I am excited to be presenting several guest posts in the upcoming weeks. While I've been feeling lately like I might have temporarily run out of things to say, a lot of the wonderful women around me are going through experiences that have given them a lot to say - and I've been shamelessly recruiting them for guest posts.
The first comes from my cousin, Maggie. We lived far apart growing up, but were close in age and shared a lot of phone calls – mostly on the topic of American Girl dolls, if I remember correctly. Now we text about breastfeeding instead! (But yes, I do have Samantha and Felicity in a box somewhere.) Maggie is pregnant with her second baby (yay, more babies in the family!) and I asked her to share her thoughts on the difference in care between her first and second pregnancies. I was so happy to get this post and see what a more positive experience she is having this time around.
Guest post: Midwife vs. OBGYN
I just went to my 34 week doctor appointment today and the first thing I told my husband after I left the appointment was, “The closer I get to my due date, the more I realize how glad I am that I changed to the midwife group.”
To give you a little background, I am pregnant with my second baby and going to a midwife group that is associated with a hospital. This means they deliver at a hospital and still have to abide by hospital rules and regulations, but they are a lot different than a typical OBGYN group.
I went to an OBGYN group during my first pregnancy. They deliver at the same hospital I am delivering at now and overall, were a nice group of women (all the docs in the group were women), but I just never felt like they cared about me. Every time I met with them I felt like I was just a number. They took my blood pressure, listened for the heartbeat and I was out the door.
I didn’t do much research about labor, pregnancy, etc until I actually was pregnant with my first and had already started to go this practice. What I know now is that I could have switched, but then I was too nervous. I felt like it was the wrong thing to do and my care would somehow be compromised. Not that I didn’t get good care there, I did, but the biggest difference between them and the midwives is that there I felt like I was just a number. They had their way of doing things and overall, they were doing it no matter what their patients wanted. I feel like the midwives treat me like a person that has opinions and feelings about how her pregnancy and labor should go. To me, that is the most important thing you can ask for in a provider, no matter who they are.
I thought the best way to really portray the difference is to give you some examples of my care at both places.
Example 1: Birth Plan
The OBGYN office did not discuss birth plans with you. The midwife office does and requires each woman to fill one out around 34 weeks. My cousin (who writes this wonderful blog) helped me put together a birth plan for my first pregnancy. I brought it to my appointment with the OB and asked her to look at it just to make sure I was on the right page. I had something in the birth plan about the hospital staff not asking me if I wanted any pain medication. The doctor’s response to this was laughing and saying, “What are the nurses supposed to do when you are lying on the floor screaming in pain?” Needless to say I left the appointment completely shaken up, crying and even more nervous about the labor.
I discussed my birth plan today with one of the midwives at my 34 week appointment. This birth plan is a lot more simplified. One thing I learned after my last pregnancy is that everything will not go according to plan and I can’t get discouraged if it doesn’t. I basically stated that I would like to try to go naturally and use certain techniques that have always helped me relax. The midwife was wonderful when going over the plan and even gave me suggestions about things to add in.
Example 2: Extras
I am not sure what to call all of the additional things that happen after the labor such as cord cutting, skin to skin contact, nursing immediately etc, but I will just call them extras. These extra things were a cause of worry for me when my first was born. Waiting to cut the cord, not cleaning the baby right away, etc were not routine for the OB practice I went to. It was just one more thing I had to worry about getting included on my plan and making sure they would follow. (Luckily they did.)
I went to a “Meet the Midwives” open house when I was first pregnant with my second and trying to decide if I should go to their practice or not. Some of the women there asked questions about cord cutting, skin to skin, etc and midwives said these are not even things that need to be included in the plan because they are all routine at their practice. In fact, the midwife I met with today even told me about a study that the hospital is doing called “Kangaroo Care” and to make sure I tell the nurses I want to be a part of it. That way I am guaranteed that all the nurses follow these procedures from birth to discharge.
Example 3: Induction
I ended up getting induced with my first. Yes, completely different than what the plan was. I was 41 weeks and the doctors recommended I get a non-stress test. Of course, we failed! My daughter’s heart deceled one time during the test and the doctor told me that I needed to get induced. Actually she told me we needed to go straight to the hospital, not to eat anything, and that I couldn’t go home and get my bags. I was freaking out! After 30 hours of Cervidil, Pitocin and an epidural my wonderful daughter was born. In the end, the labor didn’t matter. I had her vaginally and I was blessed with a wonderful, healthy daughter. But, do I want to go through that again - no way!
I discussed my last labor with the midwife today and have discussed it with my new group in the past. They basically have told me that because they are associated with a hospital if a patient gets to 41 weeks they have to recommend a non-stress test for liability reasons. Would the OB docs have told me it was a liability issue, again, no way!
They have also told me that there are more false positives than positives in a non-stress test. In fact, when I met with the midwife today I told her that I think my daughter’s heart rate never decelled. I told her that the monitor moved while I was being monitored and I believe that is when it recorded the decel. In the next 30 hours of labor my daughter’s heart rate did not drop one time. She laughed at me when I told her that. Not because she thought I was uneducated or naive, but because she could tell how strongly I felt about the whole thing. She actually went on to tell me that if I get to 41 weeks this time and get a non-stress test that I need to make sure I drink plenty of water, eat a lot before the test and “watch the monitor like a hawk.” She said if the monitor moves at all I need to pull it off, call the nurse and tell her to come put it back on. That way no false decel is being recorded. I almost grabbed her out of her chair and started kissing her when she told me that! A medical professional that is listening to me – what a novel concept!
Overall, I have had a lot better experience at my midwife group. I feel like they listen to my concerns, answer my questions and most importantly want me to have a role in my pregnancy and labor instead of just sitting back and being a passenger. That is how I felt at the OB group.
My recommendation to any pregnant women thinking about what type of practice to choose is to educate yourself first. Maybe you are okay with being a passenger, maybe you want to be in the driver’s seat. Either way, decide how you want to approach your pregnancy and pick a provider that offers you that. It has made my second pregnancy such a better experience.
Showing posts with label midwives. Show all posts
Showing posts with label midwives. Show all posts
Friday, March 2, 2012
Tuesday, January 17, 2012
More on the UW midwifery program
Seattle columnist advises you never to get between a midwife and a birthing baby:
And Shari, a midwifery student at UW, commented with the following clarification to my last post:
The petition already has almost 2500 signatures - with a goal of 10,000!
Last month, the faculty there recommended eliminating the UW's 19-year-old midwife training program.
That isn't surprising on its own. Just about everything is on the chopping block these days.
It was their reasoning. It has angered midwives all over the region. Not to mention thousands of moms.
The nurse-midwife program was judged not to meet a "societal need." In fact, maternal and newborn health were not even on the list of societal needs drawn up by a UW committee looking to cull programs.
Surprisingly, this isn't directly about money. The students in the program pay more in fees than it costs to educate them. Plus midwives are a force that drives down birth-related health costs. ...
The UW hooked me up with Carol Landis, a professor in the nursing school who helped draft the recommendation. She said it was not an "arbitrary devaluing of midwives." Driven by state budget cuts, the School of Nursing is reducing the number of areas in which it is teaching- and training-focused (regrettably to her), she said. The emphasis is on high-level research, the kind that brings in grant money.
And Shari, a midwifery student at UW, commented with the following clarification to my last post:
I would like to clarify and issue with this proposal to cut our program. It is not because of the budget per se, as the Midwifery program is funded entirely from student funds. We are one of the only programs operating in the black. This is politcal decision that must be reversed! Please stand with us and sign the petition! Research dollars do not trump the health and welfare of women and children
The petition already has almost 2500 signatures - with a goal of 10,000!
Thursday, January 12, 2012
Sign to save the UW midwifery program
The nurse-midwifery program at the University of Washington is currently slated to be cut. I am shocked that in this day and age universities would be cutting, instead of expanding, nurse-midwifery programs. With our entire health system increasingly depending on mid-level providers, and with the excellent outcomes of nurse-midwives in caring for low-risk women, it seems like a bizarre decision. According the the ACNM website, this is one of only two midwifery education programs in Washington state.
If you would like to support the program you can sign a petition urging the University and the state government to reconsider their decision (you don't need to be a local).
If you would like to support the program you can sign a petition urging the University and the state government to reconsider their decision (you don't need to be a local).
Monday, November 14, 2011
Nope, I won't bring you to a birth
Doulas and midwives probably get this a lot, and I get my share: "I am so fascinated by birth. I'm interested in becoming a midwife [or doula], but I'm not sure yet whether or not it's right for me. Can you help me find a way to attend a birth?" Sometimes people are asking specifically, "Can I come to a birth with you?"
My answer is always the same, "If you'd like to go to a birth, you should definitely do a doula training!" Doula training is a relatively low-cost and low-time investment, gives you a taste of learning about pregnancy/birth, and offers valuable knowledge about labor support if you plan to go into midwifery. Where I live, there is a local volunteer doula program that makes it easy for novice doulas to find their first clients. I tell people who ask that I am happy to be their "mentor" doula in the program (since the first birth they attend as a volunteer is always with a doula who has experience with the program), or to ask one of my doula clients if a doula trainee can come along to the birth.
I am surprised by how frequently people say "Oh yeah doula training, I thought about that, but..." The "but" usually has to do with lack of time or trouble scheduling or wanting to go to a birth sooner than the few months it will take to do the training and get set up with the volunteer program. They just don't have time, because they want to decide about midwifery real soon and go to a birth real quick.
I hear this enough and it starts to wear on me a little bit. I try to impress on the people who want to go to a birth, but skip the doula training, to think logically about the situation. There are a lot of people who want to be at a birth. Think about a hospital birth (since most births are hospital births). There's the mother's own family/friends/support people; there's the medical staff who need to be there (OB/midwife, nurse(s)); then there are other people who need to observe including medical and nursing students. For a midwife or doula to try to bring someone who's just curious to see a birth is usually not practical (and will probably exceed the hospital's visitor limits, which are often capped ridiculously low.)
