So I found the time...
I was too pissed off to sleep (or do anything else except yell at the computer). This was my reply to her comment:
I'm increasingly frustrated about being one of the two pro-breastfeeding writers on that site (it's pretty much me and Andy Steiner, who rocks, BTW. You should read her book) and one of only a couple of us there who managed to avoid a surgical birth. So you see, the whole "Natural" birth (in inverted commas if you don't mind!!) comment just made me see red. It may have been the last straw.
I am open to suggestions about how to address this. I want to keep posting things which at least highlight all the issues in the field but Jaysus I confess I find it very bloody intimidating going up against an ACOG member physician as a first year midwifery student. But then I think about the fact that I have also been a consumer of mainstream obstetrical services in this country and while I survived the experience without the addition of a lower transverse abdominal incision (and my kid did too). I have a RIGHT to work to alter the system in which she participates. I still remain convinced that the system as it exists today routinely fucks women (and babies) over.
I know that there are physicians out there who really do care about women and who advocate for them and proudly wear their "M.D - Midwife in Disguise" tag. Doc's like fpmama I suspect ranks up there among them. But seriously though, there must be hundreds of people who are at least complicit in the sorts of abuses which damage women every day in every hospital all over the country. A couple of particularly horrible examples can be found over here, and here read if you dare. Hell, one of these days I'll post my first birth story... This sort of thing happens every day!!!
Comments like hers just bring that home for me. It breaks my heart every time I hear it. I'm sure she cares deeply for her patients, but the fact that she evidently thinks homebirthers are ignorant fools disappoints me beyond words.
Why does it sometimes feel like our "team", those of us who "get it" is so bloody small. Why does this calling of ours feel so bloody lonely, so much of the time?
Isabel, you wrote: "The more that women insist on home deliveries, the more these outcomes will occur, from time to time. Anyone who wants to take those risks, be my guest."And then there was another 200 words or so in which I got even more pissy. I thought the better of it though and left it at that.
Thanks, I will.
As you yourself noted, the outcomes you highlighed happen in the hospital as well. In fact complications like the ones you mentioned occur less frequently at home because the populations who chose Licenced Midwife-attended home birth are almost always healthy, low risk, and very well educated and informed women. High risk women - and WA State midwifery licencing law agrees with you with on the VBAC at home cohort, BTW - belong in the hospitals where their much higher rates of complications can be ably managed by Obstetricians and Neonatologists.
As a student midwife (I will be a Licenced Midwife here in WA- and likely also in Australia at some point - when I complete my education and training) I will provide care to those healthy low-risk women "who insist on homebirth". This is their right, and it is at best unfair to cast their informed decision making as reckless or stupid. Planned homebirth with a skilled, licenced professional midwife has been demonstrated time and again to be at least as safe (for mothers and babies) as birth in hospitals with lower rates of intervention and higher levels of maternal satisfaction. Surgical births are absolutely necessary for some women, and they undoubtedly have their place. But when the WHO and other international research agencies peg the rate at which the surgeries should be performed at between 13 and 15% of all births and the current C-section rate in the U.S. currently stands at ~30% (and in some hospitals this rate is closer to 50%!) It's more than fair to conclude that something is going very wrong within the mainstream US hospital-based obstetrical system.
I'm increasingly frustrated about being one of the two pro-breastfeeding writers on that site (it's pretty much me and Andy Steiner, who rocks, BTW. You should read her book) and one of only a couple of us there who managed to avoid a surgical birth. So you see, the whole "Natural" birth (in inverted commas if you don't mind!!) comment just made me see red. It may have been the last straw.
I am open to suggestions about how to address this. I want to keep posting things which at least highlight all the issues in the field but Jaysus I confess I find it very bloody intimidating going up against an ACOG member physician as a first year midwifery student. But then I think about the fact that I have also been a consumer of mainstream obstetrical services in this country and while I survived the experience without the addition of a lower transverse abdominal incision (and my kid did too). I have a RIGHT to work to alter the system in which she participates. I still remain convinced that the system as it exists today routinely fucks women (and babies) over.
I know that there are physicians out there who really do care about women and who advocate for them and proudly wear their "M.D - Midwife in Disguise" tag. Doc's like fpmama I suspect ranks up there among them. But seriously though, there must be hundreds of people who are at least complicit in the sorts of abuses which damage women every day in every hospital all over the country. A couple of particularly horrible examples can be found over here, and here read if you dare. Hell, one of these days I'll post my first birth story... This sort of thing happens every day!!!
Comments like hers just bring that home for me. It breaks my heart every time I hear it. I'm sure she cares deeply for her patients, but the fact that she evidently thinks homebirthers are ignorant fools disappoints me beyond words.
