January 21, 2015 by gentlemidwife

Suggestions for a Healthy Pregnancy

Recently I’ve been searching for a short, easy-to-read handout on nutrition and exercise. I was having trouble finding what I wanted…something that hit the high points, but wasn’t so detailed that no one would take the time to read it. Here’s what I came up with, though there is SO much more that could be said. I encourage each of you mama’s to research nutrition, supplements and exercise so that you know WHY you are doing what you’re doing for you and your baby!

During pregnancy, your body faces extra demands and nutritional needs. Making wise choices in caring for your physical needs can help to build a healthy baby, improve your energy levels, experience less complications during birth, and have a more rapid recovery. How is that for motivation?

Diet Recommendations:
There are many varied suggestions out there as far as pregnancy diet goes. While it is important for you to do your research and make the best choices for your particular situation, the following are a few principles to go by when it comes to what you eat:
– Major on high-quality protein. Protein helps to give you sustained energy, builds good skin integrity, and keeps your blood sugars in check. Some ideas include: Greek yogurt, cheese, nuts, nut butter, chia seeds, eggs, meat, and seeds.
– Consume a variety of vegetables, preferably organic whenever possible. This helps to provide you with more fiber, and the multitude of natural vitamins and minerals that vegetables contain.
– Add quality oils to your diet. Recent research has proven that quality fats are good for us, contrary to what we used to be told! Coconut oil, olive oil, and butter (esp. if it’s grass fed!) are examples of good fats to be consuming.
– Reduce your intake of carbs-especially simple carbs. While carbohydrates are good in moderation, they shouldn’t be considered the foundation of your diet. Carbohydrates tend to elevate blood sugar levels, as well as adding extra pounds to you and the baby during the last several months of pregnancy. When eating carbs, do your best to make sure they are made of whole grains whenever possible, which provide you with fiber and a slower sugar release. Using a variety of organic grains (such as oats, spelt, rye, etc.) are better choices than only consuming wheat products.
– Stay away from artificial sugars, and limit your intake of refined sugar. Try using maple syurp, honey, coconut sugar or other more natural-type sugars when you need something sweet!
– Try to limit fruit juices, and eat whole fruit instead.
– Keep healthy snacks on hand, so that it’s easiest to make good choices when you’re hungry!
Supplements:
Ideally, your nutritional needs should be met through a healthy, balanced diet. But most of us can still use a bit more help!  The basis of your supplements should include a high-quality prenatal vitamin, one made from natural food sources instead of being chemically engineered. Seeking Health, New Chapter Organic, and Thorne Research are good brands, but there are more out there. Most moms are also lacking in sufficient calcium and magnesium, and I recommended taking a minimum of 1000 mg. of calcium each day. This can also help you to sleep better at night, and experience less muscle cramping and discomfort. Other supplements are normally suggested and added as needed, and we can discuss your particular needs during our prenatal visits.

Exercise:
In preparing for your labor and birth, it’s good to keep in mind that it is similar to preparing for a marathon. No one decides to run a marathon and then does it the next day-it takes lots of preparation and training for the big event. It’s much the same with giving birth. The more prepared and equipped your body is, the better able you’ll be able to handle the challenge and the easier your recovery will be. I highly recommend the following:
– Take a brisk walk at least 3 times each week, trying to go at least 1 mile in distance.
– Incorporate some type of exercise program (even just 10 min. long!) into your daily routine, and make it happen at least 3 times a week. There are many different 10 min. pregnancy workouts on youtube, and many other options you can take advantage of. A routine that incorporates lots of squats and leg-strengthening moves can be especially helpful in getting your body prepared for birth.
– Visit the “spinningbabies” website for information on daily exercises that encourage good alignment for mom and good positioning for baby. I have an excellent DVD on this subject that I encourage each of my clients to borrow and watch.
– Consider visiting a chiropractor during the last trimester to ensure your body is ready for birth!

November 24, 2014 by gentlemidwife

Frequently Asked Questions

If you are considering a home birth, perhaps the following are questions you have wondered about. Don’t hesitate to contact me with any specific questions…I’d love to help you in any way I can! Please note, these questions and answers pertain specifically to my practice here at Gentle Delivery Childbirth Services, and may not apply to other midwives and practices.

Q. At what point in my pregnancy should I contact you?
A. You are welcome to contact me at any time-with preconception questions or as soon as you find out your pregnant. A free no-obligation consultation where you can ask questions and see my office can occur at any point, but I typically schedule your first actual appointment once you are between 10-12 weeks along, as that allows the baby to be mature enough to hear the heartbeat. The earlier you are in touch, the greater chance I will have an opening over the time you are due, though it’s never too late to talk with me about your options, either…we can begin care late in the pregnancy when necessary, too!

Q. What does a normal prenatal look like, and where does it take place?
A. Prenatal appointments normally take place in my home office, usually on Tuesday and Thursday afternoons, although other times are possible. I generally expect to take anywhere from 30 min. to an hour, with the goal being able to spend enough time to answer any questions or concerns a couple might have, as well as including education regarding exercise, nutrition, positioning, childbirth, etc. At each visit a urine sample is checked, weight is recorded, BP is taken, and baby is listened to, measured, and palpated to see his or her position. Other testing and/or procedures will be performed as needed. The normal schedule for visits is every month until 28 weeks, followed by bi-weekly appointments until 36 weeks, and weekly visits thereafter. A home visit is performed at 36 weeks, in order to give myself and any other birth attendants a chance to see your location in normal daylight hours! 

Q. Do I need to see a doctor besides seeing you for prenatal care?
A. That honestly depends upon your personal preferences. The prenatal care I give would be similar to what you would receive from a doctor, including labs and referrals for things like sonograms. Most of my clients do not see a doctor while receiving care from me, as it keeps costs down and keeps them from multiple prenatal care visits. If your OB office is open to co-care, it can provide you with a seamless transition in case of transport, especially if it is covered by your insurance provider. If care with an OB is covered in full by your insurance provider, you may benefit from continuing care with them in order to have the costs for your labwork and other testing covered completely.

