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What to Expect During Your Second Trimester

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The second trimester marks the second phase of the pregnancy journey. This trimester ranges from the 13th to the 28th week. Essentially, this trimester lasts between the fourth, fifth, and sixth months of pregnancy.

For most women, the second trimester is the easiest and most comfortable. The fatigue and morning sickness gradually begins to fade. Additionally, your energy levels are higher than in the first trimester.

Lots of body changes happen during this trimester. Your pregnancy belly begins to show as the trimester progresses. You also start to feel baby movements towards the end of this trimester. An ultrasound between the 18th and 22nd week will help determine the baby’s progress in the tummy. Here are the significant changes to expect during the second trimester.

1. Weight Gain

Typically, your weight increases as the pregnancy journey advances. The primary reason for weight gain is the increment in the size of your baby.

Towards the 20th week, the body weight grows by eight to ten pounds for most women. Essentially, your body weight increases by a pound every week. In some cases, the weekly weight gain might be half a pound. The average weight increment throughout this trimester ranges from 12 to 14 pounds.

2. Backaches

Back pains become more prevalent during this trimester. Weight gain during this phase builds up pressure, mainly on your lower back.

It will help if you use a couch or chair with a stable back support feature. Most women prefer sleeping on the side to ease the back pains. Additionally, shoes with low heels are more comfortable during this phase.

If the backache becomes unbearable, consider going for a professional pregnancy massage. Alternatively, you could request your partner, friend, or caregiver to gently rub your back.

3. Abdominal Cramps

You might experience mild cramps in the lower abdomen from time to time during the second trimester. Usually, the uterus expands to accommodate the growing baby. Abdominal cramps arise due to pressure on the pelvic muscles as the uterus expands. Other causes of mild abdominal cramps include gas accumulation and constipation.

Taking a warm shower will come in handy to soothe the pain. You could place a bottle filled with warm water around your lower abdomen. Soft belly rubs also help to minimize the pain. In case you’re experiencing sharp pain, seek immediate medical attention.

4. Leg Cramps

Leg cramps are quite common in the second trimester, particularly during sleep. Often these pains occur due to the baby’s pressure on the blood vessels. Additionally, the baby may also be causing pressure buildup in the nerves connecting to the legs.

Other leading causes of leg pains include calcium and magnesium deficiency. Make sure to stick to a healthy diet rich in calcium and magnesium minerals.

5. Mild Swelling

You may experience mild swelling in your ankles, face, hands, and feet halfway through this trimester. The main reason for swelling is increased fluid retention for your growing baby. In some cases, swelling occurs due to reduced blood circulation in the body. Indulging in physical exercises is vital to control the swelling. Additionally, avoid sitting or standing for a long duration. While sleeping, make sure to change sides occasionally.

6. Dizziness

Pregnancy requires your body to pump lots of blood. Subsequently, you may experience low blood pressure. Dizziness arises due to low blood pressure or hormonal variations in the body. If you’re experiencing frequent bouts of dizziness, consider embracing a healthy diet. Moreover, take more fluids to alleviate dizziness symptoms.

Other notable changes include skin sensitivity, bleeding gums, and nasal congestion. Amid all the changes that come with pregnancy, remember to create beautiful memories during this trimester.

Have questions about your pregnancy? Contact our midwives.

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8 Facts About the Placenta

The placenta is a vital organ that enables your baby to grow inside your womb. Within a few days of conception, this organ begins to grow. It takes over with the umbilical cord by the time your baby is 12 weeks old. This organ supplies antibodies, oxygen, and nutrients to your unborn child.

Here are eight interesting facts about the placenta.

