I can't begin to describe how excited I am about this new birth center! The midwives who are opening it and providing excellent care there are Karen Pecora and Cristi Lewis. They are already loved and adored midwives who will continue to provide care for home birthers, while offering this birth center option for others. They will be offering care for VBACs, they do accept Medi Cal, and they will have tubs for water birth! How great is that?!
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If you read my last two blogs, you know that OBGYNs and Midwives are both medical professionals that provide care for birthing women. They practice differently, not just because of money; rather, a cultural perspective of birth that's practically opposite. We do have some Doctors that we love and are within reach from our little Valley in the Temecula area. We also have different kinds of midwives that provide different options and potential for charging your insurance company. So now, it's time to talk Doulas. First, here's some pictures of myself - in action - as a birth doula. As you can see, I don't really have that many pictures of myself doing something at the birth. Most of these are after the birth or at the postpartum visit. Usually, I'm very focused on what's happening with the mom. If there's a chance for a picture, it's because I'm grabbing a camera to capture the beautiful connection between Mom and Dad. Out of 73 births, I've only had two where there was a photographer. So that's where those pictures came from. You can see that my face is often pretty close to the mom's especially in times where she needs to hear encouraging words. I use words a lot because of my HypnoBirthing training. Our words are so powerful. One time I led an unmedicated laboring woman to sleep with relaxing words in-between surges (contractions) at 9 cm. Sometimes, however, it's the exact opposite. Sometimes I'm massaging her feet and saying nothing. Sometimes, what she needs is to be all alone and I'm just setting up the room for when she gets out of the bathroom. My role can vary so much! One time I was blow drying my client's hair, many times I've taken parents on walks outside, Often I'm helping the Dad communicate with the hospital staff or finding creative ways to communicate the parent's desires without actually speaking them to the nurse or doctor. Because of my lactation certification, I usually help the nurses out by getting things started with breastfeeding. First, let's talk about what a doula is NOT. One thing a doula is NOT, is a medical professional. They do not take fetal heart tones (although many times I find myself trying to help the nurse get the baby's heart rate if she is struggling to get her work done and the mom is moving around a lot). They do not do vaginal exams generally speaking (although some doulas are also student midwives or former labor and deliver nurses and do include that). They do not deliver the baby or perform clinical tasks, although they might be the most qualified person to help someone in a situation where there is an accidental car birth or something of the sort. If you read the previous blogs you know that OBGYNs and midwives are medical professionals, so to set the record completely straight: A doula is not the same thing as a midwife. So how does a doula get their education?Some doulas are not officially trained or certified at all. Sometimes they just fall into the role because they have 6 friends who all asked them to be at their side while they birthed. But for most very active birth doulas, they do seek formal education and usually some kind of certification. There are different programs that certify and educate doulas. The most popular is DONA. But there's also CAPPA, ToLabour, and probably a few others out there. The trainings consist of a weekend course. Sometimes 3 or 4 days. The certification process is much greater. I am certified with DONA. This required reading a variation of books about birth and being a support person at a birth as well as breastfeeding, attending births and being evaluated by the medical professionals, continuing education (like my acupressure certification), and writing essays and taking tests. All that work couldn't possibly compare to the hands-on education I've received simply from attending all kinds of births.
So what does a doula actually do?
