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My First Year In Midwifery School

June 11, 2014 by Sunny Daily Leave a Comment

It’s hard to believe that so much time has gone by since my last post. The commitment I made to blogging often has obviously been broken, but why? Well, looking back over homebirthTselathe year I am happy to say the reason the blog was put to rest for a while was because I was busy! Not only have I had a very busy year as a doula, childbirth educator, La Leche League leader, and midwife’s apprentice but I have accomplished a good deal of schooling as well. I am happy to report that with the assistance of my mentor Sybille Andersen I have accomplished classes through the National College of Midwifery. This year I have taken and completed classes on: The History of Midwifery, Laws and Regulations governing midwifery, Ethics, Fetal Development, part of Microbiology, written papers on International Breech Birth Practices, Placenta Encapsulation, submitted my required Fundamental Math and Statistics classes, recertified in Neonatal Resuscitation, Childbirth Education, and as a doula, completed a Spinning Babies class, certified to teach Sacred Pregnancy Mini Retreats, and Sacred Pregnancy Belly Binding. All of that and I have a little project I am working on which I will announce over the summer. Needless to say I feel like this has been a successful year.

I do want to say a huge THANK YOU to everyone who has shared their birth with me and has donated towards my education. This part of my life has patiently waited while I home-schooled my children, gathered the additional skills I felt I needed, and found my preceptor Sybille who shares her knowledge and experience with me. A big step was gathering the funds to pay for it all too. The support of my family was key in making the first step as was the organization and foresight my daughter had to set up the You Caring site. I also would like to give a big thank you to my web guru Liz Scavilla who in addition to becoming my La Leche League co-leader this year is single-handedly responsible for setting me up in the digital and print world. Couple this with the generosity of everyone who has donated has made this dream a reality. Thank you all for your past and continued support.

Over the summer I hope to accomplish a couple of classes including Community Health, Perinatal Education and Lactation, and work towards lining up classes I may need to take off island beginning this fall. It’s been a very exciting year and I am beyond grateful for the support and encouragement I have been offered. If you are interested in any of my new offerings rest assured they will be up on the website soon and I am more than happy to talk with you or expectant mamas about them. Again, thank you all for your support. It has made my dream come true.

Filed Under: Birth, Doula, Family, midwifery Tagged With: belly binding, breech birth practices, classes, homebirth, La Leche League, lizard design, midwife's apprentice, mini retreats, placenta encapsulation, sacred pregnancy, spinning babies, sybille anderson, youcaring

The year ahead

January 8, 2014 by Sunny Daily

The beginning of a new year offers a time for reflection. 2013 was kind to me and offered me the chance to renew my DONA certification  and my International Childbirth Education Certification. I  began life as a student and apprenticing midwife,  and starting working with some wonderful women to expand the scope of the work I do as a volunteer on behalf of La Leche League International . With all this going on I have had a chance to update my skills, be reviewed by peers in the childbirth community, and recommit to offering women on Nantucket options and education. It also means that as a doula and childbirth educator I have been certified and working on Nantucket for  5 years now. I have been a volunteer La Leche League Leader for 12 years. Experience has shown me that there is no one right way to give birth or to parent. Mothers and their babies have unique paths. I have really learned to listen to women and help them find their questions on birth and parenting, to support them in finding the answers, and to support parents in the vulnerable early days of birth and parenting.

New for 2014!

I am happy to be adding Newborn Care Classes. These classes are generously offered  for free with the support of the Nantucket Community School. The feedback I had been getting from families that attended my childbirth education classes or came to La Leche League was that they wanted more. They wanted to know and prepare for what happens after birth. Thus was born the Newborn Care Class. I ran a couple of classes last year just to see what the interest was and was happily surprised by two large classes. The feedback was very positive. The classes were structured but relaxed, engaging, and really helped parents reduce their anxieties about parenting by preparing. This class focuses on many things from getting to know about your newborn’s senses, how they communicate in the early days, hunger cues, feeding your newborn, growth spurts, nighttime parenting, when to call the doctor, and the essential how to’s of caring for your newborn. There are two classes in the series.

Newborn Care Classes will be held from 6:30-8:30pm Monday March 3 and Monday March 10 and again Monday April 14 and Wednesday April 16. Please send me an email if you are interested in joining or check the Nantucket Community School’s website come February.

On going classes:

Childbirth Education Classes at Nantucket Cottage Hospital begin tonight and run once a week for 6 weeks. I then take a break and will begin the next series in March and run for six weeks. The last class before summer hits will begin in May. Please contact Ellen Coe at Nantucket Cottage Hospital to register or feel free to let me know and I will assist you in signing up.

Private Childbirth Education classes are always available to fit your schedule and your needs. Please let me know if you are interested. There is a full menu of childbirth education classes available here.

