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An Unsatisfying Birth Story.

Tonight I am the fish tank.

I’m sitting right where I was told to wait.  In a small waiting room in a small hospital in a medium size city in the southern United States. A large inscription painted on an otherwise barren wall gives testimony to the idea of “patient centered care” in an inspiring font.  “Patient-centered care” is a technical term that is harder to grasp than grains of sand, or dust in the wind.  It is used in brochures (the google search yields about 1,700,000 results) and on bill-boards. It is tidily wrapped into inspirational sayings and painted on walls in a font that says, “whatever you feel right now, whatever your experience is right now, we thought we could be different for you but somehow it just isn’t working out that way, so you have to sit there, tortured by trying to reconcile this inspirational quote with how sore and sweaty your back is from sitting in that vinyl chair for so many hours.”

A group of staff walk down the hall and in through the double swinging doors that make a click-click-whoosh-click sound as they open by air compression and close neatly behind them.  They pass me but see through me.  No one nods, or smiles, or seems to be aware of me, sitting there, so close that as they pass I can smell the coffee held in balance by the one with a short white coat.  I feel like a fish tank.  I wonder what year are they taught to lose human decency in medical school.  I start to picture the class where it is stripped away and gaze at the wall, at that saying.

“Patient-centered care” is bantered about at policy meetings at the clinic, hospital, county, and national levels. It means something different in each healthcare setting and to each provider and to every patient. The idea is wonderful of course, that somehow care can revolve around a patient, meeting them where they are at and providing clustered services to avoid duplication of tests, procedures, or appointments.  Providers hope that it will mean they are doing a “better” job. Nurses hope it will be the magic cure to those insipid patient evaluations.  Community-based healthcare settings hope it will demonstrate that they got it right when no one else could. Patients hope they will finally be heard and cared for in a relevant way and that they will be seen by a doctor who remembers them and cares about their well-being.  I am staring at that quote, and I can’t find the truth anywhere in it.

A woman I provided prenatal care for is less than a hundred feet away in an OB triage room. To say I provided care for her doesn’t really cover what developed and bloomed over the course of her relationship-based care. She arrived in care with a non-pregnancy related health complication that threatened to fester into a full obstetric emergency. It was preventable and reversible but the model of healthcare she was accustomed to had taught her that she would not get help for it until it was pathological. Accordingly, she had put off calling anyone for an appointment.  When she did call, she learned the clinic she went to for an early pregnancy appointment would not see her because she did not make a subsequent appointment for too long of an interval.  She then called several other obstetrician offices and was told by all that she could not establish care because she was so far along in her pregnancy (because you shouldn’t be really pregnant and need to see an OB–and yes, this is city-wide policy).  She found us and asked if we would just see her once to make sure the baby was okay.  When I responded, “Yes, and we will see you and make a plan so that you can access the kind of care you prefer for yourself for the rest of your pregnancy,” she immediately scheduled an appointment. Over the next half of her pregnancy, we learned together and she embraced the process of lifestyle changes. She got support from her family.  She got really, really healthy.

I worked hard to support her and ensure she felt heard and understood and had access to information that made sense to her. Over time the light in her eyes, glowing skin, and great energy were easy to see as she arrived for appointments and settled in for a long discussion. She shared her thoughts and concerns about parenting, education, birthing safely and breastfeeding. She regressed herself back down from the dangerous outcome she may have seemed “destined” to arrive at if we only looked at her black skin, her economic status, and what the data from the healthcare system has demonstrated we ought to believe.

We have accomplished the best that continuity of carer has to offer. I know she is not inherently broken or incapable of good health.  I believe that time, dignity, and education make almost everything possible. I know the feel of her pulse, the sound of her heart, and the slope of her belly. I have spoken with her baby as he’s grown and promised him we would take care with his mom. I taught her daughter to use a stethoscope and a doppler and how to measure a growing uterus. I settled into the comfortable rhythm of providing care for a woman through her pregnancy. I felt proud to work with this family and so fortunate to be able to learn from and with her.  We shared space where this mother understood without question that I was hers for the duration and she would never be allowed to progress to pathological anything.

Her plan all along was to birth in a hospital. In this city, unlike the one where I trained and practiced for so many years, that path is not open. I asked for help.  I asked for a special pass. I justified why she deserved our care and theirs for no other reason than it was her choice.  I didn’t use words like, “it is her fundamental human right to choose,” but it is.  Knocking on the doors of resource-wealthy hospitals who do not support community-based providers is an abject lesson in shame and humility.  There are walls everywhere. Our value to families and the value of the lives of mothers like this one slip through fingers like grains of sand, like dust in the wind. Luckily, we found a “yes.”  A doctor took this mom into care and from that point forward always treated her with kindness.  But this doctor works behind the walls in a system that obfuscates best intentions and patient desires at every turn.

Back in the waiting room, after two hours of sweating in the vinyl chair, staring at that ridiculous font, waiting to go back to see this mom, I approached the nurses’ station.  The desk sits behind a wall of sanded glass with a two-inch opening.  The windows don’t slide which forces me to peek through, trying to get the nurse’s attention by making odd bird-like movements.  I felt foolish and reduced. I wondered how she was reconciling my pecking head motions with that quote on the wall behind me, both within her limited line of sight.  I felt like a grain of sand, like dust in the wind, like the fish tank.  I’m right there but completely unseen. Or unacknowledged.  I wondered what kind of threat they must perceive the community is to them that they need a window built like this?  I wondered how a community that is always treated as though they are a danger ever has a chance of being seen for their intrinsic value as fellow humans with windows built like this.

I wondered why anyone is asking about the cause of maternal mortality anymore, it’s right there in all the obfuscated inches on either side of that opening.  It was an undignified and inhumane moment.  I introduced myself as the mom’s midwife and asked if I could go back and say goodnight.  I explained I was not intending to stay but had arrived two hours ago to check in with the mom. Her eyebrow flew up (maybe both did but I could only see the one through those two inches).  With a snort she said just to wait a bit longer, when she got the mom into a room I would be allowed to go and see her. In the event you have not waited outside an OB unit, “when we get her into a room you will be allowed back” is a thinly veiled euphemism for “we have the power, no,”

The nurses didn’t know that I’ve sat in that chair before as an out-of-hospital provider for pregnancy care in a system where midwives were not fully known or accepted.  They didn’t know I’d sat there as a doula for years before that (long before doulas were a thing), taking the accusatory looks and stare-downs.  They didn’t know that their whispers, and their odd procession, one by one, to the obscured glass to try to catch a glimpse of the midwife, of the “other” in their space was so familiar to me.  Tonight, I am the fish tank.  They didn’t know that while humiliating, that attitude is so well known to me and that I know so fully the only remedy for it.  To demonstrate who I am in that space—to let them be like grains of sand, like dust in the wind, as I care for a mother without interfering in their work.  They peer, their faces warped through the glass, as they hold their space on that side to show me I have no place and no purpose in their world.  They ignore the family’s requests for my presence. I know this because the mother is texting me.  She is afraid, and I reassure her, I am here, I am here.  I reassure myself, I am here, I am here.

When I am eventually taken back, I find her rigid with fear.  I sit by her and breathe with her.  She surrenders.  She is contracting hard and responds to the comfort measures I provide to ease her labor.  The nurses see what I knew they would: how we trust and know each other, and how very little interest I have in speaking for the mother or telling them how to do their jobs.  How very much my heart is linked to hers because of the work we’ve done up to that point.  They don’t know it was me who said yes in a city full of no.  They don’t know it was her who said yes back to me.  They don’t know how seriously I take that.  They don’t know she would be high risk and at risk if it wasn’t for the work we did together.  They don’t know how we’ve laughed together. I find my focus and let the nurses slide into the background.  They are grains in the sand, they are dust in the wind.  This is the mother’s moment and I am with her there holding her hand, helping her breathe and move and use her body to birth her baby.  The truth rises and the feeling in the room shifts.  They maintain their position of power and can look from afar at the one willing and even happy to stay up all night, wiping sweat and vomit, listening, hearing, believing, trying to help her find her way to her baby.  They touch without permission, do without explaining, yell as they see fit.  The doctor comes in for the last hour of her pregnancy and she is kind and speaks gently when needed and firmly when needed. She uses her best skills.  She does everything right in a system that is not built for her success as a clinician. She rises up to the font of that inspirational quote.  Does it balance what transpired in the hours leading up to this moment?  I really do not know the answer to that, and it all melts away for a few moments as I watch the new mom hold her baby for the first time.

I help her nurse and watch as they get to know each other and when they settle in to sleep, head out into the rising sun.  I sit over coffee and reflect on the care and the collaboration which provided the access this mother wanted.  I think about all women as I consider this one woman.  I think about one women when I consider what all women deserve.  No more grains of sand, no more dust in the wind.  No more obfuscated glass walls or inspirational fonts.  If we could tear it all down, and reimagine it entirely, what would it be? For mothers, for pregnant people, for families?  For providers?  Dignity, kindness, compassion?  Relevant use of technology in conjunction with social support and interventions that prevent and not postpone? Teaching that mentors and bolsters?  Patient-provider partnerships?  Maybe we could take care with each other.  Maybe decency prevails.
But not yet, certainly not tonight. Tonight they stared and pointed and talked, warped and myopic looking through that glass.

Tonight I am the fish tank.

 

 

The Stigma behind Maternal Mortality

The gender and hate note

I like words.  I like how they feel—how they can elicit a sense of being in a time and space we had no right to even imagine we might access.  They are powerful weapons and potent healers.  They weep for us when we are sorry and fly through the air like venom when we want to strike. But words also exist in a little world each unto itself and each one triggers and unfolds many pathways of thinking and perspective for each of us.

I was recently watching a physician reflect on his long career dedicated to improving patient safety and experience through helping providers develop and practice compassion towards each other.  Turns out, as you probably know, compassion is leaky and when providers regard each other and behave compassionately towards each other, patient outcomes improve.  He said a remarkable thing.  He said he had mostly, if not totally, failed at every bid he made to change the larger healthcare system.  Success in small and deeply meaningful arenas, but the system he works in as a whole really hasn’t moved much in this regard.  I pushed pause and watched him again. And that’s when I began to think about words. And about how very hard it is to learn something and then do it without the lens we have moved through our whole lives with distorting what we know intellectually, so that without intentional effort, our behaviors reflect a whole lot more of our intrinsic beliefs than our working knowledge.

