PRENATAL CARE or PRENATAL SCARE?



Women in Australia ask each other “Who are you going to for Prenatal Scare?” Sadly, that could be said in North America, too. Stressed practitioners unloading their personal fears on pregnant women is a common scenario all over the world.
A pregnant woman in Australia wrote to me because of these instructions from her midwives: “Lydia, your baby’s head is not engaged in the pelvis and you are close to your due date. We’re concerned that the umbilical cord might prolapse if your membranes release before your contractions are well established. If that happens, call an ambulance to get you to the hospital and get in an all-4’s position on the floor while you wait for the paramedics!”

She wrote to me in Canada to get my opinion on that advice. I told her my favorite theory about low-probability problems in birth work. I wrote: “Yes, Lydia, all that could happen, but it’s highly unlikely. Do you know that you could be walking down the street in your city and a piano could fall on your head? That’s possible, too, but none of us refuse to walk on city sidewalks because of the falling piano danger.” That explanation gave her confidence to continue with her homebirth plans. The midwives attended and everything went well.

Discussing things that are real and present is what pregnant women need from their midwives prenatally. Hallucinations of possible disasters that aren’t happening need to be silenced.
When a woman comes for a prenatal visit (or you attend at her home), she’s excited to be with her midwife and find out how her baby is doing. When a midwife is doing her best work, she will:
Be listening intently to what the client is saying.
Be organized so the client gets the message that the midwife values the client’s time.
Be writing notes of everything the parents say.
Be able to say “I don’t know the answer to that, but I will look it up and send you what I find out.”

The prenatal visits are a “dress rehearsal” for the actual birth. The family is getting an idea about how the midwife will be once the birthing time arrives. Is she punctual? Does she answer her phone promptly? Does she smell nice? Does she answer questions honestly? Do we feel comfortable, relaxed, and included when we’re with her?

I had a young couple come to an introductory appointment with me about 25 years ago. The government of British Columbia had just regulated midwifery and families wishing to have a homebirth with a midwife could get the service on their medical plan. I was not regulated and I charged $2800 to attend a homebirth. I explained that they could get a midwife “under the medical plan” and I also reminded them that I lived a 90-minute drive away from them. There were midwives working very near where they lived who would be paid by the government.
The father responded that “No, they didn’t want the local midwife and, yes, even though they didn’t have a lot of money they wanted someone like me.” He then proceeded to demonstrate what the local midwife did that he couldn’t accept. He started speaking to me while staring at a spot on the wall that was about 18 inches above my head. He didn’t connect with my eyes for the next little while. It was very weird. Then he told me “That’s what the midwife did. She never made eye contact when speaking to me.” He didn’t want long, deep stares, he just wanted a normal conversation with someone who looked him in the eye once in a while. I wondered what kind of fear state that midwife was in during the appointment.

I had a number of different physicians palpate my belly in my second pregnancy. The possibility of a homebirth had not occurred to me and my husband. We kept shopping for a doctor who would promise that 1. I wouldn’t be given an episiotomy, and 2. The baby would stay with me at all times. Those doctors were very clear that they would be in charge and I would get what they ordered and I didn’t get to tell them what to do.
Finally, we found out there were some midwives in Vancouver, BC, who would attend homebirths. We met with one of them, Elly, and for the first time in my pregnancy, someone palpated my belly with soft, warm hands and seemed to realize there was a real little human in my uterus. That experience sold me on her. Luckily, my husband was very impressed with her, too. I am forever grateful that I found the ideal midwife for me who fit with my family perfectly. Warm hands, a quiet confidence, and a willingness to meet my requests—that’s what her prenatal care encompassed.

Gloria Lemay is a childbirth activist living in British Columbia, Canada. She has a passion for VBAC, waterbirth and ending male genital mutilation. She is a blogger at wisewomanwayofbirth.com. Her film “Birth with Gloria Lemay” was produced in 2012 and has been viewed all over the world.

