Maggie’s Birth


Check out this sweet birth from back in January 2012. My daughter had the best feedback. “Aw, it’s Maggie. Wow, mom, you have nice hands.”

Maggie\’s Birth

 

 

 

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July VBAC class!


By request we are doing a 1-day class this month, instead of our usual 3-week series. Saturday, July 30th from 10am-4pm (or maybe 5). We will share a potluck lunch with informal sharing while we eat.

The class is interactive with lots of opportunity to share, process, and learn from each other.

In general, we will cover:
Developing a positive attitude for birth
VBAC safety and myths
Fear releasing, and discussing fears and expectations (of both partners)
Creating your birth space and birth team
The stages of labor (a very detailed discussion and how to progress and cope with each stage)
Positions for labor and birth
Fetal positioning
Pain management
Comfort measures and relaxation
Common complications and remedies
Common interventions
And much more!

The class is $125 per couple ($100 for ICAN of Austin members)

All classes are held at our office at 1825 E 38 1/2 Street.

Taught by:
Brielle Epstein is a Licensed Midwife and has been a doula and childbirth educator for the past 8 years. She is also the Chapter Leader of ICAN of Austin.
Kari Sanders is a Licensed Midwife with over 20 years experience in birth. She has also experienced VBAC and VBA2C in her own pregnancies.

If you have questions or would like to register please email Brielle at brielle@moonstonebirth.com
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Celebrating International Day of the Midwife


Today midwives and supporters around the world gathered for a symbolic “Walk to Durban.” Next month, midwives from around the world will gather in Durban at the ICM Triennial Congress to discuss ensuring that midwives are part of the solution to the global maternity care crisis.

In Austin, nearly 50 midwives and consumers walked a 5k around Town Lake. Many held signs such as “I love my midwife” and “support midwives.” There were lots of new babies in attendance and even a couple very pregnant mamas. I wish I’d thought to take some pictures of the signs, but I was busy wrangling my kids and helping clients with their little ones.

Here’s a picture of one of my favorite babies who was sporting his favorite midwifery shirt.

It was thrilling to see so many people come out to support midwives, and even more thrilling to see the positive reactions from passers-by. But, I also want to use this important day to highlight the problem.

Did you know that while the US spends FAR more on maternity care than any other country, the maternal mortality rate is higher than 40 other industrialized nations?

What do these other nations with lower maternal mortality rates have in common? Well, midwifery care, of course. Not only midwifery care, but an integrated health care system that encourages collaboration between midwives and physicians and provides women with choices about where they birth.

Did you know that the US maternal death rate has doubled over the past 20 years? Is it a coincidence that during that same time period the US cesarean rate has doubled by over 50%?

Just some food for thought. Still, all the excitement today definitely gives me hope that we are slowly changing the world.

 

 

 

 

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HBAC Story: The Birth of Nayeli


The first time I met Piaf was less than a year after the cesarean birth of her daughter, Lluvia. It was the first thing we talked about and we clicked right away being fellow birth junkies. I was honored, 5 years later, to be her midwife, especially because I was still a student. Piaf and I did lots of processing during her pregnancy. She spent many hours doing birth art and working through the emotions connected to Lluvia’s birth. Piaf doesn’t talk about her feelings a lot, and she’s such a strong woman that it’s easy to miss her vulnerabilities, so art was an easier way for her to communicate these feelings.

And now, here’s the story as written by Piaf:

I went into labor at 41 wks. That afternoon, I started having contractions that were pretty close together (about every 2 mins) but they were quite mild. My 5 year old and I went to the grocery store to load up on labor foods and then came home for dinner and I put her to bed. Then I called Brielle, my midwife, but I thought I still had a long time to go. Luckily she came over anyway because things went from totally mild to really intense without warning!

Contractions were still close and pretty soon I felt I wasn’t getting any break between them at all. This was around 9 or 10 pm, I think. While she set up the birth pool, I was lying on the couch and not coping well at all with the ctx. I just didn’t expect it to start so dramatically and have no gradual build up at all.

