It has been a slow year for Due Rewards Midwifery but a crazy busy year for the Midwife! For those interested in the personal life of the midwife, 2015 has been a banner year. After finishing up a busy spring and early summer, I took off the rest of the summer to finish preparations for my wedding. On September 12th 2015, Lisa Thomas became Mrs.Thomas Welch!

Amid all the traditional wedding photos, we also took a very special picture, unique to a midwife Bride. A photo of all the babies whose births I had attended, who were also present for the wedding. Despite being out of state for the wedding, we were still blessed with 18 ‘babies’, the oldest now 14 years and the youngest only 5 weeks! What a special photograph to cherish for a lifetime.

So, the question is of course, What’s Next for Due Rewards Midwifery? While I am still enjoying some time off, I anticipate attending births again late this fall on a part time basis. The rest of my ‘working hours’ I anticipate spending in developing new classes for Due Rewards Midwifery Academy! First on the agenda will be ‘A Change of Heart - Part 2 Interpreting Fetal Heart Tones during late Pregnancy, Labor and Delivery in an out of hospital setting.’ An in-depth course suitable for both midwives and students. So much of the information for FHT specifically targets in-hospital providers, but this course will strive to provide a way to interpret and document this data in an out-of-hospital setting. I anticipate the class debuting with a live instructor in very early 2016 and on video later in the year. Stay tuned for exact dates and times!

Thank you to all who supported and celebrated with Due Rewards Midwifery during this amazing year. We couldn’t have done it without you!

GBS is a type of bacteria that is gram positive, which means its protective wall is easier to breach with antibiotics or disinfectants than its cousin, the gram negative bacteria. GBS is a common environmental bacteria, meaning that is can be found in a lot of places and can be picked up in a whole host of ways (as opposed to the weaker bacteria responsible for STD’s).

GBS is commonly found on our skin or mucous membranes, but should not be found in areas that normally are sterile, such as the blood or spinal fluid. When someone has GBS on their mucous membranes (intestines, vagina etc) but not in areas of the body usually sterile, this person is said to be colonized with GBS. We are all colonized with a host of different bacteria, so being colonized with GBS isn’t a problem. In fact as many as one in three women are colonized with GBS and it causes no problems. So, why are we making such a big deal about GBS in labor and birth? The reason is that if GBS crosses the membranes and finds its way into the blood or other areas usually sterile, it can cause a severe infection. At this point we refer to it as GBS disease.GBS disease is particularly problematic in newborns as it is the most common cause of newborn sepsis, a severe infection. GBS disease can be life-threatening to newborns (about 5% of babies with GBS disease die) or cause other long term problems such as hearing loss, brain damage, or vision problems. Babies can sometimes fully recover from GBS but it is a severe disease. Because we know that mothers who are colonized with GBS are more likely to have a baby with GBS disease than mothers who are not colonized, GBS colonization becomes an issue during late pregnancy.

The first challenge with GBS is figuring out who is colonized and who is not. Testing for GBS takes around a week in real world practice. Consequently, we must test women at the end of pregnancy instead of in labor to allow for the turn-around time. This becomes problematic when we realize that GBS is transient, meaning that the same woman may test both positive and negative during a short period of time. Sometimes the immune system effectively eradicates GBS from the body and sometimes it simply holds it in check on the membranes. So a woman may be colonized at the time of testing and not colonized at the time of birth or vice versa. A test to determine in a matter of hours is not yet available, so the issue becomes checking a woman as close as possible to the time of birth, but still having time to get results back before labor begins. It’s a system filled with inaccuracy, but currently is the most effective factor in determining who is at risk for developing GBS disease. Health practioners also take into account a few other risk factors, such as a fever in labor, prolonged length of time with ruptured membranes, or a baby born prematurely.

Since around 1970, when we first found GBS to be a cause of newborn sepsis, we have been battling this infection.Great advances have been made, both in reducing the number of babies infected and reducing the number of infected babies who die. We have tried all sorts of methods to combat this infection, but we keep hitting roadblocks. Of course, the ideal treatment to combat GBS is to prevent GBS disease from ever happening while causing no ill effects in the process. But that’s like saying the ideal dessert tastes like cheesecake, yet has 6 calories and is made from spinach. It’s a nice thought, but it fails to hit the realm of reality. So it is with the reality of GBS treatment, any intervention that we do has a side effect.

