May 13, 2024 • 42 mins
In this episode, the midwife duo reflects on a particularly memorable home birth experience. The case involved a client with premature rupture of membranes (PROM) and hypertension, as well as sensitivity to various treatments, leading to a complex and challenging birth scenario. Throughout the episode, they discuss handling unexpected complications, the significance of communication and trust between midwives and their clients, the management of medical risks in a home birth setting, and the learning curve of midwifery practice. The episode also highlights the value of midwife partnerships in providing balanced and effective patient care, as well as the importance of being prepared for a range of outcomes and scenarios in home births.
00:00 Welcome to At Home with Kelly and Tiffany: A Midwifery Journey
00:26 Diving Into Birth Stories: The Joy of Revisiting Memories
01:32 Understanding PROM and Hypertension in Birth
02:04 Navigating Home Birth Criteria and Challenges
05:45 A Deep Dive into a Complex Home Birth Story
06:29 The Importance of Preparation and Teamwork in Midwifery
13:34 Addressing Complications and Embracing Collaboration
18:21 The Unfolding of a Prolonged Labor: Day One to Three
22:05 The Challenge of Home Induction
22:36 Unexpected Hurdles and Late Start
23:51 Rapid Progress and Blood Pressure Concerns
25:18 Addressing High Blood Pressure and Labor Management
28:57 Revealing the Coffee Enema Incident
31:19 Navigating Trust and Communication Breakdown
34:56 Reflections and Lessons Learned
39:57 The Value of Teamwork in Midwifery
41:06 Launching a Childbirth Class: A New Venture
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to At Home with Kellyand Tiffany, where naturally
minded women gather together aswe pursue simplicity and
confidence in healthalternatives, so we can show up
better in our busy lives andfeel more at home in our bodies.
Join your favorite home birthmidwife duo for conversation,
candor, and community.
Welcome back to at-home withKelly and Tiffany.
(00:22):
I'm Kelly and I'm Tiffany.
Today we get to talk about.
Another bird story.
I'm really enjoying this series.
I have to say.
I can do an entire podcast.
Line up.
Like I can just do episode afterepisode of just revisiting
views.
(00:43):
Birth stories because I mean,this was happening.
Five years ago, these burststhat were starting to come
through.
And I remember many pieces ofprobably every single birth, but
once I get into the notes andstuff, I'm just like
remembering.
So many other little gems thatit is just.
It's birth nostalgia to like thebest.
(01:05):
The best degree ever.
Yeah, for real, after we did thelast one, I was like, let's,
let's like we listen more.
Like, it's just, it's just sofun to be able to share.
I think for us just personally,but also for the benefit of our
listeners, we hope you feel thesame benefit.
I have a feeling this is landingas well as it feels like it is
(01:26):
for us.
But I'm excited to chat aboutthis one in particular.
Yes.
So this one's called prom andhypertension and prom stands for
premature rupture of membranes.
That's when your water breaksbefore contractions begin and
hypertension is just stuff,fancy little word for high blood
(01:46):
pressure.
Two things we don't like to seein.
I, when we pulled this up, I waslike, oh yeah, yeah.
Those are two words I don't liketo see when we're talking about
birth.
No, slightly complicated.
And there's more, there's morethat did not fit into the title
of this.
Of this story.
And so to start us off Kelly,one of the FAQ's about home
(02:09):
birth that we get quite often,which I think some of our
listeners are going to be like,gosh, I wonder where do they
draw the line?
What conditions, risk women outof care?
I mean, it kind of runs throughso many things.
There are certain issues indifferent states as well,
depending on where you.
Live right in California.
(02:30):
We have certain stipulations forwho we can treat and who we can
serve in a home birth capacity.
So that would be right.
A mom who has between 37 and a42 weeks pregnant.
And she has one baby who hashead down.
As of last time we assessed herkind of situation.
(02:51):
But there's other things thatcome up too, depending just
previous medical history stuffthat throws a wrench in things.
It doesn't necessarily meanthere's no hope for you, but it
means that.
We ourselves.
Can't be the main providerwithout the support or
supervision or signing off of a,of an OB.
(03:13):
Yeah.
So like some specific men,maternal disease processes,
like.
Diabetes, preeclampsia.
Other health things that, youknow, can come up.
Like maybe we don't, we're notsure if your baby's growing
appropriately anymore, orthere's some kind of anatomical
abnormality or your baby has aheart condition or, right.
(03:36):
So there's many things thatwould not make home the most
appropriate place anymore whereyou want to be near more
intervention.
Those are the things that willrisk you out of care.
But there are midwives out therewho will risk women out of care.
Which means essentiallytransferring you to medical care
in pregnancy or in your birthfor some kind of.
(03:58):
I don't know.
What do you call it?
Like subjective things that likedon't have research or risk
status attached to it.
Like.
Limits on.
How long you can be in laborlimits on how long your water
can be broken, how long you'repushing or yeah.
And while everyone is Certainlyallowed to find where those
(04:20):
boundaries are for themselvesand their care.
There's no, there's no ruleabout that.
You have to feel comfortablewith things that you don't.
But you need to be able tocommunicate those things to your
client so that they know, oh, apart of birthing with this
practice or with this midwifeincludes.
Her comfortability or her.
You know, plan of care with thistype of situation.
(04:42):
Yeah, everybody needs to figureout their own level of comfort
as a provider.
And I think that can shift overtime also, but being able to ask
questions when you're consultingwith a midwife in particular
about some of these things isreally important.
So that comes back to, we did anepisode recently about Asking
(05:03):
questions or like questions toask in an interview that can
help kind of start to piece someof those pieces out.
So there are like the reallybig, like, this is not going to
happen.
You know, issues, right.
But then there's those smallerthings that can also sort of
pile up on each other to belike, you know what, like it is
not home birth at all costshere.
(05:24):
And from what we are seeing, thewisest thing to do is be
somewhere where there's extrasupport, whether that's for you
or for baby after they're born.
So it's not necessarily It's nota bad thing to be risked out
necessarily.
It can be disappointing, butit's not.
Some.
Bad.
It doesn't mean you did anythingwrong, right?
Yeah.
Exactly.
(05:44):
Okay.
So jumping into this story.
This must be our third birththat we ever did together.
If I'm like counting itcorrectly.
Right.
And we're about six months intopractice at this point.
And I think in our first year ofpractice, we did seven births
together.
And so that was feeling really.
That was feeling perfectly finethat we had this kind of slow
(06:06):
build while we were figuringeverything out.
You still had like aone-year-old.
At home with you?
I was recovering, I didn't knowit was going to take seven more
years, but I was stillrecovering from being a
midwifery student kind ofrecently I had broken my arm and
that just like threw a dangwrench in a lot of things like
those handful of months while Iwas recovering.
(06:28):
Yep.
And so this particular clientcame to us as a referral from my
old preceptor and it was kind offun because it was like the
first family that we didn't knowthere wasn't like another, there
wasn't another relationship orassociation with this family.
And so we were excited to servethem.
And really just like, kind ofplay midwife from beginning to
(06:52):
end.
It was, I remember specificallywe had our like official
consultation kind of thing, andwe walked outside together and
like high five and we're like, Ithink they're going to hire us.
Like somebody wants to.
Something that we don't knowpersonally, like wants to hire
us.
So we, I remember really feelinglike we're doing a thing that we
said we were going to do.
(07:12):
It felt good.
Yeah.
And like, there were many piecesof this story that helped to
refine what we.
Put in place after.
After taking care of thisfamily.
So we came across a lot ofchallenges that would have just
happened inevitably, as you'reforming all your different, you
(07:33):
know, things, especially workingwith another midwife for the
first time, you just have towalk through some things
together where you're like, oh,how did that feel for you?
Not good.
All right.
How do we want to make sure, howcan we try to avoid that from
happening in the future?
So lots of those little pieceskind of came up with this.
Particular family.
And so this lady was having herthird baby, but it was her first
(07:56):
home birth and the older kidsand their family had some
medical problems.
And so they had so muchexperience.
In that space being inhospitals, being with doctors,
being with specialists overthese.
Serious medical issues thatthey're like, we do not want to
spend any more time there ifit's not absolutely necessary.
(08:17):
And so they were really excitedfor their first home birth.
Yeah.
That was like a sweet part andreminder of what we're able to
do with midwifery care.
Like it's not always just peoplewho are like, I've just always
dreamed of having my baby athome.
It was like, that was a, thatwas a desire to have this
healing family experience, whichwas really sweet.
Looking back on it.
It totally was.
(08:37):
And so Kelly mentioned that likeher arm was still healing from
her broken femur and surgery.
So we brought Christina again,our happy little.
Happy little, little midwiferystudent bless her for like
hopping.
And I think this is the last oneshe did with us in this.
While she was a student.
I think so, too.
But having her there ended upbeing super helpful because
(09:00):
Kelly and I are like allcompletely wrapped up in just
managing the midwifery part ofthis, that Christina was able to
really like think on her feetand think critically and help us
like come up with, you know,some information.
And it just reminded me that.
Students are just so much morecreative, so much more
(09:23):
knowledgeable in a, not in anexperience way, but just in a,
oh, well, I was just readingabout this yesterday, you know,
it's like, it's just so freshfor them.
