Wednesday, November 9, 2011

Caution: Choose Carefully

A woman thought she had chosen her care provider carefully. One whom she thought would facilitate the peaceful, calm, beautiful birth that she envisioned for her first baby. She was comfortable with her care provider, confident that she would have the type of birth that she was dreaming about.

Then, at the end of pregnancy she is bombarded with stress from her care provider. Pressure to undergo tests that weren't based on evidence of anything going awry. A strict dietary change, which she needed to report to her care provider. When her water breaks and there is no labor yet, her care provider is unable to follow evidence based research, and have patience as long as mother and baby are doing well. Care provider talks heavily and often of intervention. Begins forcing induction techniques on the mother. The care provider's nervousness exudes from every action, in turn causing stress on the family. Soon the mother is able to force-start her labor, even though her intuition tells her that everything was fine. Her care provider ordered the birthing woman's mother to get out. When it came to pushing, she wasn't given an option of birthing anywhere but on her back. Her care provider instructed people to hold and pull her legs all the way back, while roughly hooking fingers into the mother's vagina to stretch and pull. Stretch and pull. Mom kicks at her care provider's hands, and says, “This hurts. Please stop.” Her care provider continues, saying that if mom doesn't want to tear, this is what needs to occur. Baby is born. Yet, it isn't the calm and beautiful meeting that either parent had hoped for. Within minutes, the care provider was pulling roughly on the umbilical cord, even though the mother said it hurt. Pulling tore the placenta off of the uterine wall, and heavy bleeding began. Before the family knew it, the care provider was gone, citing fatigue. The husband was left to worry about his wife's bleeding, and his child's breathing, without the professional that they had paid for.

For those of you who know the difference between home and hospital birth, this sounds like a hospital birth. It wasn't. This was birth at home. With a Midwife. Unfortunately, just hiring a Midwife to attend a home birth does not guarantee you a peaceful, safe, calm birthing experience. And there are things you can look for in the interview, and in the prenatal process. The problem for most families is that they blindly trust in their care provider. They don't question, and they don't do independent research. And the Midwives that I know of that have caused these kinds of birthing scenarios are extremely smooth with how they present things. It is almost a grooming technique. They tell you exactly what you want to hear. If you question things, they have a well-thought-out reason for why they will intervene in an otherwise healthy pregnancy, labor, or birth.

Red Flags in a Midwife:

*She has strict requirements for what you can and cannot do for your own birth. For example, she has the rule that you cannot birth on your own bed. You must birth in water (if she “lets” you actually birth in water – does not pull you out when you start pushing), or on the floor. This is controlling, not evidence based, and quite frankly – disturbing. There is nothing evidence based about not allowing a woman to birth in her own bed. A birthing woman should be able to birth wherever and however she chooses. Period.

*She becomes visibly nervous over things that are within normal or normal variation. A professional, experienced, and competent Midwife will make the family feel at ease, even if she internally feels nervous about something. This is the time for her to do research, collaborate with a peer, and then make a calm recommendation if evidence shows a reason to step in.

*She starts doing or wanting to do vaginal exams in the end of your pregnancy. Whatever reason she may give you, this is NOT evidence based. It holds no purpose whatsoever. It will not tell you when you will give birth, how well your labor will progress, or how baby is doing.

*You begin to feel like less of a peer with your Midwife, and more of a submissive party. You view your Midwife as an absolute authority figure who shouldn't be questioned, or one who will “disallow” you to do something. Your Midwife is your SUPPORT during a physiologic event in your life. Not your authority.

*She begins to come up with reasons why the things you may desire, or have planned for your birth, are not going to work out. For example – birthing in water. If she mentions that she “may have to pull you out” of the water for pushing, HUGE red flag. If she mentions that your partner or the person whom you have chosen to catch your baby can do so only with her help, huge red flag. There is nothing special about a Midwife's hands. She can sit back and carefully watch, and step in if there are any issues. Otherwise, she doesn't need to be involved.

*She answers, “We'll have to see how things are going...” in response to your desires for your birth.

And finally, for those of you who may be questioning what the heck happened during your birth...if your Midwife:

*Had you begin techniques to soften and prepare your cervix.

*Pressured you to begin intervention in your otherwise normal, healthy pregnancy.

*Began induction techniques because your waters released and labor didn't start yet, even though you and baby were not showing any signs or symptoms of infection.

*Was nervous during your labor – didn't seem like she was confident with what was occurring.

*Didn't allow you to birth anywhere but on the floor.

*Discouraged waterbirth, birth on your bed, or someone else from catching your baby. (including YOU!)

*Did multiple vaginal exams either without you asking, or because she had convinced you that they were necessary to assess progress and safety.

*Had you push before you felt the urge – your body will undeniably begin pushing on its own without any effort from you.

*Kept asking if you felt like pushing. A Midwife worth her salt knows that if you have to ask, mom definitely does not feel like pushing. Then mom wonders why she doesn't have to push yet. Is something wrong? When will I feel like pushing?

*Roughly applied perineal massage and stretching. If she told you that this is how to keep from tearing. If she told you that this was necessary. If she wouldn't stop when you mentioned how it hurt, was uncomfortable, or you didn't like it. Doing perineal stretching and massage is not evidence based. Research has shown that it does not reduce the risk of tearing, especially since the position that mom is in for this, is the LEAST optimal position for birth.

*Spoke to you in a controlling way. “Give me that baby!”, “You can either get down to business and REALLY push, and have this baby soon. Or you can keep going like this for hours.”

*Pulled on your placenta instead of waiting for the third stage to complete physiologically. By doing so, she put you at high risk for uterine and cervical prolapse, not to mention hemorrhage.

*Left shortly after your birth. A Midwife should remain in your home for a MINIMUM of two to three hours after birth. The first hour after birth is VITAL to mother-baby bonding, and should not be disrupted by newborn examination, birth certificate worksheets, or anything else if all has gone well. The time after birth is to assure that mom and baby are doing well, that they are snuggled into bed, that baby is nursing well, mom has eaten, and everything is cleaned up.

If she did any of the above, she did not practice in a safe, evidence based manner.

Overall, your Midwife should practice in a way that supports evidence based research and protocols. Not fear based, and definitely not control based. Women are perfectly capable of birthing out in the middle of the forest without anyone else around. They definitely do not need an overbearing, controlling Midwife to step in and make things unsafe.

Ask for the contact information of her last 3 clients. Ask them questions about their birth. Ask them about the demeanor of the Midwife during pregnancy, labor, birth, and postpartum. Ask about her transfer rate. Does she end up taking a lot of her clients in to the hospital? Call the hospital. Talk to the nurses. What is the reputation of the Midwife there?

If you have seen any of these red flags and feel it is too late to switch, it's not. Call around. Explain your situation. Make other arrangements for your birth, instead of continuing with these red flags, and possibly putting yourself, your baby, and your birth experience at risk.

Be careful with your choice in care provider. There are no do-overs in birth, and you will always remember the way that you were made to feel during your birthing process. Always remember that YOU are the one in charge of your birth. You hire your care provider – they work for you....not the other way around.

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