(BTW, I am a single mom, so my dear friend Brielle was essentially acting as my birth partner, doula and midwife. In retrospect, way too much for one person to handle but she was awesome!!! )

As soon as the pool was ready, I got in right away and still felt like I wasn’t coping that well, but it was definitely better than the couch. I was in the water for the rest of my labor and the only thing that helped was having water poured over my belly. None of the other things I thought I might want to do during labor were even an option to me — walking, singing, crying, bouncing on the ball, nothing! I could only sit in a reclining position in the pool with my head lolling back. I also kept nurturing an escape fantasy of going to the hospital and ending the pain. I kept telling Brielle very calmly that I was ready to go to the hospital now! (Thank goodness we had talked about this before and I had told her not to listen to me if I shld. say this unless there was an actual reason to go. I think knowing her so well made me feel safe enough to ask for this knowing on some level she wasn’t going to fall for my ploy.)

Finally, a little after 7am, I was complete and I started pushing involuntarily. At first I didn’t even realize that’s what was happening, just knew that things were changing. Once I figured it out, I started pushing her out and moved between squatting and reclining in the pool. Her head came down fairly quickly but once it was out, she was stuck. Brielle and the other midwives, Kari & Sasha, told me to get into a different position and I could hear the urgency and I jumped up and pushed as hard as I could. Kari was pulling on her shoulders. I kept waiting for the feeling of the rest of her easily slipping out of me, but I had to push her belly and butt out too before I felt that!

Finally she was out and she wasn’t breathing yet. Which would have been no problem except her cord wasn’t pulsing either from being so compressed on the way out. The midwives told me to puff gently on her nose and mouth and after three of those, she started to cry and pink up. (So two potential complications handled by these amazing women WITHOUT FEAR! I could tell when things were urgent, but because they trusted my body so much, I never felt scared at all.) We could all see why she had gotten stuck — she was huge (10 lbs) and I am not (5 ft.).

But the excitement was not yet over. Once I delivered the placenta, I started to hemorrhage. After exhausting the options at home, we took a short trip to the hospital. I stabilized quickly and we came back home a couple hours later. It was not the peaceful, easy homebirth I had visualized during my pregnancy, but it was wonderful. It did cross my mind to send a birth announcement to the doctor at my first daughter’s birth who told me my hips were too small to deliver her (she was 8 lbs)!

Here’s Nayeli 2 years later (with my daughter)

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VBAC Story: The Birth of Oliver William


Since my last post was about improving hospital-based maternity care, today I’m posting a birth story that is a perfect example of how maternity care should look. Heather hired me as a monitrice because she felt safest in the hospital, but also wanted to take all the necessary steps to prevent an unnecessary cesarean. Her OB and midwives encouraged her to stay home as long as possible to increase her chances of a VBAC. I monitored her and her baby at home like I would a homebirth client, and then a Certified Nurse Midwife took over in the hospital, with a doctor back-up down the hall in case she was needed. Heather was a great homebirth candidate, but she just wasn’t ready for a homebirth, so she did her research and created the birth that was right for her. I also want to add that she was amazing in labor. She gives me a lot of kudos in the story, but really, I hardly did anything. I wasn’t even sure she was in labor until I checked her cervix. At 7-8 centimeters she was chatting between contractions and doing yoga. What a birth warrior! I hope you enjoy her story as much as I did.

The Birth Story of Oliver William

After a traumatic emergency C-Section that was a result of many unnecessary medical interventions (in my opinion) for the birth of my first child, my husband and I were ready to have a different birth experience.  My husband and I search our hearts and came up with a list of things that we would have done differently, then we got to work!  The result of that soul searching and the preparation that followed was a wonderful unmediated VBAC!  Here is Oliver’s story.

I hired Brielle Epstein as my Monitrice.  A Monitrice is basically a Midwife at your home, then when you are ready to go to the hospital she becomes your Doula at the hospital.  This was a perfect compromise for us.  I wanted a Doula but felt a little uncomfortable with the lack of monitoring for the baby if I labored for any length at home.  My doctor recommended that we try to labor at home for as long as possible and I knew that if that was going to work I would need lots of support.  Brielle was a godsend!  The Monitrice service combines Brielle’s Doula experience with her Midwife certification.  A Doula isn’t legally allowed to monitor the baby, but a Midwife can.  So, Brielle was able to set us up for successful labor at home while monitoring the baby’s vital signs, my vital signs and checking my cervix for dilation, Then when we were ready to go to the hospital she followed us there and acted as Doula extraordinaire!

