Jeanna Deswert LM, CPM

Because May is month, I want to dedicate this space to raising awareness and sharing information and stories about perinatal and maternal mental health conditions. Perinatal mental health and maternal mental health are often used interchangeably. Perinatal refers to the period of time during pregnancy, labor and birth, and the first years of the postpartum period.

Did you know

🌿 1 in 5 women suffer from a maternal mental health disorder?
🌿 34% of new mothers report experiencing a traumatic child birth.
🌿 Maternal mental health disorders are more than the “baby blues” and consist of a range of mental health conditions, such as depression, anxiety, OCD, and PTSD.
🌿 Less than 15% of women diagnosed with a maternal mental health disorder receive treatment.

It is highly likely that you or someone you know and love has struggled with a perinatal mental health condition.

We live in a society that places unrealistic demands on mothers and primary parents. We also live in a society that significantly lacks true community support. I read something once that said, “We live in a society that expects us to work as if we didn’t have children and parent as if we didn’t have to work.”

I invite you to weigh in and share your experience with perinatal mental health problems. You can also DM me and share your experiences privately.

Today is World Maternal Mental Health Day and the entire month of May is dedicated to Maternal Mental Health Awareness. This month I will dedicate this space to talk more about perinatal mental health and its impact.

Maternal Mental Health is a complex and multifaceted issue that requires awareness and access to adequate mental health resources. Did you know that up to 1 in 5 women suffer from Maternal Mental Health (MMH) disorders in the U.S. each year.  Research shows that this number has more than doubled during the pandemic.  Now, more than ever, it is important to address barriers to maternal mental health care and treatment. 

Did you (or someone you know) experience a mental health condition during pregnancy or after giving birth?









 
 

Did you know that most obstetricians and midwives are not extensively trained to manage a vaginal breech delivery? The training most healthcare providers have provides a basic overview of vaginal breech birth and frames it in the context of an emergency. Midwives who are trained in breech birth have sought out training that exceeds what is required and/or taught in their respective training programs.

In order to offer vaginal breech birth as a safe birth option for expecting parents, we need more providers who are adequately trained in breech birth.

I have compiled a list of some of my favorite Breech Birth courses/workshops and resources!
Do you have a breech practice?
Which breech trainings have you taken?

Let’s chat about some key considerations for a vaginal breech birth (VBB)!

Beautiful words! ❤️

A piece written in honor of International Day of the Midwife!

with mother

In the sacred spaces
between woman and mother
she sits.
Negating any personal fame or notoriety,
she holds
space
for the unfolding of miracles.

Instincts and primal remembrances linger
thick in the air as she cradles the becoming
of mother
She gives reverence to the
mothers that came
before and
before and
before.

Her power lies in protecting
the intuitive power of woman:
raw,
fundamental,
the only catalyst for the future.

She believes even when you don’t,
bestowing
genuine words
gentle touches
transcendent calmness
as new life comes from motherland to homeland.

She is -
with mother -
a midwife.

Katie Drobina

(PS How was I so lucky to have the best midwife for two of my births?!) Jeanna Deswert LM, CPM

This is so fascinating!! “The lifelong consequences of the exchange of cells between a mother and her child are profound and have many applications in development, health, and disease. This intricate exchange of genetically foreign cells creates a permanent connection that contributes to the survival of both individuals."

Microchimerism​: The "forever connection" two-way transfer of cells If like me you aren't so familiar with the word, microchimerism means the presence of two genetically distinct cell populations in the same person, for example, a pregnant mother and the fetus growing inside her womb.

I never understood how important the postpartum period is for both the new parent and baby. In the society I live in, the sacredness of this period is all but forgotten. Prior to my birth, I spent time researching the concept of a slow postpartum and how many cultures around the world deeply honor and rever this time and space. It was my goal to gift myself and my baby that sacred time as we transitioned into a new state of being. There was something deeply profound and powerful about staying in bed with my fresh baby while the world turned around us. We spent our days like this, skin-to-skin and lost in milk drunk dreams. It was slow, it was deliberate, and it was nourishing in the deepest ways. When you are allowed the time and space to honor a slow postpartum period, you have the opportunity to connect with yourself and your baby in ways a busy world simply does not allow. I will forever carry with me the power of that time and the ways in which it allowed baby and I to truly transition from an esoteric or spiritual state to a materialized one here on this beautiful earth. ✨
I want to hear all about your postpartum experience, the good, the bad, and everything in between. Comment below 👇🏼 and let’s talk!

