Where to birth

I found this rather simple yet possibly effective intro mainstream news article about birthing “venues” on Cape Atlantic ICAN’s blog.  Check out this site, because Tiffany is posting really great stuff there.  Kudos to Montrose, CO and the care providers there who are doing their part to improve birthing outcomes in their community.  I’d like to discuss a few points made in the article:

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“I think our society, we control so much — we control (birth) too.”

LAY MIDWIFE

“The worst machine in the hospital is the clock,” [Bill] Dwelley [midwife] said, adding that he allows the natural process to continue for as long as needed if everything is moving along healthy.

He said 90 percent of children are born without complications. Of that 10 percent that do have complications, an experienced midwife or doctor can handle 7 percent; 3 percent require surgical care.

But because of increased inductions, which increases the risk of c-sections, surgical intervention is rising. MMH has a 17-percent c-section rate.

“It’s about keeping the right to choose,” Dwelley said. “We are doing it in the spirit of the woman gaining power.”

These are powerful and perceptive statements.  Indeed, a woman who labors in the hospital is put on a clock.  Labor that does not happen according to established norms will be “helped”.  A 17% cesarean rate is really not that bad – perhaps that is a reflection of a fairly healthy birth culture?  It is important to remember that only a small percentage of babies are born with complications, most of which can be resolved with time, confidence, and supportive care.  When these complications cannot be resolved, transfer to a hospital is prudent.

NURSE MIDWIFE

“I love that this is available to us,” Baskfield said. She added that she feels she can choose to have her baby naturally and that she is comforted with the idea that she can take as long as she needs “without feeling like it’s wrong.”

As far as inductions and c-sections, CNM DeEdda McLean said they don’t offer the option unless there is a medical reason.

The nurse-midwife experience is about encouraging empowerment and supporting the road the mother wants to take.

Consider that these births are taking place in the hospital and therefore more succeptible to the medical model of birth.  Keep in mind that CNMs are generally overseen by obstetricians.  This nursing group is managing more than a third of the hospital births in this area, and it is likely that their cesarean rates are lower than that of the obstetricians.  In my case (I must admit my bias), the CNM began suggesting intervention as soon as she arrived at the hospital.  I believed, as did Baskerfield (quoted above), that a CNM would not take me down the road of intervention, and in the heat of the moment we both caved.  In retrospect I am diappointed that her care in labor & delivery didn’t match the excellent care given prenatally.

HOSPITAL

In a larger hospital, there may be a nurse taking care of the mother before, another during and even more attending to the baby. In Montrose, she said, it’s usually one nurse and so a bond can be formed with the family.

But she said patients do choose a hospital and the hospital has rules. This means an IV tube must be set up for emergencies and intervention is possible.

“When they are coming here we have to be ready for a disaster. If they choose a hospital, they choose to have interventions available,” she said.

In a small town, mothers may receive more consistent care.  It is important to find out about the nurses’ schedules and how many would be attending you in labor and recovery.  I had excellent care from my nurses.  I also recommend knowing the hospital protocol ahead of time.  You can refuse things such as automatic IV, heplock, or continuous fetal monitoring.  Yes, you can refuse it.  Those are interventions that are unnecessary if you are a low-risk patient.  “If they choose a hospital, they choose to have interventions available.”  Keep that in mind – if the interventions are available to you they are also available to your staff.

Physician Jacqueline Garrard said the birthing world is “pretty liberal,” allowing mothers to choose when and how they want to deliver.

Liberal is not how I describe the birthing world.  Childbirth is still largely governed by men who treat the female body like personal property.  Besides, not all mothers are “allowed” to choose how they deliver.  Ask any number of women who are denied VBACs in this country every year.  We have a long way to go before someone like me will call the birthing world “liberal”. 

