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Midwife under attack

The British press is having a field day with a story about a home birth that resulted in a girl having a paralyzed arm. The shoddy, one-sided press story is the classic tale of “money hungry midwife did disgustingly bad job and mother and/or baby is maimed”. We’ve seen it many times in North America and around the world. These stories sell newspapers. The general public sips their morning coffee and reads a titillating account of the dangers of trusting a homebirth midwife. Young women reading it do not see midwifery as a career that they would pursue and hospital birth reigns as the “default” best choice for a horrified public.

Meanwhile, on the private online midwifery discussions, some will point out that there is only one side to the story and call for calmer heads but those comments will remain largely closeted for fear that the commenter will be tarnished by the witch hunt.

The consumer message boards light up with cries of anguish from sympathetic onlookers who think they know something about the inside workings of the obstetric system.

This is the weak link in making home birth available to larger numbers of women and it must be addressed. No midwife can guarantee a smooth birth every time. Midwives are vulnerable to attack and relatively unsophisticated in the ways of running their governing bodies. Of course, no one wants to see a mother and/or baby hurt from the birth process. Reacting to such an incident by punishing the practitioner with professional capital punishment is highly destructive to women’s choices. Why do I say “capital punishment”? Because, in most Western countries, once you have been stripped of your license in one profession, it is impossible to then be accepted by any other professional body. This is why you will see decisions made in the case of physicians that seem very lacking in punishment. A doctor who has demonstrated repeated sexual misconduct, for instance, will be sent for a weekend of retraining. He goes back to work as usual. One of the most famous cases of this “professional forgiving of a doctor” involved a surgeon in N. Y. who carved his initials into a woman’s belly while doing a cesarean. His professional buddies didn’t stop him for long http://www.nytimes.com/2000/01/27/nyregion/how-doctor-got-work-after-carving-into-patient.html

Not so with midwives; for the smallest error they are delicensed even though they have served women for 30 years as in the case of Sue Rose. (Internet bio: “Health care worker for 30 years and practising, independent midwife for over 15 years based in Brighton”.) She is maligned because she did not defend herself in her midwifery hearing. I can understand her not defending herself. The results of these hearings are pretty much a foregone conclusion and every word the midwife says is twisted and turned and used against her. After a few forays into the legal trap, the smart midwife keeps her mouth shut and lets the chips fall where they may. Eventually the whole drama blows over and the jackals simmer down.

What is left in the wake of these press debacles?

-midwives afraid of their clients
-clients afraid of home birth and midwives
-deals made with insurance companies for “protection” which involve restrictions on practice
-paranoia in the natural birth movement

Now, ask yourself, “Who benefits?”

WHAT IS NEEDED?

One day, the home birth movement will reach a level of sophistication where there is a plan in place for diffusing these attacks long before they happen. It may come from a large organization like MANA, ICAN or Lamaze but we will see an instant supportive response for midwives and home birth when these press slanderings begin. There will be an understanding throughout the movement that we need to stand together in times of breakdown, just as the physicians and other professional groups have learned to do. We will wake up to the basic tenet that everyone is innocent until proven guilty IN A COURT OF LAW. . . not some professional tribunal. Most professional tribunals do not have a clue about jurisprudence and basic legal fairness. We will understand that “no comment” is a perfectly appropriate response when a professional midwife is required to maintain client confidentiality plus protect her own family. Professionals and consumers who want home birth to be available will begin saying the only decent thing when news breaks about a death or injury at a home birth: “I don’t know, I wasn’t there, I’m sure the midwife did everything she could.”

When we get to that place as a movement, we’ll see the percentage of home births skyrocket and we’ll see more young women choosing home birth midwifery as a career path. There’s a saying by Angela Davis, the American civil rights activist, that applies to the current vulnerable state of independent midwives: “if they come for me in the morning, they’ll be back for you in the afternoon.”

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Baby Leo Dane Themba, born 7:40 am Sunday Jan 17, 2010 about 10 1/2 lbs, 42 weeks and 2 days.

