Breathe, Pant, Blow

The Lamaze method of birth has been known for breathing patterns that help a woman to relax and keep pace with labor contractions. I taught breathing patterns to my students. Some women reported that they used the technique during labor. Others said the hospital procedures interfered with their ability to maintain paced breathing.

When I made the transition from hospital to home birth I learned about the value of a calm supportive environment. The menu on my website has pages under the category of Healthy Birth Practices. On one page I wrote about the benefit of a calm, encouraging environment during labor. 

After thirteen years as a labor/delivery nurse, three cesarean sections and 17 years of teaching Lamaze, I saw birth from a new and holistic perspective when I attended home births. 

While present with women from early labor through birth I was able to observe the natural positions women assumed to assist the progress of labor. My knowledge of comfort measures increased, and I realized the value of adequate nourishment. I also became aware of the spiritual nature of labor and birth.

Sometimes the laboring woman’s husband prayed for her during labor. Sometimes I was asked to pray. It was a blessing to feel free to pray and ask for God’s help.

When I returned to the hospital setting, I found myself between two philosophies of birth. Women in labor need to be nourished and well hydrated. Recently a young woman came to the hospital with a birth plan. We provided the environment for her to walk and change position, as she desired. I monitored the baby intermittently. 

To read more click here. 

Photo by Ashton Mullins on Unsplash

The prompt for the Five Minute Friday community is: PACE

A Remarkable Woman Doctor

One of the women I admire provided care to childbearing women in their homes. For four years I worked in a home birth practice that followed the principles of care taught by Dr. Beatrice Tucker.

Dr. Beatrice Tucker was the remarkable woman who directed the Chicago Maternity Center from 1931 to 1973.  She had been the first woman resident doctor at the University of Chicago Lying-In Hospital in 1922.

She studied under Dr. J. DeLee who had opened the Chicago Maternity Center. It is ironic that Dr. Tucker once worked under Dr. DeLee.

 As Dr. DeLee’s career progressed he promoted the use of forceps for delivery, twilight sleep (an amnesiac type medication) and episiotomies.  He was highly influential in the developing field of obstetrics, and sadly he was outspoken in his disparagement of midwives.

Even though obstetricians were moving toward aggressive control of labor and birth, Dr. Tucker supported the natural progression of labor and birth.  In her management of the Chicago Maternity Center she set a standard for safe home birth.  

During the Maternity Center’s peak activity (between 1929 and 1941) an average of 360 births took place each month. During her tenure at the Chicago Maternity Center she participated in over 100,000 births.

The Tuscaloosa News (12/3/1975) ran a story about Dr. Tucker.  The article begins: “Shortly after her 78th birthday, Dr. Beatrice E. Tucker reluctantly came out of quasi-retirement to deliver a baby at the mother’s home.  It was a rather easy affair in a clean apartment . . .”

Later in the article she is quoted as saying “Most doctors have never seen a baby born at home and they don’t know how to do it.”  Dr. Tucker was a strong woman willing to go against the current of medical trends to provide safe and economical care to women.  

This post is part of Write28Days. To see the other posts in this series click here.

Birth in a Hotel Room?

Why would a woman decide to give birth in a hotel? Yesterday WGN News reported 0n a birth that took place in a hotel. The midwife called 911 because the mother needed additional treatment after the baby was born (the baby was healthy). The police were wondering why and how this could happen.

I have some thoughts about this. After working in hospital labor/delivery units for many years, I took weekend call for a home birth practice staffed by doctors and midwives. I learned about different approaches to birth care.

In the hospital I worked within the medical model of birth care. When I assisted the home birth practice, we worked with a physiological model of birth care. Certified nurse midwives or CNMs are trained in the medical model. Certified professional midwives or CPMs are trained to support physiological birth.

In the medical model of birth the doctor or midwife manages the birth process, sometimes aggressively. It includes electronic fetal monitoring, induced or stimulated labor, artificial rupture of membranes, pain control with narcotics and/or epidural anesthesia. All of these interventions have some risk and may lead to more interventions.

The physiological model of birth allows labor to progress without intervention. The baby’s heart rate is monitored intermittently by doppler. The mother’s blood pressure and temperature is monitored. The birth attendant makes sure that the laboring woman stays hydrated with water, juice, tea or broth. 

