Marlo

I’m writing this a year later. I still have some anger and disappointment over losing my homebirth. But I think that’s more because I know what I missed out on, having already had 2 homebirths, how easy it was, how much nicer it was. In the end, the hospital was as good as it could have been, everything we needed and could have hoped for. But it’ll never be home.

I was contracting when I woke up. I had been most the night. Almost every night, for who knows how many nights. Prodromal labor is a bitch. They weren’t uncomfortable. Occasionally crampy. Registering as a moment of ‘hmm? Oh…’ on my personal pain scale. But now there was blood. Just a hint of rust & mucus on the toilet paper. Oh. Okay then. Saturday’s a good day to have a baby.

I made the calls. Tweeted the tweets. Got the initial burst of impending arrival anxiety & energy out of my system. My people arrived. I can’t remember if my husband was on-call or not. It didn’t matter. The other directors knew the drill.

The supplies were gathered & kept close by. I still hadn’t decided where in the house this kid would land. Grandma was on older-kid duty, so that was taken care of. I did my thing. Wandered the house, puttered with this & that. Took a bath. Watched TV. Nothing exciting until about 3:30. I was beginning to think I might send people home.

Then a pop. Just a little one. A small trickle of water. Grab the chux, sit down on them, wait. Calm. Carry on. A few minutes later, a minor explosion rocked my belly, sent a river of amniotic fluid rushing out. It finally slowed, so I shuffled into the bathroom to do a quick check for cord.

Glance at the chux. Greenish. Drop trou. So. Much. Meconium. It was thick. Everywhere. And it kept coming. I sat there, weighing my options. I knew, even if the baby sounded good on doppler, I’d never be able to relax at home. Not with that much meconium. My heart sank. Last baby. Last birth. Fuck you, universe. Let’s grab our stuff & transfer.

So we drove off. Nothing dramatic, mind you. Just, off we go! Arrived at 4 pm. The nurses at the desk seemed a bit flustered, but the nurses on L&D were amazing. They swooped into the ER, picked us up, and delivered us into a nice room. We gave them the rundown of events. Not once did I encounter a bit of negativity from any of them. They set about their jobs & treated us respectfully every step of the way. Complete 180 from my first birthing experience.

They listened to baby for 20 minutes. During this time my contractions were hitting ‘yep, this is labor. That fucking hurts,’ on my scale. They ran through questions as fast as possible (fortunately my husband and doula were able to answer most for me), called the doc, and prepped the supplies. Baby had a perfect monitor strip, so they took us off the machine & let us be. Quick dilation check showed 6cm.

I was up and down, from the toilet to the bed. Spacy, couldn’t settle. I knew we had hit transition. I let everything happen around me while I rode out the contractions. It was building, fast. I was beginning to wonder if I’d beat my record of 1-1/2 hours. The nurses were wondering the same.

The doc came in. She was so easygoing. We went over the particulars of what would happen, how things would go given the meconium. I was introduced to the neonatal doc. We were all in agreement. Another quick check showed 9cm. She was unphased. ‘Doing good! Not much longer. Let us know if you start feeling pushy…’ and they left. In my head I was laughing. Because I knew what was coming.

I got off the bed, deposited my pants & underwear off to the side, and managed to grunt ‘it’s time’ as I climbed back on the bed, got on my knees, leaned over the back of the bed, and gave a half-hearted push. I could feel the freight train building steam, so I didn’t want to use up too much energy yet.

My husband ran for the door and yelled for everyone to come back, it was time. He caught his third child by himself, on our living room floor, but now he gets panicked. Again, I found myself laughing in my head. I saw the door out of the corner of my eye, and as my husband stepped back into the room, the team of nurses & docs exploded through the door. Gowns & gloves were being thrown on, tools & supplies set up, a massive rush of activity. The doc checked. ‘10cm, 0 station.’ Contraction. FREIGHT TRAIN. I felt the head slam into my hip bone as it moved down. That one push brought the head to crowning. My hand flew down to slow the burn. Contraction. FREIGHT TRAIN. Head slides through, almost out. It was a double peak, so I took a big breath and gave it everything. Out comes the head, and barely a pause before the body spins & slides out. ‘It’s a girl!’ One little cry. Quiet.

