Book Review

I am currently reading this little gem of a book; Birth Day by Mark Sloan given to me by my fabulous librairan. I have a very sweet understanding with my local librarian and friend. She orders books I request or thinks I will enjoy on the subject of childbirth and then puts them on hold for me to read. Sometimes when I am in the library with my children I will go up to the counter to check out our mound of books and the clerk will notify me that there is a book on hold for me that I wasn't even expecting! What a treat! It really pays to have a relationship with your librarian...they do work for you!
Anyway, when I first saw the cover of the book I thought, "No way am I going to like this...it is written by a pediatrician. How medical minded can you get?" But much to my surprise and like the saying goes, 'Never judge a book by its cover', I fell in love almost instantly! The book is so candid and the author really looks at all angles of every issue and withholds any judgment of superiority. He gives a wonderful history on cesarean sections, epidurals, Twilight sleep and current trends in childbirth, just to name a few. I am loving it all the way through and learning so much, too! I highly recommend it to anyone who is interested in pregnancy and birth. A great summer read!

A wonderful spring...and hiatus...a time for a midwife gardener

Here are three images that pretty well sum up what I have been doing since I last blogged in February. I have been tending to my family, my garden and my little flock of hens. I have also been able to do some much needed home repair and maintenance, too! Overall, the spring was a very productive and busy time for me and the Wrankle household.
When I last left you, I was contemplating my entire life. I believe I needed to do some 'spring cleaning' of sorts and I was so bogged down by my responsibilities and choices that I needed to take some time off to sort it all out. Well, I am happy to tell you that I am reemerging and, like a spring flower, I am blooming and ready for a new season, a new chapter in my life.
I feel renewed and revived and thrilled to find myself in a better place psychologically which reaffirms my belief that one must always listen to their heart and follow their ups and downs as they present themselves. Throw the guilt and the obligations to the wind and listen to what is right for you! Only by doing so can we, as women, move forward with a peaceful mind and a new purpose of heart.
I found this spring as I planted my vegetable garden that I desperately needed quiet, pensive time to sort things out and calm down my nerves. The simple act of putting a seed in the ground and watching it sprout and grow into a vegetable has always amazed me, but this season seemed more poignant than before! I realized that, on a much smaller scale, I was the gardener for all of the women I was attending in pregnancy and birth. I was the one tending to the seed already planted in their wombs and I carefully made sure it received the nutrients and love it needed to flower and bloom safely and beautifully! The harvest I continually was a part of with the amazing births of these women was very taxing and very stressful to a careful gardener, but a well deserved miracle for all of the months of pruning, weeding and tending.
Dealing with soil and seed made me realize, on a very simple level, how absolutely amazing my journey has been with all of the different babies and moms that were 'gardened' so carefully under my care. Many of these babies are now turning one and even two or three and I can proudly wear my wide brim hat and remember every seedling that I had the privelege of knowing and helping to grow!
Thank you to all of my past clients who have walked the journey with me! And thank you for allowing me the time this spring to step out of the midwife's shoes for a few months and catch my breath! Your loving support has been wonderful!
Now, as my garden is established and each plant has taken root I can sit back and enjoy the rest of the season watching the veggies appear and grow! Just as I will continue on my journey with moms and their seedlings and help them to germinate and grow to their fullest potential. The midwife's wide brimmed hat is back on and I've got the hoe in my hand ready once again! Here's to a wonderful summer...

Birth Change

To all my fellow bloggers and interested readers,

Sorry for the extremely long delay between posts. My life has taken a complete 180 when it comes to my livelihood and my passion for midwifery. It all started last year right about this time exactly. I was entrenched in midwifery...clients were lined up for over a year ahead, I was making and changing prenatal appointments, visiting with prospective clients and just generally one crazy woman! I was my own one woman band. I was orchestrating my life from an auto pilot perspective, thinking that this was what I had wanted for the past twelve years. I took on six extra clients for a local midwife who needed some help and I was busy with a capital B. Everything was wonderful and I was living in the moment until I started realizing that I was still a mother to three, young children and a wife to an artist husband and they all still relied on me for stability and love in their lives. I was neglecting the things that mattered most and had to choose between making time for clients or my kids. Essentially, every time I whisked away to a birth I waved goodbye to a small, sad face in the window who wondered when I'd return. There was no time for kisses or assurances, I had to be completely available to the current mama in labor. I found I had a sense of dread everytime the phone rang or my cell phone lit up and whenever I was making plans with friends or my kids I knew in the back of my mind that those plans might have to be cancelled or changed depending upon who needed me more. I was sleeping lightly, looking past today to tomorrow when the next client would be due. The due dates stuck out on my calender in Red when,in reality, my children's and family plans should have taken top priority.

