Weight Loss

I am on day four of my new diet and I've already lost eight pounds! I checked and double checked and it's true. Just a bit too much for a breastfeeding mom, and while I've had some hungry nights, I really have been very satisfied during the day. I sure wouldn't have guessed though. Many more pounds to go, but a great start!

Attitudes, Beliefs and Perceptions

"Attitude plays a critical role in determining the difference between self-sabotage and success."

Your attitude, not your aptitude, will determine your altitude. ~Zig Zigler

For fun, try these perception exercises or these. While attitude is key to success, developing clear perception also keeps you on track in achieving your goals. It seems every now and then, I need a reality check. I am a visionary and have no real struggle for visioning big and believing it.

The difference between attitude and perception is choice. When we are faced with something new or challenging (or frustrating), we can choose to have a positive attitude toward it but that doesn't mean that we automatically perceive it for what it is.

One of the true ironies in life is that ten people witnessing any particularly event will likely give ten different depictions. Our perceptions are affected by our history, beliefs and physiology. This is why it is so important to get feedback from trusted advisers. It is also easy to get tunnel vision and believe that your vision is absolute truth.

My recent blog rant is truth, but only a portion of the truth because the reality is, I can sum up the bad side of midwifery in one blog posting. The beauty of midwifery can't even be put into words. No book, no conversation over tea, and no eloquently written blog can give justice to the miraculous and awe-inspiring, blessed events I have had the privilege to witness.

How do I avoid self-sabotage? I surround myself with people that build me up. This lesson took me until just the last two years to learn. The five women I work with are true blessings from the Lord and validation for me that He has created this practice and has asked me to be obedient as he leads me where He wants me to go. The Lord created this practice and He can tear it down however and whenever He sees fit. It would be a great misfortune though, if I allowed my own inadequacies, including self-doubt, to crumble the practice and/or my own calling prematurely.

I will admit that I can fall into negative-talk and sometimes it takes me a few times to learn from my mistakes, particularly with respect to social circumstances. I can procrastinate and have a tendency to want to please, even the most unreasonable. These are all qualities that invite self-sabotage.

What a blessing it is to come into work and have your office manager tell it to you straight, "Get it together, suck it up, and move on. You have a job to do!" Negative conditioning is simply not allowed if you want to succeed as an independent midwife. Here is an interesting trick for testing your subconscious beliefs. This site, along with this one, is suggested for training in personal growth, although I am a bit cautious in recommending either because I haven't explored them thoroughly and these sorts of mind-body cleaning or energy tricks can often lead to New Age thinking.

This morning on the Early Show (yes, I was up before 8am) a lady who has suffered from MS was being interviewed after having recently releasing a book titled, "29 gifts in 29 days." She was told by her "spiritual adviser" after venting a self-pity party during a particularly challenging day that she was simply focusing too much on her own situation and needed to look beyond herself. She was instructed to give 29 simple gifts to people, anyone, for 29 days and it absolutely changed her life. I don't have any doubts that this story is genuine and would be successful for most anyone.

Our thought process absolutely can direct our experiences. Mothers that answer my question regarding their intentions to breastfeeding with, "I am going to try," are actually saying, "I don't think I can do it" or "I don't really want to do it," but I am going to put baby to breast once or twice and then allow my body or baby to fail me. I won't accept this answer. They are either committed or they aren't. I am not going to assist a mom that can't give me commitment because when her experience fails, I don't want to be the one blamed for failing her. She needs to take responsibility for her own success.

So here are some thoughts I am sitting on at 3:00 am in the morning...

The things have I wanted to accomplish, but haven't...
The projects I've begun, but never completed are...
The communications I've withheld are...
The goals I've put off are...
The things for which I haven't forgiven myself are...
The things for which I haven't forgiven others are..
Thing things that are important to me are...
Some of my major goals in life are...
I see myself as...
Others perceive me as...
Having a successful career means...
The ways my career supports me in achieving my life goals are...
The ways my career limits me in achieving my life goals are...
Regarding my career, things I don't want to ever have to do are...
Regarding my career, things I really enjoy are...
The ways I would have to change to achieve my goals are...
The things I am really willing to do to achieve my goals are...

Even if you're on the right track, you'll get run over if you just sit there. ~Will Rogers


I can definitely be a procrastinator, but I typically get the job done...eventually. According to business experts, this is the most common symptom of self-sabotage for a small business owner. My biggest issue or reason for procrastination is that I have such a high, perfectionist expectation for performance that accomplishing the task appears overwhelming. I will admit that a motto my Dad drilled into me was, "If you're going to do something do it right, or don't do it at all." Somewhere I heard and knew he expected, perfection. Adequate and sufficient were never acceptable.

Again, is my perception appropriate? High standards are great, but are mine realistic? Perfectionism in itself is highly desirable, right? Then why do I have to break my addiction? What I am failing to realize is the toll it is taking on me. Often I find myself agreeing to a task or activity that I am not really sure is a real priority and so I procrastinate - my boundary disorder. I am becoming a delegation queen!! Procrastination is a symptom. Figure out the problem. Then fix it!

You are never given a wish without also being given the power to make it true. You may have to work for it, however. ~Richard Bach

Ottawa Breech Conference

Mike and I traveled to Ottawa last week to attend the International Breech conference. I have a strong desire to become skilled at breech birth. I feel it is a lost art and I feel women should have the option to birth breech babies naturally. It breaks my heart that breech birth was professionally eliminated because of liability, yet our culture in less than a decade had come to believe it is because breech birth is unsafe.

Canada has made a bold move and developed a statement that supports vaginal breech birth in women who are appropriate candidates. CBCnews.ca reports on the statement here. Canada overall has a much more open forum between midwives, physicians, and nurses. The art of each as an individual profession is appreciated, as opposed to the hierarchy here in the states.

Breech birth is an art and no matter how many workshops and practice births a provider attends, if he hadn't the talent, he isn't an appropriate attendant. Those that lack this skill are terrified of breech birth and argue passionately that the technique should be outlawed.

This conference is a step towards reestablishing the lost art of catching breech babies. The Society of Obstetricians and Gynaecologists of Canada (SOGC) had a large presence within the workshop and clearly, on a national level, are moving in the right direction.

Dr. Andre B Lalonde was the initial speaker on day one, presenting "How did we get here?" He is the Executive Vice-President of the SOGC and like all the speakers presenting at this conference, very approachable and sincere. Unfortunately I lost my notes, so am writing from memory. (Normally this would make me panic but I soon realized this conference was just to confirm that yes, I am called to catch breech babies and will have many more workshops ahead of me.) However, if I remember correctly he summarized the transition from breech being a skill of art to one of fear due to associated liability and in just a decade our providers have lost the skill entirely.

The second presentation by Dr. Marek Glezerman of Israel and a later presenter, Dr. Savas Menticoglou's, were flipped in their order from the agenda, so their presentations are running together for me. One presented about the lost art of breech birth and the challenges we face in putting this skill back into the hands of birth professionals (lack of training primarily) and the second presenter discussed the landmark breech study, Hannah and Hannah, 2004.

