This tidbit of information was shared during a routine prenatal visit. The pregnant client and her husband were careful and deliberate about sharing this intimate detail. They were concerned that being a virgin might make her upcoming childbirth difficult. First, I assured her that this didn’t concern me; a full term baby is always bigger than a penis (no matter what the penis owner might say), a baby coming out of a vagina is very different than a penis going in and besides, the Blessed Virgin Mary did it, right? (This got smiles and small laughs from them both). Next, I asked if they were willing to let me know any more about their ‘relations’ (code word in that community for ‘sex life’). Their body language led me to believe that they had a very loving and trusting relationship. I had no idea how right I was.

The husband, tall, dark, handsome, young and Hispanic, looked like a Malboro Machismo Man. Speaking quietly, he sounded exctly like a man that dearly loved his wife. Softly stroking her hand, he explained that she had ‘many fears’ because of things that had happened to her as a child, that they had tried to have ‘marital relations’ (code for sexual intercourse) but it was not possible without her becoming scared. He did not want to hurt or scare her. And they very much wanted to have a child. So they had gotten creative. They had, um, made sure that his seed was ‘placed close to the door’.

They were thrilled to be pregnant. Watching them with their fingers intertwined and eyes sparkling, that was easy to see. It was also easy to see that sharing this very private information was difficult for them but they wanted to do what was best for their baby.

About now, my time with this couple was almost up, soon the midwife would come in to review their chart and quickly palpate the pregnant abdomen. I squeezed their joined hands and told them how lucky this baby was to already be loved, how lucky they were to have found each other. Also, I restated that I was not concerned with Virgin Birth (it worked the first time, right?). I suggested that pregnancy was a time of growth (pointed at belly, got a laugh) and maybe, just maybe, ‘martial relations’ would not be so scary now. I said that it was important for this pregnant virgin to feel good, safe and loved. I said that it was ok for them to keep enjoying each others’ company (wink, wink) in whatever ways felt good and not scary for this brave woman. Enter the midwife. My time for this prenatal visit was up.

A month later, I saw this couple again. She was beaming. She wanted me to know that even though she conceived as a virgin, she would not be having a virgin birth. She smiled and said that we could leave that title for the Madonna.

~Michelle

May all babies be born into loving hands

The post (Almost) Virgin Birth appeared first on Midwifery, Mothering & Me - An Albany Midwifery Blog.

Several times during prenatal care, we discuss the criteria for making this call. At the prenatal homevisit, about a month before the estimated due date, I review labor signs and criteria for calling the midwife.

“Call the midwife if your water breaks. I may not doing anything besides tell you to go back to sleep but call right away.”

“Call the midwife if there is blood running down your legs. This is not normal and I would need a call”

“Call the midwife if all your are doing is dealing with contractions. Five minutes apart, ten minutes apart, I don’t really care. However, if they are intense, if they are taking all of your attention, I need a call”

“Call the midwife if you are just not sure, if you are concerned, or if you just need information or reassurance”

And this is what I always say to the partner, “Most importantly, if YOU think that it is time to call and your wife says ‘No, not yet’, YOU WIN. Call the midwife!”

That last instruction, may be the most important. The reason I say this is because when things are working well, the woman in labor may not realize that she is really deep into the process. Labor, the work of giving birth to another human being, is really hard work that is done best by deeply relaxing. With deep relaxation and intense physical work, endorphins are produced. Endorphins are powerful brain chemicals. They can produce a hypnotic effect lovingly known as LaborLand. LaborLand is a strange place with soft, blurry edges and no sense of time; it is a place where the rational mind does not function. Labor is working really well when the laboring woman’s body is gracefully surging from one contraction into the next and her rational brain in not engaged. Labor is working perfectly when the mom-to-be is so far into LaborLand that she has no idea how close she is to giving birth. Sometimes, a laboring woman has no idea that she is really in labor. Someone else, dad-to-be for example, takes one look at her and thinks “This is labor” or “Wow! This is different. I want a professional to keep me company.Time to all the midwife!

