Making Home Birth Safer

I never sign these things. I am not one to get all up in arms about petitions and change and such–unless I feel strongly about it. And maybe there just hasn’t been a petition out there that has stirred me so much, until now. The Coalition for Safer Home Birth was started on Change.org to encourage our legislatures to recognize the safety standards that are lacking in home birth. The coalition does a wonderful job summarizing exactly where the issues in home birth safety rest which largely is in the hands of the home birth midwife who is lacking a certain level of education. I feel that it is best for me to leave you to read what the coalition has written as I could not have said it any better so I won’t even try.

And maybe, if you feel moved enough, if you want to see change, sign the petition.

Protect Mother’s and Babies: The Coalition for Safer Home Birth

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Shridam’s Birth Story

A note from Sarah:

I am so thankful for this community I have been welcomed into with open arms. The subject of birth is so close to every mother’s heart, no matter how her baby comes into the world. I have said a number of times that I want to share EVERY birth story that you’re willing to share. Some of those birth stories, don’t always have a happy ending. Regardless, your birth and your baby are important and your story is important. I am sharing a story below that is beautiful, loving, and heartbreaking. This is your official **Trigger Warning**. Please read with love and light for this mama. Thank you.

Sarah

******

Shridam Jasper Smith

10 lbs 15.4oz 23.5 inches

9.23.12 – 9.30.12

We wanted to have a homebirth with our first son but couldn’t afford it. He was a week late and we declined to go in for an induction that Friday but then nonstress testing said the amniotic fluid was low so we made an appointment to go in at 5am the next day to be induced. I went into labor Friday night and things were picking up steam when we got the hospital (My mom, husband, doula and myself). We labored pretty naturally for most of the day and didn’t get any pitocin until the evening. The back labor was pretty intense. Then after a totally refreshing nap compliments of Stadol, the nurses woke me up and I hopped into the stirrups to push for about 2.5 hours. I saw baby’s head in the mirror!  Dr.Koh came in and saw that the baby was OP so he got us all to prepare for a C-section. Dasaratha was 9 lbs 6 ounces, 21 inches and super awesome. Champion nurser.

Shri Kiss

  • Shridam was due September 16th. We didn’t want to have another C-section this go round and now we were in a position to afford midwives. We interviewed a few groups and went with the same midwives a couple people we knew had delivered with. We saw them for the regular checkup stuff, heart tones, measurements, weight ins etc and my seemingly endless list of questions about homebirth, pregnancy, transfer and nearly everything else under the sun.
  • For backup we saw some hospital midwives that work with M and R and take care of some of their transfers. I went to their clinic for all of the blood tests and ultrasounds. I had endless questions for them too. I was told by them and our homebirth midwives that we would transfer to that hospital in case of something like exhaustion or dehydration but that for an emergency emergency we would go to Heywood, the hospital 20 minutes from my house.
  • The pregnancy covered the best summer of my life, my husband, our toddler and everyone we knew was just so happy and excited that we would be getting a little baby boy. Stava and Dasaratha were able to accompany me to most of the prenatals this time which was really special. I was crazy healthy and felt great.
  • We went into labor Friday night but it stopped as soon as M got there. She left and told me to try to get as much rest as possible before things picked up again. I had light contractions until Saturday evening when things got hot and heavy and the two midwives came over again. We had my grandmother take Dasaratha to his Uncle and Aunties while we set to laboring. I see the hand of the Lord in that because we had considered having him babysat at our home but couldn’t think of anyone to watch him.

I labored leaning on Stava and moaning with him for awhile, at a certain point I was saying, “These contractions are stronger than me, I’m not handling them well,” and I decided to get into the tub. What GREAT relief! In my first labor I kept wanting to take a shower but we couldn’t get the monitor wet so I opted for Stadol instead. Anyways no back labor this time, baby was in perfect position very low, NOT ociput posterior (I was super afraid he would follow suit like his brother and religiously did my positioning exercises while pregnant). They checked his heart rate regularly the whole time and he was happy as a clam. We put on the birth CD my friend had burnt for us. The water made contractions so much more manageable, Stava was in there with me sometimes I would lean on him sometimes I grip the sides of the tub and stretch out.