Furthermore - and this is what I try to put gently to the people who ask me - to ask to attend a birth just because YOU want to see one, particularly just to ask to attend a birth of someone who is a stranger, is also unrealistic in terms of respecting the birthing woman's space. There are a few birthing women who have a welcoming "all-in" philosophy of birth - they don't mind having their whole extended family, neighbors, and FedEx guy watch them vocalize and pull off their clothes and push out a baby. Fantastic! It's their birth and they should have whoever they want there.
But most women want and DESERVE to hold a smaller space for their birth. They ask selected people to be there for a reason - because that person will have a lifelong connection with the baby, or because they rely on that personal for emotional security, or because that person offers them a great back massage and hip squeeze. Like I said, for a few women your curiosity in midwifery is reason enough to invite you to be present. I think that's totally fine. But for most, they're going to need something more.
I think the questioners do understand this on some level. That is why they don't generally call up pregnant women they happen to know and ask "Can I come to your birth?" They ask me to ask for them. And this is my bottom line: I won't ask. There's something that question that rankles in a way I had to separate out: beyond just trying to elbow into a private experience, it's specifically imposing on me as a doula. The questioner is asking me to use my experience as a doula and the trust I've built with a family for their own purposes, but is not going to invest their own time and energy to make that possible. To do a doula training gives you something to offer the birthing woman and a reason to be present; and it also gives me something important: honestly, I want to see, before I put myself out there, that you are serious about this interest in midwifery/doula-ing. Midwifery school and midwifery as a career are a huge commitment. It's not so much to ask to put in a couple months of prep as a doula to see if that's what you really want. If you won't, then I question whether this is just a passing idea.
Sticking to this policy, I've seen it pay off. The people who were serious and have continued to pursue midwifery, or doula-ing, became doulas without hesitation; the people who hemmed and hawed have discarded or put off the idea of birth work as a career.
Reading back over this post, I realize it sounds pretty negative to the idea of "just anyone" showing up for a birth. I want to re-emphasize that I am not opposed to a woman inviting whoever she wants to her birth - including someone she doesn't know very well, who has a passing interest in midwifery. And if someone out there has had the experience of asking and being happily invited to a birth in that scenario, more power to you - you're pretty lucky! But think hard before imagining that just getting to see a birth will help you decide about midwifery. After all, you can watch a million births on YouTube (I know, it's not the same, but still.) It's possible that what will really help you decide whether you want to be a midwife is not the 12 or 18 hours you watch one woman labor and birth; it is the experience and preparation that get you to that point.
My answer is always the same, "If you'd like to go to a birth, you should definitely do a doula training!" Doula training is a relatively low-cost and low-time investment, gives you a taste of learning about pregnancy/birth, and offers valuable knowledge about labor support if you plan to go into midwifery. Where I live, there is a local volunteer doula program that makes it easy for novice doulas to find their first clients. I tell people who ask that I am happy to be their "mentor" doula in the program (since the first birth they attend as a volunteer is always with a doula who has experience with the program), or to ask one of my doula clients if a doula trainee can come along to the birth.
I am surprised by how frequently people say "Oh yeah doula training, I thought about that, but..." The "but" usually has to do with lack of time or trouble scheduling or wanting to go to a birth sooner than the few months it will take to do the training and get set up with the volunteer program. They just don't have time, because they want to decide about midwifery real soon and go to a birth real quick.
I hear this enough and it starts to wear on me a little bit. I try to impress on the people who want to go to a birth, but skip the doula training, to think logically about the situation. There are a lot of people who want to be at a birth. Think about a hospital birth (since most births are hospital births). There's the mother's own family/friends/support people; there's the medical staff who need to be there (OB/midwife, nurse(s)); then there are other people who need to observe including medical and nursing students. For a midwife or doula to try to bring someone who's just curious to see a birth is usually not practical (and will probably exceed the hospital's visitor limits, which are often capped ridiculously low.)
Furthermore - and this is what I try to put gently to the people who ask me - to ask to attend a birth just because YOU want to see one, particularly just to ask to attend a birth of someone who is a stranger, is also unrealistic in terms of respecting the birthing woman's space. There are a few birthing women who have a welcoming "all-in" philosophy of birth - they don't mind having their whole extended family, neighbors, and FedEx guy watch them vocalize and pull off their clothes and push out a baby. Fantastic! It's their birth and they should have whoever they want there.
But most women want and DESERVE to hold a smaller space for their birth. They ask selected people to be there for a reason - because that person will have a lifelong connection with the baby, or because they rely on that personal for emotional security, or because that person offers them a great back massage and hip squeeze. Like I said, for a few women your curiosity in midwifery is reason enough to invite you to be present. I think that's totally fine. But for most, they're going to need something more.
I think the questioners do understand this on some level. That is why they don't generally call up pregnant women they happen to know and ask "Can I come to your birth?" They ask me to ask for them. And this is my bottom line: I won't ask. There's something that question that rankles in a way I had to separate out: beyond just trying to elbow into a private experience, it's specifically imposing on me as a doula. The questioner is asking me to use my experience as a doula and the trust I've built with a family for their own purposes, but is not going to invest their own time and energy to make that possible. To do a doula training gives you something to offer the birthing woman and a reason to be present; and it also gives me something important: honestly, I want to see, before I put myself out there, that you are serious about this interest in midwifery/doula-ing. Midwifery school and midwifery as a career are a huge commitment. It's not so much to ask to put in a couple months of prep as a doula to see if that's what you really want. If you won't, then I question whether this is just a passing idea.
Sticking to this policy, I've seen it pay off. The people who were serious and have continued to pursue midwifery, or doula-ing, became doulas without hesitation; the people who hemmed and hawed have discarded or put off the idea of birth work as a career.
Reading back over this post, I realize it sounds pretty negative to the idea of "just anyone" showing up for a birth. I want to re-emphasize that I am not opposed to a woman inviting whoever she wants to her birth - including someone she doesn't know very well, who has a passing interest in midwifery. And if someone out there has had the experience of asking and being happily invited to a birth in that scenario, more power to you - you're pretty lucky! But think hard before imagining that just getting to see a birth will help you decide about midwifery. After all, you can watch a million births on YouTube (I know, it's not the same, but still.) It's possible that what will really help you decide whether you want to be a midwife is not the 12 or 18 hours you watch one woman labor and birth; it is the experience and preparation that get you to that point.
Thursday, June 16, 2011
What's different about being a doula outside of the hospital?
When I posted about attending my first home birth, one commenter asked:
"As a doula did you feel that your role was very different? I had both of my children at home; looking back I wish I had a doula. My midwives, are amazing but they are very hands off and quiet. I think a little more direct verbal support could have greatly shortened both of my labors."
I have been thinking about my response to that comment since attending another out-of-hospital birth and another hospital birth since then. Below are some thoughts, some of which were included in my reply to the original comment:
It has been most interesting to experience the feeling of having to do zero "defense", to not even have to prepare myself for the possibility of running interference. When all of a sudden I no longer had to have my guard up, I realized how much energy and attention I was spending on it. I didn't have to tense myself to find out if the next nurse or OB or midwife on shift was friendly or hostile, flexible or rules-obsessed. I didn't have to explain any birth plans to nurses or nag anyone to get the monitors off or try to soften the impact of discouraging words. I didn't have to help navigate decisions where the woman couldn't be sure whether she should trust her caregivers' recommendation. And in terms of my role, I knew I was totally welcomed and my role was perfectly understood by the midwives there. It was amazing just to toss all that defense aside, know that both the families and I were in a place they could trust, and be 100% focused on labor support.
I also felt very confident that I could let the midwives take over the role of suggesting position changes, etc. when they were around - that was a new feeling. Sometimes in the hospital, I feel like I am the only one taking responsibility for suggesting proactive things to progress labor, ensure optimal fetal positioning, etc., and again I am always on guard that those will be met with negative feedback by the nurses ("what's she doing on the TOILET?") or resistance by the mom ("do I have to move??") Outside of the hospital, the midwives were on top of that stuff, and they had the trust and authority to say "It's really important and I think it would help you, let's get you walking again". I sometimes suggested things as well if I sensed it was the right moment, but I never worried that I would be the only one or that the midwives would be reluctant to try anything the mom was up for.
So I would say the main difference has been in feeling real trust and confidence in the caregivers - that they were on exactly the same page as the family, that they had and used skills that I consider very important, and that everyone who would be there throughout the labor and birth would share those goals and skills.
While one of the reasons I encourage everyone to have a doula for a hospital birth - that guard/buffer role - was not necessary for the out-of-hospital births, I look back and think how much that freed me up to simply focus on the woman and fulfill all the other parts of my doula role. I think a helpful role that I played was in being there before it was time for the midwives to arrive: encouraging rest, suggesting position changes, giving feedback on where I thought labor was at, helping get the tub set up, etc. Many people are ready for some trained labor support before they're really ready to call the midwives. And after they got there I was still doing verbal support/encouragement, taking turns doing counterpressure, and of course the "gofer" role that doulas do so well. And like the commenter mentioned, sometimes your midwives give you wonderful care but their labor support is just not the kind that helps you the most. I would encourage anyone to have a doula at a home birth!
"As a doula did you feel that your role was very different? I had both of my children at home; looking back I wish I had a doula. My midwives, are amazing but they are very hands off and quiet. I think a little more direct verbal support could have greatly shortened both of my labors."
I have been thinking about my response to that comment since attending another out-of-hospital birth and another hospital birth since then. Below are some thoughts, some of which were included in my reply to the original comment:
It has been most interesting to experience the feeling of having to do zero "defense", to not even have to prepare myself for the possibility of running interference. When all of a sudden I no longer had to have my guard up, I realized how much energy and attention I was spending on it. I didn't have to tense myself to find out if the next nurse or OB or midwife on shift was friendly or hostile, flexible or rules-obsessed. I didn't have to explain any birth plans to nurses or nag anyone to get the monitors off or try to soften the impact of discouraging words. I didn't have to help navigate decisions where the woman couldn't be sure whether she should trust her caregivers' recommendation. And in terms of my role, I knew I was totally welcomed and my role was perfectly understood by the midwives there. It was amazing just to toss all that defense aside, know that both the families and I were in a place they could trust, and be 100% focused on labor support.