In the home setting I learned that pain was a signal that helped to direct both the mother and attendant. Simple measures to relieve pain were employed—compresses, massage, change of position, a warm shower, a birth tub. The type of pain could be a sign of the baby’s position or the stage of labor and helped with decisions.

In Illinois certified nurse midwives can attend home births if they have a doctor backing up their practice. But CNMs mainly practice in the hospital and CPMs are illegal in Illinois. It is difficult for a woman to find a midwife for home birth. Perhaps the hotel was a meeting place for midwife and client that lived a distance from each other.

Illinois does not license certified professional midwives, although neighboring states do. CPMs receive their certification through classes and apprentice training (different from nursing school).

Some women prefer to deliver in a home setting instead of the hospital—they prefer to avoid or limit interventions. The prefer the privacy and quiet of home. They want to respond to cues from their body with support and guidance. When I worked in home birth, many of the women had previously delivered in the hospital. Some had been traumatized by the experience.

For years the midwives in Illinois have lobbied for regulation and licensure for CPMs. Licensure would set standards for CPMs. It would insure that the midwife was qualified to attend births and set guidelines for hospital transfer.

Pediatricians in Illinois are against home birth. My observation was that infants had less blood sugar and temperature problems at home than what I saw in the hospital. In the home infants were placed immediately skin to skin with mother. The immediate contact with mother assisted the establishment of breastfeeding.

Hospital or home–each place has advantages and disadvantages. Some women prefer to give birth in the hospital. Others prefer to give birth at home with a midwife. I think women should have a choice. 

This post is part of #Write28Days. To view the other posts in this series click here.

Book Review: Born for Life

When I am planning to travel  I  usually  find  a  couple  of  books  for my kindle.  I prefer hard copy books most of the time,  but when traveling   e-books are a great option.

I saw the title online, Born for Life: A Midwifes’s Story, and was immediately drawn to it. It is a gem of a book.

Julie Watson writes a memoir about childbirth, her own and the many women she provided care for in New Zealand. She began her career in maternity care as a nurse aid in a small rural hospital. Some of the scenes reminded me of my early jobs as a nursing assistant.

She includes practices that are now outdated and no longer recommended—sugar water for infants, high forceps deliveries and more.

When she was 37 years old she studied to become first a registered nurse and then a midwife. As she approached her training she wrote this about the Nurses Amendment Act that was passed in New Zealand in 1990 and made the independent practice of midwifery legal.

The emphasis was on the midwife and the woman being in partnership, making decisions together about the care given. It was a model of equal power, rather than of a health professional telling the woman what to do and what would happen to her. Power was now given to women, which was so different from my own [childbirth] experience.

Ms. Watson began her practice in a hospital setting and then moved on to become an independent midwife with her own practice. She attended women in the home and in the hospital. Like so many other places in the world her practice as an independent midwife was seen as a threat to the business of birth.

For women interested in midwifery, it is a fascinating read.

Childbirth

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Finding an Enduring Loyalty

The Five Minute Friday writing community looks forward to the prompt that Kate Motaung gives each week. We pause to think about the word and then write as ideas begin to flow. This week the prompt is: LOYAL

The dictionary offers this, as a definition of loyal: faithful to a cause, ideal or custom.

Over the years I have found a variety of causes to invest in.

During my college years, and after I graduated from the University of Michigan, I have been a loyal fan of the football team. My family is amused by my attachment to college football. I must admit that I am a little uncomfortable with the big business aspect, but I continue to cheer for my team.

After practicing as a labor & delivery nurse for a few years I was drawn to the Lamaze movement. I took Lamaze classes during my first pregnancy and later became certified as a Lamaze teacher. I taught for 18 years and received feedback from my students.

Sometimes students felt that the Lamaze techniques just didn’t work when their labor was induced. Interventions and the hospital environment were overwhelming. As induced labor and epidurals became more common, interest in the Lamaze method began to fade.

And then I made decision to leave the hospital labor/delivery unit and join a group of physicians and midwives that were attending home birth.  I observed that women were more able to relax and work with their labor in the home environment.   I loved working  in  the  home  environment and promoted home birth to my daughters.

