Midwifery bills hit the Nebraska legislature

The Nebraska Friends of Midwives have worked exceptionally hard this year (and last year too, laying the framework) to get 3 bills introduced this session. The bills are all regarding only certified nurse midwives (CNMs), as lay midwives are a whole other hurdle to jump. Little bits at a time, right?

The bills are:

• LB406- Right now, hospitals in Nebraska can refuse CNMs the ability to apply for privileges at the hospital (including attending births) simply because they are midwives. This bill make it so that hospitals could not deny a health-care provider equal opportunity to apply for privileges based soley on his or her credentials. And yes, this has happened already in Nebraska (namely Norfolk, which simply closed the CNM category in 2002).
• LB457- This would remove the practice agreement requirement for CNMs. Right now, CNMs must find a physician to enter into a written agreement in order to practice and everything she does then requires the strict approval of an MD. Though CNMs have and will continue to work with physicians and, of course, hand off anything out of their scope of practice, this would give CNMs greater opportunity to practice in different settings. It would allow for birthing centers to be opened, for example, as they are in many other states. In fact, this bill would make Nebraska law consistent with the majority of its bordering states.
• LB481- This would remove the restriction on CNMs attending homebirths. Homebirth has always occured in Nebraska and will continue to occur. The current law restricts mothers from accessing trained and licensed midwifery care. Currently, mothers who wish to birth outside of a hospital must either hire an underground lay midwife who may or may not be trained properly (and will be supremely hard to find!), travel out of state to deliver, or birth her baby without any assistance whatsoever. In fact, Nebraska has made it a felony for a CNM to attend a birth at home. A felony! Nebraska is one of only 2 states which restricts CNMs from homebirth in statute.
  

Anyway, they've all now been introduced and we are waiting for a hearing with the Health & Human Services committee. The good news is that we have gained a nice amount of senatorial support. (Did you know that 4 of our senators were actually born at home themselves?) But, we still have a long way to go to get these through committee, heard on the floor, and voted on.

In order to maintain a presence at the capitol, NFOM has been organizing regular "M&M Days" where we go and pass out M&M treats or cookies to the senator offices. Why M&Ms? Because it stands for Mothers & Midwives, of course. We just had one yesterday & I meant to get a picture, but drove off without the camera. The kids got to shake hands with the Lieutenant Governor, though!

We've also been serious about contacting our senators, asking them to support this legislation. I met with mine on January 9th. But even a phone call, letter, or email would help. Please, if you live in Nebraska and care about offering women the full scope of nurse-midwifery care, won't you do your part?

TIME article on home births

You can read an article from the most recent issue of TIME on home births here. It's pretty fair and balanced, I think, as far as mainstream goes. I'd love to see something on birthing at home that doesn't include the seemingly required "other side" and statistics of danger and death. Can we not just talk about home births? Must we always surround it with controversy? I guess that may be asking too much...at least as long as home birth remains a "fringe" activity. Plus, you might make the AMA mad.

International Midwives Day

Today is the day we get to recognize midwives the world over and the incredibly important work that they do. Unfortunately, due to Nebraska's nanny-state law, I cannot recognize my homebirth midwife by name. I can, however, thank her anyway. She is representative of the few caregivers that seem to be left in this country that recognize birth as a normal process and not an event of medicine.

Now, don't get me wrong. I realize that medicine does have it's place in birth. Abby's birth is a prime example of that. Without an MD and surgery, I can't imagine what might have happened. The doctor that did my surgery was absolutely amazing and I am forever grateful for his empathy and care. But, they (doctors and even hospitals) have their place, just as midwifery should have its legal place.

Why?

