Condoms in my birth bag?!

I’ve been asked many times what’s the weirdest thing in my homebirth bag… Well, I’d have to say condoms now!  Yes, you read that correctly.  I’m now carrying latex-free condoms.  Yes, they work well for preventing pregnancies and STIs, so why would a midwife, delivering babies, be carrying them?

Well, I recently attended a great workshop put on by the Oregon Midwifery Council who brought in a local OB-GYN from the area.  I had been hearing about this interesting method for controlling postpartum hemorrhage but hadn’t yet been taught how to use it (or even seen it used).

In Oregon, as a Licensed Midwife, I carry specific medications in case of a postpartum hemorrhage (when the birthing person heavily bleeds after the birth).  I sometimes start with certain anti-hemorrhagic herbs such as Shepherd’s Purse, Angelica, or cinnamon.  It really depends on the situation and how the birthing person is handling the bleeding.  Sometimes the herbs work wonderfully well and we can all focus back on the normal immediate postpartum (you know, cooing over the cute baby, helping mama nurse, doing a full newborn exam on the baby, cleaning up our supplies…).  But sometimes, we need more help.  Occasionally I’ll go right for the pharmaceutical medication if that’s what indicated instead of herbs and other times, I’ll try the herbs first and then use the meds.  I carry Pitocin, Methergine, and Misoprostol- all have their specific indications for use.  All but rarely, these medications stop the bleeding and we can, again focus on the more-normal parts of the immediate postpartum and replenish the mama as needed (an IV can really help in this situation and then iron building supplements soon after).

So what happens in those rare cases that all our herbs and medications don’t work and bleeding continues?  This is an instance where, as midwives, we go into emergency mode, place our hands on the mama in specific positions (it’s called bimanual compression) to limit anymore bleeding and transport to a hospital immediately for more tools.

But wait, here come the condoms!  So, a devise had first been described in 1951 as a balloon tamponade and then in 1999 a more specific uterine balloon tamponade came in to play.  The FDA approved this devise, called the Bakri balloon in 2006. It’s basically a balloon that you inflate in the uterus to put pressure from the inside to stop uterine bleeding.  Great, right?!  Well, it gets better… that devise is very expensive BUT you can use a condom and some supplies from our own homebirth kits to make a homemade uterine tamponade! And, according to studies it works just as well as the expensive Bakri balloon.  With the insertion of this devise, it gives us time and breathing room to get to a hospital safely for further help without the birthing person losing more blood.  It’s also amazing to have for rural home births or in other countries where hospitals are far away and transporting to the hospital with someone bleeding could be a very scary situation.

I’ve dealt with my fair share of bleeding as a midwife, but I’m excited to have learned a new method for those more intense bleeding situations.  It’s cheap and easy to make and now I get to say I carry not only cool instruments, lots of gauze, some herbs and meds, but also condoms now!   Honestly, I’d be OK with not having the need for this devise but I’m ready if we do need it!

Here’s to continually learning, updating our midwifery practices and condoms for the win!

Birthing Choices in Portland

Portland is great, for a number of reasons, right?  It is a great place to bike, be close to nature, shop at farmer’s markets, go paddling, take the bus, run into your friends at the grocery store, AND give birth!  We have a lot of different options in the Portland area, which means all families get to chose what works best for them.

Portland is home to numerous hospitals, a couple free standing birth centers, and many midwives.  So, what is the difference between all these options and what does each options look like for your birth?

Hospital

Well, the first option is the standard one that most Americans still go to for giving birth, and the majority of Portlanders do too- the hospital.  We have some great hospitals and each one has its own flair.  You could go down the standard American route and see an OB doctor for all your prenatal appointments.  This is a good option for someone who has some high risk factors, like diabetes needing insulin treatment, among other risk factors.  Often the doctor works in a group practice and takes turns being on-call fonewborn in hospital r deliveries.  Some doctors have multiple hospitals they deliver at while other doctors only work at specific hospitals.  Make sure to get to know the doctors in your group practice as well as taking a tour at the hospital that they deliver at.

