Thursday, January 21, 2010

Being "With Woman"

I've been working on a post about cesarean birth plans as well as how doulas fit into a picture that includes a cesarean, but I just can't concentrate on it. I'm too distracted thinking about a laboring friend of mine. Forgive me if this post is rambling and unfocused and more emotional than usual.

Obviously, I am pro-midwifery as a matter of principle, of course, and the ones I have met and encountered personally have all been wonderful, but I realize that this still does not mean all midwives are wonderful, deeply ethical, and compassionate people. There are bad apples in every profession. And unfortunately, I think my friend got one of them.

She has been coping with really difficult prodromal labor for a few weeks now. Her midwife is dropping her from care as of midnight CST, as she hit 42 weeks today. Now, this much is understandable, as regulations in the states that license midwifery require this. If she wants to keep her license, her hands are tied. I completely and totally get that. But this midwife is also refusing to shift into a supportive role, as is standard among home birth midwives upon transfer of care. This blows my mind.

Usually, when transfer of care happens, midwives will shift into a doula-like role (with the exception of the 11 illegal states, and my friend is not in one of them). This is true whether the transfer happens in active labor or whether care has to change hands prior to onset of labor. *I* was facing a scheduled section for a good chunk of my pregnancy, and my midwives didn't bail on me; in fact, they made it crystal clear that they would continue to be my allies throughout the whole process. Nancy literally said, "We're not just going to abandon you!" The explained all the things they could do to help me through the process (holding the baby to my chest if I was shaking too badly from the anesthesia, helping me get started nursing, running interference, helping dad deal, and so on) and make the absolute best of the situation if it came to that.

This woman actually said, point blank, "I'm a midwife, not a doula." I call serious Code Mec on this.

But let's back up a little more. This entire two weeks that my friend was coping with prodromal difficulty, the midwife somehow missed the fact that the baby is POSTERIOR. (For those who don't know, a posterior baby is in a bad position, causing slow progress and back pain for the mother.) This was discovered today by her apprentice (not the midwife, who never came over to see her at all today, this day being the last that she had a chance to deliver at home). My friend had gone the castor oil route yesterday, and things seemed to be picking up for a while - her water even broke (clear fluid, too, which is great). But then things slowed down again. Lo and behold, the apprentice immediately ascertains that she's posterior. So of course she's not progressing well, the head isn't engaged and pressing down on the cervix. How the HELL did the midwife miss this?

There ARE things you can do to turn a posterior baby, and I was talking to her about some of them . . . but these things (and also other measures that are no longer feasible, like chiropractic care) would have been much more helpful TWO WEEKS AGO, when her midwife SHOULD HAVE PALPATED THIS! I guarantee you the baby didn't just flip into posterior yesterday. So the midwife could have done something about it anytime within the last two weeks, but now, wouldn't you think she'd try to work with mom just this little bit longer, to try and help, and give it one last good shot (especially with ruptured membranes), to help with positioning, exercises, work with a rebozo, whatever? Keep an eye on mom's temperature and blood pressure and baby's heart tones (all of which are currently just fine)? Especially since she herself contributed to the situation by not picking up on an easily-identified malposition? And further, then recommended castor oil without verifying fetal postion first?


"I'm a midwife, not a doula." Are you even kidding me? Lady, let me remind you that the translation of midwife is simply "with woman". It does not mean "Almighty Birthing Empress Who Must Be In Charge, Or Else Might As Well Not Even Show". It just means being with her. I don't see how this can't evolve with the mother according to her needs, within the very definition of the word. Once again, it is completely standard for midwives to assume a supportive role upon transfer of care.

This is what happens when access to midwives is so limited - this woman is the only game in town for home births, so she can practice as uncaringly and, in my opinion, unethically as she wants.

Can you tell I'm pissed? I considered not posting this, as it's very emotional and personal, but if I'm going to be critical of many doctors and so many standard obstetric practices, it wouldn't be honest of me to not express this, too. So here's proof that I can dish it out to more than just OBs.

Okay, calming down, now that this is out of my system (sorta), I am focusing on sending my friend good energy over the miles. Please send some energy or prayers or whatever you do her way. Be "with" this woman in whatever way you can.


  1. I'm glad you did post this; it's important that people be aware of what should be avoided in any set of options. I have more to say, but I can't seem to make the words into anything but incoherent ranting about that awful midwife. Can you sue a midwife for malpractice or anything similar?

  2. I can understand why you're upset. Now that your friend is 42 weeks, I imagine it's pretty difficult to get a baby to turn facing the right way. Is it even possible after the water has broken?

    You're right that she should have the support of her midwife. You'd think they'd be friends by this point, at least enough so that she's there for her through however the baby comes out.

    I have my c-section birth plan on my blog. Almost everything on there are things that I did with my 4th. c-section birth. There will probably be a few changes for #5, but all in all it's worked well for me.

    Sounds interesting about your post with doulas during c-sections! I wish I had someone like you to come and keep me calm during surgery.

