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home birth

Considering home birth: part 4

What about the pain?

Whether you’re expecting your first baby or your fourth, it’s normal to feel a sense of trepidation when considering the actual birth. I remember very clearly being about seven months pregnant with my first baby and looking down at my belly that I knew would only get bigger and thinking, “this is really going to come out of me somehow?” I wouldn’t say I was in a full-on panic, but I was definitely worried.

Along with the normal maternal worrying is our cultural fear of birth, and we commonly hear expressions that lead us to believe that birth is the most painful thing that a body can experience.

Is it really, though?

I have a problem in my low back that is chronic, expected to get progressively worse as I age, and can sometimes be excruciating. I had one of these acute flare-ups a few years ago just before my daughter graduated from high school, and it was one of the most severe I’ve experienced yet. I cried at the thought of moving, going from sitting to standing, or standing to sitting. Bending down to pick up a dropped item was impossible. Getting in and then out of a car was a ten minute ordeal on each end. Pain was nearly constant, with no promise of an end, and I wasn’t getting a sweet cuddly baby out of it. As a person who normally avoids even common over the counter medications, I was willing to take any pain medications that were offered to me, so that I could begin healing. This experience was decidedly worse than giving birth by a country mile.

I’ve heard people describe other injuries that again make me question our notion that birth is the worst pain of all. My normally mild-mannered brother-in-law was not at all mild-mannered when his shoulder dislocated. The re-location procedure was probably a ten on the ubiquitous pain scale, given the colorful language that ensued during the event. Other medical and dental complications can be incredibly painful, and again, with an uncertain end, with the only reward in the end being going back to normal. A good imagination and a lengthy reading list that includes descriptions of war and violence, could lead any thoughtful person to see that the human body can and regularly does experience much more painful events than normal vaginal birth.

Is pain necessarily a bad thing?

If a friend were to tell you than she is training to run a marathon, you would not likely respond that she shouldn’t try to do it. She will probably experience some pain pushing herself to run farther than maybe she’s gone before. She may become injured training, or during the event, and she will probably be pretty tired after the race. Just the simple fact that she may experience some pain and discomfort would not be a reason to try to dissuade her from her desire to take on a big challenge.

Pain in our bodies is a message:

  • Take your hand out of the fire!
  • Get your shoulder back in its socket!
  • Your teeth need some expert care!
  • Good for you for exercising some unused muscles!
  • Take it easy so your muscles don’t get injured!

After many years of supporting women in pregnancy and birth, it seems true that the pain in their bodies is messages to them. Round ligament spasms, low back pain, and headaches remind us to stretch and exercise, be careful of how much and the manner in which we lift heavy items, and to stay nourished and hydrated. In labor, too, bodies speak and instincts listen. Contractions may make a woman get on her hands and knees and sway during them, which is brilliant for helping the body to open and the baby to descend. The myriad of sensations experienced during birth can help a woman to discern how far along she is in the process. And, sometimes her pain can signal that something is wrong and needs medical attention.

There is so much information in the world right now about the “right” way to be pregnant and give birth, and there’s a lot of moralizing around women’s choices. And, I must admit, at one time I felt pretty militant about un-medicated childbirth, and I was on a crusade of sorts to “save” women from pain medication. The truth of the matter is that on the scale of “Painless Orgasmic Birth” to “Birth Is The Worst Pain Imaginable,” most women’s experiences are somewhere solidly between the two extremes. (By the way, I support Debra Pascali-Bonaro’s work, appreciate her joyful spirit, and think she has a lot of good things to say). So, while I think that planning for a pain medication-free birth is reasonable, and have seen many women birth without pain medications, it’s also reasonable to consider that a positive outcome can be the result of a medicated birth.

In my experience, an un-medicated birth is more likely achieved with some preparation ahead of time. Preparation could include: childbirth classes, engaging the services of a doula, doing some soul searching, keeping yourself healthy, fit and hydrated, and being willing to accept the uncertainty of the process.

Taking a childbirth class, focused on natural birth is a great asset to a family expecting their first baby. It’s great to be in a group with other expectant parents, to hear their questions, and to begin to cultivate community. If you can’t find a local childbirth class, then do read all that you can, and your partner should, too, so that you are both on the same page regarding options and understanding what the process might look like. I still really like The Birth Partner by Penny Simkin. If your partner is only willing to read one book, make it this one.

