February 10, 2015 by gentlemidwife

Preparing yourself for labor and birth…

During pregnancy (and even before!), it’s important to spend time preparing and educating yourself about what to expect during the remainder of pregnancy, and for your upcoming labor, birth, and postpartum period. Fear of the unknown can cause more tension, thus causing more pain, and adequate preparation can help you to avoid not knowing what to expect. Moms and dads who have seriously prepared for birth are often rewarded with a much more satisfying birth experience, especially due to the fact that they had a better idea of what to expect, and what was going on with mom’s body during the different stages. Being able to learn about the natural processes, how these things affect mom and baby, what positions can help at what times, etc. all serve to enable a couple to work as a team as they bring their baby into the world.

While it’s ideal to take a live childbirth class whenever possible (this gives you personal time with the instructor, the chance to ask questions, and the fun of interacting with other couples experiencing pregnancy), there are often times when there are no natural-minded classes available in your area, or when time constraints make it impossible to attend a series of classes. When this is the case, don’t give up the desire to be prepared! There are many different online classes, videos and books that can all help to educate you on the labor and birth process, and this list is intended to give you some pointers on where to start:

Actual Childbirth Classes-either online or DVD:
http://birthbootcamp.com/online-childbirth-education-classes/online-class-faq/ Birth Boot Camp is an intense class, available online or in various locations around the US, focusing on preparation for a natural childbirth by teaching relaxation techniques, exercises, etc., taught by midwives, childbirth educators, lactation consultants and others.

http://spinningbabies.com/classes/eclass-for-pregnant-parents-2 Gail Tully teaches an incredible class on optimal fetal positioning, and this is a link for the online childbirth classes that she recommends.

http://injoyvideos.com/mothers-advocate-dvds.html This DVD is a “mini childbirth class”…30 min. of good advice and information, available to purchase, or on youtube at https://www.youtube.com/user/MothersAdvocate
Other Helpful Links/DVD’s:
http://spinningbabies.com/videos/spinning-babies-video Taught by Gail Tully at Spinning Babies, the Parent Class DVD is an excellent resource for teaching couples techniques and exercises for encouraging baby to get in a good position and prepare mom for birth.

https://www.youtube.com/watch?v=mZDeozklQw8&app=desktop An older Lamaze video, this shows several moms in labor, and talks about ways to be prepared for natural childbirth.

http://www.happyhealthychild.com/ This DVD set, available through Amazon, is taught by a variety of OB’s, midwives, doulas, and other professionals. It covers prenatal nutrition, labor preparation, natural childbirth, birth choices, newborn care, and more in a lecture-type style.

https://www.youtube.com/watch?v=Xath6kOf0NE, https://www.youtube.com/watch?v=ZDP_ewMDxCo, https://www.youtube.com/watch?v=ze53Ep-gwBQ&index=5&list=PLD8C569116E48F504, Short, 3D animated medical videos giving excellent visuals on the birth process, contraction action, station explanation, and more.

http://www.thebusinessofbeingborn.com/ Excellent documentary explaining birth choices in the US. Features quotes by OBs, midwives, doulas, and home/natural birth moms. Available to watch for free on youtube!

http://www.mothering.com/articles/6-birth-videos-used-prepare-child-siblings-entrance/ Various birth videos

http://babies.littlethings.com/husband-wife-home-birth/?utm_content=buffer0f17b&utm_medium=Facebook&utm_source=sungazing&utm_campaign=PFPost A really sweet home water birth video.

https://www.youtube.com/watch?v=Uvk08EfgECk A brief overview of the stages of labor.

One more thing to note…if you live local, I’d be more than happy to share with you some of the great options for live childbirth classes in this area!

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!

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?

April 13, 2011 by gentlemidwife

Article Links

I thought some of you readers might be interested in looking at the following links….

Here’s an excellent article by ABC news that gives some good statistics about home birth and birthing options:

http://abcnews.go.com/Health/Wellness/cdc-home-births-rise-us/story?id=9998349

And here is an interesting video regarding the development of the new idea of a “family-centered Cesarean”. If you had to have a C-section, it would be lovely to have it happen this way! Just a note, it does show details of the C-sec surgery:

http://www.youtube.com/watch?v=m5RIcaK98Yg

Enjoy!