Q. Will my insurance cover your services, or how can I afford it?
A. Sadly, many insurance companies do not cover home midwifery care, though it is always worth checking into thoroughly. I would be happy to provide you with some information on how to best discuss this with your insurance company, and I am also willing to give you a written statement complete with insurance codes to submit to your insurance company. In order to keep my own costs down, I do not file insurance, but I do try to make care accessible to all families by charging a sliding scale fee based upon your family’s income. Keep in mind, too, that when using insurance, you will have a co-pay, and for some people the cost of my services are either similar or lower than the co-pay amount you would be paying with a hospital delivery.

Q. I notice you have a student working with you. How does that influence my care?
A. When a student is interning for midwifery training, their level of involvement varies according to where they are at in their studies. A student midwife begins by observing all aspects of midwifery care, and applying the academic knowledge she has already received to practical, hands-on situations. As her experience expands, so do her opportunities-she assumes more responsibility depending upon her level of experience and skill. Students are always grateful for any opportunity afforded them to learn, and would love to be as involved with your care as you feel comfortable with. I always strive to make sure the client feels completely comfortable with any care provided by a student, whether that is allowing the student to feel for baby’s position and fundal measurement, or whether it is as extensive as allowing the student to participate in a high level of care during delivery. Whether you prefer lots of involvement or minimal involvement, a student generally acts as my birth assistant during the actual labor and delivery, helping to provide labor support, take notes, and in general act as my second set of hands. 

Q. Who will attend my birth? Is is okay to invite others to be present in addition to the birth team?
A. Normally I attend births with one or two qualified assistants. These ladies are usually either skilled students or birth attendants, and enable me to know you are getting the best care possible, allowing both baby and mom to be cared for in case of emergency. Besides this, whomever else you choose to have present at your birth is up to you. I’ve been at births where it was the bare minimum of people, and I’ve been to births where there was a crowd! The main issue is that you feel totally and completely at ease and comfortable with whomever is present, as that can majorly impact your experience.

Q. Are children welcome to attend the birth?
A. It’s your birth, so you get to decide if you want your children present or not! If you are planning on having your children attending, I strongly recommend you having an extra person handy whose sole responsibility is caring for your child(ren) so that you can focus on the delivery.

Q. Do you do waterbirths?
A. Yes! Laboring and delivering in the water are both options. For many people, their home tub is comfortable enough, but if you’re wanting to use an actual “birth pool”, I can put you in touch with rental possibilities.

Q. I had a cesarean with my previous delivery, does that rule out a home birth?
A. I am happy to help women VBAC whenever possible. For most women, a VBAC at home is statistically safer than a repeat c-section. Make sure you get a copy of your previous medical records, and we can discuss your particular situation in person in more detail.

Q. What birth positions are options at home?
A. There are about as many options as there are women! One benefit to delivering at home is the flexibility to figure out what works the best for you…whether that is squatting, laying in bed, standing in the shower, or wherever you are the most comfortable. I have a traditional “birth stool” that I bring along to births which gives you the option of a low squat, but most women instinctively find a position that works the best for them.

Q. Are you prepared for possible emergencies?
A. Yes. I maintain current certification in both neonatal resuscitation and CPR, bringing along emergency equipment in case of a baby with breathing difficulties. I also carry equipment to assist with stabilizing a mom in the rare case of hemorrhage. It’s my goal to make your home birth experience as safe as possible, which includes careful monitoring of both baby and mom during and after labor, so as to catch any concern that is out of the scope of “normal”. Consistent prenatal care combined with healthy, low risk moms lowers the chance of emergency procedures drastically, but your birth team stays alert for any signs of possible surprises. We can discuss this question in more detail during your consultation if you wish.

Q. So, laboring at home sounds nice, but what about the mess that comes along with birth?
A. Most people are surprised at how little mess is involved. I have families purchase disposable underpads (available at most drugstores) and a cheap shower curtain, which we use to protect surfaces such as the bed and carpet for the actual birth. These things get thrown away afterwards, and myself or my assistant will start laundry before we leave your home. We also make sure to tidy things up so that you aren’t left with clean up!

Q. How do I go about getting documentation for my child?
A. I will file all needed paperwork with the state, which includes the official birth certificate and request for a social security number. I also perform the newborn screening test on your baby during the home visit which occurs 24-48 hours after birth.

Sweet baby feet as baby is being weighed during the newborn exam!

September 30, 2014 by gentlemidwife

Random Life Happenings…

Well, my hopes to keep up with blogging a post at least once a month fell to the wayside this summer! My big plans and ideas came to a rather screeching halt when we found out that we have another little one on the way…soon after that discovery I was sick enough with morning sickness that I found it hard to keep anything up besides the bare minimum! I’m very grateful to be past the 1st trimester by now, and we’re anticipating our new arrival to make his/her appearance come early March. This news does, of course, have ramifications for midwifery-at this point I am taking clients until the beginning of February, and will then take time off until May. For updates on my client schedule for the next months, feel free to check out the “current availability” tab.

We had a fun family trip out to KS for my sister’s wedding at the beginning of July. All of my immediate family (along with much of my extended family) lives in the central KS area, so it was good to reconnect with family and friends again. Making memories by taking horseback rides, going fishing, eating donuts with Grandpa, visiting the zoo, and in general being spoiled by all the grandparents, uncles and aunties made for a lovely time as far as the children were concerned! 🙂

Family Photo at Aunt Charis’ wedding

Two baby girls made their appearance in June, with both of them ending in lovely births. It’s always a special privilege to be involved when a baby makes it’s arrival…those first moments of a family being together for the first time, savoring the new baby looks, smells and cuddles are all so amazing and unique to each individual, and it makes me so grateful to be able to be a part of it!

