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Entries in unassisted birth (6)

Monday
Jun272011

Disclosing Homebirth Plans to OB

On my Navelgazing Midwife Facebook Page, I asked:

If you had an OB and had/are having a homebirth, did you tell your OB? What did s/he have to say about it? Have any of you been fired from care for disclosing your homebirth plans?

I asked this because I’ve had a couple of recent inquiries about whether to share their upcoming homebirth plans with their doctor or not. My advice is to explore why you want to tell the doctor. Do you want him/her to be your back-up in case of an emergency? Do you feel that not telling is lying by omission? Do you honestly want to know what your OB thinks about your having a homebirth… whether you’re a safe candidate or not? Each woman has to answer those questions for themselves, but every single one of them also has to be prepared to be dismissed from care if their doctor isn’t too keen on the whole homebirth thing. It might not be fair, but that’s the way it is. For many doctors, even those who might be supportive (albeit, grudgingly), their malpractice insurance might not allow them to speak about their feelings, much less act upon them.

Here's how the women answered my question. No names given, of course.

C: No, I didn't want to deal with any comments my OB would have about my home birth plans. I saw the OB three times in my pregnancy for ultrasound and labs, and my midwife for all the other visits. This time I'm not planning to see an OB at all.

 J: I'm pretty upfront - my occupation is "homebirth midwife" after all. She didn't flinch one bit, although I know she personally is not a homebirth fan. But she gave me the consultation I needed. I like her a lot. She pulls no punches, just tells you what she thinks, no manipulation.

M: I hinted without saying my plans. She apparently never got the memo. After <my baby> was born (planned homebirth with a midwife turned unplanned UC [Unassisted Childbirth]), I called her to say the baby was born. She wanted me to come in right away and "get checked out". When I refused, she pretty much refused me ANY postpartum care (battled thrush, mastitis, depression); didn't matter. She was pissed and though she never dismissed me from her practice, she refused to see me and instead my appointments were with the [mean, nasty, devoid of feeling] CNM.

J: There is only one practice in our area, a family doc, who will knowingly do dual care for home birth women. Even the CNMs will kick you out of their practice if they find out you are having a home birth. Seriously! There is one group of CNMs who will do dual care on a "don't-ask-don't-tell" basis, but the others are openly hostile to home birthers, as are the OBs in our city. Any hint that a woman is considering a home birth and she'll get a discontinue care letter.

K: I sought care from the OB who performed my Cesarean for scar tissue issues, and since I was newly pregnant, but not her patient she wouldn't see me. A week later I got a letter dismissing me from her practice along with a tear-out of the increased-neonatal-death-with-planned-homebirth article. Had a beautiful healing HBAC three months ago. 

L: It was very much our intention to have an OB attended homebirth.

J: Recently, I had a client switch care to me for Out-of-Hospital birth. Then, she got cellulitis/mastitis on day four and her OB took her back, called stuff in, saw her in person when that didn't work and treated her beautifully. I really appreciate that. She didn't have to do that. She could have sentenced my client to the walk-in clinic of uncertain-care.

L: My OB took it pretty well, although he made sure to mention he wouldn't let his own wife or daughter do it, and he asked that I please call him after the birth to let him know that the baby and I both "survived." At a later GYN visit he was very excited to show me an article in some medical journal entitled "What If My Patient Wants a Homebirth?" and how, thanks to me, he has a better answer now if it comes up again. I found the whole experience amusing and I'll probably go back to him for shadow care when we have our next home birth. He delivered my first daughter in the hospital, so I did have a bit more history with him than just random prenatal visits along the way.

M: I was seeing an OB for fertility issues. When I completed the first trimester and was comfortably out of my personal "worry zone" for repeat miscarriage, I let her know that I was switching to a licensed midwife for a homebirth and she supported me completely. She is one of the local favorites for natural hospital birth and midwife backup. We are lucky to have her!

N: I'm seeing an OB but have UC plans, which I most definitely have not shared!

C: My OB used to run a solo practice and is now partnered with two other doctors. He was wonderfully supportive of my unmedicated hospital births when he was the only OB there, but I wouldn't go back to them because I don't know and trust his partners. When I was pregnant with a miscarriage I called to see if I could get in for an ultrasound and was told I would have to schedule the full OB workup at ten weeks in order to be seen in their office at all.

E: With my second pregnancy (first home birth) I told my OB at around 16 weeks. Every visit included a diatribe about the risks of home birth. Finally, at 32 weeks I said 'please make a note in my chart that I don't wish to discuss it any further and if I have to keep going through this I will terminate my care'. It was not mentioned again. With my 3rd pregnancy, the practice already knew my history and was more relaxed about it. My 4th and 5th pregnancies I had no OB care.

P: LOL to the term "fired". Doctors do not pay their patients.

Navelgazing Midwife: I understand, P, but when you can be "dismissed" from their care, it isn't uncommon to consider that fired. It does seem like the only person who can fire should be the woman firing her provider, but The System is twisted enough that women ARE fired from care.

C: I've told my OB for both planned homebirths (the first of which transferred to the hospital). I was offered the same prenatal care as anyone else birthing with his practice (which was still not as wonderful as my homebirth midwife's prenatal care). 

The second time, only had prenatal care I didn't have access to with my homebirth midwife after my first visit to say, "I'm pregnant and having a homebirth, but would like to have a plan B option." The other two visits were for an ultrasound and Group B Strep screening. My OB wished me well and made sure to tell me to not to hesitate coming to the hospital if I need anything.

J: Yes. In 2001 in San Diego. It sucked.

A: My OBs obviously don't recommend it, but they give me care anyway. Though, I am convinced it isn't the same care since they know. I also am monitored by a midwife. So many other women I know that see the same OBs tell me such different stories about how their visits go. I guess maybe they think I get everything I need from the midwife, so don't monitor me as closely. I am convinced they just pick numbers to write in my chart as measurements.

E: I saw an ob a few times -- I specifically drove an hour each way to see the one homebirth friendly ob in my city. I told her and she was cool.

K: I didn't tell my OB face to face, but I did tell the front office I wanted copies of my records because I was considering a homebirth. They let me have them for $1 a page. At the next visit, the Dr. didn't ask me about it so I didn't volunteer anything. I didn't get fired; I quietly fired him. Called the office to cancel the next appointment; they were closed (weird, it wasn't a holiday), so left a voicemail saying I was canceling the next appointment because I has chosen to have a homebirth. I was 29 weeks. I never heard from them at all after that.

C: I saw an OB a few times to do genetic counseling (I was paranoid being Advanced Maternal Age) and never told him my plans to UC.

R: I didn't share with the OB my plans of a UC!

A: It was important to me to co-care, and also to not be lectured. So I did not feel obliged to divulge my birth plans.

J: My former OB has two CNMs in his practice. I mentioned, on the first visit, that I was considering a homebirth. (First pregnancy but had been to him for well visits.) He mentioned that with his practice, I could have a, "home-style birth in the hospital" but otherwise didn't push. At 20 weeks, I switched care to my homebirth midwife. Everyone at his practice was cooperative and I never looked back.

C: I was fired from the practice.

S: I'm from the United Kingdom and I was under OB care, when I told her I was going to have a homebirth she went completely mad! Told me I would have a heart attack if I didn't come into hospital as I had Pregnancy Induced Hypertension. I spoke to the head of midwifery and she was great! In the end, our baby arrived unassisted in our living room. If i would of gone to hospital she would of been born in the car! 

R: Nope she never knew. 

L: It is interesting to read everyone's comments. I have an OB and decided not to see him for prenatal care because I didn't want to risk being ousted OR putting him in an awkward position with the Clinic he's with. So when I needed a script for tests, I saw a local DO who provides parallel care for others as well.

A: In my area, your general practitioner cares for you until around 20 weeks at which point you are transferred to OB care until the end of your pregnancy (New Brunswick, Canada). In a small percentage of cases GPs do deliveries and only transfer care or consult if needed. For my second pregnancy, I advised my GP that I'd hired a midwife for a homebirth, but that I still wanted to see an OB/GYN to introduce myself. I went for one visit with the OB and told him our plans. He reviewed my charts from my previous birth, asked if I was confident our midwife had enough training and told me there was a 99% chance that I wouldn't need him or the hospital. I was totally flabbergasted. He suggested I send in my charts from the midwife after 36 weeks in case I needed to transfer. I wish I could call this OB wonderful on all counts but, I've since worked with him for a few doula clients, he's got some good and bad points, is all I'll say. He also supports placentophagy... go figure!  

L: I planned on having a homebirth; then we ended up seeing OBs. My husband mentioned my wanting to homebirth and the OB said basically "Oh no, you don't want that." Never said anything about it to him again but, tried to find out if there was a practising midwife around - nothing. If I'd said something at nanowrimo write-ins though, I'd have had a better idea (as I found out a year later).

While I didn't homebirth, I really wish I had done what I wanted in the first place - my husband finally ended up talking to his midwife-friend who he'd kept telling me I should contact from that first anti-homebirth sentiment we got; she was there for us and was a whole lot better than the L&D staff - suggested helpful things before they even thought of them. If I were pregnant again, I'd be planning on a homebirth again.

R: I was planning a homebirth w/a CNM (with family doctor back-up) until 27 weeks when an ultrasound revealed twins. I switched to a hospital-based OB group with CNMs and tried to avoid revealing my PRIOR plans -- even though I was no longer considering a homebirth, I feared being treated as a "nutso" and disrespected for my original choice. The doctors already seemed annoyed enough at my lack of early-pregnancy ultrasounds and switching to their practice so late in pregnancy. I needed them to take me seriously and be partners in my care and didn't want to alienate anyone. I didn't even want the nurses in the hospital to know. When we arrived at the hospital at 39w5d with me in VERY active labor and the nurses rushing around, my mom mentioned it and I got upset, even though it clearly didn't matter at that point (the babies were born an hour after I arrived, I don't think anyone even had time to read my birth plan). For reference, my care providers are in the area described by J. above, so the fear of bias wasn't just in my head!

J: I live in Washington State where CNM are licensed to do home births, so when I told my OBs, they were supportive and fine with it. In their practice they employed two CNMs that delivered babies in the hospital. They also told me if I needed to transfer to the hospital to have the nurses page them and they would cover my birth. So I really did have the best of both worlds. I realize that I am in a minority!

Me again.

