Interview Questions for Midwives (or any Care provider)

I found this list someone posted on a Homebirth forum on babycenter.com. One of the most complete and well thought out lists I have seen! I did edit it a little. Posting it as a resource to anyone interested. If there are any other questions you can think of, please post in the comments!

General

How many births have you attended total, and in this area?

What is your transfer rate? Typical reasons for these?

What is your episiotomy rate? Reasons for doing them?

Are you available for phone calls 24 hours a day for advice/emergencies?
What happens if I go past 42 weeks?

What are your experiences with/opinions of Bradley? Hypnobabies/hypnobirthing?

Do you encourage your clients to write birth plans? What is the intended benefit of them?

Would you ever attend twin births? Singleton breech births?

Do you have birthtubs for use or rental? 

 

Prenatal Care

What are your expectations of clients during pregnancy?
Do you perform/recommend a pre- or postnatal Pap smear?

What are your normal guidelines for weight gain?
What prenatal tests/monitering do you recommend/perform routinely? (BP, weight, urinalysis, ultrasound?)

Do you suggest testing for GBS, and if I’m GBS+, what do you suggest?

Do you suggest testing for GD, and if I fail the glucose tolerance test, what do you suggest?
What are your standards for preeclampsia? How do you manage this condition?
Do you use a Doppler or fetoscope at prenatal visits? How often?
Have you ever had clients with partial/complete placenta previa? How was this detected? How rare are these conditions? How was this dealt with?

When or if vaginal checks are required? Can I request to not have them? What about during labor? How often do you normally perform them and can I choose not to have them?

Labor

What are your expectations of clients during birth?

What supplies do I need to provide for the birth? Where can I purchase those supplies?
At what point after labor has commenced do you prefer I call you, and at what point in my labor will you and/or your assistant come to my home? How many assistants do you normally bring to the birth?
How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?

Have you ever missed the birth of a client? If so, what were the circumstances?
What equipment do you normally bring to the birth (birthing stool? oxygen? ambu-bag? pitocin shot?)

Are you okay with my child being present at the birth?

How long do you let things go after ROM (rupture of membranes), if there is little/no progress but the mother doesn’t want to transfer?

Would you be okay with mostly being in another room, if I wanted to labor and/or deliver alone or only with my husband in the room?

 

First/second stage

What do you perceive your role to be during my labor? During labor, how active are you in checking the mom and the fetal heartbeat, etc?
Under what conditions would you perform AROM (artificial rupture of membranes) or otherwise induce or augment labor?
What natural comfort techniques do you provide?

What pharmaceuticals, homeopathics and/or herbs do you use at births?
What is your usual approach to a labor that is progressing slowly?
How many/few people are you comfortable with being present at the labor and birth?
How do you deal with shoulder dystocia?

How do you deal with cord prolapse?

What percentage of your clients tear, and how badly? How do you try to prevent this?

How long are you willing to let a client push, or do you base it solely on the baby's stress level?

How do you think the pushing stage should be managed?
If I or my husband wish to catch the baby, are you comfortable with me/him doing so?

What positions do your clients most often give birth in? What positions do you prefer, and why?

Third stage

How soon do you like to clamp and cut the cord? If all is well with mama and baby, can we wait until the cord stops pulsating? Can my husband cut, if he wishes?

How much time do you allow for the delivery of the placenta?
Are you okay with the placenta being delivered underwater?
What is typically done with the placenta afterwards? Are there any legal restrictions on disposal? Can I have it encapsulated? Do you or someone you can recommend provide this service?

How do you detect partially retained placenta? How do you treat this?
How often do hemorrhages occur?

How would you handle a hemorrhage? Do you carry pit, placenta smoothie or herbs for this? At what point would you recommend transfer for medical management of hemorrhage?

What would you do for a floppy baby? How often do you see this? Do you carry infant resuscitation equipment? Are you certified in infant resuscitation?

What are the most common minor complications you see, and how do you typically treat them?
What happens if my perineum needs stitching/suturing? Can you do that? Are you comfortable with repairing 2nd/3rd/4thdegree tears?  How bad does a tear have to be before you use stitches?
Do you help with cleanup (laundry, etc.)? What do you typically do?
How long do you typically stay after the birth?
Complications
Do you have a working relationship with one or more particular OBs to whom I would be referred in the event of a complication? What hospital would you prefer I transfer to?
What situations do you consult an obstetrician for? How commonly do these occur?
What problems or complications in pregnancy would mean that a obstetrician would become my primary maternity caregiver?

Under what circumstances do you transfer to hospital?

What hospital would I be transferred to?
What would be the plan of action if a transfer to hospital were necessary during labor?
Would you stay with me in the hospital? In the operating room? For how long after the birth?

Post-partum

Do you examine the baby after birth? What do you look for? What tests do you perform? Do you recommend eye ointment and/or Vitamin K? Oral or shot? Why or why not?
Do you have any special things you do for the mom after a birth such as an herbal bath?
How do I obtain the baby’s birth certificate/SSN?
How many postpartum visits will there be? Where will these take place? What do they include?
Do you examine the baby at any or all of your visits, and if so, what does the examination include?

When do you recommend that we take the baby to his/her pediatrician for the first time, and why? (Assuming normal delivery and healthy baby.)

Financial

Will you try to bill my insurance company? How?

