Tuesday, December 18, 2012

Keeping Our Children Safe

It is with a heavy heart that this post comes to exist.  In the wake of one of the most violent attacks on children in my lifetime, the shootings at Shady Hook Elementary in Newtown, CT, I struggle with the rest of our grief-stricken country to understand something that cannot be understood in a simple moment.  I am a parent, a teacher, and someone who knows too well the grief of losing a child...yet I cannot fathom what these families are enduring. 

You may wonder why this topic would appear on a blog advocating for safer practices in midwifery.  The reason comes in understanding that whether the threats and challenges we face as parents on a given day are mental health, gun control, drunk driving, unexpected illness, issues of neglect, poverty, or unsafe birth practices, we all aim to keep our children as safe as we possibly can.  Addressing the gaping disparities on a given issue is something we must do, no matter how daunting the task. 

In moments of tragedy we find more common ground.  We search for answers.  We contemplate change.  We look for inspiration to lead us forward out of a dark and dismal reality.  It is in the midst of that search that I would like to share excerpts from President Obama's Memorial speech given this weekend for the families of Newtown, CT.  His speech addresses a context different from ours, but the message is one that holds meaning for every danger that puts children in harm's way.  It is the message of inspiration, love, and a call to action to do everything we can to protect our children, that is most relevant here. It is the urgent message to be a better, more responsible culture of people than we are today, that I hope we all can hear.

     "...this job of keeping our children safe, and teaching them well, is something we can 
      only do together, with the help of friends and neighbors, the help of a community, and 
      the help of a nation.  And in that way, we come to realize that we bear a responsibility 
      for every child because we’re counting on everybody else to help look after ours; that 
      we’re all parents; that they’re all our children.  This is our first task -- caring for our 
      children.  It’s our first job.  If we don’t get that right, we don’t get anything right. 
     That’s how, as a society, we will be judged.
     And by that measure, can we truly say, as a nation, that we are meeting our  
     obligations? Can we honestly say that we’re doing enough to keep our children -- all of 
     them -- safe from harm? Can we claim, as a nation, that we’re all together there, 
     letting them know that they are loved, and teaching them to love in return? Can we 
     say that we’re truly doing enough to give all the children of this country the chance 
     they deserve to live out their lives in happiness and with purpose?
     I’ve been reflecting on this the last few days, and if we’re honest with ourselves, the  
     answer is no. We’re not doing enough.  And we will have to change.

     We can’t tolerate this anymore. These tragedies must end. And to end them, we must 
      change. We will be told that the causes of such violence are complex, and that is true. 
      No single law -- no set of laws can eliminate evil from the world, or prevent every 
      senseless act of violence in our society.
      But that can’t be an excuse for inaction. Surely, we can do better than this. If there is 
      even one step we can take to save another child, or another parent...then surely we 
      have an obligation to try.
       There’s only one thing we can be sure of, and that is the love that we have -- for our 
      children, for our families, for each other. The warmth of a small child’s embrace -- 
      that is true. The memories we have of them, the joy that they bring, the wonder we see 
      through their eyes, that fierce and boundless love we feel for them, a love that takes us 
      out of ourselves, and binds us to something larger -- we know that’s what matters. We 
      know we’re always doing right when we’re taking care of them, when we’re teaching 
      them well, when we’re showing acts of kindness. We don’t go wrong when we do that.
      That’s what we can be sure of.  And that’s what you, the people of Newtown, have 
      reminded us.  That’s how you’ve inspired us.  You remind us what matters.  And that’s 
      what should drive us forward in everything we do, for as long as God sees fit to keep 
     us on this Earth."

     ~ President Barack Obama

And so I ask you dear readers, are we doing enough to keep all of our children safe?  Are we giving every child the chance they deserve to live their lives?  These great responsibilities our President speaks of start with birth, and move forward with our children as they grow.  We know too many tragedies that can and should be prevented.  The issues surrounding midwifery and out of hospital birth are complex, and represent only one of the issues that pose far too many unnecessary risks to our children.  Should the daunting complexities of issues like these prevent us from healthy conversations about improving safety, from taking action to do our best to prevent he preventable?  As the President said, "Do we not have an obligation to try?"   