I had been having contractions for a few days, very far apart at first, and not too uncomfortable.  Brielle had mentioned that with VBAC’s this is very normal as the body tries to get the uterus ready by breaking up scar tissue.  I was happy that my body was taking it slowly and allowing me to practice some of the pain coping techniques that I had read about.  (Hypnobirthing, Bradley, Birthing from Within, and Inna May)  I kept texting Brielle with any updates and changes.  On the early afternoon of March 8th they started to get closer together.  By about 5pm they were about 5 minutes apart and becoming more uncomfortable.  I was still able to handle them.  We took a walk around the neighborhood which helped tremendously!  At that time my mom called my cell phone and my husband answered.  She told him to “take me to the hospital right away because I only had a 20% chance of having a successful VBAC!”  I am very glad that my husband didn’t relay that toxic comment to me.  For this birth my husband and I had worked very hard to set up a non-toxic environment, including the people that we invited to help support us.  At this time Brielle decided to come over.  She and her partner Kari arrived and it was a very relaxed atmosphere.  She checked my dilation and I was at about a 4 or 5.  I was extremely happy that I had made it that far without much problem!  My wonderful Mother-In-Law was managing the 2 year old, and everyone seemed calm and relaxed and excited!  Brielle, Kari and my hubby started to fill up the birth tub. By this time the contractions had started to get more intense and I really had to concentrate more.  I tried different positions.  I lost track of time.  I decided that I was ready to go into the birth tub.  The tub really helped with the pain!  I was now getting very vocal which was also very helpful!

At around 12am I felt like I vomited and Brielle checked me and I was about 9 ¾ dilated!  I was thrilled that I had gone so quickly and had been able to manage the pain so far.  We got dressed and went to the hospital.  Brielle and Kari followed us in their car.  I was in a lot of pain on the way to the hospital, but I WASN’T SCARED!  I had no fear.  I trusted that my body, my heart, my mind and the wonderful people surrounding me were all working together to make this VBAC work!  We checked in to the hospital at 12:30am. I yelled at the nurse who was trying to get me to fill out gobs of paperwork, then Kathy the midwife from the OBGYN North practice came.  She had a wonderfully calming energy and although she really didn’t say a word, she was exactly the right person for the job.  She was very good about different positions, and showing me how to push.  Pushing didn’t come easy for me.  It took me a while to figure it out.  About this time I decided that I couldn’t do it, and I needed the epidural.  But still I WASN’T SCARED!  Kathy said that it’s fine if I get the epidural, but that it wouldn’t help because I was already done dilating.  The way she said it made me accept that it was true, and I just put it out of my mind.  I was very loud and Brielle was coaching me on the sounds I was making to help me relax more.  I was moved to the toilet where my husband supported me while kneeling in front of me.  Then my husband turned white as a sheet and Brielle and Kari very calmly said, “Willie, why don’t you get some apple juice.”  I didn’t even realize that he was about to pass out until I looked at him!  There was a seamless transition from hubby to Brielle.  I was now leaning on Brielle while Kari led Willie to get some apple juice.  I was so glad that someone was there to look after my husband.  After what seemed like only 10 seconds my husband came back looking a normal color and took over again! J  We moved back to the bed, and after what seemed like a very long time and many more pushes Oliver was born at 2:30am on March 9th!  Kathy the midwife used lots of olive oil to prevent tearing and I only had a 1st degree.  I had been extremely worried about tearing but I didn’t even feel it!

Oliver was such a champ!  His heart rate stayed regular and he came out looking great!  He was 8lbs 6 oz and 20 inches long.  He nursed right away and we cuddled and nursed for about 2 hours!

The recovery for all of us was easy compared to a c-section.  Most importantly I believe this birth was emotionally healing for both my husband and I.  He was the perfect coach and supporter and I believe that it erased his feelings of guilt that he had from the previous birth.  I also felt healed from my feelings of inadequacy, guilt and fear.  I immediately noticed that as parents we were both more confident, and calm!  Our marriage is better.

This birth was truly an amazing blessing!

 

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Cesarean Epidemic Conclusion: Homebirth is Not the Only Answer


We need to work to improve hospital-based maternity care. There are models in the US and around the world for good maternity care. Yes, there are hospitals that have <15% cesarean rates, high VBAC rates, offer breech and twin vaginal birth, and even hospitals offering water birth. There are doctors and hospital-based midwives who treat pregnant women with respect and offer informed consent.

We need to look at these models and expand them. This means building positive relationships with our local hospitals, no matter how much they make us want to pull our hair out. We need to encourage women to bring information about evidence-based models to their care providers. We need to encourage hospitals to employ midwives so that home birth is not the only option for midwifery care.

