Friday, December 14, 2007

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Why can't women who have a cohesive and determined plan to "just give birth" be able to achieve that ?

What are all the women who truly, truly can't afford a $2000-$4000 midwife really supposed to do?

What are the women who really, truly cannot find a midwife supposed to do?

It is impossible to just go to the hospital and say "I am in heavy labor, please let me push this child out on your turf. Do not touch me. I will not lay on the little bed. I refuse the velcros, pins, inserts and cuffs. UNNNNNNNNNNNNNNNNNNNNNNGH Wahh wahh wahh cool its a girl!"

Why is it legal for giving birth in safety and dignity to be illegal?

What are these women suppossed to do?

What happens to the sweet, well intentioned Doulas when they try to wrestle the doctor sand nurses away from the laboring mom? Is that their job?

Such a battle. It sickens me. there are pregnant women right now, in their homes, at their jobs, who have absolutely no ides what in the hell they are gonna do, where they are gonna go, who is their enemy, who will hurt them, who will protect them, which way is up, and their family and friends and spouse and lover all think she is crazy for wanting a good birth and so all she has, if she is lucky, are web searches about "birth stories" and "birth photos" and "find a midwife" and thats about it.

Scared, angry, resentful, hopeless, they read and they read and they cry and they cry. And the baby grows bigger and the time grows shorter and the energy runs lower and the hope gets fainter and the giving up looks easier and the fire grows dimmer and the baby grows bigger and bigger and bigger.


mama k said...

I know it seems hopeless to me sometimes too, but there ARE good Drs and nurses out there. Sure they are not the majority, but they do exsist. I know because I found one... when I was 7 months pregnant. LOL
My Bradley teachers were the ones who recommended her when I realized that my current OB would not be supportive of my birth plan. (ie intermittant fetal monitoring and limited internal exams)
In the end I had a drug-free, (almost) intervention free hospital birth. I didn't even have an IV! My only regret is that I wasn't allowed to deliver in the tub as per hospital policy, but I did labor in it for awhile.
My point is that there is hope.
For the record, I live in very non-crunchy NJ. We don't even have any birthing centers.

Corin said...

ECHO ECHO ECHO from me! Goodness, you've read my mind today.

It's absolutely infuriating that midwifery is not the standard in this country.

And it's even more infuriating that it's not the standard because of the greedy bastards that run the entire health care system and the slimy politicians who are bought by them.

We need change, and we need it NOW.

Rixa said...

Yes, it is such an infuriating and terrifying place to be in. Birth should not have to be a battle but it is, all too often. I don't know what to say...other than list some very idealistic but impractical ideas:
- community midwives paid salaries by the city/village and available to all who want services, with no fear of litigation/harassment
- Midwife scholarships available to women who cannot afford the fees, maybe with the agreement that they'd in turn sponsor another woman when they have the means later on

Kneelingwoman said...

Hey Housefairy of my heart; It's YOUR midwife! The medical establishment isn't going to change; women should not have to beg and midwives shouldn't have to be afraid that either their clients' will turn on them for some small detail they didn't cover or for agreeing to something the client wanted....or didn't want, only to be accused, in the heated moment with a dead or damaged mother or baby; of ignorance " I really didn't know THAT could happen". And many midwives have been there. You know my work. You know that I believe in women and I believe in birth and I trust it; I think it's reliable as all get out but people are funny....sometimes, we think we know a client and then we find out they had some other motives operating. It's rough. But, there is hope. It's our conversation and the resurgence of community midwifery that I am trying, desperately, to make a reality. I don't NEED to be paid more than a family can comfortably afford. I'll barter. I'll just do it with the understanding that we live in a community together and we help each other as needed. I refuse to accept insurance because it's a cheat; I think women can learn to take care of themselves with their midwives as knowledgeable companions and skilled guides with good instincts if we can just learn to trust each other. I love you. Your Kneelingwoman

Kneelingwoman said...

Oh, and are you going with me to a postpartum visit tomorrow? I hope so. xxoo. KN.....

Jill said...

Sometimes I think you tap into the deepest, darkest part of my brain...the part that even I can't see...and dig up the feelings I didn't even know I had, and put them into words.

It's going to be a slow revolution, that's for sure. It would be grand if all women would suddenly WAKE UP and realize what's being done to them, and march over to the hospital to tear it down brick by brick (metaphorically of course, we still need hospitals for sick people!), but it's going to take much longer than that. Much, much longer. It took us, what, 100, 150 years to get ourselves into this mess? It might take that long to clean it up.

