Two Births One Doula

Okay, firstly I will acknowledge the fact that I haven't written here since August. After I was finished waiting for all the summer babies to be born, I started filling my schedule again, and haven't had time to sit and do such things. Fortunately for my vacation plans, some of the later babies were born early, and my on-call period was shorter than I had expected it to be.


I purchased the Canadian franchise of Mama Goddess Birth Shop this past September, and while incredibly exciting, it was quite overwhelming at first. The business is very similar to my midwifery supply business, but it is quite a bit more labour intensive with all the birth kits and such. There was a learning curve for sure. Now that I am more settled into it, I absolutely love it.

While I did attend several births in the Fall months, I did not have to clear my schedule as much due to a lovely doula partnership. We shared our clients and split up the call schedule. I was only on call half the week, so I could feel free to teach courses, get my expanded business in order, or reliably attend social functions even though we had clients that were due. We were also there for each other to spell each other off during a long birth or fill in when the other was ill. It also allowed us both to enjoy Christmas with our children even though we had a Christmas birth. However, my dear doula partner is pregnant, and the time has come for her to step back from doula work for a while.

So for the last week, I have been on my own again. I had 2 January clients, so I cleared my calendar in anticipation. However, as it turned out, I only needed one day. They both decided to come at once, and they were having their babies at different hospitals.

While I always make an effort to have good back up coverage, I never actually like to use back up. It's not that I don't think my back up network is fabulous, or that I don't trust them. I just really love birth and love my clients, and I'm really choked if I can't be at a birth for whatever reason. So when both clients went into labour on the same day, I began to resign myself to the idea that I was going to be calling the back up in.

However, it all magically worked out. I had been at one client's home for a few hours, and her labour had slowed down. She was trying to rest again. I got a call from the second client's husband, and I could hear her screaming in the back ground - this one was moving faster! Since the clients lived very close together, I decided to pop over and check things out with the second client. Things did progress reasonably quickly, and by the time client #1's labour began to pick up again, I was getting ready to leave the hospital - the baby was born and latched and cozy.

So now, to make a long story short, here I am with a clear schedule and all the babies born! Perhaps I will have time for activities such as blogging again.

P.S. In reference to the picture I chose- it's Tori Amos playing 2 pianos at once. She does this at nearly every concert. It's mind blowing. She often isn't looking at either of them, and her piano melodies are typically quite complicated. But she nails it, and the result is amazing, full-sounding, incredible music. It works, without causing either hand to fumble.

The Importance of Pool Liners

If you search the web and go to different birth pool websites, you will read a lot of different things about pool liners. I would like to set the record straight.

Have you ever wondered why Birth Pool in a Box requires that people use a liner for the warranty to be valid even on personal use pools, and other pools don't even come with liners included? It's not because those other pools are better and don't need an extra protective layer. In fact, Birth Pool in a Box is very well made, and very durable.

The issue is that all three inflatable birth pools on the market are designed in the UK. In the UK, BPIAB owns the patent on pool liners. That means that in the UK, only BPIAB is allowed to be sold with liners. Fitted liners on the other pools would be infringement.

If you buy an Aquaborn in the UK, it will not come with a liner in the box the way it does here in North America. It's not because the liner wouldn't be a good idea. It's because they're not allowed to include it.

So, if you go on the UK sites for La Bassine (Made in Water) and Aquaborn, they will talk about how a liner doesn't help or doesn't make any difference. It's a sales pitch. If you live in North America, and can therefore access liners for both of these pools, USE THEM. If you're purchasing a La Bassine, you will need to purchase a liner separately. DO IT.

Here is why:

- The way these pools are designed, we're not worried about some sort of catastrophic deflation and emptying of water all over your house. Whether you're using a liner or not, the vertical beams in both the La Bassine and Aquaborn will hold their shape and contain the water for long enough that you can drain the pool.

