I auctioned off a birth photography service to support Maryland Families for Safe Birth, the organization working to create and pass a bill that would legalize Certified Professional Midwives in Maryland.  (Currently, 26 states have legalized CPMs and the statistics show the outcomes and benefits have been excellent, so there’s no reason for Maryland to do the same.  The bill did not make it into the Senate this year, but new bills rarely if ever get voted on the first year, so here’s hoping for a good workgroup and success next year!)  Both the winner AND the disappointed runner-up bidder ended up having their births photographed, so it was a win-win situation all around!

I looked very forward to this birth, knowing that the client’s family had a long tradition of homebirth and was very close-knit.  When the day came, not only was I able to witness a very special birth, but I was also able to sleep under the sun, read my eyeballs off, knit and knit and knit some more, and shop sans-toddler at Target!  What luxuries!

Transition

This image shows what childbirth must have been like centuries ago…many fearless women, experienced in birth, come to a home to surround a laboring mother with their strength and knowledge.  This mom has five sisters, all of whom gave birth at home or had been around homebirths most of their lives and who rallied around her at the moment of birth.  We should all be so lucky.

 

             

 

 

 

 

 

 

 

 

 

 

 

 

 

On March 15, 2012, I and hundreds of other homebirth proponents convened at the State House in Annapolis, MD to support a bill, HB 1056, which argues for the legalization of Certified Professional Midwives.  Prior to that day, I had done my part by writing a letter to each of the approximately 30 delegates on the committee, stating my view on homebirth (which is that my homebirth clients have included labor and delivery nurses, lawyers, economists, mathematicians, and public health policymakers, all of whom understand statistics and risk far better than the rest of us, and still choose homebirth, imagine that!)    It was a perfect day and an opportunity to see lots of former clients and check in on their chubsters, but I wasn’t able to attend the hearing.  Even though I tried to do my part to support Maryland Families for Safe Birth, the grassroots organization that introduced the bill, by auctioning off my birth photography services to a lucky winner whose birth turned out to be one of my very tip-top favorite days, at the end of the day I still felt ineffectual in the midst of all these other volunteers buzzing around like madmen and getting things done.  So I jumped at the chance to exercise my old military skills by transcribing the hearing and do my part.   I had to farm some of it out to two other volunteers so I could get ready for our overseas move, but I’ve put the final touches on and you can download it here:

HB 1056 Hearing Transcript

Transcribing things really makes you focus and listen to every word you’re hearing, and I was so glad to have a reason to sit down and really listen to what the delegates, testifying citizens, and professionals both for and against the bill had to say.  My impression at the end of it was that the opposition (ACOG, AAP and their ilk) presented an incredibly weak argument against legalizing CPMs.  All I kept hearing was, “But what if midwives advertise?”  and “This one time, I saw a bad outcome.”  As the medical community likes to trumpet, “anecdotes are not data,” but the opposition failed to cite or quote any type of peer-reviewed literature or study that proved their point, which seemed to be in the end that CNMs are the only safe homebirth attendant, and the problem really is that all we have to do is fix the hospitals to lure everyone back.   Their argument was quite telling on two fronts: one, that they are worried about money and the impact on their practices and the hospitals, since we all know that birth keeps the light on in hospitals; and two, that they are truly not familiar with the education and skills of a CPM midwifery team.  For example, one Dr. Siegel’s chosen “birth is dangerous” anecdote was a shoulder dystocia where the nurse applied suprapubic pressure to free the baby, and he seemed to imply that this was something impossible at a homebirth.  The audio recording I was transcribing from was actually a streaming video, and I looked close to see many heads shaking in the audience.  I mean, even I know at least two additional maneuvers to release a stuck shoulder at home with no medical help, and I’m just a doula!  Another quote that had the heads shaking in the background came from Mary Lou Watson, the Chief Nursing Officer at St. Mary’s County Hospital, who said that you have “no choice” but to take a breech baby by cesarean, in explaining the country’s 33% average cesarean rate.

However, many excellent points were made by the speakers surrounding the smaller details of CPM licensure.   Many touched on the fact that CPM education, licensing, and oversight seems to not really be organized in a way that reassures the majority and the government.  As someone who fully intends on becoming a CPM in the distant future, I agree that I would rather take my education from an esteemed university or system rather than one of the many online midwifery schools that are my current educational choices, as well as have some protection if I got sued.   Although, I understand and appreciate why traditional/holistic midwifery is taught so seemingly “informally” and would trust or even prefer someone who received their education from these schools.  (I guess it’s just a vestige of living/working for so long in a career where Georgetown University is the only acceptable place to get an education, and a master’s degree is the new bachelor’s, and you are nothing if not certified in something and you have a string of letters behind your name but I DIGRESS.)

