March 27, 2020 by gentlemidwife

Resources and Info on COVID-19: Links, Practice Changes, Recommendations & More

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.

Here are some links that I have found helpful:

Aviva Romm Series on Covid-19 Info

WHO info for Pregnant and Nursing Mothers

National Association of Certified Professional Midwives: Covid-19

WHO Info-graphs

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:
- Midwives Swamped with Homebirth Requests
- NY Homebirth Statement

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:

Advice from a Pediatrician

Aviva Romm on Natural Remedies

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!

March 30, 2019 by gentlemidwife

Miscarriage Questions: 10 Year Anniversary Interview Part 3

Interview Pt 3: Miscarriage

This month I’m continuing to answer questions that were submitted by readers for Gentle Delivery’s 10^th 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.
Check out these sites that have further tips: Healing After Miscarriage and Healing Naturally.

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.
Check out this blog post for more practical tips: Preventing Miscarriage

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!

February 28, 2019 by gentlemidwife

Midwifery and Mom Life: 10 Year Anniversary Interview ~ Part 2

Interview: 10 Year Anniversary of Gentle Delivery ~ Part 2

Thanks again to each of you who contributed questions for this “virtual interview” as Gentle Delivery celebrates 10 years of practice! I’ve enjoyed this opportunity to connect with various readers, and I’ve loved hearing from so many of you. If you missed the first post, you can check it out here. Here is installment two as I continue working my way through the questions entered:

How do you manage being a midwife and a mom?

Sometimes I’m not sure that I do! But seriously, it comes down to having a very supportive and involved husband. I could not do it without his help & support, and without him having a flexible job. He works from home, and generally speaking is able to set his own schedule. Without these key factors, I don’t think it would be possible. We both feel strongly that our children need to be our priority, especially while they are in their young, formative years, and Joel’s job situation allows us to almost always have one parent present. If I need to run off to a birth or client emergency, than Joel changes his schedule for the day and takes care of the children, which greatly simplifies my life! I honestly do not know how midwives serve year after year with a busy client load combined with stress of needing to figure out babysitting, especially at the last minute. A few months ago, I was called to cover for another midwife who had two moms in labor at once, and the second mom was moving fast. Without having the ability to just load up the car with my gear and run, I would have missed the birth! But since Joel was working from home (his office in our basement), I was able to be out the door in ten minutes, and he took over managing the children. His work-from-home arrangement also allows me to sleep in after a birth, and he will sweetly get children up, feed them breakfast, and care for things while I get some rest.

Hot breakfast made by Joel and snuggles with the baby after being gone all night at a birth!

There are also some practical ways we have found that help to maintain balance, as well. As much as I am able to, I schedule appointments during my youngest children’s nap times, and I try to keep appointments confined to one day each week. This way I am limiting the amount of scheduled time I need to spend away from my children, especially since I never know how much unscheduled time I will be away at actual labors/births/emergencies. Another practicality is hiring cleaning help during especially busy months. My husband maintains that if I’m enjoying midwifery work and getting paid for it, then I might as well pay to get some of my other work done, instead of getting exhausted and stressed out! Oftentimes after a birth we will purchase supper (or take the family out) as a way to get some quality family time AND as a way to provide me with some extra time to do paperwork and miscellaneous business projects. I also get help with school, which is HUGE! My school-age children are part of a hybrid model co-op, where the parents help to teach classes, but they also have a classroom teacher who covers the “basics” and stays on top of the school details. If I was homeschooling full-time there would be NO WAY to do midwifery on top of it.

Each of my children have attended births with me as babies…quite the adventures we’ve shared together!

Balancing midwifery and mom life includes another factor when I have a nursing infant myself. Whenever I interview with potential clients who would be due after I have a baby, I make it clear that if you hire me, you’re also getting my baby. I always have an assistant or specific helper along who can care for my baby whenever I need to focus all energies on the laboring mom (and who needs a baby crying in the background when they are ready to push?!?), but otherwise I keep my tiny ones close so they can nurse and be with mama as much as possible. Some families are not okay with this arrangement, and that is their choice. I would much prefer they know what to expect ahead of time, and decide if they are comfortable with my boundaries, are there are always other options out there for them to consider!

