Why I Became a Midwife - Tiffany

I planned to follow in my father's footsteps and have a career in the medical field (he was a paramedic for many years). I originally started schooling to become a paramedic. However my father encouraged me to go into nursing instead as being a paramedic was a dead end job. He also encouraged me to become a nurse practitioner. So I did eventually start nursing school. I had no inkling yet of midwifery, doulas, obstetrics, etc...

Once I reached my OB rotation, I had a feeling that this might be an area I would really like. And it was! I only remember one patient from that rotation...the one who was doing natural childbirth. She was about 4cms and just very calm and breathing through her contractions. She looked like a goddess to me. Unfortunately, due to the time constraints placed on nursing students, I did not get to see her birth.

I started exploring more about childbirth. At this time I had two children of my own already (now 14 and 9). Neither had been very good birth experiences as one was premature and the other was induced for low amniotic fluid, ending with a forceps delivery. I learned about doulas and lay midwives. I also looked into becoming an ob/gyn. Then I discovered there were certified nurse-midwives. I decided that would be the best track for me although it would require several more years of schooling. I had thought about becoming a lay midwife but really wanted to utilize the nursing degree that I was almost finished with. I felt this would give me the best of birth worlds....the more holistic approach but also the medical background. Little did I know that the medical background could hinder as well as help...

At this point I really was focused on childbirth and wanted to have an impact on women's lives in that area. I wanted women to have the birth experience they desired. The more and more I learned about the state of childbirth in this country, the more horrified I became. I felt that as a CNM, I could make a difference.

I had my third child while working on my BSN. It was a much better birth experience, although there were no midwives in the area I lived in. I felt that it could have been optimal, had I had the support of a midwife and/or doula. After the birth of Liberty (who is now 6!), I finally had the opportunity to become a labor and delivery nurse. I had been an RN for a year and hadn't been able to find a L&D position until then. I worked in an emergency department prior to then.

Being a L&D nurse was where I picked up all the bad habits. I learned the fear-based approach to childbirthing. As I started my MSN and midwifery program, it was a very difficult time for me. I had to re-educate myself. What I was learning in school was very much at odds with what I was seeing on L&D. This hospital in South Carolina allowed no VBACs, had a c/s rate in the 4o's (percentage), a 90% epidural rate, a huge amount of pitocin, and just many other unbelievable practices. I eventually had to move to Arizona during graduate school. I finsihed my training at PIMC in Phoenix, while working as a L&D nurse at St Joe's. When I couldn't stand St Joe's anymore, I started teaching nursing students full-time (and yes I taught OB - and I taught from a midwifery perspective :)

I eventually ended up as a CNM working at Bethany Women's Healthcare . I have learned so much since starting there. My skills and intuition as a midwife have improved dramatically, and continue to grow. I now know that trusting birth is something I can do. I know that being in a partnership with women extends beyond just childbirth, but into every aspect of a woman's life.

I love my job.

Tiffany

Some of our favorite books!

1. Birthing From Within by Pam England
2. The VBAC Companion by Diana Korte
3. The Birth Partner by Penny Simkin
4. The Doula Book by Marshall and Phyllis Klaus and John Kennell
5. The Birth Book by William and Marsha Sears
6. The Thinking Woman’s Guide to a Better Birth by Henci Goer
7. The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger
8. Gentle Birth Choices by Barbara Harper
9. Spiritual Midwifery by Ina Mae Gaskin
10. Hypnobirthing by Marie Mongan
11. The Womanly Art of Breastfeeding by La Leche League
12. The Nursing Mother’s Companion by Kathleen Huggins
13. The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Child by William Sears and Martha Sears.
14. Your Amazing Newborn by Marshall H. Klaus and Phyllis H. Klaus
15. The Breastfeeding Cafe by Barbara L. Behrmann

What are your favorites????

Videos and Print Education

This website, which is a offshoot of InJoy Products, which I really like, has some nice videos on how to have a better birth. They are short and not by any means comprehensive, but they are informative. The PDF handouts I definitely like. Very clear and easy to read with great information! Check 'em out :)

Tiffany

Fast and Furious

I got a call from J about 1am to let me know that she was heading to the hospital. She had been contracting since about 10pm and they were increasing in frequency and duration to about every two minutes. She also reported that the last few contractions she felt a little like pushing and had some bloody show.

Uh-oh. I don't live really close so I figured I better head in as well because she sounded pretty 'active' (as in getting close to having a baby!).

J already has a handsome little boy who she had birthed naturally. She was planning the same for this one but had been a little nervous that it might be a long labor like her first. J and her husband had a doula who would be assisting her as well.

J, her husband, and the doula had arrived shortly before I did, maybe about five minutes or so. When I walked into the room, I found J squatting by the bed with the nurse and doula beside. The doula was telling her not to push yet. I checked J when she was ready for me to do so. No surprise - she was 10/100/0. She immediately wanted to get back into her squatting position. I told her she could be wherever she needed to be and could push whenever she was ready.

Pushing with the next contraction in a squatting position, her water broke. The doula was to one sise and J's husband was on the other side. I threw some gloves on as J let out a loud primal groan that had 'this baby is coming now' written all over it :) I squeezed in between the doula and husband from behind J just as J started to crown. She wanted to feel the baby's head so I helped her get her hand to where the head was crowning. She pushed beautifully, slow and controlled, her son into my waiting hands. I had her stand and passed the baby up to her. She relaxed in bed while we waited for the cord to stop pulsating, which she then cut the cord herself.

It was a fast but beautiful birth and I was so happy I had dragged my butt out of bed to meet her there, as I would have missed it otherwise! Here's a picture from after the birth (story and pic posted with J's permission!).




