I started my pregnancy like I imagine most women do - I asked a
few friends where they had their babies, chose one of the two hospitals in our
area and started going to prenatal visits.
Over the next few months, I started researching natural birth. After watching The Business of Being Born, I
was disgusted with hospital interventions and very soon had all of my family on
board the natural birth train. I read
books (a few by Ina May) and allowed myself to be convinced that hospitals
were bad. I started to panic about having my baby in one. I had to protect my innocent tiny person from
harm by staying away from evil OBs and just trusting my body to give
birth. I really wanted a homebirth, but
my husband was not okay with that. I
needed something in between...
While scouring the internet, I came across a freestanding
birth center in Okemos - Greenhouse Birth Center (GBC). It was a bit of a drive for
us, but it looked amazing - exactly what I wanted. I talked my husband into going to one of
their information nights and, although he was reluctant, I insisted on having
our son there. So, at somewhere around
30 weeks of pregnancy we left the hospital practice and started our prenatal
visits at GBC.
I fell in love with the birth center and the midwives right
away. They took the time to talk to us about
everything – even our feelings! We felt
so secure there, so calmed to be doing the best possible thing for our
baby. I felt empowered and actually
excited to go into labor since I had been completely persuaded that my body
would know exactly what to do, and because many times I was reassured that
there was almost no chance something would go wrong, because, as one handout we
received from the birth center put it, “birth is as safe as life gets.” Of course they told us how quickly we could be
transferred to the hospital if needed, but the possibility of transfer
(especially an emergency transfer) was brushed off as a very rare occurrence. We had such an absolute confidence in the
midwives and trusted them to recognize complications quickly. I found myself acting extremely defensive
toward anyone who thought going to a birth center might not be the best
idea. I only wish I had known then what
I know now.
 |
| 32 weeks pregnant |
My son was always a bit of a gymnast, spending most of his
last trimester transverse (sideways) in my belly. I was told not to worry, that he would turn
head-down when he was ready. At around
34 weeks (my best guess) I remember waking up and knowing immediately that my
son's head was UP, not down. By the time
I went to my next prenatal visit, the midwives told me he had moved back to transverse;
although I did make it known that his head had definitely been UP a few days
before. At my next couple visits, 2
different midwives spent a lot more time than usual feeling and listening to
baby, trying to decide if he had turned head-down. Both of them ultimately decided he had, and
even let me feel his head by pressing my fingers down a little on each side and
gently rocking me to move baby a bit. I
wasn’t entirely convinced - it seemed too small to be the head that had just
been in my ribs, but who was I to question it?
If they say he’s in the correct position, he must be in the correct
position! I was comforted again; my body
and my baby knew how to handle birth.
Fast forward several weeks, and my due date had passed. My mom came with me to my 41 week appointment
because she just had to ask why I was so huge (thanks a lot mom, ha ha) and
hear for herself that it was OK to be a week past my due date. The midwife I saw at that appointment confirmed
that my son’s head was down, estimated his weight at 8 pounds, and eased my fears by
saying “your body will not grow a baby that is too big for you to
deliver.” We believed her – why wouldn’t
we? She’s the professional that does
this all the time. She scheduled me for
a biophysical profile on the day I would be 42 weeks pregnant, although I swore
I could not let myself go that far.
I was given the OK to try a few things to jump-start my labor, including
castor oil and some labor cookies GBC gave me the recipe for. NOTHING happened.
 |
| 41 weeks pregnant |
I made it to 42 weeks.
I was so frustrated that I hadn’t gone into labor yet, and downright desperate
to meet my son. I was constantly
wondering “am I broken?” Worry had
started to creep in after everyone made comments about how unsafe it was to be
so overdue, and even complete strangers asked if I was having twins or triplets. I was to go to my ultrasound on July 20th,
then stop by the birth center afterward to go over the results. There was so much excitement heading into the
ultrasound, I was about to “see” my baby and make sure everything was
okay. It wasn't 10 seconds after the
tech began when she announced that my son was frank breech. She showed me his feet up by his face. I immediately burst into tears as I realized
my perfect birth plan had just gone out the window – the GBC said that they did not
handle breech deliveries. So it had not
been baby’s head the midwives were feeling down there, it was his butt! I went straight to the birth center in a
complete daze, where I was treated almost like a stranger. They said that they would call
Sparrow Hospital for me if I'd like. But since I live 20 minutes from
Kalamazoo, I had no desire to have my son in a hospital so far away from home
(you leave the birth center a few hours after birth – a hospital stay would be
days). They told me they had no contacts
at the Kalamazoo hospitals, so I should just call the one I would like to go to
and tell them I needed a cesarean section (like, right now). I felt so alone and scared, my fears about a
hospital birth were becoming a reality.
