You need “shadow care?”

Many women who plan homebirths feel the need to consider the question, “Do I need ‘shadow care?'”  What exactly is shadow care, and when might you need it, want it, or not?

WHAT IS SHADOW CARE

I take shadow care to mean accepting obstetric oversight, planning to birth at home, but not telling the care provider about plans to birth at home.  I distinguish this from concurrent care which means that both woman and care provider are engaged in an open, consensual, and honest relationship.  For those of us who have planned homebirths while maintaining some sort of relationship to a medical care provider, the best situation is to have concurrent care.  However, it would be naive of me to suggest that all women will be able to enjoy this relationship.  Most OBs will not or cannot back up homebirth midwives.  So I recommend entering into this ‘care triangle’ very carefully and cautiously.

WHEN MIGHT YOU NEED SHADOW CARE

Here are a list of situations that have prompted women to seek shadow care:

• Desire for medicinal-grade pharmaceutical therapies/treatments for things like low progesterone, insulin-resistance, blood pressure issues, etc.
• Desire for viability ultrasounds in the 1st trimester; desire for the 20 week ultrasound; desire for a biophysical profile late in pregnancy
• Desire to be treated like human beings when hospital transfer is necessary during or after birth
• Desire for continuous care if/when transfer from homebirth care to hospital (obstetric) care becomes necessary
• Desire for a ‘contingency plan’ for if/when labor presents unexpected variables

WHEN YOU MIGHT REJECT SHADOW CARE (or someone who suggests it for you)

• If your midwife suggests shadow care, you must must must get to the bottom of this request
• If you suspect that your midwife is ‘using’ your shadow care as her backup care – that’s why midwives should carry insurance; if you can’t get to the bottom of this issue, find a different provider
• If you are experiencing unwanted or unnecessary pressure from friends, family, other care providers that are unsubstantiated

WHEN YOU MIDWIFE or DOCTOR ABANDONS YOU

• It is unethical for a care provider to abandon you for any reason in your final month of pregnancy – speak up!
• Investigate your options as thoroughly as possible in the time you have remaining in your pregnancy
• Distance yourself from the care provider (and his/her network) for the duration of your pregnancy & post-partum period – don’t invite them into that special time!
• Consider filing a complaint – to the hospital, to the local board of doctors, to the local board of midwives, whatever is most relevant
• Make sure other families in your sphere of influence know about your experience

I welcome your input on this post via comments.  Please understand that I am not a medical doctor or someone who is in a position to offer medical advice.  I’m offering advice as a mother who has had to deal the BS mentioned in this article or know other women who have been dealt with unethically as a ‘patient.’

Current Research and Paradigm Shifts

I will never be free from medical ethics and consumer advocacy.  I am thankful for that.  Not only have I learned so much about my body and the complications of the medical field, but I have also learned that much of this knowledge can be applied in other fields.  I am hopeful that my research will help further an inevitable paradigm shift in my field that has yet to be “named.”  I can’t be more specific about it at this time.

I can be specific about my reading list:

• Groopman’s How Doctors Think is at the top of the list (but currently MIA from my library, argh!)
• Gawande’s The Checklist Manifesto and Complications: A Surgeon’s Notes on an Imperfect Science
• Gadamer’s The Enigma of Health
• Medical Error, Rosenthal & Sutcliffe (eds.)
• Medicine Looks at the Humanities, Newel & Gabrielson (eds.)

I suppose this will keep me busy over the long winter break!

Leaves

Leaves make me sad.  Things tend to go to hell in a handbasket (or more) in the Fall.  I’ve NEVER liked Fall.  Even when I like Fall, I’m wary of Fall.  And for good reason.

Do you see this picture?  I suppose I look happy.  I’m not.

By this time in 2007 I had suffered two consecutive miscarriages.  I was starting to panic.  I was starting to lose it.

This photo also reminds me of our last good day with Alfred, the first dog my hubby & I had together.  We were playing in the leaves that day and with our baby girl.  Life seemed complicated then, but things were good and we knew it.  Alfred died soon after.

Leaves surround me now and make me remember the wonderful things I’ve lost this time of year.  And I’m thinking of a student (and friend) with two young daughters who just lost her husband.  Another loss in the Fall.

These losses also remind me of the many blessings of my life.  I prayed and prayed for another baby . . . and lo and behold I have had 3 more!

Silver linings abound.  Blue skies lurk behind the grey menacing clouds.  If i were more of an optimist, I’d always be looking for those silver linings and blue skies.  However, the wicked past has taught me that the grey menacing clouds return, perhaps more frequently than I would like.  Does the blue and silver merely tease me?  Or does the grey remind me to be thankful for the brilliance of the others?

I continue to ponder this . . . this chiaroscuro that is life.

 

The Beginning of the End of the Beginning

I am sad (and relieved) to announce that ICAN of Greater Missoula is officially closed.  I really don’t understand why it wasn’t sustainable in this community.  Here are a couple of thoughts . . .

1.  The homebirthers and homebirth midwives are doing their part for sure, but unless you know someone personally who has birthed at home or who has used a midwife or is a midwife, you just won’t know much about how that works here in the greater Missoula area.

2.  The traditional birth culture prescribed by the medical community does not want to change.  Sure they built a “birth center” at the hospital, but all that really means is that women now have private bathrooms, tubs (I wonder if women are even allowed to use them?), and nicer accommodations.  I don’t think anything has fundamentally changed to make birthing healthier for women and babies at our hospital.  If I’m wrong, I’m happy to update this post at any time.  Our docs participate in a town-wide on call group.  What this means is that if you don’t birth your baby during office hours or during your doctor’s on call duty, you’re not likely to have your doctor help you birth your baby.  There are a few doctors that this does not apply to, and the key is to be with one of them.  Our medical community “killed” the birth center established by Dr. Montgomery, but kudos to Jeanne Hebl, CNM for establishing a successful homey birth center after Dr. Montgomery’s untimely death.  By November 15, 2011 Hebl’s birth center had assisted with 100 births.

