for yourself.

Ok, now that you have some ideas of what is important to you, let’s get down to business:Brittany-71

Step 1: Choose your place of birth to optimize your chances of having the kind of birth you want

  • Hospital: 98-99% of births in this country take place in the hospital. That being said, there can be huge differences in outcomes at different hospitals in the same area. We see this here in the Twin Cities, where some hospitals have very high cesarean rates, while another hospital across town has a very low rate. Hospitals are offering more and more choices to birthing families, but make sure you get the real scoop on what is marketing and what is real choice. There is a lot of window dressing these days!
  • Freestanding Birth Centers: Freestanding birth centers are one of the newest options in birth location, and they can be a great choice if you have a low-risk pregnancy. They have a home-like environment where you can labor and birth, but go home once you and baby are both able to (typically 4-6 hours after birth).
  • Home Birth: Home birth can be a hotly contested issue. The truth is that for a low-risk, healthy mother and baby, home birth can be just as safe as a hospital birth with a trained and skilled provider. The best part of home birth is getting to snuggle in your own bed with your baby! The benefits of home birth are many – check out our website to read about the benefits and safety of home birth.

Step 2: Choose your provider carefully

When choosing what kind of birth you want to have, it helps to have a provider that is an expert in that type of birth. If you want a natural birth, maybe hiring a surgeon (i.e. an OB/GYN) isn’t the best choice. If you want an epidural at the earliest possible time, choosing a homebirth midwife probably doesn’t line up. Here are some simple facts about different types of providers:

  • Midwives are the experts in physiologic birth. If you want a natural birth, a midwife is the best type of provider. If you have a higher risk pregnancy but still want a natural birth, you may want to check out midwives in the hospital, as many hospital midwifery practices can provide you with the care you need but still help you get the birth you want!
  • Certified Professional Midwives (CPMs) are the experts in out-of-hospital birth (free-standing birth centers and home births). They have specific training to care for both mother and baby during home or birth center births. They primarily care for low-risk, healthy pregnancies, but if you have a health situation but you want an out-of-hospital birth, don’t be afraid to ask! Midwives can sometimes manage situations in collaboration with a physician.nsm-10
  • Family Practice Docs are a great option for hospital births! Many of them attend their own patients and tend to be more laid back in their approach. If needed, they will consult with an OB/GYN for high-risk mothers or those requiring surgical intervention in labor.
  • OB/GYNs are trained primarily in surgery. Normal, natural birth is not part of their training. There are OBs who do specialize in normal births, but they are the exception rather than the rule.
  • With any provider choice, get on your local birth/parenting or Facebook groups and find out what people’s experiences have been with the providers you are looking at, then interview a few to find the right fit for you!

Step 3: Take a childbirth class that supports your planned type of birth

Wherever you are planning to birth, if you want true education about how birth works and getting the tools you need to birth with confidence, choose an independent childbirth educator! Hospital classes are designed to teach you how to give birth in that institution. Independent classes teach you how to advocate for yourself in any type of birth situation.

Step 4: Be the healthiest you can be throughout your pregnancy

  • Eat well – Eat primarily whole, unprocessed food as much as you can, limit sugar, and try to get your veggies in.
  • Walk daily – Even a 15-minute walk daily can help your body get aligned and increase your endurance for birth.
  • Listen to your body! (But not when it says to eat the pint of ice cream). If you need to rest, rest! If you need more food, eat more high-quality food!

Step 5: Hire a Doula and Build your Birth Team

Doulas are an amazing addition to any birth team. They help you advocate for yourself and can help your partner support you in the best way possible. They are knowledgeable, skilled “tour guides” for any type of birth. Doulas provide physical, emotional, and informational support.

Step 6: Consider bodywork

Bodywork, especially chiropractic care with a skilled provider for pregnancy, can help get your pelvis and your baby aligned for your optimal birth experience. Other types of bodywork that can also help you include prenatal massage, Mayan abdominal massage, myofascial work, and more!

