This post is written by Erica Moss, the community manager for the online Masters in Nursing degree program at Georgetown University, offering one of the nation’s leading nurse midwife programs. She’s also passionate about photography and meeting new people.

Midwifery is an often misunderstood profession that encompasses far more than assisting with childbirth. The history of the midwife stretches back through centuries and has involved periods of rapid change as well as controversy.

The role of the midwife in society has often been recognized as vital, and midwives even received priority passage to the colony of Massachusetts. At other times, midwives have been marginalized or persecuted because of their role in providing reproductive health care for women and/or because they have approached women’s health care differently than other facets of the medical establishment. Today’s midwives are certified health professionals who provide comprehensive care for women.

Education

Midwifery is a professional designation in the United States and requires certification from the Accreditation Commission for Midwifery Education (ACME). All midwives must complete an educational program and pass the same national certification exam. However, two classifications of midwife exist: Certified Nurse-Midwives are registered nurses who have also earned midwifery certification, which allows them to practice as midwives in all 50 states; Certified Midwives come from many different educational and professional backgrounds related to health care, and must pass the same certification exam as CNMS. Certified midwives can currently practice only in New York, New Jersey, Rhode Island, Delaware and Missouri.

The Midwife’s Role in Childbirth

Midwives are most widely known for their role in supporting and caring for women during pregnancy, childbirth and the postpartum period, as well as caring for infants during the first 28 days of life. Midwives differ from obstetricians in their non-interventionist approach to
childbirth, which primarily consists of waiting, observing, supporting and coaching women through the process. Midwives receive training in handling many complications that may occur during pregnancy and labor in a non-invasive manner. A midwife may also consult with or provide care in tandem with an obstetrician, depending on circumstance, the patient’s wishes and medical factors.

The Midwife’s Roles Beyond Child Birth

Though the popular imagination tends to depict midwives as appearing at a woman’s side only during the final moments of pregnancy, midwives often provide general care for women from adolescence through advanced age. Midwives perform physical examinations, prescribe medications and provide gynecological care, as well as act in educational and therapeutic roles. Philosophically, midwives tend to approach health care from a woman-centered perspective, emphasizing female empowerment and human rights, as well as prioritizing the construction of a healing and communicative patient-caregiver relationship. Midwives may also treat men for sexually-transmitted infections.

More than 5,000 Certified Nurse-Midwives currently practice in the United States. Though the profession has evolved considerably since the days when midwives practiced folk medicine and were sometimes hunted as witches, what has remained constant is the principle of a healing human presence in the lives of women. In a medical establishment, which is increasingly technological and bureaucratic, as well as historically male-dominated, midwives play a vital role in ensuring that women have access to comprehensive, non-invasive general and reproductive health care. The medical education that midwives receive and the rigorous standards of certification they must maintain both support this profound perspective on women’s health.

What can you do about low milk supply?

1)  Have your prolactin and thyroid levels checked
2)  Use Fenugreek (Available at Pharmaca, Rebecca’s Apothecary, Vitamin Cottage or Whole Foods)
3)  Use Goats Rue (Available-same as above)
4)  Acupuncture (Acupuncture Clinic BBCC Mondays 11:30-2:00p.m.)

• Cost: $40
• Contact: Kate Blalack, L.Ac. 303-545-5792 x 107  kblalack@ChineseMedicineDoc.com to make an appointment or with questions.

5)  Visit www.lowmilksupply.org and www.mobimotherhood.org
6)  Get more information from these books
Mother Food by Hilary Jacobson and
The Breastfeeding Mothers Guide To Making More Milk by Lisa Marasco
7)  Visit www.mobimotherhood.org and learn about the “power pumping” technique described below:

Power pumping is a technique that can be helpful in building a milk supply. For more information on basic pumping techniques, see the pumping section below. Here is a brief explanation of power pumping.
Power pumping involves using regular pumping techniques and setup, but in a unique way. The idea is to mimic a baby who is nursing frequently to increase a mother’s supply, as is common in the nursing relationship during a growth spurt. To power pump, hook-up as you would for a normal pumping session, pump for 10-20 minutes, rest 10 minutes, then pump another 10 minutes, then rest for 10 minutes, then pump again for 10 minutes. The mother does this for about an hour, once per day, to increase supply. At other pumping times during the day, routine pumping is used. It can take about a week to see an increase, so don’t get discouraged.
Some mothers prefer to concentrate their efforts and have a power pumping weekend, called “Power Pumping Boot Camp” by some lactation consultants. They power pump at each pumping for a couple of days before returning to routine pumping.