And I’m paralyzed. I want so desperately to turn around & grab her, but communication between my brain and body has ceased. I hear them waiting, for me to turn, for her to cry again. Someone speaks up. ‘We need to-‘

‘Take her!’ I manage. Clamp, cut. Dammit. Didn’t want that. Can’t fucking move. Why can’t I move?!

A big, lusty cry. I breathe. Had I been holding my breath? I can feel life returning to my arms & legs. I slowly turn myself around. Everyone is smiling, chatting. ‘She’s a big girl!’ I sit, wait for it.

‘9 pounds 15 ounces!’

They bring her to me, still a bit messy. Head full of dark hair. Face a little bruised and swollen. ‘No need for suctioning, she didn’t aspirate any of it.’ Hallefuckinglujah. Smart girl. And so beautiful.

1 hour, 10 minutes. 3 minutes of pushing, 3 pushes. 9lbs 15oz, 22” long, 14.5” head. My last baby. Happy birthday, little girl.

So, it's been a while...

Not apologizing for my absence. Not promising lots of posts in the future. But I will be around. Still trying to decide where I want this blog to go.

Oh. And there's this.

Doulas, Scope of Practice, and In-Fighting

In this post I talked about midwifery licensing and regulation and what it means for families. Now I want to talk about doulas, their scope of practice, and how this also effects families, as well as the birth community itself.

Doulas are in a grey area. Anyone can call themselves a doula. If your goal is to support a woman during her pregnancy, labor, birth, and/or postpartum period in whatever capacity she may need your support, you are essentially acting in the role of doula. This does not require special training, just empathy and a desire to help. However, most people are more familiar with the concept of the certified doula, a person who has received “formal” training, has done lots of reading and research, been guided through their educational journey by another doula, and deemed by a certifying body as fit to practice as a doula.

While medical professionals can be doulas, not every doula is a medical professional, ie., they cannot diagnose, prescribe medications, treat illness, etc. They may have a wealth of medical information and be very knowledgeable about medical procedures, anatomy, biology, physiology, etc., but it is not their job to tell you what you should do to achieve a healthy pregnancy and baby. It is their job to help you learn, find information to help you make the choices you need to make that are best for you, and support that informed choice. They can offer physical support in the form of massage, touch, breathing techniques, etc., to ease the pain of labor. They can also offer physical support in the form of help around the house during pregnancy and after the baby is born. They can watch your kids. They can talk to your partner and help them understand what you’re going through, and offer suggestions on how your partner can help you. They can be a huge asset to a first-time mom or a mom having her 7th child. They can even be a rock of support when things don’t turn out as everyone had hoped.

I call myself a doula, though I’m not really practicing at the moment. And I’m not certified. Not that I couldn’t certify, I have the knowledge and the skills. I even started certifying through two different organizations. In both cases, though, I found that my philosophies clashed with the certifying organization’s philosophies and if I received certification from either, I would be bound by them to practice as they saw fit, not how I saw fit. Which limited what I wanted to do. And I was not willing to make that sacrifice.

One of those philosophies that I had a really hard time wrapping my head around was the organization’s decree that doulas not attend unassisted homebirths. The idea was that, in attending an unassisted homebirth, a doula may be mistaken as acting in the role of midwife, either by the family or the mother themselves, or by the public. I can see the general public being confused but easily set straight by a quick ‘what is a doula’ discussion. However, every family I know who has chosen unassisted homebirth and hired a doula has no illusions of what that doula’s role is, and would not expect her to act as anything else. A doula does not suddenly overstep her boundaries and fill a midwife’s shoes just because the family has chosen no midwife.

This, of course, is when the peanut gallery starts in. “But if she’s checking dilation/listening to heart tones/looking the baby over, she’s acting as a midwife! That’s outside a doula’s scope of practice!” First and foremost, it is not anybody else’s place to determine another doula’s scope of practice. Whether she is certified or not, if she has skills beyond what she learned in her doula training, she has every right to employ them at the family’s request. She is there to serve the family. Second, these are things the mother’s partner, other family members, or friends could do just as easily if the mother requested it of them. Does that instantaneously put any one of them in the role of midwife? No. It makes them helpers. By the same token, the mother herself could do these things. Maybe she just doesn’t want to. Maybe it’s easier for her to have someone else do these things so she can focus her energy elsewhere, instead of trying to multitask. Either way, in any of those instances, the doula is not acting as midwife. The doula is simply performing a task at the request of the mother, and reporting to the mother her findings so that the mother may make decisions as she sees fit. She is not doing these things for her own information in order to make decisions in the interest of the family.

