Saturday, April 4, 2015

New Vaccine Schedule

The CDC has revised its vaccination schedule for children this year. You can find more information regarding the changes at the following:

Beautiful Beginning Birth is committed to helping parents make informed choices regarding their child's health care. As such, this article is in no way intended to be medical advice or to take the place of a consultation with your child's health care provider. We do not support or
the use of vaccinations. It is important for parents to understand that vaccinating is a medical procedure that comes with risks. We encourage each person to research the number of complications and deaths that occur with each individual vaccine and with each individual disease, to assess the likelihood of your child experiencing risks from either and to make the choice that is best for their family. You can begin your research into that at the following:

We welcome and encourage posts about additional, credible resources that you may have to share so that other parents can feel empowered in their search to make decisions for their family.We respect each person's right to chose what they feel is best for their family. As such, we ask that you do not post any disparaging comments or personal opinions on here.


Midwifery has always been an apprenticeship based program.

Women learn from other women.

Midwifery is a sacred art.

When a woman chooses a midwife, she is choosing a woman that she trusts, that she can bond with, that she can rely on to assist her through the most sacred moments of her life. She needs to have confidence in, and complete trust in her birth team.

Some midwives prefer to attend births by themselves, others come with a team. Here are Beautiful Beginning Birth, we prefer to have three birth attendants for a birth - one for mother, one for baby and one for charting and grabbing extra supplies if they are needed. While the entire team works together to assist the mother in her journey, each member has a designated role should it become necessary to multi-task.

There are several different routes to becoming a midwife, but all contain a clinical component. In general, students are engaged in didactic learning that begins prior to their clinical apprenticeship and oftentimes runs concurrent with it. So, students begin working with patients/clients after they have a baseline knowledge to work from. Selecting the right students to work with a midwife is pretty important. As a birth center, I receive several calls and emails a week from students seeking a preceptor and from doulas looking for midwives that will refer to them.

It cannot be stressed enough how important physical appearance, writing skills, and body language are to the selection process. There are literally dozens of apprentices in the Austin area looking for an apprenticeship at any one time. It is important to make yourself stand out. Here is how I select who I am willing to share my knowledge and experience with -

First impressions are lasting.....and very difficult to change. The first thing I notice about a person is their email. If it is a generic email that starts off with "Good morning/Hi, My name is Jane Doe. I want an apprenticeship. I want a preceptor in the area....." Several things stand out immediately - KNOW MY NAME! A generic good morning without addressing it to a specific person is very lazy. Secondly, people rarely just jump right in and state that "they want", but I chose that phrase to make a point. A student requires A LOT of energy and time at the beginning of an apprenticeship. There needs to be some balance - what do YOU offer ME in exchange for teaching you all I know, sharing my "trade secrets", and assisting you in being my competition? Yes, that's the hard truth - you need to give something to get something. So, tell me what you have to offer me - are you also a doula, massage therapist, EMT, phlebotomist, great with networking or media? Have something that you offer back that is invaluable, otherwise you are expendable.

How do you know what you can offer back? Another important point - just like going in to a job interview, you need to research the company/person you will be working for. Look at their website, check out their business facebook, their advertisements, etc. Know the philosophy of the company and make certain it aligns with your own., Some midwives support the "home birth at all costs" philosophy; others feel that while birth is important, safety for mother and baby takes priority. Figure out where the midwife stands on important topics and make sure you can support those views, otherwise you are undermining her practice and yourself.

Should you include a resume? I like when someone attaches a resume to their email. It gives me the opportunity to sample their writing skills, their strengths and weaknesses, their philosophy (through their interests). However, I also understand why someone making the email version of a cold call would not want to include that much personal information in an initial email. I suggest mentioning that a resume and references are available should the midwife want more information. This demonstrates to me that the person has enough initiate to have those things available and is serious about her new career choice in midwifery.

Grammar is VITALLY important in the email and the resume. I am old school. I grew up in the paper and pencil era where fancy fonts and eforms were not the norm. As such, I prefer to see traditional resumes that do not exceed one page. I still believe that you should NEVER hand in a resume with more than one page regardless of how much you have accomplished in life. It is pretentious, demonstrates a personality that cannot differentiate between relevant and non-relevant information, and does not understand the importance of brevity.

Do not just show up at a midwife's office. Some of us keep a lower birth volume and have ample time to meet with a walk-in, but others are very busy and book our appointments without much time between, so walk-ins are difficult to accommodate. Schedule an appointment and make sure you arrive ON TIME. Plan to arrive early and hang out at a local Starbucks until the appointment time. Value her time by being on time yourself.