Currently, the CDC recommends all women be tested for GBS at the end of their pregnancy. For mothers who are colonized (test positive) with GBS, they recommend IV antibiotics in labor. The reasoning behind this recommendation is simple. Mothers who test positive for GBS have higher chance of having an infected child than mothers who test negative. So we give these moms IV antibiotics, which will serve several purposes. First, the antibiotics destroy the bacteria in the mother’s vagina, secondly the IV antibiotics will cross the placenta and enter the babies blood stream and destroy any bacteria the baby may pick up as it is born through the GBS colonized vagina (routes besides IV, such as IM or oral cannot cross the placenta in time). This will result in fewer babies becoming infected. Again, it’s a nice thought. Who wouldn’t want to reduce the number of sick babies by administering antibiotics to a laboring mom? But, unfortunately, this treatment has a cost associated with it and it doesn’t always work either.

The main problem with this treatment is that we are massively over treating. One in three moms are colonized with GBS, but only 1 in 100 moms colonized with GBS have a baby who develops GBS disease. Treating all GBS colonized women exposes many mothers and babies to unnecessary antibiotics and their risks and side-effects. These risks include very minor things such as yeast infection, thrush, etc. to very major things such as life threatening allergic reactions (anaphylaxis). Severe problems from antibiotics are extremely rare and many consider the benefits to outweigh the risks. Others continue to hypothesize that we do not yet fully understand the risk of antibiotics and consequently are needlessly exposing mothers and babies who are not at risk for GBS disease to risks we do not yet understand.

Unfortunately, we also have only poor evidence to prove that IV antibiotics actually reduce the number of babies dying from GBS disease. Most of our solid evidence is over 20 years old, highly biased and based on too few women to actually be accurate. Regrettably, we no longer have opportunity to do new prospective studies because IV antibiotics have become general practice. But we have several retrospective studies that seem to indicate IV antibiotics are effective. One of the most convincing proofs is the rate of babies affected by GBS disease in the 1990 vs. 2010

1990

Roughly 1 in 500 babies developed GBS disease

Fatal in 1 of 1,000 births

2010

Roughly 1 in 4,000 babies developed GBS disease

Fatal in 1 in 80,000 births

So, antibiotics for GBS colonization become a hotly debated topic. The truth, in short, is that it’s always someone’s opinion.Two experts can look at the same studies and come up with different conclusions. It is important for parents to communicate with their care provider to help develop the best strategy to protect their baby. Not all parents will fall in the same risk category, some may have higher or lower chances of their babies becoming sick with GBS. Some moms may choose not to test for GBS while other moms may choose to test and both moms passionately defend their position. Some moms may choose antibiotics while other moms may choose more alternative or natural means. Because the controversy is hotly debated it can easily feel like one way is better than another when in reality circumstances surrounding GBS greatly effect and change from one situation to another. As with all subjects of controversy, discussing GBS within the context of the individual situation leads to the best solution. Because GBS is a complex problem it will not have a simple solution. Informed consent is crucial in determining if you should group B or not group B.

It was a midsummer’s night, the day had been hot, and the welcome evening breeze caressed the land as the moon rose and began its course through the night sky. The ambient noise of the cicadas filled the evening air as the aroma of freshly mown lawns wafted along on the breeze. Here and there dots of light shone out as fireflies danced in the air.A small, but stately cottage nestled among the oaks, with a welcoming porch light completes the landscape.Nestled deep within this cottage lies the most precious of all sounds, that of life’s first cry. Gazing within the home, the happy mother, dressed in a flowing white nightgown greets her newborn for the first time with uncontainable joy.After the first few cries, the newborn settles down into a peaceful sleep with perfectly rounded rosy cheeks, looking like the Gerber Baby, wrapped in an heirloom blanket from generations past. The pristine room is filled with warm light and flowers as father and grandmother softly look on with the gleam of love filling their eyes. And in the hidden corner of the room, stands the midwife. Looking like a supermodel with every hair in place, she is completely rested and well-fed. She smiles as she packs away the few supplies and leaves the family to enjoy their first night with their newborn, who will soundly sleep until the gentle dawning of the new day… and the pigs fly overhead.

It was the dog-days of summer. Triple degree heat had baked the landscape to dry brown grass and the evening ‘breeze’ made you feel like you were in a dryer. The noise of the cicadas was hardly noticeable because the combination of the air conditioner and traffic created enough noise to drown out a thunderstorm. The aroma of the freshly mown lawns would be rather obscured by the smell of the opossum that met his tragic end crossing the road earlier this week (I wouldn’t even venture to guess why the opossum crossed the road). The apartment complex at the interchange of two major highways boasts all of one oak tree that’s nowhere close to ‘nestling’ anything as it fighting for enough water to survive.And high in that apartment complex lies a truly remarkable sound, occurring at about 3 am, Life’s first cry. Gazing within the home, the mother, exhausted and spent with a long labor, swollen from the heat, the pregnancy, and the pushing, greets her newborn for the first time with uncontainable joy. The child squalls and is quickly dried and wrapped but continues to squall. Red faced, wrinkled, with a hat covering his molded head, and looking a little the worse for wear, the newborn looks for food. Birth supplies, towels, and paraphernalia scatter the floor and surrounding area as father and grandmother lovingly look on the newest member of the family. And in the corner, the midwife sits. Looking like something the cat dragged in, clothing disheveled and hair plastered to her head, she fills out pages and pages of paperwork as she smiles at the new family.

