Thursday, June 30, 2011

Haiti Homework

This is part of a short summary on Haiti by the UNFPA:

"Located in the heart of the Caribbean, Haiti faced many challenges prior to the devastating January 2010
earthquake, including political turmoil, natural disasters and food insecurity. With a population of 10 million, Haiti
is the poorest — and the only least developed — country in Latin America. Maternal mortality is declining, at
300 deaths per 100,000 live births in 2008, compared to 670 per 100,000 in 1990. The nursing-midwifery
workforce was decimated by the earthquake and significant emigration that followed and this has created a
major challenge. Only 26% of births are attended by skilled health personnel."

As Dina, Susan, Courtney and I prepare for our trip to Haiti, I will be offering up information about this incredible country. We leave on July 30 and will work with Midwives for Haiti for 2 weeks. I am excited to return, hoping to deepen my own appreciation of the power of midwifery in rural Haiti and hoping to reconnect with the midwives that we met last year. I am curious to hear about their year: successes, frustrations, goals for the future. Hearing that only 26% of births are attending by skilled personnel tells me that there is still lots of work to do.

Tuesday, June 28, 2011

Baby 1000!

On Friday, May 27th, 2011, with great joy and patience, I welcomed in the 1000th baby into my practice. Audrey Opal arrived, asking us to honor the most important aspects of natural birth: patience, trust, wisdom and commitment. Audrey Opal was born at home, in the water to loving and welcoming mom and dad, Kristi and Bill. It was the perfect 1000th birth!!

So, many have asked: Is that 1000 homebirths? What does 1000 births really mean? Really, what it means is that I have witnessed 1000 babies join us on the planet. 1000 babies I call “my own.” Not all of them have been homebirths, because, as we know, not all planned homebirths happen at home. And, not all of them have been natural or vaginal births. Again, even with the best of plans, not all births happen the way we intend. But, I can say with all confidence, that all of them have been amazing, incredible experiences. Perhaps more appropriate would be to say that I have accompanied 1000 women along their birth journeys. I have witnessed incredible strength, courage, compassion, challenge, testing, and will power. Birth is hard. It challenges us to the very core. Yet, embraced with integrity and sensitivity, it is an empowering, transformative journey. Birth has the power to teach us what it is like to be a woman, to become mothers, to experience life to its fullest capacity. When birth does not give us what we want, we have to work through disappointment, pain, frustration. We need to dig deeper to the core of ourselves to understand the lessons of birth, in whatever form they come. We grow and learn. We are humbled. Birth is empowering. Birth is hard. Our babies are amazing.

Here are some more numbers that you might be interested in:
I have caught:
7 triptychs (three babies for one family)
3 sets of twins at home
21 VBACs (attended) with 13 HBACs (Homebirths after CSEC)
3 Face presentations
I don't know how many were boys and how many were girls, anyone want to volunteer to count?

Maternal mortality rate in the US per 100,000 births : 13
Maternal mortality rate in Haiti per 100,000 births: 632

As many of you know, I traveled to Haiti last year with a program called Midwives For Haiti. I even have a YouTube channel. Go to You Tube and search sfmidwife. You will find the micro-documentaries that Dina made about Haiti. Dina and I and another CNM, Susan Leibel, will be traveling to Haiti again this year. We will be there the first two weeks of August. Dina and I are hoping to make this a yearly trip so that we can build continuity, rapport and camaraderie with the student midwives and graduates. In order to make this a sustainable mission for us, we are dedicated to fundraising to cover expenses. I have already raised $5700 of the $11,000 that this year's trip will cost for the three of us. I know that many of you have asked me how you can help with this project. So.... here's how. You can donate by sending your checks to me at: 206 27th St., San Francisco, 94131.

You can make your check out to me, or, if you would like your donation to be tax-deductible, you can write the check out to Midwives for Haiti, putting Maria Iorillo in the memo line. Still send the check to me and I will send them all together to Midwives for Haiti. It is quite eye-opening to see how much good can be done with just a few thousand dollars. Your donations will fund two midwives and 1 videographer to travel to Haiti for 2 weeks. Last year Ami and I both brought 50 pounds worth of medicines, supplies and baby clothes which were used immediately and much appreciated.