How much is the fee for birth alone, vs. prenatal care plus birth? If I need extra prenatal visits or labs, how much are these?

What is included in the fees? What will I need to provide? (Birth kit, lab fees, etc.)

Depending on how you feel, do you want to know her stance on circumcision or vaccines? Breastfeeding and/or support? Will she support you continuing to breastfeed a child through pregnancy? How many children she has and how she birthed them? What she recommends for nutrition (how much protein, etc.)? What other certifications does she possess?

How to feed your baby?

This topic has been on my heart lately. I have recently heard several stories of mother's who have struggled with the "right" way to feed their babies and have given up because it just wasn't "working".

Although I can't speak from personal experience since I've never given birth in a hospital, it seems as though nurses/doctors/lactation consultants hand out very specific advice on how to feed your baby. Sometimes this includes with how long and how often. (By the way - most of these people have extremely little training or experience in breastfeeding - they are just passing along the little information they've been told. They are in no way experts in breastfeeding. Want a more experienced/expert opinion? Contact your local Le Leche League).

I don't understand why there are so many "rules" given to new moms. Let's just think of ourselves for a moment. Do most of us eat the same amount of calories at the same intervals every single day? Aren't we more hungry some days than others perhaps because of extra activity or a growth spurt when we were growing up? Some days we just need some extra snacks and calories for no apparent reason. And then you add to it that some people have much faster metabolisms than others. I think babies are probably much the same way. Some need more milk than others, some are more efficient eaters than others and will nurse for shorter periods of time, some are not as efficient and need to nurse longer. How does any hard and fast "feeding schedule" apply to every infant out there?

In addition to this, nursing your baby on demand is how you establish your milk supply! Allowing the baby to nurse as often as needed is how you build your milk supply and tell your body how much milk is needed. It's supply and demand. The more baby nurses, the more milk is made. The less your baby nurses, less milk is made. So if you try to put your baby on a schedule to fast too soon (or at all), you may hurt your milk supply. So these "lactation consultants" are setting mama's up for failure. Feeding on a schedule, especially in the beginning can lead to lower milk supply. Which leads to supplementing with formula. Once you start supplementing with formula it is a slippery slope and very hard to get out of, many times leading to the end of the nursing relationship.

Breastmilk is very easily digested by our babies. They are able to digest it within 2 hours. So it makes sense that a baby would need to eat at least every two hours. And maybe more often depending on the baby. Some babies will eat an entire meal in one session. Some babies will be "snackers" and eat several times in shorter intervals. A 3-4 hour schedule MAY work for the first baby, but the second baby would be very unhappy with this type of schedule.

Babies depend on us to provide everything they need. Especially while they are little, they (usually) need so little. They need milk, sleep, clean diapers and to be held. It is so sad to me that mother's are encouraged to ignore some of these needs. Why would we deprive our babies food when they are hungry? So they fit in a schedule? Babies will very rarely overeat. They will usually only eat the amount they need (especially breastfed babies).  It doesn't make sense to me to deprive a baby of such a simple need. They are growing in every way so fast every day! They need the nourishment!

NO ONE will ever know your baby better than you. NO ONE. EVER. Listen to your babies cues. Forget about what the books say or what your nurse told you is "normal" or "best". Every baby is different and has different needs. A mother knows best. ALWAYS. Feeding on demand at the very least for the first 3-4 months of life is so very important. Only your baby knows when he/she is hungry. They are not "manipulating" you. You do not need to "control" them.

No one ever told me how to feed my baby. I just put my baby to my breast and we figured it out together. My babies have thrived. No schedules. They just eat when they are hungry. My youngest is more of a snacker than my first was. He eats much more often but in short little bits sometimes. Sometimes he will go longer stretches. I just listen to his cues. I couldn't tell you how many times per day or how long on average he eats. I have no clue. He is healthy and chubby and a happy baby - much better indicators than any numbers could tell you.

xoxo
S

Drive by Posting - Breastfeeding and Allergies/Sensitivities

Several weeks ago our midwife did some muscle testing on our baby boy. He was 6 weeks old and over the few weeks before our last post-partum visit he had gotten fussy. He would fuss almost every time he was awake. Not cry, not inconsolable. But just not himself.

Through the muscles testing we found that he has a wheat sensitivity.

Unfortunately, I love wheat. I love bread and cakes and everything that has wheat in it. Oh and pizza. I love pizza.

But the comfort of my little boy was by far more important than my love of wheat. So, the next day, I cut it out. Completely. Now we are pretty much 100% wheat free (I say pretty much because I might unknowingly eat some? I'm pretty careful though). Which really means I'm almost 100% gluten free too.

K has improved since I've cut wheat out. Now he only fusses when he is tired pretty much. Or in the car - he doesn't enjoy the car at all.

If you have a "fussy" baby or a "colicky" baby, I would recommend an elimination diet (unless you have access to someone who can do muscle testing). Wheat, dairy, soy, corn, eggs and peanuts are common sensitivities (as well as others). You can go to a bare bones diet for a couple of weeks, then add one back in at a time. If baby becomes fussy, you have likely found your culprit. For more on "elimination diets" you can see this article, or google "elimination diet for breastfeeding".

