MAYD to Birth: At Your Doorstep

Promoting gentle, empowering mother journies…

The Wine Fairy

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Back in the day, before kids, my husband, or even much responsibility at all… my alter ego was the Tooth Fairy.  It started out as a joke with some friends, which then turned into a movie short we made with a photo slideshow.  It was pretty classic, and to this day I haven’t lived it down.  It doesn’t bother me, I embrace it because I am proud of it. I had a blast before I settled down to start my family… now I have a blast with my family. Or once a year my bloggie sisters.

Well going back over a year ago to the 2010 BlogHer conference, I became the Wine Fairy.   I am not really sure how exactly it happened as the Saturday night of the conference really was busy, loud, tiring, and influenced by the drink tickets I had kept to myself to have a good time. It was the end of the conference, I was all business until the parties went into full effect.

I had received a generous offer from the Wine Sisterhood to host a wine tasting party in my room, which kind of tanked when most of the people who had RSVP’ed for the party decided not to come.   It happens, it is a busy conference, and I didn’t realize exactly how busy it would be because it was my first year attending.

With several bottles of wine, only two roommates, and tickets to some parties… I took one of the bottles in my purse and headed on my way.

But I still wanted to be able to share the different kinds and varieties of wine with the attendees of the conference. So as I went from party to party, and ball room to ball room I would stop and offer ladies some wine. If they were sitting enjoying some drinks at a table, walking with an empty glass… whatever…

Then I stumbled across the most fun table of the night, looking back I think there were 6 ladies sitting there, one of them being the hysterical Awesomely Luvvie who actually was a speaker at the conference!  Mind you, to this day, I am still buddies with her and we frequently chat.

When we had such a good time downstairs, we all went back to my room and finished up the other bottles of wine I was waiting to distribute amongst the conference.

Thus they dubbed me The Wine Fairy!

A title I still wear to this day proudly!  There is nothing wrong with having a little fun as an adult, especially when you have a little bit of time away from your children, even if it is for business.  The Wine Fairy made me a couple amazing friends that I love dearly!

I want to thank The Wine Sisterhood again a year after the fact for the amazing wine they provided us that weekend!

The Wine Sisterhood provided the wine free of charge, but all opinions, and reviews are my 100% expressed honest opinion. I did not receive any compensation for this post.

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Quebec’s Creepy Post-Birth Vaginal Inspection Policy

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Heather Mattingsly “will not have to show her vagina to anyone to prove the 5-month-old infant is hers,” begins the Montreal Gazette’s story about one of the most creepy, abusive, nonsensical policies a new mother could imagine:  Quebec’s new requirement that women who give birth without a doctor or licensed midwife have to submit to a vaginal examination to “prove the biological link between mother and child” in order to get a birth certificate. After a barrage of calls from the media, the director of the vital records agency called Mattingsly personally and told her she could pass on the exam.

But the requirement apparently still stands for other women who give birth with unlicensed midwives at home, which some do because the provincial health system doesn’t employ enough midwives to meet demand — women who want a midwife only have a 1 in 5 chance of having one attend their birth. That’s quite a punishment/deterrence policy for going outside the system. One wonders what (or who) prompted the change. Women’s rights groups are calling it “another abuse of women’s bodies” and want the policy reversed.

Riding out Hurricane Irene

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Last night with the threat of bad weather, my husband and I packed the kids into the car with all their stuff, co-sleeper and all and headed to his fire house to ride out the storm in the safety of one of the city buildings they opened up for a storm shelter.

Needless to say, I am glad we did. Our neighborhood is a war zone. Trees, wires, and all kinds of stuff down and blocking the roads everywhere.  The power, phone, cable, and internet are all down at our home, and thankfully we didn’t lose any of that just a mile down the road at the fire house.

Although it has been an interesting evening.

The boys didn’t go to bed till after midnight because of all the excitement, being at the fire house, and actually being able to sleep a room over from the fire trucks.

Addie wasn’t a happy camper that she was in a different place than she is used to.