A doula is a support person who is hired separately from your midwife to provide information and physical and emotional support during labor and birth. There is good evidence supporting the work of a doula, especially if your goal is to have an un-medicated birth with few interventions, and even if you are planning a home birth with a midwife. It is an additional expense, but I’ve not known a person to regret having this helpful and knowledgeable person available at their birth. There are many certifying organizations; take a look and see if any fits your personal philosophy and then see if there is a doula certified in that method in your local area. (Please note: the links provided are not an exhaustive list, only a starting place. I am not affiliated in any way with any of the linked organizations, and this is not necessarily an endorsement of their programs.)

Home birth is not for everyone; a bit of soul searching and understanding yourself might help you to decide if this is the right choice for you. How do you experience pain and sickness? Childbirth isn’t an illness, and it may not be the worst pain you can imagine, but you will likely experience some pain. Even women who describe their births as easy say that they felt pain. Do you have a good support system? Will you be able to relax in your home? Have you experienced past trauma, sexual assault, or abuse that may make pregnancy and childbirth additionally challenging? These are all great topics to take up with your care provider, your partner, and any other support person you will have with you for the birth.

Much has been written about keeping yourself healthy so that you can be as low risk as possible during your pregnancy and birth. I will not expound on that topic here; suffice it to say that nourishing yourself and your baby with good food, plenty of water, fresh air, relaxation, gratitude, and play can go a long way to experiencing your birth positively.

Labor and birth are an unknown, for every woman, every time. It is not a process that is easily controlled. In attempting to control it, we may alter it and create additional problems. While a medicalized birth experience may be right for you for many reasons, it is also worth considering if you want to embrace the untamed delight that can be home birth.

 

~photo credit Fox Valley Birth and Baby

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home birth

Considering home birth: Part 3

What about the mess?

This question often comes up in a consultation with families considering home birth, and it’s definitely a legitimate concern. Birth comes accompanied by a variety of bodily fluids, and it’s reasonable to be concerned that your mattress or carpeting won’t be wrecked in the process.

The answer is pretty simple: we clean it up, and we’re pretty practiced at it. We will protect your furniture and flooring with under pads from your birth kit, we will have you supply some old towels, and you will end up with one garbage bag and one bag of kinda yucky laundry. We pre-treat and start the laundry for you before we go, so someone will just need to plunk it into the dryer later. Hydrogen peroxide is a miracle worker when it comes to getting blood out of fabric. There’s a bottle of it in your birth kit, but you may want to have more on hand. If you don’t have your own laundry machines, we can talk in your appointment about how to manage this aspect of a home birth.

Next up: pain

 

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home birth

Considering home birth: Part 2

I know no one wants to think about possible complications, and some people even believe that if we talk about complications we will somehow invite them to happen. It seems reasonable, however, to consider this topic carefully when deciding and planning on a home birth. Preparing for something doesn’t assume it will happen, but it allows us the freedom to relax and release that worry, and also for us to feel confident if something unforeseen does happen. Key concepts here are prevention, management, and transfer.

Prevention: From your first prenatal visit, your midwife is thinking about who you are, what are your particular risk factors, and are you a good candidate for a home birth. We partner with you to have a healthy pregnancy and encourage you to eat well, exercise, relax and get good sleep. While we can’t control some outcomes, even if we “do everything right,” we can lower the chances that something will go wrong in the birth if we are mindful about our self-care. (This goes for pregnancy and all of life, including for midwives!). As a partner in your own care, you can assist this process by being honest with your care provider about your health and reproductive history, your lifestyle, and the things that you feel worried or concerned about. Appointments with home birth providers are typically scheduled for 45 minutes to an hour, so you should have plenty of time to share all of your concerns. It is absolutely to your benefit to learn all you can about natural childbirth, so that you can understand the process, and anticipate a likely course of events. Many families do this by reading books; I think an ideal companion to reading is attending an in-person childbirth class that is specifically focused on preparing for un-medicated births. Ask your midwife for local recommendations.

Midwives and other practitioners who work according to the Midwives Model of Care tend to avoid unnecessary intervention, which is another facet of preventing complications. Consumer Reports has recently done a nice job of summing up some of the biggest interventions that are high risk as well as high cost for mothers and babies. In short, interventions introduce additional risk. Sometimes that risk is warranted, as in the case of a mother or baby in distress, but many times that additional risk could be avoided.

Management: Home birth providers are trained in dealing with the typical complications that could happen during birth, including handling of hemorrhage, resolution of shoulder dystocia, suturing perineal tears, and performing newborn resuscitation. Typically, midwives carry an array of supplies to assist in the management of these possible outcomes, such as anti-hemorrhagic medications, IV supplies, resuscitation equipment, and suturing supplies.