But it is true that sometimes the hospital is needed. Sometimes interventions are needed that require the equipment in the hospital. I would like to see better communication and teamwork between home birth attendants and hospital staff.

Each of these ideals has limitations.

Currently I am reading a biography of  Susannah Surgeon  (book  to  be released September 4). Susannah and her husband, Charles, shared a faithful loyalty to the gospel. They worked together as a team with a love for the Lord God.

The best and most enduring loyalty is to the gospel, to God’s love and plan of salvation. I want this to be my passion.

You can visit the Five Minute Friday Community and read more reflections on LOYAL by clicking here.

Joy Restored

Childbirth practices had changed since I began my career as a labor and delivery nurse. The use of pitocin to hasten birth had become common. The rate of cesarean section had risen from 15% to 30%. I saw a full term infant die after inappropriate use of pitocin. I didn’t like my role as nurse, and I told my husband that I wasn’t sure that I could continue.

I was aware of a group of doctors and midwives that attended homebirth. I interviewed with them and chose to take a cut in pay to work with them. It was refreshing to attend women in their homes, supporting them as they labored.

Women were more relaxed, and the family was often involved. I saw that God had given women the ability to give birth. I saw the strength of women. Sometimes intervention was necessary. Hospitals are important and are equipped to handle complications. We transferred about 5 to 10% of the women to the hospital.

The four years that I participated in home birth restored my joy as a nurse. When we are burdened and lose our joy, we may need a new perspective. I am thankful that God led me to take the home birth position (something that I never dreamed I would do).

This lesson stays with me. I need to step back from hard situations and ask God to give me a new perspective. He will restore our joy and renew us in the roles he has given us.

How about you? Could you benefit from a new perspective?

I am joining  the Five Minute Friday community of writers. Our one word prompt this week is: RESTORE

Different Environments: New Perspectives

I am joining the writing community, Five Minute Friday, today. We write for five minutes (or sometimes a little more). The prompt today is: ADAPT

Family - Bouquet

 

It was a decision I came to after much thought, choosing to work with physicians and midwives that attended home birth. I had worked in the hospital for many years.

I continued to work in the hospital labor/delivery unit on a  per  diem   basis, while taking weekend call for the home birth group.   Nurse colleagues in the hospital who knew about my second job warned me to keep quiet. Don’t tell any of the doctors.

There is a big divide and limited communication between hospital based birth attendants and home birth attendants. Home birth practitioners are reluctant to transfer patients to the hospital until absolutely necessary. Hospital staff only see the home birth patients that are in crisis. They don’t see the healthy births that take place at home.

I learned so much attending labor patients in their home. I carried supplies that might be needed (IV fluids, oxygen), and arrived at the home when a woman was in early labor. I assessed her and encouraged her to rest in early labor. As labor progressed I helped her with positions changes, suggested a warm shower and offered massage. I made sure she stayed hydrated and nourished.

It was so much easier for a woman to work with labor in her home. (I had taught Lamaze classes, but rarely saw such focus and ability to cope with labor in the hospital setting.)

It was my job to notify the doctor of any problems, and to update him on the progress of labor(so that he/she would arrive in time) . Of course, sometimes a woman needed the interventions available in the hospital. Sometimes I urged the doctor to transfer the patient. A couple of times I rode to the hospital with a labor patient needing intervention.

Hospital staff and home birth practitioners could benefit from switching places. They could learn skills from each other and develop better communication.

As I worked with a foot in both settings, I tried to adapt what I had learned in the home to the hospital setting. The home setting had given me new perspectives on birth.

Women’s Rights & Midwifery

Prayer and RestWomen today have more rights than our ancestors. As we have made progress it is odd that the loudest voice in the current women’s movement is for abortion. I would rather support the right of women to give birth in the setting that they choose. Across the world there is unresolved controversy over midwifery and home birth.

At the same time that suffragists were fighting for a woman’s right to vote, the medical system in the United States, was fighting against the practice of midwifery.

