Wednesday, April 20, 2011

HIPPA for Midwirery 101

Made another addition to the Free Resources for Midwifery Study list:

HIPAA for Midwifery 101 is a straightforward guide to privacy regulations in the US written by a CPM.

Saturday, April 9, 2011

Birth Story Listener

A friend of mine on Twitter has been livetweeting the ICAN conference, and one of her tweets quoted Pam England (of Birthing from Within fame) as saying her profession is Birth Story Listener. Not having been at the conference, I don't know the context of this quote, but I think it's a sentiment we can all relate to as birth workers.

For me, the idea of being a Birth Story Listener is not just about tuning into my clients and holding the space for them as they process their previous and recent births, but about doing this for all women. Whenever someone finds out that I am a doula and student midwife, I inevitably hear their birth story. This is one of the parts of my job I love the most, even when I have to bite my tongue as they recount things like, "My baby was too big at 38 weeks, so I had to have a c-section" or "I just wasn't progressing once I got to the hospital, so I had to be on Pit." Often they ask me questions about their experience, and I realize they've never been given the opportunity to truly process their births. I don't think this is something OBs regularly do. Once I was in one of my PhD classes and during the break, I'd gotten a call from a client that her OB had stripped her membranes during her appointment with the hopes that she would go into labor before the OB had to leave for vacation that weekend. I was so excited because this was my first client, and I was telling my classmates that I would likely attend my first birth that night! Before I knew it, eight women were telling me their birth stories, almost simultaneously, just lovely detail after detail pouring out of them, all piling up around me and surrounding me with happy birth thoughts.

The most important part of being a Birth Story Listener is to avoid judgement. I will gently correct certain statements made, like "well, it's not possible to have a breech baby vaginally," with something like "Actually, that's not true, it's just that few people are taught the skills to help deliver a breech presentation" or, "Pitocin does speed up contractions, but it also makes them more unmanageable." I never ever say, "That was a bad decision" or "Your OB lied to you," (unless this is an idea they introduced and which seems obvious--often I encounter women who are looking for someone to validate their feelings of being lied to and cheated out of their ideal birth). It's also common to have women ask me if, based on what they've told me, I think they could have gone natural. I try to offer affirmation and validation of their feelings and thank them for sharing with me.

It is a gift to be able to hear a birth story, and not everyone can listen and receive such stories in a supportive manner. One of our jobs as midwives or doulas or birthworkers of any kind is to hold the space for women to safely process their births. I have heard from friends who had planned homebirths and had to transfer that their midwives never followed up and went through the birth story with them. It can be embarrassing or uncomfortable when things don't go according to plan, but this is all the more reason to process what happened, both for you and the client. We are the keepers of birth stories, and we can learn so much from each one.

Tuesday, April 5, 2011

Wax study might be onto something

Ugh, I can't help myself. Despite the heap of schoolwork before me - grown even larger by four days of conference attendance - I can't help but keep dwelling on some of what I heard over the weekend. What really rocked the boat for me and was outside of what I would have expected to hear at a midwifery conference (I mean - Huge maternal and infant mortality: big, bad problem, Midwifery model of care: good, appropriate solution - that's pretty predictable and formulaic, right?) was what Michel Odent said about the recent research about neonatal mortality and other indicators of birth outcomes that has made home and hospital vaginal birth appear more dangerous for mothers and babies. It wasn't "Those studies are shoddy." It was, "They're right, I would have expected as much, and here's how we're doing harm even in home births."

Since Science & Sensibility posted about the Wax study again yesterday, I had to comment:
I got to hear Michel Odent speaking about this study last week and was really fascinated to hear his take. Rather than criticizing the study methodology, he said that its results as well as a couple of others of the last 6 months (Netherlands and China) indicate that birth is becoming more difficult in all settings. He suggests that we have a gross misunderstanding of the needs of a laboring woman across the board, even in natural childbirth circles. I’ll be writing more about this in the coming weeks because it is possible that we are largely turning a blind eye to a lot of widely accepted and in fact celebrated and endorsed practices even in the most natural and low-intervention approaches that may not actually be physiologically sound.
That being said, I’d be delighted to see this study retracted or taken down as inflammatory or unsound – but if there IS a kernel of truth in it, I think we’re wise to look directly and honestly at the implications.
I made a few corrections over the actual comment I left where I made a bunch of mistakes - my fingers are thundering through this today so I can get to "real" work. If you see any typos or mistakes, please give me a heads up.

I had no idea, until this weekend, that midwives are widely ignoring a number of the less convenient and conventional (midwifery-wise) criticisms Odent makes about very common and very accepted interventions (or as we like to think of them, practices.) That dude is way more fringe than most midwives, makes some very specific and potentially revolutionary observations, and we're not listening.

To give you a teaser... Is it possible, despite all our advocacy for allowing women to have food and water freely in hospitals, that they don't actually need food and water in labor, and that we are actually making their labors more difficult, prolonged, and unnatural by insisting that they do? 

More to come, more to come.

Monday, April 4, 2011

Update: Forum for Creation of National Coalition of Student Midwives (or whatever)

There is now a forum up for discussing the formation of this new Coalition of Student Midwives or whatever it is going to be called for those who want to participate in midwifing it, so to speak. It is here:

From the inaguaral post by Jeramie Peacock of SQUAT Birth Journal:
"The group (council/coalition/federation/ whatever) as I understand it enters into existence consciously leaving behind any sort of descriptive term (nurse, lay, license, direct-entry) before the word midwife as this division does not necessarily serve the next/future generation of midwives... All of the issues the group will explore in my opinion must be inclusive. We need to acknowledge issues such as barriers to midwifery for women of color/ lower economic brackets, issues of gender/ birth work, culturally appropriate care and training, etc. These issues are equally relevant in my mind to the creation of a Student's Bill of rights (one of the things discussed in the MT session in Eugene)."

