We here at Birth by Design celebrate and support birthing women, no matter what their birth looks like. From home births to planned c-sections, we are here for you!
However, since May is for Midwives, what is it like to be a midwife or to use a midwife in Arkansas? (look for more concerning what it looks like to have a doula at a c-section, VBAC, and all sorts of other births in the coming months!)
So let’s explore what it means to hire and use a midwife in our state!
Every state has different laws about where, when, and how midwives can operate. In some states, midwifery is illegal. In the rest, laws range from unregulated to fully able to practice and even bill medicare. Midwives Alliance of North America has a comprehensive list.
In Arkansas, midwives are able to practice and be licensed as lay midwives or certified nurse midwives, and are overseen by the Arkansas Department of Health and the Arkansas State Board of Nursing.
The guidelines for Arkansas midwives can be found on the Department of Health website, but what does it take to become a midwife? The regulations say that a midwife must have basic education (high school graduate or equivalent), be up to date on TB tests and immunizations, and CPR certified for adults and infants. Then there’s the practical experience. Midwives “must demonstrate competency in performing clinical skills during the antepartum, intrapartum, postpartum, and the immediate newborn period.” What does that look like? Well…
“a. The applicant must attend a minimum of 20 births as an active participant.
b. Functioning in the role of primary Lay Midwife under direct on site supervision, the applicant must attend a minimum of an additional 20 births, of these:
a. A minimum of 10 must occur in an out-of-hospital setting and
b. A minimum of 3 must include at least 4 prenatal exams, birth attendance, the newborn exam, and 1 postpartum exam, each conducted personally by the applicant with direct supervision.
c. 75 prenatal exams, including 20 initial exams
d. 20 newborn exams
e. 40 postpartum exams”
Y'all. That’s a lot of work. But there’s more!
After all that apprenticing, midwives still have to pass several exams.
“1. Pass the North American Registry of Midwives (NARM) written examination. The exam may be administered by the Arkansas Department of Health and Human Services, Division of Health, or at a regularly scheduled test site arranged through NARM.
2. Pass the Arkansas Midwife Regulations exam with a score of 75% or higher. This exam is administered by the Division.
3. If necessary to obtain a passing score, the examinations may be taken up to three times. If the Midwife fails either the NARM exam or the Arkansas Midwife Regulations exam three times, she must repeat an apprenticeship before being allowed to re-test. “
After this, there’s licensing renewal (including continuing education requirements) that occurs every two years.
So, what does it look like to actually use a midwife?
First, you have to qualify to use a midwife and homebirth. “The Licensed Lay Midwife may provide complete obstetrical care to women who are determined to be at low risk for the development of medical or obstetrical complications of pregnancy or childbirth.”
Second, you have to satisfy these requirements…
Now you’re ready to give birth! There are more requirements! (yay?)
The midwives have all sorts of responsibilities during labor, not the least of which is supporting the laboring mother. They check fetal heart rates, mother’s blood pressure, etc… My favorite line of the rules and regs… “All services should be provided in a supportive manner and in accordance with these regulations.” A supportive manner is in the laws!
After labor, midwives assess the placenta, repair tears (if needed), check all sorts of vital signs and physical symptoms of both mother and newborn. She’ll stay until everything is within normal, and then come back for a follow up visit within 24 hours. Midwives are also responsible for the newborn heel prick (required by law), fills out the birth certificate and social security paperwork. Then, just like with an OB, there is a follow up check at 6 weeks.
What else do midwives do?
Record keeping. So much record keeping. They turn in a monthly log of their midwifery activities. Document, document, document. Keep records for 24 years. Submit to audits.
What about midwives in hospitals? Currently, in central Arkansas, certified nurse midwives are only available at UAMS. According to the UAMS website, “The UAMS nurse-midwives in the OBGYN department are primary health care providers to women and are able to perform physician exams, order laboratory tests and ultrasounds, diagnose and treat common problems, provided prenatal care, women’s health care, labor and birth care, as well as health education and counseling. Our nurse-midwives attend labor and birth for the patients in the hospital setting, working in collaboration with physicians trained in Obstetrics.” Practically, this means that women birthing at UAMS can request a midwife attend their birth, but it’s not guaranteed.
I hope this gives some understanding to the hard work that goes into midwifery in Arkansas. The women who choose to become midwives are caring, motivated, organized, responsible, capable and so hard working!
(There’s lots of things happening concerning the status of midwifery in Arkansas, Check out some of it here.)
