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.