Friday, October 16, 2009

The perils of midwifery, home edition

I was thinking I wasn't going to post Julia's birth story here, because like many things about birth/newborns/parenthood, it didn't quite turn out how we expected.

And then, I thought, well, perhaps that's all the better reason to post.

I have a few magic minutes while one daughter sleeps and the other enjoys a playdate, so I'll take some time to process here, and then I suspect I won't be posting for a good long while.

2/3rds of Julia's birth went so smashingly. Labored in the tub, a little more leisurely than last time, pushed her out. It was hard, but nice to feel a little more acquainted with what my body was doing.

She was born, and I got out of the birth tub and went over to our bed (with the help of my midwife and others, of course) to await the placenta.

This is where things started not going so well. The placenta did not come out. Instead, a lot of blood did.

To give some context, with Lucy's birth, the placenta came out fine, but a lot of blood did too. Enough that my midwife considered calling 911. The bleeding stopped well short of the danger zone, though, and I stayed home and later got an IV to restore the lost fluids. It was a little scary, but still safe.

This time, we called 911 after a few frantic minutes, Pitocin injections, and some attempts for me to push. Big fire fighters arrived from the fire station around the corner, lifted me onto a stretcher, and turned on the sirens to get me to our local hospital. It took about 5 minutes to drive over there.

The hospital staff and OB/gyn worked their magic, and got me stable, got the placenta out, and gave me 2 IVs and 2 units of blood.

Let me be clear: it wasn't a whole lot of fun. It was scary, and it was not very safe.

After the chaos died down, the OB that worked on me (brilliantly, I should add) came over and said, "Unless you want to leave your daughters without a mother, you should never have another home birth again." Let's just say that her tone was less than gentle.

I want to say a few things about her comment. One, in some ways I agree with her. So does my midwife. I would not be a good candidate for another home birth. Obviously, this bleeding thing is a pattern, and home birth midwives are not prepared to give emergency transfusions or to transfer directly into an OR if needs be. So. If we do decide to have another baby, I will be doing it under the care of an obstetrician. These kinds of situations are what they are trained to handle. And as I've said before, I am grateful to live in a country where that kind of care is available to me.

However. What I didn't appreciate about her comment was her assumption that I would try to do a home birth even if it wasn't safe.I'm sure there are people who would refuse hospital births even under these circumstances, but I am not one of them. Part of her tone, I think is a general problem with our treatment of mothers in the US: an attitude that we are not competent to make informed decisions about our own treatment. Just look at the hysteria about having a glass of wine every once in a while during pregnancy. Sure, don't imbibe every day, or even every other day, but a little alcohol a few times in pregnancy is probably not going to cause problems. The French, I'm sure, are not ignoring the cabernet during pregnancy.
So doctors, hospitals, and just about everyone assumes, that if left to their own devices, moms will make poor choices for their children. Great message!
Also. If you choose not to follow their advice, and say choose a home birth instead of laboring in a hospital, you have proof positive that you make poor decisions.

I have a few other things to say about our experience. We went to our local hospital, which is very baby friendly. They have a team of nurse midwives, and desipte the one doctor's comment, I generally felt supported and affirmed in our decision to birth at home. All this to say, I think this hospital is a pretty good choice for laboring moms. Probably one of the best choices in our county.
But even so, I would not be excited to labor there. I would do it, but only because home birth is no longer an option for me.
The main reason is that I saw about 20 different caregivers while I was there, none of which I had ever met before. If I had gone the hospital route, and planned to be there, I still would have only known one: my OB, and that's if he or she was on call. Also, most OBs would not stay with me during labor--they would arrive only at the end or if there were a problem.
As it was, we saw two OBs, about 6 nurses, one lactation consultant, sundry nurses aides, a pediatrician (not mine) from our ped group, and a partridge in a pear tree.
In contrast, this is what I get with a home birth midwife.
--All prenatal visits.
--Her cell phone number and pager to call anytime if I have questions during my pregnancy. When I got close to labor, she returned my phone calls in about fifteen minutes, even if was late at night. That was kind of nice when I thought (I think wrongly) that I was leaking amniotic fluid.
--She comes immediately over to my house when I go into labor and want her there.
--She stays with me, checks my vitals during labor, and coaches me through labor if I need it.
--She holds my hand if I get transferred to the hospital, and coaches me through the not-so-pleasant procedures that must be done.
--She coordinates care for my newborn while I'm incapacitated.
--She visits me in the hospital and drives my newborn over to me so I can start breastfeeding as soon as possible.
--She serves, post-partum, as not just my caregiver, (checking bleeding and such) but also as a preliminary lactation consultant and quasi-pediatrician. She comes over at 9 at night if I get mastitis or I'm worried about my newborn. If she's concerned, she tells me to go to a real pediatrician or lactation consultant or whatever immediately.

Through all of this, she knows my whole history, from my last birth, my prenatal visits, has been in my home, met my husband and my daughter, my parents. There is just no way I'd get this kind of care through the hospital. No one can tell me that her having that kind of information is not safer than having relative strangers take care of me.

One more note: Why, why why do hospital workers wake you up every two hours during the night to do things like take your temperature and see if you need a sandwich? They are kind and well-meaning and so annoying. During my first night in the hospital, I definitely needed someone checking these things, and I was so out of it it actually didn't bother me that much. The second night, I did not. And funnily enough, I kind of needed some sleep. Between waking to pee, waking to nurse my baby, and dealing with hospital policy, I got about 2 very non-consecutive hours of sleep. How can this be good for recovery?

Finally, I think my experience would have been safer were there more integration and acceptance of midwifery in our hospital system. The paramedics would not have wasted time asking my midwife if she had covered the baby's head. I might have had a backup OB (currently, OBs cannot do backups, at least in our city. The one I know would be willing has said he'd be pilloried by hospitals and possibly lose his privileges if he did). A backup might have been already acquainted with my medical history, instead of learning it while doing life-saving interventions. The hospital staff might have some history with my midwife, some relationship that would facilitate good care. Instead, as one very nice and supportive nurse said, "We don't see many successful home births like yours." I thought it was great that she thought my home birth was successful (it was, sort of) but this is a telling statement. How are they supposed to have a good opinion of home birth if they never see any of the people that succeed at them?

So all things considered, even knowing i shouldn't birth at home again, and knowing it is not a safe choice for me, having somewhat of a worst-case scenario happen has not convinced me that home birth or the midwifery model of care is a bad choice. If anything, it has done the opposite. I wish we had known that home birth was not a good choice before this birth, but I'm glad I had the chance to experience it.

And I wish more people did.


Idyllic Youth said...

My placenta didn't come out right away and there was a lot of blood. In my case I just had a poor midwife that didn't notice the reason I was bleeding was because I had a second degree tear. The midwives tried to pull my placenta out by the umbilical cord (called tractioning) and ripped the placenta from the wall. They only gave the placenta 12 minutes to come out on its own and I truly feel that if they'd just sewn up the wound and let the placenta come out on its own I never would have needed three blood transfusions and 9 days in the hospital. I was at a birth center and feel that this is a reason why I should have stayed home.

Susan said...

WE are just praising God that you are well and healthy and that Julia has arrived (with a bang!) at last! Congratulations!