Transfer: Fully participating in prenatal care, having lab work and necessary ultrasounds performed can help to show that you continue to be a low-risk candidate, and that it is appropriate for you to plan to birth at home. Transfer of care to a higher level provider with more equipment and tools at their disposal may become necessary at any time in your pregnancy, during labor or in the postpartum. Again, your midwife is trained to continue to gather information and asses for potential risks that may be presenting. There may be something that comes up in your care that requires your midwife to consult with a hospital-based provider, or requires you to be seen by that provider. This may impact the decision to birth at home. Ultimately, everyone’s goal is to have a healthy outcome for mother and baby, so even if it has always been your dream to birth at home, a hospital birth may be the most reasonable option for you. Transfer during labor or in the immediate postpartum may also become necessary, and requires safe transport for mother and perhaps baby, if the birth has already been accomplished. Clients should consider this a possible outcome, and participate in the planning of potential transfer by identifying the closest hospital, and finding out what ambulance company serves your area.

What happens if the cord is around the baby’s neck? I really like this article about this topic. Long story short, a cord around the neck is very common, found in about 1/3 of babies. Dr. Rachel Reed has done a thorough review with thoughtful analysis of this topic. It may be that around the neck is a safe place for the cord to be, so that it doesn’t get compressed while the head is coming through the birth canal.

Hopefully, you feel reassured and confident in planning a home birth, as well as managing possible complications. Feel free to post questions in the comments.

Next: What about the mess?

~photo credit Fox Valley Birth & Baby

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home birth

Considering home birth: Part 1

When I was pregnant with my first baby, I was surrounded by family who had already had babies. I’m aware that this could be both a blessing and a curse, especially if all the family members aren’t on the same page as far as their thoughts and opinions on the options for care for mother and baby. Fortunately for me, my family and my husband’s both are full of people who can respectfully agree to disagree, and the issues that created actual tension were pretty few and far between.

An avid reader, my bedside table was stacked with six or more books at all times, and I read them all during the pregnancy. While I was setting my sights on a vaginal birth without pain medications, I definitely wanted to give birth in a hospital. There were many reasons for this, including concern about complications, a fear that perhaps I would need pain medication once the labor was an actuality and not a mental exercise, and, to be honest, a worry that my home (a rental flat) would be a biohazardous mess that would cause us to lose our security deposit.

When newly pregnant families come to me for a consultation, these are often their top three worries. Typically, one partner is more convinced of the idea of a birth in an out of hospital setting, and the other partner thinks perhaps s/he is in an alternate universe because, doesn’t everyone just go to the hospital to have their babies? I will take up these three common concerns in a series of upcoming blog posts. Stay tuned for information about what if something goes wrong.

~photo credit Fox Valley Birth & Baby

about me

An Anniversary

I meandered over to my LinkedIn account the other day, and found messages in my inbox congratulating me on my work anniversary. After briefly wondering just what anniversary LinkedIn was marking, I realized that I filed the first of my legal paperwork for my solo practice on April 13, 2017. It is indeed an anniversary.

Milestones tend to prompt some introspection, an inventory of the perhaps non-tangible ground that’s been covered. So, I’m taking stock of all that has transpired over the last year and more on my journey to solo practice.

I was part of a local partnership practice since 2009 that is very busy. Prior to starting that business in 2009, I was a student midwife for about a year and a half. I’ve been mostly on call, tethered to my phone, with my brain always imagining the scenario in which I have to leave any given situation in order to quickly get to a birth, for 10 years. It is always a joy, honor and privilege to attend a birth. I still feel excited to get the labor calls; and I take enormous joy in traveling to your homes, often under the secret cover of the night, to quietly help you to welcome your little ones into your homes and families.

But, for real, 10 years is a long time to live an on-call lifestyle. And, truth be told, I haven’t been so diligent about my own self-care. For years, I have run on coffee and random snacks, little sleep and not enough exercise, and more M&Ms than I should probably admit to. Though I love whole foods and no one has to coerce me to eat my vegetables, I was often too tired to prepare healthy food and relied on not-so-healthy restaurant fare. In 2016, I was diagnosed with Hashimoto’s thyroiditis, plus adrenal stress. Of course I was.

The diagnoses prompted me to start cleaning up my act and attempt to manage the symptoms of overwhelming fatigue, body aches and pains, disrupted sleep, disrupted periods, depression and anxiety. Then in September of 2016, just a month after my diagnosis, my mother unexpectedly died. At the ages of 23, 20, 19, and 14, my kids lost their sole remaining grandparent; my husband’s mother had died just a little over a year prior. Everyone grieves in their own ways, and their stories are not mine to tell; suffice it to say, I felt throughout that autumn that my family and my life really were coming quite undone.

