I even started to worry my labor was not progressing fast enough while my midwives were here.  Stephanie was so calm and told me, ‘You don’t worry about us.  We are here for you.  Count this as a blessing that your body is easing you into labor instead of going full force.’

Stephanie was able to get a nap in on the couch and Crystal caught up on some paperwork.  About 8 or 9 AM, 7 or 8 hours into my “peaceful labor” I decided to send Stephanie and Crystal home.   I remember Stephanie telling me in some similar words, “I am right down the road.  If I get down the street and you call me to come back I will whip right around and be right where you need me to be.  This birth is about you and no one else.  Pamper yourself.”  She is just amazing.

Pamper myself!  Ok, I am going to pamper myself!  I ate and drank when I wanted.  In between contractions I even put my makeup on and curled my hair!!  One birth story I had read was of a mom who blow dried and curled up her hair before labor had started!   Her husband thought it was funny that she’d be blow drying her hair at some odd hour, but in the end she was so happy she did because her hair looked nice in all her birth pictures!   Ha!  I thought this was the best idea ever.  Whether I had pictures or not I am going to do my hair!!

At that point I figured I had better rest.  Labor position of choice was still lying on my side.  I continued to sleep.  I ate and drank when I felt comfortable to do so.  I did not like walking around though.  If I was up it wasn’t for long.  It was easier at that point to lie down.

It was about 3 or 4 hours later, 12PM-1PM, 12 hours of peaceful labor when I started to get more uncomfortable. I couldn’t lie down anymore, and wanted to take a bath.  I started my bath and pinned up my hair not knowing this was going to be my final destination ‘til Anela was born. I remember telling Will in between contractions something to the effect of, “They’re getting stronger…..wooo wooo….call Stephanie.”

I believe she came around 2:00 or 3:00 in the afternoon.  My back was to her as I faced the wall in my tub.  She gently squeezed my shoulders and calmly said, “Hi.”  I cried.  I was getting to a point in my labor where I thought to myself, “Uh oh, I don’t think I can do this!”   I remember asking her to please check the baby.  I hadn’t been feeling any movement during these stronger contractions.  She put the waterproof Doppler in the tub and we both listened to Anela’s strong heartbeat.  “She’s beautiful.  She’s doing great and you are too” …and I cried!  After I composed myself I told Stephanie, “I listened to you and pampered myself!  You can’t tell now but I actually curled my hair and put makeup on!”

After some chuckles later, contractions were getting closer together and stronger.  This was my first time I experienced back labor!  When people ask, ‘How’d you get through the pain?  I say the only pain or real discomfort I went through was the damn back pain!   So, we tried lying all the way down in the tub which wasn’t working.  We tried hands and knees in the picture below which only lasted one contraction.  I was surprised how uncomfortable that was!  The only good position was propped up and sitting with a bunch of towels behind my back.

As labor went on, Crystal would give me water from a cup and bendy straw.  Stephanie would put cold towels on my forehead and check the baby every hour.

The only thing that was difficult was that as big as I thought my bathtub was, being in there for 5 hours it was not nearly deep enough.  Stephanie was saying, “Maybe we should get ahold of Rose to bring a birthing pool? … But then again, I think we’re really close to having a baby!  So let’s just have a baby!”  She said this to me and all I could think was,’ No, I don’t think so.  I’m pretty sure I have to go through an excruciating 12 hours of these contractions before she comes, right?!’

Some contractions were long and hard.  Some were back to back, and some gave me pretty good breaks in between.  I am so grateful that my body knew exactly what it was doing.

At some point in my labor the lights went off in the bathroom which was really nice to labor in the dark.  It didn’t make a difference to Stephanie.  She was able to work around my comfort level and prepared with flashlight and all.  I remember opening my eyes after a contraction and seeing this big square light right in my face!  My husband not wanting to miss out on any action left and came back with a big huge headlamp on his forehead.  He must’ve thought since Stephanie had a flashlight, he needed one too.   Both Stephanie and Crystal just cracked up!

Soon after that, my breathing was changing during the contractions.  They were getting more difficult to concentrate through.  My body would start shaking after a big contraction   All I could do was close my eyes and let my body do what it had to do.

I remember quietly thinking, “OH boy, an epidural would be really nice about now!”  Stephanie very politely mentioned something to the extent of, “I think you’re fighting pushing the way you’re breathing.  Try to see if pushing a little takes the edge off?”  Sort of in disbelief I tried but didn’t think it could be time yet, could it?

All of a sudden, there was a very surreal, “out of body” moment where my body started “heaving” all on it’s own.  Stephanie would say, ‘Go with that, go with that.  It’s Ok.’  I was thinking to myself,’ No way, this can’t be happening so soon?  Looking up into the corner of the bathroom I said, “NO, no..”   I started to try and get out of the tub.   Even though I could feel Anela right there, I hit a fight or flight stage in my labor.  I must’ve lost my mind for a second because I thought I’m going to get out of this tub and run away from having this baby.  I’m done.

Grabbing my attention and refocusing me with firm but calming eye contact Stephanie brought me back to reality, ‘You need to push your baby out!”  Within that split second I was no longer in flight mode but back into the Fight   I remember telling Will, ‘You’d better give me your hand on this next contraction!!’

At 5:05PM, we all heard a huge POP!  Something had just shot out across the tub what I thought at the moment was my mucous plug?    Stephanie turned to Crystal, “Oh, water broke!  5:05.” She was recording it for documentation.   Smiling and continuing to assure me everything was going great, Stephanie kindly looked at me saying, “Fluid looks clear and great!  Look at all that vernix!  You are going to see your baby soon!”  This was really happening.  I was about to meet my baby.

It only took a couple of pushes later that I could reach down and feel Anela’s head crowning.  I remember thinking, “Oh no…she’s not going to fit!”

Stephanie said, ‘Push your baby!  Even if the contraction stops, keep pushing.”   I don’t think I’ve ever pushed with so much might in my life.  Once her head and shoulders were birthed at 5:15 PM her body came out like butter!

I looked down into the tub and could see Stephanie’s hands guiding her up through the water.  As soon as she came out, she came out wide awake and crying and right into my arms!

That face was a face of pure, “THANK GOD YOU ARE OUT OF ME!”  That quickly changed to “I DID IT!!  I DID IT!! MY BABY!  MY BEAUTIFUL BABY IS HERE!  SHE’S PERFECT! SHE’S JUST PERFECT!”

I’m not sure how long I sat in the tub, but it was as if time stood still.  All that mattered at that moment was me and this beautiful new baby.  We sat in the tub ‘til the cord stopped pulsing.   Will was able to cut the cord and hold Anela for the first time while Stephanie and Crystal helped me out of the tub.

It wasn’t long after ‘til my beautiful baby was back into my arms nursing in the comfort of my own bed.  All my hard work was now nothing but a memory and at that moment I felt nothing but pure joy and bliss!

Anela’s birth was amazing, empowering…intense at times…and Beautiful overall!

Thank You Stephanie and Crystal for being such a great team for this awesome experience!

Anela Taumohe Manako

8lbs. 8oz.

21 inches long

Jan. 17, 2013 at 5:15PM

While we all waited patiently for baby to make her appearance (whose gender was still unknown since we didn’t have any ultrasounds done) I got to spend time with my mom who came to help, snuggle with my 3 year old son, and enjoyed getting lots of sleep.

I knew for a very long time that my body would begin labor either around my son’s nap time or his bedtime. I was still nursing him, and every time I would lay down with him I would get contractions/braxton Hicks(pressure waves are what we call them when using hypnobabies). I was told by many people that this labor would be fast (“the second baby just pops right out”) But I really tried not to believe this, as I had a long labor with my son and I didn’t want to be let down if this was another long one. In the end Dahlia’s birth was perfect, here is her story.

Sunday December 16th, my husband went out to help a friend move, I stayed home with my son and my mother, and looked forward to spending some one on one time with my dear friend Amy later that night. My son and I played and read books all morning. Once it was time for his nap we were both definitely ready to rest. We laid down and he nursed to sleep, Just as he was nodding off I got a strong pressure wave! It was different from the ones I had been getting during the previous 2 months. I told myself, ‘nah, it can’t be it and just let it pass.’ But then I got another one even stronger which made it very uncomfortable to lay on my side, so I whispered to my son that I had to get up and fortunately he fell right asleep. I tried changing positions which helped, so I decided to rest after the next one. Resting was interrupted by constant pressure waves, so I text my Doula (and close friend, Mona) nothing more than “I think you should come over!”She called me right away and we chatted a bit before she said she was on her way. I went out to the living room and told my mom, “Mona is coming over”, she said “well tell her not to come so you can rest”. I said “Nooooo, I asked her to come over” with a big smile on my face. And Then she understood… “oooh I see”. Once Mona arrived we started tracking the pressure waves, they definitely had a pattern. I moved throughout the house, stopping during each wave. She convinced me to take a walk outside, the fresh air felt really nice! Every couple minutes I had to stop, lean on something or on Mona and just breathe through each pressure wave. I told her we should head back to the house (I’m not sure why), but once we got back something in the pressure waves changed. I can’t really describe what it was, but they were just different. I knew things were progressing. I decided to call the student midwife, who I was renting a birth Tub from to come set it up. She came within the hour and started setting up the tub. I had also been in contact with my Midwife, Stephanie, to let her know how things were going. We decided that she would start getting ready to head over soon. Before the tub was ready for me to get in, I was having a hard time trying to find a good position to be in during the pressure waves. What worked for Desmond’s birth did NOT work for this one. (I had a lot of back labor because Desmond was not in the ideal position.)