This research study offered the validation for what my heart had persistently made clear, that breech birth was an option for me. When I read this study in 2004, I concluded that physicians without experience should not attend breech births. Their poor outcomes pointed towards bad technique. I was confident that if labor proved to progress safely, then a breech birth would be an appropriate choice. When Dr. Glezerman read the same research he thought, "What are we doing so differently because the outcomes of this landmark study don't reflect what we are seeing in our hospital," which if I remember correctly sees more than 50,000 births a year (something rather ridiculous). Like each and every speaker, Dr. Glezerman shared his confidence having attended a plethora of breech births and his fear that the art has nearly vanished among maternity providers.

Dr. Menticoglou worked through the Hannah study more specifically, identifying its flaws and giving further information on the reported poor outcomes. I had forgotten about the two-year follow-up to the original study which if I remember correctly, found no difference in long-term outcomes in those born breech vaginally verses those born via cesarean section. (Do your own research here, as I may not be entirely accurate on its purpose.)

It was enlightening listening to the physicians discuss how the SGOC had come to conclude their recommendation for vaginal breech birth. It seemed as if a group of intelligent and experienced providers gathered for respectful debate and honest interpretation of the evidence in effort to give a genuine recommendation; as opposed to the US trend to call our attorneys and follow their direction regarding our own professional recommendations.

Betty-Anne Daviss RM of Ottawa presented a very cleaver presentation, "Choosing the myths and fears we live by: understanding different logic among Europeans, low resource, and North American countries." Her talk was praised by the vast majority of subsequent speakers and often physicians shared that she gave them a real awakening regarding their own biases towards breech birth. She shared that European providers focus on the pelvis through their use of MRIs to determine the adequacy of the pelvis, while no other areas seems to have such fascination. North Americans tend to focus on the passenger using ultrasounds in effort to find an overly large baby. Betty-Anne was frank. She was confident. She was compelling.

Prior to lunch, we were offered a break-out session composed of Dr. Tanya Smith, Dr. Liz Anderson Peacock, and Jay MacGillivray RM. Dr. Peacock shared about the Webster technique, although just in the need to attain proper alignment, seek wellness through fitness and nutrition, and stick to what you are good at (professionally speaking). Our practice sends many mothers to Dr. Nancy Elwartowski and consistently have great success. This is a technique that I know little about other than the fact that it works, is cost effective, and exceptionally safe. I would have loved to hear more about the technique in itself and some discussion on how you know you have a chiropractor that is trained in this very specific technique.

Dr. Tanya Smith is a doctor of Traditional Chinese Medicine and shared about moxibustion. I had originally planned to attend her break-out session because again, this is a technique I tried personally, have used on my clients, and have read about within the breech birth literature - we've had success and there is little risk, but I would like to have greater understanding about its mechanism of action. Dr. Smith shared briefly what I already knew, that it gets baby moving and should encourage baby to pursue a head-down position. She felt this was a tool that any parent can use, so I do hope in the future I am able to attend a break-out session regarding the specifics.

The final speaker from the panel, Jay MacGillivray, and until had assumed she was an obstetrician. Alas, she is a midwife. Her presentation was by far the most intriguing. Her discussion detailed how she uses ultrasound with great success to turn baby through an external version. She felt that contrary to many providers, there was no need to encourage baby to only move forward, that backwards is an option too, particularly if there is a large pocket of fluid behind baby. Often she finds that referrals are made too late, when baby is too big to move. Her preference is 36 weeks, yet she still felt the version should be tried again and again even if immediately prior to performing a cesarean section for breech. This provider also shared that she felt pulsatilla caused baby to be too toned or rigid and in her experience decreased the success of the version. She would ask mothers to discontinue pulsatilla three days prior to the scheduled version.

Her discussion made me so very grateful for Dr. Soper and her talents in the external version. I haven't a clue who to refer mothers to after her retirement. I sure hope she has taken someone under her wing, but I fear this isn't true. I have no desire to learn the skill of ultrasound. Dr. Raff at the IU Med Center seemed to be efficient at turning babies, although I think he has moved or is in the process of moving out of primary obstetrics. An important factor is the desire of the physician - would the prefer to flip baby and attend a vaginal birth or just call a section and get it done. The nurses at IU, when I was there, would place bets on the success of the version and I was quite good at predicting based simply on who was performing the version.

Lunch - and all other personal drama related to this trip - will be shared in another post.

Break-out sessions: I attended Dr. Hall's, "Breech Vaginal Delivery: Tips, Tricks, and Techniques." This is when I was convinced the Lord is molding me to attend breech births. I stopped taking notes and let it all sink in (a very rare occurrence). I knew I would be back for more. Mike also sat with me during this presentation and was as interested in this discussion as he would have been attending a talk on fast cars and trick bikes. It was quite fabulous.

Dr. Hall practices in Colorado and is particularly appreciative of midwives. He was trained to catch breech babies by a midwife, works in Boulder with many midwives, and is married to a Nurse Midwife. He has become well known for his skill, receives a large number of referrals and therefore attends almost as many breech births a year as I do vertex. I spent the entire morning visioning myself in Israel learning to catch breech births, then the afternoon imagining a few months in Colorado.

His discussion complemented a lot of what I understood while pregnant with my second breech child. "Don't touch the breech," was his common direction. A tip I hadn't maybe realized was a baby presenting to the side, rather than back up, was a baby with a nuchal arm. His technique if the arm did not release on its own was to free the anterior arm, rotate the baby either way, then release the posterior arm. He does follow the commonly taught technique of wrapping with a warm towel and slightly elevating the baby's bottom (the next day we were taught this was an old technique). I also hadn't learned to gently push down on the perineum, with fingers in the introitus, to release the head as the provider guides the body up the curve of the pelvis. He preached to the choir about keeping the cord intact because many breech babies have an initial slow start. They simply need to regain some of their blood supply.

I can't explain enough just how validating this conference was for me. We had been obedient and I continue to stand by my decision to birth my breech babies vaginally. Dr. Hall was recently pushed into the operating room for breech births because the anesthesia staff became anxious; however, Dr. Hall shared that you'll have plenty of time to do a cesarean section because breech babies tend to call it early. If baby becomes "stuck" late in the game then it is too late for a cesarean section - these maneuvers to dislodge baby should be second nature.

Jane Evans spoke after the break regarding breeches and the UK. She is a homebirth midwife in England and a presentation that I wish I could hear again simply because she was incredibly articulate. This midwife balanced beautifully the ability to present in a manner that appealed to the medically-minded while still remaining true to midwifery. She was a perfect bridge within a multidisciplinary audience. I will have to remember her coin-term, "rumping," which is when baby's bum appears at the introitus rather than the head, otherwise known as crowning.