But wait, there's more! Just because a doula is not a medical professional doesn't mean the don't know how to help you have a safe experience. Having a doula takes away the pressure from the Dad to have to remember every little thing he learned in your childbirth education class. What are the signs of infection? What are signs of progress? What are all the different positions we can try? What do I need to say to her to help her release fear and ease into a more efficient birth? What was that drug their suggesting all about again? A doula will make sure that you get informed consent, that you know all the benefits and risks of every single turn of events. If a nurse is making a suggestion, the parents can ask for a moment to discuss it, and your doula will remind you not only all of the benefits and risks, but also the alternatives to that intervention. Doulas definitely maintain the midwife philosophy which is that you don't fix what's not broken and physiological birth works left alone in the body of a confident woman who feels safe and comfortable. Some doulas are real google experts. Just kidding, it's not the doctor-google sort of thing. But doulas will have a real medical journal or scientific study for you to check out on a dime, just to make sure you can feel confident about whatever decision you're making. For example, I've read EVERY SINGLE SCIENTIFIC STUDY ON GBS THAT EXSISTS. Yeah, that took a while! Different shapes and sizes... Some doulas do this and some doulas do that. Some doulas are also childbirth educators, like myself, and some doulas maintain different philosophies within those different methods of natural birth education. I've taken nearly every method of childbirth education there is, and picked up different tricks from all of them. But I definitely maintain a priority in the mental and emotional components, especially a lack of fear. Some doulas are placenta encapsulators, I am not. Some have worked with a lot of military families. Some, like myself, know what it's like to birth without a husband for reasons beyond a deployment. Some doulas work in groups, some work in partnerships. Unless you say otherwise, all doulas will have a back up doula for your birth in case of emergency. Some doulas specialize in multiples (twins and triplets), some specialize in VBACs, some are more experienced with home birth, and some are very particular in which hospital they will or won't work within. Unfortunately, I've witnessed more coercion that I can stomach, so I'm very limited now in what clients I'll take. I expect my clients to go out of their way to truly make sure they're in the best hands they can possibly be in. Some are also postpartum doulas, some have lactation certifications (I'm a CLEC). Some are also massage therapists, and some are even Labor and Delivery Nurses too, Some are professional photographers! We usually say that you should interview about 3 doulas and really go with your gut on who is going to make you and your support team feel the most comfortable. Generally speaking, they all normally do at least one or two prenatal visits, attend the birth for it's entirety, and one postpartum visit. What does a doula charge?
In this area there's a wonderful range of doulas and options. We have student doulas who might charge as little as $300 and even take payments. The more experienced, but still a little fresh doulas might charge more around $500-$600. More experienced, skilled, and proficient doulas charge more around $800-$1200. Some do packages where you can choose what kind of services they offer (for example, including photography or not) and that would create a range within their fees. Rarely, some insurance companies do cover birth doulas. You can use your HSA (health savings account) to pay for your doula if you have one. Although, I'm doing much less births than I used to, I will still interview with you, especially if you're my HypnoBirthing student! I charge $800. Otherwise, please allow me to help you find a doula who will fit your budget! I think EVERYONE deserves to have a doula! So what happened when a doula, a midwife, and an OB walked into a bar?They all talked about how amazing it is to witness the unpredictable, completely transformative, miracle of life. And they all had only one drink because who knows when the next 2am phone call would be.
If you read my last blog, now you understand what separates a midwife from an OB. But the conversation doesn't end there. You won't always get the exact same kind of care from midwife to midwife. Not all midwives do hospital births, not all midwives do homebirths. Only CNMs (in California) can work in a hospital to deliver babies. Both can have a homebirth or birth center practice... Certified Nurse Midwives become RNs before adding on about another couple years of education to earn their Midwife-status. Their education is usually within a typical college. As they become nurses first, they often hear about birth as described in the modern-medicine way. If they only ever work in a hospital, they might earn the slang natural-birthing community label "med-wife," if they practice no different than an OBGYN. However, many CNMs maintain the midwife philosophy that birth is generally safe and natural left alone and respected physiologically. Sometimes, they become frustrated if they work in a hospital and find themselves creating their own homebirth practice or birth center. But, because of their RN background, they are generally more acceptable for insurance companies. In the Temecula area, there is no known CNM who routinely attends homebirths. However, there are a few San Diego based CNMs who have been known to make exceptions now and then. Most Kaiser hospitals in southern CA use CNMs for the majority of their deliveries. CNMs can accept Tri Care Standard, this is why they are used at the military bases for most deliveries as well. There is a birth center in driving distance called Tree of Life and the CNMs there can take a variation of insurances including Tri Care, there is no co-pay for Tri Care standard moms. And they also have an agreement for hospital transfers with Encinitas where they can continue as the main care provider even after the transfer (as long as the birth is vaginal). CNMs are also used at the UCSD birth center in San Diego. This birth center is within a hospital, but the birth center is a separate floor and maintains a true birth center feel to it. The midwives there are incredibly impressive in the way that they maintain respectful, expectant management, evidence-based care. UCSD accepts many insurances including Medi-Cal. Not only does UCSD and the military hospitals all use CNMs, but they all also offer Nitrous Oxide as a pain-relief option.