One more key factor has been working with a midwife who is willing to trade call at times, which provides me with occasional time off to take trips and spend some focused time with my family. Without this arrangement, I would be tied to my phone and location almost 24/7 all year round! But this has allowed me to still spend some quality time making memories with my children, while knowing that clients are cared for, which is a tremendous blessing. While I still try my best to make it to my clients births, it’s also a relief to know that I can go “off call” occasionally for special events such as a school program.

Twice I’ve caught babies just before delivering my own…one time a week before, and another time two days before!

Is it realistic to consider being trained as a midwife, and starting your own practice as a midwife, with small children? What advice would you give?

This is a good question that deserves considerable thought. I had the opportunity to do my midwifery training when I was single, which was ideal. In my opinion, training to be a midwife was decidedly more of a time and energy commitment than practicing as a midwife. Here’s the reason why: when you are training, you need LOTS of experience. You need to be able to be completely available to your preceptor midwife, and willing to take advantage of every opportunity you can be part of. The only way to get the experience you need to be a good, safe midwife is by spending an incredible amount of time immersing yourself in pregnancy, birth, postpartum and women’s health. There are a number of midwives who did this training while they were balancing a family, but it is HARD, and you need to be prepared that it will take a long time. As a single young woman, I had the flexibility of time & energy which enabled me to finish my studies and obtain my required clinical experience in about two years. But this included spending 18 months at a birth center where we literally immersed ourselves in the world of birth by living, speaking, and breathing everything birth related. Seriously! I don’t remember a day passing that didn’t include a significant discussion about something to do with an ongoing client situation, lab values, birth stories, complications, etc. This type of immersion would have been impossible had I been trying to spend time with family, and it certainly sped up the training process.

Now that I am an independent midwife, I can make my own decisions about how many clients to take on in a month, what risks I am comfortable with, what my parameters of practice will be (for instance, when I do prenatal appointments, or what seasons I may not be available for first time moms), and when I want to take personal time off to give my family some breathing space. In most apprenticeships, a supervising midwife counts on a student midwife to be available whenever needed, and the student cannot set these types of parameters and still get the training she needs along with keeping a good preceptor/student relationship. So these factors all need to be considered, and I think there needs to be some serious conversation with your husband and family about whether your family is at a good place to make the sacrifices that training would require. I don’t think one will ever regret spending quality time with her children while they are young, but you might regret not spending that time later on!

I would encourage any young mom interested in midwifery to read as much as you can, as learning more about your body and about the birth process is going to be beneficial no matter what. There are excellent books out there that can lay a great foundation of knowledge about how the pregnancy and birth process works. Watch videos & documentaries, read birth stories, connect with other moms and learn about their birth experiences. Look for opportunities to get involved on a small scale. Perhaps you’d be able to provide doula services for a friend, which would give you and your family the opportunity to experience what it is like to live an “on call” lifestyle (ready for mom to leave at any time day or night!), seeing how it works to have mom leave and how to figure out babysitting fast. This would give you a chance to see what this aspect of being involved in birth can be like. I don’t think any birth experience is wasted time, especially if you’re hoping to be a midwife, so slowly looking for opportunities and taking advantage of them as doors open can help as you consider further commitment. Always remember that if God wants to be a midwife, He will make a way for you…but in His timing, and in a way that it will be a blessing to your family. Be patient, pursue the small opportunities as they arise, and see how He directs as time goes on…one older midwife told me once that “women will always be having babies, but you won’t always have young children, so make sure you don’t regret not enjoying them while you have them.” Excellent advice!

I’d also recommend that any aspiring midwife read A Midwife in Amish Country, as Kim does an excellent job of detailing her experience training to become a midwife as a homeschooling mom of young children, relating her experiences and lessons along the way.

How many births do you take on, and why that many?

This really ties in with the whole mom/midwife balance topic, as this is another way we try to walk this line. As a general rule, I cap a month with two due clients. Occasionally I will take on a third, if my family is at a stage where this is more possible, and if I have a slower month before or after. As a mom approaches her due date, her prenatal visits need to take place more frequently, resulting in more mamas needing to be seen each week. Then you factor in a home visit (an additional afternoon besides my usual appointment day), the birth (for anywhere from 3-30 hours), birth paperwork, another visit to their home for a postpartum check, and the frequent contact via phone/text/email that takes place over this time, doing this more than twice a month in additional to caring for other moms is about what I can do and still enjoy my work. Here again, if I didn’t have young children, and all the unexpected things that factor into life as you care for little people, it would be much easier to add more clients due in a month. But I want to enjoy both my own children and the opportunity to do births, and this number seems to be working well for this stage in life!

