Labor:

I am 6 weeks postpartum today and feel like I am in a good place to finally write part 2 of my birth story. This is labor. This is what I have been prepping for. Excited about. Nervous about. Even though I have gone through it twice before, this labor was going to be vastly different. There were so many unknowns even with labor and birth being so familiar to me. I was not afraid of it in the normal way most people are afraid to experience labor. I never really have been. I have always greeting labor and birth with a welcoming mind and that space to allow it to happen has grown the more I am immersed in the birthing world. I did find myself in the days leading up to labor nervous about it though, which I did find strange. I guess it just goes to show you that no matter how many times you give birth, or how many timed you witness birth, you can still be nervous for it. I think that comes from the fact that no matter what, birth always looks different no matter how many times you’ve seen it and have gone through it personally.BRIEANA BIRTH

We left off with my waters being released and everyone just waiting for labor to start. Contractions were not painful or uncomfortable at all throughout the day and I was having to battle my worry of transferring into the hospital. Fortunately, my team was fielding the texts and calls from my Intended Parents so I didn’t have to put that extra stress on myself and the situation. I was playing with my kids and talking about every subject with Amanda, my photographer, texting my partner updates and just enjoying the day. I started to take some herbs in the early afternoon but they didn’t seem to be affecting anything, which was fine. I then took a dose of caster oil because I was hoping it would take some effect, it really did not do much either so I decided that labor would come when it was ready. I had to just surrender to that.

Around 8:40pm I started to have some more consistent, timetable tightening, still nothing painful or intense but it was there. So I let my Doula and Midwife know that something was heading in the right direction but nothing I needed anyone for yet and that it could still be a bit. I decided to order some Panda Express on postmates for everyone that was there because I needed to keep some protein in me for when labor decided to finally start. I laid on my bed in Mountain Climber position/Extended side lying/ (or my least favorite term for it: SIMS) position so see if I could get my belly buddy to rotate down a bit in my pelvis and put more consistent pressure on my cervix. About the same time I hit send on the order for food, I had my first “painful” contraction. My face lit up and I got so excited! Then about 3. Minutes later another string one came. I remember basically shouting, “Oh! That one hurt! YAY!” and then another came. Since I have a history of decently fast labors, I excitedly texted my Doula, Mychal, first with a text that stated, in very me language, “They just got active as f**k” and that I didn’t need her right that second but she should head over. I then texted my Midwife, Faith, that they finally were hurting and again, that I didn’t need her right that second because they were very manageable, but she should get ready and head over when she was finished with what she was doing. This was about 9:20ish PM.

The contractions decided to ramp up very quickly. Like… I should not have told people to take their time getting to me quickly. I decided to get into the shower to let the warm water run down my belly and over my body. I have always found the shower comforting. As I was getting to the shower the contractions were now very intense and about 2 minutes apart and a minute and a half long. I could not talk through them but I could still stand so I wasn’t too concerned thinking I was just in early active labor. About 10PM our postmates order was delivered and I was in no mood to eat, but I remember moaning like a buffalo in the shower thinking to myself what that poor postmated delivery person was thinking was happening in here. I labored in the shower for about maybe 15 minutes and decided it was pool time. (About 10PM)

I could not stand anymore. I was getting louder with my sounds. I was becoming more primal with animalistic feeling movements and I knew I had hit transition. Faith had texted me how it was. Going and all I could text back was “Intense and shaking” as I was kneeling at the bottom of the shower unable to get comfortable. My youngest son was by my side at the shower asking me “Mommy, are these still the good labor sounds?” which I responded that they were and it meant that baby was almost here. I turned the shower off to switch to the hose to fill the tub in my bedroom. Liam held the hose while my photographer helped him set it up and I crawled out of the tub onto the floor with a towel draped over me.

