"Just In Case..."

Yesterday I was having a nice chat with a good friend who is in the birth world and so when we get together, naturally the conversation moves towards birth. While we were talking, she mentioned that a friend of hers was planning to go to one hospital but after thinking through her options chose a different one because her original choice didn't have a level 2 NICU (Neonatal Intensive Care Unit) and so if her baby had any more serious complications she would be separated from her baby since she would be in one hospital and her baby would be in another.

One one hand that makes sense. On the other, as I have had more time to think about that - both as a midwife and a mom who delivered a baby in the hospital after planning my whole pregnancy to be at home (my daughter was born too early) I wouldn't plan my birth setting around a "just in case" scenario.

Ok - here is my opinion that could be contradictory. I believe that planning where you deliver around the "just in case" thought process is like not planning to get divorced from the person you are going to marry and are very much in love with, but getting a pre-nuptual agreement "just in case."

Sometimes you just need a day off...

Last night was rough. Eleanor has been sick once before, but not teething at the same time and I guess both at the same time was just too much for her little body to handle. We went to small group last night and had a good time - she played with the other little girls there and stayed up way past her bedtime without being crabby even! Then, on the ride home, she feel asleep almost immediately. I thought to myself, "Great! She will transition to her crib easily and we can make it an early night!" Wrong. I rocked her to sleep when she woke up when we arrived at home, and it was a process getting her back to sleep but nothing unusual for a teething baby with a slight cold.

But then the real fun started at 12:30am - like it always does. I tried everything. Finally I brought her down to our bed (which I never do) hoping I could cuddle her to bed, but she just wanted to play. So - we went back up stairs. I laid blankets down and laid down myself on the floor thinking she would just fall asleep seeing as there was nothing to do. Wrong again. She found cords and proceeded to chew on them! Yikes. So I put her in her crib and again laid down on her floor. Screamed.

So, in desperation, we went for a car ride at 2am. She feel asleep before we had been driving for 10 minutes. I got her back in the house, carried her in her (not so light) car seat managing not to wake her up and set her on the floor in her room. Before I had the chance to close her door - the dog shook making his tags on his collar jingle. She woke up. So - again we went out. This time it took a bit longer to get her to sleep. But she finally did fall asleep and I opened the windows in the car, covered her with a blanket, brought her monitor out to the garage and went to bed myself feeling a bit bad at my unorthodox way of putting my child to bed.

She slept for 2 hours. Then I brought her upstairs, made her a bottle, tried a few different things and she seemed to be calm. She normally falls asleep on her own when it's the wee hours of the morning and in fact I slept for 1/2 an hour but then she woke up screaming. My husband then went up to try and try as he might she would only stay asleep in his arms.

So I went up and scooped her up and we both slept off and on in the papason chair in the living room. She threw up once but I think that was just from her overexerting herself and not sleeping enough so we got cleaned up and slept some more. At 7:30 am she was awake and crawled around playing while I slept for another hour.

Then my nanny arrived, and seriously I could have hugged her! She only comes over once or twice a week, but if ever there was a day I needed her it was today! I handed her the baby, explained the situation and that I wouldn't be going to my midwifery meeting that morning but back to bed and I was gone.

I slept for 2 blissful hours, showered, did a home visit for a client of mine, got a coffee and then got my nails done. Frivolous I know, but sometimes, you need to. Lucky for me I had a groupon for just that - a mani/pedi - that was expiring soon so I managed to sneak in an appointment. Now I have beautiful fingernails and toenails and came home to a sleeping baby. Bliss.

I have to admit that I have nannied for some SAHM's before and although I was grateful for the job and the extra cash, I wondered what they did that made them need a nanny when they didn't have another job besides raising their kids. Although I don't think I would have a nanny if I wasn't also doing midwifery part time besides raising my daughter - I was sure grateful to be able to check out for 8 hours today.

Birth Marathon!

Birth is a beautiful thing - no matter if it happens so fast you barely have time to put your thoughts in an order that makes any sense at all, or so slowly you want to pull your hair out because you don't know what's keeping this little one from joining his family!

I was about to leave my house on Wednesday morning to start gentle labor induction (read breast pump and herbs and environmental helps etc)to encourage labor to really kick into gear when I get a call from my other client that she is in labor - oh and by the way - she lives 35 minutes from me and the contractions are only a few minutes apart and she has a history of going fast!