While it's kind of a pain to change our diets, it's just soooooo good for our babies to breastfeed and is totally worth it. It's only for a short time after all.

xo

Pain Med Free Childbirth Tips

I know several women who want to have a natural/pain med free childbirth in the near future. I wanted to compile a list of tips of achieving natural childbirth - how to relieve pain naturally to cope with labor. This list is in no way exhaustive - just things that I have used or tips that I have come across in my readings or conversations on natural childbirth. If anyone reads this and has more to add - please do so in the comments!

1. Chiropractic - Getting adjusted regularly throughout pregnancy, or at the very least shortly before going into labor, can help the baby be in optimal position for labor and delivery - therefore causing less pain. It also has the ability to shorten labor as well.

       Along the same lines as chiropractic but something you can do on your own - Make sure you spend as much time, particularly in the third trimester, in positions that promote Optimal fetal positioning (head down facing your tailbone). The better the position your baby is in the less painful labor and quicker delivery you will have. Hands and knees is one of the best positions to hang out in, five minutes at a time a few times per day. Beyond that, make sure you are leaning forward, not reclined whenever you are sitting. I know it's more comfortable to recline - but trust me it's worth it to lean forward whenever you can. You can also drape yourself over a yoga ball. Reclining on the couch is the worst - don't do it (avoid it as much as possible)!


2. Yoga balls - Great for taking some pressure off in labor. I personally didn't use one much in either labor - but I know many women who have and it has helped greatly.

3. Water - Waterbirth is great for many reasons, but it's not for everyone. However, if you are able to labor in the bath or shower do it! It's called the "natural epidural" for a reason! The water is soooo soothing. If you are in the bath you can also have someone pour water over your belly - my midwives did in both labors and it was really comforting.

4. Touch/massage/effluerage - If touch is your thing, you may want to experiment with different types of touch and massage before labor with your labor partner to see what you find soothing. I enjoyed touch during labor.

5. Counter-pressure on hips/back - I didn't have true back labor with either baby, but nonetheless, counter pressure on my back/hips was amazing during labor. This was probably one of my number one helps during labor besides water. The best I found was if my labor support (usually hubby, but my midwives did some too) would put either their fists or the heels of there hands firmly on each side of my spine, sort of right above the butt cheeks. I had to work with hubby through a few contractions telling him (as much as I could mutter!) where to place his hands and how. Once we got it down I would say it took the pain from about a 9 to a 5/6. Seriously - it helped that much! When he couldn't press hard enough I would hold on to something and push my hips back into his hands (so we would be pushing against each other).  Each contraction I could tell him it was coming and he would place his hands on my hips through the peak of each contraction.

6. Vocalizing - This sounds really weird, but it really does help in so many ways. First of all, the more open you can keep your throat, the more relaxed your bottom can be which allows the contractions to do their work of opening your cervix. If you are tense and tightened up, your contractions will not be as effective. But besides helping with the effectiveness of the contractions, vocalizing can also help with the pain of labor. This is how I got through almost my whole second labor. Early on, before I woke up my husband, I sat in a rocking chair or walked around and said "oooooooooooh" through each contraction. Now you have to make sounds that will open your throat and not tighten it so Ooooooh and Ahhhhhh are good as well as lower tones (not high, not Eeeeeee). I didn't use them as much but also Mooooooo'ing and horse lips (blowing air and letting your lips flap) are also good.

7. Singing - Along the same lines as vocalizing, but I loved it so much with my second labor that I think it deserves its own subcategory. I sang through almost all of transition. If you could have had a window into my room at this time you would have never known I was in labor. I chose a CD that I was very familiar with, I knew all of the words, and I really enjoyed and relaxed me. I sang each song and went through contractions without stopping singing or hitting any wrong notes. It was a GREAT distraction for me and was so soothing. If we are blessed with another I will sing through as much as my labor as possible (as this last one I only started singing at around 8cm... almost the end of labor).

8. Eating/drinking - I know in a lot of hospitals this is not allowed, but if you can, eat and drink through your labor. If you get too tired because you have no energy since you haven't eaten, it will be harder to finish out your labor and push. Even if it's just a couple of crackers or whatever. Try to eat something if you can (and sneak a protein bar or something into your hospital room). Also stay hydrated.

9. Positions - Try as many positions as possible. When one stops working, try another. I liked hands and knees a lot, as well as draped over the tub, and just standing leaning against the wall with my head hanging down a little. You can try squatting, laying down on your side, hanging over a yoga ball, sitting on a yoga ball. Keep changing positions to get more comfortable (this also helps baby to maneuver his way into your pelvis). I found walking pretty therapeutic, I thought I was going to die when I laid down. But everyone is different!

10. Hire a Doula - Doula's can be licensed in anything from aromatherapy to acupuncture to massage among other things. They are truly experts in labor and labor support. Make sure you find one that meshes with your personality and your beliefs - ask lots of questions in your interviews and meetings.

11. Hypnobirthing - This is a great one! I used it more during my first labor than my second. It takes some practice and I didn't practice much before my second labor. You can buy the book, Hypnobirthing, or the whole Hypnobabies home kit (which I have heard is really much better than the Hypnobirthing book). You can also take Hypnobirthing classes. Google to see what's in your area. Basically the premise is you learn to put yourself into a deep deep deep relaxation. Some women have had completely painless births because of Hypnobirthing. When I used it I fell asleep in between contractions. It was awesome. It can also shorten your labor since you are so relaxed, it allows your body to do what it needs to do - open up and let the baby out!