Now, that said...this is what midwives commit to do. We commit to put our personal lives on hold for our clients or for sick babies or over due moms or pre-term pregnancies. We promise to come at a moment's notice when the phone rings and there is a desperate dad on the other end. We race down the freeways trying to make it to preciptous labors or coach dads as the head crowns without us. We realize we will leave the warmth of our beds and go sit with a primip in early labor who thinks she can't go on. We have committed to all of these scenarios in thought but when it comes to living this lifestyle it becomes apparent that you need a staff to back you up or a reliable partner for support. Going it alone is not ideal in this marginal, counter culture profession. It is emotionally taxing and burn out becomes a reality very quickly.

I did a Google search for midwives with burn out. There were pages and pages of women who have written similar feelings. It gave me a sense of relief and it helped me to realize that I am not alone in this. As the past few weeks have passed I have spoken with many friends about this predicament I feel I am in. They all agreed it was not a bad thing to take a break or reevaluate. One friend said, "Listen to your gut. It always tells you what is best for you. Don't ignore it, you are feeling it for a reason." I am almost embarrassed to admit that I have lost some of my luster for midwifery. Mostly because I have been working for this for so many years and now that I have lived it full time for the past few years I have found it not to be what I want for the rest of my life. Sometimes I feel like a failure or I am letting others down, but the truth is you have to make yourself happy first. Do what you love and the rest will fall into place.

This is a hard post for me to write. I just had a lovely water birth last weekend but even as I was helping this mom I realized that it is time for a change for me. Maybe I will continue doing repeat clients or good friends, I don't know yet. But as for right now, today, I am feeling a sense of more 'me' time and time to be alone with my kids and husband and plant the dream garden I have been wanting. I want to be able to leave my cell phone in my house when I go outside. I want some freedom.

My experiences have been wonderful and powerful teachers. I have learned what life is about and how to have deep, interpersonal relationships, but mostly, I have learned who I am in the process. Out of my midwifery I was born a deeper, more layered and thoughtful person. I have gained so much by going down this path and now it is time to walk down a new one. I will continue to be a natural childbirth advocate online so watch for informative information in the next few months. As always, thank you for reading and following my blog. I am indebted to the wise women who continue being the voice behind natural birth.

The Wisdom of Birth

This has been an unprecedented six weeks! My last three clients have all ended up delivering their babies in the hospital. For me, this has almost seemed unfair or unreal, and for the parents it has been a complete change of their hopes and plans.

As a midwife who completely believes in natural birth and the body's ability to give birth without any intervention, I have been completely humbled and reminded that sometimes women do need assistance medically. I am not a midwife who avoids the hospital at all costs and I do completely rely upon the medical community to be my emergency back-up when needed, but there is something about walking into that institution three times in a row and asking for their help and respect. I have gotten mixed reviews when it comes to the nursing staff and their attitudes towards me and my clients, but for the most part I have been pleased, and with the last baby, especially grateful to the doctor and his staff who took care of us well.

I have learned through these last three labors that I am completely responsible to my clients and their baby to rely upon my instincts and my best judgment and watch for any abnormal signs along the way. When labor becomes ineffective or lacks progression then it is my duty to do what I can to make it normal again or transport to the hospital. I found it interesting that with these last three births I had to be the one to set a time limit or cut off for when we were going to transfer care. These sweet mothers wanted with all their hearts to deliver their babies in their homes and in their own environments. They wanted to labor quietly and efficiently and bring their child into this world with the labor team they had chosen. They had prepared for over nine months and together we had talked about what to expect and how to cope and then in a matter of hours their birth plans had dramatically changed and we were all trying to adjust to the new set of parameters for the birth. Psychologically and emotionally it felt like a roller coaster we were all on together. Atleast we had each other for support, but it still felt disappointing, frustrating and scary. The unknown loomed large for all of us and we had to have faith in the local hospital to see us through.

Thankfully, I can report that all three babies and moms fared well and came out healthy and happy after the experiences. Two mothers endured nearly 30 hours of labor and then went on to see their babies for the first time in the arms of a doctor or nurse. One mother's baby decided to come into this world a little too early, but she was ready and able to breathe and all went well with her, also.

These past few experiences have taught me to be flexible, thankful and aware. They have showed me how midwives and doctors need one another and there should be a seamless transfer of care, if needed. I have learned to surrender my objections and use the local, medical community to bring about healthy moms and babies if that is what needs to happen.

As an apprentice I worked with four, different midwives around the country. I remember distinctly one of them gloating about her low rate of transports for the year, as if it were a badge of honor. At the time I thought it was a wonderful compliment to her but now as I walk the journey of the midwife I understand the necessary place transports have in birth. I also greatly understand with these last few transfers that if I had not been willing to swallow my pride and go into the hospital I could've had less than favorable outcomes.

