Blizzard Baby of 2010...reflections from Christy a year later

I had the pleasure of being at Anjali Dyen's first birthday party today with Itzela. In reflecting on parents Madhavi and Jeremy's journey to birthing their daughter and my experience at their labor I realized I never posted the links to their accounts of the birth on their very comprehensive and enviable blog about their life with Anjali. So I wanted to share the links to their stories here so folks could check it out: Anjali's birth as told by her mama

Anjali's birth as told by her papa

and also share a bit about my personal experience as Madhavi gave birth to Anjali as it related to my own experience of labor and birth.

As most if not all of folks reading this blog know, I ended up having to have a medically necessary C-section with Itzela due to her having an unusually short cord that prevented her from being born safely vaginally after several days of labor. As one might imagine, this was especially challenging for me having been to hundreds and hundreds of homebirths and then to not get to feel my little one move down through the birth canal into my awaiting arms. I was so excited about pushing my baby out and truly mourned not having that experience (amongst many other things related to the C-section experience).However, I was also so profoundly grateful that Itzela and I were both safe throughout the whole experience and so thankful to live in a place where we have access to the best of both worlds in terms of hands-off, holistic midwifery care and high-tech, high-risk obstetric care.

When Madhavi was pushing at the end of her lovely Hypnobabies labor she was very connected and drawn to me, both physically and spiritually. As we made our way down the hallway towards the shower (which as you'll read in their stories we never made it in to the shower!) Madhavi's full moon belly was pressed tightly against my own stomach and chest. As each birthing wave came rolling through her body and Madhavi pushed, I could feel the baby moving down almost as if she was inside of me too! And then with the final wave before the head was born I felt the little one push off with her feet from the top of the uterus to help propel herself into life on the outside of the womb. It was quite a profound and moving moment for me as I realized that it was the closest thing I was going to experience to that last part of labor and birth while Itzela was still a little baby. You see the spring before I had taken a training in Cranialsacral Therapy for Newborns and Infants and the teacher, Carol Gray, had taught the midwives in the course in great detail about the efforts babies make in-utero to help themselves be born and we did exercises with little newborns recreating their birthing journeys in our arms to work through their births and saw those pushing efforts. For most of us the specifics of the baby pushing off the wall of the uterus to help move down through the birth canal was new fascinating information and really memorable, so it was amazing both as a midwife and a mama who had given birth by C-section to experience those sensations in that moment with Madhavi and Anjali. It was truly a gift and an important step in my healing from my birth experience.

Madhavi was standing leaning on me when the baby was born. I swear I even felt the sensation of the placenta started to detach as the baby was born from being belly to belly with the birthing mama, so I wasn't surprised when Meredith, who along with papa Jeremy had lovingly received the baby  on the floor below us, let me know their was a separation gush immediately after the baby was born and the placenta was coming. It was wild to feel that from the bodily perspective of the mama but to know what was going on physically, both because I'm a midwife and I wasn't in laborland!

I recognized that something special had just happened to/within me and tucked that feeling away for the moment  and worked hard to stay present as Madhavi's midwife for the next bit of time. Once we had tucked the sweet family in to their bed, I whispered to Meredith I needed to go downstairs for a few minutes. Itzela was just under 6 months old when Anjali was born and was in the house with me during the birth. It was the day after a huge blizzard last winter so Martin and Itzela both came so I could nurse since it would have been very hard for Martin to get back and forth with the baby in such weather. I went downstairs and shared the significance of the experience I had just had with Martin and held Itzela tight and had a healing, happy cry with my own family before going back to tend to the new family upstairs. I could tell that experiencing those sensations with Madhavi and Anjali was going to help me move forward in my healing journey.

We just never know what gifts we will be given in this work and I was reminded of that today being with this lovely family a year later! Thank you to Madhavi, Jeremy and Anjali for that blessing! Happy Birthday Anjali! Happy celebration of your Giving Birth Day to Madhavi and Jeremy!

The third December full moon baby!

Callie called early in the morning to let me know that she thought her labor might be brewing. Definitely having some new sensations with contractions, but no regular pattern yet.  She wondered if now was the time to alert her and Phil's dear friends from Missouri who were planning to drive to Philly and be here for the birth, or if it was too early.  "I know it could still be a couple of days once things get started," she says.  With beautiful baby Elliott making her arrival by lunchtime, it's funny to think that we thought it might be days! When I first arrived Callie was leaning over the bathroom sink with Phil squeezing her hips, moaning, and she looked at me between contractions and said seriously: "I think this is going a lot faster than we thought."  There was no doubt in my mind from the moment I walked in the house, so I started setting up my equipment right away.