  3. UGH, how terrible. :( That midwife is not a midwife, she is a disgrace. I hope your friend demands at least a partial refund since she has refused to be a part of the birth even as a doula! And she should also go to that website that has the birth survey thing and fill out a thing about this midwife, so anyone else who goes to her for care can be warned! I'm disgusted!

  4. I agree with Jill. That midwife is providing terrible service and deserves a poor review.

    I'd also be interested to know if you can turn a baby from posterior after the water has broken. what would be the technique?

  5. Thanks, you guys. Unfortunately, here's the thing: my friend wants to become a midwife herself, and like I said, this woman is currently the ONLY home birth midwife in town. There's a birth center, which she was actually planning to go to originally, but they were so disorganized and unprofessional that she felt completely uncomfortable with them (I would have too, based on what she told me). Then she switched to this midwife. SO, in order to not ruin necessary future relationships, she feels like she can't even say anything. *I* say she move away from there anyway, and come live near me - and then she can speak her mind. But unless she does, it's a really uncomfortable situation. It's pretty messed up that she even has to be thinking about this right now. But, Jill, thank you for the reminder about the Birth Survey. At the very least, she can do that. In fact, I think I'll do a little reminder post for every woman right here in a bit.

    Morgan, if you could see my draft, you'd see that you're already ALL OVER this post. :o)

    Anyway, my friend is currently in the hospital. I haven't been able to get ahold of her so far, but I'm going to try again in just a bit here.

    Anthro Doula, if the water had broken and the head was engaged fully as a result, then it would be much more difficult. But the head is not engaged - the primary the problem in ineffective dilation, but it's also kind of a gift in terms of meaning that turning is more feasible (especially if A CERTAIN SOMEONE were willing to work with her more, but alas). A combination of the knees-to-chest on all fours position ("happy puppy" in yoga speak) plus alternating sacral pressure and the double hip squeeze can do it. I was recommending the double hip squeeze in particular; it can be done with one person (for an xxxtreme pectoral workout) or with two people, ideally. While she is on all 4s/knees & elbows, press in and UP on her hipbones (the ileum), which opens up the pelvis on the bottom. This site has TONS of great suggestions. All of which I wish we had been doing 2 weeks, or even a week, even a few days ago.

    I have half a mind to submit the "I'm a midwife, not a doula" quote to My OB Said What?

  6. Any updates? I hope your friend and her baby are doing okay. Thanks for telling me about your other blog!

  7. I am still sometimes bitter that no one picked up in my posterior baby, including my doula, apparently until I had my c section. And that was after 37 hours. After 2 weeks, I just don't know what to say. I hope things go well, I'll be thinking of her.

  8. So by dropping her do you mean that she's not going to be there for postnatal care and baby follow up too? Wow, I find that pretty shocking. I had an emergency c-section and my midwife was in the room with me holding my hand and leading me through visualizations. She wasn't allowed to do of the post-natal care on the baby while we were in the hospital of course but she was there for me, everyday. Even if I had gone over 42 weeks (which I wasn't even close to) I can't imagine my midwife "dropping" me like that. Even if it was regulated for licensing. I mean the birth I can understand, but all the other stuff too? C'mon!

  9. Morgan, I don't have a clue, unfortunately. She went into radio silence after I talked to her last night, when she was packing up for the hospital. She doesn't have a cell, and I'm guessing the hospital doesn't have wireless. I am KICKING MYSELF for not getting more info from her on which hospital she was going to (I've called every single one that I can find an online listing for in her area, and she's not a patient anywhere that I've called), but I think we were both assuming she could call me from her room, not thinking about it being long distance. D'oh. I'm pretty stressed about it.

    Renee, I will ALWAYS be on the lookout for OP babies as a result of this.

    Melodie, staggers the mind, doesn't it?

  10. My "medwives" (and how I loathe that term but that's really what they were to me!) did not pick up my posterior baby with my first pregnancy either. It wasn't even figured out until I had been pushing for 4 hours already. The OB tried to turn him, but duh, his head was so firmly impacted in my pelvis it was useless. I get so frustrated just to think about it, especialy considering how obsessed my homebirth midwives were with assessing fetal position.

  11. For those following this, I have WONDERFUL news. I finally got in touch (long story) and got through after a few tries. My friend's beautiful daughter was born at 9 Friday morning, at 7 pounds 4 ounces!

    In an extreme nutshell, she was able to get some relief from the epidural, and with some stimulation (really not that much, considering), was able to push her out on hands & knees! She has latched on and is doing just wonderfully.

    I'm looking forward to reading her full birth story! There is so a time & place for everything, it just goes to show. I am SO AMAZED at her resilience and at her courage.

    Anyway, had to pass it along.

  12. Good for her!! I'm so happy to hear that.
    I will always be watching for it too, hopefully someone can benefit from the lesson I learned. It seems so strange to me that with positioning being so important and the things we can do to try to fix it being pretty simple, that so little attention is paid to it in the hospital. Unless the baby is breech, and we know where that leads. I wonder what the stat is for OP leading to C section. I heard at some point and I believe it was fairly high.