Friday, April 20, 2012

How My Birth Was Kicked By a Horse and an Imperfect Midwife

Copyright JSH 2007
I recently read a scathing article about how the natural birth and homebirth community will blindly support any midwife no matter how much she sucks. I'm not going to link the article because, while I do agree with actual point of the article, the overall tone is very anti-midwife to the point of seeming quite unbalanced. The extreme unbalanced view detracts from the overall message and I know people will dismiss based on that.

I agree that there are people out there who will defend a midwife no matter what the charge. As long as she is a midwife she must be innocent. I've seen it plenty of times out here on the internetz. A midwife commits obvious malpractice, but she ends up with tons of supporters who want to pay her legal fees, take shots at the grieving parents and brush her actions under the rug. We're not doing ourselves any favors by pretending that doesn't happen. Part of me wonders if the reason we are so quick to defend these midwives is because we fear that bringing their wrong actions into the spotlight can jeopardize the field of midwifery and the legal rights of homebirthing parents. I can see that being a very real fear in the minds of homebirth advocates. As it is, people who are against homebirths and midwives altogether will chomp at the bit to highlight a case of malpractice. They live for these stories. Still, it is absolutely no excuse to gloss over stories of midwife negligence and homebirth loss. Doing so makes "us" (the natural childbirth community) look irresponsible. We are doing other women a disservice by trying to hide the truth.

The fact is, pregnancy has the potential for problems. Birth has the potential for complications. It's part of life. Medical issues arise. Death does happen. Problems absolutely happen in hospitals all the time - everyday, but they happen at birth centers and homebirths, too. There are plenty of incompetent and cold hearted obstetricians out there who have caused more harm than good. The same goes for midwives. There are folks out there who believe every midwife should be put on a pedestal and never questioned. I'm sorry, but there are crappy midwives out there. There are midwives who really don't know what they are doing and who put their patient's lives at risks. There are midwives out there who ask their patients to hush about things that went awry during their birth so authorities get involved. There are midwives who are known as "medwives" and don't really follow the Midwifery Model of Care. There are midwives who are irresponsible and lazy and who don't have the best interests of their patients at heart. We can't just automatically assume that someone is perfect because she is a midwife, yet that is exactly what happens in some of these cases.

I don't want you to get the wrong impression here. I am not, in any way shape or form, saying there is something wrong with the practice of midwifery overall. I am a very strong and vocal advocate for midwives. I believe we need to expand access to midwives in this country and we need to knock down the barriers (such as lack of insurance coverage or anti-midwife laws or anti-homebirth laws) that prevent women from accessing midwifery care. I believe a good majority of women could benefit from the midwifery model of care in pregnancy. I completely heart the profession of midwifery. Who knows, I may be one someday when my children are grown. If you've read my blog for a while, you know that I firmly believe women should be in touch with their bodies and know how things work in uterus land in order for them to be more empowered regarding choices about their reproductive health. Having a baby is a pretty big deal and we should not walk into the experience with blind trust for anyone - whether they are an MD, DO, CNM, CPM or DEM. It is certainly up to parents to be informed and well-researched when it comes to pregnancy and hiring folks who will help with that pregnancy. Again, we just can't blindly trust someone because of their credentials. In the natural birth community, there is a TON of criticism when it comes to women who don't question doctors simply because they believe all doctors know best all the time. Yet, when it comes to questioning the decisions and actions of midwives we are noticeably silent. This hurts our cause more than it helps it. It allows people to say, "you see? They are a nutty cult. They don't care about the mother or the baby. All they care about is the midwife and the homebirth." We can't allow that to happen anymore. You need to look past the letters behind a person's name and do your research. Empower yourself.