The other day, a dad was awakened by his wife with what she said just was ‘just cramps’. Shortly after he got up, she moved to into what appeared to him to be intense contractions. He wanted to call the midwife. Eyes closed, breathing deeply, she adamantly said, no. Mom was deep in LaborLand. With the next contraction, she was pulling on her husband’s shirt (there may have been some arm punching involved) and crying “No! Don’t call. Not yet! It is too early.” Good husband that he was (and not loving those arm punches) he listened to his wife. Having remembered my instructions, he also figured he was right. So he tracked contractions. Two contractions actually. Two intense contractions that were only three minutes apart. Time to call the midwife!(Remember this was just twenty minutes after his wife had woken him, saying she was merely ‘cramping’.)

He called. I arrived. She had a baby. All was well. We were all glad that in spite of his laboring wife’s demand that he not, that this dad took matters into his own hands and called. This was definitely the right time to Call The Midwife!

May all babies be born into loving hands…

K. Michelle Doyle, CNM, NYS LM

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At my house, we eat together. Everyday. Everyday, we sit down and share food, space and time together.

There are various studies that show the importance of a daily shared meal. This simple activity is supposed to increase social skills, improve academic achievement and many other wonderful things.

Truthfully, not is not why my family eats together. We just do. It seems important to sit together, literally face to face and eat. There are few things are more basic, more primal, than eating (and those other things are best done in private, even in my house). Over the years, there have been sweet and sensitive conversations, tense discussions, terse silence, and even the rustling of papers. For the most part, we just share a meal, a little time, and a few words. Simply spending time together on this mortal coil.

For most meals, the table is set: forks on the left with a napkin under, knife and spoon on the right, glass above the spoon, filled serving dishes in the tables’ center. Some meals are just bowls of cereal grabbed in the kitchen and then plopped on the table. Sometimes, pizza boxes are flipped open on the table and everyone is handed a paper plate, paper napkin, a glass of milk. (Yeah, I like milk with pizza. Shhh… Don’t tell.)

Once when the kids were little, Cody had a friend over. We were all getting ready for dinner. I was filling serving bowls. Cody was carrying napkins and plates to the table. Looking confused, his friend asked whose birthday it was. No one’s. Then the friend looked more confused and asked was it Christmas? It took me a few beats but I realized that this little boy had no idea why we were setting the table if it wasn’t a holiday. Like many families, his family only ate together, sitting around the table, a few special times a year. It made me think: our everyday ritual was truly special.

Recently, with our kids grown and out of the house, my husband and I have started eating dinner in the living room. We sit on the couch, in front of the TV. My daughter chastises me regularly for this behavior: This is not the proper way for her family to behave. And I think she is right.

The next time that I want to eat in the the living room, I think I will turn off the TV, put an extra log on the fire and then set my intention even if I am not setting the dinning room table. Sharing a meal together, face to face, it is just what we do.

K. Michelle Doyle

May all babies be born into loving hands

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Pregnancy and Infant Loss Awareness month started in 1988 with a proclamation by President Reagan. This time of remembrance was started by a small group dedicated to give support and visibility to perinatal bereavement.

Perinatal bereavement means grieving the loss of a child sometime during pregnancy or the first year. There are so many ways for this to happen. In some cases, the loss is of a physical fetus/baby/infant. This is the case in miscarriage, termination, stillbirth, SIDs, fatal illness, and when there are congenital or chromosomal anomalies that are incompatible with life. In all cases of perinatal bereavement, there is also the grieving of the imagined child, the child that we dream of but never get to hold.

• In cases of infertility, the desire for a child that is never conceived can be combined with intense grief and loss, yet there is nothing physical to hold. The imagined child is a dream.
• In miscarriage, there is a positive pregnancy test, maybe morning sickness and sore breasts, perhaps a fuzzy image on an ultrasound screen. Yet, there is never the dreamed of birth day, there is no baby to cuddle.
• Prenatal diagnosis can initiate perinatal bereavement. Tests like ultrasounds and amniocentesis are a mixed bag: they can bring clarity, even good news and they can also bring very upsetting news. From a missing twin, to an extra chromosome, from a holey heart, to a missing skull bone, there are so many ways our babies can develop that we can not imagine, never want to imagine.
• With stillbirth, there is a birth, holding, maybe even bathing, dressing and photos, but the loss and the accompanying pain is unimaginable. Completely unimaginable.