To the families of Newtown, Connecticut, your children represent a love and light that will lead this country forward to a better version of itself in ways we cannot yet see.  They have touched many lives already, inspiring people to do better, for and by others.   As the president accurately stated, "You remind us of what matters."  

If I can offer one hope, it is that this country begins to see the larger issues that are putting our children in harm's way.  We must find a way through the complexities to address each and every one of these issues appropriately.  We can do better, and our children deserve better.  

Video, Full Text: President Obama's Speech at Memorial for Connecticut Families

Thursday, December 13, 2012

The Things That Matter Most

I always find myself a bit sentimental around the holidays.  This year is no different.  I thought I'd share a bit of that sentiment with our readers, promising more of our traditional, resource-oriented posts in 2013.  

Part I: 
I used to live snugly under a blanket of naive protection, moving forward in life, fully anticipating all of the great things to come.  A husband, and a family were what I hoped for most.  Being in my early thirties, I had not yet experienced anything in my life that I would call a "tragedy".  There weren't really even many challenges worth mentioning.  

When I met my husband, I learned about love in a way I had not previously understood.  We started a family and that love and understanding again grew.  With my second baby, I fell into the trap of expecting things to go just fine, just like they always had.  Why not hire a midwife?  After all, I had never known anyone who had lost a baby from traumatic delivery.  

Let's just say that blanket of protection disintegrated into thin air.  Left shaken, raw, and rocked to our core, we had no idea how to deal with the loss of our baby.  There was no more security in things being okay.  There was no more "guarantee" that any of us would live another day.  Instead, that naive trust was shattered.  We were afraid, insecure, and not sure what the future would hold.   Sometimes it still feels like we're bracing for the next big blow. 

(You can read more about Magnus's story here.)

Part II: 
Until tragedy touches our lives directly, we cannot appreciate fully the challenges others deal with on a daily basis.  I don't know if it's the season, or just me, but on many occasions, I find myself reading a story or watching a television program in a mess of tears for the heartache with which another family is wrestling.  I'm inspired even further by the strength these families have demonstrated along the way.  

“Wounding and healing are not opposites. They're part of the same thing. It is our wounds that enable us to be compassionate with the wounds of others. It is our limitations that make us kind to the limitations of other people. It is our loneliness that helps us to to find other people or to even know they're alone with an illness.  I think I have served people perfectly with parts of myself I used to be ashamed of." ― Rachel Naomi Remen

This post is dedicated to any family or person who has suffered loss, injury, illness, loneliness, or tragedy of any kind.  My hope is that one day you realize that our wounds have the potential to lead us forward to be better versions of ourselves, and further enable us to reach out to our fellow man in ways that others cannot.  More than ever, I realize how much our compassion is needed in this world.    

I've been reminded of the need for this kind of compassion by the lives of so many friends this year.  A family whose child is valiantly fighting cancer, a family who recently lost a father and husband to a sudden heart attack, a friend enduring the trenches of divorce,  a neighbor whose father suddenly passed away, the family looking for resources to help their injured baby, the family swallowed up by the grief of losing their baby, and so many more.  

I often think about our soldiers too, and how sheltered I feel from the sacrifices they make for us each and every day.  It's not because I don't care, or that I'm not grateful for the daily risks they take on our behalf, but because it's a path (just like all but one of those mentioned above) I haven't walked personally, and therefore cannot fully appreciate.  Somehow though, after having dealt with the unexpected loss of our child, I can relate to the harsh reality of tragedy in a way that I wouldn't have in years past.  

It is in fact a soldier's story that best exemplifies the compassion I'm speaking of this week, a compassion that can erupt from the ashes of the darkest moments that life too often brings.  Shilo Harris is a man who demonstrates beautifully, the opportunity and gratitude that can come from tragedy.  He, and many others have inspired me.  He sums up his attitude in the following quotes: 

"There are no guarantees that we'll be alive tomorrow, or that we'll have the same health we have today, but we can count the blessings we do have."  

