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Welcome to Midwife & Doula Services
I am an independent Certified Nurse Midwife (CNM) with a small, intimate childbirth service. My service is dedicated to offering quality prenatal care, birth and postnatal follow-up care to women and families in the greater Des Moines, Iowa community. I specialize in very personalized relationship building-- and optimal, not adequate care--during this special time of life.


 

 

 

 

Midwife and Doula Sercvices

The Zaffos Family - 24 hours post welcoming new baby boy, Corbin Michael, into their circle of love! A lovely home birth on a beautiful mid-September morning - couldn't get much better than this!

 

Busting the smug myth: Ladies, home births really are the VIP labour option

Contrary to popular belief, women who opt for home births aren't trying to show off or prove anything argues Beverley Turner, who's given birth twice in her house. She busts the myths and explains the proper benefits. Click here to read the full story.

 

 

Beverley Turner, with her husband James Cracknell, after giving birth at home Photo: COURTESY BEV TURNER

 

 

Sylvie | A Birth Story

So one day I had this wild idea that I wanted to try my hand at birth photography. Luckily Every one I know is expecting...including one of my dearest friends.  I finally got up the courage to ask her if she'd mind bearing all, and allowing me to photograph.  To my surprise she agreed, without thinking I was a creeper! 

Fast forward to Saturday night, around 9pm I get a message that she's been having contractions and this could be it.  So I tried to do the smart thing and lay down and rest.  Around 11:15pm I sleep through the text telling me to come...but wake up not too long after and make my way over.  Here begins the journey of what the next 12 hours would hold.  I do hope these photos help to capture even a glimpse at how incredible the miracle of birth is, how good our God is, and help us to embrace every moment!

 

Please enjoy a recent photo journal of 'Sylvie's Birth" at home!
Photographed by Stephanie Doll Click here to view the photos.

 

The Birth of Oren from AndreaG Photography on Vimeo.

 

 


 

Read this informative article about the delayed onsent of mature milk.

Booby Traps Series: Obstetrical practices are making late milk-coming-in the new normal.

 

 

Say No to Circumcision - Leave the Babies Alone

 

 
 

Maternity Care with a Heart

 

Maternity Care With a Heart from Childbirth Connection on Vimeo.

 
 

Celebs, Ordinary Women Embracing Home Birth With Help of Midwives

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Birth by the Numbers

 
 

One World Birth is a unique FREE video website about the latest issues in birth from around the world.

 

 

 

 

"Dr. Justin Case" - a video from BirthSense.com, A Common Sense Guide to Normal Birth

 
 

Short Film on Dutch Maternity Care:

 
 
 

A compelling article about homebirth can be found on Babble.com by Jennifer Block. Birth Wars: Who's really winning the homebirth debate?

 

 

 

The Baby Project

Read the article, and watch the video of Shannon Earle's story of having a baby at home with a midwife, "Birth: In The Comfort Of Home"

 

 

 

Study Finds Home Births Increase by 20 Percent: Read the full article here.

 

 

The Most Scientific Birth Is Often the Least Technological Birth

By Alice Dreger

If you look at scientific literature, you find over and over again that many interventions increase risk to mother and child instead of decreasing it.

Kenishirotie/Shutterstock

When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. What they don't envision is the omnivorous, pants-wearing science geek standing before them.

Indeed, they become downright confused when I go on to explain that there was really only one reason why my mate -- an academic internist -- and I decided to ditch our obstetrician and move to a midwife: Our midwife could be trusted to be scientific, whereas our obstetrician could not.

Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.

But most birthing women don't seem to know this, even if their obstetricians do. Paradoxically, these women seem to want the same thing I wanted: a safe outcome for mother and child. But no one seems to tell them what the data indicate is the best way to get there. The friend who dares to offer half a glass of wine is seen as guilty of reckless endangerment, whereas the obstetrician offering unnecessary and risky procedures is considered heroic.

Ethicists talk about birthing choices as if they are informed and autonomous, but I can't count how many women have said to me they "chose" pain meds during birth even though they were never told the risks.

When I was pregnant, in 2000, and my mate and I consulted the scientific medical literature to find out how to maximize safety for me and our child, here's what we learned from the studies available: I should walk a lot during my pregnancy, and also walk around during my labor; doing so would decrease labor time and pain. During pregnancy, I should get regular check-ups of my weight, urine, blood pressure, and belly growth, but should avoid vaginal exams. I should not bother with a prenatal sonogram if my pregnancy continued to be low-risk, because doing so would be extremely unlikely to improve my or my baby's health, and could well result in further tests that increased risk to us without benefit.