A Certified Professional Midwife, or a Licensed Midwife are equally equipped for birth as much as a CNM. They are both trained, educated, and highly experienced medical professionals. From my perspective, they might even be MORE willing to resolve a challenge than rely on a quick-fix in the Operating Room. For example, they wouldn't so quickly look at a birth with a baby who's head was positioned difficultly for dissention and resolve to surgically remove the baby without trying to physically manipulate baby's position. In other words, home birth midwives in particular must be of the MOST skilled to handle challenges because they actually CANNOT rely on an OR at all. In the case of a true emergency, they will suggest a transfer to a hospital where an OBGYN will take over. Some CPMs/LMs go to a school just for midwifery. The Nizhoni Institute of Midwifery is one of those schools and it's in San Diego. Others might do a different program but they all eventually take the NARM (national association of registered midwives) test which is regulated by the same medical board that regulates OBGYNs. LMs must also spend hundreds of hours working with an existing midwife as a predecessor. Sometimes they act in the role of the assistant as they learn. Sometimes the existing midwife works with another midwife as her assistant instead. From my experience in Southern California, most homebirth midwives work closely with other midwives and usually never attend a birth by themselves. Although they are educated in Breech and Twin deliveries, they are legally restricted from delivering those babies. They also have legal restrictions in California to not provide care for a woman birthing earlier than 37 weeks or later than 42 weeks. Thankfully, they can still provide care for VBACs (vaginal births after cesarean). Hopefully there will be more freedoms for them as this political battle moves forward. On a better note, LMs now have the potential to accept Medi Cal! In this area, we have a wonderful midwife who accepts Medi Cal and her name is Cristi Lewis. She and another awesome midwife, Karen Pecora, are working on opening a birth center in Fallbrook called Acorn Midwifery. Keep in touch with Cristi (who also works as a Homeopath): http://highroadhomeopathy.com/About_Cristi_Lewis/index.html There are different high risk variables that some midwives can still provide care for, there are some high risk variables that midwives would try and resolve naturally (for example, naturally lower blood pressure so a woman can get off medication), and there are other high risk complications that are best suited in the hands of an OBGYN in the hospital. Sometimes, parents chose to do co-care. This means they have both an OBGYN and a Homebirth Midwife. They know that the doctor is there if they need him/her but listen carefully to their midwives and do everything they can to not need them.
Often I'm asked what's the difference between a doula and a midwife. That question leads to an answer of much greater length then the one asking usually suspects. So, I decided to take a moment to describe all the information I'd like to share about all the different kinds of support person(s) and medical professionals you can have at your birth. I will address comparisons and contrasts throughout the next few blogs. First, lets break down what the difference is between an OBGYN and a midwife. Yes, you will get a sense of my bias. I'm not going to sugar coat any of the facts. I'm not going to unsee what I have already seen. Why do Doctors and Midwives practice so differently? Don't they both deliver babies? Is it really all just about money?
1. Dr Stu - L.A. based doctor who does homebirths. This is your only (legal) option if you are having twins and want a home birth. He only accepts cash, no insurances. He is the only OB who does homebirths in a 60-mile radius.