I am also collecting the white, mesh panties that are given to women to wear after birth. If you have any new, extra ones from your birth experience and was wondering what to do with them, now is the moment. These simple panties help to convey a sense of dignity to the Haitian mothers who often times only have a few torn clothes to use after the birth. You can also donate cotton onesies, baby hats or sox. Most other baby items are too bulky to travel with. Together we can make a difference for Haitian mothers and their babies. Thank you for being a part of this project with me.

Of course, donating your baby supplies means we get to see each other! Just call me for a time that we can get together.

Thursday, June 23, 2011

Ganden’s Timely Arrival

There were two things I wanted to accomplish before the arrival of our “little man.” 1) finish painting and decorating his room and 2) see the ocean.

This sounds reasonable enough, but at 35 weeks we learned that “reasonable” was all a matter of your frame of reference when I went into early-term labor. I had been having flu symptoms for three days and had developed a hearty cough so I think my body just went into immune system overdrive and sent a system-wide “Eject!” command to my babe.

At that point we owned a car seat (but it wasn’t installed), the baby’s room reaked of primer and fresh drywall mud, and in our denial about the contractions I had been feeling 7 minutes apart for 10+ hours we arrived at the hospital without even packing a bag. So it was a reality check to both of us when the doctor said that I was 2 cm dilated, 75% effaced, and that it was highly possible that the baby would arrive in the next day or two. “The train has left the station,” she said.  As we processed this news our midwife Maria came to the hospital as we came to grips with the idea that our baby was coming earlier than expected. Then slowly after a few hours at the hospital the contractions slowed and then stopped. We were told we could go home until they started again.

Once we arrived home my husband immediately drew me a bath and poured me a glass of wine, both on doctor’s orders.  He then installed the car seat base, assembled the bassinet, and stayed up until the wee hours of the morning painting the trim of the room (even though we knew the baby wouldn’t sleep in there for months). I knew I had chosen homebirth for a reason that was as much physical and mental—even though we were treated wonderfully at St. Lukes, my body sensed I was in a hospital and shut down my labor! My mantra became “37 weeks, 37 weeks” because my pregnancy had to last two more weeks for me to be able to have the home birth we had planned for.

We made it. At 37 weeks I told my baby that he was welcome to come whenever he wanted. At 37 weeks and 1 day my husband and I finished his room. At 37 weeks and 2 days we drove up to Muir Beach so that I could see the ocean. I had been visualizing waves in my labor preparation, imagining them washing over me and then fading away like a contraction, so I had been yearning to close my eyes and listen to the ocean and breathe the salty air so that I could imprint it on my senses to call on in time of need. It was a crisp, clear day and Dave and I went on a short walk and then sat on a log together and soaked in the sea. On our way home I suggested that we stop for lunch in Sausalito—I had been wanting to try a restaurant called ‘Fish.’ Apparently many others had the same idea because we had to wait in line for 45 minutes just to order our food. But I was super excited about the crab roll, so it seemed worth it. After we ordered there weren’t any tables free, so we pulled two stools up to the bar and sat happily watching the food being prepared. Suddenly, there was a pop, followed by a whoosh, and I said to my husband, “I just felt a pop and now I feel like I’m peeing my pants.” We both looked down and clear liquid was streaming down the stool and pooling on the floor below. It was a moment of wonder and shock; we looked at each other incredulous, laughing. It was 2:00pm. The three teenage girls sitting at the bar next to us looked over and asked (in a Southern drawl), “Are y’all going to have a baby today?” Then they took our picture. Dave’s immediately reaction was to rush out of the restaurant, but I was like, “hell, no. I just waited 45 minutes to order my food, I’m hungry, and I’m going to eat this crab roll before I have this baby.” So he ran back to the register and asked them to package everything to go. We waited another 10 minutes and then I wrapped his windbreaker around me like a diaper and we hobbled out of the restaurant.

Once in the car my first call was to Maria, our midwife. She had just arrived home from another birth and told me that contractions may not gear up for another 24 hours so I should go home and relax and call her when they were 5 minutes apart. My second call was to Natural Resources because we weren’t scheduled to pick up the birth tub for another week and I really wanted to labor in the tub. They offered to try and find a tub for us and would call me back shortly. My first contraction happened as we were driving on the Golden Gate Bridge.

Once home, we quickly sat down and ate our food—I savored the crab roll, and part of a chocolate chip cookie. It was 3:30pm and Natural Resources called to say that they found a tub, so my husband left to pick it up (which involved squeezing it into our Mini Cooper so tightly that he couldn’t move the stick shift out of second gear) and I called my parents to update them on my labor. During the conversation with my Dad I had to continually pause to breathe through the contractions, a signal that labor was progressing. At that point my contractions were between 3 and 5 minutes apart, so I called Maria again and she said she’d be over in an hour. When my water broke we debated if our little man would be a Sunday or Monday baby, and now I felt pretty confident that the baby was coming that night.