Little baby K, and my sweet assistant Beth, who also helped me with the delivery of baby K’s big sister!

My little guy delighted to hold baby C. when she came for a visit!

Another new development that has occurred recently is taking on a new student here at Gentle Delivery Childbirth Services. At some point in the near future, I’d love to tell you more about Emily, but I’ll just give you a little teaser for now. 🙂 Those of you who are current clients will likely be meeting her in some of your upcoming visits, and from the interaction we’ve had so far, I think you’ll thoroughly enjoy her and her passion for serving mamas and babies in this special time of life. Emily is just getting started in her training, and I’m excited about having a steady assistant to help me out with visits and births during the months ahead!

September brought with it two little fellows, who both interestingly enough, decided to make their arrivals on Saturday nights! They both seem to be thriving, and if they continue at the present rate, won’t be little fellows for long! For both of these births, I had the assistance of Gretchen D, a midwife/assistant who lives nearby.

Baby R with Gretchen and myself

and here with baby L!

Hopefully it won’t be quite so long until next time…but there’s a little peek into my life the past while…and here’s a peek into what is to come, as birth kits are prepared for the upcoming fall babies!

Birth kits ready to be delivered to families at their home visits!

Have a lovely fall, and thanks for your continued interest in the work here. If you haven’t already done so, feel free to take a peek at our facebook page: facebook.com/gentledelivery. And keep posted on the blog for new pages coming soon!

July 26, 2014 by gentlemidwife

Preparing for your birth…

This information is written specifically to give first time mothers and first time VBAC moms suggestions for how to improve their chances at achieving a natural, easier delivery. But that doesn’t mean this is just for them! All of these suggestions can help ANY mom as she prepares for an optimal birth! Pregnancy and childbirth is such a special and exciting time, and it is also something to be prepared for ahead of time. It is good to keep in mind that a woman’s body was designed to give birth, and that, normally speaking, your body does know what to do to get the baby out. On the flip side, though, is the fact that this is the first time your body has ever experienced this process. Because of this, labor can sometimes last longer, and be more physically demanding, as your body takes the time it needs for all of the muscles and bones to work together and stretch to allow your baby to enter this world. If you have invested time and effort into preparing ahead of time, your body will benefit, both in the labor and recovery processes. Just think, you wouldn’t run a marathon without giving adequate training and preparation-and so it is with childbirth. You must condition your mind and body to give you the best results.

Throughout the pregnancy:

– Read and educate yourself! Take childbirth classes, together with your husband. This will help you both to be informed about the physical and emotional processes, and allow you to discuss ideals, hopes, and dreams before labor begins. I believe that education can also help to reduce the level of pain, as it helps you to understand what is going on in your body, instead of fearing the unknown. The more you can find out ahead of time, the more able you will be to relax, knowing your body is doing what it was intended to do. There are many books, DVD’s, and classes available-talk with me if you need suggestions!

– Eat a healthy diet. A diet full of good, healthful foods (vegetables, protein, and complex carbohydrates), and low in sugars, fats and simple carbohydrates, can help you in several areas. One, it doesn’t build a huge baby. A smaller baby is easier to push out! Secondly, it allows your body to be able to function at it’s optimal ability, as your energy level is increased. Thirdly, good nutrition can build better skin integrity, which decreases your chances of tears.

– Exercise regularly. Exercise is an extremely important factor, as labor and birth are very much physical events. Stretching, and building up your endurance level throughout the pregnancy will enable you to persevere if your labor gets long and tiresome. Throughout the last few weeks, walking briskly (until your pelvis hurts!) for at least 45 min. every day, can help to encourage the baby’s arrival to happen sooner rather than later.

– See a Chiropractor-if your body is not in alignment before labor, this can really slow things down and keep the baby from descending. While having regular adjustments can be helpful, it’s an especially good idea during the last 3-4 weeks, as it can help your body to relax and get the baby into the best possible position before labor begins.

– Visit http://www.spinningbabies.com and try some of Gail’s suggested techniques for helping baby to achieve the best position. Regularly implementing techniques such as inversions and belly sifting can help to reduce your overall labor time by helping your body to stay aligned and encouraging good position of the baby!

– Practice relaxation. If you can learn to relax, go limp, and let your body work before labor begins, then the better able you will be to do this during labor. Remember, fighting pain and discomfort works against you during labor-you must open up, let go, and relax in order for your uterus to function the most efficiently. And the more efficiently it works, the easier it will be on you! In practicing, pick times of the day when you can work on letting each area of your body go limp. Find out what helps you to relax: water, music, massage, etc., and then have these available during labor.

During the last 5 weeks:

– I encourage moms to take the following supplements:

Gentle Birth Formula ~ this is a specially formulated blend of herbs in a tincture form that work to help prepare the uterus for the upcoming birth. You begin at 35 weeks by taking 2 dropperfulls a day throughout the first week, and increasing the amount to 2 dropperfulls 3x/day for the remaining weeks. Mothers who take this herb usually have more “warm-up” contractions, which help the cervix to begin dilation and effacement before actual labor. This tincture can be purchased through In His Hands Birth supply at the same time that you order your birth kit.
Super Primrose Oil or Borage Oil ~ this supplement is in a soft-gel form, and you begin taking 1-2 capsules orally beginning at 35 weeks. Around 36-37 weeks, you may begin inserting one capsule vaginally at night when ready to go to bed. The high GLA content and natural prostaglandin that these oils contain helps the cervix to soften, making dilation easier. It’s a great way to give your body a head-start towards dilation!

