Monday, August 29, 2011

How to Choose a Safer Homebirth Midwife — A CNM’s Perspective

Another wonderful article was written and published over on 10 Centimeters, and again I just had to share it!.  This time, it is a piece written by Deb O'Connell - a home birth CNM in North Carolina.  You can read the entire piece here.  Below are a few of my favorite highlights!



Homebirth is not safe for every woman and any midwife who tells you that is grossly misinformed. Birth is not to be trusted – it is to be RESPECTED.


Homebirth is not as safe for baby as being born in a hospital – the NCB community can state it is (and in the past I have stated it as well) – however research has proven differently and parents need to be made aware that if the midwife they choose does not know how to recognize / anticipate when normal is turning into abnormal during the labor or birth, the results can be disasterous for mother and baby. A mother’s birth experience does not trump the safety of her fetus/newborn .



Parents who choose to have their birth at home should be sure their midwife has the following:
  1. Has experience in managing both low and high risk pregnancies.
  2. Licensed and credentialed to practice in your state.
  3. Carries malpractice insurance.
  4. Has a professional relationship with an OB/GYN or Maternal Fetal Medicine team for collaboration, consultation, referral, transfer and transport if needed.
  5. Has a well- organized transport system for her clients and reviews this with you during the pregnancy.
  6. Is willing to share her risk- out criteria, her practice guidelines, her stats and her professional license numbers with you (This should actually be a printed disclosure statement that accompanies the informed consent she has you sign).
  7. Asks you about the distance your home is from the hospital that has an OB Unit – ideally you should live no further than 30 minutes from your nearest hospital.
  8. Has another midwife or RN that attends each and every birth with her and they are both current in their BCLS and NRP certifications and have also had experience managing both low and high risk pregnancies.
  9. Follows you through your pregnancy to six weeks after birth.

Friday, August 26, 2011

Babies Die In Hospital, Too!

In honor of "Friday Fallacy" a wonderful article was posted over at 10 Centimeters and I just had to share it!  A classic retort to the death of a baby at a home birth is "babies die in hospitals every day".   While this is of course true, here are some things to take into consideration before accepting that statement as evidence that home birth is as safe or safer than hospital birth.

* Babies outside the hospital die at nearly 3 times the rate of in-hospital babies of complications of the placenta, cord, and membranes. That’s things like placental abruption, nuchal cords, true knots, and so on.

* They die of respiratory issues (birth asphyxia, neonatal aspiration, hypoxia…) at four times the rate.

* Infection causes death at nearly twice the rate outside of the hospital.

* Other midwives (LM, CPM, DEM) outside the hospital have a death rate almost THREE TIMES the rate of CNMs in the hospital. And in comparing respiratory related deaths with ALL hospital births (including those attending by doctors), the rate of death for out-of-hospital births is more than four times for other midwives, and is a shocking nine-and-a-half times higher than the rate for CNMs in the hospital.

* But the most shocking number of all is the number for complications of labor and delivery. It is nearly eleven times –ELEVEN TIMES!!! — as high for babies born outside the hospital. This is the category that contains breech birth and other malpresentations.




These babies aren’t dying from congenital abnormalities; they’re dying preventable deaths!!!



(data comes from the CDC WONDER - years 1998-2006)

Monday, August 22, 2011

OB/CNM Education = Library Book Reading



Just wanted to share this little gem - a bit of humor tonight!




I'm stunned!  All of this hard work I'm putting in, all these classes I'm taking, all of the four hours of homework I did tonight, and all of the time away from my precious babies!  All of this I'm going through in order to be the most educated, competent, balanced CNM and it isn't necessary??  All I really have to do is go to the library and read a few childbirth and medical books?  Well I'll be!!  I've read numerous childbirth books and quite a few nursing books!  Guess I'm already a CNM - now who wants to let me deliver their sweet little one?


Really though.  In all seriousness.  I can only hope and pray this statement isn't believed as true by many.  Equating the education of a CNM or OB to that of someone who simply goes to the library and reads a few books on pregnancy and birth is just insane.


Where is the logic?  Where are the facts?  Where is the truth?





Sunday, August 21, 2011

Sunday Blog Shout Out!

Just passing along a few Sunday (err... it's 1:00 am, isn't it? I guess it is really Monday!) blog shout outs for everyone to enjoy!



New Nurse, In The Hood -  An awesome collection of memoirs from a nurse who sees it all!  This blog keeps me rolling on the floor in fits of laughter quite frequently!

Faith, Hope, and Love - A beautiful blog dedicated to sharing the experience and day to day challenges of a wonderful woman expecting conjoined twin girls named Faith and Hope. A beautiful, inspirational blog!