This is not a post about how compassionate care might change maternal health outcomes, though it does.

This is not a post to scare you away from birth—I’m a midwife, I practice risk aversion and skills-based prevention for a living.  Birth is not inherently unsafe.  Birthing in a place where you will not be heard, believed, and responded to with appropriate and well-timed interventions is unsafe.  That is what causes “maternal health outcomes,” “morbidities,” and yes, even “mortalities.”  I have seen it first-hand.  I have wept with families and raged against an uncaring, unseeing machine designed to protect doctors from the effects of their own bias.

How do you know about maternal health outcomes?  What phrases do you think of when you think of Serena? Black women die in Childbirth?  Maternal health?  Morbidity?  Mortality?  We use these words and phrases like water balloons to cushion against what we really mean.  Death.  Injury.  Illness.  Long term complex conditions.  All those words have lost their potency—we have found a way to accept and dilute them.

So here’s a word: Stigma.  It sits like a brick in your mouth. It tastes chalky.  It feels like a parched throat. It smells like rotten milk. That’s quite a word. It means a mark of disgrace, a mark of shame, a mark of discredit. A stain “associated with a particular circumstance, quality, or person.” The word stain is particularly interesting when you think about how stains are used in microscopic examination to bring a microbe into sight.  It is both what and how we see when we look at something, or someone.

A recent article has resurfaced regarding Time Person of The Year Salomé Karwah, a Liberian woman and ebola survivor.  The title makes it seem as though she died in childbirth.  She did not.  She was unable to receive emergency treatment for a postpartum complication four days after giving birth because the healthcare workers were afraid of Ebola.  She was a walking stigma in that world.  Don’t judge the healthcare workers who would not help her—read up on the reality of this historically charged experience.  Americans, as we are want to do, missed the point of the story—we projected our own perspective right onto that cover photo.  I have dozens of posts in my social media pointing back to the title of the article with heartfelt statements about “maternal mortality issues.”  The sweep of social media outcry reflects important progress.  It demonstrates that mothers dying in childbirth has crept into the awareness of our broader society—a very good thing.  While we consider this death a tragic and preventable Maternal Mortality, it is, in reality, a Stigma Mortality.  And while Salomé died due to a stigma associated with a terrifying disease, unrelated to why women in the US die during or after childbirth, the idea that Stigma can underlie death in many different settings for many different reasons caught my attention.

And that is what this post is about.  If every time you read a story about childbirth related near-misses or maternal mortality (or for obstetric and public health professionals for every time you hear “maternal mortality” in a meeting), I challenge you to wind that back to the Stigma where it started.

You may find that the often predictable, preventable, knowable, present with symptoms reported by a mother in time to have saved her life had anyone heard, believed, and responded to her, start with Stigma.  Our greatest stigmas in OB hospitals in this country are being a black woman, followed distantly but significantly by any person who veers outside social, economic, racial, or health norms during pregnancy or after childbirth. Nothing is protective for black women against these outcomes—not even their education or income level—because nothing one person can do in their lifetime is protective against or even responsible for the lens of Stigma that others view them through.  Efforts to place and ensure adherence to toolkits for treatment of hemorrhage and high blood pressure in hospitals across America matter. But no checklist will fix the internal, intrinsic beliefs that lead providers to provide less, to listen less, to pull the first trigger that gets that checklist going less–for black women.

And we do not have examples in proximity to work towards because even outcomes for white wealthy women in the US are nothing to aspire to. Between 2000 and 2014, there was a 26% increase in the maternal mortality rate overall. Within those numbers are the confounding realities that today, all women are 50% more likely to die from childbirth than their mothers and that a black woman is more than 3 times as likely to die from childbirth than a white woman.  In his 2002 introduction to Dr. Martin Luther King Juniors’, “Where Do We Go From Here?” speech, Senator Edward Kennedy refers to childbirth disparities in 1967, stating that black women were twice as likely to die from childbirth than white women.  We are still bound up by the effects of our own historical stigmas.  When stated in this way, it is clear we don’t have work to do, we have work we should have done long ago and because we have not, disparities have only increased.

Cause of deathStigma.

Cause of death: implicit individual and systemic beliefs and behaviors that reinforce the idea that a black mother should be discredited BECAUSE she is a black person.

Cause of death:  healthcare entities that allow OR carts to remain unstocked and unqualified residents to play at physicking without intentional, meaningful supervision because it is just fine to let them practice on black bodies.

Cause of death:  Staff that do not engage and then follow protocols for blood loss or high blood pressure in a timely effective manner.  Why?  Because of the stigma with which we cloak and separate the human who is in grave need of excellent healthcare.

Next time you read a story about maternal health outcomes, roll it back and look for the Stigma from which that outcome bloomed, flowered, and went to seed.  Let that word sit with you like a brick in your mouth, like a parched throat, like the smell of rotten milk.  Call it what it is—if at the meetings you attend, in the conversations we have—we choose to call systemic racism and maternal mortality “stigmatization of and dehumanizing black women” maybe we would wake up, face ourselves, and stop talking so much around the real issue. Then we might provide meaningful timely care for the people in our labor and delivery units because we recognize a who in the room deserving of our connected compassion and in need of our very best preparation, protocols, and skills.

 

5 Tools for Childbirth

Spoiler alert—you already know how to use these.  But in the quest to be the most prepared we often overlook what we already know soothes and focuses us.  It’s worth playing a bit to bring awareness to what helps you feel unplugged from the world as you get lost in an experience.  The more you investigate these tools, the easier it will be in a time of stress (like childbirth) to use them intentionally to move yourself quickly into that unplugged state. For some it is birth affirmations or mantras, for others it is slow walks outside, listening to certain music, dancing, or imagining the ocean. Here are five I’ve seen used over and over again.  They are easily adaptable in the moment and great for your mental and physical health to practice during pregnancy.

  1. Find your word. One that remind you of a time you accomplished something difficult. A trigger word that delivers you to a visualization of a trophy moment in your life.  Finish a marathon?  Pass a hard test?  Survive a difficult conversation?  A tough hike?  Your PhD?  Sit quietly and go back to that time—visualize it.  What did it feel like in that moment?  What words do you associate with it?  I think of how I feel when I’m worn down on a hike, and I buckle down, double-triple down, sink into my boots and take another step.  There is a place for me where the world falls away and I see the trail and feel my strongest self rise up in my body.  My word is Asolo—the brand of boot I wear and conveniently I can say it in a way that emphasizes the solo—I got this—it is mine I can also make it sound like asshole-o—which for some reason feels empowering to me.  What is your word?  If you have one that covers it, awesome.  You might need more than one.  Pick them and try them out each day.  Say the word.  Go to the place.  Can you imagine being at the height of a contraction and cueing your own strongest most capable self with just a few syllables?!
  2. Touch and be touched. The physicality of labor is a mighty thing.  Pressure courses through your body and most women want counter pressure someplace to balance against.  Some of the innate bodily moves I’ve seen:
    • assuming the 7th grade slow dance position then hanging from your partner’s or support person’s shoulders during contractions—pulling down to match the intensity of what you feel. Let them know you need them to stand tall and strong like a Stonehenge-level monolith—they will never have felt this level of your strength before.
    • Pressure against the small of your back or your hips—have someone push and guide them with simple cues, “higher, lower, softer, more, etc…”
    • Pressure on the kneecaps pushing towards the pelvis. This opens the bony structure of the pelvis but women do it naturally by sitting and pulling their own knees towards their pelvis (give it a try, it feels amazing).  Lots of women get into the hands and knees position which accomplishes the same.
  3. Rest when there’s rest to be had. You don’t need to wonder if you’ll know how to rest—you’ve been doing it your entire life.  But do take the rest when it comes—something which we have all definitely been trained out of.  Restful moments arrive in equal measure to and are as predictable as your contractions.  The work (aka the contraction) will come and it will always–sometimes for a long time, sometimes briefly, but always–be followed by periods where your body is at rest.  Follow that rhythm, use that space, let it be there for you.
  4. Breathe when you need to, how you need to. This may seem unhelpful in light of the fact that most media represents birthing as a time of exaggerated breathing patterns that you need to learn.  Not so.  When you were born, you likely arrived, looked around for a while and took a breath in that first minute of life.  You have been breathing without guidance ever since.  Harder physical exertion?  Bigger breaths!  Sleeping or eating?  Slower, drawn out breaths!  You can pretty well rely on this because your body knows when it needs air and how much air it needs and is driven by our most primitive brain to manage it all.  As a doula I saw hundreds of births with directed pushing and directed breathing.  Medical personnel telling mothers how and when to breathe.  As a midwife I am quiet and mostly non-directive and I have seen that women always change their breaths to match the length of their contractions. They do it perfectly without any guidance.  After long contractions their mouths open wide and they suck in loads of air, flooding their bloodstreams with oxygen which goes right to replenish stores for the body.  It moves through you and right to baby, whose heart rate slows a bit at the peak of those long contractions to distribute the oxygen in a measured, efficient way. Our birthing behaviors are tied into the thousands of ways mothers and babies are crafted for survival.  This is the perfect example of that system at work.  Can you use hee hee hooooo breathing to help direct your energy during a contraction?  Sure thing!  If it feels good, go with it.  But recognize this as a tool that uses breath as a focal point, a good thing—but not the same thing!
  5. Smile. When we smile it reverse-triggers us to a certain perception of the moment we are in.  Try it now.  Light up your face with a smile.  Put your hand on your belly and connect your smile to your body and to the baby.  I learned this from a mom who told me she intended to smile and feel joyful at the “working parts” of her labor.  And she did.  It was stunning.  After the birth, I asked her if she felt as happy as she looked.  She replied, “heck no, Jodilyn!” and went on to explain it was all pain and pressure, but she could feel herself smile and felt this joy popping through the pain.  Those pinpoints were critical to her, she felt them as the truth of her most inner self popping through just when she needed it most.  It was magnificent to see and I’ve seen it many other times since. It’s free, accessible, and you don’t need to ask anyone for help to get it done.

