Repeat clients, Ashley and Stephen, welcomed their second baby in the most beautiful healing, family-centered cesarean, the likes of which are sadly still hard to come by in our area. Ashley’s first baby was in the breech position late in pregnancy, and given her provider’s protocols, welcomed that baby in a scheduled c-section. It wasn’t bad, as c-sections go, except it left her feeling like she missed out on something. And the separation from her baby initially did not help her to feel bonded and like she birthed her child. So, when she saw the positive pregnancy test, she was on a mission to do all she could to have a very different birth experience. This began with securing her best chance for a VBAC. Her unicornuate uterus was a potential challenge, as it would make her second baby more likely to settle in the breech position. But she was not swayed from her goal and did her part with optimal fetal positioning.

But her baby was confirmed breech late in the pregnancy and since she had the previous uterine scar, her providers were not comfortable doing an external cephalic version (rotating baby to head down by manipulating the mom’s belly). Ashley was extremely disappointed and at a loss for options. She studied Spinning Babies and even invested in an inversion table, but to no avail. Her son was still breech. So before completely consigning herself to a repeat c-section, Ashley sought a second opinion. Enter West End Midwifery. This second opinion would turn out to be the single more important thing she did to impact her birth. In one visit just a few weeks from her due date, Ashley felt listened to and the skilled obgyn was able to successfully rotate her baby to the head down position in an ECV. She and her husband drove the 90-minutes home with a renewed fervor and desire for the VBAC they had originally hoped for. Ashley planned to stay with her original providers but as her blood pressure trended higher that week, there was strong talk of admission to the hospital and induction. So, Ashley officially switched care to West End Midwifery in Richmond, making the weekly drive and keeping close tabs on her blood pressure at home. The trust her new providers had in her was illuminating and really helped her to feel supported to follow her intuition regarding the birth.

Then Ashley was thrown another curve ball. Her water broke. I got the text at 8:30 that morning. She called her new providers who recommended she make her way up to Richmond to be seen in the office. Her water was confirmed broken so the doctor recommended she drink a castor oil shake, get something to eat, and walk around. It didn’t take long for Ashley’s uterus to start contracting and by late that afternoon, Ashley’s contractions were steady at 5 minutes apart. She could still talk through them so they would keep me posted. A couple of hours later, hooked to the monitor and admitted to the hospital, it was time to join them. Ashley’s contractions were relentless at 5 minutes apart and stopping her in her tracks—no walking or talking. I arrived by 9:00 that night.

I was immediately amazed and impressed by what I saw. There were twinkle lights strung from the ceiling and a diffuser with essential oils filling the room with lavender. The diffuser was plainly marked as hospital property, which was an amazing addition. In the corner were various birth balls, a peanut ball, and even a cub inflatable birthing chair. The room was abundantly equipped for labor, and aside from the hospital bed, might have been mistaken for a birth center. The shower and tub were one, and included jets and two shower heads, one removable for more focused hydrotherapy. Perhaps most intriguing was the trio of lights that could glow in virtually any color imaginable. Ashley could truly make that space her own and could envision welcoming her baby in that space. It goes without saying that they had multiple wireless options for monitoring—the telemetry unit, but also the Monika which is a sticker monitor that allows excellent contact with baby and laboring freedom for mom.

Ashley had some scar tissue from a previous LEEP that her doctor tried to break up. She was laboring hard but her cervix was not opening. She was left to labor freely as she wished, while her nurse checked on her blood pressure regularly. It did creep up but following hospital protocols, Ashley was given some oral medication before any talk of magnesium. Thankfully, it lowered her blood pressure and secured her freedom to continue laboring without an epidural.

Ashley spent most of the night doing every possible thing. She labored on her hands and knees, sitting on the birth ball and birthing chair, walking the hallways, all while waves of nausea came and went. Peppermint essential oil was a permanent fixture whether in the diffuser or close by on a cotton ball, a much more pleasant and effective tool for battling nausea. She took a walk on the unit as well but returned to her room shortly thereafter. She was do drawn into her labor to be out and about. This was a good sign of progress, it seemed. I did the Three Sisters of Balance to bring Ashley’s pelvis into balance and she had an emotional release in the process, a very healthy thing for her to do! I hoped in the letting go of her tears she might also be able to let go within to birth her baby. 

And as expected, Ashley was growing weary. So, we positioned the bed into a throne to allow her to lean back against a pillow between contractions, and labor upright and forward without having to fully support her weight on her knees and legs. The doctor came in to do an exam and despite 10 hours of regular contractions, Ashley was still not dilated. He suspected the scar tissue was the culprit but to break it up he would need to be more invasive than previous attempts. To preserve her energy, provide complete pelvic relaxation, and to help maintain a lower blood pressure, Ashley opted for an epidural. She felt safe and supported in her choice, knowing her doctor was trying valiantly to give her every chance at a VBAC. This was one in many steps toward that end. Once comfortable, the obgyn broke up the scar tissue and inserted a foley catheter to hold the cervix open until it dilated on its own. Pitocin was also added to the mix at 6:30 to bring stronger contractions than before. They had also spaced out as Ashley rested, so it would bring them closer. Her water had been broken for 22 hours at this point.