In closing, remember to keep yourself hydrated, rest often, and take care of yourself. And when labor begins, try to get some rest before getting excited. You need to conserve the energy for later. So think about some activities that provide fun distraction (games, movies, going out for supper, etc.), and try to focus on other things until the contractions become consistent and strong enough that you can’t be distracted through them….

June 21, 2014 by gentlemidwife

Another Birth Story!

We recently celebrated our daughter’s birthday, and I thought maybe you all would enjoy reading the story of her birth…this was written almost 2 years ago….just before the birth of our second:

Ever since my daughter was born, I’ve wanted to write down her birth story, both for myself and for her to read someday. Now that “little brother” will be making his appearance any time, I figured I really should get her story written before having another birth to get it mixed up with. So here goes….

Our baby was due June 26, which meant that I really wasn’t expecting to have a baby until the end of June, or maybe even the beginning of July. After seeing many first-time mama’s get so disappointed over not hitting their “due date”, and proceeding to go at least a week overdue, I was determined that I wouldn’t set such expectations.  This was one area where I really didn’t have an expectation…the week before she came, I was busily painting several rooms in our house (“nesting instinct” for sure!), and then Joel’s family hosted a surprise baby shower for us on June 18. While the shower really was a surprise, he had talked with me about dates for something, and I assured him that I would still be doing quite fine by Father’s Day weekend, with probably another couple of weeks to go yet. Shows you how much I knew, after all! During the last 6-7 weeks of my pregnancy, I had continued to get very swollen, and my blood pressure was creeping higher, so I wonder in retrospect if my body just realized that it was time to get the baby out.

I still vividly remember getting up Sunday morning and noticing some bloody show, and signs that my water had possibly broken. I wasn’t totally sure (and wouldn’t you know, that was the one weekend that another midwife was using my kit, so I didn’t even have the test strips to check it out!), but I started crying as I told Joel about it, which made me wonder if maybe I really was going to start labor soon. Since my mother had several labors where she experienced prolonged rupture of membranes, once again I didn’t want to count on anything happening very quickly. I figured it could be a good while yet before we saw any “action”, so I still got ready for church…I didn’t really want anyone asking any questions, and since our home is right off the road, I knew that EVERYONE would know that there was the possibility of something going on if I wasn’t at church and yet our vehicle was in the drive.  During the service I was a bit uncomfortable, experiencing some cramps and things, but still nothing regular. After church I had a humorous conversation with two moms about how I shouldn’t get my hopes up in going anytime soon…and inwardly I was smiling as I figured I probably only had days or hours left, and not weeks!

With it being Father’s Day, we had planned to eat lunch with his family down the road (they only live a mile from us, so it wasn’t far). Joel wondered if I still wanted to go, and once again I wanted to show up just to keep people from knowing what was going on. I still felt pretty good, though I could tell that the cramps were getting stronger, and I was beginning to lose a bit more fluid. Everything went fine until right at the end of lunch, when all of a sudden I just wanted to be home…and I was afraid that the pad I was wearing might not be catching all of the fluid! Joel caught the message that I wanted to go, so he made some remark about the pregnant mama needing a nap, and whisked me out…with my swollen feet and hands, no one objected to my not helping with dishes, or wondered anything about us leaving so quickly!

We came home and laid down, and right around 3 or 3:30pm, I experienced my first REAL contraction. Not one of those low-crampy kind of aches, but the actual thing. It woke me right up, and after that my adrenaline kept me from sleeping anymore. However, things still picked up slowly, with the contractions only coming every 10-15 minutes or so, and were fairly easy to relax through. At this point, we called our folks to let them know that it looked like I really was in labor, which of course made them all excited. I still was figuring on hours and hours yet to go, so I took care of some things around the house, and Joel had a friend over for an early supper (they sat out on the porch to talk). At about 6:30, the contractions got more intense, and started coming more frequently. Joel thought it would be a good idea to call the midwives and let them know, especially since one was coming up from Lancaster and had a two hour trip ahead of her. I told him that I was fine with letting them know what was going on, but that I probably had another 24 hours at least to go, so there wasn’t any hurry. He didn’t agree with me, which was a good thing!

By 8:00, we went ahead and had Rose come over, as Joel thought I should have someone here. He also called Debby and told her that he thought she should go ahead and come…and meanwhile the contractions were about 5 minutes apart, lasting around a minute. I changed into more comfortable clothing, and tried to get comfortable, though I wasn’t finding it easy. I finally got in the shower, which gave some relief. Rose wondered if I wanted to be checked, but I didn’t-I was afraid at this point that I was probably only at 2-3cm, and wasn’t sure I could handle that news with how intense the contractions were.  Joel started filling up the tub, as I always thought that I would like to labor in water…though our tub faucet wasn’t working well, and it took an hour to fill up! By 9:55, Rose suggested that she check me, and Joel encouraged me to…and I was a stretchy 6-7. That was encouraging, though the contractions by now were coming so close and so hard that I was finding it difficult to stay on top of them. The most comfortable thing I could do was sit on the birth ball, lean my head on the bed, and squeeze onto Joel’s hand…and there was NO way I could think about making the effort to get into the tub at this point!

That next hour was intense, with the contractions coming every 2-4 minutes, and lasting a good long time, and I was beginning to wonder how I could ever get through a whole night of this. I still remember thinking “they always say that when you think you can’t do it anymore, you’re almost through”, but then dismissing the thought as wishful thinking.  By this time, we were beginning to wonder where Debby was…Rose called her, and found out that she also figured she had a good amount of time to get there with this being my first baby and all, and she hadn’t left right away. I couldn’t blame her, as I would have done the exact same thing! Rose told her she should hurry…it was 10:40pm by that time, and I was close to 9cm. That surprised all of us! Just before 11:00, I started feeling pushy, and Rose said I was complete. Right about that time Debby walked in, so I felt like I could relax to begin pushing.