Tiffany

The Real Risks for Cesareans

Medscape Article, "The Real Risks for Cesareans: An Expert Interview With Pamela K. Spry, BSN, MS, PhD"

Editor's Note: Cesarean section (c-section) is the most commonly performed surgery in the United States. The frequency of surgical birth has increased from 4% in 1965 to about 33% today, despite World Health Organization (WHO) recommendations that a 5% to 10% rate is optimal and that a rate greater than 15% does more harm than good.[1-3] Reasons for this increase have been discussed profusely: The surgical focus of obstetrics and the need to train residents; The low priority and few practical skills for supporting women's abilities to labor and give birth naturally; A rigid view of the duration of normal labor; and A low threshold of definition for 'labor dystocia' (the justification for up to 60% of cesarean births[4]). Surgical birth is also a 'side effect' of interventions associated with actively managed labor: induction, artificial rupture of membranes, labor medications, and fetal monitoring.[5,6] Policies against vaginal birth after cesarean (VBAC) and, increasingly, unsupported 'supply-side' justifications such as "baby seems large," also drive the trend toward cesareans. A recent report by the Lamaze Institute associates surgical birth with obstetricians' personalities -- specifically their anxiety levels.[7-9] The risks for birth by surgery have also come under discussion. Maternal risks include a higher overall death rate, rehospitalization for wound complications and infection, placenta accreta and percreta (both with 7% mortality rate), placenta previa, uterine rupture with subsequent pregnancy, and preterm birth, with its own set of risks and complications for the newborn.[10-15]

Pamela K. Spry, BSN, MS, PhD, the President of Lamaze International, a leading childbirth-advocacy group, spoke with us about the risks for birth by scalpel.

Medscape: Childbirth methods are often trend-driven. In the 1960s and 1970s, there was a big push for natural childbirth. What has driven women away from that method since then?

Dr. Spry: In the 1960s, women were rebelling against twilight sleep -- childbirth under heavy narcotics that required being strapped down to the delivery table. There was also the push for fathers to be in the delivery room, which wasn't allowed, and certainly not during heavily sedated birth. Now we have a widespread availability of local and regional methods of pain relief that let women be awake and aware, share the birth with their families, and basically rely on technology to assist them at birth. I think this drive has been somewhat alleviated, but there is still a push for natural childbirth. This is the reason women are still seeking classes, making birth plans, and choosing home birth and birthing centers."Natural childbirth" can mean different things to different people. For Lamaze, it means a birth that's allowed to happen on its own without the use of unnecessary medical interventions, to provide women the safest and healthiest birth possible.

Medscape: Are rates of surgical delivery being driven up by women or clinicians? Is this the age of Blackberry birth -- scheduling everything ahead of time?[16]

Dr. Spry: Actually, there are 2 parts to this question. One is, what has driven up the rate of repeat cesareans, and that answer is easy: there has been a big decrease in the availability of choosing to labor and deliver vaginally (VBAC) after having 1 or 2 previous cesarean births, causing a huge increase in the rate of surgical delivery [for repeat cesareans]. Compared with the early 1990s when VBACs were encouraged and acceptable, many hospitals, insurance companies, and clinicians now refuse to allow women to try laboring after a previous c-section because of perceived medical and legal risks.The second part of the question is whether women or clinicians are responsible for the increase in the primary c-section rate, and I think that's more difficult to answer. In a study of more than 1500 women, we tried to determine just that. The research results indicated that only 1 woman in the study actually reported that she requested a cesarean, which leaves the decision for the vast majority of cesarean deliveries up to clinicians. So understanding when cesareans are medically necessary, as well as the risks involved, is important in achieving a safe and healthy birth.Although it might be convenient, babies who are born before they are ready are at increased risk for major medical problems.

Medscape: Could fear be the reason for women agreeing to surgical birth? Are women enduring pain differently than in previous decades? Is the surgical scenario easier to contemplate than the unknowns of a natural labor and delivery?

Dr. Spry: Exactly. I think all of that has to do with the fact that our culture actually breeds fear around childbirth. We've got TV shows, popular culture, and horror stories from friends and families; women are taught to expect a negative experience and incredible pain. Lamaze is focused on trying to help women get the facts, know what to expect, and help take the fear out of the process. But the unknown parts, such as labor, its duration, birth, and even the unknown of when labor will start, makes it more appealing for some women to schedule a cesarean.

Medscape: The culture of hospital obstetrics seems designed for interventions, with cesarean procedures bringing in more money than natural delivery. Do you think hospital financial incentives are a reason for the rise in cesareans? Or would the costs for longer hospital stays with cesarean procedures balance out the revenues from them?[17]

Dr. Spry: I think that sometimes financial concerns, convenience, or concerns over lawsuits do rule medical decision-making around childbirth. When women have a good understanding of what constitutes quality care, they are in a better position to ask for it from their care providers. Interestingly enough, I just returned from our nurse-midwifery convention in Seattle, and I heard a speaker address this very thing: reducing the cesarean rate. Among his suggestions was the provocative notion that providers should be reimbursed the highest rate for labor and vaginal birth after cesarean, followed by labor and vaginal birth, and the lowest reimbursement for scheduled, elective cesarean delivery. That way, providers would be compensated for their actual time involved in the process, and scheduled c-sections would have the lowest reimbursement. He thought that would make a difference.

Medscape: What are the main risks these days with c-sections? Are these risks underplayed by obstetricians, and, if so, why?

Dr. Spry: Many of them were covered in the introduction. Any time we schedule a surgery or an induction, we are assuming that we know the baby's due date. Anything that's scheduled before a woman's estimated due date could result in a baby being born before it's ready. [And iatrogenic prematurity is a reality with any scheduled birth -- that is, due dates may have been calculated wrong and inadvertently, babies are born before they are actually term.] We're getting more research looking at the near-term preemie. We find that they have breathing and developmental problems and that the risk for death is increased. Certainly, cesarean delivery increases the risk for the baby being injured from the incision. Surgery also carries risks for women, such as blood loss, clotting, infections, severe pain, and adverse anesthesia-related events. This is something that we haven't focused on, and I'm not certain that informed consent includes this information -- that there are complications during future pregnancies and that it does risk future children. There is an increased risk for stillbirth with a second or third c-section, as well as placental problems like percreta and accreta (abnormal growth and attachment of the placenta into the uterus), increasing the risk for hemorrhage. Women may experience dire complications as a result -- bladder injury, hysterectomy, and maternal death. I don't know that I would describe these risks as "underplayed" by obstetricians, but rather that women are not prepared to ask the right questions that lead to informed decision-making.It would be interesting to read the informed-consent documents for cesarean deliveries, and see what risks are included.