Like little sponges, you know,and they're more up to date on
research and you know, didactictopics because they're in it,
you know, several, several hoursa week.
(09:43):
And so that's one of the thingsthat we've kind of lost a little
bit of touch with is that as webecome more and more familiar
with the way we like to domidwifery and how we like our
practice to run we're we missout a little bit on that, like
fresh perspective.
Yeah.
I can a hundred.
Percent.
See why providers get in thatspace of like, well, this is
(10:04):
just what we've always done orhow it takes, you know, what 10,
15 years or something for likenew evidence to show up in, you
know, a hospital maternity word.
Well, it makes sense becauseeveryone's just like, I gotta
just keep going on this conveyorbelt.
I guy, like I have to put myhead down and just keep
focusing.
(10:25):
And so it really, it gives yousome, I'm not saying it's right,
but it gives you some context asto why it takes so long.
So yeah, for some things tochange.
So initially there were, like Isaid, there was a lot of pieces
of working with this family thathelped us to just like refine
our own practices.
But one thing that I rememberedthat I did not chart.
(10:46):
Is how, like dead, we were atthe way that this family was
preparing for their home birds,because Kelly they're like
pretty laid back about mostthings.
We're like we're in your home.
You're going to have runningwater and electricity, and
you're going to gather the birthsupplies that we asked you to.
And we're going to bring ourstuff too.
(11:06):
And like, it's gonna, it's gonnabe fine.
Let's not overdo it.
But this family was theabsolutely most prepared for
their home birth and they werethinking through.
Every little detail in a waythat was like, oh wow.
I I actually, I can't, I can'ttell you what.
A structural engineer would sayabout having the weight of a
(11:29):
birth tub up on the secondfloor.
You might have to contact.
And I'm 91.
I'm sure he actually did.
Yeah.
He's like, well, if we put it,if we put it as close to the
fireplace as possible, it's themost structurally sound place on
the second floor.
So that's our plan.
And I'm like, I will just.
Put it in a place where yourwife wants to give birth.
(11:51):
That's probably fine if you'realso not living in like you know
shanty cabin out in themountains, like a very new.
You know, area that they wereliving in home that they had,
they were going to be just fine,no matter where they set that
tub up.
But I never thought about itbefore.
I'm like, I wonder how much,what do you think that is Kelly
a hundred gallons of water?
(12:12):
How much does that weigh?
I don't know.
Oh, that's a lot.
I wonder.
Are we putting everybody at riskevery single time we have a baby
on the second floor?
I don't know.
What about, what about peoplewho have babies in apartment
buildings that are maybe 10 or20 stores up?
I'm concerned now.
Yep.
It was a lot.
But then also this family hadcontact paper.
(12:34):
Clear clear contact.
Clear plastic contact paper onevery single carpeted surface
upstairs.
And that was well before laborstarted that they had to deal
with that for weeks.
And someone thought this isneeded.
And we're would, there's no waywe're going to let our carpet
(12:56):
get ruined.
I'm pretty sure theyanticipated, even though we
always say like, it's not likeblood is splattering everywhere.
I think they really anticipatedlike a blood bath.
Just things just getting totallysplashed everywhere.
We didn't make a mess at thatbirth.
Sometimes we do.
I mean, we really try not to, wealways clean up the mess, but I
(13:16):
don't think that was a messybirth.
I think it was perfectly fine.
Anyway, we were dying at some ofthese things.
We were just like, this is goingto be really interesting.
Sticking to the plastic and thatwas great.
Yeah.
You ha you must wear socks.
To this birth.
Anyway, looking back in thischart, I was reminded that this
(13:37):
pregnancy was somewhatcomplicated to, I mean, we were
working on some liver stuff withthis Mon, she had some itchy
skin stuff that we ended up, youknow, doing the liver panel on
and found that like, she wasreally kind of borderline
teetering into.
Son.
Livered issues that wesuccessfully treated with herbs.
(13:58):
That was really wonderful, butshe was very sensitive to a lot
of things in her environment.
So it was really difficult tosort out what was causing what
and how to, you know, take careof her.
And so that was just a part of,that was a part of her care.
It's just knowing that she wasreally sensitive to a lot of
things.
Yeah.
We, that was the first time weever really like consulted with
(14:19):
somebody else as well.
We connected with another.
Other newer ish midwife who haddone a bunch of research on this
particular issue that she washaving, that we were seeing with
her lab work that I did somestudent stuff with years before.
And so.
We're able to actually likeconnect with her, let her look
at the labs.
Also just make sure that weweren't missing anything.
And that was a cool experiencejust to be like, oh yeah, we
(14:42):
can, we can collaborate.
Yes.
Like we don't have to have allthe answers, but it did feel
good to know.
Yes.
We're on the right track.
To have the affirmation of, youknow, seeing the results of
that.
That was really gratifying as wewere just getting started taking
care of women and that we were,you know, getting some of it
right.
I will also say that Kelly and Ihad so, so, so much
(15:06):
communication about this client,just because of some of those
pieces that were happening.
But then as the birth startedunfolding, I mean, Kelly
estimated that we probably spentlike at least a dozen hours,
Talking to each other, throughall of the different pieces of
how we wanted to communicatewith this particular client.
(15:26):
Us just working through midwifeto midwife on different things
that we were comfortable with.
And that grew us a ton inpractice because we had the
opportunity to really hash outsome things.
But there was also justpersonality pieces between the
two of us that we ended up, youknow, kind of working through
with that too, of like, where amI at in my comfort level?
(15:47):
Where are you at?
How are we going to defer toeach person's.
Comfort levels and things.
And.
Really just getting to like workout and process those pieces.
I attribute a lot of those earlyfoundational communication tools
that we developed to working onthis client together.
Yeah.
I mean, some smaller pieces fromthis labor have played
(16:09):
themselves out in other wayssince then.
And we still communicate onthings, but this was one of
those defining moments of like,Oh, yeah.
Okay.
Not everything is always smoothand easy and as low risk as
humanly possible.
What do we, what do we actuallydo with that at that point?
Because that's part of midwiferycare too.
It's not just.
(16:30):
These other birth stories thatwe share where things are just
beautiful and physiological andwonderful.
It also is.
Can we bring something back intonormal when it starts to, you
know, starts to creep outside ofit.
And how comfortable outside ofthat normal are we.
Yeah.
Yeah, totally.
And it reminds me when Christinabecame licensed, we invited her
(16:53):
to come on to our team as athree midwife team.
And so she was a new midwifeafter we'd been practicing for a
few years already.
And she would just apologizeconstantly for needing to
process and talk out througheverything.
And we were like, do not evenworry about it.
We so understand what that'slike to be a brand new midwife
(17:13):
and just feeling.
The pressure and theresponsibility and the am I
missing anything?
And how do I feel about this andwhat else can we do to support?
And am I doing the right thing?
And so that.
That was J it's a part of it.
It's just a part of it.
And it's, it's a good part ofit.
And it's unfortunate sometimes.
I mean, You don't want to be asmentally wrapped up in every
(17:36):
little detail, always, but thereis a piece of it that's lost as
you continue to do it thatyou're like, oh no, it actually
is good to continue to go backand like, Emotionally check
yourself and clinically checkyourself as well.
Yeah.
I mean, Kelly and I are so usedto knowing what the other person
feels about certain situationsthat there's very little, that
(17:57):
we actually have to touch baseon.
Sometimes there's, there's somany things that I feel like I
don't even have to run past herif I'm providing face-to-face
midwifery care, because Ialready know.
How she's going to respond orwhat she's going to want.
And there's a part of that thatjust makes.
Taking care of people so easy.
But it was a lot of work to getthere.
Yes.
Yeah.
And, and hard work on this onein particular.
(18:20):
Yep.
Okay.
So this mom, she is two dayspast her due date.
And her water breaks.
And I'm calling this day one,her water breaks in the evening.
If this shows you where we'reat, where we're headed, this is
day one day one, her waterbreaks.
(18:40):
In the evening she calls us andlets us know that.
And that is not a particularanything to us we're like, okay,
well, you're definitely having ababy in the next few days, but
we're not like, well, we'regoing to need to see active
labor pattern within the next 24hours.
And.
Duh, duh, duh.
I will say that this particularmom was GBS positive.
(19:00):
She opted to know her.
Group beta strep.
And status at the end of herpregnancy.
And that was a piece of hercare.
And so there is a little bit oflike, oh, let's pay attention to
somebody who's GBS positive whohas their water broken.
And we gave her consent for allof those pieces that, you know,
she was at a higher risk forinfection potentially.
(19:23):
And we gave her really strictparameters for vaginal hygiene
and.
Prophylactic immune boosting.
And all of that.
Yeah.
So she had the option to haveIvy antibiotics because of that
and opted.
Like declined them and havethat.
That conversation again, justmaking sure, like, this is what
you still agree to.
(19:44):
She was like, yep.
I want to avoid that as much ashumanly possible, which is great
because we could not havecollected antibiotics in the
entire county.
Yes of home birth midwives inorder to give her appropriate
dosing every four hours while wewaited for baby to come.
Cause we're on day one, still.
Okay.
