Interview With a Family in My Practice on Their Podcast

“Julia and Gino were blessed to have Anne attend the birth of four of their children in the comfort of their home (they attribute Anne for saving Julia's life by detecting an ectopic pregnancy when the doctors did not!), and wanted to share with the community what an amazing midwife, mother, and entrepreneur Anne is.

In this week’s show, Anne discusses her passion for midwifery, what led her down the path of homebirth, the amazing power and joy of giving birth, and how her struggles in life led to her own transformative healing, growth, deeper joy and inner calm.

Anne draws parallels between raising a family and creating a successful in-person and online business, and how she did not set out to write two books or create online courses and coaching sessions, but a conversation with her daughter about joining Instagram changed it all. And then it grew organically.

Since that conversation, Anne has collected more than 97,000 followers on Instagram alone, and more importantly to her, has been able to serve mothers all over the world, including Australia and Europe.”

Source: Entrepreneur, Midwife, Author, and Mother, Anne Margolis with Julia and Gino Barbaro | Jake & Gino (jakeandgino.com)

Postpartum Bleeding: Holistic Prevention Strategies

It is normal to have light bleeding in labor as your cervix dilates and breaks its tiny blood vessels. And as baby emerges from the birth canal there can some local tearing that can cause bleeding. Expect to experience the most bleeding at delivery and postpartum. Most of this bleeding is from where the placenta was located in your uterus. 

At normal vaginal birth and immediate postpartum, it is common to lose up to a half liter of blood. After cesarean birth, one liter of blood loss is the average. After birth, your uterus needs to contract around the major blood vessels that supplied the placenta to close them off and prevent excessive bleeding. 

The first few days, bleeding can be like a heavy period. Then, it tapers to a moderate period, after which it becomes lighter and changes color over several weeks from shades of red, then pink to brown. The body is healing the former placental site, shedding the internal scab there, and extra tissue and blood that was lining your uterus during pregnancy. 

Postpartum hemorrhage usually occurs immediately, or up to the first 24 hours post birth, and remains a major cause of maternal death in the US and around the world. It must be taken seriously. Currently, there is substantial evidence in support of what is termed ‘active management of the third stage of labor,’ to reduce the risk of severe excess postpartum bleeding. It includes the use of:

•  The synthetic hormone oxytocin (referred to as Pitocin in the US) via intravenous or intramuscular injection

• Early cord clamping with waiting 1-3 minutes until baby gets at least most of the cord blood

• Controlled traction on the cord along with counter pressure on the uterus to effect placenta delivery within the first 5-30 minutes after birth

• Uterine massage to make sure it is firmly contracted

• Assessments every 15 minutes for the first two hours. 

The above process, or a similar version, is done routinely in most hospitals, and can certainly be done in out of hospital birth settings. However, the studies that determined these procedures, were based on hospital births in mostly resource poor but also well developed countries. Like all studies, they have their limitations and flaws, some were even considered to be of poor quality according to the esteemed Cochrane Review. Also these interventions are not without side effects and concerns. The American College of Nurse-Midwives support the use of active management of third stage of labor in low resource settings, according to their position statement, although they do admit its benefits are not as clear in the low risk healthy population, and encourage the provider to have a risk benefit discussion with each pregnant family so they can make an informed decision about it. 

Most homebirth and birth center moms and providers are passionate about physiologic birthing, minimal interventions and holistic modalities, do not routinely want an injection of medication, and are more interested in natural alternatives. They trust the incredible wisdom of the normal birthing process, which has worked for thousands of years or we would not have survived as a species. They share a common belief that if it is not broken, don’t fix it, wary of medication and interventions unless absolutely necessary and benefits outweigh risks. They tend to like the alternative, ‘expectant management’ approach, which also entails close observation by the provider, but tends to take longer, allowing for the normal physiologic process to take its course, and for interventions only if needed in select cases. 

After birth, mom and baby are of course carefully assessed, but encouraged to bond skin to skin. There is no rush. Cord clamping is delayed until pulsation has ceased, or after placenta is birthed. Mom and baby are assisted to breastfeed which helps release mama’s own natural oxytocin.

The provider waits and watches for signs that the placenta is naturally separating and then assists mom into an optimal position usually using gravity, and encourages her to use her own bearing down efforts to birth her placenta. The provider may sometimes guide the birthing placenta with gentle traction on the cord, while supporting the uterus, then massages the uterus to make sure it is firm, assesses the bleeding until stable, and assesses and repairs tearing as needed. 

Certainly, if there are certain concerns or risk factors, you may truly benefit from medical prevention and active management.