It doesn't help that our enemy is so huge and so damn good at brainwashing. Who's going to listen to the hippie girl in the tie-dye skirt when the big brave doc with the degree on the wall says something completely different? but, one by one, we can change people's minds. It took me a few years to get to the point I am at now...maybe a few years from now, another woman will have been helped to this same point because of me, or you, or anyone else in our little birth bubble.

I guess my rambly 1:30 a.m. point is, we can do it. it will just take a long time. But Gawd, won't it be worth it to TAKE BACK BIRTH!

Kneelingwoman said...

The reason Doctors do what they do is that they have no relationship ( my over used word again! ) with the women who come to them; they have to rely on "just the facts ma'am" because they have no other parameter by which to judge what is, or is not, happening in any given labor. And THIS is the reason why I am cautious about the idea that a midwife can be used "ala carte" ie. just a few prenatals here and there, or none, just come to my birth and do nothing but do SOMETHING if SOMETHING starts to go wrong and guess what, the midwife, in that situation, is going to grab her best "clinical" judgement and probably err on the side of over caution and over reaction because she has nothing relationship or knowledge as context. Example:a woman in labor says she has deep, sharp pain ( and this woman often says this kind of thing during menstruation; experiences a strange cramping but with two prenatals with the midwife and no opportunity for extended sharing; the midwife doesn't know that) but, the woman, in the midst of labor and of experiencing a sensation she doesn't immediatly recognize says only " I have a deep, sharp pain" So, is it an abruption? A ruptured appendix? Gas? Or is it that same funny "cramp" in a muscle or tendon she always gets at such times.....which way should the midwife order her thinking or how will she probably think? Right. I better assume abruption; something serious, because that could harm or kill this motherbaby and if I don't ACT....someone will blame me. Maybe not this woman but the prosecuting attorney in my town and my midwifery community....there are answers but they lie in conversation that gets to the root of the real issues and it isn't all greed or wickedness or people trying to control others in a vaccum. It's about fear. I have attended births where something went seriously wrong so fast and so bad that it makes your head spin. And there is no time for getting a history or asking a lot of questions. Once a new midwife has been in that situation; seen how quickly something can change from lovely and perfect to bad, bad, bad....and the mother and father look at you in abject horror and terror and it's ON're the one they are looking at to FIX it...NOW. And we bleed our hearts out trying and often, we succeed. Often, but not always. And you bet, there is fear...the human responsibility inherent in birth is stunning. And this is exactly what Dr.'s do. They have to take work in a very limited context and that is why I am so surprised to hear people want to shut down the midwife/client relationship and reduce it to something mechanical, "fixed" and limited because that, in a nutshell, is the medical model of birth! Dr.'s see a woman for 10 minutes at a prenatal, get some numbers, don't talk, make no time for questions or concerns or to get to know the woman holistically and then, true to that form, show up for the birth and behave mechanistically and as though one woman is the same as anyone hearing me? That's exactly what you're proposing to have when you don't want a relationship with a midwife....just a couple of prenatals and a back up plan. We can't create anything that's an improvement with that as the extent of the relationship.
The awe and respect we should be showing Mother Nature is, in my view, almost totally absent in these conversations centered on blaming someone or finding out why the system sucks the way it does.....we do need to find out and work hard to change it but we have to start from the facts. The facts go much deeper.

Birdie said...

No, the medical establishment is not going to change, not until midwives and doctors can come together and build partnerships somehow...

In my case, we chose homebirth after nearly 8 months of nurse-midwife care from a very caring practice. Pro natural childbirth etc.

Our homebirth experience ended in horror after being rushed to the local birth center...waiting 30+ minutes for the OB on call and having an emergency C-section, out baby girl died.

Perhaps she died as a result of the mistrust between nurses, docs and the medical establishment...who fucking knows.

I do not encourage homebirth any longer, how can I?

Its just best to find a good down to earth OB and nurse midwives that truely believe in birth as a natural process etc.

There is simply too much that can happen at "home" that cannot be picked up with the fetoscope, and yes the same can be said for being in a birth center or hospital, but either way there are risks right? Why take the most dangerous risk of not knowing that your baby is in distress, or your babies heart has stopped beating. Its not worth the risk, its just not.

Birdie said...

i meant to say the mistrust between the hospital nurses and the homebirth midwives & parents coming in with an emergency, like we did. Its appaling the experience we had upon arriving at the BC....

Andrea said...

Birdie, I'm so sorry about what happened to your baby, but you are correct, there are risks everywhere. There's a risk that overtired, busy hospital staff will give mothers or babies the wrong medication, which will lead to serious injury or death. There's a risk of contracting MRSA or some other godawful infection in a hospital. There a risk of babies being switched in the nursery at the hospital. There's no way to give birth without risk.

