Log onto Squarespace
Archives
Sunday
May172015

Shaming Midwives

There seems to be a movement underfoot... by mostly young midwives, apprentices and students, but with some older midwives as well... that are about darned tired of the shenanigans some midwives are doing during OOH births. The Cytotec without consent, the Cytotec with consent, the inductions and augmentations with pitocin, attending breeches and twins... and some even feel VBACs are part of the dangerous activities of these midwives. It's just time everyone stop, take a breath, get a flippin' grip of themselves and reboot.

You midwives who operate out of the scope of practice know who you are, even as you think you are above the rules. STOP IT ALREADY. Quit lying on charts. Quit lying about ROM times, the length of second stage... quit telling women how to avoid a positive result on GBS (which is dangerous!), quit having women use Hibiclens in labor, quit lying to women about the risks of antibiotics and vaccinations during pregnancy (use that "evidence-based science" you espouse). Quit saying that homeopathics stops a hemorrhage and pitocin is a bad thing to use. Quit saying there is no such thing as GDM or GBS. Quit trying to "help" a woman "pass" her GDM screen and test... let her test and get a TRUE result! Her baby's life might depend on it! Quit minimizing LGA/macrosomic babies by telling stories of giant babies born over intact perineums... IF that story is even true, there are FAR more shoulder dystocia stories with huge babies. Enough. Quit having women push more than three hours before transferring into the hospital. Five, six, seven, eight hours? Sheer insanity. 

And let's talk about the MANA Stats. Quit lying on those, too.

No one seems to want to approach the renegade midwives. If they try to at Peer Review, the midwife will just stop coming. She feels above reproach because she's done her time and, generally, had good outcomes. But even midwives who have lost two, three, four babies aren't catching on that they are dangers to moms and babies. There is no mechanism for reporting a rogue midwife. NARM says it isn't their area and MANA doesn't hear complaints either. Unless the mom is in a legal state that has OBs and CNMs on their board, it is unlikely that anyone will care about the midwife's behavior.

I say we shame them. We name them and shame them. Even if anonymously. I will put up dangerous midwives' names here if you want. I'm hearing the same names over and over so it isn't a place to put up a competitor you want out of business, but a truly dangerous midwife. Tell me what they have done that is out of the scope of practice of CPMs/LMs and let's just shame them into compliance.

I am sick of their behaviors. Since I have written about the "Non-Con Cytotec,' I have had at least a dozen midwives, students and apprentices come to me to tell me of the horrors their fellow midwives/preceptors are doing. ENOUGH. Enough.

If we don't control our own behaviors, someone is going to come in and command it for us. We need to do it outselves.

Sunday
May102015

Addendum to "Non-Con Cytotec"

I was thinking about the post and remembered a couple of things that happened that I wanted to share. Both were at Casa.

First, for some reason, the Hispanic women fainted much more than I have ever seen anyone else faint postpartum. It happened in El Paso and it happened in San Diego as well. Very interesting. I wonder what that mechanism was all about. But, anyway, so the women would get up to pee and either faint walking to the bathroom or faint right after peeing on the toilet. Much has been talked about why that happens, so we won't talk about it here, but what happened after the fainting is what I want to discuss.

There was an especially cruel midwife who worked at Casa when I was there both times. She'd been fired a number of times for various things she did wrong, but always came back. From what I could tell, this "treatment" for fainting came from her. When the women were on the floor or on the toilet, she would grab their nipples and twist them, wrenching them hard. The women, not in their bodies, would eventually say, "Ow!" and then would quickly come to again. While the twisting did work, it was unspeakably cruel and a violation of their bodies. I did it a few times, but it just felt wrong, so I ended up sitting with women (who were not bleeding and in shock) and waiting for them to come back to their bodies. It took longer, but felt much better in my spirit.

One more experience stands out in my time there. I don't remember exactly when it was, but I think it was during my 2002-2003 stint because I had a Littman stethoscope. I was first-on, which included being in charge of the labors and deliveries during my shift. There were always staff midwives who oversaw what we were doing and who we could go to with questions or concerns. So, I had a baby and in checking vitals postpartum, the baby was in Respiratory Distress and I went to tell the midwife and ask her to please call EMS to transport. Instead, she went to see the baby herself (which was fine) and holding him, she used my Littman to listen to the baby who was audibly grunting and retracting. She frowned while listening and then said, "Let me see that stethoscope," pointing to the $10 one Casa supplied. I said, "But this is a Littman! (an $80, excellent stethoscope) and she demanded I give her the $10 one. She listened with it and pulled it off her ears and said, "That's better! He's fine" and handed the incredibly distressed baby back to me. I was stunned. She had no intention of getting this baby help. Would it have looked bad on her transport record? Was she worried about the hardship for the mom if the baby was in the NICU? I will never know, but none of that should have been at play; only the health and safety of that baby should have influenced her decision.

The baby, by the way, came back on Day 3 doing well. The midwife smugly said, "See? He was fine." Ugh. (Dumb luck.)

Just wanted to share these memorable stories.

Saturday
May092015

Non-Con Cytotec (and more)

So, the Honest Midwife, Leigh Fransen, wrote a post entitled "Cytotec Tea" and it has been making the rounds, the truth of the post being questioned, Leigh's motivations being questioned... (is she a Dr. Amy minion?!) and it is time to share, publicly, what I also have seen at the hands of CPMs/LMs.

I was also an LM/CPM like Leigh, but was an apprentice/student when I saw much of what I did that was unethical and illegal.

I was at Casa de Nacimiento for three months in 1993 and then during most of a year from 2002-2003.

In 1993, I was nearly totally midwifery green, having attended maybe 75 hospital births by that time. I knew not what was legal and what wasn't; I trusted my senior midwives for guidance and education. But, there were clearly things being done to the women that weren't right. I didn't have the presence of mind to 1) say anything or 2) to leave. Sometimes women would stall near the end of their labor and a midwife would give a clandestine shot of pitocin into the vaginal vault (the floor of the vagina), shooting the baby out almost immediately. The women never knew it was given to them. Other times, the midwives would use something called a "ghost," a gauze tampon soaked in pitocin, placed inside the vagina or rectum, again, without their consent. The ghosts worked slower than the shot, so was less dramatic on the baby (and, most certainly, mom). 

Charting, too, was often a stretch (understatement). Any glimmer of changing dates (a mom had a longer cycle? *wink wink*), lying about when women's membranes ruptured and not beginning to count second stage until you could see the baby's head were all common occurences.

After I left Casa, I moved to Orlando and worked at Special Beginnings Birth & Gynecology Center with CNMs. It was an amazing place where we charted what we saw, women were risked out according to the law and there was never, ever, lack of consent. I was startled at the difference.

Why did I volunteer... no, PAY... to go back to Casa in 2002? And stay for almost a year? It was midwifery boot camp. I learned so much there, including tips and tricks I could have in my arsenal should I ever need them. By the time I got back there, the pit in the vault and the ghosts were gone, but pretty much everything else was still there.

And so were the cameras.

Cameras had been installed to watch the students in the birth rooms. The women did not know about them. As far as I know, there was no taping going on, but the lack of privacy was terrible. I heard that later they put the cameras on the consent (buried?), but they were not there when I was at Casa. 

Somewhere near the end of my time there, I learned that some of the women were being given Cytotec without consent. I was horrified. I thought back to all those post-dates women who miraculously went into labor with the Blue & Black Cohosh (that never worked when I gave it to them!) and realized they had probably gotten Cytotec. The only time I was asked to give it to a woman, it was in Gatorade, melted; I refused to give it to her. The midwife shrugged and went and gave it to her herself. I went back and looked at my charts and saw, "Mom sipping Gatorade" in several places... almost always with post-dates women ready to be risked out. I don't know if they used Cytotec to augment labors; I never saw that occur.

So, when I've disclosed this in midwifery groups (usually in defense of Leigh), other Casa graduates have said I was not telling the truth, that they never saw any of these things happen. I say to them that the students were usually sheltered from the information, yet they still can't believe the midwives would ever use Cytotec. Blessedly, another midwife, a trusted midwife in the community, finally said she learned of the Cytotec in the herbs while she was there with some of the women who were disbelieving. Validation is a wonderful thing.

I left Casa behind to become a CPM/LM in San Diego, CA. There, most of the midwives were good and above board, but there were still the fudging on charts, the taking on of high-risk clients and, in my experience, the manipulation of consent. (I often said, "How informed IS informed consent?!" My IC form was extremely long and demanded the women explore a wide variety of providers and studies before making their decisions. I did not want to be the only piece of information they received.)

One midwife in particular was less than stellar. I learned, from her clients that transferred to me, that if she didn't have gas money, she would call the client and have her measure her own belly. Not that self-care is a bad thing, but if you're paying for a midwife to do a visit, then she damn well better pay a visit. 

Did I ever do anything wrong? You bet. I fudged charts, lied about ROM to care providers when we transferred, allowed women to keep pushing far, far beyond what the law stated we should and took on high-risk clients (the most egregious was taking a client with a history of three shoulder dystocias... who had a helacious one again). I took a woman with a history of a massive PPH... waving away its seriousness as "probably" the doctor pulled on the placenta and caused it himself. Wrong. Blessedly, she transferred care mid-labor and then had a torrential PPH in the hospital; she almost lost her uterus to save her life. I would have killed her at home.

