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?


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.


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


  • 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 a winner?

I was shocked when I opened my e-mail today and discovered that my blog won an award!

Top Pregnancy and Childbirth Blog
Online Nursing Programs

Seriously, look at the impressive blogs that are on this list.  I am honored to be mentioned along side them.  This is the encouragement that someone like me needs every once in a while.  With everything that I have been through since that first cesarean (2004), especially since recurrent pregnancy loss struck me in 2007, I have struggled at times to stay connected to this vital community.  Or if all else fails . . . I can at least offer my own experience as example and encouragement for others who might see themselves on a similar path.  (If that’s the case, may God’s peace find you.)

I’m getting emotional . . . is it me or the glass of wine?

Cesarean Scar Care Webinar

I just attended the Cesarean Scar Care Webinar with Isa Herrera via the International Cesarean Awareness Network (ICAN).  What a terrific benefit for subscribers (it was free), a great introduction to ICAN for folks who aren’t subs, and a great cost ($15) for non subscribers.

Herrera is the author of Ending Female Pain and performs physical therapy in New York City.  I was excited to attend this webinar because 5 months post cesarean, I still have a LOT of pain and tenderness, especially on the left side.  I imagine this has a lot to do with E’s position in utero.  Herrera said that an uncomfortable lie can cause more adhesions, so obviously I have a lot of work to do to break up those adhesions and get to healing!

Herrera states:

“Women coming to me are often not getting the tools and advice they need . . .” to recover from cesareans.

Sad but not surprising.

Something I previously misunderstood:  according to Herrera the abdominal muscles (the recti) are not cut during surgery.  Instead, they are pushed to the side.

Something else I didn’t know:  during a cesarean 8 layers of fascia and connective tissue are cut.  From what I previously learned, it’s the damage to the fascia and connective tissues that compromise the uterus the most.

Something of which I am skeptical:  Herrera hypothesizes that regularizing and rehabilitating the scar tissue and adhesions may reduce the risk of uterine rupture in future pregnancies and labors.  The reason that I am skeptical is that from what I know about scar formation and healing, scar tissue NEVER approximates undamaged tissue.  Scar tissue organizes differently from undamaged tissue.  On the other hand, it is possible that with Body Talk or acupuncture or other healing modalities that damaged tissue can be restored.  And it’s not like my arm splits open every time I use it, and I have a large gnarly scar on it!

Herrera talked us through a number of exercises and stretches that should help break up adhesions and encourage healing.  The ones that I plan to start using immediately are “long strokes,” “longitudinal stretches,” and kegels while drawing in my abs.  I’ve also started using my Wii Fit and have found that the exercises there have woken up my core a bit.  I am also massaging lavender oil, purchased from Young Living because of the medicinal-grade quality, into the “damaged” areas.

For more information on cesarean scar care, purchase Herrera’s book.  Also, check out the websites and

MRI Techs Post Top 100 Natural Birth Blogs

The MRI Technical Schools site posted a list of the Top 100 Natural Birth Blogs.  The compiler, L. Fabry, did a wonderful job of categorizing and providing brief bios of each blog.  Categories include: natural birth info, natural birthing stories, midwife blogs, and more.  Please do check out this list!

I’d like to thank MRI Technical Schools and L. Fabry for including Trial of Labor on this list.

Hindsight Quarterbacking a hospital VBAC

I recently joined My Best Birth, a network on NING.  Today I noticed that a woman posted a link to her VBAC story, so of course I had to go read.

My goodness what she encountered:

  • Urge to push at 2cm dilation
  • Pressure to have a cesarean
  • Early epidural
  • More pressure to have a cesarean
  • Stalled labor
  • More pressure…
  • Slow dilation
  • More pressure…
  • Scare tactics
  • Multiple birth attendants
  • Fear
  • Swollen cervix
  • Presented with “limit of liability” and cesarean consent forms
  • DH had to go fight off the OB
  • A lovely doula
  • Wonderful calm-inducing friends
  • Finally ready to push
  • Pushed in stirrups
  • BABY!!!!
  • Doc pulling on the placenta
  • Contraction finally finished birth
  • SUCCESS!!!!!

My goodness me!!

I was intrigued by a back and forth in the comments between the Feminist Breeder and At Your Cervix.  At Your Cervix was saying that pitocin augmentation might have helped speed things along for this woman.  Feminist Breeder stated that pitocin augmentation was contraindicated for VBAC… which is certainly what I thought as well.  So, I had to look.  I googled VBAC “pitocin augmentation” and one of the first things that came up was a page from Dr. Wagner’s Born In the USA (table 6) with a chart which estimated uterine rupture rates:

1 in 33,000 – woman with unscarred uterus
1 in 200 – VBAC without augmentation or induction
1 in 100 – VBAC with oxytocin augmentation
1 in 43 – oxytocin induction
1 in 20 – Cytotec induction [ref]
Have a look also at’s information on “Induction or Acceleration of Labour in VBAC Candidates.”  All of this makes me understand the wide variety of rates that I’ve heard doctors cite.  Of course they never admit a .5% rupture rate probably because a large number of them induce and augment labor.  (Maybe that’s an unfair assumption, I don’t know; the fact remains that I’ve never heard a doctor actually use that rate.)  A CNM I talked to this past year used the 2% rate.  I’ve heard 1%.  I’ve even heard 5%.

