Birth Center

Top 10 Ways to Prepare for a Natural Childbirth

Photo Credit: Kadi Tiede

Photo Credit: Kadi Tiede

Entering into your pregnancy journey is fun and exhilarating for most mamas and their partners. Once you get past the initial excitement, you may find yourself overwhelmed with all of the decisions that come with pregnancy, labor, birth and after. One of these decisions for you, may be deciding to have a natural childbirth. Whether you choose to be in the hospital, a birth center or at home, there are many ways to help prepare for a natural birth. Here are the top 10 ways to prepare for a natural birth:

Childbirth Education Classes: It is very important to educate yourself and your partner. A great way to do this is taking a Childbirth Education Class. If you are planning to deliver in a hospital, it is a good idea to find a class outside of the hospital to help you prepare better. At Health Foundations Birth Center we have childbirth education for families delivering with us that is tailored to delivering at the birth center. 

Hire a Doula:  Having a doula by your side during labor is not only comforting but also it proven to help reduce interventions including cesareans. Typically doulas also provide education during prenatal meetings. Interview 2-3 to make sure you find one that is a good fit. You can find a doula through friends that have used one or via the Internet.

Choosing a Provider and Facility: Once you find out you are pregnant, take your time over a few weeks to put research into finding a provider that fits your desires and needs.  If you are choosing a hospital, take a tour of a couple of different ones. You have the option of choosing hospital midwives (usually) or an OB.  Out of hospital options are wonderful for women who would like a natural birth. If you find that your and your provider aren’t meshing well, keep in mind that you can always transfer to a different provider. Current research shows your chance of having a c-section can be directly linked to the provider and / or hospital you choose. 

Nutrition and Exercise Keeping up with nutrition and exercise are one of the keys to staying healthy in pregnancy, which helps during labor.  Although we sometimes think it is a time to indulge, it is quite the opposite! Be sure to fill your diet with good proteins, fruits, vegetables and whole grains. Try and limit sugar as much as possible. If you had an exercise routine before pregnancy, usually you can continue with that. Walking, swimming and yoga are wonderful options for staying active in pregnancy. Always check with your provider before you start an exercise routine in pregnancy.

Self-Care: As your body changes, remember to allow time for self-care. Take time to rest, go on more dates with your partner, get a massage, spend time with friends, read a book in a quiet space, take warm baths in the evening. All of these things help to alleviate stress, which is good for you and your baby.

Supplements: Along with a healthy diet, there are some great supplements that help prepare your body for a health, low-risk labor and birth. Try and choose a food-based prenatal vitamin such as Rainbow Light Prenatal Vitamins. Click here for more information on choosing supplements. Always check with your provider before choosing a new supplement to add to your diet.

Reading: Find reading material that is not only educational but also positive. One of our favorites is Ina May’s Guide to Childbirth by Ina May Gaskin. Not only is it very informative but also has wonderful birth stories to read. For your partner, a great read is The Birth Partner by Penny Simkin.

Baby Positioning: Trying to get your baby into an optimal position is more important that you would think! There are many ways to do this during the last weeks in pregnancy especially. Posture is an easy way to help get your baby in to stay in an optimal position. You want your baby to be in an anterior position rather than posterior. This will help your labor and birth to be much less uncomfortable. Seeing a chiropractor in pregnancy has been proven to help significantly with this. Be sure to look for a chiropractor that specializes in pregnancy. Another good resource is www.spinningbabies.com.

Birth Plan: Take time to prepare a birth plan with your partner. A doula can help with this as well. Keep your birth plan simple and to the point. Be sure to communicate your labor and birth desires to your provider. Give a copy of your birth plan to your provider and bring a copy with you in your birth bag.

Find Your Tribe: Now is the time to surround yourself with supportive friends and family. Sometimes they may find it challenging to accept your labor and birth decisions. Remember to set healthy boundaries. People love telling scary stories about birth. While it is important for them to process these feelings personally, it is not the time to do it when you are pregnant. Gently remind them to save those stories for later. Find a good support system whether it be your family, friends, or an outside group.

At Health Foundations Birth Center your choices matter to us. We are here as a community of women to support you during pregnancy, birth and beyond. Call us today for a consultation or tour, 651-895-2520 or visit us at www.health-foundations.com

10 Cool Facts About Nitrous Oxide for Labor Pain

Nitrous Oxide In Labor

Rapidly increasing in popularity in the US, nitrous oxide is a safe and affordable option for pain relief during labor in both hospitals and birth centers alike. With both anxiolytic (anxiety reducing) and analgesic (pain reducing) effects at low doses, nitrous oxide is becoming the choice of many women who want to forego or postpone more invasive options like an epidural yet wish to have some relief from pain intensity throughout labor and birth. Here are ten cool facts about the use of nitrous oxide during labor that you may not know!

  1. Nitrous oxide was commonly used for pain relief during labor in the US up until the 1960s and 1970s when the use of the epidural rapidly popularized. With the rise of epidurals, the use of nitrous oxide became virtually obsolete until around 2011 when midwives began bringing the practice back. You will now find nitrous oxide available for pain relief during labor in over 100 hospitals and over 50 birth centers in the United States. 
  2. While the use of nitrous oxide for labor pain plummeted in the US with the inception of the epidural analgesic, the practice remained commonplace in other areas with sophisticated healthcare systems around the world such as Australia, Europe, New Zealand and Canada.
  3. While many believe that the nitrous oxide received during labor is the same as what you receive at the dentist, it’s actually less concentrated. When you utilize nitrous oxide during labor, the gas you are receiving is 50 percent N2O and 50 percent oxygen. Dentists use varying concentrations of nitrous oxide for their patients but can use up to 70 percent N2O and only 30 percent oxygen.
  4. Another way that nitrous oxide for labor is different than the nitrous oxide you receive at the dentist is that during labor it is controlled by the woman only. You will be given a handheld mask that contains a demand valve which opens to release the nitrous oxide when you inhale. When you exhale, the valve will close. This allows the woman in labor to use the nitrous oxide when she feels she needs it and to place it aside when she does not. This is much different than an epidural which is inserted into your spine and typically gives a continuous dose of analgesic throughout the rest of labor. Conversely, once you remove the nitrous oxide mask during labor, the effects will dissipate in about five minutes.
  5. While epidurals typically remove or greatly lessen the pain of labor, women who have used nitrous oxide report that they still feel the pain but their perception of it is altered. Because of the anxiety-reducing effects of the nitrous oxide, many women are better able to handle difficult contractions and other painful parts of the process with its use.
  6. You may begin using nitrous oxide for pain relief at any stage of labor or even post-delivery. There is no cut off in the process of labor when the treatment becomes unsafe making it a great option for moms who wish to try to make it as far as they can without any sort of medical intervention. Some mothers even decide not to use it until they are undergoing repairs following the birth for any tears occurred.
  7. If there was not an initial need for continuous fetal monitoring of your baby prior to your decision to use nitrous oxide, there will be no need for continuous monitoring after. You will still be free to move about, change positions, use a birthing ball or tub or any other position you wish to labor in after you have used the nitrous oxide. Your midwife or doctor will just want to ensure you are not experiencing any dizziness from the treatment before you go walking around but this is a quite uncommon side effect.
  8. There has been no evidence found that the use of nitrous oxide during labor slows the progression of labor at all. Particularly because you are able to move about freely in positions that are conducive to birthing, baby is able to further make his way into the birth canal. Nitrous oxide also does not impede the body’s natural production of oxytocin which is necessary for labor to progress.
  9. One of the most important factors to know when considering the use of nitrous oxide during labor is that it is safe for both mother and baby. Unlike certain narcotics that are often used during labor such as fentanyl, there is no risk of depressing baby’s breathing with nitrous oxide. It also should not negatively impact the infant’s alertness upon delivery and consequently, there should not be an effect on his ability to breastfeed and bond with the mother or father during the time period following delivery.
  10. Although unfortunately many insurance companies do not cover nitrous oxide treatment for labor at this time, the cost of nitrous oxide is significantly cheaper than having an epidural. And, unlike an epidural which requires a hospital birth and the presence (and a bill from) an anesthesiologist, nitrous oxide can often be offered at a birth center by a midwife.

If you are considering alternative options for pain control during labor, contact Health Foundations for a free consultation with a midwife to discuss the benefits and risks associated with the use of nitrous oxide. We’d be happy to give you a tour of our Birth Center and answer any questions you might have about delivering at our Center and becoming part of the Health Foundations family.

 

10 Reasons a Birth Center Might Be For You

Photo Credit: Rochelle Matos -  withlove.mn

Photo Credit: Rochelle Matos - withlove.mn

If you’re pregnant or thinking about becoming pregnant, you may be considering your options for birth. While the majority of babies in the US are born in hospitals, there’s another option available for women who wish to birth in a homelike setting but desire many of the resources and safeguards of a hospital. This option is called a birth center. Birth centers are designed for healthy women seeking a natural birth experience under the care of midwives instead of obstetricians. Midwives embrace the idea that birth is a natural and normal process and should be approached under the wellness model of pregnancy and birth. Birth centers are able to provide routine, woman-centered care that focuses on the natural, physiological process of birth and seeks to minimize unnecessary interventions. While birth centers are not equipped for emergency medical procedures like C-sections or other serious complications, they are typically located in close proximity to a partnering hospital for quick transfers when necessary. If you are hoping for a natural birth experience in a non-medical environment yet under the care of licensed midwifery professionals, a birth center may be for you. Here are 10 reasons you should consider delivering at a birth center.

  1. You’re hoping for a natural, intervention free birth: At birth centers, pregnancy and childbirth are seen as natural and normal events. Midwives seek to empower and support women in doing what their bodies were created to do without unnecessary intervention. According to the Journal of Midwifery and Women’s Health, the rate of C-sections for low risk births is only 6 percent at birth centers in comparison with 27 percent of low risk births in a hospital setting.
  2. You want to have a midwife instead of a doctor: Midwives are uniquely positioned to provide personalized care to mothers during pregnancy and birth that not only focuses on physical health, but also emotional, spiritual and mental wellbeing. Midwives are trained professionals that support women in having optimal pregnancies and birth experiences with minimal medical intervention. Births that are attended by midwives tend to have lower rates of C-sections, episiotomies and perineal trauma.
  3. You believe hospitals are for sick people: If you are hoping to bring your baby into the world in a more homelike environment but you want the expertise and resources of skilled professionals, a birth center may be for you. In many countries around the world birth is not seen as a medical event at all but a natural, normal experience in life. Birth centers offer many of the safeguards and equipment of a hospital without the medical environment.
  4. You want to have a water birth: Though some hospitals do offer the option of a birthing tub, it is more commonly available at birth centers. Laboring and delivering in water has many benefits from pain relief, improved cervical dilation and a soothing transition for baby from womb to world.
  5. You want to be able to eat and drink during labor: While most hospitals will restrict your intake during labor due to the risk of needing general anesthesia for a C-section, most birth centers encourage you to nourish yourself as needed to keep up your energy and stamina.
  6. You want to save money: While you should check your insurance policy to confirm benefits and birth center coverage, delivering at a birth center is typically less expensive than delivering at a hospital. Reasons for the difference in cost include a shorter length of stay and fewer interventions among other variables. Typically, your out-of-pocket cost at a birth center will be about a third less than that of a hospital birth. 
  7. You do not want to have continuous fetal monitoring: While your midwife will likely intermittently monitor your baby, you will not be hooked up to a fetal monitor for the entirety of your labor like you may be at a hospital. This enables you to move about freely throughout your labor to the positions that offer the most relief and comfort. You also will not have to worry about any invasive internal monitoring or unnecessary cervical checks. 
  8. You don’t want to deliver on your back: Midwives are typically more flexible in encouraging the mother to birth and labor in whatever position her body tells her she should. Laboring and delivering on your back has been found to be one of the least conducive positions to helping baby move naturally through the birth canal. 
  9. You don’t want to feel rushed: In a birth center you will be encouraged and supported in laboring as long as your body needs. Rather than hastening the labor process with interventions, midwives embrace the natural normal process of childbirth in which you place trust in your body to know what it needs to do and at what pace.
  10. You want your family (or friends) involved: While a hospital may limit the number of individuals allowed in the room for your birth, at a birth center you will be welcome to have whomever you feel you need to support you in your birth experience. Birth centers will often involve the family during prenatal appointments and during labor realizing that the birth of a new baby is a family experience to be shared.

If you are a healthy woman experiencing a normal pregnancy and feel that a birth center may be more in line with your hopes and plans for natural birth, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center. We are here to support and empower you from pregnancy to postpartum and beyond.

 
 

When Your Birth Doesn’t Go As Planned

Woman Contemplating Feelings

Whether you had hoped for a home or birth center delivery and needed to transfer to the hospital, or had prepared for a natural birth and ended up having a C-section, births that do not go according to plan can be disappointing. Many mothers spend their pregnancies preparing for and creating a detailed birth plan in the hopes of having the experience they’ve always envisioned for themselves and their baby. Despite the best laid plans, birthing classes, and providers, sometimes our bodies and our babies have other plans in mind. When your birth doesn’t go as planned, it’s not uncommon to experience some negative emotions along with the excitement you’re feeling about the new baby. Many women who have experienced some form  of birth trauma  or unexpected intervention report feeling disappointed, angry, guilty, frustrated, indifferent and sometimes even resentful towards their baby or their body. These feelings usually follow birth experiences that felt out of their control, traumatic or unexpected such as having an episiotomy or emergency C-section. If your birth experience has left you feeling as though your body failed to do what you had hoped it would do, here are some ways to cope with those negative emotions and acknowledge the strength and courage in your journey.

Writing Birth Story
  1. Acknowledge your feelings: This can be difficult to do when everyone is expecting you to be overjoyed by the arrival of your new baby. However, if you are experiencing disappointment, sadness, guilt or anger about the way your delivery unfolded, it’s important to take the time to allow yourself to experience those feelings without judgment. Giving birth may be the single most important event in your life thus far and it is okay to feel sadness about any part of the labor or delivery that was traumatic or upsetting to you. If you try to push away your negative feelings about the experience, they will likely resurface at a later date as unresolved issues. 
  2. Take steps to process your grief: It is perfectly normal to experience grief following a traumatic or upsetting birth experience. It is important to allow yourself to experience the grief so that you can move forward feeling as though you have processed your feelings. Talking to your midwife or doctor and asking questions so that you can better understand and process your experience is one way to work through what you may be feeling. Two cathartic ways to process grief following birth are: telling your birth story to a trusted friend or family member or writing down your birth story. Writing or telling a detailed account of your experience can help you process your feelings of disappointment or guilt and also help you identify  all of the moments (there are so many!) of great courage and strength.
  3. Surround yourself with loving and supportive people: Limit visitors in the early weeks following your delivery to people who can be sensitive to your feelings and your experience. While not intending to be unsupportive, people may make comments suggesting that the only thing that is important is that you have a healthy baby. You can gently remind them that the experience was important to you and you are not ready to discuss it further at this time. You can also ask your partner to help play gatekeeper in the early days staving off unnecessary visitors and unsavory comments.
  4. Acknowledge the strength and courage in your story: Even if your birth didn’t end the way you had hoped, do your best to remember the amazing work that your body did. Whether you labored for 18 hours before ultimately having a C-section, endured hours of natural labor before electing to have an epidural, or had to undergo any number of interventions that were frightening or upsetting to you, your body has done an amazing thing. There is also an incredible amount of strength and courage in having to let go of your birth plan and have a birth experience that feels completely out of your control. Whatever your story is, whatever the intervention or unplanned turn your birth took, your body has done a miraculous thing.
  5. Ask for help: Whether you would like extra support from your partner, your provider, a friend to listen or to seek out a new moms’ group in your area, make the effort to reach out for help and comfort. The postpartum period, despite the awe and excitement of a newborn, can be an isolating and overwhelming experience. Adding grief from your birth experience to this mix may be too much to handle on your own. If at any point your grief begins to impact your ability to function throughout the day or seems to overwhelm the joy you have for your new baby, see your doctor or a therapist for an assessment for Postpartum Depression. Although the baby blues are a normal experience in the weeks following delivery, moms who have experienced a traumatic birth experience are more likely to develop Postpartum Depression. Ask for help right away if you feel like you might be experiencing Postpartum Depression. Click here to learn more about Postpartum Depression

If you’ve experienced a traumatic or disappointing birth experience, don’t suffer in silence. There are many women out there whose birth plans have not gone according to plan and who are left feeling guilty, angry and even depressed. There is no shame in a birth that does not go as planned and no shame in grieving the experience you did not have. Remember that you gave it your all and that is enough; that you are just as strong, powerful and amazing as all of the other mamas before you. At Health Foundations, we are here to support you throughout your pregnancy, delivery and postpartum period, regardless of whether or not your delivery took place with us, in the hospital or in the operating room. We are here for you. Contact Health Foundations to schedule a free consultation with a midwife or to find support.

