Mother to Mother Midwifery Blog

Who Do We Invite to Our Homebirth? Part 1

By midwife, April 11, 2017

This is a topic near and dear to our hearts!  We are very aware that who you invite to your birth ( and especially your Homebirth) has a great impact on your experience. We have attended births where a mom was solo because her husband was deployed and the doula didn’t make it on time.  We have attended births where the mom said at 8 cm to the 6 people observing her sitting in a row on the sectional sofa, “hey guys do you need popcorn?  Are you enjoying the show?”

These are two extremes of course…We view birth as important, if not more important than the day you get married, so being careful about who is in your private space is imperative.  Not having enough support can make things difficult.   Having too many folks just there to watch can interfere with the flow of your experience.

The first thing to consider when formulating your team is who you are as a person.  How do you deal with pain or emotion?   Do you prefer to deal with stress on your own or do you like to lean on others?

Obviously most humans need others to help them through things but some women really rely on a larger social circle for comfort.  For some people, being alone is unpleasant.  Other women prefer to get quiet and meditative and go within to work through things.  They might find the buzz of other people overwhelming when they are hurting or stressed.

We really advocate for a combination of both for a first time mother. With second and subsequent babies, there is of course is more flexibility.

The other thing to consider is the role of each person in your space.  There are lots of things to do in labor to support the process.  Someone should be in charge of making sure the mom eats and drinks.  Someone needs to get other things ready for the baby (make the bed, keep things tidy, prepare food) and one or two people should be able to take turns providing continuous labor support.  A team of 3 plus your care providers is usually a good number.  You can invite more people to ebb and flow as needed but having more than 3 people in your immediate space can be overwhelming.

Part 2 to come…FAMILY DYNAMICS at a birth

Little fresh newborn

 

ohhh the vernix-Birth Photos

By Sunshine Chrispeels, March 2, 2017

“The International Association of Professional Birth Photographers has announced the winners of their 2017 contest, and the photos they chose show the struggles mothers go through to bring new life into the world, and the sheer joy that follows.

We took your breath away with last year’s contest, and these new photos will leave you even more amazed. Each one tells a story of pain, perseverance, and finally, relief. They document a baby’s first moments of life, and a family’s first moments of unity.”

http://www.boredpanda.com/professional-birth-photography-competition-winners-labor-2017/?page_numb=12&utm_source=Epictexts&utm_medium=referral&utm_campaign=SBP

one of the many waterbirths

SO many raw images…careful if you are sensitive to images of cesareans. Many Midwife and Homebirth pics…tons of beautiful images.  Enjoy

Why a Doula? But we have a midwife…

By Sunshine Chrispeels, February 22, 2017

One of the big questions that we get asked at Mother to Mother Midwifery during our interview process is ” Do I need a doula at our homebirth?”

The short answer?  Yes

We as midwives have very refined doula skills.  We know what words to use, what touch works, positions for you to get into, how to engage the father in the process, we know about aromatherapy, homeopathies etc….  We do all of the things that a doula does.

What we can’t do is provide that support continuously as a good doula does.

We ask that you have an extra person at your birth especially for first time mothers and you will frequently hear us say that we can provide some labor support but our focus is on the clinical aspects of labor, birth and postpartum.  We ebb and flow in our physical support, always on alert for you and the baby but we can’t always be hands on.  Often we need to conserve our energy and focus for the important moments of the baby’s emergence and the postpartum period.  This means that we may rest while you labor and we are doing other clinical things while you may need hip squeezes.

Do we need to pay for one?  That depends…

We have a regular and low cost doula list in the office.  You don’t need to pay for one but…

We encourage you to have someone who has experienced natural birth, ideally in a home setting.  We ask that the person have some labor support skills and some awareness of what it is to be on continuous call for someone.

That person could be a close family member or a friend as well.  As long as they possess the above, then you will have a solid team of support.

For 2nd and subsequent babies we just ask that you have someone that is not your partner there if your other kids are in the house with you.  Most laboring mother’s want their partner with them, not looking after the toddler, so the third person fills another role for the family.