Shift change at 7:00 am brought a new nurse and a new doctor and midwife. Before the original obgyn left, he removed the foley and was pleased to confirm that Ashley was dilated 6 cm. His strategy seemed to be working. With pitocin at 8.0 mu, we were hopeful for an active labor pattern and continued cervical change soon. Ashley breathed more deeply into each contraction, a clue to us that they were intensifying. She continued her laboring most of the day, just as she had overnight. We changed her position in the bed from side-lying with a peanut ball, to side-lying with a stirrup, and even to hands and knees. But by that afternoon, even after position changes and steady pitocin and consistent contractions, Ashley was dilated to 4 cm. But more significant than that was the fact that her baby had not moved down at all. This was very telling and it was time to have a frank conversation. 

The midwife recommended a c-section but one very different than her previous. She would have both the obgyn and the midwife participate in the birth. And here is how it went. The obgyn did the surgical part of the birth and their baby was birthed into the midwife’s hands and passed directly to Ashley. There was no stop at the warmer. Instead, he went straight to his mother for instant skin-to-skin. He cleared her fluids well with crying and some bulb suction, and Stephen cut his son’s cord as he rested on Ashley. They were never separated at any point during the c-section. Benton Leopold was born at 4:18 pm on March 31, 2021 in a very healing birth.

Ashley was returned to her labor and delivery room for her recovery period and Benton latched well for her, especially after his uninterrupted skin-to-skin time. He weighed 6 lb. 6 oz. and spent his first hour of life in his mom’s arms. Ashley emerged from the birth with the most peaceful smile on her face. She was thrilled to have a healthy baby but just as excited to feel the healing that comes from feeling heard. Ashley was met at every turn in Richmond with open minds and hearts. And when her baby was born 32 hours after her water broke, there was not an alarmist response. Instead, she was met with patience, reasonable diligence, and open communication. Ashley was beaming! In welcoming her son, she also welcomed her own motherhood, a stronger, more self-assured mother. She found her voice and listened to it this time, doing the hard things like driving far, and using every possible comfort measure and position to make it happen. She can do hard things. And in doing the hard things, she found herself. And I couldn’t be happier for her or more honored to have watched it happen. Welcome to the world, Benton Leopold! 

I’m sharing a birth experience that is quite different from the ones you see here. The mother has requested it be shared because her son has a story, just like every baby. And as his mother, she would like their journey acknowledged, however heartbreaking it may be. Megan and Dan’s journey to parenthood was not easy. Through the gift of medical advancements, they were able to conceive through IVF. After the very real awareness that birth doesn’t always just happen, Megan waited with reserved excitement for the confirmation that her pregnancy “took” and she was indeed on her way. She reached out to me on the earlier side, dotting her I’s and crossing her t’s to insure a healthy pregnancy and birth. She had done her research and selected midwifes are her primary care providers, with the goal of minimizing interventions during her birth. She and Dan attended my childbirth class at the height of the COVID-19 pandemic, virtually, and would also welcome their baby in the midst of protocols to insure safety and limit the spread of the virus. We had our prenatal visit in their home, and discussed everything from logistical details to comfort measures, and even deviated to plants. When we parted we were looking eagerly forward to Megan’s birthing time and the fulfillment of her longtime dream of having children of her own.

Megan sent weekly updates following her prenatal appointments. All was well, meaning baby’s heart rate was good and he was growing fine. Her cervix was making subtle changes, but it was looking like her baby would push the envelope and gestate on the longer side. An induction was scheduled for February 24, but we hoped it wouldn’t be necessary. Then the phone call came, not a text like the weekly updates that final month telling me all was well and mom and baby were healthy. This was different. I could hear it in Megan’s voice. She had been crying. “They couldn’t find his heartbeat.” I couldn’t believe what I was hearing and I fell silent. A pit formed in my stomach and I held it together with an “I’m sorry.” This was devastating and I began to hold Megan’s space. Dan was on his way to her and details would be hammered out regarding support. But they were soon heading to the hospital for an induction a day sooner than expected.

Megan wrapped her head around the drastic shift in her reality and her thoughts of a natural birth suddenly felt impossible. “How can I honor Theo with the birth I have been preparing for when I know he won’t be coming home with us?” She was not afraid to ask the hard questions. She did her research and communicated openly and I answered her difficult questions as well as I was able. I responded with the reassurance that there was no wrong answer and she would find the best path for laboring her baby into the world. She would know the best thing to do and I would support her unconditionally in that. And Dan would love her the whole way through as they walked that devastating journey together.