So day two, we're still feelingpretty calm and cool Kelly and I
(20:06):
have like a very a very relaxed.
Viewpoint on the, on thepremature rupture of membranes.
It's like, if everything islooking great, your tent, you.
You know, your temperature isstill normal.
Baby's moving normally the fluidcoming out of you as normal.
It's really just a waiting gamethere.
And of course we're alwaysbringing in the informed consent
(20:27):
piece of like, well, now wedon't, we don't have that
barrier anymore.
That is protecting, you know,you and your baby, but we do
have all of these other positivesigns and tools at our disposal.
And so.
Up until 24 hours.
We really like, we don't expectanything if you don't ha if
you're a contractions, don'tstart.
If, you know, if we don't haveany big pieces coming around at
(20:51):
24 hours, it's not a big deal.
But around that 24 hour, mark isstatistically.
When 95% of labors should havegot going on their own and women
always have the option todecline our recommendation to
start to.
You know, push labor forward alittle bit.
And so that's what this clientdid.
We visited her on D two.
(21:12):
We kind of gave her just like aprenatal appointment basically.
And we counseled her on herrupture status and the GBS
component.
And we talked about doing somehome induction stuff and she
wasn't comfortable with doinganything at that point.
And so we kind of talked aboutwhat that would look like for
her.
What would make her feelcomfortable?
What that timeline could looklike so that we could.
(21:33):
You know, collaborate and comeup with a plan to get there.
And we decided that the verynext morning, the beginning of
day three is when they wouldfollow our recommendation for
inducing labor.
Yeah.
So we hadn't given them sort ofa, we have this handout of
exactly what they need.
I think we all, we gave them acouple of those things that we
(21:56):
had on hand already as part ofthat.
And then they needed to go tolike a health store, you know,
to grab another tincture orsomething like that.
And.
I don't know if we discussed thefact that she didn't have a
breast pump already.
But that ended up being.
Thing cause breast pump orpumping is a part of this home
(22:16):
induction protocol that we gavethem this on and off pumping
experience.
And so I think maybe it was anassumption part or maybe it was
a.
I'm not running the details aresort of shaky for me on if they
thought they could just borrowone from a friend or what the,
what the actual plan was.
To get started the followingmorning.
Yes.
(22:36):
And so while we were in contactwith them on day three, trying
to determine.
How we could support them in thefollow through of the plan.
They did not actually gather allof the supplies until evening
time in.
That's exactly what we did notwant to do is.
(22:59):
We wasted an entire day.
To just start stimulating thingsat nighttime when everyone
should be sleeping.
But at this point it was worthit just to move forward more.
So just.
There's so many pieces there,there were so many pieces, so
they finally began theirinduction protocol, their home
induction protocol at sixo'clock at night.
(23:20):
Yeah.
And, and again, usually we'rerecommending doing that in the
morning so that it has some timeto kick in.
And if it does kick in you'relaboring during the day, and
again, not in the middle of thenight.
So at 6:00 PM, when she started.
We were like, okay, well, youknow, she's had babies before
her water is broken.
We're hopeful, but also, I don'tthink I was as like I was aware
(23:44):
of the fact that it would workas, you know, Well, as it did.
Yes.
At 30 minutes after she startedher induction protocol, she
called us saying that hercontractions were every five
minutes.
And could we please come?
She felt like this is definitelygetting going and I'm ready for
some help already.
(24:05):
And so we did, we arrived aboutan hour and a half later, and
her contractions were aboutevery two to three minutes.
But her blood pressure on herintake vitals was 140 over 80.
And Kelly, maybe you can justlike review really quickly.
Like what is, what is the bloodpressure that is concerning?
What's a blood pressure.
That's too high.
(24:25):
I mean, where's our cutoff.
This is like a textbook highblood pressure.
It's not like overwhelminglylike, oh my gosh, red flag
everywhere.
But when you look in like atextbook.
They would be like, you know,one 20 over 60, over 70,
something like that.
But once you start getting intothe one forties and especially
that bottom number being 80 issort of that beginning sign of
(24:47):
like, okay, where.
We're higher than we would liketo see this.
And so there's not necessarily anumber that's like, you need to
get out of here right now, butit is something that we need to
look in the overall picture ofwhat is going on.
For this family or for this momin particular.
(25:08):
And so it was, I mean,especially the liver stuff she
had already had going on.
I think we were just alreadylike, oh boy, what, what, what
exactly is going on here?
So usually we would come in andtake a blood pressure.
It's normal four hours later.
We're retaking vitals, unlessthere's some reason to do so
earlier, but we decided okay,there's a lot going on here
(25:30):
right now.
Right?
Like let's do some calming stuffand just, we'll take it again in
an hour and kind of see wherewe're.
We're where we're at.
So we're still feeling like,yeah, this you're fine here, but
we need to keep an eye on this.
Yes.
It's not so normal that we canjust be like, ah, yeah.
Okay.
Get that blood pressure cuff outof here.
That's annoying.
And we'll check it again in fourhours or whatever.
We're thinking like, oh, this isthe beginning of your labor.
(25:51):
That is already, everything isalready feeling like it's taking
forever.
And we did take her bloodpressure again an hour later and
it was even higher.
It was one 40 over 96, which islike, oh, well that's just
telling us something, right.
Like something's not quite righthere.
It's not just that.
You are reactive to labor, andyou're just going to sit kind of
(26:13):
higher, which is, can be reallynormal for does blood pressure
to be elevated in labor ingeneral, but also it's, it's
common for blood pressure tocontinue to elevate throughout
the labor process, just becauseof what is happening, you know,
metabolically and physically toyour system.
In a labor situation, but notthat high.
Yeah.
And if we're planning for it toget higher, I think that was
(26:35):
when we were like, Okay.
I think we had to step outsidethe room and be like, Okay.
We need to Palau again.
What exactly are we going to doabout this?
And if we don't see resolutionwe're gun.
We can't stay here if we're not,if we're, if we don't have a
plan and we're not seeing anykind of resolution here.
Yeah.
So we talked to them about thata little bit.
(26:56):
Your blood pressure is higherthan we would like it to be.
We need it to actually lower.
And so here's our plan forhelping you, you.
You know, at least work withyour nervous system a little bit
to try to circumvent that.
And then we're going to takeyour blood pressure every 30
minutes to continue to monitorthat.
And so half an hour later, wetook her blood pressure and it
was 150 over 100.
(27:18):
And that was after we hadalready implemented some of
these like more relaxationtechniques.
So this is stressing me out.
It was stressful to, it wasstressful to review.
Also because she is definitelyin very active labor at this
point.
And, you know, we're like, areyou going to have your baby?
(27:38):
Right now, or where are we at?
Kind of, we don't like to likereally assess.
Necessarily that situation, butalso there's a big difference in
if you're a centimeter rightnow.
Or.
You're complete and about tostart pushing kind of thing.
Not that those.
You know, you could be one andhave your baby and a half an
(27:59):
hour also, but just generallylooking at that realizing, okay,
are we.
Are we in this space where we'regoing to have a baby really
soon, and we can.
Expect your blood pressure topotentially resolve.
Are you becoming preeclampticright before our eyes?
So we were screening forpreeclampsia.
She had no other signs orsymptoms.
It was just this hypertensivepiece.
(28:20):
But we pulled or no, we decidedto do a vaginal exam on her so
that we could see what are, whatare we looking at here?
That's going to give usinformation about like how much
tolerance we can have for theblood pressure piece.
And she was six centimeters,which was like, okay, you've
been in labor for.
Three and a half hours.
That's wonderful.
(28:40):
You're doing great.
But we took the dad out of theroom because she was, she was
really focused and I think shehad asked to not be a part of
any.
Yes.
We wanted the dad to have themain source of conversation.
And then he could sort ofcommunicate slash make some
decisions like for her.
So she could sort of say in herspace, So we respected that and
we brought him out of the roomand we had a really serious talk
(29:04):
with him because we had already.
Recognized that there was somecommunication breakdown in
between what we needed to seehappen and the response to that.
And so we were really.
Serious about how, what weneeded to see happen next.
And so we told him, you know,the blood pressure is too high.
(29:26):
It needs to come down.
If it comes up any more thanwhere it's at, we're going to
need to transfer.
And so then he took thatopportunity to let us in on some
additional information and ourclients.
I'm sorry, I don't mean tolaugh.
It's funny.
Looking back in the moment.
We were not laughing.
(29:47):
It was not funny.
I was like this.
This is rude.
This is rude to not disclosethis.
So this is what I wrote in thechart.
I charted this.
Father of baby stated withoutmidwife knowledge, mom took a
coffee enema before her homeinduction protocol this evening.
(30:07):
Which is maybe what she wasdoing with all that time before
she started.
Well, it makes a lot of sensethat they were working on the
coffee enema instead of gettingthe birth pump yes.
Or breast pump.
So we discussed earlier, she wasreally sensitive to like,
Everything.
And so she couldn't take a lotof supplements.
She couldn't take certain herbsthat we recommended as we're
(30:30):
working on different things.
And just trying to like supporther system.
And so we were like, huh?
You added something in tosomebody who's a very, very
sensitive.
And now we're seeing this crazyhike in blood pressure that we
would not have anticipatedbecause everything was very
normal with that beforehand.
