Friday, July 18, 2008

Experience changes everything

Last February, I wrote about Apprentice Midwife whose posts flaunted the lack of basic knowledge that is so characteristic of direct entry midwifery (Homebirth ignorance 101). In the interim, Apprentice Midwife went on a medical mission to the Phillipines, and has been profoundly affected by her experience (What did I gain, learn?).

It turns out that birth is very, very different than what she had thought. For example:
... Another birth that I observed, the mom not only hemorrhaged over 1200cc, but she also tore horrendously. As one of the very experienced and very skilled midwives was starting to suture her labial tear, she found the tear inside to be incredibly extensive. Mom tore all the way back to her ischial spines, not only exposing them - but her nerves as well. Baby also had to be resuscitated, and that was my first trip to the local hospital... Their world there is a LOT different than what we see here in home births. Far more scary, far more complication-filled.
Apprentice Midwife reflects:
It was always frustrating for me to hear how "dangerous" childbirth is, and how fast things can go south. To hear that home birth is dangerous and reckless and shouldn't be done. I had always attributed it to what people in the hospital see, but never REALLY thought about it literally... Yes, there are those beautifully perfect births, but they also see lots of risk factors and complications. Had my introduction to midwifery and childbirth been in the Philippines, I'd be the same with caution and even some fear. I'm thankful that I haven't had to deal with much complication, and the complication that I have dealt with here, seems like nothing compared to a few things I witnessed in MMC...
She describes how her experience has transformed her:
During the first birth that I observed at MMC, I was put off a bit. And that sounds horrible. Understand that I come from very hands-off midwifery. So to see the midwife pulling on the baby once crowned, then to see the baby vigorously bulb suctioned, then to see mom's fundus literally mashed upon...I was a bit horrified. I was saddened, and for a moment I wondered why I had come. It was after this that I went to the Ped Ward of the hospital, and I understood. It's far better to take actions to prevent or roughly handle a complication, than it is to end up at DMC. It was still hard for me to watch, as my training screams something completely different when it comes to bulb or deep suctioning...but I understood more...
Ironically, on a midwifery mission to the Phillipines, Apprentice Midwife learned the fundamental principle of modern American obstetrics: It is far better to take action to prevent or roughly handle a complications, then to deal with the results of the complication. It's a basic principle of all medicine; prevention is better than treatment.

Apprentice Midwife also learned something about herself. Her beliefs about childbirth had been shaped by her lack of experience. She says: "Had my introduction to midwifery and childbirth been in the Philippines, I'd be the same with caution and even some fear." She understands that the difference between herself and the midwives in the Phillipines is NOT philosophy, and is NOT socialization. It is experience. And that is the difference between most direct entry midwives and obstetricians (or CNMs). It is not philosophy and it is not socialization. It is experience.

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