I also felt very confident that I could let the midwives take over the role of suggesting position changes, etc. when they were around - that was a new feeling. Sometimes in the hospital, I feel like I am the only one taking responsibility for suggesting proactive things to progress labor, ensure optimal fetal positioning, etc., and again I am always on guard that those will be met with negative feedback by the nurses ("what's she doing on the TOILET?") or resistance by the mom ("do I have to move??") Outside of the hospital, the midwives were on top of that stuff, and they had the trust and authority to say "It's really important and I think it would help you, let's get you walking again". I sometimes suggested things as well if I sensed it was the right moment, but I never worried that I would be the only one or that the midwives would be reluctant to try anything the mom was up for.
So I would say the main difference has been in feeling real trust and confidence in the caregivers - that they were on exactly the same page as the family, that they had and used skills that I consider very important, and that everyone who would be there throughout the labor and birth would share those goals and skills.
While one of the reasons I encourage everyone to have a doula for a hospital birth - that guard/buffer role - was not necessary for the out-of-hospital births, I look back and think how much that freed me up to simply focus on the woman and fulfill all the other parts of my doula role. I think a helpful role that I played was in being there before it was time for the midwives to arrive: encouraging rest, suggesting position changes, giving feedback on where I thought labor was at, helping get the tub set up, etc. Many people are ready for some trained labor support before they're really ready to call the midwives. And after they got there I was still doing verbal support/encouragement, taking turns doing counterpressure, and of course the "gofer" role that doulas do so well. And like the commenter mentioned, sometimes your midwives give you wonderful care but their labor support is just not the kind that helps you the most. I would encourage anyone to have a doula at a home birth!
Wednesday, May 25, 2011
Guest Post: Mollie's path to pregnancy/birth (Part 3: Pregnancy and Birth)
In Part 2, Mollie talked about learning how important her place of birth was and how she interviewed care providers. In the final installment read all about the part where she gets knocked up!
Part 3: Pregnancy and birth
I calculate my date of conception as August 7. This becomes important, as I learned very quickly to lie to the hospital’s ultrasound tech about the date of my last menstrual period (thanks to FAM, I knew I had ovulated on the 19th day, not the 14th day, and five days is a long time when one risks out of the birthing center at seven days overdue). As it turns out, it was a very good idea to pick out my midwife and go to their orientation night before I was even pregnant, because when I called at five weeks pregnant with a due date of April 30, they said they were already full. They said I would have to come in for the orientation before even getting on the wait list, so when I said I had already been to it, they begrudgingly took me on as a patient (again, this was the receptionist being a little snotty about my proactive approach).
There were a few times when the researchy side of me was an issue when it came to the pregnancy. First, when I went to my gynecologist’s office to confirm the pregnancy (I wasn’t going to see my midwife until about 9-10 weeks), they found a subchorionic hematoma but never told me. A few weeks later I picked up my chart to bring over to my midwife office, and of course I read through it (what sort of researcher would I be if I hadn’t?). I saw the note about the hematoma, and of course FREAKED OUT! (By the way, don’t Google subchorionic hematoma. Better yet, don’t Google anything. You’ll end up convinced that you’re about to bleed to death, guaranteed. In this case, TheBump.com forums, though I don’t recommend message boards in general, were actually more helpful and offered a quicker response than my doctor.) Another time, during my 20 week ultrasound, I asked the doctor if he could tell where the placenta was attached (I had just finished reading about placenta prevea and cord prolapse, so it was on my mind). Instead of just telling me, or politely asking me if I had reason to suspect an issue, he snapped at me with “WHY!?” I replied with a bewildered, “Um, because I read a lot and I know what can happen if it’s too low”, at which point he gruffly checked and said, “It’s fine.”
Around 12 weeks, we started looking for Doulas. Again, this is probably earlier than most normal people would start booking their help, but my experience with nearly getting shut out of my preferred midwife office had me spooked that we wouldn’t get “the good one” unless I started looking early. I asked for recommendations from friends, but mostly looked through the DONA website. You can search by location, and while there are a TON of doulas listen in the New York City area, I looked up a handful, gauged their experience (we decided we didn’t want a newbie), and emailed then. We met with a few, and chose one who best fit our personalities (plus, she had a really nice website).
The rest of the pregnancy was pretty straightforward – I threw up, I gained weight, I did my prenatal tests, and everything was fine. I never had any real surprises. My husband and I took the Childbirth Ed class, Newborn Care class, and Breastfeeding class, and did our best not to be the know-it-alls in the class. Planning like this is second nature to me, so often I would forget just how prepared we were. But there was one moment in class that really solidified it for me, and made me grateful for all my research. In Childbirth class one week, we discussed routine interventions, procedures, and regulations like Electronic Fetal Monitoring and restricted food and drink. The next week, during our “check-in”, one of the couples seemed so upset as they began to talk about their week. Mom was about 36 weeks along, and had just gone on the tour of the hospital. They had found out that the hospital required all laboring moms to stay in bed, on their backs, for their entire labor and delivery; IVs were mandatory, and all food and drink was prohibited; continuous Electronic Fetal Monitoring was required for all moms. They were devastated. They asked their OB if he had any flexibility regarding these rules, and he said no – the hospital’s rules were his rules. No one in class knew what to say to them; nearly all the coping strategies we had learned in class required SOME sort of movement.
I was discussing her situation with my husband that night. “Not to sound judgmental,” I said, “but how did she NOT know those were the rules until 36 weeks?” “Well,” he said to me, “you have to remember – you know more about this than anyone I’ve ever met. You’ve known this stuff for months. Other people don’t know that they don’t know.”
While there were times when I feel like I knew too much for my own good, there was one moment when all my studying felt worth it. Just before 4:00am on April 11, 2011, I was walking the halls of the Birthing Center at St. Luke’s Roosevelt Hospital, in labor, with my doula. At the height of one contraction, I finally let the words “I can’t do it” escape my lips. I cried, fearing that if it got any worse, I wouldn’t make it. After the contraction was over, my doula said to me, “Now I know you’ve done your homework. You know what ‘I can’t do it’ means.” And I did. I knew it meant Transition; I knew it meant it was almost over.
By the end of pregnancy, I had prepared everything as best I could. I had midwives whom I trusted, I had chosen a hospital that would allow me to have the kind of birth I wanted, and I had a doula who would guide me through it. It was a great comfort to know they respected my birth wishes, especially because at the very moment of my son’s birth, I was finally NOT in complete control of everything. None of my research could have prepared me for that moment, but at least I knew we were in good hands.
Baby Rowan was born April 11, 2011 at 3:54am.
Just a reminder that you can read the story of Rowan's birth on Mollie's blog, Tough Love Knitters. (You can also follow Rowan's current life and adventures at Little Red Rowan.) And check out Mollie feeding Rowan while he models her newest knitted creation. Congratulations Mollie! I can't wait to meet your adorable baby ASAP!
Part 3: Pregnancy and birth
I calculate my date of conception as August 7. This becomes important, as I learned very quickly to lie to the hospital’s ultrasound tech about the date of my last menstrual period (thanks to FAM, I knew I had ovulated on the 19th day, not the 14th day, and five days is a long time when one risks out of the birthing center at seven days overdue). As it turns out, it was a very good idea to pick out my midwife and go to their orientation night before I was even pregnant, because when I called at five weeks pregnant with a due date of April 30, they said they were already full. They said I would have to come in for the orientation before even getting on the wait list, so when I said I had already been to it, they begrudgingly took me on as a patient (again, this was the receptionist being a little snotty about my proactive approach).
There were a few times when the researchy side of me was an issue when it came to the pregnancy. First, when I went to my gynecologist’s office to confirm the pregnancy (I wasn’t going to see my midwife until about 9-10 weeks), they found a subchorionic hematoma but never told me. A few weeks later I picked up my chart to bring over to my midwife office, and of course I read through it (what sort of researcher would I be if I hadn’t?). I saw the note about the hematoma, and of course FREAKED OUT! (By the way, don’t Google subchorionic hematoma. Better yet, don’t Google anything. You’ll end up convinced that you’re about to bleed to death, guaranteed. In this case, TheBump.com forums, though I don’t recommend message boards in general, were actually more helpful and offered a quicker response than my doctor.) Another time, during my 20 week ultrasound, I asked the doctor if he could tell where the placenta was attached (I had just finished reading about placenta prevea and cord prolapse, so it was on my mind). Instead of just telling me, or politely asking me if I had reason to suspect an issue, he snapped at me with “WHY!?” I replied with a bewildered, “Um, because I read a lot and I know what can happen if it’s too low”, at which point he gruffly checked and said, “It’s fine.”
Around 12 weeks, we started looking for Doulas. Again, this is probably earlier than most normal people would start booking their help, but my experience with nearly getting shut out of my preferred midwife office had me spooked that we wouldn’t get “the good one” unless I started looking early. I asked for recommendations from friends, but mostly looked through the DONA website. You can search by location, and while there are a TON of doulas listen in the New York City area, I looked up a handful, gauged their experience (we decided we didn’t want a newbie), and emailed then. We met with a few, and chose one who best fit our personalities (plus, she had a really nice website).