According to the best studies available, when it came time to birth at the end of my low-risk pregnancy, I should not have induction, nor an episiotomy, nor continuous monitoring of the baby's heartbeat during labor, nor pain medications, and definitely not a c-section. I should give birth in the squatting position, and I should have a doula -- a professional labor support person to talk to me throughout the birth. (Studies show that doulas are astonishingly effective at lowering risk, so good that one obstetrician has quipped that if doulas were a drug, it would be illegal not to give one to every pregnant woman.)

In other words, if the regular low-tech tests kept indicating I was having a medically uninteresting pregnancy, and if I wanted to scientifically maximize safety, I should give birth pretty much like my great-grandmothers would have: with the attention of a couple of experienced women mostly waiting it out, while I did the work. (They called it labor for a reason.) The only real notable difference was that my midwife would intermittently use a fetal heart monitor -- just every now and then -- to make sure the baby was doing okay.

My obstetrician and his practice had made clear that they were rather uncomfortable with this kind of "old-fashioned" birth. So we left, and engaged a midwife who was committed to being much more modern. And the birth I had was pretty much as I have described. Yes, it hurt, but my doula and midwife had prepared me mentally for that, assuring me that this kind of special pain did not have to result in fear or harm.

We did end up with one technological intervention: because my son had meconium in his fluid (this means he'd defecated in the womb), the midwife explained to me that right after birth, the pediatricians would be scooping him up to suck out his trachea (his windpipe). The idea was to prevent pneumonia. They did this, and three months later over breakfast my husband presented me the results of a randomized control trial that had just come out: it showed that babies in this situation who only had their mouths and not their tracheas cleaned actually had lower rates of pneumonia compared to those who got the tracheal intervention. Another intervention that turned out not to be worth it.

So why is it that, over a decade later, when the evidence still supports a low-interventionist type of pregnancy and birth management for low-risk cases, we've made virtually no inroads to making birth more scientific in the United States.

I put that question to a few scholars who work on this issue. One of them, Libby Bogdan-Lovis of the Center for Ethics and Humanities in the Life Sciences at Michigan State University, happens also to have been my doula. (Lucky me.) Libby noted that a big part of the problem is the way birth is conceived in America -- as "dangerous, risky, and in need of control to ensure a good outcome."

Libby pointed out that institutional strictures contribute to the problem: "Insurance companies generally cover hospital birth, not home birth, they are more inclined to compensate doctors over midwives, they compensate doctors and hospital-based midwives for doing something over doing nothing, and the health care system's risk management approach backs those who can demonstrate that they did everything possible in terms of intervention." All this in spite of the fact that, as Libby notes, "attempts to control birth are fraught with real medicalized risk and commonly lead to cascades of interventions."

vlavetal/Shutterstock

Raymond De Vries, a sociologist in the University of Michigan's Center for Bioethics and Social Science in Medicine, has compared birth in the U.S. to that in the Netherlands, where he is a visiting professor at the University of Maastricht. He finds that, in the U.S., "obstetricians are the experts and the experts have come to see birth as dangerous and frightening." De Vries suggests that the organization of maternity care in this country -- "the limited choices that American women have for bringing their baby into the world, what women are not told about dangers of intervening in birth, and the misuse of science to support the new technologies of birth" -- actually constitutes an ethical problem, although we typically do not recognize it as one. Medical ethicists "would rather look to the [comparatively rare] problems of in vitro fertilization and preimplantation genetic diagnosis than to the every day issues ofhow we organize birth here in the U.S.; they would rather talk about preserving women's 'choices' than to explore how those choices are bent by culture."

So true. Ethicists love to talk about women's birthing choices as if they are informed and autonomous, but I can't count how many women have said to me that they "chose" pain medication during birth even though they were never told the risks of pain medication, never had anyone express confidence in them that they could birth without medication, and were never offered a doula to walk and talk them through the pain. What kind of "choice" is that? As Libby Bogdan-Lovis told me, "Today's average childbearing woman thinks the notion of an unmedicated birth is the equivalent of suggesting that women should eagerly embrace torture."

If I wanted to maximize safety, I should give birth like my grandmothers would have: with the attention of a couple of experienced women mostly waiting it out, while I did the work.

I think of all the choices I made, the one that shocked my peers most was not getting a prenatal ultrasound. But just a few years before I became pregnant, a major U.S. study -- involving over 15,000 pregnancies -- published in the New England Journal of Medicine showed that routine ultrasounds did not leave babies safer. That work was led by Bernard Ewigman, now chair of family medicine at the University of Chicago and NorthShore University Health System.

