When Your Body Knows Just What to Do

 

Midwife seeing mother for pregnancy examination

Midwife exanimating belly of pregnant woman with CTG scanning in practice

I just read Gloria Lemay’s blog post “Are You A Good Candidate For A Hospital Birth?” and it really got me thinking about how to reach more people to help them understand the range of choices that exist for childbirth. I think if first-time moms really understood the challenges inherent in a hospital birth experience, they might think twice. At least, the idealistic part of me thinks that – the part of me that includes my own personal experiences with giving birth in a hospital, as well as the differences when I later chose to have a child at home.

Some moms are content to not think about the choices. Some moms know both perspectives and choose the path more well-traveled by their peers. Others, like the pre-homebirth me, think that if you want a natural birth at the hospital, you can tell the staff your wishes when you arrive and it will just happen. I get it it: there is immense social pressure to conform, especially when family members or friends say things like, “Choosing homebirth is a selfish choice!” (Yes. Really. People say that.)

So, let’s get real. Let’s drill down and take a look at aspects of hospital births that many women may not have considered. I find Gloria Lemay’s list of questions from her blog post “Are You A Good Candidate For A Hospital Birth?” to be a good place to start:

  • Must not be scared of needles.
  • Must not be claustrophobic or uncomfortable in confined spaces.
  • Must be able to go for long periods of time without eating or drinking.
  • Must be happy to share a bathroom with others.
  • Must enjoy sleeping on a mattress covered with plastic.
  • Must not have a rebellious or questioning nature.
  • Must accept the possibility of contracting antibiotic-resistant infections.
  • Must be confident with caregivers who are overtired and overworked.
  • Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
  • Must like and trust electronic equipment.
  • Must be comfortable with a cesarean rate of 30%.
  • Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
  • Must realize that someone you have never met before will likely receive your baby.
  • Must realize that the written birth plan will be ignored.
  • Must be willing to have fluorescent lights turned on at all hours.
  • Must be capable of birthing without making loud noises.
  • Must look good in a flimsy blue gown that is open up the back.
  • Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.

Do women know that this is what they have chosen when they choose to birth at a hospital? Are they so afraid of the process of birth that they’re willing to give up their safety and their preferred birth experience to a system that promises outcomes for them and their babies that are worse than every other industrialized nation? What motivates women to make this choice?

I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that’s a good place for me to start as I grapple with ways to address the fundamental differences between hospital births and other birth setting births.

With my first baby, I wanted the best possible care, which, to me at the time, meant the most expensive care: an obstetrician. I thought midwives were somehow “less than” and that homebirth was dangerous. The internet didn’t exist in the average home in 1989, so the ability to make a truly informed choice was limited. My preconceived notions about midwives and uninformed opinions about homebirth and obstetricians drove my decision to seek a hospital birth with an OBGYN. Looking back I can see that I wasn’t informed and armed with facts; rather, I was making decisions based on cultural bias and confusing messages in the media and in books.

In addition, as a headstrong only-child who thought she knew it all, I believed I had fully prepared myself for a natural birth. I thought that if I informed the hospital staff of my plan when I arrived, it would happen the way I wanted. I had read good books about natural birth (Birth Without Violence, Childbirth Without Fear), but “What to Expect When You’re Expecting” had just been published for the first time. It was the new mom book of the day and I practically memorized the book by the end of my pregnancy. I felt like I really knew my stuff going into the birth. In retrospect, it wasn’t really the best choice of reading material, to say the least. Some people joke that it teaches pregnant women how to become “obedient” patients. And that just might be true.

My first birth was anything but natural. There were a lot of medical interventions. Yet active labor was fairly quick. I had a vaginal birth with no episiotomy, so I felt like I’d done pretty well. I hadn’t had an unmedicated birth, but, in the end, I felt like the reasons for that were my own failings, not the failings of the doctor or the hospital, and that they had “given me” as natural of a birth as they could-despite my “inadequate” contractions and “inability to tolerate” the pitocin-augmented labor. What I experienced emotionally was this: feeling a bit deflated, taken down a peg, proven wrong, (See, natural childbirth really is too tough for you) proven to be defective (Your body needed “help” to give birth.) Despite all of these feelings, I convinced myself I’d had a good birth. It was a defense mechanism that helped me deal with the bigger truth. It helped orient me in the cultural norms of childbirth that I butted up against in the hospital. It helped me to let go of my original feelings, preferences, and instincts about how I wanted to birth.

With my second baby, I did as I had done with the first. I told myself I was pretty happy with the first birth experience (I didn’t know anything else), so I went back for more of the same. One big difference this time around was that I was even more financially strapped than with my first; I ended up on Medicaid. I lived in a rural area at the time, and the only obstetric providers who took Medicaid were doctors at a Family Practice clinic. I was served by a large group of residents at the clinic; my birth was attended by a few residents. I felt as if they had no real expertise with childbirth, and that I was just someone for them to practice on. The birth was a tough Pitocin-augmented, persistent posterior birth with no pain relief. I was restricted to lying on my back or my side, which made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.

So, now fearful of birth, for my third birth I chose a birth I felt I could better control-a scheduled induction at 39 weeks with an epidural at 1cm. There wasn’t much pain, but instead of feeling in control, my stated goal, I felt totally OUT of control. I had no physical sensations of birth, which meant no feedback on how the labor was progressing. I felt disconnected from the experience and totally at the mercy of how the doctor felt about my progress. It was horrible.

The turning point for me, and the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. I listened to the experiences of other mothers and learned that doctors don’t know everything. I heard other mothers describe the same birth experiences and I finally began to question whether my choice to give birth with an OB in the hospital had really been the best option for me, especially when my stated goal had been natural birth. The stories of these other mothers helped me to see that it was not my body that had failed me, but the obstetrical system that had failed me. The clincher for me was on the day I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, “Kim, tell me you are NOT having a natural birth.” I nearly ran away screaming. It was clear that she was not going to support my choice.

I made an appointment with the midwives at BirthCare and Women’s Health in Alexandria. It was life-changing. At the first visit, I knew it would be a totally different journey. Our first visit with the midwife lasted an hour. It was my first experience of a provider actually listening to me and asking questions that other providers had not asked before. When I left that first visit, I felt a peace I had not felt previously about my maternity care. I knew that even though it would probably be out of pocket financially for me to have the baby at home and that the drive for prenatal visits would be over an hour each way, it would be 100% worth it. And I was right.

Charlie’s birth was an incredibly beautiful family event. Birthing at home, connected to my body’s innate wisdom, helped to heal the pain I carried with me from previous births. Finally, I did not feel defective! My body had known all along how to give birth, not unlike it had known how to nourish and nurture my babies through breastfeeding. I’ll never forget that moment when the midwife whispered in my ear after the birth, “See, Kim, your body knows just what to do.”