Well first I’d like to congratulate myself on doing so well with the longest pregnancy ever. It seems like this baby needed to grow a bit, and I’m glad I let him.

So baby was due on New Year’s Day. I was having zillions of contractions for weeks before which were a new thing for me. With the other two babies I never felt as much as a Braxton Hicks contraction before I was in labour. So I figured that with all the contractions I would probably not go much past 40 weeks. ANYWAYS….

On Friday evening I decided to try and see if I could feel my own cervix to see if I had started to dilate at all…well lo and behold I could actually feel that I was about 5 cm dilated, mostly effaced, and I could feel baby’s head through a thin layer of fluid and membranes! I was very excited. It made me feel much happier to be able to know I was making progress. I also began to think it would be a short labour once it started because I was already halfway dilated without any “labour”!

On Saturday I was a bit disappointed to wake up still pregnant, so I decided to stop moping and go grocery shopping. I walked around a few stores and then went home. Still not in labour.

That night, when we said our prayer together, Phil said “please help us to have a good rest and then that Amy will go into labour in the morning.” heehee! That was very specific. I guess God agreed it was time for baby to be born because I woke up after 5 good hours of sleep at 4:30 am with contractions.

I wasn’t sure it was labour though because they weren’t much stronger than the contractions I had been feeling on and off for weeks. I decided to get out of bed and go sit on my recliner chair in the bedroom thinking that an upright position might help things along if it was really labour.

I sat there for about an hour or so having a bunch of contractions, I couldn’t see the clock and I was purposely avoiding timing things because that’s not useful. So the rest of the story I will try to estimate times, but they aren’t accurate because I never looked at a clock until he was born. Anyway, I figure for that hour on the chair I was having a pretty strong contraction every 5 min or so.

About quarter to six Phil woke up and asked me if I was in labour. I was pretty sure I was, but I wasn’t sure if it was time for him to get out of bed and set up our birth room yet, so I said “I think so, but I don’t know”. And he asked if he should go set up the pool etc and I said “well I guess you could if you want.” so he got up and went downstairs.

I spent the next hour or so after that labouring upstairs getting more and more unable to find a good position. I mostly stood up and leaned on the windowsill or the two walls in the bathroom since I was finding it necessary to be near the toilet I tried labouring on the bed a bit, but there wasn’t anything to lean on, and I found it horrible to try and support myself with my arms during a contraction.

Eventually I thought it might be a good idea to try and eat something since I hadn’t had anything to eat since supper. I went downstairs to the kitchen where Phil was setting things up and was able to kind of drink some juice, but I really didn’t feel up to eating. By that point I was having really hard contractions and I was making some noise to get above them. I still stayed standing and just leaned on the counter or just stood in the middle of the floor and sort of rocked. The pool was almost ready, but the water was much too hot. I stood around the kitchen waiting for Phil to be able to cool off the water and get the level up where it should be. Phil was asking me questions, but I found it impossible to speak. It would take all my effort to muster a nod or a shake of the head, so mostly I just ignored his questions. It wasn’t that I was in so much pain; it was more that I was just totally stoned on birth hormones and was in another world.

By that time I was having contractions almost nonstop it seems like. I would only get a lull for a few seconds where the contraction would be duller, but it never totally went away. But in those lulls, it was like my head was floating and I would feel REAL good…the birth hormones are kind of pretty sweet drugs

So I guess it was about a quarter to seven when I got in the pool, and it was like HEAVEN! It made the pain so different and more easy to stay above. I just leaned on the wall of the pool and zoned out. While I was in the pool I had my most difficult contraction and I yelled swear words through most of it, lol. That was the only one where I really lost my grip on things. Labour is good like that because if you lose it for one contraction, you can regroup and start over with the next one.