Because

• The C-section rate has climbed to 31.1% as of 2006, when the World Health Organization holds that there is no excuse for rates over 5-15%.
• After steadily decreasing for decades (we learned to wash our hands!), the maternal mortality rate for the United States has begun to increase again and hit 13 per 100,000 deaths in 1999, which is among the highest in industrialized nations. In fact, it ranks 41st. As a woman in the U.S., you are about 3.5 times more likely to die in childbirth than in the top 10-ranked nations. The reasons are likely varied, but you must at least consider that the U.S. also has one of the lowest rates of midwifery care for pregnant women.
• Midwifery care is hands-on, nurturing, and empowering. While the average prenatal visit with a physician lasts only moments, a midwife may spend 30-60 minutes (at least!) with a mother. Midwives rely on the fact that women's bodies were designed to give birth and they encourage the mother in her role. Even their vocabulary ("birthing" versus "delivering", for example) helps to express their underlying belief that they are an attendant and that it is the mother who will be doing the work. And they allow the mother the freedom to experience birth in the way that she needs and desires instead of fitting the mother into a mold.

So, thank a midwife today! And, while you are at it, support the right for all midwives to practice legally in the state of Nebraska, as well as the other states that don't.

P.S. Be watching for the biggest and latest news coming off the farm! It'll be fantastic, I promise!

Abigail's Birth Story

What a wild ride this has been. It was an occasion filled with odd-defying turns of events and surprises for us. I'll start as near to the beginning as I can. Strap yourself in, cause this will be a long post. But, I promise to sprinkle it with pictures and I hope you'll stick with me to the sweet, sweet end.

On Tuesday, Nov 20th, I called the midwife. Man, you know how impatient I'd been, but I was starting to worry about interrupting everyone's Thanksgiving plans, the size of the baby, and the timing of our insurance (our Tricare coverage was ending as Don's official time with the military is now complete!). So, I called and asked what they (she and her assistant) thought about breaking my water if she was in a good position. They had been discussing the same thing and we agreed it seemed like a logical course of action. They arrived at our house a little before 4pm and did an exam. Abby's head was still down, she had dropped lower, and everything looked great. The bag of waters was bulging ahead and preventing her head from compressing the cervix, which is why I had been having so many false starts to labor. After hearing stories about amazingly quick births after breaking the water, we decided to get Don home and get set up before doing it. We also got a picture in of my 41 weeks plus 3 days big belly. As it turned out, I had what is called polyhydramnios, or excess water. This occurs, apparently, in only .5-2% of births. There were over 4 pounds of water that came gushing out! Whew! I actually fainted shortly after the water was broken! I don't know quite what happened there. Perhaps it was just too much for my body to comprehend at the moment. Anyway, we took an after shot of my belly and were amazed at the difference in the 2 pictures.
Here they are. The top is before and the bottom is after. I feel like it looks like I went backward in time a month or two!

So anyway, my water was broken at 4:55pm on the 20th. I was, at the time, about 4 cm dilated. My contractions began quickly, but they were fairly few and far between. I didn't spend a whole lot of time or effort timing them, but the midwives had their eye on the clock. They declared that I had moved into active labor by around 6pm. The contractions were very easy. The midwives kept me up and moving to try to intensify things, but I never moved past the stage were I just needed to stop walking and focus through a contraction. I wasn't focusing so much because of pain, but just to keep myself relaxed and because it was just intuitive. I felt the need to stop and let my body do it's work before moving on. The midwife did several exams with me, which is unusual, but they were worried that I wasn't dilating as I should be because my demeanor was so calm and I never declared pain. But, all along, I continued to dilate and by 6 cm, they let me get in the birth pool. It was so calm and pleasant and I was really enjoying myself. At this point, we called our neighbors, Lesa and Hannah, over. Lesa is the mom of 9 (with a few home births under her belt) and Hannah is her 16-year old daughter. They were planning on helping us through the labor with whatever needed to be done. Lesa, the midwife, her assistant, and I sat around chatting while I was in the pool, but the contractions started to slow a little and they ordered me out. It was back to pacing around for me. I also spent some time on the birth stool and the birth ball trying to encourage Abby to descend.
Here I am at about 9 cm dilated on the birth ball. I was talking and laughing between contractions, focusing during, and all the while, just completely amazed that I was still not in what I would consider pain. When I compare all this to my other 2 births, it makes me think that pitocin must have been invented by the devil himself. With the other 2, I was in tears and agony from the start of hard contractions.

This whole time, Caleb really made himself pretty scarce. He was uncomfortable with seeing too much of me. He was willing and ready to come see the birth, but didn't want to have to see all the "before" stuff. He spent most of his time downstairs playing games or watching movies with Hannah, the neighbor. But, he did come up regularly and, backing his way in so he wouldn't seen anything, ask if everything was alright and if we needed anything. He was so cute.