Each of us has a unique perspective on life.Two people can attend the same event and come back with very different stories of what occurred. Two midwives, let alone the mother or family members, can attend the same birth, hear the other’s perspective and say “Were we at the same birth?” (Just as a side note, you should hear the midwives telling birth stories, it’s like fish stories. “I once caught a baby that was the size of Rhode Island” “Oh really? I once had surprise twins and they were both Harvard Graduates by the time they were 2.”)

Women love to share the stories of their births, and many mothers gain comfort and wisdom from hearing the stories of those who have gone before. It is a wonderful thing to listen as mothers encourage other moms with their experiences. But strangely enough in all the passing of stories, sometimes it’s easy to lose sight that every story is different. That what happens to one mom (or midwife), will not necessarily happen to all moms and doesn’t make one mom better than another. That one story may be told remembering certain aspects of the birth while not going into the reality of what all went on before (or after) the moment of birth. This is certainly not wrong, but good for new moms to remember as they prepare for birth. Birth is as individual as the baby that is born, and each mom must go through her own birth, whether it goes as planned or takes a dramatically altered course. So I encourage moms to listen to the stories but remember that her birth and her story will be her own. At the end of the story, there will be the love of a mother for her child and regardless of the story she can say “It is a far, far better thing that I do, than I have ever done”

For instance:

Few restaurants stay open 24/7… but those that do will be known to all midwives in about a 50 mil radius

How to sleep on… a couch, one half of a couch, one third of a couch, a folding chair, standing against a wall (the one I haven’t mastered yet is how to sleep while driving…)

Sleep deprivation will lead you to believe… that any temperature below 85 degrees is subzero and wish you had a parka

A small car can contain… a spare wardrobe, a mini kitchen, a birth kit, and still have room for 2 assistants, a birth ball and a dehydrated shower

The best time to avoid traffic is… usually between 1 am and 3:30 am, before this the late night traffic is still out, after the morning rush hour has begun

At a homebirth… there will be one area where in the house is too small for a birth, this is the area the mother will birth the baby. It might be a good idea for midwifery schools to start requiring course in acrobatics.

White carpet is always a bad idea…

A fifty cent bottle of hydrogen peroxide can save hundreds of dollars…

Of all the midwifery skills… the skill of doing nothing, may be the hardest to do, to learn and to teach

Nothing beats the moment of… watching a new life emerge into a world welcomed by the love of family, (but some days crawling into bed after a long birth just might be a close second…)

But while all these preparations are taking place outside the body, it is only a token of what occurs within the body. Such an amazing journey the mother’s body undergoes in only 9 months.Looking only at the uterus, that begins the size of pear and ends the size of watermelon, the changes are extreme. This amazing organ, blessed with the office of housing a developing life is quite fascinating. Composed of mostly smooth muscle, it has an amazing capacity to grow. By the end of the first trimester, I’m barely able to feel rise above the pubic bone. The second trimester, those same muscle fibers now stretch accommodate the growing baby, reaching the size of a cantaloupe and even a casual observer can tell that a new life is growing within. By the third trimester, these muscle fibers have thinned and stretched to the point I can now feel through the wall of the uterus and make out the outline of the baby. Stretched to what seems the maximum of its ability, the uterus at full term must now perform the hardest work it will ever do. The muscle, having been stretched to incredible lengths, must now rhythmically contract and shorten in order to force the baby out into the world.

But in addition to the stretching smooth muscle, the uterus also has an outer lining, the perimetrium, which is a marvel in itself.Encasing the uterus, it is a smooth layer of cells that must grow to accommodate the developing baby, but also to allow the uterus to grow without damaging the other organs of the mother’s body. The perimetrium keeps the uterus very smooth and slippery, allowing it to slowly grow into the abdomen without causing friction, and therefore damage, to the organs that it is slowly displacing.

And inside the uterus, a layer of cells, known as the endometrium, has its own duty. From the first few days following conception, the endometrium becomes the home of the new baby. The cells that will become the placenta, burrow deep into this layer of the uterus, securing a blood supply with all the necessary nutrition for the baby.