I called the hospital and told them my situation. As expected, everyone I talked to thought I
was completely crazy and kept transferring my call to someone else. To make matters worse, my cellphone service
wasn’t that great on the trip home from Lansing and I dropped the call several
times and had to keep calling back. This
was about as much stress as I have EVER been under. Finally, one nurse told me to just come in
ASAP. I ended up having the C-section
that same night. Although a few of the
hospital staff expressed some concern that they had no records from my
pregnancy, I had a fabulous female doctor (she’s a DO) deliver my son. The first words out of her mouth when she saw
my son were "Wow, I didn't know I was delivering a 3 month old!" She laughed a little, but she was actually not
kidding. My son weighed 11 pounds 6
ounces, and was just over 22 inches long.
His head measured in the 84th percentile. His legs were "frogged" and trying
to spring back up toward his face, making it obvious he hadn't recently turned
breech. Not that he had room to turn
anyway!
 |
| 3 days old . . . the newborn socks don't fit! |
My husband and I went through a period of thinking, "WHOA, if
labor had started it probably wouldn't have turned out very well at the birth
center." We were appalled by how
far off the midwives at GBC had been about the position and size of our
son. They had made it known that a breech
delivery at the birth center was not an option, but they failed to recognize they
were dealing with a breech baby?!
When I read the story in the Lansing State Journal about a
couple losing their son at GBC after attempting a breech delivery with a large
baby, I instantly felt sick. If I had
gone into labor prior to 42 weeks,
that’s exactly what the midwives would have been attempting again - just 3 months after that baby died - and WITHOUT even knowing it!
So this is the question: is it unreasonable for me to assume that a midwife should
be able to, AT THE VERY LEAST, accurately determine a baby’s position? Or determine that a baby is MUCH too large to
fit through the mother’s pelvis? And if
they aren’t absolutely confident, shouldn't they order an ultrasound? It seems to me that since midwives aren’t held
accountable if the outcome of a birth is disastrous, they have no incentive to
be 100% thorough.
Yes it is reasonable to assume that a midwife should be able to determine the position of the baby. But it's unreasonable for you to assume a midwife should be able to determine the size. Even OBs and their fancy machines can't do that accurately.
ReplyDeleteLauren,
ReplyDeleteDo you not think a midwife should be concerned at a baby's size when the mother has gained 90 pounds and they have suggested that Gestational Diabetes isn't necessary because of false negatives too? You're right, and ultrasound isn't perfect, but it does offer much more accurate information about the safety of a post date baby and in a breech position. Ignoring the resource in this circumstance, and trying to start labor with cookies is downright reckless. A breech baby should absolutely have an ultrasound to determine a size estimate, cord position, head attitude, type of breech, etc. well before labor begins. None of this was attempted or even suggested.
No reply Lauren???
ReplyDeleteHonestly the egos of some people! And those 'fancy machines' do a heck of a lot more than your intution and guessing!!!
You make the statement at the end of you birth story that midwives have "no incentive to be 100% thorough." Which could not be more incorrect. Midwives do what they do because they love children and women, and want desperately to spare women barbaric birth practices of a hospital system that tends to treat women and infants as cattle to be processed. You and a number of other people made choices to pursue a homebirth. That was your choice. When things didn't go the way you had pictured it, when things went wrong, you blamed the midwives. I personally agree, they should have had you in for an ultrasound as soon as it was suspected your boy was breech. I personally agree, they should have done some serious checking to make sure they weren't coming up on a serious problem. But just because this method did not work for you and you were scared, and seen by a bad apple, does not in any way shape or form indicate that ALL midwives are charlatans or snake-oil sales people, not does it make you an expert. There are 100s of thousands of unnecessary caesareans performed every year. During my 3rd, the doctor didn't even hesitate or ask my opinion, while I was under general, the doctor, a surgeon I had never met before but worked on the same floor as my doctor, removed my fallopian tubes, because I had placenta previa--she was convicted I would again. Does that mean all doctors are terrible, and rob patients of their rights to make their own choices? No, it means that was a very poor, unethical doctor. Does it make me an expert in malpractice? Certainly not. You have not taken into account the millions of children delivered into the hands of midwives from the time that humans first walked this Earth. It wasn't until the 1930s that women began going to the doctor and hospital to have babies. Seems to me, a system that is as old as human history ought to be trusted over a system that's only been in place 80 years. It's wonderful that the medical Industry can save the lives of mothers and infants that would have died 80 or a hundred years ago, but that isn't the majority of women. Slow down. Take a breath. Take a couple. Simply because the care you received at the hands of a so-called midwife was not the wonderful experience you expected, does not mean ALL midwives and midwife care is bad.