What we're worried about is a small little tear in the floor, or a little puncture that goes unnoticed. Without a liner, you can either have water escaping into the air chambers and weakening the pool, or you can have a pinhole leak in the floor that goes unnoticed until someone kneels on a sopping wet bit of carpet, towel, blanket, or hardwood. At that point there is little that can be done, and it's a frantic panic to soak up the water, drain the pool, and protect your house!

Both of these scenarios can be prevented with the use of a liner. I've heard several stories of people having to abandon their plans of water birth when their pool suddenly springs a leak. It's too bad. If they had used a liner, it wouldn't have been an issue at all, and probably would have gone unnoticed entirely.

We have an Aquaborn pool set up on our patio in the summer (I've sat in it several times today). It's our old first generation demo pool. It was sent to us for free from the UK because I wanted a demo, and this pool had a manufacturer's defect so was useless to the UK distributor. It has a very small (actually, I've never been able to find it) hole in the floor. It doesn't affect the look of the pool, and the pool stays inflated very well (even the padded floor shows no sign of deflation). One day my husband forgot to put a liner on and filled it. He had been in there for quite some time before I came home and noticed. He had noticed no change in the water level, so he assumed that everything was fine. Luckily it was set up on our porch and not our living room, because the blanket underneath was SOPPING on one corner. It had leaked considerably! However, when we remember to use the liner, we don't have any leaking whatsoever.

- From a practical standpoint, using a liner makes for very easy clean up. When I am at a birth with a birth pool, I require my clients to use a liner if they want me to clean up the pool afterward. With a liner, clean up is fast and easy. You drain the pool, take the liner off and throw it away, and you have a clean and dry pool underneath that is ready to be packed away. If you don't use a liner, the pool must be washed and dried before it can be put away, otherwise you will get terrible mold and bacteria growth.


The most common reasons why people choose not to use liners:

-extra cost on a La Bassine (Aquaborn comes with a liner included)
-it's harder to grip internal handles (which on the La Bassine is all of the handles)
-it looks nicer without one, and none of the beautiful pictures of birthing women on the internet have liners in the pools

In my opinion, if you weigh the pros and cons ($1000s in floor damage with a leak vs $40 for an extra liner or having to utilize internal handles a bit less) liners are well worth it.

Choosing a Birth Pool

Whether you're actually planning to give birth at home in the water or just want to labour in the water a bit, birth pools can offer some incredible pain relief. There are several choices on the market. Here is a guide to help you decide which one to get. (Please note that all prices are Canadian).

The Aquarium Pool

This is the cheapest way to go. One of these will set you back about $30.00 from most big box stores.

Pros:

-Cheap.

-Holds less water, so less taxing on the hot water tank.

Cons:

-Many women find them too shallow. Deeper pools allow for more buoyancy, and this allows for greater pain relief.

-They are not phthalate or cadmium free. Keep in mind, you are filling this pool with hot water. When the plastic is heated it can leech these chemicals which have been shown to be unhealthy.

-Some of these pools have drain plugs on the bottom. This is a good feature if you're playing in the back yard. It's a really bad feature if the pool is set up in your living room and you accidentally kick the plug open in labour.

-The quality of material on these is variable. They also do not come with liners, which can act as an extra barrier against leaks and prevent punctures while in use.

-These can be difficult to find in the winter, as they are a seasonal product.


La Bassine (Made in Water) Birth Pool $155 + $40 for a liner

Pros:

-Designed for birth and use inside the home

-2 handles on the inside of the pool for extra support

-Holds less water than other birth pools, so less taxing on a hot water tank, and faster fill time.

-Takes up less space than a larger birth pool

Cons:

-Darker blue colour (or purple for the pro model) do not allow for the same visibility as a white bottomed pool

-Not height adjustable

-Some taller women may not get full immersion of their belly (or will have to fill it too full to do so and risk water tipping over the edge).

-Depending on size, sometimes there is not enough room for the partner to get in.