The final speaker of the day, Dr. Robert Gagnon, was not unlike those that preceded him in that he was incredibly humble and genuine. He readily admitted that breech birth was a skill he retired with the Hannah (2004) sensation. Working within the SGOC to create the breech birth guidelines however, he was converted. The evidence is hard to ignore even for those who have argued naively for years that vaginal breech birth is unsafe. Statistics can be manipulated, but they can't mask the truth from a critical mind. The real crime is that the vast majority who support a heated debate haven't read the studies!

I hadn't even realized how much preliminary data has since been published since my own breech birth, and clearly I need to do another literature search. Again, this presentation provided further validation that we were obedient to the Lord in our decisions surrounding Lyric's birth. We didn't crumble to the fad. We took the step of faith the Lord had asked of us. A final point that made me pause a moment was [paraphrased], "We shouldn't abandon women who still choose not to have a cesarean section against our own recommendations." This surprised me because it was far from US mentality. A woman in our society would have a court order served to her within the hour.

I can't wait to share about Day Two...stay tuned.

Another Homebirth Article

A client of mine shared with me an obstetrical journal that was shared to her, from her obstetrician friend (who referred her to me). The journal is, OBG Management, August 2009, vol 21, no 8. The article title is: Does home birth empower women, or imperil them and their babies? The author is Erin E. Tracy MD, MPH. She is an attending physician, an OBGYN within the Massachusetts General Hospital.

Agreed, "few issues in obstetrics spark as much controversy as home birth." The author presents the argument however, as safety verses empowerment. Clearly, Dr. Tracy is unaware of the 2009 Boucher article within the Journal of Nurse Midwifery which discovered safety as the number one reason women choose to birth at home. She does recognize that the strong statements from ACOG and AMA opposing homebirth sets up the potential for homebirth criminalization.

Did a rise in hospital births reduce maternal mortality?
As most of my readers are aware, hospital births increased dramatically in the mid-20th century and since that time, maternal death rates have decreased. However, it would be naive to assume the phenomenon of hospital birth is the only variable. Dr. Tracy feels that "others argue" the introduction in aseptic technique contributed more to the decrease in mortality than the place of birth. I can't imagine how she could argue anything differently, as maternal mortality increased the first decade births moved into the hospital, but immediately upon the introduction of antibiotics, death rates dropped.

The author states, "All studies of home birth have serious methodologic flaws." I would disagree (see my website for articles addressing homebirth safety; apologies, I have no source for research demonstrating hospital birth as safe). Oddly enough, today, hospitals are offering a "drive through emergency room," because they fear transmitting the deadly swine virus to any of its healthy patrons; however, pregnant women come forth!

Most data comes from abroad
True. Their maternal and newborn outcomes are better too. Why would we ignore a style of birth that is working and attempt to mimic it? Because Americans didn't think of it first?

The data we do have is difficult to interpret
The author argues that bad outcomes are too few to interpret, yet she uses fancy words to mask her weak argument.

Oft-cited study has weaknesses
She does make a valid point in stating the often cited United States and Canadian study published in 2005, which states authors have no conflict of interest, lacks credibility because it was funded by The Foundation for the Advancement of Midwifery. Not all loss, but recognition of this conflict would have boosted credibility.

A Fast-Track Note:
The author has in bold within the side-line: "The neonatal death rate for unplanned home delivery in North Carolina and Kentucky was 18 to 20 times higher than the rate for planned home birth." I don't know a single person that would advocate for unplanned home birth. Midwives aren't reckless in their advocacy of homebirth. Advocates for unassisted homebirth would likely find unplanned homebirth less than optimal as well. The key to safe birth is preparation. This quote demonstrates the author's desperate attempt to develop an argument with no real evidence in her bag.

Common research flaws regarding homebirth
Birth certificate information is utilized.
Misclassification of planned verses unplanned homebirth.
No identification of the education level of the midwife/attendant.
Inability to provide an RCT trial, the God of medicine.

Risk level can escalate rapidly
True. A woman with little risk antenatally can become a scary obstetrical emergency during the intrapartum period. Dr. Tracy discusses the scenario of a shoulder dystocia and how challenging it is to transfer and/or organize a team of providers in this event. As a homebirth provider who has ten plus years experience working in the hospital, let me attest to the fact that I am not looking forward to a shoulder dystocia in a homebirth scenario. I will also share that a shoulder dystocia in the hospital is also absolutely awful and no matter where this occurs, it sucks. Any baby who-so-ever that has to be cut out of his/her mother's abdomen because of shoulder dystocia, likely will not survive. Having said that, I personally feel that as a homebirth provider, I know a transfer would complicate this scenario and I believe I would institute the Zanvanelli much sooner than other American providers currently. England utilizes this maneuver much more regularly and has far more success than our providers, and I believe that is because in America we wait too long to recognize and act on the situation, then run through the maneuvers that are rarely rehearsed and then call the cesarean, which even in the hospital takes a significant amount of time to orchestrate. The Zanvanelli is rarely, if ever utilized and by the time it is baby is already too compromised to benefit. My last argument regarding this point is that birthing at home decreases the chance shoulder dystocia would occur in the first place and in itself is a valid reason for choosing to birth at home.

Fast Track:
"Certification as a 'lay' or certified professional midwife does not require a high school diploma. Yeah, this concerns me too. I know many very gifted midwives that have mastered the art of what we do, who are non-nurses. However, with research demonstrating safety as the number one reason families choose to birth at home, I believe the nursing factor is paramount. Otherwise the attendant is nothing more than a glorified doula. (Fearing I could be stoned for this one!)

A provider who has only practiced in homebirth has very limited emergency experience. This is credit to the great outcomes experienced within the home, yet if my baby needs resuscitation, I want the attendant that has performed this skill numerous times and can do so without a second thought. I don't want the midwife who has attended hundreds of births that went beautifully and has only picked up the bag and mask a time or two. I don't want to be the mother hemorrhaging and my midwife too sweaty or shaky to start an IV. I hold great value in my hospital-gained skills.

This argument reflects the skill of the provider, not the environment of birth, which leads to the next point.

Skill of the caregiver is important
I was unaware of a study evaluating 4,361 home births attended by "apprentice-trained midwives from 1970 to 1985 and 4,107 home births attended by family physicians from 1969 to 1981." The perineal mortality rate for the midwife-attended births was 14 for every 1,000 births, in contrast to the rate of 5 for every 1,000 physician-attended births. The reference for this article, which I will immediately go on the hunt for is: "Mehl-Madrona L, Mehl-Madrona MM. Physician-and midwife-attended home births. Effects of breech, twin, and post-dates outcome data on mortality rates. J Nurse Midwifery. 1997;42:91-98. Just by the title though, it seems the author may have stretched some statistics to serve her purpose, huh?

I do agree with the author that the CPM credential is what motivated ACOG's decision to issue a statement from its executive board in 2006: "While ACOG supports women having a choice in determining their providers of care, ACOG does not support the provision of care by lay midwives or other midwives who are not certified by the American College of Nurse-Midwives (ACNM) or AMCB." The great tragedy is that very few have read their statement to differentiate between the various types of midwives in homebirth, but instead hospital verses homebirth.