At Your Cervix - A blog written by a woman pursuing midwifery as a CNM.  I love reading her school related posts and getting a glimpse of what my future holds!

The Sensible Midwife - A blog by a home birth CNM in North Carolina.  Love Deb and what she stands for!  I find myself secretly wishing I was close enough to have her deliver my next little one!

Mothering Many Feet - Written by a friend of mine who lost one of her precious babies due to a negligent home birth midwife (traditional midwife, not CNM).  She stands for justice, regulation, and change in the home birth community.  Wonderful things can be found on her blog!

The Skeptical OB - The famous "Dr. Amy".  She is occasionally spiteful, sometimes harsh, and  often quite callous in my opinion!  However, her writing is wonderful and she sheds light on many topics that need addressing!  Above all she stands for safe maternity care and fights hard to put an end to all of the preventable deaths happening at the hand of negligent midwives.

Answering The Call - Another great blog written by a good friend!  This author, like myself, was also pursuing midwifery as a CPM and had a drastic change of heart!  She is not pursuing midwifery as a CNM and is documenting her journey.


The Navelgazing Midwife - NgM is awesome!  She writes about life, mothering, parenting, birth, and so much more.  Great stuff can be found over at her blog!




Lots of great reads here!  Enjoy them!

Tuesday, August 16, 2011

Paying For Perfection

I was asked to write a guest blog post by a fellow blogger - Bambi of Mothering Many Feet, and I wanted to share it here as well!

As I began the transition from pursing midwifery as a Certified Professional Midwife to a Certified Nurse Midwife, I anticipated many of my friends would not agree with me regarding my new stance and would perhaps not quite understand why I was choosing a different path.  However, there is no way I could have anticipated the fury that would be unleashed when the announcement of my new path was given.

Instead of my friends finding out through hear-say, or through things they see on Facebook or on my blog, I decided to make a blog post devoted to announcing my new path.  I felt this would be best so that I would not have to explain my decision to everyone individually, and instead, I could direct them to my blog and they could read my innermost thoughts and feelings on this change.  Slowly, one by one, my friends read my blog and commented both there and on Facebook.  Some were supportive and encouraged me in my new journey, and many were very excited to see that I had changed my path and realized some of the things I had once thought were true and good, really were not.  Unfortunately, many were not in agreement with me and there were several who were outraged. 


Another massive uproar happened when I joined a Facebook group entitled “Fed Up With Natural Childbirth”.  The group was actually created by Dr Amy of “The Skeptical OB” blog, and is basically devoted to dispelling the myths of what I refer to as the Natural Childbirth Movement (NCB Movement).  Many are turned off by Dr. Amy because of her straightforward speech and curt, sometimes callous attitude.  I will admit, Dr. Amy seems overly harsh sometimes to mother’s who have lost their babies due to negligent CPMs/homebirth.  I feel like she tends to place much, if not most, of the blame on the parent’s for choosing that particular care provider and/or homebirth.  She also seems very anti-homebirth, even with a care provider who is competent such as a CNM.  Like most anything, you must weed the bad out while focusing on the good.  Dr. Amy makes very valid points and gives wonderful, science based information and facts.  While she does tend to be harsh sometimes, I firmly believe she has the best interest of mother’s, babies, and safe childbirth at heart.  The group “Fed Up With Natural Childbirth” is not at all about hating normal, natural childbirth!  It is simply a group of women that agree you don’t have to cloth diaper, homeschool, have a medication-free birth, have a vaginal delivery or even breastfeed to be a great mom!  We also believe you can have an epidural, birth at a hospital, or even have a cesarean section and still be a wonderful, loving mother!  What we don’t like about the NCB movement/community is that so often women are put down and cast out simply because they gave birth somewhere other than their home, or had an epidural or IV pain medication, or even needed a cesarean section.  Many NCB advocates seem to think that any mother who had any of these interventions is somehow less of a mother or isn’t a “birth warrior”.  “Fed Up With Natural Childbirth” is a place where women who don’t fit the mold of the NCB movement can come and feel supported in their choices and in their experiences.  The main goal of the group, is to dispel the myths that so many NCB advocates, doulas, traditional midwives (CPMS and DEMs), and others spread.  So many lies are being told and it is ultimately killing mothers and babies.   Quite a few women in the group have lost babies to negligent homebirth midwives and now rally against them and for the cause of safer maternity care for all women.   The name is misleading unfortunately, as many of the members have had natural hospital births, and some homebirths!  Sadly however, several of my friends could not get past the fact that I had joined a group entitled “Fed Up With Natural Childbirth”, no matter how much I tried to explain to them that they needed to look past the name and look at what the group is really about.




