One of the things about Spring that I love is the energy and propulsion towards making change.
I am moving my blog! I still haven't decided if I'm going to bring all my archived posts over to the new site (I think I will, but only if I manage to get more time online), but I will start writing over at the new site soon.
So, please, update your bookmarks and your blogroll to http://www.PamAMidwife.com
Thursday, March 13, 2008
One of the things about Spring that I love is the energy and propulsion towards making change.
Tuesday, March 11, 2008
Have you seen her latest strip?
Really, Michel Odent. *deep sigh* What he has to say is so vital to our children, grandchildren and great grandchildren. We will never see world change without paying sharp attention to what we do prenatally, at birth and immediately postpartum.
Monday, March 10, 2008
Saturday, March 8, 2008
...is that I'm not the only one that feels this way about it.
Within this truth, the company I keep is remarkable. Astounding. Powerful.
Seeing, meeting and conversing with Michel Odent, Dr John, Sarah Buckley, Gail Hart, Karen Strange, Laura Shanley, Gloria Lemay - these are just a handful of the people that touched my life deeply this past weekend. Met Ricki Lake briefly (my only question was to ask her how she felt about the Hairspray remake!), saw the Business of Being Born (it was really well done!), and interacted with so many women who believe in women and believe in birth - and aren't afraid to speak about it.
I didn't take any pictures (aside from one with Linda, me and Michel Odent) because I was so busy. Sleep was scarce, down time was not possible.
I am moved beyond words. Moved beyond words. I am not alone.
(One client had her baby while I was away...she had her baby boy this morning and I'm looking forward to seeing them tomorrow!)
Thursday, March 6, 2008
Off to the Trust Birth Conference!
Two of my clients birthed on Tuesday...one a heavy, thirteen minute shoulder dystocia and full CPR to a 12lb 12oz baby girl. Later that evening, a baby boy's arrival that happened so fast I missed it by five minutes.
The big baby is doing well - she responded quickly to resuscitation (a benefit of moms who are unmedicated and delayed cord clamping!) and EMTs were called before she was out. I have had one other shoulder dystocia in my practice but somehow that seemed less daunting than this (maybe it was my memory that has failed? perhaps I have forgotten the flood of emotions during and after?). I cannot imagine how doctors do it with women who are numb from the waist down perched on the edge of narrow, high beds. Certainly the mobility of the mom helped to birth this baby. I've always heard that if your hands don't hurt the next day it wasn't a true shoulder dystocia. I cannot clearly recall my previous experience, but I can say that for the past two days my fingers, my wrists, my arms, even my legs are aching. Baby has bruising and initially we thought I had broken her clavicle, but after the paramedic and I looked at her more closely we determined that there were no broken bones. Other than screaming for three hours, she physically recovered well.
I'm grateful for a fabulous assistant midwife who is quick in emergent situations - and has a strong trust in birth. I am also grateful for the quick arrival of EMS and their willingness to assist us in whatever way we needed during the transition.
I really need this time away...looking forward to updating as the conference moves on - and taking pictures!
Friday, February 29, 2008
Barb's blog has a new post entitled Midwifery Education , a spin-off from a conversation that has been happening over at another blog (which I have to admit I haven't had time to read at all).
I have so much to say to this post, including the desire to read the referenced blog to discover where the origins and thought processes are of these two midwives.
Access to midwifery education and the homogenizing of midwives is something I feel very passionate about for many reasons, most rooted in feminism, entitlement and classism. Unfortunately, I'm in the midst of laboring women, getting over a cold, being up all night and getting ready for the Trust Birth Conference. Suffice to say I think it may take me a couple days to organize my feelings, my thoughts and my words.
Spoke at a statewide mini-conference yesterday about Autonomous 2nd and 3rd stage. It was a nice training for the Trust Birth Conference, even though I was suffering from a cold with DayQuil on board. Overall the response was positive and it reinforced issues I want to cover at the conference in California.
I leave for the conference on Thursday afternoon with my dear friend, Linda. I'm thrilled she will be joining me at the conference - and sharing a room with me, a client of mine and a wonderful doula from Seattle.
I'm so excited to be in an environment of people who are truly passionate about changing the world by speaking birth truth. It is a bit like that fantasy slumber party scenario I wrote about years ago...only I'm missing Sara Wickham and Cornelia Enning. Rixa should also be on that list, but I wasn't aware of her gifts at the time I wrote the entry. With some chocolate and a glass of red wine perhaps I can gather them all in my room for a brainstorming session. You can bet I'll be taking ALOT of pictures and blogging along the way!
Was up late last night with friends, celebrating the receipt of a grant which one of our good friends will use to produce an exhibit about an artist friend of ours (does that make sense?). Had a wonderful dinner of Macademia nut-encrusted MahiMahi with mango sauce...came home at 2am and was called to a labor at 4.30am. We came home almost twelve hours later since the labor was easing in and out - and surely our watchful eyes were not helping anything.