What was in my head?!? I wanted to help women... help them have a great birth experience... to help them love giving birth... to show them there can be respect in birth... and, now that I look back, that I wanted to SAVE them from the medical establishment. How fucking arrogant of me. I am incredibly ashamed of my behavior and actions during those years. I have apologized to the women who will talk to me (and have psychically apologized to those that won't/don't). All I can do now is speak out.

Why? Why now when so much is past? Because I have been saying these things for years and no one listened until Leigh started her wonderful blog. While there are a few things I question about her experiences, enough resonate that I know she isn't lying about most things. (I don't think she lies, per se, but is a tad hyperbolic at times.) I get messaged and told of all kinds of things midwives arre doing around the country, hear the stories of the damaged babies and the physically used women. Yes, even midwives damage clients.

If home birth midwifery is going to have any sort of quality reputation in the US, we really need to reign in the rogue midwives. We need to stop the lying, the operating outside the scope of practice. It's true, the hospital/medical system doesn't allow for a lot of leeway with autonomy and a low cesarean rate like midwives can offer and when there is IC, women should be permitted to determine their own course of care. However, far too often, the midwife isn't skilled enough, doesn't have enough education, to facilitate such complicated births. Until midwives acknowledge their limitations, we are doomed.

I encourage others to speak out, but realize they may have to wait until they are no longer licensed either. Even still, I hear those that tell their stories, in public, about the midwives who shouldn't be practicing anymore. What's so hard, is there is no one governing body to report these wrongdoings to. Where is the accoountability? Oh, that's right... there is none.

Let's fix that.

Friday
Mar272015

GoPros in L&D

So much is being said about video cameras on the bodies of cops so they can be held accountable for their actions. I say we bring cameras into L&D to do the same of doctors and nurses. 

I worked at a birth center once that had cameras in the birth rooms. From the day they were installed, the midwives and students acted differently than the day before. As far as I know, the cameras weren’t recording, but I can’t say for sure. There are very real issues of privacy to think about, but making sure the students didn’t operate out of their scope of practice was more important to the owners. 

I’ve thought about this privacy thing in L&Ds and thought if the woman was the one with the camera, the privacy issue would become moot. She could wear a GoPro on her head and her privates wouldn’t be able to be seen, but the doctors and nurses would.

Would the medical personnel act differently if they were recorded? Would they manipulate women the way some of them do? Would they humiliate, belittle, dehumanize women the way some do? Would they speak kindly to everyone finally? Would they offer the pros and cons in a way that would hold up in court? 

Hospital legal teams would never allow this to happen, of course, lest things be caught on camera that can end up in a courtroom. But what if we secretly recorded, audio recorded, our labors and births? What if we had a Google Glass and could record everything that went on? What if we have a special pen that captures what our “team” does to us? 

What does this say about trusting our providers in birth? For the majority of women, the person they hire is not who they see in labor. For too many VBAC women, the bait and switch at 37 weeks can be beyond frustrating… even angering. Maybe if doctors heard themselves talking, they would reevaluate their words to women. 

Yeah, I think a GoPro on the forehead of a laboring and birthing woman is a dandy idea.

Tuesday
Mar102015

What's Up

Let's see... lots has happened.

Zack and I broke up in December.

I moved to Orlando, Florida in late December after driving across the country with my daughter Aimee and the 2 dogs. I live with a dear friend and her family while my doggies are living with my mom 6 miles away.

I've been very, very sad about the loss of my 28-year relationship with Zack, but am trying to stay positive to the things that might come to me here, across the country.

It's a lot hotter here in Orlando than anything San Diego could give me.

I have to go to school for 3 years if I want to be a FL Licensed Midwife. Not sure that's going to happen. I want to be a Monitrice more than a Midwife, but still have to get licensed here to do that.

I'm exploring other options, including possibly working at Disney World again (a job I loved!). It would close a door on birth, but maybe I am due for a new season.

I'm becoming a SMART Recovery Facilitator (a secular AA/NA/OA sort of group) so I can bring SMART meetings to Orlando. SMART has become a very important part of my life.

It's been a relief to leave San Diego's midwifery community.

I get to see my dogs every day and take them to the dog park several times a week. They have kept me saner than anything else.

I also get to see my mom every day and she is a delight! She makes me laugh lots. I am glad I get to be here for her last years.

My girls pay for my membership to the Y and I go at least 3 times a week to ride the exercise bike. It isn't helping with my weight, but it should be doing something good, right?

I got to spend Christmas with my girls and grandbabies and it was a delight!

I'm selling my mother's Disney memorabilia for her on several Facebook Disney Selling sites. I'm meeting some cool people! Who knew there were such rabid pin collectors?!

I have something weird happening with my right groin/leg... I go for a sono next week to see what's up.

I have all my new docs set up here and things are good. I also have a great therapist who is a Mindfulness teacher. We have lots in common despite her being younger than my youngest child.

Zack and I remain good friends. He is someone I will always love; we just couldn't make the trans thing work. We, quite literally, grew apart. He will always be the great love of my life. *wiping tears*

I need/want to write more. So much is tenuous, I just don't know what to write yet. Will this remain a birth blog if I go work at Disney? Could I go to births on my days off? The way my leg feels, I am glad I am not on-call right now. But, I do miss birth.

*sigh*

More soon!

Saturday
Oct182014

Doulas Get Together

I had a great time today! First, I went to a class on how to use a rebozo (long piece of cloth) in labor and birth then got to spend some time with five newish doulas at a local restaurant. You’d think, after all this time, I would have all the knowledge I’d need, but I’ve been taking classes and learning very cool things like how to give foot baths and how to “sift” a mom in early labor to help her relax. (Sifting is another word for jiggling a very little bit.) I loved the class today and met some really great women, some of went to eat with me after the class. 

I listened as they told their few birth stories, filled with excitement and joy, expressing the difficulties the moms and babies had and how they’d been called to two births at the same time. It reminded me of my early days, too! I remember how much I learned those first few years, how it seemed every birth had a complication I’d only read about and didn’t really feel equipped to attend to. But, the Universe had other ideas and there I was, with the baby with meconium, the mom with preeclampsia, the labor that was prodromal and the dad who was freaked out. And you know what? I did great with what was given me! And these women did the same thing that was given to them. It is the way we learn; trial by fire. 

I didn’t share a whole lot of my experience, but the women said they knew of my Facebook Page and my (poor neglected) blog. Made me feel good! 

I’m putting more than my toe into the doula community and enjoying it very much. I’m finding some cool women who agree to disagree with major topics such as circumcision and breastfeeding… and perhaps even with my belief that home birth midwives need more education and skills training? (The tipping point that scooted me out of the midwifery community 4 years ago.) I’m loving the doulas; they are great! 

And look! I even wrote a blog post about them! They even inspired me to write today. Who could ask for more?

Tuesday
Apr082014

Lilia's Birth Story (Brow Presentation)

"I think she'll be born next week," my doctor told me. At 39 weeks and 6 days pregnant, it wasn't what I was hoping to hear. I had stopped working the week before, both my parents had flown in from Hawaii, baby's room was clean and ready, and her newborn-sized onesies washed. My baby was prepared, too. Since week 20-something she had been in a head-down, anterior position.

To my surprise, I woke up the next morning, her due date, with bloody show. Not long after, I began to feel contractions. My husband and I began tracking them at 8:30 a.m. on December 6. At 11 a.m., we called our doctor to let her know they were consistently 10-12 minutes apart. I continued contracting into the afternoon, but life went on as normal. I understood that contractions could stop, so I didn't want to get too excited, but I asked my mom to take some pictures, just in case it was my last day being pregnant.

Around 6 p.m. Dr. G came by to see how I was doing. "You're at 1 cm," she said. "I'll be back later." From the beginning, I loved Dr. G's calm, confident nature. When my husband and I were window shopping for obstetricians, she was the first we met. I found her website when we were just a few weeks pregnant with the search terms "home birth Panama". In a country where the c-section rate in private hospitals is 8/10, I was determined to have a vaginal birth, and it seemed like a home birth was just the ticket. Dr. G was just the person for the job. Actually, she was the only person for the job. She and her husband are the only doctors in Panama who do home births.

At 11 p.m. Dr. G came back. "You're 6.5 cm. I'll set up the pool." I was elated. 6.5! That's practically 7! I'm almost there. When the pool was set up, Dr. G invited me in. I was in darkness, in my daughter's room, contracting in the warm water. The contractions were getting pretty intense. I loved the water, but I wanted to use the bathroom, then go to the bed, then back to the water, then use the bathroom again. In the living room, my mom and Dr. G, along with her husband, talked and looked at family photos. During a particularly intense contraction, I told them to shut up. For the most part, my husband and I were alone in our little girl's room, in the dark, waiting for her to come.