Kneelingwoman -- What you said about establishing a relationship being so important made a lot of sense to me, even outside the realm of birth. I have had numerous experiences where I felt like doctors and nurses didn't trust my instinct about something that was wrong, and yet, because they didn't know me, the didn't have their own instinct as to what was wrong, either.

Joy -- You're so right, it's baffling. Especially because homebirth is so much cheaper than hospital birth with all the bells and whistles. You'd think insurance companies and whatever other powers that be who pick up the bill for expensive hospital births would notice this. In fact, if I had gone to an OB, I think my bills for prenatal visits ALONE would be more than the entire package with my midwife, pre, homebirth, and post. I do feel very lucky that circumstances with my insurance and my state were on my side.

Angi said...

I really respect your comments kneelingwoman. We can all talk hypothetically about why can't we all just birth at home because its better. You've seen the reality of what all the sides are thinking and what can really happen, like you said so fast and so very tragically.

Birdie- my heart absolutely breaks for you and I don't think it helps to say, yeah you took a chance at a home birth, but you would have been taking chances at a hospital too. I totally feel for what you are saying. How can you encourage home birth anymore after such a heart break. That scenario is the very reason that my husband put his foot down about home birth and we had midwife in hospital births which all turned out well. I can't say they were absolutely perfect, but they went well.

I don't know what the answer is. I feel that we just need to keep up the conversation, inform each other and open our eyes to the real possible problems that could arise in the hospital or at home. Having an over-romanticized view or an overly black and white view like-oh, homebirths are beautiful and peaceful and spiritual and perfect, and hospital births are horrible, and mechanical and unfeeling, or whatever, and not letting ourselves really see the risks (and benefits) of either kind of birth could really come back and hurt us in the end. I can't even imagine what you've gone through Birdie. I am so sorry.

Kneelingwoman said...

birdie; my heart grieves for the loss of your baby. I have lost two of my own infants and I have a child with a serious disability so, I know that pain.....I want to respond to what looks like a little misunderstanding of my posts here--I am absolutly pro homebirth! I am a homebirth midwife and there is no question that the statistics comparing morbidity/mortality between home and hospital overwhelmingly favor homebirth. What I am concerned about is that there are so many young birthing women who have built upon the work done by the generations of midwives and home birth families before them that has allowed them not only to believe that birth is "normal" but that EVERYTHING in birth is normal and that one can easily and quickly determine a "normal" variation from a pending serious complication. Some things are so subtle and really require both experience and a broader range of "differential diagnosis" skills than one can learn quickly. Every midwife has had things happen where it's jut not clear....where a judgement call has to be made and we always have to err on the side of caution. If I can't absolutely rule it OUT; it stays on the table! There is also a belief operating that only nature can be trusted to do it "right". By that thinking, I shouldn't be wearing my glasses/contacts even though, if I were cavewoman midwife I'd be dead now because I wouldn't have seen that wild animal rushing at me! I want women and care providers to work towards a "golden mean" and that will mean compromise.

Housefairy said...

What was originally a post about a real friend of mine and what she is going through right now has turned into a great conversation--what I always wanted for this blog...

I have traveled such a winding path in my beliefs, as my own life experiences have of course shaped them, and as my own knowledge and personality have grown and changed, so have my views on all of this kind of stuff.

I no longer fear "offending" anyone, when I say that I think too many UC'ers are unrealistic, arrogant and reactionary. But I also cannot blame them, and truly do understand the basis for the whole thing. But when I spent my 2 years on Mothering.Com's UC boards, I was very disturbed by the attitudes and falsehoods, snappish bravado and dismissive coldness being passed around, so accusatory, so flagrantly disrespectful of Mother Nature, reality, and the women whose births didn't just "go perfectly". I knew so many of them were doing this because of the lack of other options for themselves, and that concerned me as well. I have no point, but the whole spirit of too many of the Mamas (for my comfort level) was defiant rebellion under the guise of being fiercely independant--when I feel in my heart that women need to bond together and support each other and learn together and not shun traditional relationships but encourage them, even if they have to start from scratch in the face of dissaproving family and friends...I dont know. I have more real life friends who have had sucessful UC's now than I do who have had midwife attended homebirths, but I still feel this way.

For me, at 32, on my fifth pregnancy, I have no interest in being alone. I no longer feel like being a tough guy is my only safe choice. I welcome being taken care of, accepting help, respecting the knowledge and wisdom of someone who has done this not 4 times but hundreds of times. A midwife. someone who studied and studied and "did" births for years and years and years-- since I was a little girl!