12. Bradley Method - I have heard of this but I know nothing about it. So I'm not going to pretend I do! Some women love it. Look it up if you are interested. You can also take classes teaching this method as well.

The more you come prepared with and for, the more likely you are to achieve your goal of having a pain med free birth! Make sure you have lists of things to try and have discussed them with your labor team so they can help support you when you need it and may not be able to think of things yourself.

Ok... I think I've come up with everything I can think of right now. I am sure I've left things out though, so mama's if you know of more, please post in the comments!

(PS - Usually I edit and re edit my posts - with two kids I just don't have the time, so forgive me for any mistakes!)

Kingston's (home water)birth story

At around 10pm Wednesday night, January 12, I started feeling some contractions. They grew stronger as the night went on. I finally got myself to bed around 11pm, but wasn't able to fall asleep until after 1am because they were about 4-5 minutes apart and just strong enough to keep me awake. I slept until around 3am. The contractions felt stronger and closer so I decided to get out of bed and start picking up a few things and getting our room ready for the birth. The contractions slowed some so I laid back down for a little while. The contractions picked back up, so convinced that my baby would be born that day I got up again (around 4am) and went downstairs to put together the meal I had planned as our first after birth meal. The contractions slowed again.

Now, this was the opposite from when labor started with Amalie. With her I got myself up and moving and the contractions picked up. I laid down and they would slow, so I kept up and going to keep the labor progressing. So needless to say... I was a little confused :)

After more preparations and continual slowing of contractions, I went back to bed at about 6:30am and slept until 8:30am. The contractions low and behold picked back up. They were fairly intense and about 6 minutes apart but only 30 seconds long. We talked to our midwife who wanted us to come in for our scheduled prenatal that morning at 11 so she could check on me and see how things were going. So we went in.

Things had slowed again and had pretty much stopped at this point. At my appointment my midwife said I was dilated 2cm and 50% effaced at 0 station. We went and had some lunch and came home so I could try to nap.

I didn't get a nap... but things did pick up at around 8 or 9 that night. My contractions were about 6 minutes apart but getting more intense. At about 11pm they were about 4-5 minutes apart and getting to the point where I had to vocalize a little to get through them (low humming).

Now - it was kind of obvious that this was it at this point - however, I thought the night before was IT. So I waited a long time to wake Steve and a little while after that to call my midwife because I was still waiting for labor to "stall" again.

By 1am it was getting pretty intense and I needed Steve to put pressure on my back. We decided to call my parents to come pick up Amalie and called my midwife. Daddy put Amalie in the car and told her she was going "night night" with Grandma and Grandpa. She nodded and gave him a kiss. So sweet.

At this point the contractions were really intense. I hummed and vocalized through them and Steve put pressure on my back. Shortly before my midwife arrived I put on some music to try to sing and distract myself. I had seen a beautiful birth video of a woman singing through contractions so I decided to try it. I was able to sing through each contraction so well that Steve couldn't even tell when I was having one. It was really so awesome! It was so nice to be able to focus on doing something I love and take the focus off of the pain. I felt that I was in transition at this point... I told Steve I didn't think I could do it anymore and my muscles were starting to tremble.

I'm guessing my midwife got there around 2-2:30am (I haven't seen the birth notes yet and didn't look at the clock, but it takes her about an hour/1.5 hrs. to get to my house from hers). She brought in her gear and checked me. I was already completely effaced and at 8cm, still 0 station (my water had not broken). I continued to sing as they set everything up and starting blowing up the tub and filling it. I walked around a little, kneeled over the tub and hung my arms around Steve's neck while he rubbed my back and sang softly to me (best labor/birth partner ever). I could feel my body shaking and the pain was incredibly intense.

As soon as the tub was half filled (the hot water ran out) I got in. I knew I was pretty much ready to push at this point. I waited I think one contraction and starting getting a little pushy. My midwife checked and I was fully dilated but had a anterior cervical lip. Dang it. I had a lip with Amalie too. This is NOT fun...

My midwife gave me two options - either she could hold it back and we could push past it, or I could get on my hands and knees and push past it that way. With Amalie she held it back and it actually felt better than her not holding it, so I chose for her to hold it back. OH MAN!!! That was so incredibly uncomfortable and painful. But I pushed past it pretty quickly so it didn't last too long.

The baby felt SO BIG coming down, the feeling was so huge, I was determined to get him out! I could feel his head spreading my pelvis and pushing on my tailbone. After a couple of pushes there was a gush of water and the midwives saw a gush of vernix come out as the waters broke. I pushed him out in four pushes. I was a little worried that I was pushing too fast, I did pause as he crowned but I just couldn't slow myself down. I screamed a couple of times (which surprised me) - the feeling was so much bigger than I had remembered with Amalie. But he also came out a lot faster :) (she took two hours).

Anyway.. his head was born and almost immediately his body followed. I pulled him up on my chest, but lowered him to my belly so he could stay warm in the water (half filled tub). He breathed right away, but didn't cry for about a minute. He didn't need any suctioning or anything. He was perfect! I remember talking to him as soon as he was out - I was so happy to hold him! He nursed within a few minutes while in the tub - good latch and a strong suck!