Step 7: Prepare for potential variations in the plan, whatever that may be

Birth is unpredictable. We do our best to prepare by controlling the factors that we can, and handling unexpected situations as they arise. It is helpful to create a vision of your birth, but to also be open to potential variations that may occur. Think through what those variations might be, and decide what is most important to hold on to from your vision and what you can let go of.

A success story:

One of my very best friends found out she was pregnant with twins, and when we went out for coffee one day, the subject naturally turned to her plans for her birth. This is what she had to say about it:

“When I got pregnant with my twins, I was convinced that I would likely need a c-section. I thought it would make sense to go to the hospital closest to me for convenience. Aly encouraged me to think of birth in a more natural way. She told me to think more about the kind of birth I wanted and less about convenience. I took this advice to heart, and after touring several hospitals, I chose one farther away that was more supportive of natural birth than the one close to me. The advice Aly gave to me was crucial in me ultimately having the birth I wanted…Find a place and people that support your beliefs about birth!”

You have choices! Going in to your birth with a plan and support will help you make the best choices possible to help you have the birth you want! Happy Birthing!

If you are interested in learning more about our home and birth center midwifery practice or to help figure out which one is right for you, set up a free consult at https://northstarmidwifery.acuityscheduling.com/

Photo Credits: Megan Crown Photography

We have another midwife! Introducing Rebecca Polston, CPM

Heashots-5For a long time I have wanted to practice with another midwife. The demands of a midwifery practice and having a young family are intense and having another set of responsible shoulders to share the load has been appealing. Rebecca and I have known each other for a long time. I was the second midwife at her first birth and we are part of the same parenting community. We have also been in the birth community together since 2007. Last fall Rebecca came to me as she was completing her credentialing process. My senior student was going to be out of the country and the timing was perfect. Rebecca and I clicked immediately and I knew she was the one for North Star Midwifery. So far we have been having a blast learning from each other and helping families.

Having two midwives at North Star Midwifery provides multiple benefits to the families we serve:

  • Continuity of care: if there are two moms in labor at once (a rare event), the families each get a midwife who they know well to help them and then each of us would call another midwife to come and help us.
  • Multiple perspectives: at each encounter with a family there are always 2 perspectives. This serves to help families feel more supported and helps the midwives to evaluate each issue from different viewpoints to improve safety and to increase the variety of options a family has.
  • Well rested midwives: Having two skilled midwives allows us to spell each other and ensures that there is at least one fresh midwife available most of the time.
  • More love: with twice as many midwives each family can get twice as much love. Love is the heart of midwifery care, you know!
  • Happy, balanced midwives: Rebecca and I have made a commitment to self-care and work/life balance. We will strive to take days off call and vacations a couple times a year or when we need them so that we are nourished and fresh for when your family needs us most.

Rebecca attended the National Midwifery Institute and worked with several local midwives to get her clinical experience. She also apprenticed in a high volume birth center in Utah. Before and during her training she worked as a Doula at HCMC for several years and worked as a breastfeeding Peer Counselor for WIC. As a student midwife she began her training in 2007. Rebecca’s training was steeped in the values of traditional midwifery and on a cellular level she believes in birth and women’s ability to bring their babies into the world. In February, Rebecca took and passed the NARM exam to become the first African American CPM in the state of MN.

Rebecca is the mother to 3 children. Her first was a planned homebirth that ended in a transport and a c-section. She then went on to have her next two VBACs at home. She is passionate about supporting women who have had a prior c-section and helping them understand all their options.

Rebecca and I share a passion for social justice in birth and in decreasing racial disparities in infant mortality and maternal outcomes. We have several projects up our sleeves that we hope to be able to share with you soon!

If you have any questions about Rebecca or how our practice works with two midwives, please feel free to get in touch. We are thrilled to have her and we know you will be too.

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Rebecca and her two HBAC babies

The Birth Story of Baby Caleb

By Jennifer S.

In honor of Caleb’s first birthday today, here is his birth story. It is always an honor to be present at any birth, but the birth of a first baby always feels especially triumphant. Happy Birthday Caleb! And happy birthing day to you, Jennifer!