I very, very slowly stood up and made it to my hallway were another contraction hit and I had to drop to hands and knees. There was no more walking for me. It was crawling and thrashing like a wild animal form here on out. My head was noisy, my body was noisy and I was surprisingly noisy. I had never in previous labors allowed myself to vocalize like I was doing in that moment. If felt wild and really good. I think I apologized for being so loud but there was no holding it back. I managed to crawl around the corner and my Doula walked in. She was on the phone with my Midwife and asked if I wanted to tell her anything. I shook my head no and then I felt my body give a huge growling push and I yelled “YES, THAT I’M PUSHING”. I was about 20 feet from that pool in my room and I felt like I was never going to make it. Mychal got behind me and rubbed my back and squeezed my hips and I remember staring at the ground in between contractions thinking, “man, this is why people get epidurals… I get it” then I realized that means I am almost done and a new wave of energy came over me. I did one more contraction on the floor of my hallway and then I made it to the pool. I literally have no idea how I got there. Did I crawl? Did I leap? I don’t care. It was sweet relief.

I had never pictured myself to be one that delivered in the water. Historically, I like to use it as a comfort measure, but once I got in that pool… there was NO getting me out! My body was pushing and I was not going to move again from that spot. The sounds that came out of me were apparently very loud because my 5 year old decided he was out of there and went to the living room until Faith got there. My 9 year old was taking photos also. I remember him announcing that I was almost finished with labor because my vagina was parting (my mini midwife). I felt the head of my fetal passenger come into my vaginal canal and reached in to gauge how close we were. Her sweet, wrinkly head was maybe 1 knuckle in. I felt some weird pressure and swept around her head to find a piece of her membranes filled with fluid so I popped it with my fingers and with that, the pressure felt better. More even and manageable. I asked Mychal where Faith was, which I was informed that she was about 10 minutes away. I just looked up at her and said, “She’s not going to make it”. Mychal was so sweet, she found the gloves and towels and just calmly said, “Well, let’s have a baby.”

My body continued to push and just as I started to feel pressure on the end of my tailbone, I saw Faith pull up around the back of my house and bang on my door. I was relieved! She ran in got gloves on. I told her I could feel the baby’s head stuck on my tailbone and that I needed it out of the way. She asked if I wanted her to do it and I moaned I don’t know as I started another contraction. She reached down and gently applied pressure to my tailbone and that’s all that was needed for me to get that head out. The baby’s head emerged slowly and gently out of my body, my hands helping to guide and ease her out. I remember feeling like the stretching would never end. This was my third time having a human being come out of my body and it still amazes me how little give that head has and how much our bodies are capable of opening to allow passage. I called time for the head and said, “Hi, baby” and held her head in my hands. I felt for her shoulders and with one push guided them out. She was born at 10:19pm. I got to labor completely uninhibited. Uncontrolled. Nothing was pushed on me. Zero cervical exams. No one doing things to me. I was in control of my own body, my own timing, my own autonomy. It was absolute perfection.

I lifted her out of the water and onto my chest where she was draped in a warm towel while I stimulated her to breathe. She immediately let out a nice cry followed by a more gurgled one. Midwife me mode took over and I tuned her over to help drain her upper airways and called for a bulb to assist in clearing her fluids.

My surrobaby’s parents did not make it. My midwife made it at 10:17pm… just 2 minutes before she was born. We facetimed her parents while I was in the pool still and I decided I wanted to move to the bed to deliver my placenta. As I got out of the pool, I had a separation gush so once I laid down I attempted to deliver my own placenta. But it was still partially on and I started to bleed a bit. Faith had to finish getting it out for me, which made me a bit sad because that’s something I wanted to do but I had the most perfect birth and was okay that of all things, that was what I couldn’t do. Then I started bleeding, and bleeding, and some more bleeding…

 

And that brings up to part 3…

My entire labor was about an hour. It was intense. Like an unstoppable force that you just had to let take over.