I found that leaning on my dresser or my doula worked well, also if I put one foot up on a chair it seemed to help. As the pressure waves progressed I had to focus on them more deeply. I Tried using my hypnobabies CD’s but I was more distracted by them this time, so I told Mona they weren’t helping so we turned them off. I felt an urgency for my midwife to come over so I asked (told) Mona to call Stephanie back to tell her I wanted her to come right away (she was already heading out the door). She arrived as I was working through some pressure waves in the bathroom area, she waited ever so patiently for my pressure wave to pass before saying Hi. I was so happy to have her there! Not only because she is my midwife, but I needed her love, support and presence. It’s hard for me to put into words my feelings in that moment, I looked up to see her and smiled, I was happy, relieved, and knew that, yes, this was really happening. Desmond’s birth was rough, and without her I don’t know what I would have done, I gained a trust from her that doesn’t come by everyday. We hugged and she kissed my forehead, and asked what she could do. I don’t remember what I told her.

Crystal let us know that the tub was ready, so I changed into my swimsuit and got in. Ahhhhhh, what relief! It felt so good to be in there, I got on my knees and continued through the pressure waves. My son would come in every now and then and make sure I had lots of water or hugs. His hugs were so helpful, I’m so glad he was around! When he hugged me he would ask “are you ok?” and I simply replied yes, and that he was going to be a big brother soon. Sometimes he would come in, hug me and “it’s ok mama, just relax.” Sweet words from a sweet boy.

The pressure waves were getting pretty intense, I tried standing up at one point and immediately knew my body didn’t want to do that, and said “NOPE!” So I sat back down on my knees resting my head on the edge of the tub. I love how the water allowed me to move so freely.

I was so tired at my son’s birth I didn’t get to enjoy the rests during the breaks in between pressure waves, but during this birth I really took advantage of those breaks. Each break we chatted a bit and I kept making silly faces at my sister and Mona. Why? I guess it brought me back down to Earth and into my space. It helped me push away the fear of the next pressure wave.

Joseph my husband sat near me as I rested my head in his arms I felt so warm and safe! He didn’t need to say anything to comfort me, just as long as he was there!

I got to a point where it kind of felt like I needed to push… I didn’t believe I was in the transition stage though! Only after a couple hours of active labor? My midwife recognized the signs right away (I overheard her whisper to someone…. “she is closer than she thinks” but I still couldn’t believe it). She had been sitting next to the tub helping me work through the pressure waves when she leaned in and said “Shireen, I think it’s time you take your swim bottoms off.” my reaction….. I busted out laughing! I couldn’t believe it and at the same time I was so relieved! Everyone in the room was cracking up… How could I be laughing right before pushing out a baby?! That’s what having such wonderful support around you will do to you!

Time to birth this baby! I was amazed at how aware I was of everything happening in my body, I felt the baby pushing down and through, ready to enter this world. I got on my hands and knees to push, it felt right. I ended up with my head on the side of the tub for support because I knew instinctively (without planning) I was going to catch this baby on my own and wanted to be ready with my hands underneath. With my son I was very uneasy about feeling him crown, (I guess because it was all unknown to me) but this time I felt everything and was so in tune with my body that I wanted to know exactly where baby was and how baby was doing. At this point I had been pushing, I felt a stronger urge to push when, POP! My water broke! Another relieving feeling! I remember telling myself not to push too fast, but wanting to because it just burned and felt like too much for me to handle! I was starting to tense up, and was reminded by Mona to relax my body. So I surrendered to my body and did as it wanted to, when it pushed I let it and when it took a break I let it. After about 15 minutes of pushing I birthed my baby’s head! I remember holding her head and asking if she was alright. I was so close to meeting my baby! As the next pressure wave came I gave a strong push, caught my baby and lifted her up onto my chest, what an amazing feeling! So much love and joy, I can’t even begin to express these feelings! The world around me disappeared, everything was silent, it was just my baby and I. My baby was in my arms and I just kept saying “I Love you! We did it!”

Moments after Dahlia was born

For both my children we didn’t find out the gender until birth. I didn’t have one ultrasound done with this pregnancy. When they were born I didn’t even care to look what the gender was! I had my baby in my arms and that was all that mattered! I had to be reminded to check to see if it was a girl or boy. And based on the reaction of everyone, I knew it was a girl. We were so excited to meet our baby girl! And because this birth went so well we got to snuggle a bit in the tub before getting out. (I had to get out quickly with my son because he decided to wait a few minutes before getting in some good breaths.)

<http://1.bp.blogspot.com/-dbAXVhAtURw/UWO3dsdlVBI/AAAAAAAAWN8/Vr4SaqOlu6o/s1600/IMG_8577.jpg>

Once I got out onto the bed and warmed up, still snuggling my baby, my sister called my aunt, who read a prayer for the baby in Arabic over the baby’s right ear. She did the same thing for my son when he was born, and for me when I was born.

It was time to deliver the afterbirth (which was so easy the first time), but it was taking a while. I started getting worried because I didn’t even feel like pushing. I started getting a bit anxious, the birth went so well that I must have been worried something would go wrong. After a long wait I pushed out the afterbirth and I was finally comfortable and much more relaxed. I was able to just enjoy holding my baby girl! I am not sure how long it was after I birthed the placenta, but long after the baby’s cord stopped pulsating, Joseph cut his daughter’s umbilical cord. Just as he did for our son.

Once everything was cleaned up Stephanie gave the baby a little hat she makes for each of her clients babies. She sang Happy Birthday to her, whispered some sweet words in her ear and kissed her head.

Stephanie and Crystal were so wonderful, I was so blessed to have them at the birth. We are so honored to have had Stephanie at both of our children’s births! And I can’t leave out how terrific Crystal was, as a Senior student midwife she did most of the monitoring and assisting. She was fabulous, so caring and gentle. She is going to make a wonderful Midwife soon!

Mona was my rock! She makes such a wonderful doula, and friend. I’m so grateful for her, she helped me through a very difficult birth with my son and was by my side through this one. She was there every second I needed her, walking with me, holding me, rubbing my back, holding my hands, supporting me through each contraction, making me laugh during the breaks and encouraging me with her words. I can’t express how thankful I am for her!

I am so grateful for my whole birth team, I couldn’t have done it without any of them! (my husband, my son, my sister and Mom, Mona, Stephanie, Crystal and all my friends who were by my side in my thoughts. I’m very lucky to have pictures from Dahlia’s birth, Thank you so much Nasreen!! I hope Dahlia will one day thank you for them!

Desmond and Papi giving kisses

I’m so so happy that Amy was able to meet little Dahlia!

8 pounds 9 ounces and 21 inches long!

Desmond gave his little sister her first sticker. He choose a heart!

Happy mom and baby

So much a pic can’t capture
no matter how hard it tries -
but a small glimmer can be seen
if you look within their eyes.

A dad is born and gazes upon
the baby that he just caught.
Nothing else exists in his world-
in a moment all else forgot.
He falls in love just like before
on the day he met his wife
and praises the Lord with gratitude
for this family that’s now his life.

A mother sobs and holds tight
to the baby against her breast.
All those months of waiting
and today she was blessed.
She looks at the perfection
of every finger and hair
and wonders how she ever lived
before her babe was there.

A daughter opens her eyes to the bright
and she hears her mother’s heart.
A cough and a blink lets everyone know
she’s good from the start.
Looking around, she wonders what
the fuss is all about.
She feels the love, she knows she’s safe
in her soul she has no doubt.
When she’s ready, she gives a call
And here comes a milky breast.
She latches on and looks at mom
she has no other request.
She knows of no sadness or worry
no fears, or loneliness, or pains.
Just milk, love, and peaceful beginnings
and here is where she remains.

Stories written by the mother are my favorite…it’s their journey, and their point of view of their experience is what is ultimately the most important. Here is a BEAUTIFUL and very detailed story of challenges and triumphs written by an NHBS….
We love you, Kari!! Thank you for letting us be a part of your baby’s story!!!

FINLEY’S BIRTH STORY

As we neared the end of the visit, we asked the question that I have asked every single client at their final visit with me – do you have any feedback for us about your care here? Start to finish…before we say goodbye (for now), is there anything we could have done to make your experience better? Anything you loved even though you didn’t expect it from us? I am human and, while I try my absolute hardest to be the best servant I can be – being human means that I’m not perfect. But I am always willing to learn! What can I do to be better?

“You were awesome and you gave us a WONDERFUL birth experience!”