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Post-miscarriage rollercoaster

Because I get so many hits on my site from others who are struggling with miscarriage, I feel compelled to continue blogging about my journey.  I have suffered back-to-back miscarriages this year, a spontaneous miscarriage on August 1 followed by a subchorionic hematoma on October 7 that terminated my pregnancy by October 15.  My DH and I decided to take a break from trying to conceive until we could perhaps discover a reason for the repeat back-to-back miscarriages.  I am now at a point where 66% of my pregnancies (2 of 3) have failed.  I am now considered high-risk for future miscarriage by my care providers.  Some care-providers don’t even sneeze at 2 miscarriages, but I’m glad that mine have been proactive even if they don’t agree on the causes and potential remedies for my problems.

On Thursday I had an herbal consultation with a direct-entry midwife (DEM).  She may become my midwife in the future, but for now we’re working to get my body back on track.  She suspects that dysfunction in one or more of my regulatory systems is preventing me from sustaining my pregnancies.  The systems/organs that seem to be out of whack include endocrine, thyroid, liver, and adrenal.  This lines up with the feedback I get from my chiropractor every week.  She has recommended an herbal tincture comprised of vitex, auralia berry, black cohosh, and a couple of other things.  I should stay on this treatment for three months before becoming pregnant.  Then the tincture would need to be adjusted as some of the herbs are not recommended for pregnancy. 

On Friday I finally had my follow-up appointment with the OB who managed my miscarriage.  She is not the careprovider with whom I planned to establish, but at this point, I’d rather continue care with her should I need assistance from a medical provider.  She’s a nice gal and very supportive of natural childbirth.  She helped my friend deliver her baby vaginally during a placental abruption.  Anyway, she recommended some blood tests (antibody and anticoagulant) and consented to testing my thyroid as well.  She doesn’t believe I have a luteal phase defect even though my last cycle was only 26-days long and I bled in the middle of the cycle.  (I bled during ovulation when I got pregnant this last time too.  The herbalist thinks I may have a progesterone deficiency.)  Instead of doing progesterone tests, she would recommend an edometrial biopsy.  Eeek!  I really haven’t been satisfied with the information I’ve found on the internet.  I’ll probably consent to one if I have another miscarriage, but I think I’ll give these herbs some time to work.  The OB does not recommend chromosomal testing at this time.  If anything conclusive arises from the blood tests, I will post the information here.

That’s it in a nutshell.  The holidays are tough – I have a number of friends who are pregnant or have just had new babies.  I expected to have a cute pregnant belly about now.  I never would have thought I’d be grieving two lost babies this Christmas.  I do have plenty to be thankful for – my amazing husband and lovely little girl, a good job, a loving family, wonderful friends, empowering and humbling advocacy work through ICAN, and a good life.

Cross Post about Business of Being Born

I just LOVE the True Face of Birth blog.  There’s always a gem of a post there that makes me smile, or think, or cry.  I’m not a huge fan of regurgitating other bloggers’ posts, but I’d at least like to draw a few things out of a particular post that really spoke to me.  My comments are sprinkled throughout.

A family practice doctor was in the audience of a “BOBB” screening.  She sent an e-mail to Rixa sharing her thoughts on the movie:

I loved that the births were shown to unfold in their own time and that the mamas looked free to move on their own and birthed upright. I love that upright birth center birth where the mama is so joyous right after.

I cried at every one of those births. Don’t know what was up with that! My little dd even kept asking me if I was okay. (I cry a fair amount of the time at actual births, though, too–you’d think I’d get over it.) I think if people watched this movie and the only thing they took away was visions of women pushing their babies out standing, squatting, in the water, whatever, that would at least be a start. [bold emphasis mine]

I was disappointed in the ending. I don’t think they explained enough what was happening, and I was disappointed that the final interview blew off any benefits of homebirth and implied that it’s all nice if you can have it, but thank God we had this cesarean and saved my baby. I actually think in her particular case transferring for a breech, growth-restricted baby was probably a good idea–but there had to have been a better way to wrap up that movie than Abby saying “Oh well, at least I got a healthy baby” you know?

I wish they’d wrapped up with some kind of activism information–like talking about CIMS, or ICAN. Here’s where you can start to change the world kind of info.  [Thanks for the plug, Doc!!!]

