Here is a great article featuring Sego Lily Midwifery from the Hill Country Observer on the insurance reimbursement status in Vermont. I am now practicing in Utah where the trend is self-pay. I will eventually blog about my observations on the regional and cultural difference on this issue.
http://hillcountryobserver.com/news034.htm
Image courtesy of: http://cdn.sheknows.com/articles/2012/11/Sarah_Parenting/christmas-baby-present.jpg
Merry Christmas and happy holidays from Sego Lily Midwifery! We are eager to usher in 2015 here in Utah and are excited about the people and families we will be blessed enough to serve.
Please share our page with your friends and relations!
~ Sego Lily Midwife
In January I brought forth my fifth child. That makes three boys and two girls…
It is always hard but really fun and rewarding being the midwife of a midwife. I had two Vermont midwives and my own intern, Brooke, attend my home birth. Oh – and my two daughters aged 14 and 8 were there! The girls did great! Cassidy (14) was very involved with the actual water birth while Harleigh brought me cold washcloths for my forehead.
It was a long labor and birth – kind of like a first time..although it was my fifth. He was a BIG boy, weighing in at 10lbs 4oz. The midwives were highly skilled and reassuring when I floundered at the end. The old “running start” position was envoked to bring his shoulders. I was glad when he was born and I could now claim victory over all of my own births.
Breckenridge Brody “Breck Brody”
Gail Tulley brings her Spinning Babies workshop and knowledge to midwives and OBs Cheshire Medical in Keene, NH.
What is Spinning Babies, you say? Is someone actually spinning babies? No, silly. This is the popular birth movement pertaining to optimal fetal positioning designed to encourage shorter, smoother labors for mothers and babies.
Our culture spends a great deal of time worrying about whether baby is head up or down – vertex or breech. But mainstream birthers and their care providers often miss more about fetal positioning coming into the pelvis that can really affect outcomes of births.
Any woman who has experienced a “posterior labor” and pressed onward for a vaginal delivery, will do almost ANYTHING in future pregnancies to prevent that from ever happening again. Posterior means that the head is down, but the baby is coming into the pelvis facing up (mother’s belly button) rather than facing down (mother’s tail bone). In a posterior labor, the prominent occipital bone presses on the mother’s tailbone, she rarely gets relief between contractions, as would be the case with a baby in the optimal position. Additionally, the baby’s head is not pressing optimally on the cervix, causing delays in the dilation, prolonging the labor. The statistics of these posterior labors turing into surgical births are staggering. The pain is almost unbearable. Often babies will flip prior to birth, but many women opt for medical intervention before this occurs. How many mainstream OBs and even nurse midwives are discussing this in routine prenatal care? Posterior complications in labor are a far more common occurrence than the breech baby.
It is thought that our modern lifestyle of high-heels, overstuffed furniture, and reduced time on hands and knees and squatting as was done in more primitive cultures are culprits in encouraging babies to rotate around to the posterior position. Midwives will often recommend women get in their garden or scrub a floor on their hands and knees if a persistent posterior baby is found in prenatal visits toward the end of pregnancy. Spending 15 minutes a day at the end of pregnancy is the best way to encourage a gentle rotation of the baby to a more optimal position heading into birth.
Midwives spend a good deal of time assessing fetal position with our hands on the mother’s abdomen during prenatal visits. Not just for breech or vertex (head down), but we are looking for optimal fetal positioning – good flexion of the head, and weather we have posterior or anterior presentation. Although many midwives use Doppler to hear baby’s heart beat, many of us will use the low tech fetoscope or Sklar Leff (these are jacked-up stethoscopes) for heart tones, as we will only hear tones over the baby’s back nearest the head. This confirms what position we are feeling with our hands.
Spinning Babies is a web project of Minnesota midwife, Gail Tulley. Gail travels around the country giving midwives and OBs who will hear her, education and tools for helping babies in utero adopt an optimal fetal position before labor begins. Her work has been published in many recognized journals. Her information has been sought after for years by midwives and pregnant women.
