Mountain Birth Blog

Recent Article I Wrote...ENJOY!

2011-04-15T06:57:00.000-07:00

ASK AN EXPERT
Rebecca Pugh, Registered Midwife, CPM, Doula

Apr 07, 2011 | 29 views | 0 | 0 | |

Rebecca Pugh began her journey into midwifery as a prenatal yoga instructor, when she was asked to attend a birth to help the mother relax. Soon after she became a doula, a non-medical labor support person who accompanies the birthing mother to provide emotional and physical support. Pugh was so inspired by her first experience as a doula attending a home birth that she applied to midwifery school the very next day.

Pugh graduated from the Midwives College of Utah in 2004 and is now a licensed midwife in both Colorado and Utah. She is also a certified Emergency Medical Technician, and is certified in Neonatal Resuscitation, prenatal yoga and childbirth education. In 2007 Pugh volunteered at the Bumi Sehat Maternity Clinic in Ubud, Bali, Indonesia, where she worked alongside local midwives and educated visiting ones.

Since attending her first birth in 2002, Pugh has attended hundreds of births. Her most treasured accomplishment was the home birth of her daughter, Paige this past June. Her business, Mountain Birth, is located in Rico, Colo.

Q: What can a pregnant woman do to promote a low-risk birth?

A: First, let me say that staying low risk allows you to have the labor and delivery that YOU want, not the birth the hospital wants. Despite what many doctors may say, pregnancy and birth are inherently safe and natural processes that happen every day, without complication.

Staying low risk means being an active participant in your care. Bring questions and concerns to your prenatal appointments – writing them down always helps. If you feel you don’t have enough time for your own needs during an appointment then you may be seeing the wrong provider, or you may just need to ask for a longer appointment. Most providers will accommodate you if you ask.

Be aware of your baby’s position. Studies show that women who are aware of their baby’s position have less instances of breech or posterior positioning because they can then be pro-active about changing the position. Breech positioning is now the reason for cesarean section in most hospital-based care, and a posterior position can make for a long and difficult birth. During the third trimester, ask your care provider what they feel and where, practice at home with your partner by trying to guess what parts of the baby you feel and then confirm at your next appointment. Your provider should palpate your belly at EVERY visit during the third trimester.

Avoid the “whites”... white sugar, white flour and white rice. These are empty calories that leave your body needing more. If you crave sugar, your body really needs protein. Try protein first and a small, sweet snack later. Focus on nutrient dense foods like fish, chicken and vegetables and healthy fats like organic dairy, nuts and avocados. Exercise three-to-five times per week and try to get at least three liters of water per day. Pregnancy is NOT the excuse you were looking for to eat whatever junk food you would like; choose whole foods not processed ones. The QUALITY of your weight gain is much more important than the QUANTITY. If you follow these tips you are more likely to avoid problematic diseases of pregnancy such as gestational diabetes and high blood pressure.

Q: Can you address a few common concerns that you hear from women during their pregnancy.

A: Most women are concerned about anything they take into their bodies during pregnancy, from foods, herbs and supplements to medicine and alcohol. A small amount of alcohol is safe in pregnancy, so I believe that it is safe to have a beer or a glass of wine one-to-two times per week – but just one and always with a meal.

I do not think that it is imperative that women eat only organic foods during pregnancy but I ask my clients to prioritize meats and dairy when they buy organic to avoid unnecessarily added hormones and chemicals.

Almost every medication or vitamin and supplement says, “Check with your care provider when pregnant or breast feeding,” despite the fact that many things are safe. But you should always check with your care provider about anything you want to take and bring a list of your medications, vitamins and supplements to your first appointment. Kellymom.com has a very user-friendly list of common prescription and over-the-counter medications and their safety ratings for pregnancy and breast feeding.

Morning Sickness is a common problem. The worst thing you can do is NOT eat. I tell mothers not to be too concerned about the quality of food they eat in the first trimester if they suffer from nausea and food aversions, just as long as they ARE eating. Many women perpetuate the nausea by not eating because they are nauseous and food isn’t appealing, but an empty stomach is a trigger for more nausea. Increasing simple carbohydrates, adding B complex vitamins, especially B6, and eating small, frequent snacks is helpful. Many women have a difficult time digesting proteins and vegetables during the first trimester, so keep it simple – yogurt, bagels, toast, cereal and fruit are good choices. Follow your instincts; most nausea resolves itself spontaneously around week 13, if not, there are options your care provider can suggest.

Anemia, or low iron, occurs due to changes in a pregnant woman’s blood volume. This results in fatigue and in severe cases makes the birthing mother more susceptible to hemorrhage during delivery and post partum. Increasing iron rich foods such as red meat, black strap molasses, dark leafy greens like spinach, dried fruits like prunes, and cooking in an iron skillet are all great ways to combat this problem. If that isn’t enough I recommend a product called Floradix, a food based iron supplement that contains B vitamins and Vitamin C, which helps your body metabolize iron.

The naturally occurring sources of iron in Floradix do not have a constipating effect, unlike the ferrous sulfate in prescription prenatal vitamins. Unfortunately, the vitamins that most hospital-based practices prescribe have ferrous sulfate in them. Many doctors even prescribe a stool softener when they give you the vitamins. This is crazy to me when there are excellent prenatal vitamins,with more easily metabolized forms of iron available over the counter.

Q: The fear of pain during delivery is significant concern for many women. What are your suggestions for pain management, whether or not natural childbirth is planned?

A: In the hospital there are two main forms of chemical pain relief: the epidural and IV pain medications. Both administer similar drugs, however the route differs. The epidural sends a combination of an anesthetic agent and a narcotic, such as Lidocaine and Fentanyl respectively, into the dural space surrounding the spinal cord, lessening the transfer of the medicine into the blood stream. This in turn reduces the amount of medicine the baby receives. The epidural provides long-term pain relief by numbing the woman from about waist level down to her toes. The laboring woman is unable to leave bed, requires continuous fetal monitoring, a urinary catheter and IV fluids. Sometimes other medications are necessary to counteract some of the negative side effects of the epidural, including fetal distress, maternal hypotension, allergic reactions and cessation of labor. Most women receiving an epidural also receive Pitocin, which is used to accelerate and intensify labor contractions.

IV medications are narcotics, often Fentanyl, administered directly into the mother’s blood stream through a catheter in a vein. IV medications tend to be short acting and don’t provide the long-term pain relief most first-time mothers need. Because they are administered directly into the bloodstream the baby does receive some of the effects of the medicine and may experience respiratory distress at birth. The mother often feels drowsy and sluggish, but receives a short-lived amount of pain relief that gets her “over a hump,” allowing her to persevere.

Natural pain relief comes in the form of tender loving support from a partner, doula or the hospital staff. A doula is a non-medical labor support person who works for the couple, not the hospital. Her role is to provide unwavering support, both physical and emotional, for you, your partner and your birth preferences. Anyone can act as your doula.

My advice for a mother planning an unmedicated birth in the hospital is to not rely on the hospital staff for support, but come with the support you need. Honestly, you should stay out of the hospital for as long as possible if you want to avoid pain medication and you are a first time mom.

Massage, counter pressure, positioning, visualization, hypnosis and physical support are all valuable tools that will relive pain. Soaking in a hot tub is one of the best forms of pain relief available. There are no negative side effects and it is available in most hospital settings. The warm water increases blood flow, relaxes sore muscles and provides relief from the pressure of contractions.

Q: How can parents promote the bond with their newborn immediately following delivery?

A: Having the baby put on the mother’s chest skin-to-skin immediately after delivery is very important. If that is not possible because of a cesarean delivery or a complication, the father can go with the baby and provide a loving touch, or at the very least the sound of his voice to soothe the baby. Most women have uncomplicated, vaginal deliveries; in this case there is no reason why the baby can’t be with the mother skin-to-skin. Dim lighting is preferable because this encourages the newborn to open her eyes and make eye contact with the parents. Breast feeding within the first hour of life is preferable and studies show those that latch on in that first golden hour are more successful nursers. Newborns are typically awake for the first 1-3 hours following delivery; after that they tend to sleep for several hours. I believe these first few hours are very important to the bonding process. The room should be quiet and the parents should be allowed the space to touch, explore and nurture their new baby. All vital signs can be easily collected while the baby is in the mother’s arms and most newborn procedures can be delayed for at least the first hour, if not more.

Q: What can parents expect from their newborn in the first week?

A: There is no schedule in the first weeks of life, so take the pressure off of yourself by sleeping when the baby sleeps and allowing others to help you. Your baby’s poop will become the center of your universe because the state of his digestive system usually dictates his mood. His poops will transition from dark black meconium to brown and then to bright yellow when your milk comes in. Newborns take their time adjusting to the world outside; they may take some time to “pink up” and sometimes have blue hands and feet, so just keep them bundled.

The stomach of a newborn is very small so they only need to take in the colostrum from your breasts until your milk comes in. This is the “liquid gold” that is produced in very small quantities and is loaded with antibodies and protein. It is a highly concentrated “super food” that helps prevent jaundice by clearing meconium from his bowels and provides growth factors that safeguard the gut from disease. Nurse on demand until your milk supply becomes regulated, and try conforming to your baby’s needs, rather than vice versa. It is impossible to spoil a baby; they want to be held ALL the time.

Q: What can a mother expect of her own body in the first week after delivery?

A: I encourage my clients not to leave their bed for the first 24 hours and not to go any farther than the living room in the first week – rest is so important. Your bleeding will pick up if you are active, so use that as a guide; if your bleeding is heavy you are doing too much. The mama should be the queen who is waited on hand and foot in the first weeks. If you think you don’t need help, you are wrong. There are fabulous online services like mealtrain.com that help your friends and extended family organize meals for your family. And visitors should be limited to close friends and family, those who are truly helpful and those dropping off a meal without fuss.

Your milk will come in around day three or four; your breasts will become large, engorged, hard and uncomfortable. The only cure is nursing your baby. Be careful not to start pumping, or you will fool your body into thinking that you have two babies and you will produce more milk. Just nurse and your supply will regulate within a week or two.

After birth, many women are very sore, even if they don’t have a perineal tear. Your body has worked incredibly hard so expect to be sore from head-to-toe. Just rest and be thankful. A cesarean birth requires more time for healing. Make sure you ask your care providers about special considerations for cesarean birth healing.

Many women sweat profusely the first night or two after birth as your body sheds retained fluid, so don’t be surprised if you soak the sheets. This should resolve within 48 hours.

In the months following birth, many women experience extreme hair loss as a shift in hormones can result in hair falling out in clumps. This can be the perfect time for a short do that makes you feel beautiful again.

Around 70 percent of women report some sort of “baby blues” after birth. Even if you had exactly the birth experience you were hoping for and you and your baby are perfectly happy and healthy, it is normal and common to feel slightly depressed. This feeling often comes in waves and is accompanied by moodiness, heightened emotions and a sense of being overwhelmed. This is in large part due to hormonal changes but is exacerbated by sleep deprivation. Don’t be afraid to ask for help if this happens to you. Ask a loved one to hold the baby while you shower, eat and take a nap. Sleep when the baby sleeps and talk to other mothers who understand what you are going through.

If you feel as though you cannot make it through the day without crying, if you wish harm to yourself or your baby, or if you have no desire to care for yourself or your baby and basic duties are being ignored, you may have post partum depression. Family members often notice a problem before the mother does. Talk to your care provider about post partum mood disorders during a prenatal visit, especially if you have a history of depression.

Q: What advice do you have for a new mom who is desperate to get back in to her pre-pregnancy weight?

A: Breast feed! When you are producing milk you are burning calories – making milk requires a lot of energy and helps many women lose weight. But there has to be a balance; over exercising results in dehydration in the form of sweating, which depletes the milk supply. Also, good nutrition and hydration are important to keep up the milk supply up. Remember that it takes 10 months to grow a baby, so it will probably take 10 months to shrink the mama! Don’t be in a hurry; your body will be forever changed by birth. I hear many women say that they may return to their pre-pregnant weight before the first year is over but they lack the tone they had before. Your hips will be wider for a long time, so you may NEVER return to the same size jeans you wore before. Or you may be lighter on the scales but your shirt is tighter because your breasts have grown. Exercise is so important, so pack up your baby and get out! But my best advice is patience and acceptance. You may never fit into those jeans again, but your baby doesn’t care what size you are.

Q: So coming full circle…when will her libido return?

A: Unfortunately, breast feeding has the hormonal side effect for many women of reducing their sex drive. When your baby suckles you produce oxytocin, this is the “love hormone” that makes you feel unconditional love for your baby and deepens the bond between you and your baby. For many, the hormone receptors become saturated, leaving you without a desire for any other types of “love.” Combine this with healing from birth, sleep deprivation and a general sense of being overwhelmed, and you have a recipe for celibacy! If you are co-sleeping with your baby the problem is even worse – your privacy has been dashed.

Many couples take their sex life out of the bedroom at this point and get creative. Also, making love during the day is a better option for an over-tired mom who doesn’t want to be bothered at night when sleep is at a premium. Some parents hire a babysitter who can take the baby on a walk while the parents “play.”

Couples need to be patient with one another and understand that this is only a phase. A baby is demanding of a mother’s time, attention and love, and a partner who wants sex is often seen as another demand. Expressing your love is so important and you may need to find new ways to do so. A tired mother may find more value in having dinner made for her or having her partner hold the baby while she goes for a walk, giving her time to herself. Every woman is different – I can’t say when the libido will return, but it will.

Rebecca Pugh may be reached by calling 970/708-1298. Her website is www.mountainbirth.com.

Paigiekins!