WISE WOMAN POSTPARTUM DOULA RETREAT 2024

April 5th, 6th, and 7th 2024
Bowen Island, British Columbia, CANADA

Join us for the 1st Annual Wise Woman Postpartum Doula Retreat. Wise Woman Way of Birth will be at the Xenia Retreat Center on Bowen Island for 3 days and 2 nights, surrounded by beautiful nature, soaking up the palpable spirit of these healing grounds.

A replenishing experience for your body, mind, and spirit.
An immersive training in continued postpartum education.
A connection for the postpartum doula community.

“I have been dreaming of this retreat for almost two years now, since moving to Bowen Island. I want to bring together the community of postpartum doulas that has been building over the last few years to connect deeper in person. There are so many brilliant, fascinating women doing this work, and we can all be supporting each other to better support the families we work with. It started as this zygote of an idea to give doulas some of the skills they have been asking for and has grown into this immersive, healing, cup-filling retreat with a dream team of speakers!” Candice Johnson

Wise Woman Postpartum Doula Retreat

CHOLESTASIS

Cholestasis remedy from Nat Dash, Australia (O.C. = obstetric cholestasis)
Source: My good friend and great midwife Lisa.

Dear Gloria, I use Nat Dash’s info. here it is.
Drink minimum 2 litres of purified water daily. THIS IS MOST IMPORTANT!! (2 glasses of warm water with fresh lemon juice, 1st thing in the morning)
I can’t recommend fresh juice enough; I feel they made a huge difference to my health. I chose to use fresh organic fruit & vegetables because of the toxins on the sprayed produce. Washing them in cider vinegar helps to reduce pesticides too though. Large apple, carrot, beetroot, celery & parsley, 3 times a day, 20 mins before a meal. Great for flushing out those toxins!!!
Pineapple & parsley is great for keeping up iron levels.
Porridge/oats made with water or rice milk – great for lowering rising cholesterol, which generally happens with O.C
Raw mushrooms also helped me a lot. I ate about a kilo a day. Later I found out that mushrooms are also beneficial to the liver.
Take all fats out of the diet. None or limited dairy products & meat. These are oestrogen forming… one of the contributing factors involved in Cholestasis is over production of oestrogen.
Deep sea ocean fish would be the best alternative & full of omega 3. If vegetarian, Flaxseed oil is fantastic & great for the skin.
Herbs made up by a qualified naturopath, as listed in article – psyllium husks, dandelion, slippery elm, globe artichoke, milk thistle etc.
Guar Gum is a natural gel-forming fibre & has been very successful in aiding women with this condition by increasing faecal elimination of bile acids. Tablet or powder form should be available from health food store or natural health professional.
Metamucil also helps to bind the bile.
Acupuncture was used throughout my pregnancy to assist with good liver function & for preparation & assistance with natural induction. Acupuncturist needs to be competent working with pregnant women & liver conditions.
Relaxation – Yoga, meditation, stretching, deep breathing, Reiki can all be helpful for both mind & body. Good preparation for labour also!!

Some women find it difficult to retain vitamin K with this condition (vit k is necessary for blood to clot).
Here are some suggestions to minimise bleeding/ Postpartum Haemorrhage (PPH):
Have blood tests to check haemoglobin at 36 weeks; use natural means to help avoid anaemia or supplement – floradix, Spatone etc
Take a good quality multi vitamin for pregnancy
Take alfalfa, 4 – 8 tablets per day, any brand. Alfalfa contains every vitamin & mineral, as it’s roots go extremely deep into the soil – it is an excellent source of vit k

This has worked in my experience.

Lisa

WISE WOMAN WAY OF BIRTH DOULA TRAININGS (2024)

Featured

The Next Scheduled Course begins on
Wednesday, September 4 at 7:00 p.m. (Pacific Time)
Cost: $675 (Canadian)

taught by Gloria Lemay

Jessica Austin, with a Doula client.