I’m an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don’t consider myself to be one to bury my head in the sand when it comes to making important decisions. So I ask myself now, what could have helped me to know the truth sooner? To become more aware of the cultural implications of birth? Maybe if I had read Gloria Lemay’s blog back in 1989, or maybe if I had viewed the Business of Being Born, maybe, just maybe, I would have understood the truth about giving birth in the hospital-the limitations, the restrictions, the very philosophy of institutionalized childbirth. I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way, through documentaries and books or movements, or simply sharing stories and making a difference, one woman at a time.

*Some women require obstetrical interventions in order to have a good outcome. This post is not directed at women who have benefited from necessary intervention-intervention we rely upon obstetricians to provide with their surgical and high-risk skill sets.

The Shaming Has to Stop

soapbox7

Get ready for a major soapbox post.

I get it. Those of us who choose to birth outside the box are different. We make choices that don’t necessarily follow mainstream society norms. Our choices may not be in alignment with what is embraced by the obstetrical model of care. Our choices may make medical professionals feel uncomfortable, challenged, exposed. I get it, really I do.

But…

That doesn’t give a healthcare professional the right to deny care in order to shame women and midwives, to bully us, or to punish us into submission because a laboring woman didn’t choose what the medical professional thinks we should do for ourselves, for our children, or for our clients.

Yes, this really happens. All. The. Time.

And, it never should. Ever.

For the most part, people who choose to give birth outside of the hospital feel that giving birth in a hospital is like using a sledgehammer push a thumbtack into a cork board—way too much fuss for something that most people can do on their own—and that a healthy woman having a normal birth in a hospital is asking for trouble. It isn’t that doctors have bad intentions. Most of the time, doctors and nurses have the very best of intentions. But, once a woman walks into a hospital, she will need to be “treated.” And, once a normal labor is “treated” (read, “interfere with”), risk is introduced.

People who choose to give birth outside of the hospital view the medical community as a necessary resource if the normal process doesn’t go normally. Most of us don’t hesitate to seek medical care if there is a need. Yet, why would a woman hesitate? Why do so many of home birthers/birth center birthers distrust the medical community? The lack of trust in the medical community exists because women have been burned many times, and women share their stories with each other.

As a midwife, I’ve personally seen patients yelled at, forced to have vaginal exams despite an explicit refusal, and verbally abused (put down, shamed, coerced, threatened). Doctors have yelled at me, attempted to discredit me in front of my clients, and threatened me with complaints. Why? Is it because something was done wrong? No, quite the contrary. All of these things happened because of a hospital transfer when a mom needed non-emergency help. Yes, these examples occurred during non-emergency transfer situations.

You might think, “Well, during a birth, the hospital staff acts this way because they worry about liability.” OK, let’s assume a medical professional was upset about that. Does that warrant abusive treatment of women and midwives? Quite honestly, does their bias or fear of liability even matter? Their job is to treat whoever comes through the doors of the hospital. Federal EMTALA laws protect a woman’s right to be treated in labor. ACOG supports patient autonomy even if the provider feels the woman’s choices are in conflict with the provider’s belief that her choices are unwise. A practitioner’s unprofessional behavior actually increases the provider’s liability by failing to respect patient autonomy and by refusing to provide the same level of care they would give to any other patient they serve.

This lack of professionalism experienced in the hospital sometimes extends beyond the birth. This is where I feel like the treatment is almost entirely punitive. While I can understand the frustration and stress of a provider who receives an in-labor hospital transfer, this type of post-birth discrimination seems like coercion and punishment for a family making choices that a provider does not personally support.

After a normal, healthy birth, the midwife’s scope of practice is normal newborn care throughout the first 6 weeks. The midwife conducts all of the usual assessments and then recommends the family see a pediatrician for a normal well baby visit at the end of the six-week period. The family calls to make an appointment.

Hold the phone! Wait a second, they won’t see the baby? Why not? Some practices won’t see the baby because the baby was born at home. Say what? They won’t see the baby for 6 months because they didn’t get the vitamin K shot? You’ve got to be kidding me!

Do physicians have the right to deny those people care because they disagree with their choices? For instance, is it OK for a pediatrician to refuse to accept a patient into care because the mother doesn’t breastfeed her baby? Would it be OK if a pediatrician refused care for families who homeschool? No, of course not. Yet, in many cases, with the population of families we serve, if a family has refused for their newborn anything from the mainstream model (such as a Vitamin K shot or erythromycin eye ointment or hepatitis B vaccine), they encounter judgment, fear, or a refusal of service.

It is unethical to refuse care in an attempt to coerce or bully a patient into consenting to care they have refused. It is unethical to refuse care as a way to punish families for their choice to give birth in a way that you do not agree with. It’s morally wrong.

The shame that is heaped on families who’ve chosen a path outside of the mainstream standards has created a culture of resistance and distrust, and that’s not good for anyone. Women and their families should be able to count on a multi-tiered model of care. If a woman plans to give birth at home and the labor takes a turn, she should be given a high quality of care during her transfer, and when she becomes a patient at a hospital. What if instead of shaming, a medical professional chose compassion? Understanding? And what if the medical professional were trained to see themselves as an important part of the picture for women who choose to birth at a birth center or at home?

The shaming has to stop. The punishment has to stop. Is it any wonder we don’t trust you? The distrust has been built on years of mistreatment. It rests on the shoulders of those in the medical community who lack professionalism, who don’t separate their own personal choices and/or training from the choices of the women and midwives who come to them in good faith and in order to see a labor to a successful and safe conclusion.

This dynamic needs to change. Show women that you can treat them with the same respect their midwives show them. Help women to make informed choices, and then respect their right to informed refusal (without trying to make them feel bad about the final decisions). Welcome us—the birth team and the laboring women—so we feel we can come to you for help when it’s needed. Welcome us, so we don’t feel like we want to wait a little longer to see if things get better because we’re scared of how we’ll be received when we arrive at the hospital. Welcome us, so we know we can share our stories fully and honestly with you, without fear of mocking or teasing—or retaliation against our clients.

If the goal is truly to provide good care and not to punish people whose views differ from your own, it’s time to do something to make a change for the good. Every time we interact with you, you have a golden opportunity to let the medical profession shine. Don’t blow it. Help us walk towards you instead of away from you.

If you’re a doctor or a nurse and you support families who make choices that aren’t in alignment with your protocols, this post is not about you. Or, maybe it is. Maybe this is a love story about you. You are the people who give me that glimmer of hope that change is possible and that midwives, consumers, and the medical community can work together to make outcomes better for mothers and babies, and make the experience better for all of us.

When a Home Birth Becomes a Hospital Birth

stacy

You did everything “right.” You took Bradley Method childbirth classes. You hired a doula. You hired a midwife to attend your birth. Your diet has been perfect. You rented the birth pool. You took all of the right supplements, attended prenatal yoga classes, had regular chiropractic care, and gained a good amount of weight — not too much, not too little, just right for you.

But birth isn’t just a series of checklists.