2010-11-22T18:57:00.001-08:00

Well, here it is...long awaited, My birth story! I hope all of my clients enjoy this. OK, now I really get it:)

When I look outside and see a beautiful cloudless blue sky I go back in my mind to the day of Paige’s birth. A week before my due date I attended Mountainfilm in Telluride. I stood in line and mingled with the crowd. People would say, “When are you due?” “Next week”, I replied. “Your not going to have the baby in this movie theater are you?” “Well if I do, I am in good hands, I am a midwife...” And thus went the conversation over the weekend. After being pregnant all winter and a prolonged cold and snowy spring I feel as though I emerged from my wintery cave to reveal my pregnant belly. It was a great sunny and warm weekend to get a little culture and socializing in before I settled into my birth cave. Little did I know the birth cave was already calling me. That Thursday, June 3 I awoke at 6 am and I got up to go pee. When I wiped I found some interesting discharge that looked like congealed chicken fat, hey! That’s my mucus plug. OK, that’s cool. I am going back to bed. When I laid down I was feeling crampy, like menstrual cramps and then I noticed I had 3 or 4 sharp cramps that were about 5 minutes apart. They faded away and I faded back to sleep. When Matt and I woke up around 9 I told him the news...something is brewing, maybe I will go into labor soon. We got up and sprung into action. We got the house ready and headed into Telluride to handle some errands that couldn’t wait. I set up the birth tub and felt really great, like everything was in order. That day I was really crampy, cramps and Braxton Hicks would come and go throughout the day. I went for a walk, showered and did chores. As we headed home from Telluride after dark I was hungry and tired...hmmm, something is happening:) That night when I went to bed around 10 pm I told Matt I thought tonight would be a bad night for sleeping, but I was tired and I went to bed. At 1:10 am I was awoken by sharp cramps, I thought, “Aw this is nothing for a first timer, I should try to sleep”. But I just couldn’t lie down. The cramps were sharp and painful when I was lying down but felt a lot better when I was standing. So I got up and headed for the couch, hoping Matt could sleep and be rested in the morning. I tossed and turned on the couch until 6 am. I had contractions that felt more like sharp, menstrual cramps every 5 minutes since 1:10 am. I was trying not to commit the cardinal sin of most first time moms, they never rest during early labor and then regret it down the line when they are exhausted and find that in retrospect the early contractions were pretty mild. But I just couldn’t rest! I was starving, so I ate a yummy breakfast of hard boiled eggs and an english muffin. I woke Matt at 6 am...”Hey babe, I’m in labor, I need your help”. Whoa, cool...Matt seemed excited, even though he was tired, poor thing, 6 am is not his favorite time of day. As soon as I was up and moving and Matt was awake the contractions didn’t hurt as badly. I called Marlene...I’m in labor! “Take your time and head on over, no rush, but I would love for you to be here:)” Matt and I scurried around filling the tub and dealing with the usual tub obstacles, hose won’t connect correctly, need more hot water, etc. After the tub was filled Matt went back to bed and I tried to as well. I was uncomfortable and rolling around in bed, sleep was not gonna happen. Matt and I were snuggling and got kind of turned on by the whole thing so we made love. I can’t believe I actually wanted to, but I did. I had to stop while I had a contraction but otherwise, it felt good. I told Matt I really just wanted the prostaglandins in his semen to soften my cervix:) Marlene showed up around 11 I think. We had a few visitors that morning/afternoon and surprisingly it didn’t bother me to have them there for a short time. I wasn’t ever bothered by Matt and Marlene chatting, we even watched some funny clips on You Tube that made me laugh. Unfortunately, it hurt to laugh. Almost all pain was localized in my lower abdomen, it was a very sharp and concentrated feeling. I chalked that up to early labor where my lower uterine segment was doing most of the work to dilate. Unfortunately, I got to a point later where that cramp never relieved itself in between contractions and I got really frustrated and drained by this constant “in between contraction” pain. But that comes later. Well, we all putzed around the house for most of the day and then realized it was a beautiful day and that we should get out and enjoy it, plus, I needed to walk! We made our way out to a hammock in the yard that our neighbor had put up. It is such a beautiful setting, nestled in the aspen trees. We walked out and I parked it in the hammock and enjoyed a relaxed, semi-sitting pose while rocking away the contractions. I don’t know how long we were there but things were starting to get a little trippy:) I had promised myself that unless something was noticeably different that I wouldn’t be checked until 5 pm. So I wanted to hang in there without knowing until then. Sometime in the afternoon I managed to eat a granola bar and a delicious little spinach salad. I was good about staying hydrated. For the past several hours I was having this constant cramp in between the actual contractions, it was pretty painful and tiring because I wasn’t getting real rest in between...time to try the tub! Ahhhhh! Words can not describe how awesome the tub was. Unfortunately, I got in the tub and was so relieved that I didn’t have another contraction for 45 minutes! Uh, oh! Probably too early to be in the tub. But hell! It felt so good I didn’t care. It was a nice break but we needed some progress. At this point I was poking around in my own yoni to see how dilated I was...I think I am a 4, bummer! Matt and Marlene checked me and agreed, they were really great about turning the tables on me, “Hey! 4 cm is awesome, you are doing great! You are doing it Reb, keep on truckin’” Maybe we will have a baby tonight?! Marlene suggested that we rest. Good idea but that was pretty hard because when I laid down the contractions got sharp and more painful. I squirmed around in bed and seemed to get cookin’ a little more. Matt suggested we make love again...I don’t think so buddy! Too ouchie to even consider lying down. Good idea though, I think that it really helped early in labor. Then I really started squirming, I was up and down and all around at that point. The thought of lying down and resting was so alluring, occasionally I laid down on the paco pad we had set up for the birth but that often only lasted a few contractions. Standing and squatting were my two favorite positions, oh and being in the tub of course! That was my saving grace. From then on out until the birth I was in and out of the tub. At around 6 pm we were all getting hungry so Matt went over to the hotel and picked up burgers for us. I managed to eat a little bit of mine while I was in the tub, but food was becoming less desirable. It didn’t bother me at all for Matt and Mar to eat their burgers as they sat right beside me, and it didn’t bother me if they talked. In fact, I was surprisingly tolerant of smells and sounds over all during labor. At some point the smell of my burger started to bother me and the music that was playing was not what I wanted...I was getting a little edgy. As darkness fell I really started cooking. I found myself having what I called “bladder contractions”. They weren’t real, 100% contractions, but when my bladder was full I would contract, and it was slightly painful until I emptied and then it would subside. I had those in addition to regular contractions, so that was fun:) I spent a lot of time on the toilet peeing. Earlier I had diarrhea when labor first started, that irritated my little anus and caused some hemorhoids that I didn’t even know I had to flair up. I experienced a lot of butt pressure and pain throughout my labor, it sucked! When I wasn’t in the tub I was wandering around the house in a mildly delirious state. I would check in with Matt and Mar and occasionally comment, but for the most part we were all very quiet, it was a very peaceful setting. I remember looking out the window as it got dark thinking, “I don’t want to do this all night.” Fortunately, I didn’t have to...at some point I wanted to be checked again, I kept trying to check myself but I always thought I was 2 more cm dilated than I really was b/c it is so hard to feel the back of your own cervix:) I thought I was 8 cm:) Mar said I was 6...I thought I was 10 cm, Mar said I was 8 cm...and so it went. When I was around 6 cm I was in the tub and started to get a little emotional. I had the craziest contraction that just made me cry uncontrollably, heaving with sobs and having a hard time breathing. I kept saying, “I’m OK, I’m OK”, I held one of Matt’s hands and one of Mar’s and was basically holding on for dear life. At this point I really felt labor was happening to me, over taking me...I was now just along for the ride. I looked into Matt’s eyes and saw tears welling up in them, he hated seeing me in that much pain he later said. At this point I remember being very lucid, I remember a lot of detail from that time. I remember looking around the room at the artifacts of my life, feeling like they were in the distant past. I thought, “some day I will use the computer again.” At one point I think I said, “ I just want my life back!” I paced and circled through my bathroom and bedroom, occasionally collapsing onto the bed, only to scramble to my feet before another contraction came b/c lying down hurt so much worse than standing. At one point I said, “ I am gonna really need you guys”, and they said, “What do you need?” But I meant, I just NEEDED them to be there for me! They understood:) I was starting to feel some rather convulsive, pushy feelings. The contractions were really making me bear down. We checked and I was 8...I wanted to be 10!!! I was sitting on the toilet and I tried to check myself again, I could feel a little bulging bag of water and the “beak” of my cervix in the front. That is what it felt like, a rigid little point of tissue. I squirmed around for quite a while before proposing to Mar that, “Maybe we should break my water?” My awesome midwife threw back my own advice right on to me...”once you break the water, you can’t go back, we don’t want to mess with mother nature, it could affect the baby’s position, it will go when it is ready.” Ah, I felt better...trust Rebecca, trust. So I got back into the tub for some relief, after sitting on the toilet poking around in my yoni trying to snag my bag of waters:) This time, the tub was providing very little relief. I was grunting and convulsing in the tub. I think the contractions started to space out and I caught myself falling asleep in between some of them. When finally, my bag broke and a puff of clear fluid rushed into the tub water...I am almost there! I couldn’t stay in the tub any more, I wanted to get out and get down to business. I am not sure how much time passed. I couldn’t help but push. I was standing and I looked up at the clock, it was 1 am. OK, I thought, I have been at this for 24 hours now, time to have a baby. I knelt down on the pad and started pushing seriously. I t didn’t seem like much was happening at first. I could barely keep myself upright. I took some on my side and some on hands and knees. Marlene had been at the ready, but upon seeing me lying on my side and seemingly having a hard time coordinating my pushes, she took off her gloves, knowing it could be a while. At that point I grabbed onto Matt, I was kneeling, he was holding my hips and I was holding his shoulders. I pushed SO HARD...we heard a loud POP! I felt it & Matt could feel it resonate through my body and even Mar heard it. “I think I broke my tail bone”, but at that point I didn’t care, and honestly, it didn’t hurt. Overall, pushing didn’t really hurt. It was intense in an undefinable way, there was so much pressure, you have no choice but to move the baby down. After that pop, I really started moving the baby, I felt her head descend...and here she comes, I was reaching down touching her head as it emerged...Matt readied his hands and began feeling her head too. I feel as thought I slowly, and deliberately let her head slide out...and I did a great job, I didn’t tear!!! I pushed out her head in about 1 or 2 pushes. There was a pause and I leaned forward onto hands and knees as Matt gently guided her to the ground. That was perfect b/c I needed to sit back and swing my leg over her so that I could pick her up. Matt and Mar handed her to me...I was immediately HIGH! I can’t believe the high you get from birth, it is so great, better than any drug because you have actually accomplished something. I just scooped her up and snuggled her, amazed! Matt got out the camera and took some photos...we were ecstatic. My midwife brain kicked in when it was time to deliver the placenta. I think it took a while to deliver, although I am not sure how long. I remember Mar gave me some Angelica to help it along. I will have to check with her on this but I think I finally delivered it myself after following the cord up to ID its location. I remember we cut the cord before it was delivered b/c she had a relatively short cord and I was having a hard time getting her up high enough on my chest and getting us both comfortable. After the placenta was delivered my bleeding was no problem. We encouraged Chica to come over and meet her new sister. She was pretty uninterested. She was in her bed during the last stages of labor just hanging out while mama was birthing, so casual:) After we snuggled and got comfy on the pad she began nursing right away, I think about 15 minutes after birth. She has no problems with nursing that is for sure. I felt so great I was able to get up and make it into the bathroom after handing her off to Matt so they could get acquainted. That was a really sweet sight to behold. We just weighed her at that point, 7 lbs 10.5 oz. She was pretty fussy so I showered and brushed teeth and got into bed to try to make her cozy and nurse her. Just before bed I had some of Aemonn’s burger from earlier, that was a real treat! I was so hungry. The little critter only slept for 2 hours on my chest, then she needed to change position. The bed was tough b/c my tail bone was becoming increasingly painful! We got up and went in to the green chair and snuggled for another couple of hours...Mar slept through all of our fussing and squirming. At 8 the Lindauers came over b/c they couldn’t stand to stay away b/c they were headed to Mrose that day. I was thrilled for them all to come by. They said a quick hello and met the little critter, then Mar and I took care of some biz...Rhogam and Vit K, etc. While we tried to let Matt sleep. After cleaning up and getting just 4 hours of sleep, Mar slipped away and I went back to bed. Then I really slept and so did the babe, I think we woke around 11. Then it was on with our day! And what a day, I was beaming, and so was Matt. Here she is, our little critter.

VBAC Mothers Rock!

2010-04-16T16:08:00.000-07:00

I wanted to make sure that I documented this wonderful client. Here I am with mother, new baby Rebecca (yes, they named the baby Rebecca) and the new big sister Cambree. This was Ramona's fourth baby and 3rd vaginal birth. Amazingly, I got a call from Ramona when she was 37 weeks. She was looking for help. She was being released from care by her Doctor in Utah because she was a VBAC (vaginal birth after cesarean). Even though Ramona had previously delivered 2 babies vaginally since her C-section over 12 years ago. The C-section was performed b/c her first little guy was Breech, and for a first time mother this contraindicates a vaginal birth...even in the home birth setting. At 37 weeks the doctor had his assistant call my client to inform her that she would not be able to deliver in their hospital because of her previous Cesarean. Despite the fact the last vaginal birth (Cambree) had actually occurred at the very hospital that refused to deliver her. What nerve! So, needless to say I was happy to help. We quickly got to know each other and a few weeks later Ramona had a beautiful, gentle birth in her own bedroom, gracefully birthing Rebecca into the world. Congratulations to every VBAC mama out there...you rock!

I am Learning

2010-04-16T15:58:00.000-07:00

I am learning what it means to be a pregnant woman. So many clients are saying to me, "I can't wait to talk to you after the birth!" What do they know that I don't? Well, a whole lot actually! I have attended so many births, and there is so much I feel that I understand just from being a woman myself but none of that is the same as actually experiencing it for myself. No man will ever truly understand what a woman goes through, and I now understand more than ever why women need female practitioners to support them through this process. Honestly, because of my work as a midwife a lot of the "magic" is probably absent from my pregnancy. I see pregnancy as overwhelmingly normal and really, I am not a very spiritual person, so I don't look for meaning in most things. I don't rely a great deal on symbolism or hidden meanings...I am a very practical person. I am growing a baby, it is a rather "matter of fact" affair for me. It is something I have always known I would do. I feel in some ways I am fulfilling a destiny, one that I wrote myself. I think the most exciting part of this whole journey is that I get to do it with my long time partner Matt. We have evolved through so many changes and stages that this baby seems like just the fulfillment of all of our struggles and successes. So here we go...

The Midwife is Pregnant!

2010-01-25T11:14:00.000-08:00

Phew! Is it possible that I have not posted since last April?! I recently began to write in my journal to record some tid-bits about my pregnancy (yes it is true:) and saw an unfinished entry in my journal from around the same time as my last post...last summer arrived and I abandoned my blog, my journal and somehow have managed to make it to January with a baby in my belly and about a dozen births to show for it all! Well here we go, it is catch up time...I am currently 21 weeks pregnant at 36 years old. This is a long awaited baby for me, I have always been clear that around 35 would be the time to go for it. I love babies and have been excited to experience pregnancy and childbirth for myself, but my love for attending births has kept me on the sidelines. Honestly, the thought of NOT attending births for any significant length of time makes me mortified. I mean, my idea of a vacation was going to Bali for 6 weeks and catching 62 babies. So I have been very aware that becoming a mother myself was going to put a serious damper on my midwifery practice. I have waited long enough and the time is right, I have a wonderful partner and I am ready to put my practice on hold for several months while I adjust to motherhood. I am ready to take a break from births...whoa! Did I just say that?

As for my current birth scene I am currently waiting for a very special client, a woman who has helped me at births in the past and I had the honor of catching her first baby. Her first one was a beautiful "sort-of-water birth" because she was in the water until the head came out, after which I discovered there was a nuchal cord. I thought it was tight at first, so being the relatively green midwife I instructed the birth team to lift her out of the water so that we could manage the cord. It turned out to be much looser than I had first thought and little Violet's body was easily born as mama stood outside of the tub, triumphant and ecstatic. This baby was born into my hands with the help of student midwife Marlene Bergman (now a licensed CPM) because our "teacher" had gone out for pizza (literally) thinking, "Aww, this first time mom will take a while." Nope! We walked and squatted as we paced through the mama's garden-and she progressed quickly. In the picture above you will see Marlene, who is now my midwife, holding little Penelope (a baby she helped me with this summer). Unfortunately, I don't have any pics of Violet and her mama...but I know the birth was video taped. Maybe I can post that some day!

Waiting

2009-04-20T18:04:00.000-07:00

Tonight I am reminded of one of my favorite descriptive phrases about midwifery. "A good midwife knows when to sit on her hands and when to use them." I seem to sit on my hands a lot. Waiting for labor to begin naturally, waiting for a mama to dilate in her own time, allowing a woman to rest as long as she needs to, believing that she really can do it, having faith that the baby will fit through, loving a sleepless night, hoping that the contractions will get stronger, giving a mama permission to cry, supporting her as she screams, bellows and crawls to bring the baby down. I know when to use my hands as well, when to break the water, when to stretch the perineum, when to ventilate the baby and when to give a pep talk that just may be the difference between a transport and a home birth. I love my work. I feel so blessed to be invited to a birth. I think a lot about who will attend me when I give birth. It is not an easy decision, I do not take it lightly, and I know my clients are bestowing a great honor upon me when they ask me to be their midwife. I do not take it lightly.