Jessica Austin, with a Doula client.

This course will give you the skills to assist women giving birth at home or in hospital. Doula services are in demand. There is a pre-reading requirement. Please email waterbirthinwoman@gmail.com for further information and to register for the course.

The course will be on Zoom and assignments and tests will be on Google Classroom.
12 Classes 2 and a half hours long. In 2024, this September course is the last one for the year..

Course Three: Wednesday evenings (Pacific) September 4 to November 20 7:00 p.m. to 9:30 p.m. (Pacific)

Successful students will receive Wise Woman Way of Birth Doula Training certification.

OVERVIEW OF COURSE CONTENT
Class 1: Introductions, birth “politics” and Language
Class 2: Preventing Problems before the Birth: Nutrition. Prenatal Screening
Class 3: Types of “support” in birth: Midwife, Dr, Obstetrician, Doula — what are the differences? Comparison of home and hospital choices. Assisting your client in making a clear Birth Plan for the chosen place of birth.
Class 4: Anatomy and fetal positions, introduce the concept of “pain” and normalizing birth sensations through knowing the anatomy. Introduction to the concept of breech and twins as variations of Fetal positions.
Class 5: Medical Birth Phases and the “real” phases of birth and how to recognize them.
Class 6: Breastfeeding and early days postpartum and newborn care / Doula Role in these.
Class 7: Common Interventions and the Intervention Cascade. (Fetal monitoring, ultrasound, epidurals, Caesarean, vacuum, forceps, etc.)
Class 8: Preventing Birth Derailment in common scenarios and special situations: Induction for Postdates, augmenting a “slow” birth, a diagnosis of Low or High Amniotic Fluid Levels, Meconium, premature release of the membranes, vaginal birth after cesarean (VBAC).
Class 9: “Informed Choice”: what it *really* means and how to use it as a tool for your client vs a tool for enabling the institutional model of birth, more work on creating a Birth Plan with a client
Class 10: Business Basics: Finances, record keeping, professional practices, client confidentiality, and effective advertising. Structuring a plan for working with clients from interview through to completion.
Class 11: Comfort Measures, supporting Long Births, Helpful things to say, Water Birth.
Class 12: Staying calm when the baby comes: Miscarriage, Abortion, and Stillbirth. How to support people through the hard things in birth work.

Added on May 22, 2024 From Gloria, I am training a great group of women to be birth doulas currently. It’s quite amazing to see them creating alliances and support structures from taking an online course. One of them voiced in the classroom that she thought the class would be about rubbing backs and saying comforting words to birthing women. Instead of that, we have to prepare the students for the “sysem” and how to navigate it to protect their clients from harm. This is my response to her: Quote: “Gloria Lemay May 19”
Oh, I wish so much that we could teach a nice course on how you should all be team players, think positive, reframe every terrible experience into a good memory for your client, be liked, be appreciated and live happily within a specific “scope” of practice. There are courses that try to “sell” that model of being a doula. We’re a little different. We name “Obstetric Violence” , “Medical Rape” and “Birth Trauma”. The numbers don’t lie. When 40% of our sisters, cousins, aunts, friends and associates are having their bellies cut open with a knife and their babies being dragged out drugged and dazed, we just can’t “sell” a denial of the facts. Medical birth is assaulting women.
All of your comments above are so important. Thank you for taking the time to read/watch the materials. I know they are disturbing. We need every one of you in the birth advocate business. It is scary and intimidating at times. That’s okay. You’re going to learn and experience things that will help you be better consumers of medical care to protect yourself and your family. You’re going to have moments of such pride and accomplishment when you know you’ve made a difference. You’re going to have times when you want to quit and get a nice job at a supermarket—-don’t do it! The secret agenda I have for each and every one of you is that eventually you’ll all be the woman in your community who is the “Go To, Birth Woman”. People do recognize courage and persistence.”
Contact Gloria Lemay at waterbirthinwoman@gmail.com

Postpartum Doula Certification(2024)

Featured

We have heard such positive feedback about our Postpartum Doula Certification Course. We have put together a great course that will launch participants into action in this career.