Eventually I felt the urge to push and started to do that. I was a little insecure thinking I didn’t want to push if I had a lip of cervix so I hopped out of the tub and had my midwives gives me an internal exam (the First and only) I was 10 cm so I hopped back in the tub and began to push for all I was worth. Pushing was about 2hrs but isn’t seem very long at all, not like Dasa’s. No one was yelling at me; I pushed not on every contraction but when I got a “good pushing one” I would say, “This is it!” and grip the side of the tub stand up on my knees and holler and push. I reached down and felt baby’s soft head, it was awesome then I had Stava feel too. The midwives were checking his heart rate with the Doppler pretty frequently now (I appreciate that now but at the time it was sooo uncomfortable!) and it was right where it was supposed to be. I vaguely remembered being blood pressure cuffed throughout the birth but I didn’t pay that much mind. Sometime during the pushing I felt the water bag POP and the midwives rushed over to the birth tub with maglights to check the amnioty; it was clear.

At some point I felt like my pushing was becoming a little less effective and the midwives suggested I hop onto the birth stool. That REALLY directed the pushing energy, 2 or 3 pushes on that and I had his entire head out! I was done at that point, I asked if I still had to push because I had read birth storied where the midwives help ease the body out of the exhausted mother and though that sounded good I said, “Do I need to push anymore?” My midwife said yes, “You need to push with everything you have.” Then they said, “You need to get on hands and knees.”

*Sh*t* I had read enough birth stories to know that meant shoulder dyscotia. I got onto hands and knees and pushed hard, thinking they would be able to hook him and pull him out. They told Stava to call 911 and then had me get standing upright to push. Stava started to run downstairs but I hollered at him pointing to where the phone was on the dresser while I was pushing. Then I was lunging, standing, hands and knees, on my back with legs pulled all the way  back and super pubic pressure applied. We tried all these positions rapidly AGAIN and AGAIN. M and R were taking turns trying to hook the baby, and alternating putting the oxygen on his face and then on mine. I kept screaming, “I can’t push anymore,” because I was exhausted or “I’m still pushing!!!” because I WAS still pushing and felt no give from the baby. I screamed a lot and there was blood everywhere, all over me, saturating the floor. The two midwives kept taking turns trying to hook Shridam or break his arm and hook it, and they were putting oxygen alternately on me and then the baby. Stava said, “They had to tear you apart to get to the baby.” I didn’t know it at the time but Stava then left to flag the ambulances at the end of the drive. He feels like he didn’t do anything to help the situation but they may never have found our hidden drive on that dark and rainy night if he hadn’t gone out there. We just kept going in those positions. It was excruciatingly painful, I screamed and screamed and pushed and pushed.

Shri sans tubes

Eventually the ambulance and EMTs arrived. I thought we were going to go to the hospital, I was screaming things like, “Can we got to the hospital now? Get him OUT!!! but the EMTS and midwives told me I had to deliver the baby 1st. I hadn’t expected that. The EMTS were really awesome, they took over the oxygen and focused the midwives saying, “You can do this, you can get this baby out.” FINALLY he came out, with me in the hands and knees position, at 1:42am on Sunday, twenty minutes after his head had been born.

He looked so small, and even though he was all pink and peach, without a tinge of blue on him I could tell he was lifeless. He was so limp and floppy. Shridam’s wasn’t breathing and had no pulse. The EMTS began CPR and intubation immediately. I was sure that he was dead.

My own heart rate was at 200 and the EMTS were instructing me to focus take deep breaths, calm down.  The midwives gave me two shots of pitocin in the thigh and some Chinese herbs to stop bleeding.