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As soon as my husband and I found out we were pregnant, we started to consider a home birth. This is the story of the birth of our first child, Caleb.

 I started having menstrual like cramps on Thursday morning, February 16th, two days before my due date.  Not much else happened the rest of the day, and I only noticed a little bit of blood and mucus until Friday morning.  Around 3am on the 17th, I woke up to go to the bathroom and that’s when I lost my mucus plug.  Later on that morning I started to feel what I thought were actual contractions.  Turns out they were, but I was only feeling them every 30 – 45 mins at most.  My husband came home from work and we got the rest of what we needed, including some groceries from the store, and headed to my in-laws home to prepare for the birth of our son!  We got there around 4pm that afternoon.  I had called the midwife earlier in the day to let her know that things were starting to happen.

 Saturday morning comes around and I had taken some calcium/magnesium supplements to help me sleep but I was waking up every 20 minutes or so with a contraction.  They continued at the same pace until about 1am on Sunday morning, the 19th.  My husband and I kept in touch with Aly every hour until about 4am when she and Sky started heading our way.  By that time my contractions were getting a lot stronger and were 3-5 mins apart.  Aly and Sky were both at the house before 5am and got busy warming up the birthing tub.  To my disappointment, my contractions decided to slow down during all of the commotion so Aly suggested I go sit on the toilet for a while.  That turned out to be a very good idea as my contractions picked up and got stronger and closer than before.

 As soon as the tub was filled with hot water, I was more than ready to get into it.  Being in the water felt amazing.  Very soon after getting into the tub, I felt my water break.  It was like a small explosion!  I’m not sure exactly how much time went by, but it seemed like I was ready to push in no time after getting into the tub.  The pushing proved to be a LOT of work.  My husband, Aly, and Sky were all making sure I was drinking and eating to keep up what little strength I had left, as I was very tired from not getting much sleep the past two days.  The pushing lasted a few hours, but seemed to go by quickly until the end.  I would give a few good pushes, then have to stop, catch my breath, and start again.  I tried several positions, and the last one proved to work quite well.  Squatting towards the side of the tub, leaning slightly backwards, and holding onto my husband’s hands, I was able to use all of my remaining strength to push Caleb out completely!  Though his head had been birthed a few minutes before the rest of his body, his heart rate stayed steady during the entire labor.  Caleb was born at 9:27am, perfectly healthy and very calm.  Just five short hours after the midwives arrived, I had my baby boy in my arms!  It was the most incredible thing I have ever gone through.  And I did it all without pain killers, and had no tearing!

 I did not experience my labor as that painful. More than anything, I felt that it was simply a lot of pressure, and a lot of hard work. The entire experience was better than I had imagined it would be.  I’m sure it helped that I had a good perspective on childbirth from the beginning.  That it is natural, and that women were MADE for it.

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Is out-of-hospital birth safe? Yes, new study confirms.

By Jackson Carr, Student Midwife

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Yesterday, a new study was published that confirms the safety of out-of-hospital birth for low-risk women. The study examined the outcomes for 15,574 women who planned to give birth in a free-standing birth center in the United States between 2007 and 2010. Births were attended several types of midwives: Nurse Midwives (CNMs),Certified Professional Midwives (CPMs), and licensed midwives. This is the largest study done in the US on the safety of out-of-hospital birth. You can read the American Association of Birth Centers’ (AABC) discussion of the results here.

We are excited about how the study showed that birth in a free-standing birth center with a trained midwife is a safe choice for low-risk women! One of the most significant findings was the the rate of Cesarean birth: just 6% of the women participating in the study had a surgical birth. This means more than 9 out of 10 women had a vaginal birth. Compared to the national average Cesarean rate of 27%-35% (depending on the source), we think this is an awesome outcome. There were low rates of transfer overall, with less than 1% of transfers occurring for emergent reasons. Follow this link to read the details of the study.

The results are similar to several other studies published in recent years that demonstrate the relative safety of home and birth center birth. The largest was in the Netherlands, which compares low risk births in both home and hospitals. These two studies were recently done in Canada, one comparing planned homebirth with a midwife to hospital birth with a physician or midwife, and the other looked specifically at similar outcomes in Ontario. Another large study examined the effect of place of birth on maternal and neonatal outcomes in the UK, and found that for most women home birth was as safe as hospital birth, with lower incidence of interventions.