 

The birth of baby Abel

Abel’s birth began with a weird itching that I developed around 39 weeks.  Since it was the middle of winter, at first I thought it might just be dry skin.  But then I started to realize that the itching was focused on my palms and the bottoms of my feet.  I would scratch and scratch and scratch and it would feel so good, but there was a dull itch pretty much all of the time. 

At my next midwife appointment I told Monica about the itching.  She told me that my body might be having trouble processing bile and that I should try to avoid fatty foods.  So I did just that.  But then I noticed that the itching was getting worse, especially at night.  A few times during the night it was so bad that it was waking me up.  I remember waking up itching my calves like crazy and thinking that my hairy legs were driving me nuts.  Only in the morning did I put two and two together.

So I decided that I should call in to the midwife and let them know that my itching had gotten worse.  Now, this is something that I wouldn’t normally do.  I normally ignore any health problem as long as possible.  Even as I was calling I was telling myself how silly I was being. “This is no big deal,” I was saying.  “It really hasn’t gotten worse”.  But I listened to my gut and called in anyway (now I feel that was a prompting from God) and was very surprised by the concerned reaction by the nurse on call.  She told me that she would talk to one of the midwives and have them give me a call back.

Later that day I heard back from Amy, the owner of our birth center.  I was surprised that she was the one calling me back.  She hadn’t done any of my prenatals for this pregnancy, so the fact that she was calling made me feel like we were in a potentially serious situation. She explained that she wanted Zach and I to come in that afternoon (this was Wednesday, January 7th and I was due on the 15th) to have my blood drawn in order to figure out what was going on.  I felt validated that I had called in, but also concerned.

When we came in for the blood draw Amy met with us.  She explained that my itchiness was most likely due to a complication called cholestasis where bile isn’t processed correctly in the gallbladder and liver.  The excess bile builds up under the skin and causes the itchiness.  Cholestasis can be dangerous, especially early on in pregnancy because it causes a lot of stress on the mother and the only way to cure it is to deliver the baby. 

After Amy finished explaining, she told us that they would do the blood draw and call me back the next day with the results.  She felt that because I was not acting like the itching was that intense, my levels would probably be low and we could continue my pregnancy as normal.  If they were elevated though we would have to begin a natural induction, which I had gone through with Merritt because he was overdue and was something I did not at all desire to repeat.

The next day, Thursday January 8th, I went to work as normal.  I called in about noon when I hadn’t heard back from the midwives.  The receptionist took a message and told me they would call me back as soon as they had results.  On my drive home I talked with Amy about the results that had come back.  She began to tell me that she was very surprised when my blood work came back because my levels in fact were extremely elevated.  She said that she wanted Zach and I to come to the birth center the next morning with our things because we might me staying awhile.  “Staying?!?” I asked in total shock.  “What do you mean staying?”

I was so surprised and having a really hard time processing what was going on as I was driving.  I pulled into our driveway and Zach was right in front of me going inside with Merritt.  He was mouthing to me to pull into the correct side of the driveway and I was mouthing to him that Amy was on the phone.  Amy explained that because my levels were so elevated she didn’t want me to be pregnant much longer.  We would begin a natural induction the next day in order to make the baby come a little early and take the stress off my body.

I came inside and explained the basics of what was going on to Zach.  We called Amy back and asked a million questions.  Then we proceeded to run around the house, calling family, packing, and all-in-all freaking out.  Since I was thirty-nine weeks we had most everything put together, but suddenly knowing that we would be possibly having the baby the next day made everything much more urgent.  Zach also was not AT ALL prepared to leave work so he had a lot to prep for his sub. We got everything ready in a few hours and then tried to relax for the rest of the night.

The next day we took Mer to day care (our friend Anjela’s) and went into Health Foundations.  When we got there Amy explained that we would first try the Foley catheter to dilate me and hopefully kick start my labor.  I had the catheter inserted with Merritt since he was overdue, so I wasn’t worried.  I just didn’t want to have to drink castor oil.  I was prepared to do almost anything if it meant that I could avoid that.  I remembered from Merritt that having the catheter inserted was slightly painful.  With Abel though, it was really no big deal.  I think I just wasn’t allowing myself to feel sorry for myself and again I was willing to do anything to not have to drink castor oil.

After having the catheter inserted, we had to let it do its thing.  Amy assigned us to walk, and then eat and rest.  She told us to come back to the clinic and check in with her at 3:00pm. We went to Target and did laps around the store since it was too icy to walk outside.  Then we both allowed ourselves to buy whatever we wanted at Target for lunch in order to make the day feel more like a mini-staycation inside of anxious waiting for baby time.  We bought fried chicken, cob salad, asiago cheese rolls and chocolate chip cookies.  We came home and ate in bed and then took a nap together.

We went in at 3:00pm and met with Amy but nothing had really happened.  She told us to come back in the next morning and to call her if the catheter fell out.  By the time that we left the clinic our family had all arrived from Iowa for the birth.  We decided to walk some more and for a change of scenery we went to the Roseville mall.  We met Dick and Kim there and they played with Merritt in the indoor play area while we walked laps. 

Afterwards we went back to our house and ate dinner with my Mom and Dad and my sister Sarah (my sister Natalie was coming up the next morning).  Just as people were starting to leave after dinner, the catheter fell out.  I was excited that I was more dilated, but the same thing had happened with Merritt and hadn’t kick started my labor.  We called Amy and told her what had happened.  She told us to call back if I went into labor during the night or come back in at 9:00am the next morning.  That night Mer went to the hotel with our families, while we tried to relax and stay calm.

The next morning came and I still had no contractions.  We went in to meet with Amy and soon both my sisters were there.  Amy decided that since I was a second time mom, she felt comfortable breaking my water.  I was excited that this was the next step, because I was sure she was going to tell me that we would have to start castor oil.  Amy felt confident that breaking my water would get my labor started.

So I laid down on the bed and Amy attempted to break my water, but had a lot of trouble doing so.  Apparently when you are already in labor breaking your water is easy because with each contraction your water bag bulges out making it very simple to pop.  When you aren’t in labor however, it can actually be really difficult because the bag is is flat against the baby’s head and is akin to hooking a thin film of saran wrap with a crochet hook. 

After a few attempts though, Amy thought that she had popped it but wasn’t sure.  She asked us to go into the shower and do squats for the next thirty minutes or so to put pressure on my water bag and hopefully help it pop.  So, huge and pregnant, I squatted for as long as I could as deeply as I could.  I was so motivated to break my water because, again, I was just trying to avoid castor oil.

After finishing the squats, Amy concluded that my water still hadn’t broken and asked if I wanted to try it again.  I was all for it.  She tried a few more times and then had Rachel (another midwife) try because she has longer fingers.  They both were trying really hard and it was a little painful, but I was totally willing to go for it.  They kept asking if I was okay and I kept giving them a thumbs up because I was still fighting my cough and while I was lying on my back it took everything that I had not going into a coughing fit.  Zach also told them a few times “She’s okay.  She’s tough and she really just doesn’t want to have to do castor oil.”

Still, even with both of them trying, they couldn’t break my water.  Amy commented that I had dilayed to at least five centimeters while trying, but I was still really disheartened and sort of painicky.  I just wanted it to work so badly so I wouldn’t have to do castor oil.  I suggested that maybe we could try moving upstairs and using stirrups to make it easier for them.  Although they didn’t think that the stirrups would have any effect, they thought that maybe being on the hard surface of the exam table would be easier than the bed.  They decided that as long as I was game, they would try one last time.

We went upstairs and Rachel tried to break my water.  She commented that she was very competitive and it was really bothering her that they weren’t getting it. She tried and tried and tried and then Amy tried again and then all of the sudden “Woosh!”.  I could hear and feel the amniotic fluid rush out of me and onto the floor.  I was so relieved.  I saw Amy and Zach look down at the floor with a kind of surprised look on their faces.  I asked them, “Is it a lot?”  Zach replied, “It’s all over the floor and Amy’s pants.” We laughed, and of course Amy and Rachel acted like it was a complete non-issue and covered up the fluid so I wouldn’t see it.

We went back downstairs and I announced to Sarah and Natalie (who had come to the birth center) that they had broken my water.  Then we waited for awhile for contractions to come.  I was feeling restless and asked Amy if walking might help move things along.  We went back to Target for more laps, this time with Sarah, Natalie and both of our moms in tow.   Unlike the day before, the whole scene at Target was crazy.  It was the middle of the day on a Saturday and there were tons of people, samples being passed out, and the Target mascot, Bullseye was walking around.  All the while we were doing laps and I was leaking amniotic fluid.  It was surreal and hysterical.  Since we all couldn’t possibly stay together, Zach and I would walk laps and then pick up Sarah, Natalie or Kim for awhile and then keep walking (my Mom was too busy shopping to do laps).  We even ran into someone that we knew from church and Sarah forced me to take my picture with Bullseye!

After Target we headed home again to rest and eat.  Amy had told us to come back into Health Foundations at 4:00pm if nothing had happened yet.  We were really hoping that I would have some contractions before then but alas, nothing.  My water was broken and I was five centimeter dilated but yet still no contractions.  We went in to meet with Amy and she explained the inevitable next step, castor oil. 

On the way back to the house I let myself feel sorry for myself for the first time and broke down crying.  I just wanted to have the baby without having to start off with chugging that nasty oil and having diarrhea, but I guess that was just not going to happen.  When we got back to the house I tried to collect myself because Zach’s parents and my dad were there watching Merritt.  I walked past them really quickly and went upstairs to eat.  Before taking the castor oil you are supposed to eat a big meal so that you aren’t completely depleted of energy and nutrients during labor.  We ate some really yummy pizza, but I didn’t enjoy it as much because I knew that I’d be having castor oil for dessert. 

Afterwards I went into the bathroom and chugged the castor oil, which is like drinking Vaseline.  It coats your mouth and lips and instantly makes you feel sick to your stomach (it’s making me feel sick to mine thinking about it right now) even though the diarrhea that it causes takes longer to start.  During this time Zach had told our family to all leave and head back to their hotel (you don’t really want to have diarrhea in front of a crowd).  I could hear my sisters leaving and I got really sad.  I so wanted to be with them but instead I was in bed with the beginnings of diarrhea.  I was also pregnant and emotional and wishing we could have more time together.

Soon I was pretty miserable but still not having contractions.  You take the castor oil and the homeopathic tinctures in two rounds.  Meaning you take the first round and then every fifteen minutes you either take a tincture or a homeopathic and that goes on for about two hours.  Afterwards you are directed to call the midwives.  When we called Amy to tell her we had finished the first round she told us we could go ahead and start the second (which is the whole process repeated again) as soon as we were ready.  She also said that we could wait a little bit if we want to though and have a snack. 

Well, I was definitely not ready.  With Merritt I had just chugged my second round of castor oil and then about fifteen minutes later I was in labor.  I did not want that to be the case again.  Zach gently pushed me to take the second round right away and I flatly refused.  He obliged, but set a time to start in fifteen minutes.  I know he was just trying to support me to do something that I didn’t want to but had to do, but still I was thinking, “No I’m not. Yeah, it’s easy for you to say fifteen minutes.  You don’t have to take the stuff.”  I just was hoping against hope that I would have a contraction and I wouldn’t have to do the second round.  And it’s not just about the taste (which is horrible), it’s about the fact that you feel so sick at the time so the thought of actively drinking something that you know will just make you more sick is just appalling.  So when fifteen minutes came and Zach said, “Okay, let’s go.”  I said, “No, just five more minutes,” in a super pathetic voice and he relented.  And then…

Ah, the first contraction!  It’s was so awesome!  I was so freaking proud of myself!  “I knew it! I knew!” I kept saying in my head.  “I knew that if I just waited long enough I would have a contraction and I wouldn’t have to take the castor oil again!”  Then there was another contraction and I told Zach I was sure these were contractions and that he should start timing them.  It was 8:30pm.  He called Amy to tell her that my labor had started.  She said to call her back when the contractions became more intense. I had one or two more contractions in the bed and then I had to stand up and lean against the wall in our bedroom as they were getting more painful. 

After the next contraction, I moved to the toilet and Zach called Amy again.  She made a plan to meet us at the birth center at 9:30pm.  Zach told me “Let’s do five more contractions here and then start to get ready to go.”  I agreed but didn’t think that I could wait.  The contractions were almost instantly really intense.  I had one more contraction and said, “No, we need to go now”.  Zach tried to stay with me and I ordered him to get things ready so we could leave more quickly.  I made it down to our entryway before I had another contraction against the wall. Zach was scurrying around putting Sitka (our Huskey) in his kennel and putting the chairs up on the couches so that Juneau (our Golden Retriever/Huskey mix) wouldn’t get up on them while we were gone.  Even in labor I made sure to tell him to do that!

Zach helped me put on my boots and I made it until the car before I had another contraction.  Zach went to comfort me but I told him to start the car.  I just wanted to get to the birth center.  Reflecting on it now, I think my body was telling me I needed to get to the birth center quickly.  I remember the contraction that I had against the car so clearly.  I was so dark, quiet and cold outside.  I had started moaning to help me relax through the pain and I remember wondering if any of our neighbors could hear me. I was surreal and beautiful and odd.

We got in the car and I urged Zach to drive faster, although he was trying to drive carefully so the ride wouldn’t be too bumpy.  I had a couple more contractions in the car which were very painful.  I hate being in the car while in labor because you can’t lean against anything to mitigate the pain.  I really feel for any women who have to drive long distances while in labor.

We arrived at the birth center, I walked in and immediately read the clock, 9:15pm. 

I labored on the toilet for a few contractions.  I was already naked, on the toilet backwards, moaning loudly.  Amy and Sophie immediately started to fill the tub.  My contractions were very intense.  I started thinking, “Either I’m really close to having the baby or I’m not and I need to get on top of these,” because they were overwhelming and very painful. 

During this time all the women in our family arrived for the birth.  My sister Natalie, who had been my de facto doula during Mer’s birth, immediately came back and checked on me.  I later learned that she then went back to our moms and Sarah andreported that I was very close which she knew from listening to how I was breathing.

The pain was really bad then and I was trying to figure out some way that I could get on top of it.  I asked if I could get in the shower because I remembered that feeling so good during Merritt’s birth.  Amy said of course but suggested that I could get into the tub instead.  I knew that they usually wait to let you get into the tub until you’re farther along in your labor. So when she said I could get in that’s when I really started to let myself believe what I had known from about my fifth contraction, this labor was moving REALLY FAST and I was already towards the end. 