-No top or outside handles

-No lid option available for keeping the heat in

-Liners are sold separately (it's worth the extra $ to buy a liner though. That's another blog post in and of itself).


The Aquaborn Eco Birth Pool - $199



Okay, I'll admit, I'm not completely impartial. Even though I sell all three birth pools, I am the Canadian distributor for Aquaborn. However, I wouldn't be the distributor if I didn't think these pools were the Bees Knees. I also definitely plan to give birth to my next child in one of these.

Pros:

-Green colour with a white bottom allows for maximum visibility (actually I find the difference quite remarkable).

-Height adjustable

-Designed so the midwife/support people will not strain their backs

-Comes with a lid and liner included

-Thickest padded floor

-6 handles for maximum versatility

-Opaque sides allow for privacy

-Large enough to accommodate both partners with room to move

-The deepest birth pool on the market

-The thickest eco-vinyl available for durability (all birth pools and their liners are phthalate and cadmium free).

Cons:

-Larger, deeper pool, so may be taxing on a small hot water tank and take a bit longer to fill

-No seat (though submersible spa seats can be bought separately for about $25 if this is important).


Birth Pool in a Box -$295 + $65 for lid

Pros:

-Egg shape make some women feel more cocooned.

-Has a seat (regular model only)

-Mini option available for smaller spaces/hot water tanks (but these have no seat)

-Comes with a liner included

-White bottom

-Height adjustable

-Regular model is large enough for both partners

Cons:

-More expensive

-Regular model has larger water volume, so takes longer to fill and drain than La Bassine and Aquaborn

-Lid is sold separately.


Aqua Doula - Usually available just for rental. A purchase would set you back about $1200.00

I rented one of these for the birth of my daughter.



Pros:

-Heater. You should NEVER use a heater with an inflatable pool, so if you really want a heater, this is the way to go.

-Very sturdy and large, allowing for good movement and buoyancy.

-A rental usually will come with a lid and all the accessories.

Cons:

-Not as cushy as inflatables. Many women prefer inflatables for the comfort factor.

-No handles

-Can be taxing on smaller hot water tanks


The Inflatable Birth Pool Comparison Chart

Pool	Birth Pool in a Box Regular - $295	La Bassine - $155	Aquaborn Regular $230
Material Thickness	0.38mm	0.42mm	0.45mm
Internal maximum dimensions	142cm x 114cm	125 cm x 95cm	130 x 105 cm
Internal Depth	66cm	66cm	68cm
Internal Handles	No	Yes	Yes
Side Handles	No	No	Yes
Top Handles	Yes	No	Yes
Inflated Floor Thickness	5cm	7.5cm	8.5cm
Seat	Yes (Regular size only)	No	No
Liner included	Yes	No, $40 extra	Yes
Filling Time	40+ minutes	25 minutes	35+ minutes
Weight when filled	650 kg	520 kg	560 kg
Heat Retaining Lid	Extra- $65	No	Included
White Bottom (best visibility)	Yes	No	Yes
Professional Option Available	Yes - $500	No (not available in Canada)	Yes - $410.00

When Faith and Science Mingle and Conceive

This was originally posted to the Ancient Midwifery Blog on March 16, 2010.

[Creighton Model is a method of charting a woman’s fertility and helping her to understand the natural processes of her own body. NaPro technology is a medical regimen that treats a whole host of gynecological issues without obstructing or suppressing any reproductive functions.]

Despite what I often see portrayed in the media around me, I firmly believe that faith and science are not mortal enemies. In fact, there are times when religious doctrine necessitates innovation, and amazing discoveries are made as a result.

The Creighton Model fertility care system and NaPro are two such examples.

In the Catholic Church, as well as many other world religions, the use of any artificial birth control or purposeful fertility obstruction is expressly forbidden. So what is a pious Catholic woman to do if she suffers from raging hormonal imbalances, severe endometriosis, out of control PMS, or reoccurring ovarian cysts? What if her health or socioeconomic situation dictate that she should not conceive a child at this time, but she still desires a sexual relationship with her husband? The rest of the world solved these problems with hormonal birth control. Out of this dilemma, a pious Catholic doctor responded, and Creighton Model was born.

