Poem for Haiti (by Milk Chocolate Midwife)

Mother of my mother
Who taught me to love
Upon your visage is an ache
For babies lost before their first gurgled cry
Memories of your fruitful seasons woven into the fabric of time
How you once wore the dewy, green bloom of youth
I remember
How you conjured up colors that hushed me
Blue-green blades of grass on hillsides
So beautiful the sun would beg for a peek
Streaking auburn fires and golden lightning bolts
Splashed upon cliff faces
Your beauty is forever
Though a cloak of fragility and desperation
Is what adorns you now
The memory of your warrior's spirit
Carried with you from Guinea
Is not forgotten
I remember
The strength of a mother
Too mighty to be overcome
Though man and beast
And forces of Nature have tried
You were born of the ashes of genocide and slavery
Baptized in the fires of dictatorship and terror
Nursed on the bitter teat of corruption and racism
You strike fear in the hearts of men
For secrets held close to your granite bosom
Secrets of your strength
And joy
Your hour of need, mother, is upon us
And as your need is my need
My hand is your hand to lift you
I am yours
You are Haiti
Mother of my mother
Who taught me to love

A Birth Story

I've been on hiatus. Isn't that what what folks say when they don't wanna say that they've been too lazy to keep up with their blog? Well, it's what I'm saying. I apologize. Please accept my gift of a birth story as a token of my.... Ah, hell. Let me just tell you this story.

About a week ago, I had the privilege to be an attendant at a beautiful, if mildly frustrating, birth. My frustration didn't stem from the mother or her labor pattern. It stemmed from the fact that, even though she was choosing to birth in a hospital, she was being cared for by a group of nurse midwives, and I had rather high expectations. My bad. So the story goes...

I received a phone call at about 8:25pm while sitting on the couch with the hubby. Turns out, this mama who I'd been expecting to go into labor soon had broken her water but wasn't having regular contractions yet. After having a brief conversation with her, I instructed her to call her midwives and see if they would like her to go to the hospital right away. Being that she was GBS positive, I suspected that they would tell her to come in, so I got dressed and waited for her to call me back. I was right. Off to her house I went. Because this mom and her partner had decided that the partner would stay with their young daughter if labor began at night, I would be the one to pick the mama up and drive her to the hospital.

We get to the hospital around 10pm and wait in the waiting room for about an hour while the maternity unit staff tried to find this mom a bed in the triage unit. Her contractions at this point are becoming regular and are about 4-6min apart lasting 30-45 seconds. Mom is hooked up to monitors when we finally get into the triage room and the monitors are showing decent contractions and good fetal reactivity. So, she's admitted and we're both told to go to sleep and she'll receive her first vaginal exam at 2am. She's been told my the midwife on that if she's not in good labor by then, they probably start her on pitocin. "All you'd probably need is just a whiff of pit to get things cranking.", she says. At this point, I'm thinking, "Oh, boy. The p-word already? From a midwife? Hmm." So this mama and I go into the labor room and attempt to sleep.

Instead of sleeping, I lay down in a chair and watch this mama (who is lying on her left side) for a while. Every so often, I notice that she reaches around and rubs her hand on her lower back. I ask if she wants me to rub her back, but she says she's okay and doesn't need it at that moment. She does ask me to check the monitor to see if it's registering her contractions. (Oh, did I mention this mom was on continuous fetal monitoring through most of her labor even though she was told that she'd be monitored intermittently?) I looked at the strip coming out of the monitor and noted that her contractions were not being accurately recorded even as I stood there with my hand on her belly during a contraction. I mentioned this to the nurses on several occasions and the monitor was readjusted several times.

At 2pm, the vaginal exam revealed that the mama was about 3-4cm, 50% effaced, and +1 station. She was also told that her contractions were insufficiently strong and that they could start pitocin or wait a couple of hours more. She opted to wait. As the midwife walked out of the room, the mom asked me why they were pushing pitocin on her when she'd created and given the midwives a birth plan that indicated a preference for no drugs including pit. I told her that I really didn't know, but could speculate that maybe that's what they're used to seeing and doing. I told her that whether she decided to take the pitocin or not would be up to her and her partner and they should discuss it.

