Bad news for homebirth in Utah

From an article in the Salt Lake Tribune:

    The bill would put new limits on direct-entry midwives, who are licensed and attend home births. By defining a “normal” birth, it bans them from administering to women with a host of medical conditions, from diabetes to hypertension.
    They also would be stopped from assisting women whose babies are breech or who want a vaginal birth after a previous cesarean section (VBAC).

How is it that people who never see “normal” birth (a term that is easily usurped and unfortunately true of augmented birth in this day and age) are able to determine normalcy.  If they can determine “normal”, then perhaps they should start overtly forcing more women into induction, augmentation, and other interventions.  Medically-managed labor & delivery is certainly most common in a hospital setting.  In fact, why don’t we just get rid of the mother’s (and other vested persons’) desires altogether?  Many – if not most – OBs are contemptuous towards mothers with birth plans anyway.

I can tell you that “normal” should equate to “natural”, but it doesn’t any more.  And really the only venue for assuring natural birth is home.  Sure “natural” might not happen for everyone.  I’m not even trying to suggest that all women should give birth at home.  But these restrictions . . . why not ensure that direct-entry midwives are well-trained for breech, twin, and VBAC scenarios.  How do you ensure this?  By keeping it legal and supporting midwives who feel confident in their skill level with breech, twin, and VBAC labor.  Just as an OB should know if s/he is the appropriate person to deliver a breech baby or perform an amniocentesis (and lemme tell you, some simply are NOT), so should a CNM or direct-entry midwife.

I’ve written about “normal” and “natural” before – click here to read!

Trust Birth or Don’t?

I can’t resist.  You would think that since I am new to homebirth and haven’t had a VBAC yet that I wouldn’t bother myself with polemics regarding homebirth.  I’m obviously not that bright.  My homebirth google alert today included a post about the power of positive thinking and the homebirth movement.  I had to check it out. 

I won’t link to this weblog out of principle, but if you search for the quote using your favorite search engine, you’ll find it easily enough . . .

“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

I’d like to play with the words a bit:

“If you refuse to trust birth and insist that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

Some people, practitioners and women, simply refuse to trust birth.  Some will insist that birth is inherently dangerous.  They will likely achieve the birth experience that they desire, and it will likely be overly-managed, overly-medicated, potentially surgical, and definitely exorbitantly expensive.

“If you don’t trust birth and accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

And somewhat similarly:

“If you don’t trust birth even though you don’t believe that birth is inherently dangerous, you will likely have trouble achieving the birth experience that you desire.”

Some people don’t trust birth and have accepted the “fact” that birth is inherently dangerous.  They will likely create that reality in their birth experiences.  If women engage practitioners with this guiding philosophy, they will likely lose faith in the natural processes of life and end up dissatisfied with their birth experience even if the outcome is positive.

Some women know that birth isn’t dangerous most of the time but lack the trust needed to achieve particular outcomes.  Perhaps this was me once upon a time.  I never really considered that birth might be dangerous.  Why would I be created for a particular skill if it were inherently dangerous to me or my offspring?  However, I’m not sure that I trusted myself enough last time.  I didn’t trust my body.  I didn’t trust my instincts.  That’s probably the worst part of it . . . I didn’t listen to my inner voice.

“If you trust birth and acknowledge that birth is inherently natural to our species, you will likely achieve the birth experience that you desire.”

If you trust birth you are fortunate enough to understand that certain life events are natural and far less risky than some of the every day activities in which we engage.  Things like riding in cars.  That single activity is far more risky (statistically speaking) than giving birth.  If you trust birth you may not be “rewarded” with a particular birth outcome but understand that complications and poor outcomes are possible.  Trusting birth is not about sticking your head in the sand.  It’s about understanding that most of the time women can achieve normal birth when given appropriate support, time, and space.