And my husband and I had to share a single bed in the firemen bunk room, he is 6’2 and I am a bed hog.  Needless to say my neck hurts, I woke up with a headache, after about 3 hours of sleep and my day can just be described as… ugh.

Although I am happy we are all safe!

I am kind of worried to see the damage I will face when we make our way home later…

Oh, and how great this picture from last night?

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Perspectives of Birth: Doctors and Midwives

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I recently read Born in the USA by Marsden Wagner, who is the former director of women and children’s health for the World Health Organization. He made a great observation on the essential difference between midwives and the majority of doctors when it comes to childbirth.

Doctors view birth as something that happens to a woman.

Midwives see birth as something a woman does.

Seemingly a minor difference, but it means everything for how women in labor are treated.

Midwives assist a laboring woman give birth. Everything they do is to provide support for the woman while she works to birth her baby, and they are there in case something should go wrong. Women are considered “clients,” not “patients” because they are not sick. They are simply pregnant.

On the other hand, doctors deliver a baby. They see women as patients with a condition that must be fixed. Namely, she is pregnant and she should not be pregnant anymore. The goal is to get the baby out as quickly as possible, generally through medical methods and by their own expertise. It is rare to see a doctor who is willing to allow a healthy labor to happen naturally without attempting to meddle. Doctors are expert meddlers. It’s really all about control. But labor cannot be controlled, and when doctors (or nurse-midwives) attempt to control the uncontrollable, they tend to end up doing things that are not necessary or beneficial for the mother or her baby.

Doctors should be backup for when a woman actually does need assistance, not the default option for every woman in every birth. We need support during pregnancy and birth. Not always a medical degree.

Twitter Phenom “Feminist Hulk” Revealed, Had Home Birth!

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Congratulations to Jessica Lawson, the brains behind Twitter superhero “Feminist Hulk.” (Sample tweet, in all CAPS, natch: “HULK APPROACH SMASHING PATRIARCHY LIKE JUDITH BUTLER APPROACH WRITING SENTENCES: AS LONG AS IT TAKES TO GET JOB DONE!”) Lawson revealed Hulk’s alterego in a Q&A  with the Ms. blog: she is a 28-year-old English Lit PhD candidate at the University of Iowa, a supporter of midwives, and a new mom!

Ms. asked: “Why did you decide to have a home birth? What were some of the challenges you faced in making that happen?”

Lawson answered:

While I value the ways that obstetrical science has made birth safer for women with high-risk pregnancies, mine was a low-risk pregnancy and I was compelled by the many studies that show the midwifery model of care is as safe as hospital birth, often with fewer interventions and post-birth complications. Unfortunately, though Certified Nurse-Midwives legally practice in all 50 states, I gave birth in one of the handful of states which still does not license Certified Professional Midwives. I am active in attempts to push midwifery licensure through our state legislature. I still chose home birth, though, and am so lucky to have labored in an environment that made me feel relaxed and safe, with a birth team that gave me tons of love and support. And for anyone who asks, “What if something goes wrong?” all I have to say is, “Something did go wrong.” I suffered a postpartum hemorrhage and lost about a quart of blood. My birth team responded with speed and skill to stop the bleeding (and they would have transferred me to a hospital without hesitation if they encountered a complication that required additional resources). I owe them my life, and I have nothing but faith in the quality of their care.

Google Chrome

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My wonderful ex-BIL has solved my computer problems, again. It turns out that IE was not happy with WP but, luckily, Google Chrome is up for the task! These computer thingys are weird, why did IE on my laptop make my blogging impossible whilst on a desktop it was happy to co-operate?

Trial

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Still not managing to publish anything other than the title so have decided that this may be te way forward, no nonsense, no pictures, just writing. Lets see if this tactic is anymore successful

Awakening

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This is less an entry and more an attempt to put work-life into perspective. It would easier to hide my head in the sand, bury myself deeper and deeper, and I have been trying that tactic, but avoidance is not my natural behaviour and just results in tremendous unease. I could continue to deceive myself and make believe that all is well, after all I have managed to keep my council on the RCOG calling for more women to be cared for in MLU’s; the ‘riots’, some other interested party wanting more obstetrically, trained physicians and the BBC’s Panorama programme about the midwife shortage, but a silly little incident has spurred me out of my silence.