A few minutes later, Callie turned to me again and said, "Just so you know, I'm starting to push a little bit-it just feels right." At which point I called Christy who raced over to join us as well as doula Mayumi Miller. Rarely do we have a first time mama whose labor goes so fast!

Callie spent most of her short and intense labor on her hands and knees by the side of the bed. Phil was by her side squeezing her hips when needed,  whispering encouraging and loving words, and being an amazing presence and witness to the miracle unfolding. Callie's mom, who came to be with them postpartum, marveled at how beautiful and calm the whole environment was in their home... indeed it was that way through the pregnancy and birthing as well.

At the end of her labor, Callie moved from the floor where she had been crouching down to the bed. Soon the baby began to crown, and when her head came out, Elliott turned all the way around, sputtering and making noise, to look straight up at us.   So special for Callie to be able to look down towards her baby looking up at her, while the rest of her body was still inside.  We all just stared in awe and delight...each birth is so unique.

And just a month after 7lb 3oz baby Elliott Ama Magdalene's arrival, Callie gets ordained as an Episcopalian priest...an achievement that was much more than 9 months in gestation.  Congratulations, Callie & Phil!

Bienvenido a Tara Alegría

Ivette and Steve were considering switching to a home birth late in their pregnancy and after coming to the fall potluck for Motherland families, they were convinced this approach to not only birth, but prenatal care, parenting and community was what they were seeking!

Like almost every first time mother, Ivette was surprised by the intensity of the rushes of labor but with support from her husband Steve, and Meredith and Christy, Ivette was able to shift in her experience of the rushes and draw upon her meditation practice to help her ride the waves of her labor.

Ivette shared with us that "your invitation to talk about my feelings and fears, was very important as well as the massages, the tenderness from all of you, your care in cooking meals, offering drinks, all of that was amazing!"

She and Steve were so beautiful in their connection and in their intention to be present in welcoming their daughter. Labor had begun with her water bag breaking and it seemed like the baby's head wasn't in an optimal position for stimulating strong contractions for that last few centimeters of dilatation. After more than 30 hours at home in the tub, out for walks, salsa dancing with her midwives, resting and doing some home approaches to increasing the frequency and duration of her contractions, we all decided it was best to go to the hospital for some rest and the judicious and appropriate use of Pitocin to help Ivette have a vaginal birth. We were blessed to be able to transfer to an area hospital under the care of the Certified Nurse-Midwife on-call who is an old friend of Christy's. The midwife gave Ivette a big hug and a smile as we arrived and we all knew it was going to be ok. Ivette got some rest and with the pain relief and Pitocin quickly proceeded to being fully dilated. We asked for the epidural to be turned down and Ivette was amazing at pushing her baby. It was so wonderful when Ivette exclaimed, "I can feel her moving down!" as the epidural wore off and she could really connect with the pushing and fully experience the gentle birth of her baby girl. Tara Alegría weighed 7 lb 12 oz and was present and alert from the first moments of her life. As we do with all our clients who have to transfer from home, we did all our home postpartum care and it was a true reminder of how wonderful it can be when homebirth midwives and hospital midwives, nurses and doctors can collaborate for the health and happiness of the mother, baby and family!

Full moon baby Aine-fast, furious & on her due date!

The full moon/lunar eclipse/winter solstice energy brought Motherland Midwifery a bunch of babies this year--three in 36 hours! It was Natalie's due date, December 20th, and she felt a pop and small gush of pinkish fluid at 6pm--would this baby come right "on-time" instead of a week or more "late" like her other two?  We chatted on the phone and I was wrapping up a homevisit in the neighborhood so decided to stop by and check-in.

Little did any of us know that baby Aine Siobhan (called Annie) would be born less than 2 hours later! I had left my equipment and headed home to put away groceries and nurse my baby to sleep thinking I'd be back in a few hours after big brother Connor and big sister Cara went to bed. But the contractions picked up like crazy right after I left and I turned around part-way home and raced back to Natalie and James' house with midwife Jane Cruice on her way to be there too.

Natalie was clearly in a very intense labor and seemed close to birthing when I arrived. Sure enough she started pushing and her 7 1/2 lb girl was born at 7:30 pm! What a whirlwind! It was a big of a shock for us all--especially Annie and Natalie and doula Jodi who arrived a bit after the baby. We all recovered as the family nestled in bed with their early Christmas present!

Baby Mose...the first of the full moon, solstice babies!

The full moon, lunar eclipse, winter solstice in December brought a bunch of babies this year. Three little ones in our practice were born within 36 hours and Anne was the first!