The rest of the pregnancy was pretty straightforward – I threw up, I gained weight, I did my prenatal tests, and everything was fine. I never had any real surprises. My husband and I took the Childbirth Ed class, Newborn Care class, and Breastfeeding class, and did our best not to be the know-it-alls in the class. Planning like this is second nature to me, so often I would forget just how prepared we were. But there was one moment in class that really solidified it for me, and made me grateful for all my research. In Childbirth class one week, we discussed routine interventions, procedures, and regulations like Electronic Fetal Monitoring and restricted food and drink. The next week, during our “check-in”, one of the couples seemed so upset as they began to talk about their week. Mom was about 36 weeks along, and had just gone on the tour of the hospital. They had found out that the hospital required all laboring moms to stay in bed, on their backs, for their entire labor and delivery; IVs were mandatory, and all food and drink was prohibited; continuous Electronic Fetal Monitoring was required for all moms. They were devastated. They asked their OB if he had any flexibility regarding these rules, and he said no – the hospital’s rules were his rules. No one in class knew what to say to them; nearly all the coping strategies we had learned in class required SOME sort of movement.
I was discussing her situation with my husband that night. “Not to sound judgmental,” I said, “but how did she NOT know those were the rules until 36 weeks?” “Well,” he said to me, “you have to remember – you know more about this than anyone I’ve ever met. You’ve known this stuff for months. Other people don’t know that they don’t know.”
While there were times when I feel like I knew too much for my own good, there was one moment when all my studying felt worth it. Just before 4:00am on April 11, 2011, I was walking the halls of the Birthing Center at St. Luke’s Roosevelt Hospital, in labor, with my doula. At the height of one contraction, I finally let the words “I can’t do it” escape my lips. I cried, fearing that if it got any worse, I wouldn’t make it. After the contraction was over, my doula said to me, “Now I know you’ve done your homework. You know what ‘I can’t do it’ means.” And I did. I knew it meant Transition; I knew it meant it was almost over.
By the end of pregnancy, I had prepared everything as best I could. I had midwives whom I trusted, I had chosen a hospital that would allow me to have the kind of birth I wanted, and I had a doula who would guide me through it. It was a great comfort to know they respected my birth wishes, especially because at the very moment of my son’s birth, I was finally NOT in complete control of everything. None of my research could have prepared me for that moment, but at least I knew we were in good hands.
Baby Rowan was born April 11, 2011 at 3:54am.
Just a reminder that you can read the story of Rowan's birth on Mollie's blog, Tough Love Knitters. (You can also follow Rowan's current life and adventures at Little Red Rowan.) And check out Mollie feeding Rowan while he models her newest knitted creation. Congratulations Mollie! I can't wait to meet your adorable baby ASAP!
Wednesday, May 18, 2011
Guest Post: Mollie's path to pregnancy/birth (Part 2: Preparation)
In Part 1, our intrepid heroine learned the secrets of her reproductive cycle and was blown away by a showing of "The Business of Being Born". Check out the next installment on...
Mollie's path to pregnancy/birth: Part 2: Preparation
So now my world had been turned upside down and I was looking for answers. Where did I go? The internet of course!!! I began following the Public Heath Doula’s blog, as well as anyone SHE followed. Soon I had a nice little list of Natural Birthing bloggers: Birth Faith, Our Bodies Our Blog, Science and Sensibility, The Unnecesarean, the Midwife Next Door, Enjoy Birth, and many others. And I read and I read and I read. I couldn’t get enough of it. Sometimes they were a little out there and scary, with a “if you give birth in a hospital you WILL end up with a cesarean”, but most of the time they were informative, and over time I learned about Doulas, episiotomy rates, c-section rates (and the vast discrepancy among hospitals in New York City, which range from 16% to 48%!), and most importantly, the questions to ask your care provider BEFORE you agree to work with them:
Questions to ask
A few more question
And a few more
Around this same time I also attended a talk given by the head of Parent Family Education from St. Luke Roosevelt Hospital. My company often holds mini lectures on topics like getting your kid into private school or how to reduce your stress at work. This one was called “Preparing for Pregnancy and Childbirth”, and thank goodness it had listed as one of the talking points “preconception” (I learned later that the instructor did not know she was expected to talk about preconception, but obliged because there were a few of us non-pregnants who showed up). The talk was basically a quick and dirty intro childbirth ed course, with an emphasis on “This is a really big deal, so after this, you should sign up for a real course.” But the most important thing that came up was this: pick your birth location BEFORE you pick your provider.
I’m going to say that last part again.
Pick your birth location BEFORE you pick your provider.
“Um, are you on crack?”, you must be thinking. “That makes no sense.” It sounded strange to me at first too, but the more I learned, the more I realized that the difference between hospitals – even hospitals within a few miles of each other – could drastically change the type of birth I would have. For example: St. Luke’s Roosevelt Hospital has an in-hospital Birthing Center, where many of the standard Labor and Delivery rules do not apply (e.g. there are no restrictions on eating or drinking, and continuous electronic fetal monitoring is not required). Approximately six miles away, Elmhurst Hospital requires every laboring woman to be confined to bed, on her back, with continuous EFM regardless of her risk assessment. The rules of the hospital would DRASTICALLY change not only my overall experience, but the specific ways I could cope with pain (if I’m not allowed out of bed except to go to the bathroom, I’m certainly not going to be allowed to walk the halls or labor on a ball).
“Well, my provider would never force me to stay in bed, and she can just meet me at the good hospital.” She could, if she has privileges there. I happen to love my gynecologist, but because of recent insurance changes, she only has privileges at Jamaica Hospital – not only inconvenient for me, but Jamaica Hospital has a 41% cesarean rate (as of 2008), compared to Roosevelt’s 28% (Read the stats here). You may decide that you want to do a home birth, but I highly doubt your OB/GYN is going to be your provider. Also, if your provider has privileges at multiple hospitals, he may have you meet him at the hospital where his current mom is laboring, not necessarily the one closest to you or the one with the amenities or rules best-suited for your desired labor experience. Now, this point may be moot if you only have one hospital or birthing center in your area, but if you live in a metropolitan area with many choices, it makes sense to get to know the hospitals first, and then ask the hospital or your insurance company for a list of practitioners with privileges at your favorite.
Ok, so I had my reproductive system down, I knew I had some options for hospitals, and I knew more about episiotomies than any child-less person should know. Over the three “preconception” months, we went on three hospital tours – Roosevelt, Lenox Hill, and The Brooklyn Birthing Center. I liked Roosevelt the best, so I asked them to send me a list of practitioners who had privileges in the Birthing Center. I narrowed down the ones covered by my insurance company (oh, side note: I called my insurance company and it was the opposite of helpful – the guy on the phone told me that midwives were illegal in the state of New York so they don’t cover them . . . oh Aetna customer service . . .), and set up consultation appointments. Now, I had no issues going on hospital tours while not yet pregnant, since they didn’t ask (I have heard rumors that some hospitals won’t let you come unless you’re pregnant, hoping to weed out trainee doulas and paparazzi I guess, but in that case, I imagine you can just lie). I got a little bit more push-back from the receptionists at the doctor’s offices (“Wait, you’re not even pregnant?!”) though thankfully, not from the doctors themselves; they knew exactly why I was meeting them so early, and even seemed to appreciate it. One midwife office (the ones I ended up choosing) actually had an orientation night, where they sat for an hour or so and talked about their practice and their birth philosophy, and where anyone could come and ask questions. I ranked my favorites, and now I was ready for baby-making!!!
Mollie's path to pregnancy/birth: Part 2: Preparation
So now my world had been turned upside down and I was looking for answers. Where did I go? The internet of course!!! I began following the Public Heath Doula’s blog, as well as anyone SHE followed. Soon I had a nice little list of Natural Birthing bloggers: Birth Faith, Our Bodies Our Blog, Science and Sensibility, The Unnecesarean, the Midwife Next Door, Enjoy Birth, and many others. And I read and I read and I read. I couldn’t get enough of it. Sometimes they were a little out there and scary, with a “if you give birth in a hospital you WILL end up with a cesarean”, but most of the time they were informative, and over time I learned about Doulas, episiotomy rates, c-section rates (and the vast discrepancy among hospitals in New York City, which range from 16% to 48%!), and most importantly, the questions to ask your care provider BEFORE you agree to work with them:
Questions to ask
A few more question
And a few more
Around this same time I also attended a talk given by the head of Parent Family Education from St. Luke Roosevelt Hospital. My company often holds mini lectures on topics like getting your kid into private school or how to reduce your stress at work. This one was called “Preparing for Pregnancy and Childbirth”, and thank goodness it had listed as one of the talking points “preconception” (I learned later that the instructor did not know she was expected to talk about preconception, but obliged because there were a few of us non-pregnants who showed up). The talk was basically a quick and dirty intro childbirth ed course, with an emphasis on “This is a really big deal, so after this, you should sign up for a real course.” But the most important thing that came up was this: pick your birth location BEFORE you pick your provider.
I’m going to say that last part again.
Pick your birth location BEFORE you pick your provider.
“Um, are you on crack?”, you must be thinking. “That makes no sense.” It sounded strange to me at first too, but the more I learned, the more I realized that the difference between hospitals – even hospitals within a few miles of each other – could drastically change the type of birth I would have. For example: St. Luke’s Roosevelt Hospital has an in-hospital Birthing Center, where many of the standard Labor and Delivery rules do not apply (e.g. there are no restrictions on eating or drinking, and continuous electronic fetal monitoring is not required). Approximately six miles away, Elmhurst Hospital requires every laboring woman to be confined to bed, on her back, with continuous EFM regardless of her risk assessment. The rules of the hospital would DRASTICALLY change not only my overall experience, but the specific ways I could cope with pain (if I’m not allowed out of bed except to go to the bathroom, I’m certainly not going to be allowed to walk the halls or labor on a ball).
“Well, my provider would never force me to stay in bed, and she can just meet me at the good hospital.” She could, if she has privileges there. I happen to love my gynecologist, but because of recent insurance changes, she only has privileges at Jamaica Hospital – not only inconvenient for me, but Jamaica Hospital has a 41% cesarean rate (as of 2008), compared to Roosevelt’s 28% (Read the stats here). You may decide that you want to do a home birth, but I highly doubt your OB/GYN is going to be your provider. Also, if your provider has privileges at multiple hospitals, he may have you meet him at the hospital where his current mom is laboring, not necessarily the one closest to you or the one with the amenities or rules best-suited for your desired labor experience. Now, this point may be moot if you only have one hospital or birthing center in your area, but if you live in a metropolitan area with many choices, it makes sense to get to know the hospitals first, and then ask the hospital or your insurance company for a list of practitioners with privileges at your favorite.