Of course that warms my heart and makes me smile! But somewhere deep inside it also causes the humble part of me to cringe.

Cringe? Why would I cringe? Because I know the truth, and yes I did share my thoughts with this couple.

I am so thrilled that they had a wonderful birth experience….but I didn’t give that to them. When her water broken, she went into labor on her own without intervention – I didn’t induce her. She labored freely, eating when she got hungry, and drinking to stay hydrated – I didn’t restrict her. She began pushing when her body told her to- I didn’t stop her and request a cervical exam. She birthed her baby under he own power and held him in her own arms – I didn’t put her into the bed on her back and I didn’t take him away to maintain his warmth. She fed him from her own breast – I didn’t stop her.

I didn’t give her these things! I simply didn’t take them from her.

I didn’t give her this wonderful experience – she gave herself the wonderful experience through her own choice. I simply didn’t steal it away from her.

I don’t empower women – I just do everything I can not to take their power away from them. They are strong, whether they know it or not ….sometimes that strength is hiding because they’ve been told too many times that they weren’t strong, weren’t worthy, weren’t good enough. But all you have to do is allow them the opportunity to call on that strength and it comes bursting out, like sunshine that’s been squashed into a container and the lid is finally cracked open. I didn’t give them that strength…I didn’t give them the power…and I don’t give them their birth experiences. I just do everything I can not to take it away from them.

You have no idea how much I would love to say that I gave all of these women their wonderful births! But I don’t have that kind of power….their birth belongs to them and they deserve all of the accolades and to bask in the glory of their achievement. As for me, I just feel honored to be there, help out as much as I can, and celebrate a woman’s discovery of her own powers.

But make no mistake about it – I didn’t give that to you. I just didn’t take it away from you.

I believe in love at first site.

My second birth was vastly different from my first, which had involved multiple interventions (epidural, vacuum, episiotomy, manual extraction) and violated my birth plan in so many ways. With my first child I spent the entire pregnancy allowing fear and anxiety to consume me…I was miserable. Determined not to repeat that I spent my second pregnancy focused on the joy of the Lord, His purposeful creation of this child and I visualized what I desired my birth experience to be like and, as a result, had a beautiful prenatal period (don’t get me wrong, I still had morning sickness and all that jazz, but I truly believe our thoughts can affect our bodies). Here is a link to my first birth story.  My thoughts about many of the things that occurred are vastly different now.

Friday, January 18th, I spent all day thinking about having my baby and desiring to go into labor that night. By evening I felt a little off and just picked at my dinner. I continued having Braxton-Hicks contractions that were probably more consistent than I realized, but since I had been having them for months I gave them little thought. We went a little crazy since it was the weekend – staying up for an extra hour (!!), finalizing our day around 11:00pm. As per my third trimester custom, I lay in bed with rapid heartbeat praying over the night and waiting for sleep to wash over me. And then I was wet. Soaked. So classic it was comical.

My second-baby-larger-belly was, at this point, accommodated by only three pairs of lounge pants, so I switched out the wet pair for the last clean pair and phoned my midwife, Stephanie. Since this was my second birth, I was advised to call again as soon as anything more happened to allow time for travel should Sir Monte make a quicker than anticipated arrival, and in the interim try to sleep. Meanwhile, Matthew “double-made” the bed (a throw-away fitted sheet over a waterproof mattress cover over our normal fitted sheet). After a few more phone calls (parents, our Doula, Rose) we lay down and attempted to ignore the adrenaline surge.

Within the half hour contractions were arriving every 5-6 minutes. We relaxed, waiting and monitoring for a while to see if they would fade, but they remained consistent. We called Stephanie again a little after midnight – she and the student midwife, Crystal, would head our way.

Matthew went around the house making last minute preparations while I lay in bed…not sleeping. By the time our midwives arrived I was sitting on the couch eating oatmeal. Stephanie set up supplies in our bedroom as Crystal checked my blood pressure and baby’s heart rate. As we listened to baby I had a contraction that sent another gush of amniotic fluid – rendering my last pair of wearable pants entirely useless. I changed into my ‘birth dress’ (black cotton maternity dress) with swim top underneath.

Our midwives convinced us that the best thing to do now was sleep, so we headed back to lie down. Through mild contractions I think I was able to catch a few hours of sleep. Crystal came in once an hour to listen to Monte – he maintained a steady heart rate throughout. It was comforting and encouraging to hear his little heartbeat as I progressed through labor.

From about 4:00am on I was up and down – eating, drinking, restroom. I started feeling anxious, so it was hard to stay in one place for too long. I showered to relax a bit while Rose inflated the birth pool in preparation for when I was ready to use it. My goal became to wait as long as I could so that it would be an effective “tool” once things were more intense. I also had no desire to sit in cold water turning into a prune due to getting in too soon.

The early hours of the morning were so peaceful. The entire house was dark and quite, but full of joyful anticipation, like Christmas morning. Laying down in my room left me too much with my thoughts, I needed to be elsewhere and sitting up in order to focus less on contractions. Using a multitude of pillows, Matthew packed me into the couch in the living room where he and the birth team slept amidst the toys my oldest son had scattered about the previous day. As dawn arrived and light was just beginning to seep through the blinds I started to vocalize through contractions, which were increasing in strength and frequency. Crystal and Rose heard the subtle changes in my vocalization and helped to guide me as I hit the more difficult points.

Meyer woke just before 8:00 and ran gleefully around the living room while I sat on the floor cross-legged. In typical two-year-old fashion he was relatively unfazed by everything. Perhaps it was knowing that he was awake with my Mom to care for him, perhaps not, but in any case I was ready now to submerge myself in water. I arrived at the tub and was disappointed as I looked in, “where was all the water?!” For some reason, I had envisioned water up to my neck with the ability to literally swim around. I quickly came to my senses and entered the wonderfully warm water sitting cross-legged close to the edge and chatting with Meyer about Lightening McQueen and his desire to swim as well.

During contractions I tried a few times to do the horse lip-flutter thing, but did not find it as effective or as amusing as I did while doing yoga with my sister. Rather I continued to vocalize and was thankful for the fact that I was not in the hospital bathroom, lights glaring. I was in my own room – dark and calm with enchanting music swirling in and out of my consciousness.

I progressed into transition and the harder contractions would peak and subside with my “aahh” turning into a pleading cry, my eyes searching the faces around me and silently begging for belief. Fairly certain she could magically make the pain disappear, I turned to Rose and asked, “Can I just be done now?” “That’s up to you,” she replied. I wanted to be irritated, but it was exactly the right thing to say to my stubborn self – I became incredibly focused and determined.

Contractions reached a crescendo around 8:45, minutes after my parents left with Meyer, and I found myself suddenly on my knees, almost an involuntary reaction. Then contractions subsided and my body began to push. It was a feeling both foreign and familiar. Nobody informed me that it was time to push, my body was in control. My mind took a moment to synchronize with this concept; I was just sure I was fabricating the need to push. Once my mind finally embraced the reality, I was able to surrender to what my body was doing.

With each push I leaned hard with all my upper body strength and clenched my fists around Matthew’s and Rose’s hands. With the stronger surges I would burst forth with a wild, jungle-woman cry – not out of pain, but more to center myself in the moment, focusing every part of me into bringing this baby into the world. It was magnificently liberating. I had been praying and reciting scripture to myself throughout, but in these moments I began to ask the Lord to enter my body and fill me with the strength I needed.

I was asked if I wanted to see if I could feel my baby, but declined fearing he would be further away then I hoped and I would become derailed or discouraged. Minutes later, I was asked again, but this time I knew he had begun to emerge. I felt the crown of his fuzzy little head and Matthew got in position to catch his beautiful son. As his head came forth into this world I felt a slight burning, not nearly as bad as I had expected! The rest of his body quickly followed – what sweet relief. In one quick moment the pressure was gone, the tension in my upper body melted away….and my baby was here. My face was flushed and “glowing” (‘women don’t sweat, they glow,’ says my friend, Tawn) as Matthew handed me our son, who cried briefly, stared at me for a moment, then fell into a peaceful slumber as we marveled at God’s amazing blessings.

This birth was exactly how I had envisioned and hoped it would be. I am beyond grateful to my amazing birth team for helping me to trust my body. I was never checked for dilation, never told to push, always treated with respect. I felt so loved. I cannot stop praising God.

Moments after giving birth, both parents are GLOWING with joy and excitement!!!

There is a lot of confusion surrounding the newborn screen, so in this blog post I hope to answer some of those questions and bring clarity.

An actual Az Newborn Screen

When is the test done?
The AZ Dept of Health recommends that your baby be screened twice: once at 24 hours old, and again at 5-10 days of age.
The screens are often referred to as a “first screen” and a “second screen”…and I find that misleading. A more accurate name would be “early screen” and “late screen” as it depends entirely on the baby’s age, not the number of screens your baby has had. If your baby is not screened until he/she is a week old, even if it’s the first time the baby’s been tested, it’s still a “second screen”…ie. a late screen. Your baby is too old for the first screen. You do not need to have a first screen performed in order to do a second screen.