It is one of our big topic at prenatal visits.

#keeptheoxytocinflowing #mothertomothermidwifery #homebirth

Sunshine supporting a laboring mother with belly binding and rebozo

Oxytocin-protecting the mother’s birth space

By Sunshine Chrispeels, February 9, 2017

One of the things that homebirth and midwives seek to do for the laboring mother is to create a sense of safety and respect so that a mom can unfold in labor.  Of utmost importance is the maximization of oxytocin production so labor can flow.  Home is often the easiest place for this to occur as it is a comfort zone for the woman.

The hormone oxytocin, that causes the uterus to contract, is cultivated naturally in many settings, but in intimate ones it is flowing.

The things we know that #keeptheoxytocin flowing are:  soft voices, low lights, music, water, people around who nurture the mother in labor, touch (when welcome), massage etc..

What interferes with it’s production? Fear, worry, doubt and the elements that are the opposite of the above (loud voices/noises, bright lights etc…)

The reward of this hormone is a more efficiently working uterus and a deep bonding experience between all people present.

OXYTOCIN is the hormone of love and is abundant in many physiological experiences including: sex and orgasm and breastfeeding.   It also is released in other bonding event like eye contact, skin to skin contact and HUGS of course…You know the feeling of falling in love?  The feeling after you get out of the water (especially the ocean)?  The feeling after satisfying human interactions?   All part of the human hormone cocktail…

Cultivate it in your life…it’s good stuff

Read more about it on Wikipedia

Evidence Based Birth Practices

By midwife, January 3, 2017

One of the goals of midwifery care is “Evidenced Based Birth Practices” which means that our care is guided by more than just our personal experiences and instincts.  We strive to provide what we think  is a blend of available science and technology as well as good old fashioned nurturing…

A webisie that families can reference when making decisions is
Evidence Based Birth
We feel strongly in this model of care that empowers families to make good decisions.

This article on GBS is something that we reference from the website…there are many informative articles and we invite you to explore  when making important decisions that impact your care.

 

ENJOY!

 

#homebirth #mothertomothermidwifery #Midwife #licencedmidwife #CNM #midwifeminds #evidencebasedbirth

NIPT: Early Genetic Testing

By Kayti Midwife, December 18, 2016

Non-Invasive Prenatal Testing (NIPT)

Introduction

NIPT analyzes cell-free fetal DNA circulating in maternal blood. It is obtained from a simple blood draw. It is a relatively new technology in prenatal screening and testing for trisomy 21 and other fetal chromosomal aneuploidies. It differs from the California State-sponsored Prenatal Screening program in the following ways:

NIPT CA Prenatal Screening
Cost Cost is based on your insurance; out of pocket max, $200 Free with most insurances
Tests The most common chromosomal disorders only: Down Syndrome (Trisomy 21) trisomy 18 & 13. Can also tell if your baby is a boy or a girl.  More advanced testing also available. Screening for chromosomal AND “mid-line defect” issues (spina bifida, Open Neural Tube Defects, gastroschesis)
Accuracy 97-99% Sensitive and Specific (almost diagnostic) Accuracy varies: up to 90% accurate for Down Syndrome, 80% for ONTDs
Timing Can be done any time in the pregnancy from 10 weeks. Done at particular intervals; Final results available after 16 weeks

 

NIPT Test Characteristics

Genetic testing using cell-free fetal DNA

DNA from the fetus circulates in maternal blood. Unlike intact fetal cells in maternal blood, which can persist for years after a pregnancy, circulating cell-free fetal DNA (ccffDNA) results from the breakdown of fetal cells (mostly placental) and clears from the maternal system within hours. Fetal DNA detected during a pregnancy, therefore, represents DNA from the current fetus. Although only about 10-15% of the cell-free DNA circulating in maternal blood is from the fetus, it can be detected and measured. Quantitative differences in chromosome fragments in maternal blood can be used to distinguish fetuses affected with trisomy 21, and a few other fetal aneuplodies, from those that are not affected.

