What Will This Home Birth Summit Look Like?

The upcoming Home Birth Summit, supported by funding from the Transforming Birth Fund, is raising numerous questions in my mind, and for numerous others, such as: 

  • How are the agreed-upon ‘stakeholders’ being represented?  How are consumers, in particular, being chosen?
  • What percentage of invited participants have direct experience with home birth?  In my opinion, a representation of 1/3 HB midwives, 1/3 CNMs, and 1/3 OBs would not be an appropriate proportion from the practitioner group.
  • Why exactly is the American College of Nurse-Midwives interested in the issue of homebirth considering that very few actually attend home births?
  • Given the above question, I’d like to know if the home birth midwifery organizations (NARM, MANA) submitted a grant application?
  • How will the outcomes make home birth more accessible and more safe?  Will an outcome be that hospital systems and serving on-call OBs will be more respectful toward homebirth transfers?  Will OBs begin offering back-up services to homebirth midwives?  What might that look like?
  • What are the potential positive outcomes of this summit?
  • What are the potential negative outcomes of this summit, especially considering that the need for this summit originated outside of homebirth midwifery?

With permission, I share the following e-mail from retired homebirth midwife, Linda Bennett:

Are you invited? Who is going?

I have concerns about this “Summit”. I want to encourage communication with invited participants the same way I have encouraged communication with our elected representatives. These participants have been appointed to represent the interests of mothers, families, and, coordinated by a midwifery group, I also assume the interests of midwives. I have every hope this will be the case. My long experience with some of the groups that have been invited raises some doubt.

The “Home Birth Summit”, scheduled for some time and some place in the Fall of 2011, is being coordinated by the organization called “Future Search”. The ACNM originated and identified a need to hold this “Summit”.

The American College of Midwives has many CNM members who actively support families and mothers who want a low-tech physiologic labor and birth in the hospital, in birthing centers and at home. CNMs have demonstrated over and over the value of personalized physiologic management that dramatically reduces unnecessary major surgery while improving outcomes. Their work continues to be overlooked, ignored and impeded by Obstetric professionals in overt and subtle ways. If this summit was only held with these particular participants I would have little concern for the outcome.

Unfortunately the ACNM also has very vocal and politically active members who oppose home birth and/or non-nurse midwifery on local and national levels. Here in Oregon we have the “Home Birth Safety” committee organized by L&D nurses and CNMs in Portland at OHSU for instance. Nothing they have done has improved home birth safety in Oregon, rather their actions have polarized the birthing community and has caused even more mothers to consider unassisted home birth for their VBAC attempts after multiple cesareans.

It should not surprise the ACNM and Future Search organizers that home birth families, midwives with home birth practices, and long-standing Birth Activist groups and individuals feel uncertainty about the outcome of a “Summit” top-heavy with groups who have a history of opposition to maternal choice as well as to the independent practice of midwifery.

We have a vested interest in this “Summit” as its pronouncements will be used against maternal choice at every possible opportunity. Statements made in any documents released as a result of this “Summit” will be entered into testimony for or against legislation affecting mothers, families, home birth and midwives across the USA.

Amy Tuteur is an example of a vociferous emotionally-charged tea-party-esque commentator on the subject of home birth. She is not an expert on home birth. She has never been to one. In order to be allowed to deliver another baby in the hospital she would be required to re-train. If she is in any shape or form part of this “Summit” then it will be obvious that it will not represent the interests of mothers, families or address the real concerns of home birth.

Is Lynn Paltrow invited? Her work with NAPW has been as one of the most effective advocates for mothers in the USA in the tradition of  Doris Haire.

The reality is that home birth exists in the form it is currently functioning in the USA because of what it offers mothers and families AND because of what hospital-based ACOG-controlled maternity care does not.

Please communicate to individuals carefully selected for participation in this “Home Birth Summit”. They have been selected to represent you.

Future Search
4700 Wissahickon Ave, Suite 126
Philadelphia PA 19144
800-951-6333 or 215-951-0328
fsn@futuresearch.net

Here are additional links you might find interesting:

Pissed! but Accepting?

