Showing posts with label home birth. Show all posts
Showing posts with label home birth. Show all posts

Monday, October 17, 2011

Beyond Reckless

I must express regrets that I'm too wrapped up in both studying for my Oregon massage therapy licensure exam and Boob School homework to address this properly in my own wordstuffs, but lucky for me, Barbara Herrera (Navelgazing Midwife) took the words right out of my brain.

I posted a link to this important post about the Lisa Barrett debacle by 10 Centimeters on my Facebook page. In the thread that ensued, a sarcastic comment to the effect of "I'm soooo glad you all know what's best and have decided to control every mother's birth" was posted. And Barb's reply, well, warranted me lifting it almost in its entirety, in the interest of me shouting it from the rooftops.
The reality is FOUR BABIES DIED in her care. That is not disputed by anyone. No verdict needs to be given by anyone. That is a FACT. FOUR. And TWO within a very short time. These are babies that DIED. Gone. Forever. That their mothers will never breastfeed, but will feel their breasts swell trying to sustain the babies that are gone. Buried. Or cremated.

Midwives do not lose babies like this without being beyond reckless. Taking the cases she's taken... and bragged about... is vile beyond anything anyone supporting homebirth could imagine.

Hollering about a women's rights in birth is one thing, but doesn't ANYONE have a responsibility to see that everyone comes out alive and healthy? Why HAVE a midwife if you want to do anything and everything? Midwives like Lisa make homebirth look like the stupidest thing a woman could ever want to do -and that simply is not so.

Homebirth NEEDS parameters in order to be safe. Every woman is NOT a candidate for a homebirth. And until the hollering masses like you lose babies yourselves at the hands of these horrid midwives, you're likely to continue being the sheeple you profess to not be. Instead of sheeple towards the medical way, you're sheeple thinking you can "Trust Birth" no matter what.

But, you'll be wrong. Just ask the moms of those babies that died because of Lisa Barrett.
Testify, Barb. Amen.

Tuesday, September 14, 2010

A natural surrender: Reba's birth story, in duet form

I love it when I get to do this.

Once upon a time, oh, say, about 9 months ago (plus change), I got an email from a friend of mine, announcing the glorious news of her pregnancy and asking for some thoughts on connecting with a midwife, which in turn inspired this post.

Well, the time has come! The knockout gorgeous bundle of joy has arrived. Very recently, too (just last week), and we already have not just one, but TWO birth stories thanks to both her husband and her doula! I loved hearing the father's perspective, and then seeing the doula's point of view as well. I'll intersperse:


Labor came on pretty quickly and unexpectedly, about a week before Reba’s EDD. At about 5pm on Thursday, we had a prenatal visit with Miriam. Reba began feeling some strongish cramps around then, and mentioned it, but they were infrequent and irregular. We joked while booking our next visit that it might be a post-natal — maybe we knew something! After our midwife left, we went for a walk and picked up dinner (panini from our favorite place in Astoria, Il Bambino)*. We watched the Simpsons at 7 (Secrets of Successful Marriage – a classic, and perhaps a sign of some sort), and by the end of the episode the cramps had become more pronounced and more regular, and were clearly contractions.

I started timing around 745, and they were already about a minute long, about five minutes apart (where they ended up staying for a long time — although they got longer and more intense). We called both [midwife] Miriam and [doula] Colleen to let them know, and then we got Reba into the regular tub for a bath, to relax through the early part of labor. She took two baths, and in between was mainly on the couch sitting upright leaning forward or in hands-and-knees. She began working harder soon there after. By 9 or so talking during the contractions was hard, and they kept gaining in intensity. (The chronology here is a little fuzzy, because Reba was already working very hard, and I was helping her relax during each one and then doing all kinds of stuff, like getting pillows and drinks, futzing with the lights, texting her sister, and timing some of the contractions.)

Around 1AM Colleen came over, saw that we were doing ok, and immediately began blowing up and filling the birth tub. (That took about 45 minutes, and there was no way I could have done it while helping Reba through the contractions).


I arrived in their apartment right around 1am to find Reba laboring beautifully in her living room with Kevin applying counter pressure to her thighs as he wrapped his full body around her back grounding and supporting her through the waves of contractions. The two of them formed an inspirational bubble of chanting sound energy around their space, filled with “om,” “come,” “I want/need this,” “holy” and so it was indeed a very holy sacred space to hold and bear witness. I offered primarily my presence and a reflective source of calm patient trust as Kevin and Reba were in a physical and emotional groove of perfection. They flowed together and I found myself holding space, reassuring, and lending a sympathetic ear to what Reba was feeling; I smoothly found my place easing into the tone of the energy they had set along with their individual needs.

The energy of the rushes flowed through Reba leaving her muscles shaky in its wake. Kevin was always there with steadying hands as one or both of us braced a thigh or alternately gave Reba's strong muscles a loosening massage. My arrival meant Kevin could continue caring for Reba while I took over getting the pool inflated and filled for Reba to try. As I inflated and filled the pool, Reba continued her smooth and speedy progression deeply into her labor; flowing along with its irresistible forces as her chosen birth circle quietly and gently formed around her firmly holding her space.