1. Hormones
The placenta functions as a gland, secreting the HCG hormone that is responsible for the birthing process. It also produces estrogen and progesterone. All of these hormones are necessary in order for your baby to grow.
2. Immune System Support
This organ will transfer antibodies from the mother to the baby. It will provide around 3 to 6 months of immunity after the child is born.
3. Healing Fetal Cells
The placenta sends fetal cells to the mother in case of injury. These cells can also go to areas where there is diseased tissue in the mother, offering profound healing.
4. It Takes Two
This organ is created by both the dad and the mom. The cluster of cells formed when fertilization begins becomes the placenta and the baby. Both the sperm and the egg contribute to this process.
5. Disposable Placenta
The placenta is the only human organ that ejects itself when it is done. A new organ will be formed during each pregnancy and then is ejected when the pregnancy is over.
6. Edible
The placenta is edible. Many mothers eat this organ to help increase energy, boost milk supply, reduce postpartum bleeding, and balance hormone levels. This practice is done in many different cultures. The most common way to consume the placenta is through encapsulation. This is where the organ is cooked and dehydrated down and then put into capsules.
7. Spiritual Benefits
Many cultures believe that the placenta is sacred in pregnancy. In some cultures, it is known as an elder sibling or sacred twin. A Lotus birth will involve leaving the organ attached until the umbilical cord falls off naturally.
8. Cancer
The placenta will form in the body even if there is cancer present and will not be attacked by cancer. Researchers are trying to learn more about why this organ is not attacked by cancer. This may help in the future to protect against various cancers.

The placenta is truly a miracle organ helping your baby to grow and get adequate nutrition. The miracle of life would not happen without this amazing organ.

To learn more, reach out to us directly.
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Birth Plan: Why You Need a Midwife and Doula

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The Birth Plan

If you are an expectant mother, then you understand the importance of having a birth plan. Each couple will have a different plan for their pregnancy and birth; this plan is associated with their wishes and values. Do you have a birth plan? Does your birth plan include a Midwife and Doula? First, it is necessary to understand how a Midwife and Doula can help you before, during and after your pregnancy.

Midwives and Doulas

Ever since the beginning of humanity, women have been giving birth, and they have had individuals who were there to support them in their birthing process. Midwives and Doulas are the individuals who help mothers to create and fulfill their desired birthing plan. Even though these specialists have job descriptions that pertain to pregnancy and delivery, their responsibilities are actually quite different.

The Work of a Doula

Doulas are individuals who are particularly concerned with the mother’s comfort and care before, during and after the birthing process. Doulas are able to give the mother the comfort that she needs. This comfort can include massages, soft music, aromatherapy, encouraging words or other techniques that will help the mother to have the best birthing experience possible. A Doula is not a medical professional and cannot perform any medical procedure. She cannot help a woman give birth, she is only there for the comfort of the mother who is in labor.

What is a Midwife?

A midwife is a medical professional who works directly with a mother who is giving birth. The job of this specialist may vary according to the state where she practices. Generally, midwives have received training from an accredited establishment that has licensed them as a midwife.  Midwives are able to help the mother in the delivery process. A Midwife also has the skills and knowledge to know when a delivery may require the skills of an obstetrician.

Your Birth, Your Choice

You have a choice when it comes to your birth plan and who attends (doctor, midwife, doula etc). There are traditional methods, holistic methods and natural methods that you can choose from for your labor and delivery. There is nothing that can be more special or personal than giving birth, and a midwife and doula will help make the experience more comfortable and personalized.
We’d love to help. Contact us today.
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What Are Braxton Hicks Contractions?

Braxton Hicks contractions take place during the third trimester of pregnancy. These are different from regular contractions. Whether you are an experienced mom-to-be or a first-time mom, Braxton Hicks contractions can be worrying for you. In this article, we will explain Braxton Hicks contractions and how to know the difference.

Your Body is Getting Ready for Birth

We can look at these contractions as a practice for your body as it changes to prepare for birth. Some midwives even call them practice contractions to help pregnant women understand exactly why their body is contracting as early as the second trimester, NCT reports. We tend to associate any form of contractions with labor, but practice contractions are a way for your body to prepare itself to give birth.

How do They Feel?

Practice contractions begin as early as the second trimester. They are caused by your uterus beginning to prepare for the birthing process. What to Expect explains Braxton Hicks contractions begin at the top of the uterine muscles and will spread downward for 30 seconds. The timing of these practice contractions is irregular and last between 20 seconds and two minutes.