Wednesday was a banner shite day.  My midwife had been encouraging me to maintain a relationship with an OB, and I knew this necessitated a change.  Friends and L&D nurses urged me to try this one doc, Dr. A (we shall call him), stating that if anyone was going to give me a chance at VBA2C, it would be him.

So, I naively went to my 9:50am interview/appointment with Dr. A.  I was nervous – didn’t really sleep the night before – but hopeful.  The staff was very nice; the nurse was nice.  (I had previously talked with her.)  I had previously met this doc, so at least I wasn’t worried about that.

He was interested to know why I was there since obviously I had been seeing another OB for the 1st three-quarters of my pregnancy.  I told him I had 4 reasons:

  1. I am very motivated for a VBA2C

He interrupts . . . “Don’t do it.”  Shaking head.  Patronizing tone.

I cry.

The rest of the appointment was him trying to scare me out of it, and by the time I told him I’d been diagnosed with a thin lower uterine segment (LUS) during the RCS, he was certain that I am a nut.  Actually, he recognized that I had done a lot of thinking and researching, but he didn’t think I had given enough thought to permanent damage to the baby and permanent damage to me.  (Like, DUH!  What else have I been thinking about the past 7 months.  FFS!!!!!!!)

What was scary is that he’s familiar with the same research I’ve studied.  He mentioned the Cochrane library.  He refuted the opinion of the NIH VBAC Consensus Panel (because most of them don’t deliver babies).  The research doesn’t point to maternal death from uterine rupture but he’s seen it.  Fetal demise begins within 8 minutes of the onset of bradycardia associated with rupture which is too short a time to get a cesarean performed.  Yada yada.

Terrifying.  And I’ve done my research.  I’ve been researching this since 2007.  I have a PhD.  I have fantastic research and analytical skills.  And I was still terrified.  And I still doubted myself, my support system, everything.  And I resented my baby.

And I freaked the hell out.  Couldn’t go to work. 

So, you probably see the “pissed” part.

Here’s the “accepting” part.

Of course he’s going to do “his job” and dissuade me from VBA2C.  In his experience, it’s too  risky to justify.  He’s not going to understand why I disagree.  I’ll never be able to “educate” him here either.  When I don’t rupture and have this baby at home without incident, he’ll assume I got lucky.  I accept that he views birth with a completely different lense.

However, he’s agreed to take me and said he won’t drop me either even if I go forward with the VBAC.  He’d rather babysit me through this poor choice than turn me away.  I’ll have to sign an AMA (against medical advice) waiver just to cover his butt.  Fine; whatever.  So, for now . . . I’m planning to continue my concurrent care with him.  If it becomes a regular thing for him to try and terrorize me, then I’ll drop him.

Although he really shook me to the core on Wednesday, thanks to the amazing support of ICAN and Birth After Cesarean, I’m back on track and actually feeling more solid about my birth plans.  I just don’t “see” the hospital figuring into this experience.  Perhaps God or my baby or some 6th sense will change things, but for now, I’m back to planning a peaceful birth at home.

Impactful Tweets (pt 3) ICAN 2011 Conference

I tried to catch as much of the Henci Goer chatter on twitter as I could tonight.  We have a full house tonight (our 3 plus 2 neighbor kids spending the night, oy!) so I’m playing with less than a full deck.  Ha!