The contractions kept getting more intense, so I called Miriam, who arrived around 230AM. Both Reba and I were convinced she was about to have the baby — but there was still a ways to go. The main issue was that she was very physically engaged during each contraction, and had a very hard time finding a comfortable position. Hands-and knees, standing and leaning down on the arm of the couch, and sitting on the toilet seemed to be the best. Until about 4AM or so, when she really surrendered, Reba was tiring herself out by not being able to use all of the rests between contractions.


Miriam joined us around 3am and calmly consciously joined me in easing ourselves into the background. We were there for assurance but it was evident every step of the way that Kevin and Reba were beautifully in harmony with their process. Reba was in the pool briefly at this time but soon found her body asking to move around more. She spent time on a chair, on her knees, back on the couch and eventually settled into the bathroom with Kevin. Each wave of intensity brought with it a consistent flow of encouraging support from Kevin. Firm encouragement, steadfast belief and undeniable love were positioned unconditionally at Reba's side. Kevin toned along with Reba and met her right where she was as she coped with the reality of her labor each step of the way.

Miriam, Kevin and I were there to remind Reba that this was going to end and that she was doing it on the occasion that her personal mantra shifted into negative space. She was beyond doing it...she was doing with steadfast perfection; walking her own path just as she needed to. Reba meant business about labor and her body was not messing around; this was serious hard labor with only the briefest of breaks between the surges of energy, which at this point were intensified by the increasingly strong sensations in Reba's lower back as her baby descended deeper into her pelvis preparing for birth.


Miriam forcefully voiced her concerns about the amount of effort around that time, so either that got through to Reba or it was just a natural surrender. At any rate, thereafter Reba was in a zone where she was at least still during the breaks.


After a few hours in her bathroom nest Reba gave voice to the growing feeling that she need this to change...she needed something to shift...she needed to step confidently over the next threshold...and so she did. With a shift back to the living room Reba found herself on hands and knees, resting her upper body against the physio-ball between surges as Kevin and I attended to her muscles during the breaks, and grounding her feet against my palms as Kevin voiced encouragement and her body threw itself wholeheartedly into pushing. Around 8am Reba's water spontaneously released and she began following her body's cues to push with all her might.

Time passed with much effort and Reba shifted back into the bathroom to continue pushing. Shortly she was able to reach within her healthy stretching layers of tissue to feel their child’s otherworldly skin for the very first time. Awe and reverence reflected in their eyes. Reba assumed a squat supported by Kevin sitting behind her. She followed her body's own irresistible cues and pushed in accordance, roaring her birthing song in strength and abandon. Continuously in tune and able to voice her desires, Reba soon noted that she would like to move back to the living room.

Finding a supported squat again with Kevin backing up his birthing goddess physically and emotionally, Reba began her final pushing stretch. The babe rocked back and forth in the timeless dance of birth slowly but surely opening Reba’s strong pelvis and tissues easing toward earthside. Miriam applied the soothing radiating warmth of water/oil compresses to Reba’s perineum as she calmly and quietly held the space for Reba to birth her child. Glorious crowning shortly followed smoothly moving toward revealing the babe’s face presenting with a nuchal arm. A push later at 9:38am Reba was reaching down to help bring her triumphantly birthed baby to her stomach and up to her heart radiating bliss.

Around 730, she began her pushing phase, and finally gave birth at 935 in the morning. I was sitting on the couch in our living room, holding her as she squatted just above the floor. Post-delivery, we both got to hold Rosalie right away, which was amazing. Reba was basically completely wiped out, and had to hand the baby over to me almost right away. After about an hour, we moved her up to sitting on the couch, from sitting on the floor where she had been during the delivery. After a few hours, she started feeling better, but Reba was really drained for that first chunk of time post-delivery. Miriam took great care of her.

Really, it was all amazing. I cried a lot during pushing and after delivery, and I still feel a little bit emotional. The labor totaled about 3 hours of gearing up, 11 hours of active labor, and 2 hours of pushing, but those numbers don’t do justice to the simultaneously grueling and amazing physical feat Reba performed.

I guess there are lots of things I could advise, but since even among our stories here the labors are so different, and we are well-prepared from class (really, we are — so much stuff came in handy), all I would say is, to the partners, watch the faces of your midwives and doulas, that will tell you if things are OK; and to all, try to figure out a way to allow the woman use the rests.

I can’t imagine either of us having made it through this wild, awesome, primal experience (to echo some of the sentiments below) without a real understanding what was going on, and that understanding was brought about mostly by the wonderful [childbirth ed] class we took — thanks Mary Esther!

Congratulations to all the new parents, and best of luck to those of you who are next — it is great, and there is nothing like finally having your baby enter your lives.