Such an amazing organ, capable of growing more than ten times its original size, yet returning to its non-pregnant state within a remarkably short time following the birth. it then remains hidden and tucked away until such a time as it may be needed to again make ‘much ado’ for another new life.

As the years pass, I frequently make my way to this home. Each time the joy is the same. Each time there is a new name for a daughter, but the same name for the son, waiting to be claimed.Six consecutive times I came, bags in hand, smile ready to greet the newest member of the family.Six times I was not disappointed by the familiar joy that filled the room at the announcement. “It’s a GIRL!”

My car recently made its way to this home again, to join in the joy of welcoming a new baby, this time the seventh. I arrive, no longer a brand new midwife, to a well-known house, well-used bags in hand, and with a well-practiced smile ready to greet the newest member of this family. Labor progresses, the moment comes to welcome the new little one. But this time, an especially entertaining twist of events. There is the familiar room, the familiar faces, the familiar sound of life’s first cry, the familiar joy that pervades the room, but a very unfamiliar announcement. “It’s a BOY!” Delight and surprise mingle to make the beautiful picture of a family much in love with the newest member.

Beyond the privilege that belongs to the midwife of watching a baby grow within the womb, midwives also have the honor of watching families grow. Few midwives are given the honor of attending all the children for one family, even fewer are given the privilege of delivering seven members of one family. So I reflect with gratitude both to this family and to the Lord for giving me such an honor, as I add another picture in my memory of the Joy and Love of Family.

Welcome little man, we are so glad you came to claim your name.

Sometimes I feel like I’m climbing my very own cliff of insanity in midwifery. Telling an overdue pregnant mom that the best solution you have for her is to wait, feels pretty insane. As the aches and pains of being heavy with child combine with the anticipation of the much awaited day coming very soon, I feel as if there are many promises of how much better it is to let spontaneous labor occur on its own. There is information on the benefits of not hurrying the end of pregnancy, of remembering the crucial development of the baby’s lungs that occurs at the end of pregnancy, and of the risks of intervention to hurry labor along. Pregnancy is something that simply can’t be hurried. Still, at the end of the day, I just feel like the mom says, “That’s very comforting, but I’m afraid you are saying I’ll just have to wait” and everybody, from midwife to mom wants to say “I hate waiting”.

I would love to be able to end the difficulties of the last few days of pregnancy, and the challenges associated with an unknown time and date and just get labor to happen. But if I could, just think how royally I would mess it up. How easy it is for me to be so caught up anticipating the future, that I miss the joy that I currently experience. For, if I live in constant anticipation of the birth, I risk missing some precious moments that happen. I do enjoy listening to the heartbeat of a new life still within the womb, watching the baby’s tiny limbs move within the mother, and seeing the light of love grow in the eyes of parents anticipating this new life. I do like knowing that labor will not happen on my timetable, but in His time. And eventually, it will end and I will know this baby’s birthday. But even all this I seem to think is, “very comforting, but you’ll just have to wait” and we all know in my flesh, “I hate waiting”.

So for all my musings, I can only say, yes, the best solution I have for an overdue mom is to wait, but I know the One who will determine when the waiting will end. We can trust Him and the best solution I have is to wait, but I will wait with you.

Tucked deeply within the womb, each tiny baby grows, dependent completely on the placenta and the mother’s body for every need. The infinitesimally small size of the heart as it forms in the first few days of life astounds my brain. Even as it is forms it begins to pump red blood cells through the baby’s new body that is still beyond recognition to the human eye. The baby grows and the heart becomes more sophisticated. The blood pumps from the baby to the placenta where it exchanges carbon dioxide and waste products from the developing baby for nutrients and oxygen from the mother’s blood stream.