Going back to the original quote:
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

“Trust” – in the original text, the blogger puts the word “trust” in quotes; this diminishes the validity of “trust” in relation to childbirth
“Refuse to accept” – ultimatum . . . polemic
“Inherently dangerous” – emotional scare tactic
“Reward” – as if there’s a prize involved???
“Desire” – as if all that matters for homebirthers is what the woman desires

Do you see yourself anywhere in my “play on words” section?  Where do you want to be?  Do you want to be afraid to be pregnant?  Do you really want to go into labor and delivery afraid?  Do you really want to go into labor and delivery lacking trust?  What is positive and proactive about being fearful and lacking trust?  What do you as a pregnant and/or laboring woman gain from that perspective?  I would say nothing.  You have lost your power and are no longer an active participant in your care when you are afraid and can’t trust.  Perhaps you (and your birth experience) are more manageable that way.  How do you feel about that?  Do you want to be managed?

I can’t really define homebirth for you.  Everyone comes to homebirth from different paths.  Some women always know that they’ll have their babies at home.  Some women are involved in social structures that are more inclined to promote homebirth, homeschool, extended breastfeeding, attachment parenting, and the like.  Some women are disgruntled consumers.  Some women aren’t given the choice to have a vaginal hospital birth and turn to homebirth as their only choice.  Some women who give birth at home don’t fall into any of these generalized categories.

For me homebirth is about safety, sanctity, Faith, Trust, natural life processes, achieving physiologic birth, what’s best for me and baby, avoiding an unnecessary cut, vaginal birth after cesarean, comfort, family, community, and a whole host of other things that I haven’t even discovered yet!

BFP Sturm und Drang

BFP = Big Fat (or your favorite “f” word) Positive; used on TTC (trying to conceive) and birth loss boards on the internet.  Women who use this terminology tend to record BBTs (basal body temps) and other fertility signs.

Sturm und Drang = German for “storm and longing” or “storm and stress”

From Wikipedia:

” . . . the name of a movement in German literature and music taking place from the late 1760s through the early 1780s in which individual subjectivity and, in particular, extremes of emotion were given free expression in response to the confines of rationalism imposed by the Enlightenment and associated aesthetic movements. The philosopher Johann Georg Hamannis considered to be the ideologue of Sturm und Drang, and Johann Wolfgang von Goethe was a notable proponent of the movement . . .”

And since Goethe was one of those poets who was set by “everyone and their dawg” in the Classical musical period, I’ve come across the theme quite a bit.

What does Sturm und Drang have to do with BFP?  Here I type, “barely” pregnant, bearer of the positive pee stick (home pregnancy test), being pulled by my rational mind and wild emotion.  I have been pregnant 3 times in the past 5 months.  My June cycle led to pregnancy and a 5 week miscarriage in early August.  We waited a full cycle and conceived again, but I miscarried between 5 and 7 weeks in early October.  We waited 8 weeks for my menses to return, and in the third cycle following the miscarriage I “accidentally” got pregnant again. 

The rational mind says: (1) miscarriage is a possibility, and a higher possibility now that I’ve had 2 back-to-back miscarriages; (2) although miscarriage is a possibility, I am statistically MORE likely to carry the pregnancy successfully to term; (3) there’s nothing I can do to cause a miscarriage; (4) there is nothing I can do to necessarily prevent or treat a miscarriage; (5) that I’ll survive another miscarriage should that be the journey.

The emotional heart says: (1) Trust God; (2) God won’t necessarily spare me from another miscarriage; (3) I can’t bear another miscarriage; (4) I’ll survive a miscarriage if I have to . . . my family needs me; (5) Bond with this pregnancy; (6) Stay emotionally detached from the pregnancy . . .

Another aspect of Sturm und Drang as it applies to BFPdom is guilt.  I have guilt on two levels.  First, I didn’t intend to become pregnant this cycle, so I am a bit embarrassed about being pregnant so soon and feeling foolish for having “accidentally” gotten pregnant in the first place.  My herbalist wanted me to be on a particular herbal regiment for about 3-6 months before TTC.  Second, I participate on a birth loss forum.  Some of the women in my group have been trying for months if not years to become pregnant.  Some have been trying for months if not years to become pregnant and see a pregnancy through to term.  Some have suffered multiple losses.   So I sometimes feel guilty and petty because I do have one beautiful daughter and have at least experienced pregnancy now 4 times.

As happy as I am for me, I grieve for these kind women on my board.  It’s hard to see one of them go on to a pregnancy board and continue with their pregnancy and birth.  It’s hard to see them return after a pregnancy was lost.  It’s hard for all of us to be excited about possibly being pregnant and scared that the inevitable (menses, miscarriage, stillbirth, etc.) will fall upon us.  It’s rough waiting for the next hcg or progesterone test or ultrasound that assures us that the pregnancies are moving forward. 