It was also discouraging, though, to hear how people struggle to get the birth they want. I am pretty disappointed in this whole VBAC thing, and disappointed especially that so many “low-risk” providers are just giving up VBACs and verbalizing that it’s just too bad, so sad for the women involved, but nothing we can do.  [You and me both.  I feel abandoned and betrayed by the medical community at large.]

I actually think all of medicine needs to be reworked.[emphasis mine] Something I was trying to say, and may not have got it out coherently at the panel discusson, is that having doctors in charge of medical care and responsible for the outcomes doesn’t benefit anybody.  [Whoa!  Again, this is coming from a DOCTOR.  Wow!!  I wonder how many other practitioners feel like that.]

I’m not sure how to make a change in modern obstetrics, but I think one factor is that women have to refuse to accept paternalistic, condescending care. I don’t care what kind of choices women make, but they need to insist on accurate information and fully informed decision making.OBs need to get out of the business of normal maternity care. We have put normal care into the hands of folks trained in the abnormal.   [I couldn’t agree more.  I wish obstetrics would accept its mandate as a surgical specialty.  Practitioners trained in normal birth need to attend and assist low-risk moms, and that includes low-risk VBAC.]

I am so inspired by this care provider’s perspective.  It gives me hope at a time when it is easy to despair given the challenges ahead for me in terms of maintaining a pregnancy and making L&D choices that will be best for me and my family.

Blessings to Rixa for her post and to this marvelous doctor.

Please visit Rixa’s blog and read the entire post!

I am the decider

I hate to quote our current president, but it makes for a catchy title.

I AM THE DECIDER!

You can tell the OB that:

  1. I can’t be cut against my will.  (In other words, VBAC bans are bogus.)
  2. I don’t have to have a heplock or IV upon entrance to the hospital.
  3. I don’t have to show up for a scheduled cesarean that I did not request.
  4. My baby doesn’t need continuous fetal monitoring.  (Continuous fetal monitoring does not improve outcomes.)
  5. Sometimes babies take longer than mothers, fathers, family members, friends, and doctors would like.  That’s life.  Deal with it – you can eat, sleep, and play golf later.
  6. Women don’t necessarily need to birth babies in hospitals.  (There are other options!)
  7. Most women could safely birth their babies at home (and escape unnecessary medical intervention).
  8. That the immediate availability of an obstetrician or anesthesiologist does not improve the outcomes for the overwhelming majority of mothers and babies.
  9. That hospitals without 24-hour surgical staff aren’t safe for anyone.
  10. That the risk of rupture in VBAC is equal to or less than the risk of complications from cesarean “delivery”.

Want to learn more about positive mother-child-centered birth?  Visit the International Cesarean Awareness Network (ICAN) or the links posted on this site.

Support Midwife-Assisted VBACs in Louisiana

I’m subscribed to GoogleAlerts which is a great tool for keeping up with timely news and posts regarding my “pet” issues.  My current search terms are VBAC, childbirth, and cesarean.  Today I was alerted to a LiveJournal post entitled: “Need your help ladies – about VBAC“.

The author states that a Louisiana midwife is under scrutiny for attending a homebirth VBAC.  The board is threatening to take away her license!  This is yet another example of the medical community not understanding and giving respect to the art of midwifery.  Midwifery is not about medicine; it is about women and babies.  Midwifery is not about obstetrics; it is about women and babies.  Direct-entry midwifery focuses on childbirth as a natural life process, not a medical “condition”, and is a great option for low-risk pregnant women.  (I imagine the case can also be made that midwifery is a good option for some high-risk pregnancies as well, but I’d be talking beyond my knowledge.)

Here is an excerpt from the birth_is_normal blog:

I know there are many women in here who have had or are interested in a home VBAC – so I’m hoping you will help me support an excellent midwife in Louisiana. Home birth and direct-entry midwives are legal there but they have to be licensed. Well, she attended a home VBAC and the board threatened to take her license away. Below is the information and a letter you can send to support her and to defend home birth in Louisiana. It looks like you’ll have to edit a bit for relevance if you want to send the letter and don’t live in Louisiana – but even knowing about this and passing along the information will help. Thanks!!

