After a fitful night of pesky dreams - the kind that mirror things going on in your life but are just a tad bizarre, as dreams are - I woke up with some insight. Funny.
It starts with the home-birth *transfer*.
It's safe to say none of us who are advocates - obsessive junkies, really - for home birth like it when a client has to transfer. Oh, of course we all give a lot of authentic lip service to being grateful we have the option when necessary and all that. But we really don't like it.
First, if a client must transfer from the pleasant tranquility of a home birth to the tubes-and-monitors-and-needles environment of a hospital to have a baby, then it's likely something's wrong. Maybe not always *wrong* - we use kinder words like "variation" - but it could be mom or baby is struggling in some way. (In fact, in my classes, I tell clients, "If you have to transfer from home-birth midwifery care to a hospital, it's because there's something at the hospital you *need*.")
Second, it's not always clear *what*, exactly, is wrong or what the client will need. And that is a bit unsettling. Most times the midwives will have their own suggestions: "Let's see if we can get you an epidural to relax your pelvis and get this (posterior) baby to turn so you can push him out." Other times they're not sure themselves exactly what will help, as it's not always clear if there's a true physical problem or if mom's just too exhausted or discouraged to go on. (The latter doesn't happen a whole lot at home, by the way.)
Third, we're not sure how things will go once we get to the hospital. It depends on the doctor who's there, the nurses, hospital protocol, how the staff views home-birth midwifery, the client and her desires, our own preparation and reactions and, of course, how the baby's doing. I've been to three transfers as a doula or birth assistant. Two of three were great. One, it was clear the doctor thought we were back-woods practitioners - and she treated the midwife as such.
Fourth, there's this more intangible overall *feeling* we all have in various ways on various levels. It has to do with *failure*. For the mom, often she's struggling, feeling like she "failed" the natural childbirth experience test and let not only herself but also everyone else down. After my own home-birth transfer in 2003 that resulted in a cesarean for a surprise breech baby (and other factors), I told my childbirth educator and doula, "I'm so sorry I messed up your statistics." While she was, of course, quick to assure me I was worrying needlessly about that, it was a very real feeling for me. I know other moms who transfer feel the same way. And so do the birth team members, I'm sure of it. We all ask, in various ways, "Why didn't it work?" Or "Was there something I didn't see, something I could have done better?"
See home birth - natural birth - is serious business. For many of us, it becomes our *cause* or our *passion* and we're so convinced that almost all women - given the chance - can do it. When it doesn't work, it feels like we're eating our words. I had a lot of words to eat after my cesarean. Like any medicine, they were bitter but provided some necessary healing for later. (Oh, and my VBAC at home three years later erased a lot of those feelings of failure.)
ANYWAY, whew. Where I'm going is that, this morning, it struck me that many things in life are like the home-birth transfer. We do our homework, do our research, do our meticulous preparation. We're active, vocal and confident about what we're doing - not shamelessly careless. (You should see how professional and awesome my midwife friends are who do this.) We get to the big event - the birth, but for you maybe it's a new job, a lifestyle, school, a relationship, whatever - and then things aren't going quite right. If you're like me and have done what I teach in childbirth classes, you've done what you can to first *prevent* problems. And when you *detect* them, you aim to *treat* them, using the least-invasive and most natural techniques first.
But.
Then you find things just are not improving. Maybe it's the - metaphorical, here - mom. Maybe it's the baby. Maybe it's neither. Either way, it's not getting better, and it's time to transfer. Apparently, you need something somewhere else that you just don't have at home.
My husband and I are in that position right now. We've forged ahead for a few years with a definite ideal. And it is - ideal. But here we are, things not going so great. Our course corrections - least invasive and some more drastic - haven't worked well. Maybe it's the mom. (Um, in this case, that'd be me, and it probably is.) It's time for the transfer.
And just like at a birth, I don't like it. I may understand it's necessary, but I still don't like it. And I think, when we get there, it likely will be clear what was wrong and how to fix it. But those measures probably won't be so fun either.
I was at a transfer once where mom did *everything* she could, holding off a cesarean until she had labored herself completely out and pushed for three hours with nothing but some caput (essentially baby's scalp) even *peeking* out under the pubic bone. She had her cesarean and discovered a most bizarre anomaly in the baby's presentation. It was "Aha!" for all of us. We were exhausted and emotional. (She was just happy to see her beautiful baby.) This mom is so inspiring because she - still very vocal - has not given up on the idea that home birth, natural birth, works. But for her, transfer was necessary.
