Deliverance

de.liv.er.ance

noun
1. the action of being rescued or set free.
   synonyms: liberation, release, delivery.


It never fails. Glen and I will be on our stroll through the grocery store- toddler in the cart and the 2 middles trailing behind, the 6 year old undoubtably asking if he can get an "example" from the cheese section, and the 8 year old complaining of the mundane boringness that is the grocery store.

As we walk the aisles, me having hot flashes and trying my best to not have a meltdown as I am trying to multitask with maintaining my thought process, have a coherent 'what do you want for dinner?' conversation with the husband and create dialogue with the children as to make this wonderful trip a well-rounded, learning adventure (ee-gads!), we run into a familiar face. Glen smiles and says hello, then looks at me and lets me know (as if I don't already know...), "I delivered her." It is doctor-speak at it's finest.

'I delivered her.' Delivered her? Delivered her of what, exactly? Are you Catholic? (Oh wait, yes you are.) Are you a priest? (I did indeed ask him this once. He rolled his eyes at me.) Delivered the baby? Then what did she, the woman, do? She did indeed deliver her baby, did she not?

Glen acknowledged the point behind my dramatics. He asked what I thought was better verbiage. I said, "How about 'caught'?" He then asked- "What about a cesarean birth? Did I 'catch' that baby?" Ok. Fair enough.

Historically- at least in my own circle of midwives- I have noticed that many midwives use the phrase "caught." With that notion, I have delivered three babies in my life, but have caught many.

That phrase is very midwifery-like. And I like the notion of it- thoughtful, sensitive, acknowledging of the primary source of power and labor-  the woman, not the midwife or doctor.
However, are we really just 'catching?' There has been a once or twice where the birth has been so precipitous that I have indeed been nothing more than loving, anticipating, welcoming hands. I have, quite literally, 'caught.' Mom shows up huffing and puffing- the majority of the hard work behind her- complete and pushing. No time for anything other than to catch a baby.

However, that's not the usual work of a midwife. To say that I do nothing more than 'catch' a baby is demeaning. And it's simply not accurate. I hold two lives under my responsibility and care. Monitoring vitals, heart tones, supporting, simply observing, not acting, but being prepared to act as necessary- should there be the need. THAT is a midwife, and then some. So I suppose my own verbiage of 'catching' is no better than 'delivered.'

Words are indeed powerful, and I am always ever so mindful of this. But whether it be 'catch' or 'deliver,' sometimes there is just no word that will do it full justice, in all respects.

What Say You?

Our practice definition of integrated is as follows:

In.te.grat.ed. The combination of separate elements to provide a harmonious, interrelated whole. 

This definition speaks of us, as a doctor and a midwife who are indeed separate elements, who are each independent practitioners, holding different skillsets, knowledge, and experiences, having been trained in vastly varying environments. But, as different as our training may have been, and as contrasting as our individual styles may be (ha!), we do indeed harmoniously practice together (well, perhaps I lie. Harmoniously, not always. Sometimes the boxing gloves nearly come out...) coming to each other to consult, share knowledge, and learn equally from each other. 

But what does that look like for a woman in our care? Patients usually choose one pathway- physician care or midwifery care. Some patients, on occasion, choose to do a blend of both.

Having individual clients allows us to give continuity of care, in a personalized way. I love having my "own" clients, as the relationship that develops between a midwife and the woman and her family is a cornerstone for birth. Understanding,Trust, Respect...which of course go both ways. 

An interesting thing has been happening lately. More and more people are choosing to forego the hospital and they are choosing 'Out-Of-Hospital' birth. Our Out-Of-Hospital birth rate for the coming months has sky-rocketed. Planned birth center and home birth is at an all-time high for us (hmmm...I wonder why?).

With the rising percentage of our patients choosing OOH birth, another interesting thing has begun to happen- patients are asking if their births can be attended by Glen, in addition to myself. And honestly, I go back and forth between whether this is good or bad. On one hand, I'm offended. No seriously. It offends me. I have had more than one client request if Glen can be there...you know, 'just in case.' In a professional, pleasant, but very overt way, I've had to put it out there. A midwife is trained to, and capable of, functioning independently. A midwife specializes in normal birth. A midwife is trained to recognize abnormal and is skilled to intervene when needed and seek a higher level of care, when appropriate. Having a doctor in attendance does not guarantee you a good or better outcome. You are no safer having a doctor at your birth center birth than you are having a midwife attend your birth center birth. And further, let's remember that statistics show that low-risk, healthy women with low-risk, healthy pregnancies have just as good, if not better, outcomes compared to low-risk moms within the hospital, under the care of a doctor. So...again...on one hand it might be looked at as offensive to the midwifery profession or even myself as a midwife. 

