(Im)Patiently Waiting

So I'm back to work full time and that means back to having health insurance. First things first, I made an appointment with a new ARNP for a check up and pap smear. Having worked at a doctors office for 5 years I knew it was best to arrive early to fill out the new patient paperwork. Having all my forms filled out didn't help with the wait. Forty five minutes after my scheduled appointment time, the receptionist called me up to discuss my insurance.  I made the appointment two weeks prior, if they had a problem with my insurance they could have called me so we could have discussed it before I'd been waiting over an hour! I was so mad I left. Definitely not going back to that office.

I do not understand how it is acceptable to have patients wait HOURS for their appointments. In what other industry is excessive waiting ok? Did you wait 45 minutes for your barista to make your coffee or your server to ask for your order? I don't think so.

Like I said above, I worked at a doctors office for five years and we, the office staff, were the gatekeepers to making sure appointments fit into their time slots and that people didn't have to wait. If we had a client with an issue or an appointment that ran over we'd call the next patient and give them the option of seeing another provider or rescheduling. I never remember people having to wait more than 15 minutes and even that was rare. It kept our patient happy and coming back for their appointments. I KNOW that running an office where people are not forced to wait longer than their appointment will last is possible.

Now off to find a practice that respects my time and doesn't make me wait in order to fit in a few more appointments into their providers busy days....

Two Year Sentence

So this past semester I was on a break from midwifery school, a much needed break. Like I've said before, midwifery school is not inherently difficult. The classes are not the problem. Being on call 24/7 and driving more than 300 a miles a week can and does get to a person (or it least it got to me). It was nice to be out of school. I did miss my friends but I was able to go back to work full time and it looks like I'm going to be able to keep working next semester when I go back to school. Unfortunately, I won't be rejoining my class- I'll be in the class that's just one semester behind mine. A small class of five. It should be nice.

So I keep going back and forth between midwifery and nursing. This semester I took chemistry at USF, my last pre-req for nursing school while I pondered my options. I've always wanted to do international work as a midwife but the thought of all my student loan debt makes me question that and think about nursing. I finally saw the MSF documentary "Living in Emergency" and it helped to refocus me.

International work as a field midwife is what I want to do. Period. Yes, I think I'll also practice in Florida but I also want to think globally and work with NGO's like MSF or The Hamlin Fistula Hospital. Two years left and I'll graduate. In March I'm going to the DR with three of my classmates and we're trying to plan a trip for next December to go to Senegal. Hopefully we can pepper our last two years with international volunteerism to help the time go by a little faster... one can only hope.

HBAC, Saturday October 16th

 Me and my amazing midwife preceptor, Jill

SO I didn't get to go to Saturday Morning Market on Saturday but I did get to go to an AWESOME home birth. The mom had had a previous cesarean for "failure to progress" after pushing for over four hours. This time her entire labor was less than five from start to finish! She was standing when she triumphantly delivered a beautiful daughter at home with the loving support of her husband, doula and friend.

After the birth the mom was sitting in the bed holding her precious baby and talking with her friend. Her friend had a HBAC just six months ago and they were discussing how "do-able" home birthing is. "It's totally do-able," says a mother less than an hour after having a totally natural, undisturbed home birth. Those are the moments that keep me going. I'm so lucky to be apart of such powerful rites of passage, it's almost unbelievable sometimes when I stop and think about it. I love it!

If you want someone to have a baby, make plans.

Yay for babies but seriously, can a girl catch a break? I want an empanada from Saturday Morning Market! I miss you Empanada World, one day soon we will meet again!

One more time with feeling!

Thursday I met my friends (and one of my first doula clients!!!), Jessica and Jack, at Labor of Love for their interview with the birth center. She is expecting baby number two and is hoping for a birth center birth for this baby. Her first birth was beautiful and I'm so glad that I'm going to get to be apart of this birth too! This is my first repeat client. I am SOOO excited for her and her family, it's going to be great!

9/19/11 at 8:54 pm

So yesterday, with my amazing preceptor, I caught my first baby! The mom was in labor for less than four hours from first contraction to the birth of the placenta. She was so calm and peaceful I felt at total ease at her birth. She barely made a sound and was very internal with her labor with the loving support of her partner by her side.

My midwife was great. She guided me on what to do when the baby was crowning and after the head was born. The baby came out perfectly OA and then immediately rotated into an ROA position. The dad held the baby, skin to skin, while we waited patiently for the cord to stop pulsating before cutting it.

Let me just say, hands down, that was the most amazing experience of my entire life. I got to hold a baby that was coming into the world before anyone else! I CANNOT BELIEVE IT! It was beyond words.