Our heart here at Birth by Design is for women. This month, we honor the women in our lives: the mothers, mother figures, aunties, sisters, cousins, grandmothers. The tribe of like-minded sister-friends. The women at work, the other mothers or mother figures at school pickup, dance class, summer pool. The solid group of women doulas, lactation consultants, nutritionists, chiropractors, massage therapists, nurses, doctors, and physical therapists we have the pleasure to work with.
We are a unique sisterhood of women supporting and serving women, and our support for each other overflows into our service for our clients.
We are honored to witness mothers being birthed. We are in a distinct position to laugh, cry, grieve, celebrate, comfort, endure with, sit in silence with, and empathize with the women we support. Our time with clients is short, but full! We love you and we see you.
We also know that Mother's Day isn't always easy, To those who experience loss, guilt or irritation, we hope that you find the support you need. We love you and we see you.
Happy Mother's Day from the doulas at Birth by Design!
As the month of April comes to a close, so does Cesarean Awareness Month #CAM2017. People usually become passionate about certain causes when they or their loved ones are directly affected by said cause. For me, I had a great deal of ignorance about cesarean births before I had one myself.
Before getting pregnant, I viewed cesarean births as a cop-out, the easy way out of labor pains--cheating. I subconsciously viewed mothers who've had cesarean births as having not tried enough, or not strong enough to endure real birth. I qualified my mother’s own cesarean experience to say hers was necessary because she had twins, one of them breech. Which one was breech? Me. I caused my mother to have a cesarean birth.
Twenty-four years after I came out of my own mother’s abdomen feet first, I found myself laying on an operating table awaiting the birth of my own child. She was head-down, engaged, and had managed to help me dilate 8cm. However, 20 hours of position changes, nipple stimulation, pitocin, or prayer would not help me to progress any further. My water had been broken for over 30 hours, I had not eaten or drank anything, had not slept, and was ready to meet my baby. (See how I’m trying to justify my decision for a cesarean. It’s what we do when we feel we could have done better). When my doctor mentioned a cesarean, it sounded right. We had tried everything and I was exhausted. What else could I do? At the time, I felt 100% ok with this decision.
Needless to say, I changed my tune about how I felt about cesarean births and moms who have had them. My cesarean was not a cop-out, I experienced hours upon hours of labor pains, and I most certainly did not cheat. There a million different rhymes and reasons for Cesarean births, I know my story is not everybody’s. But I know we all want what's best for us and for our babies. I am now passionate about a cause that I before had very little experience or sympathy for.
This post is to legitimize every mother who feels like her body failed her, that her birth team wasn’t enough, that her birth wasn’t real, and that the scar on her abdomen means she’s broken. You are strong, and beautiful, and your worth as a mother is not defined by which part of your body your baby came out.
I know that not everybody feels ill-will about their cesarean and does not want to be categorized accordingly by their experience. I see you too. I want to celebrate all mothers who’ve had a cesarean birth be it elected or not, necessary or not, emergent or not, gentle or not. Our scars tell a story and yours is important to me.
I will end with a Maya Angelou quote that I learned from a friend at our local ICAN (International Cesarean Awareness Network) chapter meeting: “Do the best you can until you know better. Then when you know better, do better.”
--Jenny Knight, BbD birth doula.
Jenny sees every woman as a being of deep power, capable of birthing new life into the world. She is honored to serve and guide women and families as they embark on this journey. No matter the circumstances, pregnancy and childbirth are extraordinary experiences. Every woman and family deserves love and support through this miraculous time.
As the doulas have welcomed in the new year (with a few babies, as well!), a look back at the year 2016 was necessary in order to create new goals for this year! We are beyond honored to serve so many women in pregnancy, labor, postpartum, lactation, education through classes, and placenta encapsulation. Each year, we like to look back and see what we have accomplished, and hope to improve and create better ways to serve the women of our communities. So here’s a look back to Birth by Design’s 2016!
Overall, we served many women in 2016 and welcomed 112 babies with the help of our birth doulas! (Birth by Design hopes this number will grow in 2017, as we have several more students who have completed their certification and have already started filling their calendars!) Of those 112 births, 90 of them were vaginal. (That translates to 80% of our clients!) Some were home births, some were drug-free, some were with pain meds, some were inductions, and some were VBACs! (Did you know that of our clients that decided to labor for a VBAC, almost all were successful!! That is huge!) We also served at 22 cesarian births. Some of these c-section births were elective, some were because of medical issues, some were twins, and some were just silly babies who decided to not come into this world head first. There is a great joy seeing a woman achieve her goals both as a birthing mama and as a birth worker! We were honored to serve all kinds of women with all kinds of birth plans!
