Ashley and Grey are so happy to welcome their first child into the world! Atlas was born on May 23rd at 10:02 pm. He weighed 7 pounds 13 ounces. His birth was attended by midwives Caroline and Manga and student midwife Mollie. These lovely photos were taken by his loving grandmother Deena of AlaskanFrostPhotography.com. Congratulations!
Welcome Jeremiah!
John and Teri welcomed their son Jeremiah in a peaceful homebirth attended by Caroline and Manga on May 1st 2018. Jeremiah weighed 8lb 13oz and is the 4th boy in the family!
Teri is pictured here with her oldest and youngest sons.
Congratulations!
Welcome Aaron Lucas!
Congratulations to Shannon and Keith and the birth of their son Aaron Lucas! This was their first child born at 3:53 pm on May the 4th 2018. He weighed 8 pounds 8 ounces. His birth was attended by Midwife Dana, birth assistant Nickol and Student midwife Mollie. We are so very happy for you!
Welcome Kayden!
Please join us in congratulating Heather and David! They welcomed their son Kayden in the Lake Room on April 20th 2018. He weighed 10lb 13oz. His birth was attended by midwives Manga and Caroline. We are so happy for them!
Welcome Ronan!
Kara and Cyrus are overjoyed to welcome their first child Ronan into the world. Mom labored many hours at the Birth Center and transferred to FMH where their darling baby boy was born at 6:12 pm on April 25th 2018. He weighed 8 pounds 7 ounces. His birth was attended by Midwives Dianna and Kate. Congratulations!
Welcome Otto!
Jessica, Dayton and big brother Schuyler are very happy to welcome Otto to the world. When it was time to be born this sweet little boy came in a hurry. He was born at home into his Father's hands on April 20th 2018 at 1:20 am. Midwives Julie, Kate and Hannah arrived a few seconds after the birth to attend to mom and new baby. He weighed 8 pounds 6 ounces. Congratulations!
The Hallmarks of Midwifery part 6 - The Connections of Midwifery
The Connections of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks
G. Promotion of continuity of care
P. Collaboration with other members of the interprofessional
health care team
Teamwork. Collaboration. Both hot topics in modern media, and the favorite subject of business consultants. Both ideas that get so much attention in our society. We all know we should want them, we all know they should be utilized in whatever we do. We also know they can be hard to achieve. We know that people make hundreds of thousands of dollars a year teaching others how to collaborate and work together in teams. Why do we care so much about these words, and put so much effort into achieving them?
No one functions at their optimum level when they are working alone. For decades, and really centuries, midwives have been alone in their field, struggling with their burdens, trying to carry the weight of their calling. This has been brought about by circumstance, by system design, by interprofessional sabotage, and often by midwives themselves, who set themselves apart from an established system and then had to struggle to find a way to function within it, or at least on the periphery. Finally, remarkably, the tides are changing. The number of midwife attended births is increasing in most areas of the United States. Certified Nurse Midwives and/or Certified Professional Midwives can be found in most states, and in all settings, from home birth practices, to large tertiary care centers. We are acknowledged by the public, able to bill insurances, and recognized as colleagues within hospital systems. Still there is much work to be done.
And here we are, left with clear choices, and huge tasks before us. Do we do this alone? Or do we do this together? These are big questions that plague midwives across the country, and across the world. Midwives come from so many different paths, is it even possible to allow these paths to cross? Is it possible to learn from each other and take on characteristics of the other, while still preserving what is central to each different model?
I don’t pretend to have the answers to this for midwifery as a whole. I do know the simple answer for what is right and good for OUR midwives, for OUR mothers and babies, for OUR birth center. And I can tell you, we have found our sweet spot. We have found that place of collaboration that leaves us feeling nothing but supported and uplifted. We have found that nurse midwives and professional midwives working together provide the best of both models for our clients. That we have so much to learn from one another, and so much to give to the world of midwifery.