As the contractions grew stronger I moved from lying across the exercise ball in the living room, to folding myself forward over the kitchen counter. I was listening to my hypnobirthing mp3s and focusing on my breath. I felt strong and prepared. Dave was heroically scrambling to find a way to connect the hose to the sink to fill the tub (no time for dry runs!). Since my water had already broken I knew that I couldn’t get in the tub as early as I had hoped, and I wasn’t fully confident that we were going to get it set up and filled in time, so Maria suggested that I take a shower. Ahh, the shower, my happy labor place. The warm water felt amazing on my skin, I was alone with my contractions, and my voice reverberating within the enclosed space in a way that allowed me both focus and release. I remember Maria saying that I needed to do whatever made the contractions come on stronger, so I switched between squatting, placing a leg up on the shower bar, and rocking my pelvis back and forth. I remember stroking my belly from right to left and singing, “this is the way you go” as a way of trying to coax the little to guy to turn the appropriate direction to avoid back labor. I also remember saying at the end of each contraction: “bring it on baby, bring it on.” And he did. Maria and Dave would periodically check-in, and I heard my mom arrive, but most of the time I was moaning through contractions and keeping my eyes closed. I was so happy in the shower that I lost track of time and inadvertently used up all the hot water just as Dave was able to get the hose connected between sink and birth tub. Oops. So the boiling of water began! One of my clearest memories from my labor is the cycle of Dave being around to apply counter pressure to my lower back during a contraction and then the second it was over he would whisper in my ear, “ok sweetie, now I have to go and boil more water!” and then he would disappear until my noises would signal another contraction. Dave jokes that he felt like he was attending a birth in the 1800s because we were at home, had a stack of our own clean towels and sheets ready and waiting, and were boiling water.

After I finally left the shower, Maria recommended that I move to the bed. We had recently purchased a padded stool for the cat to use as a step to get up on the bed—I kneeled on it with my body draped forward over my yoga bolster placed on the bed. Once again my eyes were closed and I just tried to relax into the contractions as they grew stronger and stronger and more challenging to bear calming—my hypnobirthing practice was being tested. After one contraction I looked up and saw that it was 9:15pm. I remembered reading somewhere that you should cover up the clocks so that you’re not tracking how much time labor is taking, so I walked over and covered it with a shirt (which now seems a bit ridiculous). I was keeping my eyes squeezed closed both during and after then so my memories are all sounds. After one particularly strong contraction subsided, both Maria and Dave started to leave the room as another huge contraction immediately rolled through me. I remember screeching, “somebody stay and help me!!!!” at the top of my lungs. I was still kneeling draped over the bed hunched over my yoga bolster and the contractions were at their strongest yet. For the few moments between them Maria was telling me to blow out the tension. The baby’s heart rate was still strong and steady. Soon, Maria told me that after the next contraction I should stand up and try to go to the bathroom. I remember waiting for the contraction to subside and as it started to lessen another one would immediately ramp back up, so at that point I think I screamed, “they won’t stop!!” Eventually there was a small break, so Dave supported me as I hobbled over to the next room and the second I sat down on the toilet my body completely took over, I became possessed. My whole abdomen felt heavy, and I started making grunting noises. In my head I was thinking “this baby needs to come out now!” but I’m not sure if I was able to convey that in words or not. Maria ran over and asked if I was pushing, I’m pretty sure I said, “I can’t help it.” Since my water broke before contractions began I still had never been checked for dilation. With one touch Maria said the baby was coming and that I should move back to the bed. That’s when my mind awarded me a moment of clarity. I remember thinking, “Dave has spent nearly all of my labor filling the tub, and I sure as hell am going to use it!!” So with that, I left everyone behind and strutted down the hall into the nursery (I wanted my boy to be born in his own room), threw my robe on the floor, and stepped into the tub. Dave and Maria followed.

