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Birth Healthcare Pregnancy Women's Care

Midwife360 Partners with Care Credit

Introducing Care Credit at Midwife360!

Having a natural birth at home is becoming more and more appealing as the COVID numbers grow and healthy pregnant people begin to question the automatic choice to give birth in the hospital.

However, home birth is not always covered 100% by insurance (think deductible and co-insurance) and even with Medicaid, there are some out of pocket expenses that Medicaid does not cover. With Midwife360, the lowest out of pocket amount is currently $1200 and many folks with private insurance may have to pay around $5000 when the numbers are crunched for their particular benefit plan. Our self pay rate is $6700. While even that is a small price to pay for one of the most beautiful and memorable days of your life, not everyone has that kind of cash available or even that much credit.

Enter Care Credit. Care Credit is easy to apply for and most people are approved and the staff at Midwife360 will help. It allows for a 4th option (other than cash, debit, or traditional credit card) to pay for your care without breaking the bank. Depending on the program chosen, there is an option for 6 or 12 months credit with no interest, or a low interest 24 month credit card.

Midwife360 pays a small percentage and we get paid for our services while the client gets to pay over more time for no extra cost (when choosing the no interest option).

We are happy to be able to help our clients be able to pay for their care without causing undue financial stress. Contact us today to find out more!

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Pregnancy

COVID-19 and Pregnancy

This is a crazy time that we are living in. Although it is not surprising for those who have been paying attention… mono-farming crops practices are unsustainable and factory farming of animals is inhumane, fraught with horrific abuse, torture, and disregard for the ultimate health and welfare of the animals and inevitably leads to disease and negative health outcomes for the humans who eat them. Fracking, deforestation and oil pipelines have wreaked havoc on this planet and destroyed entire ecosystems on a global scale. We have endangered the oceans by our irresponsible fishing practices and despicable habit of dumping our waste in the oceans the world. Therefore, we have seen devastating fires on multiple continents.

We have been raping and pillaging the earth for a long time in the name of technology. In the name of instant gratification and utter disregard for nature. Add to this the ability of world travel for the masses. Is it no wonder, that now we have a virulent, deadly virus that spreads so easily by simple human contact? That we are plagued by a world where we have become afraid of contact with one another. Now, paranoid that an accidental bump in a grocery store or neglecting to wear gloves when pumping gas make us paranoid that we have contracted the dreaded SARS-CoV-2 virus. And could either become deathly ill or spread it to countless others by association, or both? And we are watching the numbers of those testing positive growing by leaps and bounds to nearly 1 million cases. The US now outranks the world in a number of positive cases. NY now has as many infected people as in all of China.

A Silver Lining

It appears, however, that pregnant women (contrary to what we have seen in the past with some other coronaviruses) are not getting more critical infections than other people. Elders, those with co morbid conditions (diabetes, high, blood pressure, COPD, smokers, asthmatics and those with weak lungs, maybe those who take ibuprofen, immunocompromised people, etc) would be at higher risk of contracting a critical form of illness from this virus than otherwise healthy pregnant people. Also children, other than those less than 1 year old, are less likely to get a severe form of the illness. We don’t know how it might affect fetuses in the 1st or 2nd trimesters who are exposed in the womb. But we do know that it is not found in amniotic fluid, placentas, breast milk, or cord blood of newborns. So we believe it is not transmitted from mother to baby. If common-sense precautions – such as good hand washing and wearing a mask for a parent who suspects exposure, exhibiting symptoms, or tests positive for COVID-19 – are followed, it is unlikely that an infant who co habitats with parents immediately after birth will get a critical form of sickness.

Infant Bonding and Labor Support are Human Rights

Breastfeeding confers immunity for other contagious diseases and is usually recommended as best for parent and baby. Baby’s are better able to regulate their heart rate, respiration, temperature, and blood sugar if allowed skin to skin contact and early breastfeeding. It is a birth parents right to choose rooming-in and skin to skin breastfeeding with her newborn versus handing the baby off to be “watched” in the NICU with no evidence of ill health. Evidence-based birth has a waiver you can bring with you to the hospital if pressured to release your healthy baby for separation as a COVID-19 precaution. Let’s not separate babies from their birth parent and source of best nutrition, and healthy immune and emotional newborn response.

The other parameter to watch is the restriction of support people for the pregnant person. In my opinion, based on common sense, what we know about the human Microbiome, and the laws of infectious diseases (this one in particular as it is slowly revealing its characteristics to us) is that people who cohabitate tend to share their microbiota – good and bad ones. Close contact is how this disease spreads. Assuming most people are practicing social distancing and protecting themselves and their loved ones – particularly if they are expecting a baby into the household – the pregnant persons significant other will not increase the health workers risk any more than the pregnant person herself. In fact, we know that under normal circumstances, nurses spend about 30% of the labor with the client. Having their significant other would increase the laboring persons comfort and safety by providing constant companionship helping them to the bathroom, with position changes, and overall comfort. Let’s not just have a knee jerk reaction to isolate laboring people out of fear of the unknown.

What YOU Can Do

Please socially distance yourself other than essential contact. Don’t go to the hospital unless you are having trouble breathing. Do go to a drive-through testing site or hospital if you have trouble breathing. Wear gloves and a mask if you have one, a bandana will work in a pinch. Practice generous hand washing for 20 secs and remove clothing and shower immediately upon coming home if you’ve had exposure to unknown people. Take supplements that promote a healthy immune response, and eat responsibly to encourage and support your health. Meditate and be happy, the world needs it!