Just minutes after being born!

Kingston!

January 14 4:04am 8lbs. 4oz. and 20.75" long

The placenta was taking a little while, so the midwives had me get out of the water and onto the birthing stool. However, as soon as I stood and stepped out of the pool I could feel it coming out. I sat down and they literally caught it!

After some maneuvering the midwives helped me onto our bed. We ooh'd and aah'd over our son while my midwife checked for tears. Nothing but a teeny tiny little 1 mm tear that didn't even need a stitch! Even with pushing him out so quickly - water birth rocks! ;)

So, two things I wanted to try differently this time was to try to make the water birth work and to listen more to my body when it came to pushing. I'm happy that both worked out SO well.

It was a HARD labor and and a hard but quick birth. I wish I had called my midwife earlier so I could have spent some of transition in the tub! But everything went so great. So worth it and so amazing.

I love my son!!! He is such a sweet little guy - I felt all through the pregnancy his sweet spirit. So far he definitely has shown that. He fusses a little when he's hungry... like one cry and that's about all. He's a very content baby so far.

A few hours old...cuddled in bed...

Amalie loves him and is so far adjusting very well!

Their first meeting...Amalie was so excited!

First kiss!

I don't understand...

(I will get back to the "most controversial" topic in a bit - it's going to take me awhile to write).

I have recently been told stories by a good friend, my sister and my mother. They all involved slightly varying stories of tearing so badly in childbirth they required an hour +/- of stitching after.

This makes me really angry. At the OB's/doctors. There are ways to prevent much of the serious tearing that happens in childbirth. It takes a little effort and care by the birth attendant.

Don't OB's care??? Why don't they do anything to prevent this awful tearing (and no - prevention does not = episiotomy either!) Is it money? They can charge more for the careful stitching they do afterwards?

My heart breaks for these poor mama's. And it's just SO common (no surprise since 99% of births take place in hospitals and apparently very few doctor's care to do anything to prevent the tearing).

It's NOT a part of normal birth. Minor tearing, sure. It happens. Major tearing requiring an hour of repair? No. Not normal. At least it shouldn't be.

Tearing has nothing to do with (or very little to do with) the size of the baby. I have heard of mama's tearing from birthing their small 5lb. babies and I have heard of women birthing 12 lb. babies with NO tearing. (No joke!).

Midwives have (comparatively) VERY low rates of tearing. Many mama's don't tear at all, others require only a stitch or two. While I'm not a midwife and don't know all of the tricks of the trade, I will list some things I do know that help prevent tearing, in case any mama's want to try to help themselves if their doctor's refuse (or don't know how) to help them.

1 - If possible, labor in water for some time. This softens all of the tissues. This is probably mostly helpful during the end of labor. (Besides the fact that it provides much pain relief from contractions as well!)

2 - If at all possible, do not push lying flat on your back. This is the worst position for labor and delivery. (Yet the status quo in hospitals. Why? Easier access for your doc. Not for your good. Your doctor's). This position does not utilize gravity as well as puts additional unnecessary pressure on the perineum.

(Side note - I did end up delivering my daughter semi reclined on my back - after trying many positions, this is where I my pushing was most effective. I did have a small tear requiring 2 stitches. I will be trying other positions again this time, however, things don't always go as planned and I know that :)

3 - Probably one of the best things you can do: When you are about to deliver baby, you, your spouse, doctor, midwife, birth attendant, whoever can use an oil (arnica is a great choice, although any nutritive oil would do) to further soften your tissues, as well as gently supporting the tissues as the head emerges by applying pressure and gently easing the skin around baby's head.

Also, perineal massage/stretching during the last few weeks of pregnancy may also help prevent tearing. One of the greatest things about this practice, besides perhaps making the tissue more 'stretchy', is practicing how to relax when feeling an uncomfortable sensation (the massage/stretching does not feel good!). The more you are able to relax down there as the baby is being born, the easier, faster and less tearing there will be. If you are able to have your partner help it works best. Breathe deeply and close your eyes. Relax your jaw. Think of happy images or places and relax. Really good practice for birth.

4 - As your baby is being born, try to really control and slow your pushing. The slower baby comes, the less amount of tearing as the tissues have a chance to stretch and accommodate. Some women will pant during this stage to keep themselves from pushing too hard. Some will give a series of short pushes instead of one big push. *Hopefully* you have a birth attendant that can coach you through this part. If the tissues are looking white - slow down (if you can!). Your birth attendant can also put gentle pressure on the babies head to prevent baby from coming out to quickly.

Ok - as I said... not a trained midwife here... so this is all I can think of at the moment. I will add more to the comments if I think of more - or if anyone else has ideas or techniques - please add them to the comments as well!

Talk to whoever is attending your birth about techniques to avoid tearing. Ask about the possibility of pushing NOT on your back. Fight for what you feel you need and want. Be your own birth advocate! (or find a good midwife! no really!) ;)

blessings in birth,

S

"Which hospital are you delivering at?"

I was asked this question at our big family Christmas dinner last night. I suppose for 99% of the population this is a totally normal and expected question.

I've been asked this several times during each pregnancy. And it still catches me off guard. I've never even considered having a baby in a hospital. It's weird because in my own private little world, in my mind, birth is normal and natural. Not a medical event. The hospital is for illness and injury - not a place to have babies! My internal thoughts go something like this...