On my way home I called my mom to tell her my exciting news and I woke up to this vague posting on my Facebook wall. Nice! Hopefully, it won't be my last...

Some random HBAC in Lakeland....

Last night around 10:30 I was sitting in front of my computer about to watch a movie on Netflix (when I should have been studying for my chemistry exam) and my phone rang. It was a number I didn't know but being a student midwife/doula I've learned to always answer my phone. The woman on the other line starts talking about how she got my number from my friend who goes to FSTM and I immediately got annoyed, "seriously, it's 10pm on a weeknight and a woman is calling me about doula services, how rude." As soon as that thought entered my mind the woman continues by telling me she's a licensed midwife and needs an assistant to meet her at a planned home birth after cesarean (HBAC) in Lakeland. A quick shower and an hour drive later I was at a home birth with a midwife I'd never heard of and a woman I'd never met.

When I got there the mom was already ruptured and upon vaginal exam at midnight she was at 3cm. Around 2am she was 4cm and at 4am she was complete and pushing. The baby was born, in the water, at 4:42am.

The mom had a previous cesarean six years ago because of twins and at 36 weeks this pregnancy her doctor told her she couldn't have a trial of labor and would be required to have another cesarean. The mom knew she didn't want another cesarean and sought out a midwife at 37 weeks and delivered vaginally, at home at 41 weeks and 4 days. Holding her newborn, the mom laughed that she was going to send her OB a picture of the baby to hang on the bulletin board in her office. Good call.

I think it's pretty cool how unique and tight knit the birth community can be. In a few phone calls and you can find a midwife/doula/birth assistant for any birth at any time. How awesome is that?

Busy being busy

I feel like I am busy all the time, yet nothing is getting accomplished! I've been to some great births lately that I have neglected to blog about (so much for new years resolutions...).

Two VBAC moms that were incredible. They worked so hard to get their babies out at home but unfortunately both had repeat cesareans- not from lack of trying! I believe that babies are born just how they need to be born. A detour is not a shortcut, especially with these two moms. They worked so hard it was incredible to be apart of their journeys.

A home birth for a first time mom that went great! She labored so well and pushed like a champion.

Finally, a late add on doula client who labored at home for over 24 hours before we arrived at the hospital. A couple of hours on the monitors showed late decelerations. AROM revealed thick meconium and soon a fetal bradicardia that never recover above the mid-70's, even after an amnioinfusion and multiple change of positions. A timely cesarean was performed and revealed tight double nucal cord with the cord continuing to wrap around the baby down to his little foot! Once mom and baby were reunited he was nursing like a champ with an amasing suckle! It was great to be at a certified baby friendly hospital for this birth because I know the mom is going to get great breastfeeding support! She was in recovery after the surgery for several hours and they didn't even push forumla on the dad, truly a blessing.

So even though birth doesn't always go as intended, every experience can be positive and beautiful. I hope all the moms I get to make the journey with come away from their births feeling empowered because they are all strong and amazing women.

Labor of Love

I'm excited to announce that I was fortunate enough to attend my first birth center birth at Labor of Love Lutz on Friday!!!

On Monday the mom called me to let me know that she had her membranes swept. Great, was my initial thought and then, OH NO!, because Tuesday and Wednesday were my last two days of class for the semester and I had finals both days. With a positive intention that everything would work out, the mom made it to Thursday, when her labor started at work sometime around noon. Around 6 pm I called her to see how she was doing. She had been able to take a nap and was at home relaxing. I ate dinner and headed to her house around 8 pm. We were on our way to the birth center around 8:30 pm with strong contractions.

Only at the birth center for five hours, and having only been in active labor for about six, the baby was born gently, in the water, at 2:25am on August 12, 2011.  What an amazing family, midwife and birth assistant! They worked so beautifully together throughout the labor and the birth- it was such a powerful experience for everyone involved. I feel so lucky to have been a part of it!

Baby boy Bastian, 7.5 lbs, 21.5 inches

Side note: On August 4th, Kim Turner, a photographer, had emailed me that she read my blog and wanted to branch out into birth photography. She wanted to know if any of my clients would be interested in birth photography and I immediately thought of my doula clients. They had awesome pregnancy photo's taken and I thought they would be excited about birth photography, and I was right.

I have seen birth photography online before but had never been to a birth that had a photographer present. Kim did an amazing job at being "a fly on the wall" and more of a documentarian rather than an active participant in the birth. Her photographs are breathtaking. I cannot say enough positive things about having a photographer, who is solely there as a photographer, at your birth. I eagerly look forward to working with Kim in the future and cannot recommend her more highly. Below is a sample of her photographs, I cannot wait to see the rest!