 

End of Pregnancy – “Early Labor”:

Early labor. Photo by Wild Heart Photo and Film by Amanda Smith

I’ll start at the beginning of the end with my birth story and break it up into 3 parts. I feel as though this played out if acts if you will and this seems the appropriate way to tell it. As I have stated before, this pregnancy was really rough for me physically. This was mostly due to the extra hormones required to keep the pregnancy viable but, I was also really sick up until about 30ish weeks. After that, I finally felt like the normal pregnant person I usually am. I was enjoying it more and I was able to fully eat again. During the end of my pregnancy I was still taking births as a Doula and a Student Midwife. I did my last Doula birth mid December and I was taking Midwifery catches all the way through and past my due date.

Texting my partner and Midwife team Photo by Wild Heart by Amanda Smith

In previous pregnancies, I had only gone to 40+2 and 40 weeks exactly and I had zero postpartum complications so it felt safe to take about 4 catches throughout January because chances of me going into labor on the same day as some else was very low. I also had assumed that this little girl would come at the beginning of her window since she had given several scares throughout my pregnancy. One at 15 weeks with lots of bleeding and contractions that put me back on progesterone supplementation for a bit and then another contraction episode around 32 weeks where I had to lay down at the birth center and take some herbs to stop it. I also had a ton of toning contractions and even at 38 weeks I had a round of consistent contractions at night that stopped in the morning despite my efforts to keep it going. I was dilated to a 3, then to a 4 and we did everything to try and keep me going since I was having so much prodromal labor. When we tell you as a Midwife that a sweep and herbs and caster oil will not work unless baby is ready… we mean it and I am a prime example. Even with this being my third pregnancy and despite dilation and contractions, my body was not ready to go into full blown labor.

Rebozo

This period of waiting was the biggest mind game I ever could have imagined. There was a LOT of crying in January. A lot of processing and releasing things I could not control. My due date came and went and even though previously I had delivered really close to and on my due date, and even though we knew her exact gestational age because we put her there in a clinic, even with weeks of contractions, she still was not ready. I knew IVF babies tend to come later, and I had prepared a bit for this possibility but it just was not what I thought would happened with everything leading up to this point.

I was really surprised at just how upset I was watching the days past my due date as they kept adding up. I still attended births because I felt great and I even caught a baby the day after my due date, at 40+1, very very pregnant. I felt great physically and I do feel like it helped me emotionally to keep busy. Then came 41 weeks and still nothing. At this point, I was starting to worry a bit. I have never had to face the possibility of timing out of midwifery care and being medically induced. I knew I still had 6 days left, but each day closer to midnight at 42 weeks, the more worried I became. Another factor in this process was that it isn’t my baby. I was carrying for a friend of mine and our relationship had become a bit strained and I did not want them to be worrying to the point where I would have to go in for an induction despite baby being perfectly fine. The horror story running through my mind was that I would be in the hospital, hooked up to medication and machines forcing this baby out of me while a room full of people stared and judged and I couldn’t get away. When those images and worries started coming, I decided it was time to have a serious chat with my fetal passenger and to let them know that the way we had planned to birth at home without medication was a much nicer way to labor than to have medications force her out when it was not medically necessary.

Days kept passing and then finally, at 41+2 at about 7:45pm, I was eating lentils and watching some trash reality tv, and by belly buddy got really active. Like mosh pit in my stomach active. Then, I felt a slight little gush. At first I thought to myself that it was probably just more mucus plug because I had been losing tons of that, but then the slight gushes continued and it actually soaked the pad I was wearing. I had a few amnio swabs so I checked myself and it was an immediate positive. I was so excited because this means that there’s no turning back and statistically I would have her within the next 24ish hours (or at least have labor started). I texted my midwife team and my doula to update them and I went to bed immediately, expecting to start labor within a few hours. Silly me. I woke up the next morning still super pregnant at 41+3. I decided to not let it get to me but it was hard emotionally because again, this wasn’t my baby and I couldn’t make certain decisions. I would have to go into the hospital to be augmented if labor didn’t start soon on it’s own even though I was GBS – and I knew that it was safe to stay home for a few days with MFM monitoring, but I knew they would get anxious and I respected that but yet again, I was at the point of dreading a possible transfer and induction.