Another option in the hospital is to work with Certified Nurse-Midwives (CNMs).   Like an OB practice, CNMs work in a group and you get to see different CNMs in that practice during your pregnancy.  Whoever is on-call during your delivery is the one you’ll get!  CNMs practicing in the hospital setting work under different protocols than homebirth midwives, as they are under the direct supervision of the hospital OBs and their protocols.  Hospital based CNMs are perfect for low risk clients who are most comfortable delivering in a hospital but want a natural birth and/or trying for a lower intervention birth.  The Portland hospitals currently that have CNMs on staff are Providence Portland, OHSU and Legacy Emanuel.  Some of the hospitals allow for laboring in the birthing tubs with the midwives and provide telemetry units that allow movement while still being monitored.  Providence Portland also has a doula program that works with the families that are under the CNM care.

Birth Center

For families that are unsure where they want to give birth, but leaning towards out of hospital, a free standing birth center could be an option.  In Portland there are now 4 birth centers that are not in the hospitals and are staffed by a combination of midwives.   Most of the birth centers are staffed by midwives on rotation, like the hospital CNMs, so you don’t have continuity of care (like with home birth midwives), but many practice differently than the stricter protocols from the hospital.  There are CPMs/LDMs, CNMS, and ND midwives at the area birth centers.  The birth centers are made to resemble more of a home like setting than a sterile hospital environment.  All of them have birthing tubs that you can labor in and at least two of the centers you can stay and birth in them.  This middle ground is great for families that want a natural birth (no epidurals here!) but aren’t ready to commit to a home birth.

Homebirth

And then there are homebirths!  We, of course, love homebirths but completely acknowledge that it’s not the place for all families.  And that is OK!  It’s important to give birth where you are comfortable and where is the safest for your pregnancy, birth, baby, and set of risks.  Homebirths are not for women who are high risk.  But, if a woman is low risk and wanting a natural birth with her loved ones, pets, candles, pillows,  and kids around her then this is her best option!  A home birth is nice because you don’t have to leave your house in labor or get in the car with a tiny, new human being.  You have all your own things and can eat out of your own refrigerator (yes, we want you to eat in labor!).  There aren’t strangers coming into your room while you are in labor.  It also provides the best option for homebirth baby continuity of care and individualized care with midwives.  We bring all the emergency equipment to homebirths along with a whole bag of other supplies.  You also have the option to have an inflatable birthing tub which some women use just for laboring in and others give birth in it.  You have more options in your movement and birthing positions if you are at home.  We also come back to you three times in the first week postpartum, another great reason for a homebirth!  There are a lot of homebirth midwives in Portland so go ahead and interview a couple to find the right fit for you and your family if this is the option that best suits you.

It is important to know there are multiple birthing options and find the best match for you.  Just because your best friend had a homebirth doesn’t mean that’s right for you if you are worried to be out of the hospital.  Or just because your mother in law thinks all babies are born in the hospital doesn’t mean you shouldn’t look into a birth center or homebirth like you’ve been wanting to.  Go ahead, do some research, visit a couple places and talk to a couple providers and the right choice will present itself.

Happy birthing!

 

So, What’s it like to be an on-call midwife anyways?!

Have you wondered what it’s really like to be a homebirth midwife?  Every birth is so different but here’s a snippet of what an average night being call to a birth is like for your dear, midwife 🙂

9:45 pm  Make myself go to sleep early because I know a client has been having irregular mild contractions through the day.  She reported bloody show around dinnertime and we had a chat about what to do and what to look for.  So I make a pile of my birth clothes and grab her chart to lay on top of my prenatal bag and then crawl into bed.

12:05 am Reach over my sleeping husband to look at a new text on my phone and respond that they are doing great but that its still early and to try and rest as much as possible until they can’t!  I emphasize that although labor is exciting, it could still be many hours before active labor begins and its important to rest to conserve their energy.