I don't like the transfer - uh, I think I've said that - but sometimes it's necessary, and you're not sure why until much later. I'm hopeful that's my case, and I still won't say ideals aren't worth pursuing.
Tuesday, November 10, 2009
Sunday, September 20, 2009
Benefits of Natural Childbirth
Especially cynical today.
Recently, I offered a near hour-long talk about the benefits and how-to of natural childbirth.
I know - and I said so - that some people would rather never use those two words in the same sentence. Natural childbirth. Sounds horrible, doesn't it? For most U.S. women, it does, but that's because women have been sold a deceptive-at-the-least bill of goods. In this country, with all its alleged "improvements" over time, women have been told their bodies are inherently broken. They don't work right; they're gross. And women believe it.
We've been trained, socially, to believe childbirth is some kind of cosmic curse put on women, one of which we should be both afraid enough to hand it off to the "experts" and with which we should be disgusted enough to do all we can to get out of it. Handing birth off often means giving it to a doctor who's never had nor will ever have a baby (if he's a man, right?) or into the hands of the overbearing medical system, which has neatly categorized and packaged how birth should go for us and runs us through the rigors to adhere to its protocol. Getting out of it has meant allowing drugs to be pumped into our backs at alarming rates (some 80 percent at one of our local hospitals) so we don't have to feel anything. It's also meant a shift to seeing major abdominal surgery - the cutting open of seven layers of our abdomens and the extraction of the often-not-ready baby - as simply another "option" in birthing. Sick.
So I spoke on this topic - natural childbirth - knowing there really are only a few interested in it at all. And I spoke to a largely empty room. There was a straggler or two from the health fair going on outside the room, a gracious health fair worker and the videographer. One woman who wanted to be there - but left early with an active toddler - told me she'd had a c-section the first time and "they" were already talking c-section again. "Yeah," she said, "this baby will probably be big, too." Her first baby was something like 9 pounds. I flashed in my head to the 10-pound baby girl I recently watched come into a 98-degree birthing tub on the dining room floor of an Amish home. Perhaps it was just my mood, but I didn't even want to open any more conversation with that young woman, poor thing. Where do you start?
Having read the Scriptures often enough, I know the principle, "In the end, people will call evil good and good, evil." That's what's happening. If you believe childbirth is not inherently dangerous and want to experience the awesome, powerful and thrilling experience of natural childbirth - and, say, do that at home without any needles, tubes or beeping medical monitors - you're considered crazy, even neglectful. Yet, in many cases, you can ask your doctor to cut your baby out of you for no reason other than you want the baby born on a certain date and need to tell Grandma when to buy her plane tickets, and that's considered OK. The whole thing is beyond me.
Sigh.
So, to add insult to injury, my family and I stopped for a cold treat on the way home. It's one of those family-owned corner ice cream shops with everything in Spanish. (Great ice cream, good prices, by the way.) I was perusing the bulletin board (but can't read a lick of Spanish) and saw an ad for the complete prenatal and birth "package" at one of our local hospitals. (They had a sign in English, one in Spanish.) The whole package is $3,890 (still almost twice as much as a fee for homebirth midwifery services, by the way) and includes prenatal care, a spontaneous, uncomplicated vaginal delivery and two post-partum visits. Sounds good, right? Then, in finer print, is the list of what it does not cover. First, no classes - no endorsement that prenatal preparation is necessary. Second, not the epidural anesthesiologist. Ahhh. I get it. We are going to quote you a price for bare-bones maternity care that does *not* include pain medication, then *not* teach you about natural childbirth so you can actually *do* it that way, but then we'll offer you an epidural a few minutes after you arrive (if we haven't already induced you, which also is not covered in our quoted fee) and then send you a big bill for the epidural anesthesiologist and all its related add-on services. It just floors me.