Please donate to help out! Our student midwife Hannah had her belongings stolen, including her wallet, ID, and money.

UPDATE: Thank you to everyone who donated, our need has been met for Hannah! You are all amazing!!
❤️

We need a little help for our sweet student Midwife Hannah Erbeck! She has been with us several months and will be a long term Midwife with our Organization. Hannah is such a blessing to us and to the families we serve. She is not paid and relies on Missionary donations to continue her volunteer work and training with us.
Yesterday, Hannah was in the pharmacy looking for medication for a patient back at the clinic. A very unkind person broke into the New Life car and robbed Hannah of her belongings. She is now stuck in Ecuador with no ID, bank ATM card or cash. They even stole her phone that is desperately needed for the work she does serving the pregnant and postpartum women of Southern Ecuador!
Hannah is very upset and isn’t sure how she is going to replace many of the items, as there is no reliable US to Ecuador mail service.
Today we are praying to raise the funds Hannah needs to replace her phone and at least have money to live on, while we help her get the other items replaced.
Thank you to everyone in advance for your financial help and prayers for Hannah!

As a midwife, I feel that it is imperative to be trained and experienced with breech delivery. This story is somewhat similar to a recent breech birth we had here in Ecuador and the sharing of these types of stories is so important. So thankful that this babe had a healthy outcome thanks to the skills of a midwife!



https://www.breechwithoutborders.org/l/34wk-posterior-prolapse-entrapment/?fbclid=IwAR3SNhcYT_7q5Ulj9G7d-PpQvW5IYnA13bX9CBg4OoyYK85jKeQ9K8_-znU

34 week posterior breech with cord prolapse and cervical head entrapment by Kristine Lauria, CPM, of Médecins Sans Frontières in the Rohingya Refugee Camp, Bangladesh.

A year and a half ago I was working in Mexico, providing acute healthcare services to the migrant and refugee population stuck on the border in Tijuana. My colleague and dear friend pulled this book out of her backpack and it quickly became my all time favorite reference, especially for the field.
A Pocket Guide to Clinical Midwifery is an excellent resource written by midwives. While it takes a more medical/pharmacological approach, it also offers evidence-based alternative therapies. I highly recommend this resource to all midwives, whether you’re working in a home birth practice, a birth center, or working in the field.
I cannot tell you how many times I have used this book since being here in Ecuador! Midwives and birth workers, what are your favorite go to references?

There are two reasons why I almost didn’t become a midwife: 1) gaping wounds (aka tears)/suturing; and 2) vomit. Both of which are intrinsically linked with pregnancy and birth. Pregnant and laboring people vomit often...and people sometimes tear while giving birth and require sutures. It’s just part of the deal. I remember doubting myself before I even began and seriously questioning whether I could get over these things. I envisioned myself gagging every time someone threw up (and sometimes I do gag) and I envisioned passing out the first time I saw a tear or had to suture (spoiler alert, I didn’t pass out). I worried about these things to the point of almost quitting before I even began. But becoming a midwife was something I wanted and I am not known for taking no for an answer or letting things stand in my way.
I tend to approach things from a “cross that bridge when we get to it” perspective and that’s exactly what I did. I had no idea how I would handle those things, but I did. The first time someone threw up in labor I barely flinched. The first time I saw a gaping tear and assisted with suturing I didn’t blink twice. It was all in context and I was amazed at my ability to handle it after psyching myself out beforehand.
While vomit is still my least favorite thing in the world and sometimes it makes me want to do it too, I am not that bothered by it in context. While I hope birthing people do not tear and I do what I can to help prevent tearing, suturing is actually one of my favorite things to do. No two tears are alike and it is something that presents a healthy challenge.
Tell me I am not the only one who almost reconsidered a career in healthcare because of reasons like this!

I am notorious for always wearing my hair down and at times that has been a little dicey. There is a running joke among those who have done birth with me that you know things are getting serious when I put my hair up! Sometimes I don’t get my hair up fast enough and there have been many times where my fellow midwives or birth assistants have had to hold my hair back from birth tubs, babies, and placenta bowls.