La Leche League

La Leche League is a mother to mother breastfeeding support group that runs once a month. We meet the third Friday at 9am in the Early Childhood Center at the High School. Just drop in! The group is free and open to all expectant and nursing moms and their children.

There’s also a surprise in the works.

I have been inspired to work towards offering a different kind of childbirth education class that focuses more on the heart  and the woman’s path in preparation for birth and parenting. This class will be a compliment to the classes I already offer but work in an entirely new medium. This seedling is just taking root and I hope to be able to offer more information by the end of the month. Stay tuned!

Doula work

I am happy to say that I have been selected to work with 7 mamas so far this year, one of whom is a repeat customer! I can’t even express how happy I am to offer each and every one of you support. If you are interested in sharing your birth with me as your doula, I would be honored.

Also new this year is the ablity to charge any of my services to your credit card! As always we work together to find a fee structure that makes the most sense for you.

I wouldn’t be able to do what I love without the support of my island community.

I want to thank everyone that has committed to working with me, taken a class or two, come to La Leche League, donated towards the cost of my schooling, clicked on my website and read my blog, cheered me on, and especially Sybille Andersen who has been my preceptor, teacher, and guide during my time as a student midwife. Without the role each of you has played this year I wouldn’t be where I am now. Thank you all for sharing some of the most profound moments of your life with me. I strive to offer you confident care that is compassionate, honest, and just what you need. I look forward to seeing your babies grow and for some of you, working with you again in 2014.

Warmly-

Sunny

 

Filed Under: Birth, Breastfeeding, Doula, Education, Family, midwifery Tagged With: birth options, doula, knowledge is power, La Leche League of Nantucket, midwifery, support

The History of Midwifery and Breech Births

December 11, 2013 by Sunny Daily

Babies have been brought into this world since the beginning of time. Even up until the time when my father was born in 1930 a majority of births in the US were still taking place at home. This completely changed in the next ten years and led us to where we are now, with a majority of births taking place in the hospital. The reasons for this shift were numerous. Today many women sight “ what if there is a complication” as reasons to deliver at a hospital. One of these “complications“ can be a baby in breech position.

Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix and occurs in 3-4% of all deliveries. In 2010 ACOG (The American Congress of Obstetricians and Gynecologists) stated” The decision regarding the mode of delivery should depend on the experience of the health care provider. Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery. Obstetricians should offer and perform external cephalic version whenever possible. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management. In those instances in which breech vaginal deliveries are pursued, great caution should be exercised, and detailed patient informed consent should be documented. Before embarking on a plan for a vaginal breech delivery, women should be informed that the risk of perinatal or neonatal mortality or short-term serious neonatal morbidity might be higher than if a cesarean delivery is planned.”

According to an historical account of midwife Jane Sharp who wrote the Midwives Books in 1671, “if the head comes first, the birth is natural, but if it come any other way, the Midwife must do what she can to bring it to this posture. Sometimes the infant comes with the legs forwards, and both arms downwards close to the sides, this way the Midwife may endeavor to take it forth if it continue in the same posture by anointing and gently handling the place. But if it is safer, if she can, to turn the legs upwards again by the belly, that the head may first come down by the back of the womb for that is the natural way.” pg 155 The Midwives Book.  Jane goes on to out line other ways to assist a breech baby and her writing shows that she was clearly experienced in helping assist at breech births and that it was a part of a midwife’s job to know what to do to help at births were the babies present in breech position.  Given the frank discussion on how to handle a baby in breech position and the very specific instructions on how to assist at a birth like this, it is curious why “most countries now recommend planned cesarean sections in breech deliveries, which is considered safer than vaginal delivery.” (BMC Pregnancy Childbirth 2013,13(153)

First, let’s look at the numbers.  According to Birth without fear,” Breech presentation occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22% of births prior to 28 weeks’ gestation to 7% of births at 32 weeks’ gestation to 1-3% of births at term. Which means that 96-97% of babies will turn head down prior to their birth (97-99% if born at term).”Remember, that the percentage of breech deliveries decreases with advancing gestational age. This information is very helpful to a mother who has been told at an early ultrasound that her baby is breech. She can know that very often these babies turn on their own by 32 weeks.  Other factors that can play into the position of the baby, and are often screened for include, uterine malformations, the presence of fibroids, polyhydramnios, placenta previa, and multiple gestations may cause a baby to stay in the breech presentation. (Medscape.com) This information can be helpful in determining risks associated with vaginal delivery, for example placenta previa does cause major issues for a mother and baby and can play into why a baby continues to lie in breech position.

 

So the question then becomes, what can we do to assist the baby in breech position?