As a doula in the hospital I recently had 2 clients who had cesareans, one due to a posterior baby and one due to "deep transverse arrest". This is basically when the baby's head is turned looking hard right or left, whereas the head is ideally looking back toward mama's tail bone. I am so proud of both mother's. They both worked so hard and persevered. They were both incredibly disappointed at the loss of a vaginal birth, but the healing will be easier knowing they can look into their baby's eyes with joy and love. A current client just recently was telling me about her vaginal birth with a posterior baby and she said she had to "fight for my birth". The entire staff wanted to give her a section but she persevered, worked harder and gave birth vaginally. It was traumatic. There was an implication in her story that if women would just work harder, push harder, demand louder and more fervently then they could give birth vaginally, when everyone else doubts them. Is this true? Should we have to "fight for our birth"? Or should we just birth at home...where we don't have to fight? Or is it just sometimes the case that it is beyond the power of the woman, and left to some natural forces that we can't explain or fully understand. For now, I will just continue to wait.

Twins!!!

2009-02-22T17:56:00.000-08:00

Well, I have to document this amazing birth and this seemed like the best place to do it. On Christmas Day 2008 I attended my first Twin-Homebirth. It was a joyous birth, a boy and a girl, both perfect as can be. The girl arrived almost an hour after the boy. I am so grateful to the family for allowing me to be a part of this special birth. I am so proud of them for their dedication to homebirth and their unshakable belief that birth is normal and natural! I have chosen to keep this family's identity unkown to protect their privacy. Thanks to all who supported this birth! Here I am with the little ones at about 6 weeks. What an incredible Christmas gift. This was the closest I have felt in a long time to the true meaning of Christmas. New life, new experience, great faith in the miracle of life and great faith in the strength and ability of woman.

Remember Sabrina?

2009-02-17T18:33:00.000-08:00

Maybe you remember this beautiful mama? I had just returned to CO from Bali last Spring and took a picture of Sabrina and her daughter Natalie at a prenatal visit. She was one of the women I was able to return home to. I attended the births of all 3 of her children! What an honor. And here is little Liam making his entrance into the world. What a joyous birth. I love this picture because it really captures how alert and capable birthing women are. She birthed on hands and knees and as I caught the baby I passed him through her legs and into her arms, she grabbed him, sat up and just gave this big, beautiful smile. She was overjoyed. Happy Birthday Liam!!!

What a Belly!

2009-02-17T18:23:00.000-08:00

Isn't this the most gorgeous belly you have ever seen? This photo was taken just hours before "pink slide" came sliding into the world, sunny side up! I had the honor of attending the birth of Lucia as Mama Lara's doula. Big sister Lilly took immediate possession of her new baby:) Way to go Lara!

A Midwife and her Family

2009-02-11T17:19:00.001-08:00

I would like to introduce Hope Coulter and her husband Tate, their daughter Ava and their new little guy Ransom. He isn't so new anymore, I believe he is turning 1 year this month. Hope is a homebirth midwife...all of her babies born at home!

Here is another CO family birth story from mama Amy. I had the honor of having Amy and Bruce in my childbirth ed class and was hoping to be able to attend their birth, however I was in Bali around her due date and couldn't be there. Here is her story...
Hello familia lobo, and Rebecca (I'm doubling up this
email),

Indeed Brucie and I are thrilled! Little Sylvia is so
content and beautiful. We do a lot of staring at our
little package that we waited 9 months for. The birth
was really quite special. Bill's assistant Marlene was
out of town for a week and I really hoped to wait til
she returned (4 days before our due date), but had a
feeling it would happen before. So I gave dear JoJo
the heads up and asked her to be here if I went into
labor before Sunday. I went into early labor on
Thursday night while cooking dinner, just crampy but
started noticing some intervals. They woke me about
every 10 minutes that night, but just enough to make
me squirm a bit. Bill was in GJ Friday doing
prenatals, but stayed in close contact, and planned an
early afternoon return to Ridgway, his supplies
packed. He gave the heads up to Hope, a midwife that
lives just a block from us. Bruce and Julie were here
with me, and started timing the seismic activity
around 1:30pm noticing things had changed a bit. I was
in more of the focus mode and needing to breath
through the contractions, I imagined this could
continue through the day and night. Around 4:30 I sat
down for a few contractions in a chair and felt a
distinct engagement of the head. I beckoned them to
call Hope and she was over in 15 minutes. She checked
the baby's heart rate and then checked me. I was 8-9
cm dilated and close to transition. Fyew! What nice
news. Bill was due to arrive in 15 mins. so I got in
the tub. What sweet relief that was. Bill showed up
shortly after, entering with a halo of white light
around him. As I'm sure you can relate to that
feeling. JoJo came down from Tride in a snow storm and
got here around 5:30. I was in the tub from about 4:30
until her birth at 7:25pm. An hour of pushing, 3 times
harder than I thought I was capable of, and out she
came, big ol' cone head, shoulders were tougher than I
imagined, but I was ready to have her out! Gave
another mighty push, 8 lbs, 5 oz! and up she looked at
us. Of course we didnt know boy or girl for about 5
mins. b/c the cord was short and I was done. I needed
to collect myself, and then behold, a little girl!!!!
It was the most beautiful event of our lives! We have
some beautiful photos Julie took, and as soon as we
figure out how to post a file to the web, you'll be
certain to receive it. So nice to share with friends
like you, can't wait for you to meet her.
Lots of love, Amy, Bruce and Sylvia

More Babies

2009-02-11T17:12:00.001-08:00

I have to include some of the babies that were born to my Childbirth Education students as well. Here is darling Lila daughter or Jen and Eric. I have realized that part of my calling is to be a teacher. I love educating women about birth and the options that they have. My hope is that all women will be active participants in their birth and that a woman never leaves the hospital feeling that things just "happened" to them or that they got caught up in the cascade effect...that spiral of interventions that so often sweeps women away! Little Lila cam a little early...but all was well. I think mama Jen is pregnant with #2!
Here is sweet Anthem. She was a homebirth baby in Telluride. I believe her birth story, written by her mama, was one of the first posts I ever made. Look back to old posts to catch up.

Anthem! Daughter of Melanie and Nick Kotze

More babies

2009-02-11T17:05:00.000-08:00

Much needed Post

2009-02-11T16:46:00.000-08:00

Hello everyone! Right now I am just in a place of total gratitude. Grateful for the beautiful place where I live, all the beautiful mamas that I have the pleasure of working with, my incredible partner Matt and all the love that surrounds me! I guess that is why I feel so capable of taking care of others...because I am constantly refueled by everyone around me. I want to share with you all some of the wonderful things that have happened in my life and in others lives since last I posted.
We had a beautiful homebirth in Cortez last year. Here is the birth story as told by Kelsey, an aspiring doula and best friend of my client. Ironicaly, Kelsey just contacted me b/c she is now pregnant. Ah, the cycle of life. Get ready for great birth story...

Picture above shows the birth team!
The Birth of Dimitri Jay Webber
as witnessed by Kelsey Bileen
Just to give a little background, Jennifer and I have been friends since we met in nursery when we were 2 years old. All I remember is fighting over which stool we were going to sit on with another good friend Rachel. There was a maroon one which was coveted most, and a green one that was okay, but not as good as the maroon one. Rachel usually got the good one, and the green one was first come, first serve.
The next 18 years passed quickly. We had good times and hard times together, fought a lot, but made up without too much ado. I still remember when I ran into a car and broke my leg. My most vivid memory of the event was looking up in the sky and seeing my good friend's upside down head say, "You have got to be more careful!" Another favorite, though hard, memory took place at a mutual activity. We were playing human foosball, where all the players held onto PVC pipe and ran back and forth trying
to kick the ball. There was a fly ball heading towards Jennifer, although it was rather high. Her right leg swung around so high that my jaw dropped like a rock. It was a wicked
kick! She got the ball, but unfortunately ended up throwing her back out in the process.
Over the years we ended up going to church together, spending nights giggling in front of some chick flick, browsing the mall, dating and eventually we both got married, all with good memories. So when I heard that this friend of mine was going to have a baby, I got so excited. Birth is something I'm interested in anyways, so I knew I wanted to be there for her. I had been studying to be a doula for a few months before hand, although I had not yet had the chance to attend a birth. She was kind enough to allow me to attend her special day, and so, on January 11,2008, I came down from Provo to wait and wait and wait for labor to begin. It seemed like forever, but really baby Webber came right on time. On the 24th, 2 days after the projected due date, Jennifer mentioned some pains in the evening. They ended up fading out before bed time, and so we would wait another day. The same thing happened on the night of the 25th, and I was afraid the baby would make a habit out of it. I went to bed determined to get rest just in case. I told my mom my bet was on 7:00 pm the next day.
4:45 am ....January 26, 2008....
Beep beep. You have an incoming text.
My head popped off my pillow so fast I surprised myself!
"It's showtime. '" .-
With the go ahead, I got dressed and headed up to Cortez.: .. but not before I slipped on ice and hurt my back. Oh great! I thought,'Now I'm going to be achy while trying to help out! When I got there at 6:20 am, things were going well, and Jennifer was managing with leaning on the kitchen counters and breathing steadily. The midwife got there a little after 8:00 and we found that Jen was at a 4. So far, so good.
3 hours later the contractions were bringing about more groaning and even stronger urges to push than before. The second check was somewhat discouraging as she was still at a 4. Bummer. It was time to get to work. "I don't know how much longer I can do this." I imagine Jennifer had to be disheartened to feel like no progress had been made. The next hour was spent using squatting to open the pelvic outlet and encouraging the water to break. It was hard work, very hard work. After quite a few contractions, she got nauseous and threw up. "Good, good!" Rebecca, the midwife, explained that vomiting helps dilate the cervix re~ly well. She was righi. Jennifer was now over an 8.
The decision was made to break the water, as they have a family history of strong amniotic sacks. Oh boy was there a ton of water! I jerked my foot out of the way so as not to get wet ... .it splashed much more than 1 expected! Jen had been keeping hydrated really well which helped her keep up her stamina throughout the birthing process. It was beautifully clear. There was no sign of meconium at all, only a little vernix. "Oh I feel better!" exclaimed Jennifer. "Can I push now?"
Rebecca encouraged her to try pushing for a little while. With the water broken, the head comes down and puts more pressure on the cervix which usually opens it more. Not every cervix is the same though. Pushing was unproductive, and we needed to know what was going on in there. Apparently, instead of opening the cervix when the head came down, it pulled more cervix down with it. We were back at a 6! It was so very discouraging. Jennifer looked like she was going to bawl. I felt so bad. She hopped into the bathtub to help ease up the pain a little. While she was in there, she groaned a groan that although not much different than any other, really struck me. That's Jennifer's voice. I knew it logically all along, but it fmally tapped through to my emotions. I seemed to remember her like we were when we were little girls and I wanted to cry just thinking of what she was going through.
The next few hours were the hardest (from my point of view). Jennifer had an anterior lip that was preventing her from being able to push. She hadn't slept well for a few nights, had less and less energy, and was understandably tired. In addition, her appetite was non-existent, so all her energy was having to come from liquids. Resisting the urge to push was so difficult! Jennifer and John took a few minutes to say what I'm sure was a very fervent prayer. Despite how she felt, she kept remarkable composure throughout the entire labor. Between contractions she was calm and relaxed. During contractions she moaned in a low steady rhythm. It was amazing to see her coping skills!
After what seemed like a lifetime, the midwife was able to skillfully remove the lip. Thank Heavens! It was now okay to push. "I don't feel like pushing anymore," our very tired soon-to-be mom said. She was assured it was okay to take a few minutes to breathe, rest, and gain energy for the upcoming work.
Pushing was long but exciting. The first part we did while squatting. It takes two to hold up the woman, and it's a little bit of labor for us too! My back hurt so bad from slipping on the ice, and holding her up. My feet hurt too being on the hardwood floors of the living room. I kept thinking how much worse she felt than me; and did what 1 could. I was relieved every time she said she needed to stand as that mean that I could get a break too! Nikki, the other doula, mentioned that being a doula requires good squatting muscles.
Jennifer has a hooked pubic bone which made pushing longer than I expected it might be. It seemed like forever that the head would show through a little, and then slip back again. "Is anything out yet?!?" Jen was so tired. It was hard to believe all that pushing had only produced a little spot of head. Gradually the spot got bigger and bigger. I kept thinking to myself, okay, that must be where the forehead starts. It would get to that point Skin to skin contact was all he needed to get the general idea. After some family time together with the couple and their new son, we finished up with the paperwork business of height, weight, and so forth.
9 Ibs 4 oz, 21" long, and only a slight tear that didn't need stitching. So that's why Jen gained 40 pounds!
Jennifer, you are amazing my friend! In the words of Rebecca, you are a birth warrior! I love you and am so happy to have shared this experience with you. Thank you, and congrats on your beautiful new family!
With Love, Kels

Posting from Colorado

2008-05-18T18:23:00.000-07:00

I can't believe it has taken me so long to post! You would think being away from the clinic would have opened up a heap of free time for me. However, it seems just getting back into the normal routine of life and catching up from my time away is very time consuming. I feel as though I left everyone hanging when I left Bali. Matt arrived in Bali while I was attending a birth that ended in a transport to the hospital....and a beautiful cesarean birth.
I realize the true meaning of "cesarean birth" now rather than "cesarean section". When the circumstances change and we have to shift our birth plan we have to make the current situation the best we possibly can. We should mourn the loss of a vaginal birth, but at the same time we should try to lessen the trauma of the surgery as much as possible. We need to adapt to our new found situation by insuring that breastfeeding begins as soon as possible, getting baby and mama together so that bonding can begin right away, managing pain well and getting the mama comfortable, insuring that she has good information about what to expect from the healing process, and that she is supported in her joy and sadness. It is so important for her to know that she didn't fail...we just had to change course. I can honestly say that all of the births I managed where a cesarean became necessary, the surgery was truly necessary. I noticed a few births at the clinic where the mother was coached into pushing way too early, before she had a natural urge to push, which caused problems such as poor position of the baby.
I was honored to be able to attend the c-section of my patient pictured here, the doctor allowed me in to observe and take pictures of the birth. The mama, named Ati, was one of the most wonderful women I had the pleasure of working with. I have pictures of her cesarean birth, however I don't want to post them because it may be too much for some of you. However, I do have this picture of her breastfeeding right after the surgery. I got to bring the baby back into the surgery room right after the nurse assessed him and got him bundled up. Ati and I both had tears in our eyes when I brought her little dude right up to her face. She smothered him in kisses and we got to spend a little time just adoring him while she was stitched back up. It is really tough for the mama to not be able to see the baby right after a cesarean birth, but papa was waiting for him to arrive in the other room. The doctor actually chose me to attend the surgery instead of the father, which was a little strange at first, but after I spoke with the father we agreed that he wouldn't have wanted to see the surgery, it would have been too disturbing for him. Instead he welcomed his baby in the other room and was there for him when he was being "tortured" by the nurse:)

Now, I have to change gears a little bit to show you what I got to return home to! Here is my client Sabrina and her daughter Natalie. I am acting as her doula during her homebirth with another midwife. This is Sabrina's 3rd baby, and I will have attended all three...how lucky am I? Little Natalie was a footling breech born at home with no complications! Her first, a son Lucas, was a beautiful homebirth too. Number three is supposedly a boy, according to ultrasound, and his name is Liam...one of my favorite names for a boy. It just happens to be the Scottish (or Irish?) version of William, which is my father's name. Sabrina is from a great big family that is so supportive and loving, I am so lucky to have clients like these!!! I just wanted to give you all a little glimpse into my home life as now I think I have some readers from elsewhere in the world. One of my goals is to get more of my clients to post their own birth stories and photos, a work in progress.
Now, back to the conclusion of Bumi Sehat Clinic...I left Bali a little bit numb. Maybe I was preparing myself for the transition by detaching and putting my head down to forge ahead. When I arrived back home I had a serious case of, "Now What?" Life was so rich and engrossing at the clinic, I felt such a strong sense of purpose in what I was doing. That hectic pace had forced me into a beautiful place, where I was very focused and confident. Here at home I felt uncertain and bored...then the phone call came on Mother's Day! It was Bill, my mentor and my fellow midwife calling to ask me to rush over to a woman in labor. He needed me to attend to his client who was 45 minutes away from me and almost 3 hours away from him. He needed me to back him up. I drove as fast as I could to arrive at the home of Candace and Rusty, Candace had given birth to a beautiful baby girl just 10 minutes before I arrived. Quickly, I was back in my element..."oh, yeah, that's what I do!" Identity crisis solved, I was back in the game. I helped get everyone get settled and performed the immediate postpartum care for the mother/baby. What a great Mother's Day! Fortunately, it was a great birth to occur unattended...there were no complications. Everyone was a bit shaky when I arrived, but other than that, everything was great! I had attended this couples first birth several years before with Bill, so it was nice to reconnect with this family. Here is a picture of the family...sorry it is a little out of focus.