Slept for a bit, went to dinner with my girlfriend and then to Target. Now I'm here, knowing that I need some serious down time instead of getting all those swirling thoughts put out on this blog. Once I feel articulate and concise I will be back to share some of my feelings.
There is a mom that was due around Valentine's Day that hasn't birthed, two VBAC moms waiting in the wings (one of which is doing labor work), a first time mom and two other moms planning their second babies, second homebirths, all due within the first two weeks of March. While it's not within my control, I selfishly want these women to either birth before I leave or wait until I return. I realize that either way March is going to be a busy month, followed by a full schedule all the way through August. We knew that I had this time scheduled for the conference when they hired me, I'm always knocked over by the level of attachment I feel towards my clients and how very difficult it is to leave them - even if they are in wise, caring hands.
Off to snuggle with my girlfriend and watch some junk TV.
Thursday, February 21, 2008
In response to my post about the prospective study that Missy Cheney from the Oregon State University is creating, my friend Linda wrote this:
(note: Kraig Bohot is the Communications Director for the Oregon Health Licensing Office, the office that oversees the Licensed Direct-Entry Midwifery Board)
As an addendum to what Linda has written: The Oregon Licensed Direct-Entry Midwifery Board is made up of a homebirth-friendly MD, two CNMs and three Licensed Direct-Entry Midwives. It is NOT overseen by a board of physicians without knowledge, education and experience of homebirth. It is, in my experience, the most peer-friendly board that oversees non-nurse midwives in existence.
Tuesday, February 19, 2008
I am limited in my online time and it feels like anything I write or respond to never quite conveys my initial intention. Two year old distractions, a 13 year old wanting to look at the latest YouTube craze - it all takes me away from getting my thoughts down succinctly. Bear with me.
Here are a couple looks at the concept of midwifery as the practice of medicine - and why some view it as not the same.
(What is interesting to me is that the most vocal opponents of homebirth midwifery are not doctors - they are the nurses unions/associations. I find this interesting mainly because I view RNs as the single make/break of a positive birth experience in the hospital. RNs, to me, are in a tough spot because they see the action of someone else causing reactions that they are witness to. I know that many RNs in L&D are HUGE patient advocates, to the point where they will hold off calling docs or stretching the truth a bit in conveying progress in order to help a woman maintain control over her birth experience. Having had numerous experiences with RNs - including attending homebirths for them - I know the truth about what frustrations many deal with on a day-to-day basis. I think that much of this coincides with the negative feelings about homebirth midwifery. I'd like to hear more from RNs on this, for sure!)
Midwifery is Not the Practice of Medicine
North American Registry of Midwives' Position Paper on the Practice of Midwifery
I really, honestly appreciate the willingness of people to push me, to challenge my thoughts. This is the sort of thing that moves the truth forward and clarifies intention. It also brings us together with similar goals in mind - and for that, I'm grateful.
Saturday, February 16, 2008
In 1977, Oregon's attorney general held that midwives didn't require licenses to attend births without drugs or surgical procedures, says Maryl Smith, a historian with the midwifery council. Five years later, the midwifery council began a voluntary certification program that included an exam and experience requirements. By 1993, the Legislature established voluntary licensing, intending it to allow for reimbursement under medical assistance programs.
Licensing is a hot-button issue among midwives, Cheyney says. For starters, a license costs $1,500 a year, a fee some midwives struggle to pay. But most who avoid licensure do so because of their philosophical beliefs.
"They don't want to be part of this government body," Cheyney says. "They don't want somebody interfering with the art of midwifery. Then it's not mother-driven."
Viles says the move to licensure created rifts that took time to heal.
"I chose to be unlicensed because I felt it was the best way to uphold and affirm my belief and the Legislature's intent that birth is a natural body process and not a medical event," she says.
My stance on state licensure of midwives is that it should have a voluntary option, not mandatory. To mandate that all midwives be licensed only will further serve to alienate midwives, put them at risk for criminalization due to not licensing (for various reasons listed above), and severely restrict true freedom of choice for families.
I believe that every state interested in making midwives legal start with voluntary licensure, using Oregon as an example. There is no reason why any midwife should risk criminalization simply for attending families in birth.
Thursday, February 14, 2008
From Science Alert in Australia and New Zealand: Breast milk contains stem cells
[Breastmilk] not only meets all the nutritional needs of a growing infant but contains key markers that guide his or her development into adulthood.
“We already know how breast milk provides for the baby’s nutritional needs, but we are only just beginning to understand that it probably performs many other functions,” says Dr Cregan, a molecular biologist at The University of Western Australia.
He says that, in essence, a new mother’s mammary glands take over from the placenta to provide the development guidance to ensure a baby’s genetic destiny is fulfilled.