“You have to look at everything that God gives you as a gift.  It may not always be the gift that you want, but you have to take what you get sometimes and turn it into something else.  And that’s kind of what I’ve done.”  Shilo Harris

I can't say that I believe that the tragedies we face are gifts.  Shilo is a better person than I.  I can however say, that with the perspective that comes from enduring difficult situations, I can more easily relate to the struggles of others.  And further, with that perspective I can offer compassion in a way that many others cannot.  We can choose to turn life's darkest moments into something else.  There is something profoundly healing to my own being in helping another find their way forward.  What better way to honor a loved one, or heal from the challenges we've faced than by reaching out? 

Final Thoughts: 
We live in a culture filled with doubt.  In the most challenging of moments, I find that this doubt can easily overcome us.  One's faith in the unseen and unknown will go one of two ways in the face of tragedy.  It will a) dissipate, allowing doubt (aka grief, loneliness, sadness, shock, etc) to flood our very being, or b) grow stronger.  There are times in my life when my own faith has been tested beyond measure.  Yet somehow I realized, I never really walked that journey alone.  

I've come to recently understand something new, from a beloved children's holiday movie.  I think this little collection of thoughts will speak to many of you who have endured difficult events in your lives: 
"Sometimes seeing is believing, but believing is knowing the things you cannot see, are real...The things that matter most are the things we cannot see."  - Polar Express

And so I've spent a lot of time thinking about all of this, spinning it around in my head like a potter's wheel.  These are the things I've come up with that matter most to me...those things we cannot see, but know to be real: 

Faith in something bigger than ourselves (Namely God)

When I think about our son, who left this earth far too early, I am instantly filled with love.  I can't see him with my eyes, but I sure know this list of words to be far more real than I ever imagined because of him.  That in itself is a gift, a gift I intend to share with others who need it most.  I hope many of you who have walked darker paths, will find peace in your hearts this holiday season knowing you are not alone.  I hope that you will someday see your experience as an opportunity to reach out to another, and remind others that often the things that matter most are those we cannot see.  I invite you to make your own list of what matters most to you.  Thank you my dear Magnus for helping me "see" more clearly than ever, and for helping me find a way to share it with others.     

Happy Holidays!

From our Hearts to Yours, 

The Families of Safer Midwifery for Michigan

Tuesday, December 4, 2012

The Complicated Task of Choosing a SAFE Midwife

What I didn't know in choosing a midwife to attend the birth of our baby, was how critical it would be to choose a "safe" midwife.  I didn't understand the vast differences in philosophy, education, or practices that exist within one profession.  If nothing else, I want every other mother out there to understand there is a difference, and enormous difference, and that just because someone calls herself a "midwife" does not mean she practices safely. 

It is important to me that our readers understand that there is no standard for the use of the term "midwife".  It means a million and one different things, especially in a state like MI, that has no regulations or defined scope of practice that is consistent among "midwives".  In MI, this spectrum ranges from CNMs, midwives with advanced degrees, most of whom practice in a hospital setting with a license and insurance...to lay midwives who have learned apprentice style, with no formal education whatsoever.  We have many midwives practicing responsibly and safely, most (not all) of whom also happen to be practicing in a hospital.  I have met a few midwives in our state who practice outside the hospital setting, who take risking out and safety very seriously.  Unfortunately, they are hard to find, and even more difficult for a consumer to identify. 

For this reason, I find it necessary to discuss these variances, so that women can better choose a care giver.  This can only be the beginning to this discussion because it is complicated.  It makes sense to start with the questions: How do we identify different types of midwives?  How do their practices differ from other midwives?  What does "certified" mean, and how much weight does it hold?  Who is licensed in MI?  What are the minimum educational requirements?  Why does all of this matter? 

I want to start by first dividing midwives as an entire group, into two groups, those that practice according to scope of practice, and those that live on the "extremist fringe".  The latter refers to those midwives who knowingly take risks for philosophical and religious reasons.  These midwives are the  most difficult to identify because their philosophies in practice take precedence over credentials.   

The philosophical boundary that defines the extremist fringe is blurry.  This news reel from Indiana exemplifies the group I'm referring to.  There are less extremist versions of this kind of midwife, those that still trust birth at all costs, religion or not.  For some, adhering to trusting birth is the religion.  These are the midwives I would define as being on the "extremist fringe" of midwifery.  This is not all midwives, it's not even the majority, but it is a prevalent concern.  Especially if you're shopping for an out-of-hospital midwife. 