Parents-to-be don’t imagine holding a cold and stiff infant, or an abnormal amino result. They don’t imagine deciding whether or not to terminate a dreamed of pregnancy or planning an infant’s funeral. They imagine having much, much more. They imagine snuggling a newborn, pushing a toddler in a stroller and a five year old on a swing. They imagine walking a beautiful young woman down the aisle, and helping a son change diapers on the new grand baby. In perinatal bereavement, there is physical loss of a pregnancy or infant, and then there is also the loss of all we imagined and dreamed.

Sad as all of that is, it is not the whole story. What I have learned from mothers, fathers and babies (imagined or otherwise), is that while our ability to imagine is huge, our capacity to love is even bigger.

• This month, I heard a mother grieve over her recent miscarriage, tears streaming down her face while she smiled and cuddled her nursing toddler. She said she was so grateful to have been pregnant for that short time. As she stroked her toddler’s silky hair, she said that she was especially thankful for the physical comfort that nursing gave her during this time.
• This month, I relayed a dire sounding ultrasound report to a mother who was at the same moment watching her firstborn sleep in his car seat, rosy cheeked and sweaty from play. As the week and the prenatal diagnosis unfolded, she said innumerable times how thankful she was that she had this very loved baby inside her, poking and prodding and this boy in front of her needing a snack, a toy, a book. There is nothing like a two year old to give you the gift of presence.
• This month, I listened to a mother recall her miscarriage after six healthy pregnancies. Years later, she is still surprised by the pain. And she smiled, smiled wide while talking about this sweet imagined baby and how her family celebrates that short life every year, a bitter-sweet unbirthday.

How can we love a child never conceived, never held, never grown? I don’t know how. And I know that we do. We love these babies with all our hearts. They stretch our hearts to the breaking point and then pull those broken edges inward. To be human is to suffer. And to imagine. And to love. This October, Pregnancy and Infant Loss Awareness Month, I am so lucky to to have suffered, imagined, loved.

Thanks to all the women, families, babies (both imagined and realized) that have let me tag along on your journey. Thank you from the bottom of my broken, healing and overflowing heart.

Michelle

May all babies be born into loving hands

The post The Imagined Child: Pregnancy and Infant Loss Awareness Month appeared first on Midwifery, Mothering & Me - An Albany Midwifery Blog.

Autumn Beans and Greens

2 quarts chicken stock

1 package of chicken-apple sausages* (cut into the size you want on your spoon)

1 minced onion

1 large bunch (or 2 small) Swiss Chard, Kale, Spinach or a combination (cut into the size you want on your spoon)

1/4 cup brown sugar

1/4 cup mustard (dijon, honey, yellow, whatever)

2 cans of small white beans, drained

a pinch of salt

a couple of turns of the pepper grinder

Put everything into the crockpot and cook on

HIGH for 4 hours

OR

LOW or 8 hours

Serve with crusty bread for dipping

Enjoy!

Michelle

May all babies be born into loving hands

The post Recipe: Autumn Beans and Greens appeared first on Midwifery, Mothering & Me - An Albany Midwifery Blog.

Friday

Catch a baby at 2:30 AM. Do the immediate postpartum care (including newborn exam, Vitamin K injection, see other kids introduced to new baby, start load of laundry and do paperwork). Leave house at 5:30.

Drive to a friend’s house for a quick couch-nap followed by pancakes and coffee.

Go home.

Quick pass at emails and paperwork.

Quick bed nap.

Lunch with a friend, meeting former clients in passing. Drive with friend to pick up two gorgeous school-aged kids that I caught as babies.

Home to more emails, phone calls and paperwork.

Evening with hubby

Saturday

Wake at 2:00 AM with a phone call from a worried mom. Calm her.

Realize that I am really awake. Get up and do computer work (website and blog).

Go back to bed at 5:00.

Wake up and go workout at the YWCA.

Breakfast, coffee and chess with hubby.

Homevisit for mom and new baby. Take photos of new baby.

Drive to a one year old’s birthday party. Visit with friends and colleagues. Remember his labor and birth.

Deal with emails, texts and phone calls in driveway.

Drive home.

