Nursing-Friendly Clothing

Finding nursing-friendly clothes can be a challenge! Here are a few stores that have great nursing-friendly clothes, as well as some tips TCM mamas have shared.

Latched Mama – an online option that has everything from shirts to dresses to tank tops. It offers free shipping on orders over $75.

Nourish Collection – an online store that works to provide chic clothing for breastfeeding or pumping women.

Destination Maternity – located at the Mall of America this store offers a great selection of nursing tops.

Tip #1 – We’ve also heard from a lot of moms who like wearing an extra-stretchy tank tops under their normal shirt to allow for easy nursing access without buying a specifically nursing-friendly shirt. By lifting the top layer shirt, and stretching the under tank down, most tops can easily convert to nursing-friendly!

If you are looking for some sources for nursing bras, check out this post. Keep in mind that a lot of stores that sell nursing bras will also sell nursing tank tops.

Are we missing anything? Leave a note in the comments!

Peter’s Birth Story

Thank you to this incredibly strong and sweet mama for sharing her birth story. It was the best surprise when she emailed it to me on her son’s first birthday! Her writing talent is magical. I’ll let her story speak for itself. Enjoy this treasure!

When I found out I was pregnant with our second child, joy filled my body like helium. Our son, James, had turned two just five days before. He should have been in bed that afternoon, soft and heavy with sleep; instead he was full of laughter. I gathered him into my arms and together we walked the quarter mile to our mailbox. It was late September, warm and dry, and the entire gold-threaded landscape reverberated with new energy. James fell asleep on our way back to the house, head heavy on my shoulder, legs dangling on either side of my belly where already our baby’s cells wimageere multiplying furiously.

On June 6th, the day before our due date, I noticed a streak of pink on the toilet paper. I called our midwife, Kate, knowing that labor could start soon or not for several more days. There was no change in the rhythmic tightening of my belly, so despite my excitement and slight nervousness I tried to go about my day as normal. That night I took a photo of my round, low belly in front of the bathroom mirror, knowing that it could be one of my last chances to document my pregnancy.

After a restless night, I woke unusually early with very mild and erratic contractions. I left James and my husband, Aaron, sleeping in bed and took a hot shower before making myself breakfast. Halfway through my yogurt and muesli, I lost my appetite. My mom had woken early too, and we spent some time talking together before I retreated upstairs and gently shook Aaron awake, eager to tell him that I was in early labor.

I paged Kate at 9:30, wanting to keep in touch since my first labor had happened quickly and she lived an hour’s drive away, and was also planning on attending Bellyrama in St. Paul. “Hi sweetie, what’s up?” she asked when she called back, and her warmth brought a smile to my face. I told her that I was experiencing mild contractions that hadn’t settled into a pattern – most were coming 7-15 minutes apart and didn’t disrupt my normal activity. I had lost my appetite and felt slightly ill, and she recommended that I try to eat a few bites frequently, and reminded me to stay well hydrated. She told me that we could inflate our birth pool but should wait to fill it until she was on the road, and to call her back as soon as I felt my labor turn a corner.

Along with Kate, her student-midwife Rachel, and assistant Annika, I planned to have Aaron, my mother, and my two younger sisters with me for this birth, as well as my mother-in-law, Patrice, who had agreed to help care for James during my labor. My youngest sister, Laura, drove down from St. Paul that morning while Annie, who would be photographing our birth, headed to work in town with her back-ups on call. I called Patrice to let her know that I was in early labor, but that Laura had made it home and could look after James until things intensified.

I cocooned myself in our bedroom, knowing that rest would benefit my body. In bed, I opened Ina May’s Spiritual Midwifery to one of my favorite birth stories, but distraction was no longer a comfort and I found it difficult to focus on the words. I dozed for about half an hour before my contractions became too uncomfortable to sleep through.

Aaron was eager for Kate to join us, but I worried that it was too soon to call her and that the growing intensity had only brought me within sight of the corner of my labor, not around it. I hadn’t experienced early labor with James and felt unsure about what was to come. What if this labor didn’t move quickly like my first? What if Kate came down to us and I stalled, stranding her in our home for hours?

image (1)My contractions continued to gain strength and I could no longer cope with them alone. I needed Aaron’s presence and support, so we called Patrice to look after James. I began to travel between the toilet and birth ball, rocking my body as it simultaneously tightened and opened. The toilet and close security of the bathroom had been my favorite place to labor with James, but this time I felt a lot of pressure on my perineum when I sat, and I preferred the gentle support of the birth ball. Aaron sat quietly in front of me as I circled my hips, reminding myself to keep my eyes, mouth, and throat soft. He was such solid support, and serious. I asked him to smile for me, as his smiles lightened the sensations I was experiencing and brought me some gentle relief.

Just before 1:30, my labor demanded my entire focus and I began truly vocalizing during contractions. Each wave felt like an incredible weight against my belly, as if my body was trapped in a vise. As it ebbed and the pressure lifted, I felt for a moment like I was floating.

We called Annie home and got back in touch with Kate. I still felt shy about asking her to come to us – I craved a clear sign that our baby would be born soon. When she asked if I was ready for them to head our way, I said hesitantly, “I don’t know. I think so.” I’m grateful she didn’t wait for a show of greater confidence, because just before she arrived almost an hour later, I badly wanted her with me. Labor was intensifying quickly and I needed her there to feel like everything was okay, to feel safe.