NIPT is currently offered by a host of companies:

Natera: Panorama

Sequenom: Materniti21

Illumina

We like NIPT because it offers families early testing for genetic diseases that can affect their choices in pregnancy- like early follow up care, education about place of birth, or opportunities to consider further testing.   The drawback with NIPT is that it does not test for “mid-line” defects which could also impact a family’s choices.  So we’re very careful when counselling our families about the wise use of this new emerging technology.  People DO love to find out early if it is a boy or a girl.  We enjoy their reactions, too.

 

Cesarean births affecting human evolution: The female pelvis is not to blame

By Brooke Ray, December 9, 2016

Recently some British researchers came up with a dodgy, new spin on an old obstetric myth. They warn us that the high rate of cesarean births is afffecting human evolution.  They claim the female pelvis is shrinking through evolution.  They report, selection pressure from the overuse of cesarean deliveries is accelerating this evolutionary shrinking process. Consequently, more women now require cesarean births because the pelvis is too small and narrow to birth normally.

Rate of cesarean births is climbing

Researchers are baffled by how quickly the cesarean birth rate is increasing.  Their best explanantion for this phenomenon is evolutionary pelvic shrinking.

This isn’t a new conclusion, folks.  The size of the female pelvis has always been the scapegoate for complicated deliveries.  The original diagnosis for cesarean delivery was cephalopelvic disproportion.  Translation is the pelvis is too small to fit the baby.

It’s possible that high cesarean rates will lead over time to the an evolutionary smaller pelvis, but the size of the pelvis is not the cause of the high rate of cesarean births.

female pelvis

The pelvis is not the problem

The truth is, the size of the pelvis is not too blame for the high rate of cesarean births.

In fact cesearen rates for women who plan to birth at home in the U.S. have remained a steadily low below 10%. This proves the problem is not the pelvis.

Its imperative to lower the cesarean birth rates but not by blaming the female pelvis.

The Brits were on the right track two years ago when they announced their campaign to steer low risk women away from birthing in the hospitals.

In an effort to lower the rate of interventions and cesareans, in 2014 Great Britain’s National Institute for Health Care Excellence (NICE) recommended that women with low risk pregnancies are better served by giving birth at home.

More than half of cesareans are unnecessary

In our modern, developed countries the cesarean birth rate is more than twice what it should be. According to the World Health Organization, the ideal cesarean rate should be 10-15% for any country. The U.S. cesarean rate is 33%, meaning that more than half of the cesareans performed are unnecessary.

This is a good cause for all of our concern.

The overuse of technology is the real cause for increasing cesarean rates

The real problem for rising cesarean rates is not a shrinking pelvis, its the overuse of modern technology

While we are indebted to modern medicine for saving lives from time to time, it’s overuse is driving up cearean birth rates.  In time this may indeed cause selection pressure against normal vaginal birth!

Giving birth in the hospital with all its practices and technology directly increases the liklihood of delivering by cesarean.

Interventions such as labor induction with cytotec and pitocin, Friedmans curve, continuous fetal monitors and anesthesia increase the cesarean rates when over used.  Impatience of the providers, driven by production demands, also drives cesarean birth rates.

In order to decrease the cesarean rates, modern medicine needs to be used judiciously and only for delvieries that become high risk.

Planned homebirths have low cesarean rates

Planning a homebirth is the best way to avoid an unnecessary cesarean delivery.  The likelihood of requiriing a cesarean delivery for a homebirth mother is under 10%, well within the World Heatlh Organizations recommendation.

A woman planning a homebirth can trust that even if she ultimately delivers by cesarean, it is necessary and life saving.  It won’t result from the overuse of technology.  She should also believe that her pelvis is adequate and has not shrunk through evolution.Stages in human evolution

World Health Organization reommendation for cesarean rates

Cesarean births affecting human evolution

NICE recommendation for low risk mothers

Birth in the Caul

By Brooke Ray, November 26, 2016

It is rare and special for a baby to be born in the caul.  It’s also known as ‘born in the veil’ because the membrane covers the baby’s face like a veil at birth.