What an inspiring story, huh? Reba is a dancer, an amazingly strong one (that's how we know each other, in my former dancing life, she and I worked together on a number of projects and became good friends in the process), and it's so fitting to read about how physically engaged she was during her active labor - I can picture it so well. And a nuchal arm! What a challenge, and still, they worked with it so beautifully. Congratulations, new family, and welcome, sweet Rosalie.


Now here's a tidbit for ya: Reba's sister (with whom I've also had the pleasure of dancing and working together) happens to have gotten pregnant at almost exactly the same time . . . and JUST THIS MORNING, her Facebook picture finally changed from a belly to a baby. We eagerly but patiently await the details. Congratulations to little sister too!

Sunday, August 1, 2010

Weekend Movie: "A Baby Story ". Yes, the TLC show. Yes, really.

At long, long last, it's finally viewable online: the episode featuring (gasp) a home birth with (squee) Amy Romano, midwife extraordinaire, writer for Science and Sensibility and Rh Reality Check, and all around righteous babe. Not to mention her eminent colleague and partner Vicki Marnin. It takes skills far greater than I possess to be able to embed this kind of video, but just click here to view on the Birth & Beyond site. Ignore the silly, overwrought intro and enjoy.

This was great to see, and I thank TLC for broadening beyond their standard issue cascade-of-intervention fare. Also of note on the same page (belonging to Romano's past practice, Birth and Beyond) is a wonderful slide show of another mother's home birth. I've seen some truly lovely ones, and this is right up there with the best of them. The photographer (Mellissa DeMille of SmileBaby Photography) does a wonderful job of telling the entire story - it's amazing to see just how much narrative detail you get.

True story: I came THIS CLOSE to going with Birth and Beyond for my own birth - though I didn't know who Amy was at the time, I lived in Connecticut during my pregnancy and for the first 7 months of Lily's life. I did a consultation with Vicki, really liked her, and was completely torn between them and midwives I eventually went with, Nancy Farr and her apprentice Gengi Proteau. It just came down to distance - Birth and Beyond was just too far from my area to be practical for prenatal visits. Two roads diverged in a wood . . . Of course I completely adored Nancy and Gengi, but it's always interesting so see those crossroads in retrospect.

Sunday, February 14, 2010

Weekend Movie: The mixed bag that is the Duggars' home birth

My feelings about the Duggars are mixed, admittedly. There's much to appreciate along with the things I might view more critically, but in the best, most thought-provoking way.

I won't digress into the pros and cons of the Duggar phenomenon here, but, like the Duggars as a whole, the episode of "19 and Counting" which features Anna Duggar's home birth leaves me a little befuddled as to where I stand. I finally got to watch the big event on YouTube (we haz no cable, or any other direct source, so have to download, use DVDs or watch things online; it keeps life simpler while still allowing for marathon Buffy festivals when needed).

Here we get to see Josh (the eldest Duggar child) and his wife, Anna, attending Bradley classes; having a baby shower, at which I was pleased to see they did the melted-candy-in-the-diaper game that I insisted my friends include at mine, which pretty much says it all about me; and eventually giving birth to Mackynzie Renee (breaking out of the J's) at home with a doula. More on that in a moment.

Check this out. I'm embedding the last of the 6 that comprise this episode - you can get to the other links in the "related videos" sidebar when you pop out the video into its own YouTube window or tab. The first ones includes some backstory about their budding relationship and then young married life, which should fulfill anyone's quota for wholesome viewing for at least a year or so. (The birth nitty gritty starts in part 6, if you prefer to skip the shower footage, and I would hardly blame you.)

So what's your problem, Dou-la-la? Isn't it so nice to see something other than the standard medically-overmanaged affairs of "A Baby Story"/"Maternity Ward" et. al. on TLC? Well, yes, it is. And yet . . . I still have some mixed feelings. Purely from what we are told in the show, the birth was, as I mentioned above, attended by a doula. Note, not a midwife and a doula, but a doula. In the video, Josh clearly says to Jim Bob on the phone the morning Anna went into labor that they were "considering a home birth" , and that they asked their doula if she would be cool with attending them if they stayed at home.

Now, this very well may be poor editing on TLC's part. The woman who attends them may in fact be a trained midwife who had previously been engaged to act as a doula if they were in the hospital, and the fact that she is seen wearing gloves, weighing the baby with the standard midwives' hanging scale, and has cord-clamping tools on hand SEEMS to imply this, but we just don't know. If she is only a doula (and I don't mean "only" in the pejorative, of course), then she is going WAAAAAY beyond the scope of practice. Josh mentions that Anna was "completely dilated" when she started to push. Doesn't that sound to you like somebody was doing internal exams?

AHEM! Note to possibly alarmed readers: this is not part of DONA's training! Even ALACE/toLabor's workshop, which includes the option of both giving and receiving a pelvic exam as a learning experience, in no way endorses ever performing them on clients, and has nothing to do with assessing dilation.