Categories
Birth Pregnancy

Natural Sacred Birth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you may ask. Because our culture has co-opted Birth, babies, and women’s bodies for the benefit of capitalism – Big Pharma, Insurance companies, and Hospitals – the Trifecta of the medical-industrial complex. That is the only reasonable explanation as Women’s bodies have been successfully birthing live babies for literally millennia – else how would we be here? Birth has only been happening inside hospitals for about one hundred years and studies have shown that it’s safer to birth outside the hospital to avoid the unnecessary interventions that lead to worse outcomes. 1,2

Doctors are taught to fear birth

Medical schools have also contributed to the situation by instilling a climate of fear surrounding Birth mostly related to potential litigation. They believe that if the doctor is taught how to control birth, then they have control over being sued. In addition, natural birth is not taught to OBs because their focus is surgery. They are surgeons; the interventions they advocate frequently lead to surgery, and this is where they shine. Obstetricians are surgeons and if you are seeking the care of a surgeon, you are likely to have surgery. Very simple.

Birth cannot be controlled

Interventions in childbirth give the illusion of control over a natural bodily function that cannot be controlled. Women’s bodies will open and release the baby inside when the body and the baby are ready. This is normal, natural childbirth in a nutshell. Even the women doing the opening and releasing have no control over the process. The only control that is possible and productive is the act of surrender to this most basic bodily function. When a woman is able to fully surrender to every aspect – when and how – then when her body and the baby are ready, it will happen. The more surrendered a woman is to the process, the more efficient it is.

Thirty-eight percent cesareans in Palm Beach County

Our community (and there are many like ours) has not embraced this principle. It is very typical for women to be induced at 38 or 39 weeks of pregnancy for a myriad of reasons. We know that when labor is induced before the body and baby are ready, then things can go wrong. The body may not fully dilate no matter how much cervical ripening is chemically encouraged or how much Pitocin is given. Often the baby will not be able to tolerate the cocktail of chemicals involved between the induction drugs and the inevitable epidural. A woman may enter the hospital wanting a natural birth, but very few are able to tolerate the torture of hours of fasting, limited mobility and abnormally strong and consistent contractions, not to mention the flow of strangers into the room, the bright lights, uncomfortable bed, etc. An epidural is the only relief she can get in the hopes of maintaining her dream of vaginal birth. Palm Beach County has an average Cesarean rate of about 38%. That’s more than 1:3 women walking into the hospital expecting a vaginal birth and ending up having surgery to have their baby!This is NOT because Birth is dangerous. This is because our community has a culture of meddling with an otherwise normal, natural process. And that meddling leads to dangerous birth.

ACOG supports VBAC

The national organizations that oversee and regulate birth providers have reasonable recommendations regarding things such as vaginal birth after cesarean and breech birth. But the local OBs tend to disregard these reasonable and evidence-based recommendations. One example of how our local OB community rejects recommendations by ACOG (American College of Obstetricians and Gynecologists, the national organization for obstetricians and gynecologists), is with VBAC (Vaginal Birth After Cesarean) candidates. ACOG recommends that doctors offer vaginal birth to women who have had 1 or 2 previous cesareans. They also don’t recommend inducing labors for VBAC candidates. Yet many OBs in our community still recommend repeat surgery for these women or insist that they birth by 39 weeks. They routinely induce VBAC candidates at 39 or 40 weeks which can lead to the very complication that they fear – a ruptured uterus. Also, there is no solid evidence that a woman with more than 2 cesareans is not a good candidate for a VBAC, but there are very few OBs that are willing to “allow” these women to attempt a vaginal birth.

ACOG supports out of hospital birth

Another example of how our community defies the national recommendations is through a document is known as The Levels of Care document that was endorsed by both ACOG and SMFM (Society of Maternal and Fetal Medicine, the obstetric specialists). In this document, it is recommended that all healthy, low-risk women birth outside the hospital in Birth Centers. If the situation changes, the woman is transferred to a higher level of care – one where the ability to perform a cesarean or other interventions such as Pitocin or epidural is available. There are even higher levels of care such as Intensive Care where caring for someone who is on life support machines is available and not all community hospitals have this option for women during or after childbirth, so she would have to be transferred from the lower level hospital to a higher one. The idea is that we have lots of birth centers, less of the community hospitals and only one or two regional centers to care for the very complicated cases. However, our local OBs do not encourage their healthy, low-risk women to birth outside the hospital. Rather, they look for reasons to elevate a woman’s risk and encourage interventions such as unnecessary inductions.

Birth is sacred

Birth is a sacred event that happens to each of us only once as we enter the world. How it happens is important for the one being born and for the one giving birth. If we are going to see a world that is healed from all of the devastations of poverty, war, climate change, and abuse it has to start with how we care for those giving birth and being born. I have grown up in my Midwifery career hearing the saying that ‘Peace on Earth begins with Birth’. We have to honor the process and respect both mother and baby by not causing pain and trauma but rather supporting, facilitating, and protecting the process. This can happen more easily out of the hospital in a woman’s home or in a birth center. However, I have not given up hope that we can shift the culture of childbirth within the hospital by spreading information and demonstrating a better way. We do this by supporting birth centers and encouraging the growth in the number of birth centers in our community.

Support the ‘birth’ of Gentle Birth Centers

I’m happy to announce the addition of a new birth center in Wellington – opening soon. Gentle Birth Centers will be teaming up with Midwife360 to create an integrated practice of home, birth center, and hospital care for healthy, low-risk candidates. We plan to open this spring and are located within a mile of the nearest hospital. Let’s change birth together!