In the tub I felt like I was in a movie.  I was so aware and I was talking a lot.  With Merritt I had so much more time to get in the zone and I felt like I was in a dream, but this time I could see and process everything and everyone.  I felt a little silly like I needed to perform and have the baby quickly because my family was all watching and wouldn’t that just be so convenient for them.  As soon as I had these thoughts though I tried to push them out of my mind and focus on what I was doing.

Pretty soon I told Amy that I felt like I was going to poop, or maybe I needed to push.  I knew that I needed to push, but I just always doubt myself in order to not get my hopes up.  Amy told me that it was fine if I pooped and assured me that it wouldn’t hurt the baby to poop in the water (which I was nervous about) but also said that she would check me to see if I was ready to push.  She did and confirmed that I was.

So I started pushing.  I had a lot of emotions flowing through me with all the hormones.  At one moment in between contractions I broke into an intense looking cry.  I could immediately see that my family was worried so I started saying, “I’m happy.  I’m happy” and Zach repeated what I was saying loudly.  Then I tried to explain that I was thinking about how much I loved Merritt and that I was about to have another baby and that I would feel that same way about him or her.  I thought I was making perfect sense but when Natalie repeated back what she thought I was saying, it wasn’t what I had intended.  I got really frustrated because to me I was speaking completely normally.  Zach understood what I was trying to say and translated for me.  Later he told me that I wasn’t making much sense at all.

Pushing went extremely quickly and in about five pushes Abel was out.  It was 9:56pm and I had been in labor for only about an hour and a half!  Zach caught him and I held him in my arms.  I announced to everyone that he was a boy and his name was Abel.  Then I specially addressed my mother-in-law, Kim, when I announced his middle name, Matthew, because that is Zach’s brother’s name.

Abel was bluish when he was born and needed to be given oxygen through a hand pump.  It made the first few moments of his life a little more worrisome.  Amy was giving him the oxygen and I told her, “Amy, is he okay?  I really can’t enjoy him until you tell me he’s okay.”  She told me that he would be fine and in a few minutes his coloring was normal.

I stepped out of the tub and went to the bed to deliver the placenta which came out pretty easily.  I was shaking really badly which I didn’t enjoy, because it made me look and feel weak.  My family thought that I was cold, which I did feel cold but the real reason that I was shaking was because of adrenaline. My body had produced adrenaline to help me through the birth, but because of my extremely short labor I ended up not using it.  The shaking continued for a long time.

I had a small tear that didn’t need to be sewn up which I was happy about.  Amy thought that the tear was probably caused by Abel’s hand that was curled up by his head when he came out.  I nursed Abel right away and he was a very good nurser right from the beginning.  Nursing him was a good distraction because then I began to bleed. 

At first I couldn’t really feel that I was bleeding, but then every time that Amy pushed on my uterus to make it clamp down I could feel a gush of blood coming out of me.  Then I started to get interventions.  Amy gave me a shot of pitocin in my leg and then asked me to slowly chew a chalky pill.  I was aware of the procedure for interventions at the birth center, so I said aloud, “This is because I’m bleeding too much.”  She then gave me an IV with fluids and even more pitocin.  The mood in the room began to change a little bit.  Amy and Sophie stayed calm but Amy’s voice tone changed.  Instead of asking Sophie to do things she began to tell her.  Not rudely, just in a matter of fact way.

I began feel really sleepy and closing my eyes a lot.  I could see that my family was worried and I was trying to act normal so to not scare them, but I was just having such a hard time keeping my eyes open.  I learned later that at one point I actually started to fall asleep on Zach and Amy and Sophie had to tell me to stay awake.  After a few minutes, my bleeding started to calm down.  Abel was happy and healthy and started to get passed around to my family. 

The next couple hours pasted quickly.  Amy left and I gave her a big hug.  I was so grateful that she had been with us throughout the entire process.  Katrina, another midwife, took over.  Abel was weighed and measured.  Katrina sat with us and debriefed about the labor and delivery and discussed all of our questions while I ate some Jimmy John’s.  I was grateful that she took the time to talk through what had just happened because I know many women don’t have anyone explain the intricacies of their labor to them.

As we went home it was so oddly similar to having Merritt.  So cold and the middle of the night.  We came back to the house with my Mom and tried to get ready for bed as quickly as possible because we were so exhausted.  I remember as I laid down I could hear Zach, who had fallen asleep almost instantly, snoring loudly.  I could also hear Abel, who is a very loud, snorty sleeper making noise.  With my boys snoozing around me I felt exhausted, sleepy and at peace.

Postpartum:

My postpartum time with Abel began really similarly to Merritt.  My mother-in-law Kim stayed with us and we enjoyed time as a family.  I bonded with Abel really well and spent lots of time with him one on one during the first week. 

Abel overall was a normal little baby, but because Merritt had been so incredibly calm we worried about him when he had small issues (that didn’t feel small at the time).  He had some really difficult nights during his first couple of weeks, where he would be extremely unhappy and inconsolable.  They absolutely panicked us.  Even during just those few nights we felt extremely helpless and like he would never be happy.

Also the day after Abel was born, Merritt came down with the flu and was the sickest that he had probably been in his whole little life.  He actually threw up in Zach’s hat while on a trip to Target (Zach still wears the hat).  It was really difficult because we had to keep Merritt away from Abel and because Abel was more or less attached to me, away from me as well.  Pretty much it became that Zach and Kim cared for Merritt downstairs while I cared for Abel upstairs.  I missed Merritt and felt really scared that he would get Abel sick.

At the same time I was still recovering from the cough I had come down with around Christmas as well as the birth.  I was trying to take care of myself, but also having a hard time parenting since I wasn’t yet able to wear Abel (which he really loved) or pick up Merritt.  I also was having some extreme headaches and baby brain or cloudiness.  I would have hours at a time where I felt disconnected and had an extremely difficult time focusing.

All of these things kind of came to a head on week three when Zach went back to work (although we didn’t realize it until afterwards).  I got through the first two days after he went back okay but I was dying by the time that he got home and overall just not feeling well (very exhausted and sometimes faint).  Then on the third day, I woke up and began to feel very faint in the shower.  By the time that Merritt had woken up I was concerned that I might pass out. At the same time Abel had been pretty fussy over the previous couple of days and was needing almost constant soothing, but I worried about wearing him because I was still recovering.  I was completely overwhelmed and felt like I couldn’t make a single clearheaded decision. I started bawling and then I decided that I just wasn’t up to it yet.  I called Zach and told him I needed him home for a few more days.

Zach was extremely worried about me (and with good reason). He left school that day and took off the rest of the week to stay home with me.  I felt like I was sick and Abel was sick, but Zach could see that the biggest problem wasn’t either my physical health or Abel’s, it was my mental well-being. I went into the midwives and then ran blood work on me. I almost fainted in their office during the blood draw; that is how sick I felt.  I thought for sure that my iron levels were insanely low from the bleeding I had after birth and that’s why I was feeling so horrible.

The next day we went in and got the results from my blood work.  Everything was completely normal.  I was happy to be healthy, but really shocked as well.  I knew how horrible that I had felt.  I knew that I hadn’t been just making it up.  In the end though it was most likely intense exhaustion combined with the beginnings of depression. 

Thankfully over the next day I began to feel much better.  The combination of having Zach around the house to help me, and realizing that Abel and I weren’t sick, helped me to be able to feel on top of things again.  We also worked on getting me more high quality sleep.  Abel was an extremely loud sleeper so I realized that I was never getting into REM sleep because I was constantly waking up to him or thinking that he was about to wake up.  We moved Abel into his nursery, but kept the doors open in between us.  Then we turned on a fan next to me just loud enough that I would still hear his crying but not every noise that he made.

By four weeks Zach was ready to go back to work for the second time.  The Sunday before he went back, I did a “practice day” where I pretended like I was home alone with the boys.  That day went really well and really boosted my confidence about staying home.  It put me back into the mindset that staying home with the boys would be a fun adventure instead of something that I just had to “get though”.

From then on I really fell into a rhythm.  I realized, or should I say remembered, that I am a person who can’t stay at home all day, that I need to feel busy and productive.  I tried to go on a fun outing almost every day and got together with other stay-at-home moms, so that Merritt would have other kids to play with and I would have adult interaction and conversation.  I figured out ways to keep both the boys happy and myself happy and balance all of our needs.  I started to love every day and enjoy the time I had with the boys.

I wanted to write about my postpartum experience for myself to remember it, the feelings and thoughts and emotions that I was going through.  It was the most intense two weeks of my life thus far as far as emotions are concerned.  I want to make sure that I remember how I felt at the time but also how I came out of it. Also, I hope that reading this might help another Mom if she is in her dark time to feel validated in her feelings and also to see that there is a beautiful light at the end of the tunnel.


Welcome Dr. Dennis Hartung!

BlogIcons_MeetStaffWe are so thrilled to introduce you to the newest member of our team: Dr. Dennis Hartung. Dr. Hartung joined our practice in January 2015. Many consider Dr. Hartung a legend in the Twin Cities birth community. He has a reputation not only for being a stellar OB/GYN, but also for being very supportive of natural birth and very empowering of the women and families under his care. He is appreciated by many of his patients for his remarkable calm, caring, approachable, attentive, and down-to-earth bedside manner and incredible skill. Welcome Dr. Hartung. dr.hartungimage-1

What is your role at Health Foundations?

I am an OB/GYN physician. I see patients that need care for their birth at the hospital, but who would like to be seen at Health Foundations. I also offer well woman and gynecologic care, including managing surgery for those who need that as part of their GYN care.

What is your educational background/training?

I received my B.A in Biology at Boston University in Massachusetts. I later earned my Medical Degree at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. I received further OB/GYN training at the Walter Reed Army Medical Center.

Where were you born?

I was born in Billings, Montana in June 1958. I was born in a hospital and don’t know a great deal of detail about my own birth. I heard that my mom did not have a name picked out for me and that she named me after her OB.

Has anyone ever named a child you’ve helped deliver after you?

Not to my knowledge!

Where have you lived beside Minnesota?

I have lived all over the place! Growing up, my dad’s work took us from Billings and Bozeman, Montana to Yuma, Arizona. After my parent’s divorce, we moved west to Salem, Oregon. After that I moved around a lot with the Army to Clarksville, Tennessee; Hampton and Little Creek, Virginia; Brookline and Brighton Massachusetts; North Pole, Alaska (seriously); Ft Campbell, Kentucky; Fort Bragg, North Carolina; Fort Benning, Georgia; and San Antonia, Texas.

My favorite place I’ve lived has to be North Pole, Alaska. I worked for the Army as a medical doctor up there and our family just loved it there. It was colder, but my wife and I always say that Minnesota/Wisconsin feels colder much of the time in the winter. North Pole was a great place to raise our kids—we had a tightknit and very supportive community. We loved that wilderness was everywhere, all around you. Living in Alaska, you really have to adjust to the rhythms in a place where it is virtually dark 24 hours a day for a few months a year and then light for 24 hours a day for months. You could be out washing your car and realize it was 1am in the morning! But it was just a really cool place to live.

Where do you live now?

Hartung family in Hudson

I live in Hudson, Wisconsin. We’ve lived here for 9 years. My wife’s parents live on the east coast and my parents on the West, but neither of their home states really attracted us—they are not particularly doctor-friendly from malpractice and other standpoints. So knowing we wouldn’t live on either coast freed us to look around. We looked in the northern US—we wanted the 4 seasons and a place that didn’t get too hot and humid. I was eligible to retire from the army at this point…so we interviewed for a job here and fell in love with Hudson. We loved the small town feel with proximity to the Twin Cities. It has been a great place for our kids—good schools and after-school activities.

Can you say a little about your family?

I have been married to Linda for 33 years, and we have three kids: Rebekah (28), John (25) and Aaron (21). My wife and I have two cats named Rue and Sega. I have a younger sister named Jani who lives in Turner, Oregon, just outside of Salem.

Dennis and wife Linda, Dominican Republic

What led you to the Army?

When I was finishing up with high school, I didn’t have the financial means to go to college. My music teacher recommended I audition for the Army band as a flutist and get military college benefits. I was accepted and played flute for 6 years in the army. I received an army scholarship for my education with the expectation that I would serve the army as a doctor when I was done. I spent about 12 years as a student/resident and then about 11 years post-residency as an active duty army physician in OB/GYN care.

Dr. Hartung at military trauma course in medical school

What is one of your favorite things to do when you are not at Health Foundations?

I am a flutist and still play regularly at church and other times/places that I can. I love gardening, hiking, and canoeing.

Linda and Dennis, annual fundraising gala at church

What is one of your favorite restaurants in Saint Paul?

Pizza Luce

If you could get on a plane tomorrow and travel anywhere in the world for free, where would you go?

Ireland. My wife and I went there for our 25th wedding anniversary and were delighted by it. We want to go back sometime.

What inspired you to get into your field?

Being present for the birth of my daughter—our first baby. Our daughter was born while I was in college. We had a hospital birth with midwives and our care was much like what is offered at Health Foundations. Watching my wife go through labor (and later holding my newborn girl skin to skin) had a profound impact on me and really influenced my later decision to become an OB/GYN. At first, when I started college, I thought I wanted to become a dentist because I was fascinated by dental instruments. However, I spoke with some dentists during my college years and they really discouraged me from pursuing dentistry. Then I thought I wanted to go into surgery but I didn’t enjoy my surgery rotation during residency at all. When I had my OB rotation—by this time we had also had our middle son—I just knew that this was a good fit for me and that I wanted to serve women and families as an OB/GYN. 

Hartung family, Dominican Republic

 

What is your philosophy on birth?

A woman’s body can do it. Let’s approach it allowing normal physiology to take place without fussing. Then if there are difficulties, begin a stepwise intervention to facilitate a healthy birth, for mom and babe.

What do you wish all Health Foundations families knew? 

THEY CAN DO IT!

What piece of advice or wisdom can you share with pregnant or new mama readers?

In our culture, unsolicited advice and “birth stories” are often told to moms-to-be. People don’t mean to be rude, they often just don’t know what else to say. Humor them, thank them and then let your body do what it was designed to do. Surround yourself with the support you need to get through it.

Birth Story: "Intense. But incredible."

birth story_4 Baby Hamilton's birth story, as told by mama

I feel very blessed to have had a wonderful pregnancy, birth, and start to life together as a new family of three--and have to thank Health Foundations for providing the support to make it happen. When I became pregnant, I thought how and where I was going to give birth would be a no-brainer--I assumed I would do what all of my friends did: a hospital birth, with my OB, and definitely an epidural (you’d be crazy not to, right?!).

My first trimester was going so smoothly that I became a bit paranoid that I wasn't really pregnant. So Fran and I kept our pregnancy a secret from everyone until we made it to the second trimester. During that first trimester it felt like a mini honeymoon with Fran because we found ourselves staying in to avoid the questions around why I wasn’t drinking, etc. One night we searched Netflix for anything “baby” and came across “The Business of Being Born.” This documentary opened our eyes to a whole new concept around birth, and spoke to me in a way that really excited me. Fran and I had spent the prior 2.5 years completely changing our approach to health. Essentially we committed to putting health first, starting with our approach to fitness (we joined a Crossfit gym) and then diet (we did a lot of research around the pitfalls of the “standard American diet” and starting to cut out grains and sugars that were inflaming our system and keeping our bodies from burning fat for energy).

