Midwife Kitty Ernst — Neat story!

I might entitle this “the making of a midwife” — the story of Kitty Ernst who from a young age wanted to be a nurse, and during her obstetrics rotation as a student nurse “vowed never to do obstetrics nursing,” but found out about Mary Breckinridge of Frontier Midwifery Service, and wanted to become a midwife. The remainder of the story is her witnessing her first out-of-hospital birth. Very neat.

h/t Pinky


Birth wars

This post is a must-read for everyone. I won’t comment on it, so as not to detract from it, nor to take any extra time — except to say, it’s from Australia, so aside from a few things that pertain strictly to that country, it could be written about America. Just go read it. Here’s a teaser:

YOU’RE in the dentist’s chair with a painful tooth, feeling fragile.

“That tooth has to come out,” says the dentist.

“I’ll give you an anaesthetic and extract it.”

You’re surprised – you had hoped the tooth would be all right – but you nod and say something like “Ungh-hnghm” through a mouthful of cotton wool and dentist fingers. After all, he’s the expert.

The dentist turns to prepare the needle, when a dental technician leans over and whispers in your ear: “You know you don’t have to do what he says.

“He doesn’t know what he’s talking about. What about root canal? Or homoeopathic remedies? And anyway, you don’t need an anaesthetic.

“There’s a dentist next door who does acupuncture and hypnosis for pain relief. It’s much safer. Oh, and did you know fluoride is toxic?”

The dentist snaps at her to stop: “Ignore her – she’s pushing her own agenda.”

Tense, stressed and utterly confused, you lie back, open your mouth and look up at two medicos glaring at one another.

Who is in charge here? What’s the real truth? And why didn’t anyone tell you there was some sort of power struggle going on?

Of course, this doesn’t happen in dental surgeries. Open hostility between clinicians would be madness, serving only to baffle patients and undermine the whole purpose of creating healthy smiles.

But this is exactly what happens in maternity care, every day, in birth centres, hospitals and homes. Hostility, suspicion, mistrust, abuse and vitriol abound in relationships between obstetricians and midwives, clinicians, academics and activists.

h/t to Sidney Midwife for the link

Reducing Infant Mortality

Unfortunately, I can’t embed the video in WordPress, so you’ll just have to click here to watch this free 15-minute video on reducing infant mortality. The thing that struck me the most was the woman with the “MD, JD” after her name that taught at UCLA, saying something about there being the midwifery model of care and the medical model of care — that women need to know that there are two models, and then saying, “But why are there two models? We should see which one works better, and then move toward that one.” Yes, indeed.

Obviously, some women will actually need the medical safety net, but why does midwifery care often get the short shrift?

Free CIMS Webinar

Informed Consent and Refusal in Maternity Care, on Friday, June 19. Sounds cool!

Same team!… Same team?

A few weeks ago, on someone’s blog, I read a comment which said something along the lines of all women who support home birth need to band together, rather than break up into somewhat antagonistic groups over things like unassisted birth; this commenter said we need to remember that we are all on the “same team.”

I’ve thought about that comment a lot since I read it, and while I agree with it in some ways, I disagree with it in others, and think it doesn’t go far enough in still other ways.

On one hand, I infer (perhaps wrongly) that a lot of people set up some goal or outcome as the paragon everyone should aim at, and those who aim at it and get it are the highest, those who aim and miss are next, and those who don’t even aim are lowest. This isn’t just in birth — you see it in everything, from people who get on the exercising bandwagon to those who go on certain diets, etc. But I get the sense from the UC people I’m exposed to that unassisted childbirth is considered the paragon of birth. This doesn’t mean that UCers look down on women who do not choose UC, necessarily (although I have heard disparaging comments made towards any midwife who does not wholeheartedly support UC as an abstract or who does not support women who wanted to have a UC; and somewhat casual denigration of women who choose hospital birth because they don’t “trust birth” enough, or whatever). Rather, what I remember most strongly is women who have acted apologetic because they just didn’t feel quite comfortable with UC — for whatever reason. Perhaps I was reading into it more than was meant.

But it goes both ways. There are more than enough ways for everyone to look down in some way on everyone else. And it’s destructive. So as far as that goes, we should realize that we are on the “same team.” But it might be impossible to be on the “same team” with some people, because of some basic philosophical differences, or perhaps even antagonistic behavior between some of the sub-groups of people within certain groups. But I think we should try.