Categories
Birth Pregnancy

Birth Your Own Way

I saw a Facebook post recently, a fundraiser, for a woman who wrote about her search for a provider who would assist her in having a vaginal birth for her 4th baby after having 3 previous cesareans. For whatever reason (VBAC ban, or just no supportive providers to be found) she moved 3 states over just to give birth with a supportive provider. It seemed from the post that they actually moved their family to that location to be in proximity to this supportive provider. Due to moving during the pregnancy, they did not have the funds to pay for the birth upfront, thus the Facebook fundraiser.

How did we get here?

How is it, in our medically advanced culture, that someone has to actually move to a different state to achieve this kind of support? I know that we don’t have supportive providers in our community here in south Florida that would support a vaginal birth for someone with 3 or more previous cesareans. Though, I know that I would support such a person under the right circumstances. Those circumstances are that the pregnant person has to be in excellent health with a healthy, otherwise low-risk pregnancy. She has to be fully committed to her birth plans, to the point of saying “I am doing this with or without you”. In other words, fully committed to the choice for an out of hospital birth.

While there is no guarantee for the outcome, an otherwise healthy low-risk pregnancy has little added risk for VBAC or other complex physiologic circumstances like twins or breech. With good counseling on risks and benefits and the understanding of the limits of any guarantees, clients should be free to make the decision to birth outside the hospital in these situations. Actually, clients should be free to make the decision to birth vaginally and should be able to access a supportive provider wherever they feel the safest – whether that is in the hospital or outside of it.

I am a provider that supports VBAC, twins, and breech for a vaginal birth.

I have found that my sister midwives are not happy that I do this. They report feeling threatened by my choices to support these births out of the hospital due to the possibility that any bad outcome would reflect negatively on the birth community as a whole. They believe that if I have a bad outcome I am giving home birth a bad name. I believe that I am giving people options they would not otherwise have. There are only about 2% of people that choose to birth out of the hospital. Most of those that choose home birth are die-hard home birthers who would not go to the hospital unless someone’s life was in danger (literally). They understand that there are no guarantees in life (or birth) and they typically have educated themselves on the risks and benefits of out of hospital birth and willingly, gladly, sign the consent waiver for home birth under complex physiological circumstances.

Enter the twins

I recently assisted a couple with twins who wanted very little prenatal surveillance, and home birth with mostly a hands-off approach. She went into labor the day she turned 40 weeks. The first baby came fairly quickly and it was the most serene beautiful water birth! Soon after, we attempted to get FHT (fetal heart tones) for Baby B and were unable to locate them for a few minutes, then when we did finally find them, they were very low – the 60s. Mom was instructed to push to try to encourage baby to come quickly, and within minutes, someone called out, “head’s out!”.

When I reached over to touch, it was obvious that it was not a head, and I tore the sac to find 2 legs unfolding into the water. I instructed Mom to get out of the tub as it was a surprise breech (baby had been head down at the last ultrasound at 28w) and I was concerned because of the low FHT. The baby then came fairly easily, but her placenta was sitting on her head and plopped out right after her – complete placental abruption. This is likely the scariest and most serious complication that can happen at home. Luckily Baby A and mom were doing well, no bleeding noted and Baby A was transitioning beautifully.

We immediately began going through the NRP steps that we learn and practice for just this eventuality. We also called 911 as a baby that requires CPR needs to be closely monitored for 24 hours in case there are further issues with the heart and breathing. The paramedics arrived within 6 minutes and by then she was only requiring breaths with the bag and mask as her heart was beating on its own at the appropriate rate.

It was difficult to watch her go without the ability to witness her recovery, but we had no choice as we still had the first baby and mom to care for. One assistant and the dad accompanied the baby to the hospital, the rest of the team stayed at the house. Ultimately, she made a full recovery. She began breathing on her own before they even arrived at the hospital, and was discharged home the next day due to a lot of questioning by and the determination of her parents. She seems to be completely normal and adjusted to life outside the womb.

This couple had 3 previous birth center births and were only having a home birth because their favorite midwife was unable to support a twin birth at her birth center. They were completely uninterested in a hospital birth. I’m pretty sure they would have chosen to birth at home with or without trained medical assistance. Had there not been someone trained in neonatal resuscitation present, their baby could have died. I wonder how our community would have felt about that?

When I help clients with a breech baby, or twins, or VBA3C or 4,5,6,7C or VBAC twins or breech, or past 42w. They tell me there’s no way they will birth in the hospital or no hospital provider will give them a chance to try for a vaginal birth. I believe it’s better to have a trained provider than for them to try a free birth and have a tragic outcome. If there’s a tragic outcome anyway, they have taken full responsibility for their choices.

Think about the big picture

However, I truly believe that our job as out of hospital birth providers is to monitor and observe the big picture at all times and identify an emergency before it becomes one in order to access the proper medical care. This means that we are alert and focused on one mom and her baby(ies) at all times during the experience. This is why we love to work with doulas. It gives us the luxury to arrive in active labor, which is the ideal time to be sharp and ready as birth becomes more imminent.

While I do not relish the added stress of caring for a more complex physiologic situation. I do believe in women’s bodies and the birth process as an inherently normal, natural process. In situations such as those with previous uterine surgery, twins, breeches, or post dates, it is unlikely that there will be any major complications if the pregnancy is healthy and otherwise low risk.

In every situation, as long as the provider is on her toes, focused and present, a major complication can be handled without turning into a tragedy. This is why I will support these clients. I wish more of my colleagues could do the same. I understand that the CPMs would be risking their licenses to do so, but this is not the case for my CNM and OB counterparts. In their case, the fear of birth and mistrust in women’s bodies limits their understanding of what is possible and safe. I have found that many people are seeking healthier living, especially when they are growing a baby. Many are super open to discussions of the importance of a healthy diet, adequate water consumption, and exercise in pregnancy, which all lead to safer birth for everyone.

