The View from the AIP Class: Week 2

The Midwife practice where my mother worked, in Bethesda, Maryland, closed shortly after my daughter was born because of financial concerns. I think one other problem is that midwives tend to smaller practices, rather than giant ones, and right now the big guys get all the help to stay open.

That said, having my daughter at a free standing birth center was a great middle ground option for me. No hospital interventionist attitude, but I also didn't spend early labor running around my apartment panic cleaning because a midwife (who would qualify in my mind as "authority figure who will judge me based on my housekeeping skills") was coming over to my house.

"Oh, pets. We are nowhere near the mindset of taking on creatures to care for.... we are expecting a baby in the next few weeks. " I'd saying you're already taking on one of the most challenging and rewarding creatures to care for. I can certainly see why you wouldn't want to add another for a while.

I have seen a study, though, where children who grow up in houses with two or more pets have much fewer problems with asthma, so you might want to think about it once things settle down.

Pets have been on my mind quite a lot. We have four; 2 cats, 2 dogs. I've been working on making some of their food, but finding it challenging; one more thing to fit into this tired woman's schedule. Two are elderly; I give the cat subcutaneous fluids two to three times a week, and the dog a subcutaneous arthritis med every two weeks; both are also on various other meds. These are expensive and not something I can prepare for making at home, but well worth the money to me, to keep their lives comfortable as long as possible. But someday, I suppose, such options will be gone. I worry about disaster prep; spending so much on these meds makes it extremely difficult to set enough aside for, say the earthquake. And a week's worth in that situation wouldn't help much anyway; things would be out of commission here for months, if not years. So perhaps there's little point in worrying about it, but I do. Also about how I would feed them in that scenario. It's temporary, of course; they won't live more than a few years more at most, but currently a subject of some preoccupation. And the feed questions remain, for the younger animals. Raising livestock is not an option where we are, nor something the spouse is willing to consider, even if we had land and favorable zoning.

I'm curious...why is the *hospital* being sued when a homebirth goes awry and requires an emergency C-section?

We are lucky to live in a time where advanced medical care is available. Women used to die, regularly, in childbirth. Yes, even with midwives. Babies too, even more frequently than the moms.

Moms could get infections when labors dragged on too long. Moms bled to death. A friend is in the ICU right now after a major hemorrhage following a routine vaginal birth.

Babies can die of all sorts of things during childbirth, but mostly what it comes down to is being in distress and needing to get out ASAP, a luxury not available without advanced medical care.

I agree that we will likely go back to just midwives some day, and when we do, we'll see a lot more death and injury than we do today. It will be better than nothing, but still.

But C-sections save lives, as do things like the blood transfusions and cytotec for moms that are bleeding out post-partum, inductions for post-dates (especially when the placenta is starting to fail), c-sections in emergencies, and pitocin for moving along a stalled labor that puts mom and baby and further risk. Not to mention the ability to get a baby out early when there is gestational diabetes, pre-E, etc.

I attempted a homebirth, but after 30 hours (24 of them with broken water), I transferred to a hospital. Had an extremely malpositioned baby. Managed to get him out vaginally, eventually, after another 20 hours with pit and an epi, 4 hours of pushing (with minimal epi), an awful post-partum hemorrhage, and some minor complications for baby afterward.

Without modern medicine, we'd both almost certainly be dead.

I don't know a thing about the case that she's talking about, but it is also the case that additional interventions sometimes due lead to complications as well - I'm grateful for reductions in infant and maternal mortality too, but they come with a price - a greater inclination to use interventions in non-critical situations, and a sense that you CAN'T have even a healthy birth without all those interventions. Like everything there's a price - for the most part I'm glad to pay it. But I don't pretend it isn't there.

I think the problem is that you don't know, in advance, which interventions are "critical." Do those decels mean anything? Was the c-section necessary? Maybe, maybe not. Ditto with post-dates inductions--are they necessary? Or would the placenta have held up another week or two? There are some ways to tell the placenta is failing, but it doesn't catch nearly all of them.

In some ways, it's like wearing a seatbelt. Ideally, we'd only wear one if we were going to be in a crash where they'd save us. The rest of the time, we could skip them and be more comfortable. And we'd be spared those weird times when the seatbelt actually causes a death that would've been prevented if the person were unbelted. (Happened to a friend of mine where being a reckless unbelted teen caused him to be thrown from the car--and the roll bar somehow snapped and impaled the seat in a way that would've killed him if he'd been belted in.)

But overall, we know seatbelts save lives, and since we never know when an accident is going to happen, it's great that we have the option of wearing them all the time.

I don't know anyone who thinks they can't have a healthy birth without all those interventions...though most people I know do think it's better to attempt a natural birth in a hospital so that if things go wrong, real medical help can be had quickly.

I also think we can't disregard the very real need many women have for pain relief. It's interesting to note that in the rural, developing world, where medical care is scant and most women give birth at home or in a medical hunt with nothing but midwives, these women crave advanced medical care--to protect themselves, to protect their unborn children, and to protect them from the sometimes extreme pain of childbirth.

Women's labor's can vary widely. In an "easy" birth, women may or may not feel the need for pain relief. But with a large or malpositioned baby, an obstructed labor, or a very long labor, pain relief is a godsend that those forced to give birth without it would very much like to have.

In this sense, the fetishizing of "natural" childbirth is very much a rich, white women phenomenon. Which may explain why it's so popular in the wealthy community I now live in (as a renter of a tiny rundown house), as opposed to where I grew up, where there are lots of low-wage recent immigrants from the developing world who are eager to give birth in hospitals with pain relief and access to modern medicine.

This post makes me wish I had taken this class.
Do you have participants from Canada?
Hopefully I can do the next one.

I have a friend who recently had a homebirth. She was planning on going to the hospital and had nothing in her birthing plan about doing it at home. She grabbed her bag and told her husband to go at about midnight. They're about 30 min. from the hospital. She was walking out the door and stopped and walked back inside and said "nope, not going anywhere" 20 min. later she had her daughter in her arms. She still went to the hospital for checkup etc. But the most interesting thing to me about the whole thing was how much her friends and family freaked out about how "dangerous" her behaviour was and how "wrong" her choices were.

Personally, I was supportive. If the baby is coming it's easier to do with your husband's hands free, not his hands on the wheel of the car. It was her second and she knew she wasn't getting any farther and made the right decision yet was vilified for it.

@c.: Your friend was totally right to turn around and go back inside. Delivering in a CAR would've been a disaster. And going to the hospital afterwards was super smart--to be sure mom and baby are OK.

She is, however, very lucky she didn't have a post-partum hemmorhage. Whether she had her baby in the car or at home, it could've killed her before she got medical care. Fortunately, PPHs are correlated with obstructed labor, making them far less likely with precipitous labors like your friend's.

Still, it's important to note that these sorts of things still kill far too many women in the developing world. There's a movement to get cytotec into the hands of rural midwives so they can better treat PPH. But it's not the same as a pit drip, a blood transfusion, and ICU care. But even cytotec could save lives in the developing world--and here too!

Cytotec after giving birth was the main reason I didn't end up with a blood transfusion or dead.