We had such a positive experience with this “alternative” approach to health, that I found myself very receptive to an “alternative” approach to childbirth. I have never had a need to go to a hospital before in my life, so I really started to wonder why I should need to be in a hospital now, with all these potential intervention measures, when I was the healthiest I’d ever been in my life and knew that women have been delivering babies naturally for thousands of years? After watching that documentary and a few others, we started doing a lot of reading and research, we toured birth centers and hospitals, and spoke to midwives and my OB about our options. After a lot of debate and consideration, we followed our gut instinct and decided to transfer to Health Foundations when I was 20 weeks in to my pregnancy. The remaining fears I had around being out of the hospital quickly went away as I had my prenatal appointments with the midwives and started taking the child birth education classes.

Okay-- now on to my birth story!

When I was 34 weeks along, I got this strong feeling that my baby was going to come early. I don’t know what it was, but I was convinced. So imagine my disappointed when my “due date” came and went, and no sign of baby! I chalked it up to my first lesson in motherhood--I’m on someone else’s schedule now. He calls the shots! So time to temper my expectations and go with the flow. Easier said than done, especially when my biggest fear was getting to 42 weeks and having to go to a hospital to deliver the baby.

When I went in for my 40 week appointment Monica checked me, and she said I was still very posterior. So I spent the week going on lots of walks, got adjusted a couple times, and tried accupuncture. At my 41 week appointment (Tues), Monica swept my membranes, which made me pretty crampy for the next day or so. Through the baby stress test at 41 weeks the baby checked out as healthy and the machine showed that I was having contractions--that was a surprise because I wasn't feeling them! Encouraging, my body was working away! I also went in for an ultrasound to check on amniotic fluid--all looked good.

On Friday of that week I had my next appt with Monica, and she thought maybe baby's head was a bit tilted, preventing him from engaging my cervix. So she showed me how to do inversions at home to try to lift him up and off, and then go for walks to get him moving down. Along with that I did more acupuncture, took more walks. No contractions. Went in on Sunday (41 weeks and 5 days) and had the catheter put in and went for a walk. To our surprise, it fell out after 2 hours! I thought maybe I had done something wrong, because it came out but labor didn't start. Amy had me come back in that evening to get checked and get the castor oil+herbs -- which I was to take the next morning if I wasn't in labor. She said my cervix was in a good spot, but didn't share with me how dilated it was (we found out the next day that I was 4 cm at that point! I'm glad she didn't tell me -- would have messed with my head I’m sure).

Cramps started to get intense around 6pm on Sunday, after that appointment. We went for a walk and went grocery shopping. I took a bath at 8pm to ease the cramping, and to get ready to go to bed early to try to get some good rest. I was in bed at 9pm, and contractions started then. From 9pm-1am I was able to rest/sleep between the contractions (8-10 min apart). My back was really feeling it, so I put on a hot pack which really helped. Fran was great at telling me to relax, just as we practiced in class.

At 1am I couldn't lay anymore -- contractions were getting more intense, and about 6-8 minutes apart. I tried different positions but all I could handle was standing and leaning against the wall, and then between contractions I found myself pacing the bedroom (with all the adrenaline, I had a hard time relaxing). I had a few unpleasant trips to the bathroom, where I threw up everything in my system. We called the midwife page at 2am, when contractions were about 5-6 min apart. Amy was excited for me that I was going to be able to have this baby without castor oil (I'm pretty sure having that bottle stare me in the face was what started labor) and she listened to me breathe through a contraction. I could still talk through contractions and wasn't yet vocalizing, so she told me to keep it up and said that next time I call I won't be able to talk as much.

At that point we called our doula, Sarah, and she came over. She had me take a hot shower, which felt great on my back. And then encouraged me to try laboring on my hands and knees, and start to really focus on resting between contractions (head down on a pillow) and pay less attention to the contraction. This helped me get some much needed rest. Contractions were getting more intense, and I had to fight the urge to pace and lean against the wall like before. Sarah left the room to let me and Fran work through contractions together, and she listened from outside the door. My contractions weren’t following a consistent pattern so after a while in that position, Sarah suggested I pull one leg forward (like a deep runners lunge) and do juicy hip circles (Sarah is also a yoga instructor at Blooma, so she was using cues that she uses in the classes I would go to--which was nice and familiar). I thought she was nuts, because I thought that would be too much, too hard. Between contractions I told her that I was never going to think of those juicy hip circles the same way again! :)

But I gave it a whirl -- for 2 contractions on each side. Well that seemed to adjust baby’s position, because I definitely started to feel something new, which I later confirmed was the urge to push! I just went with it, thinking I was still more than 3 minutes apart on contractions (I had mentally prepared for a very long labor)--and I didn't really wrap my head around the fact that I was already through transition. I guess those juicy hip circles in the runners lunge helped me get through that. But apparently my vocalization changed and based on how I sounded, my doula suggested we make the move to the birth center. This was around 4:30am. Sarah got in touch with Amy, who heard me in the background and said “Oh, yep, I’ll be right there!”. We jumped in the car and the car ride was as promised -- hard. Luckily there was no traffic and Fran drove very fast!

We beat the birth team to Health Foundations, so I had a contraction or two on the ramp outside the door- -likely waked some neighbors (Sarah found my flip flops in the parking lot, I labored myself right out of my shoes!). Rachel got there first, and we got in the room and had a couple more contractions. I told her I felt my body pushing, so she checked me, and indeed I was 9 cm dilated- with just a lip remaining! She asked if I wanted a water birth, and I said I was open to it (I wanted to let my labor decide what would feel best when the time came). But I really wanted to labor in the tub for some relief. So she started filling the tub right away--though it felt like an eternity before it was full. While I waited, I labored on the bed on all fours, and put my head down on a pillow to rest in between. Fran got emotional at this point, as he was so relieved that we were at Health Foundations and in good hands--everything got so intense so fast! At one point I looked up between contractions and said “tub time?”... I was thinking, let’s do this! I wanted to get in there and be able to move forward with pushing.

birth story_1

The tub was full, I got in, and the pushing urge was really there -- Rachel said I could, but slowly like I had been outside the tub. All in all, I pushed for about an hour (the total time I was in labor at the birth center!) -- and our baby arrived! I was on my hands and knees, so Rachel said that once he was born she would push him through my legs and he would swim up to me so I could catch him and bring him out of the water. It was completely amazing. He came swimming through with his eyes wide open--such an incredible feeling to be able to grab him and pull him on to me.

birth story_2

The birth team was awesome --I was so impressed with all of them. Fran was a champ, definitely benefited from the child birth classes to help prepare. It was tough for him to see me laboring. I am SO glad we had a doula--Sarah was amazing, and really helped at home (where the majority of labor ended up happening). I was surprised that during labor I never questioned my decision to do a natural labor. I was expecting to have doubts and to have to mentally push those thoughts out, but they never came. Also I had been nervous about my umbilical cord being around baby’s neck (I had been told that this is pretty common, but it still freaked me out)--mine ended up being wrapped around his neck once, but it didn’t harm him at all and Rachel was able to easily unwrap it.

In total I'd say I was in labor for 12 hours (including pre-labor)-- 6 of which was active labor+pushing. The birth team applauded my ability to control the pushing, and take it slow. I didn't need any stitches, and both me and baby checked out as healthy and good to go. I will share that when the nurses had me get up for the first time to use the bathroom (after about 3 hours of laying and bonding with baby), I made it to the bathroom but passed out once I got there -- I think at the sight of blood (first time I really saw any... and I have a weak stomach). The nurses took good care of me, got me lots of fluids, and back in bed without any issues.

birth story_3

It was truly an amazing experience. Intense. But incredible. And everyone who has checked on our baby's health have remarked on how awake, aware, calm, strong, and healthy he is -- which was our goal in having a natural birth, and I think only made even better by going with a water birth. And my recovery was smooth and quick, I was excited I didn't need to have any stitches (even after delivering a 9 lb, 3.5 oz. baby with a 15 cm head -- which apparently is in the 99.8th%!).

Special thanks to….

Health Foundations -- for providing personal attention and care throughout my pregnancy, and an unforgettable birth experience that helped our family get started in this new life together in a healthy, beautiful, and very special way.

My Husband, Fran -- for being fully committed to being my partner through this journey, for being such a strong supporter, and a beautiful father.

My doula, Sarah Auna -- for being a strong, calm, beautiful presence and providing support through this amazing process to both me and Fran.

Crossfit St. Paul -- for helping me to put health as a top priority, and to learn that my body is stronger and more capable than my head likes to think it is and that I can push through and achieve great things.

Body Workers, Amber (chiropractor) and Adrienne (massage) -- for helping me to feel amazing throughout my pregnancy, even at 41 weeks pregnant my body felt great! You helped me truly believe that my body was made to do this and it was all very achievable--and perhaps my swift labor was possible because my body was all good to go!

Blooma -- for being a weekly reminder throughout my pregnancy that my body is completely capable of birthing this baby, and for making the journey towards motherhood a special and sacred time. And for introducing me to my amazing doula, Sarah.

My Parents -- for raising me to be an intellectually curious, confident woman who feels empowered to make informed decisions

Birth Story: Meeting Finnlee

Finnlee Joan birth story

The birth of Finnlee Joan told by mama Nicole

Since she was 41weeks, I had been getting a little worried that she would never come out, so I requested to work a evening shift of Thursday so I would be on my feet. We had a check in with Monica who gave me a belly band and told me to have a good night at work. Sure enough I started having contractions. I didn't know what they were (now I know!)-- they stopped when I would rest, so I didn't really concern myself. After three weeks of everyone at work asking me "when are you going to have that baby? I can't believe you are still at work!?" I was excited to move the process along.

Friday 10/24

Evening comes along and I started to leak- best way I can describe it- my water was slowing breaking. I probably went to the bathroom like 50 time in 4 hours. I was having to convince my husband that my water broke but he was not so sure. We called Monica and she said just to sleep, eat, and the rest will take care of itself.

Saturday 10/25

Morning came and Nick was so excited the baby could be coming, he stayed up until 4am cleaning the house. When I wanted to take a hike at 9am, he was too tired. I called my sister-in-law and we went hiking up the sledding hill by our house, which did cause the contractions to increase but I was still able to talk through them. At this point, I had pulled out all my Health Foundations binders and was looking for all the stages of labor. Also it seemed like in every birth story in the Ina May book, the women went for a hike to keep labor going. I was fearful that the contractions would not ever come consistently because after the walk, they stopped again.

I had been seeing an acupuncturist to try to get the baby out earlier that week so I went to my 2:30pm appointment to get the show on the road. My husband drove to make sure I was safe and to ask the acupuncturist how this whole thing worked. He put the needles in me and he and my husband carried on talking and laughing meanwhile my contractions became much worse and I was not so easy going at this point. We left and I really wanted some ice cream before this labor thing got really intense so we stopped at Culvers. I ate a sundae and before I could get around the block, I had to get him to pull over so I could vomit. I guess it was Mother Nature's way of making sure I didn't eat any more bad food.

Recalling that the labor stages book said vomiting means things are moving, I was getting a little nervous. The book was right, I started having contractions every 5 min. But my husband would not let me go to the birthing center until they were 3-1-1, he must have been listening to Rochelle (our childbirth education instructor) during class. I begged him for two hours to leave the house, but it was not until Monica gave him the go-ahead to drive me in at 8:30 pm that he agreed.

We arrived to hear another mama laboring in the other room where another baby was being born. This was a little intimidating until I heard the baby cry, then I was jealous because she had a baby and I had a lot of work to do still. Monica checked and I was 5cm dilated. I asked her how far I was and she said " you're far enough you can stay."  It had not occurred to me there was a chance I would be sent home. I was ready to meet my baby and did not plan on leaving! Thank goodness we stayed at home long enough.  The next 6 hours were a bit of a blur: shower-tub-vomit-repeat. At one point, Monica checked me and said I could start pushing. My husband wanted to catch her and the first thing he saw was her little face with her hand over it. Nick told Monica that the baby had her hand on her face and we were still in the tub. Monica calmly told me to get out of the tub and do a runners lunge (with a baby head half way out.) One more push and there she was! Nick got to catch her like he wanted.

We met Finnlee at 3:26am on Sunday October 26, 2014.  She was 7lbs 10oz and 20.5 cm long.

All about Birth Doulas

doula artMany of our clients wonder what is the benefit of hiring a doula for a birth center or home birth.  After all, isn’t your midwife a lot like a doula?  Not necessarily. We love it when our families choose to have a doula and believe it provides many benefits before, during and after birth.  In fact, we believe so wholeheartedly in the benefits of a doula that we have a doula internship program, which links newer doulas with families in our care.

In this post, we’ll explore what a doula is, how she* fits into your birth team, what support she offers, and what he training looks like. In our next post, we will talk about the many benefits of a doula

*While there are some male doulas, most doulas are female and thus the use of “she” here.      

What is a birth doula? 

A birth doula is a trained professional with knowledge of the physiology of birth and the emotional needs of laboring women.  She offers continuous emotional and physical (but not medical) support to mom and her partner throughout labor.

Doula as a unique part of the care team

While a midwife knows and supports a mom and her partner, she is chiefly responsible for the medical and clinical care of mom and baby during labor.  She may offer intermittent support and comfort as well.  A doula will offer continuous emotional support and comfort as soon as early labor, as a woman and her family desires.  Nurses are present to help with the medical and clinical aspects of birth and may not be familiar to the family prior to birth.  A family often knows their doula before labor.  A partner offers emotional support and loves the mom and baby like no one else on the birth team, but does not typically have the knowledge and experience that a doula can offer.

What does a doula do?

doulalaborpushSome of the specific support services a doula provides include:

  • Before birth, she often meets with an expectant family one or more times to get to know them, their wishes, hopes, and fears, and so come to understand how best to serve them in labor.  This also gives the family and doula an opportunity to develop a rapport and build trust.
  • A birth doula works to empower families through education and access to resources before, during and after labor.  She does not speak for a woman or her partner, but helps them make informed decisions and advocate for themselves and their desired birth vision.
  • In labor, a birth doula provides continuous support, meaning they will come to your side during labor when you wish (at home or in the birth center) and stay with you all the way through your labor and delivery and the first few hours postpartum.
  • A doula supports the role of the partner, and does not usurp his role in a woman’s labor; conversely she supports and enriches this bond and this support.
  • A birth doula can help suggest and facilitate physical comfort measures to help a woman cope through labor.
  • She offers emotional support to both the laboring woman and her partner.  She remains calm and objective throughout the birth process.
  • She facilitates communication between members of the birth team (professionals and kin).
  • After the birth, doulas often meet with families, offering breastfeeding and early postpartum support.

What does a doula NOT do?

A doula does not:

  • Provide medical information or clinical advice.  She will not perform clinical or medical tasks such as taking mom’s blood pressure or temperature, monitoring fetal heart rate, performing vaginal exams, etc.
  • Make decisions for a woman or her partner, or interfere with their care
  • Judge a woman or her partner for their wishes and choices in birth
  • Take away from the role of the partner or any other birth team member

What training does a doula have?

doulatrainingBirth doulas have a choice to become certified with a certifying body or not. The most common, though not the only, certifying body is DONA, or Doulas International (formerly Doulas of North America, hence the acronym).  Bear in mind that uncertified doulas may have the same level of experience and qualifications but have chosen, for one reason or another, not to become certified.  For this reason, it is important to ask prospective doulas about their experience.

To become a DONA-certified doula, a person must:

  • Read five selected books on childbirth and breastfeeding and additional materials.
  • Complete childbirth preparation (often a childbirth education series of at least 12 hours)
  • Complete at least 3 hours of breastfeeding training
  • Complete a doula training program of at least 16 hours
  • Attend at least 3 births (evaluated by the laboring woman and her care team)
  • Develop a resource list for clients
  • And more.