Don’t judge anyone for their choices in birth. Not when they choose a repeat cesarean or even primary cesarean, and not when they choose home birth – no matter what their circumstances. Every client has their own reasons to choose what is right for them and their families. And don’t judge the providers that help them when they have a track record of good outcomes. It is better to have a trained provider present and we shouldn’t have to hide or suffer unwarranted criticism for our willingness to help.

Categories
Birth Pregnancy

What’s wrong with the Medical Model of childbirth?

Let me tell you a story…

We recently attempted to assist a client to achieve a successful home vaginal birth after 2 previous cesareans. She was a little more than one week passed her due date, and she had tried to induce her labor with castor oil. The oil didn’t seem to do much, but her water broke and she was having contractions soon after. Her labor progressed quickly, but her baby remained high in her pelvis and it took a lot of maneuvering with Spinning Babies postures (Walcher’s Brim is a great one for this problem) and the baby finally began moving down into the birth canal. 

Things take a complicated turn… 

However, after hours of pushing, seeing the head and thinking that the baby was coming any minute, she began having some bleeding. It was significant enough that the midwives elected to transfer by 911 to the hospital. All of mom’s and baby’s vital signs were good, but unexplained bleeding in a mom with 2 previous cesareans is a potentially life-threatening sign. Our job is to recognize potential emergencies and get to the hospital before the train wrecks. This momma continued to push in the ambulance, and within minutes of getting into the hospital she pushed her baby out! 

Hallelujah!!! The baby came through the door, not the window! 

But wait…The baby was a bit shocked, but instead of allowing him to get his full placental transfusion and administering PPV (Positive Pressure Ventilation)* with a bag and mask to help the baby inflate his lungs, they immediately cut the cord and rushed him over to the warmer to tortuously stimulate him into taking his first breath. I had a hard time watching the video due to the roughness and lack of respect afforded this brand new being. 

How does this impact our society?

For the nurses and midwives on duty, it is just another case, just another hour in their day. However, for that baby, it is his BIRTH. That happens to every one of us just ONCE in this life. We clearly do not appreciate the importance and significance of this event for our species. I am frightened to see the future generations coming up in the world when they have embedded in their primal memories this episode fraught with pain and fear and separation from the source of their sustenance. We are not building generations of people who will have love and trust as their core values. Else wise we must figure out how to overcome a beginning like this. Prolonged skin to skin contact with both parents initially and prolonged on-demand breastfeeding with baby-led weaning will both go a long way to repair the damage.

Hospital L&D should be a place that all women feel comfortable, respected, and supported… The other thing that really bugged me about this experience is that when the midwives showed up (they followed the ambulance), they were greeted by a seasoned L&D nurse who was shaking her head and clearly upset by the situation. She said something to the effect that the client is an RN at their facility, and that she should have known better than to attempt a home birth. Really!?!?! Excuse me, but maybe your facility should do a better job at supporting women with their choices so they wouldn’t see home birth as their only option. 

We at Midwife360 would be happy to encourage our VBAC moms to birth in the hospital. We acknowledge that it is the safest place to be for someone with a complex physiologic pregnancy. We also believe that the way someone is treated during their pregnancy, labor, and birth will have far-reaching consequences for them, their baby, and their entire family. It can mean the difference between having postpartum depression or not. It can mean the difference between successful breastfeeding or not. It can mean the difference between having a vaginal or cesarean birth. On an individual level and ultimately on a societal level, these things matter!

What’s wrong with the NICU?

The next situation evolved because the baby had a ‘lesion’ on his head. It was in such a position that it was likely caused when he was trying to get under her pubic bone and the length of time that he was in the birth canal. Neither parent had a history or tested positive for herpes – which is what the hospital providers were worried about. They started the baby on an antiviral, and on an antibiotic, since mom was GBS positive and had received her antibiotics just shy of the 4 hours recommended by the protocol. The baby was not sick and had no abnormal WBC (white blood cell) nor a positive culture. They insisted on performing a spinal tap for this well-baby because they were sure he had herpes somewhere that was gonna kill him. The mom knew her baby was fine, but every time she said she was taking her baby home, the nurse practitioner would tell her that her baby could die. This baby spent 10 excruciating days in the NICU and received multiple doses of antivirals and antibiotics, with multiple IVs in his little body, and endured a spinal tap – FOR NOTHING! A huge NICU bill later for a normal baby with a skid mark on his head. I believe we can do better in our hospitals. 

What can we do? 

Expose the neonatologists who up-sell services for healthy normal newborns and get evidence-based care into standard practice. We must not stand for this any longer! This family was so relieved and ecstatic for the vaginal birth they knew was possible, only to be traumatized and beaten down by having to advocate and protect their new baby. It doesn’t have to be this way! It’s up to individual parents who have these types of experiences to write letters and submit evaluations of their experience to the hospital and local media. Also, seek out respectful maternity care and demand respectful newborn care as well. We as a society can do better for our pregnant people and newborn babies!

*This is giving the baby breaths with the bag and mask and is the first step in neonatal resuscitation. 5 long slow breaths.

Categories
Birth Pregnancy

Natural Birth After C-Section

Can I have a vaginal birth if I already had a c section?

The short answer is, “YES! YOU CAN!” While the long answer requires a conversation about various risks – risks of a VBAC, or vaginal birth after cesarean, AND risks of repeat surgery. Unfortunately, it is the second set of risks that are routinely left out of the conversation when you speak with a hospital provider (OB or CNM) about it. And, also, unfortunately, these same providers often offer the VBAC and then find a reason at the end of the pregnancy that either induction of labor is ‘necessary’ (not the best plan for a successful VBAC) or a repeat surgery if the pregnancy goes beyond 39 or 40 weeks. 

