Posts (page 2)

I read an awesome post by a midwife today. For context, the discussion was about birthing at home with a midwife or without any trained attendant (freebirthing or unassisted childbirth). When several midwives said they did not recommend this, it was suggested that they did not "trust birth". She wrote in response:

I trust birth. I trust it as much as I trust any other bodily function or force of nature. I trust birth to be birth just like I trust the sea to be the sea and the wind to be wind and the rain to be rain. Which means, most of the time, I can sit back and gaze in awe at the elemental power and beauty of the sea, the rain, the wind and the birth. But I also know that within that power and beauty there is a force of nature that is beyond my, and anyone else's, control.

I carry an umbrella in my car, just in case the rain demonstrates that wild, unpredictable side.

I watch my kids closely when they are swimming in the sea, just in case that beautiful, blue water becomes suddenly rough or has hidden under-currents that they happily step into and suddenly pull them away.

I shutter my windows and bring in my pets and remove lawn chairs when the wind threatens to become a hurricane or tropical storm.

And I watch birth, ready to shelter her with my umbrella, or lift her from the currents, or really batten down the hatches and face the storm head on when that force becomes a force to be reckoned with.

So, yeah, I trust birth, but even more, I respect the fact that it's a force of nature that can be wild, unpredictable, and powerful in mostly beautiful and sometimes destructive ways.

I'm not going to say anyone who had a succesful UC was "lucky". The odds are stacked in your favour that your birth, just like the sea or the wind or the rain, will be beautiful and safe. I don't think it's foolhardy or stupid to go swim at the beach or take a walk in a gentle summer rain, but if g-d forbid, you get swept away in an undertow you really don't want to be the only one on the beach who knows how to swim.

Brooklyn seriously lacks for a diaper service and many people who would like to cloth diaper find themselves frustrated and choosing disposables because of this lack. While cloth diapering without a service is not the right solution for all families, it is a viable option (and one that I have chosen with both my kids). Here are some tips to help you make it work:

1. Assess your laundry situation. Do you have a washer/dryer available in your house/apartment? Does it dry well/quickly? Do you have laundry in your building but not your apartment? How easy is it for you to get things to the laundry room (stairs, an elevator)? Do you currently take your laundry elsewhere and wash it yourself or have it washed for you?

Your answers to these questions will help you pick the right diapering solutions for your family. If you have a washer and dryer in your home that work well, then you have unlimited choices for cloth diapering. You can choose to use wraps and prefolds, all-in-ones, wool and fitteds, pockets, or any of the other options available! I love Bummis and prefolds (available at Still Hip http://stillhipnyc.com), Kissavuls fitteds (http://www.kissaluvs.com/fitted-diapers.php), LovelyBums for wool wraps (http://www.loveybums.com), and BumGenius makes a very popular all-in-one (http://bumgenius.com).

If you only have a washer or you have a washer and dryer but the dryer is very weak/slow, then you need to consider options that dry very easily, such as pocket diapers with microfiber inserts. I like Green Acre Designs the best for pockets (http://www.greenacredesigns.com) but FuzziBunz (http://www.fuzzibunz.com/) and Happy Heineys (solids, not the prints, they leak) also make a great pocket. Made with synthetic fibers, these diapers dry very quickly if hung or in any dryer available. Prefolds and all-in-ones dry much more slowly and while it is possible to hang dry them, I have found that prefolds end up very stiff and all-in-ones sometimes dry so slowly that they develop a moldy smell when hung.

For those without laundry in your home but easy access within your building or for those who will need to take their diapers to a laundrymate to wash, a primary consideration will be the size of your diaper stash. If you know that you will only want to be making trips to wash every few days or once a week, you'll need even more diapering options to make it through that many days. I usually tell clients that they will need at least 18 diapers (such as 18 prefolds and 4 covers or 18 pockets with liners, for example) in order to make it through the typical wash cycle of every other day or every third day (less often as your child gets older). The least expensive method for cloth diapering is prefolds and covers, especially if you find them used through a local store like Still Hip, local listservs like FGKids, or online communities dedicated to buying and selling used diapers such as http://diaperswappers.com

2. Set up your cloth diapers. Based on the above considerations, as well as other factors like cost, desired fabric types, ease of use, and ecological considerations, you can get to the work of finding the best diapers for you. Above are a number of links available for finding great cloth diapers and I also encourage you to find local resources for new diapers (such as The Stork Store in Williamsburg which carries a nice line http://storkstorenyc.com) and also for gently used diapers.