In any case, it isn’t a given that a doula attending an unassisted birth is performing any of these tasks in the first place. She may not want to. She may not know how to. The family knows what they want, and they know what the doula will and will not do, and everyone is comfortable with their role. The large majority of the time, the unassisted doula does what any other doula does; holds the space, offers emotional and physical labor support, and lets the family choose what they need to do. She will not step outside her comfort zone or scope of practice, and the family will not request it.

And then, always, comes the big question. “But if there’s an emergency…” She will still be a doula in an emergency. She doesn’t take over, she waits to be told what to do, if anything. Doulas who attend unassisted births know that it is never their job to take over and run the show. Ever. They know that they serve the mother, the family. They do what the family requests, and the family knows ahead of time what they’re capable of and what that doula’s personal scope of practice, skill level, and comfort zone are. The family will not request that the doula do anything she isn’t capable of or comfortable with, and the doula does not feel pressured or obligated to jump in and save the day.

So why, then, do certifying organizations, and even fellow doulas, feel it is their place to dictate another doula’s scope of practice, to tell them what type of births they will and will not attend? My opinion is that their own personal beliefs and fears drive this desire to regulate. The board of directors of the organization, or the doula herself making scathing remarks about another, feels that certain situations are dangerous, certain choices are dangerous, and that those choices should not be enabled by the birth community at large. Which is a blatant hypocrisy. How can you advocate for a woman’s choice when you’re vehemently opposed to certain choices available to her? How can you say you support an informed decision to elective cesarean or induction, but not an informed decision to unassisted homebirth? If it is your personal desire to not attend those types of births, then don’t. No one is forcing you to. But it is simply not yours or anyone else’s place to tell another doula what types of births she should or shouldn’t attend, what services she should or shouldn’t provide, or how to run her practice in general. When that type of in-fighting occurs, it harms the birth community as a whole. It marginalizes women who may make unpopular choices and leaves them ostracized, with little or no support, to either tough it out on their own or submit to the more popular choice. How can anyone support that type of environment, where a woman feels pressured by the birth community to choose a birth the community has deemed worthy, even though it may cause mental and emotional trauma to the woman and make them resentful of those doing the pressuring, causing the in-fighting and subsequent hostile environment? How the fuck is that supporting women? It isn’t.

I long for the day when birth workers don’t see everything as black or white, or even the shades of grey. There’s such a wide range of pregnancy and birth information and choices that can be made using that information, and saying ‘this is the choice that’s best for the majority’ is a load of bullshit. There’s no such thing. To say so ignores physical, emotional, and personality differences, individuality, the spectrum of personal experience and comfort level. One woman’s ecstatic, all-natural, unmedicated hospital birth is still another woman’s nightmare (mine, for one). If we insist on dictating what types of birth are ‘right’, and insisting that birthworkers support only those ‘right’ types of birth, we strip away the rights of others to make different choices. Are you stripping others of their rights, or are you supporting women and their families?

Homebirth Midwifery Licensing: Working for Families or a Piece of Paper?

From Wikipedia: “In particular a licence may be issued by authorities, to allow an activity that would otherwise be forbidden. It may require paying a fee and/or proving a capability. The requirement may also serve to keep the authorities informed on a type of activity, and to give them the opportunity to set conditions and limitations.”

Which begs the question: why would helping a woman have a baby at home be forbidden in the first place? Hasn’t this practice been going on for centuries before the authorities decided to butt in? It is ultimately the responsibility of the family to choose the person (or no person at all) that they deem competent enough to assist them with the birth of their child. This is true whether they choose a homebirth midwife or an OB. So why is everyone ‘pushing’ for licensure and the demise of the lay-midwife?

