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!

 

Do we take OHP for home births?

Oregon was one of many states that expanded their Medicaid program under the Affordable Care Act.  Regardless of your political views about the ACA, many more people have been able to get health insurance now under Oregon Health Plan (OHP).  And, it is also directed towards pregnant women to make sure they have health insurance to get adequate prenatal care.  So this is a step in the right direction!  Its vital to our families and communities to make sure that all pregnant women have health insurance and have safe and adequate prenatal care to help avoid and/or manage any issues that come up during pregnancy.  Its also important that with health insurance they have choices as to where they want to give birth and how they give birth.

So, at Portland Natural Birth, we feel its crucial to make sure ALL families get the care they want and need.  This means that yes, we do now accept OHP insurance!  But, unfortunately, OHP comes with many more strings attached than any of us would like.  It doesn’t stop us from accepting it and billing it, but it does come with a bigger conversation about what it means for our OHP families and what our care looks like under OHP.

The Oregon Health Plan (OHP) has their own guidelines for out of hospital births.  As a Licensed Professional Midwife in the state of Oregon, I have a certain set of criteria, guidelines and protocols that I practice under.  OHP has taken some of these rules and regulations and added some of their own, most often stricter.  Sometimes it is clear as to what their rules governing prenatal care, birth, and postpartum and their risk factors are and sometimes it can get a little murky.  We practice and strongly believe in individualized care and informed choice which means our families get to make their own educated decisions about their care after we’ve talked about all the pros/cons and benefits/risks of any testing/screening/procedure.

However, for our clients with OHP some informed decisions aren’t as optional as they usually are.  This is really disappointing but for now, its a hoop our clients have to jump through if they have OHP and want their homebirth covered.  For most, OHP assumes that the standard screening for Gestational Diabetes and Group Beta Strep, among initial and mid-pregnancy blood work need to be done.  OHP also requires monthly chart notes and updates to prove our clients still remain low-risk and good candidates for homebirths in Portland.  As it stands right now, OHP will not approve someone for a home birth if they transfer into midwifery care after 28 weeks.

So, where does that leave us?  Well, Portland Natural Birth still remains committed to serving clients, regardless of their financial constraints and will continue fighting to get our OHP clients approved for a home birth.  I have also written letters to the Oregon Health Authority (they oversee OHP and the approval process for homebirths) in support of changing their prior-approval process.  OHP pays half of my midwifery fees yet requires more than double the paperwork and headache than any other insurance company does.  But, rest assured Portland families, while we are fighting for a more equitable process for midwife and pregnant homebirth client, we are taking OHP clients and happily giving them our love and support.  Its what we believe in and your insurance company doesn’t change that fact!

Homebirth Transports

pregnant womanWhen you come into our care your hopes for a natural birth at home are on the forefront of your mind.  Maybe it’s something you’ve wanted since before you were even pregnant or maybe you didn’t even know about home births until you were into your second trimester.  At Portland Natural Birth, we work really hard to provide you and your baby the best, comprehensive but holistic care possible.  We spend an hour at each prenatal appointment going over your physical and emotional health, all while making sure you continue to be low risk and safe for a homebirth.

At interviews, transport questions are always asked by either the birthing person or their partner.  Rarely, I’m the one to bring up the “what ifs”.  But, we always talk about what we do in an emergency, what kind of equipment and training we have, what it would be like to transport to the hospital, what we as the midwives do during the transport, and what clients can do to best prepare themselves for any possibility.  Then, as your pregnancy progresses, we bring up the transport discussion again.  At the 36 week home visit we fill out a hospital transport plan which includes what hospital clients prefer to go to and which one is the closest in an emergency.  We also talk about any fears the family may have surrounding emergencies or hospitals or just about the birth itself.  And we are always open to having some or all of this discussion before and after this 36 week visit.  Some clients need to talk about it more than others to process the “what ifs” while others feel ok with just the planned discussion.  Either way is entirely ok and that’s why we provide individualized care- every person needs something a little different to feel comfortable!

So, what does a transport from a homebirth look like?  Well, it depends on the reason for transport.  Most hospital transports from home are for non-emergent reasons.  The most likely scenario is when a laboring mom asks for additional tools that we don’t have at home.  She may have been in labor for multiple days, exhausted and possibly dehydrated and desires and epidural or maybe needs a little pitocin to meet her baby.  While no one goes into a homebirth with this desire, sometimes families get there… and that’s ok!  We have a lot of resources, tools and tricks as experienced midwives to encourage babies to be born at home but sometimes they have different plans.

If we transport for maternal request in this non-emergency then we go by our own cars.  I always call the preferred hospital and A) make sure they have room and will accept our transport and B) give them all the pertinent information so they can best help us.  Then, after a bag is packed and mom is ready we caravan over to the hospital.  At least one of the midwives always stays with our clients in the hospital.  Especially if we have been there for a long time, we may rotate through the birth team so we can also get little sleep so we can come back and provide the best support… but always one midwife is with the mom!  We become ah-mazing doulas in the hospital!  We are no longer your medical care provider but help you navigate through the new surroundings and requests of the hospital.  Also, we know most of the Portland area hospital providers so we seamlessly work with them to continue providing our clients great care that they can still feel like they made their own decisions, even though the place of birth was different.  We stay with you until baby is born and help with the initial breastfeeding session.  And of course, we continue all of our normal postpartum care visits- we’ll come to you 3 times in the first week, wherever you are!

Very rarely but it does happen, a transport is for an emergency.  And then we go by ambulance.  I still call ahead to the closest hospital to let them know we are coming and we continue all our supportive care like we do in a non-emergency situation.  It can be scary when we move fast but we always communicate to our clients as to what is going on and what we think needs to happen.

Sometimes, I get the question/comment: but if we transport to the hospital then we are stuck with both midwifery bill and the hospital bill and don’t get our homebirth.  Yes, unfortunately birth costs do go up if we end up at the hospital from a homebirth.  But, the care we continue to provide is unmatched and our clients feel that.  Providing midwifery care through pregnancy is a different experience to begin with- one that you are met with caring providers who take the time to listen to you and help problem solve as any issues come up.  Midwives provide a safe and nurturing environment that empowers our families into taking the next step to becoming first time parents or seasoned parents.  We are able to walk beside you and gently guide you through harder decisions if a homebirth transport becomes desired or necessary.  To still be able to make your own decisions and come out feeling empowered from a birth that didn’t go exactly how you thought is pretty remarkable and worth every penny!

We want to help all our clients have beautiful homebirths but sometimes that’s not in the cards and that’s ok. That’s why we continue putting all our energy into our clients’ care, regardless of where they end up giving birth and how they give birth.  Though it can be a hard transition and hard to acknowledge that birth doesn’t always go according to plan, we do work with clients so they feel supported and empowered through their pregnancy, birth, and postpartum and I think we do a pretty darn good job at that!

 

 

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 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.