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!

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!

 

 

Holistic Pelvic Care – Pelvic Rehabilitation and Alignment for Women

kelley burke placenta encapsulation pelvic floor health massage therapistHolistic Pelvic Care™ is a physical-therapy technique founded by Portland’s own physical therapist and natural healer, Tami Kent, MSPT. She developed this approach for women who experience the physical and emotional symptoms related to pelvic pain and pelvic floor dysfunction.

The Pelvic Floor

The pelvic region is shaped like a bowl.  Picture two cupped hands, with muscles and ligaments supporting the uterus and ovaries. Being the center of the body, a woman’s pelvic region holds all her emotional and physical stresses. Any major change in the body, emotional upset, or trauma—infertility, pregnancy, injury, body dystopia, etc.—is stored in the pelvic floor and influences how women emotionally and physically move in the world. These imbalances can compound, leading to medical conditions such as:

~ painful intercourse

~ urinary incontinence

~ uterine prolapse

~ low back and hip pain

~ body instability

Your Pelvic Floor Sessions

Your first pelvic floor session with Kelley Burke, will begin with a conversation about what brought you to her office, a health history intake and a detailed explanation of your pelvic floor anatomy.

Once a baseline understanding is reached, Kelley will begin the hands-on portion of the session. This will include myofascial work to the external anatomy related to the pain and disfunction as well as  intra-vaginal massage.   Using a single gloved finger,  gentle pressure is applied internally to the pelvic floor to release trigger-points, increase blood flow, smooth out adhesions, encourage muscle engagement, and support whole body connection.  It is not uncommon for big emotions and memories to be released when working on the muscles deep within the pelvic bowl.  Kelley will continually check-in with you to ensure that you are comfortable and understand what is going on the entire treatment.

Before ending the session, Kelley will provide you with a treatment plan and self-care tips you can do at home to support your health and enhance each treatment.  You will likely begin to notice changes in your body  immediately after the very first session.  Sometimes soreness can also be expected.  Deeper emotional shifts, and older, chronic injuries, often require a series of treatments.

There are now 2 locations to schedule with Kelley in NE Portland. Tuesdays and Thursdays, she can be found in the MontBlanc building on NE 7th.  And if you are needing childcare or a Wednesday/Friday apt, please look into scheduling at the Luna Wellness location.