Lactation Support:
Stephanie Moore – Becoming Mothers. 303-546-MAMA
Chandra Ruiz, CLEC – lactivistmama@gmail.com.  520.225.7626  ($120/2 hours home visit)
Amanda Ogden
Nichole Didelot, CLC – joyfulmidwife.com.  303.669.9605 ($75/ home visit)
Darcy Kamin, RN – dkbabylove@gmail.com.  303.447.2609

9)  Friday Afternoon Breastfeeding Club at BCH  720-254-7834 www.bch.org
Tuesday Afternoon Breastfeeding Club at BBCC (Boulder Birth Community Classroom) Drop-in 1:00-2:00

Brigitte Mars, Herbalist, Raw Food Chef, Author

Save the date!  Boulder’s own Brigitte Mars is coming to the BBCC (Boulder Birth Community Classroom) for a book signing and herbal talk.

Herbs for Pregnancy, Birthing, Nursing and Infants
Learn the properties of a few great plants that can be used safely and effectively for conditions such as morning sickness, anemia, threatened miscarriage, labor, expelling the placenta, recovery from childbirth, colic, teething and increasing milk supply. Learn how they work and the best methods for their administration.

When:  March 19th, 6:30-8:30 p.m.
Cost:  10.00/ per person
Register:  please email:  martman@boulderbirth.com for registration or call 720-352-5316
Where?  4800 Riverbend Road Suite 100, Boulder CO 80301
Reminder:  go to boulderbirth.com for classroom schedule

Brigitte Mars is an herbalist from Boulder, Colorado, with over 35 years’ experience in natural medicine. She lived for two and a half years on solely wild edible plants while living in a teepee in the Ozarks in the early seventies. She is the author of Addiction Free Naturally, Sex, Love and Health, The HempNut Cookbook, Rawsome!, and Healing Herbal Teas.
Brigitte teaches at Naropa University, Esalen Institute,Kripalu, and many other locations. She has a nutritional and herbal private practice, works as a practitoner for Pharmaca and has a local weekly radio show called Naturally. She is the mother of Sunflower Sparkle Mars, with whom she leads Herb Camp for Kids, as well as Sunflower’s sister, Rainbeau Harmony Mars. Rainbeau is an actress, model and yogini, living in Santa Monica (www.rainbeaumars.com).
Brigitte has been happily married for thirty years to human design analyst, Tom Pfeiffer with whom she teaches raw food workshops.

We all would like to assist with smooth and uncomplicated births.  In wanting this, there are some things we can identify prior to childbirth that can have a negative impact on a mom’s experience of birth.  These issues can be altered ahead of time and change the mom’s experience of birth.  We just need to be aware of them.    There are prior issues that moms may have experienced in their bodies that need to be identified.   There are positional issues of the pelvis and the baby that can be addressed and may influence which positions during birth may be more beneficial than others.   In this class you can learn how to help moms have the best birth possible by learning what pre-existing issues, like car accidents and falls on their bottoms, may effect their births and what can be done for them.  Also you can learn how to palpate the pelvis to know the alignment of the bones and know exactly which positions can help or hinder birth.  Learn how to help moms have a faster recovery by taking care of their bodies while pregnant.  Your moms will be so grateful to you for sharing this knowledge with them.  You can save them a TON of effort in the post partum period by helping them avoid certain movements while pregnant.   This class is designed to help you help moms have an easier birth and as fast of a recovery as possible.

The Journal of Midwifery & Women’s Health (JMWH) is a bimonthly, peer-reviewed journal dedicated to the publication of original research and review articles that focus on midwifery and women’s health. JMWH provides a forum for interdisciplinary exchange across a broad range of women’s health issues. Manuscripts that address midwifery, women’s health, education, evidence-based practice, public health, policy, and research are welcomed.

We have republished links to the articles on our Reading Resource Page HERE

Prior to beginning any treatment for infection you should always be evaluated by your midwife to be sure that you do have a breast infection and not something more serious.

Suggestions for prevention or treatment of a mild case of yeast

1.  air dry your nipples after each feeding
2.  avoid plastic lined breast pads that trap milk and irritate skin
3.  change nursing pads after each feeding
4.  wear cotton bras and wash them daily in very hot water
5.  thoroughly wash pump parts that come in contact wit your breasts and boil them in water for 5 minutes daily

If the above suggestions have not prevented or provided relief, try the following:

*Grapefruit Seed Extract, take as directed.  This comes in a liquid tincture found at nutrition stores or pharmacies:  Whole Foods, Pharmaca and Vitamin Cottage.  Adding suggested amount of drops to juice will make it taste better!

*Acidopholus or Pro-Biotics, take as directed, available in nutrition stores and pharmacies

*Gentian Violet Daily-swab nipples and babies mouth (different swabs), once at bedtime for four days only.