I read an interesting discussion – “How high is too high for pitocin” at All Nurses Dot Com.  Definitely something to keep in mind.  I should write down some of this . . . and ask our hospital staff about their policies.

Another related resource that I highly recommend can be found at VBAC Facts, one of my favorite sites – “Two doctors respond to the Hastings Indian Medical CenterVBAC Ban . . .”  Specifically, pay attention to the charts and suggested protocols in the Leeman/Espey response.

On the Radar, 11/15/08

The weekend is an excellent time to catch up on the latest news. Here are some things rolling around the internet that piqued my interest.

I had to edit my post to include the latest cartoon by Hathor the Cow Goddess.  This one really resonates with me in a funny and sick way.  It’s so true . . . except that I never made it out of the hospital bed, unless you count changing beds to be wheeled into surgery . . .  If wishes were horses, I’d have followed my instincts and not left my house that night.  We were fine until the midwife broke my water. <sigh>

AMA Scope of Practice Initiative Advances – I get so focused on what ACOG and the AMA is trying to do to childbirth, that I forget the far reaching affects of their actions. This post was written by the American Optometric Association. I think it’s a good one to study to get another perspective on expanding SOPP. Plus, it makes me thing that we need to forge ties with other “secondary level” practitioners, hire our own marketing teams, and put together a real professional campaign against the AMA.

Can you give yourself a few minutes every day for the next 15 days to practice relaxation and yoga? I’ve been thinking about this a lot lately, especially since I’ve started reading Living Buddha, Living Christ by Thich Nhat Hanh. One of my students let me borrow it. While I’m at it, let me share one wonderful thing I’ve read from the book thus far:

Peace is all around us – in the world and in nature – and within us – in our bodies and our spirits. once we learn to touch this peace, we will be healed and transformed. (23-24)

It’s so hard for me to recognize peace around me, and, in a way, to embrace the healing and transformation that is promised by embracing peace. I keep being led to practicing mindfulness, peace, meditation, yoga, being present, but I keep resisting it. How about you? And will you also take mamascoffeetime’s challenge to practice yoga? If you have a little one at home, try the Animal Adventure!

I found a petition, “Practicing midwives Should Be Licensed and Carry Insurance.” I sighed in sadness and exasperation when I read it. It really stinks that this family lost their baby in this manner, but shouldn’t they have been aware through the interview process if their midwife was licensed and if she carried insurance? I’m not trying to point fingers back at this family, but these are such basic questions. For some homebirthers, it’s important that their midwives carry the proper credentials. Others recognize that midwives don’t always care about formal recognition for what they do. They help babies and their families at one of the most critical and beautiful times in their lives. A piece of paper doesn’t mean that they’re a good or bad midwife any more than a medical degree ensures that you have a good doctor. And to require midwives to carry insurance is to ask them (and us) to continue to support a system that is completely FUBAR! Anyone who has suffered from major medical problems – even if they have “good” insurance – can attest to that.

Choices in Childbirth Statement Encourages Options and Evidence in Maternity Care. What a concept, eh? Options for women and their babies? EVIDENCE when it comes to maternity care?? Here’s a taste, but please do read the whole thing! I wonder if ACOG or the AMA will respond?

The statement also calls for evidence-based practices in maternity care, and for the American College of Obstetricians and Gynecologists and the American Medical Association “to strike those resolutions that deny childbearing women the autonomy and rights that medical professionals, educators, and women’s health advocates have historically endorsed.”

A wonderful post at BlogHer, It’s lonely out here: planning for a natural childbirth. Some great comments too!

CfM Grassroots Network: MEAC Needs Our Help! What they really need is our $$.

And last but not least . . . a new website and blog to which I will subscribe: The Unnecessarian which I found via CfM and Birth, Interrupted. Read the latest blog entry and you’ll see that they’re already holding the medical community’s feet to the fire.

Childbirth Connection Report Raises Concerns

NEW YORK, NY, August 5, 2008 – Childbirth Connection, a leading national not-for-profit organization that works to improve the quality of maternity care, today released New Mothers Speak Out, National Survey Results Highlight Women’s Postpartum Experiences. The report is based on new data from the national Listening to Mothers II Postpartum survey, and includes relevant results from the national Listening to Mothers II survey, which was conducted six months earlier and focused on childbearing experiences of the same women. Combined survey results from these landmark surveys provide an in-depth look at women’s postpartum experiences during the first eighteen months after giving birth.

The broad categories addressed include:

  • Persistent physical and emotional health problems (such as post partum depression, feeling stressed, lack of sexual desire, cesarean-related problems, weight control)
  • Breastfeeding experiences (most women who intend to breastfeed do not continue as long as they would have liked)
  • Co-sleeping and demographic variation (these experiences vary widely by race/ethnicity and need more research)
  • Nonexistent or insufficient social support from husbands, partners, and others
  • Meager paid maternity leave benefits and multiple employment challenges (in other words, most women who work suffer for it)

To read the report in full, the press release, listen to podcasts, or find out more about the study, click here.

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