Tuesday, January 08, 2008

Reality wins again

Something must have happened, a bad outcome, an angry patient or a lawsuit.

That's the only way I can account for Navelgazing Midwife's blog entry and for a variety of posts she has made on the websites of other homebirth advocates indicating a new outlook on risks of childbirth and the unrealistic expectations of homebirth advocates.

You can judge for yourself by reading her post The Myth of the Vertex, excerpts of which are quoted below:
There is a belief that if the baby is head down, the baby will come out the vagina. The thought continues that, if the baby didn’t come out the vagina, something was overlooked, someone did something wrong or the woman didn’t try hard enough.

The reality is – none of these beliefs is true.

Sometimes, babies that are head down simply (or complicated-ly) just don’t come out the vagina. It isn’t often, but it happens enough that natural birth advocates really should take a moment to listen.
Navelgazing Midwife goes on to describe her experiences with two recent births, one a face presentation where the baby would have died without a C-section, the other a serious shoulder dystocia that could have led to the death of the baby. Then she offers suprisingly harsh criticism for another homebirth advocate who questioned the judgment of a provider:
In ignorance, for there is no other way to say it but this, [she] says that whenever a doctor or midwife speaks about induction because the baby is getting large, that that is a threat. Only someone who hasn’t struggled with a shoulder dystocia – either in her own vagina OR with one in her hands as a midwife – would say something so amazingly dangerous...
She describes the ways that experience as transformed her:
... [W]hen women came to me and said, "I don’t want you to do anything but sit in another room," I used to obsequiously tell them I would. It is the woman’s birth, after all, right?

Then, with more experience, I woke up and figured out I couldn’t help if I didn’t monitor the mom and baby. It’s not like I’ll do vaginal exams that aren’t warranted or intrude in women’s space, but there are minimums that I feel are necessary for competent care and I no longer will compromise on that belief...

What’s so funny is I used to be one of these women! I think I know where they’re coming from, but whenever I’ve assisted these women, I am fucked beyond repair. I worry I will have my license yanked from me long after the baby turns one year old. I worry about my reputation in the birthing community. One angry woman can make it difficult for awhile. When it was me, I was so pissed at The System, I took it out on everyone. I really didn’t think I could trust anyone at all, so I didn’t. Everyone was suspect. No one wanted me to have the birth I strove to have.

Well, I was wrong and I wonder why so many women see every care provider as a threat...
She expresses thoughts that are more typically expressed by obstetricians.
When I am hired to be someone’s midwife, I am being hired as a consultant. I am being asked to share my experience and knowledge, to utilize my skills – the ones that can save a life. As a consultant, one that differs from an interior designing consultant, I am being asked to take the lives of two people in my hands and to accept the consequences of the outcome whether that is a spritz of champagne or a cell in a prison. I’ve had a long time to adjust my considerations with my practice – and they might change again (I’d be shocked if they didn’t!). I see women as individuals, listen to their needs and concerns and if we both feel we could work together, I’m game to give it a go. If I find a woman lied to me about her medical or obstetric history, if she hides behaviors she doesn’t want me to know about or if she continually jabs at me questioning my concerns with her pregnancy (and all of these have happened in the last 2 years), I’m going to send her on her way. She is a liability I don’t need to take on… a risk to my profession and life.


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