I had concurrent care with my second baby, my UC baby. I certainly didn't tell the OBs I saw at the military hospital. I got enough crap from them after she was born. They even sent Child Protective Services out to the house to make sure we weren't neglectful parents. No, just really, really hands-off. (Much more so then than I am now!) With my third baby, my military CNMs did know of my homebirth plans with a legal hebamme (German midwife) and were wonderful about it. When my plans changed because my membranes had been ruptured longer than the hebamme could legally keep me as a client, the midwives embraced me as a hospital-birthing mama, promising to make the birth as peaceful as possible. I ended up delivering in the car with a CNM and an OB; I wouldn't consider it "peaceful." Hilarious was more like it.

In a perfect world, we'd all be able to share our whole stories... care would be seamless, whoever we were sitting in front of. It makes me sigh with frustration that women are often forced to either lie or omit information because they might lose an important link in their pregnancy care. I applaud the providers that withstand the enormous pressure to punish and ignore women who are choosing to birth at home. Thank you for your tenacity! I also applaud the women who walk the thin line of another form of Don't Ask, Don't Tell... the kind that can get you kicked out, just as readily as when it was gays in the military. Both are just wrong.

 

Tuesday
Mar082011

THE Video

Oh, my! What a ruckus Rixa’s birth to Inga (“Inga’s birth story, part 1”) has caused these past few days. If you’ve been hiding from blogs or out in space nowhere near a satellite, I’ll give you a very brief synopsis. But, you probably should go watch it first. It’ll help the discussion. 

<insert Jeopardy theme music> 

So, Rixa had the baby with just her man there… the midwifery assistant came in a few minutes after the birth (Rixa has the exact times noted) and then her midwife got there as Rixa and the baby were being tucked into bed. Her unattended birth was not purposeful despite having had a planned Unassisted Birth (UC) with her first baby. (She had a midwife-attended birth the second time.) 

Okay, so watching the birth, you see that Inga had some perking up issues, but Rixa gave her a few mouth-to-mouth puffs and she came around. Yay! Now, around the Net, oh my gosh, the noise is deafening. I won’t even quote the nasties being said, but suffice it to say some people think Rixa was the height of irresponsible and totally ignorant about how to resuscitate a newborn. And that she has a flat affect, which was the most baffling accusation of all, in my opinion. 

There’s been on-going discussions in the comments of both the first and second installments of Inga’s birth (“Inga’s birth story, part 2”), including comments from NICU nurses, midwives and others who regularly attend to newborns in trouble. Today, Rixa wrote a post about “Neonatal Resuscitation,” partly as a defense against the cacophony of criticism; it said (and the experts said) much of what I was going to say in this post, so I’ll be briefer than I was going to be in the first place. 

If we were to use Inga’s birth video constructively (and respectfully), this is what I’d say to others who might find themselves in a similar situation. 

I totally agree that Inga slipped into secondary apnea, which is a place where stimulation no longer works, but some sort of resuscitative efforts must be given (mouth-to-mouth or Positive Pressure Ventilation [PPV]). The question arises, though… if Inga had had more stimulation before she slipped into secondary apnea, would the secondary apnea have been avoided? 

Most of those reading this know there’s been a serious push to remember the sanctity of the newborn by not suctioning, not roughing them up like in the hospital, not flicking their heels or sliding your fingers up and down their back so hard their skin peels off on your fingers. So it’s not surprising to me that Rixa was very gentle with the baby. Could/Should she have stimulated her more? Perhaps, but instead of pointing fingers at Rixa, how about mentioning to others who might find themselves in a similar situation to rub the baby more vigorously… run your hand and fingers around the baby’s legs, rub her butt, rub her back. But, you cannot panic and do this or you can really hurt the baby. Talking to the baby is one good way to disperse the energy of concern/worry/fear. “C’mon, baby… time to wake up. Come be with mommy.” Or anything else that comes to mind. The talking can also help parents who have to helplessly sit and wait when others are doing the resuscitation. 

Much has been made about the baby (perhaps) experiencing cold stress as Rixa was giving the breaths and waiting for Inga to perk up. Rixa was in the birth pool holding Inga out of the water (right above the water line) and at one point, her husband offers a blanket and Rixa, with total clarity, explains how a wet blanket wicks cold all over the baby, causing a great deal of cold stress. She was absolutely right. We used to put blankets on babies in the water, I’m sure because it was a habit to dry and stimulate the baby with them on land. It didn’t take long for someone (Barbara Harper?) to nip that action in the bud. 

I love the article “Neonatal Resuscitation,” eMedicine/Medscape’s detailed explanation of what happens when the newborn stops breathing. In there, when talking about ways the baby can get cold, they reveal that even the most basic assistance can cause the baby enormous stress. 

“Another common source of heat loss in the newborn infant undergoing resuscitation is the use of unheated nonhumidified oxygen sources for the bag-valve-mask device. Inspired gasses that are sent to the lungs are subsequently heated and humidified by the infant, thus resulting in massive heat exchange due to evaporative heat losses and insensible water loss.” 

Lucky for Inga, her mom used a warmed and humidified oxygen source (Rixa’s own breath!), perhaps even balancing some of the stress she might have had from being held aloft out of the water. 

If you birth in the water and your baby needs some help, weighing (as Rixa did) getting out of the pool and drying the baby off versus getting right to the mouth-to-mouth, if you decide to stay in the water, you might try to keep the baby dipped in a little more. However, if it compromises your grasp on the baby, err on the side of standing up, getting a blanket and perhaps having your partner help you hold the baby while you give the breaths. It all sounds like a puzzle piece to remember, but if you play and replay it in your mind, especially if you’re UCing, the replaying can assist in the body memory in case it happens… you’ll have a head start on bringing your baby around. 

The last thing I want to address is Rixa’s peacefulness; what others have described as little to no affect. 

THE WOMAN JUST GAVE BIRTH! 

How anyone can watch and judge that she should have acted <fill in the blank>, must take into account that she’d given birth moments earlier. I, for one, saw a blissed-out mom who was yanked into reality to help her baby come wholly onto the earth. In part 2 of Inga’s story, Rixa says, 

“By the next day, the events of the labor and birth were already feeling surreal and dreamlike. Did I really go into labor and have a baby? Obviously yes, since I'm holding her right now! But it seems hard to believe that it really happened and that it's already over.” 

Could this have been the delayed reaction to the block of time it took to do the resuscitation and subsequent processing of it? That’s certainly possible. That surreal feeling often hits right after the birth and lingers from a couple of hours to a couple of days, but if Rixa had to set her joyous disbelief aside, I would totally expect the emotion to float back to her once the emergency was over. I love how calm she was during the resuscitation. For goodness sake, panic serves no one, least of all the baby. 

As a mother who had a baby in secondary apnea (my UC baby) and who sat immobilized to do anything, I am in awe at the clear-mindedness of Rixa and love the peace she kept as she was the one who kept her baby alive. That she cared enough to share her video with all of us is a testament to her generous spirit of continued birth education, even when she hadn’t planned for that purpose at all. 

Thank you, dear Rixa… and I hope your BabyMoon takes a softer glow soon.

Thursday
Jan132011

Defining Mid/Medwife

While the term “Medwife” is volleyed around birth circles on the Net and in real life world, I’ve wondered, for a long time, what the definition of each would be if we were to create/give them one. Sure, I’ve read numerous descriptions of what the differences are between the two, but never in a thread such as this (that I’ve seen).

I do know the strong feelings people have about these terms and really do want to continue the discussion, but ask everyone to please remain civil. (Isn’t it kind of sad that I even have to mention it?)

So here is how the thread went down on my Navelgazing Midwife Facebook  page. My comments/thoughts are interspersed through the piece in bold italics. 

DH1: MIDwives: Trust birth and do not interfere in the birth process unless absolutely necessary. They are highly educated and use that to their advantage in knowing when to or, more often, when not to interfere. They understand there is a wide variety of normal and that being "with woman" does not mean to control them.

MEDwives: Use the medical model of obstetric management to control birth using medicine, herbs, expectations, etc. for all kinds of ways to start, augment and speed the birth process. This variety is found more often than not working in the hospital setting although there are some still controlling birth in home settings as well.

KB: So do MIDwives convert to MEDwives and cancel out their trust in birth when the shit hits the fan on a perfectly unintervened birth and they need to resort to medicine and herbs?

JW: DH1 hit it with the control factor.

DH1: No. Midwives intervene as well but only when absolutely necessary... which is not very often. Medwives seem to intervene on a regular basis as "protocol". That is the different in my eyes.

KB: MEDwives are not as "highly educated" as MIDwives? Please explain that one.

RP: I have seen some "medwives" who you could not even tell the difference between them and an OB. In fact, my OB is more open to alternatives and has a lower rate of intervention than they do. I guess it was fairly obvious to me that there were what many would deem "medwives".

DH1: No, they have different training. Medwives are trained that the birth process is broken and needs to be tampered with in order to function properly. Midwives are trained to trust the birth process with a very thorough understanding of the physiology of birth, female anatomy and most importantly patience.

That you said “…trained that the birth process is broken and needs to be tampered with in order to function properly,” I really am baffled where that comes from. While I admit there are plenty of midwives who’ve been quick on the intervention draw (and I’m sure I’ve done that myself), having seen the curricula for midwifery schools (CPM & CNM), I have a hard time believing any midwife is trained or believes the birth process is broken. Maybe it would be easier if you could share some examples of what you mean.

I do think there are midwives who use technology for convenience’s sake, similar to OBs, but that’s different than believing the process is broken.

Also, if you’re looking at who has the more thorough understanding of the physiology of birth and the female anatomy from an educational standpoint, that is most certainly a CNM. CPMs get a fraction of A&P compared to CNMs.

RNK: With DH1 100%.

NgM: clapping hands Can't wait to get into this one later! grinning You all are wonderful! Thank you so much for your candor. This will be a hot button topic and already there's lively interaction. I think this topic is soooo worthy of discussion. Thank you, in advance, all of you willing to share your thoughts, even if they seem not to be the popular one.

KB: I wonder how you've been able to thoroughly assess the training modalities of "medwives" and "midwives" to come to that conclusion, DH1. And who are you talking about exactly. I've known many a "medwife" DEM and probably more "midwife" CNMs in my 10+ year career. I think it's a pretty faulty blanket statement to make and there is a lot of magical thinking going into the whole "midwife" vs "medwife" discussion.

AL: The difference is in the eye of the beholder.

Agreed.