The Midwives Alliance of North America also collects prospective data on homebirth. The CPM 2000 study found that homebirth with a CPM was a safe choice for low risk women. The North American Registry of Midwives (NARM), the certifying body for direct-entry midwives, required that all CPMs participate in the MANAstats project in 2000 in order to recertify. NARM is planning to collect similar data in 2015, and we will get an even better picture of homebirth safety with a CPM, since more families are choosing homebirth and the number of CPMs is growing all the time.

While North Star Midwifery is a homebirth practice, the results of the AABC study can be applied to homebirth settings as well. The equipment used in most birth centers is identical to what we carry in our birth bags to every birth; such as oxygen, anti-hemorrhagic medications, and equipment to monitor the baby’s heart rate. Like the midwives in the study, North Star’s midwives are highly trained and have the same goals of keeping both moms and babies healthy throughout pregnancy, labor, and birth. We also follow the Standards of Care laid out by the Minnesota Midwives Guild and MN State Law, which helps ensure that we are working with healthy women.

Sky’s Midwifery Journey to the Philippines

Aside

I first started thinking about going abroad when I started looking at midwifery schools.  Travel is a big part of my life—it is a way for me to expand my horizons and come home with fresh perspective on life in the U.S.  I have had the opportunity to travel to Europe, Mexico, Canada and all over the United States.  Those trips were crucial parts of my growth and really opened my eyes to the larger picture of our human global existence.  They, along with some influential films and pieces of art, also pointed me in the direction of global service—specifically to a dream of working with Doctors Without Borders someday.  When I started looking at going to midwifery school, I knew that being able to get midwifery experience abroad and in developing nations would be an important part of my education.

So why did I choose the Philippines?  Well, there are many reasons.  I looked at programs in Bali, Senegal, and Haiti.  But after looking more closely, while I would love to go to those countries, I knew those programs weren’t for me.  I kept searching.  My search eventually led me to Shiphrah Birthing Home, and more than the Philippines, it was Shiphrah that drew me in.

Shiphrah Birthing Home is a birth center just outside of Manila, the largest city in the Philippines.  They serve around 200 birthing women and their families each year.  What really captivated me was this:

At Shiphrah we believe in the well-being of the whole woman, her mind, her body, and her spirit. We promote wholeness through the building of mutual relationships between woman, midwife, and family through dignified, excellent maternal health care, empowering education, and genuine friendship.

Shiphrah’s commitment to empowering women and offering excellent care to those who may not otherwise have it really struck me.  This was a place that embodied the same values that I value so highly in midwifery care—dignity, quality, empowerment, service and compassion.  I am happy to give time and money to an organization like that.  And I feel that it will be an excellent environment for me to learn.

Other things that I like about Shiphrah are that they are a birth center (this is crucial to me, being that I want to practice out of hospital birth here in the U.S.) and they spend time and effort training local midwives. Training local midwives helps to improve maternity care for many more women and families in the Philippines—helping people help themselves.

As I prepare for this trip, I have been spending a considerable amount of time thinking about what the exchange will be when I go to Shiphrah.  How can I be open and willing as I can be while I’m there?  I know that a humble heart and mind will go a long way toward learning, but I must also be very aware of the cultural differences between the U.S. and the Philippines.  The art of midwifery is very subtle, and in order for me to learn all that I can I have to be aware of the small distinctions that make midwifery what it is in the Philippines.  I know that these Filipina midwives have a lot of knowledge they can teach me, and I have a lot to learn!

The same can be said for being of service.  Humility goes a long way towards understanding and being as useful as I can.  I hope my skills as a more advanced midwifery student will be helpful, but also I hope that I can help with the nitty gritty of running the birth center, like cleaning and helping the space run in the day to day.  I even have dreams of helping to start an herb and vegetable garden while I’m there, but that will depend on the needs and wants of those who work and live at Shiphrah.