As time passes and the baby grows, the first batch of red blood cells finish their work and die off as the next set of cells takes over. The waste products from the cells are placed into the baby’s intestines to await the first bowel movement (often times ending up on the midwives scrubs in about 6 months.) The tiny body makes new blood cells, more and more as the need for oxygen increases as the baby grows.The cells become too numerous to count as the baby grows to a term and healthy newborn. Soon the placenta fulfills its duty and becomes the first organ of the baby to fully complete its role within minutes of the baby’s birth.The moment of birth has arrived. The uterus contracts and soon the baby is bathed in the light of the outside world. The lungs expand with vigor, the newly fashioned alveoli filling with life’s first birth. The body quickly finds the new lungs far easier to transfer oxygen than the placenta and no longer needs so many red blood cells to do the job.Within a few days the baby has become overrun with red blood cells that are no longer needed.Knowing there are too many, the miniature body breaks down the red blood cells into their respective parts. The iron molecule is saved for future needs, but the bilirubin, or waste products of the red blood cells, just need to be disposed. Usually, this bilirubin would progress on its journey to the liver to be processed (conjugated) and sent to the intestines for disposal. But the already immature liver can’t handle such a large influx of bilirubin all at once. Consequently the body has to store the bilirubin somewhere, awaiting such a time as the liver is able to process it. Most of it is stored in the baby’s skin.After years of study, we finally uncovered why it would be stored in the skin. While most bilirubin makes its way to the liver for processing (conjugating) the bilirubin that makes its way to the skin can be processed into disposable ‘parts’ when the sunlight hits the baby’s skin taking the strain off the liver while still allowing the body to dispose of the bilirubin. Such an awe-inspiring design that the skin and the sun would work to decrease the load on the liver! In addition to the sun, we also discovered ‘bili-lights’, that act like synthetic sunlight to allow the body to break down the bilirubin when sunlight is not enough or not available. This process is ‘phototherapy’ and is commonly used to protect newborns from the ill effects of too much bilirubin in their system.

Yet another reason to enjoy the summer sun and stand in awestruck wonder at the incredible Creator who designed the body so that the light of the sun has a place in protecting the newborn baby.

It all depends on that 90 seconds. If I’m standing in line at the grocery store, 90 seconds seems short, but if I’m holding my breath, 90 seconds seems like an eternity.

We are curious creatures; we seek to understand the mysteries that elude us. We search, we discover and of all our discoveries, the one we need most of all is to discover how very little we know.After years of research, we still don’t know what makes women go into labor. We still can’t tell you how to cure stretch marks, we can’t tell you why some women develop complications with pregnancy that others do not. We find clues, we discover new ways to help, but we haven’t found the answer. Still, we keep looking; we pursue the things that evade our grasp.

I am grateful to those who in recent years researched if even a 90 second delay in cutting a newborn’s cord would actually make a difference in outcome for that baby? Through their efforts we discovered that what we thought we knew about clamping a newborn’s cord was not only wrong, but possibly harmful to a newborn.

From the work of many, we understand that after a baby is born, the circulation in the baby and the umbilical cord begin to change. The pathways in the baby’s heart change quickly from fetal circulation to newborn circulation. During the first few minutes after birth the vessel taking blood from the placenta to the baby allows the nutrient rich blood to ‘transfuse’ the baby, unless something clamps the cord and hinders the flow.

We used to think that waiting a few minutes to clamp the cord would increase the levels of jaundice in a newborn due to the increase in blood cells that would go to the newborn during those few minutes. High levels of jaundice could eventually lead to brain damage through a rare condition called ‘kernicterus’. For years birth attendants strove to protect the newborn from this by clamping the cord as soon as possible after birth. But as with many things, we are still learning. Thanks to the curiosity of a few, many babies can now benefit from the discovery that waiting for the umbilical cord to stop pulsing before we clamp it is actually filled with health benefits and this actually outweighs the risk of jaundice. One such benefit is the increase in iron that the newborn receives from the ‘extra’ blood cells. Iron is a necessary nutrient and a deficiency of iron we are now linking to decrease in cognitive function. So delaying the clamping of the cord may actually increase the baby’s cognitive function. The very thing we were trying to do by immediately clamping the cord. Around the globe, organizations are pushing to have this new research take hold and allow for a delay in clamping the cord. (http://www.who.int/elena/titles/cord_clamping/en/) Education is never complete but a continual journey, an upward climb to discover more! Oh that we may remain humble to search out the vast mysteries and be willing to change our practice as we learn more of the incredible creation of the human body.

Ninety seconds is such a short time, yet can be of such importance.

These are all moments I am privileged and honored to witness. But after the birth, after the postpartum clean up, if the timing is just right, I may get to witness yet another moment of wonder that delights my heart. It doesn’t happen at every birth, so when it does the midwives fan out, trying to find the best, yet most unobtrusive vantage point. It is the moment the toddler sibling first lays eyes on the newborn.It is a moment no one can quite predict.The tired mother who has just been through so much revives to show forth her precious treasure as the proud papa carries the toddler into the room with infectious joy. The sleepy toddler rubs his eyes amidst the flash of grandma’s camera and tries to discover what all the fuss seems to be about.At first he is more overjoyed to see mama than he is what she’s holding. Slowly for some and more quickly for others, they begin to notice the tiny bundle mama wishes to show them. Large eyes scan the room for cues as to what to do next. Chubby fingers alternate from his mouth to pointing towards the baby.Then he is asked to hold this precious bundle. Wonder shines from his eyes and joy shines from the eyes of the family in watching the reaction. The scene seems like it’s out of a picture book until this very bright toddler tries to point out the newborn’s eyes and an adult jumps to the rescue, just before the newborn receives a face full of brotherly affection. But you must watch this moment fast because at an unforeseen time, the toddler will lose interest and run to show the newborn his latest truck, returning with 6 hard toys and attempts to drop them right on the newborn’s face.