Anne, JD and big sister Tova welcomed little brother Mose to the world on December 19, 2010. Mose weighed in at 7lb 10 oz and he arrived on his own timeline. After a fast and furious first labor with her daughter, Anne experienced a very different pace this time as her labor began with the pull of the full moon breaking her waters for quite some time before active labor began.

She really welcomed and enjoyed the contractions as they came and worked beautifully and patiently with her baby, body and husband to birth her son right into her arms. Apparently only one layer of Anne's water bag had broken as Mose was born with the inner layer of the bag intact! We had to peel it off his face when he was born!

After the baby was out and settled in to bed to nurse, Anne and Tova sang him a song they had practiced--it was just so sweet and so perfect! The family is very glad they chose a homebirth this time around so they could let Anne's body take its time with moving into labor and having such a gentle birth and beginning for their son. Congratulations!

Baby Finnian is born!

Winter is Jess and Nathan's baby season--all their babes were born in the month between December 3rd and January 3rd! On December 3, 2010 Jess had her third homebirth and her third baby with Christy having the honor of receiving the new life into her hands! First one standing in the bathroom, second one in the birth tub, and this big guy came out with mama on hands and knees!

Jess was beautiful and strong and focused as she birthed her 10 lb 7 oz son, Finnian Emmett Kayleo Waggenbeek with his dad Nathan and Oma Susan and midwives Christy and Meredith there to welcome him! She had to push him out all the way to his toes with his sweet and chubby body. Big brother Otis helps Christy cut the cord and big sister Sadie joined us soon after to meet her little baby brother! Finn was a great nurser from the start and is growing like a champ so he can keep up with his siblings.

It is always extra sweet to be with a family for multiple children and especially with someone who is such a dear friend as Jess. I love you Mama! Thanks for inviting me to be part of your growing family!

Ultrasound

What is Ultrasound?

Ultrasound is like ordinary sound except it has a frequency (or pitch) higher than humans can hear. When sent into your body from a transducer (probe) resting on your skin, the sound is reflected off internal structures. The returning echoes are received by the transducer and converted by an electronic instrument into an image on a monitor, similar to a television screen. These continually changing images can be recorded on videotape or film. Diagnostic ultrasound imaging is commonly called sonography or ultrasonography.

Who Will Perform the Examination?

The examination is usually performed by a specially trained health care professional called a sonographer. A series of images will be recorded by the sonographer. These images will then be interpreted by a doctor. In some cases, you may be examined by a doctor to confirm or resolve uncertain findings.

Will the Ultrasound Exam Hurt?

There is no pain involved in an ultrasound examination, although you may experience some pressure or discomfort when having a sonogram of certain parts of your body. During the scanning procedure, a gel is applied over the area to be examined and a transducer is placed on your skin or, for certain examinations, inserted into your vagina. The gel may feel cool. It is water soluble and usually wipes off easily, but it is a good idea to wear clothing that is easily washable.

When and How Is Ultrasound Used in Pregnancy?

Common uses for ultrasound in most medical practices would be:

• Confirming the pregnancy
• Dating the pregnancy
• Genetic screening (1st trimester)
• Targeted screening- looking for physical anomalies and gender (2nd trimester)
• Locating the placenta-especially relevant for women considering VBAC
• Bio Physical Profile (BPP)-evaluates the well being of the baby (post-dates or by clinical indication)
• Hand held or bed side fetal monitoring in labor

Is Ultrasound Safe?

Ultrasound safety is still being studied. There are known effects associated with the medical use of sonography such as temperature and cellular changes, but they are not considered “harmful”. Widespread clinical use of diagnostic ultrasound for many years has not revealed any conclusive harmful effects and studies in humans have revealed no direct link between the use of diagnostic ultrasound and any adverse outcome.

Ultrasound use in pregnancy is considered safe in the medical model and is controversial in the midwifery community. There is research to support strong caution against routine ultrasound use, especially in the first trimester of pregnancy. A well researched article on the concerns surrounding ultrasound use in pregnancy appears in Mothering Magazine

What the FDA has to say:

A United States Food and Drug Administration (FDA) report1 states that ultrasound has been used for many years with no obvious detrimental effects. Nevertheless, current evidence is considered insufficient to justify an unqualified acceptance of ultrasound safety. The FDA report recommends that ultrasound be used only when a diagnostic benefit is likely, and that exposure should be limited to that required to produce the needed information.

The World Health Organization (WHO) of the United Nations, in its report on ultrasound,2 recommends prudence in ultrasound exposure to human subjects but agrees that benefits outweigh any presumed risks. The WHO report states that patients should be examined with ultrasound only for valid clinical reasons.