Deal with new website and new blog post. Play with photographs.

Have dinner with hubby. Watch some TV. Go to bed.

Sunday

Go to church.

Go home.

Deal with emails, text and phone calls (miscarriage? baby not pooping, baby sleeping a lot, need new birth control prescription called to pharmacy…)

Take a nap.

Pick up house. Roast a huge pan of beets and onions.

Have dinner with hubby and our boys.

Monday

Deal with emails.

Workout at the YMCA.

Go home. Quick breakfast with hubby.

See a couple of clients in the office for prenatal care.

Drive to a client’s house for a postpartum check (including jaundice evaluation, baby weight, nursing observation and refinement, birth certificate review and signing).

Deal with emails and texts in the driveway.

Drive back to office for client appointments including an IUD placement, prenatal appointments and blood drawing.

Home to dinner waiting with hubby and our boys (thank you!).

Tuesday

Wake up late, decide to skip the Y. Do some writing. Feel decadant.

Coffee and an egg with hubby.

Drive 45 mins to meet with other midwives for monthly meeting. Visit, kibitz, listen, learn, hug, leave.

Sat in parking lot: deal with emails, texts and phone calls, neatly write out a birth certificate.

Drive an hour to a postpartum home visit (jaundice and weight check, NYS Newborn Screen done, nursing observed and refined, phlebitis checked for and ed done).

Drive 40 minutes to the next postpartum homevisit (2 weeks, parents are now old hats at this, baby looks so different!).

Talk with my sister in Michigan about getting hospice set up for our great uncle. Wish we all were closer.

Drive home, tired but happy. Talk with my daughter in Canada, congratulate her on surviving her first day on the new job. Wish we all were closer.

Home to hubby and Flying Chicken dinner waiting. Yes!

Congratulate youngest on getting a job and being awarded extra scholarship money.

Deal with emails, phone calls, scanning stuff that came in the mail, make out deposit slip. Do electronic charting.

Happily watch The Good Wife with my good husband.

Talk with my mother in Missouri. Wish we all were closer.

Wednesday

Blessed day! Wake up. Write. Deal with emails.

Work out at the YMCA.

Make a quick road breakfast (roasted beet and herbed cream cheese sandwich).

Get acupuncture treatment. Ah!

Refer a client for Traditional Chinese Medicine consult.

Drive to office.

Get a massage. Ah!

Go home.

Phone conference.

Deal with computer stuff (emails, charting, website, writing, photos, blog). Deal with texts, lab reviewing, phone calls…

Decide to skip Evening Prayer and Potluck at church.

Dinner with hubby.

Thursday

Wake up. Write. Deal with emails.

Go to the YMCA.

Home. Grab breakfast.

Go to office. See a couple of clients. Do paperwork, clean up some charts.

Meet my friend and assistant, go together on two prenatal homevisits.

Deal with emails including stuff for NYSALM and Pregnancy Project. Deal with texts and phone calls. Reschedule our third prenatal homevisit (the family was having a crazy day).

Home to hubby, dinner, some foot rubbing and debate watching.

Friday

Wake up. Deal with emails.

Go to the YMCA.

Come home. Share scrambled egg lettuce wraps and coffee with the hubby.

Drive to a prenatal home visit and drop off a labor tub.

Deal with emails, texts and lab results while sitting in their driveway.

Drive to drop off a birth certificate. Give the Town Clerk an inservice on filing birth certificates and the role of the modern midwife.

Do a postpartum (1 week) visit. Mom, baby and whole family are fabulous!

On leaving, hear that my great uncle has passed.

Stop and do a GYN homevisit.

Drive to next town clerk. Get signed birth certificate from protected pouch in my backseat. Find that it is all smeared, no idea how. Rewrite birth certificate.

Drive to visit parents for their signatures, have wonderful heartfelt visit with them thanks to the ruined (now rewritten) birth certificate.

Deal with emails in driveway.

Visit Trader Joe’s.

Drive home. Unload groceries.

Congratulate eldest son on getting a job.

Go to Carmen’s with hubby. Enjoy blues, bowl of black bean soup.

Toast the week with a glass of sangria.