Yep.
So we're like, does coffee enemacause high blood pressure?
(30:52):
Huh?
Let's look that up 100%.
It does.
It can be that that associationis relatively common.
Yep.
And, and, but we don't have away of saying this is for sure.
The reason you have high bloodpressure and no matter the cause
of your blood.
Blood pressure.
Having high blood pressure isunsafe for you.
(31:13):
It's unsafe for your baby.
It's just.
It just is we hadn't, we hadmany feelings.
At that point.
So we, we discussed transport.
We said, we're going to keep aneye on this.
And if it goes any higher thanwhere it's at, then we
absolutely have to transport.
And he, he said something like,so what does that mean?
And we were like, If the bloodpressure increases, which we'll
(31:34):
be continuing to check on, thenwe have to transport.
And I remember talking to Kellythrough this for, you know, a
whole lot more.
Time, unpacking and processingthis.
Like, if we suggest thetransport are these.
Client's going to.
Cooperate.
Are they going to cooperate?
And if they do.
(31:55):
I think there was a piece of italso that we were like, oh man,
like we just w.
The tr the full trust orsomething just didn't feel quite
right.
And especially in that moment.
And I think it was sort ofdisappointing.
Yeah.
It was like, I understand thatyou.
Wanted to make some differentdecisions than what our
suggestion was.
That would have been helpful.
(32:17):
Two.
To, you know, at least disco, Idon't know.
Anyway.
But I do remember praying overher.
After we came back inside andbecause that is what she asked
for.
And so we prayed that her bloodpressure would be lowered and
that we would just have wisdomand navigating the next steps.
And the very next time we tookthe blood pressure, it was
already lowering, it was 1 44over 90 half an hour later.
(32:41):
It was 1 44 over 82.
And so then we thought, okay,we're trending in the right
direction.
Your coffee and a mum must bewearing off.
This residual side effects.
Great.
So then we moved to taking herblood pressure every hour, but
just, you know, half an hourafter we decided to do that,
it's 1130 at night.
So she started her inductionprotocol at six, we got there at
(33:04):
eight.
She's she, you know, had onlybeen in labor since like six 30
and she got in her birth tub at1130.
She started pushing about 20minutes after that.
And then she had a baby eightminutes after that.
So by midnight, she had a babyin her arms.
She had normal.
A normal blood pressure.
(33:24):
She had no signs of.
Any type of infection happening,you know, with her uterus or
systemically babies did not showany signs of like infection or
anything, smallest baby thatwe've had.
You had tiny little thing.
Oh, not the smallest.
Oh really?
No.
The absolute smallest was theBri the surprise breech.
Oh, wait for that one.
(33:45):
Yes.
Oh, okay.
And this one is a, this one waslike a few ounces.
Okay.
He was tiny little thing forbeing 40 weeks.
That's a whole nother.
That was a whole nother but herplacenta came 15 minutes on its
own.
She had 250 estimated bloodloss, which is like a cup of
blood, super regular amount ofbleeding.
She had six hours of labor,total.
(34:06):
She had 53 hours of rupturedmembranes, which that's a long
time.
That's 53 hours is.
It's pretty long time.
The longest we've grown sincethen.
The longest problem that we'veever had.
I think as far as my memoryserves me was 59 hours.
(34:28):
And that was like two yearslater with the client that we
had a lot of trust andcommunication and relationship
with.
And it felt very, very, verydifferent.
Yeah.
And that just goes to show youright.
That relationship.
The shift does matter, but alsowe were at a different place.
And our midwifery career also interms of our comfort levels and
(34:52):
how we were, how we werecommunicating with each other
and all of that.
Yep, absolutely.
So what a fascinating littlejourney, we talked a little bit
about like the lessons that welearned there were so, so, so
many, it refined ourexpectations of communication
with our clients and how wewanted to communicate that to
them.
What our expectations were ofcommunication.
And we learned that we can pushboundaries with some clients,
(35:15):
but not all clients can we pushboundaries with.
And that was a reallyinteresting lesson to learn that
a part of the individualizedcare that we give is really
assessing.
How much responsibility, howmuch trust, how much
communication, how muchcollaboration.
Makes us feel comfortable withgiving a more and more
individualized experience.
(35:36):
Yeah, for sure.
It definitely was probably themost uncomfortable.
I've been.
Us.
And midwife maybe.
Yeah.
I can think of a couple otherones where I've been really
uncomfortable, but this, thispiece of discomfort was more
relational than medical, I thinkfor me.
Yes.
Yeah, absolutely.
(35:56):
And I think that that partreally plays into it and I think
was.
Hard for us to peace out as wewere sorting through next
options and like praise theLord, we didn't have to make.
Any, big changes to birth plansat that point.
But it did, it did put us in aposition where we were like, oh
(36:16):
man, It really does matter thismutual fit idea and that mutual
trust.
Idea, but we also, you know, Ilearned some things learned
about coffee enemas.
Hypertension.
And we always now carry what'scalled Hawthorne in our birth
bags.
Never once used it since then,but that was the one that we
(36:37):
were like, yes, this is helpfulfor blood pressure.
We were like, this is soimportant for us to have
literally, I mean, I've taken itout and given it to my husband
because.
Mike, somebody's got to use itat this point, right?
Yeah.
Yeah.
But it's nice to know that wehave it.
So if we encounter any bloodpressure issues and we have a
tool because I hated knowingthat there was a tool that we
(36:57):
could have used for thatsituation and not having it.
And yup.
I even remember thinking, I evenremember looking up like store
like health food stores in thearea, if anything was still
open.
So we could just go grab thatone herb that we knew was gonna
help.
But we also learned aboutboundaries.
I mean, I learned a lotpersonally about what, what it
(37:17):
feels like when I am up againstmy limit and not feeling
flexible at all.
And that's just like aninterpersonal thing for me, but.
I also learned that like youKelly, just balanced that out a
bit and I can think of a couplecircumstances.
Where I have felt that way, likeI'm up against my limit.
And like, in that particularsituation, I think if I was the
(37:38):
only one making calls, I wouldhave just transferred.
Like I was upset that the trustand communication part was
broken.
And I just thought, what am Igoing to put, like my butt on
the line for this, you know,scenario, but you, you had more.
A little more compassion, alittle more reasoning, a little,
you were a little morecool-headed about it.
(37:59):
And you made a plan with them.
And it worked out.
Yeah, I'm thankful that itworked out.
It certainly, it would havebeen, it felt like a good
conversation to have, and to belike, here's the plan, but you
have to hear us that like, Wehave to be in this plan
together.
Right.
And if the, if we, I mean, itcould've gone the other way.
(38:20):
Right.
Oh, totally.
We don't have control over anyof those pieces.
Right.
But just really trying to createthe best possible scenario for
our clients in weighing all ofthose pieces out and taking it,
you know, heavy and serious.
You know, there are a few littlerandom things that can paint
outside of normal like this, andit's important to pay attention
(38:40):
to.
And I think that we did a lot ofdue diligence in paying
attention to those pieces, butit's good to remember that some
of those things can be, be alittle bit outside of normal.
And that we can bring them backinto normal or we can support
resolution into normal.
And that usually turned outokay.
(39:01):
And there's some things that youjust don't gamble with.
And it's really clear that like,this is not happening in this
particular space, but it's soimportant.
And we have such an opportunityin the way that we get to
autonomously, provide care thatwe get to look at each situation
uniquely and really figure outwhat some of those, you know,
different care.
Pieces look like for the personwho's right in front of us.
(39:24):
Yeah, for sure.
And looking back on this birthalso in like some of the vitals
and just the, how things playedout and like, Dang.
I wonder if midwife mean nowwould like what that would look
like and how that would actuallyplay out.
And if similar decisions wouldbe made and all of that, it's,
this is actually a very helpfulthing.
And I think more providersshould.
(39:46):
I mean, they don't necessarilyneed to get on a podcast and do
this, but this is so likeclinically helpful also.
On our end.
Yeah.
Like all of those differentpieces as a provider.
And I guess like one of thethings of course that I, that
I'm continually saying aboutthis birth is the value in
having you be a part of thatwith me.
(40:08):
Me and having somebody that youcan call, especially if they
have a different approach toproblem solving, especially if
they have a different approachto communication.
And there's just so much valuein us being able to practice
together because of that,because personality wise.
We're a little bit different andit just compliments each other.
(40:28):
And so that's another big plugfor practicing on a team,
practicing in a partnership.
Because when you just havethese, these one sided
viewpoints, and you're just outthere doing it on your own, you
have to make all the calls.
You have to hold all theresponsibility.
You, you know, it's just a lot,you would make different
(40:49):
decisions.
If you were practicing solo thanyou would.
If you had another, if you had apartner.
I a hundred percent agree withthat.
So hopefully this was like ahelpful at all.
Peek into this experience forus.
We are enjoying our time rightnow.
We're like halfway ish throughour very first beta childbirth
(41:11):
class that we launched.
We're just having so much fun.
We get to talk about some ofthese things that we even talked
about here just in differentways, as women are experiencing
different things in theirpregnancy and planning for their
births and just so much funleading that group of women
through.
Through just preparation for aconnected, peaceful birth
(41:32):
experience.