VM: I think it all depends on the perspective of the person using the term. Where I live, there aren't many midwives who aren't CNMs. The CNMs are controlled via their practice agreements and must be "medwives" in many cases: intervening when it is questionable, whether it is necessary, bullying moms into tests and ultrasounds that aren't supported by evidence and not supporting VBAC. Supporting women in this environment, it would be very hard to call any midwife who attends a homebirth a medwife. Because at least she trusts the process so far that she is willing to attend in a home.

What does bullying a mom into tests and ultrasounds look/sound like?

JWP: I don't think training has anything to do with it in most cases. Experiences can shape people after their training, things they've seen can make them change. I'm doulaing for a mom anytime now who is using the known medwives of the area. They are highly watched and controlled by their backup Drs. So while maybe they believe this is the right way to handle a pregnancy, maybe they don't and they don't have many choices. It's either quit and leave even fewer midwives here, switch places of employment to the other MW office in town or just deal with it ‘til we can get laws changed for autonomous practice.

SGM: I think midwives are comfortable being "with women" and trust the process, their own skills and instincts. I think medwives are well meaning, but have been jaded by the OBs that "oversee" them, and the medical model of care in general. By attending to women in the hospital, some midwives simply acquiesce to the status quo, and unfortunately become medwives. They lost their passion along the way, and it has become just a job.

I think this comment alone confuses me more than any other. That a midwife in the hospital who adheres to protocols –that she believes to be true- because she does, you feel she’s lost her passion? That it’s just a job? How did you come to that conclusion? Because she doesn’t buck the system, she doesn’t have passion? Because she works with a degree within institutional walls, her entire practice is discounted?

I rarely see the acknowledgement that not all midwives enter the profession to Change the World of Obstetrics. Not all midwives, especially CNMs, believe homebirth is the safest place to birth. And, just because she doesn’t agree with you (global you), doesn’t mean she’s a shit midwife. She’s just not the midwife for you. And not all women who choose midwives are looking for the “enlightened, spiritual” birth experience. Many women do want the kindness and care CNMs offer, the respect for choices, the time with listening and the patience with interactions. A midwife who adheres to and honors protocols, in my opinion, is not the definition of medwife; it’s the definition of a midwife who feels the protocols and rules help keep mom and baby safe. Just as you might disagree with that definition, she, too, might very well disagree that not using protocols is the safest route for both mother and baby.

KC: Medwife - manages birth for her convenience (or fear), causes herself to be "needed" yet still, usually does so with the best but misguided intentions.

Midwife - keeps her hands to herself unless nature requires it, even when it’s hard not to meddle, she addresses her own fears internally and not externally on mom or baby. She lovingly "life guards". You know if a lifeguard tried to rescue a strong swimmer it would cause drowning, hence a need to be rescued because of the "rescuing'. My midwife crotchets baby hats to keep her hands busy when the urge to "help" gets strong. I am so grateful I can trust her to be a guardian not a manager.

How does a midwife manage birth for her convenience (or fear)? Examples would be great here.

And just as a point of arguing (more), a lifeguard who tries to save a strong swimmer would not, at all, cause a drowning. Bad analogy. (I’m a lifelong swimmer and a retired lifeguard.)

DB-H: K, a DEM (Direct-Entry Midwife) can still practice obstetrics-based care. It’s more of an attitude and approach than credentials.

There are DEMs who encourage augmentation of labor with natural means because mom's tired, baby is big, etc., that check dilation way more than even high risk OBs do. This to me is a medwife.

A midwife encourages the tired mom, telling her how important these last few days/weeks inside are for her baby. She watches the labor, only assisting when medically needed and not for the convenience of herself or others.

Where are all these midwives who encourage inducing or augmenting labor because the mom is tired or because the baby’s too big? Do you mean CNMs? I’ve known a lot of midwives (and have disagreed with puh-LENTY of them in how they practice), but cannot even think of one who practiced this way.

EM: Medwife is a boorish, annoying term made up by some midwives to criticize a colleague.

JD: I am in agreement with DH1, aside from the training... two women can have the same exact training, but come out the other end with different ideas.

K, I'm not seeing where anyone says midwife=DEM (or CPM) and medwife=CNM. I think we all know that isn't the case. However, it is known that CNMs (in the hospital) have more rules to follow.

RC: Where I live there is only one kind of midwife in terms of training and where they do births (both home and hospital). But the distinction stands. Medwives work from a place of fear. They transmit that fear to their clients. Fear breeds a need to control.

Describe the fear. How do they transmit that to clients? Please tell a story that shows a midwife feeding fear to the client.

KB: J, I know that no one has stated whether someone is a CPM or CNM, however DH1 did mention training so that is why I asked for clarification.

DD: To me, I thought I knew the definition of MEDwife. Then my cousin had her baby at the hospital with the "midwife" staff.

They are REALLY not midwives there, so now my definition of MEDwife is

MEDwife: Woman doctor who is called a midwife by the hospital so that they can pay her less. Due to being paid less, she develops a complex and must prove that she is more qualified and better than the attending doctor by performing more interventions and "saving" more babies than him.

Be wary the surgeon in midwive’s clothing Just because they're female doesn’t mean they are a midwife, no matter what the hospital says.

DH2: On paper, they are no doubt equally educated. In practice, some might be more willing (hopefully all good MIDwives) to use patient-oriented, mother-friendly techniques to help a mother get the birth she wants. A medwife, in my experience, is just an extension of the OB - who might not be interested in anything other than getting the baby out at any cost, usually at your expense, and call it a "good outcome." Grr.

MNK: Midwife describes a professional credential, which typically entails a set of knowledge, values, attitudes, skills and abilities. MEDwife is a stereotype that is often used by people who are labeling a group based on assumptions. Stereotyping fails to take into consideration the unique complexities of individuals.

Here, here!

KP: I've jokingly said that a "medwife" is anyone who is "too medically minded," based on the opinion of the person defining the midwife's practice style; and a "madwife" is anyone who is less medically minded than the person wishes.

To me, a "medwife" would include those who have a high induction and/or Cesarean Section rate, and who basically manage pregnancy as if they were the stereotypical high-intervention obstetrician.

BP shares a post she wrote on this subject.

MC: If a midwife can legally use medications in labor/birth as well as other medically minded interventions and she resorts to using the meds/interventions FIRST then she is a medwife. Midwife means with woman. Bringing her fears into the birth place with her makes her unable to truly be with the laboring woman. I agree with M, too- it is a stereotype we commonly use for CNMs.

Question: So if a midwife isn’t to use medications and interventions first, what is she to use? What situations are you specifically speaking about? Is there any situation where medications or interventions are acceptable as a first line of defense?

NgM: Very interesting, all of you.

I've heard the terms compared for many years now, have been called each myself. I've asked for definitions several times, but have rarely heard an answer. This is very helpful as well as enlightening.

I've even heard such a tight definition as any midwife who carries medications is considered a "medwife." I guess if a midwife carries meds, she doesn't Trust Birth enough? I absolutely do not understand that mindset.

My experience only: I don't think I've ever met a midwife (CPM/CNM) who pushed for unnecessary inductions or epidurals. Perhaps within protocols, but not just because a mom's tired of being pregnant or because it's convenient.

It confuses me that people get all cranky about protocols. We all operate in this culture within many different sets of protocols... rules of the road, the handling of money, the education system, our legal system and more. With some, there are accepted ways around/through them and there are certainly unacceptable ways to deal/cope with them.

How can women think there won't be protocols/parameters with something as crucial as the life and death of a baby? How can women think anarchy is acceptable in birth? I don't mean the pushing of constraints or questioning authority... not at all... but complete anarchy? (Is UC complete anarchy?) Are we to just leave birth 100% alone to do its thing without touching a woman at all? Ever?

The comments above speak about a midwife knowing when to touch a mom, when to interfere (hear the tone of that word?) to save a life, but the issue arises... WHO judges whether the midwife acted "appropriately" or was meddlesome? Is it the mom? The Medical Board? Grandma sitting in the room? The doula? Where does this judgment come from and why is someone entitled to confer the epithet of "medwife" on a midwife?

And, as I ready myself to leave homebirth midwifery, am I cranky about this topic because I've been called a medwife a lot? Does being a medwife have any part in my leaving midwifery? Leaving the practice of midwifery to women who don't think about the complications as deeply as I do?

Still listening and pondering.

MNK: Can you say dogma? I highly suspect that most of the folks touting this 'Medwife' dogma have probably never held the hand of a husband witnessing his wife suffering from DIC, having her uterus removed, and dozens upon dozens of blood transfusions after the 'Midwife' delayed transporting with a PPH, because she wanted to try to get the baby latched! (I'm an IBCLC, by the way) Part of being a MIDwife is recognizing when intervention is warranted and relying on your training and wisdom to guide your reactions (and certainly this doesn't happen by consulting with the 'family, and doula' (yep, I'm a doula, too) in the room!

Barb, this is your career, sorry to sound bossy here but don't allow other people to define your parameters. You have a solid head on your shoulders, skilled hands, and a generous heart. You, Barbara, are the epitome of a MIDwife in every sense of the word. As to who decides, well you have a scope of practice to adhere to and your training. I don't think you are giving yourself enough credit but that's my .02 worth. Trust Birth, , it usually works well, and when it all goes to shit, because it does on occasion, -and it will- trust your ability to recognize it and get the pair to a freakin' qualified Perinatologist. Don't let other people bully you either. Do what you need to and know is right. If it's not right for you now, take a hiatus, but if you want to persist in practice, go girl!

I appreciate that. As you know, the decision is made.

DH1: I think this matter is complicated as you so aptly wrote NgM. You are right, there is a lot of judgment in these words. I think it comes down to "Who's birth is it?" Is it the midwife's birth because she has protocols to follow and a practice to protect? Or is it the Mom's birth because she is the one birthing and this is her baby? Who is in charge here? One of them? Both of them? Who is MORE in charge? What about the baby or the partner? I'm not sure any of us have the answers to these questions as anyone deeply impacted and involved by birth would know there are no answers to these questions because every birth is different AND dependent on at least ONE person (mama, midwife and/or baby) trusting the birth process. If the "one in charge" does not trust the birth process, it is very likely the others won't either and this is where meddling comes in.