Disclaimer: Since I read these tweets on a public hashtag channel, I’m not asking permission to repost.  If anyone wants their tweet removed or wants to clarify a tweet, please let me know.

anderzoid #ICAN2011 henci goer: how much we have over medicalized birth? IV drip- not allowed to eat or drink – induction- cord clamping- etc
I assume this was a slide of the topics used to justify the point that birth is over medicalized.  My previous research leads me to concur that these are some of the ‘biggies.’

poderyparto Ineffective & harmful practices: sonograms to estimate fetal weight, planned cesarean for breech,not supported by research. #ICAN2011
Ultrasound is such a poor diagnostic tool for assessing fetal weight in the 3rd trimester.  I can’t recall exactly ‘when’ ultrasound is more accurate for predicting due ‘dates,’ but it’s very early on – I’m thinking 8-12 weeks gestation, but don’t quote me on that.  Only one mom out of the many I know personally that were told they were going to have a big baby actually did have a big baby.  Friends and family members who have had 3rd trimester estimates done with specialists have birthed babies 2 pounds lighter than predicted!!!!  Regarding the no-questions-asked cesarean for breech – a flawed Canadian study is what dictates current US practice.  Thank goodness Canada is taking the lead to restore breech as a version of normal.

bbybirthingmama Scheduling a section for breech, twins, “big baby” and slow labor are not supported by research! #ICAN2011
I was sad to discover that 75% of twins in Montana are born by cesarean.  I imagine all breeches are born by cesarean except for the rare surprise breech or unattended breech births.  Many docs aren’t ‘allowed’ by their insurance companies to deliver breeches naturally – how convenient for them.  Slow labor – yeah!  Most women just DON’T dilate 1cm/hr.  I REPEAT – MOST WOMEN AREN’T GONNA DILATE ACCORDING TO FRIEDMAN’S CURVE.

tconsciousdoula The way to get a VBAC? Tell the Dr you are planning on having 10 children! #ican2011
Now that’s a good one.  I’ll have to add that one to my list!

babydickey: Perinatal death from csec scar uterine rupture is 6 in 10,000. But did you know pregnancy loss from amniocentesis is 60 in 10,000? #ICAN2011 AND Unnecesarean 6% of scar ruptures—> perinatal death (3 per 10,000). Compare to excess risk of pregnancy loss from amniocentesis… 60 per 10,000. #ICAN2011
Here’s what was stated in the NIH VBAC Report: “Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent.”

tconsciousdoula planned VBAC should be the norm (87%) actual rate is 9% (2007) #ican2011
Add this information to your notebooks in case you need to make the case for VBAC to a doctor, a nurse, a hospital administrator, or a friend.

tiffrobyn A 41 week pregnancy is not only normal, it is AVERAGE! #ICAN2011
Like . . . duh.  Why have care providers forgotten that?  Well, statistically that may not be the exact average for all childbearing groups (i.e. primip vs. multip), but it’s absolutely ridiculous to pressure a woman into inducing at 41 weeks.  Some providers will start pressuring you at 39 weeks, especially if you let them anywhere near your cervix!

bbybirthingmama WHO Recommends no more than 10% induction rate. I didn’t know that. #ICAN2011 BUT poderyparto US induction rate 2005: 47% (babydickey tweeted 41%) of women planning vaginal birth! #ICAN2011 #CAM2011

shedenka So hospitals and docs tell ALL women “you can’t eat/drink” during labor. Total CYA: aspiration risk is 3.2 women out of 10 million #ICAN2011

nashvillebirth Henci Goer makes my head hurt in a good way. She always melts my face off. #ICAN2011
*Giggle*  This really made me smile.  I love having my brain hurt in a good way.  It’s invigorating!!

bbybirthingmama Early Cord Clamping can take up to 40% of newborns blood volume! #ICAN2011
I had no idea!  All of my babies have had their cords clamped immediately.  I will definitely add this to my notebook – I had decided a while back that I wanted delayed cord clamping.  I know it’s not really a strange thing to ask of a CPM but may be strange for an OB.

anderzoid Henci Goer still on ineffective & HARMFUL practices: Care by an OB for LOW-risk & MODERATE-risk women #ican2011
This point was made by a NYC OB in “The Business of Being Born.”  It’s overkill, and generally speaking, normal birth just isn’t exciting enough for them.  Plus, most of them have never seen a normal birth – especially the younger OBs.

anderzoid: #ICAN2011 #ppdchat Henci Goer: it’s hard to get #PTSD on radar bc TRAUMA is centered in Institution. DEPRESSION is centered in women.
This is a very interesting statement and one that I’d like to have fleshed out for me.  I can almost grasp it but not quite.  I will say that people seem to be aware of PPD and acknowledge it but are less able to grasp PTSD as it relates to childbirth (or pregnancy loss).