“It is setting the baby up for the perfect development,” he says. “We already know that babies who are breast fed have an IQ advantage and that there’s a raft of other health benefits. Researchers also believe that the protective effects of being breast fed continue well into adult life.
“The point is that many mothers see milks as identical – formula milk and breast milk look the same so they must be the same. But we know now that they are quite different and a lot of the effects of breast milk versus formula don’t become apparent for decades. Formula companies have focussed on matching breast milk’s nutritional qualities but formula can never provide the developmental guidance.”
His team cultured cells from human breast milk and found a population that tested positive for the stem cell marker, nestin. Further analysis showed that a side population of the stem cells were of multiple lineages with the potential to differentiate into multiple cell types. This means the cells could potentially be “reprogrammed” to form many types of human tissue.
Wednesday, February 13, 2008
There has been a lot of discussion on midwifery and childbirth email lists in the past few weeks in reaction to a statement by ACOG that birth should take place in hospital. I can’t understand, for the life of me, why ACOG’s opinion on homebirth would interest anyone remotely associated with childbirth.
Aren’t these the illustrious folks who gave us 50 years of universal episiotomies? Aren’t they the people who prescribed thalidomide, high dose birth control pills, and hormone replacement for vast numbers of menopausal women? Aren’t they the ones who have made a fortune from amputating the foreskins of millions of helpless baby boys? Haven’t they unnecessarily induced labour and cut the bellies of millions of trusting women? Need I go on? Really, why would any right thinking woman be dissuaded from homebirth by the opinion of ACOG?
Although I didn’t even bother to read their statement on homebirth because I could care less, I DID want to see what they had to say last week about collecting cord blood for freezing. Now, THAT was interesting. They did not go the way of the British Society which clearly tells their members that freezing cord blood is a scam that should be done away with by intelligent people. http://thecordblood.net/?p=25 No, the American group (some call them the S. O. B.’s) tells their members that they should be informing their patients about the back door payments they receive for soliciting for the cord blood monsters. If you look closely at their statement, the message is there that cord blood banking is a ridiculous waste of money for no earthly good whatsoever but the door is left wide open for the obstetricians to continue padding their bank accounts from the stupidity of the public.
ACOG has lost credibility with the women of N. America. When midwives, nurses and doulas realize that fact, they will stop caring what ACOG has to say. It would be of more interest to me what the Teamster’s Union thinks about homebirth.
Gloria Lemay, Vancouver, BC
Let's not forget what the Royal College of Midwives and the Royal College of Obstetrician and Gynecologists have to say about homebirth. A complete opposite of what our American counterparts believe: that a woman has the right (and intelligence to make the choice) to birth her baby not only gently, but safely.
Would socialized medicine change our attitudes about birth simply because of the cost-effectiveness? (Many countries with socialized medicine have done away with routine procedures and interventions that are not evidence-based to help reduce overall expenditures.) What if we instilled a no-fault malpractice system?
Sunday, February 10, 2008
One of my clients decided recently to attend the Trust Birth Conference in March. From her perspective, there was a struggle with going. Was this conference just for those involved in birth work - childbirth educators, doulas, midwives, doctors, nurses? Or could she, a mother pregnant with her third, gain something from attending?
Never have I been presented with a conference that offers so much value to our entire culture. To say that it's a conference for those involved in birthwork is limiting the focus. This conference is different in that the goal is to shift the awareness and thinking about how we all approach birth. It's not a black/white look at birth - instead, it is an opportunity to reflect and check in with our own biases, fears and approach to birth.
Some carry a misconception about this conference. That somehow it is about people who are blindly naive about risks in birth. That when we say we TRUST BIRTH, somehow it just defines thinking that every woman can give birth without any complications. Nothing could be farther from the truth.
This, to me, is what it means to TRUST BIRTH:
As a woman and a mother I am born with a deep level of intuition. Sometimes fear arises in this place of intuition - and it is not my job to figure out what is just fear or what is a strong intuition. As a woman and mother, they are both the same. They both direct me and guide me. When another person invalidates my fear/intuition, I begin to doubt myself and my intuition. When I am challenged about my beliefs, I grow. I learn more and this will likely shift my awareness about how I process my intuition. In essence, my sense of intuition becomes a larger, stronger part of my life.
As a midwife, I have my own sense of intuition. I also have my own set of fears. At birth, I struggle with what I know to be true about how we are made and also what my experience has been. The role of anecdotal experience does not make things true for all women in my practice. I'm shown this repeatedly by the universe/God. Just because I've experienced something that was relatively scary a couple times doesn't mean I should expect it at every birth - or that I should routinely intervene at every labor/birth to ease my concerns that it doesn't happen again. It does mean that when signs show up, I am on alert and processing the things that are THEN occurring. When there is a matter of necessitating assistance, or even communicating with the parents what I feel, I move to do so. Routine intervention always has a trade off - usually a negative one.