So. One of two things is possible: perhaps the doula actually IS a midwife, and TLC just bungled the information, which should really surprise no one. Or, they essentially had an unassisted birth. I have yet to address "freebirthing" here, and have been stalling on doing so for a while. I won't get into that now, but I do feel the presentation of this birth was confusing, for all its positive aspects (and there are plenty of those too - I love that they showed Josh catching his daughter, I loved her laboring in the tub, I loved the Bradley classes, and just generally loved the emphasis from everyone, including new grandma Michelle, on how peaceful and beautiful the birth was).

Anyway, true to form, another Duggar moment leaves me dazed and confused and unsure of where I stand, seeing both sides, not bearing them any ill will, yet having serious reservations about what is being represented and how.

Thursday, February 11, 2010

Reply turned post on "Why choose home birth?"

The Batsignal went up on Facebook, calling homebirthers (and others) in to this inquisitive post at Majikthise: What Is the Appeal of Home Birth?

She asks, in earnest and without rancor:

I've never understood why anyone would choose to give birth at home, rather than in a birthing center attached to a hospital. a) Why not go somewhere where you don't have to wash the sheets? b) If there's even a remote chance that you need emergency surgery, why not arrange to be seconds away from an operating room rather than minutes, or longer?

I know that childbirth isn't a disease. On the other hand, if I had a non-disease where there was a small chance that I'd need emergency surgery within the next 72 hours, I'd prefer to park myself as close to an OR as possible.

I understand that every woman has the absolute right to make her own decisions about where and how to give birth. I'm not trying to influence anyone else.

By the time I got over there, the topic had been well-covered, safety issues addressed, specifics taken care of. So I just added my $0.02. It occurred to me that although I posted some longwinded spiels, I hadn't ever posted a simple nutshell version on my own darn blog, so here you go.
Why, because Ricki Lake did it, of course!

BUT SERIOUSLY, folks. Everyone else's answers [check out the original post and comments] completely cover my own rationale: the safety of home birth versus fighting the cascade of interventions at the hospitals. The risks of the latter put me over the edge. I won't rehash what others have covered so eloquently. Essentially, for me as an individual:

1. While it is technically possible to battle your way through the hospital for a natural birth, refusing intervention after intervention, protocol after protocol, arguing policy, fending off negative attitudes by way of the crapshoot re: which L&D nurses you get (some are great, some are not, almost all are overworked), I decided that I would rather not spend my whole labor - the birth of my child - fighting with strangers.

Your mileage may vary, and not ALL hospitals are like this. But it's fair to say that in this current state of maternity care, the odds make me wary indeed, even if you choose the perfect open-minded, supportive care provider (who may not even be the one who ends up attending you, due to the nature of group practice).

2. By the time I got pregnant, I had both read and heard firsthand SO MANY crappy hospital experiences for a first birth followed by a wonderful, healing, life-affirming experience with their second birth at home, that I just decided, "Well . . . why don't I just skip the crappy hospital experience?"

And so I did.

Final note on the matter of cleanup - as others have said, it's really nothing. So you stain some secondhand sheets and toss them, and chux pads take care of the rest, if any. It's a cinch. OR - buy/rent a birth pool and have a waterbirth! Issue = moot.

Monday, January 11, 2010

Vanity AND Perineum Intact

Tell me that's not one of the greatest, if not THE greatest moment-of-birth shots you have ever seen. How AMAZING is that?

And knowing the details makes it all the more delectable. This is the fifth child for this mother, the fourth VBAC, and the second HBAC.

And this gorgeous little boy? Eleven pounds. Nary a stitch.

This total freaking goddess is a friend of mine who gave birth at home last week. The title of the post are her own words, describing how, because she had held her hands over her the baby's head as it slowly emerged to feel what was happening and give support, the photographs of her crowning moments, which would otherwise be as graphic as they come, instead ended up being totally modest. Form AND function! Check out her great attachment parenting site at State of the Heart Parenting. Her other birth stories there are compelling - well worth reading in order. Positively revelatory.

Cheers and congrats to Justine, her kickass midwives, and her whole amazing family.

Friday, January 8, 2010

First Contact: Connecting with a Midwife

I just got some wonderful news - a good friend of mine is pregnant! She emailed me to ask some questions about how to approach home birth midwives, how to set up consultations, and the overall protocol of what to do in the early weeks when a home birth is desired. I remember feeling a little confused about how it all worked in the beginning myself, so I thought, of course! I'll share it on le blog. (With permission, of course!)

Her original missive:

I am pregnant! 6 weeks. Ah, I really don't think I have ever been so happy about anything in my entire life. Really, this is a dream come true. As happy as this makes me, I am also well aware that anything is possible at this early stage. So, please do not say a word to anyone. We plan on keeping it to ourselves and immediate families until 10-12 weeks. Thank you.

Since you have been through all this and seem to have an endless supply of information, I would love to ask you a few questions. Please don't feel rushed to reply:

1. How many midwives did you interview?
2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?
4. Should I go to a doctor to get a blood test?
5. Do midwives do blood tests?
6. Any advice on how to approach a midwife?