We stayed in the room for like 15 minutes and then we each got loaded onto an ambulance. I nearly passed out as they took me down the stairs, because my oxygen mask had fallen off. Stava and all but two of the EMTS (we had first responders from like 5 towns) piled into Shridam’s ambulance and R and two EMTS went into mine. As I rolled past Shridam’s ambulance they told me he had a pulse. I couldn’t believe it, I was so relieved. It came twenty minutes after he was fully born and they started working on him.

From there we went to the ER at Heywood, Stava was sobbing on Shridam’s side of the room and my heart was stricken fearing for the worst. They did all kinds of things for him, that I’ll never know the whole of, they managed to get an IV in his belly button. They gave me three IV ports and pumped me full of blood, pitocin, morphine and two kinds of saline water. My placenta still hadn’t come out so two nurses massaged my stomach almost right down to the bed and Dr.R, come down from the maternity ward, reached in and grabbed it by hand, delivering the whole of it successfully. I had 3rd or 4th degree tears (I would here either from doctors in the next couple days) and Dr.R stitched me up into a, “patchwork quilt.” It hurt so much because apparently, like Novocain, litocaine is totally ineffective on me. R was in with me but they wouldn’t let M in and I was so out of it I didn’t really care.

A few hours later we both transferred to a bigger hospital with a level 3 NICU, and they cooled Shridam’s body for 3 days to try to keep brain damage as low as possible, but his brain was just completely gone, 40 minutes of oxygen deprivation was too much. He was 23.5inches 10 pounds 15.4 ounces when the weighed him. I finally got to hold him when he was 3 days old. He never cried and could only move his arms and face a little. The told us his EEG and MRI showed no brain activity and that he would not live for long. That Friday he managed to knock his arm into his ventilator tube, unpositioning it. We decided not put it back in and he breathed on his own until early Sunday morning when he gently died in my arms, one week old. There are many other stories and miracles that accompany his short week of life, but they are too numerous and hazily remembered to list here.

Shridam

I wrote the above only weeks after the loss of my birth and so have left it unchanged, because it’s as fresh as it is accurate. Some additional thoughts and reflections I have had since then and answers to common questions are below.

My first son was 9lb 4oz.

When originally telling me about how prenatal visits would go my midwives told me about the pee in a cup strips to test for urine. I would later show up and ask “Don’t I need to do that strip test.” And they would reply “If you want to.” Weight tracking was also optional, but I like to keep track of things so I did both each visit.

My midwives offered me a choice of taking the glucose soda and blood test at the hospital or doing a finger prick test with them. They didn’t push either as better, I opted to go with the finger prick test with them.

I did not have Gestational Diabetes during either of my other 3 pregnancies, and had no symptoms of it during Shridam’s pregnancy so I think his Macroscopic size may NOT have been caused by GD, but that’s not something I’ll ever know for sure.

While they attempted to deliver his body they got out their 1 oxygen mask and passed it between me and Shridam. It was done so poorly because there were only TWO people there, they had to try to deliver and do oxygen and it just WASN”T ENOUGH. One of midwifes, M, was crying and in near hysterics, she kept kissing me and saying they loved me, they loved this baby. I appreciate that she was scared for us but I feel like her lost cool affected her ability to do her best on the delivery.

We never paid the 2nd half of what we owed them for their fee. Niether did they ever offer to refund us. Money just wasn’t brought up by either side.

They were there for me for anything I wanted to talk about. They brought me soup. They would likely have done more for me but it just made us ad and weird to see their faces so we declined.

On one follow up appointment they told me they had “talked to some of their peers” and played around with their soft birth doll and model pelvis to see what had happened. R said that his sticky shoulder was just “wackadoo” the worst she’s ever seen. A friend who’s training for homebirth midwifery, later told me that it HAD come up to be looked at by the ‘council of midwives’ or whatever but I never heard of it at the time. Nothing AT ALL like when you lose your baby in a hospital, and there are inquiries, there are reviews, there is an attempt to give the parents ANSWERS and some small piece of mind. No my midwives were back delivering babies the next week.