Midwives spend an abnormal amount of time waiting and on their phones. Sometimes it feels like that is all we do. Waiting on a baby, waiting for clients, waiting for test results, waiting for treatments to work, waiting for that hot cup of coffee and a decent meal, waiting for others, waiting for the birth tub to fill and the baby to turn. Here I sit, just outside the clinic and birth center, waiting, while talking to clients, reviewing lab results, putting in prescriptions, and developing treatment plans.

Tuesday is a full clinic day and we never really know what we will see or who will walk through our door. Some days we hit the ground running and cannot keep up with the number of patients coming in. Other days, we have a few minutes of down time in between. Also, does anyone else love paper charting as much as I do? I seriously love it!

Expecting parents and families in Virginia, my amazing friend and fellow midwife is now accepting home birth clients. Check out her services and share with others who may be looking for a midwife!

I'm so excited to now accept midwifery clients in Virginia - home birth and holistic well woman care (all in your home!) Find out more here >>>>>> https://www.beingandborn.com/

Today is World Mental Health Day, serving as a reminder that despite an increased awareness, we simply do not talk enough about mental health personally or professionally.
After having burned out as a midwife, followed by major depression, anxiety, and more, preserving my mental health has become my top priority. The lessons I learned through my own experiences has also led me to focus on mental health in midwifery as a profession. Midwifery is not a healthy or sustainable profession, it simply isn’t. Show me a single midwife who doesn’t have a fu**ed up thyroid, hormonal imbalances, pre-diabetes, raging levels of cortisol and stress hormones, metabolic issues, extreme exhaustion/fatigue, and more. Show me a midwife who actually has a solid work-life balance, who is able to make a decent living without compromising their health/well-being and/or their family. If you can find one, I guarantee it’s because they haven’t been in the field long enough to experience the toll this profession and lifestyle takes.
It took three straight years of working in high volume and high intensity environments, with no time off, to burn out. I felt it coming but I kept going, convinced nothing could slow me down let alone stop me in my tracks. When it hit, it hit hard and took a significant toll on my mental and physical health. It has taken me two solid years of concentrated efforts to rebuild my health and I still have a lot of work to do to get to where I need to be.
The only way to achieve balance and protect our mental and physical health in this field is by setting strict, inflexible boundaries. If you give an inch, this profession will take everything you have and swallow you whole.
It is my goal to lead by example and to teach our students and young midwives the value in prioritizing their own mental health and well-being. Some may say this is selfish, but on the contrary, it’s the best gift we can afford ourselves, our families, and our clients.

An Rx of 16oz of coffee PO daily. Is this available in an IV infusion? Midwifery seems to be embedded in its own coffee culture. There is something so visceral about a hot cup of coffee as the sun rises just after welcoming a new soul earth side. There is also something to be said about that mid-morning pick me up delivered by an ice cold frappe in the middle of a bustling clinic day with no end in sight. Every Tuesday and Thursday we treat ourselves to a cold coffee treat to fuel us through our clinic days here in the mountains of Ecuador. Maybe it isn’t the healthiest thing we could be doing for our adrenals but for a minute let’s care a little less about that and enjoy the ritual of it.
Fun fact! I tried my first cup of coffee only four years ago, when I was halfway through my midwifery program. At first I didn’t like it, but as the births kept coming and it was often readily available, I grew to like it and now I love it! I go through prolonged periods where I don’t drink any coffee at all and then periods where I enjoy a cup or two (or three) every day. Here in our village we have a couple of really amazing coffee shops and we happen to be seated along la ruta del café (the coffee route) here in southern Ecuador...and I am not at all mad about it.
Also, side note, I always find little synchronicities between the places I come from and the places I go. I moved here from Santa Monica, California and lived minutes from Beverly Hills. Ironically, Beverly Hills Café has become my favorite little coffee shop here and never fails to make me feel a little nostalgic for those pre-COVID SoCal days!