The Wise Woman Way of Birth Postpartum Doula Training will be taught primarily by Candice Johnson. Candice is the owner/operator of Cherish Childbirth in Vancouver, BC. She has built her business over the past 10 years and is the “go to” woman when families are having problems in the early days of parenting. She has a broad education in Massage, Breast Feeding, Childbirth Education and Infant Massage. Candice has trained many postpartum doulas and is active in the Vancouver birth community. She is the mother of two boys who were both born at home and breastfed into toddlerhood.
Website: https://www.cherishchildbirth.com/
FINAL COURSE FOR 2024:

6 live classes on Zoom, 2 and a half hours long.
Cost: $525 (Canadian)

Final Course in 2024 dates:

Course: Saturday September 28 to November 2 10 a.m. to 12:30 p.m. (Pacific)

6 Classes Live on Zoom, assignments and materials on Google Classroom.

Course Description:
This course will prepare you to be with families in the months after welcoming a baby. It includes all the aspects of the “fourth trimester” from practical feeding skills, to understanding the postpartum person’s body and how to support the family as a whole.
Our societal structures provide little care for new families. Having a trained eye and calm presence in a home in the early days is invaluable. Postpartum Doula care is proven to improve breastfeeding success, family bonding, and postpartum dis-ease disorders. Postpartum Doulas are in high demand!
The course will be on Zoom and assignments and tests will be on Google class room.
Successful students will receive Wise Woman Way of Birth Postpartum Doula Training certification.
Please email if you need more information or to register. waterbirthinwoman@gmail.com

Class ONE – The Fourth Trimester and the Role of the Postpartum Doula

Class TWO – Postpartum Healing – Physiology, Nutrition and Traditional Practice

Class THREE – Business for Postpartum Doulas and your Post Birth Bag

Class FOUR – Breastfeeding

Class FIVE – Alternative Feeding Methods, Twins/triplets, Newborn Intensive Care Unit

Class SIX – Newborn Care (including diapering and baby wearing).

Introducing Candice Johnson, the course instructor: Quote:
I have been living and breathing all things birth since I was asked to attend my first birth over 15 years ago. I feel a deep innate knowing of the undisturbed birth process. As an extension of my birth work I organically began supporting breastfeeding. I enjoyed my time with families postpartum but until I had my own babies I didn’t fully understand the importance of supporting someone through the postpartum period. Suddenly what I had always known, respected, and held space for I experienced first hand. This sparked a passion for serving new families. I hope by sharing my knowledge of how to support the “fourth trimester” through doula education, much needed support can be brought to communities everywhere.
Candice Johnson, Birth and Postpartum Doula, Childbirth Educator, Breastfeeding Counsellor
— on Bowen Island, British Columbia.

Is the baby breech?

The baby can be breech or head down throughout the pregnancy and it’s of no real concern until 34 weeks gestation. At that point, the baby’s head is big enough and firm enough that it can be palpated and a reasonably good assessment can be made by a clinician. This is also the point in the pregnancy where it makes sense to take steps to encourage the breech baby (3% of all pregnancies) to turn to head down through Webster technique (chiropractic), knee/chest position, or external cephalic version by an obstetrician.

For birth workers, these are some of the things I’ve observed about pregnant women carrying the baby in a breech position. They are not 100% diagnostic but can alert you to look closer for breech position. If the only thing that is concerning in the final weeks of pregnancy is “What position is this baby in?”, it’s possible to have a “one swipe” ultrasound. An ultrasound technician can do a very brief scan and see where the baby’s spine, head and bum are. There’s no need to do a time consuming (prolonged ultrasound exposure) scan just for position. If the baby is breech, you’ll want to know where the placenta is located as well. If the baby is head down, the scan can stop and the parents can go celebrate.