Your appearance is very important. At Beautiful Beginning Birth, we have a dress code that requires professional attire for office appointments and scrubs for births. Someone that shows up wearing jeans, spaghetti straps, or dirty clothing will not be well received. Hair should be neat and brushed, fingernails should be short and their should be attention to detail that demonstrates an understanding of what it means to be a midwife - ie no red nail polish or excessive jewelry.

Body language is important. When the midwife comes out to greet you, stand up, introduce yourself (to remind her of your name), and shake her hand. Make sure your hand shake is socially appropriate. You can tell a lot about a person from their hand shake - do they grip your hand with their full hand? The finger tip grip implies distrust. While shaking, do they turn their hand so that theirs is on top and yours on bottom or grip your hand in both of theirs? This is a sign of an aggressive personality type, one that will have difficulty following instructions and will always be questioning. Do they hold the hands for too short a period of time? This implies insecurity.

Stand and sit straight and walk with confidence. Midwifery is holistic care. Make certain that you are the walking example of what you want to teach clients. You will lose credibility with patients if you continuously counsel them to exercise during their pregnancy when it is very obvious that you have never exercised. (Would you go to marriage counseling with a marriage therapist that has been divorced five times?) Live what you will be teaching. During your interview, make sure you stay focused and on task. A couple of personal stories makes you a real person, but remember to keep them to a minimum. Demonstrate time management skills by respecting her time and not dragging the interview on into a second hour.

Respect what she has to say and do not argue with her. If you disagree with her philosophy, you don't belong there. I had one interviewee tell me that she did not want me to waste her time teaching her the business end of midwifery because her husband is a lawyer.......I asked her if she knew how to get a CLIA waiver (she did not know what that was), if he was going to be filing birth certificates, writing her protocols, etc. She very quickly came to realize that the "business end" of midwifery includes all the paperwork, how to get medications, how to find a sponsoring physician, etc. Ignorance is your enemy. It is extremely disrespectful to assume that you know what you should and should not be taught.

Bring in a work sample for her to see your motivation. Have you created a neat handout for pregnant women on nutrition, teratogens, breastfeeding, any aspect of maternity care? A cool looking "cheat sheet" chart for NRP? Anything that shows that you are a self started and motivated learner is a huge plus. I'm not one for bribes, but chocolate always helps. :-)

Hopefully, with these tips, you will be well on your way to being a marketable asset to a midwifery practice.

Thursday, October 9, 2014

Didn't I Just Do This? - Postpartum Depression

Everyone knows that the Baby Blues are common. After birth, mothers are sleep deprived, the are nursing all hours of the day and night, they are exhausted from the work of labor and delivery, the body is starting to produce milk. There are a lot of things that happen in the first few weeks after birth that can leave a mother feeling tired and overwhelmed. This is pretty “normal”, or well, common enough that we can just call it normal. Some women have a smooth, graceful transition with effortless breastfeeding, labors that hardly seem like work at all, get sleep when their baby sleeps, and the baby seems to be on a fantastic schedule from day one, and…well, the majority of us are jealous!

For others, the transition into motherhood is a rocky one. These moms usually have higher maintenance babies that have no discernible pattern, they are left exhausted, frustrated and overwhelmed. They don’t wake up in the morning and think “Oh jeez, I have to take a shower again today”, their thoughts are focused more on the minutiae, where the task of taking a shower becomes “Oh no, I have to get up out of bed, use the bathroom, take my jammies off, heat up the water in the shower, get in, get ALL of me wet, find the shampoo bottle, struggle with the cap, pour enough in my hand, scrub my hair, then sit there forever rinsing it out, THEN I have to find the conditioner….”  What, to most of us, is a simple “one-step” activity – taking a shower – becomes a monumental list of activities that all must be performed.

For women with depression, the minutiae of the day wear them down and they think “Didn’t I just do this??? Didn’t I just take a shower yesterday? Didn’t I go to the bathroom already? I have to wake up again?” It’s more than just being too busy or tired with a new baby that keeps them from taking a shower. It’s that a shower has become too great of a task. Even the thought of a shower has too many components and the mother’s mind wants to shut down at the thought of so much work.
This is a sign of postpartum depression and and a sign that she needs help. Professional  help. There’s no shame in that. Our hormones can wreak havoc on our bodies and through off the neurotransmitters in our mind.