I heard Kate’s voice from the bathroom and felt instantly relieved. She was here and I was having our baby. I joined her in our living room, sitting next to her on my birth ball while she removed a few things from her bag. When she pulled out the blood pressure cuff, I started to cry. Kate gently asked me what I was feeling but in that moment I had no words to describe it. I felt open, sensitive, and vulnerable. I was overwhelmed by the vastness of what was about to happen to myself and to our family: the birth of a baby. “Let it all out,” she said. “Don’t hold anything back.” In the few moments before the next contraction, while I watched the numbers climb on the monitor around my wrist, I cried, and felt a quiet relief.

Kate asked if I’d like to get into the birth pool, but I felt I could cope a little longer on my birth ball, and in the support and comfort of Aaron’s arms. During the next contraction I braced my hands on Aaron’s knees while he gently held my shoulders. I pressed my forehead against his forearm, rubbing it back and forth while I rocked my pelvis. As the contraction lifted I looked into Aaron’s smile and out the window behind him, watching Rachel’s car pull up the hill and her quick steps toward the house, a bag slung over her shoulder.

After two more contractions I suddenly decided that I needed the warmth and security of the birth pool. I stripped down to my bra, which I left on not for modesty’s sake but because I felt the next contraction approaching like a thunderhead and I wanted to submerge my body before it overtook me.

image (3)There was so little to anchor myself with in the water and I struggled at first to find a comfortable position. Between contractions I draped my arms over the edge while Aaron moved his hands firmly down my spine and put pressure on my lower back. I loved the effort he put into comforting me. Eventually I settled with my arms around Aaron while he sat on a low stool by the edge of the pool. During contractions I rocked back and forth on my knees while he held me. Sometimes his embrace was too tight and I had to shake it off to move my body freely. I closed my eyes and in the spaces between came to rest deep inside of myself.

Someone began pouring pots of boiling water into the pool to maintain its temperature. It slid over the surface like oil, encircling my belly. It burned and comforted. My contractions were becoming very intense and I was having a difficult time coping. I tried to keep my tones low but my voice started to climb at the peak of each contraction. I felt like I might vomit, and Aaron got a bowl under my chin just in time to catch it. I thought I must be getting close to the end. Now and then I would hear Kate tell me that I was strong, and to trust my body and move how it wanted to. When I felt discouraged, I thought to myself, “You’re doing this today and you won’t have to do it tomorrow.” Remembering my first labor, I reminded myself that I just needed to make it through transition, and once I felt the urge to push I would find relief.

I began opening my mouth wide during contractions and moving it back and forth over the edge of the pool. I felt a pop in my belly, then another deep in transition, a warm gush between my legs. Flecks of white floated in the water.

image (2)I was deep in the intensity of transition when my body suddenly bore down and a pain I never experienced in my first labor tore through my pelvis. I felt like I would split in two and I panicked. I began to fight my body. I struggled to gather myself back together, to tell myself that everything was okay, that I wasn’t being ripped open and that I needed to try to relax, let my body do its work, and let my baby come.

The pressure was unbelievable and constant, and I barely had time to catch my breath between contractions. I bellowed, pressing my face against the inflated pool, my body curling in on itself. I felt like I was still trapped in transition and I started to despair. I couldn’t do it anymore. I didn’t want to labor anymore. I didn’t want to have our baby. It wasn’t supposed to feel like this.

I felt for my baby’s head between contractions, soft and firm and about 2 1/2 knuckles in. Kate asked where I was feeling our baby but I couldn’t answer her. Another contraction surged through me and I felt for our baby again. He or she was still 2 1/2 knuckles in. I felt another rush of panic. I was losing my hold and I needed our baby out now.

Kate and Rachel passed the doppler up between my legs and swept their hands across my lower belly. Another contraction seized my body and still their hands were there, searching. I was near breaking; I wanted to knock them away. In that moment I didn’t care whether our baby’s heart was strong or struggling – my thoughts were consumed by pain. Kindly they asked me if I could move to my back and I clumsely shifted onto my heels and rolled into a semi-reclined position. I could feel our baby moving down the birth canal and I roared even louder. I screamed from the deep cave of my belly. I wonder now what my baby thought as he felt those primal vibrations and the constant pressure of my contracting muscles. Did he feel my strength? Did he feel fear? I was too overwhelmed by my own body to offer any comfort.

image (4)Every push was painful but it was all I could do. I looked up at the women gathered around me, ready to welcome our baby, and I met my mother’s eyes. I silently begged her to help me. I wanted to cry. She looked back at me with so much empathy that I knew she could see I was having a hard time. I closed my eyes again. The only way out was through, and I roared through another contraction.

Kate supported my perinium as our baby crowned. Finally there was a pause, a release of pressure as our baby was held between. “That feels good,” I sighed. What a relief to have a moment of rest before those last contractions, before every muscle bore down again and our baby’s slick body tumbled out of mine and into Kate’s waiting hands.

image (5)Kate helped lift him onto my chest, his arms spread wide, and as I gathered him to me I began to sob. I felt such complete relief. I had made it through. It was over, the pain was gone, and my baby was in my arms.