These are some signs that the baby could be breech at 34 weeks and beyond:

1 heart tones heard with fetoscope (not doppler) in upper segment (belly button level or higher).
2. Woman has feeling of a hard ball in her ribcage. Woman tends to squirm and press down on the top of her uterus when sitting.
3 head is slightly firmer than the bum on palpation after 35 weeks gestation age.
4. Abdomen has a more tight/taut sausage shape/quality than the usual round/squishy orange shape/quality.
5. Where are the baby hiccups felt? If high (woman’s belly button region), breech is suspected.
6. If the woman has had a previous breech birth, check carefully because a fibroid or a bicornate uterus (or other unusual anatomy) may predispose to carrying all her babies breech. (One woman I have worked with had 7 breech births. She had 2 uterii.)

I must admit that the best breech births that I have attended are the ones that were NOT diagnosed in advance. Women who have a surprise breech are spared all the worry, over-testing, over-lecturing and general misery that diagnosis of breech can bring.

Please let me know in the comments if you have any other tips or techniques for spotting those little beings who want to back into life. Thanks Gloria

LITTLE THINGS MEAN A LOT

Quote

I wanted to write this story down because it is one I can’t forget.

I was walking back to my car after a late night downtown meeting and I was accompanied by Peter and Molly, old friends. Molly was someone I really admired and she had two young children. As we were walking along together, Molly said: “Gloria, I don’t think I’ve ever told you what an incredible difference you made to me.” My ears perked right up, I love to be acknowledged, but I couldn’t remember anything special that I had done for Molly.

She said, “Remember that day we bumped into each other on the street when I was hugely pregnant with Caroline, my second daughter? We hadn’t seen much of each other during my pregnancy and I was working with two registered midwives and planning a homebirth.End of Pregnancy

My mother had come out from Eastern Canada to help the family at the end of my pregnancy and it seemed to be taking forever for the baby to come. I was worried that my mom might be really scared to see me birthing and I had a feeling she didn’t like the idea that, this time, I would have the baby at home. I didn’t even want to talk to her about the idea I had of having a waterbirth. Everything else about the birth was going smoothly but I had this nagging fear about my mom’s reactions. Well, Gloria, you listened to everything I said and then you said “Oh, do you know what? I have the most amazing video of waterbirth that you just have to watch. Everyone who sees it has a lovely smooth birth, you’re going to love it”. (The video was Barbara Harper’s “Birth Into Being”). You went to your car trunk and presented me with the vhs tape. I took it home and we watched it that evening. My mom watched it with us and said at the end “Why don’t you get one of those water tubs and do it that way, Molly!” All my worries were gone and the next morning my birth process started. The birth was everything we wanted. Afterwards my Mom said “Honey, that is the most beautiful thing that has ever happened in my whole life. I’m so glad I came out to Vancouver and got here on time to be present to the miracle.”
My Mom returned home to Eastern Canada. She was a widow and she liked to live in her own home alone. A few months after Caroline was born, we got the terrible news that my mother had taken a fall down a flight of stairs and she died. The grief was terrible. Amidst all the grieving I had this sense of peace that my Mom had been present to a miracle and that we had shared a profound experience. I don’t know if it would have unfolded that way if you hadn’t run to your car and lent us that video.”

 Only two remain undilated.


Only two remain undilated.

Molly (not her real name) only told me this story when the baby in this story was about 12 years old. You never know what the ripples in the pond of your actions might be. Love Gloria

A Doula’s Experience with Breech

After a birth, it helps to get a perspective on what could have/ should have/ might have been different in order to learn and grow. Every birth story is different. Gloria

A DOULA WRITES:
The family had a super healthy (first) pregnancy, with opportunities
galore; access to acupuncture, chiropractics, yoga, watsu, massage,
walking, biking, good rest and healthy food (they are both vegan and
eat really well). They chose not to have any ultra sounds and had
her first internal exam at 40 weeks, at her request. She was quite
anxious about having internal exams, learned that it is possible to go
through pregnancy and birth without any fingers up her vagina and
decided that would be best for her. She asked for the exam at 40 weeks
because she felt it would be better to have a ‘practice’ exam in a non
labour situation to see what it would be like just in case she wanted
to have one in labour.