I love these women dearly.  I wish the circumstances that brought us together were different, but I learn something new every day.  Someone posts something heart-felt every day that touches me.  These hopeful grieving women have marked me and I them. 

Musings on Birth Safety

Which is it – childbirth is safe, normal, natural or dangerous, wild, and unpredictable?  Do we really need to draw a line in the sand like that?  Isn’t childbirth all of that – normal, natural, wild, unpredictable, sometimes just fine, sometimes not?

No, childbirth is not always safe.  I work with a gal who has nearly died in childbirth several times.  She lost one child along the way.  She birthed at hospitals under the care of a high-risk obstetrician, and that was a necessary reality for her.  A friend of mine recently birthed a baby still.  They don’t know why the baby died during birth.  Another friend of mine suffered an uterine rupture.  Her smart baby was blocking the artery that was compromised, and that is why she is still alive today.

But often pregnancy and childbirth is normal and uneventful.  (Well, it’s always a big life event, but it’s not nearly as dramatic as Baby Story would have you believe.)  It seems like it is more fun for people – some natural birthers and some who want all of the technological bells and whistles – to hype up childbirth.  “Ugh, it was SO PAINFUL I just HAD to have my epidural.”  “No one is going to take away my VBAC.”  “Oh my gosh if I hadn’t had that c-section, I’d have died in childbirth.”  “I’ll have to be dying before I let anyone take me to the hospital again.”  (For what it’s worth, I said that last statement following my October miscarriage.)  Drama drama drama.  Me me me.  I want I want I want.  I’m being a bit extreme here, but I read so much selfishness and self-indulgence and self-glorification on both sides of the proverbial childbirth fence.  Does this help women?  Does this empower women to make informed choices that “make” childbirth safe?

Let’s come back to that term “safe” as it applies to childbirth venue.  If you don’t believe homebirth is a safe choice, then it’s not . . . for you.  If you don’t believe that you can have a natural non-interventive birth in the hospital, and that’s important to you, then you probably won’t have a good experience in the hospital.  If you don’t trust anyone but your self and perhaps your partner in childbirth, you will probably prefer unassisted childbirth.  We’re only “safe” when we believe we’re safe.  I honestly don’t believe that MOST women are safer in the hospital or safer at home or safer at a birth center.  They perceive a level of safety and psychologically, and even physiologically, respond to that way of thinking.  Certainly there are plenty of “yeah, but” scenarios out there, but I very clearly wrote “MOST women” above.

Be afraid to birth at home.  That’s fine.  But don’t call a woman crazy for choosing to feel safe at home, especially if she is surrounded by well-trained and caring support.  You can be afraid even when someone else isn’t.  Be afraid to birth at the hospital.  That’s fine.  But don’t criticize the woman who chooses to deliver at a hospital, especially if she is surrounded by well-trained and caring support.

It is an unfortunate reality that babies die in childbirth . . . that women die in childbirth.  I think doctors, midwives, and other childbirth support providers are all interested in reducing negative outcomes in childbirth.  I just wish, hope, and pray for the day when these parties can meet and work from a point of mutual respect.  That’s when we’ll have a maternal-child healthcare system that is woman-baby centered and certainly safer for all involved.

We can’t make changes if we don’t talk.  Debate is not talk.  People who debate don’t listen.  I think people who get caught up in debating issues without stopping to listen and learn are afraid.  They are frightened sad unhappy people.  I have my own set of fears just like anyone else, but I strive to run my life from a place of power and trust.  I don’t want to pass fear along to my children.  I don’t want to be remembered that way.  I don’t want to approach God that way.

May you find power, faith, and love, now and forever.

Gloria Lemay Responds to ABC Segment on Unassisted Birth

“The baby could be born in a breach [sic] position, or with the umbilical cord
wrapped around its neck. The mother could suffer from significant tearing or
from a maternal hemorrhage and bleed to death in as little as five
minutes.”

Dear Women,

The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.

I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.

First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING.  Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough I.V. fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could.  I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.

Think about it – would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes?  I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1000). Two women have required transfusions. The other 8 recovered with I. V. fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.