I am going to sign off for now. I realized that when I was at the clinic blogging was my social life. It was the only thing I did other than work, sleep and eat. Here at home there are so many distractions, relationships, projects, work and play...I have lost touch with the blog! I realize it was such a valuable sounding board for me, it allowed me to debrief to all of you and helped me process everything that was happening. Thank you all for listening...it means so much to me. Keep reading!!! More birth stories to come.

Maybe my last birth?

2008-05-02T22:19:00.000-07:00

Let me ask you...how would you feel about these women staring at your crotch all night? This picture is taken from the mother's perspective one night toward the end of a very long birth that ended in a transport to the hospital where Dr. Widegama performed a successful vacuum assisted delivery. Hooray...no cesarean! The cesarean tends to be the solution for most transports around here. In the states, women have the luxury of maybe receiving an epidural and inducing labor, among other possibilities depending on the circumstances. But here they don't use pain medication so loosely. It is only implemented when a cesarean is in sight. Ibu Ketut is on the far left, Joe is next, then Ibu Robin in the foreground in pink and Kadek on the right. Robin was falling asleep sitting up and the rest of us had been up all night. We usually only call Robin at night for special circumstances, in this case the mama was just stuck at 8cm! We had a tough go of it, and of course, so did the mama. We had run out of ideas and now it was time to make the call. So we transported. The head was so low it was really frustrating to not have her dilate all the way. But in the end the Dr. just pulled the baby's head right past the rest of the cervix. She just couldn't push past it herself, which normally you don't push past an un-dilated cervix at all... weird and interesting. At one point during this birth the mama was on a birth stool and Robin set up camp below her crotch, resting her head on a pillow and falling asleep below the mama. Just staring up, hoping for some sign of change and descent. It was a tough one!

Here it is May 3 and I am awaiting the arrival of Matt who should be here in about an hour. We have 2 mamas in labor, one who has been here almost 24 hours with a very tricky labor, but now we seem to be making some progress and another who is having her second baby. Ati, the first one I mentioned may be my last birth here. My enthusiasm is waining dramatically, I can say I may just be officially burnt out. (Can you tell I really don't want to admit it.) But of course, I have see this last one through. I have been with them all night and we have a really nice connection. What a luxury when the mama speaks English.
I have to tell you all that my departure is bittersweet. This has truly been an incredible experience and I feel as though I have done so much good, learned so much and fine tuned my practice...however, I feel as though it took me 3 weeks just to hit my stride and then, the time quickly vanished. I am now comfortable with the methods of practice, I understand more of the culture, I have an excellent rapport with the other midwives, I am beginning to understand the quirky nature of Robin, the director, but now...I have to say goodbye. I guess I have just made a good case for a longer stay for a trip of this sort. The course I set for myself was not sustainable for a long period of time though. I basically attended every birth I possibly could. The clinic did 74 births in April and I reached 62 births in 5 weeks. About 6 of those were transported to the hospital. Pretty good stats though. I believe I was in attendance for every birth that was transported, so 6 out of 74 were transported.
I think I will sign off for now. Getting a bit busy here...love to all.

A little crispy...but not quite burnt!

2008-05-01T17:42:00.000-07:00

The title of this post describes me...a little crispy, but not quite burnt! I did another 48 hour stint at the clinic so last night I had to get home to sleep. It was so hard to pull away with 4 mamas in labor at about 8pm last night. My right lower back was so tweaked from hunching over 2 difficult perineal repairs yesterday, it is a little sad to be sore from doing births! My exercise has been squatting with the mamas to show them what to do or to get down on their level, holding mamas up and bending over tubs. Not exactly the same as a hike or trip to the gym. I was more emotionally drained than physically tired last night. We have had quite a few transports and some difficult births that have really been testing me. I am looking forward to just sitting down with Matt and some friends and just debriefing on everything I have experienced here. I don't have time to process the intense moments because I am just on to the next thing immediately. Speaking of the hospital, here is a pic of the nurses at the maternity ward desk...I couldn't really get any good pics of the hospital, regretfully.

Today I will go do a home visit on a couple who just had their baby 2 days ago. We resuscitated their baby and usually first time parents stay 2 nights, repeat parents only stay one. The father wanted to be released because it was a special ceremony night the next night so he convinced the local midwives to let him go early. Not such a big deal if the baby hadn't been resuscitated! He needed to be observed. We called them and checked on them and they are doing fine, however I will go with my friend and co-worker Ayu who will translate for me to check on the mama/baby. We had a pretty intense night the other night with this resuscitation. It was a strange course of events and I think it would be educational to hear about for many of you. This mama came to us in very light labor saying that her water had broken. A few hours later, no real changes. The protocol here is that the mama needs to be in active labor 12 hours (preferably she would give birth by the 12 hr mark) after rupture or, left to the local midwives, she will be taken to the hospital. So, she hung out all afternoon, still nothing. One of the local midwives checked her again, her membranes were in tact! Her water had not broken, great! At this point her labor was virtually non-existent. I thought, let her sleep here and if nothing is happening in the a.m. we will send her home. Her due date was in 3 weeks so it may not even be time yet! But no, for some reason, the local midwives and Robin gave her castor oil to get her labor going that morning and burned moxabustion over points on her feet. Moxa is a chinese herb that is burned over certain accupuncture points in order to get certain results, in this case it was to stimulate labor. So there I was, not quite sure why we were trying so hard to get labor going, but I went along with their call. She was in light labor and then I think the castor oil kicked in in the afternoon, she was making frequent trips to the potty to poop (a normal result of castor oil) and contractions were light but consistent. In a couple more hours something shifted and she was pretty much getting solid contractions with very little break in between. The uterus needs to be in a good pattern of contract/relax in order to keep the baby from getting overworked from constant contractions. Also, constant contractions are very exhausting for the mom. The baby began to stress, we had some very low decelerations in the baby's heart rate so we put the mama on oxygen. That seemed to help temporarily, but the decels came back. Fortunately, the baby was about to be born. Anticipating a problem I readied the resuscitation equipment. I believe the stress resulted from an "overdose" of castor oil that created an overactive labor that was too stressful for the baby. Good lesson: even natural methods of induction can be too hard on the baby. In addition the mom passed out during labor...that's right, just decided to go out cold for no apparent reason. She wasn't even exhausted or dehydrated. A passed out mom who was low b.p., low respirations and low pulse means insufficient blood flow for the baby, another cause of stress.
Side Note: I have never seen women go so far away from their bodies in labor until I came here.
The women here get really spacey and lethargic during labor. It is very hard to get them to walk or change positions during labor, they want to lie down the whole time. Lying down during labor makes labor longer and is bad for circulation for mama and baby. Also, we don't get gravity to help us out! When a mama doesn't move, neither does the baby and this can result in a poor position or presenting part for the baby.
Am I boring you yet? To try to wrap it up here...the baby couldn't clear the fluid from his own lungs so we suctioned and assisted respirations and now all is well. I got to visit the family in their home today and I am happy to say that everyone is doing well! Here is a picture of my visit

I know the family really looks thrilled:) but they never smile for pics here. Maybe that goes without saying, cameras are a pretty expensive luxury.

Here is a lovely picture of some of the offerings that are made for ceremony, and ceremony happens a lot here. I include this picture here because the above family took their newborn baby out of clinic care in order to have the mama/baby pair at home for this particular ceremony day. They are a particularly devout young couple. "It just wouldn't be right", he said, about not having the mama/baby home.

I thought this was a really nice pic of the placenta and how we treat it. I think I mentioned that we wait to cut the cord until 3 hours postpartum and cover it in flowers as soon as it is born. A nice tradition don't you think? One papa last night wanted to make sure he could take the placenta home for ceremony. Of course, we said. Apparently, the placenta is placed on a certain side of the family compound according to whether the baby is a girl or a boy, burned and buried with a pencil (so that the baby will be clever) and a few other things I can't remember:)
That is all for now...too tired. Need to go lie down now, I am on call tonight here at the clinic. Only one mama here, so maybe it will be quiet? Only about 2 more days here! See you all soon...

Placenta Post-Graphic!

2008-04-29T19:58:00.000-07:00

Sorry for the graphic post, but I had to include this incredible placenta. Check out the vessels on this thing! Now that is one healthy placenta. I know most of you don't have other images of placentas in your mind to compare this too, but trust me. These vessels are so plump, all the better to transport oxygenated blood. This placenta came with a great big juicy cord, the biggest I think I have seen here, or maybe ever. That picture is available upon request because it includes a very graphic post-birth yoni picture:) Had to include this...Selamat Sore! Good Afternoon!

More fun with midwifery...

2008-04-29T18:31:00.001-07:00

Hello again...I always know that when I sit down to blog that we will get busy. I was right. We now have 2 mamas "on deck". Two first time mamas. The first was here all night, just sleeping mostly, with very light contractions. We gave her castor oil to get things going and now she seems to be having stronger contractions. The other mama was here last night for her regular exam. I did the exam, so it was cool she came in today while I was here. Now, we wait.
I wanted to show you this picture of a family waiting for their turn at prenatal clinic. I love her belly in the foreground. We saw 40 women last night in just over 2 hours. Rockin!
One pet project of mine has been to train the untrained birth assistants that are here. As I may have mentioned, there is really no structure for education. Technically, it is not a training facility. And yet, the clinic asks for untrained people to volunteer. This is a shame in my eyes for volunteers to be here without getting the least bit of basic childbirth education...so, of course, that is where I come in. Megan and Emily are participating in an "internship" that has turned out to be very unstructured and without a real preceptor. I am trying to get them more involved and educated. It is a shame to be attending births and not even understand some of the basics. So, Emily did her first vaginal exam today. She was so excited, and she did really well. She was dead on, the mama was at 2cm and slightly effaced...and she called it! We have been spending a little time most days just talking about birth, I answer questions, demonstrate things, etc. It has been great to offer this because now they are getting so much more out of their time here.
Up next...pics of the pediatric clinic. Here is Yvette, she is a massage therapist that does infant massage. She is massaging Komang, a sweet little dude who is almost 4 years old, believe it or not. He was born without event and then around 3 months, something seemed wrong. His muscles began to atrophy and his growth slowed dramatically. He can't speak, his head has flattened from spending so much time on his back, he can't crawl. He can only eat softened foods. He doesn't seem to have any very serious health issues otherwise. He is mentally disabled. It was so wonderful to watch him be massaged. The first thing he did was urinate because he got so relaxed. He made beautiful eye contact with Yvette and seemed positively stimulated by the massage. She also did some therapeutic exercises with his arms and legs and taught the mother how to do them herself at home. He needs to be massaged, exercised and stimulated because he is incapable of normal movements that develop the muscles, strengthen the bones and encourage blood flow.

I had such a great morning working in the pediatric clinic. We had lots of babies come in with miscellaneous, minor problems. Some conjunctivitis, a small fatty cyst on a penis, colds, flus and fevers. Here is a little cutey patooty (below)...This is a chunky little breastfed baby. Most of the mamas breastfeed for at least a year, often for 2 years! In the hospital the doctors get $20 US from the formula company for each mama they successfully convince to formula feed! Can you believe it? They also tell anyone who has had a cesarean that they should not breastfeed because they have had a surgery...this is horrendous! I may have mentioned this before because it is so crazy. This little one stole my heart. She loved her massage. She just had a stuffy nose, so we gave her some herbs and a massage and off she went. We sent 4 kiddos to the hospital for problems that were above and beyond our natural ways. One little guy who had jaundice ended up having Hepatitis B...poor guy! We are hoping he gets good treatment. One mama came in with her 2 year old and here new baby that was born a month ago with me! It was great to see her again and she was doing really well. Her 2 year old was the one with the fatty cyst on his penis. Poor little dude! I tell you what, there are few things more difficult than trying to get an ornery 2 year old to show his penis to perfect strangers!

Just wanted to show you all this funny picture of me...Amazon Woman and my friend Ayu who works here at the office at the clinic. She had just returned from a funeral so she was in her temple garb that looks so pretty. Isn't she gorgeous?! It is so strange here because much of the female population here wants to lighten their skin. Skin lightening creams are heavily marketed on television. They are envious of my skin and tell me that my skin is so beautiful. Ironic isn't it? White women all want to go to the beach and get a suntan, go to tanning beds and put on tanning creams to look darker! No one is ever happy with how Mother Nature made them. Ayu isn't really one of those women. She seems comfortable in her own skin. Ayu is the aunt of the woman who had the VBAC here where we had to resuscitate the baby and was present at the birth. That was very traumatic for her. It was great that days alter, one of her cousins came in to have her baby. That second birth was a beautiful, uneventful, waterbirth which was very healing for Ayu. I have a soft spot in my heart for Ayu because we shared a very intense and troubling birth, that fortunately turned out well. I think we both feel healed now. Time to go now...love to all!