How much does a doula cost?

Doula services, which vary based on a doula’s experience, her included services, and other factors, can range anywhere from free to over $1000.  Some doulas have a set fee while others use a sliding scale.

While most insurance coverage does not cover doula services, the benefits of having a doula are so well demonstrated that insurance companies and the state are beginning to consider and adopt coverage for doulas.  It’s always a good idea to ask your insurance carrier if they cover doula care (every request for a service, even if not approved, is documented and is taken into account by the insurance carrier when determining covered services in the future).

Bear in mind that a doula has often completed a rigorous training process, makes herself available on call for a 4 to 5 week period around a woman’s due date, spends anywhere from a few hours to a few days with a laboring family (sometimes paying for childcare and other expenses while away), devotes hours to supporting a family before and after labor, and has professional expenses like any other independent small business professional.

How do I find a doula? 

  • Talk to us!  We have a list of a few doulas we know and recommend. We can also talk to you about our doula interns.
  • Childbirth Collective Parent Topic Night: All About Doulas.  This is a great event held monthly in Saint Paul and Minneapolis where doulas and expectant families gather to meet and talk about doulas. The Collective also has a list of doulas on their website.
  • Blooma.  Many of the yoga teachers and educators at Blooma are also doulas.  This may be a great way to make a connection.
  • Childbirth education classes.  This can be another possible avenue to connect with a doula.
  • Word of Mouth.  Talk to other mamas who have had doulas and find out who they recommend.

Check out our related post on the benefits of having a doula!

Birth Story: "I couldn't believe he was ours and what I had just done."

20130305_Merritt_final_056The birth of baby Merritt

By Hannah Pierson

The Tuesday of my first week off work (9 days overdue) Zach and I went into the midwife for a non-stress test which the baby eventually passed , but took his sweet time to do so.  I had a cervical exam and I wasn’t dilated at all.  Then we got an ultrasound to make sure that the baby was still doing well.  Since Merritt passed everything, we went back home and scheduled another appointment for Wednesday.

On Wednesday we went back to the birth center and I had a Foley catheter inserted.  A Foley catheter is a type of intervention to try to induce labor where they insert a catheter and then fill it with small balloons full of water (one balloon on the inside of your cervix and one on the outside).  The objective is to use the catheter to slowly stretch your cervix open over the next 24 hours.  Getting the cervix to begin to dilate is a way to jumpstart labor and can sometimes even begin contractions.  The hope was that this would begin my labor or at the very least dilate me so that labor would be easier once it began.

Getting the catheter inserted was painful and uncomfortable, but Zach was there which made it much easier.  We went home with Jimmy Johns as a treat and Zach returned to work and I was pretty much bed bound.  As the day wore on I got more used to the catheter (the most annoying part is that it’s taped to your thigh) and in the afternoon Zach and I even took a very slow walk around the block.

As we were getting ready for bed, I went to the bathroom and started to feel the catheter falling out of me.  I screamed for Zach, as it was a weird sensation, and then it just sort of plopped in the toilet with my mucus plug attached to it.  It was much larger than Zach and I had thought so that was a bit of a shock.  We were so excited that the catheter had dilated me and we called the midwife who told us to come in the next day.  We then proceeded to call our moms who were very excited for us as well (we had to stave off Zach’s mom from jumping in the car and heading up right then).  We calmed ourselves down and were able to go to bed.

The next day (Thursday, 11 days overdue) we went in to meet with the midwives.  The catheter had indeed done its job and I was now 4 cm dilated.  We formulated a plan.  That Monday I was going to be two weeks overdue and would have to be induced at a hospital.  After the catheter, the midwives still had one more thing to try to make the baby come: an herbal induction.  An herbal induction begins with taking castor oil and then every 15 minutes taking a homeopathic or tincture.  All of these are meant to make your uterus contract and begin labor.  We decided that we would give my body one more day to go into labor naturally and then do the herbal induction on Friday.

We spent the rest of the day on Thursday (Valentine’s Day) doing absolutely everything that we could to make the baby come.  I got acupuncture for the first time, went to the chiropractor and got an adjustment, at the spiciest food that I could handle at Everest on Grand, had chocolate cake at home and then went for an epic walk at night in the snow.  Nothing happened.

DSC_0154The next day (Friday, February 15th), worried and feeling super unenthused about the herbal induction; I got up and did my prenatal exercise video one last time.  Then I ate a big meal and chugged the half cup of castor oil in orange juice.  It wasn’t as horrible as I thought it would be.  The worst part was the oily residue that it left on my lips and tongue.  As the morning passed I hung out in bed and followed the herbal induction regimen (the tincture was very foul tasting).  At first I felt just fine, but then by mid-morning I was on the toilet miserable.  At one point I cried to Zach, “This is horrible and I bet the baby won’t even come and I’ll still have to be induced!”

In the afternoon I repeated the castor oil again and was feeling pretty sorry for myself.  I was lying down in bed when suddenly I felt what can only be described as a gunshot go off from my uterus to my vagina.  I screamed to Zach downstairs and rushed to the bathroom.  When I sat on the toilet I could feel liquid falling out me.  I told Zach that I thought that my water had broken.  He kept saying, “Are you sure?” and I kept saying, “Well, I know what peeing feels like and I know I’m not peeing!” It was 3:00pm.

At the same time I was still experiencing the unpleasant side effects of the castor oil and shooed Zach out of the bathroom.  I then started to feel contractions and I was screaming out the bathroom door to Zach, letting him know when they started and stopped so he could time them on his phone.  He desperately wanted to be in the bathroom but I wouldn’t let him come in.  At one point I saw him peeking through the door and yelled at him to get away.  Even later, I could hear a swooshing sound coming from the hall and I realized that Zach was “sharking” (steam mopping) our floors.  He said that he felt so helpless and needed to do something.

It was all very intense between my water breaking, the contractions, and the after effects of the castor oil and I eventually let Zach in for support.  He called the midwife and they told us to come in to get checked and see how I was progressing.  Zach began to fly around the house packing our things for the birthcenter.  He also made a frantic call to our friend, Alex, who was going to watch Juneau for us while we were gone.  Later she said that she had never heard him sound so out of control.

On the way to the birth center, Zach began calling family to tell them to come up.  Funny story though, just a couple hours earlier, he had actually told them to stay home.  Earlier in the week Natalie, my mom, and his mom had told him that they planned to come up to the cities on Friday and stay until Monday.  They explained that they wouldn’t need to bother us and they would stay in a hotel.  Zach let this little detail slip to me and I completely flipped!  I already felt like the whole world was breathing down my neck to have this baby and now my family would be in the cities the entire weekend!  I felt like a watched pot.  So Zach kindly asked all of them to please wait to come up.  Natalie decided to go ahead with coming to the cities anyway.  My mom and dad decided to go visit my Grandmas in Manchester and then head up afterward.   Only Kim and Dick actually listened to Zach and they decided to go to the movies to get their minds off waiting for the phone to ring.  Just as they were about to leave is when Zach called them and told them to come up right away.  Kim says that she never would have forgiven him if she would have missed the birth.

We arrived at the birth center and I was still having contractions and my water was slowly breaking.  As it was February in Minnesota, it had snowed recently and there were huge mounds of snow in front of thebirth center.  Worst of all people had parked in front of the plowed sidewalk entrances to the building.  Zach was about to yell at someone to move their car when I grabbed his hand and climbed over the pile of snow.  The situation seemed much too urgent for waiting for a car to move.

Once inside the birth center we went upstairs and Jill (the nurse) checked my cervix to see how dilated I was.  She asked if I wanted to know and what would be a “good” number to me.  I told her that on Wednesday, after the catheter had fallen out, I was four centimeters and I would like to still be there our more.  She told me I was looking “great”.  Later I learned that “great” was still four centimeters.  Jill also tested to make sure that the fluid I was leaking was amniotic fluid and it was.

Afterwards Jill told us to go downstairs to one of the birthing suites.  Although a lot had happened, Zach and I had it so ingrained in our minds that labor would take many hours and we would spend many of those hours at home, that we thought that we would probably still be sent back home.  When we got downstairs, I asked, “Are we staying now?” and it was confirmed that we were.  That’s when I allowed myself to finally register that I was in active labor.  For the next few hours, even as the contractions intensified, I was just so grateful that I was in labor and finally having my baby.

At the beginning of labor I was walking around between contractions and then leaning on the counter in the birth suite during contractions, making big hip movements.  Zach began to squeeze my hips during each contraction and although I had him try other types of massage, hip squeezes were the best for me and that’s what he did through each contraction throughout the entire labor.  I often thought, “Ugh, I’m so glad I have a strong husband,” because at one point Natalie tried to do the hip squeezes and she simply couldn’t do them.

DSC_0163

Speaking of Natalie, she came early in my labor and we asked her to begin to photograph the birth.  She was wonderful throughout my labor and, pregnant herself, acted as our doula providing encouragement and fetching things.

After a while I changed positions and labored sitting on a small stool, bracing myself against the bathtub.  Afterwards I moved to the toilet facing backwards. Then Amanda (our midwife) suggested that I might enjoy laboring in the shower.  Amanda helped me in and I sat on a birth stool facing the support bars of the shower.  As I moved to the shower, Zach raced to change into his swimsuit.  There were people in thebirth suite and Amanda was in the bathroom.  Zach started to take off  his pants and Amy (our other midwife) noticed and closed the door.  Zach  said to Amanda, “Amanda, I’m changing now.  I’m like the least modest person on the planet” and Amanda said back, “Don’t worry, I’m not exactly modest either.”

For the next while, I labored in the shower, leaning forward and having Zach press my hips during a contraction, while the water ran on my back.  In between contractions, I would lean back and let the water run over my face, it felt so good, like a reward for a well done contraction.

During each contraction I would try to deeply breathe in and out and stay as relaxed and limp as possible.  Zach would remind me when I would unconsciously tense up parts of my body to stay relaxed and loose.

When I came out of the shower, completely naked, there were two girls about my age in the room who I had never met before.  They were birth assistants, RNs who the midwives bring in for extra medical support.  We had been told that they would be coming to the birth during one of our prenatal appointments, but I completely forgotten about that fact so when I came out I very snottily said, “WHO ARE YOU?”  In the end both of the assistants were wonderful and so helpful.

After the shower, Amanda suggested that maybe I should walk around upstairs in the yoga studio and do some big hip movements to help my labor along.  As we walked upstairs I remember looking out the big uncovered windows at the birth center and thinking, “Well, there we go, I’m in a bathrobe for all of Grand to see!” although I really didn’t care very much by that time.  I had a contraction on the front desk of thebirth center and then walked upstairs, slowly taking the stairs two at a time and doing lunges to help open me up.

In the yoga studio I did hip circles sitting on a yoga ball, then kneeled and leaned over the ball as I did hip circles.  Zach and I also slow danced together while I did big hip movements.  During this time is when my mom and dad came.  My mom came up to the studio and looked like she felt really bad for me, like her heart was ripping apart seeing me in pain.

After awhile, my legs began to get tired and I asked Amanda if it would be okay for me to lie down and labor on the bed for awhile.  As I went back downstairs, I passed my dad, who was fiddling on his phone in the lobby.  I remember I said, “Hi Daddy,” and he said, “Hey, Honey” and I was thinking, “I can’t believe that other people are on their phones right now!”  It was the first reminder that I had that life was going on outside my labor, which seemed crazy.

When I got back into the birth suite, I got into bed and Amanda left Zach and me alone to labor together.  My contractions on the bed were excruciatingly painful.  I think it might have had to do with the fact that I had nothing to brace myself on and was unconsciously tensing up during each contraction.  Zach helped me to get through about five in that position and then I moved back to the toilet and finally back into the shower.

This time though, even the warm water wasn’t enough to relieve the pain.  My contractions were beginning to become unbearable and in between I began to say, “This is so hard,” to Zach many times.  I also began to think in my head that I couldn’t go on any more.  I thought that I could get through a few more contractions like these, but if I would have to continue for hours and hours I simply couldn’t do it.  I longed for a plan of action and even told Amanda, “Amanda, if you could just tell me that I only had to do ten more of these I could get through it”.

Amanda could hear that my contractions were intensifying and beginning to change by the fact that my breathing was harder to control.  She also could hear that I was beginning to push before I even knew that I was.  She and I developed a plan that I would do two more contractions in the shower and then move to the bed to get checked and to ensure that my cervix was fully dilated with no lip.

Now, with this plan, I had a renewed confidence that I could carry on.  We moved to the bed and Amanda checked me.  At this point I was almost dilated although there was a lip on my cervix.  She manually had to push it back (which I really don’t remember as being very painful) because I was so focused on the fact that I had a plan.

After she pushed my cervix back, I got in a pushing position sitting on a birthing stool facing the bed.  Amanda originally suggested that I face away but when I said that I wanted to brace myself on the bed she was fine with it although she had to use a mirror and flashlight to check me in what was a more awkward position for her.  Amy was lying on the bed in front of me (I remember thinking that she looked so comfortable) and she began coaching me through pushing contractions.

Now, no one ever really told me how incredibly different pushing contractions are from the rest of contractions during labor.  I found regular contractions to be painful, like the most intense menstrual cramps you can imagine.  But pushing contractions, I barely even remember what they felt like because I was doing such intense work during each one.

At the beginning of each contraction I would tell Amy that I thought one was coming (they were actually harder for me to identify than regular contractions) and then I would take a big breath and bear down through the contraction as long as I possibly could.  I would breathe in and repeat and then do it again as the contraction faded away.

It felt like the most intense exercise of my life and there was so much pressure on my bottom that it was shaking, but I really enjoyed it.  Instead of just breathing through pain I was an active participant with a task and everyone was so encouraging.  By this time Kim was also in the room and in front of me were four mothers who had birthed a total of 13 children and they were encouraging me and cheering me on through each contraction.  They would all say, “Good job, Hannah!  Great pushing!  You are an awesome pusher!” which felt so good to hear.  In between contractions, I would say, “Thank you, thank you,” which everyone thought was kind of funny.

I also felt extremely loving at this point and kept telling Zach (who was still behind me, squeezing my hips) how much I loved him over and over.  I almost even told Amy that I loved her and then realized that was a little weird and held it in.

After pushing on the stool for awhile, I was making good progress.  I asked Amanda if she could see the head and although I wasn’t that far, I could reach up and feel his head inside me (it was squishy).  Amanda suggested that I could move to the tub and although I was fine on the stool, I took her suggestion.  Everyone helped me move and position myself in a way that I was wedged perpendicularly in the tub, pressing my feet and back against the sides.  As I got in I saw that Zach still had his shirt on and immediately told him to take it off as I thought he looked so weird.

I pushed Merritt out in the tub.  With each contraction I could feel my vagina opening more and more.  It burned a little around the edges but instead of experiencing a lot of pain, I mostly just couldn’t believe how weird the feeling was.  I kept saying, “This is craziness!” because it absolutely was.

During this time everyone was gathered around the tub, watching.  I talked to Amanda and asked her to please help me to slow down when he was crowning because I wanted to make sure that I didn’t push too hard and hurt myself.  She did just that and while Merritt was crowning she had me make “puh puh” noises like The Little Engine that Could to slow down my pushing.  Eventually Merritt’s head came out and then his body came out in a large gurgle afterwards.  It was the most insane feeling I’ve ever experienced!

DSC_0484

He was placed right on my chest.  It was 10:55pm. Zach and I cried and smiled.  I opened his legs and announced that he was a boy to everyone.  Then I double checked just to make sure.  I always deep down felt that he was a boy and I told everyone that.  Zach felt a little deceived because I had even kept that from him, I was worried that if Merritt was a girl, she would have a complex because her mom always thought she was a boy.

