Tuesday, September 20, 2016

Moments of a Midwife

Water broke and hour 20 with no action. Tick tock, tick tock...if the damn clock was working, that's what it'd say. That's what is on everyone's mind, anyhow. They know what the birth center regulations say, and that hour 24 seems so near. Sent them to the mall for a walk, but they return with nothing to report. Smiles, yet underlying doubt and discouragement. My best midwife reassurance that there is still "plenty of time," and not to worry. Even if that midwife herself had doubts. An hour later and that 4th time momma labors hard, her first unmedicated birth. Sirens blazing outside in downtown Anchorage and roads surrounding us blocked off. A suspected bomb right down the road. Sirens, fireworks, people in the streets. I reminisce to myself, "This sounds like Haiti." Downtown Anchorage on a Saturday night. We ain't in Palmer anymore, Toto. 

Low quiet noises and that momma repeatedly apologizes for how loud she is being. This is a real-life lesson on our individual Reality and Perception...such a funny thing. Wanting a waterbirth and realizing it ain't for you. That's ok. Pushing past that pain, and a baby boy is born. 
Those parents thanking you for what you've given them, but you being thankful that there are families out there who give you the opportunity.

The very next day, in that very same room, within those 100 year old walls...

First time momma contracting every 2-3 and she means serious business. Partner like a deer in the headlights, looking at anyone, everyone, whoever for reassurance. Little does he know he is probably one of the best support I've ever seen. He asks the midwives, "Are you scared?" He's stone faced serious, but we laugh. I would hope the midwives aren't scared! A room full of strong women, supporting this first time momma. She doesn't bat an eye at the laughter and clatter in the room...she is what we call In The Zone. Mary is primarying- midwife speak for the person primarily responsible and catching the baby- she's front and center. I'm directly behind her on her left, but even more so her proverbial "Right Hand Man." The head comes out and Mary looks at me, and states matter-of-factly, so, so serious, "The.head.is.out." I'm not by any means normally witty- it's a characteristic I seem to have been born without- but it comes out without skipping a beat, "Thanks, I see that." We laugh at that she felt the need to state the obvious. We can pretty much read each others minds, so this makes it even more comical. A baby girl is born, welcomed into the world by the hands of a midwife that I trained, and the hands of her mother and father. The sun shines in through the window. It's 8:58 am and a beautiful Fall day in Alaska. 

I've been up for two days straight...but all I can think is...
This. Right. Here. 

Wednesday, July 13, 2016

50 Questions For Your Dr./Midwife When Planning a Birth Center Delivery

 At Integrated Women's Wellness & Center for Birth, we offer a monthly Birth Center Orientation class, to give new and potential clients the opportunity to learn about our free-standing birth center, the services we offer, and what to expect when you have a baby with us!

Here is a list of questions that might be helpful in interviewing or getting to know your doctor or midwife! 

Pregnancy

1. What is your philosophy regarding pregnancy and birth? What is your role during the pregnancy and birth of your clients? 

2. How long have you been a midwife/doctor and how many births have you attended? 

3.  Have you ever had a mom or baby die under your care? (What is the maternal and infant mortality rate?) What was the situation? 

4. Who is on your birth team? How many midwives or obstetricians? Do you have students? Nurses? Medical Assistants? Who will attend my birth? Do I have a say in my birth team? Will I be certain to have you attend my birth? 

5. How many births do you attend per month? Do you have a cut-off for the amount of clients you accept? 

6. How many women are under the care of one midwife or doctor at a time? How much will you be with me throughout my labor? Will anyone else be providing care to me or supporting me during labor?

7. What happens if I go into labor at the same time as another mom? 

8. What does a typical prenatal appointment consist of? How often will I be seen? How long is each appointment? Who can be present for my appointments? 

9. How do I get in touch with you after hours? Can I call or email you with any questions? 

10. What are your thoughts on weight gain, nutrition, and supplements during pregnancy? Are you familiar with alternative and complementary therapies such as essential oils, homeopathy, acupuncture, massage therapy, chiropractic care, etc.? How, if at all, are these a part of your practice? 

11. What are some reasons, as well as the most common reasons, why a client "risks out" of your care? What can you do to help me avoid "risking out?"

12.  Do you offer childbirth classes? Any other educational offerings? What is the cost? 

13. What prenatal testing do you recommend and why? 

14. Do you recommend or offer GBS testing? If so, do you offer any treatment for GBS positive moms? What? 

15. Do you recommend ultrasounds? When, why? Who performs them? 

16. Do you typically do vaginal/cervical/pelvic exams prenatally? If so, when and why? 

Labor

17. What happens if I deliver early? How early can I be and still deliver with you? What happens if I go late? How late can I be and still deliver with you? 

18. What would happen if I had pre-term labor? What would happen if I went past my due date? What testing is available and when would it begin? 

19. Do you do vaginal exams during labor? If so, when and why? 

20. What type of monitoring do you do during labor? How often? For how long? What are you looking for and why?
21. Will I get an IV in labor? When would I need one? How often do you place IVs? 
22. What are my options for pain relief? 
23. Is waterbirth available? What percentage of the births you attend are waterbirths? 
24. Am I and the baby still able be monitored while I'm in the water? 
25. Are you comfortable working alongside others such as a doula or birth photographer? 
26. What kind of circumstances would you recommend induction for? Are you able to offer natural methods of induction? If I had to have a hospital induction, would you be with me? 
27. If my water breaks first, without me being in labor, how long do I have to get into active labor naturally? 
28. How long can my water be broken when I'm in labor? How long can I be in labor? 
29. Who attends births? (Other providers, apprentices, students, nurses, medical assistants?)
30. Do you ever artificially break water? Under what circumstances? How is this done? 
31. What is the percentage of moms who need to transport in labor to the hospital? What is the most common reason? What does that scenario look like? 

32. What is your episiotomy rate? 

33. What is your cesarean section rate? 

34. What is your postpartum infection rate? 

35. Can I eat and drink in labor? Do you provide food? 
36. What positions are an option during labor and birth? Would there be any restrictions on what I am able to do? 
37. What are the reasons why a transport to the hospital would be necessary? Which hospital do you use? Why? 

Postpartum & Newborn Care

38. Do you practice active management or expectant management of the 3rd stage, and why?
39. How long do you allow for the delivery of the placenta? Do you offer delayed cord clamping? If so, what is your definition of delayed cord clamping? Do you offer cord burning? Do you offer placental encapsulation, or can you refer me to someone who does? 
40. What if I tear and require stitches? Are you able to repair a laceration? What if I have an extensive tear such as a 3rd or 4th degree laceration? 
41. How long is the typical stay after birth? What is the soonest I can go home? What is the longest I can stay? What post-partum care do you provide? When? How many appointments?
42. What does newborn care consist of? When and where does this occur? Under what circumstances would my newborn need to be taken away from me?
43. Are you trained in and do you hold a current certification in Neonatal Resuscitation? Is everyone on your birth team trained and certified in neonatal resuscitation? 
44. Are you trained in and do you hold a current CPR or BLS certification? Is everyone on your birth team trained and certified in CPR/BLS? 
45. How often do you perform resuscitation efforts on a newborn? 
46. What resuscitation equipment do you have? 
47. What newborn testing and/or procedures do you recommend? What is available at the center? 
48. Are you comfortable with me declining any recommended testing or procedures? 
49. Do you offer breastfeeding support?
50. Do you offer continued care or support, beyond the first few weeks postpartum? 

Can you think of any thing else to add to this list when interviewing or getting to know your doctor or midwife?