Moving forward, I am getting really excited to do some world travel again.  I’ve been trying to learn some Tagalog and getting all my travel documents in order.  I can’t wait to get outside my comfort zone and experience new things!  I’ll be keeping everyone updated via my blog: www.manamidwifery.wordpress.com.  I’ll make sure to write while I’m in the Philippines and upload pictures, so keep checking back!

Lastly, I want to thank all the people who have so generously contributed to my IndieGoGo campaign and bought raffle tickets supporting my trip.  I don’t have the space to name them all individually, but know that I will carry all that love and support with me on my trip. Thank you, thank you, thank you.

Meet the Students of North Star Midwifery

For a long time in my practice I did not feel ready to take on the responsibility of training student midwives. It felt overwhelming to be in that role of teacher, especially as I was getting established as a midwife and learning so much myself. Right around the 5-year mark, things started shifting for me and I suddenly felt ready to take on that job (it didn’t hurt that I was having a baby too!) I also recognized that in order to increase the number of midwives so that more women have access to midwifery care, I needed to participate in the education of future midwives. Since then I have had several students in my practice and I have enjoyed learning from all of them as well as sharing what I have learned since leaving midwifery school. Having students in my practice pushes me to be the best midwife I can be. I will always be growing as a midwife and it feels vulnerable to have people observing you while you do that work. I now have two students in my practice and the three of us work great as a team. I couldn’t ask for better people to help me along into the role of teacher. I am thrilled to introduce them to you here.

Meet Sky

I first heard about midwifery when I was 17—a woman that I knew was a midwife and
she said to me that she thought I might really enjoy this line of work. Being a typical 17
year old, I blew her off and continued on my way. I got my Bachelor’s degree in
Environmental Studies with a minor in Cultural Sustainable Development from Western
State College in Gunnison, Colorado. I worked in that field for 5 years, culminating in
a job as a naturalist at Haleakala National Park on the island of Maui in Hawaii. I was
living on Maui when I attended my first birth, and it was then that I knew that the woman
from my past was right—midwifery is what I am meant to do. From there, I enrolled
in Birthwise Midwifery School in 2009. I finished the academic part of my training in
2011 and started formal apprenticeships that same year. I have apprenticed with home
birth midwives, and with a birth center. I started working with Aly and North Star in
February of this year. This fall I will go to the Philippines to a high-volume birth center
in Manila to study abroad and volunteer. You can read more about my trip and contribute to my efforts here: http://www.indiegogo.com/SkyConnelly and here: http://manamidwifery.wordpress.com.  I am planning to take the NARM in February
2013, and graduate from Birthwise in June 2013. When I’m not “midwifing”, as many
of my friends call it, I’m usually on my bike, doing yoga, reading or in the lake. I am so
delighted to meet all of you and to be a part of North Star Midwifery!

Meet Jackson
As a teenager, I first knew I wanted to be a midwife when I read “Immaculate Deception” by Suzanne Arms. There was no doubt in my mind that I was called to provide holistic, family-centered care to people who are growing their families. For the next twelve years, I worked with a diverse array of families as a nanny, postpartum doula, birth doula, and as a teacher, much of that experience being in California. I began studying midwifery more intensively in 2009, taking an 8-week midwifery course with Elizabeth Davis. I then headed off to Birthwise Midwifery School, a Midwifery Education Accreditation Council (MEAC) accredited school in Maine. There, I was fortunate to learn from several direct-entry midwives, nurse midwives and naturopathic doctors both in the classroom and in two clinical rotations. I am grateful to be working at North Star Midwifery, because I love the balance that Aly strikes between trust in birth and safety in care. I plan to graduate from Birthwise and become a Certified Professional Midwife (CPM) and Licensed Midwife in 2014. When I am not working with Aly and Sky, I like to hang out with my large family (especially my niece and nephew, both born at home), take walks with my muppet-dragon of a dog, and share meals featuring lots of local produce with my friends.