After announcing that he was a boy, I remember that everyone was talking a lot and I almost had to yell to tell them his name and explain why we picked it.  Then we hung out with Merritt for awhile longer and eventually Zach cut his cord.

I stepped out and delivered the placenta without even pushing, which was wonderful because at that point I just wanted to be done with the whole birth part and snuggle Merritt.  We hung out in bed for awhile and Merritt latched on right away.  In the next couple of hours the Grandpas visited, I got stitches (not fun) and ate a Jimmy John’s #9.  Then Natalie left to get some much needed sleep and so did my parents.  Kim stayed with us and we made the journey home.  Zach drove so slowly to not hurt me on the bumpy, snowy roads but it didn’t matter because no one was out at that time of night.  I remember looking at the clock at 3:30am as I snuggled in bed.  Merritt was in his cradle next to me and I reached over and touched him.  I couldn’t believe that he was ours and what I had just done.  I was so grateful to God.

DSC_0317

Fatigue in Pregnancy

It’s remarkable to many women just how tired they can feel in pregnancy, especially in the first and last trimesters.  While the amount of sleep your body demands may be shocking, its important to remember all the hard work and energy your body is devoting to creating a healthy baby. By the end of the first trimester, your body has helped your baby develop all of his or her body parts—an amazing accomplishment!  Your body is also undergoing tremendous transformations (e.g. significant hormonal changes, remarkably increased blood flow and volume) and your psyche is adjusting to this monumental change in your life.  With good reason, the first trimester is when many women feel the most tired.

As pregnancy proceeds, your body is working hard to support and nourish your growing baby, making the later months of pregnancy tiring as well.  Some women feel they have more energy in the second trimester.

While fatigue is your body’s normal and useful message that you need more sleep to accomplish all of this incredible work, it can be hard to cope with this sometimes overwhelming need for rest in pregnancy, especially if you are working or have other children.  Though you may not be able to eliminate your fatigue, there are many ways you can cope and support your body at this time.

AT BEDTIME:

  • Get lots of sleep (at least 8 to 10 hours) with as many of those hours before midnight as possible, as this is when your body recuperates.
  • Take naps if possible.  It’s common for women to take hour-long (or longer!) naps daily during pregnancy.
  • Support your tummy, lower back and legs with pillows (or one pregnancy pillow) during rest, especially in your last trimester.
  • Sleep in a well-ventilated room, as oxygen replenishes your cells while you rest.

IN THE KITCHEN:

  • Eat small meals regularly (every 2-3 hours) to maintain balanced glycogen and insulin, the two hormones that regulate your blood sugar levels.  Carry nuts or fruit with you on the go.  Too much sugar in the diet can contribute to fatigue.  Ensure you are getting enough protein and complex carbohydrates.
  • Stay hydrated: Drink 2-3 liters of water a day to promote healthy digestion.  Constipation can contribute to fatigue.
  • Avoid coffee, while it can temporarily boost your energy, it also causes a crash that can actually increase your fatigue.
  • Alternative energy boosters include: Peppermint tea (as long as it doesn’t aggravate heart burn), Spirulina or kelp supplements, Nettle tea

DURING LEISURE TIME:

  • Yoga and meditation are regarded as energy-enhancing practices.
  • Take a bath with two drops each of lavender, neroli, and mandarin essential oils.  Other great essential oils for fatigue include peppermint, lemon, orange, sandalwood and rosemary (AVOID essential oils, however, in the first trimester)
  • A brisk walk in fresh air, when possible, can increase oxygen intake, improve circulation, appetite and bowel function, and decrease fatigue.
  • Massage can be invigorating and relaxing.

Speak with your midwives about your fatigue.  You may want to be checked for anemia, which is common in pregnancy and can certainly cause fatigue.

Be kind to yourself, prioritize your activities (maybe reducing your responsibilities if possible), and don’t be afraid to ask for help.  You are doing important and difficult (and ultimately rewarding!) work right now.

Please speak with us if you have any additional questions or concerns about fatigue in pregnancy.

Rest well, mamas!

Birth Story: "the single most amazing experience of my life"

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The birth of baby Norah

By Rebecca Barth

Everyone always says that you’ll know a contraction when you have one, but for the first hour or so I wasn’t sure that I was in labor.  I told my partner, Dylan, to start timing the squeezes to see if there was a pattern.  Sure enough, each squeeze lasted about 40 seconds and they were coming about four or five minutes apart.  Labor!

We called the midwife to let her know what was happening.  She encouraged us to labor at home for as long as possible.  “Call me back in a few hours,” she said.  I took a warm bath and tried to nibble on snacks and drink water.  The contractions were getting more persistent and requiring more focus.  I rolled on an exercise ball for a while, listened to Abbey Road on vinyl, but the thing that helped the most was to hold on to the back of one of our dining room chairs while swaying my hips and gently stepping my feet.  I let my whole spine undulate during contractions while trying to relax as much as possible.

By midnight I was sure that labor had progressed enough to go to the birth center.  The midwife asked to talk to me during a contraction, which was not easy but I could do it.  She confidently said that I was not ready to come in yet and that I should try to labor at home a little longer.  However, I was getting concerned that if we waited too much longer the 20 minute car ride to the birth center would be extremely uncomfortable.  She encouraged me to take another warm bath and meet her at the center in two hours.

Although I had been anxious about the car ride, my contractions actually slowed way down on the drive over.  By the time I waddled into the birthing suit in my jammies and slippers, my contractions were much more manageable than they had been at home. Even so, I was confident that I was at least four or five centimeters dilated.  I had heard so many women say that they too were confident about their progress only to find that they had not dilated at all, but I was certain I was not one of them.

The midwife asked how dilated I had been that afternoon.  “About two,” I replied, “How far am I now?”  The midwife maintained a cool composure and said, “You’re making nice progress and you have some work left ahead of you.”  I laughed, “No really, how far am I?”  She just reiterated that I was doing great and that I should keep up the good work.  I was able to translate her evasive language myself: I was pretty much exactly where I was that afternoon.

My lack of dilation aside I was really proud of myself.  I felt like I was handling my contractions beautifully; I was able to turn inward, tune out the rest of the world, and focus on relaxing and staying open and calm.  I swayed, rocked, and gyrated around the dim room.  I quickly shed all of my clothing and hopped into the glorious tub.  I kneeled in the tub for quite a while as my doula supported me through contractions.  (Dylan had ducked out for a quick nap, knowing that we still had a long night ahead of us.)

Although the contractions were getting intense, I remember being able to quietly talk with my doula during the breaks.  I had known ahead of time that I didn’t want a lot of talking or noise during labor, but in this warm, cozy room with just the two of us, our soft whispers were so comforting.

My midwife came and checked on me periodically.  I was laboring fine and Baby was doing well.  Thus far in labor I had almost exclusively been upright, either standing or kneeling.  Lying down, even being on my hands and knees or draped over something, was not comfortable.

The midwife got concerned that with so many hours of being on my feet I was going to get tired.  She asked me if I felt I could lie down to try and get some rest.  Rest?  Was she kidding?  I humored her and gave it a try, but just as the first contraction set in I jumped up and started my swaying dance.  No way was that going to work.

The contractions got stronger and I became more introspective.  The talking in between contractions stopped.  The nurse and my doula encouraged me to try and eat something.  Food sounded revolting, but I remembered from our birthing class that eating and drinking during labor were important.  I forced myself to swallow a bite of applesauce, and somewhat defiantly shoved the spoon back into the bowl as if to say, “There, I ate.  Are you happy?  Now stop bothering me.”  I remember the nurse chuckling and saying that one bite wasn’t going to cut it.  I think I later stomached a fruit popsicle which seemed to satisfy the masses.

Some time later the midwife was back and strongly suggested that I try to get off my feet for a bit.  I understood why she wanted me to rest--I needed to have enough energy to keep laboring at the birth center and to be able to push later--but I really didn’t think I could do it.  However, I remembered hearing about women who eventually needed to be transferred to a hospital for an epidural and a break because they were exhausted.  The one place I didn’t want to end up was the hospital, so off to the bed I waddled.

The second my contractions started in that bed I started to cry.  I squeezed my eyes tight and started to fight each contraction.  For the first time in my labor I started saying “Ow,” and “I can’t do this.”  I silently cursed at the midwife for making me lay down.  I felt lost.  Then, my wonderful nurse took both of my hands and ordered me to open my eyes.  She looked straight at me and said, in a calm but firm voice, “This is your birth.  You get to decide how you do this.”  I remember feeing like the words could mean anything, but her look said everything.  She was helping me find my way back.  She was telling me to work with my body, not fight against it.  I sniffled, nodded my head, and took a deep breath.

The next contraction came, and I let it.  I breathed, and I let it happen.  And then, I kid you not, I fell asleep.  My contractions slowed down and I remember waking up in a dream-like state for each of them.  I would make sounds, move, or even sit up during a contraction, and then I’d drift back off to sleep.  My partner told me later that he and the doula marveled in disbelief at the sleeping woman in labor.

After I had rested for a time I felt ready to continue laboring.  My contractions were strong and increasingly intense.  The midwife checked my progress again, but she still wouldn’t tell me how much I was dilated.  Seriously?!  I was sure that meant that I hadn’t made much progress and that the midwife felt it would be discouraging to hear how little change had occurred.  She tried to focus on the positive changes (my cervix was thinning, Baby was doing fine), but I “still had some hard work ahead.”

I tried to rally.  I gathered my strength and went on laboring.  By now my contractions were becoming relentless.  There was little and sometimes no break in between contractions.  I stood under the hot spray of water in the shower for what seemed like eternity.  I gripped the support bars with all of my might while I swayed back and forth under the water.

Talking was long gone.  I didn’t talk and everyone around me knew not to talk either.  I started making small, sometimes completely unrecognizable hand gestures to communicate.  I mimicked drinking from a cup when I was thirsty, I shook my head almost imperceptibly when someone asked me a question, and I held up one finger when I wanted people to wait while I was having a contraction.  If someone reached out to touch me during a contraction, up went my finger.  It said, “back off, I’m busy.”  If someone tried to take my vitals and I felt a contraction coming on there was the finger again saying, “hold on a second, don’t touch me.”  My partner and doula deserve so much credit for being able to give me what I needed during this phase.  I wasn’t speaking or letting anyone touch me and yet I still felt completely supported and cared for.

As the contractions got even more intense I found myself dismayed by how relentless the process was becoming.  I couldn’t call for a time out and my body didn’t listen when I wanted a break. I felt like I was a servant to the process.  I kept talking to myself, reminding myself to stay open, visualizing how the contractions squeezed from the top while pulling the cervix open at the bottom, but I started to surrender to the knowledge of my body.  I took solace in knowing that I didn’t actually have to do anything; my body was doing it for me.  I could help or I could hinder, but this baby was coming.

We learned many comfort measures in our birth class, but as I felt my body changing during labor I instinctually found my own comforting rituals.  For a while I had the urge to push against something with my head.  Somehow pushing with the top of my spine helped me free up the bottom of my spine and I was able to sink into more relaxation.  Dylan’s chest was the lucky recipient of my pushing head.  At the start of the contraction I would find Dylan, grab him by the arms and pull him toward me.  I would push him up against a wall and then sink my head into his chest and twist it back and forth as my lower body swayed and swung.

I also started to do more sounding in this phase of labor.  I had the urge to make a lot of “mmm” sounds, but I remembered our birthing instructors words: “open mouth, open sphincter.” I tried my hardest to turn every “mmm” into a “mmmaaah.”  I also started talking to the baby.  During particularly hard contractions I would mumble, “it’s okay, it’s okay...” over and over.  My partner and doula knew I was talking to the baby, but at one point the midwife came in and seemed to be concerned.  “It is okay,” she affirmed.  I wanted to tell her “no, I know that I’m fine, I just want the baby to know he or she is fine.”  This felt like my first real motherly act: the baby was going through this stressful and arduous process with me and I felt responsible to help the baby stay calm and to reassure him or her that everything was going to be okay.  And somehow, putting the needs of the baby before my own made the contractions more bearable.

The hours kept passing and the contractions got overwhelming.  At one point I said, “I don’t know if I can do this any more.”  Even as I said the words I knew they weren’t true.  I knew I could keep going, I just needed some reassurance that everything I was doing--all the movements, moans, and grunts--were normal and okay.  Later I learned that when my doula went to get the midwife and told her what I had said, the midwife simply nodded, stood up, and calmly walked into the birthing suite.  This was just a phase that most women went through.  She crept into the bathroom where I was laboring and said just enough calm, reaffirming words to help me continue.  I was fine; this was what labor was supposed to be like.  It was so much harder than I thought anything could be, but it was normal and that knowledge was comforting.

As my contractions got even stronger and the baby got even lower, I decided to try sitting on the toilet.  I had read that many women found that to be a comfortable place to labor and I was going to take any iota of comfort I could find.  Now, I didn’t just sit on the toilet, I laid on the toilet.  I went as horizontal as one could get while still sitting on a toilet.  My head rested on the wall behind me and my feet were out in front of me as far as they could stretch.  During each contraction I grabbed Dylan’s hand and pulled back as hard as I could having him counter my weight.  (He told me later that his thumb had turned purple but good man that he is, he didn’t complain once.)  The toilet became my labor station for some time.  If there was a contraction, I needed to be on that toilet and in my pulling-on-Dylan position.  At one point in the early morning the midwife suggested that she check me once again.  I tried to get up and walk to the bed but as the next contraction started I literally ran back to the bathroom to have the contraction on the toilet.  It was the fastest I had moved in months.

I tried again to make it to the bed so that the midwife could check on my progress.  I made it just outside the bathroom door before another contraction hit.  I remember grabbing Dylan and pressing my weight into his body while thinking “if there were drugs here, I would take them.”  But then I thought, “If I really want drugs, I’m going to have to put clothes on and get into a car.  No way in hell I’m getting into a car.  I’ll be fine.”  That was the only moment that drugs crossed my mind and I am forever grateful that they weren’t available and that no one offered me any.  I understand why people take them, but I was really committed to a natural birth and I am so thankful to have been a facility that encouraged and supported that choice.

During the most intense hour of labor I remembered another bit of wisdom from our birth educator: “When you feel like you can’t do it anymore, it’s probably the transition phase, and you’re probably almost done.” I told myself that as I got back into bed to get checked a third time.  While I had no sense of time, I could see the sun streaming in through the window.  I smelled coffee brewing.  I had labored through an entire night.  I felt a little surge of power.  I had made it at least twelve hours.  Then my midwife looked down and smiled at me, “Now I’ll tell you your progress: you’re at nine centimeters.”  Nine!  I really was almost done.  That little surge of power turned into a wave, a tsunami of confidence.

I went back to the toilet for the final lap of labor.  I started to feel unbelievable pressure getting lower and lower.  With each contraction I felt more and more like I was sitting on a bowling ball.  I just couldn’t believe that I could labor much more without this kid falling out.  I muttered “I think I might be ready to push.”  The midwives had a shift change in the morning, so the new midwife who had taken over filled the birthing tub.  My doula, my partner, the nurse, and I made a small processional to the tub.  I realized this was really happening.  My dream of having a baby was about to come true.

Suddenly the once quiet, almost empty room was all abuzz.  It was still incredibly calm, but it had a sense of aliveness.  My mother came in and sat quietly in the corner.  The nurses prepared instruments and post-birth equipment.  Dylan slipped away quickly to put on his swim trunks in case I wanted his support in the tub with me.   The midwife helped me into the tub and to get comfortable.  Everyone was in their places ready for the show to begin.