2. Dr. Kenneth James - Laguna Hills 3. Dr. Cobb - Pomerado hospital in Poway (gets booked quickly! catch him early) This hospital has laboring tubs. 4. Dr. Capetanakis - Scripps Encinitas. Also known also for allowing skin to skin in the OR in the case of a necessary cesarean. 5. Dr. Vu - Sharp Grossmont (also privileges at Sharp Mary Birch). Best known for being highly skilled with Vaginal Breech deliveries. 6. If you are a Kaiser patient, you're best bet is to go to Zion in San Diego. That hospital compared to Palomar, Moreno Valley, and Riverside, has much more of a comfort with the natural birthing community. Usually the nurses are familiar with HypnoBirthing. The day you arrived though the eyes of the doula: It was mother’s day, May 11th, 2014 and I was pleasantly interrupted by a much anticipated phone call from your mom at about 6:43pm. I listened excitedly as she explained she’d been having mild and very far apart contractions, she guessed about every half hour they would come. I got myself ready because I was preparing for the good chance she would wait too long to have me call. I could tell she was going to be one of my exceptionally strong ones because of the story of how she gave birth to your brother. The way she waiting until he was ready to be born, in her circumstance, is very different from most women. She was patient and relaxed, but also brave and aware of what she deserved. My experience has taught me, this is the formula for a strong birthing woman. Your daddy was also someone I was excited to work with because of his inner strength! He taught me something I’ll never forget and I will use to help many more families; people who are responsible sometimes mistake their responsible-role for one of authority. He used this wisdom to stay confident about all the birthing decisions for you and your brother too. So, needless to say, when I got that call I was more than ready to come help with your special delivery. There was one thing I was nervous about as a result of knowing how strong your mom is. She and your dad had made multiple jokes about having the baby in the bathtub on “accident” at home. So knowing how strong she is, I was worried she would be unaware of how progressed she was and stay home too long. She really heightened my concerns when she emailed me the list of her supposedly mild and far apart contractions…they were only about 6 minutes apart! Shortly after that, your dad called me to tell me her water just broke! AGGGGGHH, I thought, and jumped in my car. I arrived at your house at 10:20pm. I was relieved at what I saw. Your mom looked relaxed enough that I knew we had time to stay home. I watched her take on a “wave” and saw how she went deep within herself and breathed slow to maintain a totally tranquil state. WOW I thought, beautiful. I was also happy to see she had taken my advice and been drinking lots of water. After some time there on the birthing ball, she jumped in the shower to clean off all of your amniotic fluid coming out. She then laid down with your brother Cole and ironically breathed slow through contractions to also help him relax and finally fall asleep. The next part was really fun. I got to meet your aunt Tabitha who came out to help cook some llapinganchos. Your dad, mom, aunt, and I all sat around, some of us also on balls. This was very special to your mom because she got to somewhat repeat the way her mom gave birth to her. There is a picture of people just hanging out and being really calm about the arrival of her when her mother was in labor. The intensity started to build here. We all breathed with her to help her remember to keep her breath slow. I put a heating pack on her back. When the contractions stopped, we laughed about how different it was in and out of them. As it got more uncomfortable, she decided she would feel more at peace in her bedroom, so we all followed her into there. We were playing a peaceful soundtrack over and over that she seemed to really like. She must have felt very safe there because her body started to make those contractions even stronger. Her senses were getting very sensitive, she had your dad change shirts twice because of the smell on them! It was pretty funny. She wasn’t interested in taking the drive and having to go through that transition to the hospital at any later stage, so she started to voice a desire to leave. It hadn’t been a very long time in labor yet, so I reminded her that her original plan to get there at a late stage might not be the case; however I was REALLY hoping I was wrong. There were some signs that I really could be wrong; she was throwing up and said she started feeling shaky. She started doing her most comforting position which was to hang from your dad’s neck and squat. Also, I had that original concern of waiting too long knowing how strong she was. So…off we went! I called the hospital on our way out at 12:36am. I was able to find