It’s good to pay attention to what contributes to a healthy pregnancy and birth, but it’s not a guarantee that the actual birth will perform like an item on a checklist.

Birth is complicated, often messy and surprising, and it’s best to remain flexible as you approach the due date.

Despite doing everything “right,” for some reason, things might not go as planned, and the blissful, ecstatic, empowering, or even orgasmic home birth you planned becomes the birth you didn’t plan. Your home birth becomes a hospital birth.

Is this such a bad thing? It doesn’t have to be. It can be a very good experience, even if it deviates from the original plan. As a midwife, I’ve seen the good, the bad, and the downright ugly hospital transfers. Fortunately, the ugly transfer experiences have been rare.

The Different Paradigms of Care

Midwives and obstetricians approach birth from different paradigms. So what is a different paradigm of birth and why does it complicate things? For one, midwives are trained to attend the 95% of births that occur without complication. The approach to labor is grounded in this very real statistic, but also has to do with the midwife’s training, which focused on continuous labor support and limited intervention.

A physician and/or surgeon is trained to handle the 5% of complicated births. In contrast to midwifery training, obstetrical training is grounded in staying ready for that rarer complication.

It’s important to note that midwives are trained to recognize when a complication arises and vigilantly keep an eye on a woman’s labor to ascertain if there is ever a need to transfer care to a hospital, where a physician/surgeon can take over the birth.

Sometimes the two types of training can clash. Most often obstetricians have never attended a home birth or observed a birth with a midwife in the primary care role, whether at home or at a birth center. Thus, their only experience with home birth moms is likely the mom who has transferred with a complication. They don’t see the other, larger population of women who have had healthy births at home or in a birth center with the midwife.

In their training, obstetricians see the more complicated side of childbirth. One physician I know spent her obstetrical rotation at a hospital serving a poor community that had limited access to prenatal care. Some of the mothers were addicts. The deliveries were complicated and the outcomes not always optimal. While this training and awareness is necessary and important, especially in emergency situations, it can color their responses to home birth transfers. They have seen what poor prenatal care and poor lifestyle choices can mean for a birth. The part of midwifery care that they may not understand is that midwives have already carefully screened their clients to be sure that the pregnancies are healthy and that home birth or birth center birth is a viable option for the mom. It’s also not uncommon for a midwife to transfer care during the pregnancy if the mother becomes high risk.

In my case, as a member of my local healthcare community, I do my best to educate the hospital staff, nurses and physicians alike, as to how a midwife practices. It can be hard to cast aside a person’s training experiences to learn about a different model of care, but with hard work and respectful dialogue, between the moms and midwives and the hospital staff, care providers in the obstetrical care setting can gain greater understanding of just “who these midwives really are.”

So what will a transfer birth look like?

The ability to transfer a mother is an important tool in the midwife’s toolbox. And a transfer hospital birth can turn out just as positive as the home birth might have been.

Depending on the hospital and staff, a midwife may shift into more of a doula role during the birth, helping the laboring mom make the best decisions and making sense of the medical events that often happen quickly with a transfer. The midwife can provide support to the family members who might be there as well. Sometimes the hospital will require the midwife to leave, but that is becoming a rarer exception. If that happens, the midwife will still provide some sort of postpartum care and support. During the transfer, the nurses and doctors are doing their job when they take over the birth – they know complicated birth best – and it’s important to remain grateful for both models of care.

The goal of every birth is a healthy mom and baby. Stay focused on navigating the transition with a positive attitude; it will help you feel better after the birth, whether your birth is a home birth, or a transfer hospital birth. Assert your needs, but don’t be confrontational. Be respectful. A combative attitude helps nobody and serves as an obstacle to good care. Your midwife will be there to help you process the unexpected transfer and transition in care. Midwifery care does not stop with the transfer; it simply follows the needs of the mother, no matter the birth setting or interventions.

Disappointment is Natural

You know you did everything right: you followed the latest nutritional guidelines, you exercised, you took a childbirth class, you prepared. But your birth didn’t happen at home like you planned; it happened at the hospital. The important thing is to remain grateful that you could rely upon a two-tiered system of care. The right provider used his/her skills to bring the birth to the final stretch. Yet, you have an overwhelming sense of disappointment.

Birth is an emotional event. It’s physical, it’s spiritual, and it’s a hormonal journey that sometimes bring tears, elation, sadness, joy, or a combination of all. If you’re feeling disappointed about the birth, find ways to express that disappointment. Write about it. Talk about it. Cry about it. Practice radical acceptance.

Your birth is just one step in the path into motherhood. Celebrate that you’ve become a mother and focus on the positive. Your birth happened just as it needed to happen.

The Differences Between Hospital and Out-of-Hospital Birth

SONY DSC

People who have never given birth outside of a hospital may have no idea of the differences between hospital and out-of-hospital birth. What’s the big deal? You can have a natural birth in the hospital. Why would someone want to have their baby at a birth center or (gasp!) at home? The answer is not so black and white.

Can you have a natural birth in the hospital?

Well, that all depends on what you call “natural,” but yes, to varying degrees, you can have a “natural birth” in the hospital. There are many labor & delivery nurses who are excellent at supporting natural hospital births, and there are many doctors and midwives who are supportive as well. Some hospitals have adopted policies that are more tolerant (even encouraging) of birth plans or that allow doulas in the birth room. Those are steps in the right direction. And many women have found creative ways to ensure a natural birth, such as waiting until transition to head to the Labor & Delivery floor, or laboring while roaming the halls of the hospital with a labor coach (a partner or doula or friend). Of course, a birth plan as an avoidance of interventions, rather than as a vision of an ideal birth, seems to really miss the point in a lot of ways. Should birth really be about strategic plans for dodging unwanted interference in your baby’s birth?

Let’s break this down. You’ve hired your care provider because you’ve heard great things about them, they have a great reputation, their statistics are great.. etcetera… Pushing the boundaries within a set system is one thing, but can you ask your care provider to be someone they’re not? A great hospital-based provider is skilled at hospital birth and what hospital birth has to offer you. A great birth center or home birth midwife is skilled at the midwifery model care. The models are not the same. As anyone who has seen birth both in and out of the hospital will tell you, there are a few key differences between the two:

The provider on call attends the birth at the hospital.

If your care provider is part of a group practice, who will actually attend your birth? If it’s a combination of physicians and midwives, are you guaranteed a midwife to attend you? Are all of the providers on board with your birth plan? You may have a favorite midwife or physician in the practice, but what are the chances that your favorite provider will attend the birth?

Most out-of-hospital practices are solo providers, although some are small group practices. In a solo practice, there is a rare possibility that your midwife will be unavailable due to illness or family emergency-after all, we’re only human! If you hired an out-of-hospital provider, do you know who the backup provider is?

All of the above are important questions to ask as you consider your birth options and whether to give birth in the hospital or out. What is most important is that you are comfortable with your decisions and ultimately your birth experience.

