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.’
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
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.
I just read a press release from Maryland’s Department of Health and Mental Hygiene. First, how strange is that term . . . mental hygiene . . . MENTAL hygiene?
Anyway, on the one hand I am glad that steps are in place to give women access to home birth. And if physicians and CNMs will actually attend these home births, then it’s possible that insurance will cover these births. Hooray!
However, I don’t believe that a physician or CNM is necessary for a great outcome at home. A trained midwife, CPM or otherwise, should be just as capable of handing low and lower risk births at home.
Furthermore, many women who fall outside of the definition of low risk will have better birth experiences outside the confines of a hospital. Typically, physicians and CNMs are not able to provide homebirth services to these women and their babies. I don’t recommend limiting their ability to find qualified providers who will attend them at home. I hope this board will use better mental hygiene and reconsider their ban on lay midwifery.
No, I still haven’t finished my 4th and final daughter’s birth story. I’ve been too busy and too distracted, and honestly not terribly motivated to share all the gory details. This is why I’m trying to post these ‘snapshots.’ I wrote about my VBA2C for ICAN’s blog, so if you’re interested, go read that post – it shares a lot of what went ‘wrong’ with the birth.
I’ve never enjoyed one of those ‘perfect births.’ You know – the ones you do hear about in the homebirth community – the candles, the soft music, the water, the privacy. I’m still left so unsatisfied . . . and yet thankful.
My baby did come out vaginally. I still don’t know how that happened. Sheer dumb luck? God? A little of both?? In spite of all of the interventions at the hospital, the stress, the loss of my quested homebirth, she came out vaginally.
image by Ixionx
Man, nothing like a really bad flu bug to just knock your butt down. I feel miserable. It started with soft palate irritation and has resulted in me being in bed for 2 days. I finally took some extra strength Tylenol today, so I’m less achy, but I’m coughing and congested and my head hurts. I FEEL TERRIBLE! And I’m cuh-RABB-y!!!!! (Yes, I know I’m *only* 38+ weeks.)
This is the last thing I need right now when I’m feeling the pressure to get out and walk, have ‘relations’ with my husband, do lots of deep squatting, and other things to remind my body that it wants to go into labor. Really, it does! (Yes, I know I’m *only* 38+ weeks.)
My 38 week appointment with Mr. Dr. Hyde was uneventful. He wanted to check my cervix, and he confirmed what I already knew – that my cervix was posterior and closed up like a little clam. Since then, I’ve been contracting more, I guess, but nothing spectacular or indicative of immanent labor. (Yes, I know I’m *only* 38+ weeks.)
Last night I had a horrid dream about my baby not only kicking her way out of my uterus but out the side of my gut. In my dream I start screaming for my mom to call 911 and then pass out . . . and that’s when I woke up. I know it was just a dream and that it doesn’t mean anything, but pairing that with being sick has just deflated me. Now all of a sudden, I can’t imagine lasting in labor. Not only that, I don’t want to be in pain, and I sure as hell don’t want to in pain for hours and hours. Maybe I’ve watched too many YouTube birth clips as I’ve laid here in agony? (Yes, I know I’m *only* 38+ weeks.)
My amazing husband – he said to think of what I’d be telling any woman at 38-39 weeks pregnant who is losing steam and gaining doubt. He says such fantastic things about birth and trust and intuition; I’m not sure he recognizes how wonderful he is. All I know is that he’s talked me down off of several ledges. I’m not quite off the edge this evening, but maybe once I get to feeling better, I’ll regain my trust and faith in myself and in the amazing process God designed for me, my body, and my baby.
Stand and Deliver posted more information about the upcoming Homebirth Summit called by the ACNM. Have a look at Rixa’s post and my previous post if you haven’t already (additional links on my previous post).
Geraldine Simkins, president of MANA, sent out a message with more information regarding this “work team.” I’d like to further break down the point that addresses “stakeholders.”
The stakeholders are NOT ANY ORGANIZATION but rather are individuals who are defined as belonging in these nine stakeholder groups:
- Consumers (from a variety of perspectives)
- Consumer advocates (doulas, childbirth educators, childbirth and women’s healthcare activist)
- Home Birth midwives (CPM, CNM, LM, Amish, traditional, whatever)
- Obstetricians and OB family practice
- Collaborating MCH providers (nursing: L&D, neonatal, pediatrics; CNMs who provide backup)
- Health insurers and liability insurers
- Health policy, legislators, legal, ethics
- Research and education: Public Health, epidemiology
- Health models, systems, administrators
In this way, the WHOLE SYSTEM is at the table. Otherwise, we will not be able to seriously come to consensus.
Here are my thoughts on each identified group of stakeholders:
- Consumers from a variety of perspectives – why would they invite consumers who have no understanding of or appreciation for home birth to the table? How would an anti-homebirth consumer help improve home birth? How are these people being chosen?
- Consumer advocates – are these all people who currently (or have a history of) support families who desire or choose home birth? Doulas, CBEs, and activists are not necessarily supportive of or educated about home birth. How are these people being chosen?
- Homebirth midwives – ok good, hopefully they will select some midwives (with solid experience & reputations) who have chosen NOT to be certified.
- OBs and FPOBs – aside from receiving transfers in a hospital setting, what experience do they have with homebirth? It is possible that an FPOB would be more supportive of home birth, but puh-leez, how many OBs have actually attended home births??? Additionally, how forceful will a FP be in an arena over-represented by “first class” medical participants or will they be subverted by their more ‘highly esteemed’ colleagues?
- Collaborating MCH providers – other than practitioners who willingly back up homebirth midwives and their families, what business do these other people have weighing in on homebirth? I have yet to meet a nurse who thinks home birth is a good idea. This is now the second category of stakeholders that I place within the larger category of ‘back up.’
- Health insurers and liability insurers – at this point in time, I think it will be useful to have this group participate in the discussion. They need to “face the music” and know that women and their families expect home birth to be a viable option. Insurance is often a barrier for people who desire home birth. Additionally, liability insurers have stuck their big fat toes into every crevice of maternal-fetal care, so they need to know what a huge obstacle they are providing for families searching for the best options that suit their needs. (The fact that my OB couldn’t/wouldn’t deliver a breech baby because of his stinkin’ malpractice insurance drives me INSANE to this day!) This group should listen and learn.
- Health policy, legislators, legal, ethics – what in the HELL kind of catch all category is this? I can’t make sense of it. However, representatives from state-level governing/licensing boards, like Montana’s Alternative Health Care Board, should participate.
- Research and education: Public Health, epidemiology – please add medical anthropology to this group!
- Health models, systems, administrators – again, too vague for my comfort. And it is premature to invite this group to the table.
Which of these stakeholder groups are rooted in public health and/or naturopathic (including midwifery) perspectives?
- Consumers (??!!) – maybe, but again, it depends on the “variety of perspectives” invited . . .
- Consumer advocates (??!!) – see above
- Homebirth midwives
Which of these stakeholder groups are rooted in allopathic tradition?
- OBs and FPOBs
- Collaborating MCH providers
- Health insurers, liability providers
- Health policy, etc. (??!!)
- Research and education – some of these folks might have training in non-allopathic perspectives
- Health models, systems, etc.
So SIX groups (already with institutionalized POWER) interacting with THREE groups (with hardly any power when it comes to institutional change) with two-thirds of its representation from somewhat questionable backgrounds . . .
And people involved wonder why women (like me) are so concerned?