parking quickly and walk in with your parents as they arrived at the hospital too. Thank Goodness your mom took my advice to keep the eye mask on, anyone that looked at her could tell she needed her space. Your dad was really brave to insist the security allow me up to the triage floor even though they normally don’t. However, once we got up there, the nurses had me wait outside the door until she was checked. I was hoping it would be fast and we’d be in and out of there anyways. I learned that her cervix was 4cm dilated, 80% effaced, and you were at a -1 station. Your mom had a little bit of bleeding there that I couldn’t be sure was okay, the nurse checked and also seemed on the fence about it. We finally made our way out of there a while later and up to the Labor and Delivery floor. When the elevator got to the 3rd floor, we had to hold the door open so she could have a contraction there. This moment was incredibly special to me personally, because your mom didn’t know it then, but she made a doctor wait for her in order for him to use the elevator. This particular doctor was the one that I worked with at my very first birth and he was the reason that first birth was an unsuccessful VBAC. That was so redemptive for me! He had to stand there and wait as he watched your strong momma chose to endure the intense and uncomfortable feeling of her contraction. I was thinking, YES you see? We birthing women are strong, we chose it, and you can’t stop us! I have to thank your mom for being the one to demonstrate that strength for me and for the mom who was kept from accomplishing her desires. THANK YOU SO MUCH TANGY! We walked into the Labor and Delivery room #316 and met our nurse, Marly. She was very kind and helpful, but she was having to be the bearer of bad news by informing your mom she would have to be on constant monitoring, not only because of her previous c-section but also because we couldn’t be sure if this bleeding would be a problem. I tried to get more information from the nurse asking her, if this was a uterine rupture (the biggest possible concern) what else would we see to be sure? Wouldn’t we see the baby’s heart rate look poor? (which is wasn’t, your heart rate looked perfect the whole time) Wouldn’t she have more pain and more bleeding then this? But the answers we got were so vague. Even though the eye mask was still on and really helping to keep your mom from all this commotion, she started to get very concerned, understandably. She spoke with the on-call doctor on the phone, but she was also very vague and told your parents they could chose to either keep laboring or have a repeat c-section. Everyone was very frustrated with this. Your mom’s fear of you and your brother missing one of their parents, as she did growing up, was manifesting. I reminded her that she hasn’t even seen a doctor to assess her situation, and to remember what a real emergency looks like. Finally she decided to get into the shower, totally against what the nurse said she was allowed to do. With the helpful support of your vocally confident dad again! There she was able to re-center herself and go back to her usual brave state. WOW, I was so proud of her! The next stage of labor was a long one! Your mom took it on like a real warrior! She had that deep inner strength that I knew she would. Her senses became extremely sensitive and she wouldn’t allow very much talking around her. Every little smell would bother her. And she also stopped wanting anyone to touch her. I was so proud of her, but I had to practice sitting on my hands so to speak. I really wanted to help her more. Your dad did too as he reminded her, “I really want to hug you right now, just so you know.” She even switched robes 3 times! She said, “get me the gray one, no the other gray one, NO THE OTHER GRAY ONE.” That was pretty funny too. I couldn’t ever come close to being offended by her snappy words because her ability to know what she needed and ask for it takes an immense amount of strength. Most laboring women don’t do that, they just throw in the towel and ask for an epidural. Not your mom! In fact, she never seemed to go through that highest level of pain called “transition.” Rather, she just kept doing what she knew worked for her. I learned later from her that she had a very elaborate vision she would focus on through each contraction, of which I’m sure she’ll describe to you one day. She is truly made to birth! She has the best instincts and she really listens to them! I could only compare her strength to one other women I’ve seen giving birth for the 4th time, but in a way, this was her first time! Your dad was such a trooper too. He continued to be there for her just how she needed, no judgment, and no throwing in the towel for him either. No matter how sore his neck and legs must have been! At 6:45am I noticed her body start to bare down a little bit in the middle of contractions. We