Ok, so I had my reproductive system down, I knew I had some options for hospitals, and I knew more about episiotomies than any child-less person should know. Over the three “preconception” months, we went on three hospital tours – Roosevelt, Lenox Hill, and The Brooklyn Birthing Center. I liked Roosevelt the best, so I asked them to send me a list of practitioners who had privileges in the Birthing Center. I narrowed down the ones covered by my insurance company (oh, side note: I called my insurance company and it was the opposite of helpful – the guy on the phone told me that midwives were illegal in the state of New York so they don’t cover them . . . oh Aetna customer service . . .), and set up consultation appointments. Now, I had no issues going on hospital tours while not yet pregnant, since they didn’t ask (I have heard rumors that some hospitals won’t let you come unless you’re pregnant, hoping to weed out trainee doulas and paparazzi I guess, but in that case, I imagine you can just lie). I got a little bit more push-back from the receptionists at the doctor’s offices (“Wait, you’re not even pregnant?!”) though thankfully, not from the doctors themselves; they knew exactly why I was meeting them so early, and even seemed to appreciate it. One midwife office (the ones I ended up choosing) actually had an orientation night, where they sat for an hour or so and talked about their practice and their birth philosophy, and where anyone could come and ask questions. I ranked my favorites, and now I was ready for baby-making!!!
Saturday, May 14, 2011
Should the ACNM become just the ACM?
A long and thought-provoking interview with a CPM/CNM on the American College of Nurse-Midwives' proposal to become the American College of Midwives:
Read the whole thing here.
Erin: You have spoken out publicly against the proposed name change of the ACNM. Yet you have worked as both a CPM and CNM, and have previously spoken out for unification of the profession. Why would you be opposed to this move?
Hilary: I would only support this name change if the ACNM concurrently commits the organization to working in partnership with MANA, NARM and MEAC to create one unified midwifery profession in the US. Without this commitment, calling CNMs “midwives” will increase their potential for working in opposition to direct-entry midwives who are striving on the political front to have CPMs included in national health reform initiatives, and of their being at odds with legislative efforts in states where the CPM has not yet been recognized. If the ACNM is going to rename itself the American College of Midwives, is it going to wield this moniker for the betterment of ALL midwives, or is the organization going to promote only its own brand of midwifery? As a corollary, is it going to change the title of all its members to CM – Certified Midwife?
...
Erin: You’ve mentioned a merging of nurse-midwifery with direct-entry midwifery. How would one midwifery credential better serve childbearing women? Wouldn’t it mean less choice for them?
Hilary: It would only mean less choice if we allow the current model of nurse-midwifery to subsume direct entry.
A true merger takes the best of both worlds, and in the process gives the participants a greater societal voice. As long as we continue to put our focus on creating hierarchies within the midwifery community, rather than really listening to each other and learning how to work together, we will not be successful in building midwifery as an independent and powerful profession. If we choose instead to have one unified profession, where all midwives are educated to work in all settings, where the goal is to increase the profession until all women throughout the US can have access to a midwife, then we are creating more, not less, choice.
Read the whole thing here.
Saturday, May 7, 2011
Weekend at the movies: Midwives Diner
What do you get when you go to the Midwives Diner? Well for starters, no IV and as much water as you want!
Thursday, March 24, 2011
Breastfeeding and Feminism, Day 2 (...2 weeks later)
My Lent resolution has apparently not yet translated into more posting! A few factors have contributed to that, among them my new full-time job(!) I have gone from per diem at the hospital working 24ish hours a week, to full-time working 36 hours a week (three 12-hour night shifts). Going from working 8-hour shifts to 12-hour shifts is a surprisingly big adjustment (although fortunately not as big an adjustment as beginning to work nights was.) There are drawbacks to my new schedule (less flexibility, losing several evenings, etc.) but the benefits are, well, the benefits! Apart from my grad school assistantships, I haven't had a job with health insurance since I was in AmeriCorps. I am looking forward to having good health insurance, along with retirement benefits. One of my goals in going to grad school was to finally get a "real" job with salary + benefits, and while it didn't happen in exactly the field I expected it to, I couldn't be more pleased (except for the part where I work nights. Hopefully someday I'll work days again!)
Now that I've made my excuses, long-delayed highlights from the second day of the Breastfeeding & Feminism conference:
* Possibly my favorite presentation of the day was Robbie Davis-Floyd's report on the International MotherBaby Childbirth Initiative. Based on the Baby-Friendly initiative, the IMBCI has outlined 10 Steps to optimal motherbaby maternity services, developed with the input of organizations around the world. Steps include treating every woman with respect and dignity, offering continuous labor support, providing evidence-based practices, and providing access to emergency OB care. Three sites have applied and been accepted to become demonstration sites, one each in Austria, Brazil, and Quebec, Canada. You can read more about the (very diverse!) demonstration sites here. She discussed more about the sites and more details of their applications. She also talked about sites that will be added soon, in South Africa, Mozambique, India, and - amazingly - the largest maternity hospital in the Philippines, which does 22,000 births a year (I cannot even imagine). It's inspirational to see institutions from countries with different levels of development and each with their own unique strengths and challenges, working on the aim of improving maternity care. I am so excited to see ow the demonstration projects go.
* Michelle Lauria, an OB-GYN from Dartmouth, gave a great talk on reducing late preterm birth, a project of the Northern New England Perinatal Quality Improvement Network. She also talked about eliminating elective inductions before 39 weeks, and in mothers who do not have a high enough Bishop's score. She said the key is to put power in the hands of the nursing staff with the hospital authorities backing them up; the doctors know if they send someone in for an induction who does not meet the guidelines, the charge nurse will send them right back home. She talked about the next step being setting stricter guidelines on ways that some doctors use to get around the restrictions; she gave the example of mildly elevated blood pressures without proteinuria being called pre-eclampsia and used as a reason to induce early.
She also discussed VBAC at some length. Her take on it was, in her region, it's all about the money - as in, medical malpractice insurance costs. In northern New England, which has a lot of isolated rural communities, she gave an example of a small regional hospital that wants to offer VBACs but would have to pay $120,000 more in malpractice insurance to do so. Given that they anticipate 2 VBACs a year, they would end up paying an extra $60,000 per VBAC. Her proposed solutions are both governmental: either medical malpractice reform of some kind, or for the government to coordinate regional VBAC centers. There would be one hospital in each region designated as the VBAC center, and all the other maternity hospitals would contribute towards the VBAC center's additional malpractice insurance. She considers this unrealistic without government intervention because of the nature of competition between hospitals.
* Beverly Rossman from Rush in Chicago did a very inspiring presentation on breastfeeding peer counselors in the NICU. The NICU breastfeeding peer counselors are truly peers - they are women who have personal breastfeeding experience with very low birthweight (VLBW) babies. She summarized some themes from qualitative interviews from mothers who worked with the peer counselors: instrumental support, emotional support, finding hope, empowerment, community, and emulation. Over and over again the interviewees talked about how much they identified with the peer counselors, how much hope they drew from seeing mothers who had been in their situation, and how important the emotional support was. It left me wanting a breastfeeding peer counselor program in our NICU so badly! (If you'd like to learn more and you have access to the Journal of Human Lactation, you can check out their journal article. Citation: Rossman, Meier, Engstrom, Verheed, Norr & Hill. "They've Walked in My Shoes": Mothers of Very Low Birth Weight Infants and Their Experiences with Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit. JHL. 2011. 27(1):14-24.)
It was a great conferences with some great conversation! It was hard to choose between the CIMS and the BF & Feminism tracks sometimes because there was so much interesting stuff going on, but I'm glad they combined the conferences for the opportunity to pick and choose from both programs.
Sadly, I won't be able to go to the CLPP Reproductive Justice conference this year. Please, everyone who's going tell me all about it! I am determined to go next year.
Now that I've made my excuses, long-delayed highlights from the second day of the Breastfeeding & Feminism conference:
* Possibly my favorite presentation of the day was Robbie Davis-Floyd's report on the International MotherBaby Childbirth Initiative. Based on the Baby-Friendly initiative, the IMBCI has outlined 10 Steps to optimal motherbaby maternity services, developed with the input of organizations around the world. Steps include treating every woman with respect and dignity, offering continuous labor support, providing evidence-based practices, and providing access to emergency OB care. Three sites have applied and been accepted to become demonstration sites, one each in Austria, Brazil, and Quebec, Canada. You can read more about the (very diverse!) demonstration sites here. She discussed more about the sites and more details of their applications. She also talked about sites that will be added soon, in South Africa, Mozambique, India, and - amazingly - the largest maternity hospital in the Philippines, which does 22,000 births a year (I cannot even imagine). It's inspirational to see institutions from countries with different levels of development and each with their own unique strengths and challenges, working on the aim of improving maternity care. I am so excited to see ow the demonstration projects go.
* Michelle Lauria, an OB-GYN from Dartmouth, gave a great talk on reducing late preterm birth, a project of the Northern New England Perinatal Quality Improvement Network. She also talked about eliminating elective inductions before 39 weeks, and in mothers who do not have a high enough Bishop's score. She said the key is to put power in the hands of the nursing staff with the hospital authorities backing them up; the doctors know if they send someone in for an induction who does not meet the guidelines, the charge nurse will send them right back home. She talked about the next step being setting stricter guidelines on ways that some doctors use to get around the restrictions; she gave the example of mildly elevated blood pressures without proteinuria being called pre-eclampsia and used as a reason to induce early.