With regard to ultrasound scanning during pregnancy, the FDA states that "ultrasonic fetal scanning is generally considered safe and is properly used when medical information on a pregnancy is needed. But ultrasound energy delivered to the fetus cannot be regarded as completely innocuous. Laboratory studies have shown that diagnostic levels of ultrasound can produce physical effects in tissue, such as mechanical vibrations and rise in temperature. Although there is no evidence that these physical effects can harm the fetus, public health experts, clinicians, and industry agree that casual exposure to ultrasound, especially during pregnancy, should be avoided. Viewed in this light, exposing the fetus to ultrasound with no anticipation of medical benefit is not justified."3

In conclusion, based on experimental and epidemiological data, there is presently no identified risk associated with diagnostic ultrasound. However, a prudent and conservative approach is recommended in which diagnostic ultrasound should be used only for medical benefit and with minimal exposure.

Where can I get an ultrasound during my pregnancy?

Motherland Midwifery clients can obtain ultrasounds at the Philadelphia Pregnancy Center where we can send a referral on your behalf at your request. You may also pursue this testing through a hospital-based OB practice.

1 US Department of Health and Human Services, Public Health Service, Food and Drug Administration: An Overview of Ultrasound: Theory, Measurement, Medical Applications, and Biological Effects. Publication # FDA 82-8190. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1995002

2 Environmental Health Criteria 22: Ultrasound. World Health Organization: Geneva, 1982, p 19.

3 US Food and Drug Administration, Center for Devices and Radiological Health, Diagnostic Devices Branch. Fetal Keepsake Videos. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm064756.htm

Genetic Screening

Genetic testing, screening and counseling is the process of providing individuals and families with information on the nature, inheritance and implications of genetic disorders to help them make informed medical and personal decisions. Ultimately, the decision to undergo prenatal genetic testing and screening is something each woman decides for herself based on individual indications and personal philosophy. Some prenatal tests are screening tests and only reveal the possibility of a problem or give a risk ratio for the baby having a problem/condition. Other tests are diagnostic, which means they can determine — with a fair degree of certainty — whether a fetus has a specific problem. In the interest of making the more specific determination, the screening test may be followed by a diagnostic test.

Prenatal genetic testing is further complicated by the fact that more abnormalities can be diagnosed in a fetus than can be treated or cured.  In addition, some tests carry inherent risks as the procedure is both physically and emotionally invasive [see our information on ultrasound].

Tests and screens are performed through a variety of methods.  Most common tests utilize maternal blood analysis, analysis of fetal DNA (through amniotic fluid or placental tissue or now via cell free DNA testing), or ultrasound. A decision-making tool with an overview of and timeline for the specific tests and screens can be found here.

Comprehensive genetic screening is offered by the Philadelphia Pregnancy Center where we can send a referral on your behalf at your request. You may also pursue this screening through a hospital-based OB or Nurse-Midwifery practice.

Initial Prenatal Lab Work

The Prenatal Profile is a Maternal Blood Screen that typically includes:

Blood type, Rh factor, and antibody screening

It is important to know your blood type in pregnancy. Blood type is based on particular molecules that sit on the surface of red blood cells. People either have A antigens (type A blood), B antigens (type B), both (type AB) or neither (type O) on their red blood cells. When it comes to Rh factor, some people have the antigen (Rh-positive) and some people don't (Rh-negative.) In other words, your blood type identifies which antigens you have from each group. If you are Rh negative, we will also order an antibody screen and discuss options for prevention of Rh sensitization. [More information on Rh factor and issues for Rh negative mothers.]

Complete Blood Count

A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC test usually includes:

• White blood cell (WBC, leukocyte) count. White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly.
• Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.
• Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present.
• Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body.
• Platelet (thrombocyte) count. Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting

Rubella (German measles) immunity

This test, called a rubella titer, checks the level of antibodies to the rubella virus in your blood to see whether you're immune. Most women are immune to rubella, either because they've been vaccinated or had the disease as a child.

Hepatitis B testing

Some women with this liver disease have no symptoms and can unknowingly pass it to their baby during labor or after birth. This test will reveal whether you're a hepatitis B carrier.

Syphilis screening

This sexually transmitted infection (STI) is relatively rare today, but all women should be tested because if you have syphilis and don't treat it, both you and your baby could develop serious problems. In the unlikely event that you test positive, you'll be given antibiotics to treat the infection.