I was camped on the edge of the pool, arms hanging over the side, resting on my knees. When I got the urge to push, I told my husband, who alerted Dr. G. "Push if you want to push," she said. So I did. I pushed when I felt the urge to. I didn't feel like I was making any progress, so I thought that maybe I was misreading my body's cues. Still, I pushed when I felt the urge to. I pushed with my whole body.

Dr. G came to check me and said that there was something preventing me from being fully dilated, and that it was preventing my baby from being able to come down the birth canal. I'm actually not completely sure what she said, as Spanish is my second language and I was in labor, but that's what I understood. She finished breaking my water, which had partially broken while I was on the bed earlier.

Though I was not aware of the time, it seemed hours passed. The sun began to light up the room. "December 7th," I thought, "My daughter's birthday will be December 7th." Dr. G insisted that I drink some juice. "You need energy," she said, "Take a sip." I refused. "Take one sip. Now another. And another. OK, finish the cup now." I didn't want any of it. All I wanted was to finish the job. Dr. G was right, I lacked energy. But I did not lack determination.

Dr. G encouraged me to feel for my baby. "How many knuckles in?" she asked. "Two." After several pushes, we were still at two knuckles. What am I doing wrong, I wondered. I'm doing everything I can.

At the insistence of my mom, my husband Jose got in the pool with me. She had been gently suggesting this for the past half hour, but I did not want to move from hugging the side of the pool. Finally, I gave in. My tired body rested in the arms of my husband, who sat behind me. With each contraction we pushed together, his hands gripping my legs and giving me strength. Soon some black hair emerged. It was at this point that the pain of the contractions were matched by the pain of my daughter's head grinding my tailbone as it curled back inside me post-contraction. I don't know what was worse, the pain during a contraction or after a contraction.

I remember my contractions pausing for some time. When they came back, I pushed with everything I had while my cheerleaders coached me in English and Spanish. I was so caught up in pushing that I hadn't realized the progress that I had made. "Look down," my husband said, "Look at her face!" As soon as I looked down she was already swimming out of me like a little fish. Dr. G got her, unwrapped her umbilical cord from her waist and leg, and handed her to me.

Lilia Marie was born with her eyes wide open at 8:30 a.m. on December 7th. 7 lbs, 2 oz and 19 inches long.

I didn't think much of the unicorn shape of her head then. I knew babies' heads were funny-shaped when born, and I was more taken by her beautiful face, her precious hands, and her full head of hair than the shape of her head.

When Dr. G came back the following day to check on Lilia and me, she mentioned that the obstetrician books say Lilia's type of birth, brow presentation, is not possible vaginally. I didn't understand then what I understand now. The diagram below is helpful. The most common presentation is A. Lilia's brow presentation is illustrated in C.

 

I also did not understand how this would effect my recovery. Supposedly, a benefit of vaginal childbirth is a quicker, more easy recovery. I, however, could not stand up without immense pain for three weeks. It felt like a bulldozer had cleared a tunnel through my body, and when I nursed, I could feel my insides going back together. It was so painful I would often cry. At my six-week check-up an internal wound was still healing, so I was prescribed Sufrexal to help it along. My physical recovery took a toll on me emotionally as well, as I could not hold my daughter in a standing position for the first month of her life, and I felt that I could not adequately comfort her.

Monday
Apr072014

If You Have to Ask...

FACEBOOK!... the answer is TRANSPORT!

That is all.

Monday
Apr072014

Kristen's Uterine Rupture Story

In 2005 I delivered my first child, a son, via emergency c-section due to "non-reassuring tones".  I miscarried my second pregnancy at 10 weeks in 2009.  After infertility treatments, I became pregnant a third time in 2011.  My pregnancy was glorious, healthy, and I felt great throughout.  I was seen by a seasoned midwife at a highly respected practice that delivered at a large suburban hospital. My midwife was pushing for a vbac, but I was on the fence.  I told my midwife that I would not want to attempt a vbac if my baby was over 8 lbs, at which point she reassured me he wasn't (he was actually 9 lbs, 9 oz at birth). I think my instinct was telling me not to vbac, but I was being overwhelmingly told how much better for my baby a vbac would be.  Ultimately, I decided to let God/the Universe decide.  I prayed about it and said if I went into labor prior to Jan. 2, 2012 (the first date the hospital would allow an "elective" c-section due to the March of Dimes 39-week guideline), I would attempt a vbac.  If I did not go into labor prior to Jan. 2, I  decided I would do a RCS. 

My water broke around 1:00 AM on 12-31-11, as I was brushing my teeth before bed.  Because I was Group B Strep positive, we went right to the hospital so antibiotics could be administered.  I labored slowly, and around 7:00 AM began receiving Pitocin.  They continued to increase the amount of Pitocin and I began to have a lot of pain, so around 10:30 AM I asked to have a C/S.  The midwife talked me out of it, saying both the baby and I were doing well, and why would I want an unnecessary surgery.  She suggested I get an epidural and I remember saying, "but if something goes wrong I won't be able to feel it".  She assured me they were doing continual monitoring and all was well.  It will haunt me forever, but I agreed to continue laboring as well as to get the epidural. 

Around 3:30 PM on 12-31-11 is when I believe I ruptured.  I noticed I didn't have one big baby bump anymore, instead I had two smaller ones that were diagonal in my abdomen.  I pointed it out to the nurse but no one seemed worried.  Minutes later, I heard my son's heartbeat slow and not come back up.  My parents had just arrived, and at this point the midwife and several nurses came rushing in, only to realize I was bleeding heavily.  They rushed me to the OR for a c-section, but for reasons still unknown to me, no doctor showed up to perform the c-section for 45 minutes.  During that time, the midwife, nurses, and anesthesiologist simply had to stand there knowing my baby was most likely dead already.  When the doctor did show up, my son was found up in my abdomen, my cervix had also torn, and my catheter was filled with blood as my bladder had also been damaged.  The suction necessary to pull my son out was so strong, it lifted my body off the OR table.  When my son came out, my husband said my body fell back onto the table and I passed out. 

My son was blue and not breathing at birth.  He was resuscitated and put on life support, then sent to a NICU at a trauma center an hour away.  While initially there was some hope we would eventually bring our boy home, sadly his brain damage was too significant.  He went into cardiac arrest at five weeks old, and although he was again resuscitated, he suffered further brain damage and we had to remove his life support so he would not have to suffer anymore.  Of course, after watching my son's incredible suffering, I will always wish I had trusted my instincts and demanded the C/S when my son was still perfectly healthy.  Or refused Pitocin (didn't know then I could have said no), or not taken the epidural...   I am learning to live with the million "what if's" that I now have.

Monday
Apr072014

Anna's Uterine Rupture Story

On Christmas Day, my husband unwrapped my gift - six consecutive boxes to find, eventually,my positive pregnancy test. We were expecting our second baby the following August.  Through that winter, spring and finally summer, I had a perfect pregnancy. Even in the heat of a southernsummer, I loved being pregnant.  

Early on in my pregnancy, I read a newspaper article about a mom who had chosen to give birth at home after a previous c-section.  It sounded so different from the hospital c-section I’d experienced with our daughter who turned breech at 39 weeksThis mom described her birth as “empowering” and her story was so full of emotionWhat a relief it would be not to be separated from my 2 year old daughter and have her welcome her little brother as soon as he was born.  How comforting it would be to walk my own halls – or better yet, the garden – as my contractions progressed.  How nice it would be to not be caught on the hospital conveyer belt of pregnancies, but have a midwife who knew me and my family, attending.  I contacted the midwife mentioned in the story to see if she would be willing to have a patient over an hour away from her practice.  To my surprise she said yes, and our journey began. 

We took our preparations for our son’s birth seriously. We studied pain management techniques, I was active and did weekly yoga.  I found a local doula and signed up for childbirth preparation classes.  We also grappled with days of doubt.  We asked our midwife hard questions about recognizing problems before they became emergencies: How would we know if something wasn’t right? “I’ll know” she assured usAnd as a Certified Nurse Midwife with 10 years of hospital experience, as well as experience with hbacs, I expected her to know what she was doing, how to manage the risks and when to transfer to the hospital.

Finally, at 40 weeks and 2 days, we thought Christmas had finally arrived.  I woke up at 1am in intense pain, but figured I should try and rest for as long as I could.  There was no resting.  I called my midwife, barely able to talk through my contractions.  She was at another labor, but promised to send another midwife from her practice.  My nerves kicked in - this was not what we had planned. I remembered my husband predicting the midwife would not be there for us when I went into labor on the long drive up to one of the many appointments she had cancelled.

The sun rose.  The alternate midwife arrived.  The pain increased. I couldn’t move, I couldn’t breathe, I couldn’t focus and around 7am said I needed a break.  I knew that was supposed to be a sign that my labor was transitioning, but I also knew that the pain I was experiencing did not feel like the pressure I expected; it was too raw.  I did not feel empowered, I felt vulnerable.  Nothing about this was “beautiful” or “healing.”  Hours had passed.  The water in the birthing pool had been warmed up again and again but was no longer offering much comfort. expressed my concern that I was experiencing the “wrong kind of pain.”  There was a strange popping sensation. The midwife had no answers for us.  My husband noticed that my abdomen looked asymmetrical and pulled our midwife aside to express his concern about my pain.  The midwife said everything was normal; he continued to encourage me accordingly.  For hours.  

