It’s hard to believe another year is almost completed! As we head towards the New Year, I wanted to take a few minutes to update you all on happenings here at Gentle Delivery, as well as thank each of you for your continued support. Whether it’s returning clients, new clients, supportive local services (lactation consultants, medical teams, ultrasound technicians, etc.), back-up midwives, students or assistants, I am blessed to be part of the local midwifery community, and I’ve been grateful to see the way this community works together!
So far in 2022 I’ve been privileged to assist in welcoming 15 babies, most of whom were little girls. Several of these were born to first-time mamas, and once again I was amazed, humbled and stretched throughout the experiences of assisting these families with the unique challenges and victories that accompany the unknown journey of becoming parents for the first time. Besides the first time babies, the rest ranged from being sibling #2 to sibling #8 for their families, and I had the special privilege of attending 3 moms for the 3rd time. Seeing children that I remember catching as tiny babies become big siblings is a fun perk that comes from providing ongoing care for client families! The smallest baby this year was 6# 4oz, and so far 8# 14oz was the biggest, with one more baby pending who could change these statistics!
Lanna and Christine, my usual assistants during 2022
The teamwork of our community stood out to me in greater ways throughout the pregnancies and births this past year. Over and over again I have been thankful for good working relationships both with other midwives and the medical community—which is such a key factor for providing sustainable, safe midwifery care options. There were times this year where additional medical help was needed in order to provide us with the ultimate goal of having a healthy mom & baby, which made me especially grateful for several MFM’s and CNM’s willing to provide consultations, input & care for clients as well as for a welcoming hospital environment when complications necessitated a transfer of care. Along the lines of providing good care options, it was exciting to add the services of a diagnostic ultrasound tech who has been able to regularly perform scans right in my office!
Birth teams have varied this year depending on availability of different assistants & midwives, but each one of these ladies have added to the birth experiences and help me in so many different ways, bringing their own special support and care to births. There are many behind-the-scenes details that these women take care of, besides their willingness to drop whatever they have going on to come help me in any way they can at any hour of the day or night, and I couldn’t continue to provide midwifery services without them! Due to a family emergency for one local midwife, I ended up covering at various times for her over the year, and catching several babies while she needed to be out-of-state. While I know it can be disappointing to not have your expected team for your birth, it was also a blessing for these families to still be able to continue with their homebirth plans despite the need for the original midwife to attend to important family needs. Along similar lines, I was very thankful for midwives willing to cover for me so that I could spend a few weekends away with my family, both for vacation and a family wedding. The strain of on-call life is challenging (especially with young children!), and being able to rest knowing that your clients are in competent hands while you take a break is a huge factor in maintaining a sustainable midwifery practice!
Denae, a midwife in Philipsburg who assisted and covered for meEmily, a local birth assistant who helped me out a number of times when I was in a pinchHannah, a midwife who covered for me and assisted with births & appointments…and Christine, my faithful assistant this past year
In closing, I also wish to express my thankfulness to my supportive family. The way they pray for me when I’m at births, pick up the slack when mama needs to rest or is away, and adjust their lives and schedule is such a vital part of midwifery work, and it really is a family effort. Also, I realize that none of this could happen without God’s continued blessing, provision and care. As we head into 2023, my children are very excited about the addition of a baby sister arriving in early spring, Lord-willing. I’ll be taking a few months off for maternity leave, and trying to put into practice the things I tell all of you about rest and recovery postpartum! Blessings to each of you in the New Year!
The photo we sent to our families, to let them know baby #6 was on the way!
As I think back over this past year, it is with a sense of gratefulness for the ways that God has led, protected and provided. 2021 has included more complications, challenges and adrenaline rushes than I’ve ever had in one year’s time since I began practicing as a midwife 12 years ago! The additional gray hairs accumulated over the months prove this, and I am ending the year feeling like I’ve gained a level of experience that I honestly wouldn’t have minded doing without. However, I’ve also been reminded that this is WHY a midwife takes training seriously, and I’m more committed than ever to doing my best to assist families in safe births, even when at times this requires a different birth location than what we had hoped for, or more invasive assistance than what I prefer to provide.
Besides being the most intense year complication-wise and the most stressful year when it comes to constant changes & research due to the ever-changing Covid landscape, it was also my busiest year baby-wise! I had the honor of helping to welcome 6 girls and 11 boys by the time the last December babies arrived. Weight ranges were fairly average: smallest was 6#8oz and the biggest was 9#9oz. While a couple of little ones came a week or two early, most typically went on the later side with two babies waiting until 13 days past their due date. Three babies made child #6 for their families, and two boys were the first ones for their families. While there were several long labors and many hours spent with a family before the birth, one little guy was in a big enough hurry that he made his appearance in his home before I did! As usual, birth always has an element of surprise that keeps us all on our toes.
Lynelle, Myself & Lanna
I was blessed to work with several great assistants this year! These ladies really help to lift my load, and add a lot to our team. After assisting with births throughout the past 6 years, Lynelle is sensing a need to step back for a time, so she won’t be seen as frequently in the next year. Lanna began helping this spring at the height of our busy season, and has been such a blessing! She will continue to assist as her schedule allows, and there’s the potential of another assistant joining the team in the near future. I’ve also been grateful for the continued help of the midwifery community here in central PA: other assistants and midwives have been willing to fill in as needed, and I’m thankful to have had help available whenever I’ve needed an extra set of hands or someone to cover for a trip or emergency. I was especially thankful for RoseMarie’s willingness to cover for me this fall when our family had COVID, and I was thankful for the baby who so beautifully cooperated in waiting to arrive until I was recovered and my family was past quarantine!