I am *so* ready for my phone to ring about 2 a.m. To pull out of my driveway, flashlight in hand, while my mind starts thinking about set up, about the precious family I'm about to see, about the midwife and what I can do for her. With the clear skies looking down on us, I'm so ready to walk up a walk, let myself in and listen for just a second. I'll hear a moan - maybe a low, quiet one, maybe a shout. I'll kneel next to the sweet young thing. It won't be long and she'll start grunting. Then we'll see it - the baby's head - maybe by flashlight, maybe by gas lantern. Mom might say, "I can't!' and we'll tell her she's almost done. Then the baby will come, in a holy "whoosh" up to her belly. She'll lay her head back and grin. The dad and midwife will cry. The baby will offer a sneeze or two and grow pink in the arms of its mother. (That's natural childbirth, and that's all covered in the fee.)
Recently, I offered a near hour-long talk about the benefits and how-to of natural childbirth.
I know - and I said so - that some people would rather never use those two words in the same sentence. Natural childbirth. Sounds horrible, doesn't it? For most U.S. women, it does, but that's because women have been sold a deceptive-at-the-least bill of goods. In this country, with all its alleged "improvements" over time, women have been told their bodies are inherently broken. They don't work right; they're gross. And women believe it.
We've been trained, socially, to believe childbirth is some kind of cosmic curse put on women, one of which we should be both afraid enough to hand it off to the "experts" and with which we should be disgusted enough to do all we can to get out of it. Handing birth off often means giving it to a doctor who's never had nor will ever have a baby (if he's a man, right?) or into the hands of the overbearing medical system, which has neatly categorized and packaged how birth should go for us and runs us through the rigors to adhere to its protocol. Getting out of it has meant allowing drugs to be pumped into our backs at alarming rates (some 80 percent at one of our local hospitals) so we don't have to feel anything. It's also meant a shift to seeing major abdominal surgery - the cutting open of seven layers of our abdomens and the extraction of the often-not-ready baby - as simply another "option" in birthing. Sick.
So I spoke on this topic - natural childbirth - knowing there really are only a few interested in it at all. And I spoke to a largely empty room. There was a straggler or two from the health fair going on outside the room, a gracious health fair worker and the videographer. One woman who wanted to be there - but left early with an active toddler - told me she'd had a c-section the first time and "they" were already talking c-section again. "Yeah," she said, "this baby will probably be big, too." Her first baby was something like 9 pounds. I flashed in my head to the 10-pound baby girl I recently watched come into a 98-degree birthing tub on the dining room floor of an Amish home. Perhaps it was just my mood, but I didn't even want to open any more conversation with that young woman, poor thing. Where do you start?
Having read the Scriptures often enough, I know the principle, "In the end, people will call evil good and good, evil." That's what's happening. If you believe childbirth is not inherently dangerous and want to experience the awesome, powerful and thrilling experience of natural childbirth - and, say, do that at home without any needles, tubes or beeping medical monitors - you're considered crazy, even neglectful. Yet, in many cases, you can ask your doctor to cut your baby out of you for no reason other than you want the baby born on a certain date and need to tell Grandma when to buy her plane tickets, and that's considered OK. The whole thing is beyond me.
Sigh.
So, to add insult to injury, my family and I stopped for a cold treat on the way home. It's one of those family-owned corner ice cream shops with everything in Spanish. (Great ice cream, good prices, by the way.) I was perusing the bulletin board (but can't read a lick of Spanish) and saw an ad for the complete prenatal and birth "package" at one of our local hospitals. (They had a sign in English, one in Spanish.) The whole package is $3,890 (still almost twice as much as a fee for homebirth midwifery services, by the way) and includes prenatal care, a spontaneous, uncomplicated vaginal delivery and two post-partum visits. Sounds good, right? Then, in finer print, is the list of what it does not cover. First, no classes - no endorsement that prenatal preparation is necessary. Second, not the epidural anesthesiologist. Ahhh. I get it. We are going to quote you a price for bare-bones maternity care that does *not* include pain medication, then *not* teach you about natural childbirth so you can actually *do* it that way, but then we'll offer you an epidural a few minutes after you arrive (if we haven't already induced you, which also is not covered in our quoted fee) and then send you a big bill for the epidural anesthesiologist and all its related add-on services. It just floors me.