So plans change quickly to us (my assistant and I) going to my other client's house and not too surprisingly everything is all done and mom and baby are happily tucked into bed a little after noon so after we get some lunch and debrief the birth, we call my first client and ask if she still wants us to come over today or wait until tomorrow.

She wants us to come today still. So we go around 3pm and as long as the breast pump is going she is having strong contractions but otherwise they almost completely stop. The labor pattern is so mystifying that I end up calling my dear midwife friend from the Philippines to talk through the situation since she had attended a woman in a similar situation not too long ago.

In the end, we all decide it's for the best to go to bed at 1:30am. Baby had been in a good position, but then at one point shifted and as long as mom was in a running start position he was fine, otherwise not. We all slept and then woke up around 7am the next morning.

Around 10:30 we found a wonderful chiropractor who was willing to come out and help baby get into a better position and so with some adjustments and a little acupuncture and breast pump action labor finally got going and strong!

Soon after we were joined by a handsome little man and joy permeated the room as all the hard work finally paid off.

Thank you Lord for beautiful births.

Baby Constipation

If you thought it was unpleasant for you to be constipated, let me tell you - it all takes on a new meaning when your 7 month old baby is the one having troubles. She can't say what's bothering her - just that things aren't right. One night - the night we hit google big time asking for remedies - she woke up from a sound sleep and just looked at us sadly before bursting into tears. Talk about ripping a parent in two! That night we found ways to help her fix it and continued to have to help her (mostly with qtip covered in a lubricant) while I searched for the reason why this might be happening. I thought for sure it had something to do with the fact that I could barely get her to drink 20oz of milk when she was supposed to get between 20 and 28 so I would try harder to get her to drink more, but when she didn't want it there was nothing I could do.

I had already completely eliminated bananas from her diet and tried to make her cereal more soupy but she wouldn't eat it if it was too liquidy. Then, we went to my in-laws in Iowa for Christmas and I didn't want to bring a 1/2 empty box of baby cereal with me so I bought a new box while at Target. I was giving her Gerber brand cereal - not rice, oatmeal and whole grain so I thought I was doing good, but then because the box was smaller, I bought the Good Earth brand. I gave that to her and once she got that in her system the constipation totally disapeared! I love accidental discoveries like that and I hope that this post will help another mom struggling with the same issue figure out the problem faster for her baby.

TIme Passes and Things Change

I realize that my last post was more than a year ago which means quite possibly no one reads this anymore, but as I learn more and more of what it means to be a midwife and a mom I have more to write. The problem is, until now, I haven't figured out how to write in here about things other than midwifery until now.

So - I changed the title. Now I can write about either mommyhood or midwifery or both as they collide :) And I do have some burning posts that I have been mulling around in my head as I learn first hand what this mommy business is all about. So stay tuned!

Progress...

First and foremost, I (with much help from my wonderful husband!) published many new updates to my website! So check it out! www.newbirthmidwifery.com I welcome suggestions and constructive criticism :)

I love being married - when I get discouraged, I have Cullen in my court, fighting for me, and encouraging me like no one else could. When I get impatient (which can happen often since I am not very patient!) he encourages me by reminding me of all the progress I have made in promoting New Birth Midwifery.

I got a lot of great promotional materials for next to nothing thanks to vistaprint's online sale/try things for free deal. So that has been helpful. I have been able to go to coffee shops and other places to put up business cards and informational flyers on midwifery.

But best of all, I have met with 3 moms-to-be about becoming potential clients and those have gone very well. I have a few more to meet with this week before I go on vacation with my family, and I know that personal referrals are going to be the best way for me to really make a go of my business. So - if you know of a mom-to-be who is looking for a natural birthing option who lives within 1.5 hours of me (or who lives in some far-reach country (I will travel to far places to deliver babies!) please tell them about New Birth Midwifery!

On a more personal note, I have been asked to be an advisor for a freshmen cell group at Bethany this year! Julie is their mentor, and having been a mentor at Bethany (2008-2009) I am so excited to be an advisor (basically go to cell groups and do one-on-ones with the mentor each week) this year!

There's No Place Like Home...

The advantages and and joys and of giving birth where you live.

By Pam England

"I know that I'm healthy and everything's going well with my baby and I know everything's going to be fine."