And here’s how I think it doesn’t go far enough: the original analogy was that all home-birth people were on the “same team.” This implies that those who do not support or have home births are on a “different team,” and that we struggle against each other. In some ways, we do — specifically when home-birth or CPM advocates have to fight tooth and nail against the intrenched medical establishment for legislation that legalizes CPM-attended home birth. But can we not find some common ground, even in this area?

Here’s the “same team” idea I have — everyone who wants mothers and babies safe are on the same team. We may differ in what “safe” looks like, but we can all at least agree that whatever “safe” is, we want.

Among the blogs I read are those written by L&D nurses, CNMs, CPMs, doulas, childbirth educators, and other “birth junkies”. Some of the hospital-based nurses support home birth, while others think it is unsafe. We can all learn from each other. For my part, I get so into my “healthy, low-risk profile” women that I can easily forget that a lot of women are not healthy and low-risk, and bad stuff can and does happen, and home birth can be dangerous for some mothers and babies. Reading blogs written by nurses who see the not low-risk births is eye-opening for me. Contrariwise, a lot of L&D nurses can get their perspective about birth changed by a “refresher course” in normal low-risk births by reading about out-of-hospital births. Those who cannot understand why women would “take the risk” of having an out-of-hospital birth or a UC can read what these women have to say about the reason behind their choices, and then learn. Same goes for home-birthing women who don’t understand why women would choose to go into the hospital when they don’t have to.

Rather than just disparagingly saying, “I don’t know why they’d do that,” we can atually sit down and find out why and then we will know — and as the saying goes, “knowledge is power.” For instance, take an L&D nurse that can’t figure out why a woman would choose to give birth at home. She can read the stories of women who felt like they were abused (physically, emotionally, mentally) or coerced into unwanted and unnecessary interventions by those who were supposed to be caring for them in the hospital. And then she can learn from that more of the perspective a laboring woman has — of her care givers, her hospital, and herself — and the nurse can work on making her hospital unlike what these other women experienced. If she reads that a woman blames her PPD on her C-section which she believes was unnecessary, she can double her efforts to make sure 1) that the women she cares for do not have unnecessary C-sections or other interventions; and 2) that women fully understand what is happening to them and their babies, and why it is necessary. Because a lot of the thrust behind the home-birth movement is simply anti-doctor and anti-hospital — and this is because a lot of women believe themselves to have been taken advantage of by doctors or hospitals. A lot of the thrust is simply pro-natural, “back to the earth” philosophy, but there is a definite percentage of women who choose home births simply because of how they were treated during a previous labor or birth. The whole “god complex” of some doctors, and the inflexibility of hospital protocols (especially those not rooted in any sort of science or evidence-based medicine) contributes a lot to the home-birth movement. And people who refuse to listen to what home-birthers are saying, simply because they are home-birthers, do themselves a disservice. Also, if you believe home birth to be dangerous (or at least, that hospital birth is safer), then dismissing out-of-hand what home-birth advocates have to say, ignoring the experience of thousands of women who were traumatized by their hospital births, and trying to legislate home birth out of existence, is actually serving to increase the number and rate of women who will choose an out-of-hospital birth. And some of these women will be truly high-risk and will truly be putting themselves or their babies at risk by having a home birth with or without a midwife. Let this sink in — they are willing to take the risks of birthing without medical assistance, than to take the risks of birthing within a hospital — so what does that say about birth in a hospital? If you want these women to give birth in a hospital because it is safer for them or their babies, then change the system to accommodate them. By forcing them to adjust to the hospital, you are keeping them out.

So, let’s get on the same team and be on the same team as much as possible, shall we? Here is an analogy that comes to mind. In this country, we have several branches of military, and sometimes they fight and squabble amongst themselves (jockeying for position, prestige, money — whatever), and they even have football games or other sports matches in which they directly oppose each other. But when an outside enemy comes along, all differences disappear because they all understand that they are truly on the same team. In a similar way, we have several branches of people involved in birth, and sometimes we oppose each other on certain issues; but let’s always remember that we do have one common goal, and that is that we protect mothers and babies from unnecessary harm. We can learn from each other, and support each other in the common goal — even if we don’t always get along in other matters.

