Gunnarr’s Blanket

(Gunnarr has the traditional Scottish spelling and is pronounced “gun-er”.)

I began an afghan for Gunnarr before he was born. Of course we didn’t know if “he” was a boy or girl so I chose a lovely green color – organic cotton – a lovely yarn and a challenging pattern for my knitting skills. Certainly doable though. I’d been knitting for a couple of years and knew all of the stitches.

Well.

It just wouldn’t come together. I tried and tried, frogged and frogged… and only NOW, with his 9 month birthday looming, is it nearly complete. It was quite a journey, but of course, so was his pregnancy and birth. I’ll blog about the pregnancy another time, but for now will talk a bit about his birth.

I had the MOST lovely home labor I could have dreamed of. Predictable labor pattern, totally what I wanted with my husband at hand, in the water, candles.. music… got the 10 cm and felt like pushing after about 6 hrs. I couldn’t believe how fast it was going! 🙂

And I pushed. And Pushed. And PUUUUSSSHHHEEDDD. Nothing. Changed positions, used homeopathics, contractions hard and strong… the little fellow wouldn’t budge.

Now, of course we hasn’t a little fellow at all. 🙂 He weighed 10 pounds and 8 ounces and was 23 inches long! But I’ve seen 10+lb’ers be born slick as a whistle, easy and in a state of bliss… it just wasn’t happening for me.

6 hours later, Gunnarr plugging along just fine, he was born surgically in our local hospital. He was fine, I was devastated. Even though I made the decision to transport, even though he was ok and so was I (physically) it really REALLY hurt.  A few months later I attended a butter birth… big baby whose mother I now call my friend… and she had MY birth. And it hurt again.

Then today, as I am finishing up Gunnarr’s afghan…. it suddenly started just falling into place… the last few stitches, the edging… all of it. And it hit me: “This doesn’t look exactly like I envisioned it but it still is a nice little blanket!”

Sometimes crap happens. Sorry for using that word, if it offends anyone. But it does. And it’s messy, and it stinks, and well… who wants it? Not me! But it happens. So we clean up the mess and move on. And once in awhile, something beautiful turns up in spite of it. 🙂

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Off-label drug use

I understand that the off-label use of pharmaceuticals is a normal occurrence in the medical world. I get that. What’s not cool is that this is done in maternity care as well with dire consequences.

I’m not talking about the random, “uh-oh”, I’m referring instead to the drug company themselves issuing statements saying “We do not endorse the use of this product for any use other than that described on the label.” Yeah, they’re probably just covering their b*tts but still. They said it. Yet it happens everyday in the labor and delivery department of nearly every hospital in the country. It has become so commonplace to induce labor that not only have we stopped wondering how/if this affects the baby or the mother we have now started grabbing whatever drugs we can find that give us “a better induction outcome”.

Hrrumph.

Bishop’s score be damned. God created women’s body to birth. With consideration made for the odd-one-out with pituitary damage or other disorders that truly make her body hold onto her baby long past safely, using drugs to begin labor before the body begins to open up on it’s own is risky risky risky.

Births are kindof like bowel movements. They happen on their own. Can’t plan ’em, can’t stop ’em, can’t hurry them along. Bowel movements happen (errr… I can’t help but think of a certain bumper sticker I’ve seen alot of right now).

Birth HAPPENS as well. Babies are born when it is TIME. If we have accepted that every other body system has knowledge to know when to open and release, then why can’t we accept the body’s wisdom in birthing when it is time?

You might have had a Cytotec induction. And so did your sister, your friend, aunt, daughter’s 2nd grade teacher… and all went well. On the surface perhaps. But what did it do to that baby’s emotional/psychological health to be so rudely pushed into the world before he/she was ready to come? And what about the women reading this who is a victim of a cytotec induction who is grieving the loss of her womb? Suddenly hurrying a baby out seems less important when faced with an emergency cesarean to save your baby’s life and a hysterectomy to save yours.

All from a couple of tidy white pills manufactured to treat ulcers. Who’da thunk?

Only if…

“It’s a numbers thing,” says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. “You don’t get sued for doing a C-section. You get sued for not doing a C-section.”

I’ve seen this quote before, but it never quite made me as angry as it did this morning when I was reading it in the context of THIS TIME MAGAZINE ARTICLE. This California mom has to drive 100 miles to have the chance for a VBAC. Give me a break!