Let’s remember: A license doesn’t guarantee competency or flawless performance of said task. It simply means that minimum requirements have been met and dues have been paid to the satisfaction of the licensor. We need only look at the slew of bad drivers currently plaguing our roadways to understand that licensing guarantees nothing. When I discussed the licensed driver parallel on Twitter, someone responded that they’d rather have a licensed driver drive their car than an unlicensed driver. Personally, I’d rather have an experienced driver, one who’s been around the block a few times, doesn’t immediately panic if the situation gets a little hairy; a confident driver, rather than a freshly licensed 16-year-old whose experience consists of book-learning and a driver’s education class. I don’t give a shit about a license, I want ability. Nor do I want a driver who’s been conditioned to believe disaster lies around every corner; someone who’s nervous and jumpy, checking mirrors and dashboard dials every few seconds regardless of the current road conditions or driving situation. That’s just looking for trouble. I want someone who’s calm, reassuring, who isn’t going to jump the gun and possibly make matters worse.

Do you understand my point? Had enough of the driving analogy? Me too. In other words, why isn’t a seasoned midwife, one who has apprenticed for years, learned from experience, chooses not to have a piece of paper proclaiming her accomplishments, as good as a licensed one? There’s something wrong with this way of thinking. Education is education, whether you get it through life-learning and experience or through an institution. They’re simply different paths to a similar goal. It makes me wonder if those who are against lay-midwifery are also against homeschooling. Same idea, yes?.

Now we move on to regulations. Regulations go hand-in-hand with licensing. ‘In order to do what that paper says we’re allowing you to do, you have to work within our predetermined scope of practice, regardless of what you’re capable of handling.’ In some states midwifery regulations are so tight that only the most textbook-perfect of pregnancies and births will be ‘allowed’ to happen at home. Overweight/obese? That’s too risky. VBAC? Forget it. Postdates? Out of the question. All three? You’re fucked. Say bye-bye to your planned homebirth, you’ve been determined to be a ticking time bomb that only an OB and his scalpel can manage. To this I say bullshit. One person’s ‘complication’ is another person’s ‘variation on normal’. But if you want to keep that license, you better work within those guidelines, no matter how many women you end up having to risk out to the hospital, no matter what you’re capable of handling or what you think about those ‘risky’ situations. All for a license that says you can and, by law, you have to.

Which brings me to this: What about that license is worth turning women away? Does it have magical powers that save you from litigation? No, you can still be sued. Will it rally a bunch of fellow midwives or medical professionals to your defense? No, only your reputation and relationships within the community can do that. It may make it easier to accept insurance coverage, but this is not universal and shouldn't be a primary goal. So, then, what do you really lose if you lose your license? Being kicked out of the club?

Some say licensing works to protect the consumer by regulating how a professional can practice. If that’s so, why bother with second opinions? Why interview doctors until you find the one that jives with your lifestyle and preferences? Because some doctors have different experiences that formed the way they practice, different methods of treatment, different ways of seeing a problem and solutions to that problem. So why do doctors have such a wide range in which they can move around with regards to their practice, but licensed midwives do not? Is it because the medical community, even after all these years of working with licensed midwives, still has no respect for the practice, believes that birth is still inherently dangerous and best left to the ‘professionals’ to handle? Hammer, meet the head of the nail. Licensing has not improved the face of midwifery. Instead, it has created a new breed of midwife, one who is more medically-minded, whose practices are based more on a medical model of care because they need to work within a highly regulated scope of practice or risk losing a license.

I have a secret. If you’re good at what you do, honest with the families you serve, know your personal limitations and work within them, are not afraid to seek help when you need it, and develop good personal and professional relationships within the birth community, a license becomes nothing but a piece of paper that tells the world you paid your dues and met ‘continuing education’ requirements for that year. It doesn’t open more doors, it doesn’t bring respect, it doesn’t make you a better or more competent midwife, it doesn’t guarantee you a certain income, it doesn’t make you bulletproof. It doesn’t protect women from ‘bad midwives’. It doesn’t improve outcomes. If you didn’t have that license dictating your abilities you would be able to expand your practice to include those women who aren’t covered by the regulations but whose desires for a peaceful homebirth are no less important. You could do so much more for women and their families if you just served women to the best of your abilities and stopped letting a license hold you hostage.

Whatever your alliance, whatever your motives or goals or opinions with regards to homebirth midwifery licensing, one thing is certain: if you let a regulatory body have control you become part of that machine. Many join up with ideas of change, bringing healing and reason to a broken and irrational maternity system that fails women left and right. But so many get held back by that paper, allowing it to determine their path, and eventually molding them into part of the system where they find themselves arguing in favor of more management and medicalization and against the change they were fighting for. They lose sight of what’s at the heart of being a midwife: serving families, helping them achieve the birth they want, educating and supporting them in their decision-making and honoring their choices.