Just Checking In

2008-04-28T00:02:00.000-07:00

Hi everyone,
Just thought I would take this opportunity to check in with you. My time here is running short and I find myself in an introspective mood. What have I learned here? What have I accomplished? What could I have done better? What is next? The clinic is very quiet right now, in fact, it is empty! All the mamas have gone home. We had no births yesterday and none so far yet today. It feels nice to clear the energy of the place. It is very intense for us as care providers to be around all of this birth all of the time. Even the actual space of the clinic seems to get bogged down by all of the emotions and activity. Now we have room for new birthing energies! I will be leaving here in about 5 days. I can't believe it! I have such a beautiful life at home, wonderful clients and incredible work...I am looking forward to returning to all of that. But there is also a big part of me that wishes I could invest more of my time and energy here. I am already thinking about the next trip I will take. I would like to go serve in a Spanish speaking country, as one of my primary goals is to develop Spanish as my second language. This trip has reminded me of the definition of "midwife", it means to be "with woman". I have certainly been with woman. In so many ways. I snuggled babies and waited anxiously at a mama's feet. I have wiped poop from a woman's bottom and cried with her when her baby died. I pat the father on the back and breathe with the mama during labor, one contraction at a time, breath for breath until the baby is born. I have sat down to dinner with a blood clot stuck to my leg and not cared one bit, I was too hungry and tired. My legs have gone numb and my back got sore after crouching over a mama's torn perineum, diligently suturing until she is back together. There is a part of me that wants to return home and just open a free clinic. Let all the women know that they can come to me anytime, for any donation and I will help. There is a part of me that sees here that if you just serve, everything else will fall into place.
When I first arrived there was a lot to process, there was so much to get used to and so many intense births. Now I find myself longing for that intensity. In a sense I can't believe I was actually overwhelmed, I have developed a new hardened self that can handle more now. An interesting develpment to experience. I have always known that I was cool in emergencies, but this trip has been a real test to that coolness. In a recent birth where I was the primary midwife we had a serious shoulder dystocia in the water followed by the resuscitation of the baby. It was a pretty intense birth but there was this inner voice observing and commenting on my actions. A very intentional and collected voice that was so reassuring. I am pleased to recognize that instinctual part of myself, which is so reassuring when you are in this work! My assistant later said that as things were happening and she was getting stressed she realized I was actually staying "positive" and that reassured her. I recall asking her to hand me things in a positive tone, not a fearful one. I guess that is a big reason why I came...to develop my "emergency self" to learn to maintain a degree of calm thourghout emergency where the entire birth team, including the parents, remains grounded so that I can continue my work in a good environment. I hadn't thought about it before...but it is kind of like making sure the scene is safe when you enter an emergency scene. You can't work in an environment that is in chaos and you can't help anyone else if you yourself become a victim.
I am really just writing all of this to process what I am feeling. I deserve very little praise. If you saw how things are here you would realize that I am not the one that deserves the praise. Really it is the women themselves that deserve the praise. To allow a white woman who they have never met before to catch their baby. To allow me to examine them, to suture them, or walk away with their baby. They are so trusting and open and that is to be admired. This was a great warm up to more challenging missions, which of course I want to take (Sorry, Mom!). This has been, "Medical Mission Light" as we like to call it here, but I wouldn't have missed it for the world. It is very politically complicated here and is neither overwhelmingly busy, understaffed or understocked. We are 10 minutes from a hoispital and have plenty of help. There is very little structure for volunteers and very little definition of the boundaries or expectations. I was told to just jump in. Births can get chaotic, with several midwives trying to direct the show. The births can become a sort of "show" with the mama as the star attraction. I have really worked on modeling how to hold a sacred space for the mama, which has been a challenge. It took some time to earn the respect of the other midwives, but once I proved myself, things fell into place.
Thanks for letting me journal all of this...I really want to get as many of my feelings down so that I can have a record. This blog is really my only recreational exercise, my social life if you will. Love to all...

Adu! Sakit! Long Post

2008-04-26T23:31:00.000-07:00

I thought I would fill everyone in on some of the subtleties of life around here. The title of my post is "Adu! Sakit!"...so I should explain. Adu means "ouch" or "oh my goodness". It is not uncommon to go through a labor and hear "adu" 200,000 times! Women here also feel a very strong urge to tell us that they are in pain..."sakit" means pain, in this case, contraction. The answer to every question is "sakit". "Adu, sakit" is pretty much all you hear from many of the women, the entire labor. These women are so strong! However, there is an interesting dynamic here. Despite their strength, the women here don't usually believe they are strong and often are convinced by their husbands that they are not strong. Women like to be catered to and adored and the men know this, but rarely are they actually adored. Public displays of affection are non-existent. Many of the first time mothers here have had sex once, gotten pregnant and then (because sex during pregnancy is taboo) not had sex again since. The guys are either very involved and catering to their every need during labor, or the guy is not around at all. Many of the guys hang back until labor gets really hard and then they are there through the end. Usually first time dads stay with the mom through the entire labor. I hate hearing the men say that their women are not strong because it is so untrue. However, the ladies do seem to enjoy playing up the "whoa is me" aspect of birth. I think this is because they don't get enough adoration on a daily basis, so now, in labor, this is a good opportunity to get everything they need!!!

Well, this blog is up to the minute, I tell you what! I just returned from a birth, just this moment! Another teenager, 17, who just spit the baby right out! She had only been here two hours while quickly dilating from 3cm to complete with about a 5 minute pushing phase! I am telling you ladies out there who are thirty-somethings (me included)...we missed our calling. Who says teen pregnancy is a bad thing?! From what I have seen it pretty much guarantees a quick and slippery birth and often with no tearing because the mama is so young the poor nutrition habits and toxicity of old age haven't caught up with her yet. The family is very happy. We often don't see the mama smile at all during labor, unlike in America, until the baby is born...then, she beams!

The above picture is of a first time mom I had the pleasure of helping. This baby was another nuchal arm baby! A nuchal arm is when the baby is born with its hand up by its head or neck. So, it only makes sense that more baby parts in addition to the head makes birth a little harder. In comparison, when the umbilical cord is around the neck it is called a nuchal cord. We seem to be having a run on nuchal arms lately. Things certainly do occur here in groups. We have also been having a stream of first time moms transported for "failure to progress". Really, it is very unusual for a woman to just stop dilating for no reason. It seems as though a poor head presentation is almost always to blame. Recently, we have had several first time moms whose baby's heads were extended rather than flexed, which is not a position conducive to birth. I have never seen so many women get "stuck" at more than 7cm for so long. These situations have required me to do a lot of vaginal exams to try to determine the baby's head position and troubleshoot the best course of action. So I have gotten a lot of practice determining suture lines, the lines where the bony plates of the baby's head meet. If a midwife can determine the position of the baby early in labor or when a problem arises then she can potentially solve the problem.

Here is the promised picture of the super tanker baby Antonio. This was the most interesting labor I have ever attended. This was an attempted homebirth that ended in a cesarean birth. This couple did such a great job! This picture doesn't do the baby justice, he is huge...4.5 kilos, 10lbs. Combine a 10lb baby with a really long labor, a rather flat pelvis and maternal exhaustion, and, well... For a first time, Asian mom this is a big deal! Check out her husband...he is 6ft and I am guessing over 250lbs.

Here I am doing fundal height measurements at our prenatal clinic that meets from 5-7pm on Sat, Tues, Thurs. Yesterday, prenatal clinic was nutso because we were a little short handed, we had 2 ibus in labor and we had all had a very busy few days, so we were dragging. We had two ibus that were more than 7cm dilation so I had to stay close. So I hung with the ladies while clinic happened. Of course, it was really busy because all of the pregnant mamas had skipped clinic 2 weeks ago because of full moon ceremony. I think we saw over 30 women in 3 hours, usually it just takes about 2 hours for the same amount.
That evening one of the babies born was born "in the caul". I think I explained this before? That is when the baby is born in the amniotic sac. It was a beautiful quiet, gentle birth by a mama who I could barely tell was in labor half the time. She seemed a little crampy most of the time and only got visibly uncomfortable during the last couple hours, this was her second baby. The first had apparently been a 3 hour labor! When she pushed, it kind of looked like she was just pushing out a little poop:) She didn't have to work hard at all. But there was the baby...hiding its head behind a bulging sac of water. In fact, a big fluid filled bubble the size of a softball was born before the head. The sac looked like a snow globe, you know the kind you shake so that it will snow inside the globe. Little sparkling specks of vernix (a cheesy white coating on the baby that protects her from the watery environment) were floating around in the sac as the contraction pressurized the water behind the sac and made it swirl. Beautiful! And auspicious.
This is a great representation of the birth rooms. This is the first time mama I am holding hands with in the above picture. The two birth rooms have these bamboo ladders in them and each has a birth tub. Each birth room can accommodate two women. When we get really busy we can do births in one of several other rooms, but not preferably. The ladders are really useful for support during squatting and for propping up a leg in a lunge. Most of the women like to just lie down during their labor. We really have to work to rally them to get up and be active. As you may know, being upright, changing position often, eating, drinking and urinating regularly are all very important to keep a labor functional and progressing. So a lot of what we do is encourage the mom to do all of these things. The local midwives tend to just leave the mama on her own...often they don't care if the ibu lies down the whole time, until the labor become dysfunctional, then they spring into action.
tears! Yeah! So I try to show by example how to improve things. Another great example is suturing. I believe I have described some of the problems with the techniques here previously. Briefly, the midwives here use techniques that increase scar tissue production and future tearing. I have been showing them more gently ways of suturing that reduces scar tissue and promotes better healing. Fun stuff! A prime reason for having the birth assistant volunteers is to provide labor support for these mamas who would otherwise have very little. They also provide comfort to the family by showing them that everything is normal, many families are very nervous about the out of hospital setting, despite that fact that the statistics for the clinic are much safer and healthier than the hospital. I have come to learn that the primary purpose of the volunteer midwives is to bring a little bit of the best of I haven't really explained how things work here. There is a paid staff of local midwives who hold Indonesian Licenses. Their training is hospital based. So here at this holistic, out of hospital birth setting some of them are a little lost. Overall though, this clinic is the shining light in the midst of a very dark health care situation, so beggars can't be choosers right? I guess, but as many of you know me...I always see more that can be done.
A big reason why I am here is to relieve Robin, the founder of the clinic and primary midwife. Although, Robin doesn't keep regular hours here or see clinic clients regularly. She kind of pops in as she sees fit. She also has a regular homebirth practice that mainly consists of western clientele. Robin, in my opinion, needs a sabbatical!!! She is the definition of a birth junkie. For more on Robin Google "Robin Lim". Another reason I am here is to relieve the local midwives and give them someone else to lean on when it gets busy. I am here to role model gentle birth practices really. Even though the care the clinic provides is highly superior to the hospital care...there are some problems here. The local midwives like to get the mama into lithotomy position (basically lying flat on their back) and crank their legs back with force. This position stretches the perineum taut and increases the likelihood of tears. It also is likely to cause fetal distress because this is a poor position for good blood flow to reach the uterus/baby. In addition, as if that weren't enough, you don't have the benefit of gravity in this position and it is not empowering for the mama. She is flat on her back...like a helpless little bug:( They also like to coach the mom into pushing as soon as she is completely dilated, which in my opinion is not appropriate ( really can't go into that here and now.) It has become a joke around here...the local midwives run around all of the time asking me, "complete?" They are fixated on 10 centimeters!!! If the mama isn't complete, they got nothin'. I called one of the midwives on this the other day and now we laugh about it, always asking each other, "complete?" A large part of my role here is to gently show the local midwives what can be improved, using laughter and lots of love. Because most of the women are poorly nourished and eat a lot of MSG they have poor tissue integrity and tear easily and severely. So it makes sense to try to use positions that prevent tears. I have had several first time moms give birth on hands and knees, with pretty big babies and no perineal tears. The volunteer midwives bring a little bit of the best of homebirth to Ubud every time we visit. Hopefully! Honestly, it was hard to figure out exactly what I was going to be doing when I arrived here. There was virtually no structure for integrating me into the system. I won't go into it now but, it is not what I expected and I was a bot disapointed. But here I am now..loving life, a full tilt birth junkie. We are a bunch of birth junkies, who need to get our fix!
Have to leave you with this lovely pic of one of my favorite couples. I just did a home visit for this couple yesterday, they just live around the corner. The parents were concerned about the umbilical cord and breastfeeding. A note to you new parents out there...as a general rule, there is usually nothing at all wrong, however sleep deprivation and a general lack of knowledge often makes you feel as though EVERYTHING is wrong. So a big part of what I did was to just reassure the couple and give a few pointers. I gave some breastfeeding postioning advice, provided some lanolin for sore nipples and checked out the naval, which was doing just fine. So fun going into the homes here. The families create compounds surrounding beautiful gardens that are meticulously cared for. In fact at this home, there was a lovely, small garden and the father said, "Please excuse the garden, the gardener is not good." But of course, it was lovely! Love to all...

Pics of the Latest Here at YBS

2008-04-22T01:22:00.000-07:00

Thought I would shoot some pics your way...Here is one of the beautiful young mamas I helped with her birth. She is just 16 years old! She had really flat nipples so I worked with her a bunch on good latch-on and getting nursing up and running. I was working with her the other night and I showed her how to hand express...she was amazed when little bubbles of colstrum starting coming out of her nipples. I don't think she thought there was anything in there at all. She is a natural. Her mother was right behind her, literally, during birth, holding her up on the bed. It was really sweet.
I named this one "happy family" because...they are!!! This mama was really working hard during labor. At one point she set up her "labor camp" right by the public bathroom near the kitchen area, complete with chairs and pillows and her support people because she had been told to walk around, but didn't want to walk anymore:) We finally got her into the tub for some relief and her husband got in too! This was so cute, he was down to his undies, very unusual for this area. I hope you can see the little onion that is placed above the right shoulder of the baby. This is to protect the baby from evil spirits because apparently evil spirits don't like the smell of onion! When the baby leaves the home the parents place an onion skin on the forehead, hands and feet to continue the protection away from the home. The mother/baby pair do not leave the family compound for 42 days post partum and the child is not to touch the ground for the first 150 days.

Mom really wanted to see my room...and I don't think I have yet showed a picture, so here it is. This is my bed. On either side are two other beds, my roomies. The ashram is really my second home, the clinic being my first. Today we had a very eventful day at the "ashy" as I lovingly call it. First, a dog, most likely and hopefully, peed in my duffle bag which I keep on the floor. He managed to soak several items. I think he is the neighbors dog, who basically roams the vicinity looking for trouble. So off to the laundry I go tomorrow. Then, this evening, I climbed the stairs to see blood splatter and bloody kitty paw prints all over the floor of our room. A cat had most likely hunted down a mouse, had its way with it, and then escaped via the balcony! Life in the great outdoors. There is an open access point to our stairway from a courtyard behind the ashy so it is an easy access for critters unfortunately. Tomorrow I think I will construct a barrier...this is too much!

Just got back from a birth...2nd time mom, no tears. Very interesting placenta. Parts of it were virtually undeveloped and most of the placenta was calcified, which often signifies that the placenta is old and is a poor transporter of nutrients. It was fortuitous that the baby was well developed, however he was a little small for his gestational age. On her chart her due date was supposedly May 26 but she couldn't remember when her last period was, so we were a big concerned that we were getting a preemie. However, the mama seemed to be at least 38 weeks, but with an old placenta that was deficient and a baby who was probably not getting all of the nutrition it needed. This baby is better off on the outside, where he can get lots of booby milk.
Here is a pic of locals in ceremony, a common occurence around here with the Hindu religion. This is the reason why we have had very few women at prenatal clinic the last few times. Every month there is a full moon ceremony that basically lasts a week. The people are in ceremony constantly, well, at least weekly. Thought you might like to see what "church" is like for them.
Right now we just turned away a first time mom who was having light contractions and was 0cm dilated...they live 5 minutes from the clinic. So cute, and very excited...but they need to rest. As you new mothers can attest to, resting in the early hours of labor is so important! Meanwhile, we await two first time mamas, pertama bayi as we say here..."first baby". I am hanging out in the office, catching up on e-mail stuff, blogging and joking around with the girls I work with, my birth assistants.