But, with my initial emotional feelings pushed aside, is there a positive to families desiring to have their Out-Of-Hospital birth attended by a physician?

Well yes, I suppose there is! Let's think about it: there is a vast demographic of women and their families who may not ever have considered delivering their baby outside of the hospital, who would have otherwise, without a second thought, delivered in the hospital setting (and therefore potentially encountered various restrictions and interventions that may not have been needed). If having a doctor attend their birth- so that they can have an unmedicated birth center waterbirth- opens the gateway for more families to feel comfortable choosing that, then one might argue, Why Not?

So, what say you?

The Countdown Is On

The bank asked us for a 'profit and loss statement.' We looked at each other as if they were speaking Chinese. We've never had one of those. We get our bills, we pay them. We bill for the services we provide. At the end of the year, we send things off to our accountant and magically, wonderfully, our taxes get done. Profit and loss? Hmmm.

Now, we have indeed done a profit and loss statement and I'm thinking I would have been just fine not seeing it all laid out in front of me. Ignorance may indeed be bliss!

Is it December yet? But oh, I suppose the stress, excitement, and anticipation is all part of the whole 'life experience,' eh, so why rush it? I better try and soak up this crazy time for everything it is...for come December, it will be but a memory.

Things are moving along and in about 10 weeks Integrated Women's Wellness should be moving in to our new home. 10 weeks! I can't say I'm feeling real, raw excitement yet. It seems surreal. This project has taken so much time and effort that I'm beginning to have a love-hate relationship with it. There was a point, long ago, that I was excited at the prospect of one day picking out wall colors and stain colors and art and fixtures and stone. Now decision-making feels like a full-time job in itself because the decisions seem to be continual. I'm not complaining. Just laughing at the irony of it. ;)

But with that said- today Glen and I made one of the best choices yet for the new space- we found a sleek, beautiful, leather sofa that pulls out to a queen-size bed. I find that amusing. To heck with the wall colors and fixtures! We care about sleep! Even between appointments or during lunch...we need a place to relax! A queen size bed to lay on...heaven! (Can you tell we are a doctor and a midwife?)

I'm excited about my sofa.



And well, perhaps a bit excited that the countdown is on...

The Birth of Wyatt- A planned homebirth, turned emergency c-section at 35 weeks

I had the honor of being Shelby's midwife throughout a completely normal, uneventful, uncomplicated pregnancy. Our last visit had been a home visit at 35 weeks, discussing the complications of pregnancy and birth, and preparing for her homebirth that would happen in the coming weeks.

The array of vitals and checks were all normal- no contractions, no leaking of fluid or abnormal discharge, blood pressure was great, plenty of fetal movement, ample amniotic fluid, and a fundal height that was within normal limits. Paisley- her daughter that would soon be a big sister- snoozed on the couch as we did our visit in the living room.

On the day that Shelby was 35 weeks and 3 days, I was headed out to Willow to do a 24 hour postpartum visit. The kids were loaded up to come along, and Glen was driving. I checked my messages and saw that there was a message from Shelby. I read the first sentence and immediately knew something was wrong. It said, "We might have a problem..."

Funny how powerful words are...and amazing the bond and relationship that is formed with midwifery care. I had spent nearly 8 months getting to know Shelby and her family. I knew her for her sweet, laid back, nonchalant personality. She never made a big deal about anything. Ever.
And now this...this "We might have a problem." I responded to her message and told her to head to the hospital and that I would let them know she was headed in. I looked at Glen and said to him, "This isn't good. I do not have a good feeling." For the duration of our drive to Willow, I was literally biting my nails. Glen called the hospital for me to let them know that Shelby was on her way. I sent a text to Rebecca (Dr. Wayman) to fill her in and let her know to expect Shelby. I asked her to please let me know what was going on as soon as she knew, and I would be coming in as soon as I was done with my home visit.

Through the flurry of events- calls and texts flying, information being shared- the beauty of it stood apparent to me. Shelby had only known me as her midwife and had not known Dr. Elrod or Dr. Wayman as her care providers. But yet they were on her team. We were a team. It is what I hope for every midwife and for every woman.

As it would be, things were not good. Shelby would very quickly find herself in an emergency c-section (though thankfully not so emergent that general anesthesia was required), at 35 weeks and 3 days.


This is the photo story of the birth of Wyatt- a planned home birth, turned emergency c-section.

Going into the O.R. Not the home waterbirth that was planned, but rather what ended up being needed.

Getting her spinal.

Dr. Wayman supporting Shelby as the spinal is placed, Dr. Elrod watching.

 

 

So full of emotions

 

Dad joins us.