The induction process was slow, as is often the case. But there was no cadence of a heartbeat to break up the monotony and remind her of why she was doing the work. It was a means to an end and one that she knew would be difficult and so very different than the meeting she had been envisioning for so many months. Years really. The first step was a foley bulb to encourage Megan’s cervix to open a bit more so it would be more receptive to pitocin. Megan tried to sleep that first night but it’s hard to sleep when your heart is broken and your mind is reeling. But she needed rest more than ever and she still had labor coming. Pitocin was incorporated and with it came stronger contractions. Megan accepted iv medication to help her rest and relax, as well as take the edge off the labor pain that had already begun. It could not touch the emotional pain though. An epidural soon followed, but it was not effective and Megan had several hours of intense labor even so.

Once her labor picked up it took off, which was a small mercy in the midst of such a task. Megan was dilated 8-9 cm by midday and the realization began to hit that Theo would be coming soon. We reminded Dan to eat and both of them to rest but self-care is especially difficult in grief. Megan’s body came through in amazing fashion, dilating rapidly and moving her baby down to +2 station in a short couple of hours. She continued to feel break through pain, the physical kind. But the emotional pain was just as acute. Megan began pushing sooner than expected and moved through that phase with a courage that I cannot fathom. It was a challenge she knew she had to face, and she did so without the reliable aid of the pain medication button. She relied on the physical pain to cue her to push. Megan used immense strength and powerful emotion and brought Theo out of her body with a tearful roar. He was born at 3:09 pm on February 23, 2021. And in his birth he was also gone.

The midwife gently placed Theo on Megan’s chest and she grabbed hold of him. There was no vigorous rubbing to elicit a cry. Just a gentle stroking to wipe away some blood. Dan reached out to touch his son and immediately noted all of his perfect parts. “He has ten perfect fingers and ten perfect toes,” Dan whispered. Then he laughed to see the same “mean mugging face” that Megan’s dad had. Her father was Theo’s namesake and had passed away just two years ago. Seeing his expression was heartwarming and heartwrenching at the same time. He was in that room though. Megan and Dan had a lot to get to know in a short amount of time and they relished the opportunity to become familiar with their son. They were given a cuddle cot so he could spend some extended time with them before their final goodbyes. Theo was perfect. He just looked like he was asleep and I suppose he was. The cause of his sudden passing was clear at the birth and something that could not have been prevented or foreseen. It is also a very rare circumstance. But those words don’t bring comfort when your son is the rare case.

I held their space and took pictures. Megan’s nurse was kind and compassionate. She gently bathed and dressed Theo in the outfit of his parents’ choosing. It fit perfectly, although we initially had out doubts. Theo weighed 9 lb. and was 22 ¼ in. long. He had chubby cheeks and substantial shoulders and a head full of dark hair. His parents memorized those details along with so many other things none of us could begin to imagine.

There was palpable love in that room. There was sadness, yes. There was great sorrow. But there was also talk of family and stories told. Megan and Dan laughed over memories from their wedding that were ridiculous and endearing, and only made their experience more precious. I could see how much Megan and Dan valued family and how much they loved each other. I could see how much they loved their son. They modeled patience and courage as they walked through the most difficult thing a human can. They will continue that walk lifelong. I also saw yielding and openness and hope as the mention of children entered the conversation. And spring was a promise just a few weeks away, hinted by the first color growing from the ground and the first buds of the trees. I will always cherish the hours spent with Megan and Dan and the beautiful reminder it was of the strength of parents’ love and how it transcends space and time. And knowing how fleeting life can be, remembering to savor every little thing. For you just don’t know. Holding space for this sweet couple today and every day. Thank you for your lessons to us about love and loss, and for wanting to share Theo’s story.

I’m so pleased to announce the Rachel and Jason have welcomed their second daughter, Quinn Hawley. Rachel had a long and involved first birth and hoped things might be different the second time around. After all, every birth is unique and offers the same clean slate as a first birth. She did make some changes to her preparation, however. She enrolled in my refresher class, enlisted care with a chiropractor, and hired me as her doula. We were in communication off and on after appointments, and we had our prenatal visit and discussed logistics and Rachel’s birth preferences. It was a nice chance to reconnect and to meet Jason! (Thank you, Covid.) And after that, we were left to simply wait and see.

Rachel’s cervix made some gradual changes leading up to the birth. She was dilated 1 cm at 39-weeks and she felt pain in her hips as her body got ready. She incorporated the Miles Circuit into her routine in the hopes her baby would have the benefit of optimizing her position for birth. But ultimately it would be up to Rachel’s baby what she wanted to do. And on February 25, around 4:00 pm, Rachel texted to tell me she had felt the rhythmic cramp of contractions every 7 minutes for about 4 hours. They were mild enough to minimize and mostly ignore, but she did have to breathe and focus through them. By 8:00 that evening they were a little closer and a little stronger, so she labored in the shower for the second time to help her relax. 