Caul- the amniotic membrane enclosing a fetus.

Caul- The amniotic membrane enclosing a fetus.

Benefits of strong water bag

To be born in the caul is the result of a strong amniotic membrane that doesn’t break.  There are many physical benefits to an intact water bag including decreased infection, protection of the umbilical cord, and more freedom of movement for the baby.

How to have a strong water bag

The best known method for an expectant mother to grow a strong waterbag is to eat a diet high in Vit C, amino acids lysine and proline and phytonutrients.

Spiritual benefits of birth in the caul

Beyond the physical benefits, there are long standing beliefs about the spiritual gifts of caul births.  Supposedly these people inherit the gift of clairvoyance and healing abilities.

Legend tells us the “caul carriers” can never drown and are able to divine sources of underground water.  Best of all, birth in the caul bestows overall good fortune to these chosen ones. Parents and midwives used to save the membrane and keep it for the child for good luck and protection.  It’s possible to put the membrane a locket or wear it as an amulet.

Superstition and persecution

It’s not all good news though.  During the medieval inquisition, the inquisitors accused “caul bearers” of heresy,  along with midwives and healers, for suspicion of witchcraft and supernatural powers.  The penalties for heresy at that time were various tortures and punishments, including burning at the stake. In spite of persecution and torture, caul births have survived.

Modern birth in the caul

Even in modern times, we continue to recognize the rarity of caul births and respect them as such.  The majority of babies are born in hospitals nowadays, and attended by obstetricians. Only 9% of births are attended by midwives in the U.S.  Since doctors are more likely to artificially rupture the membranes to hurry along the birth, caul births are more and more rare.

We midwives still have the good luck to attend caul births because we do not routinely break the water bag.  It’s not our practice to rush the birth and we respect the benefits of the intact water bag. Allowing the membrane to remain intact increases the likelihood for a baby to birth in the caul.

How to deliver a baby in the caul

If the baby births in the caul, we simply wipe or peel the membrane from the face so the baby can draw his or her first breath.
Influenced by our predecessors, we modern people continue to unconsciously believe birthing in the caul bestows certain good qualities.
If we check, a lot of us believe caul babies and waterbabies, their waterbirth siblings, are lucky and have an affinity for water.  We might even believe they will grow to be talented swimmers, surfers and water people.

Caul birth and water birth

Nowadays many birthing women instinctively choose to birth in the water.  Water births and caul births are virtually the same because both result in the baby born in water.

Surfer

Surfer

Women can’t give precise reasons for their interest in water birth but I suspect their  unconscious attraction to it grew out of our ancestors  folklore about birth in the caul.

Would you like your baby to be born in the caul or in the water?

NY Times Midwife Article

Caul Birth and En Caul Birth

A Strong Water Bag-How to Avoid Premature Rupture of Membranes

By Brooke Ray, November 25, 2016

There are many benefits for a strong water bag.  The risk of infection for mother and baby remains low, the amniotic fluid insulates the umbilical cord, and the baby is better able to navigate the pelvis.  Here is an evidence based prescription for you to follow to grow a strong water bag!

The chorioamniotic membrane, fondly known as the water bag, is made of the connective tissue, collagen.

Nutrition for a strong water bag

Nutrition is the best known way to build and protect collagen. Eating a daily diet high in vitamin C, lysine, proline and phytonutrients will give you a strong water bag that is more likely to stay intact through labor.

Vitamin C Foods for a strong water bag

Vitamin C Foods

Vitamin C is necessary to build collagen and to prevent damage from free radicals.
Studies show that consuming Vitamin C 100mg daily decreases the rate of premature rupture of membranes from 24% to 7% of pregnancies.

Prenatal vitamins contain approximately 70 mg of vitamin C that contribute to building a strong water bag.