And he was beautiful. Smaller than James was at birth, and duskier, but after a few moments he let out a vigorous cry and his skin turned pink and rosy. “I know, baby, I know,” I said as I stroked his body and we cried together. The pain had been isolating, but as I held my newborn against my chest I felt suddenly how intimate our experience had been. I looked up at the faces around me. “That was so intense,” I said. It was so intense.

image (6)I stroked my son’s cheeks and circled my fingers around the small patch of vernix on his head. Here were my first memories of James as a newborn – the soft hair coming down over his temples, curling along the rim of his ears, velvety over his arms and back. There was something of James in this baby’s face, but something wholly new as well. He was simply himself, the same baby who, at 25 weeks, we had watched play with his toes on the ultrasound screen, his lips touching the umbilical cord to feel its reassuring pulse. And now in my arms on the day I least expected to meet him: his due date.

image (7)I cupped our baby’s small feet as Aaron leaned forward to cut cord. My placenta was loosening from my body, blood coloring the water, but it took some effort to push out. The water cooled. After lifting our new son into Aaron’s arms, I stood carefully, surprised again by the strength of my legs. But I also felt tender and a little raw, and I feared that I had torn deeply again. Kate could see my discomfort and asked if I would like her to examine me. Her touch was gentle but still painful, and so I was amazed and relieved when she announced that I hadn’t torn at all, hadn’t bruised, wasn’t even swollen. Ibuprofen and an ice pack gave me immediate relief.

Out of the water, I felt suddenly ravenous. My mom brought me a small, sweet strawberry that my dad had plucked from our garden where he had spent the afternoon, now and then hearing the sounds of my labor. My youngest sister disappeared into the kitchen and returned a few minutes later with a plate of scrambled eggs and sourdough toast. She tore the bread into bite-sized pieces and fed me with a tenderness I hope I’ll never forget. Nothing could have tasted better.

image (8) When James came in from his play several hours later, I was sitting up in bed, Peter cradled in my arms. I hadn’t seen him since that morning, and in that time my little boy had grown into a long-limbed child. He carried a book in his hands and shyly asked us to put the baby in the crib. A few moments later he brought his face close to Peter’s and gently stroked his hair and cheeks. Later, when I nursed James to sleep, I marveled at how much space he took up next to me in his bed, how heavy his head was, the sun just beginning to lighten his blonde hair.

For two days after Peter’s birth, I felt shaken by the differences in my two labors. Both progressed quickly and intensely. But while the three hours that I pushed with James were full of effort, they were also painless and almost serene. Afterward I felt strong, ready to tackle anything. The 28 minutes that it took for me to push Peter into the world were nearly excruciating, a raging storm, and I discovered how deeply rooted that strength was. I saw it in our birth photos, the deep intensity of my quiet and then straining body. Several days later, I played our birth video with a feeling of trepidation, afraid of revisiting the pain. Instead I heard the strength in my breaking voice. I watched my husband bury his face into my neck as I birthed our son. I saw love in every touch. I walked away empowered.

There are other things I think as I look back on my birth photos, things I was too busy to consider in the throes of labor. I look at the purple birth pool and I think of the other women it has cocooned during their labors and births. I think of how it has traveled through city, suburbs, country, how its been filled in family rooms and bedrooms. I think of women laboring against a backdrop of snow reflecting light, the first lush growth of spring, the bloom of summer, the leaves dry and curling. The hum of furnaces, air-conditioners, insects outside an open window. Intimate dark and bright sunshine. Partners, doulas, mothers, sisters, friends, children. I think of women who have brought their babies into the world with a quiet intensity or with a ferocity we sing from our bones. But always the women, the water, and Kate sitting quietly by our sides.

image (9)

Nursing Peter on the spot of floor where he was born one year ago.❤

Twin Cities Midwifery’s Cesarean Rate and other Statistics through December 2015

When I meet with families who are looking to choose a midwife, I am often asked about the statistics available for my home birth practice. While I do gather data, the small size of my practice brings the usefulness of these particular rates into question. With such a small pool of data, how statistically significant would these numbers be? Thus, I often direct families to studies that look at a much larger pool of data than mine.

Home birth studies shed light on safety and other key indicators

A number of studies demonstrate the safety of planned home birth for healthy, low-risk women with a trained attendant, such as this one from Canada, this one from the Netherlands, this one from England, and this one from New Zealand. An article by Johnson and Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America,” is especially important in that it uses data from planned home births in the U.S., and it not only addresses safety but also looks at hospital transport rates, cesarean rates, and other statistics that families commonly ask about. In 2014, Cheyney released a study looking at outcomes of almost 17,000 planned home births in the United states. This study is a great reference for similar outcomes that I track in my practice, such as transfer rates, vaginal birth, assisted delivery, and cesarean birth rates for families planning a home birth.