I'm still the optimist.

Not only is today a Monday and the first of the month, it's also my birthday month! How exciting!

I just want this semester to be over. I am done learning about the muscles of the pelvic floor and the physiology behind gastrulation. My friend Angie told me that I turn into a restless 9th grader by the end of the semester and I'm starting to agree with her. I need a break!

So in less than a month I will be the age my mom was when she had me. Kinda makes me stop and think. What am I doing?! I have spent the last 20 years of my life in school. I want to be done. I have plans and goals and things waiting for me when I'm through (hopefully). Graduation cannot be here soon enough.

A great person recently told me that I need "to stay up and keep dominating your life goals." Good advice! So on this awesome day, I make a resolution to do just that.  Seriously, I got things to do and people to see! 

Dead woman walking: Obstetric Fistula

“When I reflect back over the years, certain faces come swimming unbidden out of the tide of memory. Even though everyone’s story was amazing, some were even more so. One young woman arrived at the hospital and handed us an envelope with a letter inside that had been written by a missionary doctor down near the Kenyan border. It introduced her and asked us to treat her fistula. There was nothing especially unusual about her. Like so many of our patients, she was dressed in rags and weak from hunger. The sealed envelope was so worn and grubby you could hardly read it, but inside the letter was clear and legible enough. To our surprise it had been dated seven years ago.
“Why has it taken you seven years to get here?” I asked. She told me she had been begging at the bus station for her fare. That was how long it took to raise the money.”

The Hospital by the River—a Story of Hope by Dr. Catherine Hamlin with John Little

I just finished my paper on obstetric fistula. I'm sure it could have been better but I must say I've learned so much along the way about the plight of the poor women afflicted with this devastating condition.  Dr. Catherine and Reginald Hamlin are PIONEERS in fistula repair and opened the greatest fistula hospital in Ethiopia in the late 1950's. To this day Dr. Catherine Hamlin still works there and in 2007 they opened a midwifery school to help train birth attendants to prevent prolonged labor. 

Follow below to read my paper.

(Home) Birth Observe #10

My first placenta print with paint

Thursday I went on prenatal visits with my midwife. One of my favorite mama's was 39 weeks and 5 days and eagerly awaiting the birth of her first baby. She wanted to be checked and was 1cm, 60%, +2. Exciting but nothing to write home about. Later Thursday night the midwife forwarded me a text that she lost a big glob of mucus. Yay, we are getting closer.

Friday morning around 8 am my midwife called me to let me know that our mama had been contracting since about 4 am and that she was going to head over and check her. I went to teach childbirth class and headed to St. Pete around 11am. I arrived at her house at 11:45 am right after she was checked: 80% and 4cm. The mom SROM'd right after the check and was handling her contractions like a CHAMP!

At 1:15 pm she wanted to be checked and was COMPLETE! By the way this mom was handling her contractions you wouldn't in a million years be able to tell she was where she was in her labor. It was AMAZING! First time mom took 10 minutes to push our her baby! It was so beautiful! I am so happy for this young couple and excited grandmother! At 19 years old this mom owned her birth. "I can't believe I just had a baby," was her postpartum catch phrase! Totally awesome! 

Infant formula and divorce attorneys

Exhibit A: Infant formula given to an exclusively breastfeeding mother

(she donated it to the local pregnancy center)

So my newly formed family of three recently got home from the hospital but before they left they got a little parting gift. A bag of infant formula. This is a breastfeeding mother on her way home to nurse for the first time- now with a handy supply of artificial breast milk for when the going gets tough. SERIOUSLY, what is this?

Research shows that the last thing a mom that is nursing needs is free formula as she navigates the ins and outs of breastfeeding. Giving a breastfeeding mom infant formula as she leaves the hospital is like the wedding planner handing the newly married couple business cards to divorce attorneys as they leave the wedding reception. Have we no faith? Not when infant formula is a BILLION dollar a year industry in this country.

Lactation resources need to be made available to newly nursing moms, not the easy solution of formula for when there are issues with breastfeeding. Although breastfeeding is natural it isn't as instinctual as some would think and both mom and baby need to learn this new skill. Practice makes perfect!

It makes me so angry to know that profit is put first over the health and wellness of both mothers and babies. Breastfeeding is the perfect nutrition for baby and it also helps protect the mother from breast and uterine cancer among its running list of other amazing benefits!

There is formula available to every person 24/7. Anyone can go to the store to pick it up in the event of an "emergency"- day or night! Giving breastfeeding moms formula as a "just in case" is helping nobody except the formula companies bottom line. Major THUMBS DOWN to any person and organization that supports this unethical practice!