I am *so* ready for my phone to ring about 2 a.m. To pull out of my driveway, flashlight in hand, while my mind starts thinking about set up, about the precious family I'm about to see, about the midwife and what I can do for her. With the clear skies looking down on us, I'm so ready to walk up a walk, let myself in and listen for just a second. I'll hear a moan - maybe a low, quiet one, maybe a shout. I'll kneel next to the sweet young thing. It won't be long and she'll start grunting. Then we'll see it - the baby's head - maybe by flashlight, maybe by gas lantern. Mom might say, "I can't!' and we'll tell her she's almost done. Then the baby will come, in a holy "whoosh" up to her belly. She'll lay her head back and grin. The dad and midwife will cry. The baby will offer a sneeze or two and grow pink in the arms of its mother. (That's natural childbirth, and that's all covered in the fee.)
Thursday, September 3, 2009
So I've been kicking around the idea of nursing school. See, in Indiana, to be *legal* to practice, a midwife must first be an RN. It's been that way a long time - despite the fact that active and passionate midwives and their supporters have been telling Indiana legislators for years that non-nurse (or "lay") midwives do just as well. As far as I can tell, there's no proof that being a nurse makes one a better midwife. None.
Sigh.
Yet the world rests in the alleged security of certifications, licenses and letters. Right, letters. You know, like RN, BSN, CNM, ABCDEFG, whatever. So then someone like me, with dreams of inserting fingers to see what a "stretchy" cervix truly feels like for myself, has to face this issue: One, *if* I could find a midwife willing to train me knowing I wouldn't then later be *legal* to practice, would I then be willing to take the risk of practicing in a system hostile to me? (Oh, the stories I've heard of midwives having to practice clandestinely with little or no free access to medications, referral providers or supplies. I feel for them and greatly admire them at the same time.) I think I *would* be willing to take the risk - doing so in faith - but then I'm back to having no real access to full-fledged training and apprenticeship because my CNM friends could be compromised just by hanging out with me, let alone offering me any kind of training.
Argh.
So then one of my midwife friends convinces me that having a nursing degree and license is like a ticket into a wide world of possibilities - midwifery included, obviously. There's the likelihood I'd always have *some* kind of job if I wanted it. There's hospital work, clinic work, home-health work. There's hospice care, which I found myself drawn to as I held my hand over my precious grandma's heart and felt it stop beating last winter. (That's another interesting topic, as a few times a month I - conversely - pinch between my fingers a freshly aired umbilical cord to feel *brand-new* heart beats.)
I spend a few months thinking about it. Nursing. Nursing! What? It's so bizarre, as I studied *journalism* in college, signing up with hungry anticipation for every writing and literature course I could manage. I literally asked my guidance counselor what the minimum requirements were for math and science. "Sign me up for those and let's get them out of the way." I graduated college with something like an A- average. Math and science definitely were the "minus."
And now I've done it. I've gotten the application - with intentions of filling it out - for an 18-month accelerated BSN program. ("Accelerated" means cramming a lot of work into a short time - just my style.) My request for college transcripts is almost in the mail - just need a stamp - and I'm thinking about things like anatomy and physiology and microbiology.
It's a big deal to think about school. I have three small children and homeschool them. I have less than no money to invest in education. For the most part, I hate the hospital and cringe at the thought of what I've heard called "clinicals," where I know I'm likely to curse the whole U.S. health-care system. But ...
Just think. I *could* be a CNM - legal and all - by age 45. I *could* learn the rudiments of basic care to help my children and aging parents. I *could* really feel a stretchy cervix. Ooooh, now that's exciting.
Sigh.
Yet the world rests in the alleged security of certifications, licenses and letters. Right, letters. You know, like RN, BSN, CNM, ABCDEFG, whatever. So then someone like me, with dreams of inserting fingers to see what a "stretchy" cervix truly feels like for myself, has to face this issue: One, *if* I could find a midwife willing to train me knowing I wouldn't then later be *legal* to practice, would I then be willing to take the risk of practicing in a system hostile to me? (Oh, the stories I've heard of midwives having to practice clandestinely with little or no free access to medications, referral providers or supplies. I feel for them and greatly admire them at the same time.) I think I *would* be willing to take the risk - doing so in faith - but then I'm back to having no real access to full-fledged training and apprenticeship because my CNM friends could be compromised just by hanging out with me, let alone offering me any kind of training.
Argh.
