I'm done.

Today is my last doula birth. I'm retiring. I've spent five years fighting the good fight. I've encouraged families to choose hospitals known for their low intervention rates and providers that support natural birth. I've labored at home with women who were motivated to have natural births. I've supported women, who after being informed of their choices and evidence based practice, still chose the 'other.' I'm done. I can no longer sit idle while providers give bad care and propagate antiquated practices (no eating in labor, continuous fetal monitoring, immediate cord clamping, perineal massage, episiotomy, Freedman's curve...the list goes on and on). I'm done.

Today I step away from my role as a doula and fully embrace my role as the midwife I would want my doula clients to have. The midwife that follows evidence based practice and supports her clients in making informed, autonomous choices about their care. The locus of power in birth belongs with the woman giving birth and I will continue to support her on her journey. I honor the path that being a doula has brought me down and I hope that I have paved the road, in some small way, for the doulas that follow me; however, I'm done.

Jack and Kelly

My go-to breastfeeding resources are anything Jack Newman, MD says and kellymom.com and this weekend I was fortunate enough to go to the La Leche League conference in Cocoa beach to see both of these breastfeeding giants speak. If you don't know who Jack and Kelly are please take the time to familiarize yourself, they are a fantastic resource for providers and families.

If these links stay active, here are the PDF's of Jack and Kelly's presentations:

How Birthing Practices May Affect Breastfeeding - Jack Newman

How Breastfeeding "by the numbers" Ruins Breastfeeding- Jack Newman

When The Baby Has Not Latched- Jack Newman

Anatomy and Physiology of the Breast- Kelly Bonyata

Gadgets and Gizmos of Breastfeeding- Kelly Bonyata

50/50

Friday's home birth was my 50th birth on my license, marking the point where I've officially attended as many births as a midwife as I had attended as a student. One hundred first breaths, one hundred new humans.

I applaud all of my classmates who graduated from school with their 50 managements and embarked on independent practice. I am only starting to feel confident in my skills as a midwife so to be on my own right off the bat would have been very stressful. I am very grateful for being in a practice with experienced midwives as my mentors and guides. It's also been great to be in a practice that does approximately 150-200 births a year. Being busy has given me the opportunity to attend a lot of births in a short period of time, allowing me to practice and perfect my midwifery skills every day!

As I embark on my next 50 births, I am making a conscious decision to become more integrated in my local midwifery community. I also want to promote midwifery by embracing student midwives and help them in anyway I can. I find mentoring student midwives a great way to share what I've learned and to also reflect on my own practice. They offer an astute mirror to view your practice style if you're open enough to respect their thoughts, questions and opinions.

Onward I go!

Guest Post: Welcoming Anna and her last year of midwifery school!

Anna is a midwifery student and this is her last year of school. She has joined the birth center and we are so happy to welcome her as part of our team. Read her guest blog post on her first week and join us in welcoming her to our community! 

“So here we are, in our rare and precious lives, surrounded by gorgeous moments begging to be noticed and celebrated.”

                                    -SARK

Officially in my final year of midwifery school, I found myself at a crossroads. And in what can truly be appreciated by a student of midwifery, I made the decision to take the proverbial leap and...change preceptor sites.

So with my devoted partner, beloved village, and sassy chickens in my rear view mirror, I drove towards this new horizon with a tear in my eye that contained one last bit of lament and all the joy and anticipation for what was to come.

Guest Post: Kitty's first day of midwifery school!

Kitty is a birth assistant at the birth center I work at and started midwifery school at Florida School of Traditional Midwifery, where I went, this week! I asked her to write a guest blog post, so here it is!

The Birth of a New Day, by Kitty Lakey, Student Midwife

Each one teach one

My preceptor/employer teaching our student midwife how to do a pap smear 

(Yes, I'm snacking on cereal. A girls gotta eat.) 

Now that I'm officially back to blogging, I took some time yesterday to re-orient myself to this blog. Boy, is it hard to read some of the things I wrote as a brand new student midwife- cringe! If reading my own writing taught me anything it is to be patient with student midwives. The passion I have for midwifery is apparent in my writing but so was my naivety. Oh, how I've grown as a person and as a midwife since starting this blog four years ago. 

Here are my five tips for new student midwives:

1. Be present. 

Make your clinical site your priority and make yourself available as much as possible. Be in the office, help the administrative staff, make useful handouts for clients, know where everything is and what everything does. Help your clinical site by being present and productive. Attending births is just a small part of what happens in a busy midwifery practice. Show up and be a part of the BIGGER picture. 