Things continued to intensify through the night until at 12:10 am her water broke. And the contractions jumped to 3 minutes apart just 20 minutes later. With the contractions very strong, Rachel and Jason left for the hospital shortly thereafter. Rachel had done some work at home because her cervix was dilated to 7 cm upon arrival. Things appeared to be moving right along and we thought there might be a baby before sunrise.

After her initial stint on the monitor, Rachel went straight to the shower to labor. She sounded through her contractions and we angled the shower to hit her back just so. The pressure intensified in her bottom too. Rachel called the shower a “miracle worker,” she found it so helpful. And she labored in there for over an hour. She had opened to 8/9 cm by shower’s end and her baby was at +1 station. Conditions seemed right for pushing sooner rather than later. Rachel used a squatting bar on the bed to squat into the contractions in the hopes her baby’s head might melt her cervix away. The playlist “Push!!” filled the room with rollicking tunes Rachel had selected for that purpose. And we applied counter pressure to her lower back through each contraction where she felt the most discomfort. 

Rachel used the rebozo to dangle through contractions as well, with the same goal of opening that cervix. And she lunged on her hands and knees through several contractions too. She was doing every single thing to get her baby out, but she was hitting a wall. It was time for some information and to possibly make a change. Her nurse confirmed that there was still cervix and also that her baby was trying to rotate! Rachel labored on her side and pushed a few times that way, but her cervix wasn’t budging. The midwife recommended some Pitocin to give more oomph and Rachel was willing to try. She had been up all night though, and the day was looming large in that moment. So Rachel decided it was a good time for an epidural. And thankfully, unlike her first birth, the CRNA administered it quickly and effectively, providing the relief and relaxation (and rest) that Rachel was counting on.

Two hours later at 9:20 there was the tiniest bit of cervix left. It was stretchy but would not yield to the midwife’s hand. So we rotated Rachel one way and another, incorporating the use of a peanut ball and stirrups to maintain an open pelvis. About two hours later, Rachel felt pressure in her bottom and an exam confirmed that her cervix was completely gone! And after laboring down another 40 minutes she began to push. It wouldn’t be easy, since her baby was determined to be in the OP position. Rachel was no stranger this since her first baby was in the same position and rotated at the very last moment. This baby appeared to be gearing up to do the same thing. But Rachel was game to push on her hands and knees which would prove to help rotation! Baby’s heart rate dipped, which isn’t uncommon during second stage. So an oxygen mask was placed over Rachel’s face to help give her little one a boost. Rachel continued to push in various positions—why stop moving at second stage, right? Her stamina and tenacity did not wane. It was there in full force all the way to the end of her marathon labor. All told, Rachel pushed for just over an hour and her baby was born at 1:18 pm on February 26, 2021 with the cord wrapped around her neck twice. (That would explain some heart rate dips that showed up late in labor.) Welcome to the world, Quinn! She weighed 7 lb. 12 oz. and was 21 in. long. 

Rachel cried at the sight of her daughter – relieved, exhausted, elated, and happy tears! She did it! And she did it without even tearing, which was another huge win for her in comparison to her first experience.  Quinn needed a little bit of stimulation to get that first robust cry and to transition, but she was back in her mom’s arms a few minutes later and was latched at the breast at less than 20 minutes old. And that gave her parents the chance to investigate how she looked like family. She looked like her sister, only different, and she had a hairy back like her great grandpa! 

Rachel’s labor is one that defied our preconceived expectations of second labors. And shame on us for trying to predict what a baby can do! For ultimately, we really have no clue how a birth will unfold. We only grasp at generalities that happen more often than not. When it comes to birth, the most important skill is to be flexible. Rachel exemplified this! She was an expert at dodging and weaving with her birth journey. She took her labor one contraction at a time and was able to labor through another birth experience that took about 24 hours. She is a rock star in my book and she also managed to maintain her sense of humor too. Once again, this is an important mothering skill so Rachel is well equipped with two essential skills. Congrats again on another surprising birth and a beautiful baby! 

Shelby and Ryan welcomed their second child, Jeffery Clay, on February 4, 2021. (Fun fact: He was the third birth I attended on that exact day. It was a record-breaking doula day for me!) After giving birth the first time, Shelby realized what she valued in her birth experience and what she would want to do differently. Shelby prepared her mindset by reading many books that reinforced her goal for an unmedicated childbirth, and she took the advice of her labor and delivery nurse friend, and set up an interview with a doula. (I was the lucky doula she met.) And we soon began our client/doula partnership.