The scene repeats itself from family to family as the wonder of new life breaks upon the shores of everyday life. It crosses the cultural barrier and is a moment of joy captured on cameras around the world.And just outside the frame of the photo, the midwife stands enjoying her privilege of witnessing the wonder of it all!

Rhesus Monkeys are small furry primates, native to much of Asia, who have been beneficial in the discovery of many medical breakthroughs over the years. In the late 1930’s early 1940’s Doctors were able to use the Rhesus monkey in understanding a particular marker on the human red blood cell, and so from the Rhesus monkey, the Rh factor got its name.

The Rh factor is an antigen, a specific microscopic ‘marker’ that is part of the red blood cell. Most people have this particular marker on their red blood cells, they are termed Rh positive (+) but a few people don’t have this factor, they are termed Rh negative (-).Who cares? Well in the normal day to day life, nobody. Rh positive blood will look just like Rh negative blood if you happen to cut yourself. But we do know that it becomes very important in the event of a blood transfusion, or in the event that a pregnant mom happens to be Rh negative.

This tiny marker on the face of the red blood cell causes the body to see that cell as belonging to the person who carries it. It is seen by the body’s immune system as part of the body and therefore to be defended. However, for those without this tiny marker naturally on their cells, their body sees any blood cells with this marker as foreign. If the body is exposed to this foreign antigen, the first time it sees it, it will recognize it as foreign and develop specialized antibodies, like soldiers, specifically designed to attack any time they see this particular marker.

This becomes incredibly important when it comes to expectant mothers who do not carry this marker on their blood cells, but are carrying a baby who does carry this marker. While the blood supply of mom and baby shouldn’t normally mix, it does occasionally happen at the time of birth or in the event of an accident or anything that might damage the placenta. If the blood cells of the baby carrying the marker gets into moms blood stream, this signals her immune system to produce these ‘soldiers’ should she ever see this marker again. Mom’s first baby isn’t affected because she just developed these soldiers after the mixing. But should Mom become pregnant with a baby who has these markers on their blood cells again, these tiny antibody ‘soldiers’ are already in her blood stream and will quickly cross over into the baby’s blood stream and attack the baby’s red blood cells. Mothers who have developed this antibody are called isoimmunized. Isoimmunization leads to major problems with future babies. Her second baby, with the help of much modern technology, may go on to live a healthy life after being delivered early, but a third and any subsequent baby is likely to have problems so severe, that it cannot live.

This heart wrenching problem of a mother that simply miscarries and miscarries is unbearable. Such heartbreak for her and her family left us searching for an answer to treat this problem.Since shortly after the discovery of what was causing this problem, modern medicine has been blessed to find a ‘treatment’. The treatment though, is not so much a treatment as prevention.We have discovered that if blood mixes between mom and baby and the mother develops these antibodies (soldiers) its too late. Word got out to the body that foreign cells have invaded and now we have a full blown war on our hands. But we also know that if we can destroy any blood cells before her body recognizes them, we can keep her immune system from developing these antibody ‘soldiers’. The way these cells are destroyed is to give the mother artificial antibody ‘soldiers’ to go and destroy the red blood cells that entered the system and destroy all the evidence before the body’s immune system can make its own.This amazing breakthrough, (we call the artificial antibody ‘Rho-Gam’ or Rh-D antiglobulin) has saved countless lives. But it only works as a prevention, not a cure. You can’t give it to moms who have already developed their own antibodies or you’ve simply complicated the problem.So, we started to give mothers these artificial soldiers after delivery of a baby who has these markers on their red blood cells, just in case some should have crossed over.And it turns out we reduced the rate of mom’s who were effected drastically. We then started giving these soldiers at the end of pregnancy as well as after delivery and we found that we reduced the incidence of moms developing this to less than a tenth of a percent.This amazing breakthrough in understanding has saved he lives of countless babies.

So, today I am grateful for a monkey, who helped in the quest to improve the lives of innumerable people across the world!