Thanks for taking the time to read this second installment in this interview series! If you’d like to contribute a question for a future post, feel free to add it in the comments below. As always, thanks for sharing, and feel free to check out Part One if you haven’t read it yet. See you next month!

January 31, 2019 by gentlemidwife

Interview: 10 Year Anniversary of Gentle Delivery, Part 1

The year 2019 marks ten years since I started my practice as a midwife, after having spent several years studying, training and preparing to serve families in this way. I still remember the excitement of catching my first baby as a graduate midwife in January of 2009, after having moved home from TX (where I completed my academic training & clinical experiences here in Dec. 2008), and I cannot believe how quickly ten years have passed! Since that birth, I have been privileged to catch babies and care for moms & families in four different states, I’ve moved crossed country, married, and have had four babies of my own. All of this has certainly helped to mold, shape and broaden my experiences and skills, and I am so very grateful to each of the families I have been privileged to work with.

In honor of reaching 10 years, I thought it would be fun to see what questions some of you might have, and I was delighted by the questions that were thrown out on the Gentle Delivery Facebook Page. Here is Part One of a series in which I’ll start answering these questions…and I would love to hear yours, so if you haven’t left a question yet, feel free to do so below in the comments!

How and why did you get started in the field?

The “how” is the fault of my mother, who pursued homebirth after two negative hospital experiences, back when birthing at home was not such a popular idea. After her first birth at home with midwives, she went on to use them for care with the rest of my siblings (there are 7 of us!), and I grew up with the idea that having babies at home is a normal experience, and much preferred over the standard hospital setting! The midwives became close family friends, and were certainly heroes one would aspire to be like, in the eyes of a 7 to 14 year old girl growing up watching these women serve, care for and love on our family.

My 11# 8 oz cousin!

The “why” part is two-fold: one, I had a dream of serving God on the mission field somewhere, and thought that having a skill to offer would be an amazing way to connect with and become friends with women, while hoping to make a difference in an area where women were at high risk during pregnancy & birth. I was interested in pursuing midwifery with this dream/idea in mind, and several friends and relatives knew of this interest. My dear aunt then invited me to be present at the birth of her son, and I still treasure the memories of the time I spent with her and my uncle while we waited on my cousin to make his appearance. This not-so-little cousin of mine still tops the record as the largest baby I’ve ever witnessed being born, and it required a great amount of skill on the part of the attending midwife to not only deliver him, but also to help him breathe and recover from his rocky transition. While this was not your typical smooth, low-complication normal birth, I learned a tremendous lesson through this experience: a skilled midwife can make a difference between life & death, and that this is a serious responsibility to consider. After this birth, the thought that kept playing in my head was that I never wanted to be in a situation surrounding birth and wish I had learned what to do to help. It also helped to solidify that this was something I wanted to pursue, but it also gave me the reality check I needed as I began.

In light of the fact that my original dream was to work with women in another country without access to good maternity care, I do find it a bit humorous how God has taken me down a completely different path as I serve women in a very prosperous, beautiful little university town in Central Pennsylvania!

What changed in your approach / practice as a midwife from before you had children to after you experienced birth first-hand?

This is a good question! I find that I have a totally different perspective on the intensity of labor…there were times I seriously wondered if I could actually do it when I was in labor myself, and experiencing that has certainly helped me to understand what moms are going through. I also don’t look down on anyone for getting an epidural after experiencing labor myself! Before I had children, it was like “why would you do that?!? Don’t you know the side effects??” but once I was in labor I totally understood why that option would be considered! I’ve also found myself trying to be more sensitive to each mom’s individual preferences, spoken or unspoken, as I found out in my own labor that just because someone thinks they are helping, it’s not always the case. I think it’s helped to soften my opinions, too, as I’ve realized on a different level how many things are actually outside of our control. For instance, while not specifically about birth, I always thought that any mom could nurse if she tried hard enough. Well, I learned the hard way that trying hard isn’t always enough, and nursing has been a complete battle for me, which has taught me that each mom must figure out what actually is right for her and her baby, and that might look different than what you anticipated. So maybe the simplest answer to this question is that it’s helped me to grow in empathy!

What is one “bucket list” experience you haven’t had yet but hope to in your midwife career (e.g. delivering triplets, delivering a breech birth, an en cual birth, etc.)?

