Midwife Musings: Listening to Birth Stories With an Open Heart

By Rachel Kiene, LM, CPM

The birth of a baby creates a story. Every mother has one for each of her children. In the age of Facebook, many birth stories become public, or at least are shared among a wide circle of friends and acquaintances. Most often, they elicit “likes” and supportive comments from readers. But occasionally, reading a birth narrative in a public forum seems an invitation to offer our perspective, or even criticism of others’ choices.

When I was learning to be a doula, I would hear stories from women who had cesareans or difficult births and immediately think, “What would I have done differently?” The thought was natural. I sought a deeper understanding of the birth process and of how to support women. By identifying avoidable interventions and how they contributed to unwanted outcomes, I hoped to be able to guide my clients more confidently through the challenges of labor and birth. If I could see where things “went wrong”, I might offer thoughts about how things might have been different in a different setting or with a different care provider. But I quickly learned that many women did not welcome the idea that their baby’s birth could have been better.

When we hear or read a birth story, we have a responsibility. How we listen and respond does matter. When we jump to give feedback or to share our own stories, the mother may feel judged or misunderstood. When we listen patiently and choose our responses carefully, we honor the mother’s own healing and learning process.

Each mother’s birth story is a sacred part of her journey into motherhood. The work of bringing her baby into the world affects her identity as a mother. A woman who believes that her baby’s life was saved by surgery or technology has found a way to understand what may have been a negative or even traumatic experience in a positive light. If her friend, trying to be supportive, says, “You didn’t need surgery. You could have birthed your baby if you had been at home with a midwife,” she may hear, “You made the wrong decisions (about place of birth, care provider, when to go to the hospital, etc.) and therefore you caused unnecessary problems for yourself and your baby.” The idea that an epidural or other pain medication may have contributed to birth complications is especially sensitive. The mother may hear, “Your weakness and selfishness caused your baby’s distress/cesarean/vacuum birth/breastfeeding problems/etc.” Since women often share their birth stories in the early days and weeks, these responses may come at a time when she is especially vulnerable and trying to make sense of her experience.

It is very common for women to question the events of their own births. Even a woman who sees her birth as positive may have mixed feelings about some aspects of her experience. As friends, midwives, and doulas, what can we do?

·         DO listen respectfully as she expresses her own thoughts and feelings about her birth.

·         DON’T assume she is dissatisfied with her birth just because it doesn’t meet your ideal.

·         DO answer her questions sensitively and soon return to listening rather than analyzing.

·         DON’T offer your own assessment of “what went wrong”.

·         DO continue to offer friendship and be available when she wants to talk about her birth.

·         DON’T dismiss her feelings of guilt or disappointment, but help her see how she was strong and made the best choices for her baby given the circumstances and the information she had.

·         DO refer her to resources such as the International Cesarean Awareness Network (ICAN), which connect women who have faced similar challenges.

·         DO encourage her to see a trusted care provider or professional counselor if she is experiencing depression or post-traumatic stress disorder (PTSD).  Postpartum Support International has many online resources including "Chat with an Expert" and local resources.

As midwives, we support many women who come to home birth and midwifery care because their previous births were unsatisfying, disappointing, negative, or traumatic. For some of them, the decision to approach birth differently came after months or years of processing. This is an ongoing journey. With a little sensitivity, we can give the mother space to grow into her own wisdom.

Originally Published in Birthstream Newsletter Spring 2015

How Often Do You Need a Pap Test (and did you know midwives can do paps?)

By Rachel Fox-Tierney, LM, CPM

With the beginning of the new year and a newly renewed health insurance plan, my health insurance company sent me a glossy infographic from the CDC letting me know what I can do to "Prevent Cervical Cancer with the Right test at the Right time."  Little do they know that I have in-home Pap tests available to me as a "perk" of being a Birthstream midwife, so I will not need to "talk to my doctor today!"  But the letter was a good reminder to answer the question I often am asked by Birthstream families about when they should get a pap test.

What is a Pap test and why do we do them?  Pap smears, also called Pap Tests, are done to check for early changes in cells in your cervix that could indicate a risk for, or the presence of cervical cancer. HPV (human papilloma virus) screening looks for the specific high risk HPV strains that are associated with increased risk of developing cervical cancer. 