I still hate that it can be hard to find a midwife, and I dont like that. I still hate that it can be hard to afford a midwife, and I have been there with my last baby. I still hate that Unassisted Childbirth fuels "debates", and I wish that the state of maternity care in the past 100 years had not done this to us all. I have alot of respect for anyone who educates themselves about their lives, and I will always encourage that ideal. But I do not think that birthing alone, ESEPCIALLY when it is done out of a financial or reactionary decision due to "not wanting to go to the hospital" is best for families. This is just my opinion, and it is different than it was 2 1/2 years ago and that is how life has changed me.

I am so, so sorry for anyone who has ever lost a child, whether at home or in the hospital, at birth or in infancy. I cannot even imagine the pain, the what-ifs, the daily sadness. As mothers we are so programmed for guilt and burden bearing anyhow, so I really am amazed and heartened that any of you can go on as beautifully and bravely as you have. Even as I type this I feel like my words cant possibly mean anything to those of you who have lost a baby.

Angi said...

Joy, I totally agree that there should be every choice out there for our births. No woman should ever feel forced into anything they don't want for the birth of their child because of lack of funds or insurance. I also agree that we need to be bonding together and not judging and condemning each other. That is the main way to true change-I believe.

I can also tell that you are pro-homebirth Kneelingwoman, I was just impressed by the realism and experience that you injected into the conversation. You are obviously a great resource.
When you say that it is overwhelmingly shown that morbidity and mortality between home and hospital overwhelmingly favor homebirth, can you elaborate? I was under the impression (from my once again very medically minded husband) that these claims are based on one or two somewhat flawed studies and that the main data collecting agency for midwifery has refused to release their most recent data. DH also went on wikipedia and apparently a lot of claims were disputed and had to be taken off of the homebirth and UC entries because they were unfounded (or at least unsupported by evidence).

PLEASE do not be offended. I hear a lot of the other side from DH and I just really don't know what to think on it. I would like to know the truth on this.

Housefairy said...

angi, here is a big one that came out recently that alot of people, even homebirth safety skeptics are impressed by, being from the British Medical Journal.

Let me know if the link works.

I had a recent post asking for some data just like this and I got alot of good feedback. (This was the post, from October 25th, 2007)

Kelley said...

I AM in this situation right now, to go back to the original intent of the post. (Am I the friend you were talking about?) I have found a wonderful midwife whom I would LOVE to use, but I have no idea how I would pay her. I am now in the uncomfortable position of either waiting and seeing what turns up, or doing something I really don't want to do - go to the hospital which wouldn't cost me hardly anything at all.

I am extremely disturbed at the turf wars being raged by the "all-powerful" ACOG and other medical associations. These organizations are so determined to make sure that their business doesn't escape that they are making it almost impossible for women like me to have the choices WE want.

I'm not sure what to do here. I really don't want to go to the hospital, but is that turning into the only feasible option financially? Ugh!

Great post, Joy. I love the way you write. Love love love it.

Kelley said...

Makes me want to cry, actually.

Angi said...

That was a great resource, thank you! It seems to be a very large and well done study. I did notice it said the mortality rates of home birth were similar to low risk births in the hospital. I wasn't surprised to hear that medical interventions are far less (of course!), and that high risk births (including twins and breech) were not advised at home. Anyway, a lot of great information. I hope studies like this one help pave the way for more birth choice and a broader acceptance of attended homebirths. Thanks again!

Hannah said...

This all makes me sad. More importantly it makes me realise what I have taken for granted. In NZ, while we certainly do have our problems with the system, we have completely free maternity care, and midwives care for close to 80% of women and babies.

this link is to a post from a NZ midwife about the structure of our maternity system:

I know very little about your (US) system, but I understand in some states midwifery and home birth is illegal. There is no shortage of stupidity in this world.

One thing I am constantly saying here is that women need to take more responsibility. And women need to speak out more. To reclaim birth, they first need to realise that THEY OWN IT.

doctorjen said...