By this time I moved to the bed in a semi-sitting position, as it seemed to be the most comfortable for pushing. The pushing part was not at all what I was expecting…I guess I had heard enough moms say that they enjoyed that part of it as it felt like they were doing something, but I felt like I wasn’t making any progress, and there was a constant sharp pain near my pubic bone. It took only 35 minutes of pushing, and she was born with a nuchal hand…which I think attributed to the pain during pushing AND to the tear coming out!

Having that squalling little baby put on my chest was amazing…I kept looking down at her and thinking, “she’s mine to keep!”. Although we hadn’t had a sonogram during the pregnancy, Joel and I both felt like the baby was going to be a girl, so it almost felt like it was no surprise to see our little daughter. She pinked up and cried right away-just about as perfect as it can get. I was in for another surprise, though…I felt so sore that I could hardly move afterwards! The placenta came about 10 minutes after her birth, and I was so relieved to have everything all over, and thankful for how well everything had gone. Postpartum continued without incident, though it almost made me laugh to think of how difficult it was to get out of bed just to go to the bathroom, and how incredibly sore and tender everything was-and this was a small baby! I decided then that I did not believe the nonsense that is talked about in regards to a mom not needing pain relief if she is sutured right after birth, as she is still numb and on a high from the birth…that certainly was not the case! 

Rose was ready to go within two hours after the birth, and since Debby had been up the night before at a birth, she stayed the rest of the night to catch some sleep before heading back. We were so grateful for how the Lord took care of every detail, and gave us a wonderful first birth experience, and a beautiful, precious daughter!

our little princess!

May 22, 2014 by gentlemidwife

Helping Baby Achieve the Best Position…a little report on my day at Spinning Babies!

At the end of April, I had the special opportunity to take the Spinning Babies workshop taught by Gail Tully at the Midwifery Today Conference in Harrisburg. While the day was packed with information, I enjoyed every minute of it…I honestly felt excited about the prospect of having another baby myself after learning so many practical tips on how to promote optimal fetal positioning for both the baby’s sake and the mother’s comfort. Gail has a wealth of information at her fingertips, and I think I’d have to take the class several more times before I could really retain it all (even though I took lots of notes!), but I wanted to at least give a few pointers from things that I learned. Visit her website at: http://spinningbabies.com/ to learn more yourself.

To begin with, Gail showed a diagram about the structure of the uterus, and how it is covered in fascia, just like all of our other muscles. When the fascia is pulled or stretched in an unnatural angle, it is going to affect the way that the baby is positioned in the uterus. This is one reason why it is important to watch your repetitive movements…do you carry a child on your hip? bat a baseball? If the muscles and ligaments are too tight, too loose, or twisted, the baby will NOT be able to settle into the correct position. The balance of your soft tissue can be more important than your pelvic size. Thus, doing specific exercise techniques throughout your pregnancy (and during labor when needed) in order to help align these muscles can make a big impact on what position the baby settles into. When the womb is symmetrical, the baby will naturally assume a more flexed position.

When it comes to the “perfect position”, the place to aim for is having baby settled on the left side. The tendency is for baby to settle on the right side, as our uteri have a natural propensity towards this direction. However, the shorter, curved left side encourages the baby to flex his head and assume a “C” type position-his physiology is actually enhanced by this flexed position, as well as this position providing more consistent, even pressure on the cervix, which in turn encourages dilation. When the baby is on the mom’s steeper right side, the baby naturally wants to assume a more “military presentation”, where the head is not flexed-this causes uneven pressure on the cervix, and can really reduce progress in preparing the cervix for labor, and stalling progress during labor itself.

Demonstrating how the different muscle layers work to support or constrict the uterus

Another interesting aspect Gail brought out is how thyroid malfunction can cause the baby to assume a negative position. A root metabolism issue can affect the way in which the uterus operates, as well as causing it to be more susceptible to twisting. Making sure your entire body is working optimally can help prepare you for a better pregnancy and birth! The fact that we spend so much time sitting both in the car and in a reclined position also contribute to a asymmetrical uterus. Women used to be encouraged to sit “like a lady” with good upright posture, which can also help to promote good posture of the womb.

In presenting exercise techniques, Gail focused on three separate types of exercises that she calls the “3 Sisters” to provide balance and room for mom and baby. Each of these exercises helps the mom to relax, and thus in turn helps to relax the fascia of the uterus, which then helps to provide the balance to help the uterus to become more symmetrical. She would encourage pregnant mamas to do these exercises at the minimum of once a week, but once a day would be even more ideal! Besides encouraging baby to engage in a good position, these exercises can also help to improve mom’s comfort by relaxing the muscles that receive so much strain during pregnancy. In labor, these techniques help to promote descent of the baby, and can be done multiple times. Rather than try to explain these techniques myself, I’ll point you in the direction of where you can find instructions on her website:
– First, encourage deep squats and calf stretch. Then move on to the “3 Sisters of Balance” http://spinningbabies.com/techniques/activities-for-fetal-positioning/423-the-3-sisters-of-balance- :
1. Rebozo sifting: helps relax the broad ligament and get the mother loose and relaxed herself. http://spinningbabies.com/techniques/activities-for-fetal-positioning/rebozo-sifting
2. Forward Leaning Inversion: This is best for resolving a transverse lie, and helps to encourage healthy circulation. http://spinningbabies.com/techniques/the-inversion
3. Side Lying Release: Helps relieve pressure on ligaments.

Once these techniques have been performed to help achieve balance, your next goals are Gravity and Movement-especially to help during a pause in labor.

During labor, you can use these techniques to help whenever you reach a point where progress is being stalled. Gail encouraged us to rethink the usual question of “what is dilation?” and instead think “where’s the baby?”. If the baby isn’t descending, then something needs to change, regardless of what dilation is. And depending on where baby is at, different techniques are needed to get the baby to descend. For any stall, she recommends trying the “3 Sisters of Balance” in order to relax mom and balance the uterus.

