Lots of midwives.

I am now the owner of a practice with FIVE wonderful midwives. This new reality has suddenly exploded at my feet in all its newness, challenge and opportunity. FIVE midwives.... what is going on at Lovers Lane Birth Center?
One is me: Dinah, owner and roll-with-it-midwife, mistress of the "And why not?" school of philosophy. Another is Adelle, second short, curly-haired, Jewish, middle-aged midwife type who is unfurling in the freedom and ambiguity of life away from the hospital. Third is Kristy, our modest, quiet,and gentle money-and-billing managing midwife. Fourth is Kristine, the amazingly able, get-it-all done office-organizer-midwife. And fifth is Anna, who has yet to begin but will find her own place in our roomy birth center, bringing with her her life with her chickens, her garden her nearly centenarian live-in grandma, her still breastfeeding youngest and her 100-mile-running spouse (now that sounds intriguing doesn't it?)
I'm thinking about subsuming our feelings and being open to our clients wishes, learning and growing as midwives and as people from that. But, at the same time our own feelings matter, our boundaries and comfort zones move over time but they do define us as people and our midwifery practices. We midwives are works in progress. So is the birth center. And so are our clients and their families.

I'm in a positive vortex!

Yesterday had a sort of wildness. Seeing prenatal visits, my 3 o'clock appointment, N, appeared at 9am just as I was about to see my 9 o'clock appointment. The 9 was J, a former client in a intense state of distress. I knew her well. She had all her babies with me. She is on a quest for the stable family life that she and her sisters never had. How hard to make that work when you don't really know what it feels like. It was crumbling again. She was in for STD testing. I can provide the testing but the challenges remain. Meanwhile N, who is 37 weeks along, is in the waiting area with her 15 yr old son. She says her water broke at 4 in the morning and she is contracting. She had not called me. As she drove herself to the birth center and was sitting calmly on the sofa with scarcely a labored breath, I thought it might be a while. I gave J a hug and ushered N into my office.
As N sat opposite me, describing her night, I noticed that she didn't look quite the same as she had 10 minutes earlier in the waiting area. She was definitely beginning to work a little. Hmmm. Maybe not an obvious send-back-home. We walked to the birth room and I checked her: 3cms, completely effaced, zero station. "What about a walk in the park with the ducklings?" "Good idea" she said and off she went.
So I went into my office to see my 10 o'clock appointment. This was B, past her due date, blood pressure rising, baby persistently posterior: that's the mom who should be in labor. Oh well, she is thankfully stable and doing OK.
Meanwhile N cannot focus on the ducklings. Things are more serious. It is now 10:15 and we need to get her husband here from work ASAP. N labored standing and swaying. Then she labored kneeling with strong pressure on her back. Then she lay down on her side and things got really strong. It was 10:45. Her husband and sister were at her side. My wonderful assistant, Kristine was there to help and N was feeling pressure. As she pushed a little for the first time, we asked her if she wanted to get into the tub. By the next push she was kneeling in the water and 2 pushes later her sweet little girl swam through her legs and into her arms. Her baby opened her eyes and stared at her mom in that perfect state of entrancement that only a newborn has. Kristine and I kept an eye on them for a bit and then they went home in time for me to see my 2:30 and 3:30 appointments. Life is good!
Last night I slept well. Adelle worked seeing prenatals today. Usually I do come into the birth center on my days off for a bit. Because as I said on a prior post, the birth center is my baby. So in the afternoon I went in to touch base with my baby. Imagine my surprise. Adelle had a mirror day to mine. In between her appointments a client came in in labor. She was also a little early and somewhat unexpected. She showed up 9 cms along and slid out her teeny little baby who hollered and nursed just like the big ones.
Our team at the birth center has undergone a lot of change lately: trying to find the right midwives, the right office help, the right birth assistants, has been very bumpy. But I am feeling almost ecstatic. The midwives are right. The new and perfect office team will be completed tomorrow, and the 2 regular birth assistant (who are also incidentally the office team!) are fabulous. I am in a positive vortex. 
While Kristy, who had assisted at the birth, helped to clean up and see the family safely out the door, I chatted with J who had a prenatal visit with Adelle: "definitely in a positive vortex today" I commented. "I can feel that" said J.