But that’s not the point!  The point is that 26 other states have managed to trust CPMs with the education they bring to the table now, and the other good point made by Pam Casemeyer is that we need to really study what the other states have done and learn from them.  It will remain to be seen whether that results in more or less restrictions on practice; for example, it may mean that breeches and VBACs will become “illegal” to do at home, which hardly solves the original problem!

The final good point made was there needs to be a trusted, established, RESPECTED plan of transferring care between CPM and OB/GYN, especially in emergency situations.  But, I think they were preaching to the choir there.  No CPM wants to be a renegade.  They all want to be accepted without the nasty politics of birth when they show up at the hospital with a woman whom they have recognized needs some help out of their scope.   The stories of successful homebirth transfer are rarely positive.  Instead of happiness over a safe birth, the hospital transfer stories are often clouded with mentions of police, Child Protective Services, unnecessary force and/or coercion, and passive aggression against the new family by resentful hospital staff, such as forced unnecessary NICU stays because they “didn’t monitor the whole labor.”   If anything, THIS is what I want done away with.  This is not a CPM licensing issue, this is something that needs to be systematically addressed at all hospitals with all labor and delivery staff.  That’s not uniquely our fight, because it still happens with perfectly legal CNM-attended homebirths.

So that is my personal reaction to the hearing.  My thoughts don’t represent MFSB or anyone else!  I shall cleanse your palate with some pictures from the Annapolis rally.

 

 

 

 

The birth of my daughter at Special Beginnings was the best experience of my life, and my appreciation for it has only deepened with each birth story that I hear or witness. So imagine my excitement when I was invited back to Special Beginnings for the first time to photograph a birth almost three years later! I could hardly contain myself when I was called in and discovered it was going to happen in the same room with the same midwife who caught my baby. Fortunately I was able to hold it together enough to get some photos of what turned out to be a graceful, easy birth:

No fear here!

 

Though I don’t want you to be under the impression that there was no effort involved….

Bobbie on water duty.   You don’t have to eat, but during healthy birth you will be nagged to drink!

 

After some position and location changes, a baby girl emerged carefully into the world, caught by her father, and hale and healthy.  Note the nuchal cord.

 

Special Beginnings has big ol’ beds that beckon family members to get in bed and snuggle with their new colleague.

 

I love watching the wizened and waterlogged newborns unfold into irresistible chubsters.  Especially when they are actual 9-lb chubsters like this one!

 

Little miss popular!

It is actually a rare occasion that someone inquires about my birth photography and doesn’t ask about my price.  Either it’s “That’s too expensive, I’ll just have my friend do it,” or “Why aren’t you charging $3000 like the other birth photographer in Northern Virginia?”

I’d like to write a little about what I’ve discovered now that I’ve got about 25 births under my belt.  I know, reinventing the wheel.  It seems like every “Mom with a Camera” has a post like this on her website.

Photography:
My fees are currently $400.

• Canon 5D MK II camera: $2400 (chosen for its performance in low light conditions, such as one might find at a birth)
• Canon 50mm 1.4 lens: $350 (also chosen for its low light performance)
• Canon 24-70 f2.8 lens: $1000 (ditto, and is good for tight spots like at homebirths)
• Adobe Photoshop CS5: $150 (for making everything look lovely)
• Adobe Lightroom 3: $150 (for managing, processing, editing photos, making slideshows)
• Photo editing monitor: $350 (many technical reasons, look up TN vs. IPS if you are curious)
• Zenfolio online portfolio/print ordering website: $150/year
• Weekly daycare: $185 (paying for a week is cheaper than paying per hour, which can be 6 hours or 24 hours, depending on the birth)
• Gas: .50/mile (my limit is 50 miles one way)
• CDs, DVDs, business cards, advertising, shipping materials: $200/year
• Time at the actual birth: 6-24 hours, once up to 36 hours!
• editing/processing time, which is from 6-12 hours depending on the number of photos.

Most photographers charge a “sitting fee” and then have you choose from the various images and pay for them individually, and then also pay for prints. (This is where they make their money). I don’t think birth works like that- it needs to be seen as a story from beginning to end, so I want you to have all your pictures.

I do, however, want you to buy prints from my website, not because I make money, but because Mpix’ prints are so beautiful, always.

I also know what it’s like to have to pay for your birth out-of-pocket because of insurance, and I want everyone to be able to afford beautiful photos on top of all the other things they have to pay for.

So, as you can see, I am not making any money off this little venture, and it’s fine.  (I’m actually about $10,000 in the hole this year, making about $2/hour, all things considered.)   I just wanted you to know why I am “so expensive” or “so cheap,” depending on where you stand.
I am not a pro photographer in the sense of “expert,” oh no.  Pro as in “professional”-as in this is my profession- sure. I have the pro camera, the pro software, the “eye,” the respect for childbirth, and the willingness to go at any hour and stay for however long it takes, which is the key feature that your local portrait photographer may not have.