The have a tough time getting baby out.



Still trying

Wyatt is born!



Dr. Elrod comes over and shows Shelby the placenta- Small and circumvallate.

Showing the amniotic membranes.

Sweet baby Wyatt- 3 lbs. 15 oz.

Dad stays with Wyatt as they prepare to transport him to the NICU at Providence.

Mom says hello and goodbye, before Wyatt is taken to the NICU.

And now, just a few weeks later, Wyatt is out of the NICU, thriving at home! (I had a photo of our recent visit at the office but it won't post!) There are so many facets to this story, teaching and reaffirming so much.

Mothers- your instincts and intuition are priceless. Never dismiss it or underestimate it!

Midwives- Always, always listen. Just as it is the same for being a mother, your instincts are one of your most valuable tools!

Care providers- Is this not what we should strive for? An integrated team? Midwives who know, support, and guide normal and healthy- but who are skilled to recognize abnormal and have the back up and collaboration of supportive physicians with a higher level of care.

It's a beautiful thing.

A Strong Foundation

Everyone- everything- needs a strong foundation.

Yesterday morning, in the still of the 2 o' clock hour and in the depth of my deepest sleep- my phone rang. Startled, mentally disheveled with the confusion that your hardest sleep can bring, I answer it. It is the husband of one of my home birth clients. He tells me that Alayna's contractions are 2 minutes apart and that it's time for me to head over. My adrenaline starts pumping. "Do you want to talk to her," he asks? No...I know Alayna and I know it's the real deal. I need to get there. I tell him no, it's ok, I'll head over. Worst case, I say to him, I get there a bit on the early side and set things up and go back later.

We hang up, I get up and begin to collect my things. My phone rings again. I answer. It's my home birth client's husband, telling me that my client is contracting every 2 minutes and they think it's time for me to head over. I am utterly confused. Am I the one losing my mind or is it him? Did we not just have this same conversation?! As he continues to talk, I realize that it is not Alayna's husband, but Meggan's. One of my other home birth clients. I reassure him, I tell him that someone will be right over, but that it will not be me, as minutes before I had committed to another client that had called before him. This is not a scenario that we have not talked about. We have indeed talked about the "what ifs." My clients know that no matter what they will be taken care of. He knows the back up plan. Glen and Tish will go be with them. While he may have been reassured, I can still hear the disappointment in his voice. Just as I am disappointed about the prospect of missing Meggan's birth. I have spent 9 months with these women and this event is monumental for me. I want to be by her side.

I hang up. I am calm, cool, and collected on the outside, but my brain starts to fire, blasting off thoughts. I dash upstairs to wake Glen. My mind is dancing with thoughts and checklist of musts, my mouth seems to be moving in slow-mo and not keeping up with my brain. It dawns on me that it just simply does not make sense to send Glen and Tish to Meggan's house. Meggan has only been a client of mine. She does not know Glen. Alayna, on the other hand, had her last baby with Glen and they have a very good relationship. We decide that Glen and Tish will go to Alayna and I will go to Meggan after all, and call another midwife to assist me.

I get to Meggan's house. The house is so calm, so quiet. I sit on the living room sofa as Meggan sits on the comfy recliner. We chat. I ask her about what she's had to eat and drink, how long her contractions have been happening, if baby is moving....the array of intake questions. But in the quiet and dim living room, mostly I just observe. She says her contractions are terrible, but they seem from my perspective to be but a minor discomfort. She is handling them beautifully. I listen to baby. I take her vitals. Then I ask if she would like to be checked. She says yes. Her husband, Matt, asks me if I would like him to turn the big light on so I can see better. I tell him no, it's ok...there's nothing I need to see...just feel.
I check her right there as she lays on her living room sofa and I find that her cervix is central, thin, and a nice, stretchy 7cm. This is great, I tell her! She goes to get in the shower and I go to text Glen to give him an update. My phone dings with a text message from him. Alayna is 7cm. I find the parallel between these two women- who do not know each other and likely never will- amazing. Two women, connected by the same birth team, doing the same monumental work, at the very same time.

I consider my options of midwives to call. I know that the midwives of Mat-Su Midwifery have clinic in a few hours. They are all very busy themselves. I've never worked with any other midwife other than Mat-Su Midwifery. Though I've never worked with Stella, I decide I'll give her a call. She seems to be a very competent midwife and she seems to bring a very different style than I...but in a good way. I'm curious to see her in action. I call her and she agrees to come assist.

Later, as I carry up the supplies to the bedroom where this sweet baby girl will likely be born, I turn the corner from the stairs leading to the bedroom, and hanging on the wall is a painting of Jesus. It stops me in my tracks. I pause and breathe. It is calming. I feel a sense of relief.