Totals:

1 baby

2 Birth Certificates

6 Postpartum home visits

3 Prenatal homevisits

1 GYN homevisit

631 Miles driven to serve clients

5 Counties visited to serve clients (Rensselaer, Albany, Saratoga, Washington, Columbia)

9 Towns visited to serve clients (Troy, Argyle, Greenwich, Saratoga Springs, Catskill, Balston Spa, Albany, Guilderland, Feurebush)

Various Office Visits (both GYN and prenatal)

Numerous emails, phone calls and text

Moments of intense career satisfaction? Too many to count.

~Michelle

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The movie is about childbirth as a Human Right and contains clips of many interviews with experts on birth. The film features two Hungarian women, one a jailed  midwife named Agnes Gereb, the other Anna Ternovsky. Agnes was incarcerated for attending home births (as well as for malpractice in a few of the over 3,000 homebirths she attended). She is currently under house arrest. Anna brought suit against Hungary in the Europe’s highest court and she won. Freedom For a birth discusses the present state of childbirth choices worldwide and the implications of Ternovsky versus Hungary.

In the audience last night, there were people who have recently had babies at home or who are planning to soon. Currently, in NY’s Capital District, planned home birth with a licensed provider is an viable option. There are six different Planned Home Birth practices with NYS Licensed Midwives in the immediate area.

In the audience last night, there were women who had home births in the this area several years (or decades) ago. While they had wonderful care, they were attended by midwives that were not licensed, that were not recognized as midwives by the State of New York. The film brought them back to the days of their pregnancy, openly excited for the upcoming birth, and yet living clandestinely with their ‘illegal’ birth plan.

Home birth in New York has always been a legal option for families. In the first half of the 20th century, there were many licensed (or certified) providers on this area. After the 1940’s, most births took place in hospitals and only a few providers attended birth at home. Then in 1993, NY State, passed a law licensing midwives. The law clarified whom NY State considered a midwife and whom it did not. 

The passing of this licensing law also made outlaws out of anyone practicing midwifery without a State issued license. While in other areas of New York, licensed midwives set up planned home birth practices in the 1990’s, here in the Capital District, the Home Birth providers were unlicensed. I believe it is this anomaly that makes people in the area believe that home birth itself is illegal. In the last few years, 2009 to the present, six NYS Licensed Midwives have opened, openly advertised and run Planned Home Birth practices. We have come a long way baby!

And we have a long way to go.

• Currently, local hospitals have surgical birth rates (C-section rates) above the already abysmal national average of 33%. 
• Currently, women in this area are routinely told that they cannot eat or drink in labor.
• Currently, there are no volunteer doula practices, making this crucial service available to all women. (Yes, there are a few doulas that will donate their services but there is not a system in place for any woman to have a doula.)
• Currently, Vaginal birth after Cesarian, or VBAC, is not an option for all that might choose this, even if they are low risk. Some local hospitals simply do not allow this as a choice, essentially forcing surgery where it might not be needed or desired.
• Currently in NY’s Capital District, there is only one independent hospital based midwifery practice (Capital Region Midwifery) and one other hospital based practice with midwifery coverage 24 hours a day, 7 days a week (Dr. Sattar’s group). There are not midwives with delivery privileges at every local hospital. And at the hospitals that do have midwivese, they may not have midwifery coverage 24/7.
• Currently, we have no Baby Friendly or Mother Friendly hospitals in our area. None. While Baby Friendly International is head quartered on Wolf Road in Albany, NY, our nearest Baby Friendly hospital is across state lines. (http://www.babyfriendlyusa.org/eng/03.html)
• Currently, while women in the area may be able to choose to birth at home or in the hospital, there are no real birth centers in the area. None. NY has only two accredited birth centers (and one coming in Western NY). Both of these free standing birth centers are more than two and a half hours south of us. (http://www.birthcenteraccreditation.org/find-accredited-birth-centers/)

So, we have a lot of work ahead of us. If we want to make birth safe, satisfying and empowering for all involved, we have a whole lot of work ahead of us.

Want to help? Join the Capital District Birth Choice Revolution!

