Entries in birth advocacy (7)
I ran into Amy Romano of Science & Sensibility here in San Diego a few weeks ago and thought I'd prove it with a picture. laughingwink
It was wonderful to hug you, Amy!
Today begins a new chapter in my life.
For those that know me, that is hardly unusual; I almost thrive on new beginnings! I’ve started and stopped several adventures since I’ve been back in San Diego these last eleven years. I thought about making a list, but simply reading through my blog, you can recount many of them for yourselves. laughingwink
But this new start is more profound; doesn’t include learning additional skills or investing in a start-up kit. Instead, this undertaking capitalizes on the very best of who I am –as a woman and as a midwife.
Today, I’m setting aside my homebirth midwifery career. In this moment, it seems long-term, maybe forever, but, as a woman and as Barbara E. Herrera, LM, CPM, I reserve the right to change my mind.
While my homebirth practice is being set aside, my midwifery licenses, knowledge and passion for birth remains intact.
I’ve been attending births for 28 years now (the anniversary is in two days) and over that time, I’ve been able to observe myself in a variety of childbirth settings and roles… from hospitals, birth centers and home… to doula then midwife. I’ll be fifty years old in two months, twenty-eight days; I know myself pretty well by now and it’s time I utilize my strongest attributes.
Today, I offer myself as a Monitrice and Doula to women birthing in the hospital. 97% - 99% of women have their babies in hospitals and, as most of us know, that can mean traversing a maze of technical and mechanical obstacles if one desires a more peaceful, physiologic birth experience. Even while choosing to (or having to) have their babies within the confines of a medical institution, I believe women have a right to autonomy and a peaceful, enlightened and empowered birth. I will not be conferring peace, enlightenment or empowerment, but I want to be a font of knowledge and skill from which a woman is able to drink.
It’s been interesting, this mental shift from midwife to monitrice/doula. I’ve wrestled with not seeing what I’m doing as a step backward, but a step sideways. A wise woman pointed out that I surely felt as if I was going backwards because so many of us in birth see being a monitrice and doula as a stepping stone to midwifery. But, perhaps the phrase, when asked if she’s a midwife, a woman says “I’m just a doula” needs to be abolished. What if we were able to say, “I’m a doula,” “I’m a monitrice” or “I’m a midwife” with equal pride and delight in our voices. (Hear me talking to myself?)
As a monitrice, I will be hired to help a woman who’ll be having her baby in the hospital, but who wants to stay home in early-to-mid labor safely. She’ll begin contractions (or her membranes will spontaneously rupture) and then call me. Once she’s begun her labor in earnest, I’ll go to her home and, for all intents and purposes, I’ll be her midwife as long as we’re there. I will keep a chart on the mom, monitor fetal heart tones, the mom’s vital signs and if she desires, check cervical dilation periodically. Then, when mom says, “It’s time to go in,” or if I say, “It’s time to go in” (either because birth is becoming imminent or there is a concern for either mom’s or baby’s safety), we’ll head into the hospital and there, I will become her doula, attending to a woman in all the wonderful ways a doula takes care of her client.
When a mom hires me as a doula, I will meet her once she’s in the hospital and laboring actively. As with the most doulas (who’re worth their salt), I will not interfere with the medical aspects of her labor, but will be the emotional and physical support she needs and wants. The benefit of having a midwife-as-doula is I recognize and understand the plethora of technical and medical lingo as well as the actions that go along with them. If a mom’s able to maneuver within the medical constraints, keeping the baby and herself safe, I’m utilized at my highest abilities. I know how to work those monitors, keeping them on mom and baby, holding the transducer on the baby’s heartbeat if I need to. The technology in the hospital doesn’t intimidate or scare me; I know it all well. (And, I know! I should have been a certified nurse midwife! Alas, in another life.) I know how to support the nurses so they’re better able to attend to my client. I’m comfortable seeing myself as an ally with the medical staff as opposed to an enemy, as someone hired to protect a woman as if I were a castle wall. I know, because I’ve seen it, that kindness and understanding between doula and nurse helps a laboring mom far, far more than antagonism and distrust. I’ve listened to doula after doula tell me how they despise hospital births, how they’re burnt out from watching birth violence and being so helpless to do anything about it. I’ve watched as doulas fall by the wayside of hospital births, some even saying they will now only doula with certain hospitals, doctors or even only for women who’re having homebirths. My heart asks, “Who helps the others? Are those that might need a doula most be left wanting… nay, needing… someone to, at the very least, bear witness to the assault upon their bodies and hearts?” I have a knack for helping women process difficult births; maybe I’m supposed to be one of those that replaces an overwhelmed, traumatized doula.