I am grateful Gail made a trip to Cheshire Medical Center in Keene, NH this fall where I attended her workshop. It was day to deepen and enrich our understanding of tools and tricks to help babies adopt the position they are naturally meant to be in while in utero.
Most midwives will tell you that midwifery, and obstetrics in general, is a profession where education is ongoing and constant. No two courses of prenatal care are the same. No two births are the same. A midwife could have the most sophisticated education offered, and still be humbled often. It’s guaranteed. As a consumer of home birth, I would be concerned if I encountered a midwife who seemed to have all the answers. Even the very best high-volume OBs I know are not afraid to say – I’ve never seen that before. Because it’s the truth.
Licensed Vermont home birth midwives are required to attend 20 hours of continuing education every two years to reapply for licensure. There are a small handful of organizations who sanction Continuing Education Units (CEUs) that are recognized – a couple of these entities are MEAC and ACNM.
October seems to be the month where CEU clinics are often held. Vermont midwives in solo practice often find it difficult to peel away from our client loads and 24/7 on-call status to attend workshops out of commuting area to an anticipated home birth.
I had a blessed window of time off-call this fall and attended two continuing education workshops – one in Montpelier, VT and the other in Keene, NH. They represented 14 hours of total class time and 8 hours or total drive time. This is no small feat considering I am seven months pregnant with my fifth child.
The first workshop was “Peripheral IV Insertion and Care” – a didactic and experiential course. It was facilitated by an RN who trains tertiary hospital staff the same skills. She was amazing. I completed a few workshops in IV insertion while attending midwifery school, but it is a skill that is best maintained by doing 20 a day. Obviously, as home birth midwives, we are not doing them often, if at all in clinical practice.
Midwife Heather placing an IV catheter in midwife Hannah’s arm with nursing supervision. Both of us very pregnant. Still smiling!
Why and when would we offer an IV to clients? A few scenarios:
1) If a client is experiencing a very severe hemorrhage and the regular course of medications that are routinely given via IM injection are not effective, we would call for emergent ambulance transport to the nearest facility. If we anticipated a wait time of significance for the ambulance, we would consider inserting an IV with fluids that would help stabilize a woman while in transit. Some ambulance services in very rural areas do not have Paramedics who are trained to insert IVs while enroute to hospital. In home birth practice, I have never seen IV insertion for this scenario. But it is an important skill to have solidly onhand in the once-in-a-career event that calls for it.
2) Some Vermont midwives offer IV fluids to normally laboring women who are seeming a little dehydrated. Rather than transport for dehydration, the issue may be resolved by IV administration during labor at home. Other Vermont midwives feel that if a woman requires an IV for any reason, she should be transported to a hospital. I see no fault with either thinking, but my training in IV administration did highlight the gravity of the procedure and the risks that accompany it. It also made me feel like any of us who have IVs in the hospital must closely monitor the procedure for extreme cleanliness and proper insertion and I walked away from my training wondering if I had ever experienced or witnessed an appropriate IV insertion in the hospital or if I or those I was with were being placed at risk by the nursing staff.
3) Lastly, a Vermont home birth midwife might offer a woman who tests positive for Group B Strep (GBS+) at the end of pregnancy IV antibiotics in labor. This is the CDC recommendation and the community standard of care in the hospital setting. The culture of home birth has been one where most women decline IV antibiotics prophylaxis, but there is additional risk to the newborn of sepsis in this scenario. I had one septic baby last year, presumably due to GBS, who was born perfectly but showed signs of sepsis in the first couple of hours. He went on to a NICU at a large facility and was in perfect health after a 7 day course of IV antibiotics. Although the parents suggest they have no regrets, I got another grey hair from the case and have been offering GBS+ women IV antibiotics in labor. So far there have been no takers.
As midwives are not inserting multiple IVs a day – it is not a skill that is even taught in nursing school – it is really important to continuously hone the skill. The Vermont Midwives Association has brought the instructor back in for those wanting more practice.