Unlike so many other homebirth loss moms my midwives weren’t negligent They didn’t lie to me. They did call 911. They just were not enough. Their skill wasn’t enough, their equipment wasn’t enough the sheer fact that there was two of them vs. a whole floor of maternity staff wasn’t enough and it turns out our “transfer plan” was way too little when emergency struck and even the heros at 911 were too little too late when we decided to birth at home.

I see so many people say to other moms, “You should have gotten experienced certified midwives, you needed complimentary care, they should have called 911 sooner, a good midwife will know complications when she sees it, Well your midwife should have been monitoring you and baby.” I HAD ALL THOSE THINGS. The *BEST* OOH Midwives are still NOT ENOUGH to save baby’s life in an emergency.

I am not “anti-home birth”.

This post has been quietly brewing in my mind for awhile now. It’s hard to define where exactly I stand on home birth but what I do know is that I am anti-bullying, anti-discrimination, anti-judgement, anti-disrespect…but I am NOT anti-home birth. Somehow the subject of birth and how one chooses to do so has become almost as delicate a subject as religion and politics. Oh wait…maybe that’s because those two things happen to fuel a lot of how and why someone chooses to birth. There is a terrifying birth story that is making waves and going viral all over the internet right now. You may have read it. Here is a link. The comments on the post itself as well as on a number of birth communities on Facebook have ranged from empathy, sorrow, love, and kindness to blame, distaste, and apathy. This is not a dead baby story. But it could have been.

Many of the more negative comments talk about how the writer is clearly anti-home birth and how “that’s just not fair” to happy home birthers. I get it. I had two beautiful hospital births and when people talk about how bad hospital births are I get a little defensive. Truth is it really doesn’t matter. We are humans with our own emotions and we get to own them whether someone else agrees or not. Maybe the writer is anti-home birth. She is sending a message that “hey, there are crappy home birth midwives out there. Be careful.” Maybe not everyone is hearing that but I am. But NO ONE has a right to say her feelings are not valid or that she should have picked a better midwife, etc….

I cannot emphasize the importance of education any more than I already do. This includes the client but more than anything includes the provider, or any professional one may hire for a service. Our country has a problem with how it manages home birth deliveries and the midwives and people that attend them. States vary on their regulations and standards of education. Many midwives are not bound legally by any form of liability insurance. More than anything, this just makes me sad. So I’m not anti-home birth….I am anti-lack of education, lack of experience…so many mistakes were made in that birth. It’s not the first time and sadly, that won’t be the last time either. An educated, proficient provider would have called 911 the moment she noticed the waters were stained with meconium. This is just one of the many problems with the birth and I am not going to keep breaking it down. Anyone can see from reading the story that there were many mistakes made.

Lastly, I would like to address a comment that keeps getting thrown around by many people who are clearly “anti-hospital birth”….”Babies die in the hospital ALL THE TIME!”. You guys. This is NOT true. In fact, it is RARE for a baby to die in hospital and most of the cases in which one does not make it is due to some kind of fetal anomaly that could not have been prevented (like a cord accident or genetic issue).

Anyway, I had to get these feelings out. I had to express how sad I am that, 16 months later, this mama is experiencing so much birth trauma. I have no doubt that writing about it helps her. I had to share that, though I may have concerns about home birthing, I am not against it.

Behave in the comments. Remember to be respectful.

Calling all BIRTH stories!!

It has been FOREVER since I posted a few birth stories and we need to change that. I will post ANY kind of birth story. Home, hospital, c-section, loss…every birth story matters. YOUR birth story matters, no matter what. Please consider sharing your story, with or without pictures. As long or as short as you want. Leave a comment here or send me an email. Thanks!!

midwife101blog@ gmail . com

In the mean time, check out my kids’ birth stories by following their links above. Enjoy!