Please read the post and consider sending your own letter of support to the address provided there.  Women & children of Louisiana will surely appreciate the support. 

Husband scores points

This morning we took breakfast materials over to our friends’ home.  Our daughter spent the night there since she was being babysat there while we adults were at a big Halloween party.  [I was a moulin rouge inspired burlesque girl; my husband was Richard Simmons (you’ve got to watch this video of RS on “Whose Line Is It Anyway”) and won best male costume.  Too bad my friend’s camera was stolen; I’d’ve loved to share some pictures with you!]

Anyway, Missoula birth reality came into the conversation, and I couldn’t hardly believe my ears.  MY HUSBAND WAS TALKIN’ THE TALK.  I think he’s starting to “get it” – why I am so worried about attempting a hospital VBAC here.  He recognizes how bad the “odds” are that I would have a successful VBAC in our hospital since they only had 16 successful VBACs there in 2006.  Like me, he is alarmed by the frequency of cesarean birth.  He is aware of the cost/time ratio for cesarean vs. natural (as in non-medicated non-invasive) vaginal birth.  

Does that mean he’s down with a homebirth VBAC?  I doubt he’ll ever be fully comfortable with it, but I think he knows that we’re on a journey to HBAC.  I’m so proud of him.  He’s starting to conquer his fear, and that adds to my confidence as well.

Danger Will Robinson

I read this over at Birth Matters:

the American Medical Association formed a group called the Scope of Practice Partnership (SOPP), whose mission is to launch investigations of unlicensed “midlevel providers” and to support initiatives to fight legislation expanding the current scope of practice for licensed “midlevel providers”.

Doesn’t the AMA have anything better to do?  Like schedule unnecessary procedures and fight law suits?

 Watch out for AWHONN.  Here’s another group of medical folks looks like mostly duped L&D nurses) that just must not be busy enough.  This group is trying to stir up trouble for direct entry midwives, stating that they aren’t educated enough to perform their services.  Here’s an excerpt from their Fall newsletter:

AWHONN strongly supports the practice of midwifery by a Certified
Nurse Midwife (CNM), who is a registered nurse with an advanced
degree and broad range of training in areas including pharmacology,
and formal collaborates with other health care professionals as an
expectation of their licensure to provide safe, holistic care.

Certified Professional (Lay) Midwives (CPMs), in contrast, have a
far more limited apprenticeship and are not required to have
relevant college degree, pharmacology training, or collaborative
practice agreement with an obstetrician or hospital in case of
complications.

Far more limited apprenticeship?  Could you be more specific please?  What I know about midwifery apprenticeship is that they have to observe and then participate in (as an apprentice) a large number of births before they are allowed to practice alone.  This is regulated state by state.

Relevant college degree?  And what is that?  In this day and age a bachelor’s degree is only a vehicle to get you somewhere else.  A bachelor degree is not something to measure proficiency in ANYTHING by.  I have a BS in Psychology and certainly wasn’t qualified to practice or conduct scholarly research at the end of my program.  And I don’t have a bachelor’s degree in music though that is my field of specialization.  I happen to be a damned good singer and teacher in spite of my lack of a degree that is not considered terminal in my field.

Collaborative practice agreements?  What a joke.  I had a PA tell me recently that her OBs were no longer able to provide back-up service for homebirth.  I’m sure it boils down to liability/malpractice.  So, this group is fudging that part of the argument.

I am surprised that AWHONN is turning its back on homebirth.  They were evidently founders in the Coalition for Improving Maternity Services (CIMS).  According to the CIMS website:

In its first five years, the work of the coalition has focused on the creation and implementation of the evidence-based Mother-Friendly Childbirth Initiative (MFCI), which provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.

So what’s different now in 2007?  Anyone else smell something stinky?

TRAITORS!