Birth statistics are becoming more freely available

Over the past few years, I have noticed that hospitals and clinics are becoming more transparent in the care they provide. There is still a long road ahead of them, but due to the demand from informed consumers (pregnant people and families!), data on interventions like cesarean sections is becoming easier and easier to find. Annually, a report comes to my email discussing the cesarean rates by Minnesota hospital and Wisconsin hospital, and this report details rates by clinic (starting on page 175).  Here is a blog post from a local doula stacking up the cesarean rates for local hospitals. I think it is fantastic that families have this information accessible to them as they choose a provider and consider who will walk with them on their journey of pregnancy, birth, and postpartum care.

I’m also inspired by our very own, local Childbirth Collective, which requires members to participate in a data-gathering project to learn more about the births its doula members attend. I always look forward to seeing what is included in their data report!

Statistics are a mirror that help us see and improve practice

I have been amazed by how Twin Cities Midwifery has grown and flourished over the past five years. I still limit my practice to about 2-5 due dates a month, and there are certain months when I plan ahead, not taking any due dates, allowing for a planned vacation, or a birth in my own family. This means that the pool of data is still small, but I need to start somewhere. I intend to update my statistics annually to provide a level of transparency to families wanting to learn more about my practice.

I know that the numbers will ebb and flow. I think that the Johnson and Daviss article gives good estimates of where my statistics will eventually hover around. For example, when they looked at all home births attended by certified professional midwives in the U.S. and Canada in 2000, they found:

  • 12.1% of women who intended to deliver at home when labor began were transferred to hospital during labor or postpartum. First time moms had a 25.1% transfer rate and those having a second or subsequent baby had a 6.3% transfer rate.

Medical intervention rates included:

  • Epidural: 4.7%
  • Forceps: 1.0%
  • Vacuum extraction: 0.6%
  • Caesarean section: 3.7%

Another great place to look for statistics is Cheyney’s article, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Her study found that of the 16,924 pregnant people who planned homebirths at the onset of labor:

  • 89.1% gave birth at home, meaning 10.9% were transferred to hospital during labor. Of first time mothers, 22.9% transferred during labor, while only 7.5% of non-first time mothers transfered.
  • There was a postpartum transfer rate of 1.5%
  • There was a newborn transfer rate of 0.9%
  • 93.6% gave birth vaginally

Medical intervention rates included:

  • Epidural and/or oxytocin augmentation: 4.5%
  • Assisted vaginal birth (forceps or vacuum extraction): 1.2%
  • Caesarean birth: 5.2%

All obstetrical interventions have a place, and I’m glad that I practice in an area where we have access to wonderful hospital care when it is needed. Being able to transport when we need to and receiving appropriate care in the hospital is what makes planning a home birth so safe; when we need extra help, we get it.

The problem we have in our country is not that women have cesareans or other interventions, but that so many have unnecessary cesareans or unnecessary interventions (which in turn carry risks and cause additional health problems for moms and babies). Just like all obstetrical interventions, when overused, they can cause more harm than good. The Childbirth Connection has a useful article about why our national cesarean rate of 32.8% is so high. According to the article, the optimal cesarean rate is 4-6% for a low-risk population. Since home birth midwives work with an exceptionally healthy and low-risk population, it would make sense for the rate in this population to close to that range. The Johnson and Daviss study found a 3.7% cesarean rate. The Cheyney study found a 5.7% cesarean rate.

So what are Twin Cities Midwifery’s stats over the past five years? 

These statistics below encompass all 138 pregnancies of clients who established care from when I started Twin Cities Midwifery in December of 2010 with due dates through December, 2015. In this five year period, 41.3% (57) of my clients were first-time moms, and 58.7% (81) were experiencing a subsequent pregnancy. Unfortunately, 8.7% (12) of the pregnancies ended in miscarriage. Another 12.3% (17) transferred out of my care during their pregnancy, 6.5% (9) were for non medical reasons (such as moving out of my service area, or changing their mind on place of birth), and 5.8% (8) were transferred during pregnancy for medical reasons (preterm labor, preterm rupture of membranes, or high blood pressure). I joined all 8 of the clients who transferred prenatally for medical indications at their hospital births, providing non-medical support (such as doula support), and accepted them back into my care for postpartum and newborn care after hospital discharge. Out of all 138 pregnancies of clients who established care with TCM , 5.8% (8) transferred to the hospital during labor.

Place of birth for all Twin Cities Midwifery pregnancies with due dates between December 2010 and December 2015

Place of birth for all Twin Cities Midwifery pregnancies with due dates between Dec 2010 and Dec 2015

Stats for full term pregnancies, starting labor as a planned home birth

Of the 109 pregnant people who were under my care with full term pregnancies (37 weeks or later) when their labor started, 38.5% (42) were first time parents, and 61.5% (67) were experiencing their second, third, fourth, or sixth labors.

The majority of those families, 87.2% (95), chose to have a water birth tub available to them in labor. Of those women who had water immersion available, 90.5% (86) labored in water, and 57.9% (55) gave birth in water. Not all of the clients who had water available planned or wanted to birth in the water. There were 9 women who planned to labor in the water but did not. They were not able to utilize the tub in labor either because their labor was so fast that there was no time to set up the tub, once the tub was set up they were already pushing and did not want to move to get in the water, or because they transferred to the hospital prior to active labor.

Of the babies I helped to welcome in the world, 48.6% (53) were girls, and 51.4% (56) were boys. The smallest baby was 5 pounds 14 ounces, the heaviest was 11 pounds 5 ounces, and the average was 7 pounds 15 ounces.