As you attempt the three above techniques, consider where baby is: If he is stuck at the brim of the pelvis (characterized by a long latent phase, or start-and-stop labors for days), then the baby needs to flex his head in order to enter the pelvis. Tight round ligaments can prevent baby from descending. At this point it is much more important to get the baby to enter the pelvis, rather than trying to get labor to become more regular. Dilation won’t do any good if the baby isn’t in the pelvis! Trying Gail’s Abdominal Lift and Tuck followed by Walchers, can help to flex that little guys head and get him to descend. http://spinningbabies.com/techniques/activities-for-fetal-positioning/abdominal-lift-and-tuck http://spinningbabies.com/techniques/activities-for-fetal-positioning/walchers

If baby is stuck in the mid-pelvis (right at the ischial spines), labor tends to stall around 5-7cm. This can often be caused by a tight pelvic floor, and special attention to the side-lying release technique can help to relax those tight muscles. Trying a lunge, and the “Shaking the Apple Tree” techniques can also help to get the pelvic floor relaxed and help baby to descend.

When labor stalls around 9-10 cm (think anterior lip, etc), realize that you must address the root cause, not just push back the lip. Trying positions that open up that part of the pelvis can provide more room (deep squat, McRoberts, hip press, toilet, etc.). Sometimes putting pressure on the sacrotuberal ligaments can help them release and provide more room for birth. If there’s not an urge to push, try to rest, and wait until the body is ready-sometimes mama just needs a break!

There were many, many more things that Gail taught and shared…not to mention all the stories of different complicated, stalled labors where these techniques were used. If you ever have a chance to sit in on one of Gail’s classes, I would highly recommend it! Much of her information is located on her website, as well, which is an excellent resource for both midwives and mamas alike.

Where is baby’s position in relation to the mom’s pelvis? How can we use that information to help us decide which technique(s) to try?

March 3, 2014 by gentlemidwife

February Travels…and what the CPM Title Actually Means

Beautiful palms and lots of green-we soaked it up while we could, and then returned to 12 in. of snow still on the ground at home!

Happy March to each of you! I am really ready for winter to be over, especially since this one seems to be stretching on and on. This past month has been busy, and I even enjoyed a 6 day reprieve from cold when I took my 15 mo. old to Costa Rica in order to attend a dear friend’s wedding. It was a great trip, though not without excitement (like when I realized I left my wallet behind when I arrived at the airport and was ready to depart…or when flights were cancelled due to weather…and other such things….so grateful for how the Lord took care of every detail!). The chance to reconnect with old friends was very special, and it was fun to introduce them to my little fellow, though it would have been even better if my husband and 2 yr. old could have joined us. They seemed to manage quite well on their own, but we were all ready to be back as a little family once again!

The way to travel with a toddler…

Matthias LOVED playing in the water-this same day it was -10 in PA!

I was trying to come up with a good idea to write about this month, and then I thought that perhaps I could blog about one of the items on my list of things that I want to add to my prospective client handout folder. One question, or series of questions, that comes up frequently during the initial interview has to do with my certification, and what exactly it means. There are so many different names and titles out there that it can be confusing at times! When you go to figure out what care provider is right for you, it is helpful to have an idea of what his/her qualifications are, and what all is entailed with those. So, here’s a brief look at what the Certified Professional Midwife title means…

The North American Registry of Midwives (NARM) was founded in 1987 by the Midwives Alliance of North America, and they oversee the certification standards of the CPM credential. In order to become certified, one must first show that she can provide competent, safe, and qualified care to mothers and babies throughout the birth and postpartum process, both by completing academic studies and by demonstrating care in a clinical setting. This requires that a prospective midwife both study through a NARM-approved academic institution, as well as complete an internship under the supervision of other certified midwives. Proving that one has the mastered the skills necessary to provide knowledgeable care takes time, and there is an extensive set of qualifications that must be met before one can sit for the final exams that cover questions relating to each phase of maternal and infant periods. Once the exams are passed, re-certification must take place every 3 years, which requires ongoing continuing education and re-certification of CPR and NRP.

When I first looked into obtaining midwifery education, I decided to pursue getting certification, even though the state I was working in did not recognize the credential. It was important to me that I do my best to provide the best care possible, and submitting to the qualifications necessary to become a CPM helped prospective clients to know that I took my job seriously and that I had demonstrated the ability to pass the national standard for midwifery care. In areas where licensure is not offered for homebirth midwives, this certification also gives clients the assurance that a certain level of training has been taken, instead of not having any idea of what a midwife’s qualifications may or may not include. Interestingly, many of the states that offer licenses to midwives are using the CPM as the basis for their training requirements. While many midwives who do not have the CPM title are competent and experienced, I feel like having a standard of competency for certification helps to ensure safety and high standards of care for each mother who desires to birth out of the hospital.

Finally, I like the way this quote sums it up, taken from http://www.nacpm.org/what-is-cpm.html
“A Certified Professional Midwife (CPM) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM). CPM is the only international credential that requires knowledge about and experience in out-of-hospital birth.”

If you’re interested in looking into this topic further, I’d suggest you check out these links:
http://narm.org/advocacy/narm-brochure-text/ gives a good overview of the Midwifery Model of Care and how CPM’s help to promote this, and http://midwifeinternational.org/how-to-become-midwife/certified-professional-midwife-vs-certified-nurse-midwife-whats-difference/ details the differences between the CPM and CNM titles.

Feel free to let me know if you have questions, or if you’d like to add a comment regarding this…thanks!

Little M ready for his newborn exam…a March baby who will be having a birthday soon!