Why am I in such a slough of despondancy? Well, the miasma of NHS bureaucracy has finally overwhelmed me, I am entirely embroiled in the totally mad maze of management which consticts every aspect of being employed in the health service, and it is frustrating me beyond belief. I am terrified that I could well give into panic if I don’t get a grip on all the ends which are snaking
around at will, needing to be organised, needing to all join up. The maze is constantly causing me to bang up against seemingly inpenetrable, prickly hedges so I backtrack and try another route, wasting more time and energy, only to meet another vicissitude.

I don’t want to be a manager in the NHS, I can’t imagine why anyone would want to, it’s a thankless task. Yes. There are too many managers but it’s all do with the way the NHS has developed, it strikes me that everything is kneejerk rather than planned by individuals who understand how the whole organisation functions. Nothing is radically re-organised, rather, another side-shoot is
grafted on to the already overburdoned branches. The new little side-shoot is given it’s task and it happily thrives, initially. It receives adequate nourishment and produces acceptable fruit. After a while the environment changes, the nourishment is rationed slightly but demand for it’s product increases. Initially the side-shoot responds by exploiting it’s reserves but they are limited and soon it displays signs of weakness. What to do? Look for stronger branches to share the workload, perhaps form a framework, no, just graft on another shoot to further drain the whole organisation.

Don’t expect any of this to make much any sense, it makes no sense to me so why should any innocent, who has never really experienced the NHS, understand this rambling. Many have tales of their encounters with the NHS, those at the receiving end, patients, or clients as we now have to call them, let me assure you working for the NHS is no bed of roses either.

Anyway, where was I? I don’t want to be a manager, but I do really, not for ever, or even a month, just a day would probably allow me time to formulate a structure which would enable me to work logically and efficiently. Mind you, the Trust Board would need to be disempowered during my frantic reorganisation, because I wouldn’t have the time to wait for them to rubber stamp my decisions, and I would need to be able to command co-operation from other drones but, given those criteria, I would be flying.

I’m just going around in circles. My new job is an absolute, organisational nightmare, I keep taking 2 steps forward and one step back. I have 2 different managers who act as if they function within 2 different organisations, although we all work within the maternity sector they carry seperate budgets, which they guard ferociously this impacts adversely due to others not appreciating that I cannot cross theoretical boundaries. I can’t go into detail so it possibly sounds as if I’m making a mountain out of a molehill, maybe I am but that molehill is wrong-footing me, constantly.

As if the actual working maze is not frustrating enough there is also the minor fact that, 3 weeks after I started my new role, supposedly on a contract, my new manager confessed to me that she hadn’t gone through the right process so Ihave been working on ‘bank’ since I started. I’m just wondering if this is a double-edged sword as it does mean that I could walk into my new managers office and tell her to stuff the job. The trouble is that if I can create logical working pathways the role is one that I would love.

 P.S I’m still having real problems posting anything other than the title and category. Wrote this last night but it has taken me hours, literally to post it and it’s still a mess. I give up!

ACM Homebirth Position Statement & Guidance: My response

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The Australian College of Midwives have issued an Interim Homebirth Position Statement and Interim Guidance for Privately Practising Midwives along with a request for comments. Here is the response I have sent…

As a privately practising midwife who attends homebirths I have grave concerns regarding the above interim documents and the direction of the College in general. I am providing my comments despite having little faith that the opinions of homebirthing women and their midwives will be heard or reflected. My main concerns centre on the expectation that the midwife, rather than the woman determines risk status, and then actively blocks access to birth options based on this assessment.

Evidence-based practice?