A doula was present at 57.8% (63) of these labors; 64.3% (27) of first-time moms had a doula, while 53.7% (36) of mothers of two or more had a doula with them.

Of these 109 clients who intended to deliver at home when labor began, 92.7% (101) gave birth at home, meaning that we transferred 7.3% (8) of these labors to the hospital. All of the hospital transfers were non-urgent, and all except one were for first-time moms; one transfer was due to signs of infection during labor, one due to elevated heart tones with history of previous cesarean, and the others were due to very long labors with a labor progression that slowed or had stopped.

Due to transfers to the hospital during labor, Twin Cities Midwifery has an epidural rate of 5.5% (6) and a pitocin augmentation rate of 5.5% (6). All but one of the women who transferred gave birth vaginally; 0.9% (1) were assisted by vacuum, and 0.9% (1) were assisted by forceps. Twin Cities Midwifery’s cesarean rate is 0.9% (1).

We have had a 2.8% (3) postpartum transfer rate (going to the hospital for extra care for mom after baby arrives) and a 2.8% (3) newborn transfer rate. Of the total 31 transfers (prenatally, during labor, postpartum, and newborn), only 6.45% (2) were considered urgent. Most transfers, 93.5% (24) were not urgent.

I’ve also tracked rates of intact perineums and perineal tears. I have recently heard people say things such as “all first time moms tear,” “most women need stitches,” or “it just doesn’t matter what we do, you will tear.” I’ve been shocked when I hear these statements, because they don’t resonate as true in my experience.

Over the past five years, 72.5% (79) of women who started labor under my care had no or minimal tearing (36.7% (40) had an intact perineum, 7.3% (8) had minor skids, 28.4% (31) had a 1st degree tear). There were 25.7% (28) women who experienced a 2nd degree tear, 1.8% (2) who had a 3rd degree tear, no 4th degree tears, and 0.9% (1) who required an episiotomy. Not all tears require suturing, therefore 24.8% (27) of the women who started labor in my care needed sutures to repair their tear.

I also separated this data by first time mom and non-first time mom. I found that in my practice, it is true that first time moms are more likely to tear, however I would not agree that most first time moms tear. Of the 42 first time moms who started labor under my care, less than half, 42.9% (18) required a repair. There were 19% (8) of first time moms who had a perfectly intact perineum, 33.3 (14) who had a skid or 1st degree tear, and 47.6% (20) who had a 2nd or 3rd degree tear. Looking at perineal outcomes for the 67 multiparous women (women who have previously given birth), only 13.4% (9) required a repair. There were 47.8% (32) who had an intact perineum, 37.3% (25) who had a skid or 1st degree tear, and only 14.9% (10) who experienced a 2nd degree tear.

This year I also started tracking insurance reimbursement rates. State funded Medical Assistance (MA) or MN Care plans do not cover services provided by Twin Cities Midwifery, however, private insurance plans often do cover our midwifery care. Eighty-one percent of our clients who birthed in 2015 with private insurance had 100% coverage after meeting their deductible. Since deductible levels varied, we also looked at specific dollar amounts families were reimbursed. Of those who birthed in 2015 with private insurance, over 90% were reimbursed at least $1,000, 62% were reimbursed over $2,000, and almost half (47.6%) received more than $3000 back from their insurance plan to pay for their care. Almost a tenth (9.5%) of those families received more than $4,000! For more information on insurance coverage of home birth services, check out our Insurance Benefits blog post.

Toward healthier, safer births for moms and babies in Minnesota

I am honored to have attended each and every one of these births and am so grateful for the opportunity to be with families during this incredibly special time. I look forward to our regular TCM events so that I get to watch these babies grow! With this midwifery model of care, Twin Cities Midwifery is helping to improve our state’s maternal and newborn outcomes in a healthy and safe way, one birth at a time.

The birth of baby Jasper!

A huge thank you to this amazing mama, who is so near and dear to my heart, for sharing her incredible story. Enjoy!!!

When I close my eyes and I envision a place that is calming for my soul, a place that I feel at peace and complete happiness, I see mountains .. woods .. water .. nature. A place where I can take deep breaths and cleanse my soul. I feel my body relax and all the tension leave me. Our family is happiest when we are outdoors in nature.

Finding out I was pregnant was quite the surprise. We were on the fence about wanting a fourth. I always had said four was the number of kids I wanted, this was pre kids of course! So after our third was born I wasn’t sure we’d go through another pregnancy. But as life happens, some things don’t always go as planned. I remember finding out I was pregnant and being completely shocked. Knowing that there was a bigger plan but that it wasn’t the plan right now. After experiencing quite a bit of bleeding I called my midwife to talk through things with her. I opted for an early ultrasound. The tech informed me that there was a big sub­chorionic hemorrhage. It was too early to see anything other than a gestational sac and we should schedule another ultrasound for two weeks. I left the ultrasound thinking this would likely end in a miscarriage. As I packed my bags that weekend to second shoot a wedding, I packed extra pads, fearing that at any moment I might feel a gush. Days passed, and then weeks. The second ultrasound came and there it was, this flickering heartbeat and bleeding that was almost completely gone. It was the same tech and she told me she was so surprised to see most of the blood gone. I knew that this baby was a fighter, meant to be in our lives, our family.