Where can I have a successful VBAC?

This drives many women to seek an out-of-hospital birth provider for their planned VBAC, even though everyone agrees that the hospital is the best place due to the easy and quick access to emergency services. Since VBAC is prohibited in Birth Centers, this leaves home birth as the only option. And home birth is not for everyone. It is certainly not the best idea for someone whose main reason for choosing it is to avoid the hospital. It is always better to run towards something rather than running away from something. In other words, the choice to have a home birth should be driven by the desire to have your baby in the comfort and safety of your home, not by the fear of the hospital.

Successful home birth requires dedication and preparation

We have seen a situation like this where the client chose to have her baby with us because of her fear of having another c section and her inability to find a hospital provider who would support her decision to birth vaginally. She did not have a doula or take a birth preparation class. (These are 2 of Midwife360’s 3 keys to successful, efficient birthing. The 3rd is using the birth tub.) Consequently, she was unprepared and unsure when her labor did start, and did not request the midwife presence in a timely manner. She birthed on the toilet and her baby actually went into the toilet! They had the midwife on the phone throughout the process and she was able to guide them verbally (the part about the toilet came out later!) and everything turned out well. 

This is an example of how normal the process is for most people – even those who have had previous c sections – and for most babies. Babies are resilient and born to survive and know how to start breathing with little to no help in most cases.

Most predictions by OB providers are wrong

“Your baby is breech, and even if it turns, your pelvis is too small to push. There’s an 80% chance you’ll have to have a c section if you try, and then it would be an emergency surgery, which is more dangerous. So let’s just schedule the c section as this will be safer.”

I’ve heard this same speech from many clients over the years. This particular client told us this story of her first birth – the baby turned out to be 5#5oz. When she got pregnant the second time, they said she would have to have another surgery – it would be safer, they said. “But my mom had a c section and then pushed my brother out right after – he was over 10# – can’t I at least try?” “No”, they said, “it’s not safe”. There was no discussion of the risks of surgery, all focus is on the risks of trying a vaginal birth.

You can do it!

When this woman got pregnant a third time, she knew that she could birth her baby vaginally. She drove an hour away from her home to find a provider that believed in her and would support her. And although she did not take advantage of the 3 keys to success, (she used the birth tub only), she was so determined and dedicated that she was able to adequately prepare herself mentally for the big day. She was able to birth an 8#3oz baby vaginally in the birth tub with her sisters, husband, mother-in-law, and daughters all present and cheering her on! She pushed for over 2 hours, but barely tore and the baby came out quickly with no problems.

Our bodies and our babies are made for birth

When will OB doctors and other birth providers stop telling women what their bodies cannot do? Women are created with the social imperative to create life and deliver it to the outside world. Among many other things, we are very well designed birthing machines! If you didn’t know this already, then you do now!

Be empowered, be informed, stand up for yourself and your baby!

Categories
Healthcare Pregnancy

Call to Action

My name is Fadwah Halaby and I am a certified nurse midwife serving families in Palm Beach and Broward counties. I offer well-woman care with a holistic touch as well as pregnancy and birth services with birth in the clients home. This is a choice that any woman can make and a viable option for all low risk, healthy clients and even with some that have a more complex physiologic pregnancy – such as previous cesarean, twins, or breech.

Pregnant people have human rights too!

The bottom line is that we all agree that everyone should have certain rights by virtue of being human – we call them human rights. And these rights are repeatedly denied to many pregnant women because her care provider has decided:

  • that he or she is not comfortable with a given situation
  • has decided on a particular course of action
  • is determined to force the client to comply

This has gone so far in some cases as getting a judge to order a forced cesarean surgery by deeming the client incompetent to make decisions for her own body and that of her baby. It is ludicrous to imagine that a person who has conceived and grown a baby in their womb for 40 weeks does not have the best interests of that baby in mind when making decisions regarding the birth of the baby. No one has more of a vested interest in that baby than that pregnant person. And no one has more of a vested interest in the woman’s body than the woman herself. We have a right to choose to birth at home, in a birth center, in the hospital or anywhere else a person would choose to birth. This is a basic human right and is upheld in the laws and rules of our state.

What is not supported by our laws and rules is the right of that pregnant person to have the trained and licensed provider of their choice attend to them in any of these settings.

Nurse Midwives are trained to practice independently

As a certified nurse midwife (CNM), I am trained and licensed to attend to women in any of these settings. I have maintained hospital privileges without any negative incidents for more than 8 years and over 1600 births. Yet now that I am attending to women in their homes, I am not allowed to continue to care for them should they require a transfer to the hospital either before or during labor. ACOG (American Congress of Obstetricians and Gynecologists, the OB/GYN national organization) recognizes women’s right to choose their place of birth and makes a recommendation that if a woman wants to birth at home she should be a healthy, low-risk candidate, choose a CNM to attend her, and birth in an integrated environment. [ACOG Committee Opinion on Home Birth] And this, my friends, is the missing piece of the puzzle. The lack of integration makes out of hospital birth less safe for everyone.

Transferring from home to hospital is fraught with anxiety for both clients and home birth care providers

How many times have you heard stories of “train wrecks” – home birth transfers to the hospital when things have gone far past the point of being OK? Midwives dropping clients off at the door or not participating in the transfer at all are tales that are told by hospital personnel about home birth transfers. It is true that the out of hospital provider is bound by duty to shift location to the hospital once they feel that it is no longer safe to be at home and if it is for an emergent reason, then the 911 system should be employed to make the transfer. If it is for a non-emergent reason (as 90% of home to hospital transfers are), then the transfer can happen by private vehicle. In both cases, the hospital should be alerted and records sent ahead to facilitate care for the client and to give the receiving provider as much advance information as possible. The provider should accompany the client and be prepared to give a concise report of the relevant details and reasons for the transfer. This is considered a hand-off and according to JCHAO [Joint Commission for Hospital Accreditation] is where most critical incidents happen.