I remember seeing a hummingbird at the window, hovering, curious over the roses my husband had put in the window for meThen, in one contraction my whole body suddenly felt like it was tearing apart. I thought my son was descending; in reality it was my uterus rupturingMy midwife tried to check my son’s heartbeat.  I could hear the faint dull, slow, thud.  60 beats per minute when it had been in the 130s.  And then the vomiting and shaking started.  I closed my eyes and did not open them – willing the world to go away.

After eight hours of labor there was nothing my midwife could do to save our son.  There was no operating room in my kitchen.  She only had a pediatric oxygen maskWe put in a 911 callimmediately but even with the EMS arriving within 10 minutes it was a further 15 before they had managed to get an IV in and we were even on the move to the hospital, each bump in the road causing all-consuming ripping pain.

By the time we reached the hospital by ambulance – under 8 miles away  Brody had no heart beat.  He was gone.  I prefer to think that he died when I felt him struggle upwards out of my uterus while we were still at home, than in the ambulance to the sound of my screams to get him out.  

I am lucky to be here after the volume of blood I lost.  Without the rapid transfer I would have bled out.  When my surgeon performed the emergency c-section I needed to deliver my dead baby even he was shocked.  My uterus was – in his words – shredded.  Brody was lodgedagainst my liver.  I had insufficient blood volume for anything other than general anaesthesia to work.

I will always regret the gamble I took with our son’s life.  If I had been in a hospital, continuous monitoring could have shown that Brody was experiencing trauma; that my contractions were not the right intensity given the pain I was experiencing; and my rupture might have been caught early enough to have given our son a fighting chance of survival.  Aultrasound later in my pregnancy would also have shown he was going to be big – 9lb 2oz – rather than the 7lb my midwives guesstimated.  An obstetrician might have raised concerns about the short time, just 10months, between my pregnancies, and warned me of the risks involved with being too far from an OR.  There’s a reason ACOG’s guidelines recommend hospitals who allow vbacs have an OR available and staffed 24 hours, 7 days a week.  I had come to believe in “trusting birth” and “trusting my body.”  But my body broke.

If we had been in a hospital I would probably not tell myself every day that not only did my choice to give birth at home result in the death of my baby, it deprived my husband of the gift of a first son, and took away my daughter’s chance to have the little brother she now asks to go rescue from heaven in a rocket ship.  We all want him back.

In one out of every two hundred vaginal births after caesarean, the mother ruptures.  But, I had a perfect pregnancy – why would I be that one?  The bigger risk – surely – was “unnecessary interventions” inevitably leading to a repeat c-section.  I did not know how quickly my baby could die.  I did not know that the hospital would be too far away to save Brody.  I did not know that I was gambling on my son’s life for the sake of an idyllic birth at home.  

I know there are lots of stories of mothers who have had a great experience birthing at home.  They were very, very fortunateI need you to hear my story: parents who suffer tragic HBACoutcomes do not tend to speak out because we know it was our choice. But, the absence of their voice should not give you the false impression that heartbreaking experiences like ours don’t happen.  They do.

My medical records state “13:15 client stable, holding baby”.  My warm, pink, perfect baby who quickly began to turn blue.  I stroked his soft cheek, willing him to come alive in my arms as thetears fell on his closed eyelids.  There was no magical fairytale ending to break the curse.  No true love’s kiss could make him breathe and let me look into his eyes.  My hummingbird had flown.  We love you Brody, I’m so sorry I let you down.  xxxx

“i carry your heart with me (i carry it in my heart).”  ee. cummings

Monday
Apr072014

K's Uterine Rupture Story

I had my son by C-section in 2006.  Joey was a little giant, 10 lbs. 2 oz.  Reason for the section was shoulder dystocia and cord prolapse.  My recovery was pretty uneventful, but I still thought that if we had another child, I’d like to try for a VBAC. 

I had several miscarriages between the births of my children, and consulted a reproductive endocrinologist at the University of Iowa (we lived about 45 minutes away from there in a small town called North Liberty.)  One of the tests I underwent was an ultrasound to check if my C-section scar was a contributing factor.  It looked good, so good that the tech called it “the most beautiful scar she ever saw”.

They found that the reason I kept miscarrying was most likely due to low progesterone levels, not anything as a result of my section (the only other uterine procedure I had was a D&C because of a miscarriage).  I was given the go ahead to try one more time.

I got pregnant with my daughter in the summer of 2009.  My doctors carefully went over my file and told me that they thought I would be a good candidate for a VBAC if I wanted one.  Even though I had a difficult pregnancy (I had lost Victoria’s twin at 8 weeks, she had been diagnosed with a congenital heart defect at 20 weeks, and I had gestational diabetes that was difficult to control satisfactorily, even with insulin), they still offered me the chance to attempt a VBAC at the University Hospital, based on that ultrasound report about my scar and their opinion that it was highly unlikely that I would have another child with cord prolapse.

We scheduled a C-section for March 7, in case I didn’t go into labor naturally, so we could have the NICU ready for my daughter’s needs.  I went into labor naturally, however, on the evening of the 4th.  I stayed at home until my contractions were about 5 minutes apart, then we headed to the hospital.

My doctors had told me that they were not going to give me Pitocin, which was fine with me.  They told me that it could increase the chance of rupture.  Before I could get an epidural, they had me sign a bunch of paperwork.  I remember one of the sheets talked about uterine rupture, but said the risk was small.  They would not let me proceed with a VBAC unless I signed it, so I did.  And I waited.

I got moved to a primo spot (I could see the football stadium from my room’s window ~ which is a huge deal to UI fans.)  I quickly progressed from 3 cm to 8, then to 9.  We expected her to come any moment.

Then we stalled out.  I was stuck at 9.5.  Breaking my water didn’t help.  I asked my doctor for one more hour, but had no progress.   We agreed to wheel me down to the OR for a repeat C-section.  We were all pretty tired, and we wanted to finally meet this little girl.

At first it went pretty much like my first C-section had.  There was a light mood in the OR.  We told them what her name was going to be, we waited a bit for the NICU staff to arrive (so they could get their first really good look at her heart), and we waited for my husband to get suited up.  The doctor said she was making the incision, and there was happy chit chat.

Then about two minutes later, it went silent.  I looked at my husband.  He didn’t seem to know what happened either, but when we looked at the doctors and nurses they all looked pale.

My doctor spoke first.  Clipped tones, slightly louder voice, no nonsense, precise Indian accent. All business.  Everyone moved quietly, efficiently.

My baby girl was lifted high for me and my husband to see.  “She’s beautiful” my doctor said, then handed her off to the NICU staff.  Still no talking, other than a call for a certain clamp or other surgical instrument.

Me and my husband knew something was wrong.  No idea what, though.  It had to be bad.  Everyone in the room was pale and holding their breath but us. 

Then someone said the word “rupture”.

I looked at my husband.   English is not his native language, but he understood it before I did.  I have never seen him look that scared before.  I hope I never do again.

Oh shit, I thought, as it slowly sunk in.   Was that the only glimpse I was going to get of my daughter?  She was….is….beautiful. 

Someone asked my husband if he wanted to go to the NICU with Victoria.  I told him to go.  He refused.  I then ordered him out, and said she needed him more.  (Actually, I thought there was a good chance I was going to die and I didn’t want him to witness that.)  He reluctantly left.  I wasn’t sure if I was ever going to see him again.

The doctors continued to work.  I started silently praying, and occasionally dry heaving.  I started shivering so hard my teeth chattered, and was beyond grateful when they brought me a warm blanket.  On occasion the anesthesiologist asked me if I could feel any pain.  I couldn’t.  I did feel sleepy, though, and fought to stay awake.  I was scared to close my eyes.  I knew as long as I was awake I was alive.

I heard someone talk about my ureter.  I guess I looked confused, because the anesthesiologist told me that they wanted to be sure it was not cut while they were putting me back together. I wasn’t going anywhere until they were sure it was working correctly.

It was.  I saw some color creeping back into the doctors’ and nurses’ faces.  Someone said “closing up.”  The anesthesiologist told me I would be feeling some pressure.  I kept visualizing my guts being stuffed back inside me.  Someone told me that they were able to save my uterus.  I wasn’t going to die, after all.

When my daughter was delivered, I looked at the clock over my doctor’s shoulder.  She was born about 5 pm.  It was now closing in on 7.  Two hours of this.  I couldn’t believe it.

Finally, the doctor left the room, and I felt my gurney backing up.  They were wheeling me out of there.  There must have been ten doctors and nurses coming along with me to my first recovery room, just off the OR.  I guess I started to feel a little giddy then.  Couldn’t believe I came that close, and was still here.  I’d get to see my husband, my daughter and my son again.

I arrived at the first recovery room.  Had a nurse standing by, with what looked like six flat screens.  She was supposedly tracking other patients in there.  I noticed she kept asking me about my family, and my life, and other little chit-chat questions.  I guess all my signs looked good, and an hour later I was sent to the regular maternity ward.

