When do I call the midwife?
When your body gives signals that your birthing time is near, you usually put the midwife on alert. We know that your midwife is the "safe" space for a natural healthy birth. Having contractions does not mean you are in labor. Labor begins with active opening of the cervix. Doctors are now saying that active labor begins when you are 6 centimeters open.
So there is a time when all women will work with their labor at home before they come to the birthing center or call the midwife to come. Usually when the contractions are 3-5 minutes, lasting a minute, and strong.
Born in a Truck- 5/11/2019
Not every birth will go exactly as planned. Our vision for Harris was a peaceful waterbirth. His parents had spent months planning for this event. Mom had prepared with nutrition, reading, planning the details, and listening to Christian hypnobirthing tapes to keep her faith strong. She used hpnobabies to change the "trauma paradigm" from her first birth.
We knew Harris was a big baby as we approached his due season. Finally, one morning, the waters broke. Soon after, contractions were every 3 minutes. Mom was working with them and it was apparent she would deliver soon. However we had a glitch with the filling of the tub. We boiled water but still couldn't get it warm enough for relaxation. We moved to the bed. But it was too soft. Before we knew it Harris's strong heart beat sitting in the 150's started to go down to 70 during contractions. We were close, but not close enough. There was a sense he was strangling on his umbilical cord during contractions. I said a silent prayer the cord would stretch. We changed positions. Baby was still high. Just a Plus one station. We seemed to be getting no descent. We decided after 20 plus minutes trying to push that we should drive to the hospital since the bed was too soft to give any traction. Squatting, standing... nothing was working for mom to get the traction she needed. We headed to the truck.
Once mom climbed in the truck, hanging on to the handle, baby dropped and we could see his blonde hair peaking through the perineum. Heart tones were 140. He was born quickly after that with a tight nuchal cord that wouldn't reduce, and some tight shoulders. He was limp and required a bit of resuscitation. But over all he did come around. He was breast feeding within and hour.
Not every birth is perfect. Sometimes there are moments that don't just take our breath away, but we find ourselves holding our breath. A birth that may give a midwife gray hair. But his family has a great birth story. We praise God for sending his angels to be with us. Oh yes.... Did I mention he was 11 lbs 2 oz? Maybe that was why a soft bed, floating in a large tub of cold water, squatting, standing, and holding onto a pole to push wasn't working. She needed the gravity of holding the handle, hanging a moment, and the firm contours of the back seat of a large pickup Truck! Texas Style!
Group B Strep August 2018
GBS is a normal intestinal bacteria that sometimes colonizes the genital tract. But three of 100 babies born to women who test positive for GBS can become very sick. GBS illness in a baby may include a blood infection, spinal cord infection, and possible meningitis. A baby can die, and or have brain damage from a serious infection.
The CDC recommends Penicillin in labor for mothers who test positive for GBS. That means 97 mothers and babies will be treated for GBS and exposed to antibiotics who did not need it. There are babies who will become sick from GBS, who have received antibiotics. There are babies who will become sick who have not received antibiotics. Antibiotics are currently our best tool for prevention of GBS transmission during labor. It decreases a baby's risk of getting sick from GBS by 1%. The risk goes down from 3 babies getting sick per 100 babies to 2 babies. Our other concern is that needless antiobiotics create antbiotic resistance and add to the pandemic of antiobiotic resistant infections. Currently 700,000 people a year die from infections resistant to antibiotics. We want what is best for baby.
Prolonged rupture of membranes increases the risk of GBS illness in the newborn. The longer the membranes are ruptured, the bigger the risk for any infection.
Breast milk breaks down the GBS colonies. We strongly encourage breastfeeding. However, A true GBS infection requires a NICU stay and antibiotics for up to 10 DAYS to try and prevent a possible bad out come such as menigitis or death.
If your water breaks and you are not in advanced labor, and you are GBS positive, the CDC states Penicillin is absolutely indicated. A TRANSFER TO THE HOSPITAL FOR ANTIBIOTICS IS INDICATED if you are one of the 10% of women whose water breaks before labor and you are allergic to penicillin. The longer the bag of water is ruptured before delivery, the longer the exposure to GBS, and therefore the more likely a baby is to get sick. It is CDC recommendation to be treated in labor weather or not your bag of water is broken.