Throughout her pregnancy her various health care professionals
palpated her belly and were sure the head was down. I don’t touch
bellies, I just pay attention to how women are carrying and moving and
what they are saying, and it seemed like a vertex presentation to me
as well. At 39 weeks, her chiropractor and her midwives noticed a
difference, but figured maybe the head was engaged. On her due date
she had an appointment with one of her midwives, who is quite new to
midwifery and she basically freaked out from feeling what she thought
were hands presenting and told the family they must go for an ultra
sound the following morning at 8am. The family was left quite worried.
I asked what she felt about the baby’s position. She said she had been
feeling flutters down below, and figured it was simply mild
contractions. I also asked if she was feeling pressure up in her ribs,
or if she was pushing down on her belly in discomfort, and she said
she had been feeling that way all week. I told her not to worry and
offered to join her for the ultra sound in the am.

Later that night I received a call that labour had started, she had
been contracting since her midwife appointment, but thought it was due
to the internal exam. The contractions were building, so she called
the midwives and they told her to go straight to the hospital for an
ultra sound and one of the midwives would meet them there. The ultra
sound indicated baby was breech and the OB on call was one of the only
in the city who was open to vaginal breech births, although he clearly
stated he was not interested in any marathons and she would have 6
hours to labour (no pressure!) The midwife assured them he was good at
what he does, but he was known to have no bedside manner. That was
pretty clear, but they didn’t care.

At this point their midwife said they could go home to grab their
stuff and take a pause. She was well aware that this was a total game
change from their water birth at home plan, so taking a moment at home
seemed an important part of their birth experience. They called to
let me know the baby was in fact in a breech presentation and that
they were heading home to get their stuff. I was pleasantly surprised
they were encouraged to go home, and told them to keep me posted and
take their time. I said I would meet them back at the hospital when
they returned.

We met at the hospital at 9:45. The midwife did a very gentle and slow
internal exam and found her cervix was 4 cm and stretchy. They had her
on the monitors after that. I asked if she could be on hands and
knees, but they couldn’t get the heart rate as clear, so that was
ruled out. She was laying on her side and after 10 minutes on the
monitor we heard major dips in the heart rate over and over, tried
getting her on her other side and baby was still dipping quite a bit.
The midwife was concerned of a cord prolapse, so the nurse came in and
did a very different internal exam, got right in there fast and
vigorously and felt bulging membranes and what she thought was a cord.
Suddenly two nurses had their hands inside of her, it was terrible.
They said they were trying to push the baby up off of the cord.
breech presentations

You can imagine how intense this was for the mother to be. The room
filled with nurses and it was announced that she would have an
emergency cesarean birth. They wouldn’t let her partner go with her,
this was also terrible. The midwife wouldn’t take no for an answer and
got her scrubs on to accompany her. I stayed with her partner. He was
a mess. We found the only nurse on the floor and asked if she could
keep us updated and I asked if there was any way her partner could go
in. They were waiting for the doctor to come (this whole time with the
nurses hands inside of her…) the doctor would do one more check to
make sure the cesarean was necessary. The nurse grabbed scrubs for the father
and he got changed, but just as he was going to go in the doctor
arrived.

I later found out instead of determining whether a cesarean was
necessary, he yelled at the midwife for having let them go home. One
of the nurses spoke up and suggested they instead focus on the task
at hand and he determined the cord was not presenting, but a foot was,
and her cervix was 8cm dilated. They went ahead and gave her general
and she heard the OB yelling at her midwife as she went under. Her
partner and I waited in the hallway, he made a comment that being the
dad waiting in the hallway while his baby was born felt like we time
warped to the 1950’s.