I believe all things happen for a reason and that we stand to learn something from each experience. With each situation I felt a distinct feeling that told me to transfer the moms. I felt I knew them and their babies enough to make the call if things didn't feel right anymore. I trusted in my intuition and listened to my heart while taking into account the parent's desires and fears. That's why midwives have such a wonderful rate of healthy moms and babies; we are present and aware for 9 months of prenatals and we take the time to know each parent's situation and personalities. We have felt the baby's position and heart beat each visit and are mindful of their little, distinct characters. We know the family and the home environment and have a complete picture so that when complications arise we know immediately if we can handle them ourselves at home or if we need to go with them to the hospital. On average each client receives over 13 hours of prenatal care and about 6 or 8 hours of postpartum support at home and in my office. With that much time shared it only seems natural that midwives truly know their clients and their situations.

I am humbled by the wisdom of birth and how each one has its own story to tell, its own path to take and its own wisdom to impart. Each experience deepens my understanding and my intellect for birth, and afterwards, I am amazed by its uniqueness and depth.

As Harriette Hartigan so beautifully put it; "Birth Is As Safe As Life Gets".

We Birth The Way We Live

I recently attended several moms who had their babies within hours of their first pain to holding a baby in their arms. I was surprised by how quickly they went and how efficient their labors were. Both commented on how they imagined their bodies opening up and giving birth easily and smoothly with each contraction. Visual imagery really works!

Another similarity between the women is the way in which they live...the way they carry out their daily parenting and other responsibilities. From my perspective both women have very peaceful, matter of fact ways about them and when it came to pregnancy or other life experiences they kept any drama out. They chose to calmly ride the waves of their lives and their labors and, therefore, gave birth fairly easily and with much intention and very little drama.

At the end of each woman's pregnancy I make a home visit. This gives me a chance to see the woman's surroundings and help her imagine where she will be giving birth in her home and where all of the supplies will be when I need them. I also find this a wonderful time to observe how this woman arranges, decorates and moves within her own space. I can usually tell at the home visit whether this woman will birth quietly and privately or if she'll be someone who needs extra attention and who may choose to complicate herself unknowingly by inviting less than supportive people to her birth.

We have seen in the media since we were children the scenes of dramatic childbirth and how the woman is rescued from her pain or emergency by medical personnel. This has made an imprint of fear on each of us, whether we believe it or not, and it often comes up in homebirth. Women may feel isolated or alone or too far away from a hospital and the quiet midwife in the corner doesn't always satisfy this underlying fear. Some women will be very vocal or dramatic with their contractions or feign exhaustion when in reality they are doing well and their labor is progressing normally.

With homebirth you don't get as much drama. The labor and birth happen without bright lights or clanking instruments or a room full of people. Babies slide out of their mother's bodies with grace and hard work and relative quietness. At homebirth you will hear the songs of birth moms singing their baby's into this world... bringing them down and out. Midwives sit quietly with watchful eyes and quiet hands and are a witness to the miracle unfolding.

As humans who share the same species as mammals, we can birth in a lovely, unscripted way without all of the drama that the media has put upon us. We can trust our bodies and our minds to take care of the birth of our babies without intervention or control by an outside person. We birth the way we live...whether that be in a chaotic, controlling way or in a more gentle, peaceful way. It is up to each woman to decide how she will birth her baby and it is up to me as her midwife to guide and support her on her own journey.

Home birth for financial reasons alone

As the economy gets tighter for most of us and making our monthly incomes stretch further gets more challenging, I have had an increase in women calling and inquiring about my services based upon the fact that home birth is a less expensive option than hospital birth.

Home birth is something you want to feel completely comfortable with, fully engaged in, wholly passionate about...not just something you do because you don't have insurance coverage or because it is the cheapest option.

Most couples begin wrapping their minds around the idea of homebirth by becoming educated about it on the internet or through childbirth books or from word of mouth referrals. They learn that midwife-delivered babies have less interventions and better outcomes. They learn that midwives take an hour during each prenatal visit and build a relationship with the pregnant mom and her family. They see that midwives use prevention to steer away from any possible problems that may arise later in pregnancy and that midwives really get to know the mom/baby and come to truly care about her health and well being.

Home birth is built on a foundation of trust between the parents to be and the midwife. It is a service that is somewhat "old-fashioned" in today's high-tech, lawsuit happy world. It is based upon a hand shake, of sorts, which gives equal responsibility between the two parties involved. Midwives provide the best care they can give with the information and intuition received from the parents, as well. No decisions are made without consulting the parents and every decision is made together and agreed upon. This is why midwives don't have to carry malpractice insurance or worry about being sued. In today's society this type of business relationship is nearly archaic, but so valuable. It brings the responsibility of the baby's pregnancy and birth squarely where it should be: on the parent's and midwife's shoulders. It doesn't allow for women to fall through the cracks or receive marginal care because both parties are engaged, responsible and accountable to each other. In a perfect world this is how all of our dealings would be.