If there is an actual hemorrhage, make sure your provider is skilled, experienced, and fully equipped to deal with it with at least the commonly used effective medications, IV fluids, suturing material for lacerations needing repair, and hands on care that are usually sufficient to control it successfully. 

However, you can build up a strong blood supply and reduce excess bleeding and its risks with the following suggestions for natural support both in your pregnancy and postpartum.

Prenatal Support

Make sure you get checked and treated for anemia common in pregnancy, that your iron stores (ferritin) are sufficient. 

Eat 3 large servings of wild greens or dark green leafy vegetables every day. They can be made into a salad, lightly sautéed or steamed. Good options are parsley, dandelion, alfalfa, kale, collard greens, comfrey and turnip greens.  For additional support, you can try the following:

NETTLE AND RASPBERRY TEA

Starting in the third trimester, drink 1 cup of this nourishing herbal infusion several times per day. 

1. Combine a handful each of the dried herbs Nettles and Red raspberry leaf with 1 quart boiling water.

2. Steep for at least 4 hours.

3. Strain to a glass mason canning jar.

4. You can add fresh mint leaves, lemon juice, or honey to taste.

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GREEN DRINKS

Drink 1 ounce fresh, frozen, or powdered  wheatgrass juice 1-2 times daily to enrich and build your blood.

Or, try 1 scoop daily of powdered greens in your smoothie, 1-3 Tbsp bottled chlorophyll, or tablets or powders of spirulina and chlorella.

Postpartum

You need to rest in bed, on the couch or an outdoor lounge chair as much as possible for the first 2 weeks to recover.  Make sure you arrange for help in the home during this special time. Limiting activity and increasing rest help the area of open uterine blood vessels where the placenta detached to heal. 

Check the top of your uterus regularly for firmness, and massage it if it feels soft, until it hardens. Postpartum bleeding can be minimized when mothers are taught regular postpartum self massage of the uterus so that it stays firm and contracted around the blood vessels that supplied the placenta. 

Start breastfeeding right away, and every 1 ½ - 3 hours thereafter, especially taking advantage of the times when your baby is awake and alert and eager to suck.  Nursing frequently causes the body to secrete its own natural hormone oxytocin to keep the uterus firm and decrease bleeding.

Urinate frequently to keep the bladder empty so the uterus can contract easier.

You can also take homeopathic caulophyllum 30 or 200 C immediately after delivery, then 3-4 pellets arnica 30C under your tongue every 2-3 hours. Or, try herbal shepherd's purse, 1 dropperful of the tincture three times daily for the first 3-5 days after birth. If you need additional herbal support for heavier or persistent bleeding, you can try a dropperful of Angelica tincture a few times daily. 

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for postpartum bleeding prevention or search them individually. My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple, and the products will be shipped directly to your home or work within a few days.

As always, if you need more personal guidance, schedule a consultation with me. 

If bleeding becomes heavier than a heavy period, and you are soaking through two maxi pads an hour for 2 hours, empty your bladder, make sure the top of your uterus is firm and massage it if soft until it becomes hard. If no relief, take 1 tsp shepherd’s purse herbal tincture under your tongue. You can repeat the dose a few times, but if the bleeding becomes heavier, contact your practitioner. 

Do read my Natural Birth Secrets book, to prepare yourself for a healthy, joyful and calm pregnancy and childbirth - NOW OUT IN SECOND EDITION!

For further inspiration, empowerment, and optimal health in pregnancy, birthing and postpartum, please make sure to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

Photo by Megan Hancock Photography

How To Build A Successful Midwifery Practice

What I Didn't Learn In Midwifery School

As midwives, we go through years of college and post graduate education and clinical training. We learn a lot about women’s bodies and supporting the natural processes of puberty through menopause, of everything childbearing and breastfeeding. We learn to provide excellent midwifery care - the science and the art of it. We learn prevention and management of complications and emergencies, and to collaborate or refer to a physician, when we are presented with situations beyond our broad scope of practice.

Doulas take a short course to learn how to provide labor and postpartum support, what is needed to mother the mother during this special journey. These things are obviously necessary to a successful midwifery or doula practice. But how to run a thriving midwifery or doula business is not really included in our training. Unless you’re going to be working in a setting where you’re purely an employee with no administrative or marketing role, there are some key elements missing to our education.

For those of us who are called to accompany families through the incredible journey of nurturing and birthing new life into this world, there is no greater honor than when a momma tells us, “I choose you.”