"While in general, the risk of cancer is very low for women in the US, representing only 1.5% of all deaths related to cancer in women, it’s not zero." reminds Aviva Romm, MD.

The American Cancer Society estimates that in 2017 in the US there will be an estimated 12,820 new cases of invasive cervical cancer, and 4,210 cervical cancer-related deaths.  Most cases are present in midlife, in women who have not had regular screening or did not follow up with screening guidelines after an abnormal pap.  If you're not sure what your last pap results were, contact your midwife or doctor and have them send you a copy of the results.

Many of us grew up referring to the pap as our "Annual Exam" because women were recommended to have paps every year.  New guidelines no longer recommend yearly paps.  In part because cervical cancer progresses very slowly, and in 93% of the time requires the presence of one of the high risk HPV strains, so HPV status now plays a bigger role in determining frequency of screening.  But also because, more frequent testing has the possibility of over-treatment which can impact pregnancy and birth.

So how often should YOU have a pap?  According to the American Cancer Society's Guidelines from 2012 (and they haven't changed since then):

  • Women under the age of 21:  NO Paps and NO HPV screening, "HPV is very common in women younger than age 30. Since most HPV that is found in these women will never cause them health problems, it is not useful to test young women for HPV. Most young women will fight off HPV within a few years." according to the CDC.
  • Women 21 -29 years old:  Paps every 3 years, unless abnormal, and NO HPV screening, unless pap is abnormal.
  • Women 30-65 years old:  Paps every 3 years, unless abnormal, or Pap test plus HPV screening every 5 years, IF HPV negative .  Women who are HPV+ will need more frequent pap screening.
  • Women who are over 65 years old:  NO paps or HPV screening, IF they have had normal paps for the previous 10 years and no pap with serious pre-cancerous cells for 20 years.

Individual Considerations:

  • Women who have had a total hysterectomy (uterus and cervix removed):  Stop screening, unless hysterectomy done as a cancer or pre-cancer treatment.  You should consult your MD.
  • Women who have had a hysterectomy without the removal of the cervix:  Screening according to age and risk guidelines above.
  • Women who are high risk for cervical cancer because the have a suppressed immune system or were exposed to DES medication in utero:  May need to be screened more often.
  • Women who have been vaccinated for HPV:  Should be screened according to their age and individual risk guidelines.  The HPV vaccine does not protect against all strains of HPV.
  • Women who are HPV+: Should get pap + HPV screening yearly.

We discuss these guidelines with all of our clients so together we can determine what is the best screening schedule for them given their personal and family history.   We provide pap screening as part of our midwifery care when needed prenatally or postpartum, but we also offer pap screening at any time in a woman's life.

We often get asked,"Can people who aren't Birthstream clients get paps done with you?"  Our answer is, "Of course, because once they use our midwifery service for paps or Well Woman care, then they ARE our clients!  People don't need to have babies with Birthstream in order to enjoy the benefits of in-home Well Woman care!"  

Sometimes medical providers will encourage Pap Screens and describe them as preventative care.  But remember, Pap tests are not really "preventative care", they are "early detection screening tools."  Preventative care is eating a whole food-rich diet, getting walks in the fresh air, having tools for stress management, avoiding smoking and other high risk behaviors, and most of all telling your body what an amazing job it is doing!

There will be some people who do all of the "right things" and still develop cervical cancer because sometimes despite our best efforts we have outcomes that we don't want or expect.  I have cared for people who have developed cervical cancer but have come to the other side, cured in body as well as healed in spirit.  It is possible some times.  So I encourage people to get screened appropriately knowing that I will midwife them through any abnormal results...but likely as is most common, the report will say"within normal limits" or rather as we like to translate "healthy and wonderfully normal cervix!"

If you are interested in having your Pap screen done by a Birthstream midwife, please contact us to schedule an appointment in the comfort and convenience of your own home!


Midwife Musings: Chickens and their Eggs

By Lesley Nelson, LM, CPM

I have four chickens. And they lay the most beautiful eggs – every single day I get three or four little brown, bundled-up, nutritious gifts for myself and family. It's the sweetest thing: going out to the little red coop my daughter and I built (mainly my daughter -she's kinda' awesome), and opening the nest door and finding these perfect presents in a small bed of hay from our happy, hopeful hens. It's such a joy!

