Glimpses of the Darkside
I should be completing my second last Physiology assignment but after pushing through the unspeakable awesomeness (sarcasm dripping) of the digestive system after lunch I cannot bring myself to immerse myself in the regulation of fluids, electrolytes and pH in the body this afternoon. And besides I have something pressing to talk about.
I've been recently been talking to a couple of friends who are just beginning their journeys as Doulas and their enthusiasm made me remember how full of joy and optimism and brimful of faith I was when I started out and my first couple of births were easy, gentle and perfect. It seemed as though I had joined the small ranks of true believers. I'd reclaimed a birthright of women and luxuriated in the power of being a woman who could absolutely birth babies. Finding that faith was a pretty mind blowing thing for me. Furthermore I could share this secret with others. For a while it seemed to me that every intervention was tantamount to assault and I raged about the injustices I percieved were perpetuated against women daily in modern American hospital birthspace. I felt righteous in my indignation and full of anger toward the establishment. Ok. That's perhaps a lifelong trend people close to me might recognise...but anyway.
But then I was doula at a birth that went very, very bad, very quickly. The big, scary interventions employed by the Obstetrician and the nursing staff saved two lives. I was stunned by the pace and the need for the decisive steps taken in that case. The birth process is perfect when it works perfectly, but sometimes (I still believe, rarely) it doesn't. I learned then that there is a time and a place for most every intervention in birth.
Shortly after my second son was born I made a new friend who's baby very nearly died at birth from what sounds like a very long (+5mins?) shoulder dystocia. SD for those of you not up with the terminology is when the babies head is delivered but the shoulder gets stuck behind mama's pubic bone or elsewhere in the pelvis. If it's not resolved quickly (not easy to do) the baby will be brain damaged and/or die. When I moved away she gave me as a parting gift a newborn photo of her baby taken an hour or so after his birth. In the picture his swollen face is purple with bruises and his chest streaked with livid red scratches from where her Doctor tried to hook his shoulder out. It sounds like his clavicles (collarbones) were broken in the process though my friend isn't sure. She told me that she had never shared that photo with anyone but she felt that as a midwife I could use that snapshot. Oh boy.
I find echoes in my head of the conversation I had (with righteous indignation in full swing) with my friend Hamilton who was completing his med school internship in Australia who offered simply, and quite non-judgementally "Wait until you've seen a few bad outcomes and then see how you feel."
And finally today a mama left a comment to me on another (unrelated) post. I visited her wonderful blog. Now expecting her 4th baby, her second son tragically died seven weeks after birth from hypoxic ischemic encephalopathy. HIE is sometimes called birth asphyxia and it is possibly the most feared result from a complication like shoulder dystocia. I noticed she links to a site on SD which makes me wonder...
I've been reading avidly my new midwifery textbooks and their discriptions of how to manage SD and other serious (and to me super-scary) complications. I find myself thinking hard about the shift from Doula to Midwife. Handling complications is something that Midwives are trained to do and my favorite (Navelgazing) Midwife has handled and written about the (larger than normal numbers of) SD cases which she has encountered on her journey. I have great faith that my studies and teachers will prepare me with the knowledge and skills to do my best with SD and myriad other nasties but it still leaves me imagining vividly the scenario when it's me and my hands who must bear the responsibility of swift and effective decision making which could determine whether a baby (or a mother) lives or dies. It doesn't get bigger than that.
Here I sit now with my eyes open to the reality of the dark side which lurks. I reassure myself that such complications are rare and that much can be done to minimize the risk... for example, it seems to me (forgive me if this is outta control ignorant) that it would be a bit easier to manage a shoulder dystocia if a woman is without an epidural and is able to move (or as much as one is able if a head is stuck just outside your vagina). I imagine women faced with the alternative are capable of quite extraordinary feats. And for the first time I understand what my friend Hamilton may have been getting at when he urged me to wait and see how I felt... I don't want to ever find myself so frightened of the possibility of complications that I resort to the sort of paranoia which I've sensed from a few of the OB's I've worked beside as a doula but I now have a sense of where that fear (or experiences) of bad outcomes might lead you. It's most definately a dark, dark place.
I'm a bit humbled today by the reality of one mother's loss.
I've been recently been talking to a couple of friends who are just beginning their journeys as Doulas and their enthusiasm made me remember how full of joy and optimism and brimful of faith I was when I started out and my first couple of births were easy, gentle and perfect. It seemed as though I had joined the small ranks of true believers. I'd reclaimed a birthright of women and luxuriated in the power of being a woman who could absolutely birth babies. Finding that faith was a pretty mind blowing thing for me. Furthermore I could share this secret with others. For a while it seemed to me that every intervention was tantamount to assault and I raged about the injustices I percieved were perpetuated against women daily in modern American hospital birthspace. I felt righteous in my indignation and full of anger toward the establishment. Ok. That's perhaps a lifelong trend people close to me might recognise...but anyway.
But then I was doula at a birth that went very, very bad, very quickly. The big, scary interventions employed by the Obstetrician and the nursing staff saved two lives. I was stunned by the pace and the need for the decisive steps taken in that case. The birth process is perfect when it works perfectly, but sometimes (I still believe, rarely) it doesn't. I learned then that there is a time and a place for most every intervention in birth.