talked about how getting checked might be a good idea to know whether she should or shouldn’t start pushing. And thank God we got a new nurse who happened to be the best at that hospital. Her name was Tommy Lynn. We learned she was 8cm, 100% effaced, and you were at a 0 station. I’m glad we knew because she had to hold off from pushing for three more hours until she was checked again and learned she was 10cm. We tried different types of positions for pushing. But after two hours something strange seemed to be happening. We eventually learned that her cervix was swollen. She must have been so exhausted! She didn’t show it at all, but I felt so bad for how hard she had to work. Finally her doctor, Dr. Timothy Riley came in and pushed that cervix up over your head. NOW pushing was finally more effective and we really started to see you make your way out. At 12:57pm on May 12th (the exact day your mom predicted) you were born! You went right to your mother’s arms. There were a few surprises that needed addressing, your mom needed to be repaired quickly and so your dad stayed with you. You also needed some help breathing so your dad followed you the NICU. We learned that you weighed 9lbs 1oz and were 20 in long. Your mom was excited to hold you but she was very grateful for her skilled doctor taking care of her and the nurses taking care of you. Thank goodness again for your dad’s ability to stand up for what’s right. He demanded to be with you even when they said no. In the recovery room, we got some info from your dad that you were stable. After everything she had been through, her love for you was what got her through all of that. What an amazingly loving and strong momma you have Kai! You are SO BLESSED to be a part of a family who puts their priorities in what is loving and what is best for you and your brother! I am forever grateful to witness parenting at its greatest. Thank you so much to your whole family for allowing me to be a part. You are a miracle Kai! Your mom was able to snuggle you and nurse you in the NICU. You were always surrounded by love. Lots of love your way continued! Your forever birth doula, Heather's own words:
I am so fulfilled, so empowered, so proud, so thankful and so blessed that we were able to have our baby in the comfort of our home. I wasn't sure I was in labour, and was hesitant to have my Doula and Midwife come over. I began having surges (contractions) in the swimming pool at around 6:30 pm, and I was certain I just ate something funny because surges were immediately about 15 minutes apart :0. At around 9:30 ish, I was still uncertain and began messaging my Doula and "on... call Midwife" (whom I had not previously met; my own Midwife was out of town for the evening...). I had asked my Doula to come over, just incase, at 10:00. I threw up a little bit. She had arrived by 11:00. After i threw up a little more, I had asked the Midwife to come. I remember my own Midwife telling me something about vomiting, and it made me certain, that YES MY BABY IS COMING. Before I threw up for the second time, I was in this state of mind, still not sure if my baby was coming or if I was just over exaggerating. The Midwife arrived by 11:45 ish. I just wanted to be left alone, in my bedroom, where I swayed back and forth in front of the fan. I was so hot. Again, I threw up, and this time my bag of waters broke at the same time. It sounded like a water balloon hit the floor :0. Shortly after, the Midwife "checked me" and told me something along the lines of "when your body feels like it wants to push, let it". I did not think I was fully open and asked her "push what"? .... And shortly after that, I got into the birth tub, where I began pushing/trying to breathe baby down. I consciously tried to let him open me slowly and spent about 35 minutes doing this. The last "pushes" were spent on the couch so that baby could be better accommodated (I couldn't maneuver a good leg lift in the tub). Troy Aeric was born at 1:40 am, on Wednesday August 31, weighing 9 lbs., 9 oz. and measuring 21 inches. The entire time, Alexander was asleep in my bedroom. He woke up about an hour or so after the birth. He was able to see the placenta and where the baby lived. I am so thankful for all of the support with the fundraiser, generous friends and coworkers, and Ginger Lee Doula for letting me do my thing (and for cooking me the mac and cheese I had requested after delivery ;) We did not take many photos during, because I just wanted to be left alone ;). The entire experience was completely new to me because I had NO sign of labour with my first pregnancy, and was medically induced at 41 weeks, where I had delivered in a hospital. I am so pleased, overall. A healthy pregnancy, healthy baby, and a happy Brother. |
Karen Brann
Birth Doula, Childbirth Educator, Lactation Educator/Counselor Archives
July 2019
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