I wasn’t sure that I truly had the urge to push but once the midwife gave me the okay I gave a little test push during my next contraction.  With that little test push my body surged into a strong push.  It was a lot like throwing up in reverse: the second you start to push it just takes over your whole body and you can’t help but push.  I gave a few strong pushes and the midwife told me to reach down to see if I could feel anything. When I did I was astonished to have felt a tiny, quarter-sized bit of soft, squishy, wrinkled baby head.  I remember exhaling, looking up, feeling the sun shine on my face, and smiling.

I gave a few more strong pushes before I felt the baby’s head in the birth canal.  I remembered that once the baby had crowned I should stop pushing to avoid tearing.  As I felt the fullness of my baby’s head, I willed myself to stop pushing.  It felt a little like stopping a race car on a dime--nearly impossible--but I slowed the baby’s progress to a screeching halt.  My position in the tub didn’t allow the midwife to have the best view, so I don’t think she saw quite how far the baby’s head had come.  She told me again to reach down and touch the head.  “I don’t need to,” I gasped, “I feel it.”  In a flash her hands were down under me, supporting me as I gave another push.  I felt the head slide out and then in a wave, the rest of the baby slid out into the water.  Dylan scooped up our baby and handed her to me.  I was so surprised that she was out so quickly!  Wasn’t I supposed to push more?  I thought the baby’s head would come out and then I would have to give several more pushes to deliver the rest of the baby.  All I could muster for intelligent conversation was, “We had a baby!”

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Norah was born at 10:30 in the morning, weighing six pounds, ten ounces, and measuring 18 1/2 inches long.

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After Norah got some vigorous rubs and puffs of air, she started to pink up.  We got out of the tub and delivered the placenta.  Once the cord had stopped pulsing, Dylan clipped the cord.  Our family of three made it to the bed to cuddle.  We tried nursing, but Baby wasn’t super interested yet.  I was so in awe of this beautiful baby that I was completely unaware of the nurse and midwife monitoring Norah closely.

IMG_1297Not long after we got snuggled into bed the midwife told us that Norah wasn’t breathing well enough on her own.  If she didn’t get the hang of it soon, she’d have to go to the hospital.  While I was worried and disappointed at the idea, I remember feeling like “we made it through all of the labor and delivery.  If this is what we need to do, it’s what we need to do.”  The happy post-birth hormones were wonderful.

 Norah did end up being transferred to the hospital.  My partner went with her and spent several hours in the NICU holding her and telling her all about the family she had just joined.  I stayed at the birth center to get cleaned up and to rest.  My pulse rate was really high for hours after the birth so I too was transferred to the hospital.  I had great nurses at the hospital who let me sleep in the baby’s room in the NICU.  One nurse even came to me in the middle of the night to take my vitals so that I wouldn’t have to leave Norah.  I spent the night nursing and cuddling my new, perfect little baby.

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Although I was sad about being transferred to the hospital and especially about missing those several hours with Norah after birth, I’m glad that our midwife did what was best for us.  Neither of us needed any medical intervention aside from monitoring, and we were sent home the next day.  I am forever grateful that we were able to birth the baby at the birth center and not in a hospital, but I am also thankful that we were taken to the hospital when we needed it.  It will always be a somewhat bittersweet ending to our birth story, but luckily it is just the start of our lifetime with Baby Norah.

I am so grateful for the amazing and empowering birth experience we had.  Sometimes when I’m sitting and nursing Norah I start to daydream about her birth, about pushing her out, and about seeing her for the first time.  It is the single most amazing experience of my life so far.  The fact that I birthed a baby makes me feel fierce.  It makes me feel like I can be a good parent, because if I am strong enough to birth a baby, I am strong enough to face anything that life sends my way.

Interview with Lindsey Deeb, Pediatric Nurse-Practitioner

Recently, we had the good fortune of catching up with Lindsey Deeb—our fabulous pediatric care provider—to chat with her about her practice, her style of care, and her recommendations for expectant and new families.  Lindsey is accepting new clients at Health Foundations, where she practices every Thursday.  She practices out of her clinic in Inver Grove the rest of the week. LINDSEYName: Lindsey Deeb, nurse-practitioner and owner of Dakota Pediatrics 

Hometown: Sioux City, Iowa, where her parents, brother, and his three kids still live. Lindsey’s family makes the 4 to 5 hour drive to see them almost monthly.

Family: Husband, Bobby, and two kids: Andrew (3) and Kathryn (18 months).

Education/Background:

  • Studied child psychology at University of Wisconsin-Madison and worked in inpatient child psychology for a few years before going into nursing.
  • Studied nursing at Saint Catherine’s in Saint Paul. Worked in pediatrics at the University of Minnesota for a couple years.
  • Moved to San Francisco to complete advanced practitioner studies at the University of California, San Francisco.  Spent four years in San Francisco, where she married her husband and had her son, Andrew.

Current Home Turf:  Lives in Minneapolis and is building a house on the Eagan/Inver Grove border, which will bring her closer to the clinic.  She’s excited to run or bike to work!

Can you tell us a bit more about Dakota Pediatrics?

We are a small private pediatric practice located in Inver Grove (and I see patients at Health Foundations as well).  The practice was founded by my mother-in-law and we had always planned on working together.  Unfortunately, she died suddenly of cancer, so now I own and operate the clinic with my husband, just like his parents did 30+ years ago.

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Vivian Rider is our pediatrician; she’s been practicing in the area for over 25 years. For a long time, she practiced at a small clinic that was engulfed by a large corporate clinic system.  Once the clinic transitioned to new protocols, she was seeing about 30 patients a day and would often get in her car at the end of the day and just want to cry—it was just a horrible way to practice medicine.   But now, she loves practicing in our atmosphere here and believes that she is practicing medicine the way it should be done.

We have three medical assistants, Leann, Kao Song, & Chrissy, who are all trained in pediatric primary care and triage.  They can handle the most common issues, and if they have questions about something they haven't seen before, they always come to us for guidance.  And we have an in-house billing and referral specialist, Deb, who has been with Dakota Peds for over 20 years.  Jenny is our receptionist, but also handles some billing and administrative duties. Bobby’s aunt Linda, who is also an LPN, is our special projects coordinator.  And Bobby helps me with almost everything else that goes on "behind the scenes" or outside of the patient room in our case…so he’s like a jack of all trades and, like myself, is always available to any family if they have an issue or concern.

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Though we are small, we have a robust electronic medical record (EMR) that helps us provide better care and more services to our families.  Compared to a practice that still uses paper charts (many of them that still do!), our EMR helps take care of the busy "paperwork" more efficiently, so we have more time to devote our families.  Our EMR also gives each patient an online portal account where they can see their medical records and shot records, schedule appointments, see lab results, etc.

We have two patient care coordinators (social workers) who come in once a week—they can get families lined up with services that they may need or help navigate complex cases involving multiple care providers, such as situations of chronic illness, where families are maybe feeling overwhelmed and need some extra help.

We operate an on-site lab that performs the most common tests, such as blood draws, urinalysis, urine cultures, rapid strep screens, etc. right in the clinic.  Any complex test that we can't handle in-clinic is sent to an outside lab (almost every clinic does this) and our courier comes twice a day so we can get urgent tests back very quickly.  We receive all our lab results electronically, so we get them very fast and the results are automatically posted to the patient's online portal account and an email notice is sent the family, so it's a pretty convenient feature of our EMR.

I anticipate that we may bring on another provider possibly within the year. I am not sure who that person will be yet, we’ve talked about family practice and sort of expanding that way a little bit.  So we’ll have to see.

How did you get connected to Health Foundations?

I approached Amy not too long after I moved back from California—I was trying to get to know other people in the area. Also, as a pediatric nurse-practitioner, and just personally, I really believe in natural birth (I had my kids naturally with a midwife) and I really believe in the midwifery model of care.

So I knew of the Birth Center, and I approached Amy, just to meet her. We seemed to hit it off from our first meeting.  And I think it was during that meeting that she brought up possibly working together—so things just slowly evolved from that point on.

I actually just saw the baby I did my first home visit with—he just turned one.   I’ve been doing home visits for a year and I have been at Health Foundations since February 2013—and I am really enjoying it.

How has your experience working at Health Foundations been so far?

It’s been really great.  Obviously, the entire team here is really warm and welcoming.  I like the atmosphere, its nice to be here and see people who really appreciate the Center for what it is.  My appointment times are a little longer here so I feel like I really get a good amount of time to see people.

The thing that I enjoy the most is home visits, which are done 6 to 10 days postpartum. It’s so nice to see people in their home environment—I get to know my patient families on a little bit different level and its nice to be able to sit and chat and not feel like you are in a clinic setting.  Even though I feel like our clinic is very inviting, it is still really nice to be at home with your newborn and not have to leave.

Also I think that home visits fit really well into how Health Foundations does their postpartum home visits—someone comes to you at 24 hours, at three days, and then I come a few days later, then [the family] is back at Health Foundations at 2 weeks—so its good continuity of care that way.

How about going forward at Health Foundations?

Well, long term, I would love to have another location here in St. Paul and I can see that happening if things keep moving in the right direction.  I don't have any real specifics on when or how that might work, but I've really enjoyed working with Amy and the Health Foundations staff. So, I would hope that if we expanded further in Saint Paul, we would continue or strengthen our working relationship with Health Foundations. 

What do you love most about working with kids and families?

LINDSEYBABYI have always wanted to do primary care.  I’ve worked in several different hospital settings and I’ve always worked with kids.  I realized at some point, while I like working with people in the hospital, I really wanted to see kids grow over time and get to know parents and families.  Being in a small practice, that’s something we can really do, and I think it’s really hard to come by these days. That is, building a relationship with your provider and feeling like you are not a number when you come in.

I really like the preventative care part of my job.  Growing up, my mom was always very prevention minded—she always talked about being healthy and active—how taking care of yourself now pays dividends in the end. We had a big edible garden, we composted and canned so we had healthy food to eat all winter. Being healthy and taking care of myself and my family is a big part of who I am.  For me to able to share that with the families I serve is probably one of the things I like the most.  Especially today, because everyone is so busy and there is less time.  I strive to provide people with efficient ways to be healthy—easy things you can do here and there.

How does being a mom shape your practice?

Oh, huge, it’s huge. My work before kids and after kids looks completely different.  It actually caught me off guard.  Before I had my son I never realized that I would lose all objectivity in caring for my own children.  After kids, my empathy level went up even higher than before—I worked in pediatric hematology and oncology before I had kids and I don’t think I could do it again.

I am a worrier by nature—I would say that I worry about my patients a lot.  And I think that makes me a better provider, but it’s increased since I had my own kids because, now more than ever, I feel how important of a job it is to take care of other people’s kids.  I feel honored to take care of other people’s kids.  And, as a parent, I hope that anyone taking care of my kids really takes it seriously, because it’s a big deal.

I think having kids has ultimately made me a better provider.  I can definitely relate to everything people are going through—being up in the night, worrying about your child for this or that, yeah, all the experiences of having young kids.

How would you describe your style of care?

I really believe that the entire family is my patient.  Trust is a big component, too.  I hope people find me to be a really down-to-earth, approachable, trustworthy person.  I am really into relationship building.  And I want people to know that if I recommend something, its really coming from a good place and something I feel is important. I want people to feel included in decision making whenever possible.  It drives me crazy when people come in and they say they’ve been to someone else who was “scolding” them about something—that’s a word that people use a lot—or giving them a hard time or judging them.  I just think that no matter what the topic, doing that is so unhelpful.  I might not always agree with everything my families do but I certainly respect their decisions and I want there to be open discussion around everything.  I never want anyone who comes to me to feel judged.

In addition to that personal level of care we talked about, what are some of the benefits of a small practice setting?

Calling someone like us versus calling a larger corporate clinic to make an appointment, you are going to have a very different experience.  With us, you will probably get someone that you have talked to before, you’re going to be able to make the appointment then, and you are probably going to be able to get in when you want to get in.  If it’s important, we will fit you in or we will stay late and that is not something you’re always going to get at a bigger clinic.

And the other big thing is that if you want to get a hold of us, you can.  Vivian or I are always on call at night, and during the day our staff is great but if you want to talk to one of us just say so when you call.  There is not a run around, you are not going to get bounced all over the place to get your needs met.  For billing or insurance issues, any of my staff members can handle most issues, otherwise Bobby handles him.  And I've seen him email families with an answer at 11 pm or on the weekends, so it’s much simpler here.  We’re a small staff that takes care of you as best as we can.

I really hope that we convey a family atmosphere, that people feel welcome and comfortable when they come to us.  I know Dr. Rider feels the same.  And I think our practice is unique because we have a doctor and a nurse practitioner—we come at health care from a couple of different models and I think it leads to a more holistic way of caring for people.  She and I talk about patients together all the time and make sure we both feel like we are doing the right things.  We’ve built a solid network of good specialists and colleagues we can call on when we need to as well.

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One final benefit is that we charge about 20-40% less than a larger corporate group for the same service or test.  That's something not everyone realizes.  Who wouldn't want more personalized service while saving money at the same time?

What do you love to do when you are not taking care of patients? 

I’ve always been a really active person—I swam competitively, through college at Madison.  Then I started running after that and I’ve completed several marathons and a few triathlons.

lindseykidsI love spending time with my kids, especially outside.  This summer, we’ve been going to lots of parks, going on walks around the neighborhood, and playing with neighbors. We also hang out with Bobby’s sister and family, their kids are 5 and 3, so they are close in age to ours.

I love to knit, although I haven’t been doing it lately.  And I love to read—I still read lots of medical literature, but I have enjoyed a couple of novels lately. I really, really like to cook.  My favorite dish is a squash risotto with rosemary and its really good.  And though I like it, we are challenging ourselves to go light on meat these days.

 As far as travel, my parents have a log home in the Black Hills in the middle of nowhere, so we try to get out there a couple times a year.  I also try to get to Ontario, Canada’s Lac Seul to go fishing every year.

How do you feel about seeing pregnant women/couples before baby arrives?

I really love it when people come in before they have the baby—I always love that visit.  It allows me to see them before and get a feel for them, and we can see if we’re a good match, which I think is really important.  It’s good to know that ahead of time.

What do you recommend that families look for in a pediatrician?

There are many things you should ask.  If you are going to meet ahead of time, its good to really think about it and even write down the questions that you have.  I do think it’s better when people are a little prepared before they come in.

I can always speak to the things that most people ask me about, but that is not necessarily what everybody is wondering about. Everyone has some topics that are really important to them, for some people it is immunizations for others it’s antibiotic use.  So, directly ask about those things.  I think its okay to ask some personal questions too to get a feel for that person.  Ask if they have kids.

I think you should ask how long visits are and how easy it is to get in. Ask about how easy it is to get a hold of someone off hours.  Because those are the things that, once you have the baby, make you feel better—to know if you can get a hold of somebody,  to know that someone is going to have the time to answer your questions.  And its good to ask about experience and education as well.

What are your thoughts on well child visits? 

SONY DSCSome people ask “Are well child visits really that important?” I do think they are important for a few reasons.  Some people are worried that they may get hounded about immunizations during these visits or that immunizations would be the only reason to go to a well child visit.  And really, it’s more about questions and talking through things.

And growth is really important to monitor, in the first two years especially,—to make sure the head is growing appropriately, that baby is gaining weight fine, etc.  And well child visits can offer a lot of guidance—for example in terms of nutrition, making sure breastfeeding or bottlefeeding is going well.  Well child visits are an opportunity to do a full exam and to just to look over everything.   You might feel pretty bad, as a parent, if you knew you could have caught something sooner, but you didn’t go in.

