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Thursday
Jun152006

Border Patrol Learns "Emergency" Childbirth

http://www.10news.com/news/9372210/detail.html

The gist:

Border Patrol agents are learning how to "deliver" babies that might be born in the middle of nowhere. A San Diego hospital (the one with the highest induction, epidural and cesarean rate) is giving them a three-week course (8 hours a day? 5 days a week?). They are practicing on doll babies, but will also be observing births (or participating, it isn't clear) in L&D.

My beef:

How in the heck can a hospital teach normal birth - or even normal birth with minor complications during birth - when nearly all of the women they deal with are drugged in one way or another? How realistic is it going to be to watch as woman after woman is wheeled into the operating room for a baffling array of reasons from "because I want the baby born now" to iatrogenic disasters? Don't you all think this type of training (and I use the term loosely) is going to scare the bejeebers out of these people?

Why didn't the supervisors consider the plethora of Licensed Midwives in the San Diego area? There are at least 15 to choose from; 20+ are Licensed, but not all live in San Diego or are actively working as midwives.

I would think a Licensed Midwife would much better be able to demonstrate normal birth without medications and medical paralysis. Or, are the agents being schooled in giving desert epidurals, too?

And what the heck is taking three weeks?!?

1. Keep your hands off the woman and baby
2. Watch for a cord and remove it if necessary
3. Cut the cord if it hampers the baby's decent
4. If the cord comes before baby, put mom's ass high in the air and her face on the floor of the car/truck and race to the hospital for a cesarean.
5. Don't pull on anything! Cord, head, hand, vagina included
6. If the head comes and the body doesn't, change the mom's position to a lunge (even lunge one way and then the other) - if that doesn't work, flat on her back, knees in her ears, and supra-pubic pressure should dislodge the baby's shoulder from behind the pubic bone.
7. Do not try to "deliver" the placenta! Just let it come when it is ready.
8. If there is bleeding before the placenta, have mom stand to see if placenta is ready to be born; if it doesn't come, do nipple stimulation (put the baby to the breast) to make a contraction to encourage its birth.
9. If there is bleeding after the placenta is born, massage the uterus while also putting the baby to the breast or having her do nipple stimulation to contract the uterus.
10. Keep mom and baby and placenta together. No need to cut the cord!

How hard is that?

Since they are always taking women to the hospital, any birth that isn't straightforward like this will be in the hospital anyway. Prolonged labor, bleeding, mom having blood pressure issues, etc. all would find their way in the hospital (just like UCers do).

I wish I could go through their course or get the agenda so I could see what exactly they are learning. Wouldn't it be nice if a Licensed Midwife had some input that demonstrates the normalcy of out-of-hospital births?

My favorite quote in the short piece was:

“Babies are born all over the world outside the hospital,” said Irene Carr, of Scripps La Jolla.

Now, isn't that just so!?

Ayup. She's right.

Reader Comments (11)

Oh my! Please tell me you are submitting that for the Grand Rounds!!! Or at least to the Boarder Control for their perusal!
k

June 16, 2006 | Unregistered Commentermm

MM - I will submit this for next week's Grand Rounds because I WAS ACCEPTED FOR THIS COMING WEEK'S!!!

(*happily clapping and cheering*)

What I didn't say in this piece is how would *I* react if I were asked to teach Border Patrol myself. I might need to write a piece about it, actually. I have REAL serious issues about Border Patrol and what their job requires them to do to migrants. However, would I spend time to help them make a migrant woman's birth experience more humane and caring? That I think I would do.

June 16, 2006 | Unregistered CommenterNavelgazing Midwife

I'm afraid that I have very little exposure to boarder issues... well, unless you count the one about an hour South of me, and that just entails the lousy mood of whomever is working that day =)
CONGRATULATIONS ON GRAND ROUNDS!
Feeling like you are part of the club yet?
I've got a few posts I haven't put up, that I'd like to submit... but I'm not sure I want all kinds of strange people coming to my blog!
Ayup, too chicken!
Could you please enlighten me to the proper way to say Ayup... I'll tech you to say 'eh with a perfect Canadian accent =)
k
*would you teach them, if they asked? I mean you could be a guest for part of the training... ?