After a review of the research literature ACM acknowledge the lack of ‘good quality’ research into homebirth yet concludes that “it seems evident from the literature that planned homebirth is a safe option for women who are at low risk of complications…”. To my knowledge there has been no research specifically examining the outcomes of homebirth for ‘high risk’ women. Therefore, we do not have adequate research about outcomes of homebirth for women who are classified as high risk. However, we do have research supporting continuity of care for all women, and often the only way in which a woman can access this care is by hiring a private midwife and having a homebirth. There is also research available regarding birth outcomes for those women you have categorised as being too high risk for homebirth. Women classified as high risk (eg. previous c-section) often choose homebirth in order to increase their chance of a successful vaginal birth after accessing this research.

It can be argued that the way in which ACM have determined ‘high risk’ (simply by the chance of an adverse event occurring) places all women in a ‘high risk’ category. A woman with a ‘scarred uterus’ has a 0.5% chance of a uterine rupture during labour. A woman with an unscarred uterus has a 1% chance of a shoulder dystocia occurring. However, ACM is not advocating that all women should birth in hospital in case they experience a shoulder dystocia.

In addition, the notion that ‘evidence-based’ means purely ‘research-based’ does not align with the vision of early advocates of evidence-based medicine from which the concept of ‘evidence-based practice’ emerged . For example, Sackett et al.’s (1996) interpretation of evidence-based medicine involves blending research evidence with the expertise/experience of the practitioner and the individual requirements and choice of the ‘patient’. This definition of evidence-based practice seems more aligned with a midwifery philosophy than one which universally applies research findings to practice. Particularly in an area in which ‘good quality’ research is difficult to come by for many reasons. Midwives should develop their own body of knowledge on which to base practice using a variety of types of evidence (experience, intuition, research, stories, etc.), rather than trying to emulate the medical profession and their narrow/technocratic definition of evidence (RCTs).

In any case the right to self determination and bodily autonomy has nothing to do with research evidence or externally defined concepts of safety.

Redefining midwifery

ACM appears to be contradicting and re-defining the role of the midwife. The International Confederation of Midwives (ICM) Philosophy of Care includes these statements:

  • Midwifery care empowers women to assume responsibility for their health and for the health of their families
  • Midwifery care takes place in partnership with women and is personalised, continuous and non-authoritarian
  • The woman is the primary decision-maker in her care and she has the right to information that enhances her decision-making abilities.
  • Midwives provide women with appropriate information and advice in a way that promotes participation and facilitates informed decision making
  • Midwifery care promotes, protects and supports women’s reproductive rights and respects ethnic and cultural diversity
The Australian Nursing and Midwifery Council state that:
  • Midwives value the woman’s legal and moral right (in all but exceptional circumstances) to self-determination during pregnancy, labour, birth and early parenting on the basis of informed decision making (Code of Ethics for Midwives)
  • Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman (Code of Conduct)
  • Explains options while recognising the woman’s right to choose (Competency Standards)
These statements suggest that the role of the midwife is to share adequate information with women and respect their right to choose ie. to determine their own risk status and place of birth. Whereas the ACM statement requires the midwife to determine the woman’s risk status and withdraw support if her choices do not align with regulations. Whilst the midwife should offer consultation and referral – to enforce it does not respect the woman’s choice (and breaches confidentiality). I also object to the use of the word ‘refuse’ and think ‘decline’ would be less judgemental in relation to women’s choice. 
According to ACM “…a midwife has the right to decline to continue to provide, or to accept, midwifery care if it is felt that this would require the midwife to practise outside of the midwife’s scope, skills and competencies.” However, the midwife’s scope is debatable because it is based on what is considered ‘normal’ (by obstetricians) and for many women and midwives VBAC, post-term, breech etc. is normal. The College should support a privately practising midwife’s right to withdraw from care if she is unable to meet the woman’s needs. For example, she does not feel adequately prepared or experienced to attend the birth and/or will bring fear to the birth room. However the midwife should also be supported if she decides not to withdraw care and instead support the woman’s decision to homebirth despite any risks involved. The alternative is to leave the woman without a care provider who can identify if the birth becomes abnormal and transfer if necessary. Whilst some women choose freebirth – this should not be a choice based on the inability to access midwifery care.
Both the ICM and the ANMC state that midwives should promote normal birth and women’s ability to birth. Assuming birth will not be normal because the woman has a uterine scar, is over 42 weeks, has twins, etc. does not reflect a trust in the birth process. Midwives should be able to identify when birth deviates from normal, and when complications arise. But to embrace the obstetric stance of ‘birth is only normal in retrospect’ does not align with midwifery philosophy.
My personal observations from within the homebirthing community