I'm a licensed veterinary technician. I have a big place in my heart for my profession. I am proud of it and I want to see it advance. However, I wouldn't trust someone just because they are a fellow veterinary technician. I have known some really crappy technicians in my day. I have worked with technicians who are not allowed, under any circumstances, to touch my animals. The same goes for veterinarians. I'm not going to blindly agree with someone just because they went to vet school. If there is something I find questionable, I will speak up. Again, there are veterinarians who are not allowed to touch my animals under any circumstances. This doesn't mean that I have a lack of faith in veterinary medicine. Far from it. It means I am proud of my field, yet I know perfection doesn't exist and their are lousy vet techs and vets, just as there are lousy human doctors and nurses. It's not an attack on any one profession. It's an acceptance of reality.

I have been interested in natural birth since I was a teenager. My mother worked in maternity care for 35 years and I was raised knowing that birth is a normal and natural process in life. My mom saw birth, babies and boobies everyday, but I didn't get horror stories. I got truth. I learned that breastfeeding was normal, too. When I played house or barbies with my friends we pretended the babies were born at home. And they were breastfed. Nothing scary. It wasn't until my teenage years that I really became a fledgling birth advocate. A few friends of mine in high school had babies and I got to see what they went through and there were some things that never sat well with me. Baby Story became popular on TV and those episodes showed me exactly what I didn't ever want for myself. One night, in the cafe at Barnes and Noble, I noticed a copy of Mothering Magazine. I picked it up and read it cover to cover. Everything in it resonated with me. I remember flipping pages and saying, "yes! yes! yes! I agree!" out loud and attracting looks from my boyfriend and other patrons. I took one of the little subscription cards, filled it out and popped it in the mail the very next day. I wasn't even out of my teen years, I was a good Catholic girl (read: virgin) and didn't have any kids, but everything in that magazine was what I wanted for my future. Within months, I had devoured natural birth books such as Gentle Birth Choices, Having Your Baby With A Nurse-Midwife, Spiritual Midwifery, Birthing From Within and more. I remember seeing a homebirth on A Baby Story and tearfully realizing that I wanted a peaceful birth like that. I knew that I wanted natural births, midwives and breastfeeding. It began there.

A few years later, when I was 19 or 20, there was a women's health expo at the mall. A local birth center was handing out information and business cards. I walked up and asked if they do regular gynecological care as I didn't intend to have kids for years. They said absolutely and my relationship with that birth center was born there. The birth center was owned by one midwife who had been practicing for 25 years. She was an Ivy League grad CNM with a few fancy degrees (including bio-engineering). She operated with one other midwife. She went through 3 or 4 different partner midwives (including my best friend) during my 8 years as a patient. From my first appointment, she knew my deal. She knew I was a birth nut and she was so happy to share her wisdom with me. I went in for my yearly pap and she happily discussed birthy and natural parenting stuff with me. When I became pregnant there was no question what I wanted. I wanted to give birth at the birth center.

I was seen at my first appointment by a new midwife on staff. We discussed birth plans and toured the rooms of the birth center. My new midwife - now my best friend - told me I had to get clearance both from my cardiologist and a perinatalogist from a local hospital in order to birth in the birth center due to my minor heart conditions. Fine. I saw my cardiologist several times during my pregnancy and he was totally fine with me giving birth in a birth center (and at home for my subsequent birth - love that man). I saw the perinatologist during my 8 week ultrasound and she cleared me, especially since I was under care of my cardiologist. Next. At 24 weeks, I got hit in the belly by a horse. This was not the first time that equines would hurt me this pregnancy. I was at work when a horse came in with colic. He was placed in the stocks (like a horse cage, for lack of a batter description - keeps the horse stable and keeps us from getting kicked while evaluating him). He was in a lot of pain and fought us quite a bit. I let other technicians lead him into the stocks and get him set up. One technician was holding his head steady for me so I could place a catheter in his jugular vein. She let her guard down and he swung his head (because he was hurting from the colic) full force right into my belly. Long story short, I ended up in the hospital and I still have no clue how that little boy survived such a direct and hard hit by a several hundred pound horse head. Being in that hospital was awful. They strapped the fetal monitor on me and I was to lay in bed for four hours while they monitored for contractions and other problems. I was in so much pain because I couldn't get up and move around. At my follow up visit with my midwife, I told her how horrible it was to be in that hospital bed and how I couldn't imagine how women in labor managed pain when they couldn't move. She told me not to worry because I wasn't going to have my baby in the hospital. Yay. My pregnancy progressed normally until the end of my eighth month when blood work revealed anemia. They won't allow you to birth at the birth center if your levels fall below a certain number. So, I ate iron-rich foods, cooked in cast iron, took Floradix, stayed hydrated and got my hemoglobin up to a nice happy number. Yay! Then, my blood pressure crept up and I started to swell. I was borderline pre-eclampsia. That risked me out of the birth center unless I was able to get my blood pressure under control. So, I ate tons of protein, drank lots of water and exercised in order to get my blood pressure under control and steady. And I did. Yay! From my heart issue to the anemia and  blood pressure, I had nearly risked out of a birth center birth three times. I was happy that I overcame those issues and that I would have my birth center birth.