Does the rhetoric surrounding home birth "empower" women?
"I worry that patients may become so caught up in the rhetoric of their own power and choice that, when uncontrollable events occur, the happiness of a healthy delivery is overshadowed by deep disappointment." Well, then lets just remove their choice altogether! If every mother is controlled and manipulated than it will be the norm and that disappointment won't seem so unusual. Sounds like an awfully pessimistic view point. I understand her argument, but don't know that it holds enough weight to even print.

Heated debate isn't helpful
The author does offer great commentary to the unfortunate rift between members of the midwifery community and physicians. She cites the ACOG and ACNM joint position statement regarding practice relations. She further discusses an article describing hostile transfers and their impact on care. Another article I'll be digging for: Davis-Floyd R. Home-birth emergencies in the US and Mexico: the trouble with transport. Soc Sci Med. 2003:56:1911-1931. Are we surprised this is a Davis-Floyd article?

The author does appreciate that both "The American Public Health Association and the American College of Nurse Midwives support home birth.

Conclusion
Dr. Tracy sums up that homebirth isn't going away. Physicians should be supportive and respectful of homebirth providers upon receiving a transport. She even states, "There are certainly data supporting the safety of home birth for the vast majority of women who choose it, but there is also a significant number of women who will experience unpredictable events that could be fatal if blood products or surgery isn't rapidly available. For that reason and in light of the very high stakes involved, I wonder: Why take that chance?"

Such an odd conclusion. Blood products and surgery are only immediately available in a very few hospitals, fewer than ten within Indiana. Should all other facilities close their doors?

What about the fact that simply walking through the door of the hospital increases dramatically the likeliness such an emergency will occur and women seek homebirth to prevent the scenario in the first place!

There is no guarantee of a good outcome once the urine stick shows a positive pregnancy. Most all homebirth families are well aware of their odds, but choose to face a bad outcome as the result of nature, than a bad outcome as the result of medical intervention, all while knowing a bad outcome at all is drastically reduced simply by staying at home.

I would give this article only two stars - not a lot of valuable argument, but not completely bull-headed either. Another bit of irony, the article that follows this one in the journal is medicalVerdicts, a long list of medical mistakes and their law suit outcomes. Here is an example:

"A woman in labor at full term presented at the hospital for delivery. Labor progressed normally, and the physicians performed an amniotomy. Prolapse of the umbilical cord occurred, and a cesarean delivery was performed about an hour later. The child suffered asphyxia, leading to brain damage with cognitive delays and mental retardation.
Patient's Claim: The physicians were negligent for (1) performing the amniotomy before determining that the fetal head was engaged in the bony pelvis; (2) failing to recognize cord prolapse in a timely manner; and (3) failing to perform a timely cesarean delivery.
Physician's defense: The amniotomy was indiated because the fetal heart tones showed unexplained prolonged decelerations [WHAT!?!]. Also the child's condition was unrelated to labor and delivery, because the child had no motor impairments.
Verdict: $500,000 Michigan settlement.

Another case, ironically a mother having planned to birth in the hospital and in fact presented at such facility with an emergent need. Eight months pregnant and taken to the emergency room when experiencing vaginal bleeding. The ER physician evaluted her and judged her condition to be stable. He ordered transfer to another hospital. She continued to bleed during the transfer, and her child was delivered stillborn after arrival at the receiving hospital.
Patient's Claim: The ER physician was negligent for failing to recognize the need for an emergency cesarean delivery. Also, the hospital violated EMTALA because she was not stable.
Physician's Defense: The patient was properly assessed and was stable.
Verdict: $1,674,000 Iowa verdict. Fault was assessed 70% to the hospital and 30% to the physician.

Proving homebirth safe through RCT is like arguing we need research to prove the wheel is round. Redundant and naive.

Follow-Up

I've had a few questions...

How is Keely's foot? She is completely recovered. She was still using crutches when we left but very soon after was putting her weight on the foot and when we returned, seemed completely back to normal. Apparently she just had a nice sprang.

Now that she is healed though, I am going to poke fun. Do you know that until yesterday, Keely thought "wants" and "once" were the same word. Say them. I never realized how one could mix them up, but really, it took until her freshman year?

Her other sort-of-funny this week... yesterday she had some friends over and she was getting a bit mouthy with me, showing off. She started to give me "da sista" roll of the neck and apparently was a bit too aggressive. Just as soon as she started to roll and mouth off, she had a look of terror in her eyes, "I think I just pulled a muscle." Her friends get way too much joy out of Keely's blonde moments.

Thursday the kids are in all day co-op classes. Keely is taking a few higher level high school classes, so has a bit more work than she is use to. This week she was suppose to design a garden, discussing what vegs she would plant, where and how to plant, harvest and care for the plants. She also had a book report to complete, as well as typical chapter, summaries and test preparation to do. Wednesday evening about 8pm, Keely asks me where my gardening books were. She was up until 3am and she is not very good past 10pm. Thursday morning, my prissy little daughter who I rarely ever see without mascara and perfectly straigtened bangs wore her pajamas to class.

I realized she had them on soon to leaving time but figured she would soon be changing. I didn't pay her attire anymore attention until she stepped out of the van to walk into her classes. "Keely! You have your pajama bottoms on!" She shuts the door grumbling, "I was just too tired." I was shocked.

After school she said, "Mom, no one made fun of me today." She argued that she was going to start a trend, that every other student would come next week with their pajamas on. I agreed, "It is probably the one day of the week homeschoolers actually do get dressed."

Why did Simon have to go to Riley? The funny/sad/odd thing was Keely's dermatologist has been at Riley, so clearly we wanted Simon to be seen by the same great physician. However, we don't have health insurance on Simon so Riley was unwilling to accept him. The desk clerk said, "I don't think she accepts cash." Ha!

Simon is fine. He has psoriasis, diagnosed by another fabulous pediatric dermatologist. He was on a lot of medications for a while - one of the worst cases of psoriasis they had ever seen, but all is well now. He is very sensative. However, it is nice to know this isn't an autoimmune or allergic issue. It is concerning that they all have psoriasis and greater risk for skin cancer, particularly with Mike's history of cancer.

Canada, the Capital, 4-H and my weight loss will have to come in another post, as well as Mike and I's marriage recovery. Stay tuned.

Offending Someone

I am irritated, frustrated, maybe even quite angry. This post will likely offend. However, I seem unable to stop myself and ultimately, I think the message is important.

I am a midwife. My being a mother is just as important, if not more important, than my being a midwife. I am most importantly, a wife.

I believe when the old testament midwives were blessed by the Lord for their protection of the Israelite boys, they were blessed with fertility. I believe this because I assume the reason they were midwives was because they were either unmarried or infertile. How could a mother blessed with many children attend all the births in the community? Granted, prenatal care wasn't provided in old testament days, or even a few decades ago. There also was no phone or e-mail that allowed pregnant mothers to reach their midwife at all times of the day and night for any reason what-so-ever. This is where I have become frustrated. This expectation that I sit idle, awaiting any need is absurd. However, not nearly is arrogant as the subsequent argument I receive after their bill arrives.