I then roll back and try to fall back asleep as quickly as possible because even though I just told them to rest I know I’ll be awoken in the next two or three hours 😉

3:20 am Reach across in bed to read my new text and quietly get out of bed.  I call the laboring family so I can really hear what is going on.  Its so different reading a text that says a mom is contracting every 4 minutes.  Sometimes that means she’s in hard active labor and other times it might still mean early labor.  How do I know the difference?  I hear the difference in the mom’s tone of voice, her level of consciousness and I read between the lines.  I usually only need to hear her through half a contraction to know exactly what part of labor she’s in.   Except if she did hypnobirthing…. then that’s a different story!

I close the door to my bathroom, and talking softly I chat for less than a minute with the partner and then ask to speak to the mama.  Sorry partners- you are super important but I always ask to talk to the laboring person before I come over there! The mama is doing great and yes, she’s progressed to a nice active labor pattern. I ask questions to make sure baby is moving, that her bag of water hasn’t ruptured, that she rested a little, and that she’s eating and drinking well.  Mamas need energy to give birth so its vital to mom and baby to continue eating and drinking through labor.  I listen to how well she’s breathing through the contraction and find out what she’s doing during them. I make a plan to come over in an hour.

3:45 am I gather my clothes from my bedroom and go back into the bathroom. At first, I don’t want to turn on the light because then I can pretend I’m still sleeping but then my brain kicks in and I realize, yes in fact I need to fully wake up so I turn on the light, brush my teeth and get dressed.  I check my phone for the time and start collecting the meds from my fridge.  Its funny having a mom as a midwife for my kids.  They know there’s a container on the fridge door that stays there and they don’t touch it.  They also know sometimes they may open the fridge and find a bagged placenta waiting to be picked up by Kelley for encapsulation.  They also know that sometimes they wake up and only their papa is in bed and they may not see their mama for the day.   But they also get excited knowing a new baby is being welcomed into the world❤️

3:55 am I carry my homebirth bag, prenatal/postpartum bag, and the oxygen tank to my car.  Then lug the birth tub and bag (if they don’t already have it) outside as well.  And run back inside to grab my personal bag (I always bring an extra change of clothes because birth is messy!) and the client’s chart.

The client’s address is already preprogrammed and good-ol’ google maps gets me to where I need to go. I text the rest of the birth team to let them know I’ll update once I get to client’s house.Portland Home Birth

4:20 am I arrive to the homebirth to smiling faces, relieved to see me, knowing this is finally it!  As I comfort the family and take in the scene before me I start setting up all our equipment/supplies.  From here, birth happens!  Mama progresses and we lay witness to the raw, beautiful, intense energy of birth.  We clean up and tuck the sweet, happy, tired family in bed, promising to return the next day.

Being a homebirth midwife is a pretty crazy profession.  It is not for the faint of heart nor for those needing routine and order!  I have to be completely flexible yet 100% dependable.  My family knows I may not be with them for a holiday or I might miss that family hike we planned Saturday morning.  My friends know I may cancel plans 30 minutes before I’m supposed to be at their house- or they at my house!  My east coast family knows not to text/call me before 7 am PST because I sleep with my phone and will wake up to their texts.  I know I always need gas in my car, or at least know where the 24/7 gas stations are and that my phone always needs to be charged!  I always have to keep a log of all the medications I have to make sure they aren’t expired and that I have enough newborn screen kits for all my clients that want them.  I always make sure I have at least one clean outfit for a birth.  And yeah, I can’t go more than an hour from my house if I’m on-call.  And on-call is for all my clients that are between 36 and 43 weeks.  Crazy, huh?  It sounds crazy sometimes.  But… I wouldn’t trade it for the world!  I was called to midwifery at a younger age and knew that was what I was supposed to do.  I can’t imagine sitting behind a desk or computer all day.

Its neat to be coming and going through the night… I sometimes feel like a little birth elf that comes in and slips away unnoticed to help new life into this world while all the neighbors continue sleeping! Its pretty amazing to witness sheer strength and determination from the families that I work with.  Its humbling to support such strong empowered women!

So to all the families that I have had the chance to work with- thank you for including me in your intense and magical journey to parenthood ❤️❤️❤️

 

 

What does prenatal care look like with PNB midwives?