February 3, 2014 by gentlemidwife

Learning Empathy…

A big thanks to each of you for your interest in helping to get Gentle Delivery Childbirth Services off to a great start here in State College! During this past month I’ve had a chance to interact with a number of new friends, and I’m enjoying the opportunity to learn more about what this general area offers as far as birth choices. If you haven’t done so, take a minute to check out and like the new Facebook page: www. facebook.com/gentledelivery I’ve also added another testimonial to the website-feel free to read through that as well!

As many of you know, I practiced midwifery for a couple of years before I married and had children of my own. During that time, I occasionally met a prospective client who wasn’t sure about using someone for care who hadn’t experienced birth herself. In all honesty, being a single midwife allowed me to give much more to my clients, as I didn’t have the same pressing schedule-it didn’t matter if I disappeared for 2-3 days at a birth, as no one was depending on me to be around! Sometimes when I think about those days, it dawns on me how much more freedom I had to spend time learning, talking on the phone, answering questions, making home visits, spending hours with clients, taking classes, teaching, etc.

But the flipside does have some advantages-I now have an increased level of empathy. I don’t think that I wasn’t sympathetic before. But, my ability to feel with another mom the challenges she is going through has dramatically grown. And the realization of how much growing a baby, giving birth and adding a new member to the family changes things. So, for those of you who have been curious (there were many times a client would tell me, “I want to be there when you have a baby yourself! :), here are a four specific ways my perspective has changed:

1. I now know what it means when someone says “nothing works!”. During my first pregnancy, I had severe morning sickness. The kind that lasted and made you throw up and generally wish you weren’t alive anymore. I would lay on the couch feeling terrible, and cry just thinking of EVER having another baby, because if I was this sick with the first one, how would I ever take care of another baby while going through this. Not exactly the best thing to be thinking at that moment-“sufficient unto the day are the evils thereof”, right?! 🙂 Before I went through this, I would freely hand out suggestions on what helps to relieve morning sickness. After, I just listen, and then offer a list of things “that might help, but they may not work for you.” And feel really bad that I can’t just take it all away or give them a cure-all!

2. When a mom is experiencing the last few weeks of her pregnancy, and comes in with that I-can’t-take-another-day-of-being-pregnant attitude, I take her seriously. Until I was pregnant myself, I didn’t realize how awful you could feel, and how desperate you could be to just get the baby out. But you do really feel like this will last forever during those last days, and a shoulder to cry on can mean the world!

3. Giving birth naturally hurts! Not that I didn’t realize that before. And not that it’s not a beautiful experience. But the intensity of the experience amazed me. I still remember right after my first baby was born, the midwife instructed me to move so she could place fresh pads under me. She kinda grinned and said, “hey, you know what to do!”, and it dawned on me that there was no way I could move those two inches off the bed…I was WAY too sore and tired…and I told her “I know what I’m supposed to do, but I was under the impression that I’d still be able to move after I had a baby!” That made her laugh-but it didn’t seem very funny at the time! During the actual births of both of my children, I also remember how easy it was to feel over-stimulated, and I made me realize how much I personally appreciated quiet during labor and delivery…and it gave me a greater desire to try to carefully understand what really made each individual mom I’m working with feel able to relax and concentrate on her birth.

4. Having a baby changes your life! And here I’m not talking about the birth…but the fact that this little person has come here to stay. And he is totally dependent on YOU for everything. I really thought I knew what it was like to be tired…really tired…I mean, seriously, being up for 48 hours at back-to-back births makes you exhausted! But I had no idea what it meant to be up every 2 hours around the clock for days on end. Now, this is another subject for another time…as both of my babies have struggled with nursing/sleeping/tummy issues….but I do remember when one baby was 2 weeks old, wondering if I would ever know what it would be like to sleep solid again. But I understand now what postpartum depression can be a real live thing to deal with, and why a new mom needs lots of understanding, a listening ear, and sometimes just assurance that what her baby is doing is normal…maybe she knew that herself at one time, but it’s hard to remember when your life has just been turned upside down!

Well, these are just a few things that come to mind when I think of how I look at things differently from this perspective….while it’s been a change, it’s been a good one, and I love my little ones and the experience of carrying them and being able to deliver them at home. But it’s not always easy, and requires alot of work and sacrifice. And when I do a birth now, it means nursing baby comes along, and I don’t get to sleep until I feel caught up…but those days will come again…and quickly, I’m told, by moms further ahead than I am!

In closing, I feel like there were definite advantages to being a single midwife to being a midwife who is married with children. But there are advantages to this stage, too. And I can’t say that I feel like one is way better than the other-it’s just a different perspective, and different time in life. I’d be interested in hearing your perspective in the comments…what do you see as advantages/disadvantages to using a care provider who hasn’t had children herself? or how has your perspective changed since having children yourself?

January 1, 2014 by gentlemidwife

Matthias’ Birth Story

With this being the start of a new year, I’m attempting a new start at keeping this blog more up-to-date. My hopes are to at least post once a month, so we’ll begin with this, and see if I can keep it up! Blessings to each of you in 2014!

Having just celebrated Matthias’ first birthday, I thought you all might enjoy hearing a few of the details surrounding his birth…

They say that being a midwife to a midwife can be a challenge, and I’m afraid I’ve proved that to be true once again. My second pregnancy, while easier during the first half of the pregnancy, was definitely more uncomfortable during the last several months. My friend/neighbor was expecting as well, and since we were due the same day, we joked about who was going to have hers first. In hindsight, I don’t think I was really joking-I thought I should be the first one, as I was certainly bigger and seemed to be more uncomfortable!