Sarah

we need GREAT midwives

This post is coming to you as I have had several days to think about the amazing reactions I’ve had to my most recent post My Thoughts on Home Births. The thing about midwifery is that there are way too many distinctions of different kinds of midwives. Just a few: Lay, Direct Entry, Certified Professional Midwife and Certified Nurse Midwife….the only thing you need to know is that a CNM is the ONLY type of midwife with a clinical degree in nursing. That means she (or he in some places!) has a high school diploma, bachelors in nursing, masters in nursing and nurse midwifery certifications and degrees. I’m taking a rather slow and easy road to midwifery, but if one is on the normal track to becoming a midwife straight out of high school, then she will have been in school for at least 6 years, if not more in some cases. She also must take continuing education in basic life support, neonatal resuscitation, suturing, etc. CPMs, Lay, and Direct Entry midwives may have some pre recs to take before entering a program and in less than 3 years they could be on their own catching babies, mostly at home. Those midwives are not certified to work in a hospital or in some birthing centers. All this to say…education makes a huge difference and as I said in the last post about home birth, I am a HUGE advocate for education, both of the provider and the patient.

I say this because, despite my not being a fan of home birth, our country still needs good great home birth midwives. People who want to give birth at home, educated or not, are going to give birth at home and they should do so with a great midwife. The most ideal home birth midwife would be a CNM. I know a few CNMs who actually attend births at home. This area gets sticky depending on different state regs, but in Colorado, it is allowable. Now, does she carry liability insurance? Probably not because it is too expensive to do so. Would I hire a midwife to attend my birth without liability insurance? No, because that also means that my insurance is most likely not going to cover a dime. Regardless, we need to accept that, while home birth is not the safest place to have a baby, that it’s still going to happen and they need to be attended by great home birth midwives.

What does a great home birth midwife look like? In a perfect world, she is a CNM and has experience working in a hospital setting. She has a relationship with the local hospital in which transferring is not looked at with such negativity and she carries liability insurance. She carries a post-patrum hemorrhage kit with her, along with a tank of O2, an IV kit with plenty of fluids and oxytocin. She has THREE assistants..not just one or two. These are also CNMs who have just as much experience and understanding in labor, birth, and newborn care. She also only takes on truly low-risk moms. In a perfect world, right? For now, our focus should be on having the same standard of midwifery care at home as we do in the hospital. That scope needs to include the same amount of schooling and continuing education that is required of CNMs today. If you know anything about education, you also know that those standards change constantly and in my experience, become more thorough and strict. That is great! Midwifery is a profession just like any other and you wouldn’t hire someone who was not fully educated to take care of you and your baby, right?

The reason we need great home birth midwives is because we need to lessen the number of neonatal deaths. Since families are going to make that choice whether I agree with them or not, we still need to have educated, great midwives attending those births. We need to continue to hold midwives accountable who have had deaths or complications made because of their lack of education or preparedness.

Remember, we don’t want to bury our babies twice, or even once if we can! #notburiedtwice

my thoughts on home births

I have thought long and hard about writing a post like this. It’s a touchy subject, especially in the natural childbirth (NCB) arena and I’m still having a hard time finding my words but I’ll try.

When I was pregnant with Logan, I had no desire to ever enter the medical field other than working in administration. When I was 28 weeks, we watched The Business of Being Born and I thought my world was turned upside down. I cannot explain how one documentary on childbirth, home birth, and how OBs are only surgeons, changed my mind in 90 minutes and made me question every decision we had made up until that point about our care. We were with an OB office and had a decent, uncomplicated experience so far. We had started going to natural Bradley Method childbirth classes and learning more about the birthing process. But as I reflect on that time almost 5 years ago, I am dumbfounded how easily influenced I was, and how I tried to manipulate my  husband into thinking that a home birth was the only way and that hospitals were just a place where they wanted to perform all these interventions so they could get more money.

Um….crazy thoughts, right??

