Thursday, March 25, 2010

So, I think this is worthy of a second post today...

I opened my email and got this message from a fed-up friend:

So, apparently, I am now a pariah among my "friends" here (she lives several hundred miles from me now) because I decided to give birth in a hospital with a doctor.

This really annoys me because they know what happend with F's (name abbreviated to protect identity) birth and how the lack of intervention by _______(midwife's name left out) caused the shoulder distocia (sic). One mom told me to forgive and forget. Well, I've forgiven even though my son was put at great risk, but I don't feel comfortable forgetting and I told her so.

See, here's the deal, we are all so quick to criticize doctors and the "sterile hospital setting" and too many interventions, but why don't I hear women coming out like I am about midwives so set on their own version of childbirth they put you and your child at risk. That sometimes the lack of intervention causes serious injury or death!

She went on to apologize for ranting but needed to get it out.

I don't know why more women aren't coming out with stories. Any number of possibilities exist among which are a) they don't want to relive a horrific incident publicly b) there is a low incidence of negative experiences with a midwife assisted birth and c) they may have signed some kind of legal document barring them from doing so. It really does not matter because the point my friend is making is a valid one, there have to be some cases of misconduct so why are they not being aired as publicly as complaints against doctors performing "too many" Cesarean sections or inductions.

I will summarize what happened to my friend (which she has given me permission to do) who we'll call Cate. Cate is in her late 20's and is expecting her second baby. Her first son, who we'll call Fred, is now 2 1/2 years old. Cate was excited to become a mom and had a very specific birth plan. Give birth at home, without drugs and with a midwife. Her two older sisters (who happen to be twins) are both l &d nurses and had been present both for midwife and physician assisted births at the hospital they worked at and thought it was a great idea, provided Cate was getting proper care. They both were on hand at the birth. Cate chose a midwife she liked personally although she felt the woman was a little unorthodox, she was not too much older than Cate and Cate felt sisterly toward her. More like a girlfriend than a health care professional. Cate had asked early on about a back-up physician just as a regular run of the mill type thing. She was a little surprised when her midwife told her that she did not "contract" with one particular physician group, but her patients were more than welcome to consult on their own with a physician. It seemed odd but Cate wasn't concerned. She also did not get any ultrasounds which she found unusual as most of her friends and family who had had midwife births still got at least a viability scan and most got an anatomy scan around 20 weeks. Looking back now, Cate says these should have been red flags, but she was enjoying her pregnancy too much. Disturbing to her older twin sisters was that Cate was told she didn't need a GTT aka the glucose tolerance test. Especially since Cate seemed to be larger than most women at her stage of pregnancy at that point, but the midwife told her that the GTT was overkill by physicians afraid of insurance companies and law suits, that women rarely had it and false positives were common. (Disclaimer here: due to a high dose of antibiotics I was on during my pregnancy with Shelby when I had my GTT my diagnosis of gestational diabetes was, to say the least, questionable but I went along with it to avoid retesting.) Cate went past her due date. 18 days past her due date. Finally she begged the midwife to strip her membranes to bring labor on. Thankfully it worked. And thankfully, her sisters were there when she delivered. Fred turned out to be close to 14 pounds at birth. Cate tore severely and he was so large he got shoulder distocia. And thankfully Cate's sister brought a glucose test meter and found that the baby was going into a diabetic shock. She called 911. Cate had undiagnosed, untreated and rampant gestational diabetes. Perhaps interventions in that way would have prevented such an oversized baby. And even if Fred had turned out to be quite so large anyway a doctor would have been able to assess this with ultrasound and make the call as to whether an induction or c-section was needed.

The midwife, in this case, was stripped of her license in that state and I think is a rare example of recklessness in midwifery. I saw a wonderful midwife for one visit while pregnant with Will. She knew I was high risk and a repeat c-section (I was not originally scheduled to see her, the doctor I was to see got stuck in surgery). She did a more than thorough exam and wrote down everything I told her and apologized the doctor had not been in and assured me she would personally sit down with him and go over my chart and have him call me. He did. She went out of her way to provide excellent care and I highly recommend her to anyone interested in a midwife birth in my area. I shared with her Cate's story and she was outraged. She told me that typically she has to be firm with a mother she is comforting who is finding out that she is high risk and will have to have a physician birth or who needs a c-section. She insists to them that they are still giving birth and that their first act of selflessness as a mother is giving up their "ideal" birth.

I see and hear all the time on birthing and mothering websites about how "dangerous" it is to tell stories in the media of negative things happening in midwife assisted births but I never hear anyone commenting on why it is okay for people to portray physician assisted births as negative. It is clearly a double standard. I understand that midwifes and their patients are immediately on the defensive because they are not the "norm." However, I don't think that gives anyone the right to criticize a woman for choosing a hospital or physician assisted birth nor for having a repeat c-section. This defensive posturing only serves to add fuel to fire against having a home birth or choosing a midwife.

Ricki Lake began her "social network" of Your Best Birth to show women that midwife assisted home birth was the best way to have a baby. I don't disagree that for some women it is and maybe a community should exist for those women. But calling it "your best birth" implies women either choosing to or being forced to consider doing anything else are not having a good birthing experience or are somehow less of a woman or a mother.

I'm all about representing balance. I am at peace with giving birth in a hospital by c-section. But I know a lot of women are not. A co-worker (who has had a vbac) and I were discussing this and she said it disgusted her when she heard women telling someone like me (who has had multiple c-sections) that I had made the wrong decision. "It's not their life, it's yours and you did what was best for you. Why don't people understand that? As badly as I wanted the vbac, if it was in anyway too risky for me, I would have had the repeat. It's not worth risking my or my daughter's lives." I couldn't agree more. But when I hear a woman ranting about her unnecessary c-section, I don't try and convince her of anything. I simply tell her I am sorry she had to go through that and I hope she'll be able to try for the vbac she wants the next time.

We've gotten to a point in our country and society where we don't care what others think to the point that we think that everyone who doesn't think our way is wrong and should be told so. That's just not right, especially in matters of birth, parenting, etc where there is clearly more than one way to do something.

I would not be telling Cate's story today if she had told her friends that she was giving birth in a hospital with a physician if they had, instead of treating her with disgust, told her that as long as she was doing what she believed was right and was best for the baby, they supported her.

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