How is the test done?
The baby’s heel is cleaned and then a lancet is used to make a small cut on the baby’s heel. 5 large drops of blood are collected on a card and allowed to dry. The card is then sent through the US mail where it is used for the test.

How we try to make the test look

What does the Newborn Screen check for?

The Arizona Newborn Screen checks for 28 metabolic disorders of the newborn – most of which you probably won’t be able to pronounce even if it were right in front of you to read. They are not curable, but they are treatable.

The Arizona Dept. of Health Services website states that there are 29 disorders that are screened for because they include the hearing screen that is offered to all babies as well – but obviously that is not part of the heel-stick test.
You can see a list of disorders that the screen checks for here on their website..

I find this list especially helpful as it even explains how common each disorder is – you will see this notation at the bottom:

* Items are categorized by their occurrence as follows:

• common: occurs in greater than 1 in 5,000 US births
• relatively common (occurs in greater than 1 in 5,000 US births)
• relatively rare (occurs in greater than 1 in 25,000 US births)
• rare (occurs in greater than 1 in 50,000 US births)
• very rare (occurs in less than 1 in 100,000 US births)

How we usually get it to look

The newborn hearing screen is considered part of the test, but is not something that I can offer to your baby.  If you desire a newborn hearing screen for your baby, it’s recommended that you contact one of the local hospitals closest to you to make those arrangements - here is a list of locations you can take your baby for the hearing screen.

Why is it offered to my baby twice?
This is more challenging to answer – so I would like to share my personal experience with the recommendations rather than simply leave it at, “because the state says so”.
Many years ago, I asked the state why we were running TWO screens on each baby instead of one. The answer that I received from the state was that the early screen wasn’t accurate for all 28 disorders (the number I was told was that it was only accurate for 8 things on the list). I then asked why they did the early screen if it wasn’t accurate – their answer was that once discharged from the hospital there was no guarantee that the baby would ever be seen by a medical care provider and therefore couldn’t be sure that the baby would ever be screened…in other words, at least we could check for those 8 things. Also, if any of those 8 things showed up, we could begin treatment immediately. To me, that makes a lot of sense – for hospital births. At homebirths, I ALWAYS see them later and follow up.

Most of my clients were unwilling to allow me to run the test twice when they found out that the first test wasn’t accurate for everything – and when they found out that it was sent through the US Mail (in otherwords, not run immediately – therefore giving them the impression that there wasn’t urgency to the results). My recommendations at that time were that if only ONE test was to be allowed by them, that we do it at our 1-week postpartum visit thus ensuring that it’s accurate for everything. Most agreed and complied.  I then went through another training provided by the state – and got their training manual. Hidden in their manual inside their FAQ was this line:

“A baby who is only 3 days old has come for her first doctor’s appointment? Isn’t this too early to collect a 2nd screen?

No, the second screen should be collected at this appointment. Improved testing methodology makes earlier testing results valid and reliable.”

Fantastic – my recommendations changed! If someone was only going to allow me one opportunity to test I would recommend a 3-day late (second) screen and get accurate results even earlier for all disorders! And that was exactly what I recommended and did for several years – and all was good.

Until the state contacted me recently (2013), encouraging me to do more to encourage the first screen. The head of the education department (whom I freely give her name and phone number, but won’t in this blog post. If you desire her information please ask me and I will provide that to you) informed me that due to even more recent advancements in the test, the early 1-day screen IS ACCURATE for everything it is checking for. I repeated several times (probably to her annoyance) – “Just to be absolutely clear…you are telling me that if we do a 1-day early screen, it IS accurate for everything now!” She said an emphatic, “YES” (which is when I asked for her name and phone number to follow up with any questions). I then asked her why we are then doing a repeat screen…she said because it’s what’s recommended. I asked why it’s recommended – she said that it was how the test was run and they recommend doing two screens.

In other words, I actually didn’t really ever get an answer to that question.

Therefore – your options as the parents as I see it are this:

* You may choose to test your baby two times as is recommended by the state of Arizona…once at 24 hours old and once again at a week old.
* You may choose to test your baby only one time – an early screen at 1-day old, or a late screen either at 3 days or 1 week.
* You may refuse to screen your baby at all, refusing all tests.

I don’t have a history of any of the disorders – so why should I test my baby?
You can not tell by looking at your baby if he/she has any of the disorders – it is not until they become symptomatic that you might know. Sometimes the first symptom is death. Not having a history in your family can be of little comfort if you consider the fact that Arizona hasn’t been screening for everything that long – how many illnesses or SIDS have occurred due to some of these disorders but was undiagnosed because we never tested then? We will never know.

The odds of your baby having one of these disorders (when you combine everything on the test) is not high – approximately 1 in 500 babies will test positive for something on the screen. The disorders we check for are treatable, although not curable. Low risk does not mean no risk – it is up to the individual parent to choose what level of risk they are willing to assume for their family and their baby.

I have heard that the state keeps my baby’s DNA for 18 years – is that true?
EDITED TO CORRECT:
When I took the training with the state several years ago – they told me at the training that they keep the samples for up to 18 years for research purposes.  I was told at that time that it was the parents’ right to have the sample destroyed and that all they had to do was contact the newborn screen department of the Arizona Department of Health Services.
According to the AZDHS website  under their “Frequently Asked Questions” they say – “Specimens are stored for approximately 3 months and then are destroyed and discarded. Sometimes the leftover blood is used for testing or validating new laboratory methods for newborn screening.”
So either I was misinformed at the training (probable), or their website is inaccurate (less likely)…but I am happy to say that IN ARIZONA, according to their website, newborn screens are destroyed after 3 months.

CONCLUSION
Thank you for taking an interest in the health of your baby and reading this posting. I respect that you as a parent are educating yourself enough on this subject to actually get to this part of this posting and appreciate you taking such an interest in your baby’s health. Thank you – your baby is lucky to have you as parents!! Please know that if any questions remain after reading this post, I am available to answer anything that will assist you in making this important decision for your baby.

Let me try and explain it to you.

* * * * * * *

One of my most popular blog posts is this one on umbilical cords…

Magic Umbilical Cords

In case you haven’t seen it yet – it is one of my shortest blog posts, yet has become one of my most shared and well known. I have had an interest in the umbilical cord and our rush to clamp it for a while, and had previously looked for pictures to demonstrate the changes that the cord goes through from immediately after birth until it is no longer functional. Imagine my surprise when I couldn’t find the desired pictures even when looking through google images!! Billions of images shared, but that one eluded me. So one morning I watched a friend (whom I had watched birth her first baby) push her second baby out into the world – and was struck by the beauty of this thick, blue, pulsing umbilical cord. I asked the mother if I could take pictures of the cord to use for educational purposes, and she said yes. I asked my student if she could grab the camera and take some pictures for me…and she took those amazing pictures that I was then given permission to share in the hopes of educating others as to the importance of respecting the function of the cord.

(sidenote – lesson learned…next time I will watermark the images after editing them)

I knew that I loved the pictures and have a respect for the umbilical cord, but I guess I didn’t realize how popular that blog post would become or I would have seized the opportunity to educate more on the wonders of this cord that connects baby to mother. Here are some really interesting facts that you may or may not know about the umbilical cord.

IT PROTECTS BABIES’ BRAINS

The debate is far from over – should we clamp the umbilical cord immediately at birth, or should we wait until it has stopped pulsing or the placenta is delivered?  Those advocating that we delay cord clamping often say that doing so would allow oxygen to continue to be delivered to the baby until baby begins breathing – but the truth is that it does even more than deliver oxygen, it delivers blood.  At first glance that might seem like the same thing – but perfusion of blood can be more important in the immediate protection of brain function than oxygen levels.

What causes brain damage in a person? If I asked that question to a classroom of students most of their hands would go up and I would easily get the correct answer of “Lack of oxygen!” That is correct. In a person, lack of oxygen (otherwise known as hypoxia) eventually causes brain damage. Usually the cause of the hypoxia is respiratory depression or heart failure. In other words…. the reason that they would be without oxygen long enough to cause brain damage is that they have stopped breathing or their heart stopped pumping the blood.

What would cause a neonate (newly born baby) to be hypoxic? It’s not the lungs or the heart that had a problem – it’s the cord. The solution is to protect the return of the function of the cord, thus correcting the problem. If the cord was the problem, then the cord is the solution.

Here is something that not everyone understands – perfusion of blood to the brain has more immediate repercussions to its function than oxygen level of that blood. Babies in utero grow and thrive in an oxygen level much lower than ours. Oxygenated blood comes through the umbilical cord, mixes in the inferior vena cava and in the heart with DE-OXYGENATED blood from the inferior+superior vena cava….and that mixed, lower oxygenated blood is then circulated throughout the baby.  Even with lower oxygen levels, they thrive.  Their skin is purple, but their system is perfused with blood that is lower in oxygen than ours. This offers protection from hypoxic injury…as long as organ and placental perfusion are good.