She also discussed VBAC at some length. Her take on it was, in her region, it's all about the money - as in, medical malpractice insurance costs. In northern New England, which has a lot of isolated rural communities, she gave an example of a small regional hospital that wants to offer VBACs but would have to pay $120,000 more in malpractice insurance to do so. Given that they anticipate 2 VBACs a year, they would end up paying an extra $60,000 per VBAC. Her proposed solutions are both governmental: either medical malpractice reform of some kind, or for the government to coordinate regional VBAC centers. There would be one hospital in each region designated as the VBAC center, and all the other maternity hospitals would contribute towards the VBAC center's additional malpractice insurance. She considers this unrealistic without government intervention because of the nature of competition between hospitals.
* Beverly Rossman from Rush in Chicago did a very inspiring presentation on breastfeeding peer counselors in the NICU. The NICU breastfeeding peer counselors are truly peers - they are women who have personal breastfeeding experience with very low birthweight (VLBW) babies. She summarized some themes from qualitative interviews from mothers who worked with the peer counselors: instrumental support, emotional support, finding hope, empowerment, community, and emulation. Over and over again the interviewees talked about how much they identified with the peer counselors, how much hope they drew from seeing mothers who had been in their situation, and how important the emotional support was. It left me wanting a breastfeeding peer counselor program in our NICU so badly! (If you'd like to learn more and you have access to the Journal of Human Lactation, you can check out their journal article. Citation: Rossman, Meier, Engstrom, Verheed, Norr & Hill. "They've Walked in My Shoes": Mothers of Very Low Birth Weight Infants and Their Experiences with Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit. JHL. 2011. 27(1):14-24.)
It was a great conferences with some great conversation! It was hard to choose between the CIMS and the BF & Feminism tracks sometimes because there was so much interesting stuff going on, but I'm glad they combined the conferences for the opportunity to pick and choose from both programs.
Sadly, I won't be able to go to the CLPP Reproductive Justice conference this year. Please, everyone who's going tell me all about it! I am determined to go next year.
Friday, January 14, 2011
Defensive medicine and the c-section assembly line
Apologies for the long posting silence. I have so many drafts in progress. In the meantime, I want to direct people to the excellent and thought-provoking posts and comments at the Unnecesarean's series Defending Ourselves Against Defensive Medicine.
I thought I would tell a little story to go with it. My last CenteringPregnancy group had their reunion today. The midwife organizes it so that the reunion takes place at the meeting of a group who is about to have their babies. Then the new moms can share their experiences of birth, breastfeeding, and baby care with the moms-to-be.
One of the reunion moms had quite the story. She had 3 days of labor and was finally at the hospital making very slow progress with a posterior baby. The midwife who facilitated the group was working with her and the doctor came in to tell the midwife that the woman should have a c-section.
The midwife took him out into the hallway to discuss it. Turns out he had a morbidly obese patient who was also going to need a c-section, and would need the OR and a number of staff for a significant amount of time. The doctor's take was, "Let's get this one out of the way, then we'll do the more complicated surgery." The midwife went to bat and said "No. Mom is fine and baby is fine. I know my patient is stalled, but you do this longer surgery and THEN, if she's still not progressed, you can take her to the OR." They argued and (thankfully!) the midwife won. She went back in and put mom in a knee chest position (keep in mind this was a mom who had an epidural! these positions are possible under many circumstances!) The baby rotated to OA, and after that labor progressed and baby was born easily.
Thank goodness for guardian midwives in the face of not just defensive but assembly-line medicine.
I thought I would tell a little story to go with it. My last CenteringPregnancy group had their reunion today. The midwife organizes it so that the reunion takes place at the meeting of a group who is about to have their babies. Then the new moms can share their experiences of birth, breastfeeding, and baby care with the moms-to-be.
One of the reunion moms had quite the story. She had 3 days of labor and was finally at the hospital making very slow progress with a posterior baby. The midwife who facilitated the group was working with her and the doctor came in to tell the midwife that the woman should have a c-section.
The midwife took him out into the hallway to discuss it. Turns out he had a morbidly obese patient who was also going to need a c-section, and would need the OR and a number of staff for a significant amount of time. The doctor's take was, "Let's get this one out of the way, then we'll do the more complicated surgery." The midwife went to bat and said "No. Mom is fine and baby is fine. I know my patient is stalled, but you do this longer surgery and THEN, if she's still not progressed, you can take her to the OR." They argued and (thankfully!) the midwife won. She went back in and put mom in a knee chest position (keep in mind this was a mom who had an epidural! these positions are possible under many circumstances!) The baby rotated to OA, and after that labor progressed and baby was born easily.
Thank goodness for guardian midwives in the face of not just defensive but assembly-line medicine.
Tuesday, December 7, 2010
Surprise breech story
An amazing story from a classmate of the student midwife and L&D nurse At Your Cervix:
Read the rest here.
And if you have thoughts about who should get donor milk, or ideas for Blessingways, I am still happily welcoming comments on either!
There are several nurses in the room readying for delivery. I lower the bottom of the bed, glove up and Mary hands me the amniohook. Nice hard vertex presentation, large bulging bag, just a bit of an anterior lip, then AROM, and clear fluid. It was going to be easy. Ana bears down, my fingers still in. But… something is just not quite right, palpate around, what is that at 3 o’clock? Lips? Nope. Ear? No. Scrotom? Yep!
I glance over to Mary and in a remarkably calm voice, say:
“Glove up”
“Huh?” says she.
By this time Mary is taking in the rather “unable to ignore” saucer- sized eyes that I’m exhibiting.
“We’re breech”
Read the rest here.
And if you have thoughts about who should get donor milk, or ideas for Blessingways, I am still happily welcoming comments on either!
Tuesday, July 27, 2010
I'm on a (posting) roll! Midwives posting their stats for the world to see
Apparently I'm on a posting roll tonight...
Did you know that CBS Midwifery in Manhattan posts all their stats for the previous year? An excerpt from 2009's:
Vaginal deliveries 80 = 88%
Normal spontaneous vaginal 76= 95%
Vacuum extraction 4 = 5%
Vaginal births after previous C/S 8 successful out of 9 attempts = 88%
Furthermore, they deliver babies at the in-hospital birth center at St. Luke's Roosevelt. A common complaint I have heard from doulas is that their clients expect to use the birth center, and are either risked out before labor ever begins, and sometimes during labor and then they are sent to L&D. Or they get there and are told the birth center is full. So I liked even more that the midwives make that piece transparent too:
Women who wanted Birth Center and were eligible at term = 68
43 - delivered Birth Center = 63%
24 - Transferred to Labor & Delivery in labor = 35%
1- Birth Center full- had to deliver on L&D = 2%
They also provide stats on degrees of perineal trauma, meds, reasons for c-sections...
Imagine if every practice did this! How amazing would it be to be able to compare this information when looking for a care provider?
What are practices out there that you know of that make some or most of their stats available to consumers?
Did you know that CBS Midwifery in Manhattan posts all their stats for the previous year? An excerpt from 2009's:
Vaginal deliveries 80 = 88%
Normal spontaneous vaginal 76= 95%
Vacuum extraction 4 = 5%
Vaginal births after previous C/S 8 successful out of 9 attempts = 88%
Furthermore, they deliver babies at the in-hospital birth center at St. Luke's Roosevelt. A common complaint I have heard from doulas is that their clients expect to use the birth center, and are either risked out before labor ever begins, and sometimes during labor and then they are sent to L&D. Or they get there and are told the birth center is full. So I liked even more that the midwives make that piece transparent too:
Women who wanted Birth Center and were eligible at term = 68
43 - delivered Birth Center = 63%
24 - Transferred to Labor & Delivery in labor = 35%
1- Birth Center full- had to deliver on L&D = 2%
They also provide stats on degrees of perineal trauma, meds, reasons for c-sections...
Imagine if every practice did this! How amazing would it be to be able to compare this information when looking for a care provider?
What are practices out there that you know of that make some or most of their stats available to consumers?
Doula memories
I've been puttering around today, catching up on some of the things I put off while getting ready for the exam. Some of my friends have been talking birth stories/birth plans lately and we talked a bit about wanting positive hospital birth stories since there are so many scary ones out there and yet there CAN be such lovely births at the hospital.
I started thinking about a birth I attended back when I was in AmeriCorps and went searching through my old birth stories (we wrote one up for each birth we attended, and when I left I kept a copy of all of mine and am SO glad I did - they are wonderful to look back through) to find what I wrote about it at the time. And I cannot for the life of me find it. I must have missed it when I was making my copies.
So, without that sheet of paper I can't remember all the information about the birth, like whether mom had an epidural or not, what # baby this was for her, even whether baby was a boy or girl! But I do remember that the family had a few older children, some of whom were present, and that they were very positive, friendly people - I really enjoyed being at the birth with them. There was a recently hired (but experienced) midwife at this hospital that I hadn't worked with before* and she was the midwife on all day as mom labored and I worked with her.
As the birth grew nearer, and mom was working hard and pushing, the midwife beckoned the dad over to where she was keeping an eye on the perineum. Baby began to crown and she said to dad, "Come here. Give me your hands." As the baby's head emerged, she laid his hands on the baby's head and guided him in catching his own baby - the first person ever to lay hands on his child. I watched his eyes widen, his face about to split apart with a smile as he did it. Together they handed baby to mom and she cuddled her new baby as they got baby cleaned off.
Afterwards, dad was just glowing, literally bouncing around the room, still unable to wipe that huge grin off his face. "Did you see that?" he kept asking everyone there. "Did you see what I did? That was amazing! It was AMAZING!"
It was even neater - to me - because these were not people who had sought out midwives to get greater control over the birth process. They were community health center patients who just needed quality affordable prenatal care, and ended up working with midwives because that's who did the births for the CHC at that hospital. And they were handed this really amazing gift of participating more fully in their child's birth.