The intensity of these contractions is not the same as real labor contractions. They will cause your abdomen to take on a “pointed” appearance. When occurring early in your pregnancy, practice contractions will not be intense and can be eased with a change of body position. As you move through your pregnancy, you will find your practice contractions will become intense. Your contractions will not be as easy to halt with a change of body position.

Knowing the Difference Between Contractions

There are some ways of understanding the difference between practice contractions and real labor pains. The real labor contractions you face will be regular in length and intensity, growing closer together and more intense as you move closer to giving birth. In the majority of cases, a real labor contraction will last between 30 and 70 seconds in length, with a more intense feeling.

The pain and intensity of labor contractions are accompanied by other signs of labor. The Braxton Hicks contractions are easier to control and are not as intense as labor pains. Your cervix is not affected by practice contractions in the same way as it is with labor contractions that cause you to dilate.

For more information and support, reach out to us directly.

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Insomnia During Pregnancy

Are you pregnant and dreaming of the days when you would get tired and doze off easily? Getting a calm and consistent sleep now can seem like a tall order, thanks to insomnia during pregnancy.
Insomnia is a common culprit during pregnancy, especially in the first and third trimesters.

What is insomnia?

Insomnia is lack of sleep, or the ability to maintain sleep throughout the night. According to ejog, 44.2% and 63.7% of insomnia cases occurred in the first and third trimesters, respectively.

What Causes Insomnia During Pregnancy?

In the first trimester, hormonal imbalances greatly attribute to sleep disorders. Stress also contributes to sleep deprivation. New mothers-to-be are often anxious about being a new mother, delivery, and the labor process.

Other factors responsible for restlessness include:

Diet causing stomach discomfort at night
Constant bathroom visits
Hunger
Nausea
Heartburn
Hot flashes
Dreams
Shortness of breath
Restless legs and leg cramps
Back pains
Breast tenderness

Simple Remedies for Insomnia During Pregnancy

1. Lifestyle Overhaul

Work on your diet and sleep. Incorporate the following:

• Drink lots of water during the day but limit the intake hours at bedtime. This will help you avoid frequent trips to the bathroom.

• Steer clear of coffee, strong tea, and spicy foods. Caffeine keeps you awake for long durations and limits iron ingestion for the baby. Excessively spicy foods often cause heartburn and bloating, thus keeping you awake.

• Pull the plug on screens before bedtime. The blue light from mobile screens, tablets, and televisions often affects your eyes and may keep you awake throughout the night.

• Feed to sleep. Adopt a healthy diet that won’t cause you any stomach discomfort and will facilitate seamless digestion. Try having your dinner early and refrain from going to bed while hungry. A warm glass of milk also attracts sleep greatly.

• Exercise. Be active during the day to attract sleep easily. Take a 30-45 minute walk daily, or even jog.
• Take a warm bath and have your partner massage you.
• Keep your bedroom cool, dark and quiet. Tranquil environments help to attract sleep.
• Install a meditation app on your phone to calm you down.

2. Medication and supplements for insomnia

Control your restless legs by adopting folic acid and iron-rich foods. Folic acid nourishes pregnancies by forming healthy red blood cells and lubricating the gut.

There are so many options for supportive supplements. To get recommendations based on your unique circumstances, contact us today.

3. Cognitive Behavioral Therapy

CBT helps to counter restlessness by changing ones thought cycles. CBT relaxes the mind from unnecessary stress, tension and grief. You thus consolidate your thoughts and exude positive energy all throughout.

There are many other forms of holistic modalities and therapies that may help you through insomnia during pregnancy.

Lack of sleep when expectant is ubiquitous. With minor changes, it is possible to conquer insomnia. We’d love to help.

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What to Expect in Your First Trimester

You’ll have a virtually invisible but amazing transformation during your first trimester. Knowing what emotional and physical changes are in store during this early time in your pregnancy can help you face them head-on. Above all, your first trimester is a time to celebrate and feel incredible.