The best and safest way to consume additional Vitamin C is through dietary sources. Foods such as bell peppers, oranges, strawberries, broccoli and papaya are all high in Vitamin C.

Amino acids, lysine and proline, found in animal proteins and egg whites contribute to the formation of healthy collagen. A plant based source for both of these amino acids is wheat germ.

Phytonutrients in berries, dark colored fruit and green tea protect collagen from breakdown.

Our prescription for a strong water bag is a diet high in Vitamin C (strawberries, oranges, broccoli, papaya, bell peppers), lysine and proline (animal protein, egg whites, wheat germ) and phytonutrients (blueberries, raspberries, cherries, cranberries, green tea).

Qualities of Amniotic Membranes

Effects of Vitamin C on Amniotic Membrane

Giving Thanks for an Intact Water Bag

By Brooke Ray, November 24, 2016

We all know there are two membranes that surround the baby in the womb: the inner amniotic membrane and the outer chorionic membrane. These two membranes don’t always release at the same time.  Sometimes a mother may leak amniotic fluid, believing her water bag to be broken, only later to learn the water bag is still intact! How can this be?  Because the chorionic membrane released and the amnion remained intact.

This is a true Thanksgiving story of an intact amniotic membrane after leaking amniotic fluid for 40 hours.

We recently attended Adriana’s inspiring birth of her baby Amos,  whose water bag had been leaking for 40 hours before labor started.  The mother was sure the leaking fluid was amniotic fluid. And we midwives were certain it was amniotic fluid because we confirmed it with nitrazine paper.  When we finally performed the first vaginal exam in active labor, we were surprised! Our midwives’ concerns and surveillance were relieved to discover an intact amniotic membrane.  We knew the risks of prolonged ruptured membranes no longer applied.

water-break-pregnancy

 

Ten minutes before the birth the amnion finally released with a huge gush of clear fluid, quickly followed by a healthy, vigorous baby boy.

As a midwife, I’m grateful when the amnion remains intact because it protects mother and baby against infection; the umbilical cord is insulated; and the baby has more freedom of movement.

A common challenge in childbirth is when the membranes release before labor starts.  In medical terminology we call this premature rupture of membranes (PROM).

The literature tells us the longer the membranes are ruptured before birth, the more likely it is for the mother and baby to develop an infection. This is why hospitals and birth centers induce with pitocin (or Misoprostol) 24 hours after spontaneous rupture of membranes (SROM) if labor hasn’t started.  (Birth Centers transfer to a hospital for induction).  Homebirth midwives also recommend a variety of home therapies to naturally induce labor after the membranes release.

When the membranes release before the beginning of labor, the homebirth midwife and her client have concerns of increased risk of infection while waiting for labor to start.  Of course the expectant mother is informed and has the option to go to the hospital and induce labor- but she usually doesn’t want to!

So the homebirth midwife and her client are very careful to minimize the risks by monitoring both mother and baby and following precautions to decrease the likelihood of infection.

Then we wait… and wait…and wait some more.  It can feel like a long time.

diagram

According to the literature, 95% of women with PROM will start labor spontaneously within 72 hours.  I’ve never known an expectant mother in this situation to exceed 72 hours before labor finally started.

As a midwife, what gives me more patience and reassurance during this suspenseful time is the hope of a remaining, protective amniotic membrane.

The presence of an intact amnion is usually unknown since we avoid vaginal exams after SROM to limit infection.  We usually aren’t able to confirm the presence of the amniotic membrane until the first exam.

If it does remain intact, the amnion will release later during active labor or birth, often with a big, dramatic splash of amniotic fluid. Be ready! This can be a baptizing event. Or even more rare, the membrane remains intact and the baby is born in the caul.

I give thanks for our healthy mother and baby this Thanksgiving and all those strong amniotic membranes that stay intact until the very end. They give a nice sigh of relief for the homebirth midwives.

Stay tuned to learn how to grow a strong water bag!

Inspired by Adriana and Amos

Inspired by Adriana and Amos

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