Did you know that we now offer postpartum doula care with certified postpartum doulas? Those doulas finished their training in 2016 and began their work in serving mamas! Overall, albeit new, they were able to serve 16 mamas, 17 babies, all for a total of 230 hours of postpartum care! We are positive this number will grow even more in 2017!
Our goals for 2017 are being set even as this is written! Already our calendars are filling up with more babies! Already, our office space in Conway has grown by moving locations to a bigger space! Already, we are looking for ways to better serve the community! Our hope is to serve even more women from all sorts of backgrounds and with all sorts of birth plans- there is no right or wrong plan… just what works best for you and your family!
Thank you for making 2016 a great year for us and here's to making 2017 even better!!
-Mekelle and the rest of the BbD team
April is Cesarean awareness month, and we would like to spotlight all you awesome moms who have experienced a cesarean birth. Whether it was part of your plan or totally unexpected, this birth experience became yours. Whether you had a tough recovery or a relatively uneventful one, you experienced the cesarean recovery. Whether you had a difficult time emotionally dealing with the trauma, or were able to mostly overlook it due to your gratefulness for modern medicine, you were cut. You have a scar, and a beautiful one, at that. We want to celebrate it, because of the strength it represents. We want celebrate you, because this strength of yours is deserving.
Cesarean births presently occur in approximately 1 out of 3 births here in the United States, which means that this experience is much more common than many might believe. They occur for many reasons. Sometimes it is absolutely necessary and can save the life of mom or baby--or both. Other times, it isn't necessary and was performed out of a lack of patience of the medical staff. Sometimes, it is completely by choice of the mom. Whatever the reason for the cesarean birth, women are having to recover from them. What so many that have not experienced a c-section do not understand is how trying the recovery can be. It can be painful both physically and emotionally. Those who have gone through it usually come out on the other side with new strength they had not previously discovered within themselves.
The physical recovery of a cesarean is challenging and very different from its vaginal delivery counterpart. This is no walk in the park....we are talking MAJOR SURGERY! Top that off with having to care for a new baby, that sleeps precious little, and the task seems doubly daunting. The best thing doctors tell you to do in recovery from surgery is to rest; kind of hard to rest well when you are up....a lot....feeding and caring for your new baby. In a vaginal recovery, sometimes the most worrisome task is that first bowel movement. A cesarean recovery, on the other hand, taunts you with every laugh, sneeze, or cough that you dread....repeatedly. You need help to get up, or sometimes even to get back in bed. You are supposed to be walking in order to help the recovery process, but you loathe the moment of getting up to start the walk. Did I mention that after surgery there is some serious gas to deal with? Hopefully this delightful post-op gift will bless you with its presence when no one else is around, but that is not always the case. When it does rear its ugly face, control is hard! Just let. it. go. (As if you had another choice!). Additionally, that beautiful scar needs extra care and can become quite itchy. But you, cesarean moms, you didn't let all of this get you down. You rock! You have dealt with the recovery and have survived and all while taking care of you AND your sweet baby!
The emotional recovery can be even more difficult to some than the actual physical part. Many women went into their pregnancies assuming that the culmination would be beautiful vaginal births. Some want an all natural, drug free birth and come out with completely the opposite. Their expectations, hopes and desires seem to have deserted them. They feel robbed. They feel as if they have somehow failed as a woman. They may feel let down by their own bodies or by people they trusted. The emotions can take months, even years to deal with and accept. Cesarean moms, you have journeyed through many of these valleys. You are stronger for it, although you may not realize it. You deserve a sash and a crown!
Later, down the road, a cesarean mom will have to think of the future. Will she try to VBAC? Will she have a repeat c-section? Will she continue to have children? Whatever her decision, it probably will come after much mental wrestling and internal debating. Her decision can have the backing of the whole family or none at all. Whatever the case, there is a lot of support out there for you. There are doulas, who are trained in all kinds of birth experiences to help you on your next birth, to assist and to encourage you in all your decisions. There are support groups such as ICAN where women with previous cesarean births can share their stories and gain the love and encouragement of others with similar experiences. Maybe you have made that decision and have achieved your desired birth, perhaps with a doula, or perhaps with a bit more knowledge. Maybe you are already drawing upon your own strength to help others in their own experiences.
Whether cesarean rates increase or decrease, there will still be women who experience them, therefore there will always be beautiful scars and beautiful women to celebrate. You, you cesarean birth goddess, overcame!! Your unique birth experience has put a beautiful baby in your arms! Your birth story is that baby's journey into the world and is unlike anyone else's on earth. Embrace it--the joy, the pain, the trial, and the victory. Embrace your story. It is beautiful and so is your scar. WE CELEBRATE YOU!!!!
Blog Post Written by Mekelle Daniel VBA2C Certified Birth Doula