Something to prove

"We have a secret in our culture, and it's not that birth is painful. It's that women are strong. "
Laura Stavoe Harm

After my hospital birth last Monday, I went downstairs to All Children's to talk to my friend who still works there. While I was sharing a picture of the baby and the details of the birth, a former co-worker questioned why anyone would want an unmedicated birth, "does she have something to prove?" His comments stopped me in my tracks. Was he serious? What does this mom have to prove? What do moms who plan unmedicated birth have to prove? Well, a lot actually. 

When women plan an unmedicated birth they are proving that birth is normal. When you are in labor there is not a DAMN thing wrong with you. Why would you want to use drugs during physiologically normal process? The pain of labor is gradual and rhythmic. Non-augmented labor pain will only take you as far as your body can handle and no further. Your body doesn't know that there is an epidural waiting for you at the hospital. There is an end to every contraction.

Moms who are having unmedicated birth are often surprised at how fast it can go. Once a steady rhythm has been established unmedicated birth is often quicker than those with epidurals. The great thing about unmedicated birth is that you can move. You can walk around, get in the shower or tub, do whatever position your body is telling you to do! This is probably one of the reasons why it can go a lot faster than the births where the mom is strapped to the bed.

There is this great myth that epidurals will save you from the pain of labor and birth. I've been to over 15 births where epidurals have been used and I can tell you first hand that that's not always the case.  Some epidurals leave spots of sensation, you still have pressure and sometimes they don't work at all. However, even if your epidural "doesn't work" that doesn't mean that you're again free to move around the room. In fact, once the epidural is placed you are now tied to the bed, almost literally. IV to saline (often Pitocin as well), blood pressure cuff, fetal monitor, contraction monitor and pulse ox are almost routinely required once you get an epidural. Not to mention the joy of the indwelling catheter to collect your urine now that you can't feel your lower half.

Epidurals are a great resource. I'm not anti-epidural. They can truly help preserve vaginal birth, in some rare cases. However, epidurals are often the first step in a cascade of interventions that lead to an operative deliver, either via cesarean or vacuum/forceps. When women are accepting an epidural are they truly doing so under informed consent? Have they weighted ALL the risk (increased risk of invasive interventions like Pitocin, major abdominal surgery, effects to the baby?) When you have a woman who hasn't eaten deli meat, soft cheese, or had any caffeine for the past 8 months but gladly accepts an OPOID epidural, we have a major dichotomy on our hands which leads me to believe they haven't been properly consented. Why would you subject your body and your baby to the increased risk of complications and additional interventions when there is a better way?

Having a doula at your birth has been shown to reduce the incidence of Pitocin, operative deliveries and the mothers request for pain medication. Epidural anesthesia has become the hospitals version of a doula. It offers pain relief while leaving the mother attached to the monitors, which have become the new labor and deliver nurse.  A doula is your labor partner, your coach, your cheerleader, your tour guide as you navigate something you may not have experienced before. "You can do this, you are doing this," is often all a mom needs to hear as she goes through the most intense time of her life. Why would you not want to be completely present at your birth? This is the most powerful day of your life!

The question shouldn't be what do moms who plan an unmedicated birth have to prove, the question should be what do moms who plan a medicated birth have to fear?

Two for Two

Woo Hoo! I'm batting 1,000 for unmedicated, vaginal births. Well, if you count my last two hospital births, anyways!

 This morning I woke up early because I had a potential doula client interview and I was going to have a birth plan meeting with a client who was a couple of days past her due date. Her plan was to stay at home as long as possible but this morning when I looked at my phone I had a text from her from earlier:

Shoot! I hate when my moms run to the hospital as soon as they get a single contraction. I was upset because I know what kind of time restraints people get put on in the hospital but this birth went great. She SROM'd around 6am but was only contracting every 10 minutes when I got there around 9am.

Walking, standing, singing, sitting on the toilet and nipple stimulation got our mama to 7 cm by 5:30pm (with no pain medication or Pitocin). Around 6:30 pm she started feeling pushy so the nurse checked her. She said she was 8-9 but the baby was still "very high." I knew that this mom had hit transition. She was feeling extremely pushy and pushing uncontrollably with every contractions. The nurse reassured me that she still had a while to go and that we could keep walking around and even go sit on the toilet for a while. Seriously? This mom is bearing down! There was no way I was going to have this mom sitting on the toilet because the last thing that I need (as a doula) is to catch a baby in the bathroom of a hospital!

