Judgements

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

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

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

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

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

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

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

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

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

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

US Maternal Mortality Ranking

 

I find it mildly satisfying to note that the countries with the highest level of midwives in maternal care have the lowest maternal losses. Then I am saddened to see our country on the same plane as South America, parts of Africa and the more “un-modern” countries of eastern Europe.

Cure Gum Disease = Cure Pre-Eclampsia

I read an interesting article a couple of days ago and it’s been bothering me ever since. In essence, this study is showing a link between a protein marker for inflammation and gum disease with pre-eclampsia. Ok. So ok. I can deal with that. Nutritionally speaking, if one is eating a diet low in protein and quality amino acids/vitamins/minerals/etc. then gum disease is likely to be present along with pre-eclampic symptoms. Ok. So far so good. But the last line just cracks me up. Then it ticks me off. Are they for real?

“What remains to be seen,” concluded Ruma, “is whether treatment of maternal periodontal disease can reduce the rate of preeclampsia.”  ~ Gum Disease, inflammation risky for pregnant women

Alrighty then. So we’re going to see if “treating gum disease” will prevent 30% of pre-eclampisa cases? Good grief. I mean, this group is actually WONDERING this!

Do any of the people who do these expensive studies on toxemia ever consider that MAYBE the midwifery community might be right in saying that dear Dr. Brewer was onto something when he claimed to cure and prevent 100% of eclampsia with dietary measures??? And that hey, I don’t know, but maybe gum disease is also a symptom of DIET issues and just happens to occur simultaneously with pre-eclamptic symptoms???

UGH. I’d think, after all of these years of turning up NOTHING, they’d be willing to dive into Dr. Brewers research and actually try to help women. But that’s the rub isn’t it? Helping women doesn’t seem to be the main focus of the medical community at large. Making them “feel” better… maybe, by delivery thier babies via surgical wounds. Yep. That “fixes” the problem doesn’t it? All better. Makes the joke “Take 2 aspirin and call me in the morning” seem pretty fitting.

Lest I end this sour post on a sour note, here is some further reading on nutrition in pregnancy.

Modern Baby Books Full of Bad Advice

Brewer Diet FAQ’s

Toxemia Case Studies

Of course Brewer’s Diet could use a little “tweaking” but overall it jsut makes too much common sense to ignore completely. yes, it’s pretty calorie dense, and yes there are alot of fats in it. But for me, reading the research, case studies, and first-hand accounts (and the latter carry alot of weight for me)  makes it too good to just off-handedly set aside. I’ve seen first-hand, an increase in protein ALONE fix pre-eclamptic symtpoms. Within a week’s time blood pressure readings went down to normal that had been steadily climbing in this mon with a high-carb / low-protein diet (otherwise healthy eating habits). So - read the stuff, decide for yourself. But I believe it’s worth investigating.

 

Activism, Shmacktivism

I wonder sometimes if I am really doing ANYTHING of value these days. I have an open door at the local hospital concerning VBAC’s, as in, they won’t let me have one and by them refusing I could create a HUGE media frenzy and demand appointments with hospital administration. And probably get them. I might. At the very least, I’d like a local paper to do an interview or something regarding the fact that I have no choice in birthing my baby unless I can afford to drive to Kansas City or Columbia. I might write a letter to the editor at least. No doubt, small town, it won’t be published but I’m mulling it over.

The down side to being so public about things is that 1) they will have contat information should they get really peeved and send DFS out to visit after they discover I’ve had a homebirth. There’s nothing they can LEGALLY do, but it would be a headache nonetheless. 2) they would, no doubt, remember me if I ever am practicing in this area and have a transport. So I’m trying to weight out those factors plus the stress of fighting a battle like this while pregnant. Not sure I want to, but I hate passing up the opportunity too for other women who could be helped by it.

It seems to me, that if one woman would start the ball rolling and then when the inevitable happens (ie: “We’re sorry ma’am but this is policy. We will take your suggestions to the board.” ) a group of women could storm the waiting rooms or parking lot with signs we might get something done. But then I have been told I am tenaciously optimistic. And that wasn’t a compliment. LOL Who knows what would really happen. Maybe I’m the only woman in the area bothered by this at all.