Newborn exam on a baby that I caught during my first year of practice.

To be honest, I don’t mind the un-eventful and un-exciting ones these days! All midwives know that at some point they will attend a breech birth (usually a surprise baby that turns between that last appointment and birth, or when the head is mistaken for a butt), and I experienced my first surprise breech two years ago (I was called to cover for another midwife, so it was a REAL surprise!), so that one is off the “bucket list” with plenty of gray hairs to prove it. I’ve missed several babies that didn’t want to wait for me to arrive (even if I was driving fast…my brother used to say he thought it would be fun to drive for midwives, so he’d have an excuse to drive FAST!), and I had the special privilege of catching twins & assisting with several sets. Two things I would love to witness yet would be an en-caul birth (I still haven’t had a baby born before the membranes have ruptured…though I’ve had plenty that ruptured JUST before birth, providing me with a shower of fluid!), and I’d like to top my current highest repeat client number of three babies for the same mama. One downside to moving across country (and then moving across several counties a few years later!) is that you don’t get to continue care with the mamas you might have started with. Up until recently, two had been the record I had been able to deliver for the same family, and I finally caught my third baby for the same family in 2018. If we can stay put long enough (and I can convince my clients to keep having babies-ha!), maybe that record will be higher eventually…though I’m guessing that not of all my clients want to help accommodate my wishes on that one!

So, after reading these, what are your questions?? Feel free to let me know, and stay tuned for Part Two of this 10 Year Anniversary Interview. Thanks for sharing & adding your comments!

October 31, 2018 by gentlemidwife

The Return on Your Midwifery Investment

The beginning of October found us celebrating “National Midwifery Week”, and the posts on social media about midwives and the personal care that they provide to so many moms and families got me thinking about the investment that midwifery care requires, on the part of both midwives and clients. Of course, one of the biggest investments that clients make is the cost involved. Sadly, many insurance companies are not willing to cover the costs of midwifery care, especially when it comes to delivering at home. This means that families have to weigh the costs, and determine if they can afford care out-of-pocket.

Oftentimes, it is easy to see the price tag (midwives are good at giving you all the costs up front, so you know what you are paying for at the beginning!), and think that a midwife must be making pretty good money. But I wonder, have you ever stopped to think about all the “hidden costs” that are involved with midwifery? It’s easy to think that the only time the midwife is investing is the time you are with her…your appointments, your birth (and maybe you’re one that has quick births, so it doesn’t seem like THAT much time!), and a handful of home and postpartum visits. In communication with other midwives, I have realized that many clients don’t realize all the “behind the scenes” time and costs that a midwife incurs in order to offer safe, up-to-date, competent & individualized care to each of the families she serves. So here’s an attempt to help you realize how much you are actually receiving in return when you choose to invest in midwifery care:

TIME: and not just the time you see her for your appointments and birth. On average, I spend about a minimum of 20-24 hours total with a client in-person (8-10 prenatal visits, 3-4 postpartum visits, and the birth…and of course, this amount of hours can be much more than this depending upon many factors!). However, there
After-birth paperwork

are many hours spent on each client that you don’t see: writing notes about your history and ongoing care, filing paperwork for records, birth certificates, & tests, research when clients have questions or develop issues, answering questions via email, text & phone, submitting reports when required, attending state-required conferences, creating handouts with updated information, and the list goes on…
ONGOING TRAINING: if you stop and think about it, you don’t want to trust your life and the life of your baby to someone who practiced something 10 years ago, but has never reviewed her training OR has not continued learning, right?? But ongoing training takes time & money, especially when it oftentimes requires traveling for classes. Maintaining current CPR, Neonatal Resuscitation Certification and accumulating the needed CEU’s to keep your NARM certification current, CPM re-certification fees, and regular peer reviews are all ongoing commitments and costs that a midwife must stay on top of.
COLLABORATING CARE & NETWORKING: When a client develops a complication the requires more medical intervention, it can take a number of hours to locate medical professionals willing to see them, copy and fax records, contact the proper offices, and obtain referrals.
COMMUNITY RELATIONSHIPS: Another aspect of good midwifery care that is oftentimes overlooked is that of having good relationships with the local midwifery community. In order to have back-up arrangements (both for planned trips AND for unpredictable emergencies, which will occur at some point in a midwife’s career), a midwife MUST have a solid relationship with other midwives, and facilitating these relationships doesn’t just happen. Another aspect of community relationships is the side of the local medical community. To facilitate good transports when needed, a midwife needs to have a good relationship with local care providers.
Grateful to have good relationships with my back-up and colleague, Rose Marie!