Walking to help engage baby lower.

My Midwife, Faith, came to do vitals on us in the morning when I was still not in labor. We both looked great and we decided to let my intended parents know that I had released waters and that labor should be sometime today and that everything was fine. I was feeling some pressure but nothing major and we made the decision that if I wasn’t feeling more things by the afternoon I’d start taking some herbs to get it going.

My photographer came up to be with me because I have a history of pretty quick labors and I was feeling consistent tightening, however, for me, they usually are not “painful” or intense until I am closer to about 7cm dilated so we knew there was a chance of her missing it. She hung out with the boys and I. My Doula, Mychal came over and we did some rebozo sifting and stretching to loosen up my ligaments and get baby maybe a bit lower to get this labor thing going. We went on a walk and both my Photographer and my Doula could tell when I was having contractions, but I reassured them they were not anywhere near painful and that this could take a while. I started the herbs and I did one round of caster oil just in case because I knew that it could take up to 12 hours for the caster oil to take effect. I also continued to eat really well and hydrate as well as just rest and enjoy the day. I set up the house and my room for birth whenever it decided to come.

To be continued…

Early labor tickles with my youngest. It’s always nice when birth is family centered.

History of Midwifery in California

My anticipated state of practice is California. We have some decent laws and have come very far, but still have a long way to go to fight for women’s rights to autonomous birth.

Sept. 9th 1850 – California entered into the union and midwifery was unregulated and lawful and only holistically trained midwives existed.

1917 – Midwifery became an independent profession with the California Medical Practices Act under amendment AB 1375. Holistic midwives were names “traditional non-nurse midwives”. 1,2 Category and license program developed under the California Board of Medical Examiners (now called Medical Board of California). The exception was a “grandmother clause”4 stating that actively practicing midwives had 180 days to apply and provide qualifications and satisfactory documentation that showed skill level. With this, they also had to provide 2 letters of good will recommendations by 2 professionals. One reference had to be a doctor and the other from her religious leader (priest, minister or rabbi). 217 midwives were licensed under AB 1375 with only 3 being revoked. Article 24 in AB 1375 was passed before women had the right to vote with a patriarchal provision determining the difference between “man’s tools” (drugs, sugary, etc.) and “girls tools” (non-allopathic management of childbirth) with the board being able to revoke licenses if midwives were caught using “men’s tools” i.e. anything medical.

1949 – The year Midwifery almost died. SB 966 really put midwifery on the block 5,6,7,8 . This bill abruptly dismantled midwifery with no prior notice of action. It repealed ALL practice abilities including non-allopathic treatment 9. The government stated that “midwifery was almost a dead class”. The norm became “childbirth is dangerous” and women were delivered by surgical intervention, prophylactic interventions, twilight sleep and forced obstetric management. This is the year that recommendations started of childbirth required to be Doctor attended. In reality, midwives threated Doctor’s economic status. The sneakiest part of this whole thing, the repeal came only in the final publication of the bill where it just simply didn’t include provisions for midwifery practice therefore outlawing it. Sadly, the possible proposed end to midwifery may have in fact stemmed from the fact that many holistic midwives were of Japanese descent3 and there were hostile views towards them at this time. Another factor, was the doctors coming back from war and they needed jobs and in the true male dominated fashion, shoved women out of these professions and back into their homes. This included shoving midwives out of practice due to the male doctors being more entitled to the caregiving positions, which included “delivering” babies.

1974 – Finally, after 25 years, a Nurse Midwife law was passed 10. They were deemed “physician extenders” and used to create cost effective pregnancy care to low income families. Physician supervision was required but it wasn’t legally required for physician to hire Nurse Midwives or allow them in their practice. Another hurdle was malpractice insurance refused to cover doctors that supervised nurse midwife that did any care other than in the hospital. This was also to prevent economic competition. Ah, there’s a pattern here.

