Monthly Archives: June 2015

Provider Interview Series: With Women Wellness

In the triage room, her presence imbued calm, strength, and confidence in the mother’s innate ability to labor and birth. The words she chose and the tone in which she uttered them clearly reflected this sense of peace: this was not a race. It was a journey: the first one ever for the mother, yet she stood on the heels of so many women before her who were cared for by Suzanne. While as the mother’s doula I had the opportunity to stay until after the baby was born, Suzanne’s shift ended shortly after my client was admitted and another obstetrician colleague came in to carry on the torch. I later had another opportunity to meet Suzanne and I was struck by our conversation about language and the importance of word choice when it comes to the care of laboring families. I was smitten! I had been wanting to do this interview for quite some time now, and am so glad to have had the opportunity to talk not only with Suzanne, but also with her current partner and co-founder of With Women Wellness: Michelle Killingsworth, who is also a fabulous midwife dedicated to the holistic well being of women.

Family yoga and With Women WellnessTogether, they have been courageously and competently bringing about a new type of care to women and their families (including a number of hospital water births!), while also creating community. Through their Facebook page, the morning family yoga sessions, the invitation to doulas and other birth workers to chime in on how they could use their lovely space in East Hartford, the involvement of a professional counselor with their practice: they are essentially building a village dedicated to the holistic well being of women and their families.

It is my honor to introduce them to you through this interview. Read on and learn more about their perspectives and insights!

Why did you become a midwife?
Michelle: After working in Labor & Delivery and a GYN office for many years, I developed a strong desire to support women in their healthcare and birth choices and to help women achieve optimal health.  The best way for me to do that, was to become a midwife!
Suzanne: I was hooked from the first birth I witnessed, but didn’t actually know it yet and didn’t know it for many years.  I was 18, working as a tech in an Emergency room when I watched an 18yo walk in and delivered five minutes later.  She had just told her mother about the pregnancy the day before and had hid the whole thing, never getting prenatal care.  She didn’t want to bond with the baby and seemed so ashamed, disconnected and disempowered by the experience.  It was at that moment that I realized the power of birth and motherhood, how it can build someone up and also tear them down. I reflect often on that moment when I am working with pregnant moms, about how important it is that we assist and encourage their empowerment.

What do you find most rewarding about midwifery practice?
Michelle: When a woman tells me that her birth made her feel empowered!
Suzanne: That moment after a women delivers, has baby on her chest and I look her in the eyes and say “look at what you just did, you are awesome!”

What do you find most challenging about being a midwife?
Michelle: It’s hard to make any set plans – babies come when they want to!
Suzanne: Boundaries!  Midwifery is my life, it is part of who I am as a person, its not just a job.  It is so hard to not take work home with me.

What made you decide to open up your own practice?
Michelle: We had a strong desire to provide true midwifery services to women – time intensive, evidence based care.
Suzanne: I wanted patients to feel that they were listened to, that they weren’t part of a cog wheel, that they are a person with real questions and needed accurate answers. I feel so often “normal, healthy” pregnancies are ignored by modern healthcare, but these are patients who need support, education and attention in order to stay normal and healthy.

What’s been surprising about having your own practice so far?
Michelle: I have been so pleasantly surprised by the number of people who are excited for our practice and want to support it!
Suzanne: All the support from previous patients, new patients, physician colleagues, nurses and the hospital.

If you could change anything about the U.S. maternity care system, what would it be?
Suzanne:  Oh boy this is a loaded questions with so many answers!  Maternity care in the US is so backwards.  The primary place I would start is to stop treating all women as they are diseased and high risk.  The main way to achieve this would be to adapt a system similar to New Zealand’s, to have all women start prenatal care with a midwife and then risk-out to an OBGYN if and when they become high risk.

What are your thoughts about doula support?
Michelle:  You can never have too much labor support!  Some people think you do not need a doula if you have a midwife, but having both a doula and a midwife is the perfect scenario.
Suzanne: Agreed!  A well-informed doula can be a powerful tool.