Adult brains and organs aren’t much different….an adult can survive without oxygen of any sort (ie. breathing pure nitrogen) for 5 minutes and, while they will lose consciousness, will suffer no long-term effects. No brain damage. However, if you occlude the cerebral artery (stop blood flow to the brain), brain damage begins almost instantly. Losing perfusion of the blood to the brain is much more damaging to the tissue than losing the oxygen to the brain.

It is understandable, then, that our primary goal for the depressed neonate should be allowing the placenta and cord to re-perfuse the baby and his/her organs immediately after birth!  If baby’s system has been compromised of blood supply, then it is imperative that we do not remove that cord until perfusion has been re-established.  Providing that baby with oxygen via a mask with positive-pressure-ventilation to resuscitate doesn’t address the PROBLEM – which is the perfusion of blood to the baby’s system at the moment of birth.

A fully functioning cord…this baby was born at home. His mother is snuggling this baby, oblivious of the gifts this cord is providing her baby.

The same baby baby, now snuggled with his daddy…while still attached to the placenta that is in the bowl. Notice that his cord, previously thick and purple, is now thin and opaque white.

AND IT’S NOT JUST THE BRAIN

Perfusion of the liver helps the baby maintain glucose levels as the baby now needs to tap into their own glycogen stores in the liver to maintain glucose levels. The liver is also responsible for processing bilirubin and preventing jaundice. While it is understandable that one could think that having a higher blood volume at birth could contribute to physiological jaundice of the newborn, having a liver that is properly perfused could actually assist in preventing jaundice.
Perfusion to the kidneys is necessary to maintain blood pressure which is required for fluid, electrolyte, and acid-base regulation after birth.
Perfusion of the lungs “erects” the alveoli and initiated respiration – with perfusion resulting in lung aeration before respiratory efforts even start. Respiration is a reflex controlled through the central nervous system which needs copious perfusion of the reflex circuit and well as the respiratory muscles for it to function. A large portion of the blood volume given by the unclamped cord at birth goes towards establishing the pulmonary (lung) blood flow.

This is usually where I take a moment to reflect in the awesomeness that happens in that moment of birth…when the cord is blue and pulsing, when baby is changing from purple to pink – when this cord, that has supported this baby their entire life, gives its final gift before it will collapse, almost as if it has given its life for this baby.

IT PROTECTS THEM UNTIL THEY START TO BREATHE

The moment of birth is dramatic…for no one more than for the baby. The umbilical cord words to make this sensitive time easier by protecting the baby on many levels.

First, it protects their temperature.  Until the cord stops functioning, it is pumping mother-heated blood from inside her body (the placenta) through the cord into the baby – thus acting like a circulating heater keeping baby’s temperature stable until baby can be snuggled into mother’s warm arms.  I’ve seen nurses, doctors, and midwives rush immediately to rub baby with towels, drying baby off, slipping a hat on their head…all in an effort to maintain baby’s body temperature.  The truth is that for the minutes that the cord is functional, there is really no reason for any of that yet.  Once in mother’s arms, her body heat will adjust to maintain the baby’s body temperature perfectly.

Second, it gives the baby a grace period by providing oxygen (along with blood, see above), giving the baby time to initiate respiratory efforts.  I’ve heard medical care providers say that a depressed newborn (one with low APGAR scores – or one who isn’t breathing and responsive immediately) is one of the instances in which delayed cord clamping can not be accomplished as the baby needs medical attention in a warmer where the neonatal team has full access to that baby. Proponents of delayed cord clamping state that a depressed newborn is when it is most crucial that we don’t clamp that umbilical cord in order to support the baby until respiration is established.

The truth is that in 1957 (over 50 years ago!) a paper published in the Lancet demonstrated just how dramatic the support and protection of the cord can be for a baby. In the report, the medical team tracked the weight of a newborn who was wrapped immediately at birth in warm cloth and placed on a scale near mother’s vagina. Baby didn’t start breathing for 10 full minutes. For 10 minutes they watched the baby and recorded it kicking the bed (at 4 minutes), recorded the baby’s weight as it changed with uterine contractions that pushed blood into the baby….and finally recorded the baby’s weight surge immediately after the baby began breathing (as a full 100ml [.42 cup] of blood was pushed into baby from the placenta), finally stabilizing after the cord stopped functioning. The baby was never in any danger even though it took 10 minutes to establish respiration.

Initially at birth, the placenta and umbilical cord continue to function similarly to how they did in utero. After birth as it is exposed to temperature change, the gelatinous substance in the cord (Wharton’s Jelly) that was firm and thick and protected the integrity of the two arteries and single vein inside the cord….begins to chemically change, liquefying, collapsing the cord and restricting the vessels it contains. As the Wharton’s jelly begins to collapse, it first restricts the smaller arteries (that bring blood from baby to the placenta) before finally collapsing the larger umbilical vein (that brings blood from the placenta to the baby. Clamping the cord prematurely interrupts this process and demands immediate respiration from the newborn as well as possible severe repercussions if that doesn’t occur.

HOW MUCH BLOOD DOES BABY GET?

In the Gunther study mentioned above, they found a 100ml surge within one minute of the baby beginning to breathe. That may not seem like much until you think of it this way…

* the estimated blood volume of a baby is determined as 85ml for every kilogram of full term baby.
* the average baby weighs approximately 7.5 pounds. Converting that to kilograms is approximately 3.5 kg (approximating for simplicity)
* using these calculations – the average blood volume of a newborn baby is approximately 297.5 ml.

A fully functional umbilical cord being clamped by the physician immediately at birth. Baby was then immediately taken over to a warmer, rubbed down, and kept for almost half an hour.

While they did not mention the size of the newborn studied….if it was an average sized baby, he or she would have received approximately 1/3 their total blood volume FOLLOWING the initiation of respiration. Studies have shown that it can be even more significant – up to 50%. If you or I lost 30-50% of our blood volume, we would be in stage 3 or 4 (out of 4) hypovolemic (low blood volume) shock. We usually are symptomatic and in the beginning stages of hypovolemic shock at only 15% blood loss. A loss of 50% usually requires severe intervention to prevent death.

CONCLUSION

The more I learn of the umbilical cord and its function, the more I am in awe at its incredible abilities to protect our babies both inside and out of the womb. I have yet to see ANY compelling arguments that would convince me that we should do anything in that immediate postpartum period that would interrupt the function of the cord – especially if baby is compromised. In fact, I believe strongly that to do so is to put that baby at significant risk – and as health care practitioners, how can we justify that? The only logical approach is to leave the cord alone until the placenta has delivered, only clamping before then in extreme circumstances and after exhausting all other options.

Arizona has had licensed midwives since 1978 (yes, they have only been legally recognized for 35 years) and there is a VERY LONG list of rules and regulations (R/R) that govern those midwives who are licensed. This list of R/R is what states what a midwife is allowed to do as a midwife…but, equally as important, it states what licensed midwifes (LMs) may NOT do as an LM.

These R/R have not been updated in about 15 years and therefore have not kept current with evidence-based practice in obstetrics – haven’t been fluid enough to conform to new ideas and discoveries.

To put it simply….the fact that the R/R are being revisited in Arizona is a BIG DEAL. It means that consumers (mothers) and midwives are fighting to expand our scope of practice, and the medical community is coming out in force to try and restrict the LMs in Arizona.

* * * * * *
My Summary of Last Night’s Advisory Committee Meeting

Will Humble, Director of the AZ Dept of Health

First I’d like to give a big thumbs up to Director Will Humble – who gently guided the meeting with respect as he listened to both sides present their findings, concerns, and opinions.

The main portion of the meeting began, and they didn’t get two slides into their powerpoint before it was effectively brought to a screeching halt. The largest controversy was the proposed expansion of the R/R to allow for LMs to legally attend the homebirth of VBACs (Vaginal Births after previous Cesarean Section), twins, and breeches. The proposed draft suggested implementing a requirement that each mother wishing to have a homebirth VBAC be required to consult with an OB and get a form (provided by the state) filled out and signed as proof that they visited with the OB and therefore understand the decision they are making.

Consumers on the panel argued it was insulting to require them to get this form as it’s insinuating that they aren’t bright enough to do their own research and make their own decisions. Besides, they have a care provider (LM) who can provide the same level of informed consent (education) that an OB would be able to provide.
Midwives on the panel argued that it’s an unobtainable requirement as no OB will ever sign that form due to liability concerns – therefore it continues to render VBACs illegal for LMs to attend.
OBs on the panel argued that VBACs can go tragically wrong very quickly and should always be done in a hospital regardless – and the fact that the birth certificates submitted by homebirth midwives shows that most of their clients are “self-pay” demonstrates that they are probably less educated, less professional, and less likely to be able to understand the research as well as the two consumer members of the panel who are educated professionals.

This type of lively discussion continued for well over an hour. Very little was agreed upon.

Finally, Director Will Humble opened the meeting to public comments (for those who had indicated upon entering that they wished to speak and submitted the form for it). Again, the division was clear…medical representative, one after the other, proudly stating they are the director of this group or the chairman of that medical group, stood to say that they have seen HORRIBLE things at the hospital, and if you’ve just seen these terrible things you’d know that births belong in hospitals!