I already have two/three midwifes that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincents. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???

Thanks, Anne.
Here's my response, with a few embellishments. PLEASE, midwives, doulas, experienced home birthers and others, correct me on anything that I might be mistaken about. Because she lives in New York City, there are some rules and regulations about which I only know the bare minimum. Comment and correct away!
Oh, I am just so tickled. WHEEE!

Ahem - on to your inquiries:

"1. How many midwives did you interview?"

I interviewed two. I honestly really liked both, but it came down to distance, primarily. One was just too far away - we could have made it work if there were no other options, but since I liked Nancy just as much as Vicki, why not go with her? And I'm oh so glad I did, as I just adored Nancy and her apprentice Gengi - though I'm sure I would have had a wonderful experience with Vicki & Co at Birth and Beyond as well. (To think I could have been attended by the great Amy Romano, by chance? I wasn't even reading her mighty Science and Sensibility blog at the time. Ah, close calls with greatness.)

"2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?"

With EACH of them, I called, told them my approximate due date and said I was interested in a home birth and would like to do an consultation. They each met with me for about an HOUR apiece, and I had really great conversations with them both. This consultation is, generally speaking, very much standard among midwives - I would have raised an eyebrow at anyone who wanted to charge me for an initial consultation.

BUT - and this might be a big but - New York State has its own set of laws and regulations regarding midwifery (it does with massage, too - every other state is pretty much the same, but ooooh, special New York has to have its very own system! *affectionate eyeroll*). You're going to be dealing with CNMs (Certified Nurse Midwives) as opposed to CPMs (Certified Professional Midwives), which won't necessarily affect the quality of your care, since these particular women deliberately chose to go into home birth, but it may affect some of their standards of practice in ways that I might not be aware of. Hope that makes sense!

Then you would go home, talk it over with your husband, weigh the pros and cons of the various contenders, and once you've decided, THEN make the first Official Prenatal Appointment.

As for payment, this varies from midwife to midwife no matter where you are. I'm sure most would absolutely LOVE it if you paid it all right up front, but I know that many will work out a payment plan as well, usually to be completed before or at least by your guess date (I will confess, it took me a a bit longer to pay off my remaining balance after Lily was born, but we did it! Thanks again for your flexibility and understanding, Nancy!)

[I will address the Questions to Ask in my next post, as that is a whole topic unto itself!]

(Was there a number 3? Or was that just Pregnancy Brain?) <----- Very much a real syndrome, as I'm sure you're discovering.

"4. Should I go to a doctor to get a blood test?"

Just to confirm pregnancy? Not necessary, unless there are specific personal reasons to do so. For example, if you had a history of miscarriage and wanted to get a series of *quantitative* blood tests done (this is where they measure the levels of hCG to make sure they're increasing appropriately), I could see why this might be something you want to do. But just for confirmation, no.

"5. Do midwives do blood tests?"

I assume we're talking about the overall initial blood workup, not testing to confirm pregnancy. Some midwives can and some can only do a few things, like blood sugar, not the full workup. Now, since you'll be working with CNMs, they most likely will do blood tests - that's one of the perks! If, as in my case, you were working with CPMs, you would "outsource" it by going either to a cooperative OB office, as I did, or going directly to a lab to get them, and would then bring the results back to the CPM.

Urine tests can always be done by either. And my midwives tested my blood sugar around 28 weeks, just, again, not the entire workup. YOURS very well might be able to do it all. I hope that's clear!

6. Any advice on how to approach a midwife?

With an 8x10 B&W glossy, a resume, and a prepared monologue.

Or, just give them a call and say that you just found out you're pregnant and are strongly considering home birth (even though you're already clear in what you want), and would like to do a consultation to find out about her practice and how it works. Like I said, this SHOULD be common courtesy/procedure, I'm just not 100% on NYC. DO ask whether there is any cost for a consultation, just to be sure. And then she'll take it from there! The first official prenatal visit, separate from your consultation, once you've selected a provider, might not happen until 12 weeks, depending (some might meet earlier - I'm just saying, don't be surprised).

"I already have two/three midwives that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincent's. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???"

Already having a few to choose from is great! I definitely think you should meet with them all. Don't worry about not being far enough along, either - making these calls at this date is common and fine. And bringing your husband with you for the consultations is also very much accepted - some spouses/partners have reservations and meeting with the midwives helps address their concerns.

Okay, I'll give it a rest. PLEASE do not hesitate to ask other questions or just share more info!

Now, as I said, another entire post can and will be written about what to actually discuss in that consultation! Feel free to add your thoughts on that in the comments as well, and stay tuned!

(Man, I wonder if I'll ever run out of things to blog about. I have so many juicy up and coming posts already, and I just keep adding to the list . . . )

Monday, December 14, 2009

O Happy News!

Remember the pregnant mama-to-be whose concerns I responded to in Letters to a Young Homebirther? Well, I'm happy to announce that her daughter was born at home in the wee hours this Sunday morning.