This translates into taking the time for peer reviews, staff meetings, staying up to date on local situations and politics, taking the time take thank you gifts and notes personally when services are received, and so much more. Having a positive relationship with local hospitals and doctors translates into better, quality care for clients, so it is a very worthwhile investment of the midwife’s time and energy.
OFFICE FEES: These costs are more obvious, but real nonetheless. You want to be able to reach your midwife anytime, ASAP, right? So she must maintain cellphone service and a working phone. Then there is the fax service that most medical offices require for sending/receiving medical records. Internet for research, copier for providing records for other medical providers & clients, ability to print forms, handouts, etc. I might also add that most midwives are doing all of their own office work, too, so time to order supplies, keep track of bills, payments, answer inquiries and all the paperwork that is required to run a business has to happen at some point!
EQUIPMENT & SUPPLIES: quality equipment must be purchased and maintained in order to provide excellent, safe care. Dopplers, birth stools, testing machines, ability to sterilize instruments, repair of equipment when needed…all of these go into maintaining a midwife’s supplies.
Birth supplies ready during a labor

Medications also need to be purchased in order to always have them on hand (even if you don’t use them frequently, you want your midwife to have them-and many of these items are not cheap!). Keeping emergency supplies to deal with the unexpected is also a real cost, as these things need to be keep up-to-date, which mean some items need to be purchased regularly, whether they are consumed or not.
RELIABLE TRANSPORTATION: You want your midwife to be able to get to you anytime…which means she needs a reliable vehicle in working order. Just last month we replaced all the tires on our vehicles, as my husband felt they were getting too thin to count on them during the winter weather. We also pay more to run an AWD vehicle as we have lots of snow & ice in PA. A midwife always needs to keep her gas tank full, and regular maintenance is a must.
A flat tire meant new tires for the vehicle had to be purchased ASAP!

Oftentimes a midwife will routinely drive a separate vehicle to events in order to be able to leave at a moment’s notice, instead of driving with friends or family. This is additional expense she must pay for!
HOME & FAMILY COSTS: Another aspect of midwifery life, especially if your midwife has a family, is that of having reliable and available babysitting at a moment’s notice. Meals that can be prepared quickly, or household help during times when mom has missed lots of sleep attending births are also very real costs. A family certainly must work together in order to let mama help other families, and I am blessed to have this type of support from my husband and family. But we do pay for it-bringing in food/eating out at times and getting regular cleaning help are two ways our family has made midwifery life sustainable.
ON CALL STRAIN: The last item I will mention on this post is the physical, emotional and mental strain of being on-call. While most midwives stay in this field because they genuinely love serving families as they bring their babies into the world, there is the very real downside of always being on-call. If a midwife has a small, independent practice, this generally means that she is the one who always answers the phone unless she has arranged back-up. No matter how much you love what you do, there is a toll that it takes on your body to always be available. You honestly never know when the phone will ring, and you will need to totally re-arrange your plans and be ready for whatever is at hand, day or night. Most midwives’ friends get used to all plans being made with the contingency of “unless I’m at a birth”, but the honest fact is that sometimes it’s not a birth. Sometimes a client has an emergency right when you’re in the middle of a much-anticipated event, or right as you closed your eyes after being up for 40 hours, or…you name it! I’m not sure how one can put a price tag on this aspect, but it’s well worth whatever your midwife charges!

My hope is that this post can encourage families that they are making a wise investment when they utilize midwifery services, and perhaps give you a greater appreciation for all your midwife is doing to ensure that you receive quality, informative, excellent care. I’d love to hear your thoughts as you’ve read through this. If you’re a midwife, what would you add to this list (I know I haven’t covered everything!)? If you are a client who has benefited from midwifery care, what would you add or comment? Did any of these factors surprise you? Thanks for sharing your comments!

May 22, 2018 by gentlemidwife

The Birth Story of Baby Darius

It’s hard to know where to start with Darius’ birth story, as there were several starts-and-stops along the way during the last week or so of my pregnancy. Joel will shake his head and say something along the lines of “shouldn’t a midwife know when she is in labor?”, but once again I had trouble figuring it out.