****************
MY RESPONSE

I didn’t get a chance to speak, so I share my response here.

First and foremost, it greatly disturbs me how we so easily fall into the “us vs. them” division. Ladies and gentlemen – OBs, nurses, CNMs, LMs, Neonatologists, Perinatologists, NDs, DOs, MDs……..we are on the same team!! Do we not all have the same goal here? The best outcomes for moms and babies? If you think anything else, then please step back as I think you need to reapproach this topic from a completely different angle. Midwives don’t want emergencies or bad outcomes…neither do doctors.  Most importantly, neither do mothers!

It is being argued by the medical establishment, homebirth isn’t safe. Their answer to this problem – is to make it less safe by imposing greater restrictions as to what midwives can do. Do you really believe that restricting our access to emergency medication is in the patient’s best interest? Do you really think that making transporting to the hospital challenging and adversarial is in the patient’s best interest? Do you think that you are protecting women by making LMs unable to attend VBACs at home? Do you think that the choice here is homebirth or hospital birth? It is NOT! That is not the choice that this group of expectant mothers are considering!! They are considering an LM assisted homebirth VBAC or an UNASSISTED VBAC. Are you really arguing that if someone makes the decision to have a VBAC at home – because you disagree with it then you will make it your mission to make it as dangerous as you possibly can by removing a medical professional who can monitor heart tones, who can resuscitate a baby, who is trained to recognize the signs of problems…? That it is in THEIR best interest to ensure they have an unassisted birth rather than a midwife assisted birth?

Time and time again the medical community stood and described tragic outcomes they have seen, emergency situations that have occurred on their watch in the blink of the eye and how this demonstrates that births belong in hospitals – especially VBACs.

To all of those who stood I would ask this simple question: Have you ever seen a homebirth?

*crickets*
Why not?

Let’s compare and contrast for a moment…please. Indulge me.

Hospital births – deal with inductions, analgesics, anesthesia (epidurals), and many routine interventions that hinder the birthing process such as routine vaginal exams and in-and-out care providers as they care for 2-6 patients at a time.

Home births – one care provider (midwife) in constant presence with one patient in an unhindered unaugmented birth without interventions that increase risk.

An epidural – way too dangerous to do in a homebirth! But dangerous enough to restrict a woman’s right to choose one?

With all due respect to the members of the medical community who stood to speak out about the dangerous of homebirth because of what you’ve seen at your hospitals…. I agree with you!  The births as they occur in hospitals…I agree that *those births* are too dangerous to do at home!! That is why that is not our model of care. We aren’t bringing the risks into the home – we keep it as low risk as possible. Elective induction increases risk. (if it’s for medical reasons then it doesn’t matter where she intended to birth…she’d be in a hospital) Epidurals increase risk. Augmentation of the labor increases risk. (again, if it’s for medical reasons then the original intended place of birth is irrelevant as she’d be in the hospital being augmented) Having one care provider responsible for 3-4-5-6 people at the same time increases risk.  I think that the types of births you are used to would be INCREDIBLY dangerous to attempt at home!!

That is not what these mothers are doing.

I actually think that this argument is missing the point, however. We can argue all day about where it’s safest to give birth – but that diverts us from what I feel should be the TRUE discussion I think we need to be having….that is: when should a woman be allowed to choose risk? Do we respect woman’s autonomy when it comes to her body and her birth or not? She’s smart enough to choose an epidural and understand the risks/benefits that may come with that…but not smart enough to choose a VBAC and all of the risks/benefits that may come with that. We respect her enough to allow her to induce her 39 week pregnancy because her husband is being deployed overseas and wants to meet his baby before he leaves….but we don’t respect her enough to allow her to have a homebirth VBAC in the name of safety (and then will make it less safe by refusing to allow a care provider to be with her).

She can choose to ‘labor at home as long as possible”….but the thought of doing so with a midwife is somehow scary to them? Many CNMs and OBs have told VBAC mothers to just labor at home as long as possible to avoid many of the interventions of the hospital that they are hoping to avoid….so they are okay with that mother not getting to the hospital until pushing, but aren’t okay with that mother being monitored at home and just birthing at home because the risk of a catastrophic rupture is too great?

There seems to be this misconception in the medical community that what they see in hospitals is equal to what we are seeing in homebirths….and it’s simply not accurate. There are increased risks at every turn at the hospital, and we decrease those risks to the barest minimum at home. Lower infections due to less antibiotic resistant strains around a person’s home. Lower infections due to fewer invasive procedures like vaginal exams, breaking their water, episiotomies, and c-sections. Lower risk by providing one on one care. Lower risk by not introducing drugs into the process – either to induce or augment, or to provide pain relief.  We simply aren’t doing hospital births at home.

What you see at a hospital is NOT what we see at home…and our outcomes show that.

While I criticize you for not having any experience in homebirths before passing judgment – let me state that for 12 years I witnessed births exclusively in hospital settings. For 12 years I saw us introduce risk, then try and minimize what we just did. I’ve seen the hospital side and can truly understand why, if that’s all someone has seen, that they would be scared when they think of THOSE births being done in the home! But I would bet money that not a single “medical professional” who stood up to speak at the meeting had ever seen a homebirth.

I also heard time and time again how hard it is on the medical professionals to receive the homebirthers who transfer to the hospital…how hard it is to see these “trainwrecks” (derogatory term, btw) come in ‘off the street’ and have to care for them. I ask you this….what other area of medicine has this complaint? Are there doctors in the ER complaining that they only see car drivers when they wreck? That they wish that the skier had called before taking to the slopes and not wait until they actually broke their leg? In what other area of medicine do they get upset at receiving the patient when there’s a problem?

None.

Every other area of medicine is expected to ONLY be there when there IS a problem! Obstetrics is the only time in our lives that we are expected to check ourselves into the hospital while totally healthy…the only area of medicine in which they complain when something goes wrong that you should have already been in the hospital. And that only happens during labor…because presenting to the hospital at 32 weeks for preterm labor doesn’t make them mad. Presenting to the hospital at 34 weeks because you are throwing up and can’t stop doesn’t make them mad. Presenting to the hospital at ANY OTHER TIME IN OUR LIVES when there is a problem doesn’t get them upset. The one instance is in labor. If you are in labor and present to the hospital because you have a problem then and only then they get upset because you should have been there sooner.

But my bottom line is this:

I support a woman’s autonomy and respect her intelligence. I think that the woman should have the right to determine what level of risk she wants to assume when it comes to her birth. I think that the woman should be able to choose an epidural on demand or a homebirth. She should be able to choose an elective repeat cesarean or a VBAC at home.

At the beginning of this blog post I stated that we are all on the same team! We all want a good outcome!
I also believe STRONGLY that nobody wants a good outcome more than the mother does. Nobody. If she makes a decision – whether I agree with it or not – it is her decision to make. Why punish her? It’s not our family, it’s not our baby, it’s not our body. We should be there to help her…and make whatever she chooses as safe as it can be for her and her baby. She wants an epidural? Fine – but ensure a sterile field, good training for anesthesiologists, training for nurses dealing with epidural labors. She wants a homebirth VBAC? Fine – but ensure she has a trained care provider with her, monitoring her and the baby.

Who is this about? Is this about the medical establishment? About the midwives? How very arrogant we are to take that approach.
It’s about mothers and babies and families and I implore everyone to keep that in mind. Lets keep safety and respect foremost in our minds as we proceed forward. If the OBs and midwives fight and argue over territory then I believe they are demonstrating the biggest problem in obstetrics today – it’s not our territory to fight over. It doesn’t belong to either one of us – it belongs to the mother. Please, lets work together to make it as safe as it can be for her.

Lillie – Sweet little girl – her parents’ first born whose mother exclaimed as you began to crown, “Am I dreaming?” It was a dream-like beautiful waterbirth that your mother gifted you with. Thank you for kicking off my 2012 in such a special way!!

Lucija – After seeing your big brother born and needing way more help than I want to have to give to a baby….I prayed your birth would be the smooth birth that your mama deserved so much. Your birth was even beyond my prayers! So gentle, so quick…my assistant almost didn’t make your birth! Heck, your daddy almost didn’t make your birth because he was putting your brother down for a nap!! But everyone who was going to be there was actually there and it was absolutely perfect!!!

Byron – Oh man…too much to say about your birth. I have some new grey hairs on my head named “Byron”. Coming out crooked, you made your mother work much harder than she should have had to – and yourself as well! Poor little guy scared the daylights out of all of us when he ended up in the NICU. I can honestly say that you were the most challenging and scary experience I’ve had as a midwife – an honor I don’t wish for anyone. But challenges thrown in your path be darned….you are a tough little fella that recovered and thrived under your parents blanket of love and have become an absolutely perfect (and adorable) boy who is about to become a toddler!! Enough drama for one lifetime – be nice to your parents from now on, you hear!!