While this system was created by a Catholic to meet the needs of Catholic women and families, the knowledge learned can help a whole generation of women regardless of religion, creed, or point of view.

Creighton Model is more than keeping a chart. It is a way for women to learn to trust their bodies, understand their reproductive cycles, and receive natural, hormone balancing treatment for any abnormalities that occur.

We live in a society that loves to solve every problem with a pill. The problem with this is that pills usually treat only the symptoms of a problem, and don’t get to the root of it. If a woman suffers from heavy periods, severe cramping, irregular cycles, excessive body hair, or other hormonally driven problems, the most common solution offered by doctors is a birth control pill. While on the pill, women typically have regular 28 day cycles, bleed less during menstruation, and often any external issues also lessen or disappear. However, they have not been cured, and if they choose to go off the pill, these problems often simply return. So these women are left with two choices: stay on the pill, or suffer.

But what if a woman wants to conceive? Obviously she would need to stop taking her birth control. What if the problems return? What if her hormones return to their imbalanced state and conception is unlikely or impossible? This is where pharmacology alone fails us.

When a woman charts her fertility through Creighton Model, and regularly reviews her chart with her practitioner, many problems can either be caught early, or treated quickly and simply. I have personal experience with this.

I had no idea that there was anything abnormal about my cycles other than their length. They were incredibly variable. Sometimes they were 30 days long. Sometimes they were 70 days long. It had always been that way since I began menstruating, so I never thought twice about it. When I began charting with Creighton, my practitioner quickly saw that I had abnormal spotting, prolonged bleeds, as well as other abnormalities in my cycles. My husband and I were not trying to conceive at the time, so I had really not considered any issues with future fertility. My practitioner referred me to a Creighton trained physician in my area, and through blood tests and ultrasounds, I was diagnosed with PCOS (polycystic ovarian syndrome). I had no outward physical symptoms of it, but my cycle showed it clearly. If I had been on birth control, I would never have known.

This diagnosis can be devastating for a family trying to conceive. Many women with PCOS struggle for long periods of time, and often go through many different therapies to try and ensure ovulation, conception, and retention of a pregnancy. This is where NaPro came in. NaPro protocols simply work to balance the hormones to bring back (or create for the first time) normal reproductive function. While I can never know definitively, I have a feeling that our ease in conceiving our daughter is due to this therapy regimen.

However, the greatest benefit that I have taken from fertility awareness is the power and knowledge I have acquired about my own body. I don’t have to rely on a regular 28 day cycle to know when I will menstruate or when I am optimally fertile. I can listen to and work with my own body to plan my family and be responsible for my own reproductive health. It puts the power back into my hands, and out of the pockets of drug manufacturers and doctors. It costs me nothing per month, and there are no negative side effects or drug interactions. It will last me my entire reproductive life. When I choose to become pregnant again, I will be able to know my due date without the help of an ultrasound, regardless of the length of my cycles.

So, when it comes to reproductive science: religion does not necessitate ignorance, and knowledge is power. Let’s give that power back to women.

For more info:

http://www.creightonmodel.com
http://www.naprotechnology.com

Why Home Birth Is Safe

I am a member of the Facebook group "I gave birth at home- not brave, not crazy, just educated".

It's funny because brave and crazy are the two most common reactions I get when I tell people I had a home birth.

So, this blog post is designed to show why you don't need to be brave or crazy to entertain the idea of home birth, and why for some it may be more brave or crazy to go to the hospital (it seemed that way for me, anyway).

In the spirit of being educated, the following is simply the research and facts. You can draw your own conclusions. Keep in mind, the following research and factual information are relevant for people here in BC, Canada who have access to registered midwives and live within 30 minutes of a hospital. If you fall outside of this, you may need to do some more research.