Guerrero, Mexico Summer 2021
On the home front, my little family is growing and doing well! In spite of lots of babies and the craziness this adds to our calendar, we were thankful to get to spend some time camping over the summer, as well as taking a family trip to Mexico to visit missionaries serving with the organization my husband works for. I couldn’t serve as a midwife without the amazing support of my husband Joel, who graciously steps in to care for everyone when mama disappears at a moment’s notice. With children ranging in age from almost 2 to 10, life at home is always exciting and active, and my girls can’t wait until THEY are old enough to “help mama at births”.
A big thank you to each one of you who have trusted me to support you as you navigated your pregnancies and deliveries—it is something I count a privilege and honor! I love to hear from families, so please feel free to send an update and picture when you have a chance!
Many blessings as you head into the New Year,
Kelsey Martin & Gentle Delivery Midwifery Services
Be sure to check out the blog and Facebook page to stay updated on current news, helpful information, health suggestions, birth stories, and announcement of special events such as playdates!
As we head into flu season and continue to navigate the Covid-19 pandemic, I wanted to share some suggestions for pregnant moms wanting to boost their immune systems. There are so many ways we can proactively support our bodies in order to provide better resistance to germs and illness, and possibly prevent severe sickness. Many women find their immune systems face greater stress during pregnancy, so it’s extra important to try to support your body as it grows a baby while exposed to germs!
Before mentioning specific supplements, it’s important to remember that there are some key factors that also play into your overall health. These factors include:
Sufficient, regular sleep: you need ENOUGH sleep to support your body’s needs, and these needs are often increased during pregnancy. Make a habit of going to bed early enough to get the hours of sleep you need! If you’re having trouble sleeping, let your midwife know (I have some suggestions for pregnancy-induced insomnia, so don’t hesitate to reach out!).
Reduce Stress Levels: stress wears your body down, and makes it harder for your immune system work properly.
Eat a healthful, whole-foods diet with lots of variety. If you need information on what a good pregnancy diet looks like, I highly recommend Lily Nichols’ book Real Food For Pregnancy (check out her blog for helpful info, as well: Lily Nichols, RDN)
Stay hydrated: this helps to keep your body flushed and supported.
Add fermented foods to your diet, such as raw sauerkraut, kefir, etc.
Get 15-20 min of direct sunshine daily whenever possible!
Exercise regularly, especially in the fresh air: a 30 min walk outdoors daily is excellent for ALL pregnant moms!
Consider the following supplements daily (check with your prenatal vitamin to determine your needed dosage to reach the recommended levels below):
High Quality Probiotic: it’s no secret that our culture’s frequent antibiotic usage and lack of cultured and fermented foods are contributing to inadequate and/or imbalanced intestinal flora and correlating issues. A good probiotic with multiple different strains can help your body to work the way it should! One that specifically targets Candida overgrowth can be especially helpful in supporting the immune system. Klair Labs and Jarrow are two brands I recommend, but there are many options out there!
Vitamin C (preferably with bioflavonoids) 2000mg daily: this can be split up throughout the day.
Vitamin D34,000IU daily: for best absorption take with a meal containing fat.
Zinc lozenges5-10mg daily: preferably in the form of acetate.
Elderberry1-2TBL daily
When needing extra support (feeling run down, extra or direct exposure to illness, etc.) you may want to add the following to your regimen for 7-10 days:
Gargle with Salt Water 2-3x/day for 15-30 seconds.
Echinacea: 300-500mg dried herb (capsule or tablet) 3x/day or 2.5-5mL of tincture up to 3x/day
The following are some combination immune boosting blends that are wonderful to have on hand for extra immune support (they contain combinations of the above suggestions):
For clients of Gentle Delivery, you know that routine Group B Strep testing is offered to every expectant mom in accordance with the ACOG standards of care. While the pros and cons of testing and subsequent treatment plans are discussed in detail elsewhere, the purpose of this post is to help you to minimize your risk of developing Group B Strep colonization during pregnancy, thus promoting better health for you and baby (and increasing your chances of obtaining a negative test result!).
If you are interested in researching Group B Strep info, I’d strongly encourage you to read Aviva Romm’s article: Group B Strep in Pregnancy: What’s a Mom to do? You’ll find clear explanations of GBS, risks and benefits of antibiotic treatment, and tips on promoting health. This post by Wellness Mama also includes further links for study along with Katie’s suggestions for avoiding GBS colonization with natural methods: How I Avoided GBS Naturally And finally, this article provides a few other options to consider while making decisions on prevention and treatment: Decrease Your Chances of GBS
As a practicing CPM in a state that does not offer licensure, I am currently unable to offer IV antibiotic treatment to GBS+ clients. This increases my desire to do all I can to help support a mom’s immune system and decrease the possibility of a GBS+ test result, as it greatly simplifies the care protocols and necessary decision making for clients and their families!
So here are the primary suggestions for making your vaginal flora inhospitable to Group B Strep:
High Quality Probiotics (if not started early on in pregnancy, then beginning at 28-32 weeks orally, adding vaginal support at 32-34 weeks)
“Many species of Lactobacillus have been shown to be beneficial to the vaginal flora; Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for supporting healthy vaginal (and bladder) flora, while these and others, including L crispatus and L. salivarius strains, have been shown to to inhibit the growth of vaginal pathogens including Gardnerella vaginalis and Candida albicans, and also reducing the frequency of bladder infections in addition to vaginal infection.