Medscape: A story in The New York Times recently reported that women who have c-sections seem to have fewer children. That story provoked over 200 comments, from women who have had all of their children by planned cesarean to women who had had births at home. A strong fear-driven contingent regarded childbirth as fraught with pain and danger, and that anyone who risked giving birth outside of a hospital was committing child abuse. Can you discuss any evidence comparing the risks to mothers and children between in-hospital and at-home births?[18]

Dr. Spry: A number of studies have looked at this. Some of the criticism of these studies has been that hospitals end up with higher-risk women, so it's an unfair comparison. But there are studies of low-risk women who had a planned home birth with a qualified birth attendant, compared with low-risk women who chose hospital births; the outcomes for home birth were better or as good as outcomes for women who birthed in hospitals.Each study limits what kind of comparisons are made, but certainly women with previous surgical uterine scars, medical complications, or breech babies are all considered high-risk.

Medscape: The recovery period after any birth, from time immemorial known as the "lying-in" period, used to last several weeks after a birth. Now, even after surgical birth, women are up and around within a few days. Postpartum depression is another health consideration that has been much in the news lately. Do you think we have lost something with this shortened period of rest and recovery?[19]

Dr. Spry: I do. Studies have shown that it's better for mothers and babies to stay together after birth. Experts agree that unless a medical reason exists, healthy mothers and babies should not be separated following birth. Interrupting, delaying, or limiting the time that a mother and her baby spend together may have a harmful effect on their relationship and on breast-feeding. Babies stay warm, cry less, and have a better start on breast-feeding if moms and babies are together.[As for the question about depression], women with postpartum depression do experience difficulty bonding with their babies. But this could be a result of depression rather than the cause, so it's really hard to answer [whether a shortened period of recovery is related to causing postpartum depression]. Most people get 6 weeks off of work, but even in those 6 weeks, women are still running around [trying to take care of other children, do chores, and manage the household]. I don't know whether we, as a culture, discourage mothers and babies to be together in the postpartum period by no longer posting signs on the doors that say "Don't knock, baby sleeping!" I'm just not aware of any comparative studies on how different postpartum protocols correlate with postpartum depression.

Medscape: There's a marked trend toward inducing delivery -- vaginally or surgically -- before 40 weeks, with mounting evidence that this is risky business. Where is this coming from?[20,21]

Dr. Spry: This increased induction rate has occurred for several reasons: the desire on the part of the women or the providers to arrange a convenient time for delivery. Again, it's a scheduling issue. Concerns about postmaturity, or a post-dates baby, with a fear of adverse outcome and litigation may have contributed to this. But despite the large number of women experiencing induction, one-half of the women who responded to the "Listening to Mothers" study said that they felt that labor should not be interfered with unless it's medically necessary. Eleven percent of the mothers also said that they had experienced some pressure from their care providers to have an induction. Lamaze gives this information to women to help them select their place of birth and communicate with their healthcare provider. These tools can assist women in having a safe and healthy birth.

Medscape: Even truly full-term infants born by cesarean end up in intensive care more frequently than their vaginally born peers. Is this because such infants born by cesarean are high-risk to begin with, or is the procedure itself responsible for this?

Dr. Spry: I think that it's both. I definitely think that some medically indicated surgical deliveries do end up with babies that were higher-risk to begin with. But if you compare low-risk babies that are born by cesarean with vaginal-birth babies, vaginal-birth babies do better. There is an increased likelihood of babies born surgically having problems with fluid in the lungs and less ability to clear it. So actually going through the birth canal seems to be better for the baby.

Medscape: In 2005, surgical birth was the most common Medicaid-billed procedure, performed on women who are most likely at risk for the poorest aftercare, complications, and support. Why is this population at highest risk for c-section?[21]

Dr. Spry: I don't think this statistic indicates that the Medicaid population is at highest risk if they were compared to the insured population. I think that a large part of the Medicaid population consists of pregnant women, because this is a time when they can get coverage. So Medicaid often ends at the 6-week postpartum exam. A childbearing woman would be more likely to be covered under Medicaid than a woman in her forties who needed gallbladder surgery.There have been a couple of studies that looked at the cesarean delivery rate of women with private insurance delivering in private hospitals, and found that privately insured women had a higher surgical risk than the Medicaid population. The rate in New York was 30% for private vs 21% for Medicaid, if the Medicaid women delivered in a public hospital (a teaching hospital). So what has happened is that we've had somewhat of a shift of Medicaid patients moving into the private sector; they've shifted their deliveries from teaching hospitals to private institutions, and this has increased their probability for cesareans.A study from Kaiser in California showed that this increased risk persists even after adjusting for patient demographics and clinical factors. The risk was associated not so much with Medicaid, but with delivering in a private institution. Teaching hospitals tend to follow evidence-based practice, and encourage women to deliver vaginally.

Medscape: What's your perspective on recent reports about the rate of repeat cesareans jumping from 65% to 90% between 1997 and 2006?[22]

Dr. Spry: Again, I think it's litigation fear. There have been more and more restrictions placed on women who want to have VBACs. Some insurance companies won't cover clinicians or hospitals [if they provide a trial of labor after cesarean; and] there are certainly clinicians who won't do VBACs. Women are finding it more and more difficult to seek and have a vaginal birth after a prior cesarean.I just went to a conference where I talked to a number of women whose previous experience was with c-section, but who wanted a vaginal birth. Some of them chose home birth for their next pregnancies because it was their only option.

Medscape: As the concept of birth transitions from a physical, sexual, and societal passage to a billable surgical procedure, placing women in a more passive role, how is the overall well-being of women affected?

Dr. Spry: Within the maternity system, there's a distinct drive toward convenience: predictable process of labor and birth, maximized reimbursement, and limited liability. All of these factors can lead any care provider to make decisions that aren't necessarily based on the mother's and baby's needs. Women's decisions are affected as well, because without maximum reimbursement, they can't select a place of birth that they can't afford. I think it's critical for every birthing woman to recognize the realities of the environment and be prepared to advocate for herself, taking a more active role in her birth. This is something that Lamaze focuses on.Studies have been done where a woman has experienced a kind of birth that she didn't want, and she felt that she had no control over it. Penny Simkin just gave an excellent talk on the risk of posttraumatic stress syndrome resulting from a birth in which a woman felt not in control, who felt decisions were made for her and were imposed on her. I think that sense of control is really important to the mental health and to the feeling of being competent and OK after birth.

Medscape: Obstetrics is a surgical specialty. So far, the significant numbers of women now practicing in the field have done little to change the surgical view of birthing women. Do you think there will be a tipping point away from the surgical approach to birth among obstetricians?