However, wouldn’t you know, but 2 weeks before our EDD, my friend calls me at 4am wondering if I’m having my baby, as she thinks hers is on it’s way. At the beginning of her pregnancy (before I knew I was pregnant myself!), she had asked if I would deliver hers, but with our due dates being so close, it was pretty much impossible to commit to it, which was disappointing for me, as births have been pretty few and far between since moving to PA. Once she found out I wasn’t in labor, she said she’d call if things progressed before her midwives arrived (they had 45 min. to drive), and sure enough, things progressed rapidly, and I was soon on my way up the hill and had the sweet privilege of delivering a little boy about 10 min. before the midwives arrived. It really was humorous, me, who was so big and cumbersome I hadn’t cleaned my own tubs in weeks, was leaning over a large tub delivering a baby without any thought at all!

Baby E – here about 1 hour old!

I remember reading somewhere when I was initially beginning my midwifery training about there being strong hormones present at a birth, and how these sometimes made other pregnant women have their babies when they were exposed to a birth environment, so it wasn’t very hard to wish that I would have my own baby yet that day. However, it certainly didn’t work that way, and I began what turned into a very long week. With my first baby, I had no “false labor”, and everything was very straight forward. This time around, I had night after night of timeable contractions, little sleep, and an active toddler to care for during the day. Then Thanksgiving vacation arrived, and Joel was home from school for 4 days-and that would be a PERFECT time to have a baby. But that didn’t work either! By the end of the week I was a basket-case…exhausted, ready to be done, my blood pressure was going up and making me feel sick, and I was ready to do anything to get this baby out. My midwife suggested that I try to get some sleep, and wait to do anything until I was rested…which sounds like something I would have told someone else…but wouldn’t hardly hear myself.

Sunday morning I again had timeable contractions. Strong enough to be uncomfortable, but I wasn’t going to dare miss church, lest all the ladies wonder if I was home in labor, only to show up pregnant again next week. We had a Thanksgiving get-together with Joel’s family, and by the afternoon all my possible labor signs had died down. I hiked up our mountain trail TWICE (really desperate!), and gradually got grouchier as the day wore on (hormones kicking in, in retrospect). By afternoon we had decided to give castor oil a try, so I started chugging, and consumed more than I will recommend to anyone to take again. However, by the end of four hours of hoping something would kick in, it felt like nothing was happening. I cried again…and talked to my midwife …she lived 2 hours away and thought she should go ahead and come “just in case”, but I was just as adamant that there was no reason she should drive all that way only to turn around and go home again.

At 9:30pm I checked to find that was a good 4cm dilated-not much more than a few days before. So I let my midwife know that nothing was going on, and I was giving up and going to bed. Joel and I had a few minutes to talk, and then I had a contraction around 9:45pm. We thought, maybe things are actually going to start…and a few minutes later they did…this time I had a massive contraction, followed quickly by another and my water broke. Joel jumped up and said he’d better make sure Debby was on the way. She assured him that despite my wishes that she would wait, she was already on the road. By the time he came back to our room, contractions were coming so strong and so fast that I thought I was going to go crazy. At that point I asked him if we should go ahead and tell Rose to come (she was a midwife friend of ours who lived close by and was home in our area for Thanksgiving break-we had been hoping she could be there for our birth). He gently told me that I had contractions like this for a long time with Yoanna, so there really wasn’t any rush. To this I replied that if I had to go a long time like this I would just die, and I meant it.

Because he was teaching school, Joel needed to have a sub to take his spot the next morning since it looked like he wouldn’t be going in himself. So he quickly got on the phone to line one up-he had made some tentative plans but needed to make sure they were confirmed. It felt like he was on the phone forever…the contractions were incredible, and I didn’t even have time to move between them…every time I even breathed another one would start, and I never even got up off the end of the bed. By about 10:05, I started calling for Joel…not too loudly, as we wanted Yoanna to stay sleeping…but I didn’t know how I was going to make it. When Joel realized how serious things were, he tried to call Rose…which took longer than it should have, as I had scribbled her number on a scrap paper, and couldn’t tell Joel where to find it! I still remember him finally getting ahold of her, and hearing him tell her that she’d better hurry, as he didn’t think she had 10 minutes to get here (and she only lives 1 mile away!).

Right about then I realized that unless Rose really hurried, no one else was going to be around. This baby was COMING! Thankfully, I had set up my birth kit earlier that day, and everything was ready. Joel had the bowl of immediate supplies handy, and stepped right up to the plate. It was kinda weird…one minute I couldn’t think of anything, and the next minute I’d think, “oh, I need to make sure I…” Guess that’s the strange side of coaching so many other people through their births! Joel did especially well at helping me to slow down and breathe, allowing Matthias to be born slowly…I felt like my body was just pushing him out without me making any decisions. At 10:20pm, Joel caught his son, and handed him to me, and we both looked at each other a bit awed. It was just over 25 min. from the first major contraction! Rose walked in about 2 minutes later, about as surprised as we were to see the baby had already come.

We quickly called Debby, and told her we were in good hands with Rose, so she turned around and went home…good thing, too, as she had a quick one the next morning that she would have missed if she had been at our place. Rose took care of all the remaining things, and Joel said he was really glad to have her walk in and finish the job. We were so grateful for a safe birth, but for the record, my husband says he isn’t going to plan on delivering the next one solo. And we found out why the last weeks were so uncomfortable…Matthias weighed in at 9 lbs., over 1 ½ lbs. larger than his sister!

About an hour after his rapid arrival!

Big sister meeting baby brother

Matthias around 1 week old

If you’ve wondered about eye ointment used on newborns…

For those of you following this blog, you probably thought I had given up ever posting anything again! 🙂 Time seems to keep me from spending much time on the computer, and blogging is at the bottom of the priority list! But, I read this article today and just had to pass it on, as it refers to a question that often comes up during the newborn exam. Enjoy!

http://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/

Gentle Delivery Midwifery Services (Centre Co. PA)

"…He shall gather the lambs with his arm, and carry them in his bosom, and shall gently lead those that are with young." Isaiah 40:11

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