What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post operative mothers very distressing.

I hope this information is helpful to you.

As far as the other nonsense this person is trying to frighten you with:

1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.

2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs”. Breech presentations are about 3 percent of births.

3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.

Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at www.consciouswoman.org
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008
www.trustbirthconference.com

Why “I don’t care” hurts

My sister-in-law’s birth experience came up in discussion this week when we were home visiting.  We knew at the time of her cesarean that the baby was likely premature – even at 41+ weeks – because of the thick coating of vernix on her when she was extracted from my SIL’s body and based on her mother’s gestational pattern.  Her OB of course recommends repeat cesarean for future childbirth.  Perhaps some of the reasoning is valid, but personally, I think she’s being misinformed and discriminated against.

My husband asked her if she was interested in a VBAC or would go with the OB’s recommendation, and she said “I don’t care.”  She doesn’t care?  How can that be?  How can she say that in front of me knowing damned well that I DO CARE!

Because I do care!

Telling a woman like me that you don’t care is offensive.  I do care.  I care that my baby likely was unnecessarily removed via major abdominal surgery.  I care that the physical and emotional effects of this surgery may not be seen in and by my daughter until later in life.  I have just this year (at age 34) begun to learn about and remedy some of the ill effects of my own cesarean birth.  I also care that my brother’s wife was subject to interventions that lead to cesarean birth.  I really care that she was subjected to a surgery that could have prematurely ended her own life.  Stories of maternal death during or shortly following cesarean surgery are working their way into the mainstream media.

We know that this is not the best way for babies to be born unless it is an emergency situation.  We know that babies who are born via cesarean section risk breathing issues, spinal issues, being accidentally cut, being seperated at birth from his/her mother, needing NICU support, as well as emotional and chemical problems in the future.

Because of what “I don’t care” implies

She said she doesn’t care to my husband and me knowing full well that we do care.  She knows about my work with ICAN.  By saying “I don’t care”, she made me feel like she doesn’t believe in the work I am doing or honor my birth philosophy.  Instead of saying “I don’t care” so bluntly, she could have said something much more tactful.  Try “I’m not sure which path I will take, but given my reproductive health history I will likely do as my doctor recommends and schedule a repeat section.”

My whole being in invested in two very important personal issues: (1) cesarean awareness and advocacy through ICAN; (2) miscarriage – cause, prevention, “treatment”.  By saying “I don’t care”, I am left feeling like she doesn’t care about me.  (Now, I recognize this as a bit extreme.  I know she does care about me, but she didn’t care to think about how this statement would hurt me.  This happened days ago and I still hurt.)

Because of who says it

I’d imagine that you or I are more likely to hear something along these lines from someone we care about – a close friend or family member.  This makes it all the more painful.  If some idiot woman I don’t know or like said this to me, it would roll right off.  But the horrible things our family members and friends say to us are really tough to forgive and forget.  I know that I must forgive and forget, and that’s partially why I am writing this post. 

Because she should care

I recognize that I have no power over another person’s decision to care about health care decisions made for them.  However, does that mean that I back off and let a family member be led to medical decisions that could adversely affect her family?  This is tricky for sure.  I have no desire to badger her and don’t want to negatively impact my relationship with her and my brother, but it is really hard to stay silent when your family chooses to stick its head in the sand.  They’d just rather I stick my head in there with them than have to endure one of my “rants”, as I am sure they see it.

I don’t want to negate anyone’s birth experience.  I don’t want to tell another woman how she should plan childbirth.  However, I believe it is my Calling to advocate, support, and educate women (and their families) with regard to safe and ethical health care decisions specific to prenatal, childbirth, and postnatal care.

What is so offensive about that?  Why should my caring be taken so poorly or treated as trivial?

‘Tis the Season to be Reminded Why My Family Drives Me Nuts . . .
Fa la la la la!

Remniscence

Today is Saturday (barely), November 17. 

I started to lose my last pregnancy 7 weeks ago tomorrow (October 7).

Menses finally returned yesterday.

I saw a very pregnant lady tonight at a concert.  I was intensely jealous.

I see new babies every day.  They excite me.

A baby is in my future.  But when.  Will the next pregnancy be successful?

A baby is in my future.  But when.  Will the next vaginal birth be successful?