Dr. Spry: Sometimes it takes us years to figure out what we've been doing wrong; this is an alarming aspect of surgery, and few women are aware of the poor state of maternity care that we have in the United States. Many women assume that because they're birthing in the United States, they're getting quality care. Research and outcome studies suggest that this isn't necessarily the case, but I don't think our population knows that yet. We're seeing an increased number of maternal deaths. We haven't seen an increase in maternal deaths in this country for a long time. [An example of a delay in recognizing risk of accepted treatment is, that] in the 1950s, 1960s, and 1970s, we gave diethylstilbestrol to women to prevent miscarriage. It wasn't until the next generation, and even after the next generation -- 30 years -- that we got rid of that practice. So I think change will come. And I think that we need to continue to perform research, monitor maternal morbidity, and look at these statistics, and then we'll see a shift.The other issue is that really adverse, terrible events are rare; maternal deaths are rare, even though they are increasing. So an obstetrician having a personal experience of a maternal death is infrequent.Essential skills are being lost in obstetrics -- for example, breech deliveries or twins. However, they are preserved in the world of midwifery.I hope that we get the message across that women want and need a positive birthing experience, and that they will choose a birth team that will support that goal. We would like for everybody to have a safe and healthy birth.

ROM+2hrs=birth

I had a woman by the name of E come in for her postpartum visit recently and we were re-visiting her birth story. She graciously has allowed me to share her birth story here!

E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.

I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.

She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.

She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).

I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!

Tiffany

Changes are needed

Many people invest energy and resources (and are perpetually frustrated) in pursuit of better outcomes for mothers and babies in this country. We have tried a variety of strategies, but thus far have seen little progress. Indeed in some areas, statistics have been abysmal and unabated for years. We persistently fund programs of similar ilk that offer more of the same kind of care…and expect improved outcomes. We support a system which dis-empowers women from the beginning. We place birth in a sterile environment, strap women in unnatural positions for birth and do not appreciate the need of babies to be handled gently and have time to bond. If we are to truly experience meaningful change for our mothers and babies, we must work toward sweeping systemic change and explore new places for answers.

Unless and Until…

Our healthcare system embraces a new paradigm and acknowledges for the majority, birth is a natural biological and sociological process rather than an illness, fraught with danger and problems

We have sweeping malpractice reform that allows providers to practice without fear and financial burden, yet provides for those truly injured and in need of compensation

Our culture sees a need to change the focus of pregnancy care from a sterile medical model to a wellness model offering freedom and choice

We offer programs that teach our young people about healthy sexuality and offer them information they need to invite pregnancy at the appropriate time, having fewer “unwanted” pregnancies

All providers caring for women realize women themselves have the true ability to effect healthy pregnancy outcomes., that they have insight, intuition, self-knowledge and power to successfully grow, labor and birth healthy babies

We appreciate that all pregnancies and births do not need all the technology and testing we have available

We are willing to step outside the box of conventionality and courageously address systematic change with innovative approaches

We appropriate funding to programs and providers who document their care with outstanding statistics and greatest consumer satisfaction

We realize our system must reallocate healthcare resource dollars in more prudent ways that assure resources are available for those experiencing a medically complicated pregnancy and birth

…our system will remain inefficient, ineffective and expensive.


Unless and Until…

Our culture views birth as a sacred event

Birth is recognized as a process that can be trusted to be inherently workable as designed

Our system realizes though we may lead the world in many areas, in pregnancy and childbirth, we do not

We look to those systems where maternal infant outcomes are excellent for ideas, best practices

We seek strategies that empower women and offer them resources and support to nurture their pregnancies and give birth with dignity and privacy

We appreciate that babies are sentient beings from conception, exquisitely sensitive to the whole of their uterine environment on the cellular level

All those who attend births have an appreciation for the importance of maternal-infant bonding and allow time for this process to unfold

We seek ways to help women focus on their assets that support a healthy pregnancy rather than on their “risks” and “potential problems”

We transform the design of facilities where women give birth

…we will continue to experience stagnant birth outcome statistics and our nation’s mothers and babies will not be adequately served.


Lylaine Gavette

J's Birth story

I wanted to share this story about a birth I attended. It was a great experience and is written from the perspective of the doula (I have her contact info for anyone interested in her services).

~Tiffany

"I don't think I've seen a doula post a birth story, but I just couldn't resist sharing this with everyone. I have permission to post this, but am just using initials instead of full names....How J and I met is kind of an interesting story, so I'll start with that. I randomly went on freecycle one morning and saw that someone was getting rid of a boppy breastfeeding pillow. I thought it would be great to have one as a doula to demonstrate with or just have to loan out. So I responded 12 minutes after the ad was posted. I emailed back and forth with her mom, T, and then we ended up talking on the phone. T said her daughter (J) was pregnant and looking into natural birth and was so excited to hear I was a doula. I said I'd be happy to talk with her when I came to pick up the boppy. A few days later I went over there and J and I immediately connected. She was just so excited about natural birth and so curious and had so many questions - a doula's dream! She was so receptive and open to everything I was telling her and we ended up talking for several hours. Our conversation went beyond birth and I felt so comfortable with her - I knew I had to attend her birth. We stayed in contact the next few weeks and went to the Phoenix birth circle together and to a La Leche League meeting. After watching the Business of Being Born and attending the birth circle, she was getting more and more excited and confident about having a natural birth. She was getting more and more uncomfortable with her OB and decided to interview the midwives at Bethany Women's Healthcare. She switched on the spot after talking with a couple of the midwives and being there for several hours. I was thrilled! She met Lylaine and Lisa that day and was set to meet Lynette at her next appointment. She loved Lynette too and I was so happy to hear the excitement in her voice. I think it was so freeing and empowering to her to feel that things that she wanted were totally doable. A whole world had been opened up for her.

"On Thursday, May 28th J used some evening primrose oil as a way to possibly naturally stimulate labor. J called me at 8am the next morning to say that she had been having regular contractions since 5am. She had been able to sleep, but they had started waking her up. She didn't feel like she needed me to come just yet, but definitely felt like "today was the day." We talked again around lunch time and she said that this was for sure happening and they were getting a bit more intense and closer together. This was around noon. She called me again a couple of hours later to say that she wanted me to come. Heather came home shortly after and wished me good luck. I went home and packed my bag and then headed over to J's.