*One dose of 200 mg Diflucan followed by 150 mgs by mouth for ten days.  If no relief in 48 hours it is probably not fungal and is most likely bacterial.  Diflucan is prescription only.

*All Purpose Nipple Ointment (30g) (APNO).  Apply after each feeding.  Rinse nipples before & after feedings with a warm washcloth.  APNO is available at Walgreen’s Pharmacy at Boulder Community Hospital, Pharmaca on Pearl Street and Pharmaca at Table Mesa.  This ointment is prescription only.

Most babies are head down or “vertex” at 30 weeks gestation, but not always. At Boulder Nurse Midwives we begin checking the position of your baby at 30 weeks gestation and every visit thereafter. We use a technique called Leopold’s maneuver which means that the midwife will feel your baby’s position with her hands. Baby’s can be breech for a variety of reasons. The baby may not be ready to turn head down yet! This may be very normal and usually babies will turn head down by 35 weeks all on their own. Breech babies can also be in this malposition because of the woman’s uterine shape or there may be a septum or fibroid in the uterus that prevents the baby from rotating. Usually, if the reason is septum or fibroid related, we know this already by ultrasound diagnosis, but not always. Sometimes breech position is related to a short umbilical cord or how the baby is entangled in the cord. If we suspect that your baby is breech at 32-33 weeks we will suggest that you try the following to help your baby rotate:

1. Frozen fruit or vegetables applied to the baby’s head. This does not hurt your baby but they sometimes move away from the cold.
2. Acupuncture (Moxy)
3. Chiropractic (Webster Technique)
4. Deep water swimming doing flips or hand stands in the swimming pool. (The theory is that the bottom can come out of the pelvis and this helps the heavier head be able to rotate     downward).
5. Pelvic tilts (Laying on your back and lifting your hips above your shoulders)
6. spinningbabies.com
7. Please ask your Nurse-Midwife for referrals to acupuncturists and chiropracters who have experience working with pregnant women.

If your baby has not turned by 36 weeks gestation you will be offered to schedule a ECV (external cephalic version)

This procedure is done at Boulder Community Hospital at approximately 37-38 weeks gestation. The ECV involves an attempt to externally turn the baby under the direction of an OB/GYN MD & Nurse Midwife. We have women be NPO (nothing to eat or drink except sips of water) 8 hours prior to the procedure. Upon admission to the hospital we will confirm position via ultrasound and make sure there is adequate amniotic fluid. The nurse will monitor your baby’s heart beat with a non-stress test and start an IV with a blood draw for a current CBC, platelets and T&S. If there is an emergency, the anesthesiologist needs to see the platelet number in order to safely administer spinal anesthesia for an emergency Cesarian section birth. We give women a medication called Terbutaline to help relax the uterus for the procedure. This medication makes your heart feel racy like you would feel if you had drunk a couple of cups of coffee. It can also cause some women to have a little headache. We watch the baby’s heart rate carefully with ultrasound throughout the procedure and if the baby’s heart slows we stop the procedure immediately and let the baby recover and stop all attempts to turn the baby. We put oil on the belly and the CNM usually lifts the baby’s bottom out of the pelvis while the OB/GYN attempts to move the head downward. We usually try a front flip or back flip or both depending on the baby’s position. Some women want this procedure done under epidural anesthesia to help with discomfort but the procedure is very short in duration so it is usually very manageable with breathing techniques. The pressure and pain from the ECV is no worse or long in duration than a labor contraction.

The risks include placental disruption possibly leading to abruption and fetal intolerance from cord entanglement leading to a potential emergency C-section. If there are signs of fetal intolerance we stop the procedure immediately.

You will be monitored for about 2 hours following the procedure to ensure that your baby looks well oxygenated on the monitor. The statistic that we typically quote for success with this procedure is 50%.

If the procedure is unsuccessful we recommend scheduling a C-section between 39-40 weeks. We do not recommend vaginal breech birth even with providers who feel skilled in this area due to increase risk to your baby.

If your water breaks and your baby is breech this can become an emergency because the cord is more at risk of prolapsing. The head usually acts like a cork on the cervix in vertex presentation and prevents this from happening but with breech babies the bottom does not tend to settle down in the pelvis as easily. This is why we recommend C-section between 39-40 weeks and to call immediately should labor begin or if your water breaks.

Talk with your Nurse-Midwife if you have additional questions or concerns. If you feel a big rotation with your baby please call the clinic and we can check to see if the baby has turned. If your baby is now head down you should obviously stop all exercises to turn the baby from breech to vertex and begin focusing on Optimal Fetal Positioning exercises to now attempt to get the baby in a good Occiput Anterior position!