Controversy surrounds the trend of home birth 

The article below talks about how those choosing, or encouraging risky births outside the hospital are "chipping away at choice from the other direction".   The author's audience is to the "radical birthers", from the perspective of someone who home birthed herself.

Dangerous home-birthers Spoil it for the rest of us

How do we identify midwives that function on the extremist fringe?  This is difficult.  The most obvious hint comes in the language they use (not in their credential):
  • "Trust birth" 
  • "Your body was made to do this"
  • "You can't grow a baby too big for your body to birth"
  • "...(insert high risk situation here)...is just a variation of normal"
  • Gestational Diabetes Screening, Ultrasounds,  (other important assessments) are not proven to be useful or safe

How do their practices differ from other midwives?  These practices differ greatly from other midwives.  Midwives who are practicing within a defined scope of practice are adequately assessing women for risk factors, treating them appropriately, and risking out.  They appreciate that not every pregnancy or clinical condition is appropriate for out-of-hospital birth.  They value the mother and baby's safety above anything else.  These midwives value natural childbirth, and the beauty of it, but will not sacrifice your safety if a clinical situation arises.  These midwives have the skills, knowledge, and training to monitor risk factors.  They recognize that sometimes women need help, and work to get them the help they need, whether the mother "chooses" it or not.  What is murky, is that some midwives believe they have these skills, or tell mothers that this is how they practice, when in fact they do not.  So what's a mother to do? 

We can start with gaining a better understanding of three components: 1) know the dynamics: that not all midwives are the same, or believe the same about birth and risk, 2) learn about different credentials for midwives, and 3) fully understand the laws in your state (in this case MI) surrounding midwifery, and how that impacts your care...particularly in the event of a bad outcome.  For this reason, I find it necessary to provide a resource that explains the various types of midwives, and their educational background.  Let's look more closely at the various types of midwives.  This can help move our thinking forward in understanding how to find a safe care giver.  (We are also working on a blog post that articulates and explains MI's current laws and their impact, in conjunction with scope of practice.  Will post soon!) 

Types of Midwives doc.

Why do a particular midwife's philosophical position and credentials matter?  The problem is that once a midwife steps outside a regulated situation, such as a hospital, there is little consistency in how midwives practice or adhere to any scope.  Practices are purely individual, making it difficult for mothers to depend upon credentials alone.  Understanding that midwives, within a widely varied profession, differ drastically in philosophical beliefs, and further, that those beliefs directly impact practice and safety, is vital.  Being a "certified midwife" doesn't mean a thing.  It's a term used to sound professional, but when we examine educational training and consider the impact of philosophical differences, we see that the term is meaningless.  

The "Types of Midwives" document presents an ideal, a black and white snapshot based upon credentials alone.  It does not take into account philosophy or beliefs about midwifery and birth.   Filtering those aspects is even more difficult.  It is very possible to hire a CNM or a CM (the most educated type of midwife), who delivers outside the hospital, but resides philosophically in that "extremist fringe".  It is also possible, albeit rare, to hire an out-of-hospital midwife, who functions within a well-defined scope of practice, and risks out appropriately. 

I think the key, from a mother's perspective, is seeking a care provider, and interviewing him/her from the standpoint of safety, credentials, and practices, rather than focusing so heavily on the experience itself.  It means seriously considering the fact that even a normal, low-risk pregnancy can be disastrous in a moment's time, and having access to medical assistance can mean the difference between life and death.  It means accepting that the "experience" matters, but the experience should always be trumped by safety.  If you find yourself interviewing a midwife who tells you birth is inherently safe, that you were made to do it, that you can't grow a baby too big, and that high risk is a variation of normal...well, keep looking, because "safety" is not the priority. 

Women need to understand that hiring a midwife can mean many things, and who you hire, will greatly impact your safety.  When we set out looking for more personal care, I did not fully understand the dynamic within midwifery today.  Nor did I understand the fundamental differences in practice among various midwives in our state and country.  This is vitally important information to grapple with, before considering any midwife for your care.