What is your stance on home birth?
Michelle: I believe home birth is a safe and reasonable choice for the low risk pregnancy with the properly trained midwife.
Suzanne: I had both of my babies at home and wouldn’t trade those experiences for the world.  However, they were safe, under strict guidelines for risking out, and attended by educated/experienced midwives.

What are your thoughts about VBAC?
Michelle: C/Sections are not without their own risks. I believe the benefits of avoiding a C/section far outweigh the risks of VBAC for the right candidate.
Suzanne: My primary goal is the prevention of the 1st cesarean.  In the case of a VBAC, my goal is the prevention of the second cesarean and the majority of previous cesareans are good candidates.

What do you enjoy doing on your days off?
Michelle: Spending time with my kids, family, and friends!
Suzanne: Taking in life outside of midwifery.  Just spending time with my kids, husband and friends.

It gets better after six weeks: no, really, hang in there… it really does!

I still vividly remember the boundless daze in which  I spent countless hours in those first weeks after giving birth to you. The minutes merged into hours, and the days into nights. I remember the house being quiet and the two of us being the only ones awake… barely awake, ready to fall asleep between latching you on (hopefully on the correct side) and the next feeding. Sleeping on a makeshift  thin red mattress on the living room floor, to make sure you wouldn’t fall: too exhausted to put you back in the bassinet and too drained to get up for your next crying calls for closeness and mother’s warmth. We both needed sleep and closeness and that is what we got: we did it our way.

Sleep deprived mom

I remember it like it was yesterday. Feeling so out of control and unnerved because your helpful (and also exhausted) daddy took you from my arms to try and console you, because what I was doing wasn’t working.  My mama bear came out that night and it was not pretty. How dare he take you away from me, insinuating that I didn’t know how to mother you?

Exhausted new dad needs to go to work in the morning

I can still feel the anxiety I felt when you would cry hysterically pulling yourself away from my sore cracked nipples: what was I not doing right? Why didn’t you want to drink my milk? Why weren’t you gaining enough weight? I remember the 30-minute car rides to and from the hospital to meet with the lactation consultant who suddenly shared her tricks to help me understand you better, to get a sense of when you were really done eating and when you were just being sleepy and lazy. She put you on that scale before and after a feeding and showed me that indeed you had swallowed a few ounces of liquid gold… it had worked!

I remember the trick my mother showed me to get you to fall asleep by gently  and rhythmically swiping our finger tips over your eyelids while “shooshing” you and humming sweetly.

I also remember the rush of panic and confusion I felt when the pediatrician asked me how I was feeling. Was I supposed to be honest? Could I be honest? What would have happened had I told her that I was crying my eyes out at least once every day and that life with this new tiny person had actually been really really really hard… would she have reported me to DCF or a psychiatrist? Would she have taken you away from me? I told her everything was fabulous…

Here’s something else I remember. I remember something someone told me and I latched onto it for dear life. It was my light at the end of the tunnel. “It gets better after the first six weeks, ” she said. 

By the time that mark rolled around, I was still waking up every two hours to feed you, but I was handling it much better. It didn’t weigh on me. It was just my new normal and both my body and mind had found a way to naturally cope with it. I had finally become the butterfly after spending time in that grey slimy chrysalis.

Smiling or gas?

I was walking more easily. My scar was healing. My mastitis had cleared. I discovered we both loved pouch slings and I could have my arms and hands back again, while you slept dreamily against my reassuring heartbeat. You suddenly decided it was ok to wait for me in the bouncy seat right outside the shower curtain, while I took a minute to regenerate under the warm and sound-muting shower. You started smiling at me too… or maybe it was gas, like everyone else thought, but I was pretty happy with thinking that you were smiling because you knew we had made it out of that whirlwind of emotional rollercoasters and the boundless, shapeless time warp.

It was mostly smiles, giggles, and raspberries from that point on… until you became a precious chatter box!


Fast forward eight years. I now have a Master’s in Maternal and Child Health and I am a doctoral candidate in Maternal and Child Health doing research about low-intervention, high-value, family-centered maternity care models. I’m a birth geek: yes, I am! As a practicing doula I incorporate evidence-based information about perinatal mood disorders, breastfeeding, and the early postpartum period into my services and support to families. I also use birth art and Birthing from Within concepts and sensibilities to equip parents with a diverse toolbox as they approach this complex and exciting time.