A few hours later, the midwife returned and asked what mom'd decision was regarding the pitocin. The mother stated that she like to hold off on the pit for a while longer. Again, she was told that her contractions, at 6 min apart, were insufficient and pitocin would help to move things along. The mother declined the pitocin again. That midwife went off shift and another came on. The new midwife removed mom off the monitor (after readjusting it for the millionth time and getting the monitor to actually read the contractions which were quite strong) and sent us into the hallways to walk. The contractions weren't much closer together but were building in intensity. Mom's partner got to the hospital around 8am while we were walking. We went back into the room and the midwife came in to tell the couple that the contractions were still not very strong and pitocin would be their best bet. "...With your GBS status, CDC guidelines recommend delivery as soon as possible. Yes, we've given you antibiotics but the literature tells us that even if we do that, babies can still get the GBS infection...", the midwife stated. When the mom nodded that she understood and began saying that she and I had discussed the pros and cons of receiving the pitocin, the midwife cut her off by say, "Well, she's the doula. I'm the midwife. And I'm telling you that you need this pitocin." I didn't even bother to inform her that I was also a midwife. I don't think it would've helped.

At this point, the mom started having a contraction and went into the bathroom. Her partner followed and the midwife turned to me and said, "Why's she so resistant to the pitocin? I mean, I don't think she gets it. I haven't heard her say that this GBS infection could be deadly!" Umm, okay. So I replied, "I think she gets it. She's had this conversation with me, with her partner, and with the midwives she's seen during her prenatal care." Exasperated, the midwife walks out of the room shaking her head. 10 minutes later, the couple call me into the bathroom and mom has the look of a woman getting ready to push etched on her face. I step outside to call the midwife who was sitting 10 feet away. I called her name, said the mom looked like she was getting ready to push and was not acknowledged. Another nurse told me she'd send the midwife in. 5 min passed and I poked my head out the door again to call the midwife and was not acknowledged. A third time 5 min later and I was told by yet another nurse (not the midwife) that mom had to be out of the bathroom in order to be checked. 5 min later, the midwife walks in to check the mom who is completely dilated and pushing. After pushing for less than an hour, a beautiful 6lb 9oz baby boy emerged.

After the birth, we had a few more hurdles to jump in order to get baby to room with his amazing mother but we did it. I was exhausted and frustrated at how my expectations of the midwives at this hospital were not fully met. This mother delivered a healthy, beautiful baby a little over 12 hours after breaking her water. She DID NOT need pitocin. And none of the midwives sat with her long enough to monitor her contraction pattern themselves. I take the meaning of midwife, "with woman", to heart and I expected the midwives to be with this woman. All in all, I know that things could've been worse and I appreciated the midwives' willingness to let the mother and her partner have time to discuss things. I thanked both midwives for their patience. However, I also know that while things could have been worse, they could've been a little better, too. And I know that's not strictly due to the midwives, but our entire system of maternity care.

When Doctors Give Birth

This weekend, my husband and I attended a get-together to celebrate the birthday of one of our dearest friends and his mentor. Because the hubby is a medical resident and his mentor is an attending at our local hospital, most of the party guests were either doctors, residents, or involved in the medical field in some respect. It was all good food, good conversation, laughing and sipping wine...Until the topic of birth came up!

You see, one of the doctors was expecting her first child and another had recently given birth. Was it fate that I would end up in the same room with both of these women and their partners? As I've said before, folks (including myself) have some really strong opinions regarding birth, breastfeeding, and parenting. So, of course the new mom proceed to give the mom-to-be an earful about what she should and should not do before, during, and after birth. Dr. New Mom's breathless advice: "Regardless of what your OB tells you, go to the hospital early because I waited at home an walked and changed positions and stuff to ease my discomfort (which was stupid because that's what helps you have stronger contractions, so don't do that) and by the time I got to the hospital I was 8 cm and they refused to give me the epidural. - Go early and get the epidural! Oh, and after the baby is born, don't ever let the baby sleep in your bed. EVER. Not even for a minute. Otherwise, you'll never get them out of your bed." *sigh* Dr. Mom-to-Be's response: Silence (wide-eyed, terrified expression plastered on her now ashen face).