What are your words?  What are your tools?  Share your tips and stories in the comments!

 

 

 

Birth Affirmations Deconstructed

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Click here to read the gender and hate note

This is written with a slant on homebirth experience because I am a homebirth midwife, but I spent all my formative years attending hospital births as a doula and you can use all of this regardless of where you are—though if you take my advice on 2b you may find yourself with a room full of happy nurses waiting for their turn…

I am often asked how to write birth affirmations, and when and why women use these during labor. My short answer the same as I give for most inquiries like this—here’s some thoughts, if it resonates with you, use it.  If it doesn’t, don’t.  If you want to skip the opines and deets just scroll down for the list of categories.

A woman in labor using affirmations is not what home birth is “supposed” to look like.  And while one key element of planning for a homebirth is imagining how it will look, feel, smell and be—none of that matters if how it looks, feels, smells, and is—does not resonate with who you are in the world.  Not who you are when you are birthing.  Who you are.  You will bring your whole old self with your whole history and your whole emotional range of expression into birthing with you and while we don’t know what this will look like in that space, I know it is not going to look anything like the women on YouTube, not because they did it wrong (they are each fabulous!), but because you are not them.

Firstly—what I’ve seen:  everything from professionally printed flags in the Tibetan Prayer Flag style like those pictured above, to posters made at baby showers and blessingways by loved ones, to post-its literally in the hundreds everywhere we look in the house, to hand written in barely legible scripts on a notebook pad arranged in no order at all, by topic, by preference, by level of stress they help cue to calm.  So how you display them is up to you.  They can be just for you, for your team, or for the general viewing public (say visitors to the house including your mailman and your mother-in-law).  Creative, beautiful, scribbled.  You decide.

Secondly–what I’ve read:  and here I want to create a little order to the chaos.  And to acknowledge that I have read the ones that are shared with me—and often detail deep hopes of the heart and a higher vision of purpose for birthing.  I have not read the private pages—the journal entries and sayings and quotes that mothers often read to themselves in the space between contractions.  Love letters to themselves so deeply personal I have not intruded upon.  But I can imagine what I would say if I got to write a love letter to a woman in labor.  And you can write one to yourself, too.  So it’s there, if you need it.  My most cherished memories of births are sitting quietly with a mom who has instructed me to read her affirmations to her at the peak or the ebb of a contraction (it’s hard to know ahead of time when you will want to hear them but it’s usually one or the other). Reading slowly to her the words which she has gathered, and which represent some rooted connection to her deepest inner world and strength.  I always cry when I read them.  Not sobbing, but just tears leaking.  Because I get a glimpse of the heart work at play in this space and it is sacred and beautiful and painful and trustworthy.

I wanted to organize categories and sources for you to sort through.  Take what works.  Leave what doesn’t.  Share yours if you will, I would love to read them.  Call me if you want me to read some to you while you close your eyes and imagine how you will bring your whole complete flawed sacred self into birthing.  Is that too creepy?  You can ask a partner or friend or child to do the same.  Or even better—actually best--read them to yourself in a voice memo.  Then lay down and listen to them.  Feel the conviction of the woman speaking to your heart. Then when you read them in labor, the feelings you want to elicit in that space will be right there at the surface ready for you.

1.       Source for quotes.  Common places are: Psalms, the bible in general, the Quran/Koran, proverbs, Bartlett’s book of quotations, Rumi, online pregnancy, birth, and mothering groups, Oprah, Louisa Hay, your favorite author, movie, or TV show (yes we see quotes from Star Wars and Star Trek quite a lot!), etc…I also want to acknowledge the role of art.  From beautiful self-made creations in water color, charcoal, or oil, to coloring pages from books with mandalas in them, I see a lot of art used as a mechanism to fulfill all of the categories below.

2.       Typical categories of affirmations.

 This is adapted from Dr. John Rossiter-Thornton’s prayer wheel. 

a.       Count your blessings:  Affirmations that give thanks or praise.  There are loads of articles about why and how gratitude work for us human people.

b.       Songs of love: Affirmations that express your love for your world, your community, your family, your baby, your self (not necessarily in that order).  This might include having a play list of love songs you like to sing along to.  Do NOT be afraid of karaoke in labor—there is time to have fun!

c.       Requests for protection and guidance.  This is a calling out for safe passage, a reminder that there is a physiological system which works safely and well and you want to share this journey with a religious, spiritual, ancestral, or emotional guardian. 

d.       Forgive yourself and others.  Affirmations of forgiveness are about release—making space inside your self for what is coming.  It is an act which promotes creative energy and reduces space for consumption (of your heart, your mind, and frankly your time—you know I’m right!)  You are about to hold the entire emotional world of another human in your hands and power—prepare space to allow baby their own thriving, emotionally healthy discovery of humanity—free from the burden of your hold on past grievances. Forgiveness does not say that what was done to you is alright. Forgiveness acknowledges that what has hurt may be the garden where all your future flowers bloom.

e.       Ask for your needs.  Ask for others.  There is an intensely powerful connection between a pregnant person and the earth and spiritual power.  We feel acutely directly connected to a higher source as we are witness to a miracle in every second of pregnancy.  That’s a full 24,192,000 seconds.  We feel in every single one how we are growing, nourishing, and preparing for a new life. And the labor—don’t get me started.  The birth?  That moment where we see the light in a newborn’s eyes, you will feel her heart beating against your chest—thump thump thump thump.  It’s powerful.  Seek to have your needs met in this space.

f.        Fill me with love and inspiration.  These will be quotes that just fill you up and make you soar.

g.       Listen.  Affirmations that remind you to listen to your inner self and the wisdom from your environment, your faith, your family, your ancestors.

h.       Your will is my will.  Affirmations of surrender.  So much of labor is surrender.  For many that means to a higher power.  For all—it is faith that your body and your baby will do this work for you.  You can surrender to the powers you feel within your body.  The sensations of baby moving, rotating, shifting downward, resting.  The strength and power of your contractions.  The pain.  It is all so temporary and all-encompassing. Surrendering yourself to the physicality of this process, totally out of your control, will help you through to the other side, where you are holding your baby in your arms, knowing that you allowed him to do this thing for you, and he relied on you to do this thing for him.  It’s so deeply intimate.  When you think of a moment in your life where you were wrapped in intimacy—a conversation with a loving friend, mentor, or a moment with your partner—I suspect that surrender is high on the list of words you might use to describe it.  

Affirmations do not guarantee a perfect birth. They do offer you the opportunity to spend meaningful time creating a resource list which reinforces all you are dreaming of and believe possible for yourself.

A note for those who have a cesarean even after designing a complete master list of affirmations, practicing them daily, and using them throughout:  You did not fail to surrender, you succeeded in making the best decisions you could along the way with the information and resources you had and you met your baby in an unexpected way.  You do not relinquish the work and connection of those 24,192,000 seconds or the work and connection of birth, or the work and connection of parenting now because of this mode of birthing.  It is not what you wanted.  It can be a time that you can easily make sense of and move forward from in good emotional and physical health.  It can be a time of great doubt, shame, and turmoil.  It can be both of those on alternating hours or days or months.  There is no right way to do this work.  But do join ICAN online (free on facebook), share your story, seek comfort from your peers and professional help if that is not enough to see you through. 

You are seen. You are loved. You are heard. 

 

 

 

Five Flicks for First Time Birthers…

Notes, disclaimers, and whatnots. Click Here.

A flick note…flick here refers to a sharp. quick. reminder. It’s for real, but not a movie you see with the girls. If you flinch or cringe at the word flick, please replace with snap. It’s five snaps for you.

Also 5? Please—I really wanted to only use 300 words here but there’s…well, there’s more… cause I had to add some resources and straight talk at the end. I’m working on it!

1.      Just cause you haven’t has never stopped you before.  So too here, friend.  So too, here.

2.      Get yourself a mentor (a doula!)  and go get it! 

3.      Do not listen to anyone especially healthcare providers who say you have something to prove—or worse that your pelvis has something to prove.  Your pelvis will be fine—it will be huge!  It will open up to 30% more than it is right now when the hormones of labor kick in.  So let’s be real—it’s us providers that have something to prove to you—that we will support you in your efforts and guide you with wisdom and skills and the judicious, timely, and appropriate use of technology.  Also, that we can sit and do nothing while you do EVERYTHING. Hold your provider accountable, they are working for you.  You are paying them.  Don’t keep them in your employ if they are not living up to the company mission (your mission—it’s yours—you’re the boss, you make the rules, you pay the bills, you are the first one in and the last one to go each night and the one up all night thinking about how to get it done).

4.      Move your body.  Every day.  Working in a chair?  Set an alarm every 45 minutes.  20 squats. 20 knee raises.  20 shoulder shrugs.  You look goofy?  No you don’t—you look Inspirational!  Your colleagues might start to move too.

5.      Avoid processed sugars and eat 7-10 cups of fresh green salads every single day.  That’s about one bag of prewashed, precut salad.  Add some veggies, have half with lunch and half with dinner. Make blended smoothies not juice smoothies.  The veggies in there count towards your 7-10 cups.  It’s that fiber that will act as a buffer for the insulin promoting carbs and protein (they are not bad, they are important nourishment) you include in your meals.  Keeping your body insulin sensitive is real work during pregnancy when it naturally becomes a little more resistant.  Also, your physical body is the platform for accomplishing all your life goals.  Which you will, cause you’re you.  The thing no one will tell you because they don’t want you to feel bad is that sugars cross the placenta but your insulin does not.  Meaning your baby gets your sugar load but not the tools to process it.  That’s not even nice.  It’s a little tiny undeveloped baby pancreas working waaay unpaid overtime for you.  Add in the veggies.  All the veggies.  It makes a really big difference and will buffer for the two pancreases (or pancreata depending on how Greek you want to get) in your body right now.  I’m not shaming you.  I’m flicking (or snapping)—because it’s for real.