Trusting Birth in the truest sense means knowing that birth does work beautifully. What we're up against isn't defects in the birth process (though there are variations that require assistance, interventions and different outcomes than what we originally expected), but a cultural brainwashing about the process of birth. It's about challenging yourself to look at what we're taught, what we believe and what we know to be true medically, physiologically and emotionally.
TRUSTING BIRTH. We're not there yet. I'm not there yet. I am not sure that I ever will be in the way that I expect from myself - I am living in this culture, bombarded by the same doubts, the same selfish desires and struggles as anyone else. It's taken me years to get to this place where I am right now - and while it's a far cry from where I stood ten years ago, I'm still aware of how much more I have to travel.
The process of being involved with birth has changed one major thing in my life: my perception of who I am. My ability to be humble to the fact that many times birth has nothing to do with me as a midwife. I can offer assistance, support and love for my clients but their journey is their own. I sincerely hope that I'm self-reflective enough to withstand disappointment that someone may have with my role, and smart enough to use that to move forward and make adjustments in my views/communication.
In essence, birthwork has empowered me. When I started this path I was focused on empowering women. There was no focus on what this path had in mind for ME. It was about caring for women, assisting them, doing for them. Every cesarean or transport was a failure on my part. I was still in this place of feeling like birth outcomes were about ME.
Letting go of those expectations, realizing that I'm a partner in a woman's care and actually being witness to unhindered, gentle birth has empowered me as a PERSON. It has given me hope for humankind, hope for children and a sense of faith that I never would have learned otherwise.
I am going to the Trust Birth Conference not because I have been asked to speak. I am going because there is still so much I have to learn - when I'm uncomfortable, facing those issues head on will only help me grow even if my views don't necessarily change. It's about being around people who are on the same path, seeking the same personal truth, the same challenges.
Trusting Birth is about working on deprogramming ourselves. Whether you're a midwife, mother or doctor, we all have elements of birth fear that has been deeply ingrained on a cellular level. Sadly, it is generations old. Talk to our grandmothers, our great-grandmothers - these are beliefs that are still being taught to our children. When we talk about BIRTH TRUST we begin to shift those cells - and in essence, shift the dominant paradigm.
I trust that birth works. I trust that labors and births that are not routinely directed, managed or interfered with work the best. I know that babies have incredible adaptability (a thought brought up by my apprentice/assistant) when not faced with drugs or routine intervention. I trust that mothers and attendants have a same mutual goal: a healthy baby and a healthy mom.
I also trust that our ideas and thoughts are leading us to a place where, when really needed, we have technology and specialized assistance available. I trust that women are the experts in their care and have more at stake than their providers to see a healthy outcome of themselves and their baby. I trust that we have gotten to this level of humankind because of a perfect, awe-inspiring design.
I am not naive by trusting birth. I am merely open to the idea that birth was created, as Karen Strange repeatedly says in her Neonatal Resuscitation classes, "to work even if a woman is alone." I trust birth because trillions do it. Every second of every day. Despite the odds that women and babies constantly face, the vast majority survive, whether it's birthing solo or birthing by cesarean. Our bodies - and our babies - are built for survival.
I trust birth because I trust God. I believe that every human being has the fundamental right to a healthy, gentle start in life. I believe that birth is more than the emergence of a healthy fetus from a healthy woman's womb. I believe that birth is a life-changing event that affects how we view ourselves as women and how children are treated in our world.
We are up against a culture that distrusts birth. That distrusts women. That expects catastrophe. That looks at legal ramifications rather than personalized care. That puts providers on a pedestal.
If you're a parent and are interested in being challenged, sharing your truth and offering your story, please join us at the Trust Birth Conference. The organizers have created a path in the conference that is geared towards parents at a lower cost. Though I must tell you that the whole conference will change your life.
Trusting Birth is not about being blind. It's about having your eyes wide open, moving forward, hearing what is being said, processing it and making your own decisions. If we're afraid to do those things, how can we ever trust ourselves as parents?
Friday, February 8, 2008
Rixa has an amazing, honest and accurate response to the recent ACOG press release on homebirth.
She says it much more succinctly than I ever could.
While I wouldn't expect them to say anything differently, the patronizing tone of the release (that somehow a mother just wants a candlelit romantic experience and cares little for her health or that of her baby's) really disappointed me.
We are part of a large, successful, truth-seeking movement...proved specifically by the defensiveness of this release.
Monday, February 4, 2008
It's easy to get down on all physicians providing obstetrical care in a hospital setting. Knowing doctors personally and professionally I realize there are many out there that are struggling against the hostile rise in cesarean sections and practice approaches. The book Pushed offers an honest look at the pressure and conflict that many obstetricians face.