If she would like to share her birth story here, it could be my first guest post!


Wednesday, November 11, 2009

Letters to a young homebirther

I got permission to share a recent exchange with a several-degrees-removed family member, a terrific, sharp, lovely young woman who is expecting her first baby by the end of November. Her recent training as a physician's assistant included a rotation in labor and delivery - and the experience made her extremely disillusioned and uncomfortable with a hospital setting for her birth unless it becomes medically indicated. We talked about all this for a while while I was visiting family this summer, and exchanged a few emails as well. She had found a great midwife and things were going smoothly. And then, like many moms experience, especially first-timers, she went through a questioning period. Here's what she sent me:

Okay, Anne. I need your help. I am having a hard time feeling 100% confident with the home birth. Did you ever second guess- what if her heart rate drops and I need a c-section in 2 minutes instead of 10? This is my biggest obstacle. [The father] and I met an awesome midwife and I honestly feel really good and at peace with the whole thing. And the thought of going to the hospital just makes me, well, not want to deal with it. Can you help me out. Since you had your first at home too, maybe you could give me some good advice...

Now, before I share my responses, I want to make clear that I would never, EVER try to "talk someone into" a home birth. At least I hope I never come off that way. I would never want someone to feel pressured, and women should absolutely give birth where they feel the most authentically comfortable. And for some women that is going to be the hospital, period. I can help support their informed choices no matter where they are. IF, however, a mom is intrigued, and curious and, maybe eventually, leaning towards a home birth, I can share my own reasons why it was the right choice for me, and why it is a good choice for many others.

So! My responses, in two parts:


Hey there!

I just wanted to let you know I DID get this, and plan to reply to it in more detail, but I am just in the middle of an insane week, starting with my first postpartum doula client, and tomorrow I start a 3 day weekend of doula training! Yikes! Anyway, absolutely I have some thoughts for you and will elaborate soon.

Hang in there! I'm so glad you met an awesome midwife. In the meantime, before I can write some more, here are some other links [I had emailed her a bunch before] you might find interesting and reassuring:

Recent Canadian study, the most comprehensive yet:

And here's another study that came out earlier than the Canadian one, from the Netherlands:

You also might really like this blog, it's one of my favorites: Stand and Deliver. The author happens to be LDS, too, and is a PhD in the study of American medical care and environmental issues. Browse around!

More to come . . .



Okay! The dust has settled a bit. Sorry, you just caught me at a particularly crazy time!

Did you have a chance to look at those studies and the blogs? How did you feel about them?

But ya know, I can inundate you with tons of compelling blogs and studies and articles, and it still may not quell the deep-seated fear you're worried about. Right? I totally get it, I do. Like, yes, it may have been shown in a number of studies (and it is) that for low-risk women with qualified CPMs, home birth outcomes are just as good if not better than their hospitalized counterparts - but . . . what if YOU are the one exception? WHAT IF? And that's a valid question, and I think it does a disservice to both you and, less importantly, to home birth advocates to act as though it's not, or, even worse, pretend to give you any kind of guarantee.

The first thing I would tell you is to talk about it with the great midwife you said you found, or, if you've already talked about it, heck, talk about it with her some more, seriously. Midwives are very used to this, and any good one should be willing to take their time with you on this matter (or any matter that concerns you - this is one of the best things about midwifery care; I got a MINIMUM of an hour per visit, often more, as opposed to the 5-10 minutes you typically get with an OB*). I talked with Nancy quite a few times about transfer and how that would work, and under what circumstances.

Nancy's rate of transfer was about 15%, and most home birth midwives, from everything I've read, average between 10 and 15%. I was actually kind of pleased to hear that she was on the conservative side - to me, that meant I could be reassured that she wouldn't be taking any chances. Really, I think that CPMs who do "take chances" are extremely rare, but it's always good to talk to your own and find out what her rate is, and what that means. Many CPMs will share their statistics right up front. With Nancy it was right in the materials she gives out to every client on the first visit. (Try getting an OB to disclose the same.*)

We talked in detail about what kinds of things would warrant a transfer. Some things are absolutely non-negotiable and obvious, like the rarity of a prolapsed cord (I can give you examples of when and how a transfer under this circumstance would work if you like). Some are very common, such as persistent late decels; it's just a matter of timing, and deciding when to leave. There are a few things that actually will vary: Nancy would transfer any time there was meconium in the amniotic fluid, even if there were zero other signs of distress, whereas some other midwives don't feel that this is always necessary. Again, talk to your midwife about this! I think it's important to feel comfortable with her philosophy, not to mention that you can always tell her, as well, that you absolutely want to err on the side of caution (which they do anyway, but you know what I mean).

One thing Nancy also made clear to me is that within that 15%, very, VERY FEW of these transfers are actual emergencies. She has only had to call for an ambulance a few times in her entire career, and she's extremely experienced. MOST transfers can be done in a calm, if not exactly leisurely fashion. Ask her about this as well.