I knew that I couldn’t keep up the pace I was going, or the pressure of a busy practice with an unrelenting overhead, all while trying to heal my body, grieve, and be there for my kids and husband. My business partner and I began discussions about me selling my share of the practice, and I began preparing for a smaller, slower paced practice. That was all finalized on June 30, 2017.

Pregnancy, labor and birth have always been powerful metaphors for my life. It’s been 26 years since I was pregnant with my first born, but the giddy, excited feeling knowing that a whole little person is forming and going to be born is unforgettable. It was similar imagining a solo practice–purchasing new equipment, designing the logo, creating my own procedures, and reveling in all the spreadsheets. (I REALLY dig spreadsheets.)

But nothing is all giddy excitement. (Did your parents say, “It’s all fun and games until someone gets hurt,” when you were growing up? That was a favorite of my dad’s, addressing a general air of chaos brought on by a household of six kids.) A new thing also brings worries, doubts, queasy stomachs, and a whole lot of hard work. I’ve had to self-talk some of the things I say to laboring clients in the middle of the night.

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“Just breathe”

“Take it one step at a time”

“You can do this”

“You are doing this”

“It will be so worth it in the end”

And you know what? It is worth it. A year on, I am delighted by

  • office mates who are filled with laughter and joy
  • a leisurely drive into the country to get to my office (it’s really not that far away, I promise!)
  • the opportunity to walk at the state park on my way to or from work
  • a slower paced practice, with time to soak all of you in, and hear your stories, and hold space for you and your babies
  • an opportunity to continue to support Heather on her way to becoming a midwife
  • a new assistant, Hanna, who is intelligent and excited and dedicated to the work
  • Arvigo® work being integral in my care
  • the opportunity to participate as part of the teaching team for two Arvigo® workshops since January
  • repeat clients who have followed me to the new place, whose kind words of encouragement and appreciation have meant more to me that you can possibly know
  • new clients–for home births, Arvigo® Therapy, and lactation consults–welcome! I am grateful for your business

The storms of life come and go. Labor lasts for sometimes seemingly endless hours. Eventually, we are delivered. Delivered into new time and space, a new sense of being, a new opportunity, a new soul to nurture and love. The stormy experience gets integrated into our beings, teaches us lessons that we can return to time and again, and helps us to create something beautiful in the present.

May it be so.

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Arvigo, events, Self-Care

Arvigo® PechaKucha

That’s quite a title, isn’t it? Almost like a foreign language. Lucky for you, I’m a pretty good explainer.

My son’s very awesome public school has an annual fundraising event called Pecha Kucha. This is a simple, brief presentation style that originated in Tokyo in 2003, that helps folks to start having community conversations about great ideas. Each speaker presents a power point, 20 slides, with 20 seconds to talk about each slide. The slides advance automatically while you’re speaking. Let me tell you, as a speaker, you really have to figure out how to make your point concisely. It was a lovely challenge.

I tend to shake like a leaf in a windstorm when I’m speaking publicly, even though I’m not afraid to speak, and I usually say yes to these types of opportunities. I was grateful for the structure of the talk, and the solidness of the podium to hold on to as I was speaking.

Of course, my topic was Arvigo® Therapy. I can’t talk about it enough–I think it’s such a great tool that can help so many people. If you want a general overview, and you have 6 minutes and 40 seconds, you can view my recorded presentation here.  As I write this, it is April 16th, and we’ve had two solid days of an intense blizzard named Evelyn. Everything is closed down, and roads are impassable. It’s a great day to watch some of the other Pecha Kucha presentations from all over the world about so many topics. Learning all the time, but especially during blizzards.

Stay safe and warm, Midwesterners! The rest of you from balmy climates are so jealous that I live in a veritable snow globe, I just know it. This photo was taken yesterday, before ice started raining from the sky and an additional ten inches of snow fell. Totally jelly, aren’t you?

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Blizzard Evelyn 2018

 

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events

Upcoming Events

My introverted self is going to be out and about in public in March. I hope that spring will grace us with her presence for those events, because I’d mostly like to stick around home with a warm cuppa and some knitting if it’s terribly winter-y. Anyway, if I’m overcoming my introverted nature and the weather, I hope you’ll come out to meet me. It’s always great to see some warm and friendly faces at events. I really value our local community and the cool events that folks put on, and look forward to being involved in more things in the future.