Less than 30 minutes later I paged for the nurse to come back. A new nurse came in (it was after shift change) and the mom was complete at a +1 station. The doctor came in very shortly after that and he had the nurse push with her. Boom, head crowns. Less than 15 minutes later the baby was gently born.

Soon after the birth the mom was nursing the baby with a great latch. This was such a happy birth. I'm glad that I got to be a part of it! It's amazing how intuitively I'm starting to understand where moms are in their labor. The physiology of normal, unmedicated birth is becoming clearer to me the more births I experience. It still amazes me when hospital nurses (who see THOUSANDS of births) have a hard time 'reading' physiologically normal birth! Truly undistirbed birth is still a hospital rarity. I'm glad that this doctor was hands off and let the mom labor at her own pace, in her own time. It was beautiful!

The thing I lost in the fire.

I'm in the last few weeks of my first year of midwifery school. Only two years more before I graduate and become eligible to become a Florida licensed midwife! Time has flown by.

A lot has changed since I started midwifery school in August. One of the biggest changes came when Mike and I broke up during my first semester. I've been wanting to write about this for a while but how do you sum up two years in one blog post?

There is no blame for how our relationship ended. When I got the calling to become a midwife it was as if a fire consumed me. I was being pulled toward midwifery on an almost cellular level. It takes a lot of compromise and patience to date someone who is in midwifery school (or who is a midwife!). Not only was I spending two days a week in Gainesville, I could get called to a birth at anytime and not know when I'd be home. How would you feel if you had to share your partner with laboring families for hours, or even days, at a time? It's asking a lot.

I don't know if I was just extremely busy with school and clinic this past semester but I've been thinking about us more now than when we first broke up. I miss us. When I look back at the good times it brings a smile to my face because we had a lot of fun together. I miss our dog family, going to his moms to hang out and just spending time together. I don't regret going to midwifery school at all. I know that I'm in the right place. I just wish that we could have figured something out. I suppose everything is exactly how it should be.

I've been carrying around this ache for a couple of weeks. I am grateful for everything that has happened and I can't wait for all the changes that will happen next. When some people break up they see their relationship as a waste of time. I look back at our relationship and see it for all the ways it changed me in a positive way. Moving to Saint Pete, meeting my midwife preceptor, becoming a doula and applying to midwifery school all happened because of my relationship with Mike.

I haven't seen him since February but I wish him love and happiness in whatever he does. He truly helped change my life.

"Love hurts sometimes when you do it right." - John Legend

Pelvis Project

This semester is Reproductive Anatomy and Dr. Scott has gone crazy with the art projects! I'm no artist but here is my Pelvis Project. The female pelvic floor muscles and the female bony pelvis in 2 views. Thanks to my friends suggestion I used tracing paper and the project was 100 times easier than I thought! 

 

 My poster board

I traced those!

100,000

 

Well, it's official. My 2007 Toyota Corolla has over 100,000 miles on it!!! When I got to the hospital last night it registered at 99,999. Too bad I forgot to take a picture of it at exactly 100,000.

Each mile gets me closer to my goal of becoming a midwife.

(I sleep well at night knowing that I'm balancing my carbon emissions by being beef, pork and seafood free for the last ten year.)

"Best Doula Ever"

Today was the day of one of my happiest and most beautiful births (thus far).

The couple hired me late in their pregnancy after they took a childbirth education class at St. Joseph's (43% cesarean rate as of 2008)  and the teacher recommended that they hire a doula if they were wanting an unmedicated birth. I had met the couple a few times and was super excited to work with them. They were incredibly nice and the mom had such a beautiful pregnancy I just knew her birth was going to be amazing! Plus I had never doula'd at St. Josephs and was up for the challenge of preserving a vaginal birth at the hospital tied with Brandon Regional for the highest cesarean rate in the county.

I met the couple at their house around 2:30 pm yesterday after the mom's water started leaking at work around 10:30. After hanging out for a couple of hours (watching a child care video, walking on the elliptical, eating the best grilled cheese sandwich and with nipple stimulation for 20 seconds every 5 minutes) the contractions picked up a regular pattern. Around 8 pm the mom took a shower and the contractions were getting stronger, longer and closer together as time moved on. The dad did an AMAZING job at timing the contractions and keeping a log!

Dad's contraction log

Around 10:30 pm we decided to go to the hospital because I suspected the mom was in transition (good moaning sounds during the contractions, hot flashes, shaking). At 11:10 pm we were in our cars and on our way to the hospital (honorable mention: we made it to the hospital in 30 minutes when it usually takes 45)

Hospital art in the lobby

When the nurse checked her in triage she was 9.5 centimeters dilated! Family soon arrived and the baby was born gently, completely unmedicated and natural around 2:30 am. 