It's been really, really sweetto watch it all play out.
We would love.
As we open the doors andlaunched this officially out
into the world this summer.
We'd love to get you on the waitlist for that, so that you can
stay up to date with all of theannouncements.
You'll be the first to know whatour plans are, what is coming
(41:54):
what's ahead.
And you'll also get access to abunch of exclusive.
Content about pregnancy, aboutbirth, all that good stuff.
And so hop on there.
The link is in the show notes.
Yep.
And you can also find it abeautiful one, midwifery that
calm.
It has been a pleasure toprocess and unpack this one.
(42:14):
I mean, Wu, I guess there was alot there that I was not
expecting to remember all thefeelings I'm going to need to go
like sauna bag after the sun,just releasing things.
I agree.
Next week.
Bye.
Welcome to At Home with Kellyand Tiffany, where naturally
minded women gather together aswe pursue simplicity and
confidence in healthalternatives, so we can show up
better in our busy lives andfeel more at home in our bodies.
Join your favorite home birthmidwife duo for conversation,
candor, and community.
Welcome back to at-home withKelly and Tiffany.
(00:22):
I'm Kelly and I'm Tiffany.
Today we get to talk about.
Another bird story.
I'm really enjoying this series.
I have to say.
I can do an entire podcast.
Line up.
Like I can just do episode afterepisode of just revisiting
views.
(00:43):
Birth stories because I mean,this was happening.
Five years ago, these burststhat were starting to come
through.
And I remember many pieces ofprobably every single birth, but
once I get into the notes andstuff, I'm just like
remembering.
So many other little gems thatit is just.
It's birth nostalgia to like thebest.
(01:05):
The best degree ever.
Yeah, for real, after we did thelast one, I was like, let's,
let's like we listen more.
Like, it's just, it's just sofun to be able to share.
I think for us just personally,but also for the benefit of our
listeners, we hope you feel thesame benefit.
I have a feeling this is landingas well as it feels like it is
(01:26):
for us.
But I'm excited to chat aboutthis one in particular.
Yes.
So this one's called prom andhypertension and prom stands for
premature rupture of membranes.
That's when your water breaksbefore contractions begin and
hypertension is just stuff,fancy little word for high blood
(01:46):
pressure.
Two things we don't like to seein.
I, when we pulled this up, I waslike, oh yeah, yeah.
Those are two words I don't liketo see when we're talking about
birth.
No, slightly complicated.
And there's more, there's morethat did not fit into the title
of this.
Of this story.
And so to start us off Kelly,one of the FAQ's about home
(02:09):
birth that we get quite often,which I think some of our
listeners are going to be like,gosh, I wonder where do they
draw the line?
What conditions, risk women outof care?
I mean, it kind of runs throughso many things.
There are certain issues indifferent states as well,
depending on where you.
Live right in California.
(02:30):
We have certain stipulations forwho we can treat and who we can
serve in a home birth capacity.
So that would be right.
A mom who has between 37 and a42 weeks pregnant.
And she has one baby who hashead down.
As of last time we assessed herkind of situation.
(02:51):
But there's other things thatcome up too, depending just
previous medical history stuffthat throws a wrench in things.
It doesn't necessarily meanthere's no hope for you, but it
means that.
We ourselves.
Can't be the main providerwithout the support or
supervision or signing off of a,of an OB.
(03:13):
Yeah.
So like some specific men,maternal disease processes,
like.
Diabetes, preeclampsia.
Other health things that, youknow, can come up.
Like maybe we don't, we're notsure if your baby's growing
appropriately anymore, orthere's some kind of anatomical
abnormality or your baby has aheart condition or, right.
(03:36):
So there's many things thatwould not make home the most
appropriate place anymore whereyou want to be near more
intervention.
Those are the things that willrisk you out of care.
But there are midwives out therewho will risk women out of care.
Which means essentiallytransferring you to medical care
in pregnancy or in your birthfor some kind of.
(03:58):
I don't know.
What do you call it?
Like subjective things that likedon't have research or risk
status attached to it.
Like.
Limits on.
How long you can be in laborlimits on how long your water
can be broken, how long you'repushing or yeah.
And while everyone is Certainlyallowed to find where those
(04:20):
boundaries are for themselvesand their care.
There's no, there's no ruleabout that.
You have to feel comfortablewith things that you don't.
But you need to be able tocommunicate those things to your
client so that they know, oh, apart of birthing with this
practice or with this midwifeincludes.
Her comfortability or her.
You know, plan of care with thistype of situation.
(04:42):
Yeah, everybody needs to figureout their own level of comfort
as a provider.
And I think that can shift overtime also, but being able to ask
questions when you're consultingwith a midwife in particular
about some of these things isreally important.
So that comes back to, we did anepisode recently about Asking
(05:03):
questions or like questions toask in an interview that can
help kind of start to piece someof those pieces out.
So there are like the reallybig, like, this is not going to
happen.
You know, issues, right.
But then there's those smallerthings that can also sort of
pile up on each other to belike, you know what, like it is
not home birth at all costshere.
(05:24):
And from what we are seeing, thewisest thing to do is be
somewhere where there's extrasupport, whether that's for you
or for baby after they're born.
So it's not necessarily It's nota bad thing to be risked out
necessarily.
It can be disappointing, butit's not.
Some.
Bad.
It doesn't mean you did anythingwrong, right?
Yeah.
Exactly.
(05:44):
Okay.
So jumping into this story.
This must be our third birththat we ever did together.
If I'm like counting itcorrectly.
Right.
And we're about six months intopractice at this point.
And I think in our first year ofpractice, we did seven births
together.
And so that was feeling really.
That was feeling perfectly finethat we had this kind of slow
(06:06):
build while we were figuringeverything out.
You still had like aone-year-old.
At home with you?
I was recovering, I didn't knowit was going to take seven more
years, but I was stillrecovering from being a
midwifery student kind ofrecently I had broken my arm and
that just like threw a dangwrench in a lot of things like
those handful of months while Iwas recovering.
(06:28):
Yep.
And so this particular clientcame to us as a referral from my
old preceptor and it was kind offun because it was like the
first family that we didn't knowthere wasn't like another, there
wasn't another relationship orassociation with this family.
And so we were excited to servethem.
And really just like, kind ofplay midwife from beginning to
(06:52):
end.
It was, I remember specificallywe had our like official
consultation kind of thing, andwe walked outside together and
like high five and we're like, Ithink they're going to hire us.
Like somebody wants to.
Something that we don't knowpersonally, like wants to hire
us.
So we, I remember really feelinglike we're doing a thing that we
said we were going to do.
(07:12):
It felt good.
Yeah.
And like, there were many piecesof this story that helped to
refine what we.
Put in place after.
After taking care of thisfamily.
So we came across a lot ofchallenges that would have just
happened inevitably, as you'reforming all your different, you
(07:33):
know, things, especially workingwith another midwife for the
first time, you just have towalk through some things
together where you're like, oh,how did that feel for you?
Not good.
All right.
How do we want to make sure, howcan we try to avoid that from
happening in the future?
So lots of those little pieceskind of came up with this.
Particular family.
And so this lady was having herthird baby, but it was her first
(07:56):
home birth and the older kidsand their family had some
medical problems.
And so they had so muchexperience.
In that space being inhospitals, being with doctors,
being with specialists overthese.
Serious medical issues thatthey're like, we do not want to
spend any more time there ifit's not absolutely necessary.
(08:17):
And so they were really excitedfor their first home birth.
Yeah.
That was like a sweet part andreminder of what we're able to
do with midwifery care.
Like it's not always just peoplewho are like, I've just always
dreamed of having my baby athome.
It was like, that was a, thatwas a desire to have this
healing family experience, whichwas really sweet.
Looking back on it.
It totally was.
(08:37):
And so Kelly mentioned that likeher arm was still healing from
her broken femur and surgery.
So we brought Christina again,our happy little.
Happy little, little midwiferystudent bless her for like
hopping.
And I think this is the last oneshe did with us in this.
While she was a student.
I think so, too.
But having her there ended upbeing super helpful because
(09:00):
Kelly and I are like allcompletely wrapped up in just
managing the midwifery part ofthis, that Christina was able to
really like think on her feetand think critically and help us
like come up with, you know,some information.
And it just reminded me that.
Students are just so much morecreative, so much more
(09:23):
knowledgeable in a, not in anexperience way, but just in a,
oh, well, I was just readingabout this yesterday, you know,
it's like, it's just so freshfor them.
Like little sponges, you know,and they're more up to date on
research and you know, didactictopics because they're in it,
you know, several, several hoursa week.
(09:43):
And so that's one of the thingsthat we've kind of lost a little
bit of touch with is that as webecome more and more familiar
with the way we like to domidwifery and how we like our
practice to run we're we missout a little bit on that, like
fresh perspective.
Yeah.
I can a hundred.
Percent.
See why providers get in thatspace of like, well, this is
(10:04):
just what we've always done orhow it takes, you know, what 10,
15 years or something for likenew evidence to show up in, you
know, a hospital maternity word.
Well, it makes sense becauseeveryone's just like, I gotta
just keep going on this conveyorbelt.
I guy, like I have to put myhead down and just keep
focusing.