Even still, we checked into our insurance options and switching providers and to a home birth was not something our insurance would cover. Good thing since our son had a spontaneous pneumothorax at birth. When I shared this with a local home birth midwife recently, she said it must have happened when they tried to suction him since he had meconium in the waters and she had never seen a spontaneous pneumo in her 30 years of doing home births. Not so. I have a video of Logan laying on my chest immediately after birth and you can tell he is really struggling to breathe and cry. And he didn’t actually aspirate any meconium. Had we been at home, it would have taken at least an hour to transfer to the hospital if the midwife attending was able to quickly determine that there was something wrong. By the time Logan was an hour old, he had been treated with an oxygen hood, chest xray, and diagnosed with the pneumo. It was, by far, one of the scariest nights of my life, but I am so incredibly grateful that we delivered in a hospital with a level 3 NICU.

After his birth, I found my passion. It took many months for me to accept it, but I knew pretty quickly that my career path was about to change. I toyed with the idea of what kind of midwife I wanted to be. I even considered home birth at one point but I never felt comfortable with the liabilities and risks. Even as I type this, I feel a lump in  my throat. My husband also expressed his concerns and thoughts and we have always had a deep understanding with each other that if one of us felt strongly about something, that we would respect each other’s thoughts and feelings on the subject. He’s a very easy-going guy and for him to feel strongly about my career path means the world to me.

Since then, I have busted my butt to really figure out what kind of midwife I want to be and what I believe. I know that there are good CPMs out there, just like I know there are good OBs and CNMs as well. This is not a post where I am going to knock CPMs and talk about how terrible they are and how home births should be outlawed. I’m not that close-minded or disrespectful. What I will say, though, is that I do not agree with the safety of home birth and how it is portrayed in the NCB. I think it feels like brainwashing and I can say that as I was one of those new mamas feeling the pull to make a rash decision without any education behind my choice to have a home birth (or not). I can say that I felt brainwashed into thinking that OBs were just surgeons looking for the big bucks and that they have no invested interest in their patients. In general, this is not true! I know and work with some incredible OBs, both male and female (not that that matters). I also know some OBs who I would not want to be under their knife, but isn’t that the case about any thing? You can have good lawyers and bad lawyers, good engineers and bad engineers, good OBs and bad OBs. 

There is a huge part of me that wants this to sound like I am a devil’s advocate, comfortable with either side of the debate of home birth vs hospital birth but the truth is, and what I believe, is that there IS a difference and that there are countless statistics showing how much safer hospital births are than home births. I am not going to list those here because most of us know how to use Google and other people have already gone the distance to do all that work. This blog is one of them. And here is another.

Long story short, I am not a fan of home births. I respect you if you’ve had one and if you are planning on having one, I hope you’re doing everything you can to learn about risks and complications for both mom and baby. Post partum hemorrhage, nuchal cord (around the neck), shoulder dystocia, meconium aspiration…just a few to name as complications that can happen even to a low risk healthy mom. Some of these become even greater risks if mom has other identifying factors, but they can still happen. I had a mom come in recently who had been laboring most of the day. She came in to be checked, was a 3, contractions kind of all over the place so she was sent home. She came in later that night when I was on and was a 6, but complaining of terrible pain in her stomach and baby heart tones were pretty low, despite position changes and even after contractions ended. Baby was not recovering and something was wrong.  We rushed her to the OR and it turns out her placenta was abrupting. Had we waited much longer both of them could have been in a world of trouble and had she been at home…I don’t even want to think about how badly that could have turned out.

I am constantly learning. The more I learn, the more I realize that home birth really is not a safe choice. It wasn’t for me, and for so many others it has ended in absolute tragedy. I have worked in the hospital for over 3 years and in that time, no babies or mothers have died due to something we were able to treat them for. Yes there have been hemorrhaging and codes and even an amniotic embolus in which both mom and baby survived!!

In closing, I would like to officially join the #notburiedtwice movement. I’m not going to go into detail about it here as I’d like to encourage you, dear readers, to find out for yourself. I am a firm believer in self-education and this is an opportunity for you to do just that.

Thank you for reading and allowing me the space to express these tough feelings. All I ask is that if you choose to comment, be respectful.