Religion or spirituality had never come up during mine and Meggan's visits. And so seeing that painting reminded me (not just of Jesus...;) of one of the many beauties of home birth- I am in their home. I am a guest in their space. There is much I may not know about them, and so much to learn.

Meggan moves from the shower to the bed. She is getting close. Glen texts me to let me know that they just had a baby- born in the water by candle light, caught by his daddy- and all is well. He asks about Meggan. I tell Meggan, "Glen let me know that the other mom just had her baby. Him and Tish are thinking of you. You are close behind..."

Soon we too had a baby...mom gave birth to a 9 lb. 5 oz. baby girl, in the comfort of her own bed, over an intact perineum, caught by dad.

After the immediate postpartum period and the newborn exam, I thought of the events of the busy morning. I was terribly disappointed in missing Alayna's birth, but so very happy to have gotten to be with Meggan and witness such a beautiful, peaceful birth. I felt in my heart the beauty of when everything works out the way it is meant to be- each mom got the birth team that was meant for her. We each were where we were needed and meant to be.

I thought of the team I have behind me, supporting me, supporting these moms...How much good this team of ours is doing and how much it matters. I could strive to do all of the good that I want, but without my strong birth team and team at the office, I could not do it. Together, we can build on this and continue to grow.

As I did my morning drive to the office, I made my morning ritual glance at our property as I zoomed down Trunk Road. The foundation was set! Ah, the foundation! My heart ached for the significance of that. When someone looks at the foundation do they know how much work and sacrifice went into making it a reality? Do they know what that gray innate concrete symbolizes? It is the foundation of where so much HEART goes into the work that will takes place there...so much life will happen- literally- on that foundation.

It feels so good to have a strong foundation. The sky is the limit.

The Birth of Eli, a Cesarean Birth After 3 Cesareans

Mary came to me desiring midwifery care, but knowing that because she was high risk, she could not ultimately deliver under my care. Wanting the personal care that midwifery care brings, she chose me as her midwife, knowing that I would ultimately turn into her doula for her repeat cesarean birth.

Mary's story is unique, and simply not one for me to tell. It is hers to tell and hopefully share with us someday. At the heart of the story is a mother who had previously experienced three cesarean births resulting in three sick babies- all, simply, born too soon...A cascade of the misuse of technology and intervention, and the foreverness of 'shoulda, coulda, wouldas.' Her previous experiences and her instincts told her that this baby simply needed more time.

Today, at 41+4 weeks, she gave birth via cesarean section to her 4th baby boy. Though this was her 4th c-section, it was a very different experience than her other births.

This is the photo story of her birth.

Filled with emotion, patiently waiting.

Her birth team.

That doctor of hers...

Contemplative.

Happy Mary...

Matt joins us.

Baby Eli

Eli goes immediately over the drape and into his mother's hands.

Mary holds him for the very first time, before anyone else.

Beautiful.

A perfectly designed pillow.

Eli opening his eyes for the first time...and seeing Mom and Dad.

Right where he should be. THIS is how it should be when cesareans are needed...family-centered, gentle, respectful.

The Birth of Aria- A Home Waterbirth

I met Ashley during my first year as a student midwife. She was one of my first "continuities,"- meaning, I saw her throughout her pregnancy and then saw her through her labor, birth, and postpartum period. As with most women and most births I have attended, I learned a lot from Ashley and having the privilege of attending the birth of her first born. We have quite fond memories of her labor with Ryder (most comically told through the storytelling of her mom, Jeffrey), and we can now laugh at the story of how she passed out cold on me (literally, on me...) while going to the bathroom. And through that special and exciting time, we made a connection. She took care of my children on occasion afterward. Glen and I attended her wedding. We kept in touch. Such is the beauty of midwifery care- Personal. Sometimes forever bonding.

I was thrilled when she told me she was pregnant again and wanted me to be her midwife. Just 2 days ago she gave birth to her 2nd baby, Aria.

Here are the photos, telling the story of her home waterbirth...

Laboring in the tub. Ashley was the first mom to use our new portable tub. When she got in for the first time she said, "Just so you know, this feels SO much better!"

Listening to heart tones as mom labors in the water.

Big brother Ryder was around for the entire labor. He got to see the normalcy of birth and what it looks like to see mom work hard, surrounded by her support team.

Laboring mom holding mom's hands.

Hard, strong, exhausting work!

All of the excitement wore the big brother out!

We all get to lay eyes on Aria for the first time.

I love all of the hands in this photo, welcoming beautiful Aria.

Hello sweet baby!

She had such a short cord!

So relaxed.