Beautiful baby boy

Today when I went to the bank to deposit the check that the dad had written for the birth in the 'for' line it read: "best doula ever." That just made me smile. While I am honored at the title, that birth would not have happened the way it did without the incredible way they worked together and their faith in her ability to birth their baby. It was an amazing experience to be a part of. I am so proud of them, it was beautiful.

Lunch with the ladies.

I just got home from a really nice get-together with the other student midwives in Pinellas county. It was so fun! One of the girls couldn't make it but me and the other two sat around and talked about birth for over 2 hours! It's so awesome to share the experience with wonderful people like my sister-midwives!

Hopefully we can keep it up and meet more often. It's always nice to share time with like minded people with similar interests!

Your placenta IS an organ

SO, I was at this (typical) hospital birth ALL day yesterday. After the birth the mom wanted nothing more than to be "unplugged" from all of the machines that were tying her to the bed. Joking with the mom I said, "you're already down one organ what more do you want?" The nurse, rudely snapped, "the placenta is not an organ it's the inside of an organ."

Ok, I'm not one to argue or bet but this woman is out of her mind. The placenta IS an endocrine organ. The first sentence of Wikipedia (which the entire world can access) begins, "The placenta is an organ..." The placenta is the only temporary organ. It's the baby's little apartment. It keeps the baby warm, safe and fed along with other magical things.

I really shouldn't be in shock. This woman was the nurse at my first birth that ended in a cesarean last January. She was rude to me then and was no better this time around, she wouldn't even sign my silent birth observe form!

Sometimes I wonder how and why some people became nurses! I don't even mean that in a bad way because I love nurses. My best friend is a nurse. My favorite teacher is a nurse. I respect and admire nurses. I wouldn't even mind being a nurse. They are typically full of amazing information, however, last night the nurse was way off base because: The placenta IS an ORGAN! (I promise)

I just don't understand how someone could complete something as difficult as nursing school, work in labor and delivery (for at least a year) and not know that the placenta is an organ. People with the "I don't know I just work here"- attitude really shouldn't be nurses and the nurse last night was one of those people!

ROM

ROM- rupture of (amniotic) membranes
SROM- spontaneous rupture of membranes, happens naturally during labor, pushing or at birth
PROM- premature rupture of membranes, happens at least an hour before the onset of labor
PPROM- preterm premature rupture of membranes, happens before the onset of labor before 37 weeks gestation
AROM- artificial rupture of membranes, happens when a physician or midwife purposefully rupture the amniotic sac releasing amniotic fluid

Before you arrive at your due date it is important that you research the rationale, benefits, risks and alternatives (including doing nothing) of AROM. It is one of the most commonly performed procedures in hospital birth. It has pros and cons and proponents on both sides of the coin.

Pro's
-May speed up labor by an hour
-Allows for the placement of internal fetal and contraction monitors
-Allows for the examination of amniotic fluid for the presence of meconium
-Used for labor induction (ALSO, understand the rationale, benefits risks and alternatives of induction before consenting to an induction)

Con's
-Opens the mother and baby to infection
-Places the laboring mother on a "time-clock" for delivery which may lead to other interventions (ie, Pitocin)
-Lack of mobility (must now stay on monitors)
-Umbilical cord prolapse
-May make contractions more painful

If you are declining AROM be sure that your provider is aware of your refusal of AROM before they perform each vaginal exam. If you are consenting to AROM it may behoove you to delay AROM until you have established a consistent contraction pattern in active labor, this way allowing for shorter time between rupture and birth. A shorter time frame between ROM and birth may help lower your risk of infection because of fewer vaginal exams.

Please, research your options. It is your right as a health care consumer!

Home Births are Awesome

So my goal of keeping up to date on my birth observs hasn't gone exactly as plan. Sorry, I've been busy with school and the such. However, I did want to share about this awesome birth I was at. The mom totally trusted herself and her baby. It's so refreshing to have that experience because often we, as women, look to others to tell us if this is "right" and that everything is "normal" and "ok."

Trust your bodies, ladies, they know how to birth your babies!

"Strike when the iron's hot"- preserving vaginal birth

I had the amazing opportunity to attend a birth at Brandon Regional Hospital. I was nervous about my doula clients delivering there because their cesarean rate (as of 2008) is over 40%. Although the birth did not follow my clients ideal birth plan, ultimately our goal moved from wanting an unmedicated birth to preserving a vaginal birth.