Even after helping moms to give birth to over 1,000 babies, every time I am hired to provide holistic maternity care I am so grateful and so delighted. I know that I will be a part of a powerful experience for that family. Returning power to women, encouraging them to feel their vitality, live in joy and love their birth are some of the hallmarks of my successful midwifery practice, as are my holistic approaches to health and healing.

However, I didn’t earn the opportunity to support the successful births of so many beautiful babies or empower so many inspiring mommas by education alone.

Having a successful midwifery practice of 21 plus years has provided me with many resources and a lot of lessons that I wish I would have known when I first started.

After my education and training, I felt skilled as a doula, childbirth educator, and a midwife. I could help people heal and transform psychic pain with Clarity Breathwork; I could teach yoga for pregnancy, labor and postpartum, and for life. With much experience and ongoing deeper work, I knew I had what it takes to help mommas love their birth experience and I created an online course to share my local practice with the global community. Professionals around the world also take it, to help them help the mommas they serve. Eventually I could write #1 international best selling books on natural holistic birthing and healing emotional pain, trauma and stress so prevalent in the modern world!

On the other hand, I had no clue how to build a successful, thriving practice. I spent a lot of money and time taking many workshops and continuing education. I embarked on my own self-study to master and refine my skills as not only a midwife, but also as an owner of a private practice and its administrator. And I made A LOT of mistakes along the way.

Below are the key things I wish I knew before I embarked on my doula, and my midwifery journey.

10 skills you need to learn (even if you outsource) for a successful midwifery practice

1) Bookkeeping. Billing, collections, taxes, accounts payable. If you don’t have financial systems in place from the start, things can get pretty messy.

2) Dealing with insurance. If you plan to accept medical insurance, there’s a whole world of claims, codes, and coverage that you need to understand.

3) Online Marketing. Between the ever-changing social media platforms, chat rooms and websites, online marketing can feel overwhelming. It’s important to learn how to stand out on the over-crowded internet.

4) Client paperwork. Making needed practice forms, legal documents, and informative handouts for clients is a must in every practice.

5) Charting. The most efficient chart forms vary from practice to practice. And charting challenging cases can be well...challenging.

6) Professional communications. As you grow your practice, there will be a variety of situations that call for written communications to other health care professionals. These include networking and forming collaborative relationships, thank you notes for excellent supportive care, and summarizing cases for consultations or referrals.

7) External Communications. These are letters written to individuals outside the health care team on behalf of expectant mothers as their obstetric care provider. For example, disability claims, approval for gym membership, dental work, or travel, insurance exemptions, as well as payments and appeals.

8) Team Management. As my practice grew, it became increasingly necessary to have clarity about the roles of other members in my practice. Birth assistants and administrative team members need clear protocols for things like handling emergencies and maintaining certain skill sets.

9) Supply Management. This may seem simple, but not having the right supplies for a care visit or a birth can be a real nuisance. Not to mention embarrassing!

10) Self-care. Setting boundaries in your practice for your own personal health and self-care is key to being the best you can be for everyone in your life - family, clients, and self.

Want to learn how I did all this and more (like how I consistently earn six figures)?

Whether you’re considering a career as a midwife or doula, getting your practice started, or an experienced birth professional looking to take your practice to the next level, my programs will get you where you need to be.

You can have a successful midwifery or doula practice, and I’m here to help.

The Homebirth Midwifery Model of Care

           As a certified nurse-midwife with a full-scope group homebirth midwifery practice,  I am often asked what the homebirth midwifery model of care actually is.  I can speak for my philosophies, which are shared in general by many of my colleagues. We provide prenatal, labor, delivery, postpartum and newborn care, as well as breastfeeding support for healthy low risk families planning to give birth at home; we also provide gynecological and some primary care services to well women. We offer a unique, comprehensive model of maternity care that provides an exceptional level of holistic support and services to achieve optimum health. We believe there are several ingredients that contribute to a deeply positive and healthful pregnancy, homebirth and postpartum experience, in addition to our midwifery care. These include wholesome nutrition, whole food supplements and healthy joyful living, relevant health education with books, movies and childbirth classes, connection with a supportive community, regular exercise as well as an ongoing practice of yoga and meditation and other such methods to reduce inner stress and increase inner calm; we often draw on the expertise of additional professionals, such as doulas, childbirth educators, lactation consultants, acupuncturists, massage therapists, chiropractors or osteopaths, and mind/body medicine practitioners to name just a few. We also encourage each woman and partner to take advantage of the many classes and support groups we recommend  – from prenatal yoga, yoga for labor workshop, and postpartum mommy and me yoga classes, positive birth story pregnancy circles, community new mother blessing ceremonies, annual family reunion, postpartum mom circles, pregnancy retreats and a variety of other educational, supportive, and fun events, classes, and ways to connect with other likeminded people and build community – in an effort to bring back the needed village it takes to raise a new baby, and new parents.