Shelby sent me a text just before 8:00 pm on February 4. She knew I had been up the previous night at a birth and then attended another one right after, so she held off texting me until she was pretty certain she was in labor. The first text came through at 7:51 pm explaining some signs she had been seeing and feeling. She developed contractions low in her groin that incorporated her entire uterus. And she was trying to decipher if they were labor contractions or perhaps her uterine response to a membrane sweep that had occurred at her appointment earlier that day. Then two minutes later she texted to say that she was 99% sure her water JUST broke. She called and spoke with her midwife and with contractions already coming 5 minutes apart and getting stronger, they left for the hospital within the hour. We decided to meet there and go in on the “early” side (so we thought), to allow Shelby time and space to settle in and labor.

We arrived at virtually the same time and were able to walk in together, all three of us. Shelby was triaged and breathed and swayed with Ryan through intensifying contractions. She declined an exam since she was dilated 4 cm at her appointment the previous day and her water had broken. Shelby also sang through her contractions until she was no longer able to, which was around 10:30. Over the course of an hour in triage where she got an iv setup for antibiotics, spent some time on the monitor, answered all of the admission questions, and also breathed through contractions, and finally got an exam by her midwife, Shelby was dilated 7 cm! 

Her labor had definitely taken off like a shot and she felt her son’s head deep in her pelvis with each contraction. There wouldn’t be time to use the shower like we had discussed. Instead Shelby was staying in the moment coping with one strong contraction at a time. After laying in the bed for the monitoring, she took a trip to the bathroom, and then we moved the bed into the shape of a throne for a more upright labor position. Shelby leaned forward with each contraction and felt immense pressure down low. We put cold wet washcloths on her forehead and neck as her body heated up with the work of labor. 

Shelby moved to her hands and knees upon the throne bed and that’s where her baby really moved down. Ryan used a rebozo to lift Shelby’s belly, providing some relief from the intense pressure. And something about that position and where Shelby was in her labor made for a perfect combination to send her headlong through transition. She vocalized with her contractions and with no time to even fetch the squat bar she requested, Shelby crawled higher in the bed and labored sitting in a semi-squat on the bed through her contractions. She breathed in some peppermint essential oil to stave of the waves of nausea rode in on transition. And in no time it was clear that she was about to have a baby and her midwife needed to get dispatched quickly.

Shelby was involuntarily pushing and it didn’t take long. She cried out her power as she brought her baby down, and she even reached down to feel his head for herself. That only motivated her to push again and when she did his head was crowning. Shelby paused and blew out air as her baby crowned and it would be the reason she didn’t tear too. She pushed as her midwife encouraged her, and after his head was out the rest of his body came into the world. Jeffery Clay was born at 11:29 pm in the unmedicated birth his mom had been hoping for and prepared for. Her face was the picture of such joy! She cried and then she was elated, exclaiming, “I can’t believe I did it!” So much emotion was felt by both Shelby and Ryan as they took in the details of their son. They even noticed that he had a flattened nose like his big sister did, the result of a baby whose face is squished up against the uterine wall for a long time. Clay weighed 8 lb. 2.6 oz. and measured 20 ½ in. long. But they wouldn’t know those details until after the magic hour was over.

Clay was latched to his mom’s breast not long after birth, and Shelby coasted on the euphoria of the oxytocin as she tried to remember the timeline of her labor. It’s a difficult thing to do in the midst of that hormonal haze whose purpose is to dull the details and heighten awareness for bonding, so we helped. All told, Shelby was in active labor a total of maybe 4 hours. It’s really quite remarkable and encouraging how different each labor can be. And sometimes when it goes the way this one did, it has mom already thinking of her next birth! I was so proud of Shelby and honored to be there to stand beside her as she realized her strength. I knew she could do it!

Ashley and Wade welcomed their second beautiful baby girl, Jolene Renee on February 4, 2021. This birth was so different from the first, and believe it or not, was a bit more challenging for a few reasons. The biggest difference was the fact that the COVID-19 pandemic was in full swing. Initially, we weren’t even sure whether I would be providing doula services virtually or in-person. Thankfully, by the time Ashley was nearing full-term, doulas had been reinstated at her hospital as part of the birth team, not a visitor. This provided great relief to all of us. We had our prenatal visit, as is customary, and Ashley and Wade explained their rock-solid plan for big sister’s care during the birth. Grandma would be on an extended visit with them as the due date approached. Believe me, this alone helps to alleviate a huge potential stressor, and would allow Ashley to let go more easily for labor.

Still, she had weekly membrane sweeps at the end since that seemed to work for her first labor. But this baby was different and those sweeps didn’t get things going as soon as expected. In fact, Ashley remained pregnant a bit longer than her first pregnancy, making gradual movements toward labor in those final weeks. She was 1 cm dilated at 30 weeks, then 2 cm dilated on her due date. Ashley felt minor contractions that started at 2:00 am on her due date. They were erratic but persistent. By 5:20 that evening Ashley knew the contractions were regular but they were far apart at 20 minutes. So continued to ignore them and went along with her regular evening routine.