Why? Can’t everyone just have a home birth? Well, no, actually. Let’s set aside the issue of risk. Obviously, many women are not home birth candidates. There are women who have health issues and babies with health issues, as well as women who will develop complications during pregnancy. But I want to talk about the women who don’t feel safe at home. This is our reality. Even in countries with high home birth rates, and a midwifery model of care, some women choose to have their babies in the hospital.

It’s where they feel safe. Some women (and their partners) will always feel safest in the hospital. For some women, eliminating fear of childbirth means being in the hospital. We know that women usually can’t dilate or progress in labor unless they feel safe. Ina May’s “Sphincter Law” works both ways. While for many of us, we can’t open up in the hospital with strangers walking in and out and monitors buzzing, for other women, they cannot relax enough to birth at home. I’ve also worked with women who desperately wanted a homebirth, but their partners were not willing to explore the option.

If we want to truly improve outcomes and empower women, then I believe we need to work toward a maternity care system that allows collaborative care, focuses on evidence-based medicine, and encourages women and their families to make educated decisions and take responsibility for their health care decision.

 

 

 

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Cesarean Epidemic, cont’d.


Instead of posting myself today, I’m going to continue the topic, by reposting a comment I received on my first Cesarean Epidemic post. I asked how we can turn this epidemic around, and here’s what one of my favorite birth enthusiasts had to say. (Note: her comments in quotes and my commentary after each quote)

Melek says: “I think an important place to start would be to get an idea of what kind of birth a woman wants. If she wants a natural birth, does she know what it will take on her end to get this? As I learned, it is more than just saying you want one–it takes a lot of work and the willingness to take personal responsibility for so much in your pregnancy. If we know a woman wants a certain type of birth, we can give her a lot of the knowledge and resources necessary to make this happen. For example, if she doesn’t even know, or think to ask, what her doctor’s policy is on going post-dates, she may be staring down the barrel of an induction around 40 weeks when she never even thought of that when she chose her care provider.”

Right on, mama. As Ina May says, “Ask the woman. She will tell you everything you need to know.” The first step is remembering that this is her birth.

“I think also erasing, or at least trying to address, a lot of the fear around childbirth and the unknown would be really helpful. So often a woman’s only information about childbirth may come from mainstream media or people who are all too happy to talk about how painful the experience is and create a lot of fear and anxiety around the whole thing. This can lead to a woman accepting all kinds of interventions she might not otherwise want for fear of not being able to handle the pain of labor. I’m not saying every woman should have to go all natural, but I do think it is important that women are informed on the risks and benefits on all procedures associated with the birth they desire.”

Yup. It’s all about the fear. I like to ask a woman questions, like “why are you afraid of the pain” or “what are you afraid will happen if you do/don’t do xyz.” When we really listen to the woman, we can let her express her fears. Those media and societal messages have penetrating her for her entire life. It makes sense that it will take a while for her to process her programmed beliefs and decide whether or not to let them go. Sometimes this is about needed information, but I think sometimes it’s more about having someone listen without judgment.

“As far as care providers, I think it would do a lot of good if doctors (and midwives) would be really up front with what their practice is comfortable handling. It would be great if they would spell out their policy on going post-dates, when they would consider inducing a woman (whether she asks or they feel it is time and how difficult would it be for a woman to refuse), a woman’s ability to refuse routine prenatal testing and/or ultrasounds. As far as VBACs specifically, I think the post-dates issue is especially important, as well as if they would induce (and how). That can really be important information for a VBAC mom to have. And, of course, you don’t want to have a mom get to the end of her pregnancy and have a VBAC mom, who thought everything was proceeding well and normally, all of a sudden be on a timetable to have her baby. I think if a CP is going to have a policy, that’s fine, but I think they should also be willing and able to explain the rationale behind it, have that be supported by scientific evidence, and be open and honest with their patients so that no one is blindsided.”

Absolutely! One of the most important steps in stopping the epidemic is treating the woman like an intelligent human being, capable of processing information and making good decisions for herself and her baby. She might still choose the option her care provider recommends, but being honest and upfront builds a trusting relationship, necessary for good outcomes.

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The Cesarean Epidemic, Part 3: Positive Birth Stories


In my last post, I discussed the importance of telling our children their birth stories. Today, let’s talk about telling others our birth stories.

