A little r-Evolution

If I had a better computer mind, I would make these posts organized and beautiful and vivid like most things I see from my mind. But me and computers, we know each other to an extent and I never take it that extra step to just spend the day learning how to make things pretty. Right now, I make my garden pretty, I take time for my body and mind and soul, for my family extended and near, exercise my relationship with nature and seems like maybe I am feeding my relationship with my local hospital a little bit of fertilizer. Or, did I just luck out extremely when I transferred an almost 36 week momma to our local hospital in Bozeman (and where to say the least we have had many more negative experiences than positive with our transports) and received the dream team? I think I believe in "it's written."

As I walked into LnD yesterday and met up with the OB we would be having, as our provider. She was young like me and cute and a smile from ear to ear, and a compassionate voice. It brought much relief to my mother of 35 weeks who was planning for a home birth and very much accepting of the hospital adventure we were embarking upon. This story is about my perspective, not my clients. I very much take their confidentiality to heart and if they want to share their side, that is a gift. For me, this is about getting out what is happening in a world where the maternity profession is being forced to expand because of advocates and evidence-based research, and consumer activism. I turn the corner, and I could have thrown my intestines on the desk I was so nervous, instead I just handed them a few pages from my somewhat massive charts these days. The doc kept welcoming me as I said things like, "I am sorry to bring you our messes." But what did I mess up? NOTHING. All her labs were normal throughout pregnancy, she was eating well, she had just come back from a long trip overseas and experienced stress but had I really made a mess? No. In my nervous state, the staff welcomed me and said, "We're introducing nurse-midwives to our staff and have one in training today, do you mind if she assists your birth?" Not at all. The next question (one eyebrow raised), "What role do you want to act in? Do you want to be the primary deliverer of the baby?" HUH? Let me go down to the ears, nose and throat doctor and make sure I don't have wax built up before you SAY THAT AGAIN? She got the biggest smile on her face when I turned into the classic deer in headlights. I then thought, "oh no, the way I catch a baby would make you all dance behind me as I have a different level of patience and know non-medicated birth." My actual response, "Thank you for that offer, wow. However, this is your turf and what I would like is for there to be collaboration and for us to all work together. You're training a midwife, let's do it together." So, the OB and I worked together with this midwife (even though she is well seasoned, she hasn't caught babies in a long time) and it was so cool. Beautiful birth.

The birth was natural. She did receive antibiotics for being group beta strep positive. She progressed beautifully, labored in water, the lights were almost completely off the whole time which she loved otherwise she totally reacted to the distractions and noises of the room and I loved the responses of the other attendants. When I did something I learned from another local midwife to release pressure in the hips, they all oohed and awed at the "technique." They were open to being soft and quiet and she chose the way she would push her baby out. The baby crowned and she grunted loudly, she had no epidural and rupture of membranes took her from a 7 to fully dilated in 15 minutes. Freight train and really intense sensations when you dilate that rapidly. Baby came out crying and this is where I had to go stick my head in the closet. The way that little BREATHING baby got rustled up made me want to cry. This 7 lb 2 oz 35 week old baby was breathing and healthy and I wanted to run over and stop them from jostling him around but this is their turf, not mine. I just swallow. No tear. No pitocin to stop hemorrhage. That conversation was great for me to hear, "Do you want to run an IV of pit?" (to the nurse-midwife) She says, "As a standard I do even if not indicated, but let's leave it out on this one." The nurse says, "OK, there is an injection on the counter." I smile. Let the body do it's job and most of the time it responds. They never gave her pitocin postpartum.

Then there were hugs between the OB, the CNM, and me and the nurse. Wait, hugs? The OB and I both acknowledged confusion and discussed as to why this baby was "preterm." Placenta going to path might explain it or not. Was it the nuchal cord that probably would have become extremely tight as this baby became a 10 pound baby? Would that cord undone? Was it the elevated liver enzymes? All things we can think about and I could question as I move forward caring for women and babies during pregnancy and birth. As I woke this morning, I said, "It was a good birth. This was a success." This opening at Bozeman Deaconess raises my confidence for the myriad of birthing women in the area. Maybe, just maybe, the opening will happen in a place I thought would always be adversarial towards midwives forever and then awareness will sweep over and we will change our cultural view...those last 13 words are for my friend Mollie.