Student midwives, ah what a grand thing. They have brought such joy to me as I have progressed in my journey in midwifery. But some things are just impossible to explain to bright eyed energetic midwifery student who wants to pursue midwifery. Of course going into midwifery I was hazed as well as the next, but I still had no idea what I was walking into. You hear all manner of stories when you are beginning midwifery. Because we all know, midwives tell stories. If you have the chance to hang out with a group of midwives, chances are they are telling stories.And the subject material we have for our stories rarely blends well with dinner conversation, not that it ever stops us from discussing it over dinner. A group of midwives eating at a restaurant is about as subtle as a flock of parrots in a library.We eat, we tell stories and the uproar that follows is rarely low on the decibel scale. I’ve often wondered what the other patrons of a restaurant think when the midwives get up and leave.(Honey, what WERE those ladies talking about?)

As a student I was told stories of midwives who worked long hours and the sheer ‘slap happiness’ that can happen after 40 + hours of working in a day. But then I lived those hours and I was the one slap happy, who slurred her words and tripped over her own feet. I earned that story.

You hear midwives talk about having car trouble on the way to births, but then I was the midwife who had a client in labor going fast.I get all loaded up and in my car to peel out for the birth. I hear an unfamiliar thumping as I drive down the road heading for the highway. The thump, thump, thump, just can’t be good. So, in the midst of my hurry I get out of the car and the students hop out. Together we examine the underside of the car. ‘Is this piece of rubber supposed to be hanging off the tire like that?’ Yeah, this is not the time to be needing new tires. Turn around and go back to find a another car, jump in and head out trying to recover the time lost discovering your tire has developed road-pattern baldness. Finally, you make it to the client’s home, forget all manners and barge into someone’s home, all the while hearing the sound that the baby is fast approaching. Within 20 minutes, I was smiling at a new mother and baby enjoying their first moments together and wondering how quickly I could get new tires. Can’t quite explain the way that feels, you can only live it, and tell the story.

Some defining moments in a midwife’s training include the first times she finds a baby’s heart rate on her own, or assesses dilation without a preceptor, the first time she discovers she knows the difference in a head down baby and a breech baby, the first time she gets a primary client of her own, the first time she is the first person to touch a new life as it emerges fresh from the womb. No one can tell you the way it feels the moment you get the envelope that contains the result of your final test. And certainly no one can prepare you for the first time you attend a woman all on your own and your preceptor is home in bed because you have completed your training and bear the letters CPM after your name. No one can tell these stories for you, they are a story all your own. Just as each baby has its own birth story, and each mother embraces new life in beautiful uniqueness, each midwife has her own story.

So tonight I congratulate the new midwives who’ve just taken their final test. Your journey to midwifery has been different, for some attaining to this has been a relatively smooth road, for others the journey has been rocky, with uphill battles. Your journey to become a midwife may be ending, but your journey in midwifery has just begun. Congratulations! Carry high the banner of midwifery and we look forward to hearing all the stories you’ll tell!

Imagine an Olympic event with the sports announcer, “And today the discipline we award medals for is who can birth the largest baby, and then tomorrow stay tuned as we watch the race for the fastest labor!” Such a ridiculous thought is hardly even laughable, and yet somehow in more subtle ways we attempt to make the idea of ‘success’ in childbirth something that can be quantified.

As a student, I completed about 95% of my clinical experience after I completed my academics. So when I first started, my academic knowledge outweighed my experience like an elephant trying to ride a unicycle.I had read about birth and complications and all manner of related information. As well as these books are written, and as much as I studied them, these things were still words and numbers on a page. Academics are a vital and important aspect of midwifery, but as my apprenticeship unfolded I became more aware of the reality that these words and numbers all equate with real people, who have real lives in a real world.

I am so glad to see that recently a large study by MANA (Midwives Alliance of North America) addressed the safety of homebirths. The study examines more than 16,000 planned homebirths from 2004 to 2009 where the woman consented at the beginning of her care to have her chart entered in the study. The size of this study is pretty impressive considering that homebirth still accounts for only about 1% of births in the United States. Over 89% of women who began labor at home succeeded in having a homebirth, the remaining 10% were transported to the hospital. The study included the outcomes of the women transported as well as those who had a homebirth and concluded that the risk of homebirth was relatively the same as the risk of hospital birth, but with fewer interventions.This is exciting additional proof of something the midwifery community has long been sure.Kudos to the many mothers, midwives, authors, and supporting staff needed to accomplish and publish a study such as this. Success for homebirth! I award a gold medal! (If you want to read the article you can find it here http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract )

As I celebrate the findings of this study, I also think back to when the data was first being collected and one of my preceptors was participating in the study. It’s pretty crazy to think that a few of the births that were in the study were births I attended in some capacity. These I can connect with in ways beyond the ‘numbers’ on this page. These I can remember the anticipation, the defining moment, the anguish of pain, and the ecstasy of joy. From this I can better connect into the life lived beyond the pages of the study and into the homes and lives of the women behind those 16,000+ births. Births where success was not measured the place where birth actually occurred, but rather birth was an intimate and extraordinary event in these lives.