HIV testing

The Centers for Disease Control and Prevention and the Pennsylvania and New Jersey Departments of Health recommend that all pregnant women be tested for the human immunodeficiency virus (HIV), the virus that causes AIDS.

OTHER BLOOD TESTS

There are other blood tests that are offered in addition to the prenatal profile. There are some tests related to genetic screening and others that might be specific to certain conditions or situations.

Genetic Blood Tests

Gestational Diabetes

Toxoplasmosis- Toxoplasmosis is an infection that has few symptoms for an adult, but can cause serious illness for a fetus. Many adults have been exposed to the parasite that causes the disease, and have developed immunity to it. But if you are not immune, and get your first bout of toxoplasmosis while pregnant, your child could be affected. "Toxo" can be gotten from raw meat, and from cat and kitten feces. So, if you have cats and handle their litter box, you might want to consider this blood test to make sure you are immune to toxo.

ADDITONAL TESTS/CULTURES:

Urinalysis and Urine Culture A urine screen is used to assess bladder or kidney infections, diabetes, dehydration and preeclampsia by screening for high levels of sugars, proteins, ketones and bacteria. Repeated findings of sugar in the urine my necessitate dietary changes to help maintain normal blood sugar levels throughout the day. Higher levels of protein may suggest a possible urinary tract infection, or kidney disease. Preeclampsia may be a concern if higher levels of protein are found later in pregnancy, combined with high blood pressure. This screen is normally performed in our office at each prenatal visit. We will do a Urine Culture with your initial bloodwork to make sure you do not have an asymptomatic urinary tract infection (more common in pregnancy) nor Group B Strep bacteria in your urine.

STI cultures The Pennsylvania and New Jersey Departments of Health also recommends screening for Gonorrhea and Chlamydia, sexually transmitted bacterial infections (STIs). Screening requires a speculum exam in order to swab the cervix.

Newborn Critical Congenital Heart Screening (CCHD)

The latest screening being done for newborns born in the US is a pulse oximetry test to screen for Critical Congenital Heart Defects (CCHD). This screening is done between 24-48 hours postpartum as the baby's circulation makes the transition to life outside the womb. Motherland Midwifery offers this screening at our first postpartum visit. Depending on the nature of any abnormal results and the over assessment of your baby, we can consult with a pediatric cardiologist, or may refer your baby to your pediatrician or to the nearest pediatric hospital.

This blog post  from Science & Sensibility  provides a good overview of the process.

"Critical congenital heart defects refer to heart defects that babies are born with and that require surgical intervention within the first month (or year, depending on the defining organization). About 1 in 100 babies have heart defects (1%), and about 1 in 4 of those with a heart defect have a defect so severe that it needs to be corrected immediately (0.25% of all babies) Only some of these defects will be picked up by prenatal ultrasound, and they may not show up on exam before the baby goes home (or the midwife leaves in the case of a home birth). Depending on the defect, some babies may be able to compensate with structures that were in place during the fetal period but begin to go away after the baby is born."

This resource from March of Dimes is directed towards parents and has thorough and accurate information.

Meredith's trip to Haiti: reflections, thanks and photos!

It is with much gratitude that I share some reflections on my recent trip to Haiti.  There is truth in the cliche "you get just as much as you give," out of a mission like this.  My earnest hope is that in 2 short weeks, I made some small impact on the heartbreaking problem of a high maternal and infant mortality rate...both by bringing much needed supplies, and by supervising/training Haitian midwives who will be there for the long term doing this important work.  I was welcomed graciously, both in the orphanage and among the midwifery students.

I was reminded of my own adaptability...and that even amidst the very different circumstances, in a different culture with very different resources, there is a fundamental sameness of women giving birth.  It is part of what has always captivated me about attending births- it is at the same time exquisitely personal and universal, it is both a sacred event..for some a peak spiritual event...and a mundane event happening every day all around the world.

Midwives I know come to this calling from many paths and for different reasons.  We are disgruntled by a medical system that seems to have undermined women's confidence in their bodies to give birth, we are political activists, we want to see women have the full range of options when choosing their care provider, we want to help women have empowered, sometimes even ecstatic birth experiences, and we believe that our work is contributing to the way families are welcoming their newborns and parenting the next generation.   I learned that women become midwives in Haiti in large part because they want to save lives...at least the women I met in this program.  They have seen enough women and babies in their families and communities die in childbirth, that they are compelled to learn the skills to help ameliorate this devastating reality.  While I didn't always observe the groovy "midwives model of care" that we strive to provide in our practice, the 12 students I met are well on their way to making a big difference in the lives of the mamas they serve.