SROM occurred at home with no contractions for over 12 hours. Pitocin was started and the contractions maintained a beautiful pattern until the mom pushed her baby out, over 24 hours after rupture of membranes at the hospital with the highest cesarean section rate in the county! Every decision that was made regarding the birth was based on the informed choice of the mother. She owned her experience!

Every intervention that exists in the hospital exists for a reason. Do I think that the rate of intervention is too high? Of course I do, however, there is often a time and a place for most interventions. It is important, as birth professionals, to understand the resources available at the hospital (Pitocin, epidural...) that can be utilized to achieve a gentle birth which preserves a vaginal birth.

As always, be flexible. Every birth is uniquely different!

Conviction

"As I have observed in subsequent encounters with midwives around the country, the decision to embrace this calling often seems to strike with a force akin to religious conversion."
- Jessica Mitford, The American Way of Birth

Spring Semester 2011

Today was my last day of class for the Spring semester, woot woot! I'm so glad that it's over! I passed everything: anatomy and physiology II, Florida Law and Rule, Health Care Skills II, Practicum A, Female Sexuality and midwifery clinical. I turned in my clinical notebook today. I had a total of 6 births and 107 clinical hours.

 (Me and my fellow classmates during our fist birth circle!)

Clinical is so much fun. I've been getting to do all the prenatal measurements during the visits and I checked my first cervix on Monday. It felt like total much but the mom was 39 weeks so I assume that's normal and knowing what cervices should feel like will come with practice!

During this semester we had our first birth circle where we get together and share our birth and clinical experiences. It's nice to share your experiences with people that are in similar situations and can truly understand. Explaining shoulder dystocia and postpartum hemorrhage has less of an impact on the average friend than it does to my sister/brother midwife.

I am most looking forward to summer semester. We are finally taking our Pelvic Exam/Pelvimetry Workshop, reproductive anatomy, antepartum, diagnostic tests and a phlebotomy workshop. I cannot wait to start doing more clinical stuff and being more hands on with the mamas!

Also, here's a great video I love that teaches the Leopold's Maneuver to find the baby's position

Goals for the summer semester:

1. Post all of my births on my blog
2. Keep up to date on my paperwork for my clinical notebook
3. Pass all of my classes!

United Cerebral Palsy

"United Cerebral Palsy (UCP) is a leading service provider and advocate for adults and children with disabilities, including cerebral palsy. As one of the largest health nonprofits in America, the UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network."
From: UCP.org

This week I start my awesome new job as a doula at United Cerebral Palsy. I cannot believe that I've made it to this point in my maternity care career. Yesterday, when I talked on the phone with one of my best friends, she congratulated me on becoming a "professional doula." That's me! Jessica, professional doula! Friday I start at the clinic, I'm so excited!

UCP Mission Statement

The mission of United Cerebral Palsy of Tampa Bay is to guide and assist families and individuals with any disability or other barriers to achieve their full potential, resulting in community inclusion and independence.

Vision Statement

United Cerebral Palsy of Tampa Bay will be the west central Florida provider of choice and the leading in community responsiveness to early intervention, developmental preschool and child care, therapy, family support, respite and employment programming.

The Second Annual USF Maternal Child Health Symposium

     Last year I attended Robbie Davis-Floyd's lecture at USF on the anthropology of childbirth during the First Annual Maternal Child Health (MCH) Symposium at USF. This year I also attended the symposium with keynote speaker Dr. Kendall-Tackett who is a researcher and author of several books including, "Breastfeeding Made Simple."

     I didn't make the first day of the sympoisum because I went on clinicals with my midwife and a fellow classmate. However, after clinicals we did make it to Birth the Play at USF. I'd heard a lot of great things about the play and was excited to go. Three of my fellow midwifery school classmates came too as well as my best friend (in real life), Sarah.

Me and Sarah at Birth the Play

     The MCH symposium was really great. The speakers talked about various topics including the effects of childhood sexual abuse on breastfeeding, fatigue and breastfeeding, fetal and infant sleep and post tramautic stress in "near-miss morbidity" (near death childbirth experiences). It was nice to hear experts in the field discuss in detail things I've learned while in midwifery school. I had a really great time and am looking forward to next years symposium.

 Me with fellow classmates: Jessica B. (center) and Shea

Birth Observe # 3

     The week of February 7th, I was in Gainesville all week for my Florida Law and Rule workshop. One of my midwives clients was in her window to have a baby and I was concerned that I would be stuck in Gainesville for her birth. Her birth would be my first HBAC (home birth after cesarean) and I really didn't want to miss it.
     On Tuesday around 8pm, my midwife called me to let me know that her mama was in labor. The midwife informed me that she was on her way to their house. She was going to check her and then let me know the status. Around 10pm, the midwife called me back to let me know that she was about 4cm's. The midwife knew that I really wanted to make this birth but she also knew how important it was that I not miss school. I told her if she could use me I'd come for the labor, even if I missed the birth. So around 10:30pm I headed back toward Tampa to meet her at the birth.
    Everything went so perfectly. My first HBAC was born in the water at 8:19am on 2/8/2011 weighing just over 10 pounds. 