In addition, over the 30 years our practice has been in Fairbanks, we have developed and grown relationships with midwives and physicians within our hospital system that leave us no doubt about the quality of care our clients will receive if they risk out of our care and need a hospital birth. We ask all of our clients to establish a hospital provider, and we have close relationships with most of the practices in town, whose midwives and physicians will happily see our client for one prenatal visit, and then accept her into their care if she transfers to the hospital. If problems arise before birth that may risk her out of our care, we are in close collaboration with the hospital provider, and we develop a plan of care together with them and the client for follow up and transfer if needed. This gives us, and our clients, an enormous amount of reassurance.
I am always so grateful to be able to tell a client, “I’m so sorry we have to transfer you. But you have seen this provider, and I know she/he will provide you with excellent care as close to the birth center model as possible.” I am so relieved when we call the accepting provider and let them know we are headed in, and we talk about a basic plan of care before we even arrive. The collaboration doesn’t end here. We have close relationships with the hospital as well, and when our clients transfer, their choices are treated with respect and care, and as many of them as can be honored are. This is not just about comfort and emotional support. This close working relationship leaves our mothers and babies safer.
Numerous studies have shown out of hospital birth is safest when done within a system that has processes in place for transfer. Both out of hospital and in hospital midwives will tell you, they feel safer and more supported when they know these systems are in place. The close working relationships benefit every party involved, and leave midwives and clients feeling connected and part of a system of quality care on a continuum. Less bad outcomes occur, for both mother and baby, with collaborative care that provides continuity. Not fractured care, but a smooth system of transfer from one place of care to another, with full communication between providers. Every mother, and every midwife, should get to feel this safe and supported from all sides.
As the week closes, I would like to send out a thank you to the network of midwives, physicians, and nurses I work with, that has grown me and held me up. Both near and far, in hospital and out, we have shown that when you work together, great, great things can be accomplished. May we continue to show the world the power of midwives, united in mission and solidarity, is an unstoppable force that will accomplish the good we have set out to achieve.
In faith, love, and gratitude
Julie
“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf
Accessed 4/29/2018
“Smooth Transitions: Enhancing the Safety of Planned Out of Hospital Birth Transfers.” Washington State Perinatal Collaborative. March 2015. http://www.washingtonmidwives.org/documents/Smooth-Transitions-Hospital-Transport-QI-Project.pdf. Accessed May 4, 2018
The Hallmarks of Midwifery part 5 - The Science of Midwifery
The Science of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery- The art and science of midwifery are characterized by the following hallmarks
C. Incorporation of scientific evidence into clinical practice
M. Incorporation of evidence-based complementary and alternative therapies in education and practice
Midwifery is an age old calling. Midwives are mentioned in the Bible, and in nearly every ancient text from every culture on earth. Midwives serve a basic, fundamental need of humans-to guide and support new life into this world. The knowledge we hold as a profession is often revered as sacred, and passed down from one generation to another. Over the centuries much of this old knowing has been lost or forgotten, but there are still guardians of this knowledge, and many can be found who still know the importance of these fundamental pieces of the puzzle in the care of the care of women and babies.
There are still many midwives who know how to utilize alternative therapies, and who understand the importance of complementary care. There are still those who understand how to skillfully and safely employ herbals to improve the health of a mother and baby. Midwives abound who understand the key role nourishing foods, supplements, and a healthy diet play in pregnancy.
Similarly, you can find multitudes of midwives who pride themselves on evidence based care. The entire focus of much of our education is on discerning the most up to date, thorough, quality evidence, and employing it in practice. Midwifery journals are full of the most recent studies and findings of professional organizations.
Often, you do not find these two seemingly opposing qualities in the same midwives, nor even in the same practice or practice setting. Occasionally, though, this beautiful union will occur, and this is where the true glory of midwifery is seen.
Consider midwives attending a birth in the hospital, surrounded by monitors and equipment, and screens, and all the best technology has to offer. Imagine them understanding the importance of low lights, undisturbed birth, and mobility on the health and well-being of the mother and baby. Imagine them discussing fermented foods, probiotics, and vitamin D with the parents during prenatal, and the importance of a nourishing diet. Imagine them understanding the latest evidence on physiologic cord clamping, and the importance of uninterrupted skin/skin, while able to quickly intervene with medications and procedures when called to. This is always a glorious thing to see, and leaves you no doubt that the mother and baby are being well served.