Another issue that many of my friends disagreed with me over is my stance on traditional midwives (CPMs and DEMs).   I’m a firm believer that traditional midwives need much more education, mandatory licensing, a nationwide set of practice standards, must be required to carry malpractice insurance, and have strict penalties for not adhering to these regulations.  I also believe if a midwife practices without any of the above requirements there should be strict penalties including fines, loss of license, and prohibition of practice.  If these requirements are not satisfied, I do not think traditional midwives should be legal.  There simply must be a nation-wide standard each and every midwife must conform to.  Unfortunately, many of my friends did not agree.  They felt as if this would infringe upon the rights of a woman to choose where and with whom she gives birth.  I believe in a woman’s choice as well, however we must make the choices safe, and as it stands now, birth with a traditional midwife is not safe.   I typically do not like to make blanket judgments or statements, but in this case, it is something that must be done since there is no real way to judge the good apples from the bad apples when it comes to midwifery.  I have many friends who choose to birth with a traditional midwife at either home or a birth center, and they were deeply offended by my feelings on traditional midwives even though I try my hardest to not be offensive and strictly speak fact.  Even though I don’t agree with their choice in care provider, I respect their feelings and decisions, and I wish I could say they did the same for me.
Ultimately, my decision changed quite a few friendships.  After many arguments and disagreements, after being called many names and being accused of just trying to be better than everyone, being told I was just a midwife hater and homebirth hater, and after being told I simply go with whatever choice gets me the most attention - I lost 29 friends from my Facebook friend’s list.  Many of those were simply acquaintances, some were great friends, and a few of them were people very near and dear to my heart that I never expected to turn on me like they did.  I’ve been called names, told I was wishy-washy, told I was acting like a defensive child, and talked about openly on message boards and other Facebook pages.  I was even told by one that I was no longer welcome to our local playgroup because of the thoughts I had shared.  I did expect some backlash when all of my feelings came to light, but I could have never prepared myself for the hateful words I received.
The way I was treated by so many reminded me of the way many NCB advocates treat mothers who do not fit into their perfect mold or mesh with all of their ideologies.  I define the advocates in the NCB movement to be those who feel any woman who doesn’t birth at home, has pain medication or an epidural, is induced, has a cesarean section to be inferior, or somehow less of  a woman.  I personally have had an induction due to HELLP Syndrome, an epidural, and ultimately a cesarean, as well as an induction due to preeclampsia, no epidural but one dose of Nubain, and a VBAC.  I was ostracized by several because I called my VBAC a “natural birth”.  For me, I simply meant vaginal, but was called out numerous times and belittled for allowing them to induce me even though it was medically necessary, and attempts were made to make me feel like less of a woman for having a dose of pain medication to help me cope around 8cm.   I caught flak from others because I gave my son the “evil” Vitamin K injection because he had a severe cephalahematoma  due to birth trauma.   I have sat back and watched women hen-peck others on Facebook groups and message boards because they had cesarean sections, or decided to have pain medication, had continuous fetal monitoring during labor, had their membranes ruptured artificially, or decided to have their baby receive the Vitamin K injection or Hepatitis B injection at birth.  The NCB community seeks out women to prey upon and criticize in order to make themselves look and feel better and seem superior to another.  There is simply no need for all of the hateful words, looks of disgust, and shameful glances given to mothers just because of the way their precious baby came into this world, and there is absolutely no need for the hateful words I received simply because I chose a path where I can serve a large number of women and their precious babies safely and fight against a broken system that is continuously allowing traditional midwives to kill innocent babies.
Ultimately, I have learned so much during this transitional point in my life.   I have learned much more about myself over the past few months than I have in the past few years!  My goals and ideas are growing stronger day by day and my realization of how broken our maternity system is becoming clearer.   Just as the NCB advocates forsake those who do not fit their perfect birth or motherhood mold, many of my friends have forsaken me due to the fact that I am seeking to better myself and better our nation’s maternity system so that more women have access so safe, competent, and personal maternity care.   At first, it bothered me that so many seemed to truly hate me for my choices.  However, I stepped back and allowed myself to think with my heart instead of my head and realized that as long as I know I’m making the right choices and trying to better myself, that is all that matters.  Along the way, I have realized that I do have some amazing friends who have stuck by me through this change – even one’s who do not agree with me, but respect me just as I respect them!  I have also found a great circle of women who are all fighting for the same thing I am.   I intend to continue growing, learning, and discovering more about myself.  I hope to be a key component in either abolishing the title of CPM/DEM, or making it so that they are more on par with the CNM credential so that no more mothers and babies have to suffer at the hand of a negligent traditional midwife.