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Birth Survey is here!

Although I haven’t gotten anything official, the national results for The Birth Survey have finally been released! Woo-hoo!!! I checked it a couple of weeks ago, and I didn’t see any local hospitals — or any care providers outside of New York City — but today I checked, and it’s up! Yippee! Of course in my area (backwards as it is), there are only a few responses, but I hope to change that. I’ve got a stack of postcards and take some with me to the store, and when I see a pregnant woman or someone with a small child, I try to give him or her a postcard and explain what it is about. Yes, I gave a “Birth Survey” postcard to a man — how’s that for being unsexist? — he had an infant, so he was fair game, as far as I was concerned! 🙂

If you have had a baby in the past 3 years, please fill out the survey about your experiences — whether you loved or hated your doctor, midwife, nurse, anesthesiologist, etc., or just found him or her to be “okay”, other women in your area want to know about it! Think about it this way — if you had a real jerk for a doctor, don’t you wish somebody had told you he was a jerk before you ended up with him? Do someone else a favor, then, and tell them through the survey. Contrarily, if you had a great doctor (or other care provider), you can also do other women in your area a favor and tell them about your wonderful experience.

One of the good things about this survey is that it asks about so many things, and you can rate your care providers and place of care individually — in other words, if you had an awesome nurse but an awful hospital, you can reflect that in your ratings. Or if your nurse left something to be desired but your doctor was wonderful, you can say that. Also, if your doctor was great on prenatals but not so great during birth, you can say that. Or if he was ho-hum during prenatals but the best birth attendant you can think of, you can say it. Were you pushed into having unwanted drugs or other interventions? — say it! Did you ask for an epidural and had to wait a long time? — say it. Did your doctor tell you one thing during pregnancy and then totally change the rules during labor? — say it!

Ok, I’m so excited! But I’m going to stop now before I ramble on even more. Yee-ha! Go check it out, and if you haven’t yet filled it out, do it!! Your pregnant sisters now and in the future will thank you for it. Let your voice be heard!

Labor Rules

I’ve read this list before, but didn’t post it fully. I’ve recently came across it on another blog in full, so this time I’m going to put it here. Rather than risk sending negative traffic her way, I’ll just copy and paste it.

Before reading the following, I’ll say that some of these — maybe even most of them — are supposed to be sarcastically funny and taken with a grain of salt. Even though I’m not an L&D nurse and never have been, I can see humor in a lot of this, because change the setting from hospital to pharmacy and I could have written it myself. It’s called “dealing with the public”; and I daresay every profession that has to do so has a list of “rules” similar to this one. But I still don’t like it — even while I can see the humor in it. Sometimes when you “blow off steam” you just end up building up even more steam and more steam.

I’m sure that most L&D nurses have had to deal with most of these things — from teenagers or women who don’t know who the baby’s daddy is to druggie pregnant women who are putting their babies’ lives and health at risk on a daily basis to women who fake labor or exaggerate their claims. And there’s nothing that L&D nurses can do, except their jobs.

I will insert some comments here (and just because I don’t comment on every one doesn’t mean I like or dislike it; or that I approve of the rudeness and attitude).

Rules of the Labor and Delivery area

1. Don’t ask me if my wheel can tell you if you got knocked up on the 15th or 16th. That’s too damn close to have 2 different partners anyway. Just suffer for 8 more months, assuming the father is not the one it should be.

2. Bed rest does not include walking around Walmart or running by the mall to pick up something.

3. Don’t come in the middle of the night because you’ve been throwing up for a week and then ask me to get you something to eat.

4. Breathing hard and faking to your family like you’re having contractions WON’T open up your cervix.

5. Tears and rolling around in the bed also will NOT open your cervix.

6. Doing sit ups while in the bed to make the monitor “go up”also… WILL NOT open your cervix.

7. Until your cervix is opening, don’t plan on staying.

8. If you fight with your boyfriend and need a little TLC… go to his mother’s house, not the labor room.

9. If you are there with someone in labor, don’t try to read the strip and tell me what’s going on. You don’t know the difference between a fart and a contraction and you’ll likely just piss me off and delay your loved one getting pain medication or her epidural.