In one study, 110 pregnant women at 35-37 weeks of gestation who were diagnosed by GBS culture as being GBS positive for both vaginal and rectal GBS colonization were randomly assigned to be orally treated with two placebo capsules or two probiotic capsules (containing L. rhamnosus and L. reuteri ) before bedtime until delivery. All women were tested for vaginal and rectal GBS colonization again by GBS culture on admission for delivery. Of the 99 who completed the study (49 in the probiotic group and 50 in the placebo group), the GBS colonization results changed from positive to negative in 21 women in the probiotic group (42.9%) and in nine women in the placebo group (18.0%) during this period. The researchers concluded that an oral probiotic containing L. rhamnosus and L. reuteri could reduce the vaginal and rectal GBS colonization rate in pregnant women.
In another study involving 57 healthy pregnant women, L. salivarus was taken daily by the 25 GBS positive women in the group from weeks 26 to 38 of pregnancy. At the end of the trial (week 38), 72% and 68% of the women were GBS-negative in the rectal and vaginal samples, respectively. The researchers concluded that this seemed to be an efficient method to reduce the number of GBS-positive women during pregnancy, decreasing the number of women receiving antibiotic treatment during labor and birth.” (copied from Aviva Romm’s article here)
In light of these studies, and knowing that probiotics are vitally important to the health of both mom and infant for a variety of reasons, supplementing regularly with probiotics during pregnancy can be beneficial in more ways than one. For GBS specific support, it’s recommended that you begin supplementing orally at 28-32 weeks (though earlier is even better!), and then increasing your oral dosage and consider using a probiotic vaginally for at least 2-4 weeks before your Group B Strep test (and then continue the oral support through the rest of your pregnancy).
As you shop for probiotics, pay attention to the different strains it includes, as not all probiotics are created equal, and they will be most effective against GBS strains if it includes L. Rhamnosus, L. Reuteri and L. Salivarus.
Some brand suggestions that other midwives have given me are:
Eating a diet high in fermented foods/drinks (kefir, sauerkraut, kombucha, yogurt, etc.) help to promote a healthy gut flora.
Eliminating sugar and simple carbs are also effective in promoting beneficial gut flora.
Add 1-2 tbl of coconut oil into your daily diet for it’s antibiotic properties, specifically in the few weeks prior to testing.
Apple Cider Vinegar consumed daily or in capsule form may be helpful.
Vitamin C
Consuming 1000-2000mg of high quality vitamin C daily (in divided does) can help to increase your body’s immune response, which makes it more difficult for unhealthy microorganisms to grow. You can begin this regimen around 30 weeks.
Garlic/Allicin (active component of garlic)
Garlic has been used as an antimicrobial agent for generations, and for good reason. However, high doses of garlic can cause blood thinning, so I don’t recommend staying on high doses of garlic or allicin after obtaining your GBS test. But it is a treatment to consider to reduce the possibility of GBS colonization before getting tested. Currently there is a midwife practice conducting a study where participants are instructed to use Allicin Gel 2x daily for 12-14 days along with ingesting 180mg of Allicin capsules 2x daily for 12-14 days prior to testing. The basis for this study is from a preliminary study done in 2009 where Allicin was shown to reduce the possibility of early rupture of membranes and chorioamnionitis, both of which can be complications of GBS infection. Other methods of using garlic include: taking garlic capsules daily, consume raw garlic daily, and/or insert a raw garlic clove vaginally at night before going to bed.
While we still have a lot to learn about Group B Strep (how exactly it is transmitted, best ways to treat it, and how to prevent it from the beginning), and while there still seem to be a few moms who naturally carry Group B Strep bacteria in their vaginal tract no matter what they try to do about it (antibiotic or otherwise!), one of the benefits of utilizing these suggestions is that they promote health for mom and baby regardless of the GBS presence (or lack thereof). While obtaining a negative Group B Strep test does eliminate a certain amount of worry, risk and decisions, the benefit to your body of increasing the good bacteria and gut flora through healthy foods, probiotic supplementation and other factors may provide long-term benefits that you will see later on. I’d highly encourage every pregnant mom to consider these suggestions, and wish each of you a healthy and safe pregnancy and birth!
I’d also love to hear: did you try any of these prevention methods? How did it affect you and your GBS status? Did you test positive in one pregnancy and then negative in another? What was most beneficial for you?
Are you looking into the possibility of working with a midwife, and trying to decide if it’s the right choice for you? If you’re blessed to live in an area with several options, it can be a great idea to take the time to “interview” each one, and see which one feels like the best fit for you and your family. Most midwives (myself included) offer free consultations that can give you a chance to sit down and ask your questions in person, and this can be a great opportunity to explore whether or not you and this care provider will be a “good fit”.
While I think it’s a good idea to look into your options for ANY medical provider, it can be especially important when thinking about a homebirth. Your midwife will be coming into your space, and you want both yourself and your husband to feel completely comfortable with this person, which facilitates clear & open communication, thus providing you with the best care possible. So besides some specific questions (which we’ll get to below!), also think about the intuitive side of how you connect and communicate throughout the interview. Another important component in this interview is dad’s perspective, so whenever possible please have him attend this initial consult, as this can give him the opportunity to ask questions he might have, and help establish a good working relationship from the beginning.
There are many posts out there that cover long lists of questions, but I want to get you started by giving you a few basic questions, which might bring up more as you go along. It’s a good idea, too, to do your own research before you meet with a perspective midwife. For instance, does she have a Facebook page or website? Are there reviews you can read by previous clients? Is there information listed about the types of services she offers, or things that set her apart from other options in your area? What type of credentialing/training does she have? Do the philosophies expressed on her website correspond with what you are looking for? Do what you can to find out as much as possible before meeting up, as this will enable you to get the most information out of your time together, and may raise specific questions that you might have missed otherwise. It will also keep you from wasting time that you could be spending looking into other options!