In the hospital, it’s the nurses who take care of you, not the doctors.

You spent weeks researching practices, settling on the one practice you think will best support your birth plan. Your doctor is a local superhero. But, who takes care of you at the hospital?

During your time in labor, the nurses will take care of you. Nurses are the amazing unsung heroes in the hospital. They are the ones who do the heavy lifting (literally, as well as figuratively) in patient care. They’re often over-worked and underpaid. We love nurses, yet even though they are awesome, they are also people you’ve never met before. Nurses are the ones who will be with you, almost single-handedly helping you with your labor. What if your philosophies on birth don’t match? Nurses vary in their training in natural labor support techniques. How do you know if you’ll be the lucky mom to get the super nurse who really knows her way around a rebozo or who does her best to be at the bedside as often as possible? Answer: You don’t. It’s a roll of the dice.

Once you get to the hospital, you’ll be checked in by the L&D staff. If you are seen by a doctor or midwife, it might be a provider from your group, or it might be an OB hospitalist, a physician who only sees patients in the hospital and does not have a private practice. If you’re admitted, you’ll most likely be monitored and “treated” per your provider’s standing orders. It’s good to know beforehand what orders are standard for your care provider. Your nurse will keep in contact with your provider and will update and consult with them, as needed, typically by phone. If you have questions about the orders or want to refuse something, you will have to wait until the nurse can reach the provider.

The provider may briefly check in during your labor, but typically they are not continuously present until you are pushing and the head is visible. Their training rests on the ability to take action if something unexpected happens. They are surgeons and the best option for a high risk situation, which happens in a small percentage of births.

Out-of-hospital midwives are the people who take care of you at your home or birth center. Together, with a birth assistant, they provide continuous labor support from beginning to end – and they determine when and if you need someone as highly trained as an OB or a transfer to a hospital. Rather than treat every laboring woman as if they are the minority of women who have complications, out-of-hospital midwives treat laboring women as the if they are the majority, who will not have complications, all the while keeping an eye on whether a complication could occur and when/if to transfer the mother to an OB’s care – much like the maternity models in most of the developed world.

Your nurse is taking care of more than one person at a time.

No matter how awesome your nurse is, she is only one person, and is most likely taking care of multiple women at the same time. It’s not realistic to expect a one-on-one continuous physical presence and support from your labor nurse. The hospital system is set up with floors of patients who are typically divided among the nurses for twelve hour shifts. The care will fluctuate based on caseload, changing shift hours, and the preferences of the nurses in term of hands-on care. There will be no chance to meet the nurses who will attend you before you are admitted. And no choice in terms of which nurse is assigned to you.

On the flip side, hiring a midwife means that you have a chance to interview and pick the right provider for your care, including a back-up midwife. Whether the primary midwife or the back-up midwife, you will have a good sense of exactly who will be providing continuous labor support during your birth.

They work in shifts.

Nurses typically work in 12 hour shifts. Unfortunately, labor doesn’t often fit neatly within one 12 hour shift. Your labor will typically straddle two shifts, or maybe more. While getting through contractions, you may have to shift gears and adapt to a new support person- right before transition, or even right in the middle of pushing.

The typical out-of-hospital provider does not work in shifts. She’s there with you from the beginning to the end.

A different team takes care of your baby.

Every hospital has different protocols and rules about labor and delivery care. The nurses who attend your labor and delivery will likely not be the nurses who take care of your new baby. With the lack of continuity in care for the family, mistakes can be made, such as giving a breastfed baby formula or giving a baby a pacifier when the mom doesn’t want one offered to the baby (in the event it causes nipple confusion and adds stress to the new breastfeeding relationship.)

Usually, the father or another family member can be assigned to accompany the baby whenever he/she leaves the mother, to ensure that no unwanted procedures were carried out despite their wishes to the contrary. Even with this safeguard though, the pediatric team still can’t possibly know the whole picture.

They haven’t been with the family throughout the entirety of prenatal care and birth, so they don’t know you in the same way your midwife would.

Yet another team takes care of you during postpartum.

With midwifery care, the mother’s care, the baby’s care, and the family’s care are all provided by the same team. In fact, the postpartum care is also provided by the midwife who attended the birth.

A different philosophy.

You’re “allowed” to do something, you’re “not allowed” to do something. If your wishes conflict with a physician’s preferences, you might be asked to sign an AMA (Against Medical Advice) form, which can feel intimidating when in the throes of labor. It’s important to remember that hospitals are large institutions with rules and regulations that are applied to every woman, despite the wide differences between them.

Obstetricians handle emergency situations well. In emergencies, the obstetrician is the necessary authority and operates from that perspective.

But in the case of normal birth, the woman is just as important of an authority. When she is able to follow her intuition and pay close attention to her body, with minimal interruption, she can communicate valuable information to her caregiver.

Midwives are trained to respect this authority in normal birth. The philosophy of midwives is that the midwife/client relationship is a partnership and decision-making is shared.

A different outcome.

Hospital and out-of-hospital birth are two very different things. It’s hard for me, as someone who has had it both ways, and who has seen many births both ways, to minimize the difference in outcomes. Personally, my hospital births left me feeling less powerful and capable as a woman and new mother. My home births helped me to feel empowered, intelligent-like I was the expert when it came to my new baby’s needs. There really isn’t a way to quantify that kind of effect, or to easily measure how it impacts your mothering in the long run. Or even to measure how it affects the child long-term. It’s easy to measure the physical benefits of a natural birth.  But it can also have an unexpected and very healing impact on a mother’s life, just when she is embarking on new motherhood with a newborn. The unquantifiable effects of home birth may, in some ways, be the very reason that home birth is the optimal birth choice for so many women. And this may be the biggest difference of all.

20 Interview Questions to Help You Find the Right Midwife for You

Chances are, if you’re reading this blog, you’re probably already thinking about hiring a midwife.  You know all about the Midwives Model of Care and you’re ready to find the perfect midwife for your family. There’s a midwife for every woman. What’s right for one woman may not be right for another. So, how do you choose the right midwife for you?

What’s most important to you? What personality traits are most important to you? What type of practice style suits you?

Baby SleepStart with the big decision first. Where do you want to give birth?

This topic may require a whole other blog post, but let’s assume you’ve made up your mind about whether you want a hospital birth, birth center birth, or home birth; your decision about the birth setting will largely determine care provider options. For instance, if you want a hospital birth and you want a midwife to attend, you will hire a Certified Nurse Midwife (CNM). If you want an out-of-hospital birth, you can choose a CNM or a Certified Professional Midwife (CPM). Some women choose other options, such as unlicensed midwives and unassisted birth, but the focus in this blog post is on licensed care providers in a variety of birth settings.

Make a list of questions.

Before you meet the midwife, come up with a list of interview questions. If you don’t have a list, the midwife will likely still be able to give you a good overview of her philosophy and the care she provides, but if you have a list of questions, you’ll be more likely to come away from the experience feeling as if you have all of the information you need to make a decision. After meeting with hundreds of families over the years, these are some questions that I’ve heard:

image6 (1)1. How many births have you attended? How did you become a midwife?