I recently called Dr. Ewigman and asked him why so many low-risk pregnancies now involve routine ultrasounds. He suggested that it was partly emotional -- people like to "see" their babies -- and partly due to the unsubstantiated belief that knowing something is necessarily going to lead to better outcomes than not knowing. But, he agreed, routine prenatal sonograms in low-risk pregnancies (that is, pregnancies in which there have been no problems) do not appear to be supported by science, if the outcome you're seeking is reducing illness and death in mothers and children. Routine prenatal sonograms don't seem to be dangerous, but they are also not health-giving.

Dr. Ewigman told me, "The approach you took to your pregnancy was rational and well informed. But most decision-making when it comes to medical issues involving a pregnant woman or baby are not well informed and not based on rational thinking." He added: "We're all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don't exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome."

Dr. Ewigman and I talked about how some people derive false certainty from prenatal sonograms, thinking that if the clinicians see nothing unusual, the baby will be born perfectly healthy. I explained to him that that was one reason I didn't bother; I knew from my own research on birth anomalies how often sonograms mislead. He observed that our culture has "a real fascination with technology, and we also have a strong desire to deny death. And the technological aspects of medicine really market well to that kind of culture." Whereas a low-interventionist approach to medical care -- no matter how scientific -- does not.

I'm not against taking into account, when making birthing choices, the kinds of hard-to-measure outcomes that may matter deeply to some pregnant women. I get that there are some women who don't want a baby shower like mine, where most of the gifts consist of yellow and green baby clothes, instead of pink or blue. I get that some want to have those fuzzy pictures of the babies in their wombs. I get that some might want to abort if a sonogram were to show a major anomaly.

And I get that some women want a particular experience of birth -- I mean, I really get that now that I have had a birth that left me feeling more powerful, more humble, more focused, and more devoted to my lover than I ever thought I could feel.

But I wish American women were told the truth about birth -- the truth about their bodies, their abilities, and the dangers of technology. Mostly I wish all pregnant women could hear what Libby Bogdan-Lovis, my doula, told me: "Birthing a baby requires the same relinquishing of control as does sex -- abandoning oneself to the overwhelming sensation and doing so in a protective and supportive environment." If only more women knew how sexy a scientific birth can be.

This article available online at:

http://www.theatlantic.com/health/archive/2012/03/the-most-scientific-birth-is-often-the-least-technological-birth/254420/

 

 

 

 

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"There's no place like Home!"

 

After attending births at Iowa Methodist Medical Center for many years, Dana has returned to her roots - attending Out of Hospital births for healthy, low-risk women. Providing well-woman care to women of all ages continues. Contact Dana to arrange a consultation visit at no cost!

 

 

"Having a baby is hard enough.
No woman should be asked to do anything else while she is having a baby. She shouldn't have to renegotiate a birth plan, argue with her care providers about the evidence supporting her decisions, or advocate for her baby. She also shouldn't have to comfort her husband, or reassure her mother or educate her sister. Everyone around the birthing mother should attend her like the queen that she is." - Elizabeth Allemann, MD

 

AnEmpoweredBirth.com

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"The Swedish parliament is considering banning circumcision for boys under 18. The lawmakers who put forthe the motion, Bjorn Soder and Per Ramhorn, contend that “boys should have the same right to avoid both complications of reduced sensitivity in the genitals, painful erections, increased risk of kidney damage and psychological distress by permanent removal, and the tremendous violation of privacy that circumcision actually means.”

"The parallels between making love and giving birth are clear, not only in terms of passion and love, but also because we need essentially the same conditions for both experiences: privacy and safety."

 

-Sarah Buckley, MD

 

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American College of Nurse-Midwives

 


"The most important period of your child's health is the nine months before birth! Cutting-edge research in a new field known as metabolic programming reveals a startling new fact:  What a mother eats during pregnancy has a far greater effect on her child's future development, overall health, and resistance to disease than was previously thought.  In fact, adult chronic illnesses long blamed on an unhealthy lifestyle or genetic influences are now believed to be a direct result of the uterine environment during pregnancy."  

-Barbara Luke, PhD, Programming Your Baby's Health:  The Diet for your Child's Life Long Well-being.

 


 


CNMs receive similar or better grades on cesarean section, low APGAR score, episiotomy, labor analgesia, and perineal lacerations.