Meagan, however, was excited beyond belief to share in every bit of labor. She watched every exam and was so incredibly helpful in getting whatever was needed. She wants to become a midwife when she grows up. However, things started to drag on into the later hours, and even an aspiring midwife needs her sleep!
We suggested she lay down in our bed so that she'd be nearby and we could wake her easily if anything exciting happened. She agreed and, within minutes, was snoring. She remained there for quite a while, sleeping soundly while I was getting examined in the same bed and we were all talking and laughing around her.

At around 8 cm, the midwife had felt and elbow come to the opening. Her head was still there, but her elbow was coming first. The midwife said that it would mean that she would probably need to help pull the arm out first as Abby crowned in order to give room for her head to follow. I continued to progress to 10 cm, but by 10 cm, the midwife could no longer find Abby's head there with her elbow. It felt as if Abby's head had moved over and was sitting off to the side. We talked about just waiting to see what happens, but the midwife suggested that the best course of action would be to go to the hospital at this point. She was concerned about the cord being able to slip down through now that Abby's head was not there to block it. She also felt that with an ultrasound, they might be able to manipulate Abby back into position.

At 2am, the morning of the 21st, we left for the drive to Omaha. There was no emergency, as both Abby and I were doing fine, so we just drove, with the midwife and her assistant following. We arrived at the hospital at about 3:30am, and were put into a small room where only Don could be with me. The backup doctor (family practice) who I had seen earlier, had not arrived yet, but one of his partners came in and examined me and did an ultrasound. The ultrasound showed that Abby had completely turned and was now transverse. Her head and feet were out to the sides and her spine was down and across the cervix. Transverse presentation happens in only 1 n 2500 births. Unfortunately, unlike other breech presentations, there is only 1 way to get that baby out and that is by C-section. Other breeches can still be delivered normally, although many physicians will not attempt it. However, a transverse, especially one at this stage of labor, just won't come. When the doctor told me this, I started to cry. This was so far removed from the serene home birth that I had wanted. But, I was comforted by this...when I started to cry, the doctor did as well. I have never seen such empathy in a doctor before. He knew I had attempted a home birth and knew how disappointed I was. He said that he would've delivered any other type of breech, even when others wouldn't. But, he just couldn't make this happen. The midwife (who was now considered my doula since walking through the doors of the hospital) was able to stick her head in and cry a little with me as well. But, they wouldn't let her stay in the room and we told her to go home and rest. We would call when it was over.

The began to prep me for surgery and Don and I were emotional wrecks. At one point, the doctor came in to explain some things and told us that there was a slight possibility that he may need to make a vertical cut as well in order to pull her out, as she was in such a bad position. This would mean that I could never labor again. Through tears and prayers, Don and I readied ourselves for the surgery.

Don was able to sit in with me through the surgery. I have never felt anything as uniquely bizarre as that C-section. The pulling and tugging and pushing was so strange. Don remembers the doctor saying that an arm popped out immediately when they cut into the uterus. This made the doctor concerned because he wanted something more substantial to pull on than an arm, but she made it out ok. I knew that she was out and heard her give a little whimper. Of course, the tears came again! I got a tiny peek of her before they whisked her off to another room. She was having trouble getting going and needed some oxygen. They worked on her for a while, while the doctors worked on putting me back together. They did bring her back in and laid her on my chest for a few moments for me to kiss and look at. She was beautiful.

Don then was able to go with Abby (and I told him to!) while they finished on me. I laid there and listened to them talk about the stitches and counting the instruments. They lost one for a few moments and the whole room stopped doing anything else until it was found (it had been hiding in the placenta!) which made me a little relieved. I didn't want to be one of those who comes home with a pair of scissors sewn up inside! I got back to the recovery room and Don, with Abby, was just a few seconds behind me. And, here she was.
It was so different not seeing her right away after being born, as I had done with the other 2. I know I will continue to mourn the loss of many things I had wanted in this birth, and that is one of them...seeing her emerge. But, I am so grateful that she made it through everything just fine.
Don got to hold her and even catch some shut-eye while we waited for our permanent room. And yes, that is a beard he is sporting.
Here I am, holding my precious baby.
We got into our new room and almost immediately, it began to snow. It was so beautiful to see the large flakes outside the window. Abby's birthday was the first snow of the season. You can see a little accumulation here on the roof.