It was about 7 or so when I decided to try and feel my progress again, so I reached up and I couldn’t feel any cervix anymore, and I could feel the bag of waters protruding out. That made me feel so much better to know I was nearly done, and I just kept my hand there so I could feel that during contractions after that point. I guess the older kids woke up then, but I didn’t hear them. Phil left me and went upstairs, brought the portable DVD player and some grapes and told them to stay in their room a while because mom and dad were busy! lol.

While he was gone I started to feel like maybe pushing a bit at the peak of contractions, so I tried some gentle pushing and I found it felt good! This was a happy discovery because my pushing with Roysten felt like torture. After that, I would push a little bit when I felt like it, and I could feel the bulge of waters slowly moving even more downward. Phil came back into the kitchen and around then the sac exploded during a contraction. I think if I had not been in the pool it would have made a HUGE mess! the fluid was clear and full of bits of vernix, but I didn’t notice that at the time. All I was thinking then was that I must be really almost done because after Roysten’s water broke in the pool, he was born within 2 or 3 minutes.

So, another thing that changed with the pushing contractions, especially after the water broke was that they didn’t hurt anymore. My body stretching around the baby did hurt, but not like torture, and the contractions themselves did not hurt anymore. and pushing felt kind of good to do even though it did hurt. I didn’t say anything to Phil about what was going on, but later he told me he could tell I was pushing by the sounds I made. He told me that when he went behind me to see what was happening. the room was quite dark though, so he couldn’t see very well.

I was making very loud roaring sounds, not because of pain, but just because it somehow helped to make noises as loud as possible. I wonder what my kids thought! They stayed in their room very nicely anyhow.

I could feel that the head was going to come down, and then I knew it was serious so I took my hands away from my bottom, and leaned on the wall of the pool again, kneeling. I just pushed how I felt like doing, which was sort of panting a bit and pushing hard, but panting a bit and then pushing hard… it hurt quite a bit, stretching around the baby, but I knew I wouldn’t tear so I wasn’t afraid. I gave one strong push with a contraction, and I felt his head be born under the water. I reached down and felt to make sure, and yes, there was his head sticking out of me! YEAH! I was glad. My mind got very clear then and I was happy that I had done the biggest part. Later, Phil told me that he was behind me watching, and he saw something in the water, but wasn’t sure what it was because it was so dark in the room, so he also reached in the water and felt the lump he saw, and figured, “yep that’s baby hair!”

Then, I rested for a minute waiting for another contraction, and I thought about just not bothering pushing the rest of the baby out because it was pretty painful with all the stretching, but I figured I had done the big part, and so I would just be tough and do the rest quick! heehee. So I just pushed like crazy with the next contraction and the baby slid out and floated into the water. Phil said “there’s the baby!!” or something, which was good because I wasn’t totally sure the whole body had come out, and then I somehow flipped over really quick, leaving the baby underwater for the moment, and Phil picked him up and put him on my chest! ahhh!! that felt so good! It was just amazing.

He was very quiet for a bit, but I could tell he was alive, just looking around, so I never felt worried that he didn’t cry right away. in fact, it seemed like it was only about five seconds that he was silent, but really I figured out later that it was the more part of a minute. babies who are born in water and whose cords are not cut are often quiet like that because they feel calm and there’s no big rush since the cord is still giving them oxygen for a minute or three. anyway, after a time I felt that I would like to hear him make a noise, so I said to him “ok baby, it’s time for you to make a noise.” and he cried a little, and then he cried a little more.

I wanted to wait until after the placenta came before cutting the cord, but after half an hour in the pool after the birth it hadn’t come out and I was worried the baby was getting cold, so I decided to get out even though it was sort of tricky with the baby still attached to me, and getting us both dried off! but anyway, we did it fine and I went and lay down on the couch with a towel and a couple of chux pads under me. after another half hour, I knew the placenta must be separated by then, and I was having very difficult contractions with the dumb thing just sitting inside me, so during one of them Phil wrapped a facecloth around the cord and pulled it a bit and it came out which was a relief. then we tied the cord with sterilized string, and cut it with sterilized scissors. it had been an hour since the baby was born.