So then one of my midwife friends convinces me that having a nursing degree and license is like a ticket into a wide world of possibilities - midwifery included, obviously. There's the likelihood I'd always have *some* kind of job if I wanted it. There's hospital work, clinic work, home-health work. There's hospice care, which I found myself drawn to as I held my hand over my precious grandma's heart and felt it stop beating last winter. (That's another interesting topic, as a few times a month I - conversely - pinch between my fingers a freshly aired umbilical cord to feel *brand-new* heart beats.)
I spend a few months thinking about it. Nursing. Nursing! What? It's so bizarre, as I studied *journalism* in college, signing up with hungry anticipation for every writing and literature course I could manage. I literally asked my guidance counselor what the minimum requirements were for math and science. "Sign me up for those and let's get them out of the way." I graduated college with something like an A- average. Math and science definitely were the "minus."
And now I've done it. I've gotten the application - with intentions of filling it out - for an 18-month accelerated BSN program. ("Accelerated" means cramming a lot of work into a short time - just my style.) My request for college transcripts is almost in the mail - just need a stamp - and I'm thinking about things like anatomy and physiology and microbiology.
It's a big deal to think about school. I have three small children and homeschool them. I have less than no money to invest in education. For the most part, I hate the hospital and cringe at the thought of what I've heard called "clinicals," where I know I'm likely to curse the whole U.S. health-care system. But ...
Just think. I *could* be a CNM - legal and all - by age 45. I *could* learn the rudiments of basic care to help my children and aging parents. I *could* really feel a stretchy cervix. Ooooh, now that's exciting.
Thursday, August 27, 2009
This is NEW to me
OK, so I'm a college-degreed journalist. I've written my entire life - one way or the other - and find much satisfaction is feeling words flow. But the whole "blog" is new to me. I can relate to essays, to printed stories of all kinds, to the concept of a book, even. But until recently, I didn't even really know what a "blog" was - and I'm not sure I yet do. (We'll find out, eh?)
I'll write here largely about my work in childbirth. Sure, that'll be interesting to some people. It's thrilling for me. You see, there's something so sacred, so primitive, so utterly *raw* about childbirth that it's hard to not be excited about it. It's like looking out at the ocean - it's amazingly powerful and fearsome yet soothing and gentle, if only because it's so, well, *natural*. And it's natural childbirth about which I teach and in which I often participate. Finding a way *out* of that natural experience seems odd to me - though I get it why women do so.
So, guarding all privacy laws as best as I'm able to, I'll tell you about what I learn. Because I do. Learn. Every. Birth. Something. New. Something great. Something either profoundly deep or amazingly simple. Birthing is like that. It's so dang complicated but wildly simple.
The last couple of births I've been to I've seen this: young mothers who have transformed in little more than a year from being newlyweds giddy with playing house to being seasoned young *parents*. For the first times in my short birth-work career, I've gotten to attend the *second* births of girls not even yet age 25. I watched them become mothers the first time - with all its pain and stretching and breathing and moaning. (One of the sweet little things took to whimpering. She was so tiny.) So this second time around, whoa, they looked, well, *older*, yes, but wiser, too. (That's way too many commas in one sentence.) They just looked like mothers. Mothers. Mothers.
I'll write here largely about my work in childbirth. Sure, that'll be interesting to some people. It's thrilling for me. You see, there's something so sacred, so primitive, so utterly *raw* about childbirth that it's hard to not be excited about it. It's like looking out at the ocean - it's amazingly powerful and fearsome yet soothing and gentle, if only because it's so, well, *natural*. And it's natural childbirth about which I teach and in which I often participate. Finding a way *out* of that natural experience seems odd to me - though I get it why women do so.
So, guarding all privacy laws as best as I'm able to, I'll tell you about what I learn. Because I do. Learn. Every. Birth. Something. New. Something great. Something either profoundly deep or amazingly simple. Birthing is like that. It's so dang complicated but wildly simple.
The last couple of births I've been to I've seen this: young mothers who have transformed in little more than a year from being newlyweds giddy with playing house to being seasoned young *parents*. For the first times in my short birth-work career, I've gotten to attend the *second* births of girls not even yet age 25. I watched them become mothers the first time - with all its pain and stretching and breathing and moaning. (One of the sweet little things took to whimpering. She was so tiny.) So this second time around, whoa, they looked, well, *older*, yes, but wiser, too. (That's way too many commas in one sentence.) They just looked like mothers. Mothers. Mothers.
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