During my prenatal sessions with parents, I teach them about the “Laborynth”. We don’t just talk about the twisty and unpredictable journey taken from the time labor begins to the magic moment in which parents get to meet their child for the first time. We also talk about the journey back, and how twisty, topsy-turvy, raw, and hard it can be to get out from that Laborynth. We prepare with realistic expectations and with decision-making and coping skills that can come in handy when we are faced with yet another decision-making opportunity and challenge as new parents… just like we did when preparing for birth.

Birth is unpredictable. So is the early postpartum period. Falling in love may not be as easy. Breastfeeding may not come naturally.  Recovering from the exhaustion of birth while getting used to a new sleep  rhythm may take some time. Negotiating new family and relationship dynamics may not be easy. Adjusting to new identities and roles can be a confusing and emotional process. Throw in some hormones and you have a very potent cocktail! Listen to your instinct: do you need help? Ask for it! Even if it is the baby blues, the right kind of help can attenuate the symptoms and make you feel a lot more supported!

But trust me: it does get better. For many it takes anywhere from two to six weeks, and if it doesn’t… it’s ok too.  It may be time to reach out and not chalk it up simply to the baby blues. It may be time to give yourself the gift of more support, if you haven’t already, from professionals and peers who can share tips, strategies, support, and referrals for appropriate care. Close your eyes for a few seconds, feel the ground beneath you, breathe, trust that you’ll get through it and believe that you don’t have to go at it alone. In fact, you shouldn’t: it’s time to gather your tribe!

 

The mighty epidural: is it the answer for all people scared of childbirth?

Epidural SpaceWhen I first became interested in childbirth and maternity care I undoubtedly favored as natural a childbirth as possible for all women. Unmedicated, vaginal, home waterbirths were my golden standard. That is until I realized that all women are different, as are their labors and each individual birth. One size cannot fit all when it comes to birth.

What is most important to me, nowadays, is for childbearing families to gather comprehensive reliable information well in advance, so that they may explore their personal beliefs and needs to formulate a preference during pregnancy, and then adopt an open stance towards what may come their way during labor and delivery so that their decisions may be made with calm, confidence, and self-love.

Being open to giving yourself permission to stray from your preferred plan during the various twists and turns of labor and birth, will allow you to own your decisions with an empowered stance, backed by the knowledge and self-exploration acquired while still pregnant. While I have supported plenty of unmedicated vaginal births that went just as the family had preferred and planned, I also had the honor of witnessing empowering births that, while different than what had been planned/preferred prior to labor beginning, were exactly what the family needed at the time. They practiced informed choice.

Birth without fearI have also had many opportunities to share other options and alternatives with families who wanted to know more about different ways to cope with the anticipated discomfort and pain of labor. When I meet prenatally with parents, we explore different ways of thinking about labor pain, so that they can try to reframe it in ways that are more positive and less scary. After all, pain is Purposeful, Anticipated, Intermittent, and Normal (P.A.I.N.) and it sometimes helps to know that on that same day, 300,000 other women are also gathering their strength, love, and energy to give birth to their miracle. It also helps to learn that not everybody feels pain during labor… and some people experience quite the contrary!

We talk about mindful birth and the power of natural coping mechanisms, self-hypnosis, vocalization, position changes, movement, hydrotherapy, visualizations, non-focused attention, breathing patterns, aromatherapy, distraction, comforting touch, feeling love and safe to promote the production of  oxytocin and endorphins. We also talk about the logistics and documented evidence of benefits and risks of different pharmacological options such as epidurals, analgesics, narcotics, and more. We cover it all so that we know what tools are at our disposal on d-day.

So no: epidurals are not the answer for everyone, but merely one of the many tools that © Copyright 2010 CorbisCorporationlaboring women and their families have at their disposal. As a childbirth doula, I believe it is my job to share comprehensive information about your various alternatives, to invite you to explore your preferences and needs, and to remind you about the questions you may want to ask your provider to ensure an empowered, safe, and healthy birth experience and outcome. Your birth is unique, one size does not fit all!