The way in which midwifery is being regulated and redefined is resulting in registered midwives being unable to reflect the philosophy of midwifery and meet needs of homebirthing women. Women are subsequently turning to doulas and birthworkers because they are the only practitioners able to provide ‘with woman’ care at home. As a registered homebirth midwife I feel unsupported by the College and marginalised by my own profession. I don’t want to be regulated the College – I want to be supported. Perhaps an alternative homebirth statement would be: ‘Women have the right to choose where and how they wish to give birth. Midwives must provide adequate information to assist women’s decision making and support their birth choices.’

We could learn a few lessons from history re. midwifery regulation: Gloria Lemay’s podcast Licensing and regulating midwifery – at what cost?

Natural Pain Management During Labor

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Less than three weeks ago I gave birth to my third daughter. Exciting, right?! Well, I’m excited. She’s adorable and it was literally the perfect birth. Absolutely perfect. Once I finish writing my birth story I’ll post it for anyone who wants to read about a home birth. Anyway, since I’ve now had three natural births, one in a hospital and two at home, I think it’s time to write about pain management during labor.

Although the majority of women in the U.S. choose to get an epidural to block feeling, there are definite risks to the procedure, both for the mother and her baby. I don’t think anyone would disagree that a drug-free vaginal birth is by far the safest. Unfortunately, not many women believe that they are capable of a drug-free birth. Most, if not all of this is due to our cultural opinion of birth. Nearly everyone, from doctors to the media, treats labor and birth as a medical condition that requires medical intervention and a highly-specialized doctor present to “get the baby out.” However, a healthy woman, left to herself or with a trusted labor assistant, will also give birth, and generally much more quickly and peacefully.

With all that being said, let’s talk about labor pains.

Now, labor is a lot of work. It is hard work. And for good reason. During labor our bodies go through incredible physical and hormonal changes as the baby moves down the birth canal to be born. How many are in awe that a baby is able to fit through an opening that is so small? I know I am! With all the changes occurring within a laboring woman’s body, there is also a level of discomfort. Each woman experiences it differently; some refer to the sensation as an intense ache on her pubic bone, some women describe extreme pain.

Whatever experience you’ve had or heard stories about, there are ways to alleviate painful sensations during each contraction (also called a surge or rush by many natural childbirth books – I like those terms much better, don’t you? They describe labor much more accurately than contraction does. What a distant, medical word) – without drugs. Here are some ways to handle the surges:

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1. Relax

Seems counterintuitive, right? When we experience pain or discomfort our natural reaction is to tense up in a “fight or flight” mentality. Our adrenaline kicks in and we’re ready to react. Normally, this is a good thing. However, labor is not something we can escape from, and it is not something to fear. We are bringing new life into the world, and that is a wonderful thing! Tensing muscles during a surge will only make the pain worse. Our tendency is to tense up, then when that makes it more painful we tense up more, which creates even more pain. It turns into a vicious cycle in which a woman even begins to tense up in anticipation of the next contraction.

In order to break free of that cycle, it helps to relax our muscles, especially in the abdomen, butt/vaginal area, and jaw. If you’re having trouble relaxing those muscles, allowing your mouth to fall open in a “duh” expression helps open up the birth canal as it lessens tension in your vaginal muscles. I know, it sounds weird, but those two sets of muscles are connected. It is possible to relax all these muscles even while you’re using others, such as while standing or kneeling.