And just past 1:00 am everything had changed. Ashley’s contractions were not yet a minute long but they were very strong, requiring her full attention. They continued to intensify to just 2 minutes apart. And while they were still short, their intensity was enough to have Wade and Ashley head to the hospital. After her initial triage, she was confirmed 4 cm dilated. And while this was not as much as she had hoped, her first birth experience was a lesson in “ignore the numbers” since she zoomed from 4 cm to baby in a very short time.

 Some i.v. fluids came on board to help baby’s heart rate stabilize and it appeared to work. Wade did belly lifts to relieve Ashley of lower abdominal pressure as her baby worked to find her place in the pelvis. Something was a bit off in baby’s position since Ashley’s labor had been so protracted and erratic. So we encouraged Ashley into some positions that might help. Labor picked up quickly after arriving at the hospital, and Ashley was quickly drawn deeply into focus and listening to her body and intuition. And by 4:45 am she was dilated 5-6 cm, 70% effaced, and her baby’s head was still high at -2 station. 

And not thirty minutes later, Ashley’s body began to shake—a normal sign of the hard work and muscle fatigue that come with labor, but also a sign of transition. She thought her baby was coming soon and wanted an exam an hour after her previous one. She learned she was 6 cm and 90% effaced and it was not what she was hoping to hear. But Ashley forged ahead. And you know what she did? She lunged. She didn’t like it but she did it anyway! We thought it might encourage her sweet baby to rotate too.

But she had hit her wall and was ready for a change. Ashley asked her midwife to break her water. Yes, her midwife ended up coming on duty right as Ashley entered transition! She had her water broken at 7:00 am and her cervix opened rapidly from 8 cm to 9 cm. And with the very next contraction after that, Ashley was pushing! She pushed with such strength that she brought her baby down lightning fast. We watched as Jolene rotated one way and then the other, and got herself situated out of the OP position at the very last second! She came barreling into the midwife’s hands at 7:11 am on February 4, 2021! And she weighed 8 lb. and measured 20 in. long.

Ashley welcomed her second daughter like her first, in a birth free of pain medications. But so much of it was different! Her baby’s position likely delayed the onset of her labor and when it did, it made it take even longer. Then when the conditions were right, her body moved quickly to bring Jolene into the world, just as a veteran pelvis is known to do. Ashley hit a wall or two, and looking back she is still amazed she was able to do it, considering the added challenges she had this time. But we always knew she could. And in her wavering moments, Wade was her champion, speaking encouragement and strength to her without fail. And always having her back, literally and metaphorically. 

 Welcome to the world, Jolene Renee! May you always celebrate your birthday with a free Slurpee from 7-Eleven! And be sure your mom gets one too, why don’t ya. She certainly deserves it!!

In the midst of a pandemic, when things are just so crazy, and extra restrictive protocols exist, it’s inspiring to see a woman transcend the baggage of the present moment, or even the past, and meet her baby in her chosen way. Introducing sweet Amara Forrest and her strong mom, Hannah. We met many months prior and Hannah made her goals clear to me about wanting as natural a birth as possible. She also explained that her birth partner would not be the father of her baby, but rather her best friend. We got to know each other over the 8-week childbirth education series I taught, and we suddenly found ourselves on Hannah’s due date.

Now ordinarily that doesn’t mean much. But I should have known. At 5:12 the morning of her due date, January 12, Hannah texted to tell me she was having waves on a regular time cycle. They were getting longer and closer and felt quite different than the Braxton Hicks she was accustomed to. Rest and hydration was the plan and she would update with news. Turns out Hannah had a challenging morning. She was vomiting often and having a hard time even keeping fluids down. Her friend, Rosey had made red raspberry leaf ice chips but that was the only thing Hannah could take in. Her contractions were coming 3 minutes apart and lasting more than a minute. So with an hour-long drive they thought it best to head to the hospital around 11:00 that morning.

Just past noon they arrived. And after going through the initial questioning, Hannah was checked and confirmed to be dilated 3 cm. But she definitely wasn’t acting like it! Her midwife suspected she was dehydrated so she recommended a bag of fluids to see if it helped her contractions to be more effective. Hannah and Rosey labored in triage for three hours. Apparently it was a very popular day for babies to be born. But some wonderful things happened over those hours. Hannah labored in positions that felt most intuitive to her, and as her contractions escalataed she met them with vocalizations. Then when she suspected a gush that might be her water breaking they summoned the nurse. Hannah was 7 cm dilated and would finally be admitted to a room! The bag of fluids definitely did the trick.

Once in her room, Hannah headed right for the shower, knowing the water would bring some relief and help her to stay loose and open through the intensity of her contractions. She continued to vocalize in the shower as Rosey and I encouraged her and spoke strength to her. Hannah was working hard and though she never wavered, she was definitely in unchartered territory. She blew through the pressure she was feeling so as not to push. Then she felt some stinging and reached down to feel what she thought was her baby’s head. It wasn’t, it was her bag of water. But her baby was not far behind.