My pregnancy was easy. While I battled emotionally trying to wrap my head around having a fourth, weaning my almost 2 year old and a feeling of sadness for that, and also trying to process going through another birth .. physically this pregnancy was easy. Early on I had a very vivid dream that I had a baby boy. Him resting on my chest postpartum and those glorious newborn smells. By twenty weeks, I had embraced all that was to come. I was excited about this tiny person and was so ready to welcome him/her to our family. I embraced the remainder of my pregnancy. Loving the growing belly, knowing that I would never have this moment again, The movements that came from inside, knowing that at some point they would end and that would be the last time I felt those sacred movements between only mom and baby. Every time he moved I felt grateful that he was letting me know that he was okay, growing just as he should be. Every lab draw, every appointment showed a perfectly healthy baby and a perfectly healthy mama. So we continued on. Thanksgiving, Christmas, New Years. I spent countless hours reading birth stories. Mentally preparing myself for this birth and telling my mind that this birth would be beautiful in just the way it was supposed to. I tried to not get inside my head, telling my anxiety to go away and that my midwife would keep us safe. I had a beautiful home birth with my third and had no reason to think otherwise with this one.

At 37 weeks pregnant my kids came down with an awful flu type virus. High fevers, coughs, aches .. the works. Days passed and I soon felt myself getting hit with some form of this virus. I got a nasty cough. One of those coughs where you just can’t stop coughing. The cough that makes you gag. I just couldn’t seem to shake it. And then, at 38 weeks pregnant I started itching. Thinking nothing of it and just figuring it was end of pregnancy itching, I let it go for a bit. But I was exhausted with the up in the middle of the night coughing/itching so I reached out to my midwife. She said it was likely just end of pregnancy itching but that we needed to draw labs because there is a rare chance that it could be a pregnancy condition called cholestasis. Initial labs came back normal and my midwife told me to have a Happy Valentine’s Day!

Tuesday, the 16th, at 39 weeks pregnant, my midwife called. I had pulled a stomach muscle from all the coughing I was doing and had seen the chiropractor that day, so I was assuming she was calling to check on me. I heard the tone in her voice and I knew. I knew my second round of labs weren’t right. I knew I would have to be induced. She confirmed it. My bile acid levels were pretty high, showing that I most likely had cholestasis. She had consulted with two other midwives and both agreed, we needed to consult with an OB. So as we devised our plan, I sat there shaking and crying. I had a traumatic hospital birth my first and the last place I wanted to be was a hospital. Pitocin, IV’s, interventions, no water birth, my other three kids .. my mind was racing and I could hardly hear the words on the other end of the phone. I remember telling her Denny Hartung was my first choice, call him first. I couldn’t even much think of a second choice because I knew Dr. Hartung was the best of the best. He was the one who would give the most freedom to birth naturally with as minimal intervention as needed. I hung up and called my mom, I could hardly breathe through my tears and all I said was “you need to come now. I have to be induced”. I called my husband and tried to talk through the tears, giving him as much information as I could muster out and just kept saying “I’m scared .. I never wanted another hospital birth”. My midwife called and said Dr. Hartung agrees that the levels are high enough that this is in fact cholestasis and that I need to come in first thing tomorrow morning for an induction. I had the choice between Baldwin and United, and even though Baldwin was an hour from our house it seemed like a better fit. We told our kids that I would need to go in the next morning to have baby and that our plans for a home birth were changed. We tried our hardest to be upbeat about it but I could tell the kids were concerned and didn’t fully understand. Family shuffled in and out and amidst the fears, there was genuine excitement about meeting this new baby. The rest of the night was a blur.