This birth trust does not come from credentials or training. I never said anything about CNMs or DEMs. It especially does not come from fear based on a few experiences gone wrong. We have to trust that women know what they want, they know how to give birth and their babies know how to be born - even after her birth attendant has had an adverse outcome with another woman. This does not mean she has to change her protocols for everyone thereafter. Every woman/baby is unique and every woman/baby deserves the chance to prove that interventions are not necessary without protocols being pushed on her because the "protocols, practice, law" says so. We all know right from wrong and can make educated choices that make sense for each situation.

I also agree that the distinction of medwife and midwife is painful to both parties (not to mention Mamas and babies). If we are to be honest with each other though there is a difference. It comes down to control. Who do you think is in control of this birth? Not responsible for, but in control of. Getting out of your own way to allow the birth process to unfold is what being a midwife "with woman" is all about.

After reading this comment, I started a post (that I haven’t finished yet) about how a bad outcome changes one’s practice. The short analogy is: if you sped through the intersection 1000 times without incident, but sped through once and had an accident that killed your child, how will that accident affect your driving forevermore, especially as you cross the intersection?

Watching a mother or baby die in birth cannot NOT affect you.

We are all products of our experiences. Women choose to UC based on previous experiences. Asking a midwife to not incorporate her experiences in birth, asking her to leave her accumulated knowledge at the door is absurd. We learn with each birth! Each experience builds on the one before, creating a block for the one that will come after. It is the midwives with many births under their belts, with many years of experience, that are most honored.

Regarding the control aspect, in the perfect midwifery/client relationship, each woman uses her strengths and leads her Self. The laboring woman is in control of her labor and birth. The midwife is in control of making sure the mother and baby stay alive… in fact, she was hired by the woman to do just that. And then, ultimately, the baby is in control… the baby guides the actions of the others around him/her. To me, this is symbiosis at its best.

SM: ‎"Blind maternalism is just as dangerous as blind paternalism" if I may quote one of my favorite OB/GYN buddies. I agree.

KB: ‎"Birth trust/Trust Birth" is a sales pitch and just as polarizing to this profession as the circular midwife versus medwife argument. It's interesting that not many midwives have contributed their two cents to this thread but lots of others have. I'd like to know when those of you who are the most critical plan to start your midwifery practice and if 5 years later you have a different opinion.

AHH: I agree with E and think that we midwives have enough resistance and criticism from the medical community in general and the last thing we need to do is echo their thoughts about us.

DH2: I'm just basing my ideas on the care I've received from midwives, versus what I read from very different midwives like Barbara and others. Very different care than what I received.

AKS: Honestly? I think it's a dumb distinction to make. There are good midwives and there are "bad" (unskilled, or controlling, or unkind, or a bad fit for a particular woman) midwives. I would guess there are DEMS, CPMs, and CNMs in both groups --and I would guess there are medically-minded midwives (who follow current standard medical practices, whether or not they are supported by evidence) and "alternative"-minded midwives (who also follow practices that may or may not be supported by evidence) in both categories.

NgM: It's been a hard day, so I'll try to keep my tone at a civil level.

1. We are all a product of our experiences. Anyone who thinks otherwise... or who thinks the experiences don't affect us every single day... is in serious denial.

2. There ...is NO WAY one (me) can watch a birthing woman die, right in front of her (me), and not have it affect her (my) practice as a midwife. The experience doesn't control my right hand and force it to rupture women's membranes or wrap itself like a boa constrictor around my head, controlling my brainwaves, but it most definitely colors my reality that women can -and DO- die in birth.

It (the memory) doesn't mean I sit wringing my hands, just waiting for my clients to have an AFE, but it does give me a gift (a GIFT)... the woman who died gave me a gift... of the deepest respect for life and its precariousness, even in birth.

I know there's so much more to say about this, but it's late.

And yes, #3 is it is so, so, SO easy for non-midwives to speak about what a midwife should or should not be doing at birth. I defy any critic to stand in my shoes... in any midwife's shoes... and then tell me what a midwife should or should not be doing.

My job is to keep two people alive. With that statement comes an endless list of scenarios and what-if's that cannot be rattled off in a Facebook (or blog) discussion.

DH2: Given what I know just from reading your blog and hearing you talk so passionately about birth, Barbara, I would not call you a "medwife." You respect birth, and do not a take a cavalier approach to it - with good reason (as you just stated). If someone hires you to help deliver their child and then calls you a medwife, then it sounds like what they want is perhaps an unassisted birth. Because you already sound pretty hands-off unless there is a reason not to be.

MG: I agree that the label is harmful. So often those who are labeled "medwives" are only following protocols they wish they didn't have to follow... so why are they hospital midwives? Because they believe they can make a difference in women's births by offering them hospital-based midwifery care even with those protocols as opposed to giving birth entirely over to OB's. And from what I've seen, they are right, and do not deserve to be insulted for going to the front lines for women who for whatever reason aren't having a home birth. They work hard for the benefit of women. And there are midwives who are disrespectful of women with any or no letters after their name and who work both in and out of hospital.

On another note, using medication to save lives and interventions to avoid larger interventions is prudence, not over-medicalization. 

One thing is clear: Medwife is an epithet, hurled at a midwife who, for whatever reason, isn’t aligned with the woman spitting out the word. As KB says, this is one of those circular discussions and I’ve been watching it go ‘round and ‘round like a playground ride for years. I don’t expect it to stop anytime soon.

Wonderful midwife Pamela Hines is more diplomatic than I am (as usual). She says:

"There are midwives for every family. If you have specific expectations, only communication help you decide if that midwife is right for you. While I do hear of midwives with a bit of a 'bait and switch' persona in labor versus prenatally, this is not the norm. I hate that people decide that their idea of care should be the norm for every other woman in the world."

Brilliant.

    Me doing a vaginal exam on a mama who was pushing for quite awhile with no forward movement. We eventually transferred to the hospital where she did deliver vaginally; baby'd been quite acynclitic. Anecdotally, this was the one baby I caught in the hospital.    
                                                                                                                                                                                      

Monday
Aug022010

Separatism: conflict amongst the ranks

We recently celebrated Pride here in San Diego, PrideFest, aka HomoFest. I went to the parade and stood with 150,000 others, cheering for our freedoms (and demanding even more), our hard-won self-esteem and for the sheer joy of hanging out with friends. When I marched with the kids in 1990, the parade was all of forty-five minutes long. This one went on for a couple of hours. 

Sarah and I had broken up for awhile in 1988. I was a crazed mess, so went into therapy and immersed myself into the lesbian community here in San Diego. I went to several lesbian support groups, but the one on Thursday nights turned out to be the most interesting of them all. 

Those weekly meetings at the (then) Gay & Lesbian Center, took me from the myopic, white, heterosexual, middle class mindset and introduced me to… nay, challenged me… to see from various vantage points and acknowledge that I was really just a self-centered, ego-driven, hypnotized woman who thought she knew what was going on in the world. I sat, spellbound, listening to women talk about oppressions I never knew existed. I grew up in the Deep South, so had an inkling of racial oppression, but sitting face to face with women of color was stunning. I endured finger pointing, enumerating the ways I, too, was oppressing women of color… saying things like “I don’t see color; I see people,” and not knowing the PC (politically correct) terms for the nuanced cultures of the women right around me. 

I learned about other marginalized cultures (“marginalized” was a word I heard many times in those days)… the bdsm (bondage/discipline/sadism/masochism) folks, the butch (more “masculine” energied) dykes, teens coming out, lesbian mothers (my people! …who were few and far between back then), migrant lesbians, etc. and the subcultures of each of the marginalized people. Those nights at Group opened my eyes to worlds I’d never imagined. It was there I realized that every topic, every person had their own subtext within them. And those subtexts were never-ending. None of that even begins to examine the “isms” of the day, including classism and sizeism (another group I embodied). 

It’s like this in birth, too, isn’t it? Under the umbrella of human procreation, there exist an infinite number of choices women can make (or are forced to endure). Depending on where you live and even the political atmosphere of the day, the choices are rounded up like a huge net grabbing fish in the ocean. Whoever does the throwing can alter the birth’s path and outcome. Birth in the hospital? At home? With a midwife? Alone? Or, if we live in a Third World Country, does the mother feel safer with her family or the local Traditional Birth Attendant (TBA)? Do we risk losing our safe hiding place to transfer to the hospital because of a hemorrhage? (And, please know, this is an area I do not have much information about… the different choices women have in other, less mechanized, cultures. I welcome the education.) 

And then we move down the flow chart, each choice above having an infinite number of options, or, if not options, an outcome that is different for every single woman… maybe not in the live baby/live mother, live baby/dead mother, dead baby/live mother or dead baby/dead mother, but each woman carries her own experience, some in the body, others in the heart and some even deep in their souls. 

At the Festival, I ran into a couple of women from those long-ago rap groups and the flood of memories prompted me to write this. The analogy was so striking, the things that are going on in birth; I just couldn’t ignore the beckoning sirens. I hope I don’t crash amongst the rocks. 

When Sarah (who was in the Army) and I were in Germany, we’d found an underground group of gay men and women (Friends of Dorothy) and one of those women called herself a Separatist. Not having the Internet, I learned through context what that meant. 

Kathy Belge describes Separatism like this: 

“Lesbian separatism is the feminist political act of choosing to be around only lesbians or only women. In the early years of the Feminist Movement, some lesbians chose to avoid interacting with men as a way to remove themselves from male-dominated society. Their belief was that even well-meaning men were sexist and influenced by the patriarchy. They chose to be around only women in order to understand what womanhood and sisterhood is really all about. Some women moved to the country, bought land and created women-only societies. Avoiding all men was impossible, but they chose to have all of their significant relationships with women. The idea was that women could never truly understand themselves as powerful beings if they were immersed in the dominant, sexist culture. From lesbian separatism the idea of women-only space came into being at concerts, conferences and festivals.” 

This particular woman we met in Germany was so much of a Separatist, she gave her son to his father because she couldn’t abide by having a penis in the house. 

Historically, it’s important to note the connection between the Black Separatist movements of the sixties, acting as models for the women who came after in the seventies. Other societies have also chosen to remove themselves from the mainstream, too; the Amish and the Shakers, for instance. 

Any of us who’ve been in the birth world for any length of time have watched the same happen. Doctor? Obstetrician? Doctor of Osteopathy? Family Practice MD? Registered Nurse? RN with or without a BSN? Certified Nurse Midwife? Certified Midwife? Licensed Midwife? Certified Professional Midwife? Unlicensed/Direct-Entry Midwife? Religious Midwife? Overseeing organizations are created, a board elected, rules written (and continuously debated); exclusivity is a hallmark of any patriarchally-oriented organization.