Sigh. It's hard to see so many women not have the choices they want for their births.
On my end, although I feel I provide great woman-centered care, I get so frustrated that it seems so few of my clients actually want that!
So here I am attending medicalized, epidural and pitocin births when there are so many people in cyberspace who'd prefer what I really like to do - attend normal non-intervened births.
Like kneelingwoman, I am a big believer in community. I practice in a small town where my clients are also my neighbors, my kids' classmates' parents, and my friends. I've been here only 6 1/2 years, but have several women I've attended 3 births for and my first 4th time client is now 14 weeks. I practice in a group practice, but the 2 of us that attend births practice solo for pregnancy care, so I do every prenatal, attend all of active labor, and don't leave until the baby nurses. My prenatals are never squeezed into 10 minutes, and by the time my clients birth I am likely to know a lot of social information about them, as they are about me. I have some clients that I can just tell at a glance where we are in labor, because I know how they look when things are real. I have one family still teasing me because I fell asleep during the second night of mom's long labor and drooled on myself - the mom still says that seeing me with my guard down made her more appreciative than any of the more "doctory" things I've done for them. I've had some docs tell me that I should learn to distance myself more, but that is not how I want to be with my clients and no matter how I try I find my life getting intertwined with my clients, who are also my community.
I absolutely cherish the more in depth relationships I have with my birthing families, and it is the reason I stay in my career.
But you know what? A lot of my clients don't seem to want that. They want a physician who makes decisions for them, they want a promise of a pain-free birth (never mind that we can't actually deliver on that promise, even with an epidural most of the time) and they don't want their birth to be an intense, spiritual event in the family, they just want the baby.
I live for my clients who come with a "list of demands" and who are wanting their pregnancies and births to be sacred. I could not agree more that the whole way maternity care is provided in the US in the medical system needs to be tossed out and totally revamped to follow a midwifery model. If that really happened, though, I'd probably give up being a family doc to be a midwife so I could still attend normal births!

Rixa said...

I'm really enjoying this discussion. Thanks Joy for your great blog! I wish we had more good midwives and more good doctors like those who have posted, so that women at home or in hospital could have the kind of care they are seeking.

Joy, I totally agree that it's crazy that birth choices still spur debates--why don't we redirect our energy into making changes for the better...of course, what can "normal" people like you and me do to actually make it better for pregnant women? It's sometimes discouraging to see how decades of natural childbirth activism in various forms have done so little to change mainstream hospital culture. I mean, if only 2% of women are receiving optimal care in hospitals, as defined by evidence-based medicine, then how on earth are we going to get changes to happen?

Anonymous said...

More midwives, that's what's needed. I read what Mama K says, there are good nurses out there, but I went to a hospital last time where I've had good nurses and got a very bad one. She only had me for 5 hours, but I felt brutalized by her. I didn't get a c-section with an OP baby probably because I had an OB on call who at least knew something. But, the OB was not who I saw, I was with nursie who wouldn't let me pee (and did that pee I had in me hold the baby up high, maybe). Ugh, I thought I could have a hands off birth as she checked me every 15-20 minutes...5 hours, that's a lot of internal exams for NOTHING!

So, the only answer I can think of is that more midwives who either help women birth at home or in centers so they are away from the hospital. Otherwise, it's about 50/50 you get a good nurse. I have only gotten my OB to be there once during a birth.

More birthing centers, there's only one in the Kansas City area. One. Midwives do deliver at home on the Kansas side legally, and yet I have no idea who to go to. Also, in the hospital, midwives are more like Medwives as far as I know and you still have to deal with hospital policy and the like. Birth shouldn't be a battle ground, period.


Housefairy said...

Dawn, I so agree. More midwives is where I am going to devote my life to. Otherwise I think Id die of frustration. So I am going to be a midwife.

It is the labor attendant who sets the tone for the birth, and those are almost always a nurse in hospital, and yep, if you get a good one or a bad one determines it all. Infantilized, and vulnerable in the little bed, we lay there and hope she is nice---rediculous. But so so true. "Let" me pee? I am never doing that again. I pee and eat and do what I need to do, and staying home is the only way I can be an adult and birthing is an adult job, hard hard work and for me, the babies simply dont come out when I have to worry about being a good little compliant corpse.

Thomasin said...

Ah, Joy, this is so true for me today. I don't know if you still get the comments for old blog posts, but I wanted to say that you've been an inspiration to me this past year and a half and while I know you're crazy busy now with all your little ones and homeschooling, I still check on this blog because I really like your take on things.

I'm prompted to write this because I had what I would consider an unneccessary c-section last Oct b/c my baby was breech and I couldn't afford to go to the 3 hour away center that would let me birth my baby vaginally. And now I'm trying to find either a midwife who will attend a primary VBAC (so far no one will b/c their insurance won't let them) or an OB who will let me labor and birth in a fashion that I think is best (able to move about, push standing/squatting, eat and drink if I want to, etc.). I had a bad interview with an OB today (told me that the Business of Being Born vilified MDs without cause and that she doesn't like working with patients who are fans of home birth or midwifery). I'm discouraged. But I'm going to keep looking. It's good to know there are voices like yours out here--I'm hoping that somewhere nearby there's been a birth attendant who's responded to the call!