As a doula, I saw a big disconnect between the current evidence and recommendations and the care that was actually given.  I had a client who wanted delayed cord clamping.  The American Academy of Pediatrics and World Health Organization were recommending it.  My client asked her doctor to delay cord clamping and he refused, stating it would harm the baby by giving it too much blood. That incident had me wondering what the doctor was doing, if anything, to stay current on evidence based care.  I watched as mothers were not allowed to eat even though the evidence did not support that.  I witnessed parents being coerced into making decisions to appease medical providers and I witnessed medical providers giving an "informed consent" talk that did not fully cover all the risks of whatever the provider was asking the parents to consent to.

What finally tipped me into a full on drive to become a midwife was my sister's birth.  She lived in an upscale suburb of Detroit.  She was an athlete who had a very healthy, normal pregnancy. During her labor, she and her doctor agreed that a cesearan section was the best way for baby to be born.  I was present when the doctor discussed the risks of cesearan section.  She did not tell my sister she was at a higher risk of a postpartum hemorrhage or discuss risks a c-section may pose for future pregnancies.  Ten days after her baby's birth, my sister experienced a postpartum hemorrhage.  She nearly died sitting in the hospital emergency room waiting to get adequate care.  She was asked what she did to cause the hemorrhage in way that left her feeling she was somehow to blame.  After emergency surgery, she was sent to the ICU where the medical providers searched Google in her room to tell her she should dump her breast milk for the next 24 hours.  Had they contacted the hospital's lactation consultant, they would have gotten the correct information that the breast milk was fine for baby.  She was not allowed to see her baby, hold her baby or nurse her baby until she left the ICU 3 days later.  She was traumatized by how she was treated.

That was when I decided that no woman should ever have to experience the medical care my sister did. No woman should have to sit bleeding out in an emergency room, waiting for care.  No woman should be made to feel that they somehow intentionally caused a hemorrhage.  No woman should watch a medical provider search Google for the wrong answer.  No woman and baby should be seperated after birth. The fastest way to start the change to compassionate, respectful, evidence based care women need and are entitled to is to beome the one providing the care.  That is why I am a midwife.

Scale and sling: At every postpartum, I will weigh baby to monitor weight.  Babies typically lose weight in the first few days after birth and I want to track this.  It is normal for a baby to lose up to 10% of birth weight.  I like to see that baby is gaining weight and is close to or back at birth weight at the two week visit. 
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Stethoscope and blood pressure cuff: I also take Mom's blood pressure at each postpartum. Blood pressure numbers can tell me how well the body is handling birth related blood loss and helps me monitor for postpartum preeclampsia.

Pulse-oximeter: I carry a pulse-oximeter to use on baby to check for critical congenital heart dieases if parents want the check completed.

Newborn heel lancet and Kansas newborn metabolic screening collection form: I use these to collect five blood drops for the state to complete the metabolic disease screening.  Parents can decide if they want ths screening completed.

My hands: I like to palpate the uterus at the first 2 or three postpartums to check how quickly it is going back to pre-pregnancy size.

Questions: I ask lots of questions.  I'll ask about nursing, Mom's sleep and appetite, how everyone is adapting to baby and many more questions.  Questions help me assess how things are going and give me the opportunity to help everyone navigate any issues that may come up.  

My most important tools:  I feel my most important tools are asking questions and listening well and trusting parental intuition. 

Postpartum is wonderful and exhausting at the same time. Rest, good support and evidence based information can all contribute to a wonderful postpartum period. My goal in the postpartum period is to work together with parents and baby to help them have the best postpartum time they possibly can have.