There are so many stories I could share...but I fear this email is getting too long already. Like:  the twin delivery that we did in the middle of the night by headlamp, talking to the mamas of the 2 hydrocephalic babies that were born on my last day at the hospital, the lady who came in from a village a few hours after she had given birth because the placenta hadn't been born yet...manual removal of the placenta and then that mama stayed at the hospital for a good week of the time that I was there, the 4lb premie baby that I carried around the hospital looking for oxygen, the 4th c-section on a 23 year old that I sat in on.  On and on...would love to tell you more stories in person!

Let me tell you how your generous donations made a difference on my trip.  Not only did they contribute to my pre-departure visit to Penn Travel Medicine along with the proper vaccines and medicines to keep me safe while there (my mom also thanks you!), but also towards a personal translator to be at my side during all hospital and prenatal shifts, a 2 week stay at the guest house of Maison Fortune orphanage, transportation while in Haiti---all things which made it possible for me to do the work I came to do.  I was also able to bring two 50 lb. bags of luggage, filled with some art supplies for the children at the orphanage (which numbered over 200), and mostly medical supplies for the hospital and mobile prenatal clinic.  Baby scale, stethoscope, vitamins (most of which were used the one day we saw 70 women at a rural prenatal clinic!), hemoglobinometer and supplies, pee sticks, chux, sheets, mesh panties (they giggled at these...there is very little of anything disposable there), wind up flashlights (turned out to be very useful since the electricity goes out basically every night at the hospital), etc. etc.  AND, I have $500 left over to donate directly to Midwives for Haiti, which is amazing.  Thank you, thank you, thank you.

Love,

Meredith

Newborn Vitamin K & Eye Prophylaxis

There are two medications routinely given to newborns born in U.S. hospitals in the immediate postpartum period (i.e. first 6 hours after birth). With Motherland Midwifery you will need to make an informed choice about if you want these medications administered to your newborn. This information, along with our discussions during your visits, will help you make your informed choice about if you would like these medications given to your baby. Vitamin K (section coming soon!)

Newborn eye prophylaxis

Newborn eye prophylaxis refers to the practice of eye drops or ointment containing an antibiotic medication being placed in a newborn's eyes after birth. This is required by law to protect the baby from an unknown Gonorrhea or Chlamydia infection in the mother's body. The primary signs of an eye infection (conjunctivitis) in a newborn are redness and swelling of the lids and sclera of the eye.

Erythromycin ointment is the antibiotic most commonly used and we do carry this ointment if you choose to have your baby receive this preventative treatment immediately after the birth.

This blog post from Evidence Based Birth provides thorough information about this procedure and its risks, benefits and alternatives.

Alternative Treatments

Screening and treating for Gonorrhea or Chlamydia in pregnancy is a very good way to prevent spreading these infections to your baby. Most women will experience some kind of symptoms with both of these infections, but risk factors such as multiple sexual partners can increase the chance of undiagnosed vaginal infections.

Most babies are born with their tear ducts still closed. Without tears, they are unable to rinse their eyes of dust and other irritants. We usually recommend a few drops of your breast milk as a "rinse" of the crusty discharge that often develops in your baby's eyes during the first few weeks of life.  This discharge can be clear or yellow and does not indicate an infection is present.

Good handwashing  (especially after diapering) is an important component of reducing exposure to unfriendly bacteria.  If your baby does develop an eye infection, antibiotic treatment is still an option, as well as herbal rinses of chamomile, eye bright, echinacea, and goldenseal, and homeopathic euphrasia.

Circumcision

Male circumcision is the removal of some or all of the foreskin around the penis.

There is controversy surrounding circumcision. Advocates for circumcision state that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period. Opponents of circumcision state that it is extremely painful, adversely affects sexual pleasure and performance, may increase the risk of certain infections, and when performed on infants and children violates the individual's human rights.

US Medical Viewpoint

About 50% of all US male babies are circumcised.  This number is higher than the global percentage (30%), but is actually on the decline.  Part of the decline in this procedure has come out of multiple medical professional organizations issuing statements in the last 10 years that state that there is no significant medical benefit to removing the foreskin of a healthy newborn in the United States.