You know you better hustle when it’s the midwife calling you to come to a birth instead of the clients. So that’s how I found myself on the road 30 minutes after rolling out of bed at my normal time to start a normal day, certainly not to photograph a birth that was not expected to happen for 4-6 more weeks! I walked in just in time to see baby crowning. If I had lingered one minute longer at the babysitter’s or taken any of the many possible wrong turns in their tricky neighborhood, I would have missed it!

This is the scene I walked in on after a breathless drive and some frantic moments spent defogging my camera lenses.

 

 

Take note of the texture/color of the umbilical cord.  Flaccid and white, baby received all of her blood before the cord was clamped.  (It looks like a lot of blood in the tub/bowl but it is really not very much at all.)

The name on dad’s shirt belongs to the family’s first baby, who passed away as a newborn. So she is there in lots of photographs, watching over her new little sister.

New big sister acted typical of most kids at their siblings’ births- calm, totally accepting that this is how life starts and it is just not a big deal, and can I please have breakfast and cartoons?

The mysterious creamy substance that many babies have at least a schmear of behind their ears at birth, vernix caseosa, elicits either an “ew!” or a “WOW!” depending on what you know about it.

Vernix is mostly made up of dead fetal skin cells, fetal skin oil, and lanugo, which is that fuzzy hair that term and preterm newborns have all over their bodies.  It is found in the highest quantity on term (38 to 40-week) babies, and as the baby cooks past 40 weeks, the vernix disappears again.

Far from being a mere side-effect of living in a bag of water for 10 months, vernix has many important features and functions.  It is thought to lubricate the baby on her way out, and after birth, serves as skin moisturizer and as a protective barrier against germs and bacteria.  One study found its antimicrobial properties to be similar to breastmilk.  Remember how I said that post-term babies have less vernix?   This is because the surfactant that is released by the fetus’ mature lungs mixes with the amniotic fluid and causes the vernix to release from the skin.    The vernix is then swallowed by the fetus, bringing in all the antimicrobial goodness that provides the newborn with built-in, immediate immune defense.   Amazing!

Another function of vernix is to keep the newborn’s delicate skin protected and insulated against the elements, whether it be amniotic fluid or cold, dry air.  This study showed that babies who were allowed to retain their vernix had healthier skin, AND a higher body temperature.

So, what are the practical lessons to be learned from all this? 

Delay your newborn’s first bath for as long as you can stand it!

Don’t wipe off the vernix, rub it right into baby’s skin to moisturize and provide antibacterial protection.

My vernix-enrobed baby girl went eight days before she touched water again; she smelled sweet as sugar and her skin never peeled, as is characteristic of newborn babies!

Girl, 40 weeks.  None more cheesy!

Fun fact:  This study shows that more girls are born with vernix than boys…this has seemed to be quite true in the wee sample of 25 births I’ve attended thus far.

Recently I wrote a post about the importance of leaving an umbilical cord intact.  At a recent homebirth I was invited to photograph, the new baby took a few minutes to come into his body after rocketing almost effortlessly into his dad’s hands only a few hours after labor started.   (I once heard somewhere that when babies come so fast, they have to wait for their souls to catch up to them, and that’s why sometimes fast babies are “shocked” and slow to start).  Anyway, cord pulsed for close to an hour after his birth, ensuring that he got all the oxygen he needed, making this the third time now that I’ve seen a cord pulse a long time for a baby who took a while to get it together.

Quiet

Suddenly there is someone else here.

This reminds me of the Ina May Gaskin quote: “If a woman doesn’t look like a goddess during birth then someone isn’t treating her right.“

A new family!

Mom is a fellow knitter, so I had to get a picture of the cute hat she made.   I wish I had known how to knit before my baby came!

 

Whenever I work with this apprentice, I tell her how lucky she is to have gotten into homebirth midwifery right away and found an awesome preceptor. She’s got the best job in the world, and she knows it!

Sometimes the best-laid plans don’t pan out.  A recent birth made me truly appreciate the miracle of normal, spontaneous birth as I’ve been so lucky to see it happen many times.   I was really beginning to take it for granted.  This was my first experience with induction on a very unfavorable Bishop’s score, with which my client was facing a 50 percent chance of cesarean section.

While in the throes of induced labor, she took the time to think and learn about every intervention thrown at her, an incredibly overwhelming task, especially after planning during her entire pregnancy for a waterbirth with CPMs.

 

At the end of nearly four days of labor with the full complement of comfort measures, medication and interventions, baby finally began making her way down and out, but…you can guess what happened next.