I have always felt, since my days as a childbirth educator when I often talked about nutrition for pregnant women, that the egg was the perfect food: inexpensive and chock-full of vitamins, mineral and protien. An average egg has 7 grams of protein, vitamin D, B6, B12, fat soluable vitamins, A, D, and E, and minerals such ass zinc, iron and copper with about 75 calories total. But most recently, eggs are also designated as the number one source of choline, a relatively newly discovered nutrient (1998), which has been found to be especially important for pregnant and nursing mothers as it is essential for normal neural tube formation and brain development. The recommended adequate intake (AI) for choline has been set at 425 mg for women, 450 for pregnant women and 550 for lactating mothers. With one egg containing 125mg of choline and figuring most women get around 300 mg according to the National Institutes of Health they conclude that adding an egg to the diet each day would increase the number of pregnant women meeting the AI from 10% to more than 50%. In addition, choline is found to be key in preventing liver disease, heart disease, and possibly neurological disorders among adults. For women, diets high in choline have recently been associated with a decreased risk for breast cancer.

            So my chickens leave me these delicious,  nutritious packages daily and I gratefully hard-boil, poach, and scramble them and include them with other good-quality ingredients to try to do justice by them.  Organic tomatoes, fresh broccoli, steamed spinach and co-op made sausage goes very well with them, along with a big green salad and greens mixed in for a lovely quiche. Eggs are our go-to for breakfast or dinner. Fresh, clean water, organic chicken feed, sunshine, and dirt or a compost pile to scratch in daily are all that my hens require and in return my family is well-fed – what more can one ask for? I hope that however you go about getting them, that you consider eating eggs daily as part of taking good care of yourself and your family.  And remember to thank the chickens!

Previously Published in Birthstream Newletter Spring 2016

Postpartum Care: Not just for home birth families anymore!

By Rachel Fox-Tierney, LM, CPM

In many countries around the world, new mothers and babies have several midwife visits in the first 4-6 weeks postpartum as a standard benefit of their health care system.  Cross culturally, for 40 days post birth, new mothers are expected to rest and eat special healing foods.  There is wisdom in this 40 day rest time.  Physically, women are better healed and able to resume family and community activities when their six week rest time is completed.

Unfortunately, in the United States new mothers are viewed by society as "back to normal" within a few days after giving birth.  Most American women do not get any preventative medical care during the first 4-6 weeks after birth.  There is little support or evaluation of their physical or emotional adjustment until their 6 week OBGYN visit.

What I truly appreciate about the postpartum care is the fact it was a home visit. In my culture, a month bed rest postpartum was a mandatory custom. It was believed that it would help with postpartum depression and our health in the long run. So without this home visit postpartum care [with my first two hospital births and American postpartum care schedule], I found myself having to sacrifice and assimilate to Western culture by taking a newborn to physician’s office for postpartum checkup. With postpartum care offered by Birthstream Midwifery, I was able to maintain my dignity as Woman of Color and kept my cultural customs in regards to postpartum. I felt so much love and respect. One of the most memorable things I had about the postpartum care was witnessing the beautiful interaction between my midwives and my newborn. How delicate and respectful they were with my newborn when they were performing newborn screen, to the point where my newborn was not traumatized at all. As a third time mom, that ceased my worries and concerns. I would recommend it to all families.
— Client who had two hospital births followed by a home birth with Birthstream

In addition, new mothers are expected to leave the house within a few days of giving birth to get pediatric care for their new baby at a time when they are not yet healed from this major life transition.  It is not surprising then, that as many as 1 in 7 to 1 in 5 women experience postpartum mood disorders in this country.  Although midwifery care alone cannot prevent all postpartum mood disorders, many families have reported that they have felt better emotionally or are able to get the care they needed from mood specialists sooner than after previous births.

My postpartum care with Birthstream was best experience ever. I was able to avoid postpartum depression as I was cared by very supportive and knowledgeable midwives. Birthstream offers their [home birth] clients placenta capsules which was one of the reason I was able to get back on my feet way sooner [than after first birth]. When I had any question or problem they would respond very quickly or even stop by on their way just to provide herbs needed to heal. All of the midwives are very loving and wonderful women, they truly care for you and your baby. If I ever have another child I will definitely call Birthstream.
— Client who had two home births, second with Birthstream

Midwives who attend home births have always included extended (or from our perspective basic and necessary) postpartum care for 6 weeks.  Typically, midwives provide 4-6 visits in the first 6 weeks, some at home and some at the midwives' office.  Birthstream Midwifery Service is unique in that we visit 6 times in the first six weeks and all care is provided in the comfort and convenience of the family's own home.