There is no right answer here. New midwives bring new energy and up-to-date knowledge to their care. What they don’t have in experience, they make up for in resourcefulness. They tend to be very well-connected to a wide community of student midwives and experienced midwives, and they know where to turn when they encounter a non-emergency situation that requires further research.

Experienced midwives tend to have the gift of having seen a lot of births, of having helped a lot of different types of families, and having seen wide variations in what’s normal. Their knowledge and experience is vast. Where others might be nervous, the experienced midwife has “been there, done that.” Experienced midwives work hard to stay current in their field, attending continuing education classes and conferences, and participating in midwifery associations, although some are very busy in their practices and may find it difficult to find the time to participate in activities other than helping mothers and babies in their care. An experienced midwife is a gift to her community.

Fireandrescue2. What happens if there’s an emergency? What is your role if I transfer? Do you stay with me until my baby is born? What about postpartum visits for moms who transfer?

Every midwife has a plan for hospital transfer. If you’re planning a home birth, the midwife will come up with a plan customized to your particular needs and based on your location. As a client, it’s good for you to understand what happens when there is a transfer. If you go by ambulance, does the midwife ride with you? Who goes with the baby? What hospital do you go to? What have her experiences been like there? How long does the midwife stay?

12439120_10208534688063276_3445913896829134711_n3. How many postpartum visits do you provide? Are those provided in-home or in-office?

There’s significant variation from practice to practice with regards to postpartum care. Most practices provide a postpartum visit within 24-48 hours after the birth and again at 6 weeks postpartum. There’s usually at least one other visit between those two visits. Some practices see you for a few more postpartum visits than that, and some keep in touch by phone between visits.

4. What is your fee and what’s included? Do you bill insurance? How does that process work?

Finances can get complicated. Often, if you’re a healthy person, this is the first time you will have had a major medical expense covered by insurance. The billing process is often not straightforward. Ask the midwife to explain how she handles it. Who does her billing? Will you be dealing directly with the biller or with the midwife? Is there an insurance billing fee? Is she in-network or out-of-network? Does she offer insurance benefit verification? How much is required as a prepayment towards what she bills insurance? What payment options are available? How does the reimbursement process work?

vaccine5. What labs do you require? Will you draw labs for me or will I need to go to the patient service center for that? Do you require ultrasounds? How many? Do you offer them in-house or will I need to go to an imaging center? What if I decline certain labs or ultrasounds?

How your midwife answers these questions is important. If she launches into “I require____” that tells you something about how much she values your opinion and right to make informed choices about your care. Some women want the midwife, as “the expert,” to make such decisions and have clear rules, and she may be the right midwife for you. If, on the other hand, the midwife says something like “there are certain tests I recommend, some tests are required by law in this state, and others may be worth considering depending on your history. I generally recommend ____, but I also recommend you do your research and that we discuss your options before you make a decision…” this shows a respect for you as the ultimate decision maker for your care and the expert on your own body, your right to make informed choices, as well as a commitment to a shared decision making process. For many women, this is an important characteristic in the care they seek.

6. What is your policy about postdates?

There are various factors that may affect a midwife’s postdates policies, such as hospital rules, laws in your state, physician supervision, or experience with postdates. “Postdates” means different things to different providers. To some providers, postdates means after 41 weeks. To others, it means pregnancy after 42 weeks. Does she have a firm cut-off date for you to go into labor? What happens if you go past that date? Explore the possibility of a postdate pregnancy and how the two of you would navigate such a situation. For instance, the midwife may work with an acupuncturist or chiropractor who specializes in postdate care. She may be able to offer herbal or homeopathic options for labor stimulation. The midwife may prefer that you have an ultrasound at 41 weeks to check on the baby’s well-being, or she may simply want you to count the baby’s movements.

7. What is your policy on prolonged rupture/release of membranes (PROM/ROM)? How does that change if I test positive for GBS (Group Beta Strep)?

Ruptured membranes (water breaking, release of waters) can happen before or during labor. Once it happens, there can be additional concerns about increased risk of infection. Some providers have very firm guidelines about transferring to the hospital after a certain point after ROM. Some providers have the option of IV antibiotics at an out-of-hospital birth, which can provide additional options to help reduce the need for hospital transfer for prolonged ROM.

8. Do you attend breech, twins, or VBAC births? If so, under what circumstances?

Contemporary recommendations continually fluctuate on the best practices for breech, twins, or VBAC (vaginal birth after cesarean). There is ample evidence pointing to the long-term risk of cesarean births for the mother, but there is also evidence that the risks for vaginal birth are higher for the baby. Each mother needs to evaluate her own situation to decide whether a vaginal breech birth is something she would want, as well as whether she would want that option in an out-of-hospital setting. Current training practices for obstetricians have focused solely on surgical solutions, so vaginal breech birth in a hospital setting is a rare option. It’s important to know how a midwife would handle a breech birth, and, if she doesn’t attend breech births, what practitioners she recommends.

Some midwives have experience with attending twins births and feel comfortable handling the birth on their own. Some prefer that you consult with the back-up practitioner.

VBAC recommendations continue to fluctuate, but many women who have previously had cesareans seek midwifery care for a VBAC, and most are successful. In my own experience with VBAC, the cesarean rate for the clients attempting VBAC is roughly the same as all of my other clients (5-8%). Hospital VBAC success is lower. ACOG estimates that about 60-80% of women who attempt VBAC should be able to have a vaginal birth, but only about 4-22% actually do. Virginia’s VBAC rate is 10.2%

2013vbacmapAscertaining your midwife’s skill level and experience with each of these situations is important. And if she is not comfortable with any of the three types of births, what is her referral practice?

9. What medications do you carry?

This will vary state to state based upon the state’s regulations for the midwife. In states where midwives are not allowed to carry medications, the midwives sometimes work with physicians who can assist with access to medications.

10. Do you use herbs, essential oils, and homeopathics?

Each midwife will have her own philosophy about herbs, oils, and homeopathic remedies. Some midwives have a lot of knowledge, skill, and experience with these modalities, while other midwives do not. Depending on the relative importance of this to you, it may be good to know your midwife’s experience with these options.

AdobeStock_79081005.jpeg11. What is your relationship like with the medical community?

As midwifery care continues to grow, medical communities are finding ways to work with midwives in terms of transfers, back-up care, and supplemental care. Some midwives require that the mom finds her own back up care and some midwives have long standing relationships with physicians and hospitals. Regardless of your feelings or your midwife’s feelings about hospital birth, the fact is that out-of-hospital birth is safest with the option for a smooth hospital transfer when needed. Having a good relationship with the medical community can go far to facilitate a coordinated and efficient hospital transfer.

