One of the most important skills I have as a midwife is being flexible.  I think this is an important skill for clients too.  

A lot of work and preparation goes into planning and preparing for a home birth.  Shopping for and setting up the nursery are such fun as you anticipate birth.  Lining up pet sitters, or child care for your little ones, getting a car set and stocking up on diapers are all part of being ready for baby's arrival.

Taking a childbirth education class, finding a doula, deciding if you want a birth photographer, deciding if you want to use a birth pool or not, reading books and watching videos about breastfeeding are some of the things I encourage clients to do to be prepared for labor, and the immediate postpartum.

Sometimes though, even though you have gotten all the things, have all the help lined up and have everything ready, plans will change at the very last moment.  I operate from the principle of the Boy Scout Motto: Be Prepared.  Being prepared means having a basic birth plan written out, and having a bag packed and ready to go with the essentials you will need for a birth at the hospital.  Being prepared means having the car seat installed and ready to use, as well as giving the petter sitter and child care providers a heads up that you might be calling on them soon.

There are many reasons plans can change.  Baby's heart rate may tell me that we need more help than we have at home.  Mom may not respond to the tools I have to stop bleeding if it's too much.  Mom may decide she wants pain relief.  Mom may start running a temperature, or her blood pressure may become higher than is safe for a home birth.  These are just some of the reasons plans may need to change.

When plans change from home birth to hospital birth, I like to let the hospital know we are coming and why.  I also like to send them pertinent records, and lab results so they have time to look them over and be familiar with past care before Mom arrives. I will go to the hospital with Mom and Dad if they want.  Because of hospital rules on how many people can be with Mom, sometimes parents want the doula or a family member to go instead.  If that is the case, I will be available by phone. My assistant will stay behind to do a thorough clean up. Once Mom is home from the hospital,  I will do postpartum care if Mom wants me to. 

While it is stressful to change plans, sometimes we need to change them. To lower the stress for everyone,  I try to hold space for my client and family to adjust to the idea that birth will now happen in a hospital, and I work to have a smooth transition to the hospital setting. In the end, I want families to feel heard, respected and cared for regardless of where birth ends up happening.

We like getting to know people, learning where they are from, what things they like, what hobbies they have and so on. I often see social media posts with lists of things you can select from to let friends know more about you such as if you have ever had a broken bone, or traveled overseas. In the spirit of those social media posts,  I'm sharing a few facts about myself to let you get to know me better.

• I ride motorcycles. My current ride is a BMW F650 GS.  
• I love to bake and am actually quite good at it.
• The only time in my life I did not have a cat was during college. I couldn't have one in the dorm, or my first apartment.
• I grew up in Kansas.
• I am the oldest, I have two younger sisters.
• I do not like onions, to the point of picking them out of my food no matter how small they are cut.
• My house is decorated with raccoons. Several came with my hubby and we have added to the collection through the years.
• I did not learn to read until I was in 2nd grade. I am so thankful for the teacher who made me stay in during recess until I finally learned. 
• I enjoy curling up with a good book, a cat on my lap, and a nice cup of tea.
• And finally, I get to serve the most amazing clients and families as a midwife!

​Recently during a birth, my client commented on how hands off I was. I took that as a huge compliment.  

I've attended many hospital births. At every birth I attended except one, all the doctors were very hands on, stretching vaginal tissues as baby's head came down, reaching hands in to grasp baby by the shoulders to bring baby out, or worse yet, placing both hands on either side of the baby's head and applying traction to pull baby out. These were births where there were no indications the baby needed any help to get out.  

Being hands on, intervening in the physiological process of birth, can have negative impacts. Pulling on a baby's head can cause nerve damage to the shoulders, and/or face. Placing hands in to stretch tissues may actually stress and weaken the tissues compared to letting them stretch gradually around baby's head.  Placing hands in to pull baby out by the shoulders can lead to tearing when there normally wouldn't have been tearing or it may make a tear worse.  

There are times I need to use my hands to help baby navigate its way out. A shoulder could get hung up on the pubic bone, or baby's torso could be larger than the head leading to the need to help baby out. Often in those situations, simple position changes to open the pelvis in different ways are all that is needed to help baby out. It is rare that I actually have to use my hands to help baby. In fact, I have only needed to use my hands to help baby out twice in the births I've attended in my own practice so far.

I firmly believe birth works best when it is not interfered with. I am mindful of this at every birth I attend. I don't want to disrupt physiological birth unless baby lets me know they need help, and then using an intervention that involves my hands is a last resort when other options have not worked. Balancing my knowledge, and intuition with trust in birth helps me keep my hands off unless there truly is a need to use them to help baby.

Can we talk? I think there's a myth that anything that comes up during pregnancy is because of being pregnant or should be handled by your maternity care provider. Pregnancy can bring some typical complaints and discomfort, but not everything that happens during pregnancy is because of being pregnant. Sometimes pregnant women can get sick and it has nothing to do with being pregnant.

My focus and expertise is on pregnancy, labor, birth and postpartum, so everything pregnancy and birth related. As a CPM in Kansas, I have to rely on holistic remedies to bring relief or resolve something. I cannot prescribe medications even if they are necessary to treat an illness that pops up during pregnancy.

If I have a client who has a urinary tract infection that is not resolving with herbal remedies, I will ask them to see their regular doctor. If a am working with a client who has extreme morning sickness that natural treatments aren't able to make manageable, I will encourage her to see a doctor. I have asked a client with heat exhaustion to see the doctor.  She needed IV fluids right away. I have had a client seek care with medical professionals who learned her symptoms were caused by food poisoning. Both these clients needed more help than I could provide. I do not take it lightly that I am asking someone to see a doctor.  If I am asking it is because I'm concerned that something is going on that needs more help than I can offer.

I am thankful that we have doctors, and can avail ourselves of their expertise when needed. I also appreciate when clients understand that we need more help and are willing to see their doctor. Not everything that happens during pregnancy is related to the pregnancy, and sometimes medical help is necessary.
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The wonder, and joy of feeling the first little flutters that you are sure is baby moving around is incomparable. It is amazing to have that intimate connection to your baby!

Just as we are all different, when baby movements can be felt will be different for each mother, and for each pregnancy.  Some Moms are so in tune with their body that they can feel the flutters around 14 weeks, and rarely, even earlier.  Other Moms may not notice the movements until 20 weeks or a little later, especially if the placenta is implanted on the front of the uterus. At first they feel like little flutters but as baby grows and gets stronger the flutters are replaced by kicks and punches. Once baby gets even bigger, those movements change to more rolling, nudging movements because there isn't room for baby to punch or kick as much.

Early in pregnancy, there may be days when you may not feel much movement from baby. This is normal.  As pregnancy progresses, baby's movements become more noticeable. Around 28 weeks gestation, babies have settled into a predictable movement pattern. I encourage clients to become familiar with this pattern.  

It is pretty common for baby to move more at night when you are laying down. As pregnancy progresses, it is my opinion that baby has more room when you are laying down compared to when you are standing or sitting so that is why they tend to be more active.  

Baby can be affected by how Mom is feeling. If Mom is dehydrated, or has a cold or other illness, baby's movements may be a little less or subdued. I have worked with mothers who just needed to eat, and then baby was ready to dance a jig. Sometimes Mom is up and busy and doesn't notice movements but when she slows down and focuses on baby, the movements are noticeable.
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Baby's movements can give insight into how baby is doing in utero, so it is important to pay attention to them. Changes in baby's movement pattern might mean something is happening that we need to check on, usually with an ultrasound. Significant changes in baby's movement pattern can indicate baby may need help to prevent a stillbirth, so get to know baby's movement pattern well.