Several studies have been done in the last few years to determine the safety of home birth vs. hospital for low risk women at full term. Probably the best one out there at the moment is from the Canadian Medical Journal in September, 2009. You can also read some commentary on it from the same journal here.

The results of this particular study was similar to several before it: the perinatal outcomes were very similar between hospital and home. However, when it came to interventions in the birth process (electronic fetal monitoring, assisted vaginal delivery) and adverse maternal outcomes (3rd or 4th degree perineal tear, postpartum hemorrhage) the stats were better for the home birth group than even midwife attended planned hospital births with the same cohort of midwives.

So basically, if your goal is simply that mom and baby are both alive at the end of the day, then either option is valid. However, if Mom wants to avoid unnecessary interventions and come out in good shape, the home birth group had better numbers.

Statistics and studies aside, I would like to clear up some common misconceptions about home birth safety.

1. What do midwives bring with them to home births?

A lot of people think that midwives show up with some towels and a stethoscope. This is simply not true. Here is a list of the MINIMUM mandatory equipment that a midwife MUST bring with her whenever she attends a woman in labour in their home:

EQUIPMENT
• Foetoscope
• Doppler foetoscope
• Stethoscope
• Paediatric stethoscope
• Sphygmomanometer with appropriate sized cuff
• Thermometer
• Two haemostats
• Portable suction equipment compatible with intubation
• Newborn intubation equipment
• One pair of blunt-ended scissors
• One pair of scissors for episiotomy
• Newborn resuscitation bag and mask
• Newborn laryngeal mask airway
• Equipment for administration of epinephrine and/or fluids for volume expansion via the umbilical vein
• Suturing instruments
• Baby scale

MEDICATIONS
• Oxytocic drugs
• Local anaesthetic
• Epinephrine
• Oxygen (sufficient for transport)
• Eye prophylaxis
• Vitamin K
• IV fluids

SUPPLIES
• Cord clamps or ties
• Antiseptic solution
• Sterile gloves
• Non-sterile gloves
• Sterile lubricant
• Syringes
• Needles (appropriate sizes)
• Suture material
• Urinary catheter
• Urinalysis supplies
• Cord blood tubes
• Sharps container
• IV supplies
• Maternal oxygen masks
• Oral airways

2. What if there is a postpartum hemorrhage (significant maternal blood loss)?

It is dealt with exactly the same way at home as it would be in the hospital. That's what the oxytocic drugs on the list are for. Registered midwives carry the same drugs as would be on hand at the hospital. When they are attending a birth at home, these drugs are drawn up in a syringe and ready to go so they can be used very quickly in the event of an emergency.

Also, midwives can set up IV drips right in your home!

3. What if the baby is not breathing when it is born?

You will note a lot of suction/oxygen/resuscitation equipment on the list. Most midwives carry even more resuscitation equipment than what is listed up there. It is exactly the same equipment that is used in the hospital. Midwives also will bring an electric warming blanket with them, and set up a warmer station, just like the noisy, bulky, fancy warming devices at the hospital.

4. What if the baby has shoulder dystocia?

It is managed the same way at home as at the hospital - changing mom's position. McRoberts and Gaskin maneuvers are the most commonly used. This looks the same regardless of birth place. If the baby needs resuscitation afterward, see above.

5. What if my labour is too fast for the midwife to get there?

Then it might also be too fast for you to drive to the hospital. Unplanned unassisted births at home, while frightening, tend to be even more frightening in a car in traffic ;-)

6. What if I want drugs?

Then you go to the hospital and get them. You are never locked into a home birth decision. In fact, registered midwives require that you preregister with your local hospital prior to 36 weeks in case you do end up there in the end.