Speaking of real, if you want to learn more:

Read (related in order to the 5 flicksnaps above):

1.      The Essential Homebirth Guide (yup, for transparency I’m co-authoress and I’m paid about 12.5-25 cents per copy so I benefit from your purchase. It’s good for all birthing people to get a sense of what they are capable of in this space of pregnancy and birthing, regardless of where you want to birth)

2.      An article about doulas.  Evidence based.

3.      How to choose a provider. Kind of dry but a really reliable website.

4.      Exercises you can do at your desk.  I did not mention the shadow boxing listed here, but I say, what fun!  

5.      Real food for Pregnancy.  This is the only nutrition book you need.  Unless you know you are in that category of pre-diabetes or metabolic syndrome (extra abdominal fat, sleepy after meals, easily gaining weight).  Then read this and this. Don’t be worried if you are—this is pretty normal these days and entirely reversible.  It’s hard work and it works.  Get yourself a buddy who supports your goals and you will be healthy in no time!  Seriously, we have gotten people who fail their gestational diabetes test to pass it within five days of lifestyle changes (how and when you move and how and when you nourish yourself).  The longest anyone needed was thirteen days to get their glucose to normal and keep passing blood glucose levels every day and every week after that. Your body is awesome and loves to heal and be healthy!

 

 

The Blog Disclaimer Notes and Whatnots

Some disclaimers and notes.

The gender and hate note:  Most of my writing refers to birthing people as birthing people or she or her.  I state at the opening of all conference presentations (and try to attach to all blog posts) that this is how I refer to birthing people when I get to talking fast—not because I don’t know or don’t recognize that some people with a uterus identify as non she and non her or him or that some people who identify as her think I’ve lost my train of thought when I say birthing people.  I have not (good news for me). While certainly the majority of birthing people identify as she and her, we can be reminded by the expansive language that it’s just not so all of the time for everyone.  All are welcome here.  We need to find smooth ways of writing and talking that are inclusive and easily understood.  I haven’t found one thing that means what I mean when I talk about birthing women and birthing people yet.  I welcome your thoughts on this and all related topics.  Hateful remarks will be deleted because I believe that we can all find ways to communicate to teach, learn, and engage with each other and hate is not one of them. 

The Cesarean Birth Note:  Welcome.  You had One.  I did too.  I hear from a lot of you that it is hard when you see my posts about birthing.  About homebirthing.  Many of you transferred from a homebirth to a cesarean and feel extra rough about it all.  It’s okay to tune out blogs and posts that bring this up for you.  You will be ready one day, but today might not be it and I highly honor that.  My cesarean made a mom out of me and frankly, a midwife out of me too.  I didn’t realize I did not want to birth that way again until I was pregnant with my second.  I did not get into birth work until after the birth of my third.  I got in, not from anger, but from understanding that we don’t know what we don’t know until we know it–and that usually comes along after the first cesarean just like mine did, and people need a welcoming landing spot to investigate all of it.  You did not fail, you succeeded in making the best decisions you could along the way with the information and resources you had and you met your baby in an unexpected way.  You do not relinquish the work and connection of those 40 big long weeks of pregnancy or the work and connection of the hours or days of laboring or your birth, or the work and connection of parenting now because of this mode of birthing.  It is not what you wanted.  It can be a time that you can easily make sense of and move forward from in good emotional and physical health.  It can be a time of great doubt, shame, and turmoil.  It can be both of those on alternating hours or days or months.  You might want to understand and reflect further.  There is no right way to do this work.  But do join ICAN online (free on facebook), share your story, seek comfort from your peers and professional help if that is not enough to see you through.  You are seen. You are loved. You are heard. 

The VBAC note:  Hello!  I adore this journey you are on–it is extra extra in the best ways.  You should find a lot of resources in your community and on ICAN.  Surround yourself with a team who has proven they support this process and approach the use of interventions judiciously–timely, appropriate, not jumping the gun.  Join ICAN (link above) if you haven’t, it’s free and there is nothing like peer support to get you there!

First Timer? Click here.

 

 

Community-Based Midwives and Hospital Systems: A Case for Partnership (The Notes)

These notes are extracted from This Article

  • A set of good vitals and an uncomplicated medical history are not remedies for social inequities or lifelong lack of access to healthcare education and navigation, or accessible, timely, effective, and therapeutic interventions.
  • When a patient presents with a medical complication, a midwife can identify it and ensure access to appropriate care if she has access to those who would provide it.
  • The midwifery model of care recognizes that technical improvements in healthcare delivery are irrelevant without addressing the places where unjust and deeply impactful social determinants of health drive the patient’s life experiences.
  • This work [of midwifery care] results in trusting connections between patient and midwife. Indeed, at the time that hospital staff or a physician meets the patient, she may be experiencing a very real grief over the potential change in relationship with her provider and hopes for a unique and well-planned birth experience.
  • No one anticipates that the nurse or physician standing before them will do harm, but how likely is it that they will see you as an ally in their care when you take a stance of juxtaposition and even mockery of the one provider who has ever truly listened to, heard, and understood them?
  • Ignoring or belittling the midwife or any community-based provider for accessing those resources will make them hesitant to enter into the system in the future.  It is this behavior that pushes midwives to move patients further away from safe and timely interventions.
  • However, the ideals of community-based hospitals, so richly developed in many places, is to open the doors and welcome what the community brings, and to share the fullness of knowledge and technology from a place that recognizes the humanity of each patient and the irreducible needs of each person with whom it interacts.
  • …at all points of intersection [of the preventative and therapeutic pathways of care] patient health improves when they can easily step from one to the other as is appropriate for their needs.
  • We know that the impact of technical interventions is effective and wonderful but it is reliant on hospital policies that make these interventions accessible to the community.
  • If we can look together beyond the responsibility of the hospital to the community and financial interest in receiving midwifery patients, here are some ideas that lead to beneficence [see article suggestions]
  • Joining efforts to achieve the common goals of good health and easy, timely access to healthcare resources can only lead to improved outcomes and the development of a model that can truly serve the consumers and the providers in our community.

Community-Based Midwives and Hospital Systems: A Case for Partnership

Click Here to read just the notes from this article

Community-based midwives are held to particular and sometimes unjustifiable standards by the healthcare community.  They are under tremendous pressure to have perfect outcomes while serving the same communities who face the disparities that lead to premature birth, infant mortality, and maternal morbidities experienced so often in the hospital system.  Wanting or needing access to technology and resources is often seen as a failure of the midwife or as a nuisance to the system, even when those same resources which can prevent the same outcomes are distributed in medical care in an effective and timely manner.

The methods and standards by which Midwives determine that a patient is “safe for midwifery care” are not protective against these needs or outcomes.  A set of good vitals and an uncomplicated medical history are not remedies for social inequities or lifelong lack of access to healthcare education and navigation, or accessible, timely, and effective therapeutic interventions.  When well-networked, midwives can be a leverage point for patients to receive guided access to the larger healthcare system.  There they can receive the interventions and medical support necessary to achieve positive outcomes.  In other words, when a patient presents with a medical complication, a midwife can identify it and ensure access to appropriate care if she has access to those who would provide it.

Failure of a patient to stay healthy enough to remain under the sole care of her midwife, or to qualify for an out-of-hospital birth is often seen as both a shame on the patient who could not achieve optimal health or reach her birth goals, and shameful of the midwife.  Midwifery consumers work hard to address their health concerns, and there are times when all of the lifestyle interventions, guidance and education cannot overcome lifelong health disparities. We work hard to prepare for labor and birth and the most common reason we transfer during labor is for a patient who is just tired and needs an epidural, a nap, and will wake up and push her baby out just fine.  This is normal and reasonable and there is no shame in it—either for the patient, who is equally deserving of pain relief and rest as a patient who planned a hospital birth nor for the midwife who supported the efforts and goals of a family.

In community-based midwifery care we use the continuity of carer model, with hour long prenatal visits.  Three-quarters of this time is used to address healthcare prevention, education, and social support.  The midwifery model of care recognizes that technical improvements in healthcare delivery are irrelevant without addressing the places where unjust and deeply impactful emotional and social determinants drive the experience of a patient’s life.  These are the soil in which the patient is growing from and nurturing both herself and her pregnancy in.  These are the hardships, griefs, and burdens of absorbing the responsibilities of her family and community.  These are the anxieties over how to achieve perfection or avoid failure at every turn.  And these are the sheer terror for many due to the likelihood of their pregnancy resulting in their death or the death of their child simply because of the color of their skin.  This is intensive work, achieved on a platform of preventative healthcare that views each mother as vested in her own health and capable of change. It recognizes that she needs access to resources too long withheld and hidden from her until this point and it provides those freely.  This work results in trusting connections between patient and midwife.  Indeed, at the time that hospital staff or a physician meets the patient, she may be experiencing a very real grief over the potential change in this relationship with her provider and hopes for a unique and well-planned birth experience.

When a risk factor develops that requires entry into the hospital system, the patient has an acute sense that they must relinquish emotional and physical safety in healthcare.  This may very well be a contradiction from the midwife’s perspective because we are in the hospital due to a physical safety issue at the direction of the midwife because of her clinical judgment.  However, statistically speaking, every parent this patient knows who has lost a baby was in the hospital when that baby died or had a hospital birth.  Every mother they know who died or was harmed during childbirth was in a hospital when that event occurred.  While these events have been normalized in a broad sense, it is impossible to mitigate the very real fears that arise from personal exposure.  Every social message about the safety, especially of being a black pregnant patient, has taught them that their odds are not very good.  Every cell in their body and that most powerful function of our minds, the implicit memory, brings on a full red-alert for them in that space.  No one anticipates that the nurse or physician standing before them will do harm, but how likely is it that they will see you as an ally in their care when you take a stance of juxtaposition and even mockery of the one provider who has ever truly listened to, heard, and understood them?

We know that once the sympathetic system is activated in this way, people become hyper-alert to whatever is in their realm of focus.  This tunnel-vision is most often directed towards hospital staff—the nurses and doctors who she interacts with in triage before she regains access to a state in which she is ready to learn, engage, and process information.  These are basic principles applicable across many fields of medicine, and even more so when there is a sense of needing to protect one’s baby.