1977- AB 1896 finally declared midwifery an independent discipline NOT controlled by the medical profession. New licensure was brought in September 8th 1977. There was still a long road ahead though. From 19770-1992, there was endless trying for 6 new bills to be passed to make midwifery more available and less governed by the state with no avail. You can thank the Obstetric Professionals for their vast opposition12 and fight back against the proposed bills.

1990- Senator Lucy Kella was a huge supporter of women’s rights and fought for the 6 bills mentioned above to be passed. In 1993 we finally have the introduction of SB 350 Licensed Midwife Practice Act13. This bill stated that licensed midwives were equivalent but not equal to nurse midwives. Since no physician supervision was required, it created an immense standoff between midwives and standard medicine since there was no control of these midwives by the medical profession.

August 11th 1994, after spending 50 years of arguing over aspects of “physician supervision” and majorly ignoring all other important aspect of midwifery, a midwifery committee was implemented. Its task was to “clean up” legislation and to get the supervisory clauses taken out. This resulted in requirements of each LM (licensed midwife) to submit a “written supervisory agreement” with an OB. NAFTA (North American Free Trade Agreement) deemed physician supervision was in failed system that created “unnecessary boundaries of the trade” and that licensing requirements must “not constitute a disguised restriction of the provision of services…. Requirements should be based on competence”.

1999- OAL (Office of Administrative Law) confirmed supervision of midwives dysfunctional and unenforceable. LMPA (Licensed Midwives Practice Act) cannot be used to make practice of midwifery illegal14.

2000- LMPA was amended… again. SB 147915, reduced some legal burdens by stating that each planned home birth, client and midwife were to identify arrangements for referral and/or transfer specific to each individual client. A big win was including a “legislative intent” section statin childbirth was a “normal aspect of biology and NOT a medical disease”.

2002 – SB 1950 Standard of Community-Based Practice of Midwifery. This bill required the medical board to abide by midwifery standards when making judgments on merits of complaints and not an obstetric consult. Now we’re getting somewhere.

2006- SB 1638 was signed into law including LMAR do a midwifery advisement council and licensed annual midwives report to determine the safety, effectivity, outcomes, transfer and cesarean stats. This also required 2-way communication between midwife and physician boards. The midwifery board was to be made of 50% midwifes and 50% consumers interested in midwifery. The outcome was a 6-person counsel in which 3 seats were midwives and 2 seats were taken by ACOG certified OB’s. Not exactly what was in mind when the word “consumer” was written into the bill but they found a loophole and used it. Finally, in 2012, The board agreed to replace 1 of the ACOG Certified OB’s with an actual consumer that had used the services of an LM (Licensed Midwife). OSHOD16 was created and each midwife was required to report outcomes.

2014 brought the requirements for functional communication/relationship between midwives and physicians. AB 1418, SB 1479 & SB 1950 17. Prohibition was over and freedom from physician supervision became a reality! AB 130818 made the repeal final however, massive restrictions on scope of practice for the midwives was now signed into law. This provision shifted a lot of low risk qualifying women into “high risk” positions and in a transfer to physician category. Criminal penalties were also now implemented for failure to comply with transfer or referral laws. It was basically a sneaky “land grab” at best. Midwives now had strict restrictions of no postdates pregnancies, no multiples, cephalic presentation (head down), no preexisting maternal diseased likely to affect pregnancy, and more. There’s also items in the bill that state a physician can risk them out if they decide that the patient is “high risk”. The other incredibly sneaky addition, or should I say non-inclusion, was once again, the writers of the bill simple didn’t include SCCLM in the final revision. This revoked the requirement of the medical board to use midwifery standards when judging the merits of a complaint. The bill was signed on October 9th 2013. This was deemed “the single most detrimental aspect of AB 1308”.