If you are allergic to penicillin or do not want antibiotics in labor, we strongly suggest you begin taking probiotics in your first trimester of pregnancy. Probiotics offer the opportunity to colonize the vagina with good bacteria and down play the Group B Strep bacteria or to kill it off entirely.
Start immediately in the first trimester of pregnancy; and by 28 weeks start inserting a lactobacillus probiotic in your vagina once a week. IT TAKES TIME TO CHANGE THE BACTERIA LIVING IN YOUR INTESTINAL TRACT. IT IS IMPORTANT TO START ONCE YOU KNOW YOU ARE PREGNANT. The goal is for the probiotics to grow in your vagina and intestinal tract to prevent the GBS from being dominant at the time of birth.
Vaginal washes in labor with hibiclense have not been shown to decrease the risk of GBS transmission according to studies. We encourage all women to start taking the probiotics in their first trimester.
Post Partum Depression-What can I do to offset depression after my baby comes? 4/28/18
The actual act of giving birth is the easy part of parenthood. Once you have a beautiful baby in your arms there are a myriad of changes. Some women have longed for a precious baby, or are " natural" mothers. They seem to flow with the changes in their sleep patterns and revel in having a little human that can't be left alone, who tends to cry a lot. They breeze through the sore nipples and are seemingly over the moon in love with their baby. Happy to be a mother. Smiliing all of the time! Not everyone has that experience.
It isn't easy adding a new family member to the household wether this is your first or your fifth baby. While there is something magical, and beautiful holding and nursing your little baby, the lack of sleep and the feeling you must be there constantly because baby needs you can cause some post partum blues. Not to mention the hormonal shifts happening right after birth.
Feeling a little blue, or even like the world might cave in on you in the first week or so is somewhat normal. These blues should generally be gone by six weeks. You feel a little sad, a little isolated, but no thoughts of harming your self or baby. You might be irritable.
True post partum depression makes it difficult to get out of bed and begin your day. Symptoms range from depression and irritability to just plain old feeling miserable, and hopeless. This type of depression is long lasting and worsens over time. Seek Medical help. Tell your care provider. Seek a counselor.
There are several things you can do to help mitigate the feelings of post partum blues. Join a parenting group, seek out other mothers and make friends. Talk about what you are feeling. Start an exercise regimen. Get out in the sunshine. Most of us in the South don't really get outside enough to get the correct amount of vitamin D, so talk to your health care provider about vitamin D supplementation. Continue to take your Omega 3's especially in the form of krill oil and or fish oil's. Eat a healthy well balanced diet. Eat! Not eating for 6-8 hours can cause energy levels to plummet and create a metabolic shift that leans toward "crying spells". Placenta encapsulation appears to help with the irritability and moodiness that hormonal shifts can cause. Other modalities: Accupuncture, massage, warm baths, taking time for yourself and letting a friend, or your mother, or your significant other watch baby for short periods so that you can have free time is essential.
While these are suggestions- if you feel your feelings are getting more hopeless, sad and blue Please tell your provider and seek out counseling from a professional.
Molly Crenshaw is available for counseling 512-864-4216
See her web site at Deepcounselinggeorgetown.com
WE LOVE DOULA's
If we have a doula, what does the midwife do? 2/7/2018
A husband and wife came to interview for the possibility of a birth center water birth from Burnet, Texas. Toward the end of the interview the husband asked, "if you have a doula, what does the midwife do?" Well perhaps that husband was from Killeen or Temple, I can't quite remember. His questions was inspiring and had me thinking. What is the difference between a midwife and a doula?
The midwife is the guardian of a safe happy home birth. A midwife isn't magic and can't change karma. She can't eat for you. She can't exercise for you. She can't change your behaviour. She can't even get in your mind and change how you feel about your birth. But she can walk beside you and help you create your healthy birth experience. She can offer healthy choices for your particular circumstances. It's up to you to follow through.
If you aren't healthy, or if your baby is born with issues that require hospitalization...then the home birth experience might not be the best option.