So tonight, I applaud the new MANA statistics study, I revel in the success of such a study, but I also applaud the women behind such a study, the real lives that are in the numbers we read on these successful ‘Gold Medal’ pages.To these women, in gratitude, I say thank you for allowing us all to benefit from your experience, whether your birth was one of textbook perfection or of great difficulty, thank you for letting us benefit from your ‘number’ and gather more information to those who will come after.

For the past several years, I have developed and taught several different midwifery classes. This weekend, I attempted to capture them on film. After 2 days, and 8 hours of recorded sessions, my feet are killing me, but my heart is happy.

I enjoy teaching. I thrive on the “light bulb” moments. The times when I understand and grasp the concept, and the times when I notice this “light bulb” in those I am teaching.

Of the many concepts in my research for this week’s last class, a class on understanding the thyroid, one thing stands out greater than the others. It is the thyroid binding globulin.Before I started researching for the class, I couldn’t have told you what it was or even that it existed. But let me tell you why I marvel at this tiny strand of protein, The Thyroid Binding Globulin.

The Thyroid, a small endocrine organ, is located right below your voice box.The thyroid’s main purpose is to produce hormones that enable the body to convert the calories you take in, into valuable energy. However, these hormones can’t get where they need to go unless they are protected by something that will pick them up from the thyroid and take them to where they are needed. This job falls to the thyroid binding globulin.

Thyroid binding globulin is produced by the liver and made in such a way as to be able to bind with the thyroid hormone, take it where it needs to go, and drop it off only where it needs to be. Tiny, yet extremely complex, this globulin (measured in kilodaltons, a unit of measurement that is about 10 to the negative 27^th power of a kilogram) has 394 amino acids in an exact and precise layout that allows it to do its very important job.

This astounds me. A tiny strand of protein, with complex layers, designed specifically to pick up only this hormone and drop this hormone off only where it’s needed.And while this astounds me, what really blows my socks off is that this globulin is present and functioning in baby that is only 12 weeks gestation.

Twelve weeks, just three short months to go from non-existent to a baby with a functioning thyroid and matching thyroid binding globulin. Not to mention the myriads of other functions occurring in this tiny life! My mind just cannot wrap around the intelligence of design required to create something so complex.

And so I stop to marvel again, and stand in awe of God, my Creator, who can not only plan out such a complex globulin, but who created it, and made it function in me, when I was yet unborn.

Truly, “It is the glory of God to conceal a matter;to search out a matter is the glory of kings.”

I am a midwife currently practicing in the DFW area. Having begun my journey to midwifery at the age of seventeen, I have seen the world through the eyes of midwifery for my adult life. From the thrill of a woman’s first positive pregnancy test, to the special moment of hearing the baby’s heartbeat for the first time, to the first movement felt both from the inside and from the outside of the womb, pregnancy is unlike any other season of life. Then the seemingly interminable waiting for labor to occur, the excitement of the first contraction, the relief of the last contraction, and all that comes in between. And then it happens. It is a sound, the sound that makes the sweetest of music fade in comparison, a sound that melts some of the toughest of men and causes hearts to sing, it is the sound of life’s first cry. The nearly involuntary smile that spreads across the room is proof of this sound’s heavenly origin. These are the moments that shape my own little view of this world. They are not the only moments, but they are moments that I am honored to witness.

Being involved in training student midwives for years now, I have also been honored to witness another frame of life’s special moments. The thrill of a new student as she attends her first birth, to the joy as she catches the rhythm, the light of understanding that spreads over her face as she gains understanding of the concepts involved, the excitement as she realizes she is the first to touch a life fresh from the womb, and the sense of achievement as she passes from student to midwife. These are also moments that serve to shape my view of the world.

I love learning and I love watching others learn. The joy of learning has led me in many directions. These include things such as teaching in a classroom setting with CEU workshops and conferences, to impromptu student teaching “sessions”, generally occurring between the hours of 11 pm and 2 am. I also frequently focus on one topic of midwifery that becomes the current ‘vent’ that permeates teaching conversations and dinner conversations, and hopefully doesn’t spill over to the poor cashier checking out my groceries. Perhaps a blog will help catch some of those topics before they spill over on the unwitting person who dares cross my path. Welcome!