(10:25):
And so it really, it gives yousome, I'm not saying it's right,
but it gives you some context asto why it takes so long.
So yeah, for some things tochange.
So initially there were, like Isaid, there was a lot of pieces
of working with this family thathelped us to just like refine
our own practices.
But one thing that I rememberedthat I did not chart.
(10:46):
Is how, like dead, we were atthe way that this family was
preparing for their home birds,because Kelly they're like
pretty laid back about mostthings.
We're like we're in your home.
You're going to have runningwater and electricity, and
you're going to gather the birthsupplies that we asked you to.
And we're going to bring ourstuff too.
(11:06):
And like, it's gonna, it's gonnabe fine.
Let's not overdo it.
But this family was theabsolutely most prepared for
their home birth and they werethinking through.
Every little detail in a waythat was like, oh wow.
I I actually, I can't, I can'ttell you what.
A structural engineer would sayabout having the weight of a
(11:29):
birth tub up on the secondfloor.
You might have to contact.
And I'm 91.
I'm sure he actually did.
Yeah.
He's like, well, if we put it,if we put it as close to the
fireplace as possible, it's themost structurally sound place on
the second floor.
So that's our plan.
And I'm like, I will just.
Put it in a place where yourwife wants to give birth.
(11:51):
That's probably fine if you'realso not living in like you know
shanty cabin out in themountains, like a very new.
You know, area that they wereliving in home that they had,
they were going to be just fine,no matter where they set that
tub up.
But I never thought about itbefore.
I'm like, I wonder how much,what do you think that is Kelly
a hundred gallons of water?
(12:12):
How much does that weigh?
I don't know.
Oh, that's a lot.
I wonder.
Are we putting everybody at riskevery single time we have a baby
on the second floor?
I don't know.
What about, what about peoplewho have babies in apartment
buildings that are maybe 10 or20 stores up?
I'm concerned now.
Yep.
It was a lot.
But then also this family hadcontact paper.
(12:34):
Clear clear contact.
Clear plastic contact paper onevery single carpeted surface
upstairs.
And that was well before laborstarted that they had to deal
with that for weeks.
And someone thought this isneeded.
And we're would, there's no waywe're going to let our carpet
(12:56):
get ruined.
I'm pretty sure theyanticipated, even though we
always say like, it's not likeblood is splattering everywhere.
I think they really anticipatedlike a blood bath.
Just things just getting totallysplashed everywhere.
We didn't make a mess at thatbirth.
Sometimes we do.
I mean, we really try not to, wealways clean up the mess, but I
(13:16):
don't think that was a messybirth.
I think it was perfectly fine.
Anyway, we were dying at some ofthese things.
We were just like, this is goingto be really interesting.
Sticking to the plastic and thatwas great.
Yeah.
You ha you must wear socks.
To this birth.
Anyway, looking back in thischart, I was reminded that this
(13:37):
pregnancy was somewhatcomplicated to, I mean, we were
working on some liver stuff withthis Mon, she had some itchy
skin stuff that we ended up, youknow, doing the liver panel on
and found that like, she wasreally kind of borderline
teetering into.
Son.
Livered issues that wesuccessfully treated with herbs.
(13:58):
That was really wonderful, butshe was very sensitive to a lot
of things in her environment.
So it was really difficult tosort out what was causing what
and how to, you know, take careof her.
And so that was just a part of,that was a part of her care.
It's just knowing that she wasreally sensitive to a lot of
things.
Yeah.
We, that was the first time weever really like consulted with
(14:19):
somebody else as well.
We connected with another.
Other newer ish midwife who haddone a bunch of research on this
particular issue that she washaving, that we were seeing with
her lab work that I did somestudent stuff with years before.
And so.
We're able to actually likeconnect with her, let her look
at the labs.
Also just make sure that weweren't missing anything.
And that was a cool experiencejust to be like, oh yeah, we
(14:42):
can, we can collaborate.
Yes.
Like we don't have to have allthe answers, but it did feel
good to know.
Yes.
We're on the right track.
To have the affirmation of, youknow, seeing the results of
that.
That was really gratifying as wewere just getting started taking
care of women and that we were,you know, getting some of it
right.
I will also say that Kelly and Ihad so, so, so much
(15:06):
communication about this client,just because of some of those
pieces that were happening.
But then as the birth startedunfolding, I mean, Kelly
estimated that we probably spentlike at least a dozen hours,
Talking to each other, throughall of the different pieces of
how we wanted to communicatewith this particular client.
(15:26):
Us just working through midwifeto midwife on different things
that we were comfortable with.
And that grew us a ton inpractice because we had the
opportunity to really hash outsome things.
But there was also justpersonality pieces between the
two of us that we ended up, youknow, kind of working through
with that too, of like, where amI at in my comfort level?
(15:47):
Where are you at?
How are we going to defer toeach person's.
Comfort levels and things.
And.
Really just getting to like workout and process those pieces.
I attribute a lot of those earlyfoundational communication tools
that we developed to working onthis client together.
Yeah.
I mean, some smaller pieces fromthis labor have played
(16:09):
themselves out in other wayssince then.
And we still communicate onthings, but this was one of
those defining moments of like,Oh, yeah.
Okay.
Not everything is always smoothand easy and as low risk as
humanly possible.
What do we, what do we actuallydo with that at that point?
Because that's part of midwiferycare too.
It's not just.
(16:30):
These other birth stories thatwe share where things are just
beautiful and physiological andwonderful.
It also is.
Can we bring something back intonormal when it starts to, you
know, starts to creep outside ofit.
And how comfortable outside ofthat normal are we.
Yeah.
Yeah, totally.
And it reminds me when Christinabecame licensed, we invited her
(16:53):
to come on to our team as athree midwife team.
And so she was a new midwifeafter we'd been practicing for a
few years already.
And she would just apologizeconstantly for needing to
process and talk out througheverything.
And we were like, do not evenworry about it.
We so understand what that'slike to be a brand new midwife
(17:13):
and just feeling.
The pressure and theresponsibility and the am I
missing anything?
And how do I feel about this andwhat else can we do to support?
And am I doing the right thing?
And so that.
That was J it's a part of it.
It's just a part of it.
And it's, it's a good part ofit.
And it's unfortunate sometimes.
I mean, You don't want to be asmentally wrapped up in every
(17:36):
little detail, always, but thereis a piece of it that's lost as
you continue to do it thatyou're like, oh no, it actually
is good to continue to go backand like, Emotionally check
yourself and clinically checkyourself as well.
Yeah.
I mean, Kelly and I are so usedto knowing what the other person
feels about certain situationsthat there's very little, that
(17:57):
we actually have to touch baseon.
Sometimes there's, there's somany things that I feel like I
don't even have to run past herif I'm providing face-to-face
midwifery care, because Ialready know.
How she's going to respond orwhat she's going to want.
And there's a part of that thatjust makes.
Taking care of people so easy.
But it was a lot of work to getthere.
Yes.
Yeah.
And, and hard work on this onein particular.
(18:20):
Yep.
Okay.
So this mom, she is two dayspast her due date.
And her water breaks.
And I'm calling this day one,her water breaks in the evening.
If this shows you where we'reat, where we're headed, this is
day one day one, her waterbreaks.
(18:40):
In the evening she calls us andlets us know that.
And that is not a particularanything to us we're like, okay,
well, you're definitely having ababy in the next few days, but
we're not like, well, we'regoing to need to see active
labor pattern within the next 24hours.
And.
Duh, duh, duh.
I will say that this particularmom was GBS positive.
(19:00):
She opted to know her.
Group beta strep.
And status at the end of herpregnancy.
And that was a piece of hercare.
And so there is a little bit oflike, oh, let's pay attention to
somebody who's GBS positive whohas their water broken.
And we gave her consent for allof those pieces that, you know,
she was at a higher risk forinfection potentially.
(19:23):
And we gave her really strictparameters for vaginal hygiene
and.
Prophylactic immune boosting.
And all of that.
Yeah.
So she had the option to haveIvy antibiotics because of that
and opted.
Like declined them and havethat.
That conversation again, justmaking sure, like, this is what
you still agree to.
(19:44):
She was like, yep.
I want to avoid that as much ashumanly possible, which is great
because we could not havecollected antibiotics in the
entire county.
Yes of home birth midwives inorder to give her appropriate
dosing every four hours while wewaited for baby to come.
Cause we're on day one, still.
Okay.
So day two, we're still feelingpretty calm and cool Kelly and I
(20:06):
have like a very a very relaxed.
Viewpoint on the, on thepremature rupture of membranes.
It's like, if everything islooking great, your tent, you.
You know, your temperature isstill normal.
Baby's moving normally the fluidcoming out of you as normal.
It's really just a waiting gamethere.
And of course we're alwaysbringing in the informed consent
(20:27):
piece of like, well, now wedon't, we don't have that
barrier anymore.
That is protecting, you know,you and your baby, but we do
have all of these other positivesigns and tools at our disposal.
And so.
Up until 24 hours.
We really like, we don't expectanything if you don't ha if
you're a contractions, don'tstart.
If, you know, if we don't haveany big pieces coming around at
(20:51):
24 hours, it's not a big deal.
But around that 24 hour, mark isstatistically.