So let’s get started:
What kind of training did you go through to become a midwife?
Some midwives have attended midwifery school, others have been trained strictly through apprenticeships. Some midwives have credentials that indicate a certain level of training, and require a stated number of continuing education hours to be maintained. There are midwives who have gone through rigorous school programs and have delivered few babies outside of the hospital, and others who have done minimal studies and have only delivered babies at home. This question is not meant to dictate which type of training and educational experience is best, but rather to help you think through whether the training this midwife has received is adequate for your own comfort and safety concerns and desired birth location.
How would you describe your style during labor & delivery? Hands-on or hands-off?
Depending on your preferences, this may help you determine if you can work together well. If you know you want someone very involved, or you want to be left alone as much as possible, the midwife’s answer may shed some light on how her style could affect your labor. Some midwives are very good at adapting to their client’s wishes, and some have their own set way they want to see things happen.
What do you provide or include in your services, and what will be my responsibility?
Depending upon your state, local regulations and/or your community options, a midwife’s care package may include the ability to obtain lab work and/or ultrasounds or refer you to providers for these items, or you may be responsible to figure these things out for yourself. Some midwives include a “birth kit” as part of their package, while others ask clients to purchase this separately. A birth pool is included in some midwives care bundle, while others provide options for rental. Some midwives are able to give your baby vitamin K or provide mom with RhoGam if needed, while others need you to get these items from your pediatrician if you want them. Most midwives are able to file the needed paperwork to obtain a birth certificate and social security number, while there are a few who need you to do this legwork. Asking clear questions and getting an idea of what is and isn’t included will hopefully eliminate unmet expectations and surprise expenses as you continue through your pregnancy!
4. What tests & procedures do you routinely offer, and am I given the freedom to decline when I prefer?
It’s great when your midwife is willing to discuss the pros and cons of different tests and procedures, and allows you to make a true informed choice on each of these. Depending on the political environment, local standards of care, protocols, etc the midwife may have more or less freedom in these areas, or she may have personal preferences as to certain tests.
What are some of your recommended resources for pregnancy and for birth preparation?
This question may give you some insight into the birth philosophies the midwife has, as well as indicate how in-touch she may be with more up-to-date resources and educational material. Some books and resources are old classics, but there is also a wealth of more recent publications that can help you to be prepared. Are her health suggestions in line with your perspective and preferences? Does she require certain books to be read or DVD’s to be watched? Does she provide some resources for clients, or are you expected to purchase certain materials? Does she encourage a parenting style or lifestyle that you may be uncomfortable with, or that you find helpful?
What is her client load typically, and what happens if two mamas are in labor at the same time?
While this doesn’t happen often, it does occasionally, and it’s a good thing to discuss. This question will reveal what sort of back-up plan the midwife does or doesn’t have, and will give you some indication with how well she works with the midwifery community around her. It also helps you to think about the “what-if’s”, since birth can’t always be controlled like we wish!
What do you see as your role during labor, and would you encourage me to hire a doula?
It’s great if a prospective midwife can be honest about the support she can provide. Some midwives operate with a large team or a small client load that allows them to spend more time coaching and supporting a mom throughout labor. Most midwives are glad to support in whatever way they can once you’re in active labor, but they need to conserve their resources so that they have the energy and alertness they need for the time of birth, which means that if you really want hours of support early on, you’d probably be best served by considering a doula. This question can help you determine what the midwife’s expectations are for when she would come to you, and what sort of support you can expect, and will help you to define the role she would see herself filling at your labor.
What are some of the reasons I would be risked out of care?
This gives you an idea of the midwives range of comfort, and whether she takes a more cautious or more relaxed approach. Each approach has it’s place, but you need an approach that makes you feel most comfortable and safe. It’s also good to remember that each midwife should only operate within a realm that they truly feel is providing safe care, so this is not a “good vs. bad” topic, rather a way to understand and communicate. Is this midwife comfortable with breech delivery? With a mom that goes past 42 weeks? With a baby that decides to come before 37 weeks? Continuing if gestational diabetes develops?
What happens if I need to transfer care for some reason?
Does the midwife typically accompany clients to the hospital, or send them in by themselves? Does she have a doctor she works with, or a preferred hospital? Why or why not?
How do you handle emergencies, and which ones have you encountered the most often?
This question will give you some insight into the midwife’s perspective: does she rely only on herbal remedies? Does she carry medications? Is she trained in NRP? Does she take a proactive approach to prevention? Does she see many emergencies? The answer may vary according to your area, too, as some incidents of complications can depend upon the clientele and area the midwife works in.
I hope this list can help you as you think through what is most important to cover as you interview your potential midwife! If you find it helpful, or if you have other questions you think should be added, I’d love to hear from you. Feel free to comment below, and be sure to share this list with others that might be looking into hiring a midwife for their maternity care!
As 2020 comes to a close, I am reminded of the fact that we really do not know what the next day or year will hold. Last year at this time our family was anticipating the arrival of our fifth child, little knowing how many strange twists and turns the New Year would bring to everyone all over the world. I am grateful to rest in the confidence that nothing takes God by surprise, and that He cares about the details of our lives, which provides strength & courage to press ahead into the future!
After adding baby Tirzah to our family last December, I enjoyed a lengthy maternity leave, and felt so blessed and cared for during those first postpartum weeks. Thanks to many of you for your part in this! It’s true that you learn some things by experience that you couldn’t learn through academic study, and I am more committed than ever to encouraging moms to get adequate rest, adjust expectations, and take the time to really recuperate during those first postpartum weeks. It really is worth it! This baby has been our most contented, too, and while there are many things that probably play into this, one key factor that seemed to make a difference was the addition of infant probiotics into her daily routine from the very beginning. If you have struggled with fussiness in your baby, please take a minute to check out the blog post I wrote where I detailed this information—I really want to see more families benefit from my own challenging experiences!