I felt like you were very available and knowledgeable. You really allowed us as new parents to get situated with a new baby in the way we felt most comfortable and fully supported that, which made the transition as a family much easier. You were also so patient and sweet with our other children.
— Client who had two hospital births, a home birth with another midwife, and last baby at home with Birthstream

In the past few years, several families who planned hospital births have contacted Birthstream to request the kind of postpartum care they would have received if they were giving birth in their home country or the kind of care their home-birthing friends have received with us.   Some families who had standard American postpartum care with previous babies felt that the patchwork of postpartum care that they had to piece together themselves didn't work out as well as they had hoped.

We understand!  Postpartum care from skilled midwives was what all of the Birthstream midwives experienced after we gave birth.  This is the kind of care that we think is beneficial to health and well-being for mother and baby and an essential component of comprehensive midwifery care.

By popular demand, Birthstream created a special Postpartum Care package just for families who give birth in the hospital:

·     One meeting during pregnancy to meet and discuss postpartum care plans.

·     Six scheduled postpartum visits for mother and baby: Day 1, 3, 5, Week 2, 4, and 6...or a personalized schedule, if preferred.  Visits average 60-90 minutes in your own home.

·      24-hour availability for urgent concerns.

·      Breastfeeding support.

·      Postpartum Herbal Kit:  Healing Peri-wash herbs, Manuka Honey, and Happy Ducts tincture for breast health.

·      Keepsake with baby footprints.

·      Placenta encapsulation available for an additional fee.

During each of the 60-90 minute visits, we include a newborn exam and new mother exam.

  • The Newborn Exam includes:  checking baby weight, assessing heart rate and rhythm, evaluating breathing, assessing feeding and diapers.  If there are concerns that we cannot address, we refer to a pediatrician of your choice.
  • The New Mother Exam includes:  checking blood pressure and pulse, assessing postpartum bleeding (lochia), assessing tissue healing (especially if sutures placed), supporting lactation and evaluating emotional and psychological adjustment to new parenthood.  If there are concerns that are outside of our scope of care, we can refer to physicians/specialists.

We have limited space in our calendar for families choosing this Postpartum Care package.  Please contact us if you are interested in finding out more or scheduling a consultation visit.

I often say that while my home birth with Birthstream three years ago was perfect in every way, it was the six weeks of postpartum care — for both me and the baby — that was the best part.

With our older two children, it was a real struggle in the days and weeks after birth to get the baby and ourselves out of the house and to pediatrician and subsequent OB/GYN appointments. I clearly remember the stress it created with our first child, when I was struggling with breastfeeding and in desperate need of sleep, to have to haul her to the doctor for her regular checks, when really what she (and I) wanted to be doing was lying in bed, working on nursing. As a new parent, hearing my daughter cry in the car seat on the way to the doctor’s office was really difficult for me. I worried about my child contracting some ailment from another child in the pediatrician’s waiting room. I often returned home feeling defeated after realizing the pediatrician did not know very much about breastfeeding and to positively facilitate that relationship. Visiting the pediatrician felt like a marked intrusion on our attempt to bond and figure out life together as a family — but, of course, I wanted to make sure my baby was doing okay, so we went.

When we had a second child 21 months later, it was even more logistically difficult to get everyone out of the house for all the appointments in the first six weeks, and many tears were shed in the process. (By my children, but many by me.)

With our third child, we had a beautiful home birth, and it was a wonderful gift to be able to climb into my bed with our newest arrival immediately after her birth. But what was equally wonderful is that, for every check on the baby and me after that, I was welcome to stay in my bed with my baby! It was so freeing to not have to interrupt nursing and sleeping to get ready to drive to the doctor’s office. The wonderful midwives at Birthstream were able to do all of the baby’s assessments, as well as mine, for the entire six weeks. It truly made the postpartum period infinitely more lovely and less stressful than having to leave the house.