To give some background (especially if you’ve read my previous birth stories), we had used our dear friend Rose as our midwife with our girls, and she ended up being the first one on the scene after Matthias was born (she was home on a school break THAT weekend, and our midwife was on her way from Lancaster, but Matthias came in a hurry-read his birth story here). We love her, but due to a variety of reasons (especially the fact that Joel has no desire to ever catch one of his own babies again) we decided that this time we needed to use a midwife who lives closer to us. In the past two years I have been blessed to meet and work with Rose Marie Spicher, a midwife who lives half an hour away, and who worked for years in TX (where I did my midwifery training). She provided the “mothering” care I needed throughout my pregnancy, and it gave Joel a sense of relief to know she wasn’t too far away. With me being on maternity leave the month of May, and the fact that everyone else was expecting in May as well (I have NEVER received so many inquiries for one particular month!), I was just hoping that she wouldn’t be tied up whenever our baby decided to come!

So fast-forward through all the months of sickness, fatigue, finding out that we were expecting a baby brother (the children are still certain this was a direct result of their prayers, as I was convinced it had to be a girl given how sick I was!), and everything else until the beginning of May. By early May I was reaching that totally-done-being-pregnant stage where I wasn’t sleeping at night, having lots of cramps & contractions, felt extremely emotional all the time, and we were wondering just when this little fellow would decide to make his appearance. Between 34-36 weeks I was experiencing enough cramps and contractions to know I needed to take it easy, and once we hit 36 weeks I had a couple of times where I thought perhaps we were getting started-I distinctly remember one night when I couldn’t sleep because of contractions, so Joel & I slipped outside to take a walk in the moonlight. It would have been so romantic if I hadn’t been so uncomfortable! But everything always fizzled away, and left me feeling tired and discouraged.

At this point we were preparing for a visit from my parents, who live in Kansas. My sister had her first baby the month before, and my mom wanted to come out to help her over the time my brother-in-law was graduating and they were preparing to move. So she flew into northern PA, spent a few days with my sister, and was then joined by my dad. The plan was that they would drive down to see us before they headed back to Kansas, and of course we hoped that baby would arrive before they left, though we knew it was entirely possible that he would wait until they were home again. However, with all the early labor signs I had been experiencing, I’ll admit that I was getting my hopes up! Mom & Dad planned to arrive on Mother’s Day, and the night before I was trying to encourage things along, and ended up with a night of contractions with no baby to show for it. Everything was regular enough that I actually called my midwife to give her a heads up, but then it all petered out.

Mother’s Day 2017

I really had to work through the disappointment of knowing that perhaps my folks wouldn’t get to meet their grandson on this trip. We didn’t know when we would be seeing them next, and I hadn’t realized just how much I had my heart set on them getting to be here to see MY baby while he was new and tiny. It took some talking, praying, crying and processing with Joel to get to the point of being okay with the fact that perhaps this time with mom & dad was to be spent enjoying their company and not stressing over whether baby was here or not. So for the next few days, my parents helped to take my mind off of waiting for baby, and we enjoyed some lovely family time at the park, taking walks, picnics, a backyard barbeque, and some time for Joel & I to be together while our children were cared for.

The last night of their visit, they took our two oldest children back to stay the night with them in their cabin. In the interest of full disclosure, I had taken some castor oil in the afternoon, knowing full well that there was a good possibility nothing would come of it, and yet hoping that perhaps it would give my body the nudge it seemed to be waiting for. I was NOT going to get my hopes up, though, and I tried to just go to bed to get some sleep. I think it was around midnight or 1am when I woke up with a contraction, and yet I tried to sleep, as it sure wasn’t the first time that random contractions had woken me up at night! After an hour or so of not really sleeping, I figured I might as well get up to see if moving around made them go away or get stronger.

Joel sweetly got up with me, and fixed me sourdough toast with strawberry jam-his mom had given me jam and sourdough bread the week before, and it was becoming a regular midnight tradition to eat a piece when I couldn’t sleep! After another hour or so, Joel commented that these contractions seemed to be pretty regular and close together. I did NOT want to give another false alarm to anyone, and didn’t feel sure that this was anything more than what had happened on previous nights. Looking back, they were coming close together (every 2-4 minutes!), but they weren’t very intense, and they didn’t last long, so I wasn’t convinced they were doing anything. With my previous babies, my water had always broken either before labor began or at the start of active labor, so I kept waiting for that to be the clue that this was the “real thing”.