I think I was born in the wrong decade. :-/

My Local Midwife/OB VBAC Policy

In the interest of anonymity I will not tell you where I live exactly, or what practice I am speaking of in this post. I will tell you this: the trend is nationwide, it is staggeringly illogical and we need to do something about it.

I went in yesterday to my local OB/midwife group to see if they could get heart tones for me. I’ve had symptoms or warning signs of miscarriage for about 2 weeks and just couldn’t stand the “tentativeness” any longer. I needed to know.

I sat in the exam room, fully dressed still, as the midwife and a student midwife came into the room. I say “came into” but they really didn’t. Before they put down my chart, before they introduced themselves, before they even closed the door, they said that I needed to be aware of this hospital’s VBAC policy before they proceded with the appointment.

“Oh, I’m aware of it.” I said, smiling.

“Well good. Then next time you’ll be in to see a doctor and he will get you scheduled.”

“I won’t be in to see the doctor next time and no, we will not be scheduling me.” (for an elective section) Still smiling I added, “I’m here for THIS appointment today. That’s all. And just for the record, that policy stinks.”

She replied, “I understand. It’s not about us, it’s about anesthesia. They are the ones with the issue with it, they are why we don’t do them anymore. We don’t really know why.”

I said, “Yes, I’m aware of the ACOG bulletin regarding VBAC’s which is probably the “proof” they used to support their position. I’m also aware of the totally illogical presumptions that a VBAC ban is based on. If it’s unsafe for me , a VBAC mom, to birth here because I might need an emergency c-section and anesthesia isn’t always immediately available, then explain how it is safe for ANY woman to birth here. Suppose she has an abruption? Or non-reassuring heart-tones? Or any of the other hundred reasons women get sectioned these days?”

Deer in the headlights. Looks at the ground. She doesn’t like it either, but she’s stuck. Or maybe she doesn’t know what to do. I want to believe she knows better. She says, “Well I didn’t tell you this, but they can’t technically cut on you without your consent.”

“Oh yes.” chuckling now, “I know that full well. Trust me.”

I said all of this with my sweetest southern smile and tone of voice. Not inflammatory or rude or condescending. Just sweet, sweet, sweet.

The appointment continued with the student midwife doing the risk assessment, genetic screening questions come next.

“Does anyone in your family or the baby’s father’s family have mental retardation or autism?”

“Wow. I dont like that categorization of autism with mental retardation, but yes. My son has autism.”

“But you don’t want genetic screening test done?”

“No. I don’t.”

“Why not? You realize we can screen for some of these things?”

Oh give me a break! If we could screen for autism IN-UTERO then we’d have a CURE for it. Jeez Loueeez!!!!!!!!!!!! No less than 5 times did the subject of genetic screening come up. With LOTS of eye contact.

They were very kind and found heart tones (yeah!). I left with a script for prenatal vitamins, a packet about the lovely “birthing suites” my hospital has, a free formula coupon book (which they strongly discourage but still hand out), and a sheet of paper for blood work. Plus an appointment for an ultrasound next week to rule out multiple pregnancies or ectopic. Though I really dont’ have symptoms of either other than my uterus feeling a little bigger than 10 weeks.

Can we say… “Mul-ti-pa-ra” ????

Highly educational visit. I’m not sure what I want to do from this point on. Keep going to appointments, push this VBAC thing since I have a voice there now, while at the same time having NO intentions of delivering there? There is such a startling contrast in true midwifery care and hospital birthing care. Wow. I’m still shocked.

 

 

 

In the interest of contradiction…

This is so frustrating for me - to be sitting here with so much to say - and to be constrained within the bars of ”propriety” and “graceful woman” and “Christian” and even “feminism”. PROPRIETY does not allow me to say “F–K you. All of you. This is my body. My baby. My life. Piss off.”  CHRISTIANITY does not allow me to say that I ***hate*** doctors that perform surgery on normal, healthy women and babies (because a cesarean is performed on the baby too - let’s not forget that) in the name of liability and scheduling and “long hours” and ignorance. FEMINISM does not allow me to say that I want someone to rescue me from the dungeon of hospital birth.  I want a guardian when I cannot express my wishes, and if/when I do/can they are routinely ignored.  I want the person closest to me (a man) to protect me. GASP. “I am woman, hear me whimper.”