Phil had gone and called the kids down when I was in the pool right after the birth, and they both came in and were very excited. Averie likes the baby, and has given him lots of kisses and wants to see him all the time, but Roysten LOVES the baby and is very enthusiastic…so basically I can never ever put this kid down or Roysten will crush him with loving embraces! lol. I hope he figures out how to be gentle soon. Roysten has even shared his blankie with the new brother, and has tried teaching him about dinosaurs already. also, he has named the baby Roysten. Averie wants to name him Molly, but she understands that’s not a boy name. Roysten might call the baby Roysten for a long time though.

So this little guy slept all day, but has been nursing ALL night since the moment we tried to go to bed. He literally nursed for about five straight hours, just going from one side to the other. Wow, I hope my milk comes in fast. This is a hungry giant baby.

Now that I’m on the computer he has finally decided to sleep. I put him in one of my slings, and walked around with him until he fell asleep. he liked that, but when I tried to go sit on my recliner with him in the sling, he started to cry, so that was a no go. Oh well, Phil is off work for a few weeks, so I can sleep today.

Right now he’s sleeping in my arms. He’s the cutest baby ever and we like him lots and think we’ll keep him
______________________________________________________________________________
Amy’s first birth was a hospital birth with an epidural at the end. Second birth was in a birth centre managed by registered midwives in Canada.

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Being a midwife starts with the ego. Our “ego selves” see the status, admiration and responsibility of the job as an attraction. What the ego cannot see is that the aspiring midwife has placed her foot on a road by taking up the work. This road will take her on a journey, which she will only finish when they chisel the word “midwife” on her gravestone.

The midwife will know days when the road is clear and smooth and her heart is bursting with joy. Along the road, she will also be ambushed and attacked. This is the nature of life and it is not personal, but it will seem to be personal. Childbirth is so pivotal to society and there have been so many years of misinformation that the attack that befalls midwives is swift and harsh—it is not for the faint of heart. Many good women have left the midwifery road because the attacks were just too violent for their spirits in this lifetime.

The midwife who sticks to the road learns to temper her pride in her work, knowing that, to the degree that she is pumped up by success she will be devastated by failure. Failure and success become less important to her as she walks the road and her focus on the birthing family becomes more important. She begins to disappear as an individual and a personality and, in that disappearing, her true Self emerges.

She learns from the mothers. The most important things are the simplest: be on time, keep your word, keep confidences, be organized and, above all, be patient. These things take a lifetime of mistakes to master. She constantly looks critically at herself to unearth her failings in these areas. The midwife makes many mistakes. There can be no learning or growth without mistakes. She doesn’t make the same mistakes over and over. She listens to the experiences of others to avoid those mistakes she can avoid and is grateful for the teaching. She is able to be honest with herself and her clients about what she learns.

She is averse to condemning other practitioners, knowing there is a karmic come-uppance that comes with self-righteousness.

She understands that her words are remembered for a lifetime and chooses them wisely. How she speaks results in the birthing woman being honored, respected and dignified. She knows her role is to be transparent in the process of birth. She has a quiet, dignified way of being. Her context for each birth is, “This is the only one.” Her actions and attitude at the birth will affect the family for the rest of their days. She is trusted because she has shown by her actions and speech that she is trustworthy. She has no need to prove anything and is able to discover some new lesson from every birth.

Numbers of births, degrees and licenses do not concern her. She knows that she chose her profession with all its inherent risks and she refuses to portray herself as a victim.

She takes responsibility for passing on the knowledge to the new ones; her legacy will be generations of women who emulate her. She teaches the old ways because birth is ancient and it works. She distances herself from the crowd. She takes the time and space to develop and formulate her own values and ideals.

She has known the warmth of the placenta, the tear-filled eyes of a happy new father, the devastation of miscarriage, the freedom of a fast car and the fear of imprisonment. She has been honored and insulted, blessed and cursed, loved and hated and has reached a place where she likes the woman who gazes back at her in the mirror. She is excited about her future and at peace with her past. All this she brings to the birthing chamber as her contribution.