In my state there are not many choices for malpractice insurance. In fact, as of this writing, there are two companies that offer such coverage. Both insurance companies offer a premium discount for practices with higher cesarean rates. Why? In court a cesarean is always going to be viewed as the safest route of delivery (for the infant, which is where most malpractice claims arise). Hence, if you do more cesarean births the insurance company is less likely to pay out millions of dollars in litigation. This pressure has led many providers to stop doing births in my community. In essence, the docs that honor evidence-based approaches to care are getting tired of the fight and leaving birthwork altogether.
Here is a recent article published about a doctor that is in the same predicament in North Carolina...one that forced her to leave a booming obstetrical practice altogether. Her stance and the truth she speaks about is important - not only for consumers but also for other providers. If a stance is taken against this sort of climate could we see change occur?
From the article:
"I don't see any end in sight right now," said Dr. Bruce Flamm, regional chairman of The American College of Obstetricians and Gynecologists, saying there's little concrete data on how many c-sections are unnecessary. "All of the current pressures seem to be going in the direction of more c-sections, not less."
He and other national medical experts are concerned with the trend; a trend they believe is pushed by medical liability issues, convenience for both doctors and patients, and perhaps hospitals' financial and staffing pressures.
"There are some doctors who say the only cesarean section I have ever been sued for is the one I didn't do," Dr. Flamm said. "It's a sad but true situation." Not only is there a decreased chance of getting sued if a c-section is performed, but it's less time consuming to perform c-sections instead of waiting out long and sometimes difficult labor.
Leading medical groups such as the Centers for Disease Control and Prevention, National Institutes of Health and the World Health Organization have all spoken out against the increase, demanding the medical community investigate ways to lower the rate to 15 percent or below. ...Dr. Sandland thought she was doing just that.
In the decade she has delivered babies and cared for their mothers in New Hanover County, she has always had a rate below 10 percent.
"I've always maintained I'm a midwife with a MD behind my name," she said from her two-story Pine Valley home last week while preparing to move. "It's better for Mother Nature to decide when it's time, not the doctor. My philosophy is you don't interfere unless you really have to."
Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was considered too set in her ways or a renegade by some doctors, he admired her talents to deliver naturally in situations when other doctors would have automatically pushed for a c-section. "She was a valuable asset for patients," he said.
Dr. Sandland said she became the target of the hospital's professional review and credentials committees. Because it is confidential by law, she could not legally discuss the peer review process.
Friday, January 25, 2008
Not sure how much longer this Craigslist ad will stay up, but I had to share this with all you birth junkies:
For Sale - beautiful pink "vagina couch" that I made in art school and no longer have space for. The couch is large: measures 5' 3" long, 3' 3" wide at the middle, and stands 2' 3" tall (and is heavy like a couch). The pics are from my portfolio and are several years old; as a result, the couch has some scuffmarks and stains around the bottom from being moved, but otherwise is in excellent shape. A professional upholsterer helped me build the couch, so it is also functional and durable as a piece of furniture. The couch must be picked up in Mendocino, a 3-hour drive north of SF. I am asking for $600 and a loving home! Call Willow at [deleted] or reply to posting.
It's a vulva couch... (I have to say that calling things 'vagina' when it's clearly a vulva is a pet peeve, but that's just me. Eve Ensler? You hear me??)
A good friend of mine sent it to me, thinking that THIS would have been the perfect new couch for my office.
Edited to add:
Here is the entire link on Craigslist. I'm uploading the pics from it and adding it to this entry in case the link goes bad.
Just how do you sit in it? Like you'd expect to sit in a vulva!
Thursday, January 24, 2008
I hope you can tolerate more celebrity news from me!
Jessica Alba, who is currently pregnant, recently told the press in an interview:
"It had to do with breastfeeding, which is the only thing I'm paranoid about, more than giving birth."
Read the entire article and watch the video clip here
We live in a culture that is set up for so many breastfeeding moms to fail. It's no wonder that women naturally believe that breastfeeding is hard and not something that they can do.
Don't even get me started on the weight gain comments - or the fact that a superstar is receiving free gifts from a network. Couldn't those gifts go to a more needy recipient?
I hope she finds solid informed support for her breastfeeding experience. I am pleased to hear that she's at least considering it. Even a week of colostrum/milk to a new baby is better than none at all.
Monday, January 21, 2008
I'm always searching for new blogs that cover healthcare issues for women and children (if you would like to share more, including your own, please do!). I recently found this blog of a midwife and midwifery educator in New Zealand: Carolyn's Blog.
It's a rich, full blog. Enjoy!