Here is the bucket brigade I mentioned earlier. We hauled a bunch of dirt that day. Fortunately, today it was busy at the clinic so I had to be at births rather than hauling dirt...ahhh, sweet reprieve. Here you go mom, you asked for pictures of me...how is this? Sorry!

Here is the open clinic I told you about earlier. I had to include this great photo of Endang demonstrating the use of the syringe as a douche of sorts to treat a yeast infection. The patient is receiving acupuncture as well.

OK that is all for now. I really need to sleep, it is going to be a long night. Two first time moms simmering at 2 cm...love to all.

Work Day at the Clinic

2008-04-21T21:51:00.000-07:00

I think it has been about 2 days since my last post. Things are pretty quiet around here. We are having about 1-2 births a day rather than seven, like last week. This is a relief actually. The clinic was granted some money from a client so there is an additional birth room being added on to the clinic as we speak. I was part of the bucket brigade, hauling dirt with our staff and crew. This is actually kind of interesting...the young man who donated the money for the additional room is a recent client of Robin's. He and his wife recently had a homebirth. The couple has their own line of clothing that caters to celebrities. This guy designs clothes for Madonna apparently and has quite the international reputation...of course I had never heard of him, he is from Israel. Anyway, he donated some money, so ground is being broken!
There are only two mamas in house right now, one 16 and one 20. Of course, I don't have to tell you how sweet they are...I will post pictures soon. Both of them I sutured so I feel especially close to them. When I go through suturing with them I feel a particular intimacy with them. Also, they are so young and impressionable, I want their births to be as gentle as possible. The young girls are incredible birthers. The 20 year old last night went from 3cm to pushing in 3 hours!!! Incredible. A really quick pushing phase resulted in a pretty big tear that took me about an hour to repair, which is unusual because I have gotten really fast at stitching. Around here, the midwives do a pretty functional job at stitching, they are not so concerned with aesthetics. I am! In fact, a note to Bill, my teacher, that I was complimented yesterday on my suturing job...so I have you to thank for that Bill. Bill taught me always to do subcutaneous sutures on the outer closure to reduce scarring, scar tissue and improve appearance. Here, the midwives, do a lot of very tight, puckering cutaneous stitching that binds the tissue and causes clumpy, lumps of scar tissue that has a tendency to become re-injured. I have been trying to teach the other midwives by example and show them how a suture job can have great integrity, but look good too. The way the midwives approach suturing is probably related to the cultural attitudes surrounding genitalia here. Apparently women here never look at their yonis, they are discouraged from touching themselves or inspecting themselves. Many women have no idea what their yoni looks like, before or after birth. So honestly, most women don't care how they are sutured. Most have no curiosity at all about their tears or sutures. But good suturing has so many more benefits than just aesthetics! In fact, I can segway into another clinic story here...
Yesterday I got to "play doctor" at the Acupuncture/Open Clinic. You never know who will walk in and you get to spend the afternoon troubleshooting, counseling, dispensing herbs and vitamin/mineral supplements and assisting the acupuncturist. I got some really great client contacts. One was a vaginal yeast infection. This was a cultural eye-opener. After discussing with my translator some cultural norms I came to realize that there was no way that this 40 year old was ever going to actually clean out the inside of her own yoni with her own fingers...never had, never will. Despite her condition. Endang, my super translator and I worked with her a bit and made some progress. We think she might give it a try!? Very interesting.
So it was a great day to mix it up a bit and do some general medical trouble shooting. We got a sweet little white boy with chronic nose bleeds, a possible breech baby and some infertility issues. More fun stuff! I didn't want to miss yesterdays clinic because it was my last chance to work with Dr. John, an awesome acupuncturist from Australia. I have really been blown away by him and wish he wasn't leaving. All the students scramble to work with him because he is a natural teacher, so positive and gentle and works really well in this chaotic environment. Another highlight of my day was working with Endang, a hopeful acupuncturist and volunteer translator for the clinic. Her husband showed Matt around when he was here looking for woodworking contacts.
Well, lunch break is over...gotta go back to the bucket brigade. Love to all...

News from the Birth Zone

2008-04-20T04:37:00.000-07:00

Hello Again...would you like to know what i have been doing for the last 48 hours? Sure you do! I have been sleeping on floors, hanging out in hospitals, playing with nipples and getting bitten by mosquitos...what have you been doing? I have to tell you what a real honor it is to be allowed into the lives of these families. Birth is such an intimate experience for the couple that I feel humbled every time I am allowed into the circle.
I had the honor of being asked to attend a home birth, away from the clinic, with Ibu Robin, the founder of the clinic. We were attending to Patricia and Roberto, the cutest couple! She is from Singapore and he is from Italy. To make a long story short I will fill you in on a new theory I have developed: Asian women need to be careful when they marry tall, hulking, broad shouldered, big-headed, heavy-set white men and want to bear their children!!! We labored at home for 30 hours, all the while a champion baby chugged along happy as a clam. I was at the home for 24 hours. I slept in the same bed with the couple and on their floor, shared meals with them, showered and made tea. All the while working on keeping this labor cooking and mama/baby happy. It later became evident that this baby was just not going to come down any farther and mama was exhausted, we decided to go to the hospital before baby became exhausted. This little guy (pics soon:) was NO little guy! 4.5 kilos!!! Our special super Doc, Dr. Widegama performed a cesarean to reveal a super tanker of a baby with the head and shoulders of a linebacker! The baby's head was not molding at all, so not only was he big, he was hard-headed.
Three of us ladies from the birth team attended the family in the hospital because you have to keep a constant eye on things at the hospital around here. They will give the baby a bottle just because the baby was born by cesarean...which is no valid reason at all. Mama Patricia was so relieved and papa Roberto could not stop kissing Antonio, who loved the attention despite papa's whiskers. Mama definitely earned this one! This was one of the most interesting labors
I have ever been exposed to. Her labor literally stopped for 7 hours during the second day of labor. I mean it just stopped when she was 8 centimeters! She slept, showered, ate a full breakfast, joked around with us. Then we called in Dr. John, the acupuncturist, in the afternoon who expertly got labor restarted in under an hour and were back in action. (Working at this clinic has taught me so much about acupuncture. I really have a newfound belief in its capabilities.) Labor resumed and we got to 10 cm, mama pushed for hours and the baby would not descend. So we found ourselves at Clinic Mas or the Rumah Sakit (Pain Rooms) for a consult with Dr. Widegama that resulted in the c-section.
Very educational. Learning to work with what the body provides, and not against it is a crucial aspect of midwifery that I love. My time here has been a valuable lesson in listening to the signals the body gives you and not ignoring them.
That beautiful birth occured after a bit of a lull around here, I had just spent the day baking dozens of cookies for the Earth Day Celebration that was held on April 19. Of course, I missed Earth Day because of the birth...but of course I didn't mind! After all, I am a birth junkie who needs to get her fix! The energy is truly contagious. Although, I was talking with Robin about how intense it is to be around all of this birth energy all the time. She is headed to Italy for a month in June, getting away from the clinic should be therapeutic. Being around new life is invigorating, and the joy is contagious and you would think that that would make you happy all the time...however, it can be incredibly depleting and draining. Interesting to think that part of the training to become an excellent midwife could be to be around so much birth, all the time, so as to actually become immune to the intensity of birth so that you can always perform calmly and without volatility during emergencies. It will be such a luxury to come back home and focus on my small client base, one birth at a time. Unlike today, when I kept wondering which birth I was going to miss because I was in the other room. I had another 16 year old mama today. Sorry to all my thirty something mamas out there...another 6 hour labor and 20 minutes of pushing! Although, Robin and I missed another homebirth because we were so tied up at the long one where a student midwife had to catch the baby because he came so quickly. This 37 year old mama went from 1cm to birth in 3 hours! Another testament to the power of acupuncture because she had a lot of acupuncture done to stimulate the onset of labor because she was over her due date. Who knows? The nice thing about acupuncture is that why not try it...there are virtually no side negative effects! Gotta post...battery running low...ciao!

OOPS, forgot to mention...

2008-04-16T23:54:00.000-07:00

sorry, but the next post has a sensitive birth story in it...for those of you who can handle it only!!!

A moment of peace at the clinic

2008-04-16T22:46:00.000-07:00

Whoa...I feel like I just got run over by a truck! The past 3 days have been a whirlwind. Actually, there were two days where we did 9 births in 48 hours. I am now up to 34 births here at the clinic. On day three, I crashed, coming down with a cold that everyone at the clinic seems to be passing around. So, just to give you an idea...it was a slow day of rest for me yesterday...so I only attended two births:) We started out with an interesting VBAC (vaginal birth after cesarean) which I think I mentioned previously. The local midwives wanted to send her to the hospital because she kept saying, "I am not strong." More importantly, her husband kept saying, "She is not strong." She was four centimeters at the time. I encouraged them, supported them and explained that if they went to the hospital they would still have to labor because cesareans are only done in the morning here, unless the clinic calls in their special doctor who will do them on call. But even he lives over an hour away in the mountains and because it wasn't an emergency, it was unlikely we could get him out of bed! So I ran a warm bath with some nice essential oils and called Mandi, a Canadian student midwife for some extra help. Ibu Ayu quickly went to 8 centimeters and then to 10 in a couple more hours. I was thrilled! But pushing was a different story! It was really tough for her. We asked if we could take pictures of her because of her cesarean scar. I hope you can see in these pictures how intense the scar is. In the US I can't do a VBAC with a woman who has a midline vertical scar like this. After 1.5 hours of pushing she gave birth to a little peanut of a baby. After assessment, he was most likely only 36 weeks, a month shy of term. As I mentioned earlier, due dates are so inaccurate here...very frustrating because we really don't know what we will get at a birth. This was evident when he was born because he did not breathe and his size was very small! When he did begin to breathe, after resuscitation we could see his chest retracting, another sign of underdeveloped lungs. He could have had a developmental disorder of some kind, but we will never know. We suctioned a lot of meconium stained water from his trachea because he wasn't able to cough or clear it himself. After getting an airway we used the bag valve mask but to no avail...time for mouth to mouth. I was the lucky one to do mouth to mouth on this little guy and I am telling you I will never be the same. The beauty of it was...It Worked! I was so happy!!! The baby is doing really well, nursing well, but is jaundiced, which is common in pre-term babies, so he is under observation at the hospital. I hope they don't screw anything up! The hospital, as I have mentioned, is a bit lacking! That event was the beginning of nine births in a row. Some of them happened on Tuesday during our regular prenatal clinic where we had a packed house of mamas waiting for exams. In fact, at one point I was giving another Midwife a break by doing exams when a birth assistant ran in and said, "Rebecca, I need you now!" I ran in to barely get gloves on while viewing a bulging amniotic sac, with a head right behind it! I caught a beautiful little girl born "in the caul" or born in the amniotic sac. You have never seen something so beautiful until you have seen the amniotic sac draped over a bay, peeling them back to reveal a slippery little newborn! Wow! So, as you can see, life is rich here and overwhelming.
After our rather traumatic birth the rest were wonderful. I had a lovely first time mom that I cared for who had a beautiful waterbirth with no tearing! We "white" midwives are getting really good at preventing tears around here. Which is no small feat, considering that poor nutrition makes tissue integrity poor. Unfortunately, this mama left this morning before I got to say good-bye...:( So let's look at pics, shall we?
Here is Ayu and her husband Kadek. Once we turned him around and he saw how strong his wife really was...he was a real champion! He was right there for her the whole time. She is the VBAC.

I wanted you to see this scar because it is so intense! They don't even do this kind of c-section in the US anymore, not since the seventies. Even emergency sections in America are low-transverse and much healthier for mama.

Here we are, after we got baby Putu stable. I wanted to include this picture in order to show you the placenta. Here, we do not cut the umbilical cord until three hours after birth. Here, Ibu Robin asked us to put a heat lamp over the palcenta to keep it warm during the final moments of transfusion. I have been learning a lot about the placenta and the benefits to delayed cord clamping. I won't go into it now, but really cool stuff that is now being confirmed by research about not cutting the cord immediately after birth. We also put fresh flowers over the placenta and the family takes the placenta home, along with all the other bloody trash from the birth and burns it and then buries it in the back yard of the family compound...pretty cool! The birth team and the baby were blessed by priests because this is a family of priests.

Well, I think that is about all for now. Love to all...

Single Mom Awesome Waterbirth!

2008-04-13T06:32:00.000-07:00

Here is a very sweet first time mom, 16 years old! Above her is her best friend, who has a baby herself and has been to a few births. Surrounding her is the birth team! Our team of birth assistants here at YBS, we are all here because Ibu Robin told us to "love her up" although only two of them were at the birth. This was a two birth day, so after I assisted at another birth I was able to pop in for the end of this one. Really, it was a pretty sweet, fast labor, only about six hours total. Teenage moms really put the pedal to the metal! She is a single mom, dad hit the trail when he found out she was pregnant! Her family has really been supportive, but the road has been tough and long. But here we are...and now they all have a beautiful baby boy to be distracted by!

Need to post these quickly because I am needed. A second Ibu just arrives...third baby, 2cm and 50% effaced. It is 10:30 pm here...looks like a long night ahead! Lots of love to all. Check out this true knot in the umbilical cord! This baby was truly blessed because a true knot can be devastating for a baby in utero. Fortunately, it is very unusual for a true knot to become so tight that the blood flow is totally restricted. That is what the Wharton's Jelly is for. Also rare to see a true knot at all. This is the result of the baby swimming through a loop of cord when it is very small and "swimmy" early in gestation. The jelly creates a buffer of cushion around the vessels so that some compression is possible without obstruction of blood flow. Of course, some compression of the cord is a given because of how much the baby grows, squirms and compacts itself into the womb. The Wharton's Jelly keeps the precious jewels inside, the vessels, flowing. See you on the flip side of these births...think happy birthing thoughts!

More from YBS...

2008-04-13T05:38:00.000-07:00

So I started a post earlier to fill you in on the latest, however the electricity went out! The computer I was on shut down and then a family came in with a feverish/fluish kiddo, so I watched the local midwives treat the little guy. Anyway, here I am again. I think I left off by saying that it looked like we might have another three baby day. Well, we had a four baby day and then we had a two baby day right after that! So, needless to say I got a bit distracted. Now here we are. I had a nice evening last night, out to dinner with some of the other volunteers. Then this morning my co-volunteer Meredith, a chiropractor, and I went to Cantika, a "spa" where we were treated to massages and hair and scalp treatments with homemade lotions and potions. It was a much needed get away, really the only significant trip away from the clinic since my second day here! So now I am hunkering down for the second half of my trip. My appetite is back with a vengeance so I have been enjoying local food again and cooking for myself with local goodies.
As for the above picture, some of you may recognize the tall black man in the middle. That's Michael Franti. If you don't know ho he is Google him...he's famous! Really he is an incredible singer/songwriter and an advocate and activist for human rights of all sorts. Also, he is a major supporter of YBS. He is apparently moving here and has taken up the cause of YBS. He recently did a promotional concert here and was shooting parts of a music video here at the clinic the other day. He really is a lovely guy and has access to a lot of money and resources that can benefit YBS. A great friend to have! So I had to put in this cute shot of him with some of the mothers from the clinic. That is Ibu Robin in the middle, the creator and director of YBS.
Here is a really nice photo of me attending a beautiful waterbirth. This was the baby I caught in the tub that ended up being a shoulder dystocia...sound familiar? She ended up having a tricky little labial tear that was reminiscent of a tear Bill and I struggled with last Fall in Colorado. It was awesome to see this same problem again and to be able to repair it well after seeing something similar before. Getting the skills honed is key!
As for now, we just received a new Ibu. She is 1cm dilated, light contractions, second baby, Vaginal Birth After Cesarean. She is hoping to have a vaginal birth this time after the hospital gave her a c-section for "failure to progress". Apparently, she didn't dilate past 3cm last time. But of course, we are skeptical. You just can't be sure what was going on last time and the assessment of the doctors at the hospital is always suspect around here!

