What Happened to the Contractions

It happens frequently, contractions are strong and regular. You are coping with them well but you know if you are going to make it to the hospital, you need to leave now. You get in the car, the excitement building and begin your journey to your new life. Your life with a new baby.


You arrive at the hospital, you are questioned, examined, asked to sign a stack of papers, put on monitors and finally settled nicely into your bed to labor. But oddly enough your contractions have spaced out and not as intense. What happened to the contractions. The contractions that you were so excited to be having. The contractions that were going to bring your baby.
This is an all to common scenario. How it is handled can be the difference between a natural birth and a c-section.


Let's address first what happened.  Oxytocin is the  hormone released by the brain to cause contractions. The more oxytocin, the more contractions which will eventually bring baby to delivery. Oxytocin has some natural inhibitors-stress, observation, cold, speech, and bright lights. Michel Odent has taught this concept for years and has written several books on the subject. So when one arrives at the hospital with all the excitement, questions, bright lights, people talking and having to think and making decisions, the oxytocin level can drop drastically. When the oxytocin drops, contractions slow or even stop. Usually in time, if the stressors are removed, the oxytocin returns and labor will intensify. This may take a few hours or days.


I recently attended a hospital birth and got to see this event first hand. It was very dramatic. Contractions had been strong and 3 minutes apart. Everything slowed to the point that the mom was working diligently just to keep contractions going. After 10 hours of latent labor with no change, the wonderful OB we were working with suggested everyone go home. Once back home, contractions picked back up and once back at the hospital, labor was advanced enough that all the distractions were ignored and this mom reached complete.


The next slow down happened during pushing. The mom had been laboring in the tub, the lights were low, there was no talking, the water was warm and she gently moved her baby down behind a bulging bag of waters. She had to be moved to the bed for delivery, all the staff comes in for the big event, the lights are turned on so the scene can be visualized. Legs are spread, perineum is exposed and all stand expectantly waiting for the big event. This mom pushed her babies head out as instructed and then contractions stalled again. Of course this created quite a panic. The OB even commented that the one contraction that was bringing the body just quit. Go with me just for a moment  What would happen if you were in the middle of lovemaking ( the other time in our life when we produce a lot of oxytocin) and six strangers walked in to your room and started observing you and cheering you on? 

All ended well, but it was a  great illustration reminding me of how important it is to be vigilant in our preparation of the environment we invite women to give birth in.


As a guardian of the natural process of birth, I want to always  honor and respect the God's design  and not interfere in such a way that will inhibit labor or birth.

Midwife Documentary

http://vimeo.com/71202401

This trailer reveals  the most important issue women face today in regards to birth. 

Birth is a woman's right.

She should be able to decide:

• where she gives birth
• with whom she gives birth or alone
• if she wants to allow her body to go into labor naturally
• if she wants to have a VBAC at home, a birth center or a hospital
•  if she wants to have her 7th baby at a birth center ( currently this is forbidden)
• if she wants to have any testing done on her or her baby

This list could go on and I'm sure everyone has their pet cause. The bottom line is that women should be allowed to make these decisions for themselves and their families.

Murder...Really??

http://www.foxcarolina.com/story/21820796/police-unlicensed-midwife-charged-with-murder-of-unborn-child

This story was published with very few details of what actually happened. It is unfortunate because in our society she has already been convicted of the crime of murder simply because she is a midwife attending births out of the hospital.

Let's look at what we know. She is a woman. She practices midwifery. She is unlicensed. She attended a labor where a baby died. She has been charge with the crime of murder.

What don't we know? How long has she practiced midwifery? Why is she not licensed (wait I know that one...the state of NC doesn't have a licensing procedure even though it has been asked for by members of the state for YEARS) Would this baby have died if the mom had been in the care of an OB? If this baby had died in the care of an OB, would they have been charged with murder? Did she do anything wrong in the management of this labor? Did she misrepresent herself to be something she is not? What are the parents opinions of the care they were given?

I don't know the answers to these questions and I am not here to defend this midwife or to judge her. I understand from someone who knew her that she was well respected in her community.

There are some things I do know. If NC had licensure, this woman would have been investigated by a board who had an understanding of what midwifery is, what is normal and what risk factors where involved. She would have met a standardized set of requirements in order to have become licensed and remained licensed. Instead she is being judged by individuals who have no understanding of birth, nature, medicine or informed choice.

What if every physician who lost a patient, was sued for murder? Ridiculous you say. Well of course it is. If every physician who lost a patient was convicted of murder, we would not be able to train physicians fast enough to keep up with demands of our health care system.  Is this because they are neglectful or unskilled? No, it is because unfortunately bad things happen to good people.