I started squatting, as that’s how I had seen it done in all the birth videos, but Maria told Dave to get into the tub as well and support me like a chair so that I could scoop my pelvis upward. Then the “animal” body kicked in, I surrendered. Sounds were coming out of my body that I was not in control of, nor even knew how I possessed. I remember Maria saying, “Jaime, you need to stop screaming. Make low, grunting, animal noises.” Then Dave started making them in my ear so that I could mimic them. Next thing I knew I was being told to reach down and feel the head. All I could think was, “this baby needs to come out now.” He had politely waited to hit the 37 week mark and now was rushing, ready. I only pushed a few times. I had Dave pinned between me and the side of the tub, the back of my head pushing into his face and shoulder. During the pushes Maria was reaching into the water and I could feel a tug—later I found out that the cord was wrapped around his neck twice and she was untangling my babe. I was imagining water and expecting to feel the “ring of fire” but only felt splitting. Only later did I learn that my little man burst through on his way into the world, my body either didn’t have the time or the ability to stretch around him. With one big push his head was out, with the next push out flew his body. It was 10:30pm; 8.5 hours after my water broke. Maria scooped him up and handed him to me. He was so slippery and I felt so awkward, still balancing on my husband’s lap, trying to keep the little guy warm without dropping him. As he was born Sue, the second midwife, had let herself into the house—the ending speed of my delivery must have taken even my midwives by surprise. I called for my mom, who had been waiting, praying, in the next room. She ran in with the camera and shot the most amazing photos that so perfectly captured the moments after his birth: Dave and I in the tub holding Ganden, Dave cutting the cord, both of us in mouth-gaping awe. Just after the birth I remember thinking that I didn’t feel the euphoria that seems to so often appear on women’s faces in the birth videos just after they give birth, all I remember feeling was discomfort. But then I saw the photos and was surprised at how glowing I look—I was radiating joy, love, power. I was mighty.

Two truths were confirmed for me through my birth experience: the wisdom of the body and the power of the mind. It’s a delicate dance between these two because birth is about surrendering to sensation and allowing the instincts of the body to take over while harnessing the power that the mind has over the body. By thinking ‘relaxxxx’ (another of my mantras) and focusing the mind on a particular body part, that body part responds to the command. And relaxing into contractions is far less painful and more productive than fighting them. I mentally understood that going in, and physically felt its truth after a mere few contractions.

Body and baby engage in unknown communications to determine the proper timing for delivery. While a bit earlier than expected, my little boy knew he was strong enough to enter the world. He waited for us to finish his room so that he could be born in calming space fashioned with love. He waited for me to see the ocean so that I could imprint the sounds of the waves within my mind. Perhaps the sounds and smells of the ocean were his beckoning call, a prompt for my bag of waters to rupture, a shared signal to both of us that our minds and bodies were ready to turn inside out.

Ganden, may your laughter always reach up to heaven, my sweet little boy.

What happens after delivery is so often skipped in birth stories. After birthing the placenta I returned to my bed and was able to spend some quality time with my new baby and my husband. We cuddled and practiced nursing. I remember being in awe, but also being completely distracted by pain and continued contractions. After an hour or so Maria said that I had to go to St. Lukes for a repair since I had a fourth degree tear. When people ask me if I have any advice for women regarding birth I say, “embrace discomfort.” I felt mentally, physically, and emotionally ready for the challenge of birth, but a bit under prepared for what would come afterward. I certainly didn’t want to leave my brand new baby at home to go to the hospital. Once at St. Luke’s I had to adamantly refuse the IV pain medications—I had made it this far naturally and other than local anesthetic was planning on staying natural. While laying on the table I had to repeat ‘relax, reeeelllaaaxxxx’, again and again because I was still racked with labor strength contractions but needed to lie still for the delicate suturing that was going on. But in the end I was able to return home and back to bed where my husband and little boy were lying skin-to-skin.

Thanks to Sue Baelen who took such good care of my little boy and my husband while I was away. And much thanks to Maria who caught my little boy and helped make our desire for a homebirth as close to our dreams as was possible. And thanks to my Mom and Dad who both gave Dave and I the space to share the birth experience together, and was very present and supportive during key important moments. And most of all, thanks to my husband who was with me every step of the way (especially when racing to carry pots of boiling water across the house to fill the birthing tub) and who even managed to stomach cutting the cord. I am truly blessed. I was prepared for the first few weeks as a mother to be challenging, but was not prepared for how gentle, joyful, and blissful they could be as we nested at home as a new family. The homebirth experience was wonderful in that it allowed me to “do my thing” during labor and delivery, but what was even more wonderful was the care and I support I felt after the delivery. Dave was there every step of the way (who knew breastfeeding could be a 2 person job?) and I felt like there was a team of people helping me to be successful as a mother, and for that I will always be grateful. 