When we are pregnant or have just birthed, our hearts are wide open. When people tell negative birth stories, they sink deep down inside us and lurk. Positive birth stories (even if the outcome is not what was planned) fill us with joy and power. They remind us to trust our bodies.

If people grow up hearing positive stories. If women and their partners hear positive stories from coworkers, if you see positive stories on Facebook, if the dominant message becomes ‘birth is normal and beautiful,’ I believe we will see outcomes improve.

Here’s a few ideas for telling and listening to birth stories:

1. Think before you speak. What is your intention in telling this story? Pay attention to your tone. It’s okay to say it was hard or painful, but are your making it sound like torture or a beautiful, challenging journey.

2. As soon as a negative story begins, say “Thank you so much for wanting to share, but right now we are only listening to positive stories.” or “wow, it sounds like your birth was really intense for you, it’s really important for us to focus on our birth right now.”

3. Have compassion for those who have had negative birth stories. Birth is a big deal, and of course they want to share. Sometimes, if a woman (or partner) is unhappy with her birth, she is not ready to hear that there is another way. Meet her where she is at and give her cues to do the same (see #2)

4. Watch lots of positive youtube birth videos and read positive stories. Share them with friends, especially friends who haven’t had kids yet.

 

 

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The Cesarean Epidemic, Part 2: Birthday Birth Stories


So, after an awesome weekend with dear friends and a super fun trip to Old City Park in Dallas, my mind is clear and I’m ready to tackle this issue. A dear client, got me thinking about birthdays and birth stories, so let’s start there. My mother always told me my birth story on my birthday. She didn’t have any political or ideological mission behind it. She just did. Her mother told her birth story to her as well.

When I was pregnant with my first baby, a midwife told me of her family tradition to tell birth stories on a child’s birthday. I loved it! She felt that by telling the story, we would get our children comfortable with the idea of birth.

So every year, on my children’s birthdays, I tell their stories. Sometimes I tell the whole thing in one sitting, but mostly I tell it throughout the day. “Right now, 9 years ago, I didn’t think I could do it anymore, and the midwife didn’t think I was in labor.” “Right now, 9 years ago, I started to push.” My kids love it! I tell it all, not just the pretty parts. I tell about throwing up in the subway grate in NYC in transition, about my midwife not believing I was in labor and telling me I was too loud, about pooping in the tub, about yelling. My daughter isn’t fazed by the ugly parts of birth. Even when she once witnessed a shoulder dystocia and hemorrhage, she stayed totally calm and trusted that it would work (and it did).

I remember a client telling me that she couldn’t ever tell her daughter her birth story because it was so traumatic. We spent a lot of time reframing that idea, and by the time her next baby was born, she could tell both stories from a place of triumph. She told her daughter about how scared she was, and how she didn’t feel in control of her body, and how the doctor made her think her body didn’t work. But she also told her of the excitement of the first contractions, how proud she was to have labored naturally for many hours, how daddy had held her hand and rubbed her back for hours, and how when she saw her for the first time, she fell in love. Then she told her of the journey to a different way, of all she taught her about being a woman and trusting her body. Her daughter got to become part of the story of her mother becoming an empowered woman. And I’m sure when the time comes, no matter where or how she births, her daughter will have an empowered birth.

 

 

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The Cesarean Epidemic


In continuing to discuss VBAC in honor of Cesarean Awareness Month (CAM), I was planning to write about skyrocketing cesarean rates. In my life before kids, I worked in public health, and I always get a little excited when I can merge my two worlds. So, I’ve been mulling this over, but someone else beat me to it, and since her writing is way more eloquent than mine, I’m just going to point you to her blog:

http://wellroundedmama.blogspot.com/2011/04/peek-into-future.html

If you haven’t checked out Kmom’s blog and website, you should. My friends and family tease me about my love of reading and reciting research, but I’ve got nothing on Kmom.

Of course, I do need to offer my own commentary as well. Here’s what I want to explore-how do we fix this? When I first started working in the birth world, I thought I could rescue women. I thought if only every woman could have a smart doula who could empower her with lots of information and defend her against her doctor, we could solve the problem. But as I’ve said before, it’s just not so.

How do we help women to find their power? Trust themselves? Ask questions?

How do we help care providers to be more compassionate? Take more time with women? Practice evidence-based medicine? Stop basing standard of care on time and liability?

I’d love to hear your thoughts on this. And I’ll share mine soon.

 

 

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