When I first opened my practice, I had little mentorship. I created every network, discovered every resource, wrote every practice guideline, designed my own web site, created my own childbirth education program and each and every one of my chart forms. I researched practice management, hired and trained staff, and organized equipment. All of this, I did almost entirely independently. I then took every phone call, provided each and every interview requested, returned every e-mail, provided each prenatal visit, attended each birth being the first one to arrive and the last one to leave. I've offered each client four times more postpartum visits than any medical provider, and I care for baby as well.

I have missed only four home visits. Two because I was at a birth. One because I was out of the country and the other, because I was simply too exhausted. All but one mother was blatantly upset. These services are just what I provided as a standard, for many mothers I provided much, much more.

During my first year in practice, my daughter was victim to a horrific crime, yet only one of my clients is aware of this. In fact, I attended a blessingway on the evening I was interrogated by the prosecutor and she was brought in for questioning. That mother hadn't a clue. I was her midwife.

During my second year in practice, my husband and I nearly divorced. In fact, papers were filed. My husband was walking out the door the minute I was called to a birth. That mother was completely unaware of my desperately broken heart. I was her midwife.

My clients expect a return phone call in only a few hours. They have no appreciation for piano recitals, birthday parties, days at the pool, or intimacy with my husband. They have no ability to comprehend that they may be the fifth phone call in under an hour and it isn't even 8 am yet! All my clients expect my undivided attention during prenatals, during home visits and of course, during their birth, but then how do they expect me to return each and every one of their phone calls if I am offering the same to another client? What if I have attended three births in five days, plus had a full twelve-hour clinic day? Who cares for my kids during that time, particularly my youngest son who is breastfeeding and needs to see a specialist at Riley hospital in the midst of all these midwifery responsibilities?

I have only missed prenatals twice for births. If I am up late and come home early in the morning, I still attend each prenatal and not one mother is aware of how completely exhausted I am. I missed only a week following my birth and only a handful prior, but clients were irritated by my absence. I attended a birth two weeks after my cesarean section in the middle of the night, two hours north. Then I turned around and did her home visit two days later.

I have more than a handful of clients that call or e-mail almost every single day. I have clients that call when their spouses reject them in bed. I have clients that call to be sure it is safe to eat processed lunch meat. I have women who I have never met call at 1:30 in the morning to share their bad birth experiences, and my request to call during office hours falls on deaf ears. I have women that want me to share my lengthy testimony, as a prerequisite of their choosing me as a provider. I have clients who call late Sunday evening and when I don't immediately answer, they call each of my birth assistants and tattle tell on me. I get at least five e-mails a week from people interested in midwifery and want me to direct them or inspire them.

I've had a client call the office and leave a message. Then call my cell phone and leave a message and because I was in the van with my kids, I missed answering it while it was ringing, but immediately returned the call. However, she was already in the process of calling a birth assistant to discover why she was unable to reach me. She shared with me that she was very concerned, "What if my placenta was coming out of my ear." Then, hunny, you should call 911.

I have ladies that have transferred care because I took three days to attend a conference, the first time I have taken even an hour without call in two years. I had one lady terminate care because it was her understanding that when you hire a midwife, you also gain a best friend.

I have clients that demand appointments on a particular day or particular time of day, or weekends every single time. I have clients that have demanded home visits because they were too tired to drive to the office, less than thirty minutes away. I've had clients demand that I make a home visit on Sunday morning while I was on the way to church, because she was simply too tired of being pregnant and wanted me to strip her membranes. When I declined, yet still offered to meet me back at the office after church, she responded that her and her husband didn't want to drive that far. I've had clients call for an urgent appointment because they felt their breasts were too far apart or just show up to have their cervix checked, assess breastfeeding, weigh baby or have an additional lab checked.

I have clients that stay four and five hours while their children run through the entire house, absolutely destroying my son's room and/or the kid's school room. Clients walk through the house with mud on their shoes or allow their children to urinate on the floor or bathroom wall. Kids climb on my couch with their shoes on, spill food on my furniture and throw toys at the windows. Parents ask for me to provide juice, milk and snacks for their children. Numerous clients ask for tours of my home.

I had a woman demand an interview on a holiday because it was the only day her husband could attend, and then after three hours of interrogation, they asked if their kids could stay for a while and play in our backyard. No, they didn't even choose the practice!

Many of the clients I've mentioned above were offered far more than the standard prenatal package. Each one of them were exceptionally complementary regarding their care. Yet, ironically, each one of them complained about their fee. They didn't realize they had to pay. They didn't receive a bill. They didn't think I really meant it. They knew they were told, but forgot and now haven't a clue how they will pay. They "just wanted to see what a midwife was like" and didn't realize a health history, physical exam, referrals, prescription and/or labs meant they would be charged, even though they signed to that affect including providing their insurance card.

Do I sound bitter? I am. I am offended. I find it grossly disrespectful to ask me to be on-call for you 24/7 for more than nine months, your 24/7 healthcare wicapedia and friend, yet whine that I charged you for one, of the additional five lactation visits I provided. I find it utterly horrendous to call me every day for a week demanding I file a lengthy FMLA or short-term disability, and then make me beg you for payment you have known since the first day we met would be due in full upon your thirty-sixth week of pregnancy. I feel slapped in the face when I give grace for "forgetting the check book" or "having recently changed banks" or whatever other excuse given, prenatal after prenatal, and then ultimately given a check, post-dated, that bounces...all after my services were provided in full.

During our first year in practice we had several clients fail to pay a dime. We had a few clients receive their insurance reimbursement, then decide they were in more need of the cash than their midwife. We had a horrendous midwifery billing company fail to file numerous claims, totalling nearly $100,000.

We filed for a hardship with our mortgage company hoping for a few months grace and because we demonstrated an inability to pay d/t lack of income in my practice, we were immediately placed in foreclosure. That same summer, we had no hot water for several months. Showers are still freezing cold in the middle of summer without any gas to heat your water heater.

My statistics are phenomenal. My experience is exceptional. My birth assistants are top notch. We offer expert lactation services, file insurance claims, high quality tub rentals, TENS machines without additional cost, extra labor support, clean and cook for each family, yahoo groups, a full childbirth education program, supplies at no additional charge, opportunity for families to interrogate on my own time, hours and hours of educating the community and medical providers, and an incredible amount of advocacy work just so families who choose to can have the legal right to birth at home.

Until very recently, I have been the office assistant, the medical assistant, the midwife, the biller, the lab technician, the housekeeper, the answering service, the counselor, the marketer, the advocate, the childbirth educator, the manager, risk management, and every other person that it takes to run any other medical office...and I was expected to perform each task simultaneously.

