By Any Means Necessary

I've put it off for a week, but I have to comment on the pending legislation for Missouri midwifery. I say pending because it has yet to be signed by the governor. It did pass the House and Senate and is expected to be signed. When the original bill failed to pass after yet another year of valiant effort, the sponsoring senator, simply slipped one line legalizing CPMs into an existing health insurance bill. It passed without the opposition knowing it was in there until after it passed. The language is as follows:

"Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U. S. C.1396..."

Later, I found an article in our local paper about how this all came about. It displayed the sponsoring senator in a bad light and suggested his reputation was irreparably damaged by the bait and switch maneuver referencing tocology (the practice of midwifery or obstetrics). Of course the problem with this strategy is that two can play that game. The opposition is still trying to repeal the bill which has yet to be signed into law. As much as I wanted the original bill to pass, I'm having trouble justifying the means. I want a law that protects women as much as midwives. This wording gives the what but is lacking on the how. I'm not sure what this means for midwifery in Missouri or how it will all go down. But when I know, you'll know.

A Long Time Coming

Could it really happen here in Missouri? The CPM (Certified Professional Midwife) bill may finally become law. Govenor Blunt has stated at a press conference that he will sign the bill that has just passed both the House and Senate at the eleventh hour. I hardly know what to think or how to feel. This bill has been so long in the battle (over 20 years) that I really didn't expect that it would pass this year either. Wow. I just have to let is wash over me. What does this mean for the birthing women of Missouri? What does this mean for me? Should I take another look at the CPM credential? I ruled out becoming a midwife so long ago, that it seems a foreign thought now. My fustration has been increasing lately that women can't access the births they want, but becoming a midwife would utterly consume me. Part of me wants to shout yipee, but the other part wants to wait to see how things really come down. I'll take a good look at the bill and perhaps post it for comments.
In the meantime, I've started to plan for a family retreat. We plan to camp for a week at a quiet get-a-way and get some well deserved R&R. This month has seen so much growth (ie, change) for my business and so many projects going at once, that I'm more than ready for a rest. In fact I'm taking a mini-retreat today. My goal is not to leave my house (and yard). I helped my friend Dotty with her daughter's wedding yesterday and I'm exhausted. Today is just for enjoying my family.

An Ass-Backward View of the World

I had a long conversation with a friend last night. She is in her final month of pregnancy, with her first baby, who is in breech position, with her doc talking cesarean. If attempts to turn the baby are unsuccessful, she will consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often unwilling to have a frank discussion with their caregiver about their wants and desires. I reminded my friend that she selected this person (or group) and that she is paying them to be trusted partners in this process. Don't start doing things behind their backs but tell them exactly what you plan to do and why and listen to their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important because it preserves the integrity of the relationship. Doctors and midwives are not mind readers. They need to know and understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women are happy with the care they are getting. I also urged my friend to look at all her options. Its not just cesarean or homebirth. There are options between those two extremes. Homebirth should be the result of a move toward something you want, rather than a move away from something you don't want. I don't envy my friend's choices. The fact is, the med schools no longer teach docs how to deliver vaginal breeches. Why should they? Cesareans are the new cure for every maternal ill, and so easy (for everyone but mother and baby that it). Its absolutely unprecedented, the number of young healthy women getting cesareans. We have an entire generation of women who won't know what vaginal birth is like. This is a tragedy on a massive scale. Young women have been robbed of their births. What's so special about this generation that they can't give birth? Nothing. Its not the women that have changed- its the system. Active management of labor, manages labor right into the ground. Bogus research and outdated beliefs have set unrealistic expectations of birth. New technology has hindered and not helped the process. Litigation fears rule the birth place. Nature is not seen as kind and benevolent but cruel and deadly- a force to be thwarted at every turn. So who's really ass-backward here?

Advertise This

There are 16 hospitals that provide maternity care in my city. That sounds like a lot, but it isn't. Spread around our large metro area, it comes down to one, maybe two hospital choices for any given community. About 5 years ago, there were 20 hospitals where a woman could give birth. We are actually losing hospitals, two in the last 2 years. Some consolidate with other hospitals, others simply close down. We now have fewer hospitals but a growing population. The local hospitals have taken to two new means of advertising, billboard and TV. All along the highways earnest professional faces peer at you through your morning drive, touting their focus on research, or excellent nursing care. Fine. Its the TV ads that get my goat. They typically focus on one of two things, cardiac care or birth care. Cardiac care is fiercely competitive and a big revenue generator. Birth care is a loss leader that creates customer loyalty and brand identity. One ad shows airbrushed scenes that at first make you think you are looking at a spa. Finally they reveal that these images represent their 'birth center.' Yeah, its real spa-like to be numb from the waist down, have your legs hiked up in stirrups while a dozen strangers stand around gaping at your vagina. This week, I saw a new commercial with a former news anchorwoman and female physician giving testimonials for a local facility. These folks have no idea what well birth is. Their idea of normal is completely skewed. You know why? Normal birth isn't allowed to happen in a hospital setting. (Not in this neck of the woods anyway)Normal birth is entirely too risky for the average hospital. So they serve up this 'active management of labor' version that's been all the rage for the past twenty years (maybe thirty)and pawn it off as normal. It is not. Normal birth is woman respectful and body friendly, not fear-focused and controlling. Normal birth is watchful and patient, not technology heavy and performance focused. Normal birth is sensory rich and cyclic, not body numbing and task oriented. Normal birth is ruled by birthing women not litigation weary white-coated professionals, or conservative hospital protocols, or the squeamishness of health care legal eagles whose job it is to cover the hospital's collective ass. The hospitals and the professionals they employ have their interests well covered. Whose looking out for birthing women? Let them put that in their next commercial.