...want to add something here. I read a lot of blogs every day. I have about 30 blogs in my Google Reader that I scan and devour in my off time (ha!), typically on my Blackberry while waiting in line somewhere or while nursing the babe. Since the Blackberry offers slow processing I am unable to comment on most entries without it taking forever and losing my train of thought (ADD?). I used to have a list of blogs that I read on my sidebar and didn't carry it over into the new format - simply because I feel weird about listing so many blogs with the risk of forgetting one or five important reads. Which blog do I list first? If they link to me should I automatically link to them?
Ah, the new paths we are pioneering in blogland.
Friday, January 18, 2008
Modern science says that to know everything is to empower. The vast majority of the time, this is very true. I certainly feel empowered when I have complete exposure of facts and truth. The issue I have with standard prenatal testing is the myth that somehow each test that is done will ensure a healthy baby or point out any issues with a baby with special needs. The myth that each procedure (the biggest offenders - the Alphafetoprotein screen and ultrasound - which are not diagnostic, just screens) offers an accurate diagnosis of any issue - and if it's not apparent with these tests then your baby must be ok.
Current evidence shows us that the Alphafetoprotein test, routine ultrasound and the glucose tolerance test all have rather large errors in assisting with an accurate diagnosis. Still, for some reason, these tests are treated as if they are going to make sure your baby is healthy without any discussion regarding false results. If we're really looking at empowering women with knowledge the accuracy rate, along with what the test is screening for and what the path is if an abnormal result is found, should be discussed prior to the test. And women should always have the option of refusing any testing.
We all live very different lives. While some families would choose to terminate a pregnancy based on prenatal testing, other families will not change the course of their pregnancy based on the results. Knowing that for some women the information gained is beneficial, we must also look at what standardized testing can do to many other women (the majority) that are given ominous news regarding what turns out to be a healthy baby.
We cannot ignore the impact of even five weeks of thinking your baby has Down Syndrome, only to find out through an amniocentesis (complete with its own risks) that your baby does not. The emotional impact of that course is huge - even if the woman desired prenatal testing. My issue isn't with the testing alone, but the inability of the medical model to offer full disclosure about testing and it's accuracy. Or how, aside from terminating the pregnancy, there are few if any 'treatments' prenatally for these disorders.
Mothers must choose for themselves what testing they want and why. If the test results will not dictate termination of the pregnancy, care must be taken to discuss how an emotional attachment to the pregnancy/baby will be severed or enhanced with an adverse result. Some people talk about 'getting prepared' while families of special needs babies will tell you that there is no amount of information that can truly prepare you for what you will experience with a birth or a termination of a pregnancy. Those same families can also attest to an emotional detachment that occurs when, knowing the information/status of your baby, you decide to continue the pregnancy.
Prenatal testing involves a family's faith. Each woman, each family must decide for themselves if the accuracy/risks/benefits warrant these tests. For what it's worth, each of my clients receive full informed choice about Chorionic Villus Sampling, Amniocentesis, Ultrasound, AFP Screening, the Glucose Tolerance Test, Group Beta Strep Testing, etc. I've supported - and will continue to support - clients who choose prenatal testing as well as those who painfully choose to end their pregnancy because of test results.
On an emotional levels, we have to consider this: When a provider's office calls with a high positive reading from an AFP screen, does the woman hear anything but "your baby has Down Syndrome"? If she had been educated about the accuracy rates, including the rate of false positives, perhaps she could be more clear in her thinking about the possibility that her baby will NOT have Down Syndrome. In fact, by the time an inconclusive ultrasound comes back after such a call followed by an amniocentesis and the time waiting for results, many women are well into their 22nd or 23rd week of pregnancy.
Here are some great quotes and links for further review on just how standardized, blind (meaning women either don't know what they're being tested for and/or aren't told about the accuracy of the test) prenatal testing impacts us as a culture:
The MSAFP screens for the level of AFP in maternal blood—it is not a diagnostic test.. It is easy to administer and most women choose to accept it. However, research by Carole H. Browner at UCLA Department of Psychiatry and Biobehavioral Sciences, has show that women who ‘choose’ are not always informed about what this test is for and the implications of a positive result, or that it has a high (upwards of 80%) false positive rate. The result is that many women who are otherwise experiencing normal, healthy pregnancies are faced with a positive MSAFP. These women are counseled to consider amniocentesis for a diagnosis.
The readings by Hubbard, Browner and Press and Kaplan all capture the eugenic implications of these prenatal tests in different ways. Browner and Press show how the information provided by the state of California is worded so as to emphasize the "reassurance" provided by the test, and not the fact that so far we have no therapy for the conditions identified by the tests, only termination of the pregnancy. Further work by Browner, Rapp and others have shown that genetic counseling is not as value neutral as we might think. And, as we saw from last week, not all women who desire genetic testing have access to the tests.
