“Black Market Birth” - Request for Your Stories

A friend of mine in ICAN is working on a very important project.  She will be making a presentation to the American Public Health Association (APHA) in October:  “VBAC Beyond Borders.”   One thing that she asked us to share is her need for stories regarding “Black Market Births.”  She writes:

Specifically, I am looking for birth stories of women who delivered in hospitals with VBAC “Bans” in place.   I am also very interested in stories of homebirth where VBAC itself was explicitly illegal.  At some point, I will be looking at HBAC in states where midwifery is unregulated or “alegal,”  but at this time am most interested in births where homebirth midwifery is regulated, but VBAC is outside the practice regulations or scope of practice.

Please send your stories and questions to ICANMidlandssc *at* gmail *dot* com.

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Homebirth Coloring Book

I just have to give a shout out to North Carolina Homebirth for their homebirth coloring book.  I hope I’ll be able to use them sometime in the coming year.

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Homebirth Featured by Christian Science Monitor

What a great story about Diane Goslin, a Christian midwife in Pennsylvania.  If you haven’t read this article, I highly recommend it!

“The [issue of] the medicalization of childbirth has been around for a long time, now,” says Arthur Caplan director of the Center for Bioethics at the University of Pennsylvania. “There will always be [people like] the Amish, who want no technology” on one end of a continuum, and those who will refuse to have a baby “if they can’t deliver at University of Pennsylvania” on the other. He argues that the home-vs.-hospital argument should be removed from the ideological push and pull, and instead be driven by safety data specific to the woman‘s age and risk factors as well as the availability of emergency backup care.
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Finding a Voice Again

I am finding a voice - I don’t completely recognize it as my own, but perhaps I need to live with this voice a bit before it resonates authentically within me.  I shall sing again.

Thanks to Google Alerts I happened upon this homebirth post.  I made a comment which I am cross-posting here.  I am not posting it here because it sheds a new light on a circular issue but because I wrote it.  Me.  When I have had so little to say about childbirth since the loss of my 10 week pregnancy back in February.

So why then is there so much animosity against those who choose to homebirth. Why are they persecuted for their freedom of choice? I’m sure we all have our suspicions.

I think those people who are so vocal against homebirth are pretty clear about their reasons. The fear of poor outcomes for the BABY. It seems that the baby is worth more than the mother. Homebirth is a “selfish” choice, evidently, that only makes the mother feel good about herself. Homebirth is a “disaster” just begging to happen. @@

It is true that when a mother makes decisions with regard to HOW the baby will be birthed, the innocent baby is not in on the decision-making process. The “rights” of the baby only matter, so it seems, when there is a poor outcome (for the baby) outside of the hospital setting.

OBs are not used to seeing normal (as in natural) birth. They are not trained to assist natural birth. They are trained to intervene. They are trained for surgery. They are trained for catastrophe. They are trained to medically-manage outcomes not facilitate a physiologic time-proven natural process.

Blog Talk Radio features Unassisted Childbirth

Following is a notice from Lynn Griesemer, a birth advocate and author of the Your Body, Your Birth CD which was reviewed for the Spring issue of ICAN’s the Clarion which is due out this month.

~    ~    ~    ~    ~

     I will be interviewed by Lesly Federici, former Labor and Delivery Room Nurse on her program this Friday, March 7, 2:00-3:00pm EST   www.blogtalkradio.com/usmilemom.  If you cannot listen to the program live, you can access the show at any time after that by going to the website.

  I expect that we will be spending the entire hour discussing childbirth and in particular unassisted homebirth - giving birth without a doctor or midwife.  Whether you agree or disagree with the topic of unassisted homebirth, I hope you will listen to the show because I plan on sharing many secrets for having a successful birth experience and why the way we birth is so important to femininity, families, society and civilization.

Sincerely,

Lynn M. Griesemer
www.unassistedhomebirth.com
www.yourbodyyourbirth.org

—–Mother of six, Author of UNASSISTED HOMEBIRTH:  AN ACT OF LOVE and YOUR BODY, YOUR BIRTH:  SECRETS FOR A SATISFYING AND SUCCESSFUL BIRTH.  During the past six months I was featured in the Washington Post and appeared on PBS “To the Contrary” and a WJLA news story on Unassisted Homebirth.

Contrast these homebirth news stories!

I have followed homebirth legislation news in Utah and South Dakota with interest and concern.  I don’t want Montana getting any stupid ideas. 