Why does it sometimes feel like our "team", those of us who "get it" is so bloody small. Why does this calling of ours feel so bloody lonely, so much of the time?
posted by Louisa at 10:05 PM
8 Comments:
"High risk women - and WA State midwifery licencing law agrees with you with on the VBAC at home cohort, BTW"
I wanted to ask your opinion on the fact that midwives can't do VBACs in washington state. Do you feel VBAC is safe at home? Do you think Washington midwives are limited unnecessarily?
I have a very good friend from the Seattle area, who through a twisted turn of events in her first pregnancy, was transferred from her intended home birth to a hospital where she recieved a Csection. Now, with all the VBAC bans in the area, she's stuck with little choice. Un unlicensed midwife, which she feels uncomfortable with, a repeat scheduled Cesarean, or to travel to Oregon to have her OOH VBAC. (always a tenious prospect, as second labors are often short)
I am very thankful that in Oregon we have retained the right of Midwives to deliver most variations of births out of hospital. (although twins and breech were lately restricted from birth center births, they are still allowed at home)
Cherrie
Hi Cherrie,
Yeah, I was careful with the wording on that one. I personally, do not know yet how I feel about home VBACs. I just don't know enough about all the dimensions. I know a few midwives in a couple of States and in Aus who are happy to do VBAC's at home. And I also know that the research doesn't support VBAC bans for health reasons.
Midwifery care is restricted in many places and by lots of different forces among them Licencing laws, Birthcenter regulations and liability insurance . And then, perhaps most importantly all the dimensions of the individual woman in your care. Why did she have that first c-section? What were all the factors which led to that surgery? Could they reasonably impact the safety of an OOH VBAC?
My main concern with all this is that VBAC's are being forced out of hospitals, and midwives are being called to be the second to last port of call for a woman wanting one.
Homebirth should not be that last point of call. It shouldn't be a last resort. It should be a choice for all low-risk women (I'm not convinced that VBAC automatically means you're high risk - though in individual cases it may be).
The Group Health Birth Center CNM's will help women have VBACs in Seattle?
I'm sorry for your friend's predicament. :(
Thanks for the props, Louisa. You rock, too.
I confess I find it very bloody intimidating going up against an ACOG member physician as a first year midwifery student
Louisa, don't forget what Henci Goer said when confronted by an ACOG member who asked her what she thought qualified her to speak on obstetric issues...."I can read."
They want to think they hold a corner on "secret knowledge" but the truth is, anyone with a high school or above reading level can learn anything and can learn to read and interpret studies as well.
As an HBAC mamma myself, I am extremely passionate about women's rights to choose OOH settings for VBAC, although you are right, it's not always equally safe.
For women in some states, homebirth is the ONLY place they will have a vaginal birth. I've even heard horror stories of women showing up pushing and being given terbutaline so they can "hold off" and get them to the OR for their repeat C.
Uterine rupture is a risk with VBAC, but cord prolapse, placental abruption and other cord accidents, as well as hemorrhage are also major life threatening risks for ANY birth. The thing is that these risks are reduced at home where women are not given prostaglandin gels and other drugs that have a proven record for abrupting placentas, rupturing uteri and causing embolisms.
And just remember, ACOG isn't really a college ;)
It's a trade union.
"And then, perhaps most importantly all the dimensions of the individual woman in your care. Why did she have that first c-section? What were all the factors which led to that surgery? Could they reasonably impact the safety of an OOH VBAC?"
Ah, yes, important questions. She was transferred because thin mec was present, (itself a restriction of WA midwives I understand) In the hospital she didn't progress according to their schedule, agreed to pit with an epidural, and although she was very hesitant a 'wash' which I can't remember the name where they infuse a saline into the uterus through a tube to wash the mec from the uterus. Completely not evidence based of course. After hours of this wash they discovered the baby's head was cocked to one side (away from the tube) and she couldn't push him out. C-section after 3 hours of pushing. To my knowledge no effort was made to reposition baby.
Baby was place in a warmer across the room while Mama recovered and kept herself awake with aromatherapy in hopes they would bring baby to her soon. Then after 5 minutes of holding they decided he had a fever and off to the NICU for 5 days he went.
No infection, low transverse scar, and at least 3 years between pregnancys should make VBAC as safe as it gets. (in the absence of induction/augmentation drugs)
Cherrie
Hey Cherrie.
It may be too late for your friend but I'm hearing that there are LM's about who will do low risk HBAC clients with some fancy footwork. Typically they will co-manage care with an OB and then just "not make it to the hospital in time". It's worth having good, frank discussions with the midwife who is doing her prenatal care. She may get lucky. Again, I'm sorry that it's so hard for her. It shouldn't be this way.
I just wanted to add my $0.02
I had a beautiful home VBAC eight years ago and would do it again, but I'm done having kids.
It's not that midwives "can't" do home VBACs, it's just that most of them "won't." This is according to my midwife here in northwestern Washington State, who, by the way, does home VBACs.
Peace out.
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