In the instant that you are introduced to the patient, she will see your response to her decision to use midwifery care, she will note how you greet or ignore her midwife, and she will read a thousand cues from your actions and responses.  How you treat the patient for her choices and the midwife for asking for an evaluation or intervention matters.  Her body will decide very quickly:  Fight, Flight, or Rest.  Can you ensure that she is never alone and has her partner or midwife with her at all points during care—especially those first few moments when she is most susceptible to panic?  These first interactions set the table for the rest of the patient stay and experience.

Midwives have extensive training and evaluate ongoing data sets from blood work, ultrasounds, clinic visits, and interactions over many weeks or months of care. She is in your hospital because she wants to be—because you are a resource and have access to resources her patient needs.  Like any community-based or rural provider, she relies on you, on hospital staff, systems, and technology to be there when her patients need it.  Ignoring or belittling the midwife or any community-based provider for accessing those resources will make them hesitant to enter into the system in the future.  It is this behavior that pushes midwives to move patients further away from safe and timely interventions.

The burden of community-based hospitals is to receive what the community brings and to provide basic medical care.  However, the ideals of community-based hospitals, so richly developed in many places, is to open the doors and welcome what the community brings, and to share the fullness of knowledge and technology from a place that recognizes the humanity of each patient and the irreducible needs of each person with whom it interacts.

The work of community-based midwives exists on the preventative pathway of maternal child healthcare.  The work of hospitals and obstetrics is on the therapeutic pathway of maternal child healthcare.  There are many opportunities for these pathways to cross, and at all points of intersection patient health improves when they can easily step from one to the other as is appropriate for their needs.

Midwives and the families and communities we serve are your families and your communities.  We share the work of seeking health and access to healthcare for all people.  We know that the impact of technical interventions is effective and wonderful but it is reliant on hospital policies that make these interventions accessible to the community.

We understand that relationships between community-based healthcare providers like midwives can be seen through a transactional lens—and if so, then view the midwives as great business.  They rarely bring a patient who does not require interactions and interventions that are highly billable and great for the bottom line.  We must address the scarcity mindset—that somehow allowing midwives to access resources will play a role in the diminishing of patient numbers for the hospital.  The number of patients that midwives see is negligible to larger healthcare institutions.  As stated, the patients midwives do bring in for care will typically increase the hospital census and income.  While this is a very low-level view of the potential relationship between the hospital and community-based midwives, it is very real and just fine to rely on.

If we can look together beyond the responsibility of the hospital to the community and financial interest in receiving midwifery patients, here are some ideas that lead to beneficence:

  • You receive patients every day who arrive in labor, screaming and incoherent, possibly drug-addicted. You have no history, no labs, no ultrasounds and no idea who that patient is.  You follow your guidelines and do the best you can for them.  Midwifery patients arrive with loads of documentation.  They come in with labs, ultrasounds, a known history, and notes about how this patient learns best and the stressors and norms of their lives.  That is a lot to work from! Use your guidelines and do the best you can for them, too.
  • Greet patients warmly regardless of where they arrive from. Use simple statements that have been shown to be effective in other teaching hospitals, “I’m so glad you are here today.  I see you were receiving your care from a midwife so this might all be new to you.  I want to assure you we are going to do our best for you today” or “I see you were in the middle of a planned homebirth.  I’m sorry that didn’t go as you wanted it to.  We are going to do the best we can for you here today”.
  • Greet the midwife with kindness—she will expect you to take the lead. She has decided based on clinical information or a concern that this patient is safer with access to you and the resources that you have. Talking to her about your thoughts and plans (when it is not an emergency) or being inclusive will help foster good will with the patient and out in the community
  • Adapt policies to allow consulting, referring, partnership and education for community-based physicians to include midwifery-led clinics. Seek community rotations in midwifery clinics for your residents.  Learning from and with each other allows providers to get to know each other and deconstruct ideas of “other” so common from both sides to this relationship.
  • Provide credentialing for Nurse Midwives who operate in community-based clinics so that they can follow patients and manage care for those that want to plan or are in need of a hospital birth

Joining efforts to achieve the common goals of good health and easy, timely access to healthcare resources can only lead to improved outcomes and the development of a model that can truly serve the consumers and the providers in our community. To learn more about midwives in your area, and to find out how your institution can ensure easy access to resources for the community, contact your local midwifery-led clinic or midwives association.

 

 

Access in Healthcare

I have several posts written that haven’t been posted.  This is partly due to me trying to find my space in this new space, and partly because as we learn about and settle into a new practice in a new community, there is not much time for editing.  This article is from March of 2018 and examines our model of care through the lens of one of our programs, group prenatal care.  This program and many of the classes that spin off of requests made in the group, are open to all families, even if they are not in our care.  If you are in Memphis and want to join us for a program or come into care, please contact me.

As a community-based midwife I have been drawn to, pulled, and stewed in the places where midwifery and public health come together like a heated 32-beat tango.  Connected, dependent, free-spirited in nature yet grounded in science, this form of perinatal healthcare is my deepest heart’s work.  In Seattle our clinic, situated in the heart of a medically underserved neighborhood, was founded with the basic premise that we could reimagine healthcare.  The families, colleagues, health systems, and communities that participate in the care are committed to this mindset or to providing space within a more rigid system where we can explore the outer bounds of our ideas.  That organization continues to evolve and stretch into places and ways of being present for families and communities that astound me.  There are other midwifery-led clinics innovating and serving their communities around the US. Midwives are busy people, working through the wee hours trying to make a dent in maternal and infant health outcomes. In Memphis I am again working in an environment where that element of possibility leads us forward and exposes innovations as they naturally arise from our efforts to meet the needs of the families we serve.

Over and over again, wherever I am, I am taught a singular lesson about imagination and healthcare.  I am taught to follow my commitment to seek the strength and health of families I serve, even when it is not arranged as we are told it should be. When I first learned about labor I understood it to come in phases and stages which one neatly progresses through.  My doula certification required rote memorization of these steps, the signs of each one, and how to provide physical and emotional comfort and support for the pregnant person through labor and birth.  Yet I did not attend my first birth as a trained doula.  I sat in a small hospital birthing center with my brother and sister-in-law while they labored and birthed my nephew.  It was not my response to the phases and stages that provided her comfort.  It was my presence and attunement with her and my brother, my faith in her abilities, my interest in seeing my brother become a father from a place of strength, and my keen sense of wanting her to have a meaningful and timeless experience that mattered.  This experience was the first of many that taught me to look at pregnancy, birth, and early parenting as equally whole, layered, complex, and varied as the mothers and fathers I served. As equally needful of a response that understood both the expected norms and the reality and potential of the person in front of me.  I have witnessed alchemy a thousand and thousand times.  A shifting, morphing, and transforming moment.  Sometimes it is in prenatal care when a connection is made, sometimes during labor when the power of contractions takes a mother away from us and she retreats to a private universe, sometimes when she breathes her first breath as a mother to her baby now here, warm in her arms.

The science of pregnancy and birth is remarkable.  It allows us to support, aid, and even rescue mothers and babies every day.  As providers what do we have to learn from but the tools we are given?  Our books, our lectures, our machines that keep us moving in linear phases and stages through expected norms.  Those great teachers of mine gave and continue to give me command of the skills I need to care for families safely during their perinatal year.  But those other great teachers—the mothers, the fathers, the babies—they have informed me too.  From them I learned that the work I feel pulled to—this creation of micro-systems where families don’t just survive but really thrive and come into their fullness does not exist or occur in a linear progression.  It lives in the expansive reaches of our imagination.

It lives in discarding programs and services that always meet the needs of a linear and ordered system but rarely the true needs of the people in it. 

For many years I have run models of group pregnancy and postpartum care.  I have tested and tried curricula written by organizations committed to improving maternal and infant outcomes.  They have demonstrated success in these important areas.  The organizations that designed them have a lot of rules—so many people need to be present, they all need to be pregnant within about the same gestational age, they are assigned topics and facilitated, there is required attendance at a specified number of groups, they replace the individual visits with the midwife or doctor.  This makes perfect sense if we are trying to facilitate a group that teaches to the phases and stages of pregnancy and birth.  It makes perfect sense if we read any of the text books.  They all highlight “expected changes at this time” by trimester.  Naturally, we group pregnant people together who are the same gestational age experiencing the same changes.  We can conveniently teach to these issues and this does provide a kind of comfort—knowing that you are not alone in your changes and learning to adapt to them.  However, I have never been able to exactly stick to the prescription or the curriculum.  Usually because someone wants to participate but for work or life or financial reasons they can only get to a group that is running at a certain time.

Not the group they are slotted to, but to the group that is accessible when they can access it.

People arrive to group care full of ideas, needs, and questions that are totally unrelated to any prescribed content.  So what if the curriculum is the content of their lives in that moment? Ours is.

Now buckle up, I’ve said this before but let’s discover what it means:

When it comes to maternal and infant health,

there are only no answers if all of the answers are “no”.

If you are running a community-based clinic which fundamentally believes in access to care and services, you say yes a lot.  You say yes when the curriculum says no. You say yes when it means someone is going to skip a phase or jump over half of the progression.  You say yes when someone can come tonight but not again for six months.  You say yes when someone has never shown up but wants to sit in group now.  You say yes when a grandmother-to-be shows up with her pregnant child to explore this new model of care.  You say yes when a patient calls and tells you their car won’t start and they are out of money and they need a ride—even when it means the group will wait an extra five minutes to start. You say yes when a new mom shows up because she was lonely and knew that there was a prenatal group today.  You say yes because connection is the remedy for isolation and prevents depression, and her mental health matters.  You say yes because her presence there teaches the expecting mothers about what it looks like to care for a baby over the course of two hours in ways you could never script.  You say yes because someone else, maybe even someone else’s grandmother will hold and rock and walk that baby and tell her what a good job she’s doing.  You say yes because there are not limits on your imagination and you don’t see the people who come into care as limited, as broken, as needy, as powerless.  Your system does not rely on anything that resembles a normal healthcare delivery experience.  Why should it?  You are unbound so you are allowed to follow the dictates of the moment, the needs of the individual, the kindness that needs to manifest from your own heart.  And you are unbound so you can think with curiosity about the clinical presentation of disease, disorder, and dysfunction.  You are unbound so you can think about prevention and isolating a remedy that leads to health and not merely symptom management.