First time I was alone in hours. 

I started wondering what the hell just happened to me, and was my baby ok.  I was exhausted and finally passed out for a bit.

I heard a nurse come in, and I asked her about Victoria.  She was fine, she said, and asked me if I wanted to see her.  YES!!!

They found someone to push my wheelchair over to the NICU.  I know I looked like hell, and even being wheeled over was tiring.  But I got to see her around midnight.  She still looked beautiful, and they got her out of her bassinet so I could hold her.  We made it.  Thank God.

The next morning, the nurse got me up to use a walker.  I remembered that from my first C-section.  I dragged myself down the hall, and would have tried to make it back to the NICU if I wouldn’t have been so wiped out.
Then, the first pair of doctors visited me while I had breakfast.  They were two women, in their late 20’s.  One brunette, one blonde.   They were the first to tell me just how badly I ripped apart. 

The blonde doctor told me that the OB was just about to start the incision into my uterus when she watched it split apart before her eyes.  I tore all the way into my vagina.  When I asked about my original C-section scar, she said that held together.  Everything else fell apart. 

Then the brunette doctor spoke.  They were able to save my uterus, but I should never think about having another child.  She said that it was highly unlikely I could carry another baby to term.  Any attempt would likely kill us both.  They could not guarantee that I would pull through a second time.

We had already decided that Victoria would be our last child, but hearing that was hard to take.  I know that doesn’t make a lot of sense.  Maybe it is because it wasn’t just me and my husband making the decision any more, but my body hitting the limit of its capabilities. 

I got a variation of that second doctor’s speech about five more times before I was discharged four days later. 

The doctor who saved my life was able to answer a few more questions when she checked in on me.  Maybe her soft Indian accent made it easier to take.  She said the walls of my uterus were paper thin, and we were lucky that they held as long as they did.  I had lost two liters of blood before she could stanch the bleeding.  She had been practicing since the late 70’s, and I was the third rupture she had witnessed.

I didn’t have enough guts to ask her what happened to the other two women, or their babies.  I hope they made it through, too. 

For the next few months, I concentrated on getting my daughter prepared for her corrective open heart surgery.  She was born with Tetralogy of Fallot, and surprisingly the whole ordeal of her birth didn’t affect her one bit.  (She’s now a beautiful little four year old imp who loves torturing her older brother, dancing, swimming, ice skating and Hello Kitty.) 

I didn’t deal with the rupture until my daughter was almost a year old.  By then, she had recovered from her surgery with flying colors, we had moved from Iowa to Florida, and life was starting to settle down a bit.

I started to look up things about uterine rupture and   came across some survivor groups.  I’ve never met anyone in real life who had a uterine rupture, so they’ve been a source of comfort.  I stopped feeling like such a freak of nature knowing there’s other people out there like me and my family.

I’ll never be completely over it.  I can’t help but think about it whenever my daughter’s birthday rolls around, for example.  I can’t help reliving at least part of that day.  I dread the day when she innocently asks me what it was like when she was born….”was it a happy day, Mommy?”

Sometimes it hits me at random moments.  Just recently, when I was at Publix, I picked up a bottle of wine.  750 ml., average size.  For some reason, I put two more next to it in the cart and said, “That’s how much blood I lost that day.”  I sat and stared at it for a while.  Couldn’t believe I could lose that much, not have a transfusion, and still drag myself down a hallway the next day.

My husband still tears up and says he thought I was going to die and leave him a widower.  He only recently told me that while he was waiting to hear if I would make it, he was wondering how he would raise two small children alone.
No one ever tells you that uterine rupture affects men, too.  How could it not?  They watched the mother of their child almost die; maybe they witnessed their child’s death.  I worked with men, and know how they always want to “fix” things.  This is something that they can’t fix, possibly the first thing they can’t do one damn thing about.  I know women who would try again, but their partners just refuse.  They don’t want to take that risk.  Their hearts can’t take it.


One of the hardest things to accept is how many of the women in the survivor groups shouldn’t be there.  Most of them were in better shape than I was.  They had healthier pregnancies, they were younger (I was 41 when Victoria was born), their children had nothing wrong with them (or at least, nothing as serious as V’s heart condition).  I had a c section, and several of them did not.  Yet their children were taken, and my daughter wasn’t.  I still can’t make sense of that.

I didn’t think when I signed the paperwork that I would be that 0.5% they were talking about.  I had no idea how I would freak out over a late period, and start worrying about possibly being pregnant (After all, maybe I’m in that 1% of women who get a tubal ligation and it doesn’t work?).  I still have no idea how I’m going to address my daughter’s questions about her birth.  What if my daughter, or future daughter in law, is trying to decide if a VBAC is the right choice for her?  (I still think it’s a great option, but damn straight I start worrying like crazy when a friend of mine attempts one.)  How do you explain that you are happy when other survivors find your group, but you wish there weren’t so many of you in it?


This is why I get angry when I see some half-wit post that uterine rupture is overblown.  If you are only concentrating on the number of women who experience it, yes….it’s statistically small.  But the effects on the families who experience it are huge, even if everyone pulls through.  Shouldn’t that factor into the discussion, too?

I post a little about my story from time to time, usually when a post about HBAC (or UBAC) comes to my attention.  I say that a VBAC at a properly equipped hospital is an excellent choice, please reconsider your plans for something other than that. 

I get one of two reactions.  Either I’m ignored, or someone calls me a fear-mongerer.  I’m not.  I’m the best case scenario.  I pulled through, my daughter did too, and physically, I’m ok.  I have a talented doctor, a first rate surgical team and a properly equipped hospital to thank for that.  I practiced what I preach, and that’s why I’m here to talk about it.

I’ve not only heard the stories of women who tried HBAC and/or UBAC and fell on the wrong side of that percentage, I know their names and the names of the ones they lost or left behind.  They aren’t mere statistics to me.  They’re beautiful, brave women and beloved children.  They were someone’s everything. 

You don’t want to join our club, and we really don’t want more members in it.  That’s why I speak up.

Monday
Apr072014

Uterine Rupture Birth Stories

It’s very difficult to find uterine rupture (UR) birth stories. The moms who have them say they are shuffled off into the dark side of the Internet where they huddle together in isolation from the support they’d once had when they were pregnant. Told they need to go to Loss Groups, they are left almost alone in their grief. 

I’ve decided, after talking to several of these moms, that enough is enough. Their birth stories deserve to be heard, even if they ended in tragedy. And not all did, thank goodness, but enough have that it will surely make the reader uncomfortable and sad going through the stories. 

I am pro-Vaginal Birth After Cesarean (VBAC) and pro-Home Birth After Cesarean (HBAC). I get a little more woogily when it comes to Vaginal Births After Multiple Cesareans (VBAmC), but do support them if they are done in the hospital. 

I believe in order to do a VBAC, the client needs to have a very skilled and experienced provider, one that knows the signs of UR in its beginning stages. These are fetal heart tones going down with or without uterine contractions, the uterus looking divided, the baby crawling up in the uterus, pain in the mother, not necessarily over the scar, a mother’s feeling of panic or fear, her blood pressure crashing and finally, and the least likely to be seen first, is bleeding. The blood doesn’t often come until the abdomen is opened during a cesarean. 

URs are rare, but are, as far as I can tell, happening more and more. Whether that’s because there are more women wanting to VBAC or because the cesarean rate is also climbing, I don’t know. Maybe I’m just hearing about them more. I’ve only seen two URs and both were in primip(aras –first time moms) when they were given too much Pitocin. I’ve never seen a UR in a VBAC mom. I know midwives that have, however, and they become skittish about attending VBACs ever-after. I wonder what I would have done as a home birth midwife if I’d have had a client experience a UR. Would I have stopped attending them at home? I often say that a midwife is a product of her experience, so very well could have stopped servicing HBAC moms and only doulaing them in the hospital. 

I’ve attended about 40 VBACs in the hospital, about 20 in birth centers and about 15 HBACs. I’ve attended VBAmCs in the birth centers, but none at home. The most previous cesareans a woman had was four, VBA4C and there were two of them at the birth center I was at in El Paso many years ago. I doubt they would do that again today. 

Concurrently being published is a piece by Dani Repp at “What Ifs and Fears Are Welcome.” She wrote a post regarding the risks and benefits of VBAC, Elective Repeat Cesarean Delivery and HBAC. I took part in the Q&A on the post and you can read it here

If any of you need more information or support from UR moms, you can contact me and I can put you in touch with a Facebook group or a UR mom.

Tuesday
Mar042014

A Baby Died

A baby died.