June 26, 2010 by gentlemidwife

More Information about the Summer Childbirth Education Class

Alright, I finally have more detailed information regarding this summer’s childbirth education seminar. This all-day class will cover topics such as prenatal nutrition, exercise, explanation of the childbirth process, tips for couples on how to work together during labor, positions and comfort measures for labor and birth, suggestions on writing a birth plan, and much more! There will be opportunity for you to ask questions, meet other couples who are sharing similar experiences, and learn together about the miracle of birth. Designed especially to help those planning a natural childbirth, this class will help you to better understand and prepare for your upcoming birth from a Christian perspective. I strongly encourage couples to attend together, as well as any other support people who are planning to be present at your birth.

In order to enable the best concentration and involvement, please make other arrangements for your children, with the exception of nursing babies.

When: Saturday, July 10th, 2010
Schedule: 10am-Noon, break for lunch-we suggest you bring your own, as there aren’t many restaurants close by, 1pm-3pm
Location: the home of Heidi Nisly, cpm ~ 9101
W. Red Rock Road, Partridge, KS 67566
Cost: $75/couple (note: for those using Gentle Delivery Childbirth Services, this class is included in your total fee)

A workbook, drinks and snacks will be provided for your enjoyment!

Taught by Kelsey Hobbs, CPM
Please register by July 5th in order to ensure availability of materials. Feel free to call if you need more information or have questions. Email: gentlemidwife@gmail.com ~or~ phone: 316-253-0099 Please pass this information on to anyone you know who might be interested!

June 16, 2010 by gentlemidwife

Summer Childbirth Classes- Date is set!

Just wanted to let you all know….I’m planning to teach another childbirth class seminar on Saturday, July 10th. There are a few more details that are in the process of being figured out before I give you all more info, but go ahead and mark your calendars and let me know if you are interested!! Feel free to let others know, as well! email: gentlemidwife@gmail.com

February 19, 2010 by gentlemidwife

“Birth is not an Illness!”

While compiling helpful articles and information for the childbirth class handbooks last month, I came across this one and thought it would be a good one to share. It is interesting to get this perspective!

Birth is Not an Illness!

15 Recommendations from the World Health Organization compiled from Care in Normal Birth: report of a technical working group 1997 – WHO/FRH/MSM/96.24

These 15 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

1. The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

2. The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy and birth and following birth should be the duty of this profession.

3. Information about birth practices in hospitals (rates of cesarean sections, etc.) should be given to the public served by the hospitals. There is no justification in any specific geographic region to have more than 10-15% cesarean section births (the current US c-section rate is estimated to be about 23%).

4. There is no evidence that a cesarean section is required after a previous transverse low segment cesarean section birth. Vaginal deliveries after a cesarean should normally be encouraged wherever emergency surgical capacity is available.

5. There is no evidence that routine electronic fetal monitoring during labor has a positive effect on the outcome of pregnancy.

6. There is no indication for pubic shaving or a pre-delivery enema.

7. Pregnant women should not be put in a lithotomy (flat on the back) position during labor or delivery. They should be encouraged to walk during labor and each woman must freely decide which position to adopt during delivery.

8. The systematic use of episiotomy (incision to enlarge the vaginal opening) is not justified.

9. Birth should not be induced (started artificially) for convenience and the induction of labor should be reserved for specific medical indications. No geographic region should have rates of induced labor over 10%.

10. During delivery, the routine administration of analgesic or anesthetic drugs, that are not specifically required to correct or prevent a complication in delivery, should be avoided.

11. Artificial early rupture of the membranes, as a routine process, is not scientifically justified.

12. The healthy newborn must remain with the mother whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.

13. The immediate beginning of breastfeeding should be promoted, even before the mother leaves the delivery room.

14. Obstetric care services that have critical attitudes towards technology and that have adopted an attitude of respect for the emotional, psychological and social aspects of birth should be identified. Such services should be encouraged and the processes that have led them to their position must be studied so that they can be used as models to foster similar attitudes in other centers and to influence obstetrical views nationwide.

15. Governments should consider developing regulations to permit the use of new birth technology only after adequate evaluation.

January 20, 2010 by gentlemidwife

Making an Informed Decision on Epidurals

I wrote this article on epidural anesthesia while I was in school, and I thought someone may find it helpful….it’s always important to consider ALL aspects of the information available!

There is much debate today over the use of epidural anesthesia during labor and delivery. On one hand they are reported to bring miraculous relief from labor pain, and yet on the other hand many different risks and complications have been reported. How much do we know about this method of pain relief? For how many years have epidurals been used? How is it administered? What are the possible risks and complications? How does it affect other facets of labor? What are the benefits? Let us take some time to look at the issue from the perspective of researchers who are representing both sides.