Those words, uttered by an extremely pregnant Dawn Louro on CBS's Morning Show in February, sound more innocuous than momentous. But in some ways, they are revolutionary. Because Ms. Louro's calm assessment of her pregnancy came only weeks before she gave birth on television, before an audience of millions. At home.

In some circles, laboring or birthing at home is considered quite radical. Most first-time mothers probably doubt that they know enough to give birth anywhere, much less at home. They are surprisingly out of touch with the innate, miraculous processes involved in giving birth. Even though those mothers do not know birth technology either, they know it is out there. Daughters of our technological age, users of cellular phones and computers, understandably have faith in technology.

In addition, women who plan to labor and give birth at home typically get little support and a lot of anxious skepticism from those around them. Under such circumstances, it is not surprising that so few women today give birth at home.

But that may at last be changing and more than 20 years after Mothering first began writing about the possibility and the pleasures of delivering your child in his or her own home. Oprah Winfrey has done shows about alternatives to hospital birth. Chris Bohjalian's book Midwives has been a national bestseller. And then there was Ms. Louro's labor. "I just want it to be in my own home environment," Mr. Louro told the CBS correspondent. "I want to be able to get up, walk around, and have my whole family around me after the baby is born."

As a childbirth teacher, one of my greatest challenges is to inform people objectively about their choices and give them respectful support in their decision-making, so they are not left feeling coerced or guilty about whatever informed choice they eventually make. That is what I wish to do here. Homebirth may not be right for you, for reasons of physical health or personal philosophy. It also may be the perfect choice for you, but one you hadn't considered until now. In a childbirth class I taught recently, the topic arose spontaneously. A couple, one of whom was a physician, said they were thinking of a homebirth. The class erupted into animated discussion, provocative questions, and a sense of hopeful excitement.

At the end, one mother turned to me and sighed happily, "I feel more relaxed just knowing that a homebirth is a possibility," she said, "whether or not I choose it."

IS HOMEBIRTH SAFE?

The Farm is a 1,700 acre commune in Summertown, Tennessee, founded in 1971 by Stephen and Ina May Gaskin. The trained and skilled midwives there have professional consulting relationships with physicians and refer mothers with complications or risk factors to the hospital.

In 1992, a major study compared 1,700 homebirths attended by The Farm midwives to a sample of 14,033 physician-attended hospital births. The findings were dramatic and heartening: The cesarean rate among mothers who received prenatal care at The Farm was only 1.5 percent compared to 16.5 percent in the doctor-attended group. The transfer-to-hospital rate was 13.5 percent. There was no significant difference between the two groups for perinatal death, bleeding, birth injury, or respiratory distress syndrome.

This excellent outcome for those choosing homebirths has been found in other studies as well. In a famous 1977 project, Dr. Lewis Mehl studied birth outcomes from the medical records of 1,146 elective homebirths in the San Francisco area. The results: the perinatal mortality rate among women who elected homebirth was 9.5 per 1,000 births and compared to a rate of 20.3 per 1,000 among California women who gave birth in the hospital. In other words, as Dr. Mehl concluded, "the [homebirth] outcomes were better than average and the complications rates lower than expected."

And then there are the subjective, anecdotal reports from women who have chosen a homebirth. According to a wide-ranging 1992 survey, "91 percent of . . . women who had had their last baby at home said that they would prefer to have their next baby at home, compared with 15 percent of those who had had their baby in a hospital. Among the few women who had experienced both a homebirth and a hospital birth, 76 percent preferred giving birth in their homes."

THE ECONOMICS OF HOMEBIRTH**

Homebirth is significantly cheaper than a hospital birth. But that doesn't mean it will save you money. Why is that? Consider the following: In 1997, a normal hospital birth cost between about $4,000 and $6,000, with a complicated birth costing many thousands more. In comparison, most homebirth midwives have an inclusive fee of about $2,000, which not only covers labor and delivery but also all prenatal care and several postpartum visits.

In some states, homebirth midwifery is covered by private health insurance. Unfortunately most HMOs do not yet reimburse licensed homebirth midwives, which in effect limits consumers' freedom of choice. It is extremely difficult for some people to make a "choice" which requires substantially greater out-of-pocket expenses.

If your healthcare coverage is limited only to in-hospital birth, write the benefits manager at your place of employment; they seem better able to exert leverage on insurance companies and HMOs than can individual consumers. Issues like this also are being considered in some state legislatures. Write a letter to your local representative or call and make your opinion known.