Yeah, I know. A bit of contradiction there huh? I know. Get over it. I’m pissed off today. While giving birth unassisted sound LOVELY when I think of laboring and delivering my baby without ANYONE there but me, VBAC status (and my recent dive into the statistics of uterine rupture) leave me a bit shy of doing so. I can’t have a vaginal birth (no matter how managed they would make it) at the local hospitals. If I hire a midwife - she takes an incredible risk to care for me and emergency back-up is non-existant. I must hope and pray there are no complications.

Yet there are the likes of certain “Dr. Amieees” in the world (and I know I mispelled it. I don’t want her to get any more google tags than she already does) who would say, “Life is hard. Have the section. They are recommending it for a reason. You’re not a doctor. You can trust them.” There are SO many nay-sayers, I find it increasingly in my best interests to not tell anyone of this pregnancy, or my plans to birth at home, and G_d-forbid I mention we won’t circumsize or do routine immunizations! UGH.

Can you hear me screaming?????????

So now for the fine print: I am a Christian. I do not use language like this in real life (can’t say NEVER, but I can say rarely). I am not generally an angry, tantrum-throwing person. But if this scenario, and knowing that hundreds of Missouri women find themselves in just such a predicament, does not bristle YOUR neck hairs too… Well, then you’re reading the wrong blog.

Ok - so here we go…

 

Wow. WOW. I am still in shock. 2 weeks ago I got a very pink line on a pregnancy test. So here we go again! As I’ve posted already, the local hospitals all have VBAC bans in place. Besides and regardless of that, (it just really still hacks me so I mention it every chance I get!) this will be my very first home birth.

It is exhilerating and just a tiny bit frightening to realize that I have total freedom this time around. My husband (I was recently married) is completely and 100% supportive of any decisions I make regarding place and method of delivery. His motto is, “You have to do it, you get to call the shots. Just tell me what you need and I’ll get it.” How very very refreshing. I wish he could buy a bus and go on tour convincing hospitals and doctors, husbands and in-laws that this position is the very best kind of support anyone can offer a birthing woman. Ahhh….

So at this point, I’ll be having a homebirth, my 4th VBAC, in the water if it works out that way, alone if at all possible (just my husband and I “catching”, with a midwife in attendance in case of an emergency. I’ll keep you all informed.

Should make another good book.

“Advanced maternal age multipara, with history of gestational diabetes and “macrosomic” infants delivers at home despite a former diagnosis of cephalopelvic disportion and resulting surgical birth 15 years ago”

I cried when i read this…

 So much of this story is like my Luke’s story. He was dx’d with autism spectrum disorder at 20 months of age. “Early” the pdeiatrician said, and I had to fight like you-know-what to even get a referral for a developmental pediatrician then. I knew something was wrong a few months earlier, after his 15 month set of shots. I enrolled him in the Missouri “First Steps” program where he had numerous visits form physical, occupational and speech therapists weekly. I nearly forgot I had other children during that first year while I fought for him. Insurance. Assistive devices. Diet changes. Filtering through autism studies and “cures”. Trying to get him to sleep through the night. He once went 4 days straight without sleeping. I bought a little pop-up play tent and put a crib mattress inside. He slept for 20 hours straight in there, and most nights afterwards. He had sensory integration disorder and the open space that was his bed kept him on “high-alert”. The occupational therapis likened it to the feeling we have when we trip and are about to fall backwards.

For months no one would take me seriously. I switched pediatricians. She listened. She didn’t see it but she heard me and gave me a referral for services. I didn’t know what was wrong exactly but I knew something was. When I was pregannt with him I had a dream that there was something wrong with his eyes, and his feet. These were metaphores for what would happen to him. He walks a different path, he sees the world differently than we do. He is autistic.