The history of epidural anesthesia:

According to one source, the epidural block was first introduced unsuccessfully in 1901. (1) At that time, administering an epidural through the caudal region was being experimented with, but was a complex technique that required extreme skill. In 1921, Fidel Pages from Madrid, Spain, first reported on his successful results using the epidural space for insertion of anesthesia. As this method became more familiar, and new discoveries were made in the invention of better needles and equipment along with further understanding of anesthesia and its effect on the human body, the epidural block has become part of the modern medical world. (2)

How is an epidural administered?

Before administering an epidural, the patient must first be given an IV of crystalloid solution (in order to counter-act the hypotensive effect of the medication), and it must be determined that she is in active labor. The anesthesiologist will take a full history and determine if there are any contraindicating factors. Ideally, he will also talk with the patient about the possible risks and benefits of the procedure. Then she will be instructed to lay on her side, in a curled, arched position so that he can reach the vertebrae and insert a needle into the L3-4 or L4-5 area. (3) The patient must hold extremely still, as the epidural space is only 3-5 mm deep, and it is easy to accidentally puncture the dura, which can cause major headaches and other side effects. (4) Once the needle is inserted, it is replaced with a catheter, and a test dose is given to make sure that the dura has not been punctured and that the patient will not have an adverse reaction to the particular drug used. She must continue to lie on her side to prevent aortocaval compression and hypotension that results from being on her back, and the remainder of the anesthetic is injected. Some evidence of pain relief should occur within 5 minutes, and full effect should take place within 8-15 minutes. The catheter is then taped to the patient, and remains inserted so that more medication can be injected as needed for the duration of the labor. (5)

How does the epidural work?

The anesthesia of choice (usually a combination of two or more of the following: lidocaine, bupivacaine, mepivacaine, chloroprocaine) is injected into the epidural space (6), which surrounds the outside membrane of the spinal cord. Since the spinal cord carries signals to the brain, the nerve sensations can be numbed or blocked by filling the epidural space with anesthesia. This affects the areas just above and below the insertion spot. The amount of pain relief depends upon the type of anesthesia used, and the amount that is given. It is possible to have all sensations blocked so that the patient has no feeling from the waist down, or to have just enough pain relief to “take the edge off” and yet still allow the mother to be mobile. (7)

Advantages of an epidural:

Advantages of using an epidural block include:

– Completely pain-free labor and birth experience is possible, while allowing the mother to remain aware of what is transpiring. (8)

– Pain relief is constant for whatever length of time is desired. – During a long, difficult labor, it can bring about needed relaxation to help the mother progress and give her strength by providing a chance to rest. (9) – Should a cesarean become necessary, the entry route for anesthesia is already established, allowing the mother to remain awake during the surgery, thus enabling her to be a part of the birth and postpartum periods. – If the mother is having trouble coping with labor pains, an epidural can help her to relax and enjoy the process. (10)

Disadvantages and possible complications:

– Complications are reported to occur in about 23% of women. (11)

– Safety to the baby is not proven.

– Restricts the mother’s movement, as she must remain on her side in order to prevent complications and allow the catheter to stay in place. (12)

– Lowers the blood pressure, which may make the patient feel nauseas and possibly vomit. This also affects the baby due to the reduced amount of blood flow through the placenta. (13)

– There is a 15-20 % chance of the patient developing a fever, in which case further testing must be done in order to make sure the baby is not being negatively affected.

– Changes the normal progress of labor, many times lengthening the second stage. (14)

– Increases the possibility of other interventions: urinary function can become impaired, necessitating a catheter; second stage may be prolonged, indicating a higher incidence of oxytocin, episiotomy, forceps, and/or vacuum extraction. In addition, continuous fetal monitoring is indicated, and the mother’s vital signs must be closely observed. (15)

– It can influence the baby’s heart rate. In one study, 8-12% of the women who used an epidural experienced low fetal heart decelerations, indicating fetal distress. (16)

– The actual strength of the uterine contractions can be concealed, which can increase the possibility of uterine rupture, especially when oxytocin is involved. (17)

– There is an 8% incidence of the dura being punctured during insertion of the catheter. This results in extreme headaches, which can last for up to a week, with some patients experiencing long term chronic problems. (18)

