In midwife circles, the poor medical care for birthing women in our country is well-known, but among the general public it's still assumed that the US has the best results possible. It's time we wake each other up and talk about what's being done to mothers in the delivery & operating rooms, and what effects this has on women's health for the rest of their lives.
Aside from underreporting maternal deaths, or attributing them to a different cause (like saying a woman who had a cesarean died from an infection, when the major infection wouldn't have happened without the cesarean) there have been problems in the past with state death certificates lacking a field to record whether a woman was pregnant within 6 months prior to her death. This means we have no idea what the U.S.'s actual maternal mortality rate is.
This is from the above article:
“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there are another 10 morbidity cases related to childbirth.”
When they say 'infection', they're not talking about a yeast infection here, it means a systemic on-your-death-bed infection, an infection from your bowel getting nicked during surgery, or an infection from a catheter left in for hours and hours that progressed all the way to your kidneys.
Now I know that pregnancy, birth, and postpartum is not always smooth sailing, but seriously, that's a LOT of injured women.
The most revealing part of the article was this quote from Dr. King who leads a special inquiry into maternal mortality for ACOG - he still thinks we're just getting better at counting.
“ 'I would be surprised if there was a significant increase of maternal deaths,' said King, who has not seen the California report."
Without even seeing the report! I'm not sure how the leader of a special team designed to see these reports could have an opinion without doing his job. Keep in mind, he's working for the foremost organization in America involved in maternity care. We're in good hands (heavy sarcasm).
I received an email from a mother I worked with. After I wrote her back, I realized that it was something I wanted to say to all the women I've ever assisted in the journey of childbearing. Here is my response:
I am filled by your words and they help remind me of who exactly is on the other end of the work I do. I recently described the life of a midwife as an avalanche where I myself am trying to keep from getting swept under. It is wonderful to have your thoughts to reflect on and they cause me to pause and remember the meaning of my work.
I am honored to have a place in your life, and you have a very special place in my life as well. I've tried to solidify in my mind what it is like to care for you as a midwife, when you helped and mentored me into becoming one. It is a circular experience where the receiver is the giver and around and around. This cycle is born out in the natural world where the death of one organism gives life to others, and in our own generational cycle when our aging parents come to rely on us like children and infants for their care and we are required to give back all that we were given in ways that we as parents could never conceive of needing from our children.
I learned a lot from our relationship about the sacred vulnerability that exists in pregnancy. It is a reality. Most childbearing women feel vulnerable and in lots of ways they are. What a special trust given to care providers who must hold a woman delicately so that her strength is exposed and her growth is allowed for. In the past I feared and condemned the medical model of care, but I have a healthy respect for their role since becoming a care provider myself. Now I find myself mostly shocked at our societal naivete and recklessness in trusting the most tenuous states and delicate moments of our lives to those who are gruff, depleted, calculating, impatient, inconsiderate, overworked, callous and unknowing. This may sound a little cliche but it's not abstract or theoretical for me like reading Suzanne Arms was 5 years ago, I live this everyday and I see the effects on our whole world. We have relegated the sacred moment when new life is created to a jail of machines and foreigners and drugs. We fear the essential power of creation and do not understand it's proper place in our daily lives. These miracles are for witnessing. These gifts are ours to experience and enjoy. It is our birthright.
Little June-bug was much awaited and she came in her perfect time. Both mama and midwife were so tired after an intense labor but it was worth it. We had a birth team of 5 people, coordinating their support and helping this mom and baby get through the waves and waves of contractions that just kept coming. No breaks. Until the wonderful moment of pushing.
I consider this mother a friend, and I'm in awe of her trust in her body and her baby to know what to do. That wasn't easy. It was hard to be patient waiting for the labor that seemed like it would never come. But babies DO come out, and I'm convinced that they will come at the right moment for them and sometimes not a minute too soon.
I've been in the birthing world for a while now, but tonight I realized just how long. As I was wandering through the church history museum (on an excellent personalized tour), I saw a familiar face which turned out to be the husband of one of my very first doula clients.
I supported them through the birth of their first baby while I was in the early years of midwifery school. They've since had another baby out of state and it was so neat to see their little ones, and how much their oldest has grown. Guess how old she is.
That's right, I've been at this for five whole years and I still love it.
I got to help a lovely family receive their healthy newborn, and witness the making of a big brother. If you look closely you can see him hanging onto my glove. And there's always the honor of spending a birth day with my dear friend.
I also got a picture, and therefore, a reason to post (finally).
I met this lovely family in dire straits. Close to her due date and with her first labor lasting only a few hours, G and I didn't have much time to get to know each other, but our trust was built quickly. She called one night just after midnight with something like gas pains and I rushed right over, luckily I live close by.
Just over an hour after she called me, her baby was born in the bathtub without water (a shower had been running previously) and this little boy woke to his new baby brother.
I have come full-circle with my very first client. It was a beautiful and rewarding experience caring for her and her baby, and I'm sad to say goodbye.
I met S and her family last summer. As a third time home-birther, she taught me many things about beginning my new practice, and she was the perfect client. She was healthy and strong, took good care of herself, and her baby grew perfectly. When it came time for our home visit, she even had John and I over for dinner. I loved getting to know S and her family, and I was honored to be their midwife, to nurture her as she nurtured me. Congratulations on your new little one.
Yesterday was the Christmas party for all Utah midwives and their assistants. I drove down with Cathy, my favorite midwife, and we visited some of our pregnant moms before joining the other 'baby catchers' in Pleasant Grove.