After the birth drought

It is weird the way births come in droves and then...... nothing. Heard that it's the moon, or that it's the weather. Maybe..... I'm sort of more of the thought that my mamas and their babies are somehow communicating with each other. That's really what it feels like.

It was just over a week ago when my last birth drought ended. I had been feeling typically antsy, just the way a birth drought makes me feel, when L, a fourth time mamma called. L was having her fourth boy ("Oh well, that's just the way it's supposed to be, I guess" she philosophized). Her first birth had been a typical, rather unpleasant hospital business. Her second, at a birth center, had been a miraculous revelation. Birth could be quick, smooth, energizing, wow! She and I had expected the same with number three. It was an uncomplicated water birth like the second.... but L found it more challenging than the second (ever heard the midwifery chestnut about the jinx of the third birth?) (Actually, I don't believe it at all). As she labored for the fourth time, L kept looking up at me "This is really hard, I can't do this" she hollered again and again. I worked with her, but she struggled. The baby slid out into his father's hands. L was relieved and happy. L accepted that that was the way it was supposed to be.... but I didn't understand it.

That thursday morning. I saw people for prenatal visits through the afternoon, and was pretty tired by the end of the day. That evening D called. She is a first time mother who thought her water had broken. No contractions. Nearly 42 weeks! OK. Went to bed later than I should have done (always).

Middle of the night, a phone call. D? No! S! S is having her second baby. Her husband's grandfather died and he left town to go to the funeral. We had had a conversation a few days earlier about what to do. She was 38 weeks along. Should she go too and risk having the baby in some random hospital in Lubbock?! She could stay behind and risk going into labor without her husband?! As we thought she would probably not have the baby anyway, it was of course, a purely theoretical discussion. (I always feel like babies are going to stay in,.... until they decide to come out). Well, S was in labor. The birth of S's baby was textbook beautiful. She eased her out gently, reaching down to catch her as she came out of the water. What joy. But sadly, the baby's loving Dad was present only on the end of the telephone. I suppose that was the way it was supposed to be too.

Home by 4am and up before 8 to do interviews and tour of the birth center. (I act kooky and delirious when I do tours in that state). D was having occasional contractions but was not in labor. By the 24 hour mark I was wondering if she'd been mistaken. Maybe her water hadn't broken. So we met up at the birth center at 7pm. Sterile spec and litmus paper left no doubt. Water broken. Discussed options. Decided that to go to the hospital in the evening and get induced all night didn't make sense. We'd sleep on it, keep an eye on her temperature and hope for some real contractions overnight. In the night they called a couple of times convinced that the baby was flying out the exit. I was glad their was some action but wasn't convinced. Early morning we met up. She seemed to be laboring pretty well! But, she was only 2 cms and it was now 36 hours after water breaking. Baby sounded good. No fever. But..... it was time for the hospital. So, off we went, tearful but resigned. Helped her get settled in. Baylor really is a pretty supportive place (as those places go).

Home for lunch and relax (!) a little and then C called. Now C has been feeling that she is in labor for most of the last month (or so it seemed) But all pregnancies do come to an end, and her moment had arrived. So off we went. C screamed "It hurts". She screamed "I want this to stop" She screamed "I want Mommy". I was right next to her and the screams were exploding in my head. Now I write this in my blog because it's true and that was how C labored. I may put some people off. I will tell you that VERY few women scream like that. Most moan. Many shout. Some holler. But very few women scream and keep it up. But that was birth for C. That was the way it was supposed to be for her I suppose. And her sweet baby came out too. And she stopped screaming and held her close.

And I went home to bed. Ready for another birth drought.