Later the midwife told me that she had been watching me work with the mom all day, and had been going to offer ME the chance to help catch the baby, but could tell how excited the dad would be to do it. I was bowled over by that! I told her I was so glad she had the dad catch. I was just there for one day, but I hope that every year on this baby's birthday, that dad is still telling his child the story of how he helped catch him/her, and how proud he was to do it.
So that's your wonderful hospital birth story of the day, courtesy of my free association skills!
*Do any other doulas have the experience with new-to-the-system midwives that they're such a breath of fresh air? They haven't gotten trampled down by the system yet, they're not looking over their shoulders at the nurse who might "turn them in", they're just practicing how they want to practice. That's not to say that experienced midwives who know how to work the system aren't fabulous and valuable and just as subversive in their own ways - if not more - but being with a new midwife can be so...liberating.
I started thinking about a birth I attended back when I was in AmeriCorps and went searching through my old birth stories (we wrote one up for each birth we attended, and when I left I kept a copy of all of mine and am SO glad I did - they are wonderful to look back through) to find what I wrote about it at the time. And I cannot for the life of me find it. I must have missed it when I was making my copies.
So, without that sheet of paper I can't remember all the information about the birth, like whether mom had an epidural or not, what # baby this was for her, even whether baby was a boy or girl! But I do remember that the family had a few older children, some of whom were present, and that they were very positive, friendly people - I really enjoyed being at the birth with them. There was a recently hired (but experienced) midwife at this hospital that I hadn't worked with before* and she was the midwife on all day as mom labored and I worked with her.
As the birth grew nearer, and mom was working hard and pushing, the midwife beckoned the dad over to where she was keeping an eye on the perineum. Baby began to crown and she said to dad, "Come here. Give me your hands." As the baby's head emerged, she laid his hands on the baby's head and guided him in catching his own baby - the first person ever to lay hands on his child. I watched his eyes widen, his face about to split apart with a smile as he did it. Together they handed baby to mom and she cuddled her new baby as they got baby cleaned off.
Afterwards, dad was just glowing, literally bouncing around the room, still unable to wipe that huge grin off his face. "Did you see that?" he kept asking everyone there. "Did you see what I did? That was amazing! It was AMAZING!"
It was even neater - to me - because these were not people who had sought out midwives to get greater control over the birth process. They were community health center patients who just needed quality affordable prenatal care, and ended up working with midwives because that's who did the births for the CHC at that hospital. And they were handed this really amazing gift of participating more fully in their child's birth.
Later the midwife told me that she had been watching me work with the mom all day, and had been going to offer ME the chance to help catch the baby, but could tell how excited the dad would be to do it. I was bowled over by that! I told her I was so glad she had the dad catch. I was just there for one day, but I hope that every year on this baby's birthday, that dad is still telling his child the story of how he helped catch him/her, and how proud he was to do it.
So that's your wonderful hospital birth story of the day, courtesy of my free association skills!
*Do any other doulas have the experience with new-to-the-system midwives that they're such a breath of fresh air? They haven't gotten trampled down by the system yet, they're not looking over their shoulders at the nurse who might "turn them in", they're just practicing how they want to practice. That's not to say that experienced midwives who know how to work the system aren't fabulous and valuable and just as subversive in their own ways - if not more - but being with a new midwife can be so...liberating.
Wednesday, July 14, 2010
Alert, someone is wrong on the Internet!
Some discussion going on in the comments at Science and Sensibility's post on the new meta-analysis of home birth in AJOG. Aaaand I let myself get drawn in. Funny how that happens when I have about six other projects I could be working on. I trace it to a moment of intrigue when one of the commenters stated that the Netherlands has poorer perinatal outcomes than the rest of Europe both at home and in the hospital because there are so many midwives that there isn't enough emergency OB care/neonatal services even in the hospital. All those midwives, taking up space, and just no room for OBs or pediatricians! So I went and looked around for some published evidence on that, and all I found was a BMJ summary of a Dutch government report that recommended, among other things, better emergency OB availability in small community hospitals. I responded pointing out that the U.S. also lacks immediate emergency OB care in many small community hospitals and we can't really attribute that to a surplus of midwives. But heck, maybe this commenter knew something I didn't? Maybe they spent years as a maternity nurse in the Netherlands! Maybe they speak fluent Dutch and this is all over the Dutch perinatal literature! Who knows!
Sadly, the reply to that was basically a lot of name-calling accusing, apparently, all midwives everywhere of being shameful liars. I know, I know. Having (hopefully) extricated myself, I'll slink back to studying for the IBCLC exam. Eleven more days, ack!
In the meantime, if anyone has any actual insights over this whole Dutch emergency OB care thing, I'd be curious to know.
Sadly, the reply to that was basically a lot of name-calling accusing, apparently, all midwives everywhere of being shameful liars. I know, I know. Having (hopefully) extricated myself, I'll slink back to studying for the IBCLC exam. Eleven more days, ack!
In the meantime, if anyone has any actual insights over this whole Dutch emergency OB care thing, I'd be curious to know.
Monday, July 12, 2010
Looking back at Centering Pregnancy
Donna at Banned from Baby Showers writes about her excitement that CenteringPregnancy is coming to her area. (You can read a description of Centering in her post, and learn more about the model at the Centering website.) That reminded me that I just finished the last visit for the Centering group I have been co-faciitating and have been wanting to write a post about the experience.
The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.
She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.
I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.
The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.
At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.
It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")
If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.
And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...
Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!
The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.
She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.
I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.
The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.
At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.
It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")
If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.
And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...
Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!
Tuesday, April 27, 2010
Great new blogs, and a minor LC update
You can take a look at my blogroll (greatly in need of updating) for many of the blogs I love. But I thought I'd highlight a few new (or new-to-me) that I've been enjoying:
First the Egg is not exactly new, as it's a expanded reincarnation of Feminist Childbirth Studies, but it's new enough! It's not just a blog but also a "nonsexist space for people who want to learn, reflect, commiserate, or laugh about being pregnant, giving birth, and helping children grow up whole and happy." There are feminist resources on pregnancy & birth (including breastfeeding), parenting, and women's health.
A Midwifery Journey is the blog of a nursing student who has been applying to CNM programs. She blogged a bunch about her impressions of various schools and opportunities, and has recently decided on Yale. It's been an educational and helpful read for me, given my constant personal swirling vortex of thoughts about the future ("midwife? yes? no? yes? no?" would be a short version, maybe someday I'll post the long version). I'm looking forward to hearing more about her experiences!
The Academy of Breastfeeding Medicine's new blog is great! With posts on the science, medicine, and policy of breastfeeding, this is quickly becoming a new favorite for me. Check out the post on how to critically evaluate media reports of breastfeeding studies, and the studies themselves.
That's all for today! I have a training all day, every day this week for my LC course. It's a review workshop for people interested in lactation support/planning to be LCs/planning to sit the exam. It's a mix of good, interesting stuff and a little more boring, less useful stuff, as is almost every workshop and/or conference. It does feel like a very solid review of everything we've learned this year which is both good and bad: good to review everything and get it compressed into one place in our heads (and notebooks) before the exam. Bad (or at least less good) not to be learning so much new stuff. We were talking in the car on the way back about how since we're the first class to go through this LC training, we're the guinea pigs for things like our textbook (there will be a different one used next year) and this review course (TBD if they require it again next year). The disadvantage is, of course, being guinea pigs for the things that don't work; but considering the plans to expand the training next year, I feel so lucky to have been a member of this first small class. The close relationships we've been able to forge with each other and with our precepting LCs have been so wonderful. And even when I'm getting bored in the workshop, I sit there and remind myself how incredibly lucky I am to have gotten the chance to do the training this year. I just cross my fingers that I can find a way to keep doing clinical, hands-on work with breastfeeding dyads. It is one of my favorite things in the world to do!
First the Egg is not exactly new, as it's a expanded reincarnation of Feminist Childbirth Studies, but it's new enough! It's not just a blog but also a "nonsexist space for people who want to learn, reflect, commiserate, or laugh about being pregnant, giving birth, and helping children grow up whole and happy." There are feminist resources on pregnancy & birth (including breastfeeding), parenting, and women's health.
A Midwifery Journey is the blog of a nursing student who has been applying to CNM programs. She blogged a bunch about her impressions of various schools and opportunities, and has recently decided on Yale. It's been an educational and helpful read for me, given my constant personal swirling vortex of thoughts about the future ("midwife? yes? no? yes? no?" would be a short version, maybe someday I'll post the long version). I'm looking forward to hearing more about her experiences!
The Academy of Breastfeeding Medicine's new blog is great! With posts on the science, medicine, and policy of breastfeeding, this is quickly becoming a new favorite for me. Check out the post on how to critically evaluate media reports of breastfeeding studies, and the studies themselves.
That's all for today! I have a training all day, every day this week for my LC course. It's a review workshop for people interested in lactation support/planning to be LCs/planning to sit the exam. It's a mix of good, interesting stuff and a little more boring, less useful stuff, as is almost every workshop and/or conference. It does feel like a very solid review of everything we've learned this year which is both good and bad: good to review everything and get it compressed into one place in our heads (and notebooks) before the exam. Bad (or at least less good) not to be learning so much new stuff. We were talking in the car on the way back about how since we're the first class to go through this LC training, we're the guinea pigs for things like our textbook (there will be a different one used next year) and this review course (TBD if they require it again next year). The disadvantage is, of course, being guinea pigs for the things that don't work; but considering the plans to expand the training next year, I feel so lucky to have been a member of this first small class. The close relationships we've been able to forge with each other and with our precepting LCs have been so wonderful. And even when I'm getting bored in the workshop, I sit there and remind myself how incredibly lucky I am to have gotten the chance to do the training this year. I just cross my fingers that I can find a way to keep doing clinical, hands-on work with breastfeeding dyads. It is one of my favorite things in the world to do!
Monday, March 1, 2010
U.S. midwives in Senegal
Via a blog by DC-based midwifery students about their trip to work with a maternity clinic in Senegal. Fascinating stories and pictures, and a window on to the realities of accessing medical care in developing countries:
We discuss options for getting this baby out now. Recommendation—immediate transfer.