3.  Women (families) in this town don’t know that they are “allowed” to have an opinion about birth much less how to have the birth experience that best suits their needs and wishes.  This is where I feel like I failed.  For example, when I was planning my HBA2C I ran into an acquaintance whose wife was getting ready for her 3rd cesarean.  They were told they weren’t allowed to do a VBA2C in Missoula.  I didn’t birth my baby at home, much to my surprise and chagrin, but I did have a most unlikely and uncommon VBA2C at the local hospital with a very good OB who did his best to scare the shit out of me during my appointments.  However, when push came to shove (literally) – HE WAS THERE.

Support for women and families in this community will always be there.  I hope families continue to seek out the best birth experiences that fit their needs and their dreams.  I will continue to offer support when and where I can.  And VBAC/CBAC support in Missoula does have a Facebook presence.  Click here to reach our page.

Here’s a recent picture of my amazing VBA2C baby:

My precious VBA2C baby at age 23 months

What Can I Say?

I am so out of the loop when it comes to anything having to do with reproduction these days.  I’m not in the loop . . . I’m not in the outskirts or the suburbs.  I’m off the grid.  However, a new comment on my ever “popular” miscarriage and hormones post made me feel compelled to post an update.

Random thoughts about life, birth, and the like . . .

• My 1/2 acre yard and gardens are in disastrous condition, but I did plant some annuals today; that made me happy!
• My husband is getting ready to add a second floor to our house – his company is called Aria Construction, and they do fantastic high-end work
• My youngest is now almost 11 months – I still want to smash her into 0-3 mo. clothes…
• The twins will be 3 in August, and they are such a joy and such a torment.  I still can’t believe they are mine!!
• My oldest, age 7, had a stupidly horrible time in 1st grade.  Here’s hoping for rest and recovery this summer and a better experience in 2nd grade.
• No, I’ve still not written my birth story from July 12, 2011 . . . what’s the hang-up?  Well, I still have issues with G’s birth and with a local care provider.  That’s part of it, I’m sure.

Am I recovered from my birth losses?

Yes and no . . . those losses, in a way, made these last three children possible.  However, I still feel an emptiness that will never go away.

Am I recovered from my birthing losses?

Mostly no.  Physical activity causes the adhesions to hurt.  The unevenness in my lower abdomen (fat layer – scar – fat layer) is something I see and feel every day.  Although my VBA2C was a “success,” I feel quite bitter about the last weeks (from 31 weeks to nearly 42 weeks) of my pregnancy.  From 39 weeks onward, every day was a struggle, emotionally.  The birth was stressful.  I didn’t feel a darned thing and had to be told when and how to push.  I didn’t birth my child, but at least I didn’t have to endure her being cut out of my body.

Birth advocacy . . .

I still feel quite out of sorts about childbirth in Missoula and elsewhere.  Any time I see that someone had a cesarean – primary or repeat – I want to know why.  I wish Missoulians seemed to care more about how they birth their babies.  I feel like people either go the homebirth route and mostly enjoy a rewarding birth experience or people sign up for the slaughter.  I know there are good docs and good nurses out there, but I definitely lack trust.  And people don’t know their rights or don’t care that they have rights or don’t know how to exercise their rights when it comes to their own health care.  Everyone else seems to just mind their own business.  <shrug>  I’m planning a few VBAC Resources and Support sessions this year – wish me luck!

Well, that’s where I am today.  I see that Rixa is blogging about important stuff, of course.  See her latest regarding the Human Rights in Childbirth panel.

Happy Birth Day to Me

Today is my birthday, and I have a lot planned for ugly number 39:

• Walmart for baby proofing (see photo below) and crafting stuff
• Finish G’s birth story since she turned 6 months old yesterday
• Meet a friend and hike “the M” today before the weather turns (hooray, snow!)
• Bake me a cake (no I don’t mind pampering myself on my birthday)
• Go to one of my BF’s to celebrate avec family (it may even turn into an overnight par-tay)
  

  Happy Birthday to Me (aka thank you for not killing yourselves)

My good friend from Birth After Cesarean posted this yesterday on my wall:

Well, who would have thought this past year would bring so much difference for you, woman!

Seriously, this has been an epic year for me.  I happily and healthily grew another blessing.  Against all odds, really . . . I had a successful hospital VBA2C.  I held my ground and refused a cesarean.  I achieved tenure and was promoted at my University.  I performed a solo faculty recital (my recital partner backed out on me a week prior) a mere 2 months post partum!  My hubby and I drove to and from Denver for the holidays with our four young kids (which I consider a HUGE success).  My Dad flew me to Houston to check on my ailing aunt, and I was able to see my mom, brother, SIL, niece, and meet my nephew!  And we ended our childbearing years yesterday with a vasectomy.

It’s crazy to think that my childbearing years are over.  I love pregnancy.  I might even be addicted to pregnancy.  I am jealous of every pregnant woman I see.  And thankfully a part of me is at peace with being done.  But, now I have to face raising these beautiful children that my husband and I conceived.  Some days it’s really really hard to be a good parent . . . to be a minimally acceptable parent.  I never feel like I’m a spectacular parent.  But maybe now that I’m done making, baking, and birthing babies, I can focus on being a better parent?

So, what’s next?  I think I’ll eat a little something and go for my hike.  Guess I’ll have to postpone finishing my birth story until this afternoon while my birthday cake is baking.

After that I’ll continue herding my little flock of kids and herding my big flock of students and loving my husband and my home!