It was wonderful to be with a loving community of women. We had potluck brunch and told our favorite or most notable birth stories of the past year. I learned some new things and feel such a connection to all those great midwives who have come before me, those who have made my path a little easier. I can sense that these women genuinely care about the mothers we serve, and my respect for them continues to increase.
Utah has a rich heritage of midwifery from the early days of the state, and we have always had legal homebirth thanks to those pioneer midwives. Our current legislation-savvy midwives work very hard to keep it this way so that parents have rights and options for where they give birth and who can attend them. It's important to keep it this way so we all get the best care possible (everyone knows monopolies are bad for quality).
This past month I was hired by a first-time mom and her husband who live in Utah County.
It's going to be my first trade (partial trade at least) and I'm so excited. I love the thought of a connected community springing from midwifery. If we could work for stuff or future favors instead of money, we'd all save a bunch on taxes and tons of time.
Ten years ago, this very day, I witnessed my first birth.
Thomas Edward Grant Blackwelder was born to his mother, my mother, at Saddleback Memorial Hospital in Laguna Hills, California.
My parents and I had planned for months that I would go with them to the hospital to see the baby born, I was really excited. My mother fed us dinner, while her contractions grew stronger. She cleaned up dinner as they grew more consistent. She paged my dad as they grew longer. She sewed a quilt as they became more intense (she doesn't sew). My mother stopped during each contraction to catch her breath and write down the start and stop times. I tentatively ventured into her space and observed.
After some hours, dad came home. He gathered some this-and-that and choked down some dinner, but my mom was already in the car. He said, "Are you coming?" I got in the car too. A fast drive in the rain (dad's specialty).
We marched right in. Nurses came at my laboring mom with a gown, an IV, stirrups, everything. She said, "No."
She sat on that transformer/table/bed, I held her leg, she pushed. Dad cried through photographing at the holiness of the moment, and mom labored on. The doctor tried to communicate with her, there was no getting through. Then, coming up briefly from the deep-inside she said, "I'm working here."
The myriad instruments freaked me out, they were wheeled in on vast tables, arranged on long, shiny trays and on sterile drapes, stacked, gathered, laid-out, and all around us.
Silently, the little prince slid into life without a cry, the peaceful son of a peaceful mom. All in tears we watched that perfect one, overcome with his presence, and the very real knowing that this being came to us from somewhere else.
Doctor clamped and cut, baby gasped, and his eyes were full of fear.
I'll never forget that look. I have learned so much since that day, but I don't know anything more than I did at that moment.
After a desperate post on Facebook one night about the plight of my stagnant website, I found a benevolent web guy who's got me all set up with a new site design. He also had some great ideas about a community page with testimonials and links to this very blog.
I guess sometimes we just have to be humble, let our needs be known, and people will rise up to help us out.
Stay tuned for a new and improved www.fernmidwifery.com (it will be pretty).
Sadly, my second client called a few days ago to tell me that she had been up all night contracting and laboring (she was not very far along). There was little doubt in our minds that her tiny baby could have survived that event, and after a long search for heart beats, our fears were confirmed.
My own heart goes out to these women and sisters who bear such grief alone. Nobody can know what it felt like to be the future mother of that child she loved and hoped for.
I found this wonderful blog today. I hope my blog can someday be as great as this one. The 'different better' birth story is empowering and articulate. Also, be sure to check out all the 'beautiful babies' posts and photos on the right side.
Although much has been happening in my circle of clients/friends/sister midwives; I am unable to publicly share all the details, or any details for that matter. This is kind of a bummer as I see it, because the whole point of having a blog is to tell everyone all the cool stuff that's going on!
I had another interview with another wonderful woman, and another strong couple. It's inspiring to see men and women who trust themselves, each other, and their bodies; who act in ways that demonstrate this trust rather than just saying it with words.
I feel so lucky to have hand-picked families come into my life, to share their pregnancies with me, to share the most life-altering moment with me. I can do nothing more than to honor their trust with honest effort, and presence of mind & heart.
Thursday morning I met with a woman looking for a midwife. She came to my house with her two beautiful, intelligent little boys who drew happily on my new ikea easel and drove toy cars on my walls.
We talked and connected on many levels, I really liked her parenting approach and that she was the perfect candidate for homebirth, already having had two before. I sent her on her way with loads of paperwork, information and well wishes as she interviewed other midwives.
Our appointment was between two very long nights for me (supporting a first time mom in labor) so I didn't have a chance to think too much about the interview until today; when she called to hire me! I was so honored that she would chose me over the many other competent women she had met with.
I think this vocation of mine might actually work out. I was thinking of signing up for a job at ikea (since I spend enough time there on my own) or selling my valuable eggs. Thankfully, that won't be necessary.
Today I worked as a substitute at the Montessori, this is to pay the bills. I love the kids, but I hate the job (I spent 1.2 hours slicing apples, slathering mini bagels with cream cheese and cutting them into equal fourths so 90 kids could have a snack).
Today, however, I found myself in a rather engaging conversation with the grounds maintenance man. He and his wife are very interested in having a midwife/homebirth but are afraid of stepping on their own mothers' toes. I encouraged him to have confidence in their beliefs and we talked extensively about the details of having a baby at home. It was so detailed in fact, it was like an interview; wonderful, except...they're not pregnant.
I find myself without clients of my very own but with plenty of non-pregnant folks who would gladly hire me were they only in the market. I also know plenty of pregnant folks who are willing to call me and ask questions that only a care provider could or should answer, but they are not interested in leaving their own OB/CNM/random midwife they found online, whom they do not feel comfortable calling.
I am going on faith at this point, that the powers that be will eventually see fit to deliver returns on these investments. For now, I will just talk to each of them one by one.