3. Get a couple accessories. In addition to the diapers (remember that you want at least 18 diapers, or more if you want to clean them less often), you will also want to consider getting a wet bag, such as the Bummis wet bag (http://nickisdiapers.com/catalog.php?category=99), to line a diaper pail (I use a plastic garbage can from Home Depot but anything that looks good to you and is non-absorbing will work well). Pick a place for you diapers to be stored (I prefer the bathroom but this is up to you) and put you container there with the wet bag in it. I also highly recommend getting a diaper shower - a handheld sprayer that easily attaches to your toilet and makes cleaning poop off of diapers much, much easier. (http://nickisdiapers.com/catalog.php?category=155)

You can also buy cloth wipes, which can easily be washed along with your diapers. Nickis Diapers carries a great supply of them, but you can also just cut up some old t-shirts or any soft fabric if you'd like to save yourself the money. I do not advise buying the various potions made for cleaning baby bums nor do I recommend any barrier creams or butt pastes. You can use a little coconut oil or olive oil if you need to (and you should for those first few meconium poops to help them not get tarred to their bums), but otherwise I find most babies do really well with just cloth diapers, wash water washes, and a little fresh air from time to time. For traveling you can buy smaller wet bags, like those discussed above but smaller. These are designed to hold 2-3 diapers usually. I personally have always just used a bag from the corner store or a ziplock bag, whatever I have around.

4. Pick a laundry soap. There is MUCH debate about what one should wash their cloth diapers in and the advise is inconsistent. Some people will rave about one soap as the only soap to use and then others will write about their horrible experiences with that soap. My opinion is this (just to add to the chorus!): wash in whatever you feel comfortable using on your clothing and your baby's clothing. Avoid fabric softeners, they tend to clog up diapers and make them less absorbent, and I would not use heavy fragrances. For myself, I use brands like Ecos or Planet, but on vacation I have used whatever was available, such as more commercial options like Arm & Hammer. If you find something does not work well for you, switch! Never use too much soap - I find about half the recommended amount is usually plenty to keep the diapers clean and nice.

5. Start putting cloth on your baby's bum! Check out sites like http://mothering.com/discussions for great forums where you can find answers to all your questions about cloth diapering. Email or call me if you hit a wall ~ I am always happy to help people who want to cloth diaper and are hitting stumbling blocks.

I hear rumor that there is a new diapering service coming to life this summer. A Park Slope mom has is in the process of opening a service, but for now it is just a hopeful prospect. Let's wish her the best with her new business - I hope we have a viable diaper service in Brooklyn soon!

Earlier this week I was meeting with the homebirth midwife, Marcy Tardio, who caught my baby in 2007 and we were talking about birth, politics, and life. I mentioned that I attended homebirths this month with three different midwives and how great was to see everyone’s different style at each of these births. In New York City, we are amazingly lucky to have so many terrific homebirth midwives to choose from (unlike other areas where you might have one midwife serving a 300 mile or more radius).

Marcy agreed, and told me when people ask her about her birth philosophy, she sort of laughs and thinks, “I am a homebirth midwife, that is my philosophy.”  Later my husband and I reflected on how true this is – that catching babies at home is such an amazing calling and the women who do this work all share a very similar, and unique in this culture, understanding of what it means to help women give birth. After that, so much of it is personality and finding the midwife that resonates with your own style and needs.

This being the case, over the next few months, I would like to introduce readers of this blog to several of the fabulous homebirth midwives who serve Brooklyn such that anyone interested in homebirthing might know more about their options.

Marcy Tardio, CNM

Marcy is a Park Slope-based mother of two sons, one grown with children of his own and another finishing high school. For nearly 21 years she has been a midwife and for the last 8 years she has been attending homebirths in New York City. She has caught almost 600 babies during this time, including my son Clay. She told me that she believes that most of the time, “when allowed to unfold naturally, birth works.”

Marcy described for me the first birth she ever saw – an improbable experience in a log cabin in the mountains of West Virginia. She saw a baby born in a footling breech into her father’s hands and started her path to midwifery. She believes that women can remain empowered in birth, where ever they are and whatever the circumstances when they are surrounded by people who treat them with love and respect. She told me that she does not feel that homebirth is “pass” and hospital births are “fail” but rather that providing homebirths is the service she feels called to at this point in her life and in her career.