When I first heard that vaccine might be causing autism, I stopped giving my children vaccines until I could make an informed decision one way or the other.  Recently they all went to public school for the first time in their lives (while I’m back in college, adjusting to single-again life and trying to make ends meet). The vaccine issue came front and center immediately. I was told they could not attend school unless they were fully immunized. Rather than fighting a battle I would not win on physical-harm grounds, I got religious excemption forms instead. And I do have a religious belief that precludes me from harming my child: Immunizations DO harm children. Maybe not all the time, but it’s a risk I have chosen not to take.

Here is an article and the entire court document, ver batum, by David Kirby, where the court found that vaccines cause significant harm to a child and the parents were awarded an undisclosed amount of compensation. Compensation. How much money does it take, I wonder, to compensate for the loss of a normal, healthy child?

ANALYSIS

Medical personnel at the Division of Vaccine Injury Compensation, Department of Health and Human Services (DVIC) have reviewed the facts of this case, as presented by the petition, medical records, and affidavits. After a thorough review, DVIC has concluded that compensation is appropriate in this case.In sum, DVIC has concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder. Therefore, respondent recommends that compensation be awarded to petitioners in accordance with 42 U.S.C. § 300aa-11(c)(1)(C)(ii).
 

Every parent in the nation should read this story, and contemplate whether or not there is a reason to question the enormous amounts of vaccines our children receive. HERE is the article, in it’s entirety. I find it keeps moving, so if it comes up as “File Not Found” then search for articles written by David Kirby.

ACOG Official Position on Homebirth

 You can read the release in it’s entirety HERE. Basically more of the same. Homebirths are risky, hospitals are better, blah blah blah. No statistics, no data, just more of the same. It makes me sick. The patronizing tone that accompanies these statements infer, “Be a good little girl and do what your doctor tells you.” God forbid you think for yourself, ask questions, read, educate, listen, HEAR, make choices for yourself. Oh no. We can’t have that. Ugh. Can you hear me screaming?

I recently came across Britain’s Royal College of Obstetrician’s and Gynaecologist’s statement on homebirths. It was released in April of 2007. The overall tone is one of a deep respect for childbirth choices and a woman’s right to choose where and with whom she gives birth. The high spots are as follows:

“There is no reason why home birth should not be offered to women with low risk of complications and it may confer considerable benefits for them and their families.”

“The review of the diverse evidence available on home birth practice and service provision demonstrates that home birth is a safe option for many women.”

“The observational data available show lower intervention rates and higher maternal satisfaction with planned home birth compared with hospital birth.”

“It is aknowledged that there are no known risk assessment tools which have an effective predictive value concerning outcomes in the antenatal period and labour.”

“UK maternity policies recognise that, for the majority of women, pregnancy and childbirth are normal life events and that promoting women’s experience of having choice and control in childbirth can have a significant effect on children’s healthy development.”

“There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.”

Contrast this with the ACOG’s statement and you’re probably left scratching your head. Me too. Add that to the fact that in 2005, shortly after the major study linking better outcomes with CPM’s and homebirths, the OB.GYN.News put out a very favorable article. The title? “Planned Homebirths Safe, Study Suggests“.  AOG’s article on safety of homebirth  Makes ya go “Hmmm… ” doesn’t it???

Well Said Mr. Jefferson!

“I know of no safe depository of the ultimate powers of the society but the people themselves;                                                   and if we think them not enlightened enough to exercise their control with a wholesome discretion,                                      the remedy is not to take it from them, but to inform their discretion by education.”    ~Thomas Jefferson

Well said. Very well said. The ACOG could use a bit of this advice. Constantly trying to “save” women from themselves, it absolutely enrages me that many will perform abortions under the argument of “It’s your body.” but will refuse VBAC’s, natural labors, laboring without intervention, denying women their birthing rights. And they do this in such a sneaky way. It’s unlawful for them, speaking broadly, to outright deny you services. You have rights you know. But if your decision/wishes conflict with the OB, then by golly, you can take your “rights” elsewhere. They simply write you a letter and dismiss you from their care. This is how they monopolize the childbirth experience and make it about their decisions and not ours.

When will we, birthing women with daughters who will be birthing women someday, stand up and LEARN the truth about birth and begin telling others about it? As usual, an educated mind is a healthy one and the future of birth depends on what we do TODAY to impact the birth culture.