I had a client call me for a non-urgent concern, months after she had birthed her child and although I referred her to a fabulous specialist for her particular need, offered her extensive on-the-phone counseling, and a plethora of reading material, she quickly became irate when I didn't work within her timeline to call in a prescription. No office visit. No consultation. She wanted an script NOW! She called me repeatedly, hour after hour. Then she called my birth assistant repeatedly and the pharmacy repeatedly. I don't have prescription privileges, so I have to find someone willing to provide a script I recommend and send them a full H&P which can take an hour to dictate in itself. Of course, initially I was at home visits and knowing she wasn't even pregnant, I let the calls go to the answering machine. I was offering the same care to my current client that I provided her. This woman however, became exceptionally angry with me and so when I respond that I am sorry I am unable to meet her needs, and encouraged her to contact a family physician, she responded that she did and he wouldn't talk to her on the phone and couldn't get her in for an appointment for another two weeks! What!?!

Have I mentioned that I owe $90,000 in student loans and don't charge enough money to even cover that expense? Have I mentioned that my birth assistant and I have the same level of education as your expensive attorney, yet we both make less than my twenty-four year old hair stylist?

Am I naive enough to think that if I slacked on the job the way my clients slack in their financial responsibility, that they wouldn't be on the phone immediately connecting with their attorney? Nope.

The sad truth is...all that I have shared isn't really at all the root of the issue for me. The real issue is that I sacrifice time away from my family. I sacrifice friendships. I allow myself to be abused by other medical professionals and mocked at by the community because I have such great empathy for families that genuinely seek homebirth as an option. I do all of this and repeatedly receive over whelming praise for a job well done and gratitude for the ministry I provide, and then in the time it takes to open an envelope and pick up a phone, that gratitude vanishes to nasty messages left on my machine due to money they don't feel they should have to pay when insurance cuts them short. Clients wanting to pay me $20 a month for seven years and irate that I want to include interest. The really sad part is I offer to barter their expenses yet rarely, if ever, are they interested in working off their debt. They never really respected me in the first place.

The beauty in my job is that I have families who genuinely can't afford a gallon of milk, yet call me repeatedly to be sure that I got their check. I have clients who can't pay their own utilities yet find ways to pay their midwife, without a single complaint. I have a few clients who have sold their automobiles to pay their midwife. I have families who bring me corn, applesauce, knit my boys diapers, fix our plumbing, encourage me, send me flowers, take my kids on day trips, invite us to dinner, barter until their arms are numb, and repeatedly thank me for the little things. I have many clients that had I instituted a boundary of "do not call or e-mail unless you meet these certain circumstances" would have respected those boundaries whole heartily and potentially we would never have crossed the boundary into friendship.

I sometimes fear that I am reaping too many earthy rewards because of the work I do, in that I work with women who sacrifice their time, family, and absolutely their pocketbook to assist me in serving the women in our ministry. I have gained friendships with clients that are more valuable than gold. The Lord has provided me more than I ever could have imagined and makes clear daily that this is the work He wants me to do.

However, I can't seem not to be offended by those few that push each and every boundary far beyond what they would ever get away with from any other medical provider, potentially even their own family, and yet, are quick to lash out at me and cry injustice at the first opportunity. I am tired of letting these people run me down. I am tired of being an angry mommy because I was run over by a client. If I've offended you, then maybe you should ask yourself if you would do my job - make the daily sacrifice, assume this level of responsibility, put in the hours it takes to run a midwifery practice, pay each month $700 in student loans, never ever have a moment when you can't be free of the responsibility - so that you can later receive a call from a client arguing a $350 bill or someone wanting an excuse for why you haven't called their ultrasound order in within the last twenty-four hours.

If you've read this far, you are most likely a friend, who maybe use to be a client, who now agrees that I need a margarita. Oops. Another sacrifice. I can't drink alcohol. I might need to give a client my undivided attention. Margarita or not, I must go help finish homework. It is afterall midnight and the last thirty minutes of escape within blog-o-sphere were not in the budget.

Comments

I had my settings rather strict apparently and readers have shared their inability to comment on my posts. I think I've corrected that now - anyone can post although all will be moderated. Please do. I really love the dialogue!

Visit to the Capital

Almost two weeks ago, I had a physician call the office and leave a kind message regarding a client of mine who had applied for Medicaid. She was hoping to follow-up on her care. However, upon completion of her message, she failed to hang up appropriately and her continued assault on me and my practice was eloquently recorded on my answering machine.

She shared with her staff that I was working outside my scope with a high risk client. She stated I was unprofessional and she was going to report me and get me into big trouble. She mocked my client for seeking Medicaid coverage and thinking Medicaid would pay for her desire to have an illegal homebirth with an uneducated midwife.

First thing Monday morning, I gave this kind physician a phone call as it was clear that she needed enlightenment. The Lord allowed me an hour-an-a-half on the phone with her to somehow shine a glimmer of light into her very narrow minded vision of homebirth and midwifery. Humility can really open the paths of conversation.

Amazingly, this family physician had absolutely no knowledge of Nurse Midwives (and not a great deal about maternity care either) but was adamantly opposed in every way to the direct entry midwifery. She doesn't attend births as a physician and feels she will raise her kids well enough that they would never choose to birth at home. Therefore, she felt the issue really has no direct affect on her, but as a physician who grew up in a third world country where women and children die daily, she had no ability to understand why women, her own patients, in American, with choice, would choose not to birth in the hospital.

I used this passionate distaste for direct entry midwives to encourage a potential willingness to embrace Nurse Midwives as an alternative, particularly within homebirth scenarios. She agreed with my argument and pointed the finger at me, "Do something about it. Contact your representatives!" I do. I have. I continue to often. She then explained that my efforts have been all wrong. Clearly!

Funny enough, the Lord used this completely humiliating situation for this physician to share her resources with me. Apparently, this physician is exceptionally active within our legislative healthcare committee. It seems she genuinely knows each and every representative and senator, as well as their agendas. I've been waiting for the Lord's tool and praise the Lord I came prepared. Upon my return from Canada, I had a message with an immediate appointment in the capital with a few of our legislative leaders. I gave my all. I was heard. Jaws dropped. My greatest concern is the timing, but the Lord will control that.

Ironically, as I dropped by my local ACNM chapter's web page today, I find... "We will be alert for ways to make home birth better supported for CNMs in the next legislative session." I ask specifically, what is their vision because only one person that I spoke with yesterday had even heard of Nurse Midwives and she was told that they would not work outside of the hospital? They had absolutely no awareness of the barriers we face. I challenge the chapter to step forward and represent its members. Now is the time.