Ivy – You were my healing gift in my darkest hour….under the glow of a computer monitor playing Family Guy over and over (it was my first time having ever seen the show…it’s what your mother wanted to watch and she’s the boss!) your mother labored so peacefully with the help of your daddy. Watching her birth you, her first baby, in the birthing pool in their bedroom renewed my soul, restored my faith, and brought me back to the core of why I do this job. Thank you thank you thank you.

Giles – Such a sweet family you joined that beautiful morning! Being born in the bathtub has sort of become a tradition to your mother as you joined your two big brothers as a waterbaby. This soft-spoken gentle soul that is your mother was a pillar of strength and inspiration as she quietly labored and then, with two roars, birthed you and brought you up into her arms. She was so peaceful that your daddy almost didn’t make it in the room as he was busy feeding your brother breakfast! (when we called for him because you were coming out, we scared him because the urgency in our voice for him to hurry made me think something might be wrong! Poor guy…) But everything was very right and you are a perfect little boy!

Sofia – Dear sweet Sofia…I watched your mother pray for you for years before her prayers were finally answered with her dear sweet Sofia. Laboring on her birth ball with a smile, sitting in her bedroom eating eggs for breakfast….all while laboring with a smile on her face. Slipping into the pool, clutching onto your daddy when things began to become more intense….her doulas taking pictures and all of watched in amazement as she roared you into this world, catching you herself as you entered this world….simply perfect!!

Lucius – After an unsettled pregnancy full of moving and uncertainty, stresses and question marks, I stood back in the middle of the room and watched as my student helped welcome you into this world. It wasn’t by chance – your mama had worked hard to set things up and prepared for this birth by hiring one of the BEST doulas in the world and preparing your birthing space…and you were rewarded with a beautiful early morning birth!

Suri – Your birth makes me giggle! Not your mother’s first baby, but her first girl! (all 4 of your big brothers are going to spoil you!) Under the glow of Friends playing on television, in the still of the night while the rest of the world slept, you were born in a birthing pool in the quiet calm of their bedroom. Ribbons and bows and pink and lace…your mother was so excited to welcome a girl into her life! We were all excited to meet you! And you are just as cute as I knew you would be…

Lilly – Turning a woman and man into a mother and father can’t be easy…but you sure made it look easy! Swimming into your mommy and daddy’s hands in the birthing pool while your puppy dog watched from inside the protective confines of the cradle (that made me laugh) – so peaceful yet glorious. Grandma was rushing to get to your home as fast as she could…but you were already nestled in and nursing by the time she walked into the room. Surprise…it’s a girl!!

Steele – It was a birthday party!!! So many family members were there to welcome you into this world we called it a birthday party! Cars lined up outside, pizza being served in the kitchen…and you, quietly being born in the bathtub by your parents bedroom. Good thing they have a gigantic bathroom for all of that love and support!!

Gray –GOOD GRIEF you know how to make an entrance!! From 4cm to you being born in under 10 minutes!! Your doula walked into the room just minutes before you were heard shouting to the world…shooting out into the birthing pool, nursing immediately…all things considered, a darn good birthday if you ask me!

Gregory – A first baby to this couple who never thought they’d have children….your mother made me giggle every time I saw her! She had some of the funniest nicknames for you, marveling at the fact she was actually going to be a mother – and then, one early morning while sitting in a birthing pool with her doula helping her, she lifted you up and out of the water and, before even cradling you in her arms, looked right at you and exclaimed, “Well hello there!” I actually laughed out loud – it was almost like I expected her to shake your hand. Tee hee…still makes me giggle. You chose an incredible mother and I can’t imagine a more perfect baby for her than chubby little Greg!

Sterling – Weighing in at a full 10 pounds 1 ounce….nonetheless your mother birthed you so fast we barely had time to catch! Into the waiting hands of your daddy you flew out – not in the birthing pool as they thought (the water was really REALLY cold!) but right next to the pool. Big sister adored you from before you were born and takes every chance she can to play with you and watch over you.

Julia – I watched as BOTH of your big brothers swam earthside (both of your brothers were waterbabies just like you!) – so it was an extra special joy for me to be there when you joined the family! To be there when all three of your mother’s babies were born is just something so special it brings tears to my eyes. What a blessed baby you are…

Kariya – I was there when your sister joined the family a couple of years ago, so the delight I had welcoming you was doubled! Your mother labors so sweetly and quietly, the joy and love in your family makes it obvious to me why you chose them! Born on the birthing stool just like your big sister…beautiful. Simply beautiful. I can’t think of any other word to describe your birthday other than simply beautiful.

Alejandra – I’m so glad your mother lives right up the street from me or I might have missed your birth! Your daddy was so glad that he was able to be home for the end of your pregnancy (being in the military) and for him to catch you as you were born was just incredible! From the moment your mother walked into my office for the very first time I fell in love with her – and was so excited for the day she was going to meet you, her first DAUGHTER! Peanut butter cookies, a gentle birth, and a very precise static ZAP made this birth one that will live in my heart forever. (I can hear her infectious laugh as she reads this right now!)

Conlan – The first baby for your mommy and daddy…swimming into the world in a birthing pool and into daddy’s hands! Doula perched by your side providing counter pressure….your mother used all of her strength to calmly welcome you into her life. It was a perfect night for a baby, and you were brought forth with anticipation and love! (I am not convinced that you have been out of your mothers arms yet since that moment!)

Mika – A waterbaby girl, your mother was still smiling during labor until right before you were born!! As a first time mother, she made that look way too easy! For such a petite little thing, she sure is a powerhouse! While her doula held your mother’s hand and took pictures, your daddy caught you and handed you to her. They cried tears of joy together as they gazed at your sweet and perfect little face. It was a magical birth!

Jayson – Your mother’s peaceful labor became a little more focused and intense as she was pushing you out. You didn’t like your little head getting squished and let us know you wanted to be born!! Your mother got out of the pool she’d been laboring, sat down on the birthing stool….and, with a determination that can only be called awe-inspiring, roared with all of her strength and birthed you into your daddy’s hands!! I still tear up when I think of that magical moment of seeing you in her arms, blinking, looking up at her like, “What the heck just happened to me?” We were so happy to see you pink and shouting your arrival to the world! Those few tense moments were all worth it once you were in mommy’s arms, that’s for sure!

Ethan – A first baby for your parents, we weren’t sure where you were going to be born because your mother had some concerns we were watching at the end of her pregnancy….but your gift to all of us was being born a couple of weeks before we expected you to be born so that your mother could stay healthy and so that you could be born at home! Swimming into the birthing pool and into your parents’ hearts….I wished breastfeeding could have come easier for all of you, but your mother’s FIERCE determination overcame it all!! She’s an incredible woman…but I’m sure you know that by now.

Jolie – Perfect in every way! With your doula offering encouragement, hypnobabies CD’s playing in the room, daddy excitedly taking his shirt off and reaching in to help your mother catch you, I watched from nearby as you slipped out into the water and into their waiting hands. I saw how hard your mother had to work for your brother, so to see the peace of this birth was all that much more beautiful.

Eden – I’ve never missed a birth while actually sitting INSIDE the house…but I almost missed your birth! We all did as your mother wanted privacy – and that privacy served her well! I’m glad I heard her first roar as you were crowning when I raced into the room!! Two more pushes and you and your mother were gazing into each others eyes….WOW! I think your dad was in as much shock as your mother was!

Rose – A beautiful birth of a little 7lb 9oz baby girl after sunset…it just doesn’t get any better than that! Peaceful, intimate…perfect. Your mother cried as she held you….we all cried!

Elias – There were moments when your mother doubted her own strength to bring you into this world….but I never doubted for even a moment! Even though your big brother needed to be born on the birthing stool, YOU slipped out into the warm water of the birthing pool just like she’d hoped you would! Before you were born your big brother walked into the room and said, “Keep pushing mommy!” It made your mommy smile and soon she did just that…pushed you out into her waiting arms. So much easier than your big brother, but still a lot of work – and always worth it!

Lucas – Oh my dear Lucas…you had to go and make things difficult by letting your umbilical cord get caught up by your head when you let your waters break! Your mother was rockin’ your birth, but unfortunately you had other plans. Quickly racing to the hospital, they were able to deal with that cord in a way we couldn’t at home – and you did end up coming out the way she’d hoped, just not where she’d hoped. Being born in the hospital wasn’t what anyone wanted, but it’s what you needed and I’m glad you have a mother that’s strong enough to do what is needed when it’s needed. You are going to have a life full of laughter and nerdy fun! Rule the world, little Lucas….rule the world!

Cole – Dancing with your mother in the bedroom as she breathed through her labor was such a special moment….feeling her arms holding me, the power surging through her body, the Devine presence in the room….just amazing! But to see her in the birthing pool lifting you up out of the water and into her arms under the watchful gaze of your brothers and sisters and daddy…..that’s a moment that will live in my heart forever!

Sage – Big brother and sister bouncing around saying, “It’s our baby! It’s our baby!”…smothering her with kisses while you and your mother were still in the birthing pool you were born into….perfection! I barely had time to get to your home because you were born so fast! I’m glad you waited for your daddy to get there! He would have been so sad if he’d missed it! Instead it was perfect!!