ReplyDeleteDearest Misty,
DeleteI would first reply by saying that you need to read more from our blog and perhaps visit the new website at www.safermidwiferymi.org so that you can understand why we exist and what for what we stand. This group, these stories are all families who had an adverse experience with midwives in MI. We do not condemn ALL midwives as you would imply. We do however believe that practices can be improved and accountability put into place. Midwifery, no matter how ancient is not as safe as it as sold to be, nor is it as safe as it could be. It's a blanket term that covers a vast array of individuals, some educated, some not, some safe, some not. For this reason the term "midwife" can mean a million things and is unclear to the consumer which absolutely influences safety in negative ways.
We, as an advocacy group, understand that there are many, many wonderful midwives in MI and across the country. It doesn't overlook those who do not practice safely though, and a call to action is necessary. I am terribly sorry for your hospital experience, and no not all doctors are perfect. There are however systems of accountability in place by way of review boards, licensing, certification boards, insurance, etc. In MI, for OOH birth, there is none of this for many midwives. Literally anyone in our state can call herself and practice as a midwife, regardless of qualification, education, licensing, etc. The point the mother was making above in sharing her story was that there is no accountability as a profession calling themselves collectively "midwives".
Yes she, and all the other loss/injury families that are part of our group, did make a choice to choose OOH birth. We do so however with a great deal of misinformation, dare I say programmed with hogwash such as, "want desperately to spare women barbaric birth practices of a hospital system that tends to treat women and infants as cattle to be processed." I once found myself saying the same thing and now my son is dead because he didn't have a hospital emergency room when he needed one during OOH birth.
The conversations here are about midwifery, carefully examining them and trying to have honesty come forth that perpetuates change in the direction of safety. It is not about hospitals or unnecessary cesareans. That all may be true, but it is not the focus of our mission, nor is the comparison a defense. Crappy hospitals do not justify the unnecessary deaths and injuries happening across the country that are completely preventable with improved standards for practice, and education in the field of midwifery.
I do hope you'll continue to read more.
In the interest of being fully honest here, I am a student of Midwifery, seeking the Bachelor of Science, Midwifery, four year degree. I am a resident of Michigan, and a mother of 5 daughters, all of whom are of childbearing age. I absolutely have a vested interest in this discussion--both as a one-day professional, and as a mother and grandmother.
DeleteI believe it is possible to have the best of both worlds: out of hospital birth, with reasonable use of modern medical technology, where the midwife acts as part of the community medical team. It is my belief that integrating midwifery care into the medical community provides safety as women would then be able to move seamlessly from one to another. In the case I commented on here, wouldn't it have been best for all parties if the midwives, who were clearly uncertain, could have sent the woman to radiology to have an ultrasound so that the infant's position could have been rightly assessed? With the exclusion of midwives as part of the medical community, a midwife simply does not have the medical access to send a client for an ultrasound that would then be evaluated by a radiologist. Women should not have to trade safety for the freedom to birth outside a hospital.
I hardly think "Hogwash" is an appropriate description of the statement that the practice of hospital birthing is barbaric. When I assert this, I refer to the high incidences of unnecessary caesarian sections, the routine epitomizes, the routine, forced use of Pitocin, and effectively tying women to beds to attempt to monitor and control labor. It has been clinically proven that fetal distress is frequently caused by Pitocin--and thus caesarian delivery for the baby's safety becomes necessary. Also that the use of epidurals slows labor--another cause of caesarians, that the labor was not "progressing."
As it happens, I do believe it is absolutely essential for people who wish to identify themselves and practice as midwives to be educated, tested for proficiency, meet ongoing professional development requirements, and be licensed by the state. I do NOT agree that all such licensed midwives must be Nurse midwives. While having training as a registered nurse before pursuing specific midwife training is one route to becoming a competent midwife, it is not the ONLY good route to becoming a competent midwife. My personal belief is that if the state of Michigan would follow suit with the 27 other states that license practitioners who have completed the requirements of the North American Registry of Midwives, families in Michigan would have a sound basis for knowing that midwives are educated, tested and competent to provide an excellent standard of care. An individual wishing to pass the standards of the NARM spends 2-6 years studying and practicing in clinic under the guidance of qualified instructors, mentors, and field preceptors.
