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Monday
Feb112008

The Gray, Grey Messenger - Gloria LeMay

These next three posts wind around and around. It's taken weeks to write them and while each can stand alone, I believe they are all entertwined.

I hope they make some sense to you readers. Thanks for your patience in sloshing through.

I re-published the “Sanguineous Shock” piece after reading what Gloria Lemay had to say about unassisted birth. You can read the entire response on dear Rixa's site - Gloria Lemay Responds... - but there are parts I simply must take to task.

Gloria says:

“First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING. Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough IV fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could. I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting."

"Think about it--would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes? I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up.”

So, just because Gloria hasn’t seen a mother bleed to death in 5 minutes means it doesn’t happen? Does a midwife have to SEE something happen before she believes it can occur? Does a mother? Father? Nurse? Doctor? How could she not have learned about – heard about Amniotic Fluid Embolisms? Disseminated Intravascular Coagulation?

“AFE is considered an unpredictable and unpreventable event with an unknown cause. In the national registry, 41% of patients had a history of allergies. “Reported risk factors for development of AFE include multiparity, advanced maternal age, male fetus, and trauma. In a retrospective review of a 12-year period encompassing 180 cases of AFE, of which 24 were fatal, medical induction of labor increased the risk of AFE.8 In the same study, AFE was positively associated with multiparity, cesarean section or operative vaginal delivery, abruption, placenta previa, and cervical laceration or uterine rupture.”

While a homebirth midwife wouldn’t be participating in any medical induction, cesarean, traumatic birth, forceps or vacuum, we do have women who have had more than one baby, women that have sons, women who are over 35, could have a uterine rupture or placental abruption, a cervical laceration and, if the woman hasn’t had a sono, possibly a placenta previa (although there are usually signs beforehand that the placenta is overlying the cervix). And, as we all know, there are going to be some women who don’t fit into these categories at all.

So, why would a homebirth midwife continue attending births even though she knows there is a risk of losing a woman in under 5 minutes? Why do I attend births knowing what I know – having seen what I saw 20 years ago?

When I first went to learn midwifery and left school with a license to practice, it was the birth in the poem that continually danced in front of my eyes. I kept thinking, “What if that happens when I am the care provider? How will I handle the death of a woman… or baby?”

Reader Comments (9)

Thank you. I wondered at the time if Gloria Lemay's piece was what prompted that post. Now I have my answer.
As you since noted in your response to Christy's 10 myths, qualifications and disclaimers are always in order when talking about safety in birth. Point very well taken.

February 11, 2008 | Unregistered CommenterJudit

I was in the cervical laceration category. But it scabbed over and didn't begin to hemorrage until a week postpartum. It wasn't a five-minute affair, though...thank goodness, or I would have been dead before I got off the phone with 911. It was definitely so dangerous that they were on the verge of just taking out my entire uterus because they couldn't figure out where all the bleeding was coming from (glad they didn't, since it wasn't even coming from there!)...but it didn't happen in five minutes. I'm sure it COULD, though, and I'm glad it didn't to me.

February 11, 2008 | Unregistered CommenterJill

Jill, if they'd have done a hysterectomy, they *would* have removed the laceration and stopped the bleeding... remember, the cervix IS the uterus... just the part that pokes into the vagina.

I'm glad you are well!

February 12, 2008 | Unregistered CommenterNavelgazing Midwife

Oh. *blush* I thought they were seperate parts. Guess it's back to anatomy class for me. :)

February 12, 2008 | Unregistered CommenterJill

Thank you also for writing so vividly about the most dreadful outcomes. Those which midwives know are out there, but somehow seem amorphous and surreal. Until of course it unfolds in front of you, with your hands in the middle of things and you take that long, deep draught of fear and reality and despair. I've struggled with this these past months as the universe has showed me early these things too. The weight of two lives in your hands is not an easy one to shoulder, harder still when you actually *know* (have seen, felt, heard, smelled, touched) life slipping away. When I hear the voices talking flippantly or simply ignorantly about these realities, it makes me think that they have not yet had those experiences, and have not yet learned the lessons which you can't help but learn from . I would be very worried if they had, and chose to remain flip and ignorant. That is *much* scarier than the alternative which is to learn more, be a sharper, wiser practitioner...
Morag.

February 12, 2008 | Unregistered CommenterMorag

Interesting. So I guess the PPH I witnessed in my friend after a spontaneous unmedicated labor, birth and third stage didn't really happen. She had no surgical wounds or trauma to her tissues. No one pulled on the cord to precipitate delivery of the placenta. It came on it's own, followed by lots and lots of blood and eventually clots the size of the placenta itself.
So I never held my friends head in my hands while she was slipping in an out of consciousness or slid in her blood on the LDR floor. It couldn't have happened since she had no surgical wound.
Thank you Barb for trying to balance the nice normal ideal with the rare but all to real; reality.

February 12, 2008 | Unregistered CommenterAnonymous

LeMay is a dangerous woman. Having personally witnessed both fetal & maternal demise, I know that we never, EVER have 'an hour' to play with & that if only it were simply down to surgical woundings.

If only.

February 15, 2008 | Unregistered CommenterAgatha

Is Gloria Lemay going to be at the Trust Birth conference? Is someone going to call her out on her ignorance and make it clear to all attendees that on this particular topic, she is completely full of it?

Or is no one going to bother?

February 15, 2008 | Unregistered CommenterAnonymous

Barb,

Thanks for posting this. I really enjoy that you try to see both sides of the story. It is scary the misinformation Gloria seems to have. I saw a pretty hefty PPH, how quickly it happened and how hard it was to stop the bleeding.

February 17, 2008 | Unregistered CommenterEmory Student Midwife

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