Recovery was fairly uneventful. I did end up needing a transfusion, but that went smoothly. I will say that C-section recovery is in a whole other league from a normal recovery. It has been much harder.
My dad came to see his 3rd grandchild.
And the kids loved holding their new sister.
But, I held her as much as I possibly could. She was, by far, the best-looking newborn we've had, since her head didn't have to be squeezed through a small opening. She is just perfectly beautiful.

We left the hospital Thanksgiving evening, about 36 hours later. I just wanted to get home and get our family back together again. And, I knew I would recover better in my own home.

I did end up developing a "spinal headache" from the spinal they gave me for the surgery. To combat that, I'm on some pretty strong narcotics. Therefore, I apologize for anything that isn't coherent! Now, I must go and feed my little baby. Thanks for hanging in there with me through the story!

Abigail Ruth
born 5:31 am, November 21st, 2007
weighing 9 lbs, 7 oz and 21.5 inches long
precious gift of God

National Midwifery Week

This is National Midwifery Week. Today, the kids and I had a wonderful "field trip" corresponding to it.

It started with a tour of the Nebraska Capital Building in Lincoln. It was very informative & my cousin & her homeschooled kids accompanied us. Though they live in Lincoln, they had never been on a tour. The highlight for the kids was to go to the very top of the tower part of the building and look out over Lincoln from the Observation Deck. Caleb was also amazed at the age of the building, though it is younger than our house!!

Then, we attended the Proclamation Signing with the Governor. Meagan looked like she was being tortured. It was neat, though, to go up as he signed the proclamation for National Midwifery Week and get our picture taken with him. It was a very large group. It gave the kids a small taste of the way things work at the capital.

And, to top it off, we had a leisurely lunch with like-minded folks, from moms to midwives, nurses in training to senate staffers. It was comforting to be in a place where, when I said I was planning to have this baby at home, people showed happiness and understanding, rather than shock and amusement (or worse). It was nice to meet some of the folks from Nebraska Friends of Midwives, who I've been "speaking" with online for a few months now.

Testing...testing...1,2,3

Against my better judgment, I submitted myself to a Glucose test last Monday. I don't know why. I guess I thought it was an area where I could just not fight. I hated the idea of doing it, as my test with Meagan made me feel HORRIBLE. With Caleb, I think they just took my blood one day at an appointment. I didn't have to drink the nasty drink or anything. But, with Meagan, I had to fast for 12 hours, drink the drink & then sit around and wait. Well, for someone with a history of low blood sugar problems, that was totally asking for trouble. I left the test feeling totally jittery, hot, sweaty, spastic, and a little deranged. I shouldn't have been driving, really. And, the rest of the day, I felt just horrible. It took a full day to recover. My body had completely over-reacted to all that sugar on an empty stomach & sent my sugar levels way, way down.

But, this time, after I explained how sick it made me, the OB assured me that I did not have to be fasting. So, I guess I just thought I'd go ahead and give in. Why fight if I can just go along. So, I took the test. And he was right. Doing it without fasting wasn't bad at all. Well, as not bad as drinking pure fruit punch-flavored sugar can be. All the while, I was chiding myself for not refusing yet another "routine" test. Had I been with the midwife, I wouldn't have done it. She would've just continued to check my urine at every appointment & measured the baby.

Well, I failed. By 2 points. Of course, I wasn't fasting, so my lunch could've really affected the test. I'm not concerned that I'm actually at risk for gestational diabetes. But, now, the OB wants me to do the 3-hour fasting test. Exactly what made me so sick with Meagan (and it wasn't even a 3-hour test with her!) & what I was trying to avoid. I actually started to cry when the nurse told me that. I am that scared of the way it made me feel. And, really, if it made me feel that bad, how bad is it for the baby?

