technology and it's appropriate use. when pitocin and an epidural might be the right choice.

it's monday and four hours to midnight. no birth yet, but was paged to evaluate a mother with a potential pulmonary embolism.

what i'm about to write about may piss a bunch of people off. but i think it's important.

technology and it's appropriate use. when pitocin and an epidural might be the right choice.

i've been thinking about this recently. it's an ongoing dialogue really, but now that i have the use of pitocin and pain relief in my bag of tools it's become more relevant.

there have been a number of first time mothers with long labours recently. some who have used the resources a hospital offers without reticence and those who have chosen not to.

perhaps it's not appropriate to compare any labour to another, but it's interesting.

what happens when a mother chooses to avoid intervention in her labour, striving for a natural birth without intervention, and ends up with a cesarean? what would have happened had she opted for augmentation earlier? would the benefits of an epidural relaxed her pelvis enough to open up and let the baby down?

is the mother happier, knowing she did everything she possibly could have within her body and soul to labour that baby down and bring it into this realm? if the result is a cesarean, is this still a more satisfying birth experience than had she used these other tools or "interventions" earlier?

these are the questions in my mind.

i'm not an experienced midwife. i'm an entry level midwife and damn proud of it. i know my limitations and i'm open to learning. i'm open to a multidisciplinary approach. i'm open to using modern technologies that we are so privileged to have access to in north america.

my job now as a midwife who has these tools within her scope of practice is to use them effectively.

i am experienced enough to recognize when labour has become abnormal. if i couldn't then, well, i'm not ready to be a midwife.

the conflict of interest arises when my clinical judgement may disagree with the desires of the labouring mother.

ultimately, this is her birth, her body, her baby, her decision.

i can offer, suggest, recommend what i see as the appropriate course of action or what the available options are. but the decision is not mine to hold.

reflecting on a birth, however, i can't help to wonder. if the mother had taken my recommendation and utilized these "interventions" would she have had a vaginal birth?

this leads me to evaluate the current culture of birth in which we live, in which women live and are educated.

childbirth education, the media, books teach women how to say no to intervention. however, are they teaching them when saying yes, might be appropriate?

have we completely desensitized ourselves and abused these advancements to the point that the only option is saying no, because either a) women do not trust their care providers to use these tools judiciously and as needed, or b) women are taught that if they say yes to any intervention, they have failed. that putting themselves through hell and back, fighting, being that warrior goddess, means that they must say no to the point that their only option is surgery?

i see every mother as that warrior goddess. no matter how her birth story is written.

carrying, growing, and birthing life is the utmost human feat.

how can we get to a point where women not only trust in their bodies, but also in their care providers and the technology that is available?

how can we get to a point where care providers trust women's bodies, and not rely on these technologies to manage birth?

to license or not to license. is there a question? or what is an empowering birth? who decides?

OK this is an opinion piece and i imagine it'll piss a few people off. 

but i've been in tears this last week and i don't want to keep quiet about it. i was ready to quit being a midwife. 

recently i found myself in the midst of a discussion on midwifery licensure. i don't know why i bated myself into this trap. i was premenstrual. we have a client who is going through a difficult time and a midwife who is reaching out to any and all resources that she can find to help this momma. reaching out in a way that would not be possible if she were working outside the system.

i'm back to believing i'm not a feminist because i'm not hating on the system which i guess is being equated to the "man" and therefore in order to be a good feminist, i'm supposed to hate. sigh. sorry i know that is filled with sarcasm and passive aggressiveness, but i'm still pretty upset about this. 

as most of us have heard there is a midwife in north carolina who is being charged with murder as a result of a fetal demise. tragic. for everyone. 

i've read some backlash that this case supports the flaws of seeking licensure. i'm not quite sure the logic, but i guess it is because in north carolina homebirth with a midwife is illegal. the state does have CNM's, but from my knowledge they work on the base and i'm not sure civillians have access to them, and they sure aren't doing homebirths. and this is where lets hate on the man comes in, why, because the obstetric community does not support OOH birth, CPM's much less "community midwives". 

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*tangent* i've heard this word community midwife tossed around in this case. i prefer it over traditional midwife. and from now on will try and use this term, particularly speaking of unlicensed midwives.* though really, aren't we all community midwives if we are attending births out of hospital? so maybe i'll use it for all midwives that don't work in hospital, licensed or not. i don't know. i just hate traditional midwife and medwife. makes my skin crawl to have such division between us. 