When I realized I was in labor on July 13th, I called up the birth center and alerted them. They told me to labor at home as long as I could and they'd see me at the birth center later on. I stayed home for a long, long time. They would call me now and then to check on me and all was well. We headed to my parents house since they lived very close to the birth center and it would be more convenient to drive 15 minutes in harder labor as opposed to one hour. I called up two friends who would be attending the birth. My mom had made zita, cookies, brownies and other goodies to bring to the birth center. She also had snacks, energy drinks (Recharge!) and Red Raspberry Leaf iced tea ready to go. I had spoken to the owner of the midwife later in the evening - around 9:30 pm. My contractions had grown a little more intense and were getting closer. She wanted me to have a good run of contractions three minutes apart before heading to the birth center. She told me to page her once they were a little bit closer and that they would meet me at the birth center. Ok. It didn't take more than an hour for my contractions to pick up so I paged her. I got my bag all packed up and my parents started loading their car with food and supplies. I called my friends and told them to head on out. Got dressed. Peed. Got my shoes on and was literally walking out the door when the phone rang. It was the associate midwife, my best friend. She said she was at the hospital and just finished another birth and that the other midwife, birth center owner, was not going to be available tonight. They have a policy that two RNs must be present at the birth center for a birth. Their back up RN was on vacation. I would have to come to the hospital. Now, with my regular personality, I would have likely told Lauren off and made some demands. Haha. As it was, I was weak, surprised, scared and I did not have the willpower to say, "well, fuck y'all then, I'm staying here and having my baby at my parent's house." I had to call my friends and tell them not to come because the hospital only allowed a certain number of people. All that planning for a birth center birth. All the peace that I had that day was out the window. My 15 minute drive to the birth center was now a 45 minute drive to the hospital thanks to some fucked up road construction and closures. I immediately shut down. I had not feared labor or birth at all until that point. Now, I did. Up until then, my contractions were totally manageable and barely painful. Now, they hurt.

My best friend midwife  met me at the hospital. The other birth was done so she was all mine. She knew it was so fucked up that I was put into this position. She was powerless to do anything. She couldn't force the owner of the birth center to open the birth center for me and she would risk her job doing so. She promised she would make my hospital experience as good as a birth center experience. Now, hold up. I know what you are thinking. You are thinking I am one of those women who thinks the experience is more important than a healthy baby. A healthy baby is all that matters, right? I'm not one of those women. The health of the baby is of the utmost importance. There is no denying that. But, to dismiss the birth experience as if it couldn't possibly have an effect on the mother's psyche is downright dangerous. Telling women to keep quiet about their dissatisfaction,lest they be seen as ungrateful for their healthy baby, is harmful and can lead to depression. When you have planned for something for so long and the rug is yanked out from under you at the last moment there is going to be some emotional fall out. We need to respect that fact. As for me, I stalled my labor. I resisted my body. I resisted working with myself. Eventually, I had to give in. I knew I couldn't change things and I'd be damned if I let being in a hospital ruin things. I worked through my labor. My midwife hardly left my side. It WAS a peaceful labor for the most part. Transition was a bitch, but I worked my way through that. My head went back into panic mode as it came time to push. Suddenly, my dark and quiet hospital room was flooded with lights, most of which were pointed in my direction. A staff nurse came in and started yelling, "pushpushpushpushpushpush" until I bit her head off for it. Seriously, it's one of my pet peeves. I screamed a lot. As I've said in another blog post, I often wondered if my screaming was also due to the frustration that I didn't want to be there with those lights, those hospital smells and Nurse PushPushPush, RN. I was reclined on my back where I did not want to be, but lost the emotional and physical strength to change position. I wanted it done and over with and I pushed super hard and tore - 3rd degree. Of course, I was awash in love the second my son was born and it didn't matter where I was. I did. I gave birth naturally, in a hospital. I didn't let their staff touch me, other than Nurse Pushy-Poo, and did it all with my midwife. Yay. That was short-lived because the aftercare in that place sucked hairy monkey balls. I have those details in another blog post if you would like to read it.