When 95% of labors should havegot going on their own and women
always have the option todecline our recommendation to
start to.
You know, push labor forward alittle bit.
And so that's what this clientdid.
We visited her on D two.
(21:12):
We kind of gave her just like aprenatal appointment basically.
And we counseled her on herrupture status and the GBS
component.
And we talked about doing somehome induction stuff and she
wasn't comfortable with doinganything at that point.
And so we kind of talked aboutwhat that would look like for
her.
What would make her feelcomfortable?
What that timeline could looklike so that we could.
(21:33):
You know, collaborate and comeup with a plan to get there.
And we decided that the verynext morning, the beginning of
day three is when they wouldfollow our recommendation for
inducing labor.
Yeah.
So we hadn't given them sort ofa, we have this handout of
exactly what they need.
I think we all, we gave them acouple of those things that we
(21:56):
had on hand already as part ofthat.
And then they needed to go tolike a health store, you know,
to grab another tincture orsomething like that.
And.
I don't know if we discussed thefact that she didn't have a
breast pump already.
But that ended up being.
Thing cause breast pump orpumping is a part of this home
(22:16):
induction protocol that we gavethem this on and off pumping
experience.
And so I think maybe it was anassumption part or maybe it was
a.
I'm not running the details aresort of shaky for me on if they
thought they could just borrowone from a friend or what the,
what the actual plan was.
To get started the followingmorning.
Yes.
(22:36):
And so while we were in contactwith them on day three, trying
to determine.
How we could support them in thefollow through of the plan.
They did not actually gather allof the supplies until evening
time in.
That's exactly what we did notwant to do is.
(22:59):
We wasted an entire day.
To just start stimulating thingsat nighttime when everyone
should be sleeping.
But at this point it was worthit just to move forward more.
So just.
There's so many pieces there,there were so many pieces, so
they finally began theirinduction protocol, their home
induction protocol at sixo'clock at night.
(23:20):
Yeah.
And, and again, usually we'rerecommending doing that in the
morning so that it has some timeto kick in.
And if it does kick in you'relaboring during the day, and
again, not in the middle of thenight.
So at 6:00 PM, when she started.
We were like, okay, well, youknow, she's had babies before
her water is broken.
We're hopeful, but also, I don'tthink I was as like I was aware
(23:44):
of the fact that it would workas, you know, Well, as it did.
Yes.
At 30 minutes after she startedher induction protocol, she
called us saying that hercontractions were every five
minutes.
And could we please come?
She felt like this is definitelygetting going and I'm ready for
some help already.
(24:05):
And so we did, we arrived aboutan hour and a half later, and
her contractions were aboutevery two to three minutes.
But her blood pressure on herintake vitals was 140 over 80.
And Kelly, maybe you can justlike review really quickly.
Like what is, what is the bloodpressure that is concerning?
What's a blood pressure.
That's too high.
(24:25):
I mean, where's our cutoff.
This is like a textbook highblood pressure.
It's not like overwhelminglylike, oh my gosh, red flag
everywhere.
But when you look in like atextbook.
They would be like, you know,one 20 over 60, over 70,
something like that.
But once you start getting intothe one forties and especially
that bottom number being 80 issort of that beginning sign of
(24:47):
like, okay, where.
We're higher than we would liketo see this.
And so there's not necessarily anumber that's like, you need to
get out of here right now, butit is something that we need to
look in the overall picture ofwhat is going on.
For this family or for this momin particular.
(25:08):
And so it was, I mean,especially the liver stuff she
had already had going on.
I think we were just alreadylike, oh boy, what, what, what
exactly is going on here?
So usually we would come in andtake a blood pressure.
It's normal four hours later.
We're retaking vitals, unlessthere's some reason to do so
earlier, but we decided okay,there's a lot going on here
(25:30):
right now.
Right?
Like let's do some calming stuffand just, we'll take it again in
an hour and kind of see wherewe're.
We're where we're at.
So we're still feeling like,yeah, this you're fine here, but
we need to keep an eye on this.
Yes.
It's not so normal that we canjust be like, ah, yeah.
Okay.
Get that blood pressure cuff outof here.
That's annoying.
And we'll check it again in fourhours or whatever.
We're thinking like, oh, this isthe beginning of your labor.
(25:51):
That is already, everything isalready feeling like it's taking
forever.
And we did take her bloodpressure again an hour later and
it was even higher.
It was one 40 over 96, which islike, oh, well that's just
telling us something, right.
Like something's not quite righthere.
It's not just that.
You are reactive to labor, andyou're just going to sit kind of
(26:13):
higher, which is, can be reallynormal for does blood pressure
to be elevated in labor ingeneral, but also it's, it's
common for blood pressure tocontinue to elevate throughout
the labor process, just becauseof what is happening, you know,
metabolically and physically toyour system.
In a labor situation, but notthat high.
Yeah.
And if we're planning for it toget higher, I think that was
(26:35):
when we were like, Okay.
I think we had to step outsidethe room and be like, Okay.
We need to Palau again.
What exactly are we going to doabout this?
And if we don't see resolutionwe're gun.
We can't stay here if we're not,if we're, if we don't have a
plan and we're not seeing anykind of resolution here.
Yeah.
So we talked to them about thata little bit.
(26:56):
Your blood pressure is higherthan we would like it to be.
We need it to actually lower.
And so here's our plan forhelping you, you.
You know, at least work withyour nervous system a little bit
to try to circumvent that.
And then we're going to takeyour blood pressure every 30
minutes to continue to monitorthat.
And so half an hour later, wetook her blood pressure and it
was 150 over 100.
(27:18):
And that was after we hadalready implemented some of
these like more relaxationtechniques.
So this is stressing me out.
It was stressful to, it wasstressful to review.
Also because she is definitelyin very active labor at this
point.
And, you know, we're like, areyou going to have your baby?
(27:38):
Right now, or where are we at?
Kind of, we don't like to likereally assess.
Necessarily that situation, butalso there's a big difference in
if you're a centimeter rightnow.
Or.
You're complete and about tostart pushing kind of thing.
Not that those.
You know, you could be one andhave your baby and a half an
(27:59):
hour also, but just generallylooking at that realizing, okay,
are we.
Are we in this space where we'regoing to have a baby really
soon, and we can.
Expect your blood pressure topotentially resolve.
Are you becoming preeclampticright before our eyes?
So we were screening forpreeclampsia.
She had no other signs orsymptoms.
It was just this hypertensivepiece.
(28:20):
But we pulled or no, we decidedto do a vaginal exam on her so
that we could see what are, whatare we looking at here?
That's going to give usinformation about like how much
tolerance we can have for theblood pressure piece.
And she was six centimeters,which was like, okay, you've
been in labor for.
Three and a half hours.
That's wonderful.
(28:40):
You're doing great.
But we took the dad out of theroom because she was, she was
really focused and I think shehad asked to not be a part of
any.
Yes.
We wanted the dad to have themain source of conversation.
And then he could sort ofcommunicate slash make some
decisions like for her.
So she could sort of say in herspace, So we respected that and
we brought him out of the roomand we had a really serious talk
(29:04):
with him because we had already.
Recognized that there was somecommunication breakdown in
between what we needed to seehappen and the response to that.
And so we were really.
Serious about how, what weneeded to see happen next.
And so we told him, you know,the blood pressure is too high.
(29:26):
It needs to come down.
If it comes up any more thanwhere it's at, we're going to
need to transfer.
And so then he took thatopportunity to let us in on some
additional information and ourclients.
I'm sorry, I don't mean tolaugh.
It's funny.
Looking back in the moment.
We were not laughing.
(29:47):
It was not funny.
I was like this.
This is rude.
This is rude to not disclosethis.
So this is what I wrote in thechart.
I charted this.
Father of baby stated withoutmidwife knowledge, mom took a
coffee enema before her homeinduction protocol this evening.
(30:07):
Which is maybe what she wasdoing with all that time before
she started.
Well, it makes a lot of sensethat they were working on the
coffee enema instead of gettingthe birth pump yes.
Or breast pump.
So we discussed earlier, she wasreally sensitive to like,
Everything.
And so she couldn't take a lotof supplements.
She couldn't take certain herbsthat we recommended as we're
(30:30):
working on different things.
And just trying to like supporther system.
And so we were like, huh?
You added something in tosomebody who's a very, very
sensitive.
And now we're seeing this crazyhike in blood pressure that we
would not have anticipatedbecause everything was very
normal with that beforehand.
Yep.
So we're like, does coffee enemacause high blood pressure?
(30:52):
Huh?
Let's look that up 100%.
It does.
It can be that that associationis relatively common.
Yep.
And, and, but we don't have away of saying this is for sure.
The reason you have high bloodpressure and no matter the cause
of your blood.
Blood pressure.
Having high blood pressure isunsafe for you.
(31:13):
It's unsafe for your baby.
It's just.
It just is we hadn't, we hadmany feelings.
At that point.
So we, we discussed transport.
We said, we're going to keep aneye on this.
And if it goes any higher thanwhere it's at, then we
absolutely have to transport.
And he, he said something like,so what does that mean?
And we were like, If the bloodpressure increases, which we'll
(31:34):
be continuing to check on, thenwe have to transport.