"I arrived around 3:30, walked in and gave her mom a big hug. J's younger children were quietly watching a movie and J's two "nieces" had been keeping track of her contractions. J walked out and looked so adorable! She had on a leopard print bra, black shorts and had a Breathe-Right strip on her nose. It was just the cutest thing. I gave her a big hug and she told me how she was feeling. Then she had a contraction and put her arms around me and sort of hung on me until it was over. I just immediately had a feeling of calm and peace about the whole birth. I had no anxiety, I was just excited to be there. She started getting ready and was putting on different pants and shirts until she found the right one. That cracked me up. It was a little crazy at her house though and the environment wasn't the most relaxing so when J said she was ready to go to the hospital a few minutes later I thought that was a good idea. Her mom and nieces were going to come a little while later, after the baby sitter for the two younger children arrived. So it was just J and I. She made it down the stairs and had a contraction on the walk to the parking lot. We just stopped and she held on to me and moaned. We made it to the car and were on our way. She was still joking and laughing and calling friends and family to let them know what was going on. Her contractions had definitely slowed down, but I knew that was to be expected. In my mind though I was still thinking "This is too early...." and as we got closer to the hospital I asked if she was sure she was ready to go in - we could go walk the mall for a while or something. But she insisted on going in, which was fine with me. We pulled in and parked and she had a contraction just outside the car.

"We walked into the building and went up to registration. There was a woman and a man up there. The man said "Are you here cuz yer in labor?" We both just kind of looked at him and sarcastically said "No." The woman pointed us up to the third floor and then J had another contraction. She leaned on me and then the man starts asking her questions... I was so irritated with him! Clearly she is contracting, and clearly it is difficult or she wouldn't be leaning on me, closing her eyes, trying to focus. I wanted to punch him. We got in the elevator and J immediately said, "What was up with that guy?!" We had already decided no boys allowed and this guy just reinforced that. I pointed out that the woman hadn't asked her anything. :) We made our way up to the third floor and stepped into a small office and she got registered. This was about 4:30pm. She had one or two contractions in the office. Then we were walking to triage and she had another contraction in the hall. Everyone was completely respectful, no one was trying to rush her and the nurse just patiently held the door and waited.

"We went into triage and the nurse hooked J up to a monitor so she could record a couple of contractions. J said that could not imagine labor in this position (on her back, semi reclined) and no wonder so many women scream for epidurals. Contracting while sitting up was torture for her, but she knew it was only for a short time and dealt with it soooo well. The nurse asked her all the intake questions and her contractions had majorly slowed down. Then the nurse checked her and she was 4 centimeters, 100% effaced and +2. J was psyched and I was so glad because I've had other clients who, when they hear they are at 4cm, completely freak out and say "Oh my gosh, I'm not even half way there! Ahhhh!" I think 4 centimeters is amazing and I was so glad J did too. Then the nurse suggested that we walk for an hour, come back and if J had made "progress" she would be admitted. On the one hand I liked this because I was glad they weren't anxious to admit her and get things going and start the domino effect that leads to a cesarean - this is my doula brain totally overreacting. But on the other hand I hate the idea of relying on machines and measurements and "progress". There is so much more going on in a woman's body that can't be measured. J seemed a little disappointed that she wasn't going right away to a room, but I reminded her that this was great - very supportive of an overall natural birth.

"Soon after J's mom and nieces arrived. I was nervous that this would start the whole "So how far is she dilated?", "How much longer do you think it will be?" hoopla, but they all remained pretty calm and unintrusive. J's mom was concerned with us walking around and why they wanted us to do that and why they weren't checking J in, but we explained it to her and then she went to get a Starbucks with the nieces. And we started walking the halls at 5:15pm. J's mouth was dry and she said she felt like her breath stunk. I grabbed a hand full of candy - I had some butterscotch, some cinnamon suckers and a lemon lime sucker. She snatched up the lemon lime and it was so cute how much she enjoyed it, it was like one of those simple pleasures in life. The labor and delivery floor goes in a circle so we just started walking. Everyone was so sweet on the floor. Every nurse we passed gave a sweet smile or some encouraging words. Then we passed a dinner cart with a ton of food on it and J about barfed. Then we passed another cart. Then the women delivering the food walked by us with a tray of food and noticed J's face and apologized because she knew how J felt. It was so funny. She passed a couple more times and each time you could tell she felt so bad.

"J started trying to walk through her contractions - I couldn't believe she could do that. But it seemed to be working for her. I was holding her hand and with the other hand she was leaning on the guard rail during contractions. She then said she had to use the bathroom (me again in my overreacting brain was like..."Oh god, is this one of those moments where she thinks she has to poop, but then pushes a baby out?" LOL). By the time we got to the bathroom she didn't have to go anymore, but went in anyway to splash some cold water on her face. She was getting hot flashes and getting uncomfortable. We continued walking and at one point she threw off her back gown - she had been wearing a gown on the front and the back so that she was covered. We were walking and passed our triage nurse who said "Oh honey your back side is hanging out!" I said that she was hot and didn't care, and I was a little irritated that she had said that. Obviously J knew her ass was hanging out - she had underwear on though, there's no need to make her feel uncomfortable. I was feeling very protective of her space. She asked what time it was and I said "5:38" and she was upset! She thought we only been walking for 8 minutes. I reminded her that we had started walking at 5:15, not 5:30. That was better. Then she started getting extremely tired and was having a hard time standing up. She needed to lay down so we went back to our space in triage. She got comfortable on her side with a bunch of pillows in between her legs and was able to somewhat doze between contractions. I stood by her bedside because each time she would contract she would fling her arm up and out grabbing for me. Then she asked for a cold rag so I ran and grabbed a hand towel and dipped it in a pitcher of ice water. She loved it and kept it on her head for a while. Then she was rubbing it on her face and chest. She dozed again and then when her next contraction started she began smacking her forehead. I took this as her wanting the cold rag back. Then she would hold her hand out and make a fist when she wanted water. She would smack her lips when she wanted chap stick. I laughed to myself a couple of times because it was like a comedy routine - J doing these physical gestures and me quickly figuring out what they are and delivering. I always had water nearby and I had on stretchy pants so I kept the chap stick tucked under the waist of my pants. This was all she ended up needing the whole labor - my hand/arm, chap stick and water. It was so funny. You never know what you're actually going to use out of your doula bag!