Thursday, August 11, 2011

Fall Semester - 2011

I haven't been in high school in over 6 years, and I've been out of college for 4.5 years. I figured these next two semesters of finishing up my last two pre-requisites before beginning the nursing program fall 2012 would break me back in gently to the "college" scene. Unfortunately, that isn't going to be the case at all.
This upcoming semester, I was supposed to only have to take Microbiology and Microbiology Lab since I've completed every other pre-requisite for the nursing program. Unfortunately, nearly every single class I took at my previous college is not transferring because it was the wrong class for the current requirements. Example: I took Math 155 and need 111. One would assume that 155 is a higher math and would suffice, but while it is a higher level math, it won't fulfill the requirements. Same with all four of my electives. University of South Carolina requires electives to be in certain categories, and mine do not fit the correct categories.

13 credit hours, here I come.  My scedule looks a little something like this:
Composition & Rhetoric
Advanced Computer Science
Microbiology
Microbiology Lab
Introduction to Art
Introduction to Art should be fun. I had to pick a fine art elective and music was full, so art was my second choice. Interestingly enough, my kindergarten teacher who also happens to be an amazing artist, teaches Intro to Art! Ironic to have the same woman teaching you when you were 5 and when you are 23!

A billion thoughts run through my mind right now as the semester's start draws closer.  My main worry is leaving my kids.  Ava is almost 3 and I haven't been away from her hardly at all, let alone 4 days a week.  Plus, I still have a nursling I'm a little worried about.  My schedule is so hectic that I don't really have a time to pump, so I'll need to figure that out.  Perhaps I can get a manual pump and pump in the bathroom really quickly between classes.

Monday & Wednesday I'll be gone from 5:00pm-8:30pm
Tuesday I'll be gone from 7:30am-6:00pm
Thursday I'll be gone from 7:30am-1:00pm

I'm sure we'll work it out - just need to iron out the details!


My financial aid still has not come through. The financial aid office told me not to worry, that if it doesn't come through my start of the semester (in less than a week!) I can just apply for an extension and can continue with my classes without paying.
I ordered all my necessary books last night! Big score from amazon.com for sure! Retail value of my books at the USCL book store was right over $430. I got them all on amazon.com for $126 including expedited shipping!


I guess that is all for now!  The beginning of the "big picture" is getting close!

Wednesday, August 3, 2011

Fed Up With Natural Childbirth?

In today's wonderful world of technology, we have an amazing invention known as Facebook!  This website can be a hindrance, or a hazard.  Recently, I joined a Facebook page known as "Fed Up With Natural Childbirth".  I honestly hate the name of that page, but agree with 90% of what is said there and what the page stands for.  In my opinion, a much better name for the group that would give better representation of what the group is all about would be, "Fed Up With The Natural Childbirth Movement".  What is boils down to, is weeding out the whole "trust birth" mentality and focusing on what we can do to bring safe, adequate maternity care for all women - especially those who choose CPMs or DEMs.   Several have voiced their concern that I am now "anti natural birth" because the noticed I was a member of this group.  This is simply not the case at all.  The group stands for safe maternity care.  They realize that birth is not always flowers and butterflies and that interventions can and do save lives.  Many of the ladies there have had natural births attended by an OB, CNM, and some even by a CPM.  A name, is only a name and nothing more.


I agree with a wise woman who said "I respect birth, not trust it".  Birth is unpredictable - you can not simply blindly trust it!  I feel it would be a good thing for me to go over what I do and do not stand for at this point in my life, as it may help many understand where I am coming from.


I do:

* Support out of hospital birth for truly low risk women, attended by a CNM, and within close proximity to a hospital.
*  Support natural child birth!  I believe a birth with zero interventions is a wonderful, healthy thing!! I also fully support a women who desires pain relief during her labor.  Please don't think because I joined the above mentioned group that I am "anti natural childbirth" and think all women should  have epidurals, internal monitoring, and cesareans.


I do not:

* Support homebirth with a CPM or DEM at this time.  Until there are higher educational requirements, better standards, better regulations, and insurance requirements - the only truly safe homebirth is that with a certified nurse midwife.
* Think all women should have natural births to somehow "prove themselves".  I also do not think all women should have cesarean sections!




The bottom line is that I support a woman's choice regarding her birth.  Whether that be a natural birth, or a birth plan that includes an epidural as soon as possible!  Whether she plans to circumcise and vaccinate her child, or not vaccinate and leave him intact.  Whether she plans to breastfeed, or bottle feed.  These choices are very personal and it is not my place to judge another woman's choice.

One of the main "purposes" of the "Fed Up With Natural Childbirth" group, is to make it known that you don't have to breastfeed, or have a natural birth, or even have a vaginal birth to be a woman, or to love your child!  The spreading of misinformation and dangerous facts by the NCB movement is appalling, and the "Fed Up" group is working to end that.  Scratch beneath the surface.  Look past the name and understand what this amazing group of women are trying to accomplish!  You might just be surprised!