In addition to midwifery, Marcy has also worked as a hospice nurse and a trauma and intensive care unit nurse – experiences that not only enhanced her skills as a midwife but that also ‘inform her understanding of life in all its wonder and fragility’, she said. She plays piano and oboe, takes dance classes, and has an incredibly nurturing presence. One client described to me why she hired Marcy, saying that she felt that Marcy was “hug-able” and when she thought of what she wanted from a midwife, this nurturing presence was central to her needs.

As a homebirth midwife, Marcy offers in-home prenatal care to women throughout New York City and areas of Long Island. From the initial interview, through all of your prenatal appointments, your birth, and your postpartum follow-up, Marcy comes to you for all your care. Like all homebirth midwives in New York City, Marcy accepts many types of insurance.

As a mom of two boys who each breastfeed for over a year, I am certainly not opposed to drinking while nursing on occasion (and in moderation, of course), and the American Academy of Pediatrics agrees. Drinking a small amount while nursing is a totally acceptable (and sometimes necessary) indulgence for new (and not so new) moms.

That said, there is a myth in our culture that drinking beer, particularly Guiness, will help to increase milk supply for women with low-supply issues or bring in milk for women who are recently postpartum.  Many women are unfortunately even told this by their health care provider, by their doula, or by a lactation consultant. I think this is a dangerous suggestion for new moms and moms with supply issues and I would love to see it stop circulating.

The logic behind this suggestion seems to be that new mothers are stressed and drinking will help them to relax, thus increasing both their supply and their milk let-down. While I do understand that being a new mother or a mother of a small baby can be stressful, and alcohol can be a method for relaxing, this is dangerous advise for women who are actually facing supply issues. For moms without supply concerns, go ahead and indulge, but for those who need to build their milk supply, staying away from alcohol is important.

Breastfeeding is an amazing process in which hormones in the mother’s body and suckling instincts in the newborn/infant combine to help first establish a milk supply and then maintain it at a level that should match the needs for the growing baby (or babies for mothers of multiples). When women nurse we see the hormones oxytocin and prolactin working together in the body to produce and sustain that milk supply.

A recent study at the University of Pennsylvania took the myth of beer to boost milk supply to the lab and the results were startling. Oxytocin levels fell about 78% in the women who drank and prolactin levels surged by 336% - moving both hormones in the opposite direction of what is seen in nursing mothers with healthy milk supplies.  

Thus, when women drink alcohol, their oxytocin levels decrease and prolactin levels increase, which results in LESS milk production, not more. Yet, women report feeling that drinking a beer worked to increase their supply and they often report that their baby appeared to be getting more milk following drinking.  

The University of Pennsylvania researchers found that while women were actually producing less milk, and their babies were therefore getting less milk, they felt increased fullness in their breasts, caused by the increase in prolactin levels. It is this feeling of fullness that is often experienced as an increase in milk. Coupled with this increased fullness in the breasts, babies were shown to suck more vigorously at the beginning of nursing sessions with the mothers who had consumed alcohol. This is likely actually caused by the decease in milk supply but it if often experienced as the baby drinking more.

For moms who do not have supply issues, this is not a huge problem as the hormone shifts are temporary and return to the pre-alcohol levels as the alcohol leaves the blood. Yet, for mothers with a supply issue and babies with weight gain concerns, this is a huge issue because babies suck harder (wasting calories) and take in about 20% less milk following a mother drinking. This decrease in breastmilk consumption can have very dangerous results for mothers who may have consumed the beer in the first place in an effort to increase supply and consumption levels.

If you are having supply issues and working to increase your production or if you are a new mother still establishing a healthy milk supply, please consider reading on kellymom.com for suggestions about safe food/herbal galactogogues (milk-makers) such as oatmeal, fengreek, blessed thistle, and alfalfa or information about the pros and cons of the prescription drugs that are available. Brooklyn  also has a number of great lactation consultants that can also work with you on building your supply, improving your latch, effectively pumping, or use of a supplementary feeding system, if needed.

(The final installment of my three birth story from this week) ...