"After a few minutes of laying down she sat up and vomited - thankfully we had a bucket right there. She had told me I could leave if I wanted, but vomiting is nothing I haven't seen or smelled before so I stayed. I stood behind her with my hand on her back. After a few minutes she got up to freshen up in the bathroom. The triage nurse came back in. She hooked J back up to record a few more contractions and said she'd be back in a minute to check her again. J's mom and nieces came back and J's mom was getting very anxious and wondering why the nurse hadn't checked her again and she was asking all of these questions. I tried to calmly answer her questions and just focus on J, I was hoping her mom would follow suit. She did and she was rubbing J's feet and telling her how great she was doing. It was very sweet. Then the nurse came back in, checked her and said "5cm, you're a keeper!" Again, I just hate the idea of a nurse having to validate that you are in fact in labor, but oh well. That's just how the system works I suppose. Then she said "Now I know you don't want an epidural, but do you want to order stadol or something? Because if you say no and then decide you want it later it's going to take a very long time. But I can just order it for you now and have it on standby". J can hardly think straight at this point and sort of just mumbled yes. I didn't like the nurse's approach at all and again in my negative overreacting brain I'm thinking that is where it starts to snowball - she orders the stadol to have ready just in case...at the first sign of J wavering the stadol is offered...it makes her feel like crap and doesn't last long....she then orders the epidural, etc., etc. I'm so wary of every little thing.

"J sat up in bed to get ready to walk to her room. She had declined a wheel chair and wanted to walk herself. She had a contraction sitting up and then had several more in the hall way walking over. Her mom and I were at her side and the nurse was in front of us. Then she felt like she needed to vomit so the nurse ran and got a bucket. She held it up for J and she vomited again. The nurse was very patient and didn't react at all. She just held the bucket until J was finished. Then we made our way to the room. It was a big beautiful private room with a great view, a rocking chair, a birth ball, a bed for the partner to sleep on and a giant shower. J was very much still in a daze, in "the zone", checked out, whatever you want to call it. She was so deep into her labor - it was one of the most incredible things I had ever seen. She just completely surrendered to it and let go. But this is what needs to happen - the logical part of your brain needs to shut down so that you don't care if you're moaning too loud, if you're making people uncomfortable, etc., etc. She crawled into bed and again got comfortable on her side. We turned down the lights and I just sat by her bed, ready and waiting with my chap stick and water bottle. She took to grabbing my forearm whenever she would have a contraction. A woman walked in with a big cart full of stuff and I thought "Oh crap, here comes the fight about not wanting an I.V." But no - she just quickly took a blood sample. The woman asked J if this was her good arm and J said, "Well, yes because this is the available arm." I liked that she wasn't going to move for the woman. And she shouldn't! She's in labor and everyone should accommodate her.

"Our nurse, Rian, came in and instantly she brought an incredibly calm and soothing energy to the room. I was so grateful to have her. She was young and sweet with long beautiful thick blond hair. Then Tiffany, the CNM on call, came in as well. Tiffany and Rian both just had such gentle touches and were completely respectful the entire time. Tiffany was the one midwife that J hadn't met at Bethany Women's so it was kind of funny. But she turned out to be absolutely perfect. They both asked if J had a birth plan and I grabbed several copies out of my bag and they both stood there and they actually read it! Tiffany said that a room with a large tub instead of just a shower was available across the hall and we could go ahead and move if J wanted to. J was in no position to make decisions at this point so we kind of decided for her. Tiffany thought the tub was a great idea so we moved. The nieces carried J's bags across the hall and I held onto her as she walked in a trance to the next room. She again crawled up onto the bed and got on her side. Tiffany started running a bath.

"Rian came back in with a bunch of release forms. I loved this though because at other births I've attended they just assume you want to whole standard lot of crap and if you don't want something, or you want them to do something different it's almost a fight for the damn release forms. And most certainly a guilt trip. But Rian brought in everything up front and just asked J yes or no questions to a bunch of stuff and J had to signs a bunch of things. This was difficult and I felt bad for Rian, but she had to do it. Then Rian said she was just going to monitor J for a minute before she got in the tub. That was so refreshing - she actually stood there and monitored her! She didn't make her lay on her back, get hooked up and then leave. I really hate when that happens because then as soon as the woman moves the nurse runs back in to reposition the monitor. Then the woman moves again and the nurse has to run back in. It seems like such a waste of time and the nurse inevitably gets irritated at the situation and the monitors and how is the woman supposed to relax and assume any position that is comfortable if she's constantly being messed with? One can only take so much. So Rian stood there for about 10 minutes and got a reading of the baby's heartbeat before, during and after a couple of contractions. Everything looked perfect. Tiffany came back over and asked who I was. I'm always hesitant to say I'm a doula because a lot of times people don't like that and it makes them get defensive. Especially if they've never worked with a doula before, or had a bad experience with a doula. But Tiffany thought that it was so awesome I was a doula and she called me by my name the whole night. It was very sweet. J was having trouble answering questions so Tiffany asked me instead since I knew everything anyway.

"Then we got J up and into the tub. She was sitting up and kind of leaning over to the side. She was holding onto the hand rail with one hand and holding onto my hand with the other. Her mom was in there too for a moment. I could hear her mom whispering to the nieces and could tell she was getting uncomfortable watching J labor. I just kept my focus on J and pretended like there was no one else in the bathroom with us. Then J said "Chap stick, chap stick" and her mom started calling for someone to get chap stick! I just quietly pulled it out of my waist line and rubbed it on her lips for her. I was really trying to model behavior for everyone and I'd like to think it was helping. Even if it's something not so easy like running to the closet for a towel and rushing around for ice water to dip it in - I don't want the mom to pick up on that. I want everything to seem like it's a piece of cake. Eventually everyone left, even Tiffany, and we just sat there together. I thought about suggesting she lean back more or get on her hands and knees, sort of in child's pose and lean over the side, but for some reason that didn't feel right and I didn't want to disturb her. Then she said she wanted to get out. J wasn't saying much, in fact, we really hadn't spoken any words to each other. So when she did speak it was simple and to the point. So we got right out. I pulled her up and then her mom came over with a towel. J stepped out of the tub and had a contraction. She was leaning on her mom and I was at her side holding her up. Her mom was looking at me so desperately and was on the verge of tears. I whispered that it was ok. I know it must be so hard to watch your daughter go through something like that. It's obviously easier for me because I'm not emotionally attached to J in the same way and also because it's easy for me to see her as a laboring woman just working with her labor. It's not like she's in horrifying pain being tortured and I must do something to stop it. Although that's one of the hardest things about going through labor with someone - there is nothing you can do besides just be there and offer support if needed. You have to have so much patience and be able to remain calm, even if things do not go as planned. After the contraction J's mom dried her off a bit and then we walked her back to the bed. Again she crawled back in and got comfortable on her side.