Also, the level of care my baby and I received was extraordinary. The midwives are all kind, loving, respectful, and incredibly knowledgeable. I certainly would have benefitted from their vast array of breastfeeding pointers with my first child! Every check that the pediatrician (or my OB/GYN) would have done, they did, just that this time I was in my pajamas.

It was also wonderful how much the midwives included my husband and young children in the visits. Every member of the family felt very included in the process of checking on baby and Mama. The midwives became a part of our family, and I will forever be grateful for all they did to help make this such a beautiful time in our lives.

No matter where you opt to give birth, I cannot recommend more highly utilizing Birthstream for their postpartum services. Their care for you and baby at your house will allow for the most seamless transition into your life as a new family.

I would add a line after the pajamas: The midwives were also available via text or phone call for any questions I had during this time, which provided an extra level of support and reassurance that I would not have had using a pediatrician or my OB/GYN.
— Client who had two hospital births, followed by a home birth with Birthstream

Natural Healing: Garlic Lemonade Recipe by Rachel Fox-Tierney, LM, CPM

Although the sun was out today and the flowers are starting to bloom, we are only halfway through cold and flu season, so this seemed like a perfect time to share this favorite recipe for Garlic Lemonade.  (Actually, I had intended to publish this in the fall, but since I had bronchitis during the holiday season, I was busy making many batches of this recipe for myself and focusing on recovering rather than writing!)

First, I'll say this IS my favorite remedy for nearly everything...with food poisoning and intestinal distress being the the notable exceptions for obvious reasons.  Garlic is antiviral, antibacterial and antifungal.  So all of your bases are covered when your little (and big ones) start a new school year and suddenly spend the first 3 months with a new ailment every other week!  When my oldest was little, we had many tears while I  "strongly encouraged" him to eat raw garlic on a spoonful of honey.  He was usually a good sport but fortunately I found a version of this recipe in a book by Aviva Romm, MD and Midwife  by the time he was in kindergarten.

I have used Garlic Lemonade with all the many typical childhood ailments throughout the years...colds, flu, coughs, ear infections, chickenpox and sore throats (including strep once), often in conjunction with other herbal medicines, but sometimes alone.  My boys have had it so often and recognize that it is my universal remedy for everything that once my younger son was playing a quiz game and was asked, "How do you cure homesickness?"  He said, "Garlic Lemonade" without hesitation and clearly without knowing what "homesickness"meant!

Professionally, I often recommend this recipe to my midwifery clients.  It is safe during pregnancy, although some women find it unappealing if they are overly nauseous.   I recommend it during all their colds, flu, and sinus infections, but also any time they have breast or vaginal infections.  Usually it is received with skepticism, but afterward I frequently hear, "That wasn't as bad as I thought it would be!"  Every year, I get asked for the recipe from  former clients at least a dozen times who remember drinking it during pregnancy for various ailments.

In addition, Garlic Lemonade can be taken with conventional treatments such as antibiotics, OTC medicines, or herbal or holistic medicines, with rare exception.  As always, ask your midwife, primary care provider or children's pediatrician if you have any questions or concerns.  Enjoy and feel better soon!


Garlic Lemonade Recipe

Midwife Musings: Birthstream 2016 Year in Review!

Birthstream families (and midwives) were busy in 2016 growing their families!  As the year came to a close we reflected on all the births we attended and all the new feet we met!  Let's look back on our year...the firsts, the lasts and all the in-betweens.


There were 59 Birthstream Babies:  Girls 30, Boys 29

First babies: 15

Sixth, seventh, eighth...or 10th baby: 7

Second generation home birther:  9  with 3 of those families having both parents born at home!

Smallest baby was 6 lbs 13 oz and the biggest baby was 10 lbs 3 oz!

  • 6 lbs+ 6 babies

  • 7 lbs+ 19 babies

  • 8 lbs+ 20 babies

  • 9 lbs+ 12 babies

  • 10 lbs+ 2 babies

  • with 25% of all babies over 4000 grams (8 lbs 14 oz)!

Vaginal birth after cesarean:  1

Cesarean:  1  = rate of 1.6%

Baby born vaginally when both parents born by c-sec:  1

Breech births:  2, both vaginal and precipitous (very fast)...1 at home, 1 at hospital

Thank you all for sharing your year with us!  We are grateful to be part of those moments as you welcomed new little people into your home.

We look forward to a New Year with Joy and Gratitude...and more babies!


