Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

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My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

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Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.

 

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Why You Should Choose a Nurse-Midwife for Your Pregnancy/Primary/Well Person Care

When I started on this path, I was in my mid-twenties. None of my close friends had ever continued pregnancies or chosen to parent. This is partly why midwifery had never occurred to me as a career at that stage in my life — none of us were in that place in their lives. But now that we are approaching “AMA” or “advanced” maternal age, or the ripe old age of 35 (haha), many of my friends are now starting families (or trying to). Lucky for them, they now have a midwife friend! 

So, this is an open letter to all my baby-making (and aspiring baby making) friends and family. 

My basic advice/message is:

Choose a nurse midwife for your pregnancy care!*

Here are 5 reasons why many pregnant people should consider using a certified nurse midwife (CNM) as their prenatal care provider and birth attendant.

1. Client education and counseling

Nurse-midwives aim to spend time with our patients and get to know you. We want to know what is important to you and meet you there. If you want a provider to listen to you and to openly and without judgment respond to your concerns about pregnancy and birth, you have a pretty good chance of finding this in a nurse-midwife.

2. Supporting physiologic processes

This is a hallmark of midwifery care. Take initiation of labor, for instance. A midwife will take a holistic approach — to ensuring your due date is correct, to providing physiologic means of helping you go into labor on time, and choosing not to admit you to the labor and delivery unit until you are really in labor. All of these are part of an approach that supports the pregnant person’s ability to have a baby when it’s time. It may also mean helping you push your baby out to minimize trauma and tearing of the perineal muscles, and certainly avoiding cutting your muscle to make room for baby’s head or shoulders (episiotomy). 

3. Evidence-based practice (EBP)

From my first semester in nursing school, EPB was drilled into my brain. I can’t tell you how many papers I wrote about EPB…but I’m glad I did, because it instilled in me a drive to provide care that is based on rigorous review of current evidence and is patient-centered. What does this mean? A good provider (social worker/doctor/physical therapist, etc.) draws upon current research and literature reviews to determine how they practice. I am very proud that this is a centerpiece of nurse midwifery education and culture. Not that seeing a CNM is any guarantee of this, but it certainly something that most CNMs should be familiar with. The CNM professional organization put together this fabulous resource compiling data about how we use EBP – Midwifery: Evidence-Based Practice. Our practice is not (or at least should not be!) based on expert opinion, tradition, convenience, fear of malpractice lawsuits, or other provider-centered philosophies — but rooted in solid evidence and a patient-centered approach. 

 

4. Labor support!

The best midwives will support you while you’re in labor — not just leave you to labor on your own and then show up at the end to do the delivery. In some busy practices, that may not be possible, so I always encourage pregnant people to find out what their provider does. Midwives are trained in labor support, meaning they can help keep you active and can provide comfort measures that can help you out throughout the process. Unfortunately, many physicians do not (but should!) receive training in normal birth, and often do not know what to do to promote your comfort during labor other than offer drugs. Midwives understand that labor is hard work and can support moms through it. 

5. Greater chance of normal birth

According to a recent survey of research on midwifery, you are more likely to experience the following when getting care with a certified nurse midwife: 

• Lower rates of cesarean birth,
• Lower rates of labor induction and augmentation,
• Significant reduction in the incidence of third and fourth degree perineal tears,
• Lower use of regional anesthesia, and
• Higher rates of breastfeeding. (Newhouse, Stanik-Hutt, White, et al, 2011)

These are not reasons you should not use a nurse midwife

1. I want an epidural

If you choose to have your baby in a hospital, your nurse midwife can still order you an epidural, if that is the anesthesia/analgesia option of your choosing. 

2. I want to have my baby in hospital

No problem – the vast majority of midwife-attended births are in hospitals. You may not even realize it, but there may be midwives at your local hospital. 

3. Midwives don’t know enough stuff

So you may have heard that terrible slam Bill O’Reilly made about advanced practice clinicians (APCs, formerly known as mid-level providers, yech!) — worried that the increase in care by folks in these professions aren’t qualified be good healthcare providers. (Yeah, I know, my readers are big O’Reilly fans.) “Lenny from community college” couldn’t possibly be my provider, he said of physician assistants! (See the response from the American Academy of Nurse Practitioners here.) Even so! Many people don’t know what training we receive. O’Reilly’s ridiculous comments (among thousands he’s made over the years) aside, becoming a CNM is no joke. I’m proud to say that I have attended many community colleges throughout my education, but I also will report that CNMs are required to have a bachelor’s degree, be a registered nurse, hold a master’s degree, pass a rigorous certification exam, and become licensed through the state they live in as both a registered nurse and an advanced practice nurse. We are very well prepared to take care of people when it is within our scope of practice.

4. I want someone I can see always, not just when I’m pregnant

No problem! Loads of midwives work in settings where they can provide well woman, gynecologic, family planning, and even primary care. It depends on how the midwife’s practice setting works, but in many cases, you may be able to see your CNM across the reproductive lifespan. 

5. Doctors know best

Haha, I know no one reading this blog would think that. But I really ran out of reasons why you should not see a midwife. 

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So…if you are low risk (not diabetic, chronically have high blood pressure, etc.) you may be a great candidate for working with a midwife! Get out there and FIND A MIDWIFE!!! And if there isn’t one in your area…well, shoot. Maybe you should get on the path to become a midwife, or tell someone you know who would make a great CNM to get on that path. We need more great women’s health providers. If you are feeling the call…better answer!

 

Reference:

Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nursing outcomes 1990-
2008: a systematic review. Nurs Econ. 2011;29(5):1-22

*Or your well person/family planning/gyne/primary care. More on “women” later…