Physical Changes

A missed period is usually the first sign that you’re pregnant, but you can experience several other physical changes coming quickly in the next few weeks of your first trimester. They include:

  • Constipation – Having higher levels of progesterone in your system will slow down how quickly food makes its way through your digestive tract, and this can cause constipation. You should add fiber to your diet to help prevent constipation, and you’ll want to drink a lot of fluid.
  • Fatigue – During your first trimester, your normal progesterone levels will spike. This will cause fatigue, and adding light exercise to a healthy diet can help minimize it. Be sure to rest as much as you can too.
  • Food Aversions or Cravings – You may develop sensitivities to certain odors and your tastes might change. You could find yourself craving odd combinations of food or not being able to tolerate things you usually love.
  • Heartburn – Hormones will cause the valve between your esophagus and stomach to relax, and this lets stomach acid get into your esophagus. As a result, you may experience heartburn. Eating frequent and small meals while avoiding fried or spicy foods can help lower the risk.
  • Nausea and Vomiting – Morning sickness usually starts the month after you become pregnant. This can be with or without vomiting. You want to drink plenty of fluids and avoid having an empty stomach to reduce how nauseous you feel.
  • Swollen, Tender Breasts – Your breasts may become sensitive or sore within the first month or two. The discomfort levels usually go down after a few weeks.
  • Urinary Frequency – You could find yourself running to the bathroom more frequently. Your blood levels increase when you’re pregnant, and the kidneys will filter extra fluid into your bladder to cause you to have to go to the bathroom more.

Emotional Changes During the First Trimester

Being pregnant can make you feel anxious, delighted, exhausted, and exhilarated. Sometimes, it may be all at one time. Emotional stress is very common with pregnant women, and it typically starts right away. You might worry about the financial impacts of a baby, your baby’s health, and how you’ll adjust to parenthood. If you currently work, you could worry about how you’ll balance your career and your family. Mood swings are very common. If your mood swings get very intense or severe, it’s a good idea to contact your health care provider.

Prenatal Care

The first visit to your doctor will focus on looking for risk factors, assessing your health, and finding out your baby’s gestational age. Your doctor will ask you specific questions about your history. You want to be honest, and your doctor will tell you about screening for chromosomal abnormalities. In conclusion, your doctor will most likely recommend check ups once every four weeks for the first 32 weeks of your pregnancy.

For a deeper level of care, education, and planning throughout your pregnancy process, contact Midwife 360. We are here to support you.

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Midwife360 Partners with Care Credit

Care Credit for Maternity Services Palm Beach

Introducing Care Credit at Midwife360!

Having a natural birth at home is becoming more and more appealing as the COVID numbers grow and healthy pregnant people begin to question the automatic choice to give birth in the hospital.

However, home birth is not always covered 100% by insurance (think deductible and co-insurance) and even with Medicaid, there are some out of pocket expenses that Medicaid does not cover. With Midwife360, the lowest out of pocket amount is currently $1200 and many folks with private insurance may have to pay around $5000 when the numbers are crunched for their particular benefit plan. Our self pay rate is $6700. While even that is a small price to pay for one of the most beautiful and memorable days of your life, not everyone has that kind of cash available or even that much credit.

Enter Care Credit. Care Credit is easy to apply for and most people are approved and the staff at Midwife360 will help. It allows for a 4th option (other than cash, debit, or traditional credit card) to pay for your care without breaking the bank. Depending on the program chosen, there is an option for 6 or 12 months credit with no interest, or a low interest 24 month credit card.

Midwife360 pays a small percentage and we get paid for our services while the client gets to pay over more time for no extra cost (when choosing the no interest option).

We are happy to be able to help our clients be able to pay for their care without causing undue financial stress. Contact us today to find out more!