The American Academy of Pediatrics (1999) stated: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child." The AAP recommends that if parents choose to circumcise, analgesia should be used to reduce pain associated with circumcision. It states that circumcision should only be performed on newborns who are stable and healthy. [American Academy of Pediatrics Task Force on Circumcision (March 1, 1999)[Circumcision Policy Statement]

The American Medical Association supports the AAP's 1999 circumcision policy statement with regard to non-therapeutic circumcision, which they define as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. They state that "policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns."[Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision]

The American Academy of Family Physicians (2007) recognizes the controversy surrounding circumcision and recommends that physicians "discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son." [Circumcision: Position Paper on Neonatal Circumcision]

The American Urological Association (2007) stated that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. [Circumcision]

HIV Prevention

In 2007, the World Health Organization and the US Center for Disease Control both issued statements citing recent studies in African countries that showed a decrease in HIV among circumcised males.

http://www.who.int/hiv/topics/malecircumcision/en/index.html

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

Anti-Circumcision Evidence/Advocacy

There are numerous national and international organizations dedicated to educating and ending the practice of male and female circumcision.  Concerns include trauma from pain during the procedure (anesthetic is not generally used on newborns due to safety issues), infections or other complications associated with the procedure, and adverse affects on sexual pleasure and function later in life.

Charlottesville based, Dr Annette Owens, MD, PhD specializes in medical aspects on human sexuality.  She has produced a very informative video on research surrounding the sexual aspects of male circumcision.

http://www.youtube.com/watch?v=J2zBaKLYeqQ

More information on circumcision:

National Organization of Circumcision Resource Centers

Local Circumcision Resources:

Midwives do not generally perform circumcisions.  Our practice does not have anyone skilled to provide this service is you desire it for your son.  As circumcision is generally performed from 2 days to 1 week after birth, if you are having a boy or don't know your baby's gender you will need to make arrangements with a local urologist or pediatrician to have the circumcision performed.  We can provide names of mohels who will perform circumcision outside of the hospital upon request.

Newborn Metabolic Screening

Metabolic screening of the newborn is used to detect metabolic birth defects. (Metabolic refers to chemical changes that take place within living cells during the process of digestion and absorption) These conditions cannot be seen in the newborn, but if untreated can cause physical problems, mental retardation and, in some cases, death.

The test requires a sample of blood from your baby and is most accurate if conducted at around the 3rd or 4th day of life.  The blood is collected by sticking your baby's heel with a lancet and collecting 5 drops of blood on a special test card.

Metabolic screening is mandated by the Commonwealth of Pennsylvania and the State of New Jersey. This means that all infants are required to be screened per state law unless a parent or guardian objects on the grounds that the test conflicts with personal or religious practice.

We will provide you with information about metabolic newborn screening and can provide your baby with this test if you desire.  In Pennsylvania, the cost of the basic screening is paid for by the Department of Health. A supplemental newborn screening is strongly recommended by the Department of Health for an additional out-of-pocket cost of approximately $25. In New Jersey, the test costs $100 and is payable when we perform the test at the 48-72 hr postpartum visit.  Results of the screen will be sent to your pediatrician or family practice physician.

A complete listing of metabolic birth defects and their treatments can be found at the March of Dimes website.

Specific information on the Pennsylvania Newborn Screening program can be found at the PA Department of Health website. More information about the New Jersey Newborn Screening program can be found at the NJ Department of Health and Senior Services website.

Download Motherland Midwifery's Informed Consent for Newborn Metabolic Screening here.

Cardinal Movements of Birth

Someone shared this YouTube video showing the movements a baby goes through during birth and thought worth sharing with folks here! These sweet babies really work to be born just like mama does!

Brother Bear is Born!

Marni and Tray Duffy welcomed Ryder Doyle, affectionately known as "Brother Bear" by  big sisters Sage and Fern, into the world late Sunday night October 11, 2010. After waiting patiently going past her "due date" for the first time, Marni powerfully and gently birthed her big 8lb boy into water into the waiting hands of dad and midwife. It was an intimate little circle of love and support for this little being. I'll never forget the ear-to-ear beaming smile that emerged on Marni's face when she reached down and felt her son's head crowning and knew the moment of birth was near! So beautiful! He started nursing right away and hasn't stopped already 5 oz above birth weight at 3 days old! Welcome to the world Ryder!

Welcome to the world Ryder!

Newborn Hearing Screening

Newborn hearing screening is a component of the newborn screening program mandated by the Commonwealth of Pennsylvania.  In the first month of life, all infants are to be screened for congenital hearing loss by a hearing specialist or audiologist.

The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that 2 or 3 out of every thousand children in the US are born deaf or hard of hearing. The purpose of early screening is to ensure that all babies with suspected hearing loss have the opportunity to benefit from early intervention that could support development of language skills.

Auditory Brainstem Response Screening (ABR )

ABR screening is performed by introducing a soft clicking sound to each ear through the use of earphones placed on the infant’s ear or placed at the opening of the ear canal. Adhesive electrodes are taped to various sites on the infant’s head, which are able to monitor and record the auditory response as it travels from the ear through the auditory system. The ABR response provides information regarding the integrity of the auditory pathway up to and including the brainstem.