– Occasionally there are women in which the epidural does not take, which can cause further discomfort and pain, along with subsequent loss of expectations. Some women experience numbing on one side and not the other, or in certain areas, which is a frustrating experience. (19)

– The drugs do reach the baby, and depending on the degree in which he was affected, his muscle tone and reflexes can be altered and he may be excessively drowsy for his first hours of life. (20)

– Many women experience long term backache, sometimes as a result of unknowingly straining muscles during labor, due to lack of feeling in the area. (21)

– Paralysis can last for up to several days (this occurs in 1/500 women). (22)

– Postpartum problems including a higher increase of jaundice in the newborn, and an increased difficulty with breast feeding have been reported. (23)

Conclusion:

In closing, it must also be considered that pain can be a good thing. Research shows that the pain and stress of normal labor trigger the release of adrenaline and noradrenalin, which are necessary in preparing the fetal lungs to breathe air and helps to utilize the mother’s energy. Pain can be an indicator of progress, as well as a safeguard to keep the mother from assuming a position that can be harmful. When the nerves of the pelvic floor are numbed, the body is not able to make the same supply of oxytocin which causes the pushing urge. Thus the body’s natural mechanisms are altered. Along the same lines, stress hormones cause the release of endorphins, creating a natural form of painkiller. These give the mother a type of “high” enabling her to do the work needed throughout the laboring process. (24) The decision whether or not to use an epidural must be the choice of the mother, after she has been informed of all of the pros and cons on both sides. Any type of intervention is not without its risk, as we can see from this study. However, there are times when intervention is necessary, and it is important to know what the risks are when evaluating your choices. For a mother who has had a long labor without progress, and is getting tired and worn out, and epidural may be just what she needs in order for her to have a vaginal birth. At these times we are extremely grateful for medical invention and progress, but we must not forget that a woman’s body was designed to give birth, and for thousands of years this has happened without epidural anesthesia. As with any medical advancement, we must exercise caution and make wise, informed decisions concerning what is placed inside of our bodies.

Reference:

1. Mandabach, Mark G., MD; article entitled “The History of Epidural Anesthesia”. Accessed on August 29, 2007, at: http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=AEA7FF46297392A08B32A41CD6976656?year=2000&index=14&absnum=506
2. Franco, A.; article entitled “Current Anesthesia & Critical Care”, accessed in August, 2007, at: http://linkinghub.elsevier.com/retrieve/pii/S0953711200902643
3. Article entitled “Epidural”, accessed in Aug. 2007 at: http://www.nt.net/lerouxma/epidural.htm#history
4. Article entitled “Epidural”, accessed in Aug. 2007 at: http://www.answers.com/topic/epidural?cat=health
5. Oxhorn, Harry, Human Labor and Birth, pg. 461
6. Oxhorn, Harry; pg. 461
7. BUPA’s Health Information Team, article entitled “Epidurals for Surgery and Pain Relief”, accessed in August, 2007, at: http://hcd2.bupa.co.uk/fact_sheets/html/epidural.html
8. Kitzinger, Sheila; Complete Book of Pregnancy and Childbirth, The, pg. 242
9. Oxhorn, Harry; pg. 462
10. Sears, William, MD; The Birth Book, pg. 177
11. Marsden, Wagner,MD; Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First, pg. 54
12. Sears, William,MD, pg. 177
13. Kitzinger, Sheila, pg. 243
14. Wagner, Marsden, MD, pg. 54
15. Wagner, pg. 55; Goer, Henci, Obstetric Myths Versus Research Realities, pg. 250
16. Wagner, Marsden, MD, pg. 55
17. Oxhorn, Harry, pg. 463
18. Various authors, article entitled “Epidural Anesthesia and Analgesia Are Not Impaired After Dural Puncture With or Without Epidural Blood Patch”, accessed in August 2007, at: http://www.anesthesia-analgesia.org/cgi/content/full/89/2/390?ck=nck
19. Kitzinger, Sheila, pg. 243; Sears, William, MD, pg. 176
20. Cohen, Nancy, Open Season, pg. 98
21. Sears, William, MD, pg. 175
22. Wagner, Marsden, MD, pg. 54
23. Goer, Henci, pg. 255; article entitled “Epidural Birth May Negatively Affect Breastfeeding”, accessed August 2007, at: http://www.forbes.com/health/feeds/hscout/2006/12/11/hscout536503.html
24. Goer, Henci, pg. 252

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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