On Monday night I went to bed at about midnight and was woken about 30 minutes later with news that my client's water had just broken. She was not yet in labor and planned to try to sleep. We agree she would call if she needed anything and we both headed off to bed. She was able to sleep well and in the morning she told me her friend was with them, playing scrabble, and contracting on and off. She laughed, ate soup, walked around the house, and really enjoyed herself through her labor. I checked in with them again in the afternoon, after watching Obama be sworn in! Things were still going well, heating up a little but they were handling it. Just before 6pm I got the call that they needed me and I arrived shortly after just as the midwife and her assistant were arriving also. She had begun to feel pressure and they had called us all at once.

The midwife checked my client just before I came and found that she was 10cm with the baby down low and ready. While this sounded like the birth was going to be quick, her body slowed down to give her time to adjust and get ready for the birth. Over then next 5 hours she continued to have contractions, but they were far apart and many were more mild. When she had pushing contractions, they were intense, but infrequent enough that it was clear the baby was taking his time. She was graceful and lovely, resting between her contractions first on her bed under dim lights and later in the tub, floating peacefully.

By 10:30pm she was on the loo backwards with an accupuncturist working on her back while I supported her through the contractions. We had discussed any remaining fears and worked through what was going to happen. She was strong and determined and the contractions were picking up. At one point I suggested that she reach down and feel for her baby and her face lite up when she felt his head inside of her. She was transformed - ready to do anything to help him be born. She moved back to the bedroom and began laboring in supported squats. Her contractions continued to be powerful and came more often, with his head crowing shortly into it. With a mirror on the floor, her husband could see their son's head as it became visible and the amazement in his eyes was fabulous.

In only a few short pushes, his head was nearly out and she was breathing through the sensation of being stretched by his head. Minutes later her midwife handed him up from between her legs and she sat down on the floor to cradle him, supported from behind by her husband. They looked lovely at their new baby as we all watched on with smiles, tears, and congrats!

Picking up from where I left off in the last entry ...

I came home and snuggled with my kids. My older son likes to hear about the births I attend, so I tell him the stories and he, sweetly, always offers congrats on a job well done. We put on PJs early and watched a movie together in bed, with me half asleep but managing to laugh at a few of the jokes. I went to bed early that night with the news that my client had lost her mucus plug and was starting to have regular contractions again. Although I thought I might be woken during the night, the call never came. At 7 am I recieved a text message letting me know that contractions continued but were short and managable. My client was in high spirits and told me she was "feeling groovey". We chcked in throughout the day and while labor continued to progress, it remained slow and managable into the evening.

At 10pm my phone rang and her husband asked if I could come to help them. Ten minutes later I was in a car on my way to their home with insturctions to stop at the nearby corner store for firewood if possible. I had the driver wait while I oicked up to bundles of wood to keep the fireplace filled for as long as she continued to want to labor there. I arrived shortly after, entering the warmth of a beautiful birthing setting.

These clients were not moving to a hospital, but rather had chooses a homebirth with Miriam and had prepared their home as such. Candles made for a soft glow and the fireplace made the house warm and welcoming. Upstairs, a birthing tub had been inflated at the foot of their bed and waited to be filled with warm water when the time came. My client was enjoying sitting in front of the fire, softly gazing into the flames and being held by her husband through the contractions. She was focused and solid, enjoying the sensations and feeling pleasure in the process of birthing. She remarked with curiosity about the feelings of the contractions and was excited to give birth.

Her birth was an intimate and moving experience. Her husband stayed connected to her, their love for each other so apparent as they cuddled and swayed through contractions first near the fireplace and later in bed. As the contractions built in intensity, we filled the tub with warm water. When she began to move increasingly inward and voiced a desire to be in the tub, I went downstairs and called her midwife to let her know it was time to join us. It was just after 1 am and the baby was on her way.

My client got into the tub and immediately remarked that it was amazingly relaxing and that she had no idea how good it would feel for her to be in there. She was relaxed and ready to continue facing her contractons as they grew stronger and longer. Her midwife rang the bell 15 minutes later and I helped her in the door with her equiptment and an update. She was calm and confident, never checking the laboring woman or instructing her but rather just observing the process and joining in the support team and we talked her through and eased any discomforts with cool cloths and drinks.

By 2am the contractions were turing to pushing and Miriam told my client to reach down and check for the baby. She initially said that she could not feel her but then she felt again with instructions and was able to touch her daughters head inside of herself. The contraions continued and quickly moved into forceful "throwing down", which her body pushing her baby out. She moved from a supported position on her back, resting in her husband's arms, to her side and then around onto her knees before pushing her baby out into her arms.