2015 – Two amendments were signed into LMPA. a.) SB 408 – legal category of “midwife’s assistant” 19 b.) SB 407 – can be compensated for providing care to Medi- Cal recipients. 20

2017 – AB 1612 passed and finally releases CNM’s (Certified Nurse- Midwives) from physician supervision with the allowance to practice independently 21. AB 1368 passed which was the final repeal of supervision.

2018 – CALM’s (California’s Association of Midwives) Bill 23: Access to Midwifery Act of 2018 failed. The good thing, though, is that Bate’s Bill (SB 475) that would severely limit access to out of hospital care also failed which deemed “The patient or client has not had prior uterine or abdominal surgery, including, but not limited to, myomectomy, hysterotomy, or prior caesarian section.” 22 among other damaging revisions to the current scope of practice.

The current status of midwifery in my state, is that it is legal under the LM licensure with many restrictions on scope of practice including but not limited to no breech presentation or multiples. There are also frequent bills threatened to take away rights of practice as well as bills that are not approved for expansion of scope of practice with a bill actually just introduced on the 13th of June 2018 with even more paternalistic restrictions proposed 24.

In conclusion, as you can see. The fear surrounding Midwifery and birthing at home is not based on danger. ( I will have stats in studies on the next blog). There is a long history, extending way back to the Spanish Inquisition world wide (also in a blog to come), of immense pressure against midwifery and woman healers and it’s mostly based on eliminating economic competition and men monopolizing an aspect of healthcare that may not be an area they should be in. Over time we have made something that wholly feminine and made it intrusive and masculine. We try to dominate, and calculate and put birth on a timeline when it cannot be. Midwifery allows the body to do what it’s going to do where standard obstetric care puts in on a timeline and a linear pattern.

References:

  1. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/AB1375_Nwspr_Mar26_1917.pdf
  2. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/DirectoryBME_March1918.pdf
  3. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/MfrySchools_1917-1949.pdf
  4. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/MfryLaw_GmotherClause_1917.pdf
  5. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/LegMemoGovEarlWarren_1949.pdf
  6. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/GovWarren_BME_Arnerich_1949.pdf
  7. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/GovWarren_DeptPublicHealth_1949.pdf
  8. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/GovWarren_AG-Office_1949.pdf
  9. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/SB-966_1949.pdf
  10. http://moh.gov.ms/wp-content/uploads/2008/11/nurses-and-midwives-act.pdf
  11. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/DCA-Krisman_AB1896_1977.pdf
  12. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryAdvisoryCouncil_Feb2007/HxMfry_Binder_Mar2007/Standord-Heinrich_Letter_AB1896_1977.pdf
  13. http://www.leginfo.ca.gov/pub/93-94/bill/sen/sb_0301-0350/sb_350_bill_931011_chaptered
  14. https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=5.&article=24.
  15. http://www.leginfo.ca.gov/pub/99-00/bill/sen/sb_1451-1500/sb_1479_bill_20000210_introduced.html
  16. http://www.collegeofmidwives.org/collegeofmidwives.org/MfryCouncil_2007/midwifery_advisory_council_infoPage_07.htm
  17. ftp://bsalhc.ca.gov/pub/99-00/bill/sen/sb_1451-1500/sb_1479_bill_20000621_amended_asm.pdf
  18. http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1308
  19. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB408
  20. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB407
  21. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB1612
  22. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB457
  23. http://www.cafamiliesformidwives.org/blog
  24. http://www.cafamiliesformidwives.org/single-post/2018/06/13/Protect-Access-To-Midwives-Now

 

 

 

A Doula on a Mission

Thanks for joining me on my journey as a Birth worker. I am here to support and educate birthing persons on their way to becoming parents. It looks different for everyone. Each pregnancy, birth and postpartum comes with it’s own set of unique learning experiences and it’s my hope to help make this transition easy. I use compassion, passion and education to assist you on your path.

*More to come*

The Journey BeginsIMG_9896-2