Neko Case sings, "I may not get my approving but let's not waste our time thinking how that ain't fair." This reflects onto me as I move away from this birth and having to transport preterm. I have spent many days in my training and moving into practice worrying about what the hospital staff and others will say about me after a transport. This little line reminds me life is too short, in my profession, to worry about what is and isn't fair (truly). I can only reflect on this birth as a way of moving forward as a good midwife and care provider, while stepping into the liquid of my life.

Long time trend for NO change in the United States

A videotaped lecture I watched tonight has me thinking about the work I have presented, and continuing to listen to the voices of maternal and infant health in the United States. When I wrote my thesis on The Greening of Birth, I discussed the various reasons why the maternal mortality rate could be so high in the United States. I spoke of intervention, Cesarean birth and maternal request Cesarean birth. Then, in my last post, I posed my own personal reflection/question: The journey of women, in birth, has been shortened and our power stripped from us, and I often wonder what it is about women these days that scares them (truly) about birth, that encourages them to let their deepest seated power be lifted, and that makes them willing to give up their personal rite to a higher hand or authority. If we still looked at birth as an event of empowerment, would women be fighting more strongly and choosing other paths as they walk into motherhood? Watching this lecture helped me out, reminded me.

In this lecture Dr. DeClercq asks the question, "Are US women the reason for the increasing Cesarean rate?" As a midwife it has been a lesson for me to learn about the real reasons behind Cesarean and intervention, and to accept the facts and reality of occurrence in the US. That lesson has also taught me to be compassionate and know when I can play the devil’s advocate. As I listened to the lecture, I was relieved to know that Cesarean birth by maternal request is low and not statistically significant in reports of the rising Cesarean rate in the US. The populations are still small, yet they are a reality. Dr. DeClercq diagrams the overall rates and patterns of Cesarean birth across the US and points out that Cesarean birth may trend toward "strong regional patterns" based around the way varying US cultures view Cesarean birth, rather than rising rates being a true reflection of evidence-based medicine practiced the same way across the country. Although we as a culture are often deemed homogenized, this brings to my awareness that medically we are very different and speak from different voices, and that we are truly a melting pot.  

In answer to the question of whether women themselves are the reason, research proves that the answer is no. Declercq argues that the reason for the increasing Cesarean rate in the US is practice changes. He continues on to discuss Dr. John Whitridge Williams, a pioneer in obstetrics, and how practice changes within the medical profession are the fundamental reason for "periods of undue enthusiasm," which in turn are reflected in the rise or increase of a medically indicated procedure. He also says that vaginal birth takes more time for the provider and "considerable technical dexterity."  While this researcher argues that the increasing rates of Cesarean are due to practice changes, mothers in the US feel they get very good maternity care and view the maternity care system to be better than the US healthcare system as a whole.

I ask myself, "Why do I keep working for this change in maternity care? Is there hope for change if there is 'a long term trend for no change'?" I keep watching the lecture. When Declercq poses the question of who could be at the center of the discord and disconnect between interventions in maternity care and the general belief of US women that they are receiving good care, the answer comes from a quote by Dick Cheney in the book One Percent Doctrine.  Dumbfounded by hearing the name "Cheney" and it not being Melissa Cheyney, I continue to listen and, like any great lecturer, he makes his point.  "When you set up a system that focuses on the 1% of problems that might occur, you undermine the care of the 99% of the mothers that don't need those services." This quote reflects the current philosophy of maternity care. That is so good to hear on so many levels and allows me to reflect on the disservice we as providers are put into place within our healthcare system. Declercq is clearly an advocate for home birth and midwifery, as seen in the last few minutes of this video. More important to me, he is an educated and passionate advocate working for improvement of the current trends and conditions of maternal and infant health and safety in the United States.  

In my journey to bear witness and participate in creating sustainable maternal and infant practices in the US, I have often been compared (by my family members) to a salmon swimming upstream. Yesterday, I picked up two reads. One was a short bit of poetry a friend had me read in her living room. The poet spoke of salmon, how they have soft mouths and when you hook a salmon you must play them gently or it is easy to tear the hook loose. The other book was The River Why. One chapter, "The Line of Light," stood out in my mind. It too is about a man and his relationship with salmon. At the end of the chapter, as light begins to sink into the day, the fish on her way and he back on his, he is touched by "the Ancient One" and knows that from this point on in his life there is no escape. There is no escape once you enter into something with full passion, something that drives you, something you love or fall in love with. You just have to figure out how to "play it gently" and, in some cases, get your butt kicked in the process of learning how to navigate the adventure.