Several of us watched it happen on Facebook. I came into the conversation right after the death of the baby. On Jan Tritten’s Facebook Page, a midwife “crowdsourced” (asked a question of the masses) the following scenario:

“What would you do? Primip with accurate dates to within a few days who has reassuring NST at 42.1 weeks, as well as reassuring placenta and baby on BPP, but absolutely zero fluid seen. 42.2 re-do of BPP and again, mom has hydrated well, but no fluid seen. Baby’s kidneys visualized and normal, and baby’s bladder contained a normal amount of urine. We’re in a state of full autonomy for midwives and no transfer of care regulations after 42 weeks. Absolutely no fluid seen…what do we truly feel are the risks compared to a woman whose water has been briken and so baby/cord has no cushion there either. Cord compression only? True possibility of placenta being done although it looks good? Can anyone share stories/opinions? Technology isn’t perfect and I like Gloria Lemay’s visualization of a glass tub above you…how much water will you actually see below someone in the bathtub? But, my hands feel nothing but baby (who again…is doing well and recovers well after spordic contractions). Mom feels everything is fine and wants to leave things alone.” (Quoted verbatim with spaces and misspelling intact.)

Some commenters (some of whom are midwives) were unbelievable with their recommendations that ran the gamut from homeopathy to Stevia to cell salts. It was a debacle that unfolded real time on Facebook and, sadly, it ended in the death of the baby.

“Very sad news on this baby: The baby didn’t make it. Had aspirated meconium a while back they believe. Even after another BPP that showed everything was fine today. I listened to the baby afterwards and heart rate was on the low side. We came in, chose a c-section, and they worked on the baby for 47 minutes.”

You can read the entire thread here.

Instead of expressing horror, several women wrote sympathy comments for the midwife and expressing that, sad as it is, some babies just die.

This baby did not have to die.

Questions that have arisen include: Who did the Biophysical Profile and said it was fine with no amniotic fluid? Was the mom on the fetal monitor for at least 30 minutes in order to get the BPP accurately? Who was the doctor and why did s/he say it was okay to keep going with the pregnancy when there was no fluid? Was there a doctor looking at the BPP?

In other places, it has been said this wasn’t the whole story. That the woman was being followed by a doctor as well as the midwife. That the midwife did an NST in the car after the BPP and that’s when she found the fetal heart tones going down. (An NST cannot be done with a doppler even though it is, in my experience, a standard of care for home birth midwives.) That the midwife tried and tried to get the client to the hospital for an induction. However, what sounds like a letter to the parents, the midwife says, among many things:

“Instead of … telling you to “be prepared that the perinatologist doing the NST is likely to tell you that your baby could die if he doesn’t come out;” those should have been MY words. You might have been really pissed at me for pushing you into a corner where you felt you didn’t have a choice, but … I wouldn’t care… I am angry at myself for being the midwife who tried to be as firm but gentle as possible when advising to go in when I could’ve waved the dead baby flag…”

There is a problem with midwives not wanting to be The Bad Guy with pushing women to go into the hospital. Doctors tell women bad news all the time and can’t take it personally. But, midwives take pride in becoming friends with their clients and don’t want to hurt anyone’s feelings. Look what that attitude did.

There was an assumption of who the midwife was, but I didn’t want to say until there was proof. Today, in Dr. Amy’s piece called “In Memory of Gavin Michael” the baby’s grandfather verified the midwife was Christy Collins in Las Vegas, Nevada. I have offered Christy a forum for sharing her side of the story, but have not heard back from her yet.

What more do I have to say about this that hasn’t already been said? I hope midwives around the country, specifically CPMs/LMs will take this lesson and learn from it.

First, don’t ask for advice on the Internet! If you feel you need to, then you are working outside your scope of practice – transfer care! Plus, there are HIPAA violations abounding.

Second, going post-dates has consequences. It isn’t as benign as you think it is. There’s a reason so many protocols force a referral for post-42-week pregnancies. All the anecdotes of babies over 42 weeks are terrifying. That one midwife let a woman go 19 days post-dates (and bragged about it!) is abhorrent.

Third, it’s important to start your NSTs at 41.3 weeks and then progress every two to three days after that. Starting later doesn’t offer a good baseline and isn’t good midwifery. BPPs should start in the 41st week and progress twice a week at least. Again, a baseline is important to have.

Fourth, when a midwife loses a baby, don’t just assume she’s in the right. You have to look at the whole picture (which, admittedly, we still don’t have yet… that will probably come out in court) and give the benefit of the doubt to her being wrong, too. We do make mistakes and we must look at them to see what we would do differently.

Fifth, when you are considering doing something outside your comfort zone or that is unusual, think, “What will this look like in court?” or more directly, “How will this look on the Internet?” If you are comfortable with your decision, then proceed. If it will look damning in court, reconsider moving forward.

Sixth, if you get a client that doesn't want to do what you suggest, DOCUMENT IT!

Lastly, Dr. Amy is no longer the enemy. While I disagree with many of her styles of communication and don’t consider her a friend, the parents are going to her and we can no longer ignore her or her website as the truth about these cases comes to light on her pages. By doing so, we are sticking our heads in the sand and, as she calls it, burying the baby a second time – first in the grave and the second by ignoring the death and circling the wagons around the midwife, protecting her from any questions or investigation about the death.

Let’s not forget Gavin Michael.

Friday
Jan312014

My Take on the MANA Stats "Study"

I am not a Statistician so cannot speak about the stats in the study. What I can speak about is how the statistics were gathered and what that might mean about the whole study’s validity. 

My own statistics are a part of this study. I have filled out the paperwork not only for myself, but for other midwives as well. In fact, I have spent hours filling out the statistics paperwork, poring through charts, answering questions from the beginning of pregnancy through six weeks postpartum. 

The study says they enrolled the clients before they knew the outcome of the births, but I beg to differ. They may do that now, but back when I was doing them (2004-2009), we didn’t even fill out the paperwork until the woman was past six weeks postpartum. In fact, we used to sit with a pile of charts in our laps and fill out stat sheet after stat sheet, some women even a year (or more) postpartum. At that time, the stats were filled out on paper and sent in, so I know we weren’t supposed to send in any statistics before the woman was six weeks postpartum. I can’t imagine we were the only ones that did it that way. 

So, while there are parts of the statistics that are objective – whether the woman has a breech baby, twins or was a transport – there are other aspects where the answers to the questions are subjective. How long a woman’s labor was, how long she had Rupture of Membranes, the degree of her tear… are all areas where subjectivity come into play. You wouldn’t think so, but I have seen midwives lie in the chart (and then on the stats forms) about such things, not wanting the Powers That Be to know they let a woman with ROM labor for 32 hours without transferring her or that she sutured a third degree tear. I never saw charts be subjective when I worked with the CNMs in the two birth centers I worked at, but it was a distinct part of the midwifery culture I worked in as a CPM/LM. I know I stretched the truth myself when it came to extra long labors or trying to get the best blood pressure on a woman. 

As we know, the statistics gathering was completely voluntary. I knew several midwives who never did the stats; a few that did. And this was just in one city! How can anything really be known by such skewed statistics (if you even want to call them that anymore)? And I am sure that midwives with a bad outcome just didn’t finish that woman’s stats. It would have been encouraged in the culture. So that so many did send in negative outcomes lets us know how bad the perinatal mortality and morbidity rate really was. 

I look forward to more dissecting of the perinatal mortality part of the statistics being done. They don’t look good now. That so many are just taking what pro-home birth sites have to say about the study is frustrating. Look at the naysayers, too. 

I know it sounds like I am anti-home birth now, but there is nothing like that at all. I am still pro-home birth… with a highly trained and skilled midwife with a transport plan in place and supportive back up care. I am against breeches and twins at home births (as the study distinctly says should not happen at home!) and am slowly coming to see that even VBACs might not be best to do at home (after talking to HBAC loss moms). But, I do still believe in home births, just with some caveats. 

I, more than anyone else, would love to see a real study telling us about the safety of home birth, but this one sure is not it.

Friday
Jul052013

My Hernia

I don’t know what I did to get the hernia, but when it did its thing, it hurt like crap. A hernia is when a piece of bowel or intestine juts through the abdominal muscle. It can be an emergency situation if the hole strangulates the intestine, requiring immediate surgery lest the person die from the experience. Pain usually drives the patient to the hospital, though, so death doesn’t often occur here in our part of the world. My own hernia was protruding. I could feel it through my abdominal wall, but I read to try and get it back inside the hole so I laid far back in the recliner while massaging the hernia to try and get it back in. Luckily for me, it did go back in. Thereafter, I was extremely careful about lifting or straining, waiting for the appointment to see the surgeon (it had to be approved, of course) and then waiting for surgery. All told, it took four months from the discovery of the hernia to surgery.

I just had surgery three weeks ago. It was laparoscopic, thank goodness, but still hurt like crazy afterwards. Apparently, I had FOUR hernias tucked in there. The mesh protection the doctor was going to use had to be exchanged for a much larger mesh to cover all the holes. Blessedly, I don’t feel the mesh inside… the doc said many people can feel it for three to four months afterwards, until the staples disappear.

I have to do nothing for eight weeks. I can’t do so much as a crunch lest I cause the mesh to break off or give myself new hernias. I asked if there was anytime I could try and work my abs and she said after eight weeks. My abdominal muscles feel shot; I can’t even hold my gut in properly! I look forward to being able to do something in five more weeks.

Who knew hernia surgery would be so limiting? I certainly didn’t.

In the meantime, I’m watching tons of tv and reading when I can focus (pain meds don’t allow lots of focus time). Things are better each day, but I am sure looking forward to doing something with my body after all of this. I think I want to go swimming again. I miss the water.

I just hope that with new movements I don’t give myself any more hernias. I don’t want to go through this again.

Thursday
Jun132013

Guest Post: 5 Reasons to Invest in Babywearing

Babywearing is the act of carrying your child around with you for great amount of time while being comfortable doing so. Some parents view this as an excess of attention. However, babywearing can have a great deal of personal and sociological practicality. There are many reasons why babywearing is an ideal form of raising your child, none of which has implications towards spoiling. In fact, babywearing can be greatly beneficial to solidifying the link between yourself and your child.

1. Comfort - From the moment the child exits the womb, he or she is going to need constant reassurance that everything is OK. This is a new world to him or her and having the presence of your body against the child's can help alleviate anxiety he or she may be experiencing. Since every circumstance is a new experience, the child needs that confirmation that you are present and will protect him or her from harm.

2. Ease of Feeding - For those who have babywearing clothing, breast feeding in a public place is so subtle that no one even realizes what is going on. Without having to fight straps or ties, you can cover your child while he or she feeds under the protection of a babywearing satchel. Since these are wrapped around your shoulders, your hands are free to go about your business while providing the support your baby needs. It's like having an extra set of hands holding your child.

3. Ease of Mind - There is a great relief of stress when you feel the weight of your child pressed against your body. Not only is it calming for your child, but it helps you calm down as well knowing your child is safe and secure. Some mothers have even mentioned how babywearing has eased some of the tension from separation anxiety. Children are not the only ones who can become anxious when away from the parent.

4. Less Fussy - Children that are snuggled against their mothers are inherently less fussy. This can be a benefit for instances while in public places such as movie theaters or restaurants. The less fussy your child is, the more everyone enjoys the situation. Although you may still need to cut the movie a bit short in order to deal with a dirty diaper, breast feeding during the movie or simply holding your child isn't as burdensome physically as it would be otherwise.

5. Hands-free - Being hands free whether you're in public or at home is a blessing to many parents. Babywearing can allow you to continue with most of your day-to-day activities without having to stop and care for your child. Although it may sound like it's a bit of a lazy approach to parenting, you are providing your child with the safety of being close to you while being able to complete various tasks.

You don't have to carry your child around with you until he or she is old enough to drive. However, the additional attention when he or she is between the infant and toddler stage can greatly improve the bond that many parents would be jealous over. As there are many ways you can carry a child in this fashion, comfort for yourself is not an issue. Isn't the prospect of starting off your relationship with your child strong a reason to investigate the possibility of babywearing?

Author Bio:

Rachel is an ex-babysitting pro as well as a professional writer and blogger. She is a graduate from Iowa State University and currently writes for www.babysitting.net. She welcomes questions/comments which can be sent to rachelthomas.author @ gmail.com.

Sunday
May262013

Colonization

I read a piece called “Cesarean Birth Linked to Childhood Obesity” that discussed the baby being introduced to the mom’s good bacteria as he is being born through the mom’s vagina. Theories about allergies, Type I Diabetes, and Celiac Disease have all been implicated in children not receiving their mother’s colonization from their good bacteria when going through the vagina.

Another a June 2012 study offers a detailed look at the early stages of the body's colonization by microbes. Babies born vaginally were colonized predominantly by Lactobacillus, whereas cesarean delivery babies were colonized by a mixture of potentially pathogenic bacteria typically found on the skin and in hospitals, such as Staphylococcus and Acinetobacter, suggesting babies born by CD were colonized with skin flora in lieu of traditionally vaginal type of bacterium.

There’s so much science here, I’m just going to leave it to the researchers. I know they are studying it, they are pcking apart vaginal and cesarean births, I suspect they are taking the different modes of transportation apart (via the nose, mouth, eyes, ears or a combo of any of the methods). I’m just wondering what we do know about it?

Do we add lines in our birth plans that ask for a swab of vaginal fluid if we have a cesarean so we can run it on our breast for our baby to colonize with it? I would ask for a large swab, not a q-tip sized one). Today it seems kind of gross smearing our juices on our breasts and the laying the baby on there to nuzzle. But, I don’t see it being too far in the future when it becomes the standard of care. Might we take a cloth and schmear it down the woman’s whoo haa and then rub on  the baby’s face and then clean the face off. Any of these ways seem doable to colonize the baby.

Is this far in our future? Already I hear about CMNs who swab for the mom and know that women ask for the ability to colonize their babies. Would I be doing this if it were me or Meghann? Absolutely.

What are your thoughts about this controversial experience with colonization?

Sunday
May192013

Oubli's Vaginal Tear

I was asked to share a different kind of birth scar story, different than the usual cesarean scar stories I share here. I welcomed her re-telling of her birth... and share it here with you all.

My Birth Scar

My pregnancy and birth were uneventful medically, textbook in every way - except the tear. In the standard lithotomy position in a hospital with a CNM guarding my perineum, my labia minora split horizontally in two as my child entered the world.

Cue the inept stitch work from a CNM who had too many patients and was in a huge hurry. Not enough stitches were used and days after I was discharge the too few that were there snapped while ambulating. Suffice it to say my labia didn't heal correctly, it didn't heal together, two pieces of flesh cleaving and fusing as it should have. A trip back to the CNM the next day and I was told, "There's nothing we can do, it's a purely cosmetic issue now - deal with it, you are wasting our time unless it's infected."

I hate my wound, for a long time I couldn't bear to look at it or touch it. It makes sex less enjoyable and sometimes uncomfortable (the skin flaps get grabbed by my DH and pulled inside during thrusting) and gynea exams just aren't as much fun as they used to be *snark*.

I call it a wound because I am still wounded by it, although it has healed. To add insult to injury I cannot get it repaired until after I am done child bearing, as plastic surgery on that delicate area has the same risks as Female Genital Mutilation.

Here's why I feel I need to be done childbearing beforehand - "[I]n nursing school I helped out at the delivery of a woman who'd had labiaplasty several years before, and holy shit. It sort of, um, shredded. One of the most horrific things I've seen in my career. It took them a really long time to sew everything back together, and I have a feeling she would have happily gone back to some slightly asymmetric or (gasp!) flappy labia if she could have."

http://jezebel.com/5402091/report-vaginal-plastic-surgery-has-same-risks-as-fgm

Other sources about vaginal rejuvenation or vaginoplasty, includes info about labiaplasties.

http://news.bbc.co.uk/2/hi/health/8352711.stm

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/co378.pdf?dmc=1&ts=20121129T0006283149

I fear that if I get it fixed before I am done child bearing it won't stretch properly, as scar tissue is inelastic and it may pop again creating a far more terrible tear in the same place. Even if I do not get it repaired I still worry about it tearing in the same place and becoming a vaginal wall tear. I never feared child birth before but this tear makes me rethink having more children.

4 years after the the initial tearing, it's hard to watch my birth video because of it, I resent my midwife for the lithotomy position, I resent my daughter (a bit) for causing it, I can't masturbate or have sex without touching/thinking about it (usually negatively), when I shave I have to be extra careful not to nick it as it protrudes further than the other side. Oh an did I mention that my stitches didn't completely dissolve, every few months I feel like I'm being stabbed from the inside out as bits of stitch work make their way to the surface and have to be delicately removed. I used to think my vulva was gorgeous and now it looks and feels sad all the time. My scar is still very much a wound that hasn't healed.

Sunday
May192013

How to Choose a Birth Doula

There are as many kinds of doulas as there are women who want one, so deciding how to choose one can really come down to personality. But, might there be other aspects of doula-dom that aren’t so individualistic? 

Education

It should be a given that your doula has taken a training course of some kind. I am not of the school that believes a certification makes a great doula (I am not a certified doula, either), but definitely a weekend workshop should have been had. Whether it’s DONA, CAPPA, toLabor or any of the other groups one might find (Radical Doula has a great list here), attending a training will have been infinitely helpful to your doula.

Experience

This doesn’t necessarily have to be hands-on experience since some of the best doulas I’ve met have been newbies, but there is a great deal of information out there that women can learn via books and videos. They can also learn at meetings where doulas gather to talk about cases. Watching videos of doulas, she can see what makes a good doula, how the woman touches the laboring mom, what kinds of suggestions she makes to her as the labor progresses and how to move about the room unobtrusively. I talk more about experience below in Referrals. Ask your doula-to-be how she’s come by her experience and these might be some of her answers.

Knowledge

This doesn’t have to be just book knowledge, but books cannot be overlooked when a doula is educating herself. What the doula reads and assimilates can help her practice immensely. Much of what I think a doula could do to up her knowledge is to read midwifery texts. Reading Heart & Hands and Ina May’s Guide to Childbirth are two really good books to read to get a feel for the rhythm of labor and delivery. The Birth Partner and The Ultimate “How to” Guide for Doulas are great doula books to read. I haven’t read Experienced Doula: Advanced Skills for Hospital Doulas, but the Amazon comments seem to recommend it. If it lives up to the title, it should be a good one.

Referrals

How do you know how the doula’s going to be interacting with the hospital staff? How will you know until you are in the throes of labor? The best way is through recommendations. This, of course, would mean your doula is experienced. This won’t work if your doula is brand new. But, not to knock new doulas (who might be awesome out of the gate), but I would really encourage at least a little bit of experience before venturing into a doula-client relationship. The question becomes, how can a doula get experience if women only hired experienced doulas? Most doulas start out helping friends and family, not being hired outright by strangers, so developing clientele, even if it is friends and family, is a great way to garner the recommendations she will need. This is sure to be my most controversial advice, but I do stick by getting referrals as a way to learn how a doula acts in labor and birth. You still might come up against a doula that isn’t a good fit in labor, but the likelihood would be less. How a doula interacts with the hospital staff can mean the difference between an awesome birth and a train wreck, so recommendations can’t be taken casually.

Asking the Right Questions

Knowing what kind of doula you want will help you here. Are you looking for a motherly-type doula? Or a take-charge doula? Do you want a doula to tell you what to do throughout your labor? Or do you want to lead the way? I know this can be a challenging question, but imagining yourself in labor can help you decide what type of woman you are and what you’re looking for in labor.

A good doula is able to mold herself into what you need, so if you change your mind in the middle of things, she should be able to move along with you.

So, what to ask?

- How many times will we meet? That answer should be at least twice during the pregnancy and once or twice afterwards; most meet with you twice afterwards.

-When do I call you? The answer should be “Whenever you want to.” Doulas should be available via phone, text, email throughout the pregnancy and then physically available from 37-38 weeks along. I say 37 or 38 because doulas have different beliefs about call-time. If you suspect you will go early (and not just because you hope you go early!) you might make sure you hire a doula who will come earlier.

- What If I have pre-term labor? Will you come? Most would if at all possible, but if you’re having pre-term issues, it would be good to ask the doula this question.

- When do I call you in labor? Again, the answer should be “Whenever you want to.” (I tell women, “If you think, ‘Should I call Barb?’ the answer is ‘YES!’”) Women need to be able to touch base with their doulas in early labor even if the doula is hours away from going to them. Through repeated phone calls, the doula and client can decide when the right time to get together will be. Depending on whether the doula is meeting you at your house or at the hospital depends on how far along in labor you will see each other. If you want a doula sooner than later (you think), mention that to the doula. Make sure she goes to the mother’s home before you find out in labor she’ll only meet you in the hospital.

Now, I have no qualms about a doula meeting you at the hospital instead of in your home. It’s what I do if I doula. I am uncomfortable laboring with a mom at home when she isn’t monitored, so only do monitrice work when a woman wants me to come to her home in early/ier labor. But, many doulas don’t have any issues with going to women’s homes and that’s fine, too. Just be sure you know what your doula will do before you get there.

Some answers you might hear include: When you can’t walk or talk through a contraction; When you feel you need me or When your contractions are less than 5 minutes apart. All of these are valid answers, none better than another.

- Who is your back-up? No matter how wonderful your doula, things happen and sometimes she won’t be able to make it to your birth. She or her kids might be sick. Someone in her family died. There might be another client in labor and she’s already committed to her (because the other woman went into labor first) or because her car broke down… all of these but the car have happened to me with clients over the last 30 years. It’s rare, but can happen. I have a couple of great (female) back-up doulas that are glad to meet with clients beforehand, but don’t have a monitrice back-up (yet). I am clear with monitrice clients that this might happen and I will refund them the difference if I have to send a doula instead of my going when she’s in labor. It’s best if your doula is able to connect you with her back-ups, even at least with a phone call so you know how to reach her/them if necessary.

- How do you see your role? This answer can be endless and this is when your own expectations come into play. Typical answers would be: As someone to soothe you when you’re in labor; To help you before, during and after the birth and As an educator to help you know your options in birth. It is important for a doula to be a teacher of some sort… not necessarily a childbirth educator, but have a teaching gene. She’s going to let you know your options in birth, help you learn how to communicate your wishes to the hospital staff and will probably help you get started breastfeeding (if that’s your choice). Will she help you with your birth plan? Most will help you with that, even if they start with a standard birth plan off the Internet. If she’s a good and experienced doula, she will help mold the template into your unique birth plan. (There’s nothing worse than presenting an Internet birth plan to the labor and delivery staff.)

During the interview, take note of the type of person she is. Is she direct and clear? Will that come across as bossy to the hospital staff? Or is that a trait you appreciate in a person? Is she meek and mild? Will she have the strength to guide you in labor when you need someone strong? Is she full of ideas for your comfort measures even now or is she only focused on labor? A doula who has information for you at the point you are in your pregnancy is a great doula! She will have loads of ideas in labor, too… and she isn’t afraid of sharing them with you. It also gives you a glimpse into her experiences.

- What kind of births have you seen? Has she been to VBACs? Twins? Cesareans? Moms with preeclampsia? Inductions? Natural/Unmedicated births? Moms who’ve hemorrhaged? Births with certified nurse midwives? Home births? Birth center births? Shoulder dystocias? The more complications she’s seen, the more births she’s been to –because they are generally rare and you have to go to a lot of births to see some of the more unusual ones. What does it matter if she’s seen complications? She’s not the one managing them, right? What it can tell you is that she will have acted/reacted in an emergency, helping her client through a crisis. This can be crucial to a woman’s postpartum adjustment period, how the complication went down at the time. Especially with cesareans since those are so common; it helps if the doula has gone through this with a client so she can guide you if you’re going to have one, too. Knowing the cesarean ritual helps the woman to prepare for what’s coming and can help her assimilate what happened postpartum. If she’s been to natural births, that lets you know she can work with a woman through the whole birth experience without medication… this is a totally different experience than when she has an epidural. Helping women through pain for hours and hours takes stamina and creativity. Then, working with women with epidurals, as different as it is from natural birth, takes a different type of creativity… does she work with peanut balls? Does she know the routine side effects of epidurals? Will she be comfortable sitting on her hands while the mom and dad sleep, sometimes for hours?

As you can see, there are many more ways to tell if you’re going to have a positive/good doula than just a personality mesh, although that can’t be overlooked either. After everything, do you and the doula get along? Does she look you in the eye? Does she include your partner in the discussion? Does she have ideas for him/her to help in labor, too? Is this someone you wouldn’t mind spending 20 hours with in a small room? If she irks you in any way, I’d say PASS on her and find another one. If she annoys you in the interview, how is she going to affect you when you’re tired, hungry and in pain? Find someone who will comfort you. You deserve to have the best doula for your pregnancy, birth and postpartum. I know she’s out there!

Sunday
May122013

Responsibility

Yet another home birth was deemed senseless. Joseph Thurgood-Gates was born in the hospital after a trying attempt to deliver him at home. The mom, Kate, had had two previous cesareans and the baby was also found to be breech about two weeks post-dates. The mother ignored not only the doctors who recommended she have a repeat cesarean, but even the midwife when she recommended (most likely) an NST at the hospital ten days post-dates. The coroner, Kim Parkinson, not only said they baby would have lived had he been taken care of in the hospital from the beginning of labor, but especially when the mother had a uterine rupture. She then commented, "To disregard the obstetrician's advice on the basis of a mantra founded in the uncertainty of statistical data obtained from the Internet is a dangerous course to follow."

When I commented, “The woman’s Internet “advisors” are just as guilty for this baby’s death,” a woman replied that no they aren’t, that we each make our own decisions.

So, who is responsible for the baby’s death? Is it the Internet for its anonymity and copious amounts of misinformation in the name of “telling the truth?” Is it the midwife who wrote in her notes that there are "’lots of political issues’ relating to home births?” Is it solely the mother’s because ultimately she made the decisions?

I bet those Internet advisors will find a way to incriminate anyone but themselves and the mother because mothers are rarely accused of doing anything wrong when it comes to home birth deaths. Even when it is their fault.

There are others culpable, though.

Entire websites are set up to convince women that medicine is evil, that doctors have nothing but dollars on their minds and that cesareans are the worst thing possible in a woman’s birth story. I could name five off the top of my head, but if I know them, then others do, too. There are a few that take the opposite stance, that home birth is evil and home birth midwives have nothing but popularity on their minds and that giving birth naturally is just for the experience. (I strive to be in the middle.) Neither is 100% correct, but desperate women cling to the fringes. Why is that? What are they looking for besides answers? Why do they look for the information they hope is true instead of balanced information? I’d need a psychology degree to answer those questions. It’s rather pitiful and sad, though, that they do… that there are women right now doing the exact same thing. And there are plenty of women out there validating their wishful thinking.

How many deaths and injuries need to occur before the Internet advisors start taking responsibility for their actions? Will they ever figure out the role they play in all of this? I would like to think so, but don’t hold out much hope for it. I don’t know how to get these women to own up to their behaviors, their advice to unsuspecting women who desperately want help over the wires.

Or how do we comfort the despairing woman? How do we help her so she doesn’t turn to the edge of sanity for information? Women can be so damaged; there has to be a way to help them before they go over the edge of sanity… the sanity of not taking medical advice from strangers.