10. When I ask the patient a question, that’s who I want the answer from… OK? I don’t need her mother to tell me when she had sex last….

11. This day and time, if a patient is between the ages of 37 and 42… she has had approximately 2-5 partners. If she is between the ages of 28-36, the average is 7. If she is in her early to mid twenties, then her age is how many partners she’s had… If she is a teenager, then “too numerous to count” applies.  (and she has had, or currently has chlamydia or trich) [Probably all too true, sadly!]

12. Open your damn legs. If you were a virgin, you wouldn’t be here. [Yeah, but maybe she’s a victim of past sexual abuse. Or just likes privacy. Or doesn’t want numerous, invasive, and unnecessary vaginal exams. Just because you want to stick your hand up her vagina doesn’t mean she has to let you.]

13. Shave that sh*t. If we wanted a trip to the jungle… we’d go there. [No offense, but, if you don’t like pubic hair, maybe L&D isn’t where you need to work, hmm?]

14. Clean your ass before you come in. Unless you have the umbilical cord hanging out, are in a serious accident, or are bleeding profusely, take time to wash it up a bit… it’s going to be on display.

15. You’d better be nice to your nurse. She, not the physician, decides when you get pain medication… There is such a thing as placebo. We can also make you wait the entire 2 hours… adding 45 minutes for our convenience… or we can give it to you 15 minutes early…. it’s all in your attitude. [This attitude is extremely unprofessional, and I hope that few nurses actually act this way.]

16. The fewer visitors you have in with you… the better mood your nurse will be in.

17. Get rid of that one “know it all” visitor before it’s too late. She can ruin the entire experience for you by pissing me off.

18. If this is your 6th baby, either get the epidural before you come in, or don’t plan on one.

19. Don’t blame us when you’re baby can’t say its own name when it’s 5. Chances are, it was the cocaine you snorted in the parking lot, just before you were rushed in abrupting.

20. If your pulse is 50 when you come in… from all the downers you’ve been downing… chances are your baby will be several bricks shy of a full load. It’s your fault, not ours.

21. When I ask you if you smoke… you should include marijuana in that answer. Other things that should be included are, hashish, crack, meth, and any other illegal drug that you may have smoked. Nicotine is the least harmful of all the crap you could smoke…dummy.

22. Don’t bitch at us because your baby has to stay in the hospital until it’s 2 months old, weaning off of Methadone or Morphine. Regardless of what the bullshit clinic says to you…. Methadone is NOT healthy for babies.

23. If you call us and say you’re bleeding profusely, then I’d better see some blood when you come in. Do you know how many people we notify for shit like that!

24. Hard labor doesn’t just stop with 1 bag of IV fluids. We know a faker when we hydrate one.

25. If you’re an addict, we already have a preconceived notion about you, and we probably don’t like you. Nothing personal… it’s just the way it is. You chose that life… now live it. [I agree with this — when I worked at the pharmacy, we could just tell who the druggies were; and, yes, you lose sympathy when you abuse drugs. That’s non-pregnant; if you’re pregnant, then you’re putting your baby at risk, which is even worse because your baby doesn’t even have a choice!]

26. Regardless of the fact that your neighbor’s sister’s aunt had ababy at 30 weeks and it is perfect… that does NOT mean we’re going to let you have yours at 30 weeks.

27. Your neighbor’s sister’s aunts baby likely had to stay in the hospital for 6 weeks, and could possibly have problems that you’re not aware of… dumb dumb.

28. You’d better tell us if you’re on narcotics… trust me……We’ll know soon enough, because our drug of choice is Stadol…. HA HA.

29. If you have track marks on your arm, “NO YOU CAN NOT GO OUT AND SMOKE” with your IV. What do you think we are, Stupid?

30. Don’t scream. We hate screamers. It gets on our nerves and we just sit at the desk looking at each other and grinning and making faces. It’s not to your advantage.

31. If you don’t have custody of your 3 other kids, chances are you won’t go home with this one either. We ARE calling Social Services.That’s our job.

32. If the baby’s dad is in jail, and he’s still your boyfriend, we automatically assume “birds of a feather flock together.”

Your thoughts? Funny? Sad? Twisted? Sick? Hateful? “Oh those poor mothers who get nurses like that”? “Oh those poor nurses who get mothers like that?”