Again, under each of the above monikers, factions develop, pulling together and, at the same time, pulling apart, oftentimes creating a whole new category. 

In the late 1970’s, the Michigan Womyn’s Music Festival was born. Note the spelling of “womyn” (alternately spelled “wimmin”) – any derivative of the word “men” in it was changed to a different, “womon”-centered word. (We find this same mindset in birth with the renaming of the vagina to yoni or contractions to surges.) While I didn’t come out until late 1986, the Music Festival, and many others like it were still going strong, this one in particular continuing today. 

 If you poke around, Googling MWMF, you’ll see an on-going discussion, years long, about whether to allow transgender folks to attend. Lisa Vogel, one of the founders of the yearly event says: 

“Since 1976, the Michigan Womyn’s Music Festival has been created by and for womyn-born womyn, that is, womyn who were born as and have lived their entire life experience as womyn. Despite claims to the contrary by Camp Trans organizers, the Festival remains a rare and precious space intended for womyn-born womyn.” 

Interestingly, this wasn’t a concern back in the mid-late 80’s. Instead, then, it was the battle between allowing male children to attend or not. Some didn’t want any males there… no penises at all. Others were okay with nurslings and there were women who said kids under five. They picked five years old because they were still heavily influenced by their mothers, but after that they were in school and being influenced by the patriarchy. I see now, they’ve got two delineations: five and ten. They are segregated, but still permitted to attend. Why the five to ten-year olds? They were in school, but before puberty hit, when they would be considered real men. 

To some of us, this might sound absurd. People are people! How are men supposed to change without women around to show them the way? My eleven-year/fourteen-year/seventeen-year old son is not a man yet. But, I promise, to these women, Separatism was a grave and intensely crucial topic that required an opinion, one way or the other; black or white – choose or you were dismissed (physically and emotionally). Gray simply did not exist. Whole groups (and clubs) revolved around defining the word “Separatism” and who “qualified” as a real Separatist. In a fantastic article in the New Yorker, Ariel Levy says: 

“Different groups had different definitions of separatism, ranging from a refusal to associate with men to a refusal to associate with straight women to a refusal to associate with gay women who weren’t separatists.” 

The most idealistic/dogmatic womyn transformed their lives into a world where they rarely, if ever, had any contact with men. Some moved to womyn-owned land, allowing only womyn to live or visit there, excluding even male-born children; meaning mothers were required to divorce themselves from their sons. 

Does any of this sound familiar? 

Looking around, can we see parallels in the birth community? Groups form and morph depending on the cause célèbre. Should fathers be present at births? (Interestingly, while this was a big issue in the seventies and eighties, it’s come around again with Dr. Michel Odent’s belief that men should not be at births after all.) Which childbirth classes should women take? Bradley? Lamaze? None? Of course, the gulf widens as we add in Natural Birth, Normal Birth, Cesarean Birth and Unassisted Births. 

We also see this in the politics of birth even as I speak. Whether it is women who schedule a cesarean, get an early epidural or have an Unassisted (child)Birth (UC), proponents and detractors tend to be rabid about their choices. It’s very hard to find some gray. Sometimes I wonder if it even exists. 

John MacAdams of the Marquette Warrior, says “It’s a chronic problem in the rarefied world of political correctness -- and that world has spread out of academia into the mainstream media. Members of designated victim groups are allowed to be offended at the barest slight, but feel perfectly free to express rank bigotry toward those who disagree with them, or even merely adopt a different lifestyle.” 

We see any discussion deteriorate, almost as they begin, into accusations, hurt feelings and an absolute insistence on the rightness of the speaker. Isn’t there something, anything, we have in common? How do we find it amongst the sludge we all seem to be slogging in?

 Occasionally, the thought rises to the top, “What is this doing to benefit women?” On-lookers turn their heads back and forth as if they were at a tennis match; but where’s the ball? Is all this in-fighting hurting our causes (if you will)? Or is this the normal push and pull of a larger entity, clamoring to break off and live on its own. 

The latter stages of (the larger) Separatism movement found the lesbians raging against the heterosexual women, each “side” having ghastly epithets to heave at each other. “Breeder” came from that time. 

Jill Johnston says, in “Lesbian Nation,”: (emphasis mine) 

“Women wanted to remove their support from men, the ‘enemy’ in a movement for reform, power, and self-determination. A revolutionary prototype existed in their midst. But the prejudice against women within the ranks of women, much less loving women at the intimate level, was so great (still is, of course) that feminists could only act against their own best interests and trash the women who modeled their beliefs. The split between straight feminists and lesbian feminists was extremely damaging, and will no doubt continue to be in any future wave, to the cause of women’s liberation. The internal damage within the lesbian feminist ranks was also lethal.” 

I worry the same thing will happen in birth. Will the in-fighting be so intense we will only appeal to the most radical of those interested? Will women who are simply curious be so disgusted with our polarized beliefs, they couldn’t care less if we had the answer to the riddles of the Universe because it’s impossible to hear over the roar of anger? 

In those rap group days, I worked on the San Diego Lesbian Press, the local magazine/newspaper, obviously geared towards dykes who live here in San Diego. Working on SDLP was my first experience 1. working with only women and 2. using consensus to problem solve. Working with women is a whole blog post on its own. (Sarah should write it; she has extremely strong feelings about it.) But, can I tell you now how much I HATE consensus?! I mean, seriously. Could there be anything more time-consuming and more manipulative than trying to come to a consensus? Blech. I will no longer participate in groups that use consensus as their method for problem solving. (And I know others love consensus, think it’s the only way to come to “fair” answers, but that is not the way I see it. At. All.) 

I was ignorant then, a joiner and a newly self-discovered writer, so I became a part of the SDLP Collective

The defining moment came when there was a discussion about accepting an ad from a company owned by a man. There wouldn’t be any man in the ad, no penis would subliminally peek through, but this discussion turned into a humongous, weeks-long “discussion” (and I use the term loosely). You see, SDLP needed money something fierce; could they/we afford to turn away money… even though it did come from a man? The separatist side vociferously refused to even consider accepting money from The Enemy; the ad was absolutely not to be in the paper. Just as emphatically, less rigid, though still feminist, women could see the benefit of taking the money. Wouldn’t it be using a man’s money for a good cause? Wouldn’t we be bettering our women’s lives by being able to put out a paper? (Something we very likely would not be able to do otherwise.) When using consensus, everyone has to agree, no dissenters at all. I remember occasionally making a comment, but it was obvious I was a neophyte and no one cared what I said. I was probably asking basic questions like, “What are we fighting about again? I can’t even remember anymore!” 

I ended up leaving the SDLP to fight themselves to death; and they did, too. SDLP died shortly thereafter. I snarkily say dogma killed them. 

Is this our fate as well? Are the two extremes going to kill themselves off, leaving nothing but the center? 

Thinking about myself personally, I participate in this Us vs. Them as much as the next gal… maybe more sometimes. I’ve been implored to keep my mouth shut about certain issues, to try and make peace with all the birth sisters around me, no matter how much I disagree. But, you see, I wasn’t mature enough to ask the right questions back in early 1990. However, today, with many years of birth work under my belt, I feel qualified to defend my position and to speak, if not somewhat eloquently, at least pretty darn clearly about what I see and why. I’m an old crone of a midwife now (even though my midwife years are nothing compared to many of my peers), sharing the stories of those around me. Most are gloriously beautiful, wondrous births. But, too many of the stories aren’t fabulously perfect births; they have ended in tragedy and pain. I tell those stories, too. If it angers some women, then so be it. Their stories piss me off, too, so I guess, in some alternate-universe way, we’re even. 

When I stand back and see the parallels between the two Separatist movements, I know they are but two of a billion other arguments/discussions/opinions going on simultaneously. From husband vs. wife, Catholic vs. Protestant and the United States vs. everyone else to Wall Street vs. stockholders, Unions vs. employers and organic vs. commercially grown food… thinking there are just two sides is absurd. The same way couples go to therapy, employers go to mediation and we get to choose our food by which ones we buy, there have to be other ways of bridging the gaps we have in birth besides blowing each other up with bombs. 

I think about the song “From a Distance” that Bette Midler sings. 

“From a distance you look like my friend,
even though we are at war.
From a distance I just cannot comprehend
what all this fighting is for.

From a distance there is harmony,
and it echoes through the land.
And it's the hope of hopes, it's the love of loves,
it's the heart of every man.” 

I promise to remind myself, in the heat of those moments when I am standing toe to toe with another woman, that even as I speak my mind and tell my stories, I will remember she is a sister, she does have valuable things to say and I will keep an open heart and mind to what she is saying. I would only wish the same from her.

 

Me (and my big butt) marching in the LGBT Parade in the early 90's. Look! Polarized views even about marching with kids!

 

Sunday
Jun012008

Meghann's UC Birth Story

I wrote a tad about how whiny I was during Meggie’s birth, but I haven’t actually ever written her birth story in my blog. I’ve written Tristan's birth story and Aimee's birth story and now it’s time to write Meghann’s.

I haven’t written hers, some because I am ashamed of what I did, some because it was scary and much because I now know how incredibly stupid I was to have an Unassisted Birth. At the risk of alienating a segment of readers, I’m going to plow forth and write the story… including how I saw things then – and adding how I see things now. It might jump around a tad, but I will do my best to keep things in a chronological order.

Included in the narrative are photos that have yellowed terribly with age and while I am decent with Photoshop, I don’t know yet how to restore old photos; please forgive their discoloration and blurriness. I have also blurred out the faces of the others in the photos because I don’t have permission to share them.

After my pregnancy with Tristan, where I gained 80 pounds, had pre-eclampsia, magnesium sulphate in labor, Demerol x 2, a medio-lateral episiotomy that went into my thigh muscle, nursing for a mere 4 months and still being really fat, I needed things to be different with this next pregnancy. We moved from Orlando to Tacoma, Washington when I was 3 months pregnant – arriving the day before Thanksgiving 1983. It was dark! Growing up in Florida, I never understood the Christmas song about “a long winter’s night”; I got it then! Not knowing I would suffer from Seasonal Affective Disorder when living in Northern climates, I cried my way through the rest of the pregnancy, hating living so far from home, hating the prenatal care I was getting and not having any friends.