But as I was to learn, the decision to transfer involves three levels of decisions:
* The medical recommendation that a transfer is the only available solution in this situation;
* The family’s agreement on this recommendation—which involves getting a complicated set of approvals from various family members and money with which to pay for the transfer; and
* Access to transfer—collecting money to pay for the ambulance and the ability to get the ambulance here from Ziguinchor
Check out all the entries - a multi-layered look at traditional birthing practices, medical management, and cultural and social factors, from practitioners striving to come with an open mind:
We are not arrogant or neo-colonialist enough to carry ourselves as if we are here to bring our view of midwifery to Africa. We are here to bring our skills and information and assistance to our Sista-midwives and to help the women who are birthing. We teach and learn from each other.
We discuss options for getting this baby out now. Recommendation—immediate transfer.
But as I was to learn, the decision to transfer involves three levels of decisions:
* The medical recommendation that a transfer is the only available solution in this situation;
* The family’s agreement on this recommendation—which involves getting a complicated set of approvals from various family members and money with which to pay for the transfer; and
* Access to transfer—collecting money to pay for the ambulance and the ability to get the ambulance here from Ziguinchor
Check out all the entries - a multi-layered look at traditional birthing practices, medical management, and cultural and social factors, from practitioners striving to come with an open mind:
We are not arrogant or neo-colonialist enough to carry ourselves as if we are here to bring our view of midwifery to Africa. We are here to bring our skills and information and assistance to our Sista-midwives and to help the women who are birthing. We teach and learn from each other.
Friday, February 5, 2010
Friday night movie (trailer)
I've been looking at clips from a documentary currently being filmed about Maternidad La Luz. I first heard of Maternidad La Luz through a student several years ahead of me in undergrad, who did her own version of "junior year abroad" to become a midwife in Maternidad La Luz's One-Year Program. (At least as cool as partying somewhere in Europe!) After that, she returned to college and wrote her senior thesis summarizing her experience and evaluating a model for childbirth education, which I then found, read, and was amazed by.
Since then I've met several people who interned or trained at Maternidad La Luz, and wow...it sounds awesome! Watching the clips from the documentary, it looks awesome too. The homelike setting, the quiet chatter and bustle of life going on in the background, the gentle care by the midwives. I especially loved listening to their fluent "vagina Spanish" (as a nurse once termed her highly labor-focused language skills!) - it brought me back to my time in Denver, where at least half of our doula clients were Spanish-speaking only, and we did so many breastfeeding consults in Spanish that it felt strange to do one in English. I heard that familiar cadence of the phrase you've asked a hundred times - "Como le va con el dar el pecho?" "Se siente presión?" etc.
I'm looking forward to the whole documentary - I hope it will be out soon.
Thanks to my classmate and fellow LC trainee Jenna for the link!
Since then I've met several people who interned or trained at Maternidad La Luz, and wow...it sounds awesome! Watching the clips from the documentary, it looks awesome too. The homelike setting, the quiet chatter and bustle of life going on in the background, the gentle care by the midwives. I especially loved listening to their fluent "vagina Spanish" (as a nurse once termed her highly labor-focused language skills!) - it brought me back to my time in Denver, where at least half of our doula clients were Spanish-speaking only, and we did so many breastfeeding consults in Spanish that it felt strange to do one in English. I heard that familiar cadence of the phrase you've asked a hundred times - "Como le va con el dar el pecho?" "Se siente presión?" etc.
I'm looking forward to the whole documentary - I hope it will be out soon.
Thanks to my classmate and fellow LC trainee Jenna for the link!
Wednesday, November 25, 2009
Reply turned post: Warning: this post contains the word "rectal"
Jill at the Unnecesarean recently wrote about out-of-bed birth and the Captain Morgan aspects of one of her births (you have to read it to fully appreciate). MidwifeNextDoor commented:
"Good for you! I am a CNM presently (reluctantly) working in the hospital. I've only done two out of bed births so far, but it freaks the nurses out! One nurse's chart notes on a patient went like this (the woman was pushing when she arrived at the labor ward):
"Patient REFUSES to give urine sample. She is standing by the side of the bed. I have repeatedly told her to get up on the bed, but she refuses. She stated, 'Women have been giving birth standing up for thousands of years and SO CAN I! And then she pushed the baby out. I did put gloves on before the baby was born."
This client of mine was a VBAC client, by the way! I didn't make it in time for the birth, obviously. I've done one bathroom birth, with mom on hands and knees, and one side of the bed birth with mom standing. There is so much fear surrounding anything different from the cockroach position (flat on your back, legs in the air) that it makes me stressed.
Would love to see more women refuse to get into bed."
This jogged a doula memory for me and I contributed my own comment/story. Since several people thought it was pretty funny I thought I'd repost it here:
"MidwifeNextDoor, your comment about the nurse's charting was so funny!! It reminded me of a birth one of my fellow doulas attended when we were in AmeriCorps together. There was a new CNM at the very by-the-book, public hospital we often attended births at, and she had trained in birth centers down in New Mexico. I can't imagine she's still there but at the time she was fighting to carve out a little sphere for normal birth, and we loved her for it.
One day she paged for one of our doula team to come in to a birth there because she knew the mom wanted to go unmedicated and felt like the nurse wasn't going to give her enough support. My teammate was on-call and told us the whole story later. I can't remember the exact details anymore, but it went something like this: When it came time to push, the unsupportive nurse really couldn't handle the hands-off approach. Mom began pushing standing up next to the bed and the nurse freaked out and said "She's pushing!" "Yes," the midwife said calmly, "she is." The nurse began to get huffy and started charting about the patient pushing STANDING UP. "What's her dilation?" the nurse asked. "Oh, she was almost fully dilated," the midwife said, "I'm sure she's complete now." The nurse went back to charting about how the midwife did not check but just SAID the patient was complete. The nurse at this point swings the computer around so her back is to this travesty. Whenever the midwife asks for a chux pad or anything else she needs, the nurse gets it for her and then goes back to charting with her back turned, so the midwife starts asking the doula to hand her things. As the baby descends, the midwife takes note of signs of progress and says "Could you please chart, 'positive rectal bulging'?" "WHAT?!" says the nurse. "POSITIVE RECTAL BULGING," the midwife says loudly, and she and the doula grin at each other. (Fortunately mom was Spanish-speaking and probably not paying any attention anyway so she wasn't privy to all this banter.) Shockingly, baby is born without any need for mother to get into bed, or for nurse to do much but stand with her back turned and chart ;-) "Positive rectal bulging" became a catchphrase around the office for a while.
Side note: after the baby was born, mom did get into bed to rest and cuddle with the baby, and the doula told the mom what a great job she did, how impressed she was, etc. She asked half-jokingly, "So, do you feel like you could do anything now?" and the mom looked up and very matter-of-factly said, "Oh, YES." "
"Good for you! I am a CNM presently (reluctantly) working in the hospital. I've only done two out of bed births so far, but it freaks the nurses out! One nurse's chart notes on a patient went like this (the woman was pushing when she arrived at the labor ward):
"Patient REFUSES to give urine sample. She is standing by the side of the bed. I have repeatedly told her to get up on the bed, but she refuses. She stated, 'Women have been giving birth standing up for thousands of years and SO CAN I! And then she pushed the baby out. I did put gloves on before the baby was born."
This client of mine was a VBAC client, by the way! I didn't make it in time for the birth, obviously. I've done one bathroom birth, with mom on hands and knees, and one side of the bed birth with mom standing. There is so much fear surrounding anything different from the cockroach position (flat on your back, legs in the air) that it makes me stressed.
Would love to see more women refuse to get into bed."
This jogged a doula memory for me and I contributed my own comment/story. Since several people thought it was pretty funny I thought I'd repost it here:
"MidwifeNextDoor, your comment about the nurse's charting was so funny!! It reminded me of a birth one of my fellow doulas attended when we were in AmeriCorps together. There was a new CNM at the very by-the-book, public hospital we often attended births at, and she had trained in birth centers down in New Mexico. I can't imagine she's still there but at the time she was fighting to carve out a little sphere for normal birth, and we loved her for it.
One day she paged for one of our doula team to come in to a birth there because she knew the mom wanted to go unmedicated and felt like the nurse wasn't going to give her enough support. My teammate was on-call and told us the whole story later. I can't remember the exact details anymore, but it went something like this: When it came time to push, the unsupportive nurse really couldn't handle the hands-off approach. Mom began pushing standing up next to the bed and the nurse freaked out and said "She's pushing!" "Yes," the midwife said calmly, "she is." The nurse began to get huffy and started charting about the patient pushing STANDING UP. "What's her dilation?" the nurse asked. "Oh, she was almost fully dilated," the midwife said, "I'm sure she's complete now." The nurse went back to charting about how the midwife did not check but just SAID the patient was complete. The nurse at this point swings the computer around so her back is to this travesty. Whenever the midwife asks for a chux pad or anything else she needs, the nurse gets it for her and then goes back to charting with her back turned, so the midwife starts asking the doula to hand her things. As the baby descends, the midwife takes note of signs of progress and says "Could you please chart, 'positive rectal bulging'?" "WHAT?!" says the nurse. "POSITIVE RECTAL BULGING," the midwife says loudly, and she and the doula grin at each other. (Fortunately mom was Spanish-speaking and probably not paying any attention anyway so she wasn't privy to all this banter.) Shockingly, baby is born without any need for mother to get into bed, or for nurse to do much but stand with her back turned and chart ;-) "Positive rectal bulging" became a catchphrase around the office for a while.
Side note: after the baby was born, mom did get into bed to rest and cuddle with the baby, and the doula told the mom what a great job she did, how impressed she was, etc. She asked half-jokingly, "So, do you feel like you could do anything now?" and the mom looked up and very matter-of-factly said, "Oh, YES." "
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