12. Have you ever lost a mom or a baby or come close to losing a mom or baby? What did you learn from that experience? How do you support moms through a traumatic birth, miscarriage, or stillbirth?

This is a difficult topic. No one wants to consider that a pregnancy may result in a stillbirth or other medical emergency. And yet it sometimes happens, in hospitals, at home, and in birth centers. It’s an unfortunate reality in rare situations, although it is more common that women can experience an early pregnancy loss (miscarriage). What kind of support would your midwife offer you if you were to miscarry? If you were to lose a baby, or face a life-threatening situation yourself, it’s important to know that how the midwife would handle the situation best matches what you would want.

13. Are you on a call schedule? Who will be on call for me? Who covers for you if you are not able to be at my birth?

The bigger the practice, the more chance of a call schedule for the midwife. Typically you will have at least one appointment with an alternate midwife. If there is a call schedule, how many midwives are in the call rotation? If it’s just two, you may be able to get to know both of the midwives pretty well. If it’s more like 4-6 midwives, it may be more of a challenge to feel a continuity of care.

AdobeStock_80039918.jpeg14. Who assists you at births? What kind of training do they have? How long have they worked with the midwife?

Some midwives train birth assistants, apprentice-style, to serve with them at births. Others hire registered nurses (RNs) to serve as birth assistants, which is the case at the Premier Birth Center, where I practice. Other midwives allow you to shop around and choose your own birth assistant, and typically the midwife will have a list of birth assistants she has worked with in the past. It’s important that they have experience working together.

15. Do you have practice guidelines, protocols, and informed choice documents that I can see? What’s your typical prenatal care like? What would make me “risk out?”

Most midwives have practice protocols and informed choice forms. Some states require midwives to hand out certain informed choice forms. NARM requires all CPMs have practice guidelines and an informed disclosure for home birth. If you are considering hiring a CPM, she should be able to give you those documents on the spot. If you are planning a birth center birth, the birth center (especially a CABC accredited birth center) should have a Policies & Procedures Manual that details the care they provide. Seeing a midwife’s practice guidelines, protocols, and informed choice documents can give you insight into the care you would receive with that practice.

16. Do you keep practice statistics? How often do your clients transfer to the hospital and why do they transfer?

Some states also have this data available online. Contact your state department of health. These statistics will give you a good sense of how often a mother has to transfer from the birth center or from the home. Some midwives are more conservative than others in terms of deciding to transfer, so it’s good to have a discussion with the midwife to find out why she most often has made the decision to transfer.

17. How would you describe your care?

This will give the midwife a chance to share her perspective on what kind of care she offers. You can probably get a feel for her practice style just from the answers to her other questions, but asking her to describe her care gives her a moment to pause and really think about her style and what she’d like you to know about her.

18. What does birth look like with your practice?

Ask the midwife about her protocols for monitoring you and the baby. Out-of-hospital providers almost always use a Doppler or a fetoscope for monitoring your baby’s heartbeat. Hospital-based providers are more likely to prefer continuous electronic fetal monitoring, although some will be able to offer intermittent electronic fetal monitoring. Some midwives rarely do cervical exams, while some will usually do an initial cervical exam when they arrive at your birth, and then may check periodically during your labor. Some midwives offer warm compresses and oils for perineal support, while other midwives prefer a more “hands-off” approach. Some midwives encourage the parents to catch their own baby, while others are not as comfortable with that idea.

19. Do you offer water birth?

Many, but not all out-of-hospital midwives attend water births. Hospital-based providers will often support the use of water for pain relief during labor, while not supporting the actual birth of the baby in water or not supporting water labor after rupture of membranes. If the midwife does support water birth or water labor, does she offer birth tub rentals? If you’re giving birth at a birth center, be sure to ask about their birth tubs. How are they cleaned? How do they verify cleanliness (taking laboratory cultures on a regular basis, for example)?

20. Do you offer other services besides midwifery care?

Some midwives offer birth pool rentals for moms who want a water birth. Childbirth education classes, lending libraries, and a selection of supplements or teas might be offered through the midwife as well. Some midwives also offer placenta encapsulation or work with local encapsulation providers, if that is a service you would want.

Trust your instincts and trust the midwife’s instincts.

I’ve been interviewed by hundreds of women. Sometimes, we’re a good fit and sometimes, we’re not a good fit. If someone doesn’t want to move forward with my practice, I don’t take offense. I trust that a woman knows her own needs and will find the right midwife to serve her.

Sometimes, I meet someone and know instantly of a midwife who would serve her better than I, and I recommend she contact that midwife for an interview. During the interview, the midwife is interviewing you as well. It should be a good fit for you both. Don’t take offense if a midwife says to you, “I just don’t think we’re a good fit,” and refers you to another midwife. She does this because she wants you to receive the best individualized care, and she knows that the quality of the care depends on the quality of the relationship between the client and the midwife.

Do some soul searching.

The midwife you choose will become a big part of your pregnancy, birth, and postpartum experience. Before you start looking for a midwife, step away from the computer and really think about the type of person you want to have caring for you during this process.

There’s a Midwife for Every Woman

It’s been said there’s a midwife for every woman, and I truly believe that to be true. I’ve been to many midwifery conferences and other midwifery gatherings, and while we all share that common bond of midwifery, it is clear that there can be big differences between us. To generalize, there are “hippie midwives,” Christian midwives, parteras – Spanish for midwives, young or old midwives, male midwives, married midwives, single midwives, Amish midwives… the list goes on. Midwifery is what we share. At the core, we agree on the value of serving women selflessly, helping women through the life journey of womanhood into motherhood, honoring women and their families in the ways that only the midwifery model of care can offer.

Yet, there are differences, even within the same community. So, when considering your options, how do you know which midwife is the right midwife for you?

Create a clear picture of who you want to serve you at your birth, before you begin your search.

14322655_648236645345467_8727819073420623281_n

It’s easy to get caught up in the excitement of creating the plan to have your baby at home or at a birth center, but, be sure to take a moment to consider what you truly want from a midwife before starting your search. What is your personal birth philosophy? How do you feel about laboratory testing and ultrasounds? Do you want all of your visits at home, or are you OK with going to an office? Do you need someone with a strong, authoritarian personality or someone with a more cooperative and gentle personality? Visualize what would make you most comfortable. Sit with that image awhile. This exercise is akin to creating a mission statement for a company. When there is clarity around what you want, everything else will fall into place.

Do your homework before you interview a care provider.

Lucky for you, in the Internet age, researching a midwife is not terribly difficult. You can start with Googling her name. If your midwife has been practicing for awhile, chances are that people will have written something about her online. Most midwives have at least some sort of online presence. Just about all have a website or Facebook page. Some have blogs (like me!).

Birth Partners, and Mothers Naturally are great online directories of midwives. You can do a Google search for your zip code and midwife, and you should be able to come up with midwives who are local to you.

Look on FacebookYelp or Health Grades for reviews from people who have used her services.There will likely be blog and message board posts, as well as reviews on Healthgrades, Facebook, and her Google Business page.