As you can imagine, the COVID pandemic has affected midwifery in more ways than one. After the initial quarantine I have been doing prenatal and postpartum care visits for local clients in their homes, as it reduces the exposure for those coming in and out of my home office. I’ve also had more inquiries into homebirth this year than ever before, as many families are concerned about hospital restrictions and germ exposure. Between this added level of interest in midwifery care and my added family responsibilities, I have needed to limit the distance I can travel for births, which has meant turning down requests in outlying areas even for a few clients I’ve worked with before.
One fun aspect of care this year has been the large amount of repeat clients I’ve been privileged to serve! It was really special to catch my first “fourth baby” for a family, and have the opportunity to see babies that I have caught in years past welcoming baby siblings. With one more 2020 baby left to go, the current stats for the biggest baby this year was 8#14oz, and the smallest was 5#14oz. The earliest baby came around 2 weeks early, and the latest was almost 2 weeks late, which goes to show that there is much variation in the range of “normal”. Assisting my back-up midwife with the home delivery of twins was another extra-special experience this year! Speaking of my back-up midwife, I am grateful to have the assistance of RoseMarie Spicher to care for clients when I am unavailable, and I’ve been glad to have a working relationship with a community of midwives in the general area who have all needed to pull together to cover for each other at times due to COVID exposure or for other reasons. I’m also excited to be working regularly again with Lynelle, as she plans to attend births as my assistant this next year after taking some time off to welcome her own baby this past summer.
Heading into 2021, I’m anticipating meeting many sweet babies, and I’m enjoying making new connections with many families who are choosing midwifery care and homebirth options for the first time. I continue to feel a sense of gratefulness towards each of you for giving me the privilege of working with your family as you journey through this intimate season of life. It truly is a gift to witness the miracle of birth and the wonder of that first cry, and the wonder of that moment never grows old!
As I close, I also want to thank my family for their support as I do this work, and in particular thank my husband as he quickly and competently cares for our home and children during my random absences. It takes a special family to deal with the unpredictable aspects of having a midwife for a wife and mother, and I’m grateful for all they do behind the scenes to make this option available to the families I serve. It’s a joint effort, and I could not do what I do without Joel’s encouragement and work behind the scenes.
May God bless you and your family throughout this next year!
~Kelsey Martin/Gentle Delivery Midwifery
Be sure to regularly check out this blog and the facebook page to stay updated on current news, helpful information, health suggestions, birth stories, and announcement of special events. I’m really hoping that playdates can resume again sometime in 2021!
Introduction: To begin this post, let me start by saying that for most healthy moms and babies, there is NO need to interfere and induce (“bring about or succeed in persuading something to happen”) labor. If you have done your homework, you know that induction can bring about a cascade of interventions that can ultimately result in a different outcome than you may be hoping for. I also want to make sure that you realize the importance of discussing even the possibility of “natural induction” with your care provider, as this person will have valuable information to consider in your particular situation.
With those disclaimers, I want to also mention that there are situations that arise where it is in the best interest of mom and/or baby to get labor started sooner rather than later. These factors can include increasing blood pressure, presence of concerning signs of liver stress, prodromal labor (mom getting exhausted from nights of contractions), nearing 42 weeks of pregnancy, PROM without labor, and more. There are also moms who, due to being high risk or under an OBGYN who has strict protocols, want a more “natural” alternative to encouraging baby’s eviction over the traditional route of Pitocin or other medical induction methods, and the higher risk of interventions that accompanies these inductions. For moms who fall under these categories, I want to share with you a protocol that I have been following that has had great success with those needing an option of induction at home or without medication.
One of the biggest keys to making a “natural induction” successful is preparation. You can’t decide today that you need to have a baby and have it work nearly as well as preparing ahead of time as signs arise. For more information on general preparation (which can help make a needed induction that much more successful), check out my post HERE. For this post, I’m going to detail specific suggestions for induction. Each of the things I’ll mention below can help your body prepare for labor, and may even encourage things to happen without needing to get more aggressive. I use these methods in this way: if there are reasons to encourage labor (such as knowing you have a hospital induction date scheduled, or are post-dates and need to deliver by a certain date), we start this protocol about 4-5 days before we absolutely need to get baby out. Also keep in mind that the more ready your body is, the more likely natural resources will work. To me, that is a reassuring aspect of using natural methods to encourage labor, as if your body is not ready, it will NOT work. And if it doesn’t work, you’ll need to be patient for awhile longer, which is so very different that using Pitocin, for instance, where it is turned up in increasing increments forcing the body into labor, and creating contractions that are much stronger than what the body can naturally produce on it’s own. Experiencing contractions here and there and having a higher Bishop’s score definitely increase your chances of these suggestions working.
Now on to the method (and remember throughout these days that frequent sex and vaginal insertion of evening primrose oil gel caps at night can also help!):
The “Midwives Brew” is a vast improvement over the old method I used in my early days as a midwife. Up until recently, when faced with the need to induce, we used the castor oil recipe that was basically 2 oz. of castor oil mixed with EmergenC (or some drink/shake) which was repeated 2-3 times with a dose every 1-1 ½ hours, for a total of 6oz of castor oil consumption. Do you know how nasty that is?!? And it causes massive diarrhea, which is a miserable way to start labor! But the midwives brew doesn’t work the same way. You can research it further online, but it includes just enough castor oil to cause contractions, but the theory is that the oil binds with the almost butter to keep it from making you miserable. I also feel like the minimal amount of castor oil in this recipe also makes it safer from any concerns of causing the baby to pass meconium in utero, which is another positive aspect. The crazy thing is that this recipe really does work if your body is ready for labor, and it actually has an 85% success rate (see the link above for more info).