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COVID-19 and Pregnancy

This is a crazy time that we are living in. Although it is not surprising for those who have been paying attention… mono-farming crops practices are unsustainable and factory farming of animals is inhumane, fraught with horrific abuse, torture, and disregard for the ultimate health and welfare of the animals and inevitably leads to disease and negative health outcomes for the humans who eat them. Fracking, deforestation and oil pipelines have wreaked havoc on this planet and destroyed entire ecosystems on a global scale. We have endangered the oceans by our irresponsible fishing practices and despicable habit of dumping our waste in the oceans the world. Therefore, we have seen devastating fires on multiple continents.

We have been raping and pillaging the earth for a long time in the name of technology. In the name of instant gratification and utter disregard for nature. Add to this the ability of world travel for the masses. Is it no wonder, that now we have a virulent, deadly virus that spreads so easily by simple human contact? That we are plagued by a world where we have become afraid of contact with one another. Now, paranoid that an accidental bump in a grocery store or neglecting to wear gloves when pumping gas make us paranoid that we have contracted the dreaded SARS-CoV-2 virus. And could either become deathly ill or spread it to countless others by association, or both? And we are watching the numbers of those testing positive growing by leaps and bounds to nearly 1 million cases. The US now outranks the world in a number of positive cases. NY now has as many infected people as in all of China.

A Silver Lining

It appears, however, that pregnant women (contrary to what we have seen in the past with some other coronaviruses) are not getting more critical infections than other people. Elders, those with co morbid conditions (diabetes, high, blood pressure, COPD, smokers, asthmatics and those with weak lungs, maybe those who take ibuprofen, immunocompromised people, etc) would be at higher risk of contracting a critical form of illness from this virus than otherwise healthy pregnant people. Also children, other than those less than 1 year old, are less likely to get a severe form of the illness. We don’t know how it might affect fetuses in the 1st or 2nd trimesters who are exposed in the womb. But we do know that it is not found in amniotic fluid, placentas, breast milk, or cord blood of newborns. So we believe it is not transmitted from mother to baby. If common-sense precautions – such as good hand washing and wearing a mask for a parent who suspects exposure, exhibiting symptoms, or tests positive for COVID-19 – are followed, it is unlikely that an infant who co habitats with parents immediately after birth will get a critical form of sickness.

Infant Bonding and Labor Support are Human Rights

Breastfeeding confers immunity for other contagious diseases and is usually recommended as best for parent and baby. Baby’s are better able to regulate their heart rate, respiration, temperature, and blood sugar if allowed skin to skin contact and early breastfeeding. It is a birth parents right to choose rooming-in and skin to skin breastfeeding with her newborn versus handing the baby off to be “watched” in the NICU with no evidence of ill health. Evidence-based birth has a waiver you can bring with you to the hospital if pressured to release your healthy baby for separation as a COVID-19 precaution. Let’s not separate babies from their birth parent and source of best nutrition, and healthy immune and emotional newborn response.

The other parameter to watch is the restriction of support people for the pregnant person. In my opinion, based on common sense, what we know about the human Microbiome, and the laws of infectious diseases (this one in particular as it is slowly revealing its characteristics to us) is that people who cohabitate tend to share their microbiota – good and bad ones. Close contact is how this disease spreads. Assuming most people are practicing social distancing and protecting themselves and their loved ones – particularly if they are expecting a baby into the household – the pregnant persons significant other will not increase the health workers risk any more than the pregnant person herself. In fact, we know that under normal circumstances, nurses spend about 30% of the labor with the client. Having their significant other would increase the laboring persons comfort and safety by providing constant companionship helping them to the bathroom, with position changes, and overall comfort. Let’s not just have a knee jerk reaction to isolate laboring people out of fear of the unknown.

What YOU Can Do

Please socially distance yourself other than essential contact. Don’t go to the hospital unless you are having trouble breathing. Do go to a drive-through testing site or hospital if you have trouble breathing. Wear gloves and a mask if you have one, a bandana will work in a pinch. Practice generous hand washing for 20 secs and remove clothing and shower immediately upon coming home if you’ve had exposure to unknown people. Take supplements that promote a healthy immune response, and eat responsibly to encourage and support your health. Meditate and be happy, the world needs it!

