Trust Birth or … ?
I guess I’m still reeling from a personal attack I faced last week regarding attendance at a birth. I can’t go into the details of it all but sufficient to say, my suggestions regarding concern over her rising blood pressure, swelling and general fatigue were met with scorn. Afterall… don’t I trust birth?
So the talk of me being “medically minded” might be true. I don’t know. All I know is that it is irresponsible to attend a birth without basic life-saving skills and equipment and the knowledge to implement it.
I will carry a suctioning device. In case I need it.
I would like to carry Pitocin or methergine and oxygen in the RARE, rare rare event that it is truly needed.
I will help my moms take care of themselves during pregnancy, watching their diet carefully together, tweaking as requested/needed for her and her babies optimal health.
I will keep my neonatal resuscitation certification up to date on a yearly basis.
I will continue my education as long as I am practicing, careful not to fall into the trap of “It’s worked for all these years, why change now?” and think I already know it all.
I do not consider myself a “med-wife” at all, though from the above list some would. I look at it like this:
I firmly believe in the innate knowledge and power that accompanies birth. And that nearly all births have the BEST outcomes when the mom is left alone. Totally.
Now here’s the but…
But! If I were to attend a birth where the baby needed resuscitation and I couldn’t do it? Or is he or she truly needed suctioning (thick mec/etc.) and I didn’t carry a suction device? Or if the mother hemorrhaged and none of my herbal or manual tactics were working? Or if the Mom’s diet was BAD and with this knowledge I did NOTHING TO HELP HER CORRECT IT?
Those rare instances, where life is hanging in the balance, are enough for me to be prepared. You know… like the Boy Scouts? 
Be prepared, with the firm belief and intention that those tools will rarely (and hopefully never) need to be employed. I believe anything less is irresponsible and careless. “Trust” has nothing to do with it.
I’m not God. I have no desire to believe I am equal with Him. There are times a birth ends with death. I accept and acknowledge that God is the Father of all living and is in control of what happens at a birth. I realize and accept also, that all the tools in the medicine cabinet cannot save a life destined for heaven. I’ve seen that.
But I ask myself this question: “If a baby or mother died because I didn’t have these tools at my disposal, could I sleep well that night? Would I be consoled just knowing I “trusted birth” even though the evidence shows that life might have been saved had I been prepared?” I hope this question and the answer to it resonates deeply with many. Because frankly, what I am being accused of by being careful and watchful signals to me that the insistence to “Trust Birth” has gone a bit overboard.
I expect quite a bit of “flaming” over this post. I do. That’s ok. There’s room for disagreement (I think). This is my opinion and this is, afterall, just a blog.
May 19, 2008 at 11:34 am
I don’t see a problem at all with being prepared for possibilities. I UC’ed my first baby, and I was very meticulous to prepare for certain eventualities. I became NNR certified, for example, and frankly the knowledge I gained from a lot of study and preparation, and from attending births as a midwife’s apprentice, added to the totality of the experience.
When a woman hires a midwife or other caregiver, that action signals that she wants the experience and knowledge you have–even if you don’t actively use it at most births. The trouble is that the phrase “trust birth” can mean so many things. It’s a very easy concept to build straw man arguments around as well.
May 19, 2008 at 11:54 am
To me, some people take “trust birth” like the way one would say, “trust God.” One can be done with no worries, because God is in control; the other one, not so much. I agree that in most cases, left alone, both mother and baby will be just fine. But not in every case. I read of a story just the other day of a woman who had an amniotic fluid embolism, and both she and her baby died, despite an emergency C-section being performed. The kicker? She wasn’t even term — I can’t remember how far along she was, but it was between 30-34 weeks, I think. She had a placental abruption, and the amniotic fluid entered her bloodstream through that. From what I’ve read, most cases of AFE are due to interventions, particularly induction/augmentation, which causes ctx that are too strong/long. Avoiding that procedure may reduce the number of cases of AFE. But, as the above story shows, it cannot possibly keep it from ever happening.
Yes, reduce the number of unnecessary interventions! Yes, reduce the number of unnecessary C-section! Yes, reduce the number of C-section that became necessary because of the “spiral of interventions”! But, yes, also remember that some interventions *are* necessary; some C-sections *are* necessary. We can’t be so hasty in our calls to “trust birth” that we forget that while God designed the birth process perfectly, there’s that nasty problem called “sin” and “death” in this world. And that has nothing to do with whether or not we “trust birth.” Let’s trust God, and remember that He designed us with a brain for a reason. Let’s use it! Most of the time, we will use our brains and “trust birth” because it does work perfectly well most of the time; other times, we will use our brains and use interventions as well, for the times when birth does not work perfectly well.
May 21, 2008 at 12:09 am
No flaming from me!
Some of my UC friends have criticized me the same way because I birth with a midwife (and her life-saving stuff) present. For some it’s almost become a superstition. Like if the midwife is there with life-saving equipment it will bring negative energy into the room and you’ll end up needing it. Unassisted is the only way to ensure nothing goes wrong because there is not “safety net” and no negative energy. Whatever! In that case, it’s the exact opposite of trust! It’s fear and superstition–the same ploys of those on the other end of the spectrum!