I am my oatmeal

I have nutty oatmeal with creamy whole milk from happy cows and half a juicy pink grapefruit for breakfast. I can feel myself turning into a bowl of oatmeal! I eat a bowl of white bean and kale soup and a sweet crisp apple for lunch. I am a white bean. I sit at home after work nursing a cup of tea and crunching a piece of grainy toast with half a banana on it. I am a piece of toast. I eat brown rice with veggies and garbanzo curry for dinner. I am a bowl of curry, spicier by the moment.

Yes, you know the phrase "you are what you eat". Remember, it is literally true.

My oatmeal rumbles around in my tummy and mixes with my digestive juices and begins the biochemical process of becoming me. My hair, my toenails, my lungs, my uterus, are my oatmeal.

Please think about that the next time you have a Big Mac.

Do you choose Submission or Joy?

Submission or Joy is a phrase from a novel I am reading about the 1930s in Mexico. It has nothing to do with childbirth in the context in which I read it. But it resonated with me immediately.

Do you choose to give birth in the hospital? Do you choose to submit your body, your baby, your birth to their requirements, to their meaningless and sometimes brutal, arbitrary and patriarchal rule? Giving birth is a political act. You must not submit, but give birth joyfully, as a political act of love. Take charge, act politically, give birth joyfully.

Walking is Life

I used to be a city planner. Really. Not for long. The work was boring. But I believe that where we live influences how we live and that affects our health and wellbeing. When the places we live in are designed for our natural human scale they support healthy people. We are walking animals. We walk to get food. We walk in our working lives. We walk to learn. We walk to live. So places that facilitate walking, that are walkable, are more healthful places to live. Sadly the Dallas suburbs do not facilitate a walking lifestyle. But it can be done.

When I suggested that walking to the park might be a good and pleasant way to get some exercise, Lori explained that she couldn't do that. She is afraid of dogs. When I suggested the same to Catherine she said that she was afraid to go out without her husband, who works long hours and can't accompany her. These two pregnant women are not alone. I hear these kind of fears often. What a strange, crazy and unhealthy world we live in when we are too scared to go for a walk.

I am happy to say that a month later, Catherine told me that she was able to overcome her fear and she had taken a 10 minute walk to Starbucks. She called her husband from the store and he couldn't believe she had done it! She was empowered. She is planning to walk to Starbucks every day. More power to you Catherine. You can do it too Lori.

Birth: As many attitudes as there are women

For me giving birth for the first time was ecstatic and transformative. I thought that natural birth could be like that for every woman every time. But now I know, giving birth is as varied as we are. It can be unbelievably challenging, exhilarating, orgasmic, scary, cool, tiring, energizing, calm, wild, beautiful, crazy.

Renee has had three babies naturally before, all home or birth center births. She is committed to having her babies that way. She believes in it. She knows her body can do it..... but that doesn't make her like it! In the middle of birth number four she turns to me...."Dinah, remind me why I don't want an epidural" She wants a rational evidence-based answer that will strengthen her commitment to the process. I remind her that epidurals interrupt her body's production of endorphins which will give her that wonderful post-birth high and also help her recover easier physically. I remind her that epidurals lower blood pressure which can cause decelerations of the baby's heart which could lead to a c-section. "Thank you" she responds rationally and returns to her contractions. A little later she gives birth, beautifully connecting with her newborn girl (the first after 3 boys) and smiling with that post-birth high thanks to those useful endorphins.

But not every woman feels like Renee.

Sarah admits to me sheepishly during a prenatal visit "People think I'm crazy, but honestly, I love giving birth. I'd do it 50 times if I could" Don't be shy of feeling that way Sarah! Shout about it. You are not the only one who loves it. I vividly remember Mary rocking on all fours on her bedroom floor "Here comes another one," she hollered, "Bring it on!"

But not every woman feels like Sarah or Mary. There are all sorts of women and babies and all sorts of labors and births. Natural births are different from each other just as we are.