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Natural Sacred ChildBirth

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Sacred Natural Childbirth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you may ask. Because our culture has co-opted natural birth, babies, and women’s bodies for the benefit of capitalism – Big Pharma, Insurance companies, and Hospitals – the Trifecta of the medical-industrial complex. That is the only reasonable explanation as Women’s bodies have been successfully birthing live babies for literally millennia – else how would we be here? Birth has only been happening inside hospitals for about one hundred years and studies have shown that it’s safer to natural birth outside the hospital to avoid the unnecessary interventions that lead to worse outcomes. 1,2

Doctors are taught to fear birth

Medical schools have also contributed to the situation by instilling a climate of fear surrounding Birth mostly related to potential litigation. They believe that if the doctor is taught how to control birth, then they have control over being sued. In addition, natural birth is not taught to OBs because their focus is surgery. They are surgeons; the interventions they advocate frequently lead to surgery, and this is where they shine. Obstetricians are surgeons and if you are seeking the care of a surgeon, you are likely to have surgery. Very simple.

Birth cannot be controlled

Interventions in childbirth give the illusion of control over a natural bodily function that cannot be controlled. Women’s bodies will open and release the baby inside when the body and the baby are ready. This is normal, natural childbirth in a nutshell. Even the women doing the opening and releasing have no control over the process. The only control that is possible and productive is the act of surrender to this most basic bodily function. When a woman is able to fully surrender to every aspect – when and how – then when her body and the baby are ready, it will happen. The more surrendered a woman is to the process, the more efficient it is.

Thirty-eight percent cesareans in Palm Beach County

Our community (and there are many like ours) has not embraced this principle. It is very typical for women to be induced at 38 or 39 weeks of pregnancy for a myriad of reasons. We know that when labor is induced before the body and baby are ready, then things can go wrong. The body may not fully dilate no matter how much cervical ripening is chemically encouraged or how much Pitocin is given. Often the baby will not be able to tolerate the cocktail of chemicals involved between the induction drugs and the inevitable epidural. A woman may enter the hospital wanting a natural birth, but very few are able to tolerate the torture of hours of fasting, limited mobility and abnormally strong and consistent contractions, not to mention the flow of strangers into the room, the bright lights, uncomfortable bed, etc. An epidural is the only relief she can get in the hopes of maintaining her dream of vaginal birth. Palm Beach County has an average Cesarean rate of about 38%. That’s more than 1:3 women walking into the hospital expecting a vaginal birth and ending up having surgery to have their baby!This is NOT because Birth is dangerous. This is because our community has a culture of meddling with an otherwise normal, natural process. And that meddling leads to dangerous birth.

ACOG supports VBAC

The national organizations that oversee and regulate birth providers have reasonable recommendations regarding things such as vaginal birth after cesarean and breech birth. But the local OBs tend to disregard these reasonable and evidence-based recommendations. One example of how our local OB community rejects recommendations by ACOG (American College of Obstetricians and Gynecologists, the national organization for obstetricians and gynecologists), is with VBAC (Vaginal Birth After Cesarean) candidates. ACOG recommends that doctors offer vaginal birth to women who have had 1 or 2 previous cesareans. They also don’t recommend inducing labors for VBAC candidates. Yet many OBs in our community still recommend repeat surgery for these women or insist that they birth by 39 weeks. They routinely induce VBAC candidates at 39 or 40 weeks which can lead to the very complication that they fear – a ruptured uterus. Also, there is no solid evidence that a woman with more than 2 cesareans is not a good candidate for a VBAC, but there are very few OBs that are willing to “allow” these women to attempt a vaginal birth.