5 Parenting Lessons I Have Learned (Mostly the Hard Way)

So I am not a parenting expert. In fact, I wouldn’t even call myself that great of a parent. I am in the trenches with a 20 month old and a 4 ½ year old. They push my buttons more than I ever thought possible. I am always struggling to learn, to do it better and also not to lose my freaking mind. As a midwife, people ask me a lot of questions about parenting babies. I have some wisdom from my personal experience and others’ experiences to share, but I always hope when people leave my care they KNOW they are the experts on their own baby and that they trust their own instincts above anything else. My intent is not to be preachy. I am not perfect, I make lots of parenting mistakes, but I love my kids more than anything in the world and I try my hardest most days.

1.       Parenting begins when you are pregnant.

I am not trying to make you feel guilty for that McDonald’s you ate in the first trimester, or the drinking you did before you found out you were pregnant. Don’t stress out about everything you do or don’t do while you gestate—pregnancy is stressful enough! It is important to note that what you do, your level of stress, what you eat and how you choose or don’t choose to connect to your baby inside of you affects your baby. Nutrition is a prime example of this. When you get past the difficulties of the first trimester, try really hard to eat as well as you can. It is the best gift you can give to yourself and your baby (this will be discussed more in future posts). Also if you have something really challenging going on, tune in to your baby a little every day and let them know that they will be ok, even though you are having a hard time right now. Your baby is bathed in your hormones, so if your hormones are predominantly stress hormones (catecholemines), it affects how your baby’s nervous system develops, in turn affecting how your baby will experience stress throughout life. There is a whole field of prenatal psychology and you can find more information about it here.

2.       Trust yourself.

When you have a baby, or really a kid of any age, people feel free to give you lots of advice. Though it is almost always well intended, much of it is still crap (especially breastfeeding advice). When you are a new parent, or even an experienced parent in a new situation, there are times where you will feel overwhelmed. You might be sleep deprived and emotional, you might feel at your wits end and easily influenced. Remember that you don’t have to take any advice that doesn’t “feel” right. You don’t have to listen to your mother when she tells you that you really shouldn’t pick up a crying baby (BTW, you are hard wired as a parent to need to pick up your crying baby). You don’t have to listen to your Aunt Rose who tells you that breastfeeding shouldn’t be so hard and that you should quit being a martyr and just give your baby formula. This applies to midwives and doctors and any other professional as well: if the advice doesn’t seem to work for your family, then don’t do it. You are this baby’s parent and you will find what works for you and your child. If you feel at your wits end, talk to parents you trust and see what worked for them, but don’t feel obligated to do what they did and find the solution that works best for you.

 3.       Keep your cup full.

So this is one I have a really hard time with. It is something I am working towards as a mom and as a midwife. You will be a better parent and have much more patience for the craziness of parenting if you are taken care of. You need breaks from your kid. You need to eat when you are hungry. You need sleep. You need adult interaction. You may need physical intimacy. Taking the time for those things and finding creative solutions so that you can have them does not make you a neglectful parent. Having your needs met supports the needs of your children. It helps you meet the constant flow of demands with creativity and resiliency. It helps your kids to have a parent who is rested and nourished, and thus not resentful and cranky. It also helps your kids to see how self-care is done, which is an important life skill!

4.       Babies have needs and crying is how they ask to have them met.

Crying is the only tool that babies have to ask for things and their cries are designed to get you to respond. This ability to get you to meet their needs is how babies survive. As I said above, you are hard wired as a parent to respond to your baby when they cry. Don’t ignore this hard wiring because someone told you that your baby was manipulating you. They have studied the biological reaction that mothers have when they hear their baby’s (or really any baby) cry. Their milk starts to let down, they start to sweat if it goes on too long and they are made to be really uncomfortable. This is biology at work, people. Nature wants your baby to make it and responding to your baby’s cries is the best way to get that done. There are numerous other benefits to responding to your baby: your baby learns that the world is a safe place, you learn what your baby’s different cries mean and learn to respond appropriately (this takes a few weeks or maybe months), your milk supply gets well-established, you get the oxytocin rush from snuggling your precious baby, and you get to marvel at your power as a parent to soothe your baby.