Voices of Our Families: Walk, Walk, Walk by Brittany N, mother of 5 children

Like watching each of my children grow from babies to toddlers to students, each pregnancy has certain predictable stages; but also like the children, each pregnancy comes with its own set of delights and challenges that makes it unique and memorable.  I have experienced varying levels of morning sickness, headaches, heartburn, and discomfort in each of them. During my second pregnancy I had pain that I had not experienced during my first one. It almost felt like my right hip was out of joint all the time. It was a constant nagging irritation. It would intensify into a shooting pain around my pubic bone when performing routine activities that we take for granted in our every-day (non-pregnant) lives, like using one foot to kick the shoe off of the other or carrying just about anything, not just the items Tosi forbad me from carrying, but simple things like a bag of groceries or an 18-month old son. Just like heartburn and the other pregnancy discomforts, it just went away after labor, or maybe the pain just paled in comparison to the awful contractions, either way it was gone.  The problem seemed to come earlier and get more unbearable during my third pregnancy.

A thick pillow-top mattress pad for our bed seemed to offer some relief to get the pain more manageable, but it was still persistent. One of the best forms of relief was lying on my back and having my husband gently pull on each leg for 20-30 seconds. By the end of each pregnancy I was definitely ready for my new little miracle and freedom from the discomfort.

My fourth pregnancy had its own unique “personality” just like with my previous 3 children. At about the halfway point things were going great for the most part. I experienced only mild nausea from weeks 8 to 10 followed by regular headaches (some relief was received thanks to the half cup of coffee Rachel F-T recommended) up to about week 23.  Maybe my body knew I did not have time for anything more extreme while rearing my boys (Matthew, 8, and Joshua, 6) and my busy little Lizzy (3)? The debilitating pelvic pains had not been felt at all to this point.  At about the 24 week mark the hip and pelvic pains suddenly weaseled their way into this near-perfect pregnancy! They were just as severe as they had been before. 16 weeks to go and I was not looking forward to enduring these pains each and every remaining day. Just like that we were back into the routine of my husband pulling my legs at the end of another taxing day in our little paradise. So with a recommendation from Tosi, I set up an appointment with a chiropractor – but in the meantime I began getting up before the kids to walk so I could get that much needed quiet time that a mother needs! 

Despite the cold, rain, mud and fog as well as the initial physical discomfort, I began walking every day. After a week or so I started noticing that my aches were dissipating. So I decided I’d cancel the chiropractor to see if they would permanently go away. Next I realized that I had not been enlisting my husband for the once common leg-pulling routine. On some days a subtle ache would remind me late in the evening that I had forgotten to walk due to the day’s goings on. That helped cause me to be very diligent about my walking regimen. Sometimes my walks would be up and down my hallway or in large circles around my yard with the assistance of a pedometer (I aimed for 955 steps, just 0.45 miles) at 9 O’ Clock at night. At 32 weeks my prenatal log quotes me as saying “I feel amazing - it feels so much better than my last two pregnancies.”  Also, at full term, I gained 8 less pounds than my previous pregnancies. I kept it up right through the 40th week and 4th day when my 3rd baby boy, Gideon Jay, was born on March 28th.  Another “I feel amazing” quote was written on my log soon after he was born, which I totally attribute to my walking.  If we are blessed with additional pregnancies in the future, walking will most assuredly be one of the predictable steps and hopefully the unique and memorable parts include little to no nausea, no headaches, no heartburn and absolutely no pelvic pain.  While I am thrilled to have finally met my wonderful new baby boy, I partially find myself desiring to still be pregnant. I attribute those feelings to not only wanting to avoid having to wean myself from my midwives, but also because I felt so good throughout this pregnancy. What a wonderful blessing it is to be able to cherish and enjoy this miraculous process! 

Voices of Our Families: Prenatal Care with a Midwife Vs. OB by Emma K

Comparing my 1st pregnancy with my 2nd:

Less Stress as a Stay-at-Home Mom and Excellent Home-based Prenatal Care

I can honestly say that this pregnancy has been so much easier and better than my first.  It really has been a fantastic pregnancy.  The lack of stress and hours on my feet has honestly made all the difference.  You would think that with a toddler it would be harder, but I can spend hours reading her books, singing, going for walks to the park, and countless other activities that I feel helped my womb baby adjust to the sounds and activities of our daily life, while giving me the exercise I need to stay fit for an un-medicated home birth.  Yes, the budget has been tight, but family time has been plentiful. I have enjoyed almost every moment of it (I have to say “almost” because yes, there are always toddler meltdowns and refusal-to-nap days, and finals week in which my husband has to be MIA all week long).