ACOG supports out of hospital birth

Another example of how our community defies the national recommendations is through a document is known as The Levels of Care document that was endorsed by both ACOG and SMFM (Society of Maternal and Fetal Medicine, the obstetric specialists). In this document, it is recommended that all healthy, low-risk women birth outside the hospital in Birth Centers. If the situation changes, the woman is transferred to a higher level of care – one where the ability to perform a cesarean or other interventions such as Pitocin or epidural is available. There are even higher levels of care such as Intensive Care where caring for someone who is on life support machines is available and not all community hospitals have this option for women during or after childbirth, so she would have to be transferred from the lower level hospital to a higher one. The idea is that we have lots of birth centers, less of the community hospitals and only one or two regional centers to care for the very complicated cases. However, our local OBs do not encourage their healthy, low-risk women to birth outside the hospital. Rather, they look for reasons to elevate a woman’s risk and encourage interventions such as unnecessary inductions.

Birth is sacred

Birth is a sacred event that happens to each of us only once as we enter the world. How it happens is important for the one being born and for the one giving birth. If we are going to see a world that is healed from all of the devastations of poverty, war, climate change, and abuse it has to start with how we care for those giving birth and being born. I have grown up in my Midwifery career hearing the saying that ‘Peace on Earth begins with Birth’. We have to honor the process and respect both mother and baby by not causing pain and trauma but rather supporting, facilitating, and protecting the process. This can happen more easily out of the hospital in a woman’s home or in a birth center. However, I have not given up hope that we can shift the culture of childbirth within the hospital by spreading information and demonstrating a better way. We do this by supporting natural childbirth centers and encouraging the growth in the number of birth centers in our community.

Support the ‘birth’ of Gentle Birth Centers

I’m happy to announce the addition of a new natural childbirth center in Wellington – opening soon. Gentle Birth Centers will be teaming up with Midwife360 to create an integrated practice of home, birth center, and hospital care for healthy, low-risk candidates. We plan to open this spring and are located within a mile of the nearest hospital. Let’s change birth together!

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Birth Your Own Way

I saw a Facebook post recently, a fundraiser, for a woman who wrote about her search for a provider who would assist her in having a vaginal birth for her 4th baby after having 3 previous cesareans. For whatever reason (VBAC ban, or just no supportive providers to be found) she moved 3 states over just to give birth with a supportive provider. It seemed from the post that they actually moved their family to that location to be in proximity to this supportive provider. Due to moving during the pregnancy, they did not have the funds to pay for the birth upfront, thus the Facebook fundraiser.

How did we get here?

How is it, in our medically advanced culture, that someone has to actually move to a different state to achieve this kind of support? I know that we don’t have supportive providers in our community here in south Florida that would support a vaginal birth for someone with 3 or more previous cesareans. Though, I know that I would support such a person under the right circumstances. Those circumstances are that the pregnant person has to be in excellent health with a healthy, otherwise low-risk pregnancy. She has to be fully committed to her birth plans, to the point of saying “I am doing this with or without you”. In other words, fully committed to the choice for an out of hospital birth.

While there is no guarantee for the outcome, an otherwise healthy low-risk pregnancy has little added risk for VBAC or other complex physiologic circumstances like twins or breech. With good counseling on risks and benefits and the understanding of the limits of any guarantees, clients should be free to make the decision to birth outside the hospital in these situations. Actually, clients should be free to make the decision to birth vaginally and should be able to access a supportive provider wherever they feel the safest – whether that is in the hospital or outside of it.

I am a provider that supports VBAC, twins, and breech for a vaginal birth.

I have found that my sister midwives are not happy that I do this. They report feeling threatened by my choices to support these births out of the hospital due to the possibility that any bad outcome would reflect negatively on the birth community as a whole. They believe that if I have a bad outcome I am giving home birth a bad name. I believe that I am giving people options they would not otherwise have. There are only about 2% of people that choose to birth out of the hospital. Most of those that choose home birth are die-hard home birthers who would not go to the hospital unless someone’s life was in danger (literally). They understand that there are no guarantees in life (or birth) and they typically have educated themselves on the risks and benefits of out of hospital birth and willingly, gladly, sign the consent waiver for home birth under complex physiological circumstances.