5.       Mommy guilt is a worthless emotion.

I learned this from my friend Maureen Campion and I have tried to take it to heart. When you screw up as a parent (and you will, I can promise you that), don’t dwell on it. Apologize to your kid/s and move on. It is ok and even important for your kids to see you make mistakes, lose your temper and then go back and make it right. Maureen also says that if the majority of your interactions with your children are positive (she says 80%) you will be able to preserve your relationship with your child. You will probably screw up again and again.  Mommy guilt isn’t going to make it any better. Instead, teach your kids that we all screw up, how to learn from mistakes, and how to make amends by modeling it for them in your parenting.

The Birth of Baby Noelle

This is the birth story of Noelle to Sophia and Tyler and big sister Alayanna. It is a long story, but I couldn’t bring myself to cut any of it because it all felt so essential to the overall story. Enjoy!

I wish every woman believed in the power of birth, and knew in her soul how amazing and empowering birth can be. But, I don’t think it’s something I believed myself, really truly believed, until Noelle.

If you asked me to describe my birth experience in one word, I would tell you: “thrilling”. Yes, the birth of my second daughter, Noelle Jay, was the most thrilling experience of my life. I have not had a boring life. I have sailed in a race (and won!) on the Puget Sound, I have jumped off cliffs in Venezuela, I have climbed mountains in Colorado, lived at the base of active volcano’s in Guatemala, white water rafted in New Mexico, surfed the waves of the Pacific, and the list goes on. And still, my homebirth experience was more thrilling than any, or all of these.

I went to bed Monday night feeling minor menstrual-like cramps. Trying not to get excited I told my husband, turned off the light and forced myself to fall asleep. The cramps woke me up around 1:30am, but were coming about every nine minutes and lasting only about 30 seconds. My husband told me to fall back asleep, but they were strong enough to keep me up. I tried not to get too excited, and told myself I would only call Aly if I had some bloody show. Minutes later, I went to the bathroom and was on the phone with Aly. I told her what was going on, that I was going to try to sleep, and that I would call her if things changed. Things didn’t change much. I laid in bed (my husband telling me over and over to go to sleep), and called Aly at 5:30 to tell her things were still pretty strong and I wasn’t able to sleep. I wasn’t yet convinced I was in labor yet though. She told me to eat something and that she was going to start getting ready to head over. Around 6am I told my husband that our doula and Aly were on their way. Annoyed, (not believing I was really in labor) he got up and ate something and started to get the tub set up.

Around 7am I remember texting my doula asking her how far away she was. Her reply was “I am in your neighborhood”. I said “that’s the best news I ever heard”. By 7am things were picking up. My contractions were coming at 3-minute intervals, and I mostly had to sit down or kneel during them. My doula and Aly arrived within minutes of each other. I felt a sense of relief as they arrived. With this relief, my labor picked up.

My husband started to believe I really was in labor around this time. I still wasn’t convinced though. I laid in bed with my husband, riding each contraction as it came, while cuddling and kissing him. It felt so good to be so close to his body, feeling safe, warm and surrounded by love. I felt good.

At some point Aly told me I could get into the tub. I was worried that I wasn’t ready to get in the tub, that maybe things would slow down, but Aly assured me she thought things were going well, and that they would continue to go well once I got in the tub. I climbed in and felt amazing. Surrounded by water and the soft air-filled walls of the tub I just sank in and let myself float. It felt beyond good. The contractions were still strong but felt so much lighter in the tub. I kept saying “this feels so good!”, and then began to ask if it was feeling too good. The midwives smiled and said “It’s good that you feel good, your body is doing exactly what it needs to do”. This floored me at the time. How amazing! I said “that is sooo cool” out loud, feeling high off the energy.