"Tiffany came back in a minute later and whispered to me "She didn't like the tub, huh?" Then J opened her eyes and saw Tiffany and asked to be checked. Tiffany said that wasn't necessary, but if J wanted her to she would. J did want to know where she was at. So Tiffany sat on the edge of the bed and waited for J to let her know when was a good time for her. J went to turn on her back, but Tiffany told her not to move and to just stay right where she was. Tiffany just maneuvered a bit and checked her while she was lying on her side. She was so sweet about it telling J when she was going to feel her hand and apologizing because she knew it was uncomfortable. She was 7 centimeters! I was so excited about that. She had gone from 4 to 5 in less than an hour and from 5 to 7 quickly too. At this point I think it was about 8pm. I wasn't keeping great track of the time, but that is my best guess.

"J continued laboring on her side and was moaning with her contractions and it was just so beautiful to watch. Everything was just unfolding perfectly. It was magical. There were a couple of times when Rian and Tiffany were discussing things and they just did it in such a whisper - it was so great. It allowed J to stay perfectly in her zone. That is another one of my pet peeves - when doctors and nurses are talking so loudly, either about personal stuff that is unnecessary to discuss in a laboring woman's space, or about scary medical jargon that only upsets the mother and others in the room. I was straining to hear their conversation at one point and they were concerned about the baby's heart rate going down. Again, I could only hear this because I was really straining hard. Rian monitored the heart rate through a couple of contractions and everything turned out fine. I just thought how great that was and how they avoided unnecessary anxiety on J's part. Not being hooked up to EFM is such a beautiful thing because it keeps every one's focus on the mother and not on the machine.

"Tiffany came back into the room a minute later and I realized I had never seen her leave. Out of the corner of my eye I saw her sitting in an arm chair just watching J. It took me a minute to figure out what she was doing, but then I realized she was just monitoring her. I thought how cool it was because I think you can tell so much more by looking at the woman - you can tell when she's in between contractions, you can tell when one is coming up, you can tell when one peaks and when it's over just by observing the mother's body language. I was so impressed and inspired by Tiffany's style. Although for a moment I did feel self-conscious and I thought "Gosh...should I be doing something else?" I felt like I should be offering up great suggestions or positions or speaking more encouraging words. But that only lasted for a moment and then I realized I was right where I needed to be doing exactly what I needed to be doing and I resolved to following my instincts just like J was doing.

"At one point Rian had come into the room and J sat up and started moaning and said "No, no, no I need something for the pain," and I got nervous for a second, because this is the point typically where the nurse would jump all over that and call in the anesthesiologist. But instead Rian said "Ok honey, you need something for the pain? Why don't we try getting you on the ball? Or on your hands and knees?" I about fell over. It was like a dream. That is the kind of thing I have fantasized about hearing. And what a testament to having a supportive birth team because in moments like this your team can make or break you. If you have people who are not on board or comfortable with natural birth this is when everything could shift. But instead everyone stayed strong and kept J on track. In fact I think that was the only time I spoke to J. I said "J you are doing this. You are having the birth you've always wanted. I know you can do this." I don't know if she even heard me or not, but she didn't ask for anything again. Although that didn't stop me from being anxious through the next few contractions waiting for her to start screaming for an epidural or something. But she never did. I couldn't believe how amazing and in control she stayed. You could tell that all her breathing, all her movements, all her moaning was completely involuntary. It was incredible. I am getting emotional writing this just thinking about witnessing her strength through the whole thing.

"We got her up on the ball and she had a couple of contractions on it and then said "I don't like this!!" so she crawled back up on the bed. She was shivering and getting hot flashes so we got some warm blankets that we were throwing on and off of her as needed. Then Rian raised the head of the bed up and we helped J getting on her hands and knees, but in a resting position. She didn't like that either. She sat up on her knees and I sat in front of her so she could lean on me. Then she went back on her side. And she stayed there the rest of the labor.

"A little while later J was moaning through a contraction and kind of whispering "Ow, ow, ow this hurts" and Rian said "Honey you are doing so great, this is hard work" And J sat bolt upright and said "Fuck yeah it is! This is the most exhausting thing I've ever done in my entire life! It's more exhausting than raising children!" And she collapsed back down on her side. It was hilarious! I just love her. Rian said something else later, something like "You're doing so great" and J shouted "I know I am! I am doing this!" It was just so amazing. That's how I wish every woman felt! Such confidence and pride. I loved it.

"Tiffany and Rian were getting things set up for the birth. Tiffany pulled out her cart and asked Rian to get some oil and some warm compresses ready for her. Then Tiffany was quietly explaining how you should always use natural oils like olive oil or safflower oil (versus like massage oil) because that way if that baby aspirates any, it's ok. That made sense. I had never thought of that before. I loved Tiffany's approach when explaining things. She never made anyone feel dumb or inferior and she was so happy to share her knowledge. I just couldn't get over how sweet she was to me too. I had been either squatting by the bed or on my knees by the bed next to J and Tiffany quietly rolled over a ball for me to sit on. So sweet! It's funny though because I never thought "Oh my gosh, I'm so uncomfortable or hungry or I have to pee" or anything like that. I peed once, I never ate, I had a few sips of water. I just didn't need much of anything. I was so consumed with J that I couldn't think about anything else.