Enter the twins

I recently assisted a couple with twins who wanted very little prenatal surveillance, and home birth with mostly a hands-off approach. She went into labor the day she turned 40 weeks. The first baby came fairly quickly and it was the most serene beautiful water birth! Soon after, we attempted to get FHT (fetal heart tones) for Baby B and were unable to locate them for a few minutes, then when we did finally find them, they were very low – the 60s. Mom was instructed to push to try to encourage baby to come quickly, and within minutes, someone called out, “head’s out!”.

When I reached over to touch, it was obvious that it was not a head, and I tore the sac to find 2 legs unfolding into the water. I instructed Mom to get out of the tub as it was a surprise breech (baby had been head down at the last ultrasound at 28w) and I was concerned because of the low FHT. The baby then came fairly easily, but her placenta was sitting on her head and plopped out right after her – complete placental abruption. This is likely the scariest and most serious complication that can happen at home. Luckily Baby A and mom were doing well, no bleeding noted and Baby A was transitioning beautifully.

We immediately began going through the NRP steps that we learn and practice for just this eventuality. We also called 911 as a baby that requires CPR needs to be closely monitored for 24 hours in case there are further issues with the heart and breathing. The paramedics arrived within 6 minutes and by then she was only requiring breaths with the bag and mask as her heart was beating on its own at the appropriate rate.

It was difficult to watch her go without the ability to witness her recovery, but we had no choice as we still had the first baby and mom to care for. One assistant and the dad accompanied the baby to the hospital, the rest of the team stayed at the house. Ultimately, she made a full recovery. She began breathing on her own before they even arrived at the hospital, and was discharged home the next day due to a lot of questioning by and the determination of her parents. She seems to be completely normal and adjusted to life outside the womb.

This couple had 3 previous birth center births and were only having a home birth because their favorite midwife was unable to support a twin birth at her birth center. They were completely uninterested in a hospital birth. I’m pretty sure they would have chosen to birth at home with or without trained medical assistance. Had there not been someone trained in neonatal resuscitation present, their baby could have died. I wonder how our community would have felt about that?

When I help clients with a breech baby, or twins, or VBA3C or 4,5,6,7C or VBAC twins or breech, or past 42w. They tell me there’s no way they will birth in the hospital or no hospital provider will give them a chance to try for a vaginal birth. I believe it’s better to have a trained provider than for them to try a free birth and have a tragic outcome. If there’s a tragic outcome anyway, they have taken full responsibility for their choices.

Think about the big picture

However, I truly believe that our job as out of hospital birth providers is to monitor and observe the big picture at all times and identify an emergency before it becomes one in order to access the proper medical care. This means that we are alert and focused on one mom and her baby(ies) at all times during the experience. This is why we love to work with doulas. It gives us the luxury to arrive in active labor, which is the ideal time to be sharp and ready as birth becomes more imminent.

While I do not relish the added stress of caring for a more complex physiologic situation. I do believe in women’s bodies and the birth process as an inherently normal, natural process. In situations such as those with previous uterine surgery, twins, breeches, or post dates, it is unlikely that there will be any major complications if the pregnancy is healthy and otherwise low risk.

In every situation, as long as the provider is on her toes, focused and present, a major complication can be handled without turning into a tragedy. This is why I will support these clients. I wish more of my colleagues could do the same. I understand that the CPMs would be risking their licenses to do so, but this is not the case for my CNM and OB counterparts. In their case, the fear of birth and mistrust in women’s bodies limits their understanding of what is possible and safe. I have found that many people are seeking healthier living, especially when they are growing a baby. Many are super open to discussions of the importance of a healthy diet, adequate water consumption, and exercise in pregnancy, which all lead to safer birth for everyone.

Don’t judge anyone for their choices in birth. Not when they choose a repeat cesarean or even primary cesarean, and not when they choose home birth – no matter what their circumstances. Every client has their own reasons to choose what is right for them and their families. And don’t judge the providers that help them when they have a track record of good outcomes. It is better to have a trained provider present and we shouldn’t have to hide or suffer unwarranted criticism for our willingness to help.