During one prenatal visit, I saw a social worker (we were in the military and our household goods didn’t arrive until January 1984, so we had to pilfer the Army’s loan closet, but had to qualify first) and cried my eyes out about my loneliness and fears of getting so fat again; I hadn’t even lost my pregnancy weight from last time! She looked in her Roladex and gave me the number to a pregnancy exercise instructor, Marie. I called her that afternoon.

Besides leading dancing pregnant women around a room, Marie was also a La Leche League leader and a Bradley teacher. I fell in love with her and the groups immediately. It reminds me of how people fall into cults, the place of intense vulnerability and finding a group of kindred spirits who embrace your whole being, quirks and all. It was like that.

I took Tristan’s birth pictures in to show them off and the women gathered around, saying kind things. I, oblivious to their horror, proudly told them of my beautiful hospital birth, induction, rupture of membranes, medication, episiotomy and all. They never said a word – letting the veil of ignorance slowly fall from my face over the next few weeks.

Marie invited me to read and I voraciously devoured her entire library. From Silent Knife, Spiritual Midwifery and Transformation Through Birth to Sheila Kitzinger’s books, Penny Simkin’s early writings and on to the extremely radical Marilyn Moran, the mother of Unassisted Birth in the United States.

Marilyn wrote Birth and the Dialogue of Love and a newsletter called New Nativity. Her belief was that birth was meant ONLY for the husband and wife, no outside interferences at all. No midwife, no on-lookers, no other children there. She felt birth was as sexually charged as intercourse and encouraged, even more than Ina May Gaskin, sexual expression during labor and birth. I thought Marilyn was the greatest, writing her and then talking to her on the phone as she really insisted my then-husband and I birth alone. It took more convincing, but not much.

We started our Bradley class with Marie in early March. 12 weeks of gobs of information about interventions and how to avoid them. I was in heaven! I couldn’t get enough of classes, exercise class (which was every day!) and La Leche League meetings (once a month), so continued reading like a madwoman and talking to Marie and the others about birth; I was insatiable.

During this time, I was going to Madigan Army Hospital, seeing the doctors who tsk’d tsk’d about my weight (I’m remembering I was about 250 pounds at delivery), whined about the size of the baby (too big, of course) and were baffled that I’d passed my Gestational Diabetes screen.

As the Bradley classes advanced, I wrote up a birth plan to take to the doctors to sign off. Shockingly, none of them would! Birth plans were a brand new phenomenon in 1984, yet the obvious liability aspects weren’t lost on the obstetricians.

My Birth Plan demanded that I not be induced, no artificial rupture of membranes, no IV, no episiotomy, no fetal heart monitoring (only a doppler), no silver nitrate for the baby’s eyes (they didn’t use erythromycin back then), no Vitamin K shot, able to eat and drink at will throughout labor, wearing my own clothes, able to ambulate as I wanted to and squat for the actual delivery. In class, we saw films that showed women in the hospital having births like this – I wanted that, too!

How the doctors didn’t bust out laughing is beyond me!

Now, If women are going to write a birth plan, I encourage them to write nothing more than will fit on a 5x7 index card because so many things are Birth Plan Standard Operating Procedure. But 24 years ago, you’d have thought I was asking to build a manger, lay hay in it, bring a cow in and then moo along with her as I squatted alone in the corner while everyone just watched.

My Birth Plan didn’t go over so well.

When I left crying, I’d decided to find a midwife. I was 38 weeks pregnant.

I began calling the referrals I was given, but because we didn’t have money, none would take me as a client. I called all the way up to Seattle, trying to find someone who would help me. I shake my head thinking how I sounded, hearing myself now as a midwife. I wouldn’t have taken me as a client, either!

Resigned, I decided my odds at a normal birth were better alone than at Madigan (which had over a 40% cesarean rate – even back then!), so I began planning for my DitY… (pronounced “ditty”) Do it Yourself… birth. I was going to do it.

(My former husband was along for the ride, learning, growing, changing as I read paragraphs aloud and he attended class with me. Because he reads here and doesn’t often like what I write, I am writing from my experience and will leave much of his experience and feelings left unsaid.)

My pendulum had swung so far to the left that, near the end of my pregnancy, I tried to get Tristan, 19 months when Meggie was born, to re-learn how to nurse. He’d been diagnosed with a protein allergy and was drinking donated breast milk, so I thought it’d be dandy if I could re-lactate or could re-nurse him once the baby arrived. He lay in my lap, lips on my breast, not having a clue what to do. Sadly, I just had to keep giving him the milk in a cup (I’d abandoned the bottle because of the stigma). We did bring Tris into our bed, too. That, we all enjoyed. Once Meghann came along, Tristan was relegated to his crib mattress next to the waterbed.

Getting ready for the birth, I invited Marie to attend, much to Marilyn Moran’s horror. She said she would come except she would be camping if the birth fell over Memorial Day weekend. I invited her 16-year old daughter, too, a budding photographer. I invited two women from the exercise class, Eileen, a former L&D Nurse and Candace, working on her Bradley certificate. Both women had nurslings that would also come to the birth.

On Friday, May 25, 1984, I went to my usual OB appt. I was 41.1 weeks pregnant when I was shown to the room, I was told to undress from the waist down. I told the nurse I wasn’t going to have a vaginal exam, but she insisted. Mad at myself, I grudgingly took my pants and underwear off and sat on the table waiting for the doctor. When he came in, I was really upset to see the nastiest of all the OBs. He repeatedly told me I had to be induced, that the baby was too big. When I said I didn’t want a vaginal exam, he said he had to see how “induce-able” I was. I laid back and put my feet in the stirrups.

He stripped my membranes. Hard. Tears leaked out the sides of my eyes and I asked him, “Are you stripping me?” and he denied it, but still was digging around in my vagina. He said he could barely reach my cervix and while it was soft, it wasn’t open very much. He got his hand out, told me I had to be induced on Monday if I hadn’t delivered over the weekend and walked out. The nurse came back in, helped me up and gave me Kleenex to wipe myself before I got dressed and, in pain, went home angry and sad that I had buckled under the pressure of The Man.

Before I even got home, I was having contractions. Small waves, every once in awhile, while also having constant aching in my thighs and butt.

In all three labors, I never felt contractions in my belly. I felt them in my upper thighs first, then my whole thigh and butt joined in as the contractions came and went, came and went, came and went. I hated to be touched from nipple to knees (the exact expression, “nipple to knees,” that was used at the time for where an epidural numbed a woman) – and anytime anyone tried to massage me, comfort me or guide me – touching in those places, I about crawled out of my skin, snapping at them to STOP TOUCHING ME!

It was Memorial Day weekend. Marie was leaving to go camping Friday night, but her photographer daughter said she’d stay home to photograph the birth. I’d wished Marie would have changed her mind, to stay with me, but she didn’t. It was hard and sad to see her go. But, I kept in touch with my other “doulas” (there was no such word until about 1988) and puttered around, knowing I was in early labor, baking bread and swaying with contractions.

I barely slept on Friday night, had slightly stronger contractions during the day on Saturday and felt I wanted/needed company about 6pm on Saturday night. Eileen, Candace and their nursing babies came over and I remember labor kicking in pretty good about then.

I was miserable.

Back then we thought (and some folks still think) laboring women had to walk continuously to get the baby out. It was heresy to lie down during labor and whenever I did, I was exhorted to get back up! I was flippin’ exhausted.

As labor progressed, this is how I spent a lot of the time... hanging on my partner.


Here, you see how miserable I was. I had no humor about this labor. None. I am sure I never smiled, simply whined and cried and felt way sorry for myself. It would have helped to be reminded there was a BABY in there – that I was laboring to birth a child – but, back then, in Bradley, we were taught to “do what felt natural.” I felt anything but “natural.”


My former husband, the primary attendant who’d read Gregory White’s Emergency Childbirth with me, was amazing as my partner in this journey. He never wavered in his care of me, loving me throughout the entire long labor and birth. You see his love and concern easily in the photos. However, the last thing I ever considered was being sexual with him while I was absorbed in all this pain. Was Marilyn Moran crazy?!

I walked, took several showers – where I sobbed alone – had cold cloths put on my head and neck and leaned on my then-husband.

When Eileen and Candace and the teen photographer were settled, I begged for drugs. I was damn serious, too. I was in so much pain I could barely stand it. But, that was during the contractions. I remember standing straight up after one particularly horrendous contraction, completely out of pain, and saying, “I could do a jumping jack right now. The pain is gone!” And then another contraction smacked me on my ass.

I begged the women to find me drugs. Didn’t someone have a lost joint in their coat pocket somewhere? (These were the straightest women you could ever imagine – and I hadn’t done any drug since I was a teenager!) Couldn’t they go downtown and find me something? Eileen calmly told me if I wanted drugs, I could go to the hospital… they had plenty there. She was very soft and kind in saying this. I don’t think I heard judgment at all, either. I just remember the hospital being an alternative, not a threat.

I gritted my teeth and said I wasn’t going anywhere, that I just had such a hard time believing I was going to have this baby at home. I couldn’t see it. Eileen and Candace, almost in unison, said, “Well, no wonder it’s taking so long!” and exhorted me to squat and visualize the birth over and over.

I hated squatting. I was fat and it was hard even though I’d practiced during the entire Bradley series. (We know now not to have women squat in late pregnancy until we are sure the baby is in the proper position and deep in the pelvis lest s/he get mooshed in there in a not-optimal position.)

Look how humorless I am. laughing I so wish I could go back and do that birth again. I would do things a whole lot differently. But, in the scheme of life, I know I had to birth Meghann this way; it was a huge part of my walk towards becoming a midwife.

Once I began squatting, Meggie must have come down a lot because I began feeling pushy and changed into my Birthing Shirt.

I got this shirt when I was pregnant with Tristan and we’d attended our Lamaze class at Florida Hospital in Orlando. It was one of the few things that fit me – I always wore huge sweat pants during that second pregnancy – and knew I wanted to wear it in labor as a closeness to the birth with Tristan.

I don’t even remember what Tristan was doing during the whole long labor. He was always such a good baby; it isn’t surprising I don’t have any memories of his fussing or crying. I’m sure I was the one who cooked for him and fed him – and I know he was in bed early the night the gang came over – we’d put him in his old room for the night. He went without any problems that I can recall.