Want to read more conference hi-lights?  Here is part 2 and part 1 of my Impactful Tweets “coverage.”

DH & I have a big to do list for the weekend, so I don’t know how thorough future posts will be.  Enjoy the weekend!

EDITED to add “Birthing Beautiful Ideas’s” wrap-up of the day’s presentations at the ICAN 2011 Conference.  Have a look!

Impactful Tweets (pt 2) from ICAN Conference

Looks like @DeepSouthDoula is the winner of cool tweets, part 2.  I’ll have to tell her the amazing news, LoL!  Looks like there will have to be a part 3 tonight.  Henci Goer has already made some great points, and she’s only just gotten started!  w00t!!  Here’s the link to part 1 if you missed that post.

DeepSouthDoula Abdominal scars can change your overall body mechanics for the worse. #ICAN2011
Interesting how people don’t consider what happens to the muscles and especially the connective tissue as a result of this major abdominal surgery.  I’m a professional opera singer and rely on the entire abdominal complex to support my sound.  This includes the pelvic floor.  This entire structure has been permanently altered.  Have you considered how your cesarean might (will) affect you physically?

poderyparto Herrera: People should see a c/s. Once they ser it they’ll start asking more questions. #ICAN2011
This is an interesting statement.  I just don’t imagine your average woman would be interested or even willing to watch a cesarean surgery.  And really, it’s different being in the room when one is happening versus seeing it on TV or YouTube.

Preparing4Birth: #ICAN2011 @ICANtweets Insurance company should not mandate how doc works. Write congressman. A state issue
This is HUGE.  I was aggravated to learn from my OB that his malpractice insurance doesn’t cover vaginal breech delivery.  He’s an older doctor, so of course, he knows how to do it.  I think it is incredibly unfair that my second birth was dictated by someone else’s friggin’ insurance!!!

Ethologicmom #ICAN2011 amazing that dice didn’t realize that women choose or are forced into hbacmom by bans and lack of support!
Dice?  I have no idea.  But yes, women increasingly choose homebirth and unassisted birth because they ultimately feel unsupported by some (or all) careproviders.  A woman who feels forced into homebirth or unassisted birth are not ideal candidates for those settings.  A woman should have access to the care she desires.  We’re the ones paying for it!!!

DeepSouthDoula The only true way to know if you will have a successful VBAC is to try. #ICAN2011
I just can’t imagine not trying . . . even though people would try to scare me out of it.  Fearmongering is not the way to go, folks . . . studying the evidence is!

drpoppyBHRT How do we “grow” supportive providers? #VBAC @BirthingKristin #ICAN2011 #NIHVBAC
I imagine that since newer docs are typically less willing to recommend VBAC (based on NIH VBAC consensus report), that now that the ACOG recommendation has been revised, perhaps the new generation of OBs will be less resistant.  This doesn’t mean we shouldn’t be doing everything we can to positively affect our local birth culture!

DeepSouthDoula Any person pregnant or not has the right to refuse medical treatment – even in an emergency. Goes for refusing CS. #ICAN2011
One of my friends is having her 3rd VBAC after cesarean.  We were performing out of town, and she thought the local hospital didn’t allow VBACs.  She was relieved to learn (from me . . . yay me!) that she did NOT have to consent to a cesarean if she had the misfortune of going into labor in that town.  On the other hand, it would have been an opportunity for us to ‘educate’ that particular hospital on the rights of childbearing women! ;)

DeepSouthDoula Have the NIH & ACOG statements ready & use them to our advantage. #ICAN2011
Great advice!  I’m on Spring Break right now, and honestly, I’m just now getting around to reading the NIH VBAC Consensus report.  Eye opening, really.  I’ve “clipped” out the conclusion summary and points within the detailed section of the statement that directly apply to my situation or to issues that seem most critical to me.  I will be bringing some of this information with me as I interview an OB regarding VBA2C.