Hannah made her way out of the shower and back onto the bed to see if it might be time to have a baby. She felt a whole lot of pressure, after all. And sure enough, Hannah was fully dilated and her water broke during the exam as if to punctuate the discovery. She rolled over to her hands and knees and pushed in a kneel before leaning over the birth ball to push the couple of contractions that remained. Hannah pushed her baby out so quickly, even her midwife didn’t expect it. She had stepped out briefly and in that short time (one contraction!) Hannah brought her baby’s head down to her perineum. The nurse came in to cup her hand in protection, and another push brough the head and the baby’s body right as the midwife returned. Amara Forrest entered the world calmly and quietly, giving her nurse her first catch! Hannah pushed through only a couple of contractions before welcoming her baby at 3:39 pm on January 12, 2021.

Hannah was in awe and wonder as she looked upon her daughter, and then the emotions flowed with the tears. “She’s so beautiful!” fell from Hannah and Rosey’s mouths. Hannah lay down upon the bed and cradled her Amara with such joy and tenderness. Her instincts kicked in and she longed to bring her baby to her breast as soon as possible. Her placenta came in time, shaped like a heart, but there were some complications that would require some assistance postpartum.

But in the meantime, Amara nursed for 25 minutes straight and her mom fell deeply in love with her and became a doting mother in an instant. She and Rosey were a beautiful partnership in labor and to see them was reminiscent of the days when women always birthed with women by their side. Amara weighed a chunky 8 lb. 4 oz. and was 21 ¼ in. long. She had such a thick neck roll I would have guessed she weighed 9 lb. for sure!

Leaving this birth had me feeling hopeful in some ways, as I saw my client rise above the medical constraints that are endemic to the hospital setting during a pandemic. I also saw her triumph through a challenging separation from her birth team in triage, finding her way one contraction at a time with virtual doula support in the interim. It was not ideal, to be completely honest, but in these crazy times, we were all grateful to have been connected and ultimately reunited for the most trying part of the birth. I am so thankful for being invited into a sacred space and for being reminded of the autonomy and strength that resides in every birthing woman if she is given the opportunity to express it. And thank you for my first ever doula baby to share my first name!

I’ve been doing some soul searching the past few months in regard to birth, and the transition into a new year has brought the feelings and intention for change welling up inside me so much that I need to express them. So here I go. Those who are involved in the birth community of Hampton Roads as birthing families or birth workers, are aware that right before the pandemic hit our country full force, a beloved labor and delivery unit which included a midwife staffed birth center, closed its doors. This was a huge loss for our birthing community, one that was felt acutely by countless people locally but also spanned the globe as previous birthing families had moved away. After all, it had been in operation for over 25 years, and with our highly mobile military presence, their influence on birth and the beginning of parenting has spread far and wide. The Midwifery Center had tubs for laboring and birthing, which were a huge draw for many families. But more importantly, those who were intended to birth in the Center were met with openness. Their midwives listened and gave options, and trusted in the birthing woman and the innate safety of birth. And since there is always the potential for risk, the collaboration between midwives, OBs, and pediatricians, and nurses created the best of both worlds. As risk factors developed the elevated level of medical support was available. However, by and large, birth was safe and low risk, creating the opportunity for women to welcome their babies with minimal intervention. Options like intermittent monitoring, eating in labor to their comfort, laboring and birthing in a variety of positions, and even the option of laboring and giving birth in a tub were the norm. 

The pandemic hit like a tidal wave right as so many were adjusting to ache of such a loss. The OB practice reestablished itself in a different facility, and with change come growing pains. To be frank, there was some resistance from staff in part due to lack of information or understanding, but also because the expectations of birthing women were significantly different than the status quo of birthing the staff had grown familiar with. Women who had come to expect a certain sort of care from their providers, were having to conform their wishes to the hospital rules and protocols, all while navigating the fear and panic brought on by COVID-19. To be fair, the pandemic affected the labor and delivery units of all of our hospitals. They struggled to balance safety and choice, all while incurring the additional responsibilities like COVID tests, enforcing mask wearing, and a higher level of PPE for the safety of all. However, many thought some of the COVID protocols were extreme with the risks and benefits balance questionable. Doulas were excluded from the birth space physically, relegated to virtual support at all hospitals, except one. Only one support person was allowed, leaving laboring women to make difficult choices about who would attend them. Babies were separated from moms with positive COVID tests, and masks were required by laboring women until a negative COVID result was confirmed. Women who tested positive would be required to mask up for the duration of their births. Many families chose to give birth at home where they still had a sense of agency in who would be present and how they would birth. This was a very good thing for our homebirth midwives as well as the families served, for it gave them a higher level of recognition and appreciation, while shining the light on birth as a natural process. Our homebirth midwives had more work than they could handle. And many in the birth community were very excited about it.