Your midwife is walking beside you, guiding you on healthy choices. For example- The placenta delivers oxygen and nutrients to your baby. Where do these nutrients come from? Of course you would answer "diet and good habits". For good oxygen exchange between you and your baby, it requires iron rich blood. Iron creates the hemoglobin that carries the oxygen molecules to your baby. Hence why the midwife offers the testing of your hgb and hematocrit and may suggest iron rich foods, or even iron pills. A doula may support that with education, but it is not her primary role.
Placenta's require protein, antioxidants, and various vitamins for health. For instance, the placenta is mostly vascular. Baby's blood vessels form a beautiful tree that intersperse through the protein material interacting with layers of tissue. Collagen and vitamin C make up strong healthy membranes to prevent premature rupture of the membranes. Bioflavanoids and vitamin C make for strong healthy blood vessels for the baby.
A strong healthy placenta makes for a healthy growing baby. The goal is a strong heart beat in labor. No fetal distress. And there fore no transport.
But, your midwife can't eat for you. All she can do is guide you to healthy choices. She has to guide you into changing habits. Prenatal care is about choices, and a healthy life style. It's also about developing trust in the birthing process and trust in the one holding the space for you during labor.
As a woman lives, so shall she give birth. If there are issues in the marriage, if your husband isn't as supportive as you wished he was, or if he is having an affair, this adds up to a long hard labor. Many women don't want to talk about these issues, but they are important to talk about before the birth. Or if you had an epidural with your first birth, and "it didn't take well"... the midwife encourages you to prepare for the sensations of birth which can be very intense, maybe even painful. So the midwife is like a counselor all the while assessing your health because after all we want a beautiful, easy, healthy birth for mother and baby. This is why prenatal visits last about an hour.
This all weighs heavily on the midwife. Each woman is going to have a unique experience. The midwife keeps guiding you toward health. Offering the lab tests. Offering advice.
During birth, the midwife's primary responsibility is the health and safety of mother and baby.
We listen before during and after two contractions to be sure baby's heart beat is strong and healthy duriing the "stressful" part of labor i.e. the contraction. We listen for the pattern of the FHR. Does baby move and the heart rate raise 15 or more beats. That tells the midwife that baby is well oxygenated in this moment. In otherwords, the midwife has specialized knowlege that she is using to assess mother's health and that of baby through out the birth. That is a knowlege the doula does not have. The doula is working toward a comforable, beautiful birth, but she doesn't have the health knowlege the midwife has. In partnership a doula and midwife meet all of a woman's needs in labor along with her partner whom whe loves.
The midwife uses her knowlege to prevent tears of the perineum during the birth process, or to sew them up. Yes, your husband can catch your baby, but he doesn't know how to prevent tearing. In otherwords the midwife does everything to help mother be happy, to heal well, initiate a good breastfeeding relationship... and she continues that guardianship into the post partum for the next few weeks.
The doula is a great adjunct. The doula is supportive. She offers emotional and physical support that is always available to mom. She is working toward your vaginal birth by supporting you and your husband in emotional and physical ways.
I used to believe that I was a good doula and a good midwife. I also worked in the hospital. The fetal monitor did all of the monitoring and nurses were writing down the heart rate. However, at home, while rubbing mom's back, I would get interrupted to listen to baby's heart beat, or give a homeopathic remedy. I couldn't do everything. When I worked in the hospital as midwife, I could doula really well, because the nurses were monitoring baby... or there was continuous monitoring and I could continously hear the baby's heart beat while I rubbed a back or gave a reiki energy session. But, at home, that is not the case.
That dad has no idea that the role of the midwife and the role of the doula are not interchangeable. The doula is there for mom's and dad's physical and emotional comfort. The midwife is assessing for the continuous health of mom and baby. The midwife is watching for medical issues in both mother and baby during pregnancy, birth and the first few post partum days.
The midwife's goal is something Reba Rubin coined back in the 1950's: " Safe Passage" for mother and baby while supporting a joyous beautiful birthing. It is a completely different role from a doula. They compliment one another.
Yours in wonderful waiting....
Sandra Tallbear 2/7/2018