2. Set boundaries. 

Make your clinical site your priority but don't let your preceptor rule your life. Have days where you are OFF-call. Turn your phone off and don't answer emails or texts. If your preceptor treats you unfairly because you request days off call when they like you should be available 24/7, 365- find a new preceptor. Set firm boundaries early and push back. You will finish your numbers (Trust me, I completed all my managements in my last year of school.) 

3. Be involved.

Know what the laws and rules are in your state, in your country, and globally when it comes to women's healthcare choices and midwifery. Be involved with the decision making processes around the advocacy of midwifery in your community. Reach out to the public and inform them on what midwifery is and what midwives do. Be the face of midwifery to your family, friends and peers! 

4. Read.

Did you read about that new study that came out on the benefits of x? Did you hear about the new recommendation in regards to y? Did you read that powerful blog post by that seasoned midwife? Who are the big names in the birth world in your community, in your state, in your country, globally? Know who they are. Read their books and articles. Attend their workshops and conferences. Read as much as you can about what midwifery is and means. Know where you are and where you came from. 

5. Take breaks when necessary. 

I dropped out of midwifery school twice. Sometimes it sucks. People will get in your way. You'll have shitty births and difficult confrontations with hospitals. The program you are in may make things unnecessarily challenging and be unwilling to compromise. Take a step back and take breaks if necessary. Becoming a midwife is not a race, finish in your own time and on your own terms. 

Best of luck to everyone who answers the call of a lifetime. 

I'm a midwife!

My first catch on January 11th, 2014, while the ink was still drying on my license 

This blog has been neglected but I'm making a conscious commitment to update it more often. I finished my clinical number in December of 2013 and became a Florida licensed midwife in January! That's right, I did it. It was trying but being in a high volume, stable clinical site really helped me finish my number, find my focus and motivated me to finish. 

Since January, I've attended 47 births as an "official" midwife. Check out my rad stats below: 

Back in the saddle, in Sarasota

Well, since I've been back in school I started precepting at a great birth center in Sarasota, Florida! I've attended several birth at the birth center and at homes and it's been a great experience. I have about 25 more births to manage before I can graduate! Hopefully, I'll be able to get the few things I need left done so I can take the NARM in August.

We shall see!

Transition or Prodromal Labor?

I had two finals yesterday and a paper still do. I'm working 20 of the next 26 hours. I haven't done laundry in two weeks. I couldn't tell you what's in my refrigerator or the last time I swept the floors. If I'm playing my cards right I should be done with school in August. I still have 45 babies to "deliver" and God knows how many more clinical hours I need to make up. Sometimes I feel like I'm not going to make it, I'm never going to finish. I don't know how I've gotten this far but if it's any indication of my perseverance- I'll eventually be on the other side of this tunnel where there is light.

Circumvallate Placenta

Here is a video of an amazingly unique placenta from a birth I was at this week. While I was inspecting the placenta after the birth I noticed that it was a circumvallate placenta . The baby was fine and had 9/10 apgars.

HBA3C

It's a new year and I'm back in midwifery school. Working full time hasn't allowed for me to be as active in my clinical experience as normal but I wanted to share this awesome birth I was at last night.

My midwife called me around 10:30 Thursday night and asked if I was available to assist her at a birth she was at. In my infinite wisdom I had agreed to work a double so I could be off on Friday to go to a fundraiser for our upcoming trip to the Dominican Republic so I wasn't going to be out of the hospital until 7am. At 7am sharp I got a call from my midwife asking me to go labor sit a mama who was in labor because the mama she was with was pushing.

When I arrived to the house it was clear that the mom was in early labor so I encouraged her to sleep. Around noon the midwife came over and checked her at the mothers request. She was still around 2 cm. We both left so the mom could rest and spend some time with her husband. Around 8 pm I received the call, the mom was 8 cm and "rockin' and rollin'".

Back at the house for the birth, the mom was amazing. She was laboring in the tub in the living room handling it like a champ. Around 9:30 pm she started to feel pushy, and was bearing down with her contractions, listening to her body. At 10:06 pm a beautiful baby girl was born in the water into her mothers arms, 9 lb 1 oz, 20 inches long.

Every birth is beautiful but this birth was especially so because it was her first vaginal birth after three cesarean sections. Does every trial of labor for a VBAC mom end in a vaginal birth? No, but every mom deserves a chance to allow their bodies and their babies to choose their birth route. My hope is for every mom, VBACer or not, to be given the space to have a gentle birth and to have their choices respected. I'm so glad I got to be witness of this awesome birth! ROCK ON VBACers, ROCK ON!

(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!