When I meet clients for the first time during our consultation I tell them that yes, we follow the normal obstetric visit schedule but the similarities stop there. Portland Natural Birth dedicates a whole hour to every prenatal (and postpartum) appointment with all our clients. So, what exactly happens in the hour?

Well, first off, here’s a peek into our cozy office room in the sweet Awakening Wellness Center…  The love seat is perfect for our clients to come in, relax, have some tea or water, and start telling us about how their past month (or week) has been.

We talk about any new experiences in this pregnancy they’ve encountered since our last visit or any continual issues they are having.  We do a lot of listening and then, when they are ready we dive into some great remedies from herbal and homeopathic recommendations to body work to physical exercise, nutrition, or mental health stability, along with any western treatments that are needed.

We continue talking about what is normal during this part of their pregnancy and any expectations or fun new things that may pop up in the coming months.  We make recommendations on additional educational classes, depending on how far along they are.  And we discuss, at length about any upcoming medical decisions or tests they may have at their next appointment.

At Portland Natural Birth, anyone you feel comfortable with is invited to your appointments.  We love having partners at appointments and getting to know them and making sure they are comfortable with us and the current plan.  We also love having children present at appointments if that feels right to you.  Or sometimes parents are visiting and want to check out their child’s care provider or maybe they’ll be part of the birth so they can come to your appointment and discuss any questions or concerns they may have.  Your appointment is really all about YOU.  Its about making you feel comfortable.

We still do the normal vitals: blood pressure, pulse, urine analysis (good ol’ peeing in a cup), palpating and listening to the baby and measuring your fundal height (how big your uterus is growing to accommodate your baby).  We also draw all labs in our office.  This allows you to feel comfortable getting all these vitals taken care of but in the comfort of our office and by people you trust.

Lactation News!

Well friends, the time came to step up my game as a midwife!  I love attending births and providing care to all our sweet families in those precious days during the postpartum period. I already spent time with all families making sure they had a good latch, gave them pointers on different nursing positions and gave them a quick run down of how their milk was made and why their breasts seemed fuller at different parts of the day.  I’ve always loved helping with nursing.  Not only is breastmilk AMAZING but it provides such an untouchable bond when families have the right support.  postpartum breastfeeding baby

So, I decided to further my education and learn more about breastfeeding.  After many months studying and learning more than I thought possible, I sat and passed the IBLCE (the international exam for certified lactation consultants) in October 2016!  I am now an IBCLC which means I am certified as an international lactation consultant which is the highest certification for this specialty.

What does this mean for Portland Natural Birth now?  Well, its an additional service, as needed for clients that may not have birthed with us or used other services but need some lactation support.  But, honestly, more than an extra service, its more help I can give to my own midwifery clients.  I’m really excited about spending a little extra time on prenatal education during our visits.  I’m happy to provide additional information and problem solve during the prenatal period on any possible problems or issues we may face.  And I’m happy knowing that I can save my clients an extra trip to another care provider while we snuggle in at home during their normal postpartum visit and troubleshoot whats going on.  Another perk as an IBCLC is that I can make direct referrals if necessary (specifically for a frenotomy, or tongue tie revision).

So, sit back and relax Portland families:  your homebirth midwife is now your lactation consultant as well!

New Parents Group

Come join us for a New Parents Group led by Portland Natural Birth midwife, Mirra!  IMG_1145It’s every Monday from 1-2:30 at an awesome new toy store in SE Portland, Hammer and Jacks.

Free and open to all new parents with pre-crawling babies.

http://www.hammerandjacks.com/eventcalender/2016/11/28/new-parents-group

Pregnancy Support Group

Come join your very own Portland Natural Birth midwife, Mirra, in connecting with other pregnant mamas once a month!

Pregnancy is such an exciting time but also can have its own challenges along with tons of questions.  “Is this normal?  Am I the only one that thinks that?  What will life be like once the baby is born?  Do I have all the essentials?  What do I need?  Was that the baby kicking or something else?!”