I can tell you this, midwives care for their clients, they put their client's needs ahead of their own on a regular basis. They become involved in their lives and share an incredibly intimate event with them. They are invited as guest into their home and often leave as a member of their family. They stay in touch with them sometime for years after their last delivery. They deliver their daughter's children. They often spend 15 to 20 times as much time with their clients than an OB. They miss family events, anniversary dinners and worshipping with their church family if the phone rings and it is a client in labor. Does this sound like someone who would murder a baby? Premeditated, planned, intentional neglect?? I can tell you that midwives grieve when a client calls to report a miscarriage. They are not static individuals who robotically go from client to client. They are dynamic, feeling, personally effected individuals who sacrifice their lives for their clients...and LOVE it and can't imagine doing
anything else.

Would licensing have prevented this stillbirth? Honestly, probably not. Licensure does not make good doctors, lawyers, midwives, plumber or hairstylist. There are skilled and knowledgeable people all over the world who are practice the  craft licensed or not. It is my opinion that licensing is a way for people to give their control over to the government to some how protect them. This is an impossible task. Good practitioners will be good whether big brother is watching or not. Bad practitioners will be bad whether big brother is watching or not. Having licensure give credibility to a profession although I would argue it is a false sense of credibility.

On a personal note, I grieve for this family and their lost. I hurt for the fact that they too will be persecuted because of their decision to work with a midwife. People are cruel and make unkind ignorant comments . 
I grieve for this midwife who has given so much of her life to serve others. I can't imagine how frightening  it must be for her to face the uncertainty of the future.

Let Nature Take It's Course

 James T. Breeden, MD, President of ACOG wrote the article following : 

My comments are in italics


“Let nature take its course.”
I couldn't agree more. 


"Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born. The start of natural labor is the main sign, but we’re not always patient enough to wait for it."

My personal experience also has been when we wait for labor to begin on it's own, birth is much more straightforward and effective. My clients also get tired of being pregnant and uncomfortable. As a midwife, I too sometime grow weary of waiting for God's perfect timing. 
I also find it difficult when we approach that 42 week mark, not because I don't think mom's are capable of delivering at that point, but because I know if we have a transport into the hospital, we are all going to be looked at like we have 3 heads. "nothing good happens after 40 weeks" is a popular quote at our local hospital. Although I find this statement untrue and very restrictive, I certainly understand why it is said. We as people like to be in control, allowing women to go into labor on their own shows lack of control. That can be very frightening if you are then going to be held responsible for the outcome.

 "Today, one in three babies in the US are born by cesarean—the delivery of a baby through an incision in the mother’s abdomen and uterus."


This stat is staggering! But TRUE! Let's break that down...three babies are born in your neighborhood this spring...one is going to be by C-Section.  This rate should be 10% or less. In midwifery run birth centers, the rate is 6%


"The rate of labor induction is also at an all-time high. Unfortunately, many of these births occur before the pregnancy is considered “term” at 39 weeks. These upward trends have long been a source of concern in the medical community, especially considering the increased risks to a baby who may not be fully developed at delivery."

I don't know that rate of induction at our local hospital, but informally I know my clients are under a microscope by their friends and family to be induced. They are often pressured, even before their due date at 40 weeks with statements like "when are you going in for your induction?" or "how long is your midwife going to let you go?" As if that would be my call... Our birth culture is one of fear and control. Bad things are going to happen if we don't intervene. The TRUTH: Bad things happen when we DO intervene. 


" Among cesarean deliveries, an estimated 2.5% (more than 100,000 births each year) are scheduled on a designated date by the mother and her doctor. Some women cite reasons such as a lower risk of future incontinence, better sexual functioning after childbirth, and fear of pain as motivations to schedule cesareans. Inevitably, some cesareans (and labor inductions, too) are scheduled before a pregnancy is full term, increasing the risk of negative outcomes for the newborn, including respiratory problems and time spent in the neonatal intensive care unit. The fact remains that due dates are estimates, and you can never be sure that the infant will have reached optimal maturity at the time of a scheduled delivery."

All excellent points and let's add to that the cost. 
This quote is from a study published in the  Journal of Midwifery and Women's Health www.jmwh.org

The cesarean birth rate in this cohort was 6% versus the estimated rate of 25% for similarly low-risk women in a hospital setting. Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2934 cesarean births could be expected. The Medicare facility reimbursement for an uncomplicated cesarean birth in a hospital in 2011 was $4465.49 Given the increased payments for facility services for cesarean birth compared with vaginal birth in the hospital, the lower cesarean birth rate potentially saved an additional $4,487,524. In total, one could expect a potential savings in costs for facility services of more than $30 million for these 15,574 births.