Check with the state corporation commission to see if the midwife’s practice has registered with the state. The state midwifery board (for CPMs) and state nursing board (for CNMs) will have information about the status of a licensed midwife’s license (CPM) or status of a licensed nurse practitioner (CNM), including any complaints against her or disciplinary actions from the appropriate regulatory board. Keep in mind though, there’s always more to the story than what you see online. A midwife who has been in practice for many years is more likely to have come under scrutiny than someone who is newly licensed, and the birth culture of your state can have an impact on such scrutiny . Read the information ahead of time to give you a starting point for the discussion. The way she responds about the information you found will tell you a lot about her character and professionalism.

Ask friends for recommendations.

Many will say, “I just loved my midwife!” All midwives hope for that response to their care from clients. But be sure to dig deeper and ask, “What was it that you loved most about your midwife?” The aspects one person loves may be the aspects that another person would not like. Be specific and ask about the things that you’ve already identified as important to you. Maybe your friend liked that her midwife was opposed to using a Doppler to listen to the baby’s heartbeat and prefers to use a fetoscope, but you really want to use a Doppler. Or, perhaps your friend liked that her midwife was very “hands-on,” and you want someone who is very “hands-off.”

Ask the birth workers.

The birth world is a small world. Doulas, childbirth educators, and your friends probably know a lot about the local midwives. Ask them about the midwives you’re considering – someone may have first-hand experience with them.

Look to the mom groups in your community.

Just about every community has a birth circle or La Leche League group or some sort of birth advocacy group. These groups can be a great way to meet women who have used the services of local midwives and can give you feedback about their experiences with them. And many midwives offer meet and greet sessions at birth circles or attend the meetings as members of the community.

Contacting a midwife

Most important is the “click” factor. Many moms report knowing that a midwife was right for her because they just “clicked.” Follow your intuition to make the best decision for you and your baby.

If you’re not sure which midwife to hire, consider interviewing several midwives until you find the one who is the right fit. Set up an appointment and prepare for the interview with a list of specific questions, concerns, and wishes.

Up Next… 20 Interview Questions to Help You Find the Right Midwife for You

 

 

Busy Mom Lifesaver #3: Strategic Cooking

Strategic cooking? What’s that? When you’re short on time, it helps to think about the big picture and come up with a strategy. You want to avoid eating out, you want food that tastes good, and you want to have food that involves minimal preparation, right? I love to cook, and when I have time, I am happy to spend hours in the kitchen making an elaborate meal. But, most days, I just want to get some food on the table and get it there quickly. I learned a long time ago that with a little forethought, I could cut a lot of time off of my cooking, save quite a bit of money, and make sure my family ate food they liked. Without this planning, we’re like most people – it’s 4:30pm, and we turn to each other and ask, “what’s for dinner?” Nobody has any ideas and next thing you know, we’re getting Thai food.

image-7One solution that has worked well for my family has been freezer cooking. Frozen assets, freezer cooking, once-a-month cooking, planned overs — whatever you call it, thinking about cooking this way has been a Godsend for me. It took me many years of being a grownup to figure this one out for myself and try it. Once I did, I was hooked.

The first time I did once-a-month cooking was about 10 years ago. It was a rather long and arduous process, but the result was a freezer full of great meals for my family, a bundle of financial savings, and a huge load of stress taken off of my plate. I think I was about 7 months pregnant with my youngest son when I did once-a-month cooking the first time. My motivation was to put away meals to help keep my sanity during postpartum (good plan). Over the years, I’ve gotten pretty good at doing the freezer meals, and now it goes pretty quickly, so I wanted to share with you some ideas to make the process easier and some resources for freezer meal recipes.

Day 1: Plan and Prepare

I usually break up freezer meal cooking into two days. One day of planning and preparation and one day of actual cooking. You’re going to need to set aside some time to gather your recipes and figure out what to make. Sometimes, you can just make your own favorite meals in bulk and divide them up and freeze them. Other times, you’ll want to follow some sort of freezer meal cooking plan. Whatever you’re planning to do, take some time up front to do some planning.

My absolute favorite freezer cooking site is 365 Days of Crockpot. I love how she has it so beautifully organized. The shopping lists are wonderful. The recipes are made in assembly line fashion so it goes very quickly. She lays it all out to the point where you put your bags in the loaf pans, and then her instructions say “2 T Tomato Paste in bags 3, 6, 7,10, 13, 18.” This page has a video that explains her method. You’ve got to see it! I absolutely love it. Her meals are quite good, too. If you want to try out her method, I’d recommend starting with these:

8slowcookerfreezermeals

In addition to doing one of her plans, I also like to make up some of our go-to meals like meatloaf, taco meat, and meatball mix. Now that I use the Instant Pot for my spaghetti and meatballs, I don’t precook the meatballs. Instead, I have the meatball ingredients mixed together so that I can just defrost it, form it into balls, and put it into the marinara sauce in the Instant Pot. It cooks for 5 minutes at high pressure and 10 minutes pressure release.

Go shopping

Once you’ve gathered your recipes, it’s time to make your grocery list. This is not a time where you’re going to want to be making trips to the store in the middle of your cooking, so make your list and check it twice…three times. Go get your shopping done.

Make sure you have plenty of zip top bags, aluminum foil, labels, and permanent markers. I took a tip from one of the freezer cooking sites online and use loaf pans to hold the baggies of ingredients when I’m doing my freezer cooking. This holds the upright and open, ready to receive the next ingredient. I got mine at the dollar store and I save them just for freezer meals.

Clean and De-Clutter

Clean out your freezer. Toss all of the old freezer-burned veggies and meat. Make some space for all of your new meals!

Clean your kitchen top to bottom. You are going to need every inch of counter space for this job. You probably will need to expand your project onto the kitchen table too. Clear off the counter tops of any unnecessary items. Empty the dishwasher and sink. Put everything away. Sharpen your knives and get ready to cook!

The Big Day!

Get some help

I personally recommend having a helper (or a few) when you do once-a-month cooking, especially if this is your first time doing it. There’s a lot of work involved, and having someone help you with it will make all the difference. It’s a great time to teach kids organizational skills and cooking skills.

Divide and Conquer

Some people like the more focused parts of freezer cooking, like chopping veggies. If that’s their gift, have that person chop veggies. I have a few people in my family who are a little overwhelmed with the 30 loaf pans with open baggies on the countertop. They’re much happier to just chop the veggies. Great, chop veggies! My youngest likes to do labels. Cool, make labels! I, on the other hand, like managing the whole operation and keeping track of what goes into each bag. That’s my gift, so that’s what I do. There’s plenty of work to go around, and if you have kids old enough to babysit younger kids, or if you have kids old enough to help you with cooking, all the better. Now that I have older kids, I’m blessed to have two teens who have cooking skills that rival my own. Plus, my husband is every bit as good at this as I am.