I believe in the benefits of birthing in a hospital. While I absolutely believe many, if not most, women can birth safely in the home, the reality is that isn’t happening –and doesn’t seem to be happening anytime soon. Hospitals, to me, are not The Enemy, but can be vital links to connect a family to their newborn. I believe the System as it stands now can totally use some re-vamping, some areas even in very dramatic ways, but unless someone (many someones!) stands within and humbly (or even arrogantly!) offers solutions, nothing will change. I don’t know if I’m that person and, honestly, it isn’t remotely on my agenda as I step into my new roles, but who knows what affect any of us has on another person… or institution… unless we do something.
I wrote “When You Buy the Hospital Ticket, You Go for the Hospital Ride” years ago. Sadly, it’s still a common refrain for most women to endure. I am only one woman… one old-ish, fat, loving, smart birth-loving woman… but, even I want to make my mark in the world. Imagine the stories I’ll now be able to tell! It doesn’t seem that homebirth midwifery was my (only) path. I’m setting out on another and from what I can see from here, the ways seems brightly colored, flower scent-filled and gloriously luminous.
Once again, here I go.
I've kept away from ACOG's Statement Against Homebirth because so many other people have done just fine responding to it.
However, I just came across a piece that is, to me, by far, the best response I have read. On
The Education of Genevieve's blog, she re-posts A Parody of the Recent ACOG Statement by a writer named Tienchinho. I've tried to find the author, but haven't been able to.
Assuming the author would love others to read her work, I re-publish it in its entirety.
A Parody of the Recent ACOG Statement
As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes.
I acknowledge ACOG’s right not to support programs that advocate for, or individuals who provide, home births, but I do not support a system that denies families the essential information to make informed decisions regarding maternal care. Nor do I support a system that lacks the resources to make VBAC a viable option for all women and ensure the quality of the mother-child dyad immediately after birth.
Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk.
Advocates cite the lack of rigorous scientific studies as one justification for promoting hospital births. Consistent dismissal of existing Level I evidence defining the risks of unnecessary interventions such as episiotomy, epidural anesthesia, and amniotomy has concerned proponents of natural childbirth for the past several decades and we remain committed to changing this. Birth advocates throughout the world use childbirth education, grassroots childbirth networks, and recently, the media to provide mothers and caregivers with the evidence.
Multiple factors are responsible for the persistent exceptions to evidence-based medicine in maternal care, but emerging contributors include a fear-based climate that skews mothers’ decision-making abilities and forces caregivers to follow “standards of care” that ignore the scientific evidence. The availability of a birth attendant to provide continuous labor support and of a midwife to provide expertise and intervention may be life-saving for the mother or newborn and lower the likelihood of a bad outcome.
I believe that the safest setting for labor, childbirth, and the immediate postpartum period is one that respects and trusts the birthing process, that meets the Baby-Friendly and Mother-Friendly standards jointly outlined by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Coalition for Improving Maternity Services(CIMS) and is supported by birth advocacy groups.
It should be emphasized that childbirth comes with inherent risks. Implying otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures.
They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as “dystocia” and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby.
I encourage all pregnant women to get prenatal care and to make a birth plan.
Safeguarding the process of giving birth promotes a healthy and safe outcome for
both mother and baby. Every woman should seek balanced information to guide her
decisions throughout pregnancy, childbirth and parenting. For women who despair in the lack of choices, they should look for hope in mothers who have navigated this climate of fear successfully. We are here.