I am such a rules-follower at heart. I dream of being the kind of person who can just say no, but when push comes to shove, I give in. Avoid the situation. That's my motto. So far, I've avoided it. I told the nurse I'd have to call her back. I haven't. But, I can't keep that up forever. In fact, I go in for my next appointment on Thursday. It's a countdown. I've completely decided to refuse the second test. After all, I didn't fail by much. And, I can just watch my sugar intake for the rest of the pregnancy, which I should have been doing all along (that darn pregnancy sweet-tooth I have). But, I so utterly dread confronting the doctor with this. Why does that white coat make me feel so intimidated? But, Don will be there & he is 100% behind me. I can do this.

By the way, this is precisely why I want to stay out of the hospital. If I'm there & surrounded by people who are telling me what to do, I know I'll give in to things that I don't want to happen. I can talk big at home, but I know I'll shrink in the face of a barrage of "expert" advice. But, at home, with a like-minded attendant, I'll be comfortable and secure and confident. There's no place like home!

What to do, what to do...

With less than 13 weeks until my due date, I'm starting to feel a little anxious about how on earth I'm bringing this baby into the world. I want to stay out of the hospital so much. But, in finding a midwife, I'm following lead after lead only to end in dead ends. I've actually been reading a lot about unassisted childbirth. It's not my first choice, for sure, but it is an option. Don is less than enthusiastic about that option, mainly because a big bulk of responsibility would be on him and while he's seen two births, that doesn't exactly make him an expert. I know, absolutely know, that my body can do this and will know what to do. It's just a matter of whether we can handle any what-ifs that might come up. Another kink in that option is that we are pretty far away from a hospital. If we have a midwife, my Grandma has offered the use of her home to birth in since she's in the city. However, I don't know if she'd be open to us flying solo there. Or, if I could even put her in that position.

But, in the meantime, I am getting ready as if all my options are still open. I purchased a blow-up pool last night to labor in at home. If I never end up using it, well, the kids will, I'm sure! I've ordered a few more books, these about unassisted childbirth, to further explore that. I'm thinking about ordering a stethoscope and maybe some other tools like that so that we can monitor the baby if it comes to doing it alone. I'm also planning on ordering some natural remedies for things that may come up, especially to curb bleeding.

And, if anyone in the Nebraska legislature happens to read my blog, PLEASE reconsider the legal status of homebirth in the state. It puts people like me in a very awkward position. And actually creates more risk. Homebirth is a very safe option. However, it's safety is greatly enhanced by having qualified, experienced attendants there with you.

Time gets away from me

It's been awhile, so I'll try to catch up a little.

First, I had my first real prenatal visit with my midwife. I got to hear the little one's heartbeat, as did the kids. I didn't realize how thrilled I would be. Honestly, I had been trying to brace myself for something going wrong. I've just heard of so many post-reversal miscarriages that I tried to prepare myself for the worst. Yes, we told everyone waaay early, but I still felt like I wanted to be ready if this wasn't going to happen. Hearing that heartbeat was such a relief. I didn't realize how much I needed to hear it. I'm now at 11.5 weeks and nearing that magical number of 12 and feeling much more secure. I hope that makes sense.

We've decided to go ahead and plan to move before the baby comes. I really wanted a home birth and loved this midwife, but really, it was the only thing to keep us here. Everything else seems to be pointing to leaving earlier. So, I am hoping that a home birth midwife in NE will be found (a couple of leads, but no names yet!), but am preparing myself for a hospital birth. I realize that a hospital birth will not be the worst thing in the world. I just need to stand up for myself & my desires & not worry about what the nurses will think of me. I don't like to be labeled difficult, but it would be worth it to have a little control over what happens to me & the baby.

We got a dog. Yes, there is not enough going on in our lives. Her name is Lucy and she is an 18-month old German Shepherd/Siberian Husky mix. She belonged to a friend of mine, but they just couldn't keep her exercised enough & contained. She can jump the 6-foot brick fences that everyone has around here. She has been quite the handful, but the reason we took her is that she will be perfect on the farm and will absolutely love it. We planned to get several dogs (our own little pack) on the farm for protection of the house & livestock, so Lucy is the perfect start to that. In the meantime, we just have to keep her exercised. Which means, it forces both Don & I to do what we should be doing anyway! She loves the dog park too & really enjoys playing with the other dogs, especially the big ones. She can run like nothing I've seen before...her ears flatten back and she looks like a bullet coming at you! After reading a LOT on the internet, we've begun to introduce raw meat into her diet. She is loving it & has responded well to it so far. She was actually very picky about her canned food that she was on, but man, she tears into that chicken! I'll post some pictures of her later.