First up, I will be doing a brief three minute and forty second PechaKucha presentation at this event, hosted by my youngest son’s very awesome school. I’ve chosen to talk about Arvigo® Supported Pregnancy, since it’s a thing I want lots more people to know about. I’m working out how to include the howler monkeys I encountered in Belize into the presentation, because, well, monkeys, people. They were so cool. If you can’t or won’t click through to the Facebook event, PechaKucha is on Tuesday, March 6, at 6:30 p.m. at The Fox Club, located within the Wisconsin Timber Rattler’s Stadium. The event is free and open to the public, with appetizers and a cash bar. Maybe it would be a fun date night for you and your sweetie?

Secondly, I will have a table at The Belly to Baby Expo, put on by Green Bay Doulas on Saturday, March 24th from 12:00 to 3:30 pm at The Meadows in Green Bay. I’ll have some cools mugs for sale, definitely some dark chocolate to giveaway, and I’m happy to chat with you about breastfeeding, home birth, Arvigo®, pregnancy, etc. I never pass up an opportunity to snuggle a baby, either, if you’re willing to share a squishy little person for a bit. The event has it’s own website (linked above), plus a Facebook page, plus a Facebook event. Stop by and say, hi!

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breastfeeding

Lactation Support

When I was pregnant for the first time, I planned to breastfeed my baby. Though I’d never really witnessed anyone nursing a baby, I assumed that it was just the most natural thing in the world, and that my baby and I would just instinctively know what to do.

Was I ever in for a surprise! I gave birth at a hospital, and the lactation support there was less than ideal. My baby was given bottles of sugar water and a pacifier, and by the time I was discharged three days after his birth, he’d really only had one decent feeding. That one feeding was roughly facilitated by a grouchy older nurse, who essentially mashed my breast in one hand, and shoved my baby’s head onto it with the other. Somehow, though, that worked, and my baby fed contentedly. I was completely uncertain how I would ever replicate that event, given that I would be missing the two extra arms required to make it happen.

To this day, I remember clearly being discharged from the hospital and thinking frantically, “What makes them think I can take care of this baby all by myself?!?” I didn’t know really anyone who had breastfed a baby, there was little support in the area where I lived at the time, and though my husband was supportive, he was also pretty inexperienced, and much to my dismay, was rather unable to produce milk. Feeding my baby–keeping him alive–was all on me. Cue postpartum hormone swings, an abundant increase in production of milk, and a less than ideal latch from my sleepy, small, and kind of early baby, and I was a bit of a mess in short order.

Friend, if you are struggling with breastfeeding, have gotten less than ideal help and advice, I’ve been there! And now, I’m here to help you. I attended many years of La Leche League meetings, soaking up all the mother-to-mother wisdom there, and making friends that have lasted a lifetime. As I began developing as a childbirth professional, I moved beyond the mother-to-mother model. In 2016, after a ninety hour didactic course, and documenting over 1000 hours of professional support of breastfeeding mothers, I passed my examination to become an International Board Certified Lactation Consultant. As the name implies, it is an internationally recognized certification to provide professional support to nursing pairs, and it is the gold standard of lactation certification designations.

Your initial meeting with me includes a detailed review of the issues you are experiencing with breastfeeding, as well as a general overview of your birthing experience. Then we work out a plan for you and your nursling, which may include follow-up visits for weight checks and assessment of the plan. I can typically get you in for an office visit within one business day from the time you call, and for a home visit within two business days of your call. I can evaluate your little one for tongue tie, and I have a referral network, if needed, for the revision of ties and follow-up care.

What are you waiting for? Call the midwife!

P.S. That first baby I referenced above? I managed to keep him fed well enough as an infant, and I’m grateful that he’s a confident, competent, compassionate young adult who manages to feed himself these days. Oh, and he breastfed until he was two and a half years old, no grouchy nurse required.

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about me

An invitation

It’s a lovely fertile June morning, and I would love to invite you to my deck for a cup of tea and a chat. I’m excited to hear your story, and to share some things I’ve learned with you as well. I’ve worked in the birth professions since 1997 as a doula and childbirth educator, and now as a midwife, Arvigo® practitioner, and an International Board Certified Lactation Consultant. I’ve raised four children of my own, so I have the perspective and experience that goes beyond academic training. I have a heart for new families and all that fertility, pregnancy, birth and parenting entails. Please share your stories in the comments, and I hope you will find some things here to learn, value, and take comfort in.