Birth Observe #2

     On Thursday I went on prenatals with my midwife. We received a call around 9am that we had a mom in labor. Her partner told us that he would give us a ring when they were ready for us. We went about our day and saw four beautiful mama's. Our day seemed short, we were back in Saint Pete around 2pm. Still no call from our laboring family so we went to lunch.
     After lunch I said my goodbyes to my midwife and went to meet up with my doula friend. We had a meeting with a new doula client. I had originally text her that I'd probably not be able to make it because of the birth but I made it, which was nice.After our meeting with the new doula client, my midwife called me to tell me that she had stopped by to check the mama who was around 2cm, 70% effaced, 0 station. I headed home and waited for the call.
     Around 10:30 pm the midwife called me to let me know that it was baby time. I got ready and headed to the house for the birth. When we got there the partner and their daughter came outside to tell us that it was time, she was feeling ready to push! As soon as we got inside I set up the O2 tanks and had all the midwives supplies ready for the birth. I always have towels, baby hat, stethoscope, and bulb syringe at arms length because soon as the baby is born those are the things the midwife needs immediately postpartum.
     The beautiful baby girl was born in water at 11:46pm on 2/4/2011. My second birth as a student midwife!

Auscultating Lung Sounds

     At school on Thursday we spent four hours in Health Care Skill learning to auscultate lung sounds and how to identify irregularities. There are a lot of great websites that you can utilize to hear lung sound anomalies that you might not encounter in clinic. 
     During class, my teacher made a good point. It's not necessarily the most important thing to diagnose what you're hearing as it is to understand that what you're hearing is abnormal. She also highlighted that irregularities in lung and heart sounds are often normal variations, benign and/or transient. Never underestimate the value of a second opinion, she reminded us. Armed with my new skills, I headed home to get ready for clinic on Thursday with my midwife.
    Around midnight I awoke to my 14 year old dog-daughter panting in bed. I retrieved my stethoscope and listened to her heart and lungs. Tabitha has been very sickly the last couple of years so anytime she seems unwell I always worry that this could be the beginning of the end.
     I'm no expert on canine anatomy or pathology but from what I learned in class I diagnosed her with tachypnea. I spent about 15 minutes petting her and listening for changes, worried that she was headed for the worst. I contemplated taking her to the emergency vet but decided to wake up my mom for some motherly advice. 
     "Mom!!! Wake up, I think Tabitha is dying!!!" I gave my mom report about her rapid breathing and fast heart rate. When my mom came in to check on her she immediately knew what was wrong. My room had gotten too hot and Tabitha was panting to cool off! What relief!
     It's amazing how this little life lesson reinforced what my teacher said in class. Always understand that irregularities may be benign and never underestimate the value of a second opinion! Lesson learned!

Birth Observe #1

Image from: Attachments Catalog

Thursday, I went on two prenatals with my midwife. Both women are in their delivery window, 37 to 42 weeks gestational age (wga), and the grand mulipara has a history of going early (38 wga at most). For the mama that goes early we didn't even make a follow up appointment for her because we knew we'd be coming back any day now for her birth.

Around 9pm on Thursday night the midwife called me to let me know that our grand mulipara (5 or more births/paras) thinks that she's in labor. The midwife told me to hang tight. She was going to take a shower and call me back in an hour. At 11pm she called me again to let me know that she was on her way to check the mama. The mama recently thought she was in labor a few days prior and the midwife wanted to make sure that this was it before sending me on my way. At midnight my phone rings, "get here now, the baby will be born tonight!"

I get to the birth around 12:30am. The midwife lets me know what's going on and tells me that the mom is at 2cm. Shucks, I think to myself, I have to be at work at 8am I hope I don't miss my first birth as a student midwife.

During our prenatal visits the mama told us that she goes early and she goes fast. I was expecting fast but her labor/transition and birth were unbeliable. Around 12:40 am the mama was squirming in the birth tub as what appeared to be huge rushes washed over her. The midwife wanted to check her again so around 1am she did and she was 100% effaced and 8cm. A few more contractions and the mama had the urge push.

At 1:21 am on 1/21/2011 a beautiful baby girl was born. My first birth as a student midwife! From 2cm to birth in less than an hour! Amazing.