Most of us are familiar with the signs and symptoms of depression, but sometimes these take on a more unique presentation. There can be a perseveration of an idea. One that she just cannot escape from. For me, I experienced this with my second child; however I did not recognize it for what it was. I was paranoid. I thought that if I brought my baby to the doctor he would inject her with something that would kill her. As I was driving down the highway, I experienced tremendous fear and anxiety that someone driving by would take out a gun and shoot her as they passed by. People in public were suspect as well. They may stab her as they walk by. I was fiercely protective of her and preoccupied with concerns, regardless of how irrational, that anyone could harm my baby. We did not put a birth announcement in the paper – a common practice 20 years ago – because I was convinced that it would alert baby snatchers who would then break into my house and steal her from me.

Depression can be more than just exaggerated baby blues. It can manifest in ways you do not expect. If you, or your partner, have any concerns about your thoughts and feelings, talk to your health care provider as soon as possible. Do not try to treat postpartum depression on your own. Respect your body by allowing a neutral third party to give a fair, unbiased assessment of what is going on.

Read more about Postpartum Depression by visiting

Even if your symptoms do not fit into the typical depression symptoms, talk to your provider. Here at our birthing center, women with mild PPD can be treated holistically with homeopathics, herbs, supplements, and a variety of other modalities; however they are monitored much more closely to ensure that the treatments are working and that they are not a risk to themselves or others. Not all depression needs to be treated with medications that can affect breastfeeding. Medications are essential in some cases, but not all. Remember, you can call your provider 24 hours a day 7 days a week. Offices have on-call staff for their off hours, and you should NEVER hesitate to call if you feel that you may harm yourself or your baby.

Try these resources to learn more about PPD or to find a counselor/group. You can also call your insurance company to ask for referrals.

To learn more about giving your baby a beautiful beginning, visit

Thursday, July 24, 2014

To Circumcise or Not

There are not many topics related to parenting as controversial as the decision to circumcise or not. Circumcision is the surgical removal of the clitoris and part of the labia in a female, or the foreskin in a male. I think most of us in this country would agree that female circumcision is a form of genital mutilation, however it a very common and accepted procedure in other cultures.

What we do not see here in the United States is the same outcry toward the same type of genital mutilation performed on our sons. There are many reasons why parents may choose to have their son undergo this surgery – religion, culture, a desire for him “to look like his father” (perhaps we should consider cosmetic surgery for other parts of his body as well). Currently 54.7% of males are circumcised. Some of the benefits linked to circumcision include a lower risk for contracting HIV and Herpes., however the surgical procedure does not come risk free

If you are considering circumcision for your son, we encourage you to do your research – watch the video, read about the pros and cons, and research the surgeon performing the surgery. There are many reasons why parents chose to circumcise and there are just as many that parents chose not to. It is our position that each couple should make informed choices regarding their baby's health care and the their medical team should respect their decisions.
On a personal note, I believe that nature should not be challenged. Foreskin serves a purpose and nature put it there for a reason. Let's respect the beauty of a natural, intact penis.

Written by Emma Morrison MS, LM, CPM

Monday, July 21, 2014

Developing your Baby's Brain with Toys

It's never too soon to begin providing your precious bundle with the proper stimulation to enhance his or her brain development. A great way to do this is to be interactive - sing songs, read books and talk to your baby about the things that are going on around you. Another great resource is Discovery Toys. These are excellent products that will keep both you and your baby entertained. Visit www. to see the latest products. To learn more and to get hands-on experience with the toys, call Emma to set up an appointment. 512-636-3661.

Thursday, July 17, 2014

Beyond 40 Weeks

The long anticipated day has arrived….but the baby hasn’t. What happens when a pregnancy continues after the due date?

Practitioners use pregnancy dating to help track milestones during a pregnancy. It’s important to have as accurate a “due date” as possible, however this is sometimes easier said than done. Pregnancy due dates are calculated in several different ways. A normal, healthy pregnancy is expected to last 266 days from the day of fertilization. Most women are not certain of their day of ovulation, but most women can remember the first day of their last normal menstrual period, so this date is the most commonly used date to determine a due date1. The Estimated Date of Delivery, or “due date” is just an estimate. Only 3% of babies are actually born on this date. A normal, healthy pregnancy is considered full term at 37 – 42 completed weeks.

Another way of determining the due date is through an ultrasound. Early (first trimester) ultrasounds are very accurate – to within 2-3 days. Later ultrasounds (second and third trimester) are only accurate within two weeks – not very helpful when determining a due date.

So, you have an estimated due date that has been confirmed by early ultrasound and now you hit 40 weeks and there are no signs of labor, what happens? Your midwife will probably ask your permission to perform a pelvic exam to check to see what progress your cervix has made toward labor preparation. The changes in the cervix give us information on the readiness of the cervix. The more ready the cervix, the higher the Bishop’s Score. While not usually a suggested source for accurate medical information, there is a good entry on Bishop’s Score at this site

At 40 weeks in a first time mother, we are not overly concerned if there are not many changes in the cervix yet however, I like to perform a Biophysical Profile2 to ensure that the baby is doing well, the amniotic fluid volume is adequate and to have a good baseline in case further evaluation is needed later on.