Gail Tulley of Spinning baby has been working for 10 years on techniques that can be used during pregnancy to help mothers achieve optimal fetal positioning in addition to turning breech babies head down prenatally. She outlines specific exercises for all mothers to perform and specific exercises for a mother with a baby in breech position to perform. If the baby is in a persistent breech position and labor begins, the fear that many mothers hear about is the risk to the baby that the head will get stuck. Shawn Walker, British Midwife explains it this way.” Some babies who are breech need help, more often than head-down babies. So having experienced support is crucial to the safety of breech birth. The head getting stuck is a terrible image, designed to terrify women, and probably the result of practitioners themselves feeling fearful or inadequate. I prefer to talk about the need for help because it creates an image that help is available, as it should be, but is realistic about the fact that occasionally some manual assistance is required. “(3) Ina Mae Gaskin has posted videos and written books on delivering breech babies. Gail and Ina May both outline specific modern techniques that can be used to assist in a breech delivery. Some of these techniques mimic in some form the work of Jane Sharp and others techniques are completely different.  Keep in mind that is the work of only two birth attendants in the US.

So if the techniques are there, what about the outcomes for moms and babies?

There have been several studies done comparing the results from breech babies born via c-section to those born vaginally. In 2000, a randomized multicultural trail called the Term Breech Trial (TBT) published its results. The trial followed 1042 women who were assigned to deliver vaginally and or via cesarean for babies in breech presentation. The trial reported some significant differences in outcomes with lower perinatal and neonatal mortality, and lower serious neonatal morbidity in the group of mothers who had planned cesarean section vs those who delivered vaginally. This one study had a major impact on practices and the modern practice of delivering breech babies via cesarean section and even influence the ACOG statement on breech birth.

A Norwegian group looked at information on international breech births and obtained information on perinatal morbidity and mortality in term breech infants in Norway. “Their results showed a lower perinatal morbidity among infants born vaginally in breech presentation compared to both study groups of the TBT.  The mortality rate was .31% when corrected for lethal malformations and 0.09% after the additional correction for death before admission to the maternity clinic. This could be explained by close fetal monitoring, national procedures, and sufficient skills of obstetric staff, combined with high quality neonatal service, in contrast to many of the participating clinics in the TBT.” (BMC Pregnancy Childbirth :2013, 13 (153) . Clearly there are many factors that play into the outcomes from breech deliveries.

The French have taken a different approach than doctors in the US. “French gynaecologists continue to perform vaginal breech deliveries. Through various observational studies, they have shown that their management approach, although different from the one used in North America, is safe.” (6). A majority of babies, some studies state as high as 54%, in breech position are still delivered vaginally in France and in Europe, namely the additional countries of Belgium, Ireland, Switzerland, and the Netherlands. This is because “French authors have questioned the selection of patients for vaginal breech delivery in the TBT. The reason for this is that only 9.8% of patients underwent pelvimetry, 68.7% were assessed by ultrasound, 57% were assessed during labor, and 33.4% had continuous fetal heart monitoring during labor. It should also be noted that 5.8% of fetuses were macrosomic. Finally, a slower progression of labor than the French standards was accepted in the TBT: minimum cervical dilatation of 0.5 cm per hour and maximum duration of pushing (active second stage) of 60 minutes.18 The analysis of perinatal deaths in the TBT was also criticized.” Couple this information with the risks to the mother associated with cesarean birth and the Europeans have not been as quick to jump to cesarean birth for all babies in breech position.” (6) The French go into very specific criteria for women that are selected eligible for vaginal delivery as well as specific conditions during labor. The difference boils down to not only the care the women received prenatally, the amount of information gained prenatally, but also the difference in care that women received while in labor with the key being the French standards for labor allowed for labor to progress slower than the standards used in TBT. Perhaps the women whose labors were called for cesareans in the TBT if given more time would have progressed and delivered vaginally.

In going back to what the ACOG said, ”The decision regarding the mode of delivery should depend on the experience of the health care provider. Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery.” The question then becomes, what has happened to the care providers that have the skill and expertise in vaginal delivery of the baby in breech presentation? Is it simply that in the time since 2010 and our comfort for using cesarean sections for any deviation from normal birth that we have lost the skill care providers that have had since at least the time of Jane Sharp in 1671 to delivery breech babies? And is it in for the best of all mothers and all babies to offer women only the choice to birth babies in the breech position via cesarean? Certainly more research can be helpful, but will we loose these skills before that research can be done or are the keys to successful vaginal birth for breech babies out there in historical texts and in the few hands of skilled care providers?