One solution

Giving APRNs (Advanced Practice RNs or Nurse Practitioners) the ability to practice to the extent of their training (why are we being restricted from that in the first place?!) would make this situation much safer. By allowing the clients chosen provider to be a member of the team once the transfer to the hospital becomes necessary. I have not been able to maintain hospital privileges, not due to any malpractice or incidents. This is purely due to not having an obstetrician who doesn’t have a financial stake in me or my practice being willing to “take responsibility” for my actions. Really, why should anyone else take responsibility for my actions?

I am trained to work to the extent of my scope of practice like any other healthcare provider. To make decisions, prescribe medications and tests and to interpret those results and determine when consultation, co-management, or referral is necessary. LIKE ANY OTHER HEALTHCARE PROVIDER. There is no worry that OBs will start trying to treat people for heart failure – they would refer to a cardiologist. If they try to work outside their scope of practice, then they are appropriately reprimanded or relieved of their license to practice. We understand that we would be held to the same standards. However, to require me to find a doctor willing to take responsibility for my work and to require that they sign my application for hospital privileges places an undue burden on me and is effectively restraint of trade. This has to stop now.

Please support Senate Bill 972 and HB 871 to increase the number of health care providers and contribute to reducing the costs of health care. Reach out to your Senator and Legislator with a postcard, email, and/or phone call today! Click here or below to find your elected official now.

Categories
Birth Pregnancy

High-tech Childbirth is Not Always Better

America excels in high-tech medicine

When it comes to healthcare and medicine, America is the greatest country in the world. If you get into a car crash or have a heart attack, or need a life-saving surgery, then you are very grateful to have that happen in the US of A. However, this statement is not true if you are pregnant and healthy. It is well known that the US scores shamefully low on the two standards used worldwide to evaluate how well a country is doing in the area of childbirth – infant mortality and maternal mortality. And it’s not a mystery as to why this is the case. We know that the standard interventions performed on pregnant women in the hospital on low-risk, healthy moms and babies are not evidence based. Withholding food and fluids by mouth.  Limiting movement and positioning in labor.  Use of continuous fetal monitoring for low risk labors.  Non-medically indicated inductions.  Immediate cord clamping.  Overuse of Pitocin for labor augmentation. All of these standard interventions can lead to perceived and real problems that trigger the cascade of events leading to an operative delivery – forceps, vacuum extraction, or cesarean (and occasionally a cesarean with forceps or vacuum delivery!).

Low-tech better for physiologic childbirth

When it comes to childbirth, high tech is not better than low tech. I have been privileged to attend many out of hospital births and many more in hospital births. Even a ‘normal’ birth in the hospital typically comes with continuous fetal monitoring and epidural. And unless it is the middle of the night and the lights are kept dimmed, the nurses use intermittent monitoring, the cord is left alone for at least 10-15 minutes, and the baby is kept on the mother AT ALL TIMES, no hospital birth worker has truly witnessed natural birth. There are many, many videos of home birth on the internet and it can be seen time and again the beauty and wonder of birth as it is meant to be.

Out-of-hospital birth should be first-line care for all low-risk childbirth

We have such great prenatal care standards, that any significant problem with the mom or the baby will most likely be detected prior to labor so that a baby that may need more high tech assistance can be born in a place where she can receive that assistance in a timely manner. It is so unlikely that a healthy mom and baby will have a major life-threatening problem during the birth process, that out of hospital birth and midwifery have been approved through legislation in most states. And statistics have proven that most transports from an out of hospital setting are done for non-emergent reasons. The American Congress of Obstetricians and Gynecologists have suggested that the out of hospital Birth Center should be the first level of care for healthy pregnant women. They recommend only moving up the chain to a hospital capable of performing a cesarean if there are risk criteria that have been demonstrated.

Low-tech interventions for childbirth

So that means in order to fix the problem, more doctors need to be trained in the low tech hand skills that are truly helpful to laboring women. These include Leopolds maneuvers (feeling the baby from the outside to determine it’s position), which, when performed properly, can assist the provider to be able to tell not only the baby’s position but if there is adequate fluid around the baby. Keeping hands out of the way other than to provide warm compresses during the actual birth. Turning a breech baby to avoid a breech delivery. Even being able to perform a breech delivery – these are skills that are slowly being lost to us because they are not being taught in medical schools. And delayed cord clamping is probably the single most important non-intervention that can be supported at a birth! We have been complacent, and have allowed an intervention – immediate clamping and cutting of the umbilical cord (that typically happens in the course of surgical birth) – to become standard of care for all births without studying the effects. It is part of the OB culture and doctors and CNMs are taught to do it without question. This is what happens when you put surgeons in charge of a physiological event.

Women’s complacency has really been the main cause of our loss of control over our bodies and our labors. It is time for us to stand up and reclaim our bodies, our labors, and our births. Support your local midwife, demand respect and evidence based care. Maintain a healthy lifestyle and prepare yourself for an out of hospital birth – it will transform your life!

Categories
Pregnancy

Birth Similar to Love Making?

Pregnant couple relaxing on bed at home

Birth Similar to Love Making?

Pregnant couple relaxing on bed at home

Birth Similar to Love Making?

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Many of my clients ask about birth control options that do not have hormones. There are a few, mostly they are the barrier methods like condoms (male and female), diaphragms, and cervical caps, or surgery. But the copper IUD is the only one that is long term and reversible and does not have any hormones. Since the copper IUD is not the only long term, reversible contraceptive, I wanted to break it down here for you.