2. Breathe, Breathe

“Breathing” does not mean the short, “hee hee hoo hoo” breaths that classes like Lamaze teach (well, they used to, at least; maybe they’ve changed). Patterned breathing techniques like that are only used to try to distract a woman from her contractions. When I say “breathe,” I mean deep, full, belly breathing. The kind we all used to do as children, before our culture taught us to never let our bellies stick out. Breathe like an opera singer or a baby. With each breath use as much lung space as possible. If you do it correctly, your belly should rise with each breath, but your chest barely moves. Try to visualize sending air down into your vagina instead of your chest. Deep breathing takes more oxygen into your body, which alleviates pain. Focusing on the breathing is also calming and brings your focus inward as you “give in” to what your body is doing.

3. Set the Mood

Just as there is a certain ambience that creates a romantic mood, there is an ambience that is good for labor. There are exceptions, of course, but most women need dim lighting, a peaceful atmosphere, and a very few trusted people in the room with her. If laboring at home, you can set up candles, play music, and hand-pick who is allowed to be there. If at a hospital, it will probably take a little more effort, but it is possible. Some hospitals provide cd players and bedside lamps, but others don’t. Find out beforehand and, if they don’t, you can bring your own stereo or light if you desire. Having only a few trusted people is also nearly impossible at a hospital, but you can limit who enters the room and when. In this case, a spouse or friend may have to keep unwanted people out. Also, if a nurse is rude or makes you uncomfortable, you can tell them to leave. Remember: you are paying them to help you during labor. Don’t be afraid to request a different nurse.

4. Move Around

I’ve written before that lying flat on your back is the worst position to labor and birth in. It not only closes the pelvic opening so that the baby has a hard time getting out, but it also makes contractions much worse for the vast majority of women. Early in labor, walking is great because it helps the baby move down and into a good position for birth. Later in labor, moving around to find the most comfortable position will help alleviate pain. Also, your body will tell you if you’re in a bad position for the baby as she moves down toward birth. Listen to your body, and if you don’t feel like being in a certain position, move (between contractions!) to a different one. Here are a few positions women find comfortable during late labor:

-standing, leaning forward against someone
-kneeling on all fours
-kneeling and resting upper body on a couch or bed
-sitting on the toilet, an exercise ball, or a birth stool
-resting in a tub of warm water
-lying in a side-relaxation position (on your side, slightly leaned forward, with top leg propped on a pillow and another pillow under chest and head)

5. Visualization and Listening

Many women find exercises such as visualization or self-hypnosis to be very helpful for labor. Hypnobirthing is an entire childbirth class that helps a woman learn self-hypnosis. There is also a good book on Hypnobirthing if you are unable to find or afford a class. Other classes, such as for the Bradley Method, teach visualization exercises. One popular one is called The Rainbow Visualization. Have your birth support read it to you in a calm, low voice in the months leading up to the birth, and then during labor they can read the whole thing or just the parts you find most soothing. A familiar voice is a very calming thing to listen to during labor. Have someone tell you a story, or read poetry or passages in Scripture to you. You can even recite favorites to yourself.

6. Massage

Nearly every woman loves some type of massage. During labor there are certain places that, if massaged, make labor easier. A skilled doula or labor assistant will be able to try various things to discover if one feels particularly nice. But, you don’t have to have a trained professional do it. Whoever you choose to be with you during labor can do it. One of the universal labor massage areas is the sacrum. This is the part of the lower back that lies roughly between the hipbones, just above the tailbone. Many women find that pressure on this area during contractions and even during pushing feels good. If your birth partner is unsure, have them start out firm but not too hard, then if you want more pressure, ask for it. Other good places to massage are the hands (especially between the thumb and index finger), feet, and ankles.

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So, there you have it! During labor remember: relax and give in to labor – you can’t escape it so work with it!; breathe into your pelvis; set the mood; don’t be afraid to move around; listen to a soothing, calm voice; and utilize the hands of whoever is in the room with you!