In thinking back to when I was an expectant mother, I clearly remember reading stories of babies born vaginally in breech position, In fact, one of the things that most drew me to midwifery and homebirth then was trusting the understanding midwives have for the different ways a normal deliveries can look.  I was drawn to the skills that I had read many midwives possessed in a time when many doctors were relying more on tools and machines which often times denied a mother the ability to labor and birth normally under the guise of safety. I didn’t know the terms then, just what I wanted as a woman and mother for the birth of my child. Now I know about informed consent. I try to instill in my mama friends, the responsibility of every pregnant woman to be informed of her choices.  When faced with a variation of normal, a baby in breech position, a mother deserves to have access to information about how breech deliveries are taking place all over the world, information about the risks and benefits to all approaches for delivery, and should dialogue with her caregiver about what the options for her delivery are. Birth is never a one size fits all. It really is about options and what the mother and her care giver decide together what is the best option for this birth.

 fetal compass rose

References:

1. Vaginal Breech Delivery- results of a prospective registration study.

By Ingvid Vistatd, Miladad Cvancarova, Berit L. Hustad, Tore Hernriksen

BMC Pregnancy Childbirth. 2013;13(153)

http://www.medscape.com/viewarticle/810620

 

2. Jane Sharp: A Midwife of Renaissance England by Jane Beal, Midwifery Today Autumn 2013 pg 30-31

 

3. Spinning Babies: Breech; Bottoms Up, http://spinningbabies.com/baby-positions/breech-bottoms-up

 

4. Ina May Gaskin- Midwifery Today, http://midwiferytoday.tumblr.com/post/27135829808

 

5. http://birthwithoutfearblog.com/2011/09/06/breech-birth-statistics/

 

6. http://jogc.org/abstracts/full/201003_Obstetrics_5.pdf

 

 

Filed Under: Birth, Education, midwifery Tagged With: breech births, informed consent, midwifery

Pregnant? Don’t panic! Learn about your options.

October 31, 2013 by Sunny Daily

Infinitepotential

It has been pointed out to me that it isn’t always obvious what your choices are when preparing to give birth on Nantucket.  You do have choices and knowing what they are can make it easier to decide how,where, and with whom you would like to give birth.

The first stop for a majority of women on island is the local hospital. Currently there are three primary care physicians practicing that you can choose deliver with if you want to give birth at the hospital.  There are no birthing centers on island.

What’s a doula?

You do have the option to hire and work with a doula. A doula offers professional care but without the medical roles or responsibilities of a doctor. The word doula comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth. This means that your doula works for you. As a certified doula I am trained to offered professional support.  I work with you prenatally, while you are in labor, and also in the early days and weeks postpartum.  We work together so that you may communicate with your doctor to enact your plans for birth. I support you in the choices you make for your birth. In the 5 years I have been a certified doula I have learned that one size does not fit all. Some women want and work for a natural birth, some women want to try a natural birth and feel good about using pain medication, some women are faced with an unplanned cesarian section and want to be able to bring their mindfulness and sense of sacred birth to a surgical birth, and some women are seeking and preparing for a VBAC. All of these paths to becoming a mother are special and are easier to do with support.  After birth, a mother continues to have emotional and physical needs that are in addition to the needs of her baby.   Breastfeeding is natural and so is birth however it doesn’t necessarily mean either one is easy. Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily. I chose to become a certified doula with DONA.org to offer women the support they desire to birth in a way that feels right to you.

What’s a midwife?

“Midwives are the traditional care providers for mothers and infants. Midwives are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care that is utilized in all of the countries of the world with the best maternal and infant outcomes such as The Netherlands, United Kingdom and Canada.” from MANA.org

There are many different types of midwives. On Nantucket we are lucky to have a Certified Professional Midwife Sybille Andersen. As a Certified Professional Midwife Sybille works with families who want to give birth at home.  Please feel free to visit her website and contact her to learn more about her training, experiences, and services. Midwives can offer comprehensive prenatal care, well woman visits, primary care for birth and postpartum care for the mother and newborn.

I have taken the step to begin my training as a midwife. I work with Sybille as her assistant and apprentice. I have wanted to become a midwife since the home births of my daughter and son because those experiences are the  highlights of my life. I want to offer women the opportunity to give birth at home and enjoy the comfort, safety, and unparalleled experience of a nurturing home birth.

What makes you feel the most comfortable and supported?

When in doubt, about anything during your pregnancy, it’s always best to ask questions. Take the time to ask questions and make sure you receive the care that makes you feel comfortable, heard, and educated. Interview different care providers and learn from them what they can offer you. Don’t just take your friend’s word for it. Find out what it is that you need to give birth in a way that you feel supported.

It goes without saying but please feel free to contact me. I am always happy to help assist you in any way that allows you to enjoy being pregnant, preparing for birth, giving birth mindfully, and caring for your growing family.

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Filed Under: Birth, Breastfeeding, Doula, Education, midwifery Tagged With: birth options, cesarian birth preparation, giving birth naturally, how doulas help, knowledge is power, midwives, natural birth, VBAC

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