"Hospital? I'm not sick, I'm having a baby! Childbirth is normal and there is no need for a hospital. Why would I go there? I don't like hospitals. I don't want to be in a hospital bed with people I don't know wandering in and out, with needles and tubes and beeping monitors. There are germs (bad ones like MRSA) and sick people in hospitals. Ew. I want to be in my comfy home with people that I know and love. I don't want people I hardly know poking, prodding, bathing and touching my newborn, or telling me what I need to do or can't do with him. I want to snuggle in bed with him... not put him in a car and drive him there. And.... I'm having a baby. I'm not sick."

Now, I know I'm one of a very small number that thinks this way. I'm one of a very small number that chooses homebirth because I believe it's what is best for my babies as well as myself. I know hospital births are normal and expected.

So what I say out loud is usually something along the lines of..

"Oh we homebirth with a midwife. I know... we're kind of crazy..." (Not that I believe we are crazy - but I know to a majority of the population we appear that way. It kind of diffuses the conversation at that point and most people move on... unless they are truly interested, which in that case I'm happy to talk about it :)

So thankful to have the option of homebirth.

blessings,

s

Here we go...

My first "most controversial topic" ... ok. I'm just going to put it out there. It's about circumcision.

This has been a pretty routine practice in America for ...hmmm... a little less than 100 years. (Check out the history... really interesting). It's normal, right? Well.. times are a changin'! The latest reported statistics from the CDC show that 67.5% of baby boys in America are now left intact.

Before I get into all of our reasons we have decided against circumcision, let me tell you a little about our journey.

With our first baby, husband and I talked very briefly about it. We decided that if we had a boy, we would circumcise. It was "normal" to us, and we had heard things about cleanliness and health as reasons to do it. We didn't want our son to be potentially made fun of in the locker room, etc. I also thought that if God had commanded the Jews to circumcise, there had to have been some good reason, right? We found out around 18 weeks into the pregnancy that we were having a girl, so we left it at that. We didn't do any research because it was unnecessary. Our midwife asked us if we would (with no judgement) and we said that we would but we were having a girl.. making it a non point.

Once we became pregnant the second time, I decided that I (we) should begin our research early. Really delve into the facts and find out how we really would feel given the available information. I read and read and read. I shared the important stuff with husband. And I guess what they say is true... the more you know - the more you are against it. Over a couple of months time, before we found out we were having a boy, we knew we were completely, absolutely, decidedly, definitely, unquestionably never ever ever ever ever going to do it to our child.

1. After learning that there is no medical indication for it (doesn't reduce infection, little to no effect on STD's, etc.), along with the fact that no medical organization in the entire world recommends routine infant circumcision, along with the fact that it is being done less and less in our country -- With no BENEFIT (quite the OPPOSITE) to putting my brand new, perfect little baby through pain of surgery - cutting a part off of his perfectly formed little body, I just couldn't imagine, couldn't fathom!, putting my baby through it. With all of the statistics showing no benefit, many insurance companies have deemed it what it really is (and therefore many companies no longer cover it) - an elective cosmetic surgery.
   
   
2. In addition to there being no medical benefit to circumcision, there are many risks involved, as there is with any surgery. Hemorrhage, infection and death are some immediate risks; there can also be ongoing and permanent complications. Death from circumcision may be one of the most common causes of death in babies, sadly it often goes unreported or is covered up. (Edited to add: It's estimated that as many boys die from infant circumcision as SIDS every year... SIDS is not always preventable - that we are yet aware of - but circumcision deaths are 100% preventable).
   
   Ugh... this topic is so big and I have so much to say about what I have learned, it's really overwhelming to write this....
   
   
3. The basics of the procedure: The prepuce (foreskin) of the penis is fused to the glans (head of the penis) at birth, much like your fingernail is fused to your finger. The skin eventually releases when the boy is older, 50% don't until 10 years old or later. In order to perform the circumcision, the skin must be torn apart. Forget the cutting - this has GOT to be the most painful part of the procedure (especially considering the millions of nerve endings in this sensitive part of the body!). This is something I didn't know about until researching. There are different ways of completing the circumcision once the skin has been torn apart, I won't go into that, but you can google the procedures if you like. I'm sure they are likely equally painful (although we'll never really know since our babies are too little to communicate). And remember, little to no anesthesia is used as it is too dangerous to use with a baby.
   
   
4. I have heard so many times - "do it when they are little so they won't remember the pain." Whether this is true or not (that they don't remember pain)... I just don't understand how this makes it okay?? They are brand new and have experienced little to no pain in their short lives. Some reports even say that their nervous systems are HYPER aware in the beginning. To me, the fact that they can't tell you it hurts and you can't give them any pain relievers makes the whole thing so much more awful! Poor babies...
   
   
5. "It's cleaner and / or easier to care for": Before the foreskin retracts on it's own, there is nothing different to be done. You never never never forcibly retract a foreskin. Only clean what is seen. This requires no more effort - and definitely less than a newly circumcised penis. (Check out FAQ's about care). Once the foreskin retracts, the parent shows the boy how to pull it up in the shower and let the water run over it. This is maybe different in mechanics, but little girls need to know how to clean themselves as well. And if a we are cutting little boys to be "cleaner" we should cut little girls labia off too - it would be cleaner! And they would be less prone to UTI's (girls are much more prone to infections than boys). We would never fathom cutting our little girls in the name of cleanliness. Or removing their mammary glands so they might avoid cancer in the future. Our boys deserve the same respect.
   