Utah - I blogged about their nonsense recently.  Yesterday, the Utah Senate voted to restrict homebirth practices.  The bill was supposed to have been a compromise, but what resulted was something restrictive and punitive.  Women will be forced to attempt VBACs in hospitals or on their own.  Were this the case in my state, I would have an overwhelminly large chance at “failure” since my hospital’s VBAC rate is a pitiful <1%.  They only had 16 successful VBACs at the hospital in 2006.  Utah legislators have chosen a path that makes homebirth less safe.  To search for Senate Bill 93, click here.

South Dakota - I also blogged about their homebirth “situation,” and it appears that both the SD House and Senate have approved a homebirth bill. 

The bill would require midwives to become registered nurses, get master’s degrees in nursing, and pass additional tests. Certified nurse midwives wanting to attend home births would need approval of both the Nursing board and the Board of Medical Examiners.

Allowing certified nurse midwives to attend home births in South Dakota would be allowed on a trial basis until 2013.  (click here for source article)

My concern is that CNMs were previously required to have OB back-up, and evidently no OBs were agreeing to provide back-up services.  What will be different?  And I’m not sure that having a Masters Degree makes anyone particularly qualified to attend labor.  Shouldn’t these homebirth midwives have assisted on “x” number of births before they become licensed?  Why is it always about the piece of paper??

Also, the bill states that CNMs will be able to attend homebirths “under certain circumstances” but doesn’t clarify what those circumstances may be.  I suppose we must find the Board guidelines to find more clear language.  To read the bill, click here.

Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed - via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed - we treat them. We don’t judge the obese who come in with MI’s. - we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis - we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading - we treat them. We don’t judge many other behaviors which really ARE obviously poor choices - because they are just that - choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

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!

Maternity Matters

“Maternity Matters” is the name of an initiative in the UK to increase funding for maternity services.  (source)

One way the extra funding will help women and babies in the UK is to:

Modernise options for the place of birth - this will ensure the NHS can offer women a choice of homebirth, birth in a midwifery facility or in a hospital based maternity unit.

Options for the place of birth??  Women having a choice of homebirth???  What is the world coming to! 

Critics of homebirth in America hold it to a standard that they are not willing to support.  You can’t criticize homebirth in America if you are completely unwilling to help improve it.  The fact of the matter is that women are choosing homebirth here in the US.  Another fact is that women will continue to choose homebirth, even if midwifery and homebirth became illegal.  It would still happen.  If care providers and maternal institutions see a problem with homebirth in America, they are obliged to help fix it.  The best way to ensure that homebirths will continue to take place safely in this country is to invest in homebirth as a viable option.

Homebirth in South Dakota

South Dakota isn’t particularly close to me here in Western MT.  However, SD is a neighboring state, and I have relatives who live in that state, so birth news from SD is important to me!

SD is working on legislation that will allow women to birth at home with assistance of certified nurse midwives (CNM). 

Current laws require South Dakota’s Certified Nurse Midwives to have a signed collaborative agreement with a physician as a pre-requisite to practice.  However, South Dakota’s physicians have failed to cooperate with any Certified Nurse Midwife for homebirth.
 
The South Dakota Chapter of the American College of Nurse Midwives supports the measure and provided testimony on Wednesday citing the safety of low risk mothers who have planned home births with Certified Nurse Midwives.

I don’t believe that Montana allows CNMs to attend homebirths.  I do know that doctors who used to provide back-up support for direct entry midwives (different certification and oversight than CNMs) in my community no longer do.  I like the language in the article - “. . . physicians have failed to cooperate . . .” - indeed!

Jeanne Prentice is a CNM from South Dakota that currently attends homebirths in Wyoming. 

Prentice is alarmed at the growing number of mothers who are choosing to deliver without any help at home because they fear what may be forced on them in the hospital delivery setting.

Indeed, many of us know well enough that hospital delivery can be interventive.  Women are not in a position of power with regard to their bodies, their babies, and their birth plans.  I am not talking about balking at medically-necessary intervention.  However, very little of what goes on in labor and deliver is NECESSARY.  Women are subject to a number of routine procedures and protocols upon entrance to to the hospital.  Women are resisting, and I believe this has caused 2 things:

  1. Care providers, especially medical providers, insurance companies, and other medical institutions are becoming more restrictive, more interventive, and less woman-centered.  This is evidenced by declining maternal-infant outcomes, increased cesarean deliveries, increased PTSD & PPD, and declining VBAC rates.
  2. Out-of-hospital birth is on the rise.  Women and finally starting to realize (I know I am) that their chances of having a good and safe childbirth experience are declining in hospitals.  Women are learning and owning the benefits of natural physiologic childbirth, when possible, and insisting on finding care providers who will enable that.

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