I found out later why I was in the hospital. The owner of the birth center loves one thing more than birth - horsies. Fancy little Arabians. There was a horse show that weekend and she wanted to participate. She didn't want to have to stay awake all night with a laboring woman. She knew I was a first time mom and would likely take a while and she wanted her sleep. I have no issue with a midwife having a life - but that's something you should have told me when you spoke to me at 9:30pm that night. Instead, you said you would meet me at the birth center only to change your mind within the next hour. That is entirely irresponsible and hurtful.

It wasn't until years later that I was able to process all of my emotions from that birth and face the anger. I stopped going back to that birth center. My other midwife left. I heard stories from other women in the community who had similar experiences - left to transfer to the hospital because the birth center owner didn't feel like attending the birth that night. There are other angry women out there. When people ask, I am honest. I do tell them it's the only birth center in the hospital and she is one of the few CNMs who attend homebirths in the area, but she is burnt out and she does have a reputation for letting mothers down at the last minute. She is a good midwife medically, but she is imperfect and there is potential that you will be let down.

My story is nothing compared to those who have lost babies at the hands of an incompetent midwife. I can't even begin to imagine the pain of losing a baby due to the negligence of someone else.  Such actions should not be defended without just cause if the only purpose is to save face in the natural birth community. My story is to show that I understand that being a certain profession does not make one perfect. I know firsthand that you can be let down by a professional who you trusted. We cannot blindly follow someone simply because they are members of a profession that we admire. We can't defend them just because we don't want anyone else to question us. We need to be aware that there is occasionally some bad mixed in with the good. When we realize that, we give ourselves the power to make truly informed decisions and to help others do the same. I was a little blind with my first child, but then my eyes were opened. I left the birth center as a patient after my best friend midwife resigned. I thoroughly researched my next midwife, who is very well known in the local birth community. Oddly enough, she used to work at the birth center and saw me as a patient once - years before my first pregnancy. She also delivered my best friend midwife's 1st and 3rd kids.

Let's not do a disservice to our sisters. When we know something isn't right, call it out. We talk about empowering one another all the time, but that goes both ways. If we know a birth professional - midwife or doctor - who does not serve the best interests of their patients and/or who practices poor medicine then please make others aware. That's true empowerment.


Amanda said...

I'm so sorry that your birth was derailed like that. That was incredibly disrespectful of that midwife. I think it's awesome that you can tell your story in such a respectful way. I agree with you completely. Being a midwife isn't a free pass to behave however you wish, just like being an OB isn't a free pass.

Heidi Faith said...

You raise a lot of important - and balanced - points in this article, and I'm glad that you put this together. Yes, the mother's emotional well-being is definately important in a birth, and finding the balance of honoring that with recognizing the importance of the safety of the baby can seem a difficult thing to articulate (and providing for this balance is different for every birth). You did that very well. (:

You also raise the important point that planning for an out-of-hospital birth means that moms should plan for an in-hospital birth too, just in case. That was so extremely terribly unfair what happened during your labor. :(

I also agree that it's not just midwives who need to offer better compassion to mothers who do not get the outcomes they desire in birth, but it's any and every professional who is involved in birth in any way.

Thank you for sharing your heart - I really enjoyed reading and learning from you.

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