You can accomplish all of this in deep partnership with patients, clients, and their family members. 

And here’s what I’ve learned from saying yes.  As a provider, it is no toll on me to do so.  I don’t mean to be romantic about it–this is hard work.  It is also a remedy, a boon, and a manifestation of my humanity.  The people I work with feel the same way.  They are fanned out all over the city right now as you’re reading this bringing food, giving rides, sitting and listening, available, and present.  And in this example, of group prenatal care that evolves into group perinatal, parenting, god-parenting, and grand-parenting care, each person present feels their experience reflected in the shifting, morphing, and transforming moments of others.

We are learners and teachers, we are wise and vested and new and afraid.  We see where we are going, we feel where we have come from, we sit where we are.

We recognize the suffering and joy in others and freely bestow and receive compassion in that space.  This is a platform for health.  This is our platform for healthcare.  And this is one reason why I believe families in our care emerge with health outcomes that do not reflect the societal norms even though they have extraordinary life stressors. They are at risk for all of the risks, yet they very rarely manifest any of them.  This form of midwifery exists at the intersection of love and justice and healthcare.  It is not about leveraging the cost of healthcare, though it costs less. It is not about the birth. It is about good and even robust physical, emotional, and mental health where the right kind of birth in the right place for each family is the natural outcome of a platform where every idea has the potential to become a solution and every person is worthy of our best yes.

Midwifery for All Series

Welcome!

Midwifery for All is intended to highlight some of the areas where fear has built up a tradition of practice that might not be in line with either good science or your needs.  We understand that the greatest risk many face in their pregnancy care is the perspective and bias of providers and the healthcare system.  We are missing out on options for preventative health care simply because of preconceived notions and societal and systemic stigmas about the health of pregnant people.

Read: Size Friendly Pregnancy Care

This causes devastating effects across multiple outcomes–leading to extraordinary emotional and financial costs for families and decimating the healthcare system.  While providers and systems are responsible for the tangled mess we are all in, it is the consumer–people just like you–who can create change by changing our expectations and demands for education-based, preventative healthcare.

We are managing to save a lot of people from the brink of severe conditions during pregnancy.  But it is not enough to save someone from dying. That is a terrible standard of care when so many pregnant people have clear signs and symptoms of needing help long before they need a life saving rescue.

We believe we can prevent almost all of these conditions from progressing to disease through kind attention, education-based care, and skilled and thoughtful provider behavior. You deserve to live in good health, strength, and with all of the energy you need to do what you would like to do each day.

Midwives have the time, space, and skills to address underlying health needs over the course of your pregnancy and life.  In our practice we focus on predictable, preventable, and reversible conditions that start off with just a hint of something not quite right (you know the feeling!) and progress all the way into a diagnosed disease. Our goal is to pay attention to the first hint, your signs and symptoms, and to respond in partnership with you to quickly turn a corner into good health. We don’t wait for pregnancy to start this work–if you are considering your first or subsequent pregnancy, or might want to have a family one day–we can help get you prepared through this same program.

Through this series we dig deep into the issues that so many of us are afraid of when it comes to pregnancy: race, size-friendly care, stress, poverty, preterm births, prior cesarean births, smoking, HIV, and many more.  Check back often as we upload booklets, we will live-link them here.

Midwifery for All is for you—education, support, and exploration of the options for your care.  You can use it to start discussions with your physician or midwife about the kind of care you would like to receive.  It is a tool for pregnancy and birth decision making, and we would love to hear which booklets you enjoyed, what questions you have, and how you are moving forward in your care.

Wishing you the best for healthful and joyful pregnancy, birth, and parenting!

Do you have a topic you would like to see addressed?  Contact Us and let us know!

Size Friendly Pregnancy Care

Click Here to to Download a PDF of Size Friendly Pregnancy Care.

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Our Midwifery for All Series aims to close the gap between what is known by science and what is understood by healthcare professionals, pregnant people, families, and communities.

Click HERE for an introduction to the philosophy of our care and learn why Midwifery for All matters so very much.  Click Here for our favorite resources

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Click Here to to Download a PDF of Size Friendly Pregnancy Care.

Read:  Midwifery for All Series

Read: Midwifery Philosophy 101

 

 

A Layered Question: Midwifery Philosophy 101

Let’s take a look at this multifaceted question:

How does a person navigate the stormy waters of pregnancy healthcare if you are anything other than a 5’7 140lb white, married (to a man) woman who identifies as such, hovering in the middle to upper class?

As you can see we are dealing with multiple layers of the human experience and their effects on pregnancy healthcare: your health before pregnancy even starts, BMI/Obesity, race, sexual and partnership identification, lifestyle choices, and economic status. I hope to address these topics from my midwife-minded perspective in the coming posts, starting here with our general approach and philosophy regarding pregnancy healthcare.

For my friends in the north: I am going to stretch this a little further and choose to add the extraordinary complication of living in the South to this discussion. I did not know, and could not understand, as a northern midwife, that my southern counterparts and the families they serve face challenges far far far (did I say far?!) beyond what we do in the North. I knew of course that things were different but I didn’t really understand.

I have tried 85 times to write about what it’s like to live in a place where faith-based healthcare makes room for providers to decline to mention during prenatal care the option for genetic screening (taking this as one example of dozens). They do not inform patients of these options because their faith (read: the PROVIDER’s faith, not the FAMILY’s faith) does not allow consideration of options that include the termination of a pregnancy under any circumstance. So there is no option for screening given. Not even when a pregnancy poses danger to a woman’s or pregnant person’s life. Not even when that baby will live less than an hour and in terrible agony. Not even when a family would choose to live life with an intensely high medical needs child, or one affected by a genetic anomaly, but wants the opportunity to prepare their home, family, work, and resources to meet their needs. Not even when the mental health of the mother or pregnant person is in jeopardy.

I’ve read charts here with “nuchal translucency” (a screen completed prior to the 14th week) noted at 22 weeks. There’s no such thing!  But this deception is allowed and encouraged….and this is only the tip of the iceberg. Want a tubal ligation but your husband isn’t present to consent?  You may have difficulty accessing this surgical form of family planning in the south. Of important note is that there are providers in these systems who do not practice this way but the system supports those who do. There are four major healthcare systems in this city—three of those with multiple hospitals that support providers who practice faith-based medicine according to the model that the physician’s faith determines your healthcare options.

If you are a person of faith, this might sound nice on the surface, but I would put forth that it is our religious leaders who should help us navigate the decisions we are faced with in our lives. They have training and education that enables counseling and support for our spirituality.  They help us stay aligned with our religious values and belief systems in all areas, including our medical decision-making. Our physicians and providers should offer us healthcare options, discussions, consent, and treatment based on shared-decision making. We are responsible for ensuring we integrate our religious, social, and cultural outlook into our healthcare by engaging all of the systems and people that matter to us in that process. At the same time, many systems are designed to ensure that culturally relevant care is nearly impossible to acheive and it should not be the burden of the consumer to correct this but the burden of each provider, administrator, and system to make it right .

The care options that are here are not healthcare as we know it in the North. For all of you, I know, this post so far will seem frankly unbelievable and unrelatable. The posts linked to below about health and lifestyle choices will seem dated and broad. You are working on terminology, micro-aggressions, systemic racism, and deep systems issues. We are working on basic access and consent issues very much related to the ethics behind Informed Consent and the Nuremberg Code couched in overt racism packed in systemic racism, micro-aggressions, and deep systems issues.

Conversations about lifestyle, access, and health disparities are coming into the light in many corners here. Questions are being asked:  Why is it like this?  Does it have to be like this?  What it would look like if healthcare wasn’t like this?  The midwives here have been advocating and caring for families in all the ways possible—faith based and non-faith based. And even with the two of us new to practice here, there are five of us in or adjacent to the city I’m living in now. Five who are practicing in community-based settings. Five who can create protocols and follow guidelines appropriate to the profession and their community.

We need space for conversation and inquiry here, we need routes for education and change. The South is not some backwards “other”—I am not at all trying to say that the South “needs saving”. I am new here, but I’m right here where this community is at: listening, participating, wondering. Pregnancy, birth, breastfeeding, parenting, general health. These communities are rising up and looking for solutions to the very real barriers they face. I recognize that process. It has a familiar rhythm, grit, and complexity. There is tension, anger, frustration, desperation, and there are large gaps between what is known and what is understood.

For our practice it boils down to this: How do we address public health outcomes while caring for one family at a time as if all public health depends on only their outcome?

I have answered that question many times in posts and articles and interviews.  I stand by my answer.  We must be kind and use our skills to meet people where they are at.  The rest will follow. I am committed to this model of care which leaves room for so much possibility.

I have the great privilege of holding a license to practice midwifery and of being supported by a local, long-standing clinic and non-profit organization that constantly looks to be a partner in community solutions. I have my clinical experience, my willingness to learn and to meet people right where they are at. I have the fundamental belief that kindness matters and that none of us has anything that matters until all of us have access to reach our potential. This awareness and mindset allow me the opportunity to be a part of families’ lives in the very ways midwives have since the earliest days of society.  In the very ways midwives all over the south and indeed the world are a part of healthcare systems, families, and community health.

I have the unique benefit of working with a practice partner who is fierce about identifying solutions and solving problems. She is brilliant, experienced, kind, and unafraid of stepping in to dismantle the hardships families face. We are not looking at pregnancy as an isolated, siloed experience. It exists in the layers and complexities of the lives of the people and families we serve. We are working on a number of projects right now centered around how we acknowledge and prevent non-pregnancy related medical and socially generated pathologies from determining pregnancy outcomes. My practice partner states over and over again that these problems require providers to change their understanding and behaviors,  and stop promoting the false idea that “these women” and “those families” just don’t want good health badly enough.