So, good on ya! Keep speaking your mind. We’ll keep reading and respecting you!!!
May 24, 2008 at 4:06 pm
No flaming here either. I chose a CNM for my HWBAC. When I hired her I liked that she had extra training in NNR, carried oxygen, methergen, and pitocin, and didn’t plan to use any of it.
As it happened, my daughter’s cord severed at some point during her birth (she had a difficult descent with a compound presentation); the cord and placenta were otherwise in perfect condition. When my daughter had difficulty drawing her first breath, my midwife gave her a couple of puffs of room air from the ambu bag and tucked my daughter in bed with me to nurse as much as possible for the next few hours. Thankfully, we didn’t need any of the *extras* that our midwife had, but knowing that the unforeseen had happened to us, I am so glad that we were attended by a midwife with the skills and tools to handle the unexpected, and the wisdom to know what was and was not needed.
June 1, 2008 at 5:03 pm
Not sure if you read my piece “Respectful Trust,” but I DON’T “trust birth;” I RESPECT birth. Those that profess that birth is perfection when left alone need to talk to the UCers whose babies have died or been horribly damaged when they probably didn’t need to be. Hang around birth long enough, read about birth enough, *listen* hard enough – and you will see that midwives are/have been a very active part of almost every society since forever… and there are even midwives in the animal world.
Humans are animals – with a MIND. Animals hemorrhage to death. Animals’ babies die in utero. Animals’ babies have oxygen deprivation and need assistance getting started sometimes. It is fact, not superstition or negative thinking.
I beg of you to NEVER apologize again for knowing – KNOWING – you should be carrying equipment and meds to save lives.
(Pitocin use isn’t all that rare, by the way… just so you don’t get wigged out if you find yourself using it. Bleeding in the hospital is a WHOLE lot different than bleeding in a homebirth – there isn’t the same lead time in a homebirth. Stop it sooner than later. And some herbs take FAR too long to give the same kick Pit does – which still takes 3-5 min. IM)
Stand tall and strong and the right clients will come to you. No apologies for thinking clearly and with knowledge.
Respect birth, but watch her lovingly and closely – she ALWAYS surprises you.
June 12, 2008 at 8:27 pm
So, I’m wondering…
My first baby was induced at 42 weeks. I asked for the induction. I think I probably wouldn’t have in hindsite. It took a long time for the induction – a couple of days, but once my water broke I really went into labor. Then I got an epidural, but didn’t get it till transitional labor. Everthing was ok till the end, but then the baby had a cord around her neck, no pulse, not breathing. She lived they said because they had a specialized neonatal respiratory therapist on hand. She was shoulder dystocia, but only really briefly.
My second baby was induced at 42 weeks as well. The induction wasn’t taking. They broke my water. I started progressing more quickly. Her fetal tones began to be not good, so they stopped the Pitocin. This fixed it. I got an epidural, but it didn’t take fully. After pushing her head out, which was more difficult than with the first birth, she was shoulder dystocia – for two minutes – doing their maneuvers. But she was fine. No damage. She was 10 pounds and had big shoulders. Still does.
We got an ultrasound with my 3rd baby. I knew they weren’t accurate, but it gave us an idea. She was supposed to be between 8 1/2 and 11 pounds. She was 9 1/2 pounds. I was going to be induced a week early. At the hospital I was urged to have a C-Section because of the 2 previous shoulder dystocias, the likelihood of a big baby, and the unsuccesfulness in studies of inducing early for a better outcome of shoulder dystocia. I had a c-section. It wasn’t fun and the recovery wasn’t fun, but my daughter was absolutely beautiful and perfect.
So, I know, they don’t let you labor naturally at the hospital (you have to be up on the bed, they monitor you, etc. etc.). I know being induced isn’t good in most cases. But, would my babies have been OK if I’d done a Home Birth? I think it’s great you stay certified and carry those things, but would you have been able to save my lifeless cord incident baby as the hospital did?
I would so love a natural birth – a I set my own pace, wait for my body to be in labor birth. Was I one of those unnecessary C-sections with this last baby? How do you know?
June 21, 2008 at 5:58 pm
No flaming from me! We are expecting our 5th child this fall. Our 1st was a Dr. hospital baby, a very over managed birth that caused some problems. Our 2nd was a wonderful easy midwife home birth. Our 3rd was a home birth same midwife but a hard birth. Both my dd and I needed help and we were so very glad our midwife was trained for it! Our 4th little one was another homebirth dd was born 3 min before the midwife got there LOL. Easy great birth though. But it always makes us feel better that IF something happens our midwives have the skill and knowledge to know what to do.
June 23, 2008 at 10:11 am
I assist a LM at home births & births at her freestanding birth center. We would certainly never consider you a med-wife for being conscientous, prepared and prudent. Recognizing that we are not perfect and that there is the potential for deviations from normal is rational and responsible.
We trust birth and are very hands- off but we come prepared. We will not ignore unresolveable non- reassuring hearts nor will we allow a mama to bleed to death. The midwife’s experience, judgement, wisdom and intuition are impeccable.
Anyway, good for you – midwifery care is good for mamas and babies.