By 41 weeks, in my practice, I like to see something going on. The cervix should be a little softer and a little more flexible. I would really like to see some dilation as well. At this point I like to start a natural encouragement of labor. I prefer to start off with gentle, natural methods that can help nudge the body into going into labor on its own. Our practice does not use any methods that will force a body into labor. We use gentle methods only.

Somewhere between 41 and 42 weeks I like to see the body going into labor. A pregnancy that does not have any complications such as preeclampsia, hypertension, gestations diabetes, etc can be allowed to wait this long for labor to begin with natural methods. It would be nice to allow a pregnancy to continue on for as long as it would like to, however we have to be realistic. Not all women can go into labor without intervention. Once we get close to the 42 week mark, there are some increased risks to both mother and baby.

After 42 weeks, a pregnancy is considered post-term.

 “Post-term pregnancy is associated with risks to the fetus, including increased perinatal mortality rate, low umbilical artery pH levels at delivery, low 5-minute Apgar scores, dysmaturity syndrome, and increased risk of death within the first year of life3…”

A number of key morbidities are greater in infants born to post-term pregnancies as well as pregnancies that progress to and beyond 41 0/7 weeks gestation including meconium and meconium aspiration, neonatal acidemia, low Apgar scores, macrosomia, and, in turn, birth injury...Post-term pregnancy is also an independent risk factor for neonatal encephalopathy and for death in the first year of life. 4

The potential complications are not limited to the baby. A birthing woman is at

”… an increase in labor dystocia, an increase in severe perineal injury related to macrosomia, and a doubling in the rate of cesarean delivery. Also, post-term pregnancy can cause anxiety for the pregnant woman3.”

The risks to the mother can be high, but are very manageable. The risks to the baby are not. It is important to note that “…evidence shows that antenatal fetal surveillance for post-term pregnancies does not decrease perinatal mortality…3  Statistically, the incident of these risk factors is low, this is your baby’s life we are “gambling” on. Each practitioner has his/her own set of practice protocols that must be followed. For some, that means inducing at 40 weeks. Others are more comfortable waiting until the 43rd week before intervention. When discussing post-term pregnancy with your provider, remember that your birth plan is important, but the MOST important part of your birth plan is a safe, healthy baby. Sometimes that means that more intervention than you planned for is needed.

Trust the practitioner you chose to assist you in bringing your little bundle into the world. It has been my experience that once that 40 week mark passes women tend to have high levels of anxiety as they begin to fear losing that birth plan they worked so hard to formulate. The more time that goes on, the higher the anxiety and the more difficult decisions become for a woman. Relax (the best you can) and trust. Your provider is working hard to protect your health AND the health of your baby. Trust in his/her wisdom and experience and be flexible in your expectations.


1.    Source sited July 17, 2014

2.   Source sited July 17, 2014

3.    Source sited July 17, 2014

4.   Source sited July 17, 2014

Friday, November 8, 2013

Caffeine and Pregnancy

What is a 'safe' amount of caffeine during pregnancy? It depends upon which health organization you ask. Caffeine is a drug. It's a stimulant, and as such, it does not come without risks. Caffeine readily crosses the placenta and is found in the urine and blood of your unborn baby. To confound the problem, an unborn baby has a lower level of the enzymes used to metabolize caffeine. In a healthy woman, it takes 2.5 - 4.5 hours for the body to metabolize and eliminate half the caffeine consumed (half-life). During the second and third trimesters this increases to 10.5 hours.

Most organizations recommend limiting caffeine intake to less than 300mg per day. An 8 ounce cup of coffee contains 179 mg. Please remember that very few coffee mugs or Starbucks cups are only 8 ounces. Caffeine is also found in tea, chocolate, and some sodas.

Since caffeine offers no nutritional value, we suggest replacing caffeinated beverages with herbal teas, hot cocoa, or warm almond milk. If the average life expectancy of a person is approximately 76 years, 9 months is a very short period of time (to make the change to avoid caffeine) that will benefit your baby for a lifetime.

To learn more about how caffeine can affect you and your pregnancy, visit our references:

Monti, Davorka: Is caffeine in pregnancy giving you the jitters?, International Journal of Childbirth Education, Vol. 22 Issue 1, p16-17, March 2007.

Written by Alisa Copeland