At 4:00am, Joel really felt like we should call Rose Marie, as he said he thought this seemed more serious, and he did NOT want to wait until it was too late! So I called Rose Marie, and I told her I still wasn’t sure this was “it”, yet Joel would feel better if she came, but she didn’t need to rush. The contractions were starting to get a bit more of an “edge” to them that took my breath away, but I still felt like I could make myself talk through them, though I preferred not to. Another sign I should have paid attention to!

Within 15 min of calling Rose Marie, all of a sudden things kicked in with a vengeance. Up till now I had still been puttering around, but hadn’t gotten birth stuff out yet, as I had gotten it all out and then had to put it all away a few nights before. I wanted to make sure I was in REAL labor before getting everything set up again, and figured I could do it in between contractions as a distraction. Well, that’s not how things happened. Labor went from being “not sure this is it” to “we’re in seriously active labor” in a few minutes! Joel called Rose Marie back and told her to step on it, and then he promptly called Lynelle (my birth assistant who was planning to assist Rose Marie with our birth-she lives less than five minutes away) and told her to come. I think it was around 4:30am when Joel called Lynelle, and boy did she know how to get over to our place in a hurry! Joel said he has never in his life been so happy to see Lynelle walk into a room, and it was just in time.

By this point my contractions were one on top of another, and I felt like I didn’t have any time to collect myself, catch my breath or get a break in between. Joel kept encouraging me to breathe through them (he didn’t want me pushing!), and I was leaning over the birth ball squeezing his hands for all I was worth, just praying that God would make it stop so I could catch my breath. Lynelle quickly realized things were serious, and started pulling all the birth supplies together. All of a sudden I told them there was no way I could keep from pushing any longer. It had been taking everything I had to blow through contractions, and I was done. I distinctly remember saying “you all are just going to have to catch this baby ‘cause I can’t keep him in any longer!” Lynelle calmly replied that everything was okay, and with the next contraction my water broke. Now I can laugh about it-that was the clue I had been waiting for all along to tell me if I was actually in labor! With the next contraction Lynelle could see his head, and she did an awesome job of coaching me through as I tried to breathe him out. Right at the point his head was delivering, Rose Marie walked in the room! Lynelle started to move out of the way, but Rose Marie just smiled and said it looked like she was doing a great job, so she might as well continue. Rose Marie guided Lynelle through the rest of her “first catch”, and the official birth time was 4:56am.

Those first moments after birth…

I can still remember the absolute relief that comes from being finished, and laying down with my baby on my chest. He cried just enough for us to know he was great, and then he snuggled on my chest, and we all exclaimed over his head full of strawberry blonde hair-that was a surprise! We had a really special next hour or so as we reflected over the crazy labor, the special-ness of the unplanned “first catch” for Lynelle, Rose Marie’s perfect timing, and Joel’s relief that he didn’t have to do this birth alone. We had invited another family friend to be present at the birth, and sadly she didn’t make it time, but her sweet & joyous spirit added to the atmosphere in the room as Joel fixed breakfast and baby Darius had his first meal. Thanks for coming, Mary!

And then it was SO amazing to call my parents and tell them that their grandson had arrived! Having them able to bring our oldest two over first thing that morning was so special. They were able to watch the newborn exam, meet our midwives, and see the children as they delighted in meeting their new sibling. It was the “icing on the cake” to have them around, and able to snuggle their newest grandbaby that morning, before they had to leave that afternoon to catch their flight home.

Yoanna & Matthias and Grandma & Grandpa meeting baby Darius. Yoanna was delighted to help Lynelle give him his first bath!

We had struggled with finding the right name for our little guy, and settled on Darius Rafael just a few weeks before his birth. Darius means “Upholder of Good” and Rafael means “God is Healer”. It is our prayer that our little son will grow into a man who does good, and is used to provide God’s healing to others. He checked out at 8# 10 oz, and measured 20 in long. Matthias was absolutely delighted to have a baby brother, and they continue to have a special relationship as brothers.

Here’s a few more snapshots of Darius’ “birth” day…enjoy this glimpse into our little family’s life, and feel free to check out the birth stories of our girls, Talitha & Yoanna.

Big sister Talitha was pretty excited to wake up and find that baby brother had “come out!”

Rose Marie checking baby out

Our amazing birth team-thanks so much for everything!!

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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