June 16, 2006 | Unregistered Commentermm

Do you think that dopplers will become standard issue for Border Patrol?! Do they already carry BP cuffs in their emergency first aid kits? But hey if all they need to learn can be done in 30 minutes, via your list, then what have I been doing the past 3 years! (just kidding) You would make a great teacher for them, judging from what you did with the SD EMTs :)

June 17, 2006 | Unregistered CommenterAnonymous

Anon: I didn't even think about dopplers! How interesting. I don't know about BP cuffs, but I don't think so. I can ask (contacts will know).

I never said you could learn ALL about midwifery in 30 minutes!!! I said "EMERGENCY" childbirth shouldn't take 3 weeks. Midwifery is full of nuances that take time, time and more time to feel and find. Life experience can't be rushed. Precipitous birth, on the other hand, tends to be on its own trajectory and needs very little assistance.

(We do know, of course, that migrant women birthing en route aren't necessarily precip-ing, nor are they in high emergency.)

Thanks for the kind words regarding EMS training. I enjoy doing in-services very much.

Wonder where I'd go to speak with someone at Border Patrol?

June 17, 2006 | Unregistered CommenterNavelgazing Midwife

But don't you KNOW that babies born outside of a hospital die? LMAO!
Oh, and if they don't die - they are destined for celebritism....because it's just a stroke of luck that babies are ok when born by *accident* at home, on the road side, in a car, fill in the blank....but when someone educates and prepares themselves AND has an attendant well experienced in normal childbirth...well, THAT'S just irresponsible and selfish
(choking on my own sarcasm)
Why does it take 3 weeks? Because 90% of the course will be to cover their legal asses and that has nothing to do with the normalcy of birth.

June 18, 2006 | Unregistered CommenterLife's Laundry

Oh man, this is so true. No epidurals in the desert, my friends.

And the bare-bones information on what to do when thing dont' progress smoothly was classic - I learned so much from that (OB not my specialty).

Hopefully, somewhere, somehow they will see a non-epidural, non c-sec,
normal birth so that they can see the difference.

You have to know normal before you can recognize abnormal!

June 27, 2006 | Unregistered CommenterKim

I'm an ER RN, and my son was born at home...........
This post was excellent in so many ways, and I think you told them exactly what they need to "watch out for".
someone mentioned dopplers and bp cuffs in the comments..........omg, i had to laugh on that one. Birth is such a natural thing. i would have punched my midwife had she used either.

i do need to tell you that i originally went to RN school to be able to make money while training to be a lay midwife......well.......apprentiships are difficult to come by......and i'm working er/trauma until i can do my original calling. yikes......nursing school ob sent me home crying every single day. my instructors hated me.....

if the ladies are migrating and moving things should go well...., probably wouldn't hurt to have suction, o2, and intubation stuff nearby. haha

once again, this post is excellent!

July 2, 2006 | Unregistered Commenterjen

"someone mentioned dopplers and bp cuffs in the comments..........omg, i had to laugh on that one. Birth is such a natural thing. i would have punched my midwife had she used either."

Goodness!

Pre-eclamptic fits, post-partum haemorrhages, maternal deaths, foetal deaths are all "natural" too.

You are entiteld to your opinions but opinions like this need to come with a health warning.

Why is it that, whatever happens, you radical midwives will never listen science or indeed to common sense.

Please read this:

http://nhsblogdoc.blogspot.com/2006/05/home-birth-tragedy.html

An avoidable foetal death, and STILL the midwife concerned believes in home delivieries.


John

July 4, 2006 | Unregistered CommenterDr John Crippen

I remember in nursing school we spent about 10 minutes on "emergency" deliveries. I would have died had we spent 3 weeks :)

July 4, 2006 | Unregistered CommenterDan

Awesome post. I think it's great if Border Patrol is learning emergency childbirth, I can see that it could come in handy, and maybe save some lives. You are 100% right in pointing out that this would be EMERGENCY childbirth. Certainly the circumstances would be terrible, and who knows the health status of the pregnant moms, but if emergency birth is happening, and the border control can be more educated to allow a better chance for a good outcome, who could argue with that?

July 4, 2006 | Unregistered CommenterLisa Beers

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