These experimental forms of genetic screening are clearly controversial. But even the most common forms of prenatal testing are open to dispute. Despite the matter-of-fact manner in which physicians offer the tests to their patients, their safety has never been scientifically established. Ultrasound, for example, which doctors present as a thoroughly uncontroversial procedure, is still being contested within the medical literature. A classic example of a "creeping technology," ultrasound in pregnancy has never been subjected to a large-scale randomized controlled trial to assess either its safety or usefulness.
The use of AFP tests has a peculiarly nonmedical history. Both ACOG and the American Academy of Pediatrics urged the FDA not to approve early release of AFP test kits in the late 1970s. They noted that in order to detect enough cases of open spina bifida and anencephaly the tests would necessarily have a high false-positive rate-about fifty false positives for every true positive. They recommended that the FDA make its release contingent on laboratories’ ability to coordinate follow-up tests to weed out false positives, a crucial concern in a test parents may rely on in deciding whether to continue a pregnancy. But when the FDA went ahead and approved the marketing of the kits without these restrictions, ACOG’s legal department promptly issued a liability "alert" to its members, urging all obstetricians to offer the procedure to their patients. This, it said, should place the doctor in the "best possible defense position" in the event of a birth defect.
It is also important to realize that most women take these tests without fully considering all of the implications of the test. Most women think of these as a simple blood test, a cursory part of prenatal care. They don't consider that intimately wrapped up in the question of prenatal testing is the moral dilemma of abortion and the thorny issue of eugenics. Barbara Katz Rothman points out:
The history of prenatal diagnosis has roots in the eugenics movement...part of its history has been an attempt to control the gates of life: to decide who is, and who is not, fit to make a contribution to the gene pool.
Katz Rothman is by no means arguing against the use of prenatal testing; she actually presents a number of compelling reasons to consider it. Her writing is a fair and balanced look at the intricacies and difficulties of this issue. But she has found through extensive interviewing of parents involved in such testing that most of them were simply unprepared to confront the scope of the types of decisions presented by prenatal testing, and that choosing such testing often changed the way a woman experienced pregnancy in subtle ways.
The emotional effects of these prenatal tests have not been well studied. This means you need to take responsibility for figuring this out for yourself and for your family.
One of the most obvious effects of all of this testing is that it serves to "medicalize" your pregnancy. Trying to turn a healthy pregnancy into a medical experience can cause unnecessary worry and a tendency to avoid bonding too soon with the developing baby until it is "certain" that everything is okay. Going through these tests can make it easy to forget that birth is a normal process and does not need to be frightening. And remember-none of these tests is foolproof.
In fact, being forced to worry about conditions that ultimately work themselves out (like early diagnosis of placenta previa, for example, picked up in a routine ultrasound) can have negative effects. It is hard to shake off the anxiety of wondering whether everything is okay. Waiting two weeks for the result of an amniocentesis can be very stressful, even if you have every reason to believe that you and your baby are healthy.
Parents who are especially jittery, and think they might feel better after having these tests, need to consider this information even more carefully. You might think that prenatal tests will provide you with a sense of security, but unless there is a true indication of high risk, these tests can be misleading. You can find security by discussing your concerns with your healthcare provider, who will take the time to listen and explain, and by talking with your partner, doula, or friend.
Many women have testing done even though they have no intention of terminating an abnormal pregnancy. This is often because of pressure from family and friends to "find out" if everything is OK, even though these tests offer no guarantees. It can take great courage to say no under pressure. Remember that having prenatal tests done just to appease your family or partner will have consequences for only you. You must carefully think through each step of this decision, and review the possible consequences of prenatal tests, before you decide if they are right for you.
Reading that I recommend to every woman interested in how prenatal testing impacts women and impacts what we perceive as a 'better outcome' in maternal/fetal health include:
Expecting Trouble: The Myth of Preantal Care in America by Thomas Strong, MD
The Tentative Pregnancy by Barbara Katz Rothman
Which Tests for My Unborn Baby? by De Crespigny and Dredge
Informed choice and full disclosure should be the standard in maternity care. We also owe it to women to have an understanding about the impact of prenatal testing on the feelings towards their pregnancy, towards their baby and the choices made along the way.
Wednesday, January 16, 2008
I wanted to create a list of some of my favorite blogs and websites. Hopefully some will inspire you!
Jennifer Block's blog (author of Pushed)
The True Face of Birth
Tina Cassidy's blog (author of Birth: The Surprising History of How We Are Born)
Hathor the Cow Goddess
Radical Midwife (in the making) - the title is misleading. There is no 'in the making' - this is my wonderful apprentice/assistant and she came to my practice already a radical midwife! She was, and still remains to be, an inspiration to me
The Human Pacifier
Jennifer Tipton's blog
Now for some non-birth-related links:
Etsy.com - inspires me to no end!
K Records (Tender Forever is my new favorite find!)