Her daughter emerged from the warm water just after 3am and she guided her up between her legs and into her arms. She and her husband smiled and cried with joy as they held her and examined her for the first time. It was so affirming and powerful to be in the presence of this woman while she birthed her baby and I came home 3 hours later feeling high. Two VBACs in two days, two beautiful little girls welcomed into the world with so much love, two amazingly strong mothers who got the experience of "birth working" after having c-sections with their first babies.

I love my job :) The third birth, another homebirth but this one to a pair of first time parents, will have to wait and I am tired and needing sleep.  To be continued again ...

I had a fabulous week last week. It started with a 3am phone call early on Thursday morning. A client of mine, who was nearly 41 weeks had been laboring on and off for days, was the person I expected to be receiving a call from but I was pleasantly surprised to see another name appear on my phone display that morning. My client told me for to hours she had been laboring with increased intensity and she want to check in with me. I could here the mixture of excitement and intensity in her voice and knew that this would be her birth day. We talked about her eating something and waking her husband to labor together and she told me she would call back when they needed me. As dawn rolled around, I got another call and by 6am I was in a car on my way to South Slope for a birth.

When I arrived, my client's water had just broken onto their living room floor. She was half clothed and feeling stronger contractions that required her to stop and have pressure applied to her hips and lower back. She was breathing into them but the edge of fear was creeping into her sounds as they raised in pitch during the peak of her contractions. We spoke softly in the dim light of her kitchen and fell into a rhythm as she worked through the contractions. She called her doctor to let her know that the water had broken and was instructed to come to the hospital. We knew that this would be the case - my client was having her second baby, a VBAC after the first was born by c-section after an attempted induction at 36.5 weeks. She knew that her doctor would want to monitor her closely and agreed that we would come soon.

Her daughter woke up and came downstairs with sleepy eyes and wild hair. She looked at her laboring mother with curiosity but seemed satisfied with the explanation that the baby was coming and her mom was helping the baby out. She asked her father to read her a story, which he did while getting the bags ready and preparing for the babysitter they had arranged. When the sitter arrived, my client was feeling very ready to go to the hospital, so we walked out into the cold, snowy morning and climbed into the back of their Jeep for the trip into Manhattan.

As we traveled through the Brooklyn-Battery Tunnel, my client on all fours turned with her face looking out the rear of the vehicle, my hands on her hips through each contraction, I reflected that I seem to only ever go through this tunnel with women in active labor. Because it is not the best way to get from my home to or from Manhattan, I rarely take it. As we entered the tunnel, I saw flashes of traveling through the tunnel with so many other women in the last few months who were laboring in the back of cabs or cars just as she was.

After we arrived at the hospital, we made it into triage and she continued to labor beautifully - asserting what she needed from the staff and continuing to remain focused on working through each contraction. We spent a few hours laboring in triage while they worked on freeing a room for her - moving between the bed and the bathroom, standing, squatting, and on the bed on all fours. She moved through her contractions and by 11 am she was nearly 9 cms and finally getting into a labor room for her birth.

Just after 2pm she pushed a beautiful little girl into the world, greeting her with gasps of joy and the teary eyes of a father who watched his first vaginal birth with amazement. It was an incredible moment of triumph - helping this family to get the birth that they wanted in a legal-climate that makes VBACs increasingly difficult in hospital settings. When I hailed a cab a few hours later I was feeling such joy at the victory this birth had been for my client.

While traveling back down the West Side Highway towards Brooklyn, I called the client who I had initially though would have been the one waking me early that morning. She said she continued to feel some contractions on and off and her spirits were good. She sounded bubbly and light, laughing and joking with me about errands she had been on that day. I told her about the VBAC I had just come from - news she welcomed as she was also planning for a VBAC and felt bolstered by that afternoons sucess story. She warned me to go home and get some sleep because she would be calling me soon!

(To Be Continued ..)

What a world we live in. Right before the holidays, the Florida Department of Health and the Miami Dade Police served a federal search warrant on a birth center, charging them with illegally using placentas. They apparently stored the place, as though it were a meth house or a terrorist den instead of midwives cooking and encapsulating placentas for their clients. Wow.

You can read more here:

http://www.wctv.tv/home/headlines/36945319.html

And also a pushedbirth.com