Automated ABR screening differs from a diagnostic ABR study in that the equipment is fully automated, eliciting either a pass or refer response. A diagnostic ABR evaluation allows the audiologist the opportunity to manipulate the test parameters, e.g., the stimulus (click or tone burst); the intensity of the signal and the method of stimulus presented (air conduction versus bone conduction). Additional information regarding diagnostic ABR evaluation is included in the Diagnostic Testing section of this website.

This test is routinely performed prior to discharge on babies born in hospital.  For babies born at home, Motherland Midwifery can perform this test at your 2-3 week office visit or you can arrange it through your pediatrician or a local audiologist.  Insurance will cover this test.

You can also contact the New Department of Health and Senior Services or the Pennsylvania Department of Health for more information.

Orson is born!

Parents Chelsea Thompson and Jethro Heiko and big sister Hazel welcomed baby Orsen into the world on a busy Sunday morning in August for Motherland Midwifery (two babies before 10 am!). Orsen weighed in at 9 lbs--almost one and a half pounds bigger than his sister. It was a lovely waterbirth and Chelsea birthed her son with a roar followed by a smile of relief. We were all so impressed by her strength! Way to go Mama!

From Amy, mom of Gavriel, born June 2010

Our journey to home birth was a challenging, but fulfilling one. We had previously gone through three hospital births, all with a doula, bringing us three beautiful little girls. While the outcome was amazing each time, I felt somewhat troubled by the labor and birth process. Having done a lot of reading prior to my firstborn, I was well aware of all the pitfalls of hospital births. Each time, I came in defensively and ready to advocate for myself and the birth process I desired. However, having to be on the defensive, and constantly on the alert, took away from my ability to be totally present and immersed in the beauty of each labor, delivery and postpartum care. So, when it came to having our fourth, we decided to give the birth center a try. Fortuitously, as it turns out, they were filled up for June! My husband was much more comfortable resorting to the hospital route. However, having felt enticed for a number of years by alternatives to a conventional hospital setting, I took the opportunity to investigate the home birth option. As I read all about it, I became absolutely certain that this was the route for me. While it took some nurturing on my part, I was able to convince my husband to meet with Christy and Meredith to learn more about it. Christy and Meredith were incredibly adept at addressing my husband’s concerns in a validating, fact-based way; as well as reinforcing for me the empowerment and comfort I would experience through a home birth. They made clear that a home birth isn’t a one-size-fits-all model; but rather they could individualize the experience to make it technically, emotionally and physically comfortable for each couple. Each subsequent meeting with the midwives leading up to the birth further aligned me and my husband. By the time labor began, we were both excited to be in the comfort of our own home and to experience the process on our terms.

The actual birth itself was completely pleasant and comfortable. The labor progressed faster than the typical indicators led Meredith to believe--who had planned to arrive earlier than Christy during labor; but Meredith was completely calm (and calming) throughout and made sure Christy made it to the scene by the time of the birth itself. Once the baby emerged, they were equally adept at caring for him as they were for me and we had total faith that we were in good hands. My husband and I had a million questions during the weeks that followed about new and natural ways to care for any small ailments that arose – both for mom and baby – and they had their own unique answers for everything; and their "less is more" approach definitely had a greater impact on our recovery and well being than the suggestions we were given by the traditional medical establishment. All in all, from pre-care to post-care, this was the right decision for us and an approach that we wish we had given consideration to earlier in our child-bearing lives.

From Heidi, mom of Elina born June 2010

I remember my first meeting with Meredith when looking for midwives and I knew she was perfect for us.  It seemed like she was very evidence-based,  had over 500 births of experience, had a low hospital transport rate, and most importantly we immediately connected with one another.  I am a professor in physical therapy and know first hand how many unnecessary procedures are performed in our health care system that pose risk to the individual, and, as a birthing woman, I wanted to be empowered with knowledge and given the freedom to make my own decisions for myself and the baby.  Every experience I had thereafter validated our decision to work with Meredith and Christy.  They created a safe home environment that allowed my husband and I to deliver our baby with minimal intervention.  It was evident that being at my birth was not a job for them but rather a spiritual experience bringing a soul into the world. I want to be with these midwives again if I have a future birth and plan on referring my friends and colleagues in the area who may now be considering a home birth!

PS. This is from Benoy, my husband and a man of few words: Meredith and Christy were amazing.  It takes much more courage to let go and guide the birthing process.  I thoroughly enjoyed the entire experience.