Tuesday, January 15, 2008
"Technological obstetrics makes the assumption that more knowledge is better, but, like Eve's apple, the knowledge that we gain through prenatal diagnosis can cast us from our pregnant paradise, with major and long-lasting sequellae for mother, baby and family."
— Sarah Buckley
Sunday, January 13, 2008
Both babies that were expected in December-January have been born. Both boys. There could be more to add about either birth and postpartum, but I haven't gotten around to asking for permission to share.
Working hard to keep up with all the demands of life. You know how it is - we all know how it is. Having the computer in the basement has limited my online time - but I am working on getting some childcare a couple days a week to help move everything forward.
Can I just tell you how grateful I am for the clients I have? It's hard to feel too stressed when you enjoy seeing and working for all of them!
Monday, January 7, 2008
Please help Barbara Harper keep waterbirth alive
Waterbirth International may close doors. Here is a note from Barbara Harper of Waterbirth International
Barbara Harper wrote:
I cannot yet imagine a world without the voice and work of Waterbirth International - we get calls and emails every day from women who need help convincing one hospital or another to let them labor or birth in water. If we die - a big part of the movement dies. Waterbirth has shown us all that women know how to give birth and babies know how to be born. Waterbirth gave us "hands-off", sit back and let the baby out. I see waterbirth mentioned on Blogs every single day, not to mention Baby Story on the TV. I took Waterbirth International to ACOG two years in a row - and was the ONLY booth showing birth films to obstetricians and especially to student physicians. There were tears, laughter and outrage - just the thing to stir up those young crop of doctors.
I am finally realizing a life's dream. But now I am faced with letting this dream go. Perhaps I have done enough. Perhaps it is time to quit.
About 18 years ago, maybe it was longer, when Mothering Magazine was facing bankruptcy Peggy did a heartfelt plea asking their readers to consider ordering a Life-time subscription. I think the subscriptions were $1000 or $1200, I can't remember now. I do remember that I couldn't imagine not reading my Mothering. So, I bought two and gave one to my obstetrician's office.
How can you help us stay open to take the next phone call? - to convince the next obstetrician to incorporate waterbirth into his/her practice - to work with the nurse midwives to install pools in their facilities? To educate an entire hospital on the benefits of allowing women freedom of movement in the water. How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen. Do women really want waterbirth to be an available choice in every hospital? I think so.
Can you help us by getting the word out on blogs and lists? I had to let go of all of the staff except one person to process orders. Miraculously, we made payroll today, but we can't hang on much longer. We need a miracle.
If I need to call every single waterbirth parent personally, I will. I don't want 25 years of work to end over a measly $200,000. The work that we have done the last few years has been phenomenal. How God arranged for me to teach in hospitals and medical schools around the planet - Taiwan, Venezuela, Turkey, Mexico, Canada, Holland, Portugal, China, Trinidad, Croatia - I'll never figure that out. I laugh out loud sometimes when I get up in front of an audience of physicians in a medical school
overseas - who all want to hear about waterbirth and the incorporation of Gentle Birth practices and principles into their routines.
Think about what you can do and call me if you want to chat or if you have some great ideas on how we can quickly move into the black and keep waterbirth alive and thriving.
We need your help. Barbara Harper needs your help. The waterbirth/gentle birth movement needs your help.
Barbara Harper, RN, CLD, CCE
503-673-0026 -office (out of US or in Portland)
800-641-2229 - toll free
503-710-7975 - cell phone
We LOVE helping women get into Hot Water!!
And have been doing it for 24 years!!
Can you spare three days to challenge yourself, rejuvenate yourself, learn more than you imagined, and walk away with a new approach to birth, life and your own journey?
The Trust Birth conference includes some of the most powerful voices in unhindered birth:
Sarah Buckley, MD
Michel Odent, MD
John Stevenson, MD
Hathor the Cow Goddess
I have been to midwifery conferences that essentially feature the same speakers, the same messages, the same level of enthusiasm. The Trust Birth Conference has created within me new emotions about a conference: hope, faith, excitement, awe, joy and peace.
This is a conference that really walks the talk: there is no hiding the truth, no "birth is safe, yes, BUT...." - these are people who honor the truth in birth, even when that requires recognition of when birth moves outside of normal.
I don't know that I've ever been this excited about a birth-related conference. I'm thrilled to meet all these people - and the people attending. I'm ready to be surrounded with others who can teach me and who will stand with me for the rights of women and children everywhere!
Please, please join us. I am speaking on a panel titled "Transitioning to Trust Birth Midwifery", giving a talk on "More of Them; Less of Me!" (basically my journey from being anxious about birth to learning how trusting the process - and parents - has empowered me personally), and a talk on "Hands Off the Perineum!".
I know that, despite my biases and strong beliefs, I will be hugely challenged at this conference. It's what I want, what I need. It's what we all need.
Are you ready for it?