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Entries in birth mourning (1)

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?”