Equally impressive is an out of hospital midwife whose primary focus is physiologic birth and holistic care, who is up to date on the current guidelines for management of gestational diabetes. A home birth midwife who carries all the medications for management of postpartum hemorrhage and has a clear knowledge of how to use them appropriately, and also carries a rebozo, homeopathic medications for stalled labor, and a birth stool. A birth center midwife who can detail the correct steps in resuscitation of the newborn, and then deftly explain the importance of physiologic cord clamping and immediate skin/skin with an undisturbed third stage.
My incredible mentor, Dana Brown, is fond of saying “We should never have a sacred cow we are not willing to let go.” In my years with her I have seen her live this out repeatedly. I’ve seen she and the other midwives have a belief that seemed central to our practice. Then we would become aware of solid evidence that disputed this belief. She would be the first to bring us the new evidence, and demand that we evaluate it and review our practice. She would also be the first to remind us that evidence is not everything. That evidence without experience, and without consideration of the mother and her reality, means nothing. Many times, we have modified our ‘sacred cows’. Occasionally, we have discarded them altogether.
This, to me, is the essence of balancing evidence based care with complementary therapies. We must be willing to look at what we know, what we ‘believe’, and consider evidence to the contrary. We must be willing to look at what all the evidence says, know what the solid conclusions are, are then look at the mother and listen to her when she tells us, “Yes, that may be true for others, but it is not true for me.” We must be able to balance these two sides of our profession, no matter our setting.
As Dana always reminds us, “We must be humble, and teachable.” We must learn from the books, AND from the mothers. From the newest evidence, and from the oldest truths. We must give them all consideration. If we can do this, we will serve our women and babies well. We will continue to ensure that our profession meets the highest standards of tradition and progress, blended together beautifully to make such a beautiful product-a Midwife.
In faith, love, and gratitude,
Julie
“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf
Accessed 4/29/2018
Welcome Aurora!
Caroline and Gialuca are overjoyed to welcome their first child Aurora into the world. She was born at home just after midnight on March 28th 2018. She weighed 6 pounds, 8 ounces. Her birth was attended by midwives Kate Parks and Dana Brown. Congratulations!
The Hallmarks of Midwifery part 4 - The Work of Midwifery
The Work of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks
D. Promotion of woman-and family-centered care
F. Facilitation of healthy family and interpersonal relationships
Transforming Families Through Birth. This is the core philosophy of Alaska Family Health and Birth Center. This, above everything else I knew of the place, is what brought me to Fairbanks to work with these amazing midwives. The deep and abiding knowing that this was not just about a birth, not just about a baby, or a mother, but about a family. About building, and supporting, and educating, and creating, families. Because without a healthy family, you cannot have a healthy child, or a healthy mother. Without a healthy family, you cannot have a healthy community, or a healthy world.
In every encounter we have with clients, it is clear that AFH&BC is about family centered care. This is true as well of most midwives across the world. From the first consults and appointments, where we encourage spouses and children, to encouraging fathers to take an active role in pregnancy and birth, to birth with siblings standing eagerly by the tub to catch a first glimpse of that new addition, midwives embrace family.
But family centered care is not just about including families…it is about transforming families. As midwives, we take a young couple and walk them through the first questions of “what do we, as parents, want for our child?” We help them consider questions of healthcare, of parenting, of boundaries with their own parents. We help them realize that, much like planning a wedding, this is not about the event, but about the results of the event. This is not just about the birth, but about the baby…about becoming parents, and raising a child. These are big, big questions compared to the impact of one day. We do not diminish the importance of that one day…we would not exist if we did. We understand fully the significance to both a mother and a child how that child comes into the world. But we also know so very well that there are bigger things at stake. Like how do they become a family? How do they navigate the hard decisions, the unknown turns, the times of sadness and of joy?
This is another reason most midwives have longer and more appointments, both during pregnancy and during the postpartum period. This kind of care and education is time intensive. Many birth centers offer group prenatal care, like you can find in our Arctic Family Circle classes. These long prenatal appointments connect women to other women, and allow the midwives time to educate on parenting, breastfeeding, co-sleeping, and so many other topics that fill parent’s minds. At our birth center, as in many others, we see women at 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks postpartum. We understand the importance of this postpartum time as families transition into their new roles. We try to be there to support, and guide, and inform.