Baby was born at 10:45pm and dad held him for the first time in the
hallway at 11:10 pm. Apgars 8 & 9, and he was 5lbs 11 oz.

Mom and baby were moved to the recovery room and dad right away took
off his shirt and gave baby skin to skin cuddles until mom was ready.
At 12:45am the nurse said baby’s sugar was low and suggested formula
or glucose water. I asked mom if she was ready to try breastfeeding or
if she wanted me to get on the phone and call her friend who had
offered expressed breast milk if they needed. The nurses were outraged at this
suggestion, said they couldn’t allow it and so she did her best to
try breastfeeding. An hour later they did the sugar test again and it
was way up. The midwife and nurse were both in disbelief (the sugar
level raised from 1.9 to 3.7 in one hour!) The midwife commented how
interesting it was that they had no trouble believing the low number.
I told them it must have been the skin to skin contact with mom and
some colostrum that did the trick. Once they were settled and resting, I
drove home with their placenta and made them some quick prints and a
smoothie. They were happy to have had some of their birth wishes
granted.

Today the family is doing quite well. They are breastfeeding, resting,
eating well, have lots of support and are processing their unexpected birth
experience a little bit each day.

QUESTIONS:
– Could we have avoided those low decels if she could have been up on
her hands and knees?
– What happened when that nurse felt bulging membranes? Did she cause the membranes to release?
Or is it possible to feel a prolapsed cord through the bag?
– Could a baby with apgars 8 & 9 have been in such distress moments
before? (or was it that they were worried baby couldn’t handle two
more centimeters as well as pushing?)
– Was this the only way it could have happened? In general it felt to
me like everything happened as it had to, except those few questions
above that leave me feeling a bit curious.

I have never attended a cesarean birth (I have been a doula for four years).

Any way in which we can learn together from this story would be great.
Comments and feedback are very welcome.

Ruby

Gloria’s thoughts

    Dear Ruby, It’s getting to be hopeless to have a primip give birth vaginally to a breech.
    You must be traumatized/grieving about all this. Thank goodness you were able to give them some measure of getting their wishes met.:

    When the adrenalin gets going at a breech birth, they basically find reasons to head to the surgical setting. The cord wasn’t causing problems so, in hindsight, the heart tones were fine.

    Don’t know what the nurse doing the exam was intending but I would hope she was being careful NOT to rupture that membrane with a breech. Did she break the water bag? You would have seen amniotic fluid with clear poop coming out of the woman’s vulva after that exam if the membranes released.FOOTLING BREECH

    As far as diagnosing a prolapsed cord through the membranes with a footling breech, it might be possible because the bag is thin but it’s highly unlikely and, we know in this case (again, good hindsight), it wasn’t there.

    Apgars of 8 and 9 indicate a healthy, well grown term baby (again, golden hindsight). We do know that monitoring increases the risk of cesareans without any evidence that it is helpful in improving health.

    From what that dr with no bedside manner said, the woman wasn’t going to be given much of a chance to give birth vaginally. Since she hadn’t had previous uterine surgery, it would have been nice if someone with the skill to do a cephalic version had been there when she was first at the hospital. The baby presenting by the feet is the easiest to turn, especially if the baby is small and it’s early in the birth process. To be fair, a first birth with feet presenting is not a good vaginal birth risk to take. Luckily it is a rare situation to have so the numbers should be very low.
    footbreech