Day 1: MasterGland by Nature’s Sunshine taken in the following dosage: 2 capsules every half hour for 3 hours followed by 2 capsules every hour for 3-4 hours. Discontinue if you get a headache. This is an induction preparation method mentioned in Shonda Parker’s book “Naturally Healthy Pregnancy” with a quote from the book here.
Day 3: Sip on Mama Natural’s Labor Day Tea throughout the day, and consider having a membrane sweep (sometimes referred to as stripping membranes) from your care provider.
Day 4: Either repeat the previous cycle beginning with Day 1, or proceed with the Midwife’s Brew (recipe and information below).
Midwives Brew:
10 oz Apricot juice (Goya brand Apricot Nectar found in the Mexican section of the grocery store works well)
8 oz. Lemon Verbena Tea (hard to find, but you can use 4 bags of Bigelow “I Love Lemon” tea steeped in 8 oz of hot water for 10-15 min. Alternatively, some midwives use 3-4 drops of Lemon Verbena essential oil such as this one.)
2 Tbl. Almond butter
2-3 Tbl. Castor oil
Blend ingredients together in blender until well combined. Some prefer this over ice, but I’ll be honest that when I tried it, it was easier for me to get it down at room temperature.
The ingredients I have used for this recipe.
My suggestion is that you try to get some rest, eat a good breakfast, and then drink this mix around lunch time when your stomach is somewhat empty. A completely empty stomach can make it hard to handle, but if you’re too full you won’t be able to get it down either. It honestly isn’t as bad as it sounds, though it is a strange combination of flavors! After you’ve drank it, then eat whatever sounds good, and consider taking a good walk (avoid laying down for a bit until it’s settled).
Once you’ve taken this concoction, though, please be prepared! When this stuff works, it works much more gently than Pitocin, but it can cause efficient contractions…when I took it, my midwife missed my birth, and I almost didn’t make it home (a story for another day!). So learn from my experience, and don’t wait too long to get to the hospital or get your midwife on the way once contractions are consistent. Many of the moms I’ve seen take it end up with about 3-5 hour labors, though I’m not making any promises. Just wanting to not have anyone caught off guard!
So there you go! If you’ve used this method and it worked for you, I’d love to hear about it! Be sure to share this post with someone who might want to know that there are other (and much safer!) options out there than a medical induction, as this may help prevent them from heading down the cascade of interventions with their delivery!
With the COVID-19 crisis in full swing, it can be hard to know where to go for good information. As a midwife wanting to give my clients the best, up-to-date, evidenced based care as possible, I have found it extremely challenging to navigate all the information being thrown around as everyone scrambles to learn what they can about this new virus. Even information from reputable sources can contradict each other, leaving one’s head spinning, and making you unsure of what measures should be taken to protect your clients and your loved ones from any unnecessary exposure, while also caring for the emotional and physical needs of expectant moms! I’m sure you’re probably in a similar boat, so I’m wanting to make available some information sources for you as you try to understand how the current crisis may or may not affect you, your baby, your care, and your birth.
While information is changing on a day-to-day basis, I am currently implementing the following changes to my practice in order to minimize risk for my current clients, and enable safe midwifery care to continue in my community:
I am available to answer any questions clients might have via email or phone/text at any time.
Pushing prenatal visits further apart to minimize person-to-person contact.
Practicing social distancing and limited exposure for myself and my family, and not seeing any clients if myself or one of my family members are sick.
I will be performing April prenatal visits in client’s homes to reduce the risk of transmission or exposure. My current client load is light as I am just coming off of maternity leave, so this feels like the best option as I look into ways to make my home office space more practical for office visits due to the stringent recommended disinfectant protocols.
I am not taking on new (non-repeat) and/or long distance clients during April. I hope to resume new client consults and prenatals in May, but will base this on information as it becomes available, as well as on how able I am to handle the extra time needed to maintain the possible new protocols, etc. Having to unexpectedly homeschool two children this month, as well as juggling the demands of a nursing infant (and trying to understand what risk there could be to her health) all combine to make my days extra full right now, without adding in the hours of research needed to stay on top of current medical news!
If you are just beginning to look into the option of homebirth due to concerns with exposure at the hospital, I would suggest you begin by reading these two links:
I am also asking clients to follow these guidelines:
Please reschedule your visit if you or one of your family members are experiencing any of the typical Corona symptoms, including:
Fever
Coughing
Shortness of breath
And remember that Covid-19 care is outside of the scope of practice for your midwife to advise you on, so please contact the proper medical authorities if you suspect you may have contracted it!
Try to limit your exposure to illness by practicing safe social distancing from ill persons, and practicing good hygiene and hand washing.
Due to the unknown severity of respiratory complications for both mom and infant, a home birth will be out of the question if you test positive for COVID-19 over the time you are in labor.
Realize that there may be some changes in birth practices as more information and studies become available, so feel free to reach out with any questions, and stay tuned as I continue to research and keep you up to date on current research and practice guidelines/changes. Some of these changes may include restrictions on children attending prenatal appointments, amount of people in attendance at your birth, etc. As time goes by, I hope to have more concrete information to guide our practice protocols for the safety of everyone.