See how they still had me squatting? I wasn’t even pushing yet… knew I wanted to have the baby in a squat (it was THE preferred Bradley position and as an obedient acolyte, I was going to push this baby out in the squatting position)… no one considered how flippin’ tired I’d be after HOURS of squatting. So much for doing what felt natural, eh?

My former husband was sitting in a chair and I was dangling between his legs in a squat. My arms were over his legs. In the above picture, I am sure I am flailing in frustration.


Look! They let me get up!

I say “let me” because I really was directed what to do and how. I was reduced to an infantile state, whining, “It hurrrrrrrrts” for every contraction, my mantra annoying the crap out of them all. I obeyed all instructions even though I complained the entire time about it. I had no independent thoughts about what to do or how to do anything once getting drugs was out of the question. I was drowning in my own labor – and I hated it.

We are wont to say these days that if labor brings on suffering, then medications are absolutely appropriate. If a woman is noisy and cruising along in her labor, then she’s most likely just fine without meds. But, using the word “suffering” designates the line between tolerating the birth and enduring the pain of labor. I was beyond suffering and wish someone would have known the distinction and helped me. I didn’t have any other words beyond, “It hurrrrrrts” – was non-verbal except for that evermore-grating expression.

I am sure a flopped myself dramatically over my husband’s shoulder. Vain, I usually have my hair meticulous (even now when I go to births, I always have make-up and hair done), but look at it… messy as all get out. I cringe looking at the pictures, thinking how I must have looked and smelled.

Aren’t I having a blast? Didn’t someone wonder why things were taking so long? I was in labor for about 36-37 hours by the time this picture was taken.

People talk about women knowing when something is wrong and taking care of it. It isn’t true. I’ve known more than one UCer to lose her baby and not realize something was wrong until the baby was already dead. As smart as I was, as educated as I (thought I) was, it never dawned on me that that long labor and all that pain could mean something. I had been taught that there was a wide spectrum in the realm of norm and surely this was just part of that, right? I was enveloped in my pain; I couldn’t have made any decision after making the one to stay home. I was, quite literally, out of my mind in pain.

So, so tired. And miserable.


Oh. My. God. They FINALLY let me lie down. They said, “two contractions, then you have to get up again.” I remember snoring inbetween contractions.

And look! My hair’s fixed again. shaking head and laughing

I think I was in the bed for about 8 contractions. I stalled them as long as I could (I took control for a second!), but once I was up, I was squatting again.

Only this time, I felt the urge to push.

It’s a head!

Eileen is now behind me and my husband in front of me. I can still remember that chrome, curved armed dining room chair they sat in.


Okay, so I was critiqued for YEARS about my pushing position. And closing my eyes. I even used this picture to show women how not to push! sigh

In Bradley (at least back then), one was supposed to put chin on chest (still de rigeur) and open one’s eyes, calmly pushing the baby out. I’m sorry, but there wasn’t a baby in there; I had a semi-truck coming through me. Full of cargo.

Eileen and Candace kept telling me, “Open your eyes!” and I would try for a second, but it just felt wrong, so I’d close them again. “Put your chin on your chest! Open your eyes!” Too many instructions, for crying in a bucket. Leave the birthing woman alone!

My head would bob up and down, mimicking one of those glass cocktail birds that dips his beak in the drink… moving to the instructions barked at me. Trying to do their bidding, I felt like I was patting my tummy while rubbing my head – and I’m not very good at doing those at the same time.


It’s still a head.
And still.

And still.

These are not a quick succession of pictures. And my husband kept telling me to lift up! I was sitting on the baby’s head. (Again, so much for being “in touch” with my body.)


Meghann’s head is finally born.

She sat still for a long time. No rotation. Who knows if she turtled, no one was aware enough to look for it. A cord was felt for, but nothing found. It hurt like crap while they dug for the cord.

Meghann began to rotate, but stopped.

And then, oddly, she began rotating the other way.

Now, of course, I cannot thank the angels enough for doing what an attendant would have done and that is do the Wood's Maneuver to get her out. I was already technically in the McRobert's position since I was squatting so deeply I was on her head.

And she’s (finally) born!



At 2:56am Sunday morning, May 27, 1984. 39 hours of labor. 2 hours of pushing.

Eileen sees this child, not yet in her body, needing help and begins suctioning her (?!). She also does mouth-to-mouth.

The suctioning isn’t doing crap but stimulating her. We could have rubbed her up for all a’good the bulb syringe did.



I sat there dumbfounded, unable to do anything but look at my daughter be worked on.
Meggie gasps.

Meggie collapses.

Meghann gasps.

She collapses.

The decision is made to call for the ambulance. There was no 911 back then.

Nice cord, though.


This is an extremely depressed baby needing resuscitation.

Instead of tending to the gasping child, everyone else is cleaning up the room to make it look like I precip’d. We conjured a story quickly about how I was having a baby shower and PLOP! the baby just came out!

The fire truck got there first, several men traipsing in with equipment. Immediately after were the police and ambulance folks. In all, I had 8 giant men in my small bedroom, looking at Meghann, who had finally begun to perk up. She never left my arms, but they listened to her heart and lungs and I look down and notice one of the guys with my cord in his hand. I told him to let go of it! He said, “I’m just going to do some cord traction to get your placenta out.” I told him to let go, “No you aren’t!”

I learn later that my husband is in the living room having a “discussion” with the ambulance captain about transporting me to the hospital. “She’s fine. It’s cold. We’ll go to the hospital in the morning.” The captain was incredulous asking, over and over, if we planned this – was there a midwife? and my husband explained the baby shower story again – as if we’d rehearsed it the whole pregnancy (which we hadn’t).

I’m sure the whole group of them were disgusted with my not getting on the gurney to go to the hospital. They left before the placenta was born. Today I am shocked they would do so, but they said, as they were leaving, “Call if you need us for the placenta.” Isn’t that odd?

Once we were alone again, we congratulated each other and I stood to deliver the placenta into the bowl. The cord was then cut and… what… did we use a shoelace? I think so. A new clean white one.

I got up into the bed.

And tried to nurse my baby.

It’s a miracle she didn’t end up seriously hypoglycemic as big as she was. It didn’t dawn on me how big she was, though. I saw she was fat and she had this weird thing on her forehead, but was pretty oblivious to her size. I should have known when, later, the newborn diapers we’d bought didn’t fit without snipping the elastic legs.


Meghann isn't even 45 minutes old and I am on the phone.

I hadn’t told anyone we were having a homebirth. My family would have crapped. When I told them on the phone, they congratulated us, but withheld their surprise. Later I learned they actually weren’t at all surprised I’d had a homebirth without a midwife; it seemed in character.

(Once, after having the homebirth, becoming Christian, coming out as lesbian and then telling my mom I was converting to Judaism, she said, “Barbara Ellen, if you told me you were going to be African-American I wouldn’t bat an eye.”)



Eileen and Candace trying to help me nurse a not-wanting-to-nurse newborn. I struggled with nursing while lying down until Aimee was born two years later. Until she could crawl up to me, I had to nurse her as if she was a Miss America sash, cross-ways on my chest while I laid flat on my back. Not comfortable.


Dad went to wake Tristan up to meet his new sister. Egads that boy had patience for us!
Tristan was more interested in his thumb than visiting anyone at 5am.

The girls left, picture-taking ended. Dad, Tristan and Meghann slept. I got up (alone!) and took a shower. Dang did that feel great! As tired as I had been, that’s how buzzed I was now. The intensity of the pain had vanished from my memory and I was in bliss. Look! There was my family asleep on the waterbed… pillows, blankets and all.

(Donna and I laugh about how we co-slept with our kids in waterbeds with fluffy pillows and tons of blankets. The SIDS people would have a fit if they knew!)

About 9am, I couldn’t stand not knowing how much Meghann weighed, so woke my husband up to go to the hospital.


This is 6 hours postpartum.

This is the picture of Meggie right before we left for Madigan Army Hospital. See the funny thing between her eyes on here forehead? That line?

Once we got to Madigan, Meghann was “isolated” since she was born outside the hospital. She was taken into the NICU and I went to be checked out by an OB. Dad stayed with Tristan while they checked Meggie out behind the glass.

I tore over my old episiotomy scar and they asked if I wanted to be sutured. It seemed a weird question and I said, “Of course!” Now I know that many homebirthers would rather heal without sutures. I hadn’t learned so much yet after all.

Once sutured, I went back to the nursery where I was bombarded with questions about the birth. We answered in our rehearsed words; they couldn’t crack us! At one point, a nurse spit out, “Do you VACCINATE?!?” Again, I was confused and said, “Of course we do.” She was startled and pulled back some of her venom. We didn’t stop vaccinating for another 2 months when Meghann had a horrendous reaction to the Pertussis vaccine. Even then, we selectively vaccinated after that.

Standing next to a nurse, I pointed to Meghann’s forehead and asked, “What’s up with that? Why does it look like that?” She blinked and looked at me funny. “She’s FAT! That’s a fat roll!” I couldn’t believe she was that fat.

On the scale, she weighed 9 pounds 15.5 ounces. The nurse and Pediatrician said she probably weighed 10 pounds 6 ounces at birth, but since she’d pooped and peed a couple of times, she weighed less. I use the 10 pounds 6 ounces as her birth weight. She was 20 inches long. Fat AND short!

“I’m a little Meghann…
… short and stout…
… here is my handle, here is my spout.
When I get all steamed up…
…here me SHOUT!”

This child was noisy! Unless she was nursing or sleeping, she was hollering. She probably had a headache for two years.


This is right after we got home from the hospital (you can see the Triple Dye on the cord stump). Medium diapers on her.

The day after she was born, Child Protective Services showed up at our door. I stayed in the room, but my husband had to bring Meghann out and talk about the birth, about vaccinations, about how we parented. I don't remember the details, but know the gentleman was satisfied that we were decent parents and the case closed.

I also had a meeting with the Chief of OB to discuss the birth. I brought Marie with me. Mostly we talked about interventions and the purpose of them, each "side" saying pretty much what you would expect. I was very nervous during this meeting, so let Marie talk most of the time. The meeting left us at an impasse (of course), but I (at the time) felt my decision to UC was the right one.

Meghann grew up to be left-handed. I’ve noticed many oxygen-deprived babies are left-handed. I wonder if anyone’s studied that.

Meghann at 4 months old (she’s smiling!) and Tristan at 23 months old.


Meghann right before we shipped out to Frankfurt, Germany. She’s about 14 months old here.
One of my favorite pictures of my daughter nursing her baby Rosie.