FINDING A MIDWIFE

Rare is the doctor who will actually attend a homebirth. But a few do. To see if any practice in your neighborhood, contact HomeFirst Health Services through their Web site: www.homefirst.com.

It's extremely likely, however, that you'll need to find a midwife to attend your birth. Midwives come in several varieties. Nurse midwives have an RN and have completed postgraduate training at an institution accredited by the American College of Nurse Midwives (ACNM). Direct-entry midwives have trained as midwives but without obtaining an RN (which is the usual route of entry in many countries overseas, including most of Europe). The Midwifery Education Accreditation Council (MEAC) has begun accrediting direct-entry midwifery training programs. Two other organizations offer certification to direct-entry midwives: The ACNM and the North American Registry of Midwives (NARM). Not all midwives are certified.

How can you find a midwife who is compatible with your personality and birthing goals? Begin by asking friends or acquaintances who've had a successful homebirth for a recommendation. You can also contact one of the national midwifery agencies for referrals (see below). But most important is to meet and develop a rapport with any midwife you're considering. She will, after all, be key to the success of your home delivery. You should feel you can trust and rely on her. And, as her client, she will probably wish to feel the same towards you.

THE LAST WORD

Almost every homebirth that I have attended has been a profound experience for everyone involved, including me. After the last such birth, I formulated a few principles regarding homebirth. They can, I think, stand as a summation of why the experience affects people so powerfully, and why it is a moment few new parents ever will forget:

• Pregnancy and birth are natural physiological events, so normal birth does not belong in hospitals.
• The natural course of labor is already perfect, and should be interfered with as little as possible.
• Pain is part of an essential and healthy feedback mechanism in labor. Women can learn to cope with it, especially with the proper encouragement and support.
• Medical management of pregnancy and birth should be limited to those which are medically complicated.
• Unnecessary medical interventions complicate normal labor, creating additional risk and the need for more intervention.
• Comfort and security help mothers cope with labor. Comfort and security exist at home.

Pam England is a certified nurse midwife in Albuquerque, New Mexico, where she directs the Art of Birthing Doula Training Program. This story was adapted from her book Birthing From Within (Partera Press, 1998). To order a copy, call Partera Press at 505-268-8206 or visit the Web site: http://www.birthpower.com

To Learn More

These are a few excellent books and articles that address homebirth:

Declercq ER, Paine LL, Winter MR. "Home Birth in the United States, 1989-1992. A Longitudinal Descriptive Report of National Birth Certificate Data," Journal of Nurse Midwifery, 1995; 40 (6): 474-82.

Duran, AM. "The Safety of Home Birth: The Farm Study," American Journal of Public Health, no. 82 (3):450-453.

Goer, Henci. Obstetric Myths Versus Research Realities: A Guide to the Medical Literature (Bergin & Harvey, 1995)

Hannon, Sharron. Childbirth: A Source Book for Conception, Pregnancy, Birth, and the First Weeks of Life (M. Evans and Company, Inc., 1990)

Mehl, Lewis, et al., "Outcomes of Elective Home Births: A Series of 1,146 Cases," Journal of Reproductive Medicine, no. 19 (5):281-290.

**Editor’s Note: The numbers quoted in this article for the costs of a hospital birth and a home birth are out of date as of 2005. The latest statistics from 2005 (World Health Organization)on a hospital birth are as follows:

• Uncomplicated vaginal birth = $7,000

• Complicated vaginal birth = $9,000

• Uncomplicated C-Section = $12,000

• Complicated C-Section = $16,000

These prices are just for the hospital stay, and do not include doctor’s fees for being at the birth which start at $1,500, and also does not include prenatal care or newborn care.

A midwife in MN generally charges between $3-4,000 which covers everything - prenatal care, newborn care, labs, 24 hour access to your midwife, continuity of care, at least 1 if not two assistants at your birth and more. The only things it doesn’t cover are:

• tub rentals or purchases which can be between $1-250

• Your homebirth box which has all the disposable items you need for your birth like chux pads etc which will be about $75-125.

• Your midwife may also ask that you buy old picnic table liners from a dollar store to put under your tub to protect the carpet, and you will want to have old sheets and towels. (but that is usually purchased for less than $25)