I would also strongly encourage all expectant moms to do what you can to boost your body’s (and your family’s!) natural ability to fight any virus (there are other illnesses out there you don’t want to catch, as well!). I don’t think we need to just sit back and hope we don’t get sick-you can be proactive in assisting your body in being able to resist and fight illness right now. There are some great resources available that help you to consider how healthy eating (low sugar, lots of whole foods) combined with adding some immune-boosting supplements (such as high-quality vitamin C, regular vitamin D, probiotics and others) and regular exercise can help you and your family to stay healthy and strong. Here are some resources to get you started in thinking about the possibilities:
If you’re interested on hearing additional perspective on the crisis from a well-known, more “naturally minded” pediatrician, then you may appreciate Dr. Sear’s podcast series: Coronavirus Update: Are We Doing it Right? Pt. 1
And finally, some practical ways to help you handle the extra challenges from social distancing right now, tips on reducing anxiety, and helps in understanding more about the virus: COPE Updates on Covid-19
If you have found a source to be especially helpful as you navigate the news surrounding Covid-19, I’d love to hear about it. And if you are in a different area, I’d love to hear how your midwife/care provider is implementing changes to their practices. Blessings to all of you expectant mamas navigating this new territory during this time in your life-I know it’s a challenge, and I am committed to continuing to provide you with personal, safe, gentle midwifery care!
Not the baby featured in this story, but another baby born early on in my training!
From the time I was young (8 years old or so!), I had an interest in midwifery. I’m sure it stemmed from the fact that my mother used midwives for her pregnancies and the births of my five younger siblings, which gave me exposure to this “alternative” type of care. This was back in the day when having babies at home was NOT the popular, photographed and blogged about way to have your baby as it has become today! The midwives that cared for my mother seemed like an extension of our family, and as a young girl growing up, they were certainly some of my heroes that I wanted to become like when I “grew up”.
I think I was about 14 when I seriously felt like midwifery was something I wanted to pursue. Still very young and extremely inexperienced…with no idea what all this profession entails! I had read lots of missionary biographies, and a common experience in most of them included helping in some way (either unexpectedly or because they were prepared!) in childbirth in various countries. So it seemed to my 14-yr-old mind that this was certainly a skill that would be good to know, and I pictured myself helping women in some far-off jungle or desert clinic someday. As I got older, I continued to feel a major pull towards midwifery that wouldn’t go away.
By the time I was 16, I was convinced this is what I needed to start pursuing. My parents wisely recommend that I begin by doing some reading, and they told me that they thought I should probably try to attend a few births before diving in head-first in a midwifery study program. Their reasoning was that perhaps this was just a passing whim, and why sink all sorts of time, energy and money into something only to find out that I would faint at the sight of blood, or have some other sort of aversion to what all comes with the birth territory. This is no joke. I personally know people who were SURE midwifery was what they wanted to do, but when they faced the nitty gritty, it didn’t take long to realize that it wasn’t their calling after all!
So, the next question was how on earth was I going to get any birth experience in, seeing as I was so young and inexperienced?!? I figured I would have to wait years for the opportunity, though I was reminded that if God wanted it to happen, He could figure out a way. That’s what makes my first birth experience so special-it was completely unexpected!
The summer that I was to turn 17 found me helping several families out on a weekly basis, going in to care for children, clean, cook, or do whatever was needed as a mother’s helper. One family was expecting their fourth child that summer, and they were excitedly planning their first homebirth in our state. Seeing as they had several young children, and that I had been spending a lot of time with them over a number of months, they asked if I would be on call to come and help babysit when the mom went into labor. This was the plan, with a backup plan being set where the children could go to a neighbor family’s home if the mom decided she could relax better without children in the house.
So one hot (Kansas is REALLY hot in July!) day, I got a call that the mom was in early labor, and that they would be glad if I could come care for the children so she could concentrate on resting and relaxing. I went over and made supper, took care of some household things, and entertained the children so mom and dad could focus together. An hour or so after supper, the mom decided that she would prefer the children leave the house, which left me thinking that I should probably go since my job was done. But the mom looked at me and said “I want the children to go, but you are to stay. I don’t want you going anywhere.” I sure wasn’t going to argue with that! She then went on to tell me that she wanted me to rub her back “just so” while her husband finished setting up the birth supplies and called the midwives, which I was more than happy to do. All of a sudden things kicked right in, and I vividly remember both parents bemoaning the fact that they hadn’t studied better on how to catch a baby if the midwife didn’t make it! I was blissfully ignorant, as I was only aware of my own mother’s very long labors, and figured we still had a very long night ahead of us. Little did I know!
I continued my “job” applying back counter-pressure as dad set up birth supplies, sweated nervously as he watched the signs of his wife progressing rapidly, read his childbirth class manual, and gave his wife emotional support. Thankfully, the midwives arrived just as mom started feeling more pressure, and all the last details were quickly set up and ready to go. About half an hour after the midwives arrived, a beautiful, howling, red little boy made his safe and smooth appearance, and I was in awe. I had no idea birth could be this beautiful, and I was so very, very grateful for the amazing opportunity. I was flying pretty high for days after this experience, and as you can imagine, I was totally convinced that this was what I wanted to do.
What is really hard to believe is that this baby will turn 18 this summer…I cannot believe that time has flown, and this many years have passed. After this first birth, I attended random births that I was invited to (word started getting around that I was interested, and some very sweet, very brave women invited me to share in their experiences, for which I will always be grateful!), and eventually began midwifery school when God opened the doors. It’s now been over 10 years since I graduated and started my own practice, and I continue to be thankful for those who initially helped me to start down this path by allowing me to be present at such personal, private life events. As I continue to reflect back on memories and celebrate 10 years of practice, I want to especially thank each of you moms and midwives who took this very young girl under their wing and gave her experiences that will last a lifetime!