I understand liability, I truly do, and I understand that to continue offering care for the majority of patients, one must sometimes eliminate care for the minority. But hey. This is ridiculous. As a VBAC mom myself, I would have to drive at least 100 miles and then only have “permission” for a “trial of labor” within a very small window of opportunity. “Only if” my incision was of type A, “Only if “ my bag of waters hadn’t been broken more than 12 hours, “Only if” the baby was in a perfect position (by obstetrical definitions), “Only if” the labor didn’t last more than X number of hours, “Only” if it progresses well, “Only” if I would have continuous fetal monitoring, “Only if………”

By the time all of the restrictions had been placed on me I’d have a better chance of delivering my baby vaginally in a snow storm in the middle of April. Yeah, it happens, but rarely. Birth was not meant to be a 3-ring circus with planned events and bright lights.

This mom, in the Time article, said her biggest fear was the drive and that she might not make it to the hospital.

If only… she gets that lucky. It might be her best chance at a natural birth.

“…in all cases think for yourself.”

Doris Lessing – “Think wrongly, if you please, but in all cases think for yourself.”

This pretty much sums up the motive behind the last post on this blog. I see and hear and read of SO many choices we make in regard to childbirth and breastfeeding that are facilitated by fear, misinformation and CHOSEN IGNORANCE. I had a mom tell me once, very pragmatically, that “it’s easier to just do what the doctor says. do you realize how much work it is to fight every protocol?” Yeah. I do. But what is at stake if we don’t?

Alot. and I’m not suggesting we fight protocol for the sake of fighting protocol (though some might say that is a worthwhile endeavor in and of itself). I’m suggesting rather, that we exercise our rights to informed consent. That we demand it, that we honor it, that we respect the right and exercise it.

If a woman chooses to go along with a protocol regarding her birth options, chooses it knowing the possibilities and chooses it knowing the risks then I say, “THROW A PARTY! WOOHOO!” This is informed consent!!!

But to say, “I don’t know and I don’t want to know” is irresponsible and dangerous. And it happens with sickening frequency.

I had a reader post something along the lines of my insensitivity to women’s psychological positions and backgrounds when I shout this whole “get informed” thing so loudly. That if/when something goes badly because of a choice she made I might just say, “Get over it. You did it.” I have to chuckle, because the truth is, I might feel just that. In my head anyway. I’d never say that to a woman. I’d never even THINK it really, but in reality there has to be responsibility taken when a choice is made. And if a woman chooses an epidural (for instance) and the babies heart rate drops and an emergency cesarean is needed, let’s not go blame the anesthesiologist or sue the hospital or OB for malpractice if the baby is then subsequently harmed in the birth process. Let’s be real.

So whatever you choose regarding you reproductive rights, INFORM yourself… DEMAND to be informed, then be BRAVE and make the decision your heart and head calls you to make. No one else ahs to live with the decision. YOU DO. And then… be REALLY BRAVE and tell another woman what you learned. 🙂

Prejudice…

is sickening and distasteful to me, in whatever form it takes. Many make arguments that “their prejudice is founded” like, “Chinese are always good in math.” or “African American women have big butts.” or “Women are too emotional to be in politics.” and recently, “You don’t know what you’re talking about because you’ve never had a homebirth.” or “You’re going to be a medically minded midwife because that’s all you know. Medical births.”

Ok. So I’ve never given birth at home. And that experience is just that: and EXPERIENCE. I admit fully that I do not have that personal experience. Does that make me a “junior” in all things homebirth? I don’t think so. Admittedly I don’t have the personal experience of having birthed at home, yet. But I take offense at the notion that I cannot understand how to “trust birth” because I’ve never had to. Bull. Here’s my “trust birth” story.

I layed in a hospital bed with my first child, who was posterior, for 31 hours after my water broke. The last 8 were Pitocin augmented. Hard contractions. No support. My husband went for a haircut, brought Hardee’s for his breakfast back to my room while I starved, and watched television. I had no pain relief. I wouldn’t take it. I pushed for 4 hours. Almost 5 until they wheeled me into the operating room for an “emergency cesarean” for CPD. No one told me until weeks later that he had been brow presenting. The forceps wouldn’t budge him, the vaccum extractor didn’t budge him. I couldn’t budge him. ( I know this was all the fault of my OB and the attending nurses for a meriad of reasons. That’s not the point of the story.)