"J stayed completely focused inward, hardly even opening her eyes. She would moan and move her head around, her eyes would open slightly and you could see her eyes rolled back. She held onto my arm and there was no talking, no questions, nothing. But J did lift her head up when she heard the door open. I guess she sensed that Tiffany was leaving or something. J said "Don't go far because I might want to push soon." Tiffany said "Well I'm not leaving if you tell me something like that!" It was really funny. J asked to be checked and again Tiffany said that wasn't necessary, but she'd do it if J wanted. She did. Tiffany said she was 9 and a half and could push whenever she felt the urge. J's water still had not broken and there was no talk of breaking it. It was just so amazing because in a typical hospital with a typical OB, her water would have been broken long ago and if an OB checked and a woman was 9 and half it would have been "Ok, time to push!" and then the big production would have started, people would have been rushing around, lights would have been turned up, instruments would have been pulled out and it would have been "Ok, now hold your breath, count to ten, push, push, push!" Not to say that aren't amazing OBs who would give this same level of care, but you definitely have to search around for them. Tiffany knew that J had a pretty bad tear with one of her previous births and also knew that J had epidurals. So Tiffany said, "J, when you start pushing you may feel a burning sensation - this is completely normal and does not mean that you are tearing." I thought that was a wonderful thing to say because I could totally imagine feeling that burning and thinking you are splitting in two and then freaking out. So I'm sure that made J feel a lot better.

"Tiffany and Rian stayed beside J and then J just started pushing. It was very calm and very peaceful. There was no drama, no anxiety, no voices raised, no instruction. It was perfect. After one or two pushes her bag of waters popped. It was very loud and it gushed out everywhere - we all laughed. It got all over Tiffany and got on my arm a bit. I think it may have gotten on J's mom's head too, but I'm not sure. She pushed amazingly well and after only a few pushes the baby's head was right there. Tiffany and Rian were taking turns holding warm compresses against J's perineum. The only thing Tiffany even said to J was asking her to slow down and take a breath. J said "I can't stop, I can't stop!" and Tiffany said "That's ok honey, just do whatever you need to do". It was so awesome. Tiffany was also saying how great she was doing, her pushes were just perfect, she was amazing. It was so sweet.

"She only pushed 6 or 7 times and the baby's head was out. Then Tiffany was telling her to just rest and let the baby's head stretch her a bit before the shoulders came out. Then she gave one or two more pushes and she was out! A beautiful baby girl was born at 9:52pm on May 29th, 2009. The baby was place immediately on J's belly. The cord pulsed for a few minutes and then Tiffany clamped it and J's mom cut it. It was amazing to witness. J just laid her head back and said "I did it, I did it, I can't believe I did it". She looked at me and asked if I could believe it and I said I knew she could do it from the beginning and I never doubted her. It was so sweet. She looked at me and said "I couldn't have done it without you, I couldn't have done it without you" over and over. At that point I had tears streaming down my face. It was such a powerful feeling. J moved the baby farther up on her chest and started nursing her. She latched on incredibly well and started nursing like a champ. J started having some intense cramping and Tiffany said to just give a little push. She did and then Tiffany said if it was ok with J that she would just do some gentle and very light cord traction to help the placenta out. So J pushed and Tiffany barely pulled on the cord and the placenta plopped out. Tiffany put it into a basin and put it on her cart. She then held it up for us all to see - the nieces were fascinated by this. Tiffany said if they wanted to put on gloves and feel it she had no problem with that. The nieces didn't want to, but I thought that was cool of Tiffany to offer. J kept saying how she couldn't believe how amazing she felt and how with it she was immediately after. J's mom couldn't believe it either - especially compared to her other two births. Then J sighed and said, "my vagina hurts!" and she started laughing. It was hilarious.

"Tiffany checked her and she just had a tiny little skid mark, not even a tear and Tiffany said it would heal on its own, but might hurt a bit when she peed for a few days. J was passing some pretty large clots so Rian unfortunately had to push on J's stomach and massage a bit to help her uterus shrink back down. This was painful for J, but again was done in such a respectful way. It could have been much worse. And J was constantly reassured the whole time. There was never any fear instilled in her. The baby kept nursing and J's bleeding eventually stopped, although Rian did have to massage her a few more times. Rian cleaned up the bed as best she could and brought J an ice pack. That seemed to help her a bit.

"Tiffany was leaving the room and I followed her out and thanked her and told her that was the best birth ever and it was one of the births that you read about in books and hear about and look forward to one day witnessing. She thanked me and said she was really impressed with me and said I was so calm and so there for J the entire time. She also thanked me so much for referring J to her practice and that she would definitely refer people to me in the future. I thought that was really sweet too.

"Rian came in a few minutes later and weighed her and measured her. She was 7 pounds, 8 ounces and 19 inches long. Then J's mom decided to take the nieces back home and go relieve the baby sitter that was with J's younger two children. So that left J and I. It was nice to have that time to reflect on the birth with her. She kept saying how she couldn't believe how great she felt and how after the birth of her first baby she was completely wiped out and wanted the baby taken right to the nursery and she just passed out. The baby still hadn't left her chest and she couldn't imagine her being taken away. She said she couldn't believe how everything had gone so perfectly and I pointed out that it was because of her - this doesn't just happen out of nowhere. It happened because J researched and educated herself, she switched providers and switched birthing places that she was in a more supportive environment. She made her birth plan, she had an excellent birth team. She allowed herself to be completely consumed by her labor and stayed inward the entire time. That is why everything happened so perfectly. And it should happen that way - this is how birth is supposed to be. I told J that this was by far the most wonderful birth I had ever attended and one that I will certainly never forget. I told her it was one where I left feeling completely "full" and not depleted at all. I told her how special it was to have been there with her. I am already looking forward to having my own babies, but seeing J birth just gave me all the more inspiration that I too will be able to do it someday.

"Rian came back in and took the baby to the warmer and did the eye drops and vitamin K and all of that. This had all obviously been delayed at J's request and it was not a problem. The baby went back to J to nurse for a bit and then Rian gave her a sponge bath and dressed her in a cute little outfit J had brought. Then Rian got J up to go to the bathroom. J came back out in those lovely giant panties made of netting with the worlds biggest maxi pad tucked inside. She got back into bed and just looked so great though. Then we moved to her postpartum room. I carried her things and made sure she was settled and had everything she needed and then I went home a little after 1am on the best birth high ever."

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Welcome to the Bethany Women's Healthcare Midwifery blog!

As we evolve our midwifery practice, it's out goal to keep technology out of the birth environment. But that doesn't mean we can't use technology to communicate and reach out to the blogoshere! Technology can be good in some aspects and we want to stay current, so hence our new blog.

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