I’m so privileged to be involved in this work of ushering life into the world!
This month I’m continuing to answer questions that were submitted by readers for Gentle Delivery’s 10th anniversary “ask the midwife” series (feel free to check out Part One and Part Two if you haven’t read them yet!) There were several questions asking about miscarriage and how that affects future care, and I’ve decided to make that the focus for this month. Sadly, miscarriage is a reality for many moms, and I’ve had more moms than usual experience miscarriage throughout this past year. Hopefully some of these suggestions and this information can be a blessing to those of you walking through this valley, or those of you wondering what happens next…
What is your approach when a client has a miscarriage? What do you say or do to help her through the process, and if she gets pregnant again later, does your prenatal care for her and the baby look different in any way?
This is one of the “flipsides” of midwifery practice…it’s not always dealing with excitement and new babies. Oftentimes miscarriage occurs “out of the blue”, and usually there is no obvious explanation, even though we usually wish we knew why, or what happened.
Typically, a client will have just been in touch to let me know that they are excited to set up a time to talk about homebirth (or resume care if they were a previous client), and then they let me know that they are having some spotting. Spotting in and of itself can indicate an impending miscarriage, or it can be indicative of an irritated cervix, or it can be sign of a “subchorionic hematoma” (which usually results in spotting/bleeding without harming the baby, and resolves on its own). Quite honestly, if a miscarriage is going to occur, there really isn’t much that you can do, as oftentimes if it is indeed going to progress into a miscarriage then the baby has already died by the point you are experiencing spotting. But the unknown is not easy, as you want to KNOW what is going on. Our options at this point include doing labwork to see where the progesterone and Hcg levels are by now and going in to an OBGYN or an ER for an ultrasound (usually this is a vaginal ultrasound in order to get the best look at the uterus in early pregnancy). If the mom is 5 or 6 weeks or more, they should be able to visualize the baby, and be able to tell if the heart is beating, and labwork can reveal whether the pregnancy hormones are continuing to increase as they should. If mom prefers to wait, then there are some herbs that can be taken, and some moms choose to also use progesterone cream to help support the body until we know for sure what is going on.
If the ultrasound or labwork shows that miscarriage is inevitable, then I try to offer support and encouragement while the mom walks through the next several days. In most cases, mom is able to pass the baby on her own, and we stay in touch via phone or email. Spotting usually progresses into bleeding, and cramps accompany the bleeding as the cervix dilates enough to pass everything, which typically happens within a week of the initial spotting. In the event that it takes a longer amount of time, then we can use herbs to help encourage things to move along, we closely monitor for infection, and occasionally we need to transfer to an OBGYN for further care.
Once a miscarriage has taken place, I really encourage moms to take it easy, and make sure that they give their body time to heal both physically and emotionally. Oftentimes a mom can be left feeling very tired and anemic, as the body usually loses a significant amount of blood, and the intensity of labor can leave her worn out. There is also the emotional side of processing the loss, and this combined with the hormonal swings that go along with pregnancy followed by delivery can create quite a roller coaster of emotions to work with, and mom needs to know that this is normal and okay…and that her body is grieving and adjusting, which takes time!
The good news is that a previous miscarriage in and of itself does not negatively affect care for a future pregnancy. As I mentioned before, we usually don’t know what the root cause was, but there are many moms who go on to carry a healthy pregnancy following a miscarriage. Sometimes it can help a mom to relax more if she has more frequent monitoring during the early weeks of pregnancy after a miscarriage, and I am glad to do progesterone and Hcg testing to make sure that these levels are increasing like they should during the initial weeks. Oftentimes these moms also want to get an ultrasound performed earlier, in order to know that everything is looking good and that baby is growing like he should. Other than these factors, there isn’t much different for prenatal care, unless a mom has had several miscarriages in a row.
If a mom has had several repeat miscarriages, I highly recommend consulting with a NaPro Fertility Specialist (these providers concentrate on helping to achieve and maintain correct hormonal balance in order to prepare a mom’s body for and help in maintaining pregnancy). Many moms have inadequate progesterone levels, and having a specialist helping to monitor levels and provide prescription strength progesterone when needed can be a tremendous blessing, and prevent the trauma of further losses.
In closing, here are some suggestions if you are walking through a miscarriage:
Drink red raspberry leaf tea frequently in order to help balance your hormones and increase your iron as you recover (although stop drinking if you become pregnant again, until you reach the second trimester).
Take Evening Primrose Oil to help regulate hormones and support the body.
Consider taking an herbal-based iron supplement for several weeks to help restore your iron levels.
Take time to rest, don’t push yourself too hard, drink a lot of fluid, and take time to reflect on the short life you were given to carry, and allow yourself time to recuperate and heal before trying to resume your normal responsibilities.
And if you are preparing for pregnancy following a miscarriage, here are some ways to support your body:
Take folate (not synthetic folic acid!) and methylated B vitamins regularly.
Start taking a high-quality plant-based (not synthetic!) prenatal vitamin to build your body’s supply of needed vitamins and minerals.
Look into the benefits of using a quality, natural based over-the-counter progesterone cream to help promote healthy progesterone levels.
Consider having some herbal tincture on hand (such as C & B formula from Mountain Meadow Herbs) that you could take at the first sign of any cramping or spotting-this tincture helps to calm the uterus.
In closing, would you have any suggestions you would add? If you have experienced a miscarriage, what was the best information and advice you were given? Any suggestions for moms hoping to get pregnant soon after going through a loss? I’d love to hear your answers if you would be willing to share!
Gentle Delivery Midwifery Services (Centre Co. PA) 