I slept not much that night. Trying to not allow myself to go to the “what ifs”. Somehow I woke up feeling mostly okay about what lie ahead. We ate, snuggled the kids, I cried as I said goodbye and then we headed out with our cups of coffee in hand, knowing that today we would meet our newest love. As Zach and I drove our long hour drive, we talked about our fears, our excitement, our trust in both Kate, our midwife, and Dr. Hartung, rubbing my belly and feeling him move .. reassuring me that he was fine in there. We watched a beautiful sunrise and I knew that it would be okay. We pulled in and I took a deep breath. I saw Rachel, our midwife’s midwife in training, and was happy she would be a part of this. We walked in and I saw my dear friend Jamie, my photographer. She had a bright smile and we joked about taking pictures of the amazing sunrise. Kate walked in shortly after and gave me a giant hug. Wrapping her arms around me, knowing that this was the last place I wanted to be, but bringing me so much comfort in the present. As we all trucked upstairs to labor and delivery with our load of bags, a birth tub that we were hoping to use, and food to feed the floor .. I felt like I had my army with me and we were ready to do this. Greeted by two of the sweetest nurses who assured me that we were going to make this birth as close to a home birth as we could, we were brought to our birthing room where beautiful natural sunlight flooded the room. It didn’t feel “hospitally” to me. It felt bright and cheery. Soon after in walks Dr. Hartung, with the kindest smile and the calmest energy to him. I talked about my fears, couldn’t stop shaking and all those feelings were acknowledged. Then we broke my water. Nice clear fluid, no meconium which can be a concern with cholestasis, phew! We walked and walked and speed walked on a treadmill and we walked outside and did stairs and lunges and pumped .. all to no avail of stimulating contractions. Three hours after my water broke, a hot shower and a big flood of tears between me and baby, I walked out ready to take the next step, even though I didn’t want to. The nurses were yet again great. We joked about the IV and who drew the short straw on getting to poke me. First try and it was in. Off I went with my wireless fetal monitor and my pole of pitocin. We started it on the lowest dose and upped it slowly as needed. By about 230, contractions started coming. They came every three minutes. Within the hour they were every minute/minute and a half and soo intense! I just kept saying “hear comes another one .. no another one”. It seemed as though they would never end! But I just kept walking .. leaning against any countertop type surface I could find to breathe through them. Soon enough the room became busy with people setting up. It was getting close but I didn’t really want to believe it, especially after a check and hearing I was only 6­7 cm, gah! After hearing I could get in the tub, the super stubborn side of didn’t want to believe it. The thing I hate the most is getting in and out of the birth tub. I just wanted to stay IN! But then a few more contractions and hit and in the water I went. Breathing in peppermint oil, being fanned by my amazing posse, and telling myself “it doesn’t hurt it doesn’t hurt” .. trying to get out of my head and trust my body. And with each contraction, I felt him moving down. Getting closer. Pushing is my ultimate fear of childbirth, irrational I know, but it is. Once I let go of it and embraced that there was one way through this, I pushed with all I could to get my baby in my arms. My shortest pushing of only twenty minutes and my love lifted him up in to my arms. Tears streamed down my face as I stared at my fresh new baby who was nothing short of perfect. Oxytocin flooded through and the pain was gone. He was here. In my arms and all felt right in this world.

It was a boy. A health beautiful boy. My mommy heart knew it was a boy. He was what I prayed for and although the early journey was tough and things didn’t go the way they were supposed in the end, it was the way things were supposed to go. A hospital birth with my first son that left me broken to the birth process and a restorative, healing birth with one of the best Ob’s around. I regained my trust in the beauty that a hospital birth can be. To the staff at Baldwin, thank you. Thank you for honoring our space during this process, for trying to make this as much like a home birth in a hospital setting as possible. Thank you for allowing us to snuggle our baby boy the night after his birth and for letting our girls stay with us. We appreciate it more than we can say. Kate, I know how hard that phone call was. Just know that even though it went in a direction we never expected, you advocated for me, stood by and supported me through the thick of it .. I wouldn’t have chosen anyone else! I heart you. Both moms .. thank you for watching this final addition to our family be born. Birth is always so emotionally charged and you’ve been there for me through all of them. Zach, you are pretty much a male doula. Your quiet demeanor and mellow personality brings a calm to me when I’m in the throws of it, you pretty much rock! Jamie .. my dear photographer. You have taught me so much over the years and for this one day, I got to reap all of the benefits of J Stoia Portrait Design .. thank you for capturing every moment of this day with me, you are a true treasure in my life. And I’ll let everyone see just how beautiful your work is in the pictures below..

My Jasper … you were so perfectly chosen to be ours. Whether or not I knew it at the time, but you were meant to be in my arms. Giving me strength and courage and reminding me just how simple this world is. We chose Jasper as your name because, well, have you ever seen pictures of Jasper National Park? It’s utterly amazing. A place we would choose to go to calm our souls and the noise this busy world brings at times. But the icing on the cake .. those glorious Jasper stones. They are known to be a nurturing and protective stone. In it’s physical properties it’s considered highly restorative for internal organs (such as the liver .. cholestasis being a pregnancy related disease of the liver). As soon as I read about the Jasper stones, I knew if you were a boy this was your name. You can read more about this lovely stone (linked here).

Two months later and I’m done writing your birth story. Your smile is infectious with your small little dimple on your cheek. Your almond shaped eyes draw me in every time you coo at me. You seem to be your dad both physically and your disposition. You are calm, mellow and have such an ease about you. I love every day that I get to wake up next to you and hold you in arms.

(click to view larger images, photos by J Stoia Portrait Design)

And the gal behind this lens, she was just as important and I’m so sad she wasn’t in this frame! If you’re still reading this and need a good cry, watch this. Jamie is incredibly talented and has a way to bring your emotions to the surface.


Thank you & Goodbye from Rachel

To all of the lovely Twin Cities Midwifery families, and of course, Kate:

Thank you all so, so much for an amazing year of babies, and learning and growing. This year has flown by (for me, at least!) and it has been such a joy to work with so many sweet families and welcome many beautiful babies.

Thank you to all of the families who let me join in on their pregnancy, birth, and postpartum experiences. It’s such an honor to be one of the first people to meet your babies and to witness the growing of your families. I have learned so many midwifery and life lessons from your births and our conversations throughout your care. I will take these lessons with me. Thank you for so many unforgettable experiences!

Thank you, a million times over, to Kate, for all of the lessons and laughs over the last year. I have learned a thousand things this year and cannot thank you enough for the role you’ve played in my journey toward becoming a midwife. Thank you for believing in me and patiently teaching me many, many clinical, business, and life lessons. I sincerely hope to have a practice very similar to yours one day and cannot thank you enough taking me under your wing over this last year.