Hope You Enjoy!

2008-04-09T23:26:00.000-07:00

Hope everyone is enjoying the blog, I really am! So, last I left you I went to check on an Ibu, a young 18 year old named Komang. So beautiful! Her family spoke a good bit of English and revealed to me that they were all very disappointed with her for getting pregnant out of wedlock and loosing her chances to go to college. This is a more privileged family who sent their other daughter to college here on Bali, she was also attending the birth. I tried to share with the grandmother and the sister that we are already in this place, and here we are at the birth...so let's support Komang and focus on the here and now without dwelling on mistakes! We are gonna have a baby!!! They agreed, we all have a special bond after that. The mother moved quickly, as I mentioned she might and by 9:15 am we had a beautiful water birth! The mama was making better progress squatting in the tub rather than reclining so she delivered the head in a squat in the tub. When the head popped out she instinctually rocked forward onto her hands and knees. Fine by me...especially since I ended up dealing with a shoulder dystocia, where the shoulders are "stuck" and need some coaxing/assistance to be delivered. The hands and knees position is very beneficial for birthing a baby who has "sticky shoulders" so the position was excellent. It is ideal for the shoulders and body to be delivered before 5 minutes after the birth time of the head. So I worked the shoulders a bit and...voila! A chunky little bugger emerged...who was actually mostly chunky in his head and chest only and more petite toward the lower body. Beautiful birth with a minimal but complicated tear that I hope responds well to the stitching. I have gotten so much faster with my suturing skills here, which is a sweet relief b/c spending time hunching over a mama is tiring for me but also interferes with mama/baby bonding. So now my clients will be able to get to mothering sooner, rather than later! Nice! Also, there is no time for slow stitching around here...b/c we need the beds:) No sooner did I wrap things up with this family before I found myself at another birth! It wasn't the other Ibu who had showed up last night, we actually sent her home b/c her labor fizzled out, it just wasn't time.
I ran over to the ashram to grab a shower and breakfast. I sat here at the clinic eating my breakfast, filling out paper work and debriefing about the birth. Then I headed into the post-partum room to put away some breast pump and bottle parts I had cleaned. I heard a commotion outside...whe you hear a commotion around here you grab gloves, it is instinct! So that is what I did. Just in time to help a groaning and sweating Ibu out of the taxi with her husband. BabyTime! Fifteen minutes later I was catching another little chunker. I guided the sister-in-law who accompanied her to get behind Ibu to help prop her up, she was pretty much a wet noodle! She pushed so gracefully and delivered a sweet little dude with a perfectly round head. Five baby boys in a row around here. Good Luck for sure!!!
I guess you could say this is my ideal day so far...but next walked in a sweet old guy from a village 3 hours away. He had gashed his wrist big time! Time to put on the gloves:) I just helped this guy clean his wound, changed the bandage and gave him some bandaging supplies for later and some anti-biotic ointment. The local midwife gave him some antibiotics as a preventive measure. Preventive measures are big around here b/c infection is pretty much a given! The local midwife didn't want me to send him home with a roll of the nice first aid tape that is waterproof, I tried to convince her but she wasn't going for it. We have a ton of the stuff and we just told him to change the bandage regularly. So what is he gonna do tomorrow or the next day!? When the midwife walked away I snuck a roll into his friends breast pocket and winked. The guy looked at me and winked too and said, "Makasi (thank you)." Enough Said!

Post you comments!

2008-04-09T15:35:00.000-07:00

Selamat Pagi! Good Morning! Upon the advisement of my wise father, I have resolved to improve my punctuation and capitalization habits. I have to admit, as a member of the e-mail generation I have gotten so comfortable with sending e-mail that it has become a bit like a conversation to me. A conversation full of run-on sentences, weak sentence structure and ... if you know what I mean. So, I resolve to improve with the intention being that I would like for the blog to be easier to follow and understand. So, here we go! With that said, it is morning. I wanted to make sure you all knew you could post comments, b/c I had no idea:) My dad turned me on to this. I am just getting the hang of this "blogging" thing. Just click on comment at the end of the post and let me know your thoughts and feelings. You don't have to send an e-mail separately, you can just "post a comment".
After sleeping at the clinic, so as not to miss any of the action, we had an Ibu (mama) arrive at midnight, 1st baby, 2cm. We told her to rest and we didn't hear a peep from her until i went in to check on her at 5:30am. Now we have her up and walking and she seems a little nervous, she is going to need some TLC. Then at about 6am we received an 18 year old Ibu who is at 7cm with broken waters. The young ones go quickly around here, and I think in general. Her mother (the grandmother) told me she hopes I can help her daughter give birth b/c she is so young she doesn't know what to do. I told her that her daughter's body is working just fine right now and that we should trust that her body knows instinctually what to do. Sometimes, as we age, our minds get in the way of what is best...when we are young we are more primal and raw...and that is excellent for birth! I am going to poke around and check on everyone. It is raining now so it is a beautiful morning for a birth...or two! xoxo

wow..this here blog actually works!

2008-04-09T05:31:00.001-07:00

here is the outside of my humble abode, lovingly known as the ashram. right now 5 ladies live here, all volunteers.1 midwife, 1 chiropractor, 1 student midwife and 2 untrained volunteers. i can show you more later. but for now lets finish the birth story from last time. so, the mama in early labor did some castor oil (ladies don't try this at home w/out midwife advisement) and we hung out and waited...all day. at 4pm she was 2-3cm, her water broke, at 5pm she was 4cm and at 5:30pm we had a baby! i was gloved and ready, attending to her in her room. she went to the potty and she got up to walk back to the bed, i stepped out to grab my water bottle and heard a yelp...i walked in to find a head being delivered and student midwife, mandy, catching the baby with no gloves on! the mama even delivered the placenta without a single contraction or grimace and with the most minimal blood loss i think i have seen yet! wow! talk about a natural birthing mama....she is it! i do think the baby is a little early...maybe by 3 weeks...however, he weighs 2.5 kg. he just weighed in at the "limit" for a low-birth weight baby. tedak apa apa, as they say here...no worries! we just did the 3 hr check which involves cutting the cord, giving vit k shot and measuring and weighing the baby. in this case we weighed the baby at birth b/c we were concerned...but he isn't having any breathing difficulties and everything seems physiologically correct, so...oh, and yes, they leave the cord attached until 3 hrs p.p. and then it is cut.

let's see what is next?
this is what we like to call...the baby package. parents arrive with a lovingly purchased baby set...if it is your first baby the set is brand new, usually still in the plastic. if it is your 2nd or subsequent baby...maybe the set is used and a little faded. i will offer you more pics of these sweet little baby get-ups. but for now this will have to suffice.. here is a proud new papa and his new package. all bundled up and ready to go...you would think it was 30 below here, but no, it is a cool 80 out today.

now for my favorite baby ever!!!
i think all of us want to snuggle this baby, but don't want to give birth to her!!! i knew the parents were going to think i was crazy...otherwise i would have buried my face in her cheeks and just snuggled her like there was no tomorrow. this baby was a lot of work for the mama and resulted in a 3rd degree perineal tear. the woman was very small and we worked with her a lot to help support her in the delivery. she also, has a pretty severe hemorrhage and a prolapsed uterus. ugh! however, all is well. the mama and baby are doing well...they went home yesterday. no i.v. necessary and the mama really bounced right back. the highlight of this birth for me was the older brother, who is now 3.5 yrs. his father brought him into the room just as the head was born...he looked down and saw this giant purple head and burst into tears. he literally jumped into the arms of tonya, one of the student midwives, who held him and rocked him and told him everything was going to be alright. it was the most beautiful thing! needless to say tonya had made a buddy for the rest of their stay and the little guy could be found listening to tunes on tonyas laptop while tonya was checking her e-mail:) gotta love it!

this one has got to be shared...since i arrived the place in the back of us has been doing some new construction. most of the construction is homemade cement and local rock or cinderblock. over the past few days loads of black sand and black lava rock have been dumped onto the street and then carried by hand, or by head i should say, by some of the strongest women i think i have seen in my life. here you see one of them, who is pregnant, carrying a couple lava rocks on her head! oh and yes, she is barefoot...so if any of you pregnant ladies think you can't get up and get out for a walk today...well...it goes without saying that i am constantly in awe!
one last pic for tonight...here is mandy, student midwife doing an exam on one of the mamas...this mamas #1 bayi (baby) was a little concerned about her mama being so far away...so i put her up on the bed and she stoically looked me in the eye with what i think was a thank you? mandy is measuring the mamas arm. we do that to check weight gain and monitor potential malnutrition. it is amazing to learn that many of these women who live very close to the land as farmers eat very nutrient rich foods, even though maybe not much food at all...but a little bit of nutrient rich food goes a long way. i still amazed by how they pack these 7lb babies into these tiny little tummies!!! that is all for tonight...sleeping at the clinic tonight so hopefully we will have some visitors...

lots of pics and babies!!!

2008-04-09T04:39:00.000-07:00

o.k. i have no idea why these pics are coming up in this order...but here we go! this is the view from my room. not bad huh? so mom, when you are worried about me, just know i am looking out onto a tropical paradise...the little village of nyuh kuning. we just had a birth and i am still a little a little shaken up. i am still not ready for the birth and it is over. the woman came in at 7am this morning with very little going on and 1 cm dilation. it is her 3rd baby, she was in very light labor, but the family lives over an hour away on motorbike and they didn't want to go home. her due date was in a few days. a side note here...no one is sure of their dates around here so i have learned to always be ready for a little baby with problems...unless i clearly palpate a large baby and they are measuring full term. due dates are big guesses here and many women hide perfect term babies in tiny little bellies. also, some women come in that we have never seen before. in fact i caught a baby the other night and on her chart, under her due date and last menstrual period it said ?? great huh? so basically we do a little exam if we are in doubt. most carry good size babies with very minimal changes in their own bodies. haev to send this b/c battery is dieing...more later!

trying to send pics!!!

2008-04-09T03:44:00.001-07:00

Here is the greeting I received at the clinic. The healthy mother earth giving birth to another one of her brood. I am experimenting with posting pictures, so please let me know if the blog is easily loaded, or any glitches...not sure how this is going to pan out. Bali is full of these kind of details...everywhere you see tile work, wood work, stone work, full of detail like this. i am going to start another post with smaller pics and see how it goes...see ya!

a long awaited catch up post...

2008-04-07T04:01:00.000-07:00

well, where to begin. the last you heard from me i was not feeling so well. that is an understatement. now, i am better than ever...just minorly sleep deprived and hopefully, sleep is in my near future. i ended up getting very sick...i won't go into details, but it wasn't pretty. it was probably no mistake that my first week ended with an illness. after 9 births in 7 days, i was zapped! also, they were not easy births...as you probably read! but my illness is gone after 2 days of being down for the count and only missing one birth during that time (which i am always concerned about, even when i am sick:)), i was surprised by a visit from matt. what a lovely surprise, i needed some cheering up. some of you know he is a furniture maker and one of his dreams/ side-projects is to have a line of custom made, wooden drawer pulls manufactured in bali. he came up to make some contacts here in ubud, which is a center for fine craftsmanship. after some digging and some help from my new contacts here at the clinic, matt was able to make a promising contact. he will return in 3 weeks to see the prototypes of his designs and go from there. they actually may be made in java. we will see...it is just the early stages, but exciting none-the-less.
another aspect of my positive space is that i finally got the urge to cry...i let it all come out. while i was so busy i didn't have time to react to any of the trauma happening around me...i just forged ahead. but after my illness weakened me a bit and i had some down time, i sat here in the office early one morning and just cried. i cried for so many things i have seen i don't know where to begin. i have to share some sad news. the cute little trisomy/cleft palate baby died in the hospital yesterday...after 2 days in the hospital, she had to leave this world. i know this would never have happened in the states if the trisomy was indeed only downs syndrome, but it could have been worse. however, we had no diagnosis at all. the only diagnosis was the one we did looking up everything we could in books. we don't know! we aren't doctors! but the alternative to us is not good!!!the hospital has no education or resources for dealing with these kinds of problems. they couldn't even tube feed a premature baby with breastmilk or furmula if necessary, they had no idea what we were talking about...segway into...
guess who i met today? michael franti! odd you say? well, yes. but actually michael franti is a big advocate for YBS. in fact, he did a benefit concert for the clinic here on bali. his family is moving here. i mention this to let you know that a huge goal of the clinic is to expand it's services. they have secured the funds to purchase the land next to the clinic...now they just need the money for the facility. the goal is to be able to expand their services and offer services that they can't offer in the hospital for mother/baby. such as tube feeding..it can save the life of a baby who is a bit premature with an underdeveloped suck/swallow reflex...whereas in the hospital the baby would probably die!
so yes, we had to say good-bye to our little girl. it was really sad, but we all new it was coming. there was a sense that death was best for the baby. and we really didn't know what was going on with her little heart, or that her condition was even compatible with life, even if hospital care was excellent. it was tough. i have to tell you that i learned a little something about the transport we had for a c-section...remember that one? well i learned from ibu robin, the director of YBS that if they don't call in their special, friendly doctor when they have a maternal transport that could need a c-section or assisted delivery...the doctors always wait until the morning to do the surgeries...no matter what the mamas condition!!! so that could mean dire consequences for a mama that arrives at night with a stuck baby!!! no epidural, no drugs to stop labor, nothing. ...
guess what? just got interrupted by a birth! how is this for action packed? we just had a beautiful first time mom give birth very quickly. labor started 11am...arrive at clinic 6pm...baby born at 8:15pm...life is great! no tears! and a beautiful little peanut of a baby! i want to share the good stories with you too...and there are many! this 24 hour cycle i have attended 4 births! so fun. i am getting a grasp on what the local midwives are all about. learning to work with them and also educate them about more progressive birthing techniques, while also learning some of their techniques. let's talk more about that later. got to get in some suturing today too. (also want to talk more about tears and tear prevention later) anyway, just wanted to share that we have had
4 boys in 24 hours! one we call the eskimo baby b/c he is so chubby and cute none of us can stand it! they are all precious of course, but ugh! this one is the best! we had a very emotional 1st time mom who birthed over the squatting toilets that are the commonplace over here. and a beautiful birth with a mother standing, leaning on the bed. i was the primary care on this one and the baby had a triple cord wrap around the neck. baby came, but he couldn't stray too far b/c of the wraps, i untangled him and all was well but it was a handful! 4 beautiful babes and 4 beautiful ibus (mrs./slang for married woman/mother) what a day! love to all...i just got my computer back today from being repaired so i will post pics a.s.a.p.