We believe the barriers that have separated “Self” from “Other” need to fall—we are all of us people just trying our best to give our all and find love, connection, and health in our lives.  We are unique individuals with complex cultures but we share so very much. What if as providers we use our licenses to open up this conversation and create new paths to robust health for all families?  That is the work we are engaged in here in the South. And each micro-community has to find its way in the larger social construct. We want to pull apart the loaded, layered question and answer simply, “yes, I believe in you, your interest and capacity for learning is vast, and together we can find solutions that meet your needs in the right way at the right time for you.”  There is nothing to stop us from applying this philosophy of care to pregnant people of all races, sizes, orientations, cultural backgrounds, and socioeconomic truths.

Next Up:

Midwifery for All Series

Size Friendly Care

 

Postpartum Hemorrhage Management for the out of hospital midwife

Atul Gawande’s beautiful book The Checklist Manifesto easily applies to all of us out of hospital midwives. Check that link out–it’s the audio format because I know you are driving several hours per day between carpool and pick-ups and drop-offs and client visits and the grocery store and the gym. And back to the grocery store for whatever you forgot on the first trip.

Why does this book matter to us?  Why do these ideas matter to us? I can hear your midwife brains roaring about how we intuit our way through our practice–even obstetric emergencies–and we do it better and more efficiently than an entire team of OBs, neonatologists, and resuscitation teams designed just for, well, obstetric emergencies and resuscitation. You’re right, we carry a lot of the capacity of the combined powers of these teams in our personhood. We do so out of necessity. Because we are fortunate to spend most of our time in observation, but we are trained for the times where we must act and resolve obstetric emergencies in the out of hospital setting. ALSO is a training course originally designed for family practice docs to learn to manage obstetric emergencies through the use of team work and checklists in the form of mnemonics. I took this course way back and was the only midwife present with about 200 residents and practicing physicians. It was a terrifying 3 days and I learned the management of obstetric emergencies in hospitals–then adapted what I had learned to the out of hospital setting for use in my own practice. To say it has served me well over the years is an extreme understatement. So I was thrilled to see that I could re-up my certification this year at the end of a recent midwifery conference. I am happy to say the course is now extraordinarily well adapted to my learning style and actual practice. I highly recommend it or attending Expect the Unexpected, BEST, or one of the other specific courses designed for managing obstetric emergencies.

When it comes to emergencies, there have been many studies (many! Pubmed search “safety checklist and get reading!) that we should pay attention to. Studies show that outlining steps, having someone in charge of reading the steps, and making sure they are followed really matters when it comes to outcomes.

Who is your team?  In the space of an out of hospital obstetric emergency, every adult human in the room and building is a part of your team.

I’ll be posting additional sheets like this one—they are from our practice and not universally perfect.  Take it and make it your own, let it inspire you to have clear easy to read information for every kind of emergency you drill for.  Use it, adapt it, make it work for you.

This sheet is a simple tool to help you navigate through a postpartum hemorrhage–a common maternal morbidity in high resource countries that is trending upward. By acting promptly, hitting each step, and using your best skills along the way you greatly improve the chances that you will stop it long before it causes the need for a transfer. And for that rare mom that will require the entire run of our storehouse and hospital support to boot, by completing these tasks and documenting them you can help ensure a smooth transfer of services.

Please note this is designed for states where midwives have access to legend drugs and carry them as a regular tool in their birth kit. It does not address the use of herbs or other measures employed in states where medications are not available for use or low resource settings. I would love to hear what you are doing in those places–let us know in the comments below!

Click Here for the PDF

new-piktochart_26245788 (1)

 

Inuit or I Knew It

This is a post about the profession of midwifery. It is a bit of a window into our world—all are welcome to read and give feedback, leave your comments below! Somebody give me a little CPR—this is my first post with one space after each “.” It feels cramped! It’s a new world, blogosphere!

Midwives are often viewed as mystical. We are touted as having been “called” to this work, perceived or harassed as wise women, seers, or my errgmmm least fave of all time, “hippies” which I think implies just really earthy and soul-driven. I can’t speak for all midwives–I am fresh off of a conference of a few hundred of us and can speak only so far as to say that there is a huge variety of the kind of people and types of practices in our field today. Leadership in some locals is very state focused and in others very nationally or globally or village focused. I could go on and on but here’s the best way of explaining it. When you meet an Engineer in Washington, or Tennessee, or Australia, or Uganda, or China you’re hiring someone with the basic kind of education that each of their counterparts has. Their experience, bias, and framework will be individualized for the geography, setting, and environment they work in as well as the one they grew up in. Same goes for educators, lawyers, and yes, even us midwives. And for the record, most educators, engineers, civil servants, and even lawyers I know felt drawn to their profession, so I don’t think that sets us apart in any meaningful way. We’re just people trying to get paid to do what we love.

Our profession overall is shifting–with many of us dedicated to maintaining an apprenticeship based model, self-regulated in practice, and outside the mainstream health systems. There is a newer model blooming, responsive to the pressures of technology and societal norms in education, standards of practice, and accountability. It is designing itself to function as an innate and integrated part of the healthcare system in the US as midwifery does in so many places globally. Those of us working in this model are engaged in legislative efforts, systems change, policy-building, education reform, and standardization. These midwives will be seen as educated (many with a Master’s degree in science), working in professional settings like community-based clinics, birth centers, and hospitals. They might wear scrubs every day or some will wear the clothes they’ve always worn because they believe that scrubs can create a sense of power differential and are committed to health care in partnership in all ways—starting with the perception of power. Some of those in street clothes will exude power and some in scrubs will create an art of shared-decision making. Most midwives will fall somewhere along the spectrum of this vast continuum and move up and down it over the course of their day, year, and career. I’m not here to tell you what’s right or wrong for you as a midwife or which midwife a consumer should absolutely pick. My opinion is that there is a mother for every midwife and I suspect we will always have a midwife for every mother.

I’m an evolving human being and my sense of where I am and where I want to be in my career has evolved as well. If you’ve hired me or worked with me or read anything I’ve written you can probably figure out where I fall in. You can always ask me if you want to, I’m open about my views on all this evolution in our profession.

But wait, what’s all this got to do with intuition?  I want to recap a great discussion I had many years ago which taught me one of the most valuable lessons of my professional and personal life. I admit to being one of these people who pops light bulbs in my vicinity on the regular (literally). Need a watch killed?  I’m your girl. Unsure about dating a certain someone?  Gimme 5 or 6 minutes tops and I’ll have them read. I don’t know why I do these things…I’m not always right and my willingness to participate in the world by thinking and feeling my way through has gotten me into some trouble but overall, over time it has served me just fine. For a long time people called me “intuitive”. I could “sense” things about people, or the course of events. But here’s what a very seasoned midwife laid out for me. I promise you know her and you think she’s a hippy.  She might be!  And she’s a smart, savvy, well-studied, educated and engaged learner also. She pays attention. I called her to review a difficult case I had. As I recalled the care and birth of this mother I said, “I knew that xyz was coming”. She asked me, “Jodilyn, how did you know that?”  ” I just knew it–I sensed it–I…”  “Intuited it?” She asked me in a rather forceful manner. “I suppose so. Yes, I guess that is what one would call it. I intuited it.”

She proceeded to walk me back through incident, and had me identify, step by step what I saw, smelled, heard, noticed, thought of, and did. As I did so I built a profound stack of scientific evidence that, when put together, would undeniably lead to this outcome. According to every text book ever written since the beginning of obstetric text books. “So you see,” she chirped pleasantly, “you didn’t intuit anything. That’s crap. It’s an undersale of your knowledge and abilities. You have three dozen pieces of proof for your diagnosis and you don’t need anybody’s permission to know that you were right.” Three dozen pieces of proof. She was right. I did. I knew my stuff and I knew where this mom was headed and that she needed intervention. I took the right steps and got her into the care she needed in time and just as I saw coming, she had extreme need of high level intervention. But at the time, I couldn’t explain to the doctors how I knew what I knew. Forget them, I couldn’t explain it to the family, or even to myself.

After that incident, I began to peel apart my “sense of things” and force myself into a tedious exercise. Doulas are usually massively equipped with this “sense of things” skill–walking into a room to find a laboring mother, her partner, family, providers, and nurse. Each with their own emotional experience, needs, goals, desires, and fears. The music is on and people are having side conversations. The room smells like a lot of bodily fluid (often the depth of those smells is a sign itself of how far along labor has progressed) and a lot of sterilization chemicals. In an instant that doula sizes up the room, the tone, the interactions, the body language, the mother’s noises and movements, who is holding stress in what parts of their bodies, the tension, the love, the energy, the gaps in energy, who is driving the intention in the space. Then, she matches all of that up against what she knows are the mother’s wishes, hopes, worries, fears, and dreams. And she meets every single person in that room exactly where they are with hardly a word. She seamlessly integrates and harnesses the parts and pieces needed for the family that is relying on her. It isn’t long before everyone–provider, nurse, family–everyone is in love with her. They all feel seen and understood by this woman. And that was how I trained my brain for years and years and hundreds and hundreds of births before midwifery.

My mentor set me on the path to train my brain to quantify all of the dozens if not hundreds of data points along the way that were my teachers and to let myself be informed primarily in bullet points instead of feels. At first this process gave me tremendous headaches. It was a slowing down that took discipline and discomfort. I had to stop seeing myself in one way, and open up to myself in this whole new dimension–smart, savvy, educated, knowledgeable, prepared, and capable.

I remember the first time I took a mom to a physician because of the same condition as the one that started me on this path moving from Intuit to I knew It. The physician asked me, what are you seeing that leads you to believe this?  I said here’s what I know and why I know it. I believe you are here to help this mom but I know what she needs and that’s why I’m calling. And I gave her my list of evidence. And she agreed. And mom and baby were healthy and fine because I identified a simple physiological disruption long before it ever got a chance to manifest as a diagnosable pathology.

Now I’m old (which I enjoy!) and I’ve embraced not needing anyone’s permission to know that what I see–labs, signs, symptoms, constellations of symptoms, are of great import and can make a real difference in the health of a family I am working with. I happily consult colleagues, teachers, and mentors and work with them to hear fresh ideas, consider possibilities, and to build a care plan.