Oh, what's a midwife to do, feel, or say in this situation? Here were two very intelligent women who are trained doctors and neither has clue number one when it comes to birth. I was frustrated. Yes, Dr. New Mom's comments irritated me because I don't appreciate misinformation. But misinformation coming from a medical professional, no less? It made me upset to realize how little doctors are taught about the natural process of childbirth. It made me furious to realize that highly educated women are no better protected than anyone else from the misinformation that all too often robs them of their power in childbirth and subsequent parenting. Of course, I already had some frustration simmering beneath the surface after recently speaking with a client (also a physician) who was in tears after being told that her 31 week fetus is too small (at 3lbs 5oz and within NORMAL range) following an ultrasound.

Growing up, I was taught that education is the key to not being taken advantage of. Granted, none of these women are in the field of obstetrics and I don't expect them to know what OBs know (and don't even get me started on what OBs "know" about natural childbirth). However, I did expect them to have an advantage over moms who lack education. They don't. In fact, studies show that women with post-graduate education are at higher risk for things like domestic violence and c-sections - things that many of us would like to avoid, to say the least. I left the party this weekend thinking, If education is the key to escaping marginalisation, these highly trained physicians should have nothing to worry about. Yet, they trust the medical system blindly because of their education. What a reality check.

Giving Birth to Judgement

As I've been reading various blogs about birth and women's health, I'm finding myself face to face (or face to computer screen) with people who have very passionate views on birth, epidurals, c-sections, and so on. Sometimes it feels like every chatroom or blog with birth as a subject has at one time or another become one of those vitriolic town hall meetings on I've seen CNN. Birth and the circumstances surrounding it can be a sensitive issue for many people regardless of their experience with it. Women who are proponents of natural childbirth are called selfish birth Nazis. Women who have had planned, elective c-sections are being verbally attacked for their choices. And who is attacking these women, you might ask. OTHER WOMEN!!! Women belittling, degrading, and passing judgement on other women. What has that ever solved? Ummm, let me think... Oh, yeah. NOTHING!!! *Deep breaths* Sorry, I just get so steamed when I see this stuff. I'm calm now. I promise. Back to what I was saying.

Birth is a very personal event and there is no one right way of giving birth. And I don't believe every woman on the planet can or should give birth vaginally or without intervention. Anyone who knows me knows that I am a staunch supporter of natural birth and *true* informed consent. I have no problem with a woman choosing to have an epidural or a c-section as long as she knows the risks and those risks aren't down-played to influence her decision. What I do have a problem with is a system which perpetuates the idea that women's bodies are flawed, that at least half of us don't have the capacity to birth our babies the way our foremothers have done for ages, that we are emotionally and physically unable to cope with the rigors of childbirth, that we need to be rescued. I don't feel that a woman who undergoes a c-section or has an epidural has failed. If anything, it may be she who has been failed. Perhaps if more women were supported within their communities, by their health care providers, and, dare I say it, by other women, our (non-medically indicated) c-section rates might not be as high as they are. That being said, it is time we stopped hurling insults at each other and started turing our passionate feelings and our energy toward fixing the system.

Last week, I discovered ACOG's disturbing survey, "Complications Related to Home Birth". Apparently, ACOG is concerned that the rising rate of elective home births will somehow lead to an increased rate of maternal and fetal complications. The list of complications that they provide for selection on the survey range from multiple gestation to shoulder dystocia to postpartum hemorrhage. My question was this: What does home birth have to do with these complications? Common sense tells me that the location of a birth does not dictate whether or not a complication arises. More relevant would be the awareness, knowledge, and preparedness of the birth attendant(s), perhaps. But even with the most skilled and perceptive attendant, hairy complications can happen, right? What ACOG seems to be suggesting, however, is that hospital births are free from complications until midwives or "untrained" birth attendants bring their so-called "train wrecks" from home to be rescued by doctors and hospital staff. It is precisely this type of thinking, perpetuated by many in the medical community, that leads people to expect perfect results every single time from doctors. And when perfect results are not achieved, lawsuits arise because folks need to blame someone. Who better to blame than the person or persons who assured you that if you followed all their often uncomfortable and counter-intuitive rules you'd have a perfect outcome? Anyway, that's my two cents.