Written at Burnaby Correctional Center for Women in 2002.
First published in Midwifery Today Magazine Issue 68, Winter 2003

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These are notes that i recorded on my computer while on the phone with a friend in the U.S. who was giving birth.  All 3 of her daughters were born at home.  Her midwives had a long trip to reach her place and they missed the birth by a half hour.  I was able to stay on the phone with the husband and a neighbour. 

Karen and Paul’s third baby girl 

On a Waning Gibbous moon 76% Full

5:42 p.m. (Pacific Time)   It’s going to be Karen’s own birthday tomorrow.

5:46 p.m.  “I’m feeling it in my back, just like every other time I’ve birthed little women”.  Pressure helps.

5:48       sensations every 2 minutes.

5 53    Tell Paul to put a plastic sheet on the bed.  Baby is coming soon.  Karen doesn’t feel like she can  make it to the pool.  Membranes are still intact.  She feels like she might poo.

6 03 Paul says he is seeing some rectal flaring.  It’s a good sign of health that the membranes are intact.  Paul says, “I think it came closer that time”.

6 13  Karen says “I might try to make it to the pool.”

6 26 Karen steps into the pool.  Paul and Mary (neighbour) are doing everything they can to make her comfortable.  Water seems to calm Karen and relieves some of the intensity she was feeling.  Paul should get a bucket in case she feels like vomiting.

6:33 Karen worries that it’s taking longer between sensations.  I let her know that she’s having a ‘rest and be thankful period’.  What an impatient momma, she is. . . she just can’t wait to meet this baby!

6:54  Karen wants to know “Why is it taking so long?”  It’s been 12 hours since the mucous plug came out but it has only been about 4 hours of focused birth. She’s feeling nauseous now.

7:07 pm.  Complains of feeling tired and her bum hurting,

7:16 p.m. “should I be pushing?, lots of rectal pressure, feeling scared.  Nothing’s happening.”

7:35 p.m. Karen says “nothing’s happening, why isn’t the baby coming out?”

7:49 the head is out

7:51 baby born

7: 53 “Hi baby,” Karen greets her baby

8:00  Karen in bed.  Wants placenta out right now!  Mary (neighbour) and Paul are doing a great job of helping mom/baby  get comfortable.

Baby nice and pink, responsive.

8:07 p.m. It’s a girl!

8:20  the  midwives have arrived in time for the placenta.

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When I read this study (on the ozmidwifery list) it made my little head spin round a few times. Why?
1. I can’t imagine that physicians have been studying the effects of moxibustion on turning breech babies since 1980—maybe midwives are having an influence or was it Traditional Chinese Medicine?

2. I wonder if North American physicians will be stocking up on moxa sticks now that they have “statistically significant” peer-reviewed evidence that it works. If you don’t know what a moxa stick is, it looks like a cigar that you light and the mugwort herb burns slowly because it’s densely packed.

3. I can’t believe that they would publish this analysis in a staid journal like the American Journal of Obstetrics and Gynecology.

I must admit that I’m surprised and delighted by these strange occurrences. Now, let’s push for this study to be put into practice to save women from unnecesareans.

So, here’s the article:

Moxibustion for Bringing Babies Around to the Head-First Position* Vas J, Aranda JM, Nishishinya B, et al.

Correction of nonvertex presentation with moxibustion: A systematic review and meta-analysis.
/American Journal of Obstetrics and Gynecology/ 2009;201(3), 241-59.

This review pooled the results from studies published between 1980 and 2007 that looked at ways to turn fetuses that were not well-positioned for head-first birth into that position. The studies compared moxibustion to other ways to encourage the fetus to turn (hands-to-belly maneuvers, having the mother lie with her head lower than her feet, acupuncture). Moxibustion involves burning the herb mugwort (Artemisia vulgaris) over an acupuncture point found on the outer corner of the smallest toenail. Seven studies presenting data from 1087 women were included in the analysis. All the women in the studies in this review were randomly picked to receive either moxibustion or one of the other methods, to strengthen confidence that any differences in experiences of study groups were due to the moxibustion.