Fetal Pigs

This week in my anatomy lab we had the opportunity to dissect fetal pigs. Dissection is something that I love, in another life, or maybe later in this one, I will be a surgeon. The inner workings of the body are fascinating.

OF COURSE there were many in the class who spent a lot of time sympathizing over the "poor baby pigs" and "but they are so cute", "it is just so cruel", refusing to take advantage of the opportunity to dirty their hands inside a body cavity.

On my way home, as I was rethinking the discoveries of the dissection (most amazing was seeing how the venous system of the umbilical cord ties into the venous system of the rest of the body) I flashed on an article a friend had shared with me earlier in the week, a report of a study on Maternal and Infant Mortality. An excerpt from the article reads:    

                 "Some 1,000 women and 2,000 babies died every day from easily preventable birth  complications…" (Emphasis is mine)

The article is focused on the fact that more midwives worldwide would serve to reduce the number of deaths that are being seen in impoverished nations; My heart focused on fetal pigs. Would the people in my class who were shocked and outraged at the loss of animal life have taken a moment of pause if they knew that during the 2 hour period we were in lab, approximately 83 human babies and 42 human mothers died because they lacked access to good food, clean water and a midwife? Here we were, in our charmed and privileged little world despairing because some baby pigs were euthanized in the name of science while families around the world were mourning the loss of their women and children. In my mind, the only reason to weep for those fetal pigs was thinking that, had one of them grown to butchering weight, a family somewhere in the world (maybe in our own back yard) might have been able to feed their children.

How lucky are we that we can slaughter our food source in the name of science to train the next generation of supposed "care" providers? (Cynicism is mine) How out of touch with reality are we to lament the perceived "senseless" death of ANIMALS while our brothers and sisters are losing their lives because they don't have food, water or access to rudimentary healthcare? I am the person in the corner talking to my little piggy, thanking its' spirit for the sacrifice it made, thanking the universe for the opportunity to better understand the intricacies of anatomy so that I can be the best care provider possible. I know that not everybody can see things this way. I know not everyone will cry through the article and feel deeply the unfairness of the world. I do, and I am thankful that I can feel that compassion and know that it will drive me to be the absolute best that I can be as a midwife, as a care provider, as a citizen of the world. I am thankful too that the squeamish and outraged people in my class have a measure of compassion in them as well, I just feel like it could be better placed.

I have been on the path of Midwifery long enough to realize that there will always be a struggle. A struggle for respect, a struggle for access, a struggle to maintain boundaries, a struggle to maintain marriages and care for kids while upholding our commitment to our mamas, babies and families. I have not yet been in the position to have to struggle for food, for water, for medicines for my mamas. I haven't had to watch a single one of them decide between eating enough to maintain a pregnancy or feeding her living children. I haven't watched a woman slip away as the blood slowly drains from her once lithe and dancing body because her placenta crawled through her uterus in search of sustenance. I have never handed a dead baby into a mother's arms or a newly motherless infant to its father. These things are happening EVERY DAY, more than once, 1,000 and 2,000 times a day and our sister midwives are out there struggling to stem the tide, to cheat Death of just one.

I am apprehensive. The numbers say that as I mature in my practice and as I see more mamas, I will experience these things first hand; Dead mamas, dead babies. Nobody likes to talk about this. Death of people in your care can mean death of your practice, of your spirit, of your career, especially if you are a homebirth provider in the Unites States because the cultural " we" takes it for granted that the beauty and miracle of birth and life is forever entwined with the miracle and beauty of death. I know that I am fortunate to be learning midwifery in an environment where normal, low risk pregnancy IS the norm and the safety net of medical technology is rarely far away. I have the luxury of serving a population of women who are willing to take responsibility for their own care, have clean water, access to a diverse range of fresh foods (if only they will choose to take advantage of it!!!) and the freedom to choose to give birth outside of the medical system should they so desire it.

I have to wonder, as I continue to pursue midwifery, how will I handle the realities? How will they shape me? Am I brave enough, mature enough, still flexible enough to attend births where there are far fewer guarantees of a good outcome? Will this kind of experience help or hinder me as a midwife? The answers will come and in the meantime, I am grateful to those Midwives who are serving the underserved populations, staring death in the face and yet able to celebrate those moments when life triumphs. Only the Universe knows if I will join their ranks. For the time being, I will continue my studies, attempt to maintain compassion and stay open to the possibilities.

My name is Annie, I am privileged to be a student of midwifery in the United State and I am thankful for fetal pigs.

Coming Soon: a National Coalition of Student Midwives

I could easily write two dozen posts processing and responding to what I heard at the "Gentle Birth is a Human Rights Issue" conference of Midwifery Today. Unfortunately, though it would be really useful for me personally and possibly useful for other folks if I did that, I likely won't be able to spare that kind of time for a while.

I will pass along this bit of news, however, because it is oh-so-relevant and plus very cutting edge! I'm sure we'll all be hearing more about this, but one of the things that came out of this conference was the push to start a National Coalition for/of Student Midwives (don't quote me on the name, it may morph as it takes shape but that's what was being tossed around this weekend) which will draft a Bill of Rights for student midwives and act as a protective body that holds proctors and educational programs to a standard that respects the rights of student/apprentice midwives.

Many students experience various forms of abuse at the hands of their preceptors and as of now have no way to raise their hand for help without putting themselves in an even worse position with their preceptors. This new body will provide protection and anonymity for those students, as well as a clear set of standards and rights.

I'm curious to hear what more comes of it and will share any information as it comes my way. This national coalition is the inspiration of Elizabeth Davis in response to the reports she has heard from many students and their expressed inability to stand up for themselves without putting themselves in the line of further fire.