“I will sleep when I am dead.” I said in half jest as I grabbed a clean pair of scrubs and headed back out the door after returning home following a 24 hour shift that had turned into 36 hours. At that time I was a student midwife, on the verge of graduation and I had not yet learned the hard lessons associated with absolute burnout. I have a drive and a passion and those things combined propel me full force into what I do. I never saw the burnout coming. There is nothing anyone could have said to prepare me or convince me to slow down and believe me, those closest to me tried.
One of the hardest lessons I have learned as a midwife is how to set appropriate boundaries. Maintaining a work-life balance seems to be unattainable in midwifery. As midwives (especially in private practice) we are almost always on call and are the first line contact for our clients and their healthcare needs. In other settings, such as crisis/disaster settings and war zones, the needs are acute and never ending. What is supposed to be an 8 hour day often turns into 16 hours and then 24 and then you find yourself up and back at it the next day...and you’re often one of the only healthcare providers available.
Burnout rocked my world. It derailed me in the worst possible ways. It had a profound impact on my health and it has taken me more than two solid years to regain it back. Going forward, avoiding burnout and maintaining a healthy work-life balance is my top priority as a midwife. Though actually setting boundaries can be difficult and it requires consistent reinforcement, which isn’t always easy. I continuously see and hear from midwives how exhausted and burned out they are.
Have you experienced burnout? What kind of boundaries have you set?

“Are those toes? Those look like toes.”
Have you ever wondered what your midwives look like during a birth? Now you know!
This series of photos shows us watching and discussing what we are seeing and our plan of management as this footling breech birth unfolds.
Would I even be Italian if I didn’t use my hands to talk (photo #3)!?

This kid decided not to dive into this world head first, instead stepping into 2020 like “is the water the still hot!?”
This footling breech is the most recent breech baby born with us here in Ecuador. This first time mom would have been an automatic cesarean section in the hospital. She was referred to us by the Ministry of Health to confirm the baby’s breech position and if possible, to turn the baby. After referring her to a chiropractor who performed the Webster technique, the baby turned. However, this little one preferred to come bottom (or foot) first and turned again either just before or just after the onset of labor. After a considerably fast labor for a first time mom, she delivered a beautiful footling breech baby who not only kept us on our toes but stole our hearts in the process.

|| Footling Breech ||⁣
A breech presentation is a variation of normal, characterized by a longitudinal lie with the baby’s bottom or other lower extremity presenting first and occur in approximately 3-4% of term pregnancies. A footling breech is when one or both feet present before the buttocks.⁣⁣
We have had two breech births recently. The first was a frank breech and our most recent one was a footling breech. Thankfully our licensed midwives, myself included, are trained in breech delivery. But that doesn’t mean breech births (or cephalic - head first) always go as planned. Every birth teaches us something and in under resourced settings, birth often pushes us am beyond our comfort and scope and requires us to maximize our skills. ⁣⁣
While I am thankful that we have the skills required to safely manage breech birth, I am ready for a breech break. This was my face after learning that another term mama’s baby is breech. ⁣

It was the night of the full moon and the babies were lining up. Half of our team was in Loja, attending a long, difficult labor due to a persistent posterior baby. The other half, including myself, stayed in Vilcabamba for two other mothers. I remember the first time I met this beautiful couple. I felt an instant connection and looked forward to their birth, deeply honored by the opportunity to share this intimate journey with them. All three of us came from different places, different countries, and different sets of circumstances. Yet in some random (or perhaps not random at all) twist of fate, we all ended up here, in the remote mountains of Ecuador, brought here and brought together by birth. In the early hours of the morning, this woman became a mother and this man became a father. Together they welcomed a beautiful force of nature who will no doubt live up to the strength of her name. Born en caul, in the water, and with the full moon.

What would you do…⁣
⁣
…if you did all you could safely do for a high risk client before transferring them to the hospital, only to have the local hospital transfer her to a neighboring city where that hospital transferred the client back into your care?⁣
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That’s exactly what happened and it is just one of many examples of the negligent shortcomings of the hospital system here. We had a client with a prior cesarean section with a vertical incision, whose dates were uncertain. In addition to this, she had other serious conditions that compounded her pregnancy. For context, this client would never have been a candidate for an out of hospital birth if she was in the United States. ⁣
⁣
She text me early in the morning stating she thought her water had broken. After an examination, we confirmed that her membranes had ruptured and we were now on the clock. She had been experiencing irregular contractions but was not yet in labor. With a vertical VBAC, there are only so many things can safely be done to help encourage labor. We did all of these things and then some. There were so many “little things” that simply did not add up. Individually, these “little things” can be justified, but collectively it became clear that there was a reason her body was not able to establish labor. After just over 24-hours post-SROM (spontaneous rupture of membranes, aka her water breaking), we made the call to transport her to the hospital.⁣
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She chose to go first to the local hospital. The same hospital that does not have OB/GYNs available 24/7 and in the middle of the night, the hospital is only staffed with students. The hospital examined her and transferred her to a neighboring city with a larger and better equipped hospital after realizing she quickly exceeded their scope and capacity for care. The second hospital examined her and at almost 72 hours post-SROM, they decided she could continue to attempt a vaginal delivery and they sent her home and back into our care. She was still not in labor and there had been no change in her cervix since we transported her. ⁣
This type of situation forces us outside of our comfort zone. It forces us outside our standard scope of practice. When the local healthcare system sends high risk persons back into our care, it places the burden of responsibility on us. It places the client in a dangerous position because not everyone who is released from the hospital so negligently has a team of midwives waiting for them on the other side.