Shortly after my second son was born I made a new friend who's baby very nearly died at birth from what sounds like a very long (+5mins?) shoulder dystocia. SD for those of you not up with the terminology is when the babies head is delivered but the shoulder gets stuck behind mama's pubic bone or elsewhere in the pelvis. If it's not resolved quickly (not easy to do) the baby will be brain damaged and/or die. When I moved away she gave me as a parting gift a newborn photo of her baby taken an hour or so after his birth. In the picture his swollen face is purple with bruises and his chest streaked with livid red scratches from where her Doctor tried to hook his shoulder out. It sounds like his clavicles (collarbones) were broken in the process though my friend isn't sure. She told me that she had never shared that photo with anyone but she felt that as a midwife I could use that snapshot. Oh boy.
I find echoes in my head of the conversation I had (with righteous indignation in full swing) with my friend Hamilton who was completing his med school internship in Australia who offered simply, and quite non-judgementally "Wait until you've seen a few bad outcomes and then see how you feel."
And finally today a mama left a comment to me on another (unrelated) post. I visited her wonderful blog. Now expecting her 4th baby, her second son tragically died seven weeks after birth from hypoxic ischemic encephalopathy. HIE is sometimes called birth asphyxia and it is possibly the most feared result from a complication like shoulder dystocia. I noticed she links to a site on SD which makes me wonder...
I've been reading avidly my new midwifery textbooks and their discriptions of how to manage SD and other serious (and to me super-scary) complications. I find myself thinking hard about the shift from Doula to Midwife. Handling complications is something that Midwives are trained to do and my favorite (Navelgazing) Midwife has handled and written about the (larger than normal numbers of) SD cases which she has encountered on her journey. I have great faith that my studies and teachers will prepare me with the knowledge and skills to do my best with SD and myriad other nasties but it still leaves me imagining vividly the scenario when it's me and my hands who must bear the responsibility of swift and effective decision making which could determine whether a baby (or a mother) lives or dies. It doesn't get bigger than that.
Here I sit now with my eyes open to the reality of the dark side which lurks. I reassure myself that such complications are rare and that much can be done to minimize the risk... for example, it seems to me (forgive me if this is outta control ignorant) that it would be a bit easier to manage a shoulder dystocia if a woman is without an epidural and is able to move (or as much as one is able if a head is stuck just outside your vagina). I imagine women faced with the alternative are capable of quite extraordinary feats. And for the first time I understand what my friend Hamilton may have been getting at when he urged me to wait and see how I felt... I don't want to ever find myself so frightened of the possibility of complications that I resort to the sort of paranoia which I've sensed from a few of the OB's I've worked beside as a doula but I now have a sense of where that fear (or experiences) of bad outcomes might lead you. It's most definately a dark, dark place.
I'm a bit humbled today by the reality of one mother's loss.
posted by Louisa at 3:22 PM
6 Comments:
GREAT post. Poignant and so true.
I've blogged about my "going to the darkside" with nursing (from 15 years of doula work.) And considering midwifery (except I am getting so OLD and POOR.)
I see both "sides" too, and perhaps--just maybe?--that's a good thing for us.
Hh
it's such a balance--recognizing the risks with any venture, but still being wholly trustful of it. it's something I've been talking alot with friends.
I think it's healthy to have a humble respect for the complications, the dangers, the potential losses. Things don't take a turn to The Darkside very often (in the midwife model of care, anyway - good prenatal care, honest screening for risk & underlying health conditions, minimal interventions during labor, moms who feel safe, etc). BUT, when things do go wrong, the damage can be The Worst, loss of a child. Or a mother. Or both. I think midwives who know the risks, and call for help when they need to, are the safest providers possible.
I've chosen midwives & freestanding birthing centers for the births of both my daughters because I truly do feel safer with them. Especially because I cook up some big babies (9 1/2 lbs & over 10 lbs, with nice wide chests) - Thank you, Ina May! http://www.inamay.com/gaskin_maneuver.php
But I'm also aware of the risks that come with my choice. Statistically, there aren't many times that being in a hospital is safer than being at home - But, if you happen to become one of those statistics, that's a cold comfort. I love Anne Finger's discussion of this in Past Due.
I suffered a serious post-partum hemorrhage after the birth of my daughter in January. My midwife had to manually extract my placenta, and, when my bleeding didn't stop after vigorous uterine massage, multiple shots of pitocin, misoprostol suppositories, & an iv drip of pitocin, she called 911. So, 20 minutes after pushing my daughter into the world, I found myself strapped into an ambulance, rushing with sirens & lights to the closest hospital. I lost 1 litre of blood, and spent the night in the hospital. And I felt so lucky - Lucky to have chosen my amazing midwife, lucky to have quick access to a hospital when I needed it, lucky to be alive, lucky to be a mama.
Sorry to ramble so!
I am humbled by your mentioning my blog & the loss of my son. Yes, it was severe s.d. and I was at home with a very skilled midwife. You can email me at frugalbeer@yahoo.com if you want to ask anything, I truly do not mind discussing any aspect. We also don`t blame anyone, it was a very rare, very extreme case. I still believe birth works (most of the time), but like Navelgazing Midwife always says, people haven`t seen enough births if they think its always going to work out fine. Thanks again.
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Thank you all for your comments, especially to you Clara (though I decided not to publish it... I couldn't figure out how to edit out your e-mail address). I continue to puzzle this one through.
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