Certified Nurse Midwives providing homebirths in Indiana include:
Our own practice, Believe Midwifery Services, LLC with Penny Lane MSN, CNM
Birthroot Midwifery Services with Lynn McDonald MSN, CNM
Peaceful Beginnings Midwifery with Kate Shantz MSN, CNM
Laura Gilbert CNM (serving North Central Indiana & Southwest Michigan)
Childbirth Choices & Women's Health with Diana Saunders CNM (serving Milford, IN)
Julie Stackhouse CNM (serving Corunna, IN)
Mary Doezema CNM
Moonstone Midwifery with Gretchen Jenkins CNM (serving Ft Wayne, IN)
Central Indiana Nurse Midwives with Lynda Barton-Kirch CNM

Frontier School of Nurse Midwifery and Family Nursing

I am amazed at the lack of knowledge regarding Nurse Midwifery. Let me share a tiny bit here. Nurse Midwifery is legal and practiced in each state within America. Indiana licenses Nurse Midwives as independent providers, however requires a written collaborative agreement for prescription privileges. This requirements grossly limits our profession. The American College of Nurse-Midwives opposes requirements for signed collaborative agreements between physicians and certified nurse-midwives (CNMs) or certified midwives (CMs) as a condition for licensure, reimbursement, clinical privileging and hospital credentialiting, or prescriptive authority.

There is no evidence that collaborative agreements increase the safety or quality of patient care. In fact, this requirement has hampered the ability of CNMs to provide safe care when agreements can not be obtained and/or in the circumstances of providing necessary emergency relief services. Most importantly, collaborative agreements wrongly imply that CNMs need supervision of those individuals in all situations. This has in turn limited Nurse Midwives from receiving hospital credentials, clinical privileges, or third party reimbursement for services that fall within the scope of their training and licensure.

Nurse Midwives care for women throughout their life cycle, for any reason you might see a family practice physician. We perform pap smears, offer breast exams, treat sinusitis, care for acute injuries, immunize, counsel, draw labs, order ultrasounds, manage menopause, dysmenorrhea, infertility and of course, care for pregnant women, catch babies and assist with lactation. Nurse Midwives also care as a primary practitioner for the newborn through six weeks of age.

Often midwives have a particular area that they have additional skill, experience or interest and so they may concentrate or work beyond the typical scope of Nurse Midwives. Depending on this additional skill, they may seek credentials through our professional organization in effort to gain credibility and professional accountability for this skill. Circumcision, use of the vacuum extraction, ultrasound, surgical procedures, and cervical biopsies might be among these procedures. Another Nurse Midwife might be an expert in diabetes, HIV, or menopause.

My particular interests and specialities are homebirth and lactation. These are within my scope of midwifery; however, I have gained additional experience and education beyond the basic core competencies. While breech birth is also part of our basic competencies, this is primarily so we can safely attend a breech birth presenting by surprise. I feel particularly called to enhance this skill, as I feel it is a lost art among practitioners for no other reason that liability concerns.

I also hope to gain experience with performing frenectomies and would need to apply for an expansion of my skills for this procedure. My expertise, I believe, also includes managing gestational diabetes and hypertension in pregnancy, although this is fairly common among midwives in independent practice and likely has become standard of practice.

Nurse Midwifery is graduate level study, although not all hold a master's degree. I do believe it has become a recent requirement of our professional organization however, prior to sitting for boards. Many midwives hold a doctorate in nursing as well and there is great discussion concerning the requirement of this level of academic education for minimum standards of Nurse Midwifery practice.

This was my level 3 clinical class at the Frontier School of Nurse Midwifery and Family Nursing, located in Hyden, KY. Although my experience wasn't completely fabulous (nearly expelled after having birthed my son at home), the education was absolutely top notch and I highly recommend the program for that reason. The school has grown tremendously since I have graduated, adding a PhD program and a bridge program from the Associate Nursing level to a Master's degree.
The history of the Frontier program is one that each graduate holds dear to her heart. The school was opened in 1939 as part of a project to care for the underserved in rural Kentucky. From the beginning, Mary Breckinridge viewed nurse-midwifery as central to health care. The goal of the Frontier program was to enable nurses to remain in their communities while obtaining graduate education as nurse-midwives and ultimately increase the number of practicing nurse-midwives working in underserved areas. The pilot project was very successful. In 1990, the FSMFN recognized that the CNEP model of education matched its own goals and mission. The President of the School and the Board of Directors voted to adopt the CNEP as its nurse-midwifery education program in 1991. Since then CNEP has graduated over 1100 nurse-midwives.
In the late 1960s, the Frontier Nursing Service recognized that as health care options became more complex, a broader based education was necessary for nurses to be able to provide comprehensive primary care to all family members. At this time the FSMFN developed the first certificate program to prepare family nurse practitioners. In 1970, the name of the School was changed to the FSMFN to reflect the addition of the FNP program. The last class to graduate from the combined family nurse-midwifery program was in August of 1990. The Community-based Family Nurse Practitioner (CFNP) education program was reestablished in 1999 using the CNEP distance education model. With the acceptance of CFNP class 1 in 1999, the FSMFN comes full circle in its mission to educate nurses to provide primary care that is comprehensive, safe, and culturally sensitive.
In 2003 FSMFN began offering an MSN in the specialties of nurse-midwifery and family nurse practitioner, and a certificate in the women’s health care nurse practitioner specialty. In 2005, FSMFN added the Women’s Health Care Nurse Practitioner track to the MSN options and added a post-master’s certificate for all three tracks.
In October 2004, the members of the American Association of Colleges of Nursing (AACN) endorsed the Position Statement on the Practice Doctorate in Nursing which called for moving the level of preparation necessary for advanced nursing practice roles from the master's degree to the doctorate level by the year 2015. FSMFN moved forward with plans to include the addition of a Doctor of Nursing Practice in the program offerings in 2007. The first class of DNP students will enroll in October 2008. The introduction of the DNP will ensure that FSMFN remains a leading institution in advanced practice nursing education and offers quality programs at all levels to nurse-midwives and nurse practitioners throughout the country.
Here my good friend, Diana, rang the bell passing her into the group of students that had succeeded and survived the first two levels of the program and was prepared to enter into the clinical or residency portion of midwifery program.

Nurse Midwives are employed within hospitals, birth centers and homebirth practices. They are reimbursed by most all insurance companies. They attend 10% of the nations births and hold the best outcome statistics. They are also cost effective. They are the solution for today's healthcare crisis. The number one reason for hospital admission is childbirth and with a soaring cesarean rate, as high as 40% in central Indiana, costs are escalating. Many providers have visions of a near 100% cesarean rate in the next few decades. This impacts long-term health of the newborn and mother, which further increases healthcare dollars. Physicians will not only loose their ability to attend breech births, but all vaginal birth skill will vanish.

Indiana has the fewest Nurse Midwives in all of the country. Many community members and even medical providers believe midwifery and/or homebirth is illegal. Untrue. It is quite common for me to receive e-mails from community members or healthcare providers who either themselves believe our work to be illegal or who have been hassled by someone else who has this belief.

The American College of Nurse-Midwives, who has a local Indiana chapter, is the group charged with educating and advocating for Nurse-Midwives. I would encourage each of you to write them a letter sharing your experiences of other's ignorance regarding midwifery, particularly within the healthcare system, and suggestions in how they might address these concerns. I have personally been unsuccessful in requesting they educate their own members as I still receive a great deal of slander towards my own practice from Nurse Midwives that fail to understand their own licensure.