Plus, since preventative care is completely covered by insurance in MN, you've already paid for your physical through your monthly insurance premium.  So if you don't come in for the physicals, you've basically given the insurance company $120-$200 per physical and got nothing in return.  That's a lot of money to give away.

I always tell people too, I am happy to sit and talk with parents but if someone wants to make it quick, that’s fine too!  I’m into meeting people where they are at.

Do you have any advice for pregnant or new mamas?

I jokingly tell people, do everything you really like to do by yourself now.  But I think it’s really important and something you don’t always “get” until afterwards. And do things together, because that changes.  That change is good, but it’s different and things are never exactly the same again. And I always say, too, make sure you get a lot of rest in pregnancy.

Nothing in the world will prepare you for that feeling you have when you see your baby for the first time—it’s just amazing.  So take it in, just really take it in.  And when you get really tired and sleep deprived—which I think is really hard for a lot of people—you can remember that moment. (And remember you won’t always feel so sleep deprived!)

And as far as breastfeeding, you need be easy on yourself because it’s a new thing to you, it’s a new thing to baby and you have to figure each other out.  That takes a little bit of time and it’s different for everyone.

For new parents, take lots of pictures and really take it in, because it does go really fast.  And I always tell my patients, don’t hesitate to call—no question is a silly question.  That’s what I am there for, I don’t mind the calls and it’s much better than sitting there and worrying about something.  There’s no point in that.  If you can call, we can talk and you can feel better—it’s well worth it.

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Birth Story: "The Definition Of Perfection"

The birth of baby Revira

By Emily Grace Whebbe

In recounting our birth story, I finally fully understand the definition of a word I have used so many times: perfection.

Although I write this after a generous dose of oxytocin from breastfeeding, I will try not to embellish beyond belief. Perfection is a word and concept I rarely use or believed in, unsure of it's even existence. However, after going through the experience of childbirth and now being able to be a part of this incredible baby's life, I realize that what happened more than a week ago was as close to perfection as I could experience. Let's start at 3:00 a.m., Thursday, August 4th.

Baby Revira was born on August 4th, at 7 pounds, 2 ounces, to proud parents Emily Grace Whebbe and Kai Curry.

Kai had been working late for the last few weeks, trying to get a project done before the baby arrived, and came to bed around 2:00 a.m. I had been sleeping for only a few hours when I woke up for my 3:00 a.m. bathroom trip and noticed that some fluid was dripping out of me...a lot of it. I hurried to the bathroom convinced I was finally having the incontinence issue during pregnancy that I hadn't yet had. I was wrong.

"Um, Kai? I think my water just broke," I said calmly from the toilet. I was more amazed than scared, as if the entire pregnancy I wasn't fully convinced that it would conclude with actual labor. It felt like a science experiment had begun, as if I could say "Hey, Kai, the water is boiling" in a similar fashion.

Kai got out of bed and stopped at the fridge for a glass of water on the way to the bathroom. He sat down on the floor next to me and casually drank the water. "Are you ready?" I asked him. "Maybe you should just go back to bed," he said. I called Cheryl first, one of the midwives at the birth center. She gave me the same advice to go back to bed, monitor any contractions, eat something, take a shower, whatever I needed to do to prepare, but mostly just get some rest. She sounded excited and calming, having a tone of reassurance I had gotten used to throughout the pregnancy. So, I went back to bed.

Contractions started within 10 minutes of hanging up the phone. They were 10 minutes apart, lasting 1 minute. I laid there quietly and let Kai get some sleep. The contractions weren't that painful and I was excited that they were so timely and steady. I knew I'd have a baby in my arms within 24 hours.

By 6 a.m. I felt the urge to get out of bed and start preparing. I ate, took a shower, put in a load of laundry, and packed some last minute things. I politely told Kai, "If you have anything you want to do before we go, now is the time." He answered from bed "15 more minutes." I laughed, but knew he was tired and going into labor with little sleep wasn't going to be a good idea. We laid in bed a minute and my contractions slowed down. It felt so nice to be relaxed, in labor, and in his arms. But then, another contraction hit that was so intense I ran to the bathroom to throw up. Kai took this as a cue to get up as things were getting serious, and we started our birth journey, first by going to my mom's house to drop off our dog. I figured I'd labor there a little bit and get to the birth center around 10 a.m. if things were staying steady. After all, I had a prenatal appointment already scheduled then.

By the time we got to mom's, the contractions were pretty strong. Mom seemed nervously excited. Every 5 minutes or so I'd simply get down on all fours and do some breathing into the rug of choice and then get up and promptly go to the bathroom. I thought to myself, "This isn't so bad, I can just fall to the floor for the next few hours, no problem." However, I soon realized that things were becoming even more intense and I'd soon not be able to make the car ride to the birth center, so we were off. Being in a car during a contraction was the worst, but at least we were only a few minutes away.

We arrived at the birth center at 9:30 a.m. I walked straight into the birthing suite and got on the bed to have a contraction on all fours. Midwife Amy and her apprentice, Sky, were there to greet me. I was excited to show them my progress. I said something to the effect of, "So that's that," after the contraction ended. They smiled and started preparing quietly in the background as I labored. Sky brought me some "Emergen-C" to drink and nurse, Jill, made me some oatmeal. I'd have a contraction and then shove my face with food and drink before another one started.

Emily labors in the bathroom of the birthing center with her partner Kai, before the birth of their daughter, Revira.

Emily labors in the bathroom of the birthing center with her partner Kai.

I went through a few contractions and asked Amy if I could get in the tub. She said she'd rather have me wait a bit to make sure it wouldn't slow my progress to get in there. So I had about five more contractions and asked again. Now, instead of being mostly silent through them, I had begun moaning a bit. Amy said she'd start to fill the tub and I got more excited. I was in the tub for just a short time when I asked if Kai would join me as I wanted something to push against during a contraction. He didn't hesitate, as with the entire birth, he calmly did whatever I or the others asked of him. He was collected and encouraging; completely there for me and baby. Within what felt like an hour, but was probably more like two, Amy checked my cervix as I was feeling closer to wanting to push. She found that it was not fully open on one side and kept her hand there during a contraction to see if she could help it move a bit. It didn't seem to work, but I didn't get the sense that she was nervous. I was totally in my body and couldn't feel any outside anxiety or stress in the room. Everyone was calm and reassuring.

Amy told me that if I stuck my finger in just a little bit, I could feel the baby's head. I hesitated, but put my finger in only about 2 inches. I felt it. How amazing it was to know my body had already brought the baby's head that far! She could have said how far dilated I was, but instead, letting me feel the head made the progress more real, more encouraging that my body was doing exactly what it needed to be doing.

The contractions continued and were painful, but never unbearable. I breathed through them and would take a cleansing breath through my nose at the end. Sky massaged my legs, Kai put pressure on my back. Jill checked my cervix to confirm what Amy had found. Although they didn't tell me this at the time, they realized the baby was "occiput posterior" or "sunny side up," which means she was facing up toward my front rather than toward my back. This position makes pushing a baby out difficult because the very top of the head is against the cervix, instead of the crown, which is smaller. Jill confirmed that although it would take a bit more pushing, my pelvis was able to fit the baby's head through at this angle.

I'm sure some women would have wanted to know all these details during birth, but I'm happy I wasn't distracted with measurements, dilations and technical terms. I like that I was told what I needed to know, and what positions I could try rather than how far dilated or what an occiput posterior baby would mean (four hours of pushing for me!)

Amy asked politely if I could get out of the tub and have Amber, the birth center's resident chiropractor, take a look at my sacrum (my lower back). I was helped onto the bed and Amber laid her hands gently on my back during a contraction. From one contraction she could tell what needed to be adjusted. Kai was standing by my head and held my hand during each contraction. I remember pushing my face into his shorts, which were cool and wet from the tub. I could hear him breathe above all the other noises. In between contractions, I'd try to match his rhythm. I had my eyes closed, but I could feel him looking at me. Most importantly, I could feel his confidence in me, in my body, in our baby, and in the women surrounding us.

Amber adjusted my sacrum with a tool that made a snapping noise, but didn't hurt a bit. It felt great actually, releasing all the tension in my back. A few more contractions and Amy suggested I go to the bathroom to labor on the toilet or in the shower, anything upright to keep baby moving down. After Amber's adjustment, each contraction actually felt like the baby was moving further down. I had no urge to stop, wanting each contraction to come, only getting frustrated when they'd pause for longer than a few minutes. I welcomed them into my body, silently telling my baby to descend with each contraction. The pain and intensity was increasing and I told Kai, "If this isn't transition, I am not sure what is." Nobody seemed to believe me because I wasn't howling or asking for drugs or anything of the such.

It wasn't until everything was done that someone said it probably was transition, looking back. I amazed myself that I could talk through it instead of scream. All the stories we had heard mentioned transition being the time of wanting to give up or give into drugs. Those thoughts never crossed my mind. I trusted my body, and honestly didn't feel like I had time to think about anything else but remaining focused on each contraction and getting this baby out.

I went to the toilet, which was one of my favorite positions to labor. Not only could I go to the bathroom during a contraction (which would happen whether on the toilet or not), but I could also put my head on the assistance bar behind the toilet which was nice and cool. Then I went to the shower and Amy thought it would be a good idea to have a few contractions squatting. I waited for the burn of her head crowning to begin. I asked everyone how long it would be. Not long was all I could gather, but it still felt like it was taking forever to feel her crown. Amanda, another midwifery apprentice, was to my right, Kai to my left. I sat on the birthing stool in between contractions and squatted down during them, leaning my head on Kai's. Everyone continued telling me how amazingly well I was doing. I believed them, and agreed. I felt my baby descending, I felt it starting to burn, and finally I saw everyone put on a new pair of rubber gloves. I knew this meant I was close. Jill asked Kai if she could get him a granola bar, to make sure he wouldn't faint at the sight of things. He accepted.

A few contractions later her head was out and her body slipped out with ease immediately after. I sat on the stool and held her, pink and screaming nicely. She looked amazing and felt warm and soft. I loved it. As soon as I saw her face come out of me, I felt no pain. The rest of the room disappeared except for me, her, and Kai. It was 2:51 p.m., just nine minutes under 12 hours from start to finish.

Kai cut the cord after it was done pulsing. A few minutes later my placenta came out with a lot of blood and I was escorted to the bed to make sure I wasn't bleeding too much. I felt weak and shaky. Oxygen please. Kai lay next to me holding the baby. Thankfully, within a half hour I was stitched up (from tearing), breastfeeding, and laying in a cozy bed, not bleeding too much. I was happy. The baby was healthy and alert, I was healthy, Kai was the perfect companion for labor, and all the staff at the birth center worked together like a finely tuned machine.

We were alone in the room for a bit and Kai said, "I am so glad we had our baby here instead of a hospital." Amy, Amanda, Sky, Jill, and Amber were beyond my most wild expectations of what a birth team could be. They worked quietly in the background, but were there when I needed them. Everything they suggested helped. Everything I told them I wanted was upheld. They had reminded me to breathe through my nose, to push with all my energy toward my bottom. It was as if they were so knowledgeable and respectful of the birthing process that they were actually inside of my body with me. They knew exactly what I needed to do to work with my body in bringing this baby out.

Within six hours of birth, we were headed home to our own bed with our 7 pound, 2 ounce (3.23 kilogram for Kai), 19 3/4 inch baby girl, Revira. My baby sleeping on my chest in my bed was perhaps the best feeling I could have ever imagined. She is perfect, and I wouldn't change a thing about our birth. Thank you Amy, Sky, Amanda, Jill, Amber, Greta, and everyone at Health Foundations; and thank you Kai: of everything we've been through, this is by far the most incredible.

Birth Story: "We all have this maternal power~ we just have to believe in it..."

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The birth of baby Raina

Contractions started early in the morning on the 27th of November but never gained momentum – in fact, they stopped for most of the day – until Raina’s big sister Elya went to bed. Around 9:00pm then, I finally laid down and decided to get some sleep. The minute my head hit the pillow, however, my contractions started again. You have got to be kidding me, I remember thinking. I laid there for about an hour, trying to rest since they were only about 20 minutes apart, but eventually went out in to the living room to see my husband, Peter.

Once I was there and sitting on the ball, my contractions got stronger and closer together until eventually we thought, “This is it!” That’s when they spaced out again (around 11pm). I felt incredibly frustrated and worried that this “start-stop” pattern would continue throughout the night! Sensing my exhaustion, Peter kept urging me to lie down and sleep, but I knew that if I could just get my little girl’s head in the right position (pressing down on my cervix) I’d be in “real” labor. I therefore started doing squats during contractions, and in no time, was in full blown active labor, throwing up, and calling the midwives telling them “it was time”. This was around 11:30pm.

We got to Health Foundations birth center at 12:45am on November 28th, 2012 and my contractions were 3 mins apart. The minute I walked in and hugged my doula and friend, Aubrey, I started crying, feeling so grateful that she was there and that soon I would be meeting my baby girl! Amy, my midwife, immediately told me to get in the shower. "Why isn’t she starting the birth tub?" I thought, but brushed it aside and got in anyway; and thank God too, because the water felt amazing! My birth mix started playing (which was made for me by my best friends) making the whole scene surreal and emotional. Tears started streaming down my face, and I even managed to sing along to “Wade in the Water” by Eva Cassidy (in between contractions, mind you). I felt such joy and excitement for what was about to happen, it was unreal.

Finally, Amy and Aubrey told me to get out of the shower and try sitting down. There was NO way that was going to happen since Raina’s head was causing too much pressure, making any other position except standing unbearable. I leaned over the bed then, and put my head on some pillows. I squeezed Peter’s poor hand for the millionth time (he was smart and took off his ring this time) and Aubrey massaged my shoulders and neck, which felt amazing since I had pulled some muscles during contractions; again I started thinking, Why isn’t Amy running the water? I know I’ve got to be close. (Amy told me later that she thought I wasn’t even in active labor yet since I was being so “quiet” and “jovial”).

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Eventually I demanded they fill up the tub so I could get in. I also started telling them that I “couldn’t do this any longer” and that they had to “tell me what to do!” I knew from my actions that I was in transition but didn’t care. I needed my support team to tell me it was almost time to push so I could allow my body to do what it needed to. That’s when my water broke and I threw up again. I knew I was near the end, but since Amy still hadn’t checked my cervix I started doubting my intuition and resisting “the urge”.

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Once in the water, I immediately relaxed. Amy ‘checked me’ and told me Raina’s head was super low (which I was able to feel!) and that I was ‘complete’. What a relief! I thought. She then told me to start pushing with little pushes if I wanted to so I could ease into the “second stage”. This advice was extremely helpful and allowed me to gradually prepare for the “big push”, which eventually came from a source greater than myself – in 3 minutes then, I had my beautiful baby girl in my arms! I started crying, “Oh my God oh my God oh my God!” and kissing Raina’s perfect little head. Peter was crying too, and we kissed and marveled at the beautiful creation we had in front of us.

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Raina was born at 2:23am (7lbs 11oz and 22 inches long) after three hours of incredible and intense labor. It was the most amazing and gratifying birth ever. My first one was amazing too, but this experience had been exactly how I’d wanted it (except for the hope of being able to push without guidance. Nothing is ever perfect with Life.)

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I wouldn’t have had the birth of my dreams without Peter, Aubrey, Amy and Amanda (my midwives) by my side. I am also SO thankful that I now have beautiful and gorgeous pictures (taken by the lovely and wonderful Danica) to remind me of how strong and powerful I am. We all have this maternal power; we just have to believe in it, claim it, and trust in it, so we can fully let go in the welcomings of Life.

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All Photos by Danica Donnelly Photography