But I needed the intervention of a surprising midwife to find my way. It taught me to stay waaaayyyy open to what all midwives have to offer, to trust that even if it’s not how I practice, or we don’t share cultural, social, or especially here in the south, religious ground, we share the work of mothers, babies, pregnant people, families, and ourselves. How do you Intuit? How do you Knew It?  How do you seek the knowledge and wisdom of others to help inform you as you grow and learn?  How can you leave space for others to practice in a way that is genuine to them and continue to be yourself? What pieces would you want us all to pay attention to?

 

Dysglycemia in Pregnancy

Scroll down or click here for the slide show and link to the pdf.

Many women come into pregnancy primed for Gestational Diabetes.  This is a disease process which exists on a continuum and with support, guidance, and effort, pregnancy  can be a leverage into optimal health.  This is a very exciting option compared to the standard expectation that one will move from at-risk all the way into a full blown disease which requires multiple finger pokes a day, medication to control, and affects nearly every organ system in both mom and baby as well as their long term health outcomes.  Additionally, nutrition and exercise interventions during pregnancy reduce the likelihood of cesarean section (and you know how I feel about avoiding the primary cesarean and VBACs).

Do not be fooled by common recommendations which allow for a great deal of carbs per meal.  The single most important dietary intervention is the elimination of sugars and carbs with the exception of fresh fruit which is loaded in fiber that provides benefits which far exceed the effects of fructose.  Choose low glycemic load fruits. Increase levels of lean protein and low glycemic load vegetables for filling alternatives to sugars.  Look for glycemic load which represents glucose in a normal serving (the index represents portions much greater than one person can eat). Expect the first 3 days to be the hardest as you teach your body that it can get energy from sources other than sugar-heavy foods.  Cravings will be very strong but can be helped by keeping nourished throughout the day.

During pregnancy it is especially important to provide families with support for these changes until they can take them on as their own.  Failure due to “non-compliance” is usually blamed on the patient but is actually the failure of the provider to work on education and support that is meaningful to the individual and their family in a personalized way.  It is a huge investment of time with dividends in multitudes:  short and long term health for the pregnancy, mother, baby, and family.  If the provider cannot spend the kind of time needed, and does not have a health coach on staff who can–switch providers.

For those diagnosed already with Gestational Diabetes, take a look at lifestyle changes which have been shown to improve outcomes even over medication.  Work with your midwife or doctor to increase lifestyle changes and decrease medication.  If you are at the end of your pregnancy or a new parent–it’s not too late to start.  Breastfeeding longer than six months can also help regulate your insulin resistance and improve outcomes for you.

Click Here to download the PDF of this infographic.  Please submit your questions, comments or ideas for additional content.

 

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The Blog

You’ve reached the blog of Jodilyn Owen, Licensed Midwife and Certified Professional Midwife.

Planning or considering a homebirth?  Get the book today!

Follow this link to learn about our workshops and services for families.

You can learn all about midwifery care, professional topics, and options that come up during pregnancy and birth here.  Enjoy and be sure to send me your questions or comments or contact me if you’d like to talk further.

 

NRP 7th Edition Out of Hospital Chart

CLICK her for a PDF.  OK to reuse if you cite the source (at bottom of chart)!  Use your own judgment in the care of every newborn.  Adapt for that baby’s needs.  If you need help, call EMS and get it.  This is not a replacement for your NRP program nor does it qualify you to give NRP.  It is a TOOL for people who have taken the NRP course and received their card, primarily directed to students to help you gain an overview.  And finally, this reflects my preference for practice but your preceptor will have their own expectations.

NRP EM AM WB

GBS Prevention

Illustrations by Noa Ilan: follow @ilan_noa on Twitter for more

Read the long article

See the Infographics up-close

This post examines the role of preventative health care in the inhibition of Group B Streptococcus (GBS) infection.  It uses the term “mother” for simplicity’s sake although babies have all kinds of parents who identify in all kinds of ways and all are welcome here.

Let’s break down the long article:

Infections resulting from GBS  can be life-threatening to a newborn.  All pregnant moms are offered a test which detects this bacteria around 36 weeks of pregnancy.  If found, it can be treated through the use of IV antibiotics during labor, which significantly reduces the rate of infection and resulting meningitis and/or sepsis in newborns. While this article does not focus on the treatment of women who test positive, it does promote prevention, which improves the overall health of both mom and baby through the use of probiotics taken orally throughout the pregnancy.  These come in tiny capsules or a liquid packed with powerful lactobaccili (among other gut-friendly bacterium) that usually cost between five and twenty dollars per bottle or package).  It’s a small price to pay for so many amazing benefits.  As a midwife, I often pay for them for clients because of the massive health benefits of these supplements to every mom and baby, including avoiding a host of obstetric complications that would increase risks to mom and baby and often require transfers out of my care.  Great midwifery promotes the intrinsic health of mother and baby through programs like this which lend greatly to positive birth outcomes.

Let’s explore just some of the many benefits:

The Mother

Take a look at what the microbiota is if you aren’t already familiar with it.  The use of probiotics promotes this system that does a bit of everything good in the body including prevent the over-colonization of “bad” bacteria like GBS.  It also happens to prevent diabetes and keep your mood even.  It exists in the mouth, gut, and vagina of the mom and the placenta (and some studies found evidence in the fetal gut as well).

Over the course of pregnancy, the levels of good bacteria in the microbiota change.  By the time you give birth, you have an over-growth of lactobacilli which ensures that your baby will get exposure to this important “good” bacteria during vaginal birth.  When the system is supported right it will also prevent yeast infections, and keep the bacteria that cause UTIs and GBS in check.

The Baby

Impaired levels of probiotics have been correlated to preterm birth.   They are correlated because “bad” bacteria like GBS and candida (yeast) cause cellular damage to the cervix.  It loses its integrity and is not able to hold in the pregnancy as long as it should.  There are dramatic consequences for being born too early—the March of Dimes was founded because of babies born too early or too small.

When mothers take probiotics, they are found in the placenta and fetal gut and stay with the baby after birth to help regulate the baby’s microbiota.  That’s profound!!  You can help your baby synthesize vitamins and amino acids, regulate immune function, have smoother transitions between emotional states, and get a balanced healthy start just by taking probiotics during pregnancy.  After pregnancy, breast milk takes over the important function of populating the baby’s microbiota with everything it needs.

What Matters

  • Take probiotics throughout pregnancy to help keep your body hostile to “bad” bacteria and to strengthen the integrity of your tissue (muscles and skin included), especially uterine tissue like the cervix (and to boost your immune system, keep your mood even, etc., etc., and etc.!)
  • If you are planning a VBAC this winds up mattering a lot. Infections like candida and GBS can wear down the tissue that you are relying on to keep the scarred area strong and healthy.  Take a full dose of 4 probiotic capsules per day for your entire pregnancy.  I have supported an extremely high percentage of VBACing moms in my practice and this statement is NOT a judgment about your scar.  It is part of a recipe that will contribute to your overall success.  Check out this article for more ideas from the VBAC playbook or contact me to discuss further.
  • Have a vaginal, antibiotic free birth for maximum exposure to lactobacilli
  • Ask your provider ahead of time about swabbing your vaginal tract during labor prior to any antibiotics if you need them for any reason (including a planned or unplanned cesarean birth)
  • Regardless of how you deliver your baby, spend time skin to skin with her or him. Allow them to touch your breasts and arm pits with their hands.  You have lactobacilli on your skin that they will benefit from
  • Breastmilk feeds babies and promotes the growth of healthy bacteria in baby’s own microbiota, boosting their immune system and setting them up for good health
  • Babies born to a mom who had to take antibiotics or who were born by cesarean or who drink formula exclusively or as a supplement can all be given oral probiotics. They are available with a dropper or can be mixed into breast milk or formula and given through a bottle or made into a paste (just break open a capsule and add one drop of water at a time, mixing with your finger) and applied to mom’s nipples which is both soothing and healthy for the breast

Some disclaimers and information of note

  • The recommendations in this article are not designed to cheat a test but to actually improve the health of the mother, the integrity of the cervix, and the health of the placenta, fetus and newborn
  • Taking probiotics is not a guarantee of avoiding GBS or other complications related to imbalanced or missing gut flora. Talk with your provider about nutritional measures you can take to support your over-all health.  No amount of probiotics or exercise can undo the effects of a diet high in sugar and processed foods
  • Do get tested between 35 and 37 weeks for GBS. If you still test positive after a sustained period of time taking probiotics, eating a diet low in processed sugars and carbs, and rich in food that looks like it was alive, the colonization is highly likely to be one that needs antibiotic treatment. A pregnant woman who tests positive for group B strep bacteria and gets antibiotics during labor has only a 1 in 4,000 chance of delivering a baby with group B strep disease. If a pregnant woman who tests positive for group B strep bacteria does not get antibiotics at the time of labor, her baby has a 1 in 200 chance of developing group B strep disease.
  • If GBS is found in your Urine during pregnancy, antibiotics can eliminate or greatly reduce the high colonization. Take probiotics at the same time as you take antibiotics and for the rest of your pregnancy.  The CDC recommends that anyone with GBS in their urine at any point during their pregnancy receive antibiotics during labor
  • Please discuss this information with your provider and work together to find a solution that is right for you. If your provider does not have time to discuss this or other preventative measures with you, there are plenty that will and I highly recommend you shop for the one who will serve you best

Capture

Illustrations by Noa Ilan: follow @ilan_noa on Twitter for more. You can see the source article for these infographics and get an up-close view by clicking here.

Share your thoughts on preventative health care during pregnancy and your comments and questions below!

Additional Resources

Microbiota/Microbiome and Pregnancy/Birth/Breastfeeding

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943946/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464665/

https://www.amazon.com/Your-Babys-Microbiome-Critical-Breastfeeding/dp/1603586954

https://www.amazon.com/Microbiome-Effect-Affects-Future-Health/dp/178066270X/ref=sr_1_2?s=books&ie=UTF8&qid=1490123008&sr=1-2

Preterm Birth

http://www.marchofdimes.org/complications/premature-babies.aspx

Group B Strep Disease

https://www.groupbstrepinternational.org/