Did I ever share this? I purchased this T-shirt for the end of my pregnancy and you would be amazed at how many people that read it and then apologized for having said that to me earlier in the week!

Noah and his friend's at his eleventh year birthday party...Cory, Jon, Rodney, Cody and Chelsey was gone gathering more swords.

Gone Purple

A few weeks ago, rather months ago now, Keely decided to add some color. I encouraged her to go wild because highlights just aren't necessary in her hair. We have a fabulous hair stylist and he recommended purple. Isn't this fabulous? She has since added purple highlights throughout her entire head and curls it rather than straightens it, so it is much more punk. Fun!

Anniversary Cake & Celebration

One of our moms made our anniversary cake and I was absolutely amazed at her skill, given this was her first attempt with fondant! The inside was multicolored and oh, so very moist. We will be ordering all of our future cakes from her. Isn't this amazing!

The joke was that cutting the cake would give us the first cesarean section in our practice. Suggestions were given - my putting on sterile gloves and passing out cake, but that too seemed too interventive. I explained the cake was just going to have to push! Eventually we just handed the knife to the eager boys and they dove right in. I suppose it is important to have good surgeons and at least they'll be midwifery advocates!

Paula Miller MSN, RN gave a talk on co-sleeping verses bedsharing. It was a nice discussion that offered evidence-based support for those families that desire bedsharing. She also demonstrated the use of the TENS machine, which the practice has purchased for supporting women who suffer from persistent back labor.

Rixa Freeze PhD and amazing seamstress shared the how-to's of sling use and brought several samples for mothers to browse through and experiment with. Her slings by far have been my favorite and I've used many varieties. We hope to add a collection of her slings for sale in our office in the near future. I simply need to find a wardrobe of some sort to put in the living room to hold a few sale items.

We shared a bit about the progress of our practice since opening. As most all of you know, we've been awarded the 2009 Nursing Advancement, which is far beyond anyone's expectations. Thank-you! We were interviewed for an article in the Indianapolis Star's Nursing Quarterly, (which I still need to follow-up on some misinformation).

Statistically speaking, we have been amazingly blessed. We have had only one mother transfer during her intrapartum period. Meaning, every mother that has entered labor with our practice has birthed at home, with the exception of just one mother. While this one transfer did unfortunately birth outside her home, she did have a vaginal birth and a beautiful baby girl. When asked by her hospital care provider if she would choose to birth at home again, she said absolutely yes because homebirth still encompasses all that she believes to be true. It is important to not intervene until proven necessary. Her birth proved necessary, but every opportunity was given to allow for nature to run its course. We find this a success.

We have had two postpartum transfers - one for a retained placenta and another for PPH. Both were completely stable upon arrival, but I felt it was prudent to utilize medical services for ongoing monitoring in those cases. Both were released within hours and both families felt the transfer was appropriate and appreciative of our care. We've had two babies visit the emergency room after twenty-four hours of birth, one d/t low temperature and one for an infected umbilical cord. The cold baby was warmed and the second was given triple antibiotic cream. Both are happy and healthy!

Our practice does have a high antepartum rate of transfer, meaning we risk nearly one in four women out of homebirth. The vast majority, unfortunately, are families who risk themselves out of homebirth for failing to meet their own responsibilities - attending prenatal visits, respecting the financial agreement, gathering supplies and so forth. Others have progressed to uncontrolled hypertension, persistent breech, 43 weeks of pregnancy and just too exhausted with pregnancy, and a change in heart regarding homebirth.

Each and everyone of our VBAC mothers have birthed at home successfully. Each and everyone of our diabetic mothers have had well controlled blood sugars using diet and exercise as management, and very healthy babies. All but one of our OP or sunny side up babies have birth at home successfully - one transferred to the hospital as previously mentioned.

All of our babies have been exclusively nursed through six weeks of life (and most all much longer) with exception of two babies.

Our practice has added an office manager - Dana Fort. We have added a nursing manager - Paula Miller MSN, RN. We have taken over the responsibility of filing insurance claims and have moved towards paperless charting! We have found five fabulous birth assistants - Paula, Dana, Emily, Rachel, and Amy. We have instituted office hours - Mondays and Thursdays. We have cared for many Christian families and many whose faith differs from ours... significantly. We have had four families return to our practice for their second homebirth with us!!

We have a scheduled appointment with legislative leaders to discuss barriers to Nurse Midwifery care, particularly in homebirth - Please pray - more details later. I am attending a breech conference in Ottawa this month in hopes of adding this skill to my practice in the next few years.

We have many, many future plans, but for now it is my hope to find the perfect midwife to join us in our mission and give me just a bit of relief. Anyone?

Eventful Weekend

Our weekends seem to always be packed with much more than we can genuinely accomplish. This weekend was no different. Saturday was the anniversary celebration for our practice - second year! It was a very nice day. Afterwards we headed to Lafayette for Breanna's tenth birthday party, my sister's daughter. We missed the pizza before at CiCi's but joined in the fun at Monkey Joe's. My mother was there, and my father's wife. It was an interesting evening.

Today we had plans to head down to see a friend's baby dedicated but on the way out the door Keely fell holding Samuel and heard a loud snap in her ankle as she hit the sidewalk. We carried her back inside but in spite of no swelling or bruising she was still wailing an hour later, so I drove her into the emergency room. No broken bones, but she did come home on crutches and new found love for her brothers.

After she fell, Samuel immediately laid down on the sidewalk to ask her, "You okay Sissy!?!" She tearfully asked him to go get Daddy, although fearing he would become distracted and she would lay there on the side walk in pain until we finally gathered our things and headed out the door. Almost immediately Mike and Samuel returned and when Mike realized what had happened, he left Keely laying face down on the sidewalk with Samuel at her side, and ran up to the third floor for me. Samuel was trying his best to comfort her and as soon as Noah heard the news, he became her immediate butler. He's been tending to her every need all evening and Keely is sapping up every moment. It is nice to have moments like this.

Braxton

Mike's first grandchild. Clarissa's first little boy.

Wallpaper to Paint

Mike has nearly finished scraping the last bit of wallpaper from our old home, with the help of a few friends! We need to plaster holes and then we're set to paint. However, we haven't any idea what color and would love your input.

Those of you that have been here know that our living room walls and large couch are a gold color. The office is cranberry red and the dining room is ivory silk. All the rooms have a dark mahogany, so I'd love something that would accentuate the beauty of the woodwork. This color though, has to fill the entry way, the front stair way, and entire upstairs hallway and back stairs.

We already have two green rooms - kitchen and school room - and Mike and I's bedroom is blue. I think we need to go somewhat neutral, but not boring. Please advice!

I am thinking I might wallpaper the up-stairs bathroom some crazy Victorian style paper, with lots of jazzy color. Any leads there too would be fabulous!