Lillian – the first baby I’ve ever missed because I was busy at another birth. Made me so sad…but I knew you were in good hands as I got updates in text messages. I was there at your sister’s birth, so it made it all that much more sad that I missed your birth. I heard nothing but glorious things about it, though!

Andrew – I didn’t meet your parents until late in their pregnancy (not until they were 35 weeks along!) – but they were so committed to giving you the best start possible! Your mother patiently labored through the night, and the next day, finally pushing you out into her bathtub just after sunset! What a triumph! Your daddy was overwhelmed with emotions when he saw you for the first time…they both were! I was so glad to be there…

Kaitlyn – Daddy reading scriptures to your mother as she labored in the birthing pool, big sister coming in and out of the room…to say that there was the presence of God is to understate what was going on in that room. He permeated every moment with His grace and protection….your mother surrendering to His will, trusting you and her body, freely giving of herself and her body to whatever you and God needed from her. As spiritual of a birth as I’ve been blessed to witness….she was granted a beautiful little girl as her reward. Another one of ‘our’ waterbabies, you were brought forth with grace and faith and I know your life will be blessed.

Nathan – Even though I wasn’t your mother’s midwife…I was nonetheless lucky enough to be asked to be there for your journey into this world. Your team was incredible, surrounding you with all of the support you could possibly need so all I had to do was witness…but what a journey to witness. Your mother overcame so much, and it was all worth it once you were in her arms. And a BOY! With all of those sisters before you, a long awaited BOY! So exciting!

Liliana – Your parents are so good at making little girls! While I couldn’t be there when your biggest sister was born (your mommy and I were pregnant at the same time)…I was there when the middle sister was born and was thrilled to be there for your birthday! Slipping quickly out into your mother’s arms while she was surrounded by her doulas and your daddy before sunrise….love it!

Raam – While I was there to witness your birth….I was not much more than witness as it was your parents that worked as a team and brought you, their first boy, into this world. Birthed into the water in a family birthing pool connected those members of your family in a special way. Thank you for sharing your special day with me!

Paisley – Birthing you into her bathtub, your mother triumphed with her first homebirth! You tried to be born sunny-side-up…but you did turn around the proper way and then came flying out! You joined a pretty fun family, little girl….

Olivia – Transferring to the hospital wasn’t the easiest decision, but you knew where you needed to be born! Thank goodness your mother listened to her instinct! Sometimes a c-section is absolutely needed…and this is one of those times!

Cora – I will never forget when your mother reached down into the water and said out loud, “I’m ready for you…” Moments later you would be lifted up by those same hands and cradled in those loving arms of your mother. She’s a special lady and you have chosen an amazing family! You will have years of laughter and cooking and sewing and prayer and joy ahead of you, that I know for certain!!

Aria – I wasn’t sure your mother was going to wait for me to get there before birthing you….but she did! Barely!! Catching you as you slipped out into the birthing pool….watching your mother reach down and lift you up….seeing her tears of joy as she looked up at your daddy….can only be described as magical! I bawled just about as hard as she did!! Thank you for waiting for me!

Evey – The first born, you were such a peaceful birth! A waterbaby who was caught by daddy…..your mothers patience and allowing you to be born in your own time definitely paid off for her and for you!! Welcome to the world sweet little Evey!!

Brielle – your big sister was the LONGEST birth I have yet attended!! It’s only fitting, then, that you come out lickity split fast surprising your parents with how quickly and smoothly it can be! Laughing even when getting ready to push, your family’s joy and love is sure to pave the way to an amazing life for you!

Cecily – Little backwards stinker! Finding out that you were breech when your mother was pushing was such a surprise! But your mother’s love for you was like a fireball inside of her that exploded and pushed you out quickly and smoothly! Her joy when she discovered that you were a girl was overwhelming! Not the waterbirth she’d hoped for – but it was what it needed to be. You have an incredible mother, Cecily….one day I’m sure you will truly understand that. Maybe when you have your own baby.

Ivy – in the still of the night, I snuck into the home of some friends of mine. I witnessed a miracle and shared tears with them as a new baby was pushed out into the birthing pool. A short while later, while the rest of the world still slept on unaware of the miracle I’d just witnessed, I slipped out of their home and drove to my own home with my soul bursting with amazement and joy. Thus was the night you were born, lucky baby.

Braxtin – not knowing who you were until birth was exciting…but what was most thrilling was watching your big sister catch you with her own hands and, upon seeing who you are, exclaiming to the world before your feet were even born, “It’s a BOY!!!” Makes my heart leap every time I remember that moment and I will treasure it forever!

Enzo – Oh man did your mother have to work for you!! But work she did, committed to doing whatever she needed to in order for you to be born! That commitment paid off the moment she was snuggling with you on her bed, exhausted from all of that work. There are plenty of mothers who I think wouldn’t have had the strength or courage to be able to do what she did….your mother is an extraordinary woman!!!

Ella – fast fast fast! I don’t think your mother had any idea until you were actually out how close she was to holding you! But oh my gosh how your siblings do love you!! You will never be without ample cuddles and snuggles, that’s for sure!! And it makes me smile to hear your nervous nelly family members who weren’t sure about this home birthin’ business….exclaim how wonderful homebirth is and that it shouldn’t be done any other way! We convinced them…yay! Welcome, Ella….

Phoebe – Walk in, see a baby born, clean up, walk out….that’s pretty much it!! Born so fast that my assistant didn’t make it – but with your doulas and husband, you didn’t even need me there as you caught your own baby in your own time in your own space!! You had everything you needed right there in the birthing pool with you…just you and your baby! You did it, mama…..you did it!! Thank you for letting me watch as you triumphed!

Ryder – I loved every visit with your mom and dad and brother, feeling you squirm under my hands. Watching your dads face as he held your little head in his hands as it was being born….watching your mother grip the rails of the chair as you gave her final push…seeing your dad holding you in his hands before handing you to your mother – UH-MAZE-ING! And having your grandparents there was just icing on the cake. Such a great birthday!

Alexander – I heard an angel sing! Your mother sang to you as she labored…the most beautiful and angelic voice I’ve ever heard! It rose above the birthing pool and splashed back down over all of us. You weren’t to be born in the birthing pool…you instead chose the birthing stool…but your mother’s angelic voice became power, determined, fierce….and brought forth the most peaceful boy ever!

Sawyer – I saw one of your sisters born, and you came slipping out the exact same space in the exact same way! I was just at your home long enough to get things set up for your arrival before you came out….I’m so glad your mother called me (even though she wasn’t convinced yet that it was time)! You will not only have a special place in my heart…but an extra special place in Rose’s heart as you are the first baby she got the honor of catching! (Rose was at both of your sister’s births!!) Special boy with a special day.

Liam – Man oh man….what a rough start you had! Squishing your head into that small space sideways and crooked….making your mom work extra hard with everything she had just to get you out – crazy! But she fought with a determination that left me amazed….blown away. She gave everything she had to you – mind, body, and soul. But, like your mother, you’re strong and put up with all of that squishing and pushing and finally made your way earthside and immediately yelled your protest to what just happened to you! In that moment, that cry of yours was the best sound EVER!! We were all so glad to hear it and to see your sweet face (and purple-bruised head!).

Gemma – okay little missy….did you not get the instruction manual? Not only are first babies supposed to come AFTER the due date (rather than at 36 weeks on the dot!)….you were supposed to come out HEAD FIRST!! Not surprise us moments before you’re born by presenting us with your gender side! But despite those curve balls, your mother was a warrior, birthing you quickly into her birthing pool with her incredible doula protecting her space.

Dahlia – I watched how hard your mother had to work to bring your big brother earthside, and I prayed that you’d be gentler on each other. Prayers were answered!! Your mother barely believed she was in labor when I heard her birthing sounds…I leaned in quietly and whispered, “You need to take your bottoms off.” Your mother looked at me, understanding that she was ready to birth you, and BURST INTO LAUGHTER and she said, “Already??” Yes, ma’am! And here you came…moments later….into her hands…into the water…and into her heart forever! Top the day off with baklava and it doesn’t get any better!!

River – Your mother waited patiently for you to pick your birthday…and you did! Finally! But as hard as she worked to have you at home, you also needed to choose your birth space, and that was not to be at home. Your parents were so brave, adjusting plans as the path unfolded before them – doing whatever you needed them to do to ensure your safe arrival. They met that challenge and were rewarded with the cutest little baby nestled in their arms. So challenging, but so very worth it at the same time. You will always be worth it!

To the special birth that can’t be included on this list but who will always be special to my heart…thank you for letting me be there in your special and private time. I hope your mama knows that even though I can’t include her birth on this list, it was one of the most special days of my life. She planned, she fought, she conquered! She experienced pretty much every possible thing a birth can offer – and to witness that was just profound to me. It changed me….and I will forever thank her and you for that.

And to the 11 babies who couldn’t be here with us, who had to leave before they could be held…..I will never forget you either. I shared tears with your parents who yearned to see you and hold you. Thank you for the gifts you could share with me, and I’m just sorry it couldn’t be for longer.