Hypnobabies Childbirth Hypnosis is a complete childbirth education program that eliminates the fear of giving birth, and instills confidence in its mothers and their birth partners. The Hypnobabies program teaches expectant women how to naturally reduce or eliminate any pregnancy discomforts, and how to give birth comfortably while remaining awake, mobile and in control using eyes-open childbirth hypnosis techniques.

Hypnobabies is a revolutionary method of preparing for natural birth based on master hypnotist, Gerald Kein’s highly effective “Painless Childbirth” program. Mothers learn easy self-hypnosis techniques to automatically produce a natural anesthesia throughout their bodies, using only the power of their own minds. These are the same medical hypnosis techniques that some dentists and doctors use to create natural anesthesia for pain-free dental work and surgeries, for their patients who cannot tolerate drugs!

What Options Do Hypnobabies Mothers Have to Prepare for That Joyful Day?

Hypnobabies mothers, fondly referred to as Hypno-moms, may choose to attend classes taught by a certified Hypnobabies Instructor, or may opt to do the Hypnobabies Childbirth Hypnosis Home Study Course on their own.  The Hypnobabies class consists of one 3-hour class per week that meets for 6 weeks.  The classroom experience gives couples the wonderful opportunity to meet other moms that are expecting around the same time and to create a community where birthing naturally is valued.  Birth partners attend classes with Hypno-moms so that they can become involved with the pregnancy and in the preparations for childbirth.

How Does Hypnobabies Childbirth Hypnosis Work?

Hypnosis is not being asleep or under anyone else’s spell or control, as many would mistakenly believe, rather it is a state of hyper-awareness and focus. Hypnobabies childbirth hypnosis is “eyes-open” or waking hypnosis. Moms learn to enter deeply into relaxation and hypnosis, and create hypnotic anesthesia, with the “drop of her finger”, literally. She then learns to “center” and strengthen that anesthesia in the middle, birthing part of her body. Then with practice, mom is able to open her eyes, and walk and talk and change positions as her baby’s birth process dictates, all while remaining completely comfortable, and still deeply in hypnosis.

It is very easy, and actually quite pleasant to practice the Hypnobabies Childbirth Hypnosis method. Mom simply listens and follows suggestions during a deeply relaxing thirty-minute script on CD, or while listening to the scripts that her birth partner reads to her. She alternates one or the other each day until baby comes. Mom also practices entering deeply into “eyes-open childbirth hypnosis”, and creates a natural anesthesia and profound relaxation with the “drop of her finger” 5 times each day for just 30-60 seconds at a time. Hypnobabies mothers still experience all the powerful, guiding sensations of childbirth, but they experience them as “pressure” sensations and not “discomfort” because they are actively producing a powerful natural hypno-anesthesia throughout their bodies during their babies’ births.

Can Hypnobabies Be Used Effectively by Single Mothers?

Single mothers or those whose partners will not be participating in the birth process can also, very successfully, use the Hypnobabies program. All of the hypno-anesthesia techniques can be easily learned, practiced and used alone, or with a birth partner. The birth partner can be the father, partner, doula, friend or a family member. A birth partner is not necessary to learning or practicing the program, but is a welcome participant if the mother chooses.

Childbirth Education

Along with all of the hypnosis techniques couples will learn to use, they will also learn everything they need to know about having a healthy pregnancy, the physiology of birth, newborn care, and the postpartum period.  The Hypnobabies program covers topics such as:

• Creating Positive Expectations of Childbirth
• Staying Healthy & Low Risk – nutrition and exercise for pregnancy & birth
• Your Choices/Planning for Your Beautiful Birth – information about the risks and benefits of common procedures, and other consumer issues
• Your Birthing Time Begins, Late First Stage & Birth – explains the entire birthing process
• In-Depth Birth Rehearsal – practice as if this was baby’s birth day, also postpartum recovery, new baby care & breastfeeding information

Helping Mothers Make Informed Choices in Childbirth

I discovered the Hypnobabies program when I was pregnant with my second child.  I had previously given birth in a very medical-focused labor and delivery unit via an induction and an epidural.  With this second pregnancy I wanted a different experience for my baby and myself.  The result was a very fast birth using Hypnobabies that was intervention free and completely comfortable with only some manageable discomfort at the very end.  I was so impressed that I became a certified Hypnobabies instructor so that I could teach other expecting moms how to have a comfortable and easy birth.

Kiersten Konikowski has been a labor and delivery nurse since 2002.  She currently practices at Boulder Community Foothills Hospital and teaches Hypnobabies classes at the Boulder Birth Community Classroom.  You can find out more information about Hypnobabies and Kiersten’s upcoming classes by going to http://www.coloradobeautifulbirth.com or by calling 720-440-BABY.