My ballerina… so serious!

Gay Pride Festival 2003

Disneyland! 2004

Meghann, October 2006

Meghann today.

My daughter is a brilliant woman. She made straight A’s as a student… from kindergarten through college. She’s mathematical, scientific, well-spoken, a wonderful writer, musical and an absolute delight to be around.

I worried for many years that I had somehow damaged her during her birth. After the initial bliss wore off and I realized that what I had done was a really incredibly irresponsible and reckless thing to do. I am infinitely grateful I wasn’t given a harder lesson than I already was. The weight of worry wasn't worth the fleeting pleasure of the Unassisted Birth.

Life is precarious.

Use lifeguards.

I chose midwives for Aimee’s birth. I’d sufficiently learned the error of my ways.

I know that Meghann’s birth was important for me – so I can empathize (if not sympathize) with UCers. I was there, but as I recently said, I was so ignorant of the realities of birth… I hadn’t even seen another baby born in real life yet!


When I talked to Marilyn Moran after the birth and told her the story (which I also wrote and had published in the New Nativity), she said there were complications because I had others in the room with us. She swore that if we had no one else in the room, those things wouldn't have occurred. She actually told me to get pregnant as soon as possible so we could do it again - the right way. I never spoke to her again and realized she was quite a kook because of her beliefs in sexual birth being the ONLY way to have a baby.

Yes, birth is phenomenal most of the time and perhaps some will see Meghann’s birth as proof positive that even complications aren’t devastating when left alone to resolve, but I saw her birth as a giant THWAP on my knuckles to wake up! and see birth for what it is... a wonderful event in the lives of families, one that almost always works out great, but that sometimes, when you might least suspect it, babies or moms might just need a hand.

(That powerful lesson brought me to my knees 2.5 years later as I watched a woman die in birth.)

I am blessed to be called to be that hand for the women choosing homebirth. I don’t take the role lightly.

I’m flying to San Antonio to hang out with Meghann (named for Meggie in The Thorn Birds) next week. We’re going to go see Sex and the City together. I’m going to photograph her as she does her job as a wedding coordinator (during a wedding!). We’ll swim at her dad’s house and yack and laugh – she makes me laugh so much! And I’ll tell her stories. I love telling her stories. And she laughs and laughs and laughs.

She’s never heard her whole birth story. She’s reading it now.

I can’t wait to kiss and hug her.

Thursday
Aug022007

Unassisted Birth Buzz

I'm sure most of you in Blog World have already read the Washington Post article on Unassisted Birth, but if you haven't, there it is for you. I encourage you to also read the after-chat between Laura Shanley and Mairi Breen-Rothman, CNM found here.

I wish wish wish I could stick my nose in all the places the articles and their comments are occuring because of my own experience with Meghann, but because I can't, I will remind you all here, in a shortened synopsis, what it was.

After Tristan's (hospital) birth, which I thought was fabulous and terrific, I moved to Tacoma, Washington and went to an exercise class that was run by a Bradley teacher and La Leche League leader and was slowly un-brainwashed/brainwashed (as the case may be) into understanding natural childbirth and its perfection.

I was introduced to the work of Marilyn Moran, who is the TRUE mother of the Unassisted Childbirth movement, NOT Laura Shanley as she likes to profess herself to be. Anyway. I read Marilyn's book Birth and the Dialogue of Love and was highly encouraged to have a DiTY Birth (as they were called then). I actually called several midwives in the Seattle area but could not find one to take me on at my late gestation, my extreme weight and my deep poverty level.

(I hear myself on the other end of the phone often and it definitely influences my decision to help a woman in need.)

Because I couldn't find a midwife, I chose to have an unassisted birth - not called a UC back then, but we'll call it that now for ease's sake and to use the terminology of today.

I continued getting prenatal care at Madigan Army Regional Medical Center and also gathered things to prepare for a homebirth. I was going to have my Bradley/La Leche League leader as my doula ("Doula" also being a word not yet invented back in 1984) along with another 2 girlfriends, one a former L&D nurse and another Bradley teacher. My own Bradley teacher's 16-year old daughter was also attending to be my photographer. The two ancillary women's nursing babies were also attending.

After a birth-assaultive stripping at Madigan, I began labor and all the players finally came to the house (except my Bradley teacher who was camping as it was Memorial Day weekend) where I ended up laboring a total of 39 hours.

I pushed for 2 hours and Meggie was born, a gnarly shoulder dystocia that required quite a bit of resuscitation. Someone called the ambulance (no 911 at that time) and far too slowly, the fire department, police department and finally an ambulance descended onto our tiny house where, by the time they arrived, Meghann was breathing and doing okay. Eight men stood around staring at naked me sitting on the floor with my placenta still attached, their wanting to take me to the hospital. My former husband had to argue with the ambulance driver that I was fine and he would take me in himself. Someone put a glove on and tried to pull my placenta out by the cord. No one else was paying attention but me and I yelled at them to stop it and go away.

If I'd have had a midwife there, none of that scenario would have happened. The shoulder dystocia would have been taken care of appropriately. The resuscitation would have been deftly handled and I wouldn't have had the rude interruption of those gawking men, the arguments, the self-protection - the absolute massive intrusion of negative, cruel energy - all because I didn't have a midwife there.

Granted, my reasons for not having a midwife there were very different than many women's reasons. I had a UC because I was not going to go to a hospital with a 50% cesarean rate (and I would have absolutely had a cesarean) and my choices were limited to one: a UC - because no midwife would take me on.

I've read and listened to the multitude of other reasons for UCs including privacy with one's spouse, the belief in the perfection of birth if left alone and the pain of birth trauma/birthrape and the need to be removed from The System (including midwives) in order to birth with any sense of power. Of all the reasons to UC, the birth trauma issue is the one that I can wrap my head around as the most viable. Of course, "YOUR" reason for choosing is the most correct, but that's pretty normal.

In real life, I've known one UC death. In cyber world, I've known another. I've never seen a fetal death because of the disgusting crap foisted upon women and babies in the hospital. I'm sure I will get a lot of flack for saying that, but it's my truth. I don't deny the amazing amounts of abuse, trauma, assault and even rape that happens in the hospital, but I do believe the survival of babies is higher in the hospital than when left in the hands of UCers. I believe I am trained well enough to know when to transfer so babies and mothers are kept safe and when the unexpected happens, I am prepared to keep a mom and baby in a place of safety until help arrives and we can get them to where further help is available.

I can hear the arguments. Why not avoid the possibilities of transfer at all? Why not just be in the hospital in the first place? This quote from my post Oh, the homebirth debate blog... (is more annoying than words) describes why that isn't an emotional possibility for so many women:

It would be wonderful to demonstrate a completely natural birth in the hospital (NOT a homebirth in the hospital as many would want to call it) and watch all the care providers squirm with discomfort as their jobs became almost useless "just" sitting and observing. It would take an incredibly strong woman to be able to withstand the intense tension brewing, but it would be a great lesson for hospital personnel to witness. I believe it could never be done - and that's just so sad. It's sad that not only could we not even demonstrate a normal birth, but that nothing like it would ever occur in the hospital setting. The closest I have seen is in in-hospital birth centers, but even that is difficult to compare to a homebirth.

(end quote)

So much fear operates around birth with doctors and nurses (and many CNMs and even midwives), I do understand the drive for UCers to birth alone, to maintain the stance of strength and autonomy.

But, I believe a re-education of those that are birth workers is what is necessary. It seems absurd and daunting, sure. I know it seems crazy to think we can re-train that horribly evil doctor that slices open every woman's perineum and has a 45% cesarean rate. I don't have the exact answer HOW to do it, I just believe in the answer that we have to do it. Maybe it is in "seeing" that we need to do it. Aren't we all mad enough at The System? Don't we want it to change yet? Don't we want birth abuse/birth assault/birth rape to stop yet? Don't we want the reasons for women to have to choose UC to stop being created? Until we end the trauma, UCs will multiply.

In the commentaries and blogs, don't the masses hear themselves? Don't they hear how they sound saying it doesn't matter how the baby comes out, that the misery a mom and baby experience doesn't matter, just that they both are alive in the end? Isn't that horrible? How can people who whimsically subject themselves to plastic surgery for beauty or schedule cesareans because they don't want to feel the pain say it doesn't matter how a woman FEELS when it comes to her own birth experience? How can that 95% or more who gets an epidural say that? It's absurd!

Still, even though women are "made" to have babies, women don't traditionally birth alone. Many mammals don't birth alone, some even having "midwives" with them as they bring their offspring forth. A midwife is merely someone who knows a little more than you do about a subject. It doesn't mean you are stupid or wrong or ignorant or less than. It just means she has more experience because she has studied more on the subject and/or been around it more. Myself, I've been to right around 900 births. While you do know your Self best, I still have quite a bit of experience around birth and bet I can share a thing or two with you.

A hairdresser knows a bit about hair... even though it's yours. She doesn't know ALL about hair. She doesn't know all about YOUR hair. But, she can cut your hair in a nice way given guidance from you.

A brain surgeon doesn't ask your opinion at all, yet has a damn good idea what to do inside your skull if she's inside there.

Ah, but those aren't "natural" things. I gotcha.

What if you are hemorrhaging between periods. What if you are hemorrhaging postpartum. What if you have a breast lump.

You get the picture.

Where does "natural" end and "un-natural" begin? Who decides? Laura Shanley?

I think one of the most offensive aspects of the UC movement is the rabid Us vs. Them (Black/White) and the true inability for any discussion regarding UC and the possibility of finding a midwife who might actually support a woman's need and desire for autonomy - which, they (the UCers) profess, is their true desire. It is only in the past few months that I have seen any discussion that has included outsiders and, surprisingly, the interviews have been coherent and inoffensive. Good for Shanley.

Perhaps it will take the UC movement to wake up The System to the birth assault that's occurring and affect the change that's necessary for women to get their needs met - so they are able to have a birth worthy of themselves. Birth should be gentle, beautiful, loving and respected - no matter where it happens. There is so, so much to do to make change happen. I keep writing about this and there doesn't seem to be any change (except with finding Dr. Wonderful!). I wonder what more I can do.

What are YOU doing to affect change? How best can each of us use our talents to bring forth change? Ponder on it. Use your energies to imagine a world where respect for women is a given. Let's stop putting energy towards the negative crap they foist upon us, eh? Let's "see" what we want and create it... even if it takes small steps.

We can do it.