   
6. "We want him to look like daddy" - First of all, if daddy had a missing arm, you wouldn't cut off your baby's arm so he "looked like daddy" would you? Of course not! I have never heard of any men/boys comparing genitals with their father/sons. As women, we don't compare breasts or labia with our daughters. Yes, it is a possibility (maybe even an eventuality) that our uncircumcised boy will ask why he looks different. We will explain to him, just as we would if daddy had a missing arm (age appropriately of course). The same would go for brothers (if one were intact and the other was not). If my mom had a mastectomy, I would probably have asked about that, but never wished my breast away so I could look like her.
   
   
7. As far as biblical circumcision - it was a much different procedure than what is done today.
   
   
   "It's true circumcision was a sign of the covenant God made with Abraham, but today's procedure is not the same procedure! In Abraham's day only enough of the foreskin was removed to expose the tip of the glans (or, the 'head'). The Maccabees, during their famous revolt against the Greek domination of the Jews, changed it to the procedure known today and forced it on all Jewish men on pain of death. In the New Testament, the Apostles announced (Acts chapter fifteen) that the ordinances of the Law of Moses were no longer required."
   http://www.noharmm.org/huswife.htm
   
   
   It was a blood sacrifice. There was a little nick to the boys penis and a drop of blood was taken. That was it. Anything more and boys of that day probably would have been dying left and right from blood loss and infection. The reason why it is unnecessary for us to do this now as a Christian is the same reason we don't sacrifice lambs as burnt offerings, etc. - Jesus was the final and ultimate sacrifice. We are no longer under the law, we are under the blood of Christ.
   
   
   
   

Ok - this is getting long, so I'm just going to post some links regarding some other things and let you do the research if you feel led.

The prepuce/foreskin has a purpose! It's not just a useless piece of skin.

Christianity and Circumcision - Check out this and this and this.

Are you Informed? Short article and lots of good resources (books, websites and articles)

50 Reasons to Leave it Alone

**For mature audiences only** - entertaining and informative, but terrible language and graphic video - Penn and Teller Bullsh!t on Circumcision (Hubs and I watched this together - partially covering our eyes. Great overview on the topic if you aren't into reading).

If he chooses, my son will be able to make the decision himself someday whether he wants to remain intact or become circumcised. Until he makes that (fully informed) decision and knowingly consents to the surgery, I will not be cutting anything (unnecessarily) off of his body. It's his body and his choice, not one for me to make.

Circumcision goes against every mama bear instinct in me. I want to protect my child. To keep them whole. Unhurt. As perfect as the Lord created them to be within my womb. Some things are obviously out of my control - but circumcision is not. The prepuce has a purpose, God created it and I'll leave my son just as he was made. Whole.

Respectfully,

S

PS - I know many mom's that have made the decision to circumcise their son(s) (**I have no judgement!**) My best friend did and has since learned more about it and has decided, like many other women, that they no longer agree with it. While this must be a really difficult realization, we have to also realize that we do the best we can with the information we have. This is one reason I wanted to write this - to get information out there that is rarely if ever talked about. Whether or not you see circumcision as a "mistake" - we will all make some mistakes in parenting. None of us are perfect, nor will we ever be. We have to allow ourselves grace and room to grow and learn and become better people and better parents.

"I did then what I knew how to do. Now that I know better, I do better." - Maya Angelou

(If you click on some of the links, you will see the same blog over and over many times. This woman has a wealth of knowledge and has done years of research. She lists sources and I personally think she has provided a great resource for inquiring parents. Of course this information is available elsewhere - I just have found her very honest, readable and well cited.)

Two of Our Most Controversial Parenting Decisions

In the next several blogs (because there is no way I can fit it all into one!) I will be writing about two of what I consider to be our most controversial parenting decisions. I have been hesitating writing about either subject not just because they are controversial, but because there is a lot of hard information that I have encountered. This hard information is not always easy to take and I hate hurting or offending people. However, each subject has become very dear to me and is too important to not write about.

It's not necessarily my wish for everyone to agree with me, or to come to agree with my way of thinking. What I do wish is that people would become informed on these subjects, do their own research, and come to their own decisions and conclusions based on that research and not on hearsay, what doctor's have told you, what you grew up with, or what your family and friends do or tell you to do.

We all (well, hopefully most of us) do what we do because it's what we think is best. For ourselves. For our children. I believe when it comes to our children we have the responsibility to make each decision carefully. And with so many tools and information at our fingertips - (yes, there is a lot of misinformation on the internet, but us "thinking" individuals should be able to recognize "good" sources from "bad" and weed through the misinformation to find the good stuff!) - we have no excuse for not being informed!

Bare with me through these next few blogs. If you don't agree with me, just know that I have no judgement for those around me who live differently than I do and make different decisions than I do. I only hope to have the same respect back.

love,

s

Midwives

I wanted to write a little blog on midwives and the expertise, training and experience they have to offer.

I have heard SO many times from mama's "if I would have had a homebirth/midwife, I and/or my baby would have died!"