7. What if the baby gets stuck or needs forceps/vacuum/c-section?

Then you transfer to the hospital and get some assistance. The most common reason for planned home births to transfer to the hospital is the desire for pain relief, particularly after long, drawn out labours. The midwife regularly checks the baby's heart rate and the mom's blood pressure throughout the labour process. She is trained to notice dips or concerning heart tones so that any problems can be picked up on early and appropriately transferred in a non urgent manner. If something were to suddenly go REALLY wrong, then they call an ambulance. They also phone ahead so that they are preparing the operating room for your arrival. It takes 20-25 minutes for them to prep the OR, even if you were already at the hospital. In an extreme emergency, you would probably arrive at the hospital around the same time that they would be ready for you in the OR.

8. Am I too old for a home birth?

Age in itself is not a reason to discard home birth. Older mothers are more at risk for various health complications. However, if non of these risks are present and mom is healthy, there is no reason to rule out a home birth for age alone.

Keep in mind, too, that for registered midwives to attend you at home, you need to meet certain health and gestational requirements. You would not be planning a home birth if you are expecting a preemie, or have preexisting health complications.


Another great resource for better understanding home birth in BC is the Home Birth Handbook put out by the College of Midwives.

This is a repost from the Ancient Midwifery blog. It was originally written and posted on Sept. 20, 2009.

Giving birth in water just makes sense to me.

I did my BA in religious studies, and over and over again I saw water as a reoccurring theme in religions and cultures throughout the world. For the Ancients, water was often viewed as a symbol of both chaos and fertility. Christians are not the only group that uses baptism as a rite of rebirth and cleansing. Many Jewish groups baptize as a rite of conversion and purification. Hindus find spiritual significance in bathing in the sacred Ganges. In Islam, washing is deemed necessary before entering a Holy site, and special fountains are usually situated in front of the entrance for that purpose. Nobility practiced water birth in ancient Egypt, and it was thought that a baby born in water would one day become a priest or priestess.

So how does this relate to birth in our time and context? Well, first of all, whether a person is “religious” or not, the birth of a child is a significantly spiritual event in a family. Even if people don’t realize it, becoming a parent changes a person on a spiritual level. It changes the way they think, live their lives, and view the world. Children instill a sense of meaning and purpose in our lives, and give us a vested interest in the future. Childbearing and parenthood teaches people about love, giving, and sacrifice. Is this starting to sound familiar?

It makes sense then that water be used either symbolically or physically as a vessel for childbirth. My daughter was born in the water right on the cusp of the Greek zodiac signs Aquarius and Pisces – a true water baby. While I am not a follower of astrology, I can’t help but believe that she was holding out for that birthday. She was 9 days overdue, and I had been begging and pleading with her to be born for quite some time. Perhaps that day meant something to her, or just to me. I suppose I will never really know. What I do know is on that day I was reborn as a woman. I would never be the same. In my arms I held a new life – a spotless, clean slate of possibility and limitless potential. I had entered the waters of chaos, and emerged from my pool a new person – a mother (and a whole different kind of chaos)!

Waiting for Birthdays

So, I'm trying the blogging thing again.

I've had blogs before. Some I don't mind sharing the address to, and some will remain unnamed. However, I always find that I just don't have time to write anything. I have a blog on my store's website (the Ancient Midwifery Blog), and I get around to updating it every 3 months if I'm lucky.

There's a lot of drivel out there on the internet, and I don't like to put stuff out there if I don't think it's worth reading. That's why my Ancient Midwifery blog gets updated so infrequently. Don't expect to see updates every day or anything. I'm not trying to waste anyone's time. If I'm writing about it, it's important - at least to me.

The reason why I feel I might have time to cultivate a little blog at the moment is because I'm on call for several births. This means that for once I'm not filling my schedule to the brim. I have to sit and wait for babies to choose their own timing. This is a bit tricky for me because I love to be in control of my life and my schedule. The on-call life is challenging for everyone. However, I'm hoping to get some enjoyment out of this on-call period, clean my house, slow my life down, and spend some quality time with my two babies (my actual human baby and my website).

Stay tuned.. if my mind has time to idle, perhaps I'll even dream up something interesting to write here.