As the general public begins to understand and educate themselves on the advantages of having a personal, caring and trusting relationship with a midwife we will see more positive mom/baby outcomes and possibly a more calm and gentle world. Babies will come into this world without being drugged, suctioned, poked or prodded and will find the arms of their mothers as their first skin to skin interaction. Home birth babies have less incidence of colic, jaundice and a 0% rate of autism. They rarely cry when they are born because the lights are low, voices are quiet, mom and dad are the first sounds they hear and they are welcomed into a room filled with love and peace. Wouldn't it be great if every human being on the planet could be born in such a gentle way?

Having a baby at home is a wonderful option but not just because it is the cheapest option. It entails a commitment and responsibility that parents must be willing to make. It requires being educated and forming a trusting relationship with a midwife who knows the parents and their unique situation. It is a decision that shouldn't be made lightly but one that is life changing and deeply rewarding! I encourage every pregnant mother and father to do the research and become good consumers and make their choices out of knowledge and not out of cultural fear.

Haphazard Prenatal Care

Recently I've heard from women who call me for advice or who are changing from doctors to a midwife's care that providers in St. George are not giving them the prenatal care that they are looking for and deserve. Their recent complaints include; lack of urine testing at each visit, no palpations to find out where their baby's position is, overuse of ultrasound to determine position, lack of any kind of one-on-one with their doctor and just general feelings of "factory like" prenatal care or just plain lack of prenatal care altogther. One woman reported having gestational diabetes but hadn't been tested for glucose in her urine since last April. Another said she would walk out to her car and cry after her visit because she just felt like a "number on a conveyor belt". Women are starting to realize these docs are not giving them the time and thorough care they deserve.

As a midwife who takes an hour or more with each woman and who takes it upon herself to make these women and babies a priority, I am appalled at what is going on in our community! What is happening with the medical system's answer to prenatal care? Where is all of this apathy coming from? I believe it stems from the fact that these doctors are too busy trying to pay for their malpractice insurance and stack themselves too deep with patients trying to pay for it, not to mention, they rely upon the hospital's life-saving measuresto catch the women and babies who don't fare well with the lack of prenatal care.

Here's an example of this: A woman in her twenties chooses one of these popular doctors and goes to him throughout her pregnancy. She goes through the prenatal testing and the ultrasounds and then checks into the hospital near her due date for an induction, most likely. She is a fairly healthy woman with no health problems but becomes another statistic in the hospital due to the interventions of induction, epidural anaesthesia and the like. If she doesn't progress cervically and dilate a centimeter an hour then she may become another woman who undergoes a caesarean or even more likely, become one of the 70+% who has an epidural. If anything should go wrong with her during the labor or delivery the medical staff can perform life-saving measures to save her or her baby's life. The hospital is the doctor's safety net and these doctors feel very comfortable overlooking small things throughout the pregnancy because they know they have full access to the equipment and medications to make things turn out alright in the end. Maybe this is why they don't have any problem cattle-prodding women through prenatal care, knowing full well what lies ahead to cover their negligience.

I don't think docs are doing this on purpose, so to speak. Noone could be that haphazard, could they? They are dealing with mass numbers of women and can only spend so much time with each one, therefore reducing their quality of care dramatically.

The amazing thing to me is that the majority of women are continuing to choose and accept this type of behavior from their doctors. That's what really surprises and disappoints me. As consumers, can't we be a little smarter, demand better care for ourselves and seek out those care providers who will give us what we need?

I have empathy for women who call me or who want to change their care in the middle of their pregnancy, but you get what you choose. If you choose a doctor who spends five mins. with you every few weeks and who doesn't tell you what is going on with your baby or how to eat better and avoid complications, then you have to expect that this same person will treat your labor and delivery very similarily. You are a number to them and dollar signs float over your head as you walk through their office doors. The bottom line for this lack of care is the mighty dollar. I hate to be so blunt but these docs are up against a huge mountain of insurance premiums, leases, hospital privelege percentages, staff salaries, etc.... You are paying their bills in a small way, plain and simple. Its so backwards and negligent to practice with your back against a wall but that's where the American Medical Association has gotten themselves these days.

If you contrast that to a homebirth midwife or any care provider who limits their client base and puts their health and safety as priority number one, then everything changes. No huge overhead, no huge insurance premiums, just a simple, old fashioned, intimate, trusting relationship. Its a no-brainer for me and there are more women who are wising up each year, but doctor based, hospital birth still accounts for the majority in our country today.

The bottom line is you get what you get when you choose your baby-catcher. Whether that be a quality, thorough, un-rushed approach or one which takes the minimum amount of time and concern and has you jumping through preset hoops is all up to you. You are the consumer who pays the doctors or midwives....where will your dollar and pregnancy be spent more wisely?