As midwives we are not magicians, and we are not all-knowing. We cannot make this easy for anyone. But we understand that with tools and knowledge, most tasks go from insurmountable to manageable, peppered with moments of ridiculousness. This is our goal for our families. To help provide them with the tools and the knowledge to navigate pregnancy, birth, and parenthood. In their own way. With their own values at the forefront.
In faith, love, and gratitude
Julie
“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf
Accessed 4/29/2018
The Hallmarks of Midwifery Part 3 - The Core of Midwifery
The Core of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks
E. Empowerment of women as partners in health care
K. Advocacy for informed choice, shared decision making, and the right to self-determination
Sometimes in your career you stumble across a truth that is so deep, so central to what you are doing, that it makes everything else become crystal clear. Empowerment of women as partners in health care, coupled with informed choice and the right to informed consent, was such a truth to me. Eighteen years ago, as a brand new Labor and Delivery RN, I had the privilege of working with a doctor who demonstrated the beautiful art of true empowerment and informed consent. I remember listening to her quickly summarize the risks and benefits of a proposed intervention, then sit back and quietly respect the woman’s right to make her choice, and I remember thinking, “WOW, so THIS is what they meant in nursing school! This is why I am here!”
Now, eighteen years later, I’m a certified nurse midwife, and advocacy for empowerment, informed choice, shared decision making, and the right to self determination are two of the hallmarks of my beautiful profession.
But what does this mean? There are no clear rights or wrongs in birth. No obvious choices that must be abided by, that all women MUST make. There are so many shades of gray, so many different paths to travel as families grow and birth their babies. We, as midwives, are here to support them through this, and to help provide them with the information to make the right choices for themselves and their families.
And this is an immense, critically important responsibility. Many birthing families come to us because they know we will respect their choices. They know what they want, and they believe we will support them in that. And we will, within the boundaries of our ethical obligations and our scope and regulations. However, this does not mean just listening to what the wants, and then giving it to them. This means always, without fail, discussing with a woman and her partner the risks and benefits of any proposed intervention, or deviation from standard of care. It means letting them know what our professional judgment is, as well as our regulations and legal obligations, and then letting them decide. Sometimes, because we are a low risk birth center, these decisions may risk a woman out of our care. This is one of the risks we must inform her of. But most often, it just means she is now aware of the possible implications of her choice. And this is what it is to be a human with body autonomy-you have a right to make the choice and then assume the responsibility of the consequences. And this goes for all decisions, large and small. As midwives we should not assume responsibility for our client’s choices. At the same time, they cannot be empowered, and assume responsibility, if we do not provide them with all the information.
Recently, I got in a conversation on a midwifery discussion board. Some were concerned that when we discuss seemingly small decisions, like whether or not to have an IV in labor (many were hospital midwives where an IV may be standard), or what a woman would like to wear during labor, we are bothering people with minutiae that make the process more difficult. I hold that we MUST bother people with this minutiae, as it is these decisions, large and small, that make them the responsible party, and that empower them with bodily autonomy.
It is not that we have to leave people hanging to make these decisions without any information. It is that we have to provide them with the information we have that is pertinent to making decisions about the situation.
I work with so many amazing providers, both in hospital and out, that provide this level of empowerment and informed consent. It is hard, it takes time, and often people feel you are trying to scare them into decisions when you present risks and benefits fully. As a provider, I have found that often small things, when done at times of vulnerability, affect others in big ways. I try to consider this carefully when providing care.
I believe THIS is the core of midwifery. This is the very base, core level of empowerment and informed consent. That all decisions matter. None are too small, from wearing a gown, to eating during labor, to an IV. That all choices are theirs, not ours, to make. THIS should be the core of nursing, of midwifery, and really of all healthcare.
I feel so blessed to have witnessed this and all that implied at the beginning of my career, and I hope that I come even close to providing the clear, unbiased information that I witnessed in awe so many years ago.
In faith and love,
Julie
American College of Nurse Midwives , Core competencies for basic midwifery practice, http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf