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Wednesday
Sep212005

UC - again

Here's a post to my Doula list today. What the chick said is paraphrased:

"A. wrote (with regards to birth plans and whether they were a waste of time or not):

I chose a UC. I got tired of having discussions about my choices with a "care" provider. I didn't want to justify my birth wishes - no woman should - and the constant questioning was just annoying. Do salespeople question their customers when they buy something? No. As a health care customer, I am tired of being questioned "purchasing" my maternity care.

I respond:

You might just want to hit delete right this moment, A., because you are surely not going to like what I have to say about this entire topic. And, laying my prejudice on the line right up front, I will also tell you that I, too, chose a UC - and nearly lost my child because of my selfishness and delusional belief that the body... how did you say it? "do what my body was perfectly designed for." Well, there are TWO bodies at play here... two bodies dancing and if one of those bodies is stepping on the other's toes, then the dance isn't quite as graceful as you might have envisioned.

I also write extensively on how to make unassisted births safer for women who might find themselves, whether by choice or by circumstance, alone. Much of my writing circulates in the UC community and I have also spoken at a recent conference on making UC safer.

I am not ignorant of what you are speaking about; I hear it ALL the time. So much it makes me want to scream in frustration - and it isn't at the women who choose to UC, either, that make me want to scream! As a midwife who regularly works with student midwives and who "mentors" midwives all over the Net and who writes extensively in many forums about RESPECT for all women in the birthing world, the issue begins deeper than your having a UC.

As a midwife, I never ask a woman to "justify" her birthing choices. Ever. Nor do I question her choices once one is made. However - I am hired to share information, statistics, examples, and to make sure she "gets" what it is I am trying to explain or say. As a doula to a woman choosing a hospital birth, it really is a wise idea to role play so the woman can adequately explain her reasonings for choosing, or not choosing, certain interventions or procedures. Delving deeper does not mean we, the care provider or doula, are questioning/second-guessing/doubting the woman's choice, just ensuring the client herself is clear in her communication of her desires and motives.

It is EASY to ascertain when a woman knows she doesn't want GBS screening because she has already researched and decided. She is sure and clear and there certainly doesn't need to be any more discussion about it, just make the notation on the chart and move on. If, however, a woman says, "My neighbor says..." or "What do most of the women here do?" that is an opening for encouraging a woman to explore her OWN reasoning and understanding of her end choice. Just because we ask an open-ended question doesn't mean we think the woman isn't thinking clearly; just that clarification would help all involved, especially in a transport situation where communication gets hasty and hazy.

Your analogy of "buying" birthing services being similar to buying... what, a computer? a gun? a dress? C'mon now. Women interviewing a midwife get to ask a billion and a half questions about what we do, who we are, what we think, how we vote, who we pray to, what we do in such and such situation, how did we react in such and such situation, how's our health, do we have kids, etc.

Why wouldn't a midwife also have the same privilege of discovering whom she is working with? It isn't interrogation, it is abbreviated "getting-to-know-you" so if a crisis arises, BOTH parties trust each other to make a wise and thoughtful decision filled with love and respect. It really is speed dating in a birthing context.

A. says:

It isn't just me, thousands of other women are utterly disgusted with our "choices" in birth. UC isn't for everyone, but it's great having a baby knowing that NO ONE changed, interfered or "helped" me do what my body was perfectly designed for.

I reply:

Three recent stories (in real life, not cyber):

1. Mom chooses UC after a disrespectful midwife-attended birth. Beautiful pregnancy, labor, and when the birth occurs, she experiences a shoulder dystocia. Doing what she'd read to do in a solo birth shoulder dystocia, including attending my workshop on the subject, her baby still did not come. And died. 10 weeks later, this mom remains in agony that she did not ask a midwife to attend... to just sit in the livng room... to BE there for just this circumstance. Not, of course, that a midwife, doctor, nurse, or cesarean would have necessarily saved the baby's life, but she would have had one more tool in her arsenal to save her child.

2. VBAC mom has a horrendous VBAC with #2 and decides to UBAC with #3. I met her and heard that $$ and respect were her issues. As a midwife who works SO hard to be as hands-off as possible (one VE in 5 pregnancies and births), she spoke with former clients who assured her of my skill and belief. Birth begins and it is one of the most excruciating shoulder dystocias ever as I NEVER TOUCHED HER, but the other midwife and I guided her, calmly, into different position changes, which, after 4 minutes, brought her baby out - falling onto the floor because dad missed - that's how hand's off I was. The baby's Apgars were 2/5/7 and we were no longer hand's off as we worked our asses off to save the baby's life. (Had I been hands-on, she would most likely have been out sooner, but I SO struggled with respecting their wishes with that baby's life. I told mom 2 more seconds and McRobert's she would have been.)

After this situation, mom proceeds to hemorrhage which necessitates a transfer to the hospital for blood and meds. (This is the short and fast forward version.)

Mom describes the actual birth experience as quiet and gentle and she didn't even know the crisis that was going on until she watched the video several days later - an absolute triumph of our ability to remain calm in the face of extreme stress. She and her husband, over and over, have said they are so glad they "got their heads out of their asses" and didn't have a UC because they said they KNOW that both mother and baby would have, in all likelihood, not lived. I asked if she knew she needed to move and she said it never occured to her to change positions at all and her husband wouldn't have suggested it either. It wasn't their way. This baby, btw, was just shy of 12 pounds.

I know I make this sound all dramatic and Oh Aren't I the Queen Midwife and I don't mean that AT ALL. I am one... one woman who happens to have skills that not all people have. Some people know how to fix dishwashers. Others, cars. Some people can weave or sew or make diaper covers. I can midwife (and write and photograph). It isn't arrogant to acknowledge one's skills and gifts - it is a blessing! I certainly know my own limitations! I would never presume to do 95% of the work or even consulting in my life - I hire people, research what I can, and use them for their gifts. It's what we live in a community for, isn't it?

The third was a couple of days ago. A woman who knows most of the other women in this UC and hands-off midwifery community and wanted a peaceful hands-off waterbirth. Her first hospital birth was a painless hypnobirth; she expected the same this time. Instead, she got a persistant posterior labor and I witnessed a stubborn streak in her I'd never suspected as she refused her partner's pleas to get out of the bed and move around. After watching her scream in agony for HOURS, I finally grabbed the energy and explained, strongly, that she needed to get out of the bed if she wanted to move that baby. Reluctantly, she finally did, but minimally moved, wouldn't eat, barely sipped, and was getting sick to her stomach. Well, as her midwife, I know her history of hypoglycemia and know that, gee, 10 hours without food is probably causing the nausea (as it does in hospital women consistantly!) and REALLY encouraged her to eat. Okay, I insisted. I gave her choices of foods to eat - she chose - she ate - nausea subsided. Fancy that.

Even with movement, her agony was horrendous, and after a pow wow with the other midwife and student, I suggested a VE - something I rarely do (as mentioned above) to make sure there wasn't an ear or a forehead or something presenting. She had already tried to feel what was happening herself (and I absolutely thought her own self-exam was warranted), but she couldn't. During the exam, I could feel the head wiggling and working to find the position to do its thing and let mom know there was PLENTY of room, even with a posterior birth. After the exam, I excused myself again (I left them alone much of the time) and after some time, her screaming subsided. I tiptoed to the door and there she was, on hands and knees; the position her husband and I had suggested numerous times. I slipped away again and then, 25 minutes later, was summoned with a mom's birth cry and entered the room as she held her baby's head in her hands. Dad and the son caught the baby, she delivered her own placenta, nursed, and snuggled with her family.

During her postpartum visit, she thanked me profusely for "taking charge" because she said she knew she should get out of the bed, knew she should get on hands and knees, but didn't have the strength to do it without guidance. I told her that I knew all I needed to do was get her out of the bed and fed and her body would lead her to the position she needed and that is precisely what happened. I didn't "do" anything except believe in her - share with her accumulated wisdom - offer ideas - offer choices - and let her Be in her labor.

So, all that said, I KNOW that many midwives are crap. I know that many midwives are considered "medwives." I know the term "scare provider." I know that they, too, need education regarding respect and kindness for a woman's body and choices and intelligence.

But, lumping ALL care providers into one horrid pile of garbage is no different than lumping all police officers as good and upstanding citizens. Nor are all care providers angels of mercy who live by the "First, do no harm," either. We are, just as clients are, individuals. And it would be REALLY nice if we could be evaluated as such.

I keep plugging along re-educating midwives, teaching students, speaking to EMS personnel, sharing with nurses and doctors - speaking about birthrape, birth trauma, birth abuse - I work HARD to get women's stories heard so that women who feel forced to UC because of shitty previous experiences (or experiences of their sisters in birth) might actually find a provider that does what they are hired to do - consult and save a life. Nothing more. (or nothing less!)

I am a pariah in the midwifery community, as an aside. Saying that some midwives are abusive and cruel to clients doesn't go over so well in the tight and incestuous community. And you know what? I don't care. As a birth abused woman, as a former midwife-perpetrator, as a birth abuse witness, as a midwife who struggles with her own place in birth - I will not be silent anymore.

Reader Comments (14)

Wow! Powerful writing, Barbara. Well said.

September 21, 2005 | Unregistered CommenterPenny

I told you this already, but I'll say it again: WELL SAID. I think it's easy for some people to decide they just don't need anyone or anything for the birth of their babies, but they fail to take into consideration the things that could go wrong. I am perfectly capable of fixing my car - my hands were designed to hold a wrench and screwdriver - but would I just run out there willy-nilly and start taking things apart? No way.

I realize comparing childbirth to car repair is crude, but it says what I mean for it to, which is that neither should be done without someone who knows what they're doing nearby, unless you're prepared to deal with potentially disastrous results. (Holy run-on sentence, Batman!)

September 21, 2005 | Unregistered CommenterShylah

This is why I sent my friend to you to talk about UC- because I truly believe you 'see' it in a way that I have not seen anywhere else- with balance, with compassion, with respect to both sides of the issue. You've demonstrated that beautifully.

September 21, 2005 | Unregistered CommenterKristina

Ditto, Penny, Shylah and Doula...
I admire your willingness and ability to look at things from all sides.
Hh

Thank you, dear friends.

Even when I come with fabulous recommendations, UC women find me too aggressive, too interventive, or too medical.

I am reminded of the woman who considered hiring me for this birth after her successful UC last time and when she had symptoms of stroke? pre-eclampsia? and I suggested she visit a local ER, she refused. In the blink of an eye, I was the enemy and she realized she didn't need me for anything... diagnosing a migraine in herself hours later.

Funny, that very topic *just* came up on the doula list a few days ago, too. Same snap diagnosis as I had made from many experienced women. I thank God she didn't die of a stroke.

Sometimes it's good to be wrong.

September 21, 2005 | Unregistered CommenterNavelgazing Midwife

And I just realized that was "doula"'s client! And she DID have a stroke. See? I'm not a nut.

How is your lady, Doula?

September 21, 2005 | Unregistered CommenterNavelgazing Midwife

My friend (she's the one I sent to you) did indeed have a stroke but she seems to be okay for now. The hospital is not giving her adequate care (they left her sitting in triage for 8 hours- her doc told her that she'd see a specialist in the morning, and then discharged her w/o telling her, leaving her there all night for nothing!) so she doesn't trust what they're telling her. She's 22 weeks, she has PKU and they're telling her that they can't find the baby's aorta and that the BSD (?) measurement is small. *ugh* I wish she could relax and enjoy... this is her 5th pregnancy in 6 years! It's a crazy situation all around, but she's fantastic and informed and grounded. I know she'll choose wisely for herself- no chance of UC at this juncture, too much health stuff going on for it to even be in consideration. Thanks for remembering! :)

Kristina

September 21, 2005 | Unregistered CommenterKristina

Oh- they said she had a Transient Ischemia Attack. That was the 'diagnosis.'

September 21, 2005 | Unregistered CommenterKristina

. . . an amazing post . . . I had no idea such things were going . . . glad you are in the world helping women . . :)

September 22, 2005 | Unregistered CommenterKatherine

So powerful Barb. It's amazing that healthcare, holistic, allopathic and everything in the spectrum is considered a 'good', and that as consumers, we be allowed to purchase said good at whatever cost the consumer is willing to pay. I see it as a massage therapist. "I want you to go deeper. I can take the pain". I try to gently explain that enduring pain doesn't lead to healing. That it indeed will cause MORE injury. Sometimes they hear me. More often, they don't.

I too ask questions before I provide bodywork, and so often, clients are offended that I would ask if they have a heart condition, diabetes, cancer.... what does that have to do with massage? So many feel like they are buying a physical product instead of investing in their health.

I would hope that sellers of goods DO talk with their customers. That the real estate agent would know what kind of lifestyle a family has before selling them a home that's not right for them. That a car salesman would know that a family of 5 won't be comfortable in a new Mustang. That the furniture store knows that this bed would be too high off the ground for the customer's small dog to jump onto.

We should not be consumers of healthcare. Health eminates. Birth eminates. Life eminates. You can't sell that.

September 22, 2005 | Unregistered CommenterSunlightrunes

Aimee (sunightrunes), I love love love your examples in shopping and will just love to be able to share them again someday. Thanks so much! You know how much I love and adore you.

And Doula (K), you do know your friend never called me - hasn't called me - COULD call me - to come and sit with her, be an advocate for her, etc. Not dogging your friend in particular, but isn't it interesting how some people who HAVE options and KNOW they have options STILL don't CHOOSE those options? But would rather sit in the drama? What is up with that?

Thank you, Katherine. We should go eat sushi together. *smile*

September 22, 2005 | Unregistered CommenterNavelgazing Midwife

She lives up here in WA, and I think that when I provided her an opening to really think through a UC she realized it wasn't for her.

My SIL did move down there and I am hoping she gets in touch w/you for well-woman care.

Thanks for being open, Barb. :) I hungrily wait each day for a new post!

September 22, 2005 | Unregistered CommenterKristina

I didn't even know there were that many people who do UC. Just goes to show how much I still have to learn.

As everyone else has already observed, this was a very powerful post, and fantastic writing. Well done!

Also, have you ever considered writing a book on birth rape, birth trauma and birth abuse? If not, you should!

September 23, 2005 | Unregistered CommenterSNM

I already have a complete book outline regarding birthrape. I wrote a long article and submitted it to Mothering who said take it to Midwifery Today who said it was wayyyyyy too long - maybe write a book instead! So, yes, a book is in the works.

I have a lot of surveys women have filled out for me, too, about their birthrapes and birth abuses. So, I am well on my way to formulating something that would be heard eventually.

I know that the Psych degree and title will help to get anything published once the time comes. Midwife-Therapist - wouldn't you buy that book? *laughingwink*

September 23, 2005 | Unregistered CommenterNavelgazing Midwife

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