Another benefit with this pregnancy has been the prenatal home-visits of my midwives.  Unlike seeing an OB or a midwife in a doctor’s office or clinic, my home birth midwives schedule to see me in my own home.  My toddler can play with her own toys, help take my blood pressure, and even gets the chance to listen to the baby with the fetoscope. The midwives also let her lie down and pretend to do what mommy does, such as get her belly listened to. I don’t have to worry about being exposed to icky germs in a doctor’s office.  If my daughter needs a diaper change, I don’t have to lug my cloth diapers around with me and can change her in the middle of a visit, or sit her on the potty to try on her own.  The visits often last over an hour as we chat about questions and concerns and anything else on my mind at a leisurely pace, unlike traditional doctor’s visits in which I get 5 minutes to try to remember all the questions I have while trying to keep my daughter from opening all the drawers, ripping the paper off the exam table, and climbing the furniture.  I can discuss my natural options without being judged, and get advice on tandem nursing for when baby is born.  The midwives keep a prenatal record and provide information packets to read at my leisure, and all records are kept with me so I can browse them at any time (unlike a doctor’s office at which you must request them and often do not get copies until weeks later).  I can honestly say I have been extremely happy with my choice of home birth this time around, and the reassurance and copies of research studies they have given me have helped me feel even more comfortable with my choice of VBAC (vaginal birth after c-section) at home.  Often I am told of the risks and danger of home birth by friends and relatives, but being within a 10-15 minute drive to a hospital and midwives with plenty of experience transporting to hospitals in emergency, I feel perfectly safe.   

Voices of Our Families: "Catch Class" by J Galvan, dad of 3

Our catch class was at our midwife’s country home. Three other expectant families gathered in her living room, shoes off, snacking and sipping, enjoying the quiet of the fading sunset. Our midwife Tosi coached us through what to expect and though this was my 2nd class (our son was born at home) I was struck by how much I didn’t catch the last time around: how to deal with the cord wrapping around the child (not a big deal), breech births, sounds as indicators of labor, when to call the midwives, and more. This class was as stark contrast to the clinical coldness of the Kaiser birthing class where we were marched into a room with dozens of other families, to be shown a movie. Hollywood tells us that birth is terrifying process, a woman screaming, doctors rushing, and medical equipment beeping and humming in a race against time. Our home birth was a gradual process, beginning with the visits from our midwife (yes, try getting a doctor to do that!) to her visit the day of the birth. No alarms, no beeping, no noise, just the sounds of my wife laboring and the midwives in hushed tones helping her along the way. Midwives in general, and our midwives in particular, are women with so much experience and wisdom about birthing that it amazes me that more folks don’t use their services. Women have been giving birth since we have been human, and midwives tap into that large body of knowledge and celebrate it. They don’t mute it with machines, or negate the process with drugs, but rather explain every step of the process to explain – ‘this is why your body is doing what it is doing’ to the mothers, and to the anxious and sometimes paranoid fathers. These midwives are a living connection to a time that isn’t out of date, but more vibrant and relevant than ever. After the class was over we said our goodbyes. I stood on a quiet road, to my right a creek, to my left a farm field, above me the Easter moon shining down on a glorious Holy Thursday evening.

In the dim moonlight, I made out the figure of our midwife as she pushed a cart containing our birthing tub down an earthen path to my truck. Another father helped me load the tub onto my truck, and at that moment I was transported to a strange time and place, not the past, since I had in my pocket my iPhone, nor the future, as it’s always in shadow, but a combination of all of those eras. If I close my eyes I can remember that quiet road, and I’m writing this so I can never forget it. As we drove home the scenery changed from farm fields bathed in moonlight, to the highway, to concrete, steel and neon civilization. Those surroundings however, don’t matter. From midwives disobeying the Pharaoh’s order to slay the first born children (Exodus 1:15-16) to modern women discovering the joy of bringing new life into their homes amongst family, mothers reclaiming the birthing experience with the help of midwives are keeping alive this link from the past, which stretches to the future and weaves itself through our present. I can’t help but smile knowing we are a small part of this rich tradition. We are blessed. ~ By Jose Galvan, father of 3