Label, Label, Label

Once in a freezer bag or wrapped in aluminum foil and stored in your freezer, all of the meals look pretty similar. You absolutely have to label. I highly recommend double-bagging your meals and labeling the inner baggie. Then, put the cooking instructions on an index card and place it between the inner and outer baggie. When you defrost your freezer meal, remove the instruction card first so it doesn’t get wet from condensation, otherwise your instructions will likely become difficult to read. Another option would be to label and number the bags, and then keep a list of your meals separately with the cooking instructions. Either way, you need a plan for how you will keep track of what you have and how to cook it.

How you freeze it matters

If you lay a baggie of something liquid on a rack in your freezer, it will conform to the rack as it freezes and you’ll never get it out of there later. Trust me; it has happened to me. Freeze flat items on aluminum baking sheets and then stack them, preferably in a box so that they don’t fall out and land on your foot when you open your freezer door. Again, that’s happened to me. If you are using the loaf pan method, freeze things in the baggies inside the loaf pans, and then pop them out like ice cubes in an ice cube tray. You can store them like bricks in your freezer.

Think ahead about how you’ll be cooking the item you’re freezing. If something is going into a slow cooker and you’re not going to defrost it first, freeze it in a container shaped like your slow cooker. That way, it can defrost in the slow cooker. If you’re freezing a meatloaf, wrap it in aluminum foil in such a way that you can place the frozen meatloaf back into the loaf pan while it’s still wrapped. You’ll be able to defrost it like that, bake it, and then throw the aluminum foil into the recycling bin, eliminating the need to wash the meatloaf pan.

Planned Overs

Another solution for our family has been Planned Overs. It’s a different way to think about leftovers. I try to think ahead when I’m cooking. It’s enough effort to cook once, why cook twice, right? I learned a long time ago to cook more than we need at one meal and think about how we could use the leftovers while I’m making the first meal.

Today’s Rotisserie Chicken is Tomorrow’s Chicken Enchiladas and the Next Day’s Chicken Soup

Get a couple of rotisserie chickens and a bag of salad for dinner one day. Chop up the leftover chicken meat to use for the next couple of days.

For the chicken enchiladas, put half of the leftover chicken meat and a can of black beans in a skillet with about a cup of salsa and heat it up. Add a little sour cream and cheese, roll it into tortillas, cover with more salsa and cheese, and bake at 350°F until hot and bubbly. I usually serve it with salsa, avocado, sour cream, and shredded lettuce.

For the soup, I use this as a good opportunity to use up veggies on hand that are perhaps on their last leg. It’s basically a “clean out the fridge night.” Put the chicken bones into the Instant Pot with whatever veggies you like. Season with salt & pepper and some thyme. Add the remaining chopped leftover chicken, put that in there too. Cook in the Instant Pot on the soup setting or cook in the slow cooker on low all day. Remove the bones and serve.

Today’s Pot Roast is Tomorrow’s Beef Vegetable Soup

Chop up your pot roast leftovers (meat, potatoes, carrots, whatever). Put it in your crockpot (or Instant Pot) with some stewed tomatoes and a bag of frozen mixed vegetables. Add beef stock to cover. Season with salt & pepper and fresh rosemary. Cook in the slow cooker all day, or cook in the Instant Pot on the soup setting.

Today’s Tacos are Tomorrow’s Tamale Pie

Make up some taco meat. I generally use ground beef, but you could use chicken or pork or turkey. My recipe is pretty simple – ground beef, onion, seasonings, Ro-Tel tomatoes, cilantro, black beans. I like to make a lot of taco meat and freeze some, but I also will reserve some to make up a tamale pie. This is a simple and quick way to use up taco leftovers. Layer corn tortillas, taco meat, cheese, and salsa in a casserole dish. Top with salsa and a little cheese. Bake at 350°F until hot and bubbly. Serve with avocado slices and some sour cream or plain Greek yogurt.

Today’s Veggies are Tomorrow’s Frittata

Time to use up the veggies! This is great for a make ahead breakfast or Sunday brunch. For more detailed instructions, here’s a post I did about making frittata, but you can really just wing it. Gather whatever veggies you like – onion, zucchini, mushrooms, spinach, broccoli, tomatoes. I generally just use up the leftovers in my fridge. Rough chop them veggies. Using an oven-safe pan, saute your veggies, and then add 6-12 beaten eggs (depending on how big you want the frittata to be). Cook it like you would scrambled eggs until it is partially set, add some cheese, if you like, and then broil until the top is set. Basically, you’re cooking the bottom and then the top. Remove it from the oven, wait a minute, then flip it out onto a cutting board. Cut into wedges and serve. Or, let it cool and wrap it up for a quick breakfast for the next few days.

Today’s Pork Roast is tomorrow’s Pork Fried Rice

This is a great way to use up leftover meat and rice. It also works well with leftover quinoa. I like this with pork, but you could do this with leftover chicken or beef, too. Chop the leftover meat into bite sized pieces. Chop up an onion. In a large skillet, heat some oil and saute until translucent. Add the meat and cook until heated through. At this point, you could add some leftover peas, corn, broccoli, or other vegetables you like. Push the food to the edges of the pan. Beat 3 eggs and cook the eggs in the center of the pan. Once cooked, mix with the other ingredients. Add some soy sauce and sesame oil. Add cooked rice. Add more soy sauce and sesame oil as needed and serve.

Today’s Spaghetti and Meatballs is Tomorrow’s Lasagna with Meat Sauce

This couldn’t be much easier. You could even do this as you’re putting away your leftover sauce and meatballs, which would probably be faster and would eliminate having to wash the spaghetti sauce pan twice.

Heat up the meatballs and sauce in a large saucepan. Using a potato masher, mash the meatballs and break up the large chunks of meatball in the sauce. Add an extra can of tomato puree. Mix ricotta cheese, parmesan cheese, chopped spinach, an egg, and salt and pepper in a bowl. Layer sauce, then uncooked lasagna noodles, ricotta mixture, shredded mozzarella, sauce, noodles, etc. The final layer should be noodles, sauce, and then mozzarella. Cover and bake 1 hour at 375°F. Uncover and bake until the cheese browns and is bubbly. You want to be generous with the sauce since you’re using uncooked noodles. The noodles will absorb a lot of the sauce.

Today’s Meatloaf and Mashed Potatoes is Tomorrow’s Shepherd’s Pie

When you’re putting away your leftover meatloaf, chop it up into small pieces. The next day, put the meatloaf pieces in a baking dish, add some mixed vegetables and a can of Amy’s Cream of Mushroom Soup. Top with leftover mashed potatoes. I like cheese, so I add a sprinkle of sharp cheddar on top. Bake at 375°F until the potatoes start to brown and everything is hot and bubbly.

Now, time for me to start planning my next freezer meal adventure! Let me know how it goes for you. I’d love to know which sites you’ve found helpful and which recipes have worked for your family!