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Exposition Trail: Intro

It's true. I have real concerns about the level of education and training of many non-nurse midwives. I first confessed my beliefs in a 2008 post called "Midwifery Education." That post was so reviled and I was smacked so hard by the midwifery community, I pulled, then edited the piece, now called "Midwifery Education (Lite)." In that post, I said:

"I like that nurses all go through the same courses. They don’t all have the same experiences, of course, but all have the concrete base. All that “boring” stuff I mentioned above lays a foundation of commonality that continues into the Master’s Program a nurse enters to get her midwifery degree.

LMs and CPMs come from a wide variety of backgrounds and that can be great and not-so-great. Some, like me, tried the apprenticeship route, but found working with many different midwives was a better fit. I also didn’t have the foundation of a MEAC-accredited school, something I think is imperative today and something I definitely missed out on. I know there are non-MEAC schools and they might be phenomenal, but the way our society leans is towards accreditation and having the MEAC approval means the schools went through some pretty tight hoops to get where they are. I’ve considered going through one of the three-year schools even now, but know I want a different type of experience than what MEAC-schools have to offer."

I ended the post enrolled back in school, wanting to become an RN and then possibly CNM. I just knew I needed and wanted more education.

A lot has happened since then. To me and to others. I've kept my eyes open and have seen some rather harsh experiences in birth, too many at the hands of non-nurse midwives.

Below, I share a part of the birth story from Natural Birth Goddess' blog... the January 23, 2011 Homebirth of the Twins. Even though I've been formulating this series for some time now... and it's certainly picked up momentum since I've left homebirth midwifery behind... this birth story is the perfect springboard to emphasize the crucial importance of education and skill in a homebirth midwife. While this birth took place in a midwife-illegal state and many have equated that aspect as an excuse for the midwife's actions, I know (because I've heard it several times) the same sort of actions happen in midwife-legal states.

I'm sure to piss off a whole lot of folks by my trip down Exposition Trail, but so be it. I know my thoughts are the thoughts of others, women who spend time in my email and on the phone, not knowing who to go to or who to report their midwives to. And I have similar thoughts as other midwives who also think formalized education can transform homebirth midwifery. But that story will unfold with time.

For now, sit as I did, in disbelief at what I was reading.

"I got about 5 minutes to nurse both babies and cuddle them before the second placenta (Ariana's) was birthed.  I noticed, immediately, however, that there were some large blood clots that came with the placenta (the first placenta had not been birthed, yet).  That concerned me greatly...and although the midwife reassured me that all was fine (I mentioned it repeatedly that I was concerned about the blood clots) but she immediately started giving me herbal tinctures to help with contractions and stop bleeding.  I didn't think much of it at the time.  I was just focused on getting the first placenta delivered (and worrying about the blood clots). 

However, as I pushed, I would feel gushes of blood.  Since I had hemorrhaged before with the birth of my second child (Adrian), I knew the signs all too well.  I had mentioned the bleeding to the midwife and she was still reassuring me that all was fine.  She had me changing positions (standing, squatting, sitting, etc) and pushing.  Nothing was happening.  Nursing the babies didn't help, nipple stimulation didn't help.  I asked several times about the clotting and the bleeding and stated, "I'm hemorrhaging" and she reassured me that all was going along fine.  I got to the point where I felt like I needed to lay down (I was still in the bathroom).  My husband helped me to the bed where I laid down and pushed a few more times.  I remember feeling like my energy was slipping away.  I felt weak, I felt cold and I wanted to say something and I couldn't say a word.  I looked over in to the bathroom and was shocked at the amount of blood that was on the floor, the towels and the chux pads.  I tried to say something to the midwife about the blood, but I couldn't get the words out (I knew this was bad)...at that point, she put the oxygen mask on me. 

I remember my mom asking the midwife if she was going to call the ambulance.  I remember the midwife was sitting at the end of the bed and said, "I haven't decided, yet."  At that point, my husband grabbed his cell phone and called the paramedics.  My husband called for the ambulance at 7:05am.  Almost 35 minutes after I first noticed the blood clots.  As soon as the paramedics were called, the midwife and her assistant grabbed all of the bloody towels and put them in a garbage bag, mopped up the floor quickly, and threw away all of the chux pads.  The midwife even changed the chux pad that was under me, and full of blood. 