Also, I've begun packing. I can never be called a procrastinator. Especially when it involves any sort of organizing. I figure if I pack a few boxes a week, it'll really help me get a jump on things. We hope to move a load of stuff up when the former owners of our house in NE (they are renting from us) move out. That could be mid-June, so it really isn't toooo early.

Don was offered an Air Force job in D.C. Totally unexpected. He's having trouble working through it all, but I really have no interest in it. It's not even close to the path we are taking & I'm not tempted by it at all. But, we'll see what happens.

I guess that's all of what has been going on. I'll try to get pictures up soon.

Landing smack-dab in the middle of controversy

It seems that our new state has a little controversy going on & I'm setting myself up to be right in the middle of it. I want to have my baby at home. The more I think about it, the more convinced I am. But, in NE, it is not legal. It's not illegal, per se, just not legal. However, some midwives who are doing it are being given cease & desist orders. It is, though, illegal for certified nurse midwives to attend home births, but non-nurse midwives aren't specifically forbidden. Here is an article from the Lincoln Journal Star about the problem & one woman's solution (to have her husband catch the baby.)

I'm so disappointed. I really like the midwife I found here & now, if we move mid-pregnancy, I may miss out on a home birth altogether. I don't think I could convince Don to do it "unassisted". I need to find an underground midwife. Or, I'll have to travel to Iowa or Kansas. How pathetic is that? Looks like I'll be contacting my state representatives.

Midwife interview

I interviewed the home birth midwife today & I feel really good about her. She said many of the things I was hoping for and I can see her birth philosophy really lines up with mine. Now, whether we'll be here or in NE for the birth is a complication. I want to get to NE so bad, but man, I'm really feeling right about this midwife & don't want to start over mid-pregnancy. God's timing, right? Gotta just keep that in perspective.

Oh, the stress of it all!

You'd think that with all that is going on in our lives (adoption, pregnancy, job search, move, home buying) that we would be totally and completely stressed out. But truly, I think we are taking it all in stride. God knows, even if we don't & really? That's good enough for me. Really, I just have to laugh through it. Yes, I don't know where we will be when this baby is born. I don't know where Don will be working when we move. We've got a house & land sitting there waiting for us & I have no idea when we'll get there. But, that's fine! I'm excited for the ride.

But picking a "provider" for this birth? Totally stressing me out. Midwife or OB? Home birth or hospital? How do I find her (must be female...just a quirk of mine)? The thought of interviewing people leaves my stomach turning (or is that morning sickness???). Interviewing realtors when we sold our house was bad enough...and that was just our house! This is my baby! Oh, and then add into the mix that if I pick a home birth, our insurance will not cover it. It won't be too expensive, but still, it is hard for me to spend money like that, especially if we could get by with paying nothing if I go with an OB. There is 1 semi-nearby Certified Nurse Midwife that insurance would cover with a hospital birth, but she's in a high-risk practice...I don't know what that means for her birthing practices or philosophy.

Of course, I know that the answer is to turn this over to God, just like every other aspect of life. Why am I taking the burden of this? I pray that He opens the door I am to walk through & closes the others.

Midwifery, pregnancy, homebirth, breastfeeding and cloth diapering links

I know this covers a lot, but they are all so often inter-related that I couldn't imagine dividing them up. So here goes...a few of the links I've used for anything baby-related.

• Nebraska Friends of Midwives
• Nebraska Home Birth Advocacy yahoo group
  
• La Leche League International
  
• Mother-Ease Cloth Diapers
• Natural Babies diapers and more
  
• Cotton Babies diapers and more
• Diaper Swappers
• MotheringDotCommune forums
• Christian UC (Unassisted Childbirth)
• Gentle Birth
• Spinning Babies