DeepSouthDoula SHARE – ORGANIZE – PROMOTE – CHANGE. Make connections through social media. #ICAN2011
Following the #ICAN2011 channel has shown me that a lot of birthies are now quite active on twitter.  I guess I’ll pay more attention to twitter . . . at least for a while.  Birthies and moms are welcome to request to follow me – @labortrials.


Choosing the care provider or not…

Unassisted birth (UC, UB) seems like an all or nothing adventure.  “Either you’re in or you’re out,” says Heidi Klum of Project Runway.  No smile.  Somewhat smug too.  I’m trying to sort out my feelings about UC because even though it’s not something I’m likely to do, it is a birth choice and therefore should be studied at the very least.  I read a lot of unassisted birth posts/forums and have gained so much knowledge and strength from it.  I wish I had that kind of confidence and peace.

So, like I said, it seems like UC is an all or nothing thing.  Most care providers (CP) won’t continue to see you for prenatals if they know you’re planning a UC.  (Maybe that’s not universally true, but that’s the impression I’m getting.)  And if you decide to have a UC then it also means that you’re providing immediate care for your newborn.  That seems a lot to ask of myself much less my husband.

My feelings on care providers seem to change by the second.  One minute I’m ok midwife only.  Then I’m ok with planning for homebirth and hospital birth simultaneously.  And then I’m ok with MW and ‘shadow care.’  And then these plans seem so unsatisfactory in different ways.

 The only ‘universal’ is that I want to have this baby as ‘naturally’ as possible.  But I still don’t have any idea how to accomplish this.

I have lots of wishes for me and our baby.  I want it all, and none of it seems like having it all because ‘having it all’ was stolen from me in 2004 with that first cut.  I know even that is still just a perception, not a ‘truth,’ but for me it feels like a ‘truth.’

  • Ideally, I would continue prenatal care with someone – the midwife or OB, whatever.
  • Ideally, I would birth this baby with my husband and maybe a close friend or two but no one acting as a ‘care provider.’
  • Ideally, someone else would swoop in and take care of the baby.

My ‘ideal’ may have to remain on a pedestal.

You Know You’re a Homebirther When

  1. you find yourself zealously defending the CPM/DEM designation and probably come off as a bit of a wingnut!
  2. you get pissed off just thinking about the horrible things that OBs and nurses (for God’s sake) have said to women who have had to transfer from home to the hospital
  3. you get even more pissed off thinking about the birth that screwed everything up for you (not altogether in a bad way) and your childbearing years
  4. you have this idea to become a doula . . . or worse yet, a homebirth midwife
  5. you have this even crazier idea to leave your day job with full benefits to become a homebirth midwife
  6. you have this even more insane idea to move to Canada or some other country with a better health care system to (a) have your babies and/or (b) become a homebirth midwife
  7. you recognize that malpractice insurance does NOT make birth more safe
  8. you realize that you have to take responsibility for your own choices in pregnancy and in birth – from the Costco dipped icecream extravaganza I ate for dinner tonight (oops, not one of my finer moments) to where you’ll have a baby and with whom and what you’ll allow this person to do for (t0) you as your birth; all of these choices have consequences (hello reflux) . . .
  9. you want everyone to know about homebirth for what it is . . . not what mainstream America assumes it is (been there, done that)
  10. you want families to understand that their choice of careprovider(s) is such an important decision (OB doesn’t mean superior to CNM superior to CPM/DEM; these are very different designations with very different training requirements and very different mindsets; know what you’re getting yourself into!)
  11. you can no longer ignore the voice inside that says . . . “the last thing I want to do is leave my bed and go to the hospital” – I ignored that voice six years ago; now that the option is presenting itself to stay home, I must listen to my inner Truth, pray for God’s blessing and protection, and trust that His Will will be done.

edited to add a point and adjust some “tone”