You aren’t the only one with all those questions!  Come to Doula Love to be supported by other pregnant mamas and meet a couple friends along the way!

When: The fourth Saturday of every month from 1:00pm to 2:30pm
Location: 5433 NE 30th Ave Portland, OR 97211

http://www.portlanddoulalove.com/pregnancy-support-group-ne-portland/

What is a Natural Birth?

Birth is more complex than a one-word label and our perspective encompasses all different aspects of what it can mean. We believe the term natural birth can take on many different meanings for different families.  At Portland Natural Birth, our goal is to include all Portland families desiring midwifery and home birth care, placenta encapsulation and prenatal and postpartum bodywork.

We support your right to:

Choose the kind of care that suits you best

Have full access to the information you need

Enjoy a team of supportive providers beside you

Feel a part of your care, empowered with choices

Above all, we believe natural birth means being supported, informed, empowered, and cared for in all of your options and throughout your entire process, no matter what your birth looks like.

Inspiration

What inspires you? What inspires you to choose a home birth or to be the kind of parent you strive to be?

A professional friend challenged me to ask myself this qIMG_5054uestion- what inspires me?

At first, it can be a quick answer.  I am completely inspired by nature.  I love hiking.  I especially love hiking places that you can’t drive to.  I feel at peace staring out at a mountain top, or even better hiking to the summit of a mountain top.

But, if we all stop to really think about this question- what inspires me?-  the answer is often deeper and pretty remarkable.

So, what inspires me, as a midwife, as a mama, as a human being on this planet?

I am inspired daily by working alongside all of you! I’m reminded daily about the strength women have inside them, whether they are consciously aware of it or not.  When I witness, first hand, a new mama reach into the depths of her being to birth her baby, a baby she hasn’t physically met yet but has deeply known for 40 weeks, I am inspired.  I am amazed when she says “I can’t do it” but continues on.

I’m inspired by seeing families, of all different backgrounds, coming together to support the birth of their new baby- whatever that means to them. And I’m inspired to be included on this amazing, and sometimes crazy, journey to growing your family!  To be present when the family gazes upon this new being, skin shiny and wet with fluid, eyes open with curiosity about this new world is pretty remarkable.  I’m inspired when I see the mama envelope this new being, a baby that her body so carefully and perfectly created, with raw and intense love.  It’s quite the feat to let yourself be cracked open by this love for another human being.   

Working with so many different homebirth families, inspires me to bring patience and love back to my own family.  It inspires me to continue seeing the beauty in the everyday events.  Because even as remarkable as it is, birt11170314_10205926249489919_5630618504491595071_nh is an everyday event.  As a midwife, I am in awe of birth and the human body.  It inspires me to continue talking about how amazing our bodies are with my own children- building up their confidence, strength and inner-beauty.  So, thank you to all the strong and amazing women and families I have and will have the chance to work with!  You inspire me!

Upcoming Pelvic Floor Workshop with Kelley!

kelley burke pelvic floor specialistHey mamas! In light of my pelvic floor workshop coming up this month, I’m sharing a little article with you about pain and sex today. There are a couple decent suggestions here (my advice is to NOT do #3!). But really, I just want to open the conversation about sex after baby. Many mamas are really surprised after they leave midwifery or OB care at 6-8 weeks that they still don’t feel ready to connect with their partner sexually. Regardless of what kind of birth you had (or even if you’ve never been pregnant) your pelvic floor can have a range of sensations from heavy, bruised, stingy, too tight, lacking tone, pulling pain, dull pain, sharp pain or even a lack of sensation at all. Yes, these are all normal to feel after what your body has gone through but this is NOT your “New Normal”.
What IS your new normal is the self care practices you build into your day that lead to your recovery, and long term pelvic floor health and connection.

My monthly pelvic floor workshop is on Monday, December 14th. I want to hear what you are all going through and share some ways you cpelvis pregnantan move towards recovery, comfort and care for yourself while you take care of your baby.

The class is from 10 am to 12 pm at Doula Love (5433 NE 30th Ave) and babies are most welcome.

 

Register Here!