Which leads me to another topic: doulas and their scope of practice, the vilification of choice, hypocrisy, and political alliances. Stay tuned, that post is forthcoming…

if you bake this, you’re a whore

that’s right, everyone. homewrecker banana bread!

so, there’s a ridiculous story that goes along with this one. ridiculous and unfortunate and absurd, and it all started because i did something nice for someone else and baked them a loaf of banana bread.

i’d been baking all kinds of things this past spring/summer and giving some to the neighbors. the guy two doors down from me (we’ll call him ‘L’) stopped by one day and asked if i could bake him and his wife (we’ll call her ‘B’) a loaf of banana bread. sure, why not, right? so, baked bread in hand, i go knock on the neighbor’s door, and B answers. we haven’t met yet, so i introduce myself, hand her the banana bread and say ‘here’s the loaf of banana bread L asked me to bake for you guys’. she didn’t look me in the face, kept giggling nervously, and was very eager to close the door on me after a rushed ‘thank you’. i figured she must be shy and left it at that. should’ve known better…

a few weeks later, we have a bonfire in the backyard. L stops by to hang out, along with about 5 of our other neighbors. three people got up to go use bathrooms, leaving me, L, and another neighbor (female) at the picnic table talking. suddenly B comes stalking around the corner of my house, walks up to L and announces it’s time for him to go home. never acknowledged the other neighbor, let alone the owner of the property she’s currently on. after some hushed discussion, she stalks away and he gathered up his stuff and followed. i learned later that she proceeded to yell at him out front, asking ‘so which one were you trying to get with? J’s wife or that other one (meaning me)?’. the following day, L must have left the house without saying anything. i was standing outside chatting when here she comes stomping up and down the street looking for him, specifically around my house. then he pulls up in his jeep, they fight, and he comes up to the neighbor’s house while she piles the kids into her car and goes tearing down the street. good call, lady.

then everything quiets down. the weather gets cold, no one’s going outside to hang out anymore, so i’m thinking the storm has passed. one night my brother-in-law and i decide to go out for a drink with J’s wife, and head over to L’s house to see if anyone else wants to go (the neighbors have all gathered in the basement to play poker). we were there 15 minutes. i was with my brother-in-law and the other neighbors. apparently, though, this was the straw that broke the camel’s back…

i go next door one night a couple weeks later to have a beer while the kids play. L is over there, too. as i walk in he looks up and says ‘so, did you know we’re having an affair?’. whaaaaaa? i couldn’t help but laugh. ‘are you serious?! when did that happen?’ B had been suspicious of me since the day i brought them banana bread. then she found her husband hanging out in my backyard. then (and this was the clincher), when i came over with my brother-in-law that one evening, she lost it. she cornered L and demanded to know why he hadn’t kicked me out, why he had let the whore into their house. yep, whore. they proceeded to have a screaming match, at the end of which she packed up her stuff and left. she has moved out. she honestly believes that we were having an affair the entire time. she has left her husband and children because she was unable to simply ask questions, get her facts straight, and face her own issues.

as everyone else has said, must be some damn good banana bread for her to accuse me of sleeping with her husband. so, now that she has broken her family, and i’ve been labeled the neighborhood whore, i will share my homewrecker banana bread recipe with you. you’ve been warned.

1/2 cup butter
1 cup sugar
1 tsp molasses
2 eggs
2 large bananas, mashed
1 tsp baking soda
1/4 tsp salt
2 cups flour
1/2 cup buttermilk (use 1/2 cup milk + 1 tsp of lemon juice; let sit for 10 minutes)
1 tsp vanilla

preheat oven to 350. in a large bowl cream together butter, sugar, molasses, and eggs. stir in mashed bananas. in another bowl, mix all dry ingredients. add to the banana mixture, alternating with the buttermilk. add vanilla. pour into a greased loaf pan and bake for 60 minutes or until a knife comes out clean. if you want, you can substitute yogurt for the buttermilk. enjoy! and for cripes’ sake, don’t make any for the neighbors…