That reminds me of one other point: I blogged recently about the difference between a freestanding birth center and a home birth,. A midwife wrote this: "When a dad/partner/relative tells me s/he/they would have no problem having a baby in a birth center, but wouldn't be comfortable at home, I let him/them know that I carry the same equipment that is at the NACC-certified birth center downtown (minus the sedatives). The difference is *I* carry the equipment into their house instead of them getting up, in labor, and heading out into the elements, driving to the birth center. It often comforts them to know this. I have even gone so far as to open my kit up to show a skeptical nursing relative. It is very important for everyone (who will be at the birth) to feel 100% comfortable with the parent's choice to have their baby at home."

So it's the same 'stuff'. Either they schlep the stuff to you, or you schlep yourself to them. And thus, forgive me for quoting myself, but I think it's relevant: "I could see myself choosing a birth center for one of two reasons: if it were closer than my home to a good hospital; or if my home at that moment were not a good setting for whatever reason - recent move leaving the place in a shambles, tiny apartment with thin walls, something along those lines." So I would factor the former into your decision as well. Is a birth center closer to the hospital than your home, by more than a few minutes? If so, that IS something to consider.

Still, the central fear in your gut: What if you need a c-section in 2 minutes instead of 10? Okay. Again, I feel you. It's so hard to distinguish sometimes, how much of that is a real, genuine, authentic gut feeling, and how much of that is the fear that comes from our conditioning and our culture, and the medicalized model of care that has been so deeply ingrained in us all? That's not easy to shake off. I CAN tell you, as I suspect your midwife would, that a real, out-of-the-blue, code RIGHTNOW - without ANY prior warning - is very rare. In the vast majority of cases, there are going to be signs, and a qualified midwife will be vigilantly watching for them (you know that intermittent auscultation is every bit as effective as cEFM, and in fact reduces morbidity resulting from increased c-section rates) and will recognize when to make a timely transfer.

But does it happen? Yes it does. INCREDIBLY rarely, but it does. So what happens if you're in a hospital? Let's say there is a cord accident (soooooo rare), and, as you said, you need a section in 2 minutes instead of 10? Well, you've spent time in a hospital rotation. What's the minimum amount of time it takes to scrub in and set up? Rixa of Stand and Deliver (which I mentioned to you earlier) wrote this (in the comments on that thread):

It's important to know that not all hospitals can respond similarly to obstetric emergencies. It's not like there's a generic "hospital" experience when you need a crash c-section. ACOG's rule is that you need to be able to perform an emergency c/s in 30 minutes or less.

My local hospital does not have an in-house OB or anesthesia; if there's an emergency, they have to be called in. During my hospital tour, the nurses said the fastest they have ever seen a c/s done is 10 minutes from decision-to-incision (for a cord prolapse). That's probably not typical nor normally reasonable; it depends how far away the OB and anesthesiologist are at the time of the emergency. Really, if the only "safe" way to give birth is to have access to a crash c/s in 10 minutes or under (and really, if the baby's oxygen supply is totally cut off, 10 minutes is too long), then all women should have to give birth in a tertiary care center with 24-hour in-house OB and anesthesia (which ACOG has recommended for women doing VBACs, despite the lack of evidence that this round-the-clock access improves VBAC outcomes). Of course that's not feasible or reasonable at all. In short, the public has this impression that if you're in a hospital, the staff can immediately respond to any emergency--which is not the case. It takes time to set up the OR, to assemble the surgical team, to prep the mother.

So, from decision to incision, you're not going to get a c-section in 2 minutes no matter where you are. These are the extreme minority cases where, sadly, being in the hospital would not make a difference.

But here's the practical: So, let's say you are going to need a c-section, because such a need does sometimes happen, of course. Much of that setup and scrub-in can be taking place while you are en route to the hospital. Yes, there is prep that needs to happen to you, physically, but again, you've seen it yourself. A lot has to happen besides what happens to the mom. Talk to your midwife about how such transfers take place when they arise for her. This is one of many reasons good relationships between midwives and doctors/hospitals are so important, and they do need to be improved, no doubt, in some areas more than others.

How about one other scenario that is often raised as a concern? Let's say baby is born and doing fine, but mom has a postpartum hemorrhage? The immediate response from a CPM is the same as it would be in a hospital, including Pitocin (intramuscularly) and fundal massage, and if necessary, bimanual compression, which can be maintained during transfer if transfer is deemed necessary. From there transfusion could be done (if needed), etc. I am totally not trivializing this - it needs to be taken seriously, but do be aware that a common cause for PPH is cord traction (forcibly removing the placenta by intentionally pulling on the umbilical cord), causing placental separation before it detaches normally on its own, which happens far too often in an actively managed third stage. (Yeesh, right?) Again, talk to your midwife about what steps she would take.