The Role of the Nurse-Activist

Last week I returned to my old nursing school for "Scholarship Days" to present my case study on nurse-activism. This is an annual event for my old alma mater where alumni and students and professors can present scholarly treatises, white papers, research, clinical studies etc. to the college body. I presented previously on a community outreach program for breastfeeding that I helped with (Breast Fest) and a Parish Nurse program that I started. This time my presentation was called, "The Role of Nurse Activism: The use of book and film to alter perceptions in healthcare." In my presentation I talked about my birth and read excerpts from the book, showed a clip of the film (which the Brits had emailed me), and showed pictures from the blog. That was all fine and well, but the most important part of this presentation was my talk about the role of activism and why nurses should pursue thier passions in thier various fields of nursing. I talked frankly about how my passion for birth and the politics thereof, got me fired from more than one job, and how it led me to do what I'm doing now and how I expect to make an impact. I told them that they too, can have a positive impact on healthcare by following thier passions. I feel this is an important message. Healthcare and in particular the hospital culture, has a way of bending you to its will. It takes extreme courage to buck the system. I love Maya Angelou's quote, "Without courage, you cannot practice any of the other virtues." In healthcare, in my work, in my life, I have found this to be all too true.

The Despair in Disparities

I just spent the last two days at a "disparities in healthcare" conference. I saw some phonomenal speakers, but my favorite session was on perinatal care. There seems to be a shift occurring from a focus on 'prenatal' care to 'intraconception' care. While I think there is certainly some merit to catching at risk and other women before they become pregnant, I don't believe we've begun to explore all that prenatal care can and should be. It should be more than an hour's wait for a 5 minute BP check and pee dip. The centering pregnancy model came up and while I think that's a good start, there is a real need for innovation in prenatal care. One speaker on the perinatal panel, an epidemiologist, showed an older study he had done from 1999, that prenatal care was not impacting outcomes. It didn't bother me much that the study was old, because I know things haven't really improved. Women are disillusioned with childbirth education and with prenatal care. Both need major overhauls or risk becoming obsolete (not done away with, just lowly regarded). We really need new models of care, not just new gimmicks and clever new ways of packaging the same old, same old. Models that are inclusive, empowering, and impactful. We are in a new day, that calls for a new approach.

Birthing My Way

I finished my article for the local paper about my homebirth. My Dear Readers get an advanced peek:

Birthing My Way


“Baby’s coming…” I found myself panting. Quick as a wink, I could feel the baby move downward and out. The midwife rushed to my side, the doula on the other. I was surprised to hear her say the head was already out. I kept pushing. In one long smooth push the baby fully emerged. I snatched my baby from the midwife’s arms, greedy to hold and see him. I had birthed in a standing position so she had to pass him between my legs. I turned around and sat down on the chux covered sofa. My husband sat beside me and in another minute our other children came rushing in to see the new baby, Lucy, the family dog, fast on their heels. It seemed appropriate that I had birthed in the ‘family room’ of our home. (I don’t care for birthing in bed, and didn’t want one in sight, so I selected a room with a sofa instead. It worked perfectly, I stood leaning on the birth ball during contractions, which lessened the discomfort greatly, and sat on the sofa to rest between them.) My baby finally in my arms, I couldn’t stop laughing. The video of my birth shows me clutching my newborn, surrounded by my family, and laughing my head off for several minutes. I had birthed my baby. my way, at home surrounded by those of my own choosing. Within the hour I was showered and tucked into my own bed, settling down to nurse my baby. I relished the delicious pancakes and glasses of ice cold milk my husband had prepared for us all.
Birthing my ninth baby at the age of 44 at home with a midwife was the healthiest and safest choice for me and my baby. I desired a birth free of unnecessary intervention (which carries its own risk) and to birth without distraction. I wanted a birth where I was the focus, and I had ultimate control over what went on. As a former labor and delivery nurse, I knew full well how I would be seen by the medical system. Doomed to “high risk” status because of my age and previous births (all normal and healthy), I knew I could never subject myself or my baby to all the unnecessary intervention to appease someone else’s fears. I was determined to birth at home, just as I had with my previous five babies (the first three were born in hospitals). It took some doing to find a midwife for my birth. Though I’ve used only midwives for well-woman care for the last 20 years, my current hospital-based midwife was not allowed to do home deliveries. My husband and I sadly severed ties with her for the duration of the pregnancy, since she could not knowingly see someone for prenatal care who was planning a homebirth.
We found just what we were looking for in a neighboring town. We found a certified nurse midwife with a homebirth practice who would not view me as a disaster waiting to happen. It was an hour’s drive to her home for prenatal care, but well worth it for the relaxed leisurely, unheard of hour long visits (with no waiting). We did the usual weight and blood pressure checks, but I eschewed all but the most basic lab work and tests. We mostly talked about my diet and exercise, and my mental, emotional and physical preparation for birth. Our focus was on healthy behaviors that would support a healthy pregnancy and birth.
I relished this focus on normality and wellness and was so thrilled with the pregnancy, that I made the decision to both blog and film the entire experience. I went on to blog my entire pregnancy and birth at http://homebirthdiaries.blogspot.com even blogging several entries during my labor! I not only became a devoted blogger but became quite addicted to birth blogs by others. I found an on-line community of women and care providers supporting wellness-focused pregnancy, unlike anything I had experienced as a birthing mother or a labor and delivery nurse. I hired a British documentary filming team to film me during pregnancy and of course birth. I also made the decision to write a book about my nine birth experiences and my odyssey from teen mom to labor and delivery nurse to well-birth advocate. I’ve heard it glibly commented, that pregnancy is not an illness, yet we treat it like one nonetheless. I was delighted to spend my ninth pregnancy and birth making healthy choices that focused on what goes right with birth rather than what could go wrong.