As some of you know, I’m nearing the end of my midwifery training. I’ll continue to be a student in the Twin Cities until June of this year and then I will be graduating from Birthwise Midwifery School. My post-graduation plans are not set in stone quite yet but I hope to still be around this lovely birth community for at least the next few years as a midwife. I’m sure I’ll see some of you around at TCM events and other birth-related things.

Wishing you all the births that you are envisioning and happy, healthy babies.



Cuddle Up to Oxytocin

Oxytocin is a hormone that is often called the “love hormone” or the “cuddle hormone”. It’s released by the pituitary gland in response to physical and emotional stimulation such as receiving a gift, hearing kind words, or positive physical touch from a loved one. This hormone plays an important role in labor and birth, the postpartum period, and breastfeeding. Oxytocin is released following hugs, back rubs, positive interactions with friends or family, and other “feel good” moments. It contributes to the feelings of love and happiness.

When it comes to birth, oxytocin is what stimulates the uterus to contract, the cervix to dilate, and labor to keep on moving forward. Many people are familiar with Pitocin, which is a synthetic form of oxytocin used to induce labor, augment a slowing labor or help the uterus contract and release the placenta after the birth. There are many factors that can affect a birthing person’s ability to release natural oxytocin. Many of these things are environmental. For example, the safer and more loved someone feels in their birthing space, the more oxytocin they will have. Research has also shown that melatonin (which is released in dim or dark lighting) works with the body to produce and release more oxytocin. Some things that can help to increase oxytocin in a labor setting can include playing favorite songs, dancing, receiving a massage, kissing your partner, talking about past positive experiences such as your wedding day or honeymoon, dimming the lights, and cuddling.

Oxytocin also plays a very important role in breastfeeding. It contributes to milk production, the let-down of milk during a nursing session, and helps breastfeeding parents to feel calm and bonded to their baby. Some people (especially those who have given birth multiple times) experience “afterpains” or cramps after the birth and these cramps are often strongest when breastfeeding. This is caused by oxytocin! The breast stimulation from nursing signals the brain to release oxytocin, which in turn releases milk in the breasts and also stimulates the uterus to contract down and continue moving toward its pre-pregnancy state. Pregnancy, birth, and postpartum all involve many hormones working in an intricate way. Oxytocin is just one of these hormones, but it’s an interesting and very important one.

Karen Strange, a birth professional, says: “Take an Oxytocin Moment. Oxytocin is released when you do anything pleasurable. This is especially important during gestation as the release of oxytocin helps baby’s brain become wired with a calm temperament and the capacity to self regulate emotional-state. This is the capacity to return to a calm and focused state after being excited (upset, hurt, angry). Oxytocin is what heals the body and helps prevent complications in the mother. Do this prenatally to establish a common, well worn “mental-groove”so that you will have the capacity to return to it after the birth. It is a great habit to get into for your health and to be in tune with your baby.”

Oxytocin plays an important role in many aspects of the childbearing year as well as general life for everyone. It helps us to feel relaxed, safe and at peace. So, go take an oxytocin moment; hug a loved one, call a friend, or snuggle a pet!

Postpartum Freezer Pads

As we pull out the onesies  and set up the crib in preparation for a new baby, it’s often easy to overlook the new mom and the many ways we can prepare for her postpartum time. One thing that can be set up ahead of time are postpartum freezer pads. Many women find that these frozen pads feel really great postpartum and help with any swelling. You’ll be happy having a stash tucked away in the freezer waiting for you. These can be as simple or as involved as you would like it to be. See our “what you’ll need” list below, but please note that you don’t need to use all the ingredients listed, you can pick and choose!

What you’ll need:

  • Maxi or overnight pads -any brand is fine but your tissues will be sensitive after giving birth so a scent free or organic brand may be best
  • Witch hazel
  • Lavender Essential Oil
  • Tea Tree Essential Oil
  • Aloe Vera Gel
  • Tinfoil (if pads are not already individually wrapped)
  • Gallon size ziploc bags

How to:

  • Open up the number of pads you’d like and lay flat
  • Liberally spray witch hazel over the pads (about 2 tbsp each)
  • Add a couple of drops of essential oils -keep in mind, these oils are strong and you only need a drop or two of each
  • Use a spoon or spatula to smooth aloe vera gel over the top of the pad
  • Fold wings & wrappers back over pad or wrap in tinfoil
  • Place several pads in each gallon size ziploc bag & place in the freezer

To Remember:

  • Perineal tissues may be swollen for the first 24 hours postpartum but after that swelling should go down so witch hazel, aloe, etc are the real healing agents after that.
  • You will be bleeding to some extent and your midwife will ask you to monitor this bleeding so please keep some pads separate from your freezer stash for this purpose.
  • Fresh air is also good for perineal healing. If you can spend some time sitting on a chux pad in bed giving your tissues some air that’s also great!
  • Herbal sitz baths 2-3x a day can also aid in perineal healing and are often highly recommended -some mom’s make an extra batch of herbs prenatally and put 2 tbsp of the tea on their pads before freezing.

Have you made postpartum pads in the past? Let us know how it went in the comments!