For the past few years I have been researching the life of Hanna Pörn and her court case. She was a Finnish midwife that received a certificate of midwifery from the Chicago Institute of Midwifery. She lived and worked in the Finnish/Swedish community of Gardner, Massachusetts. After eight years of practice, having better statistical outcomes than the local doctors, she was arrested for practicing medicine without a license. The case went to the district court, and was appealed several times. In 1909 she was found guilty and sentenced to two months in jail.

Other countries have had lawsuits against midwives. In recent years Agnes Gereb left her position as an obstetrician and trained as a home birth midwife in Hungary. After delivering many babies in the home setting, she was arrested because one baby died. She was placed in house arrest and the case has been moving through the courts. You can read about her case here.

Today my husband handed me the Wall Street Journal pointing out this article, Sweden Blacklists an Antiabortion Midwife. Ellinor Grimmark trained as a midwife in Sweden in response to the current shortage of midwives.

In spring 2013, with one term left in her studies, she asked supervisors at the hospital where she planned to work to accommodate her conscience rights. [She did not want to participate in abortion.]

She received a furious call from one manager. “How could you even think of becoming a midwife with these opinions?” *

It is a strange world if, in order to attend the birth of babies, you must be willing to kill babies. This brings to mind the Biblical account of two midwives.

The king of Egypt said to the Hebrew midwives, whose names were Shiprah and Puah, “ when you help the Hebrew women in childbirth and observe them on the delivery stool, if it is a boy, kill him; but if it is a girl let her live.” The midwives however feared God and did not do what the king of Egypt told them to do; they let the boys live. Exodus 1: 15-17

Ellinor Grimmark was unable to secure a position in Sweden and is now living and working in Norway. Swedish mothers are coming to Norway to give birth.

Many women are seeking a kinder, gentler way of birth.   Birth  has    physical, emotional and spiritual aspects. Midwives understand this.

So  much  emphasis  is  placed  on  the   physical aspect of birth alone—treating pregnancy like an illness. Frequently, aggressive management of labor takes place in the hospital—and there are consequences. We need to swing the pendulum back. Let labor and birth take place at a natural pace. Midwives have an important role in providing healthy birth care.

In Illinois the Home Birth Safety Act is up for debate in the senate.      Thirty-two states allow midwives to provide home birth care. Illinois should join these states and pass SB 1754. If you live in Illinois, call your state senator and ask him to support SB 1754.

*Sweden Blacklists an Antiabortion Midwife, The Wall Street Journal, April 10, 2017, A17.

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Periods, Pills and Home Birth

Some of the common practices in our culture are worth questioning. As a nurse I like to keep track of health news. I am a firm believer in women learning about their bodies in order to pursue health. I have collected some articles related to women’s health.

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Verily magazine published an article, 4 Things Your Period is Telling You About Your Health That You Shouldn’t Ignore. Menstrual periods have negative connotations for us, but they are a part of a rhythm of health. It is good practice to pay attention to signs from the body. Click here to read the article.

A new documentary is being released about the risks and side effects of the pill. The film is produced by Ricki Lake and Abby Epstein and is based on the book, Sweetening the Pill by Holly Grigg-Spall. Late and Epstein also produced the film, The Business of Being Born. To read about the documentary click here.

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When I was growing up, the fundamental Finnish Lutheran Church that I attended frowned on birth control—but it wasn’t a topic for     discussion. By the time I married, it was assumed at premarital doctor appointments that a young woman would get a prescription for some form of birth control. Birth control has become routine.

When I came across an article by Chelsen Vicari, an Evangelical Protestant, I had to agree with her as she raised questions about birth control. Evangelical Protestants don’t talk about contraception. She states: It was almost as if Protestants were sworn to secrecy when it came to discussions about chemical and hormonal contraception. Is it an issue that we should seek God’s guidance for?

Vicari examines both religious views and the health risks of hormonal contraception. To read the whole article click here.

I am glad that I was able to have open conversations with my daughters. One of my daughters introduced me to the Theology of the Body as taught by Pope John Paul II.

My personal experience with home birth demonstrated to me that many women are able to give birth with a minimum of interventions. The approach to birth is different from the hospital, yet involves safe practices.

The article, 6 Things You Didn’t Know About Home Birth, gives an accurate picture of midwife practice in the home. Click here.

Linking with Titus 2sday,  Tuesdays with a Twist and A Little R & R