• Keep our eye on Pregnacy Project as we grow in the next year, expanding to include many more providers and specialists that care for Pregnacy and the Primal Year. (http://pregnancyproject.org/)
• Contact BirthNet NY (http://www.birthnewyork.org/birthnet/)
• Support Baby Friendly USA (http://www.babyfriendlyusa.org/eng/contact.html)
• Work with Albany Birth Center to make a free standing birth center in the Capital District a reality. (http://www.facebook.com/pages/Albany-Birth-Center/163188313702389)
• Talk openly with your care provider about what you want and expect.
• And of course, Support your Local Midwife!

–

~K. Michelle Doyle
May all babies be born into loving hands

The post Freedom For Birth: The Morning After appeared first on Midwifery, Mothering & Me - An Albany Midwifery Blog.

Do you believe a woman has the right to chose where she will birth? In the European Union, the high court says she does. What about women in America? What about women in Sub-Sahara Africa? What about women in Haiti? What questions does this issue raise for you?

After viewing the film, I was confronted with many questions percolating within me, questions that were societal, legal and deeply personal.

Issues and stories of women’s choices at the beginning of pregnancy (such as contraception and abortion) make front page news and are featured in political platforms. The questions generated by these early pregnancy issues are often seen as lines in the sand, lines that cannot be crossed for fear of joining the other side.

The stories and the very important issues around the end of pregnancy (such as childbirth) appear on blog and Facebook posts, generally finding the same audience again and again. Like preaching to the choir on Sunday, these posts are read by folks that are already ‘converted’. As with the issues related to earlier in pregnancy, these questions are hardly ever fully explored.

Even now, the morning after viewing Freedom For Birth, I ponder. There are so many subsequent questions that arise for me:

• Does a woman have the right to choose how she will birth? Is this a fundamental right?
• What if a woman chooses a physiological birth for this pregnancy and she previously has had several surgical births (vaginal birth after Caesarian, VBAC)? What if no providers in her area are willing to participate in this choice?
• What if a woman chooses a midwife attended hospital birth and there are no midwives with hospital privileges in her area?
• What if a woman chooses a surgical birth yet there is no medical reason (elective Cesarian Section)?
• What about the providers’s rights? Does the provider (nurse, doctor, midwife, doula) have a right of self determination after they join their chosen profession?
• What if a woman chooses a midwife attended hospital birth and there are no midwives with hospital privileges in her area?
• What if a woman chooses a surgical birth yet there is no medical reason (elective Cesarian Section)?
• What if she chooses to birth in her own home with a highly trained professional (CNM,CM,CPM, DO or MD for instant) but her state says home birth is illegal? What if this same woman then chooses to birth at home, alone?
• What if a woman has access, both legally and logistically, to a well trained and highly qualified home birth attendant, yet she still chooses to birth alone (unattended home birth or Free Birth)?
• What if others truly believe that a woman’s birth choice will endanger the yet-to-be-born child?
• What if that imaginary person is a nurse? Or a doctor? A social worker? What is the concerned person is the father (or other mother) of the unborn child?
• What if the woman simply wants a typical American birth, circa 2010 (hospital, physician, probably an epidural), but for personal and religious reasons she wants a female provider?

You can see how the questions start coming on their own, one generating another!

The list of questions above is long but I think that they are important. I invite you to view the film Freedom For Birth and discover your own questions concerning childbirth as a human right.

The worldwide premier of Freedom For Birth is this Thursday, September 20, 2012. In the Capital district of NY there are several showings, one at Colgate College, one in Cambridge, NY and one in Troy, NY.

Local Care Midwifery PLLC and Pregnancy Project are sponsoring a free showing: Freedom For Birth will be shown at The Guild House, 27 State Street, Troy NY. We will arrive and mingle at 6:00, start the movie at 6:30. After the movie, a mere 58 minutes, we will gather for refreshments and discussion.

I invite you to join the discussion. Come to a film viewing and talk after. Comment on this blog or others. Talk with friends and family. Let the questions arise in you. Speak your questions and explore them. Just be sure to listen, listen well to yourself and to others. There are important questions here. There are also important stories. So listen, listen well.

We hope to see you Thursday night.

~Michelle

May all babies be born into loving hands

The post Freedom For Birth Premiere 9/20/12 appeared first on Midwifery, Mothering & Me - An Albany Midwifery Blog.