When the EMTs arrived, I had a little blood on the chux pad.  My husband had told them I had hemorrhaged and was losing a lot of blood.  I remember seeing 2 of the paramedics look at me (and the not very bloody chux pad under me) and look in the bathroom and not move any faster.  There was no urgency. 

After what felt like an eternity (they asked me if I was having problems with the last placenta, and the midwife mentioned I had been up for 30 hours--which was a total lie) they took my blood pressure (which was very high) and strapped me to the gurney, got me into a (very) cold ambulance.  The last thing I really remember in the ambulance is getting the IV inserted...and the one female EMT saying, "I think she lost a lot more blood than we saw..." 

When I was finally on the Labor and Delivery floor, we waited for the doctor to arrive.  Once she got there, I was given Cytotec (to increase the contractions--and it did this very effectively) and some pain killers (the contractions were that bad--and I could not imagine being induced with Cytotec, which is dangerous, anyways).  The placenta was delivered within a few pushes and I laid down on the bed.  After an hour or so, I wanted to get up to go to the bathroom (couldn't stand the thought of a bedpan) so the nurses helped me--reluctantly because they wanted me to use the bedpan--and I almost immediately passed out.  That is the last thing I remember until several hours later. 

Just after I passed out, I was started on blood transfusions.  I got 3 units of blood that day.  The doctor (who was absolutely great) wanted to keep me overnight for a 4th transfusion, but gave me the choice to go home since I  was eating, looked good (all my color was back and I was coherent).  I chose to go home that day because I wanted to get home to the girls since I had spent the first 14 hours of the girls' life in the hospital without them.  My blood count was in a "safe" range and the doctor was ok with me leaving. 

While I was in the hospital, I had 2 really good friends drop everything that they were doing to wet nurse the babies since I really wanted to avoid formula feeding them.  I cannot tell you how reassuring that was for me.  To know that the babies were being well cared for and fed while I could not be there just took so much stress and worry off of me and gave me the relief I needed to get well enough to get home to them. 

The next few days were a bit of a haze (as it is for any new parent).  The twins started out on very different sleep and nursing schedules that I was only getting about 45 minutes of sleep at a time.  I did have friends and family over all day long that helped with my other kids so I could spend all my time in bed resting and taking care of the babies.  It took about 2 1/2 weeks for me to really get used to having twins.  But I found, despite most other advice, that keeping them on their opposite schedules actually suited me (and my family) very well.  With not having to nurse, burp, and change 2 babies at the same time all the time, I have the time to really spend with each girl. I can nurse, change, and burp each individually and then cuddle with each one by themselves.  I really love the one on one time I spend with them. 

Overall, my homebirth was very good.  Excellent, even.  I did learn, though, that if there is any apprehension or concern about anything that is going on during the birth, you have to put your foot down and make the decision for yourself.  You are in charge of your birth, every aspect of it.  I should have told the midwife that I wanted to go to the hospital immediately when I saw those blood clots.  I don't, completely, blame the midwife for not transferring me sooner, but I do think she waited too long."

Mom wanted me to share the story. At first, the midwives she'd shared the story with told her everything was fine, to just move on. It wasn't until I read and commented on the story, followed by other midwives reiterating her midwife's egregious inaction that she began to believe she had a right to be angry. She has not seen or spoken to her midwife since the birth. I've counseled her to wait awhile, until she's somewhat healed from the anemia and twin birth before scheduling a sit-down meeting with her.

Mom also wants it known that she consciously chose to homebirth, that she felt her options were more dangerous in the hospital, a vaginal birth in the operating room or a scheduled cesarean, but she had discussed, at length, the seriousness of her hemorrhage history and how the midwife would handle a PPH if it happened again. She convinced the mom of her skill and experience in this area; she obviously lied.

I was shaking with fury for over an hour after reading this story. Part of my anger is the increasing frequency of these stories. Something has to be done. And the only people to do something is us... if we don't want to watch homebirth midwifery be illegalized everywhere in this country.

My writing is so we can talk, openly and transparently, about the changes we must make to homebirth midwifery... changes that, literally, saves the lives of mothers and babies.