And I remember talking to Kellythrough this for, you know, a
whole lot more.
Time, unpacking and processingthis.
Like, if we suggest thetransport are these.
Client's going to.
Cooperate.
Are they going to cooperate?
And if they do.
(31:55):
I think there was a piece of italso that we were like, oh man,
like we just w.
The tr the full trust orsomething just didn't feel quite
right.
And especially in that moment.
And I think it was sort ofdisappointing.
Yeah.
It was like, I understand thatyou.
Wanted to make some differentdecisions than what our
suggestion was.
That would have been helpful.
(32:17):
Two.
To, you know, at least disco, Idon't know.
Anyway.
But I do remember praying overher.
After we came back inside andbecause that is what she asked
for.
And so we prayed that her bloodpressure would be lowered and
that we would just have wisdomand navigating the next steps.
And the very next time we tookthe blood pressure, it was
already lowering, it was 1 44over 90 half an hour later.
(32:41):
It was 1 44 over 82.
And so then we thought, okay,we're trending in the right
direction.
Your coffee and a mum must bewearing off.
This residual side effects.
Great.
So then we moved to taking herblood pressure every hour, but
just, you know, half an hourafter we decided to do that,
it's 1130 at night.
So she started her inductionprotocol at six, we got there at
(33:04):
eight.
She's she, you know, had onlybeen in labor since like six 30
and she got in her birth tub at1130.
She started pushing about 20minutes after that.
And then she had a baby eightminutes after that.
So by midnight, she had a babyin her arms.
She had normal.
A normal blood pressure.
(33:24):
She had no signs of.
Any type of infection happening,you know, with her uterus or
systemically babies did not showany signs of like infection or
anything, smallest baby thatwe've had.
You had tiny little thing.
Oh, not the smallest.
Oh really?
No.
The absolute smallest was theBri the surprise breech.
Oh, wait for that one.
(33:45):
Yes.
Oh, okay.
And this one is a, this one waslike a few ounces.
Okay.
He was tiny little thing forbeing 40 weeks.
That's a whole nother.
That was a whole nother but herplacenta came 15 minutes on its
own.
She had 250 estimated bloodloss, which is like a cup of
blood, super regular amount ofbleeding.
She had six hours of labor,total.
(34:06):
She had 53 hours of rupturedmembranes, which that's a long
time.
That's 53 hours is.
It's pretty long time.
The longest we've grown sincethen.
The longest problem that we'veever had.
I think as far as my memoryserves me was 59 hours.
(34:28):
And that was like two yearslater with the client that we
had a lot of trust andcommunication and relationship
with.
And it felt very, very, verydifferent.
Yeah.
And that just goes to show youright.
That relationship.
The shift does matter, but alsowe were at a different place.
And our midwifery career also interms of our comfort levels and
(34:52):
how we were, how we werecommunicating with each other
and all of that.
Yep, absolutely.
So what a fascinating littlejourney, we talked a little bit
about like the lessons that welearned there were so, so, so
many, it refined ourexpectations of communication
with our clients and how wewanted to communicate that to
them.
What our expectations were ofcommunication.
And we learned that we can pushboundaries with some clients,
(35:15):
but not all clients can we pushboundaries with.
And that was a reallyinteresting lesson to learn that
a part of the individualizedcare that we give is really
assessing.
How much responsibility, howmuch trust, how much
communication, how muchcollaboration.
Makes us feel comfortable withgiving a more and more
individualized experience.
(35:36):
Yeah, for sure.
It definitely was probably themost uncomfortable.
I've been.
Us.
And midwife maybe.
Yeah.
I can think of a couple otherones where I've been really
uncomfortable, but this, thispiece of discomfort was more
relational than medical, I thinkfor me.
Yes.
Yeah, absolutely.
(35:56):
And I think that that partreally plays into it and I think
was.
Hard for us to peace out as wewere sorting through next
options and like praise theLord, we didn't have to make.
Any, big changes to birth plansat that point.
But it did, it did put us in aposition where we were like, oh
(36:16):
man, It really does matter thismutual fit idea and that mutual
trust.
Idea, but we also, you know, Ilearned some things learned
about coffee enemas.
Hypertension.
And we always now carry what'scalled Hawthorne in our birth
bags.
Never once used it since then,but that was the one that we
(36:37):
were like, yes, this is helpfulfor blood pressure.
We were like, this is soimportant for us to have
literally, I mean, I've taken itout and given it to my husband
because.
Mike, somebody's got to use itat this point, right?
Yeah.
Yeah.
But it's nice to know that wehave it.
So if we encounter any bloodpressure issues and we have a
tool because I hated knowingthat there was a tool that we
(36:57):
could have used for thatsituation and not having it.
And yup.
I even remember thinking, I evenremember looking up like store
like health food stores in thearea, if anything was still
open.
So we could just go grab thatone herb that we knew was gonna
help.
But we also learned aboutboundaries.
I mean, I learned a lotpersonally about what, what it
(37:17):
feels like when I am up againstmy limit and not feeling
flexible at all.
And that's just like aninterpersonal thing for me, but.
I also learned that like youKelly, just balanced that out a
bit and I can think of a couplecircumstances.
Where I have felt that way, likeI'm up against my limit.
And like, in that particularsituation, I think if I was the
(37:38):
only one making calls, I wouldhave just transferred.
Like I was upset that the trustand communication part was
broken.
And I just thought, what am Igoing to put, like my butt on
the line for this, you know,scenario, but you, you had more.
A little more compassion, alittle more reasoning, a little,
you were a little morecool-headed about it.
(37:59):
And you made a plan with them.
And it worked out.
Yeah, I'm thankful that itworked out.
It certainly, it would havebeen, it felt like a good
conversation to have, and to belike, here's the plan, but you
have to hear us that like, Wehave to be in this plan
together.
Right.
And if the, if we, I mean, itcould've gone the other way.
(38:20):
Right.
Oh, totally.
We don't have control over anyof those pieces.
Right.
But just really trying to createthe best possible scenario for
our clients in weighing all ofthose pieces out and taking it,
you know, heavy and serious.
You know, there are a few littlerandom things that can paint
outside of normal like this, andit's important to pay attention
(38:40):
to.
And I think that we did a lot ofdue diligence in paying
attention to those pieces, butit's good to remember that some
of those things can be, be alittle bit outside of normal.
And that we can bring them backinto normal or we can support
resolution into normal.
And that usually turned outokay.
(39:01):
And there's some things that youjust don't gamble with.
And it's really clear that like,this is not happening in this
particular space, but it's soimportant.
And we have such an opportunityin the way that we get to
autonomously, provide care thatwe get to look at each situation
uniquely and really figure outwhat some of those, you know,
different care.
Pieces look like for the personwho's right in front of us.
(39:24):
Yeah, for sure.
And looking back on this birthalso in like some of the vitals
and just the, how things playedout and like, Dang.
I wonder if midwife mean nowwould like what that would look
like and how that would actuallyplay out.
And if similar decisions wouldbe made and all of that, it's,
this is actually a very helpfulthing.
And I think more providersshould.
(39:46):
I mean, they don't necessarilyneed to get on a podcast and do
this, but this is so likeclinically helpful also.
On our end.
Yeah.
Like all of those differentpieces as a provider.
And I guess like one of thethings of course that I, that
I'm continually saying aboutthis birth is the value in
having you be a part of thatwith me.
(40:08):
Me and having somebody that youcan call, especially if they
have a different approach toproblem solving, especially if
they have a different approachto communication.
And there's just so much valuein us being able to practice
together because of that,because personality wise.
We're a little bit different andit just compliments each other.
(40:28):
And so that's another big plugfor practicing on a team,
practicing in a partnership.
Because when you just havethese, these one sided
viewpoints, and you're just outthere doing it on your own, you
have to make all the calls.
You have to hold all theresponsibility.
You, you know, it's just a lot,you would make different
(40:49):
decisions.
If you were practicing solo thanyou would.
If you had another, if you had apartner.
I a hundred percent agree withthat.
So hopefully this was like ahelpful at all.
Peek into this experience forus.
We are enjoying our time rightnow.
We're like halfway ish throughour very first beta childbirth
(41:11):
class that we launched.
We're just having so much fun.
We get to talk about some ofthese things that we even talked
about here just in differentways, as women are experiencing
different things in theirpregnancy and planning for their
births and just so much funleading that group of women
through.
Through just preparation for aconnected, peaceful birth
(41:32):
experience.
It's been really, really sweetto watch it all play out.
We would love.
As we open the doors andlaunched this officially out
into the world this summer.
We'd love to get you on the waitlist for that, so that you can
stay up to date with all of theannouncements.
You'll be the first to know whatour plans are, what is coming
(41:54):
what's ahead.
And you'll also get access to abunch of exclusive.
Content about pregnancy, aboutbirth, all that good stuff.
And so hop on there.
The link is in the show notes.
Yep.
And you can also find it abeautiful one, midwifery that
calm.
It has been a pleasure toprocess and unpack this one.
(42:14):
I mean, Wu, I guess there was alot there that I was not
expecting to remember all thefeelings I'm going to need to go
like sauna bag after the sun,just releasing things.
I agree.
Next week.
Bye.
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