" Women should keep in mind that cesarean delivery is no walk in the park. While it’s a safe option, cesarean delivery is a major surgery and comes with a number of risks, such as placental complications in future pregnancies, problems with anesthesia, infection, and longer recovery times. Certain urgent situations—such as preeclampsia, eclampsia, multiple fetuses, fetal growth restriction, and poorly controlled diabetes—may make it necessary to deliver the baby before the onset of natural labor."

Again, totally agree. There is a time and place for everything. Good midwifery care involves transferring care to an appropriate care provider if then mom and baby are no longer low risk. Good collaborative care is essential.


"However, newly issued guidelines from ACOG remind women and ob-gyns that in uncomplicated pregnancies, a vaginal birth that occurs after the natural onset of labor is ideal."

Say it again!!! 


"Additional new ACOG guidelines reaffirm that cesareans and labor inductions should only be performed when medically-necessary. Delaying delivery until labor starts naturally may not make ob-gyns too popular with a patient who’s uncomfortable and near the end of her pregnancy, but it’s a decision that will pay dividends by giving the baby the extra time it needs to face the world. 

So hoping more and more OBGYNs latch on to this concept and support women with low risk pregnancies. 
In the meantime, this is the philosophy midwives has held to for all of history.

 We trust women, 

We trust God in His perfect design. 

We trust the TRUTH is be told with all the research being done.

Off Call

I am off call for 13 days...what does that mean?

The short version ...
...not taking 2 cars to family functions, events, or church if you think someone might go into labor
...not listening for my phone while in the shower
...not committing to every event in my life with the disclaimer "you know I will be there, unless there is a birth"
...not making dinner reservations with my wonderful husband knowing I may have to leave before the main course arrives
...not being able to ride to Greenville with Amy on days we are both there
...not going to bed at night wondering if you will get called out
...not being able to take a sleep aid or cold medicine when needed
...not taking a drive to the mountains (45 minutes away) on a beautiful fall day or to see the fresh snow fall
...starting a movie that you know you may never see the end of
...not being able to drive to Montgomery to see my daughter and her family or any place more than 45 min away without making back up plans


Lest you think I am complaining, I will stop because I think you get the point. I LOVE what I do! I can't imagine life any other way. I am well suited for this lifestyle. I get bore easily, so this keeps things fresh, exciting and especially rewarding. There is nothing that compares.

So for now, I am going to enjoy my time off call and rejoice in the opportunities it affords me. And when I am back on call, I will embrace that also.

You work with babies...ah, how sweet !

I always find this statement very interesting. Yes, I love babies. I was a preschool directoress for many years, I love children. I am fascinated by them. But, what I really like is working with women!
Women are the most complex beings God created.

• We are strong and powerful, but like to be protected. (I am going to speak in generalities. I know this is not politically correct. If you don't agree with me, it's ok. I know there are exceptions to every rule.)
• We are tough when they have to be and incredibly gentle. Women have insecurities that may have began at very young age about the oddest things--"you would have been a tall girl if you didn't have so much turned under for feet" and we believe them!
• We hear and process everything around us as if it appied to us. We are protective of our children--I have seen women beat the *snot* out of their child, but you let a neighborhood child call them a name and the claws come out.
• Women can whine about a hangnail to the point you would have thought amputation was going to be necessary, and endure difficult long labors without a peep.
• We want independence at time, but love support-emotionally and physically.
• Women are highly emotional, but try to come across as cool and collected at all time.

I love working with women! There is always a delicate dance when women are together. We are intuitive, but miss the signs at times. We put out feelers to see what is going to be helpful and thrive on feedback. It gives me no greater thrill for an expectant woman to call me and express an interest in natural birth. We walk through the pregnancy together, week by week. We get to know each other. I learn likes and dislikes. I hear of insecurities and tried to provide wise counsel. We overcome fears and inhabitions. We process news reports, scarey stories, comments from the guy at WalMart, The Baby Story, and what aunt Susie's 2nd cousin once removed had to happen to her back in 1909. Sometimes we cry together at the end of pregnancy when the pregnancy just seems too long or when someone has dealt with just one too many negative comments about how "big" they are getting.

In labor the dance continues. What is working, what isn't. What helps, what makes it worse. The baby's heart beat gives delight...to both of us. I rub backs and talk moms through contractions when that seems needed or I stay completely out of the way and facilitate normacy. When women get ready to push their baby into my welcoming hands, I trust them to know when to push and how to push. I am watchful and expect everything to go just as it is planned because we are wonderfully created to give birth.