Natural Sacred Birth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you

What to Expect From a Home Birth

So you’ve decided to have your baby in the comfort of your own home. What should you expect? As a CNM who has provided home birth services for nearly 6 years, I am going to provide you with an overview of the general expectations that await you in this experience.

I believe that giving birth is similar to making love.

Normal, low-risk childbirth is very difficult to achieve in the hospital setting. Even when you have the most amazing provider, the very atmosphere prevents it. I believe the reason for this is related to the fact that childbirth is similar to making love. It’s not really such a wild idea if you think about it like this… For most people with a natural pregnancy, lovemaking is the act that starts the whole process. Pregnancy ensues and the body nurtures and grows the seed into a baby and through the maturation process until the appropriate time to release it into the world.

There is believed to be a multifactorial triggering process that is not well understood. However, it is common knowledge that once it gets going, labor responds well to dim lighting, quiet surroundings, and the soothing, loving support especially from the birthing person’s partner. Sound familiar?

What doesn’t work

When frightened, our mammal cousins have been known to stop their labors in order to move to safety. The same is true for humans, which is why there is an epidemic of Pitocin in use in most hospital Labor and Delivery units around the world. Normal labor does not respond well to bright lights, loud noises, and strangers. This has been discussed at length by obstetric greats such as Grantly Dick-Read and Michel Odent – both ardent proponents of unmolested birthing. Imagine trying to make love and achieve orgasm with all of that activity going on around you!

Your Partner

Another parallel between love-making and childbirthing has to do with the birthing person’s partner. Of course, the partner is included and involved with all aspects of the process as they were an integral part of making it happen. (What other hospital-based care takes place with the ‘patient’ AND their partner? No surgical procedures or any other procedures are a family event unless it’s a small child who needs a parent present for comfort.) In the majority of cases, the partner was present and responsible for planting the seed, and therefore is integral to the birthing process.

They have a bond in their union making the partner the one unique person in the room who is intimate with the birthing person. When the partner lovingly strokes and massages, whispers loving words of encouragement and is just completely present to the process, it causes the birthing person to release oxytocin which in turn causes the labor to intensify. Also, just like in love-making, the need for single-minded concentration is paramount to achieve the level of trust, openness, and surrender that is necessary for birth to happen.

Uncomfortable & Fearful

The combination of poorly designed rooms and standard interventions that are not evidence-based has created the need for using a dangerous drug on nearly all normal labors! When birthing people are not comfortable or if they are fearful, they will not be able to achieve the level of relaxation and focus required for efficient birthing.

Pitocin

Pitocin is the synthetic version of oxytocin – also known as the ‘love’ hormone. It is produced by our bodies when we hug another person (or animal) or make love, and it is this hormone that causes the uterus to contract and expel the baby.

We have discovered that we can give the synthetic version to pregnant individuals to start labor or make contractions stronger and closer together. But it is not without risks. It is a dangerous drug that can cause contractions that are too close together and too strong creating distress for the baby.

Pitocin is the reason for many emergency cesareans in labor. Having Pitocin creates the need for other non-evidence based interventions such as continuous monitoring and IV which in turn lead to another non-evidence based intervention – immobility, being stuck in the bed, usually on the back – all of these being extremely unhelpful to the laboring person. Another downside to Pitocin is the accompanying liters of IV fluids that the laboring person tends to receive.

It is not uncommon for someone to get 4, 5, even 6 liters of fluid during an induction, especially if they elect to get an epidural. All of this fluid can cause swelling and difficult breastfeeding due to the extreme engorgement that occurs. So instead of giving a dangerous drug to augment labor when people come into the hospital, why not redesign the physical space to encourage natural labor to do the job?

Let’s change things

We have birthed successfully without Pitocin for millennia before birth entered the hospital in the early decades of the 1900s. Let’s alter the external physical space and encourage practices that support the human body and psyche to birth naturally. The only people who require drugs to enable lovemaking are those with hormonal imbalances, it should be the same for normal, low-risk childbirth.

I propose that labor and delivery units set aside a block of rooms with dimmers on all the light switches, electronic candles sprinkled throughout the room, handheld dopplers for intermittent monitoring, multiple options for hydrotherapy including showers big enough for 2 people and a birth ball or shower chair and labor/birth tubs. They should have a welcoming attitude for partners and doulas; no standard IV or continuous monitoring; and healthy snacks. I believe that providers would find less of a need to augment labors and we could reduce our overall cesarean rates while improving client satisfaction.

Share:

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Facebook
Share on twitter
Twitter
Share on pinterest
Pinterest
Share on linkedin
LinkedIn
On Key

Related Posts

COVID-19 and Pregnancy

This is a crazy time that we are living in. Although it is not surprising for those who have been paying attention… mono-farming crops practices

Midwife360 and the Scoop on IUDs

Many of my clients ask about birth control options that do not have hormones. There are a few, mostly they are the barrier methods like condoms (male and female), diaphragms, and cervical caps, or surgery. But the copper IUD is the only one that is long term and reversible and does not have any hormones. Since the copper IUD is not the only long term, reversible contraceptive, I wanted to break it down here for you.

Natural Sacred Birth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you

What to Expect From a Home Birth

So you’ve decided to have your baby in the comfort of your own home. What should you expect? As a CNM who has provided home birth services for nearly 6 years, I am going to provide you with an overview of the general expectations that await you in this experience.

I believe that giving birth is similar to making love.