I also found a great response to ACOG's survey. It's created by a doula, Tabare Depaep, J.D., and re-posted on the EnjoyBirth blog. Very cleverly written. Here's the link:

http://enjoybirth.wordpress.com/2009/08/28/response-to-acog-homebirth-survey/

Lately, I've had boobies on the brain. That's right. I've been pondering breastfeeding. A lot. More specifically, I've been annoyed and outraged by those who claim that breastfeeding is obscene or disgusting and should only be done behind the closed doors of a public bathroom stall. And I've been vocal about it. One friend commented, "Wow, you sure are passionate about your breasts!" Well, I am. They're great. And someday, they'll hopefully nourish the next generation of the Milk Chocolate Midwife family. I'll be damned if I'm doing that important task behind closed doors unless it's strictly by choice!
So, in honor of International Breasfeeding Week, here's Blacktating's August Carnival of Breastfeeding. Love it, live it.

August Carnival of Breastfeeding: Prepared for Life

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Playing Doctor

Sometimes, I get the feeling that many, if not most, of us in the health care field went into our lines of work because we simply don't like being the patient in a health care situation. We'd rather be the people who are in charge, the ones who know what's going on. Maybe I'm projecting, but as kids how many of us wanted to be the patient when we played doctor? I sure didn't. I wanted to be the doctor because being the patient held little appeal. The doctor got to use equipment and DO stuff. The patient just got to lay there and be sick. At no time during these play sessions did the patient question the doctor or get to participate in deducing what was wrong or deciding what to do about it. How did I (and so many others, I'm betting) learn these classic and faulty elements in the roles of doctor and patient at such a young age?

It must start when we are babies or very young children, for most of us. I remember my terrified little brother thrashing around on the table and eventually having to be restrained by four adults (he was 2 or 3 at the time) while the doctor looked into his infected ear with an otoscope. No one spoke to him or asked him what was wrong or why he was so afraid. Poor kid hasn't been to the doctor willingly since then. He's now 21. My own personal experiences with doctors as a child were often less than pleasant. One of my earliest memories is peeing in a doctor's lap as he gave me a shot in the buttocks. Hey, I told him to wait and he refused to listen to me! Note to pediatricians, when a 2 year old says, "Wait, I've gotta pee.", she may be stalling but maybe you shouldn't lay her across your lap in your newly carpeted office (instead of an exam room) and proceed to give her a shot! My dad was standing there unable to keep a straight face while I watched my urine soak the doc's pant leg. Even the doc laughed. I was mortified. Daddy apologized and dried my tears.

As an adult, the experiences don't get much better but by this time I made it a point to visit the doctor only if I was practically at death's door. When you have no insurance, that's an easy resolution to stick to. In 2007, I did have insurance. I also had a UTI that was morphing into some lovely kidney pain. After visiting the ER, I made an appointment with a nephrologist in my area. I was sitting in the exam room when the doctor came in to greet me. He glanced at my chart and said, "History of UTI, eh?". I nodded and he asked me to stand up. At this point, the doctor grabbed my crotch. Let me repeat. HE GRABBED MY CROTCH!!!!!! To add insult to injury, he said, with his hand still at my crotch, "Well, that's your problem right there. It's too hot in there." What the fucking hell??? I was stunned. My mouth simply hung open and no words came out. I did not punch him, though I should have. Nor did I push his hand away or yell any of the million things flying through my brain at that moment. I did nothing. I said nothing. Because he was the doctor. He was the DO-er and KNOW-er. He had the power. I was the patient. All I got to do was be sick. And after that, I was sick.

I don't hate doctors. Far from it. My dislike is for the unequal and counter-productive power dynamic that exists between many doctors and their patients. The existance of this dynamic isn't soley the fault of doctors or the medical community. I think that patients shoulder an equal share of responsibility here. But here's the problem. Most of us were patients before we were ever health care professionals and we've been socialized to be "good patients". A "good patient" doesn't ask too many questions, is compliant, and understands the patients' place in the medical hierarchy is below the doctor/nurse/midwife, etc. Today, we need less "good patients" and more people actively involved in their own health care. We need patient education and respect. We need to stop asking doctors to shoulder the burden of making health care choices for us because when things go wrong (as they sometimes do), whoever made the decision also carries the blame. We need doctors to stop practicing health care that's based on fear of litigation. We need to be the kind of patients who don't just lay there and be sick.