Midwife Musings: What It Takes to Be a Midwife by Tosi



By Tosi Marceline, LM, CPM

Yes, I became a midwife because I felt called to it by my community. I, like so many midwives of the 1970s and 1980s had to recreate a model of care that was based in what families needed and what we as birthing mothers wanted for ourselves. We needed passion for our work and compassion and understanding for the women we served. But in order to continue to work as a midwife past the first few years, you needed more than idealism. So, for all the potential midwives among you and those who want a glimpse into the life of a midwife….I hope you enjoy my humorous, yet true (at least for me) view of what it takes to be a midwife with a long career.
What you really need to qualify as a midwife, according to my personal experiences:

1. Can eat anything and have an iron stomach. Must know how to squirrel away non-perishable food in her car for emergencies, or to eat to keep her awake while driving home after a long birth. Additionally, it would be helpful to be able to go long periods of time without any food, as the birthing family forgot to stock up on food for the midwives, or the appointment schedule is so tight that there is no time for lunch.

2. Can sleep anywhere, anytime, anyplace, and function well on little sleep. The floor may sometimes be more comfortable than the couch. You must keep a blanket and pillows in her car for short naps. Must scout out shady parks where naps are possible in hot weather. A park should not have too many ducks, especially if you are sleeping on the grass.

A book is helpful so that the sleeping midwife can put it over her face while she sleeps and needs to avoid looking like a homeless person. Hint: put your car keys in your bra, and don’t try to sleep in your car with the air conditioner running. It also helps to arrive at a social function after a nap so you don’t fall asleep among the non-midwife friends you still might know.

3. Have the bladder of a camel, especially if there is only one bathroom and the lady in labor is using it frequently. Control your drinking and save the coffee until after the birth! Out in rural areas, may need to know how to pee outside.

4. Need a good sense of direction. (Not as big a deal now that we have GPS, but what happens when they don’t work right? Don’t you hate it when they lose the signal?) We don’t want to get lost on the way to a birth or in a large apartment complex where the GPS is of no use.

5. Need a great family support system. Sometimes this means making your child believe that her birthday REALLY moved to Monday. “Honey, I was at a birth yesterday, so it couldn’t have been YOUR birthday. Your birthday must be tomorrow!”

It also helps to have someone who doesn’t think about saying, “Oh, I remember you!” when you call home. Oh, and you need a family that can tune out while you talk about bodily functions on the phone, put on a Thanksgiving dinner for 20 people without you, and put up with placentas in the freezer (or if they fall out on the family members ~ RFT)

6. Need a hefty dose of patience and tolerance. The man who used to greet my midwifery partner, Jan, and I as “Here comes Jam and Toasty!” no longer gets this newsletter so will be unlikely to read this. People DO say the darndest things. Can help a baby be born with a toddler on her lap, can do a prenatal in the middle of a group of small children and/ or household pets. Will allow a kindergartener to give you a new hair-do and be able to explain all the equipment in the prenatal bag to small children. Always must have a retractable measuring tape dedicated to the amusement of 2 year-olds.

7. Be physically fit, able to kneel on hard surfaces, bend for hours doing back massage, able to support or lift women larger than you are during labor, able to contort into impossible positions in small places to catch a baby. Imperative to have a great chiropractor and massage therapist!

8. Be conscious of clothing choices every time you leave your home. Be aware you may be sleeping in these clothes for the next two nights. You might need to go straight to a birth in the clothes you are wearing to your best friend’s wedding, or go to your best friend’s wedding in the clothes you just wore to a birth. Hint: flowered skirts do not show blood as easily as blue jeans and are more appropriate at social functions. Wear clothes that don’t wrinkle too much, keep extra clothes in your car, and remember, a washcloth works pretty well for cleaning your teeth if you forgot to carry a toothbrush in your car.

9. Drink some form of caffeine. This works so much better than Braille driving to get home after a long birth. I used to tell people I could never be a midwife where there weren’t any bumps on the lines in the road to help me get home, but then I discovered coffee! I really don’t know how Mormon midwives do it.☺

Previously Published in Birthstream Newsletter 2013 and in Childbirth Professionals International