Combined results from the studies showed that the fetuses of women receiving moxibustion were 36% more likely to turn to a head-first position than those who got other treatments or no treatment, and this result was statistically significant. To check this result, the study authors looked separately at four trials that used similar starting points for moxibustion, all after the 32nd week of pregnancy. Here too, the likelihood of the fetus turning to a head-first position was more than 30% greater for the women who got moxibustion than for those who got another treatment.

The study found no differences in safety between moxibustion and the other methods. Surprisingly, there was also no difference in the rate of cesarean birth between the groups. Six of the seven studies were carried out in China or Italy. Practice patterns in those countries (e.g., greater acceptance of vaginal breech birth) may explain why the review did not show a higher risk of cesarean section in the group that did not get moxibustion; if done too early, babies could also flip back into breech position,

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The news stories continue to emerge about the wasted billions that have been spent on the H1N1 pandemic that never happened and the toll in illness from a toxic vaccine that was hurried through government check points. European politicians are crying “foul”, when will North American politicians address this colossal error? This report is from the EnglishAlJezeera news service:

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Watch CBS News Videos Online

Former NIH Director Dr. Bernadine Healy tells CBS News’ Sharyl Attkisson that the question of a link between vaccines and autism is still open for debate.

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I went to a movie and dinner with a friend from out of town tonight. Natasha has 3 teenagers, all born at home in water. At one point, she said how “lucky” she felt that she has never experienced the induction/cesarean madness that so many North American women have to endure. That statement of hers led to me asking her “Well, how did you get so smart, at your young age, to know to do it at home the very first time?” Her reply was that she had been working in a job with a young woman who had announced one day that her friend had just had a water birth. When Natasha heard that she thought, “Yeah, that’s how I’ll do it, too, when I have a baby.” She had never thought about it before and she didn’t need any more information than that to start her on the path to a homebirth when she became pregnant. I wonder if the woman who inspired Natasha even knows what a difference she made in the life of another woman? We never know when we share our stories, films, photos, and books about birth with others where that information lands and who is moved by it. The smallest thing can make a difference if someone is ready to receive the information.

Natasha and I got onto the subject of “children who challenged us”, as well. We both had first babies who demanded to be fed constantly and did not fit any pictures of the nice content babies in the ads. We both received all the unwelcome input from others that we were “spoiling”, etc. We both dropped our pre-pregnancy weight quickly from walking the floor, jiggling and trying to soothe fretful infants. After sharing our “war stories” in that regard, we both agreed about the gift of those high needs babies. It was a path to a compassionate heart for other women who have hard to manage children. There’s a real humility that comes from having an infant that has a harder time adjusting to life than others and, finally realizing, they might be your greatest teacher.

From there, the conversation went to her son’s intact foreskin. She told me that he came home from high school recently really shaken up to learn that one of his friend’s was cut as a baby. Her son was astounded that anyone could think that was a good idea. Even though his father’s generation includes many cut men, her son was sickened to think that someone as young as him could be treated that way.
She told me that the little handout I gave her when her son was born, “Care of the Intact Penis”, was kept on a shelf in her kitchen for years and the kids liked her to read it to them when they were little. It got lots of giggles but I guess it gave them a firm grounding in appreciating intact male genitalia, too.

There’s such a comfortable, warm feeling in hanging out with a woman who has been through birthing, breastfeeding, and so many other twists and turns of life with me. Over the years since her first pregnancy, we have kept an eye out for each other’s well being. She makes a point of us “having a date” whenever she comes to Vancouver and I’m grateful that she makes an effort to insure that we see each other face to face. When we were deciding on a restaurant, I told her we should go for Thai food because she had introduced me to a wonderful Thai restaurant and I never go there unless she’s with me. She said “Oh, it’s our restaurant then.” I liked that a lot.

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