Wednesday, June 22, 2011

S's Birth by Jamie, her mom

S was born at home herself and here is HER mom's story.

"S" (name changed for this story) was my 5th baby who was born at home, and my first experience with midwives.  Our first child, Jaia, was born at home in Arvada, Colorado in February 1971, with a “cool doc” who had attended medical school in the East, but then began to think holistically and was attending home births.  His name was Richard Moskowitz.  He lived in Boulder, but was at a birth in the mountain town of Ward when I went into labor.  Ward was an hour away and there were no cell phones; the folks who were having their birth didn’t even have a landline. He arrived merely 20 minutes before she was born.

Our next 3 births were at home, with my husband Robert and myself handling the delivery.  After the birth of our 4th child I started practicing midwifery, attending births of friends and then other families in eastern Iowa. We moved to a wooden A-frame on 10 acres of land two months before Sasha’s birth.  At the time she was born, Nov. 9th, 1980, I had two midwife partners who were also my best friends, Carla and Neva.  Since my births had gotten progressively shorter (17 hours, 4 1/2, 2 1/2, and 1 hour and 45 minutes).  Carla decided she and her husband would erect a tipi in our field so she wouldn’t miss the birth!

As the clock turned midnight I had a big rush, then another.  I awakened Robert and took an invigorating, yet calming shower.  He got Carla out of the tipi and called Neva and her husband Dennis, who was a doctor.  I had gone to the birth of their son the previous year and Dennis was going to photograph our birth.  I had also attended the birth of Carla and Roger’s son 7 months before.  It was one extended happy home birth family. My brother, Chuck, also came over to witness and photograph the birth.

I relaxed on a big mattress in the loft of our A-frame. I checked my dilation before anyone had arrived.  It was a gooey 5 centimeters.  Robert woke up our four other children who were nine, six, four, and two years old.  We still have photographs of them; including the two year old waking up drowsily, and sucking his thumb.  Their expressions show curiosity, anticipation, but certainly no fear. I remember laughing as I lovingly watched our four kids taking in the sights and sounds of the birth.

It was the first birth where Robert and I did the smoochie-lovie scenario described in Ina May’s Spiritual Midwifery.  I was in labor daze so I don’t remember much.  I know Neva and Carla were vying for whom would catch our baby.  It was decided that they would both catch. It was all so short: probably 25 contractions and very little pain.  The labor and birth lasted one hour and 12 minutes.  It was such a glorious feeling, and one of relief to have my big beautiful baby lying on my belly and chest, nuzzled to my breast.  She weighed 10 pounds, four ounces; a baby sister for her big sister, who named her S.  After everyone was snuggled back in bed, we all slept until mid-morning.  My family came the next day, plus a few friends who brought food for us.  S was adored by her family, which was now seven strong!

Invest in Midwives

U.N. Report Calls for Investment in Midwives To Reduce Maternal, Infant Mortality

June 22, 2011 — More investment in midwifery could save millions of infants and hundreds of thousands of women who die annually because of a lack of access to skilled health care during childbirth, according to a United Nations Population Fund report released Monday, Reuters reports.
The report -- the U.N.'s first study on midwives -- found that 358,000 women and 3.6 million infants die annually because of largely preventable complications during pregnancy, childbirth and the postnatal period. About another three million infants are stillborn, the report found. The report surveyed 58 countries, studying the equivalent of about 60% of all births and 91% of maternal deaths worldwide.

Countries need a minimum of six skilled birth attendants for every 1,000 births to achieve 95% of needed coverage, the report concluded. A total of 38 countries need more midwives, 22 of which need to double their midwifery workforce by 2015. Seven countries need to at least triple or quadruple their workforce, while nine countries need to increase the number of midwives by between six and 15 times (Kelland, Reuters, 6/20). 

Dozens of aid, development and educational institutions endorsed the report and asked governments and philanthropists to invest in midwives, the AP/Washington Times reports. Vincent Fauveau, a physician who worked on the study, said that midwives can provide a solution for countries with shortages of doctors and nurses. Midwives also can provide contraceptive counseling and services, he said. War, poverty and hunger threaten women and children in many parts of the developing world, he explained, adding that "a long-term strategy" and many investments are needed to save lives (Bryson,AP/Washington Times, 6/20).