It is staggering to realize the sacrifices and superhuman effort that mothers give for their babies before they are even born.   Doesn’t matter how many contractions she felt or didn’t feel, how long she had to push or how baby eventually came out, or even if the baby was with us for only a short while and never took a breath.   We moms, we’re all in it together and I wish the general motherhood collective would realize this and start to build each mom up with support and praise, because some need more than others, but there’s not a mom out there who doesn’t need it at all.

And just for fun, this long-awaited peanut modeling my first knitting project!

Those of you who know me or have poked around on this site probably know that there is a gal I hold in very high regard, my milk donor and friend.   She was able to provide me with a dozen gallons of breastmilk, and from that I finally was able to feel healed in my failure to feed my baby in the  the way I intended.  I began my doula practice knowing she was looking forward to having another baby soon, with a homebirth VBAC this time, and vowed to myself that I would do everything I could to help her heal from her first traumatic birth the way she helped me.

Well, I’m proud to announce that she had a beautiful HBAC with me (almost not) at her side-what had originally been a  day-long, frustrating prodromal labor turned quickly into a fast and furious precipitous birth where the midwives and I only got back to her home after pushing had already gotten underway.   (That might be one of my favorite doula memories- stepping off the elevator and immediately hearing her pushing roars echoing in the hallway.)  I was able to get some powerful pictures to celebrate how strong and awesome my friend was at getting the birth she wanted and deserved:

Counterpressure is the best thing in the universe.

Dad passes the baby of still-unknown sex through and up to mom…

Ta-da!  Here I am, safe and sound!

We had to remind her to check and see…it’s a girl!  (Amazing how it just doesn’t matter what the sex is at that moment!)

I would be remiss if I did not include a shot of the midwife’s gentle and loving newborn exam.

When I was pregnant, I was bombarded at every turn with advertisements for cord blood banking.  I did my research and decided it was much too expensive, considering the relatively tiny chance that my child would come down with any disease that the cord blood could successfully treat.  So then I moved on to public cord blood donation.  That sounded like a nice option…donate the cord blood to people who  need it right now.  When I asked my midwives about it, they said that public cord banks don’t do business with their birth center.

I was disappointed that my cord blood was going to go to waste, until my midwife gently said, “Your baby needs every drop of that cord blood.   He deserves it more than anyone.”   He spoke with me a little about delayed cord clamping, and how they prefer to wait to clamp the cord until it has stopped pulsing and is limp and yellow, and by then there would not be enough blood to be “milked” out of the cord to really be worth the effort.   I hadn’t really heard much about this, even though I had been powering through Ina May Gaskin’s books and considered myself a birth aficionado.

So I began my research on this new topic,  and I was immediately buried under stacks upon stacks of virtual literature about umbilical cord/placenta physiology, and the harm that is thought to be caused by clamping and cutting the umbilical cord immediately at the moment of birth, oftentimes before the baby has taken its first breath.  The immediate-cutting practice is based on the since-debunked belief that letting a baby get all its blood causes non-physiological (abnormal) polycythemia and jaundice.

The importance of delayed cord clamping has been driven home for me (no pun intended) at the two homebirths I have attended where the baby was “slow to start.”   At each birth, the cord continued to pulse-once up to 30 minutes after the birth- until the baby had achieved a normal breathing pattern and had pinked up and cried.   The placenta did not detach until the baby was stable and breastfeeding almost an hour later.   It was a fascinating lesson on the interplay between mom and baby, the communication via placenta that is so often disturbed during “active third stage management.”  Never mind that the placenta can hold up to 40 percent of a baby’s blood volume.

Upon review of my own birth photos, I noticed that my baby’s cord was still cut too early, even after 10 minutes had passed.  You can see in this photo that the cord is still purple, coiled and plump.

Contrast this with the cord that had been left for approximately one hour before clamping- limp, thin and white:

(Fortunately, the evidence shows that a delay of at least 30 seconds is sufficient for the baby to get quite a bit of blood volume back.  If my daughter had been struggling to breathe, this would have been a greater issue.)

There are almost no indications for immediate cord clamping (placenta previa/abruption and a torn cord are the only indications.) Meconium, short cord and respiratory distress are NOT indications.

Delayed cord clamping and cord milking is especially important for premature birth.

Babies can be resuscitated on the mother’s chest while the cord is still attached and delivering the baby’s only source of oxygen.  If a flat surface is necessary for chest compressions or intubation, this can be done on a flat board (or cookie sheet, as is done at homebirths) placed next to mother.  And check out this contraption that will hopefully make its way into hospitals!

Dr. Nicholas Fogelson is an OB/GYN that is championing the delayed cord clamping paradigm shift in hospitals.  His blog is the place to start for your own research.

Here is an interesting illustration of what a placenta looks like when it’s still full of the baby’s blood.

Facebook page where you can get yourself buried in the latest research on delayed cord clamping.