update from YBS

2008-04-02T21:34:00.000-07:00

hello again...today is a mellow day here at the clinic. one midwife from canada leaves tomorrow and 2 assistants leave sunday. time for changes. the clinic is virtually empty with only one mama in residence right now. it is her 1st baby and she arrived here at 7am at 1 cm and no effacement. for you lay people out there that means...for a 1st time mama...not a whole lot is going on. effacement is how soft or "ripe" the cervix is on a scale of 0%-100%, so she was 0% effaced. and dilation is how far the cervix is open on a scale of 1-10...10 means you will soon be having pushing urges...and well, you know what 1 means:) after resting for hours we encouraged her to get up and get walking..."jalan jalan" as we say in indonesia. we tell her to "makan" eat and have "minum" drink. here at YBS the mamas are asked to bring in a large bottle of water for labor. after they arrive we add liquid chlorophyll and honey to their water...a little trick of the trade that really seems to work for keeping the energy up in labor. i would love to offer this to my clients back home so i think i will add it to my supply list and see how it goes. the women here are troopers to put it simply. they never waver...
honestly, i am not feeling so well today. i have a fever, accompanied by a little "bali belly" (if you know what i mean). i am trying to rest as much as i can until our mama gets "cookin"...don't worry mommy (aka: Judy Pugh) i really am fine. it is pretty much a given that you will get sick here at some point, in one manner or another. but of course i am in good hands b/c everyone is offering me remedies...mostly natural. i took gelsemium, a homeopathic for fever...which actually seems to be working b/c i am now sweating it out rather than just feeling hot inside. on about the 3rd day i was suffering from "prickly heat" common in fair skinned tourists who are not used to the moist heat. i had a minor rash on sensitive areas and just felt ithchy. it is amazing how we adapt so quickly...in 24 hours i felt better and it hasn't returned. it is actually a really pleasant temp. in the 80's with rain about every other day. i also took apis, another homeopathic herbal remedy for the prickly heat. it really seemed to help also. i know matt is cringing right now, but my faith in homeopathics is really growing!!! we use them a lot here in labor, so again i am learning a lot. i also learned an incredible new position for "getting the baby out when nothing else is working"...ironically it is an excellent position for making babies as well as for getting them born. details upon request:) love to you all across the seas!!!

yeah! catch up time...some sensitive birth stories in this one

2008-04-02T04:27:00.000-07:00

hello everyone,
i feel as though i have such a support network out there in cyberspace...and that means you! and believe me i need it! i think i may be getting into a really healthy groove here, even though as we speak i am feeling a little icky after eating a huge piece of crazy, balinese birthday cake b/c it was one of the local midwives birthdays today! yikes! the icing was like sweet chapstick that left a sickening coating on my lips. the other cake, in contrast, was vegan chocolate cake made by an ex-patriot from australia...it was delicious. the other factor in my feelings right now is that i am worked! i spent all day in one room, one very warm room with very hard floors:) i was awoken this morning by a call from one of the local midwives at the clinic...a mama is 8cm, 2nd baby. o.k. game on... however, after a very long day of resting, walking, squatting, eating, drinking, hands and knees, bath tub, etc., etc., we took the mama to the hospital for evaluation. after being at 10 cm dilation and actively pushing for a really long time (how long you ask? don't ask, just a really long time!) the doctor, who was requested by the clinic b/c he is "midwife friendly" used his intuition and what little he could feel and decided to go ahead with a c-section. rightfully so! the baby had a very short cord and the cord was wrapped very tightly around the babys neck...this situation was creating a very extended neck, preventing descent! but no worries...this baby was a champion baby. the heart tones never faltered and we never transported b/c of the baby...we had to go, the baby was just not descending. but now mama and baby are doing really well, healthy and much happier now! and the baby was a boy!!!
good luck, as they say around here. apparently boys are favored b/c when the son marries he brings his wife into the home to care for the aging parents, and really for the family. so mamas know that if they have a boy they will never be alone and neglected in their old age...if the family has all girls, the parents will be left on their own. so it was a blessing to the mama who had such a tough labor! the women here are very stoic and all of them are here b/c they can't afford a hospital birth, even if they wanted one!
let me tell you a little more about the clinic...this clinic was started by robin lim. an american midwife who married an indonesian man and who now resides here in ubud. some of you may be familiar with her work, she is an accomplished author...check out her book "after the baby's birth"...highly recommended reading for some of you ladies expecting babies soon! the clinic is a force. with a resident doctor who consults, several accupuncturists, visiting naturopathic doctors and chiropractors, a meditation guru, and more. it is so cute...the local elders come in 1x week to meditate about their health. they all sit in an audience in front of the guru and he guides them in meditation to address their different ailments. chinese medicine is the predominent method of healing here. there is a lot of active participation in health here...and many live to be very old. it is great b/c the health clinic meets here regulary so we can refer just down the hall for issues like...breech baby, back pain, etc. fun stuff! i am definitely getting more of an introduction to alternative medicine in general than i expected.
also, one final birth story before i go...i missed my 1st birth last night. had to go grab dinner and a mama was at 3cm. i thought i was safe...how were we to know that the baby would be born in less than one hour!!! i walked in right after the placenta had been born, no worries, other midwives were in attendance. anyway, the baby had a complete cleft lip and palate, and was the sweetest baby i think i have ever seen. upon further inspection we assessed the baby most likely had a trisomy genetic anomaly (see wikipedia for more on that). one factor was that the baby had polydactyly, or extra digits...an extra toe and an extra finger that was poorly formed. we don't have an official diagnosis yet...and honestly, ours was about as official as it gets around here...even in the hospital...so... segway into the transport of this baby to the hospital because she also was underweight for gestational age and having breathing difficulties. and of course, a complete cleft causes real problems for breastfeeding. but the birth was wonderful, and the mama got some important skin-to-skin bonding time before the trip to the hospital and when we transported, she came with us just until we got the baby settled...holding her hand and stroking her the whole way to the hospital. i will fill you in more about the hospital scene here in ubud...but honestly and briefly...don't get too sick or injured in ubud!!! i have to sign off now b/c i need to rest...i am in bed by 8 most nights if i can be, b/c you never know when a mama will show up:) love to all and happy birthing to all my pregnant ladies...blessings!

posting on the run!

2008-04-01T01:04:00.000-07:00

hi everyone...i have gotten so many responses!!! thank you! i have so much to say. first, we had 3 babies in under 24 hours yesterday and now i need to get going to change before prenatals. we had a surprise breech baby (more details later), a beautiful water birth and a very interesting long labor ending in a water birth. anyway, just wanted you to also know that my computer crashed so i have yet to post pictures...which i have many of for you! never fear though, the clinic has a computer guru who is working on the problem right now! lots of things to share but not right now...also wanted to add that those of you who are pregnant or maybe don't want to know all of the details of the clinic should read with caution, i want to share a lot of the excitement and my learning process without scaring you! so i will put a caution in the title if there is sensitive material. i want you all to stay positive and not to fear birth, this is a very different environment here. even though they are an out of hospital birthing center these are not low risk women like most of you. these women have not had blood work or ultrasound and have had minimal screening until they get to us, which is often late in pregnancy. more later, love to you all...

More from bumi sehat

2008-03-30T04:23:00.000-07:00

hi everyone...i didn't realize how hard it was going to be just to post pictures. i promise to do so tomorrow...well, on 2nd thought i don't know if that will be possible either b/c mondays are really busy here! not to mention right now i am hanging out while on-call for 2 women who are here at the clinic. let me fill you in...when matt and i arrived we waited at the airport for our ride, the clinic was supposed to be picking us up. i called to find that the only car the clinic has was unavailable b/c the midwives had to use the vehicle to transport a mom to the hospital. she had a placenta accreta, where the placenta actually grows into the wall of the uterus, making the release of the placenta impossible without manual removal or surgery (hysterectomy). so matt and i arrived at the clinic, via taxi, to a stillness that was palpable. only minutes before it was chaos. all is well though, after several failed attempts to remove the placenta manually the midwives transported the mother to the hospital. the doctor was able to remove the placenta m anually, without surgery. a blood transfusion saved her life and her baby was just fine in the arms of her grandmother during the whole event. now mama and baby are together in the hopspital as mom recovers. whew! sorry to start off the whole show with such a traumatic story, but so it goes! it is nice to say that the births i have attended so far have been less traumatic. there have been some issues within the clinic that i won't get into...but just to put it into perspective there is very little structure here. i am expected to be as involved as i want to be and to take the initiative for any births or prenatals i attend. prenatals are held on tues, thurs & saturday nights from 5-7 pm. last night we saw 40 women in 3 hours. i measured, palpated & listened to 40 bellies and then looked into 40 sets of eyes (we are looking at the capillary beds of all the mother's eyes b/c anemia is such a being problem here. if the beds are pale anemia may be present). i recited all of my findings to the indonesian midwife Agung who was transcribing my findings as well as another local midwife using the other side of the room. fun stuff! during the day saturday we had 2 beautiful water births for 2 first time moms. for a waterbirth fresh flowers are placed in the water and after the birth of the placenta the flowers are put onto the placenta in a bowl. so lovely! all the midwives and assistants (i am learning) sing a prayer during the crowning of the baby to bless her and welcome her. sorry to rush off...

First Post from Indonesia

2008-03-28T04:08:00.000-07:00

What can I say? as soon as we landed in bali the smells reminded me of why i had returned. it is such a rich life here. the people have very little, in fact a woman recently gave birth at the clinic who lives in a tarp tent and when she arrived she didn't even have enough money for a large bottle of water...something i drink down every day here, the cost is 35 cents. you are probably here to read my blog to find out about what i am doing and how things are going in indonesia. you probably already know that i will be in ubud, bali at the yayasan bumi sehat clinic for 6 weeks. yayasan bumi sehat means healthy mother earth foundation. if you have never been to bali you are missing out. i hope to post pictures soon, however i am just too tired to deal with it right now! i just wanted to check with some of you who are curious and said you would stay in touch with the blog. this is new for me, so be patient. but i hope to record an accurate and insightful look at my time here. honestly, i arrive here at the clinic during a great time of change. it is so interesting to see how the pendulum swings...the situation in many countries with regard to maternity care is frightening. here, a small clinic is trying to make a difference but is struggling against the current of modern medical "improvement". i will comment more on this later and i can already see that this blog just may become my treatise on the state of birth as i see it in the world. i hope that some of you will share your 2 cents. i know many of you are in the birth world and could contribute a great deal. don't forget...to post just send me an e-mail with whatever you have on your mind...just put blog somewhere in the subject line and i will post your comments and respond to your questions if you choose. here, we see the severe effect that malnutrition has on the birth outcomes. women experience a very high rate of hemorrhage and very high rates of extreme perineal tears...when the tissue is not nourished the tissue does not respond well to trauma. anemia is a major factor in the malnutrition. therefore, a main purpose of the clinic is to dispense prenatal vitamins on a regular basis. such a simple task and yet so tough! that is all i have the energy for tonight. sleep well...

Rebecca's 3-Day Check for Anthem

2008-02-26T14:15:00.001-08:00

Here I am doing the 3-day check on Anthem Kotze, the beautiful daughter of Melanie and Nick. I love this part of my job...looking after the baby as she transitions into her new world.

Melanie Kotze's Birth Story

2008-02-26T14:07:00.001-08:00

Baby's Name: Anthem Hendriena Rae

Date of Birth: December 5th, 11:12 am

Original Due Date: November 30, 2007

Height/Weight: 18.5 inches... 8lbs even!

Gender: Girl

Our Story:

My mother called me at eight in the morning on December 4th and she made me laugh so hard that contractions started. I didn't think much of it seeing as I had, had major contractions two days before that didn't turn into anything. These progressed throughout the day and finally at 10am I called Nick and told him he should start looking for someone to take over his shift because my contractions were steady at 8 mins apart. As soon as I got off te phone my contractions changed to 4 mins apart, so I called the midwfe and she said she would stop over around 2pm to check on me.

Nick got home around noon and he timed the contractions and they were consistant at four minutes apart. Rebecca arrived and checked me. I was 2 cm dialated and 30% effaced. That was pretty disheartening to hear because it had already been 6 hours. I decided I would try and sleep, no luck, the contractions were too strong and didn't give me enough time to fall asleep.

BUT HERE'S THE BEST PART! Our water heater broke. Here I am awaiting my perfect homebirth and we don't have ANY hot water. I was pissed to say the least and the apartment manager said, "Well the guy who usually fixes that stuff is off today, so you'll have to wait until tomorrow." I got out my mean growling voice and said, "We're having a homebirth and my contractions are 4 mins apart. I suggest that you find someone to replace it TODAY!" So he did, and so I had weird bearded men walking in and out of my house all throughout my early labour.

So the midwife left and came back, left and came back, left and came back and finally stayed around 12pm. I wanted to do most of my labouring with just Nick but once my active labour started and he saw how much pain I was in he started to break down too. I was crying, "Let's go to the hospital" over and over and que in Rebecca! She came to save the day! She gave me a pep talk and helped me to manage my contractions. She was so wonderful on how she filled the tub for me and just sat and helped me with my "ooooooohhhhhhhhssss" until I got the hang of it. I think she went to take a nap for awhile but I'm not sure because I got into this weird zone and nothing mattered except me, my noises and the toilet ( I spent a lot of my labour on the toilet, we're very good friends now, haha). I'd go through a round of contractions (one small, one big and another small one), walk around the bedroom, walk back to the toilet and do it again. I think this lasted a couple of hours maybe from 4am-7am? I can't remember, even though I was looking at the clock the whole time I was only makng sure time was passing not really keeping it in my head.

Then its time for transition! Oh boy was this fun, I'm sure I gave everyone a headache. I started crying, "let's go to the hospital" over and over again and "I can't do this!" Nick touched my shoulders to try and help me relax and I screamed. At one point Rebecca asked me what I wanted to do (in terms of what position do you want to be in right now, do you want anything to eat or drink) and my response was, "Die".

I started to fight the contractions and just to let you know, this doesn't work at all, haha. My back was killing me and I really wanted to quit. I kept praying in my head, "God just give me the urge to push!" Rebecca kept asking me to squat, which I refused to do because I swear it would make me split in two. Eventually Rebecca demanded that I squat and with the help of Nick and Rebecca I finally did and guess what, after that initial dynomite explosion of pain IT FELT SO GOOD! After that point all I wanted to do was squat and be on all fours (and the toilet of course).

Then I got the urge to push. Once I realized what that urge was (I had, had it for the past coupel contractions but fought it) I couldn't stop myself. My body was crunching down all by itself and its the best and most painful feeling in the world. I started chanting in my head, "Out! Out! Out!" and once I touched the baby's head I was ready to go! They wanted me to lay down (to prevent tearing) and all I wanted to do was squat even though my legs muscles were giving out from holding myself up. Eventually I got on the bed (Labouring women are VERY hard to convince to do anything, hehe) my pushing became really productive. DH was getting ready to catch the baby and he said to me, "The baby has dark hair!" I said, "The baby has hair?" and then I started thinking, I gotta see this! About five minutes later little Anthem's head streatch my vigina into a scream (it was a loud one). Once her head was out one squirt and the rest of her was out too. DH's was trying to take pictures of her head coming out but it all happened so fast that Rebecca had to catch the baby.

27 hours later Rebecca put the baby on my tummy and the first thing she did was yawn at me (like she had such and easy ride or something), then she started crying, and then she peed all over my stomach. Such a charmer.

DH got to tie off the cord and she's a big healthy girl. My homebirth was exactly what I wanted, even though I kept yelling otherwise during the whole thing!

Rebecca's First Post

2008-01-16T20:58:00.000-08:00

Hi everyone...just wanted to welcome you to my new blog! I am hoping that all clients past, present and future will post their births stories, pictures and videos. Welcome! I hope this can be a forum for sharing the joys and challenges of birth and want to create a support network for mothers. Thank you for allowing me to be a part of your birth!