    If the caregiver is palpating bellies and listening with a fetoscope (instead of doppler) in the prenatal period, the caregiver should be picking up when it’s breech at 36 weeks gestation (if in doubt, the woman can have a one-swipe quickie ultrasound to double-check). At that point, if it’s discovered, there’s time/space to get baby turned to head down. As I said, a footling breech is easiest to get turned. Frank breech is a more optimal position for safe vaginal birth of breech but not for turning baby to cephalic. Querying rib pain, listening in the 4 quadrants with a regular fetoscope (and finding the true fetal heartbeat low in the pregnant belly) and observing the shape of the pregnant belly are your best tools for early diagnosis.
    Thanks for being there for this family. Gloria

CHARGES AGAINST BIRTH ATTENDANT, LISA KUSCH

Lisa Kusch Case in Saskatchewan, Canada

When a birth worker is charged with an offense in Canada, she receives legal advice not to discuss the case and not to speak with the clients involved. This makes things very difficult because she must raise funds to cover expensive legal bills and she can’t campaign on her own because of these restrictions.
I have asked for facts from different sources and submit the following information for those who are helping with the funding and care about my friend, Lisa Kusch.

Lisa in 2015

Lisa in 2015


In October 2016 Lisa was charged, as follows:
“It is alleged that between the 29th day of October 2014 and the 29th day of November, 2014 in Saskatoon Saskatchewan, Lisa Kusch “ DID ENGAGE IN THE BUSINESS OR PRACTICE OF MIDWIFERY, WHILE UNAUTHORIZED TO DO SO, CONTARY TO SECTION 23(2) OF THE MIDWIFERY ACT” (see below for the wording of that section of the Act).
That’s it. There are no specific details of what Lisa did or did not do. It seems to me that this is an overly broad and vague accusation. The document with the allegation was accompanied by emailed complaints filed by the birthing woman and the attendant at the birth (a doula/friend of the woman who accompanied her when she transported to the hospital).

Some of the information I have gathered which is to the best of my knowledge:
1. Lisa was not present when the baby was born.
2. Lisa is not a Registered Midwife and doesn’t represent herself as a Registered Midwife. That has been agreed upon by all parties and she is not accused or charged for this.
3. The woman was having her first baby and transferred to hospital for pain management. I am told that the baby was delivered by non-emergency c-section, at the mother’s request. The medical reason given was failure to progress.
4. Mother and baby were discharged from hospital on a normal schedule.
5. Lisa is accused in the complaints of causing poor outcomes and delayed recovery, due to excess blood loss during the surgery.

If Lisa is found guilty of a summary offense the result will be a fine of up to $4000. This is not a criminal case and it is not a civil case. The burden of proof is on the Crown to prove that the defendant practiced unauthorized practices according to the Midwifery Act of Saskatchewan. If one reads the applicable section of the act quoted in the charge above, it is vague in its definitions.
This case will set a precedent as it is the first in Saskatchewan and will have national implications.
The trial date is now set for October 24, 2017.

Start of Section 23 (2) No person shall engage in the business or practice of performing any of the authorizedpractices described in subsection (1) with respect to another individual unless:
(a) the person is a member who is authorized by his or her license to perform
that practice;
(b) the person is authorized pursuant to another Act to perform that practice;
or
(c) the activity is one of daily living and is performed by the individual or by
a person on the individual’s behalf. (end of section)

I submit the above to help people see the bones of this complaint and action against Lisa Kusch. Thanks for reading. I will update/edit as more info comes to light. Gloria Lemay, July 12, 2017

Some people have asked if they can send money for Lisa’s fund by bank transfer so I’ve set up a separate email and bank account for that purpose. The email address is lisakuschfund@gmail.com I’ll post periodic messages on the GoFundMe page about the total that comes in via bank transfer.
Lisa Kusch

The GoFundMe page to donate to the legal fund is at https://www.gofundme.com/lisakusch

Grand Multipara Birth

From www.nzdl.org

From www.nzdl.org

This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.

CORRESPONDENCE BETWEEN GLORIA AND CAROLINE

Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk (edited for clarity–a daily walk in pregnancy). One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria
06:07

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

10:30
You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. ?

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.
Gloria

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.
Caroline

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.