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there was a discussion that you can listen to here on progressive parenting. there is also a post which is allegedly the mothers side of the story. *the mothers story appears to have been taken down. sorry*

i said that this is an opinion piece and so here is my opinion. 

if the midwife were licensed she would not be charged with murder. this case would have gone through a review by her peers to deem whether she acted appropriately or not. she would have had a trial and held accountable by her peers. she may or may not have lost her license based on their findings. and the family would likely have recourse in a civil suit to recover any financial damages, though that will never bring their baby back. if it is a state in which midwives carry malpractice, well then there also would have been a system in place to provide the family with compensation, not force them to seek it on their own.

and the midwife, well she would be on board with any health care professional and would not be charged with murder. this is the case in hospitals right. the unfortunate nature of what we do will be the eventual bad outcome. it happens in hospitals and there is no media coverage about it. it is silently swept under the rug and dealt with in back rooms. when this happens at home with a midwife, particularly an unlicensed midwife, and in a state where midwifery is illegal. it devastates the community.

i'm not here to judge the midwife. i'm here to talk about how it would have looked if midwifery were legal and if she were licensed.

back to the discussion i was bated into earlier this week. the discussion that had me in tears. the discussion that caused me to pause and fear being a midwife. 

i'm not naming names. there is no point. but there definitely were some heavy hitters involved. and actually most of these people are friends with midwives i've worked with.

the slogan "midwives for families, not midwives for midwives" comes to mind. 

so in this discussion, these women were critical of licensure because of the restrictions that it puts on birthing mothers - namely, breech, twin and VBAC. in many states once midwives become licensed these criteria are out of their scope and midwives cannot serve these women out of hospital. the argument - they are higher risk. the unfortunate reality is that the obstetric community has seen these women as a obstetric emergency and will advocate for early elective c/s. so the mothers are really not in a good place. 

there is a positive side however, ACOG recently put out recommendations saying that vaginal twin birth was a safe as a c/s; in many countries such as canada breech birth is coming back and more practitioners are being trained in how to help manage them, and VBAC? well in WA state midwives can choose to care for women who are attempting VBAC's using a community standard protocol that is evidence based. so things are improving. options for birthing women are improving. it's not perfect. 

i don't completely get the argument that these restrictions say that women are not smart enough to make decisions regarding their own bodies. i think if that is the case then these women should birth unassisted, at least don't hire me. when you hire me, you are hiring me because i sought education in how to help mothers prenatally and throughout their birth and postpartum. you are hiring me because of my knowledge. 

so back to this discussion that i was in. i can see for the most part what these women want is for optional licensure, like what oregon and minnesota have (though oregon is possibly transitioning into mandatory licensure). they disagree with the CPM being the standard. which i can agree with, i think midwives could do with more rigorous training, but i also think that the CPM is an adequate baseline and that these are good midwives. and to streamline a system of licensure. it's a starting place.

what shocked me out of this discussion was the alleged belief that licensure impacted the care we give to mothers. that it put licensed midwives on par with OB's. and what got me to my core was a comment that licensed midwives were intervening in women's birth causing them to have postpartum depression and breastfeeding issues. that women were hiring a midwife expecting one thing and then not getting the birth experience they wanted because it was "managed" by the midwife rather than just allowing the mother to birth the way that she wanted. 

oh my, i could break down this in so many ways, but it got to me. so not only do i have the responsibility of two lives in my hands, i also have the responsibility of how my actions may impact the mother and baby (and negatively at that). one of the reasons that i became a midwife was to protect that postpartum period, now i'm being told that if i'm "managing" a birth and that if it isn't what the mother wants (but if in my educated opinion needs to happen) that i'm causing mothers to have negative birth experiences and postpartums. pressure. ok. i tap out. i don't want to be a midwife then. i can't handle that. seriously. it's too much. 

thankfully i was surrounded my amazing women who took me in their arms while i cried and replenished my strength to move forward. 

what this all makes me wonder is what are we as women putting on other women. all these expectations. we set each other up for failure, that you are never good enough. oh a midwife helped direct your pushing or reduced an anterior lip. you didn't birth on  your own. your body didn't do it itself. seriously? do we think that women who were attending other women in pictographs just sat back and let a mother birth on her own and didn't do anything to facilitate the process? that's pretty nieve. 

a doula at a birth the other night talked about her births. her second baby she had an anterior lip that the midwife eventually reduced after the mother recognised that her pushing efforts were being held up by something. in her next birth that sensation returned. she knew within herself that the lip was there and asked to have it reduced, and then the baby came. does this mean that the mothers body failed her? what right do we have to judge women and their birth experiences? 

if i'm "managing" a birth by protecting a mothers perineum, telling her to slow down as the head is crowning so she doesn't blow her bottom out, is that her body not working? if she is happy, but you are not because someone else had hands on her body as she pushed. who needs to take a step back? birth isn't just going to look one way. i've only attended 130+ births. they have all been different. i've watched mothers birth their own babies without anyone's hands on them, i've also helped a mother direct her pushing. one wasn't more empowering than the other. and if you judge a woman because she had help, who is the one disempowering her experience? who is the one causing her postpartum depression when she's been told her body failed her? that she could have had it better? 

why do we as women sabotage each other?