I mention all this because on your blog here, you have indicated support for SB 1208, which would limit all midwife licensure in Michigan to only those individuals who are Nurses first, and midwives second. I assert that it would be worthwhile to consider that having a nursing education, which is quite broad and general, should not be seen as the exclusive path for serving a community as a midwife. It would be safer and wiser for families, for midwives, and communities for the state to qualify, test and regulate midwifery care, to include Direct Entry Midwives. Bring the practice into the open, acknowledge and license qualified midwives and promote safety for all. I would suggest SB 292/HB5070 for your consideration.
It may interest you to know, that the American College of Nurse Midwives and other Nurse Midwife associations and accrediting boards are working in conjunction with NARM, National Association of Certified Professional Midwives and other DEM associations and accrediting boards to promote licensure and standardization of midwife education and care.
Greetings Misty. You make many good points, and this is good conversation. Let me say first I appreciate your critical thinking on this matter. I can tell you care deeply about improving care for our state and that's vitally important. Your vision for midwives working as part of a community system, having access to labs, etc is wonderful and I couldn't agree with you more that is what is needed. OOH birth seems so disconnected and I firmly believe that collaborative care would be a tremendous move toward safety and options.
DeleteI disagree on the point that the hospital is "barbaric". I've had hospital births too. I was never "tied to a bed" or forced into induction or Pitocin. Hosptials today do not do routine episiotomies. This is where the language perpetuated by many OOH midwives and NCB advocates begins to do harm. There is a certain amount of fear instilled in a woman when she hears these comments, that I personally have not found to be true. I can't say whether or not the use of Pitocin is good or bad, but the hospital is not the evil place some make it out to be. This is exactly the language our midwives told us. I was so scared of the hospital that transfer seemed like the worst thing, and a cesarean even more unimaginable. But you know what? Cesarean was not the worst thing, nor was the hospital barbaric. Not bringing your baby home in the end is the WORST thing. If that means I might have to have life saving interventions, so be it. I don't think those that tout this "trust birth" language, or breed anti-hospital sentiments are clear with mothers what they are choosing. Trusting birth, eating right, going to the chiropractor...all great, sure, but what trusting birth really means is that sometimes babies really do die from childbirth and that you're okay with the outcome either way despite the very real increased risk of infant mortality outside hospital walls. No matter your fears about the hospital, it's always going to be the safer route. Will it be always as convenient, have candles, and invite orgasms? No. Could hospitals improve on supporting natural birth? Yes, absolutely. But they are not barbaric, and using fear to persuade women to choose experience over safety is wildly inappropriate.
To that end, I just met a mother from MI who described the most painful, awful labor and delivery of her son. She was in labor for 25 hours, her cervix wasn't dilated after 16 hours past when her water broke. Did they transfer?? No. The midwife manually dilated her cervix, held it open for nearly and hour during contractions and too the very real risk of that baby getting stuck. I've never heard a more compelling description of "birth rape" and it didn't happen in a hospital. It was barbaric, and it certainly was not the image that NCB folks like to sell of home birth. It wasn't peaceful, it wasn't beautiful. It was horrifying. Those are the stories I hear from real mothers every day, happening with midwives across this state. Fortunately for this mother, her baby lived, and so did she, but she has to deal with the trauma for a lifetime.
DeleteAs for education of midwives. I agree that a nursing degree isn't the only way. I firmly stand by the notion that the minimum bar for education should be an AMCB certified midwife, in line with International standards. Nothing less. NARM is not favorable. You'll have to read more about them on the blog and my experiences with their system of "accountability". Check out the posts about Education of Midwives Around the World, or the one by Judith Rooks, CNM. NARM is not sufficient as a bottom line, nor do I believe them to be ethical. Their proposals for licensing are atrocious, and do nothing to improve safety. They don't define risking out criteria, or transfer of care protocols. They don't require enough education or training. They don't establish a balanced board or require insurance. These bills are dangerous. They protect the midwives, they allow them to collect insurance, but they do nothing to protect families, improve practice, or improve the culture of OOH as a reliable option for women.
I know how limited schools are for CMs. I know how we have a shortage of maternity care options statewide, but I do NOT support mediocrity as the solution. I think we all should demand better care and safer options. Lowering the bar and including anyone who wants to be called a midwife? No way. The word midwife must mean something clear and something based on well thought out standards.
I am very familiar with HB 5070 and SB 292. I've met with Mr. McBroom, made calls, and sent letters to their contrary. SB 1208 was a wash. It wasn't done well enough. It limited the scope and practice of all CNMs in the state and that wasn't right, nor was that the intention. We need a bill that addresses the safety issues in OOH birth. I've yet to seen one that really gets at the heart of the problem. A 2 year nursing degree isn't it, I agree. I commend Senator Whitmer for hearing my story and taking a stand, but I think it was a starting point, not the perfect bill.