           While we continue to expand in our academic, clinical and intuitive knowledge and wisdom, we are also growing in understanding, appreciation and awe of the sanctity of life and its many facets, transitions and phases. Most women are candidates for midwifery care and homebirth; over 92% of pregnant women in our practice will have a homebirth, and we maintain a cesarean section birth rate of less than 5%.  Ongoing individualized care determines the needs of each childbearing family. We have developed practice guidelines in conjunction with other homebirth midwives, evidence based research and the current midwifery literature; they reflect our philosophies and professional standards for practice, and they are reviewed and evaluated periodically as needed. We follow these practice guidelines to protect the health and safety of each individual in our care; and we try our absolute best, within our human capacity, to give our utmost attention and care with integrity, honesty, and heartfelt commitment and dedication.

Photo by Niki Torres

            We firmly believe that pregnancy and childbirth are normal natural bodily functions, profoundly spiritual, truly inspiring and an empowering rite of passage for women and their families. We also believe that childbearing families are best served by caregivers who promote and encourage a loving, respectful, supportive, family-centered environment, and maintain trust and calm confidence in the normalcy of the process, until proven otherwise. We have taken and will continue to take every reasonable precaution to ensure safety, comfort, and deep satisfaction, which are our top priorities. A safe and wonderfully positive birth experience requires the joint cooperative efforts of both the expectant family and health care providers, with a relationship based upon good open communication, mutual respect, and shared responsibility. Education of women and their families is an integral part of our services, so that women are able to assume this responsibility for health maintenance and effective utilization of health care. Opportunity is offered to our clients to participate in the planning and implementation of their care, as emphasis is placed on an outcome that satisfies emotional, educational, family and spiritual concerns beyond the obvious physical needs. 

           We feel that every individual has the right to safe and satisfying health care by the provider of their choice, given with respect for personal preferences and cultural variations. We believe that normal, healthy women have the right to birth at home if they choose to do so, and as licensed practitioners, feel an obligation to make birth as safe and satisfying as possible for them. For the overwhelming majority of families, the childbearing experience is one of health rather than illness, and there is a need for preventative and loving supportive care that is not only safe, but also sensitive, compassionate and empowering. We believe in enhancing the normal processes of the female reproductive cycle, pregnancy and birth through education, physical and emotional support, and involvement of significant others according to the choices of each expectant mom and those she chooses and wants to be involved.

            Our responsibilities include review of each woman’s complete health history, physical examination findings, and lab results to determine her eligibility for continued midwifery care and homebirth, as well as ongoing evaluation and guidance throughout pregnancy, labor, birth and postpartum with attention to signs of normalcy and/or signs of complications.  All findings are discussed openly; and there will be no routine procedures or interventions unless medically necessary and mutually agreed upon. While childbearing is a healthy, normal and natural process for the vast majority of women and babies, problems can infrequently occur, and need to be recognized and attended to. Although many complications can be prevented or handled simply within our practice, some do require consultation with a collaborative physician or transfer to medical and hospital care to increase the likelihood of a safe outcome.  It is our philosophy that decisions regarding each woman’s care are informed and collaborative, and ultimately hers to make; however, rare emergent situations may arise in which the professional judgment of the midwife and/ or consulting physician must be relied on exclusively for the safety of mother and baby. We are grateful for life saving hospital medical and surgical care when there are serious complications and illness; and it is my hope that the homebirth midwifery model of care can be applied as much as possible in all birth settings, including the operating room, if surgical birth is needed.            