Normal, low-risk childbirth is very difficult to achieve in the hospital setting. Even when you have the most amazing provider, the very atmosphere prevents it. I believe the reason for this is related to the fact that childbirth is similar to making love. It’s not really such a wild idea if you think about it like this… For most people with a natural pregnancy, lovemaking is the act that starts the whole process. Pregnancy ensues and the body nurtures and grows the seed into a baby and through the maturation process until the appropriate time to release it into the world.

There is believed to be a multifactorial triggering process that is not well understood. However, it is common knowledge that once it gets going, labor responds well to dim lighting, quiet surroundings, and the soothing, loving support especially from the birthing person’s partner. Sound familiar?

What doesn’t work

When frightened, our mammal cousins have been known to stop their labors in order to move to safety. The same is true for humans, which is why there is an epidemic of Pitocin in use in most hospital Labor and Delivery units around the world. Normal labor does not respond well to bright lights, loud noises, and strangers. This has been discussed at length by obstetric greats such as Grantly Dick-Read and Michel Odent – both ardent proponents of unmolested birthing. Imagine trying to make love and achieve orgasm with all of that activity going on around you!

Your Partner

Another parallel between love-making and childbirthing has to do with the birthing person’s partner. Of course, the partner is included and involved with all aspects of the process as they were an integral part of making it happen. (What other hospital-based care takes place with the ‘patient’ AND their partner? No surgical procedures or any other procedures are a family event unless it’s a small child who needs a parent present for comfort.) In the majority of cases, the partner was present and responsible for planting the seed, and therefore is integral to the birthing process.

They have a bond in their union making the partner the one unique person in the room who is intimate with the birthing person. When the partner lovingly strokes and massages, whispers loving words of encouragement and is just completely present to the process, it causes the birthing person to release oxytocin which in turn causes the labor to intensify. Also, just like in love-making, the need for single-minded concentration is paramount to achieve the level of trust, openness, and surrender that is necessary for birth to happen.

Uncomfortable & Fearful

The combination of poorly designed rooms and standard interventions that are not evidence-based has created the need for using a dangerous drug on nearly all normal labors! When birthing people are not comfortable or if they are fearful, they will not be able to achieve the level of relaxation and focus required for efficient birthing.

Pitocin

Pitocin is the synthetic version of oxytocin – also known as the ‘love’ hormone. It is produced by our bodies when we hug another person (or animal) or make love, and it is this hormone that causes the uterus to contract and expel the baby.

We have discovered that we can give the synthetic version to pregnant individuals to start labor or make contractions stronger and closer together. But it is not without risks. It is a dangerous drug that can cause contractions that are too close together and too strong creating distress for the baby.

Pitocin is the reason for many emergency cesareans in labor. Having Pitocin creates the need for other non-evidence based interventions such as continuous monitoring and IV which in turn lead to another non-evidence based intervention – immobility, being stuck in the bed, usually on the back – all of these being extremely unhelpful to the laboring person. Another downside to Pitocin is the accompanying liters of IV fluids that the laboring person tends to receive.

It is not uncommon for someone to get 4, 5, even 6 liters of fluid during an induction, especially if they elect to get an epidural. All of this fluid can cause swelling and difficult breastfeeding due to the extreme engorgement that occurs. So instead of giving a dangerous drug to augment labor when people come into the hospital, why not redesign the physical space to encourage natural labor to do the job?

Let’s change things

We have birthed successfully without Pitocin for millennia before birth entered the hospital in the early decades of the 1900s. Let’s alter the external physical space and encourage practices that support the human body and psyche to birth naturally. The only people who require drugs to enable lovemaking are those with hormonal imbalances, it should be the same for normal, low-risk childbirth.

I propose that labor and delivery units set aside a block of rooms with dimmers on all the light switches, electronic candles sprinkled throughout the room, handheld dopplers for intermittent monitoring, multiple options for hydrotherapy including showers big enough for 2 people and a birth ball or shower chair and labor/birth tubs. They should have a welcoming attitude for partners and doulas; no standard IV or continuous monitoring; and healthy snacks. I believe that providers would find less of a need to augment labors and we could reduce our overall cesarean rates while improving client satisfaction.

Categories
Pregnancy

Creating Value in Childbirth

Costs of Care Creating Value Challenge

In 2007, the Institute for Healthcare Improvement (IHI) proposed a framework for optimizing health system performance known as the “triple aim”. The three components are:

  • Improve the experience of care
  • Improve the health of populations
  • Reduce the per capita costs of healthcare

At Midwife360 we hit the bullseye on all three! Now, where is that friendly OB who wants to play with us?

It’s time to apply the IHI triple aim to childbirth!

It is well known that the American childbirth culture is very expensive with very poor performance AND little of what happens to birthing people in hospitals is evidence-based.

Childbirth for low-risk healthy women (who comprise the majority of people giving birth) benefits from less, rather than more technology. It is, after all, the only physiologic human function that has been relegated to hospital care. Achieving good outcomes usually goes hand in hand with a positive experience of care and this can be done in a very low-tech, inexpensive way by creating teams of home birth midwives and OBs.

Comfort is key

ACOG approves of home birth under certain conditions – choosing the appropriate client, with a CNM, in an integrated environment. As giving birth is much like making love, it is easier to imagine this happening in an environment where the birthing person feels the most comfortable – whether that be her home, a birthing center, or a hospital. So creating a culture that truly supports choice for birthing people without removing the option of access to a higher level of care can be accomplished by having a care team of a homebirth midwife and OB with hospital privileges.

Recreating home

Short of that, making hospital labor rooms more homelike – dimmers on the main lights, several options for water immersion (large shower, birthing tubs), small refrigerators in the room, and a second bed for family members or the doula to use – and updating care to reflect the evidence and patient preference are all absolutely necessary to achieve the IHI triple aim.