Yet here we are nearly 10 months later, still adjusting to this new normal. Some restrictions have been lifted, like virtual doulas and separation of moms and babies, with others in place to maintain a reasonable level of protection from transmission of the virus. But it is possible to normalize, embrace and accept low intervention birth even in the midst of the pandemic. It does not require a huge overhaul in policy, except perhaps the addition of birthing tubs. The change would involve a change in thinking. The time has come. ESPECIALLY in light of the pandemic. Birth is the same as it always was. The way we approach it has changed. At a time when fear for our health and safety has overhauled so many of our daily routines, we need to remember that birth for most continues to be normal and safe. 

Collaborative care, evidence-based practices, and listening to birthing families, really hearing them out and having a dialogue with them, are what it will take to change the mindset of staff. And above all, trusting the birth process is absolutely essential. Childbirth education, in-depth thorough education about the process of birth brings a confidence to women—confidence in their bodies and their ability to tune in to it. And they also feel more comfortable laboring longer at home. But education and trusting the process must also happen from the hospital side. Childbirth education that goes beyond a standard medicalized birth is just as important for the hospital providers and staff serving laboring women. Yes, the interventions are there if needed or requested, but they should also learn how to serve a woman who does not desire those things.  The care is quite different. Education is crucial to change mindset. For example, when a woman arrives at the hospital in labor, why not trust that they are actually in labor and skip the triage room? Triage brings with it the assumption that a woman might not be in labor, as if she must prove she is in labor before soiling a room. Why not assume she’s right and commit by admitting her to a room? If she has prepared for her birth with an in-depth childbirth education class series, she is much more likely to present in active labor. Education is a win-win scenario.

Things like dimming the lights, while seeming superficial, can do a lot to allow a woman to follow to her instincts and limit distractions. Music can also have a wonderful effect on the birthing environment and the temperament of the laboring woman and her support team. Aromatherapy is another way to do this, creating strong emotional responses that can relax and empower the birthing woman during key points in labor. As she nears delivery, that is not the time for lights to be switched on, a crowd to gather, and lots of rushing about. Late second stage is precisely when a minimal number of necessary support people enter quietly (without loud side conversations!) and take their places. This will better enable the woman to continue to birth in the way she had been up to that point, with limited distractions and the support of her core team. Only a nursery nurse is necessary unless elevated risk requires the presence of a pediatrician. All others are extraneous and very distracting.

After baby is born, and the baby is transitioning well—this does not have to involve aggressive rubbing of the baby for many minutes—the initial birth cry and subsequent movements and color changes are indicators that baby is transitioning. Evidence shows that babies transition best against mom’s skin. Mom can rub the bottoms of the feet to keep baby crying and alert just as well as a stranger can. The trained medical staff can glean a lot by looking and listening to baby. Intervene if necessary, but in most cases it’s not. Covering baby with a towel against mom skin-to-skin is the best way to maintain baby’s body heat. Rubbing the wetness off (and the valuable vernix!) doesn’t amount to much. Keep that towel still on baby she they can remain warm against mother’s skin and also benefit from the microbiome being established in part by that vernix.

And when it comes to breastfeeding, the first hour, deemed the magic hour in birthing vernacular, is for mom and baby to explore each other. It is not the time to rob a mother of her power by grabbing her breast and the baby’s head and show her how to feed her baby. There is plenty of time for that. Remember, one sustained feed in the first 24 hours is a normal expectation, even after presenting the breast every 2-3 hours during the day, and 3-4 hours overnight. Keep the lights dim to encourage baby to open eyes and take in mom, and try to limit lots of extraneous noise and side conversation. This hour is magical, remember. And it is made more magical by empowering mom and baby to learn and discover hunger cues and smells. The help is there if they need or ask for it. But don’t jump to intervene at the slightest delay of a latch.

I would love for women to have the option of laboring and birthing in tubs again. The evidence shows that it is safe and an excellent comfort measure for women in the most active part of labor. It’s a shame that it feels a bit elusive right now, but I know it can happen again with proper planning and exploring resources. Birthing families want options and that is an option in high demand but very limited availability.

I have seen midwives and OBs work side-by-side to insure the best outcomes for mom and baby. But I have also seen these same providers trust birth and trust a mother’s instincts when conditions are right and all is well, to birth how she wishes. I have been welcomed and respected as a member of the birth team, working alongside the medical staff and my clients as a valuable part. I have watched women feel strong, empowered, and trusted to know the best decisions to make for themselves and their babies. And I have seen women move forward into motherhood with the best possible start because of such agency in their birth and the respectful support received. Let’s come together to create normalcy in birth for options, less intervention, and trusting moms, and most of all for trusting birth. It can revolutionize not only the way birth looks, but the way birth feels, and the way mothering begins.