My volunteer experience with New Life has been unlike other. When I made the decision to change careers and become a midwife, it was always with the intention to serve internationally in a humanitarian capacity. I have had the opportunity to volunteer with many great NGOs over the past 5 years, but with New Life I feel like I found a “home.” We have a small, but incredible team here in Ecuador. Our first birth together was a bit of a baptism by fire with a surprise breech with a sticky head. Each birth since then, with the exception of a few, have really challenged our skills as midwives. In the short time since I have been here, I have seen things I have never seen before (and that’s saying a lot considering my breadth of experience in crisis/disaster settings). I have used skills I have never used before and I have become proficient in skills that became a bit rusty in private practice. I have never felt more supported by the midwives I work with and I deeply value each and every member of our team. We are looking to expand our team and desperately need more licensed and experienced volunteers to help us as we continue to grow. Stay tuned as we will be officially advertising for volunteer openings very soon!

Sometimes birth (almost) happens in the bathroom. In the early hours of the morning, this incredibly strong woman crossed the threshold from maiden to mother and it was an absolute honor to witness her journey. The bathroom was her safe space and the toilet offered a position that felt good for her body. She intuitively followed her body’s lead and took each contraction one at a time. As the intensity of each contraction quickly increased, her husband raced to fill the birth tub. Filling a birth tub is not always easy or straightforward, especially here. It required multiple pots of water boiling simultaneously on a small gas stove and we could never quite keep up with having enough hot water. The water cooled a little too quickly and there were moments we thought we may never win the race. But we did and just in time. Only three contractions and two pushes after entering the water, a beautiful new soul entered into this world and at the same time a mother and father were made.

|| Meetings with the Ministry ||
This morning we had a meeting with officials from the Ministry of Health who came to visit our center. Developing partnerships and strong relationships with government health officials and community health workers is one of our key priorities. Through these partnerships we are able to develop better relationships with local hospitals, provide and receive high level support, and coordinate with the university in an effort to educate student obstetras on natural childbirth. There are a lot of differences, both culturally and in terms of understanding the natural physiological process of childbirth. Yet one core principle we all share is a deep commitment to our communities and the birthing people we support and care for. Our goal is to continue to develop strong partnerships and help support the local health infrastructure while working to improve the quality and safety of healthcare across the nation.

I have been sitting on these thoughts for quite some time, not exactly sure what to do with them or how to spin them into words. I sit between two worlds, with one foot firmly rooted in each, yet only one to which I truly belong. I traveled to Ecuador from a place of extreme privilege and my privilege is not something I take lightly. I try to remain as conscious as possible of that privilege and how that interjects into the world around me, especially here, as I take up space in a deeply impoverished and under resourced community. Unfortunately I cannot say the same for the expanding community of immigrants/re-colonizers (more commonly referred to as “expats”) who also take up space in this community.
The organization I work with established a reproductive and maternal health clinic/birth center that provides free healthcare to the local community. We rely exclusively on donations and funds raised to support our work here. There is a significant gap in accessibility to quality healthcare and associated health resources, especially for women and their children. Our clinic helps fill that gap. Lately, we have experienced an influx of clients, from both the local community and the immigrant community. Many members of the immigrant community have taken advantage of the free care we provide and consistently exploit the resources meant for the local community. There is a gross sense of entitlement and priority over the healthcare and resources that are not meant for them. Many individuals we have encountered have been extremely demanding with us, demanding appointments outside of clinic hours and expecting us to drop everything at their beck and call. As a result, we began charging non-locals for care and services rendered. The fees we charge are very, very low. Yet the immigrants complain incessantly and in some cases flat out refuse to pay, or delay payment for as long as possible.
I feel deeply discouraged by this behavior though not at all surprised. I am tired of seeing these communities be disenfranchised and exploited, especially here, in places like these...