Shortly after I started to feel tired, I got out of the tub to go to the bathroom and laid in my bed for a while after that. My bed felt so good. After a few contractions, I started to grow anxious that maybe my labor wasn’t progressing as much as everyone was thinking it was. In my first labor I had contractions like I was having at this point, for almost two days with no progress. I laid in bed and prayed. I heard a voice tell me to ride three more contractions in bed and then check my dialation myself. So I did. Three in bed, and then I felt….an entire head!! Just two knuckles in and there it was, a bare, hard, round head. What an amazing feeling. I knew instantly that I was dilating (even though I never felt my cervix before), and that things were progressing nicely, just as Aly said. It was at this point I finally believed I truly was in labor, that I wasn’t making a big fuss about nothing, and that my baby would indeed be coming shortly (not in days). Feeling a new rush of energy from this, I got back in the tub ready to welcome my new baby.

When I got back in the tub I felt great again. Not too long after things picked up once more and I started feeling I was getting closer to transition. I was afraid of entering transition because that’s where things fell apart in my first labor. But I just welcomed things as they came. I started feeling like I didn’t want to be in labor a whole lot longer, and that I just wanted to start pushing. I told Aly this. She assured me that she thought I was going to be ready to start pushing soon, and that my baby was on it’s way. Just then I felt some really strong contractions. I started praying again and heard a voice of reason tell me; “you can sit in the tub and do several mild-but heavy- contractions like this, or you can get out and stand up and do one really heavy one and be through with it”. I told Aly that I wanted to get out and stand but I was scared. I rode one more in the tub and decided to get out and try it.

I made my husband hold all of my weight as I rode what was the strongest contraction I remember, and once it was done I sat down and prayed again. The next contraction felt different, lower, lighter, easy and smooth. The next one did too. Then a third. I asked Aly, ‘are they all going to be like this from now on? I can do this, this is so much easier’. She said she thought I was going to start pushing soon. I got back in the tub and that’s exactly what I did.

The head was the hardest part, but it felt SO good to push. Roaring low, I remember thinking’ I can can be afraid and keep doing this gently forever, or I can go for it fully, really try and get it over with.’ I worked hard. I pushed through the stinging, which was over quickly. Once the head was out I sat there in disbelief, with a head between my legs, for 3 minutes. My husband remarked that soon we would see if it was a boy or a girl, to which I said of course it’s a boy!! (I was convinced the entire pregnancy it was a boy). With the next push she was on my chest. What a rush. The way it felt to hold her, to have pushed her out, to have experienced birth fully, consumed me for what felt like eternity. Bliss. Sheer bliss. Minutes passed and someone finally said “we should look to see what it is” (boy or girl). I looked to check, everything was swollen from the hormones and I was confused. “It’s a boy”, I said timidly as I went back to hugging her.

“NO! You are so convinced it’s a boy” my husband said “look again! It’s a girl!”

“WHAT?” I exclaimed, and I looked again. “OH MY GOODNESS!!! A GIRL!!” I yelled, suddenly entirely happy to have two daughters. I laughed at myself and continued to be high off of the experience.

I was a million miles away on a cloud with my daughter and husband. The feeling lasted for days after. I have an abundance of milk. To this day, just the thought of it brings me back. I am still riding the high.

A big part of my second pregnancy was spent trying to overcome my fears of birth. I was afraid of birth after my first labor, which lasted 40 hours and ended with an epidural and a vacuum. I was convinced that my second birth could be, would be, different. In both of my pregnancies I read avidly about natural birth, and read birth stories published in Ina May’s books. The first birth I knew I could have a wonderful labor, but I don’t think I believed I would. I tried to control how my labor would go to ensure it went how I wanted. Trying to control birth is as good as stopping it. Like anything in life, it is going to go the way it was meant to. The more I tried to control my birth process, the more anxious I became and the more difficult birth became for me. Such is life.

My second birth, instead of knowing I could, I learned to believe I would have a wonderful labor. I chose to overcome my fears. I chose to have a home birth. The use of Hypnobabies CD’s, the support and love of my wonderful husband, the care I received from Aly and my birth doula, and the power of prayer all helped me have the birth of my dreams.   When it came time, they helped me let go of expectations and be present in the moment, letting go of the past and future as I welcomed my daughter in the here and now. For me, this was the most powerful mindset to have while giving birth, and I believe this mindset, combined with the support I had at home, is what changed my second birth experience and made it so different from my first.