           There is an overwhelming cultural belief in the United States that hospitals are the safest place to give birth, regardless of the extensive scientific data that planned homebirths with skilled midwives suggest otherwise. Numerous studies around the world have documented the safety of planned homebirth by trained professional midwives, with outcomes at least as good, if not better than those occurring in a hospital.  This is especially true of women who have delivered vaginally before. The total slight increase newborn mortality risk of home birth is estimated to be 10 per 10,000 babies born at home, and that 1 in 1000 babies born at home may be adversely effected by the extra transport time in reaching advanced care in the hospital; the absolute risk is small however. Despite spending the most money on obstetric care, the United States ranks among the lowest of industrialized countries around the world in neonatal mortality and morbidity, and ranks quite low in maternal mortality and morbidity as well. Countries that consistently demonstrate the best maternal and newborn outcomes have a large percentage of midwife led maternity care for healthy women experiencing normal pregnancies - which constitutes the vast majority - a higher percentage of homebirth midwifery care with supportive hospital/medical transfer arrangements when needed, while the obstetricians attend to the women with high risk complications and serious illnesses, which is how they are educated as surgeons and medical doctors.  When midwives and obstetricians work together as a team, both using their unique skills, knowledge, expertise and training, the outcomes for moms and babies are far superior. Midwives are trained in guarding the normalcy of pregnancy, birth and postpartum, not disturbing it when all is well, knowing when to compassionately observe with loving support, and when and how to use holistic remedies, or medical intervention only when necessary as a last resort; they are also educated in prevention, assessment and treatment of complications, which most times can be managed simply and naturally, but sometimes involves consultation or referral to an obstetrician. Although unforeseen events and emergencies can occur in any birth setting, some of which can be best handled in a high risk hospital, a low risk healthy woman entering the typical U.S. hospital expecting a normal vaginal birth is subjected to a routine barrage of procedures and interventions that dramatically increase the risk of complications and problems, with potentially longstanding physical and emotional ramifications for both mother and baby. 

            There are many other benefits of homebirth midwifery care, in addition to safety, which provides an alternative to the impersonal, fear based, law suit prevention oriented medical and hospital care that has become prevalent in our society. These benefits include but are not limited to the power of the human touch and presence, of being surrounded by supportive people of a family’s own choosing, security in birthing in a familiar and comfortable environment of home, feeling less inhibited in expressing unique responses to labor (such as making sounds, moving freely, adopting positions of comfort, being intimate with her partner, nursing a toddler, eating and drinking as needed and desired, expressing or practicing individual cultural, value and faith based rituals that enhance coping) -- all of which can lead to easier labors and births, not having to make a decision about when to go to the hospital during labor (going too early can slow progress and increase use of the cascade of risky interventions, while going too late can be intensely uncomfortable or even lead to a risky unplanned birth en route), being able to choose how and when to include children (who are making their own adjustments and are less challenged by a lengthy absence of their parents and excessive interruptions of family routines), enabling uninterrupted family boding and breastfeeding, huge cost savings for insurance companies and those without insurance, and increasing the likelihood of having a deeply empowering and profoundly positive, life changing pregnancy and birth experience. Getting holistic prenatal through postpartum care and birthing in one’s own home attended by a skilled midwife, is a refuge for those who want to protect the normalcy and sanctity of pregnancy and birth. But focusing on the normal does not mean that problems go unrecognized or unattended; rather they are viewed as imbalances that need to be righted, not expected or feared. 

           That being said, certain hazards do exist however, in all settings, whether childbirth occurs in or out of the hospital; and there are risks unique to each setting.  Some of these risks will never be eradicated no matter what our state of technology or medical advancement. The safety of home birth is well documented, but childbirth by its nature is a threshold passage for the mom, and the baby.  Some babies are born with defects and injuries despite all the technology, tests, and skills of the attendants.  In spite of the fact that that hospitalization of birth has failed to eliminate fetal or neonatal death, there is a cultural expectation that doctors and hospitals can guarantee a “perfect baby” every time. This is a pervasive myth. It is impossible for any provider to guarantee much of anything. Birth defects may or may not be detectable by prenatal testing. The practice of midwifery, nursing and medicine are not exact sciences and no assurances can be made regarding the results of examinations, diagnostic tests, treatments, procedures, or interventions. It is impossible for any provider to guarantee a normal healthy birth, mother or baby. Part of the wonder of the miracle of birth is the inherent lack of guarantees in life and birth, and the surrender to a power far bigger than ourselves. Part of life is death, and we often do not know why a person lives or dies. We do have a spiritual perspective, and believe that while we can do our best to do what is humanly possible, most of life, birth and death are ultimately not in our control; we do believe that everything that happens is meant to happen, because it did, and that it happened for our benefit, even if beyond our understanding, as we are souls temporarily residing in bodies, and know that G-d/Spirit of our own understanding is only good. Conception is the beginning of life, yet every life must end sometime.  Part of pregnancy is the excitement of new life and the fear of its loss. This is normal human reality and is in part why pregnancy deepens and matures a woman and man spiritually and emotionally.

Art by Spirit Y Sol

Photo by Megan Hancock Photography

           We try our hardest to give the best care that we possibly can, pray we make the right decisions and that our hands are blessed. But we are all only human.  Midwifery and obstetrics are such humbling professions. And I would choose no other. 

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma,

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are planning a birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams.

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom andcommunicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

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