I BELIEVED I could birth my baby. I TRUSTED my body to do what it needed to. All the way to the OR I believed we were making a mistake. Too tired to fight anymore I gave up and gave in. But I “trusted birth” while hindered, drugged, scared, manipulated and assaulted and betrayed by my former husband and caregivers. I TRUSTED BIRTH in the most trying of circumstances.

Again when my youngest had sticky shoulders and (again on my back because the OB refused to catch if I didn’t lay down). She was prepping the OR while I did the McRoberts maneuver on myself and popped him out.

For those mamas who have had the priviledge of never birthing in a hospital or at least it was a one-time experience of which they have happily erased many of the memories, I find it appalling that my thoughts, desires and opinions as a student midwife would be called into question simply because I have not had that same priviledge. Some of the comments haven’t been blatant about it, but in a patronizing, pat on the head sortof way I have heard the message, “You just don’t understand.”

I TRUST BIRTH. You can’t say you really do until you’ve had to. I’ve had to. I do. I will.

Judgements

A recent story in a British newspaper left me feeling bewildered at this tragic loss and wondering what I can learn from it. A 20-something mother died 6 hours after giving birth to her baby at home.

I am not one to ignore or **hide** the less-than-optimal outcomes that occasionally occur at homebirths as some of our opposition would assert. Rather, I wish to dissect it (as much as possible form the information given in the article which is, I’m sure, far from all of it) and learn the lessons that are there for the taking.

The mom suffered a massive hemmorhage after an inverted uterus began bleeding profusely. It seems that a huge factor in this woman’s death revolves around lack of communication between the hospital and the attending midwife at the time of transport.

One of the gynecologists on staff said, “The staff were expecting a retained placenta. If they had been told it was a complete inversion of the uterus then she would almost certainly have gone straight to theatre and I would have been ready for her.”

One thing that seems to be missing from this article is the answer to this question, which of course, could only be answered by the attending midwife: “How/why did the inversion occur?” As a training midwife, this question is of utmost importance to me. All of the study I’ve come across says they are almost always caused by interference of some sort. Not always, but generally.

I am skeptical of it being anything but an induced inversion because she was not (apparently) forthright in telling the ER staff of the woman’s condition. Did she pull on the cord or placenta? Perhaps the woman was hemorrhaging and the midwife attempted manual removal in order to stop the bleeding? 

Or was there no communication because she is an independent midwife and was greeted with hostility when she arrived with her client at the ER with paramedics?

And rather than blame the midwife, we should probably wonder why paramedics weren’t trained to cannulate? When they, perceivably, attend more massive bleed situations than a midwife would? Her assumption was the same as mine might have been as she was quoted as saying, “Knowing the ambulance was only a few minutes away I thought it was better to leave it for the proper paramedics who have expertise in this on a daily basis.”  While cannulating (inserting an iv and fluids) may not have saved this woman’s life, it could have bought more time for the hospital staff to figure out what was going on and act accordingly.

There is quite a bit of talk about this on certain people’s blogs, saying this is exactly why DEM’s shouldn’t be practicing and why homebirths are “inherently dangerous”. Again, I would say, a DEM is such a broad term that I prefer not to use it. I prefer to use the term “midwife” and then find out on an individual midwife’s training is. Some CNM’s (from personal experience) have no business catching babies. They simply took the extra training for the pay raise. I had one tell me this straight out. She was an OB RN and had caught enough she thought she “ought to be getting paid for it”. “I wouldn’t say it’s my passion, but it’s a good gig.” CNM’s can also get their certification online. I mention this since it seems to be a point of contention and an excuse for the “CPM’s training isn’t good enough” crowd. All DEM’s are not created equal, just as all OB’s are not. Gasp – horror!!!!! Did I just endorse OB’s? No, I said I won’t cast judgement on them all for the actions of some.

This is all, of course, an overstepping of my bounds in regards to making a judgement on this midwife and this homebirth. There is no way for me to calculate, based on one newspaper article, what went wrong, who is to blame, etc. Nor is there enough in one article to use it as fodder for a position that says “ban on all homebirths”. It is a sadly uneducated and narrow-minded person who would do so.