I receive their new baby as I would a gift, with a thankful heart. I rejoice that another young woman has been empowered with the knowledge and confidence that giving birth brings. I treat that newborn with all the love and respect possible holding them gently and welcoming them to this world. I want their first experience with people to be positive. I believe we can change the world by treating other like we want to be treated... this includes babies.

I love watching women become mothers. We are tender, warm and compassionate. We have an inborn ability to be responsive to our little ones. We have the ability to provide that newborn everything he/she needs just as we did when they were growing inside of our bodies.

Women are strong, amazing beings created in the image of God.

Have I told you how much I love working with women?

Wait Upon the Lord

As many know I had the awesome privilege of catching my beautiful granddaughter, Kensley. Jennifer and her husband Corey came to stay with us when she approached 40 weeks. We all thought baby would be here any day and the anticipation of her birth was on our minds constantly. Jennifer took all my advice to not be too consumed with a due date, after all most women when left alone, deliver around 41 weeks. She took walks daily, visited family, ate well, watched movies, relaxed in the hot tub and of course went shopping.

As the days wore on, tension grew, doubts crept in, fear took root and I worried. That is hard for me as a christian to admit as I am always the one who tells others that fear is of the devil and we are the trust in the Lord. One day, my Bible reading was in Psalms 27. In Verse 14, it says "wait on the Lord: be of good courage, and he shall strengthen thine heart: wait, I say, on the LORD. " The same God that David was speaking of is the same God we serve today. He still offers the same promises and gives the same comfort. That verse strengthened my heart in a difficult time. I still had anxiety, we still tried every trick known in the midwifery community to try to get labor started but in the end labor started on it's own and Jennifer's body, designed by God to work perfectly, did exactly what it needed to do to give birth naturally.

I was again tested when labor did start. Jennifer's labor was long and difficult. Watching your child suffer is heart wrenching even when you know it is the right thing to do. All the years of birth stories came back to me from my daughter as she never waivered from her goal of giving birth intervention free. Progress was very slow as she had to work hard to reposition Kensley so that she would come through the birth canal. Jennifer's strength and resolve were amazing. Again those words echoed in my mind...wait on the Lord.

Now lest anyone think I blindly sit back and do nothing in the face of crisis, let me assure you that we were constantly keeping track of warning signs that may indicate there was a problem. If there had been, action would have been taken immediately.

I am of the opinion that we go through events in our lives so that we can learn of God's mercy and grace and we can minister to others. Why is it that we have such a hard time waiting? I am beginning to believe due dates are evil and create much unnecessary stress. We all know babies do not have a calendar, they have no idea that someone came to the conclusion that gestation is 40 weeks, they don't care that the world has stopped to wait for their arrival or should they. What moms and babies do know is that there is a perfect balance and a intricate dance of hormones between them and they communicate with each other constantly. The two of them decide when is the best time to be born. The baby releases hormones that signal the mom to prepare for birth, the mom releases hormone that signal the baby's lungs to develop.

As a mom, what can you do benefit the most from this process?

1. Meditate on the Word - take a quiet time each day and read the scriptures, apply them to your life, pray for understanding
   
2. Stay active- take walks, visit with friends, go out with our husband, have fun
   
3. Trust your body
4. Surround yourself with supportive people- you are going to encounter those who are negative and create doubt in our mind, love them and accept that they don't know all the answers.
   
   As friends and family to an expectant mom, what can you do to help?
   
   
   1. Support their decisions- trust them
      
   2. Don't call and ask "have you had that baby yet?" or "aren't they going to induce you" or "you know that baby is getting too big for you to have" (I thought I would absolutely scream if I heard those phrases one more time and I wasn't even the one having the baby!!!) Calling and talking is fine, ask them about their day, how they are feeling, if there is anything you can do for them or any place they would like to go.
      
   3. Remember they are still a woman, even if they are carrying a baby within- pregnant women are very sensitive to comments. "you sure are big for x months", "your baby looks so small, are you sure he/she is growing ok?", "how much weight have you gained?"

Through this process I have learned to be more sensitive to women who are at the end of their pregnancy. I have an understanding of what it is like to field comments from well meaning friends, to wonder what the future holds, to wait and not be weary. I can encourage those moms who are struggling while at the same time informing them of their options and monitoring for anything abnormal. I feel blessed to have had this experience and know I am a better midwife because of it.

I will trust you Lord...and wait.