Marsden Wagner (himself a perinatologist) wrote in "Born in the USA" that saying that you need to have an OB for a low risk, uncomplicated pregnancy is like saying that you need to hire a pediatric surgeon to babysit a normal, healthy kid. Because what if something goes wrong?? We get in our cars every day, with our children, knowing that there IS a risk that we will get into an accident. To say that there's not is just untrue, but we have weighed the risks and benefits and decided that in the context of our lives, it is worth the risk to be able to drive.

As I've said before, can you imagine if, every time you went to get into your car, people ran up to you and told you about the worst accident they've ever seen or heard of? Yet people do exactly that to pregnant women all the time. People choke to death eating food, but we don't go to the hospital every time we eat a meal, "just in case", because eating is a normal bodily function that, most of the time, goes just fine. But to deny that choking IS a possibility is dishonest. I can go on with analogy after analogy, but you get my drift.

I hope this all helps you sort this out! I really can understand having the concerns you describe, and I want to emphasize that though I tried to address your concerns and some specific scenarios, I still cannot give any guarantee. It really does boil down to recognizing that there ARE risks in either choice, as with life in general, and what you and you alone have to decide is which set of risks you are comfortable with.

Keep me posted! I wish you the best no matter what!


* P.S. I don't mean to rag on OBs too much - please know I'm aware that MOST of them are good people who genuinely believe they're doing the best thing for women, and I'm grateful we have them when we DO need them in high risk situations or with complications, i.e. when their care is most appropriate, even if I do disagree with many of their beliefs and practices regarding low risk, normal childbirth, a.k.a. "active management". There are many brilliant and wonderful ones out there, despite a few bad apples.


I hope my fellow birth advocate readers out there approve! Especially any midwives or scholars - I pray that my information was accurate and fair as much as it was encouraging.

Sunday, September 27, 2009

Much, much kinder.

Weekend Movie: "We Can Be Much Kinder", a short film on delayed cord clamping.

We Can Be Much Kinder - Birth Matters Video Contest - More amazing video clips are a click away

This will be old hat to many of y'all, but for those who haven't seen it, it's a must! Bonus: a lovely appearance by one of the grand dames of the birthbloggin' community, Barbara Herrera, a.k.a. the Navelgazing Midwife.

Friday, September 18, 2009

Freestanding Birth Center vs. Home

Just one thought, a follow-up tangent from my previous post critiquing the film Orgasmic Birth: One specific thing I did really appreciate from the film was how they made the distinct point that many qualified midwives bring everything TO the home that is available in a freestanding birth center*. I wish more people knew that. So many people who want to be in a birthing center seem to want to be there because of the perception that it’s safer than a home birth, but I think that’s basically an illusion. Not that I have anything AGAINST birth centers, I just think people sometimes want it to be a compromise between home and hospital, and I feel that this logic is a little bit off. The great, prolific Navelgazing Midwife makes this point very well:
When a dad/partner/relative tells me s/he/they would have no problem having a baby in a birth center, but wouldn't be comfortable at home, I let him/them know that I carry the same equipment that is at the NACC-certified birth center downtown (minus the sedatives). The difference is *I* carry the equipment into their house instead of them getting up, in labor, and heading out into the elements, driving to the birth center. It often comforts them to know this. I have even gone so far as to open my kit up to show a skeptical nursing relative. It is very important for everyone (who will be at the birth) to feel 100% comfortable with the parent's choice to have their baby at home.
I've already had one home birth, as you probably know, and would absolutely do it again, so long as my risk level is appropriate. I definitely prefer this to a birth center, even a really wonderful one. But still, I could see myself choosing a birth center for one of two reasons: if it were closer than my home to a good hospital; or if my home at that moment were not a good setting for whatever reason - recent move leaving the place in a shambles, tiny apartment with thin walls, something along those lines.

There's more to discuss on this topic, of course, but I thought it was a salient point to put out there, and it was a positive thing that sprang from seeing the film despite my having a few criticisms of it, so I though it only fair to mention it. Here endeth the tangent.

*Not to be confused with hospital "birth centers", which are typically the same old maternity wards with the same old policies - but sometimes new wallpaper! And maybe a manicurist! Because those are women's top priorities, dont'cha know.

UPDATE 2/05/10: The midwife writing at Birth Sense recently weighed in on this as well, confirming all the key points listed here:

For some of my clients, I did feel the birth center was a safer location. I worked in an area where a number of my clients lived a long distance from the hospital–up to three hours away. If a woman did not have rapid access to a hospital, I would recommend the birth center because of its location only a block from the nearest hospital. Some women did not have a home setting they felt comfortable in–for example, a client who lived with her in-laws and wanted more privacy for birth. But in terms of safety, a birth center birth or a home birth with easy access to a hospital, are equivalent.

I had all of my emergency equipment and birthing supplies in portable bags which I used at either the birth center or at a home birth. I had the same trained support people helping at a birth, regardless of location. There simply is no difference in what happens in a birth center or a home birth. For any serious complication, both settings will require transfer to the hospital. There was nothing I could do for a woman in the birth center that I could not do for her in her own home.