This statement just kills me. It is usually said by those who are just not really informed on exactly how trained and skilled midwives are. (Disclaimer: Yes, I know there are bad midwives out there - but there are also bad doctors). It is also usually said by a mama who has experienced obstetrical interventions during labor. Statistics will show that one intervention many times leads to another. Whereas if you leave birth alone, it is much less "dangerous" and usually requires no (or very little) intervention.

Midwives, specifically homebirth midwives, lay midwives, direct entry midwives, etc. really only work with women with normal, low-risk pregnancies (the same can be said about CNM's, but as they usually work in hospitals there is more leeway there).

An OB will use medical "tools" to diagnose a high-risk pregnancy (ultrasound, namely). Midwives use their own tools to come to the same (sometimes even more accurate!) conclusion.

Measuring fundal height is one tool used by midwives for checking on babies growth as well as fluid levels.

Palpating the uterus will tell midwives many things, such as the babies position (checking for breech).

Midwives use dopplers and fetoscopes to listen to the heartbeat as well as placental sounds.

Midwives routinely check pH, protein, etc in mama's urine. They also run blood tests multiple times throughout pregnancy, as well as check pulse and blood pressure at every visit.

These are just a few of the "tools" that midwives use to monitor the health of mamas and babies. If at any time they are unsure of something, if mama is showing signs that something isn't quite right, they will immediately refer her to an OB. If everything checks up as normal, they can continue care with the midwife. However, if there is something not right, they would transfer care to the OB.

Many/most midwives have EXCELLENT records for outcomes as far as maternal mortality, fetal mortality, as well as transfer to hospitals, c-section etc. They do not take risks - the mama and baby's health are of the utmost importance to the midwife. They know and understand their abilities as well as their limitations (such as - they cannot perform a c-section).

This is true for the prenatal period as well as during labor and birth. Midwives are highly skilled and trained to recognize all complications of labor and birth. And again, they don't take risks, they will transfer to hospitals at the earliest signs, not waiting for things to get too far.

Midwives usually carry oxygen as well as some drugs (such as pitocin) to their births. I had oxygen during my labor toward the end when I was running out of energy. I also had some excessive bleeding after the birth. My midwife gave me a shot of pitocin in the leg to help my uterus to clamp down quicker, slowing the bleeding down quickly.

They are also trained in infant resuscitation and carry tools for that as well.

Midwives are highly trained in normal pregnancy and birth. More so than OB's, who are trained in pathology and surgery.

Homebirth is not for everyone, and not even everyone who wants one can have one (if they "risk out"). However, for those women who have normal pregnancies it is just as safe - if not SAFER than a hospital birth. (Statistics support this statement, unfortunately those who oppose homebirth report statistics that include unintentional homebirths, including those on the way to the hospital, etc. that are not attended by a skilled midwife).

My midwife has delivered over 1,000 babies and has an excellent record of success in all realms. She is truly an expert on birth!

love,

s

Pregnant or hope to be someday?

If you are pregnant now or hope to be someday, no matter what kind of birth you want or plan to have, I really strongly recommend picking up a copy and reading Ina May's Guide to Childbirth. Even after doing tons of research with my first, and actually experiencing childbirth, I'm still learning SO MUCH! It is really wonderfully written, easy to read and engaging.

I think it's so important for every woman to read this book. I found it at my library.

Midwife and author Ina May Gaskin is truly an expert in pregnancy and childbirth. The insight she has to offer is so invaluable. If you only read one book during your pregnancy, choose this one!

Birth and the Two Models of Care

Whether you choose an OB or a midwife to provide your pregnancy, birth and postpartum care, there is something that will influence the outcome of your experience more than anything. This is whether your provider practices under the medical model of care or the midwifery model of care.

It seems like it would be pretty cut and dry - OB's practice the medical and Midwives practice the midwifery. Right?

While the vast majority of the time this might be true, there are still plenty of exceptions.

The two models of care by definition:

The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

http://cfmidwifery.org/mmoc/define.aspx

I couldn't find a definition of the medical model of care, but I found this table making some comparisons of the two models:

Midwives Model of Care Medical Model of Care Definition: Definition: • Birth is a social event, a normal part of a woman's life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event. • Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient. Definition: Definition: • Home or other familiar surroundings. • Informal system of care. • Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care Definition: Definition: • See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven • Trained to focus on the medical aspects of birth • "Professional" care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome

http://www.morningstarbirth.com/index.cfm?event=pageview&contentPieceID=3225

M(idwives in) D(isguise)

Some OB's, even while working in the hospital, do work under the assumptions of the midwifery model of care. One indicator would be their percentages of interventions (induction, c-section, vacuum, forceps, episiotomies, etc). Low percentages of interventions would indicate they may work under the midwifery philosophy, using interventions only when REALLY necessary.

MEDwives

In contrast, some midwives who work in hospitals work under the medical model of care. They usually work closely with an OB. Their purpose is more as an attraction to women who want a midwife but still opt for a hospital birth. The care is similar to that of an OB.

The "title" your caregiver possesses does not necessarily dictate the kind of care you will get or the kind of birth you will have. It is important to find a caregiver whose birth philosophy matches your own if at all possible. Yes, we all want healthy babies in the end. But our experiences in childbirth, our hopes and desires, matter as well.

-S