nashvillemidwife

An Open Letter

2009-06-25T23:47:00.003-05:00

This may be of interest to anyone participating in the forums at mothering.com:

An Open Letter to motheringdotcommunity from The Baby Dust Diaries

Her post was removed from the board within minutes and she was banned from the site within an hour.

Belated announcement

2009-02-24T11:03:00.004-06:00

I'm pitifully behind in making this announcement, but better late than never, right?

Ouida Mae Lillian Brown
Born Dec. 11, 2008
7 pounds 8 ounces
19 3/4 inches

Updates, photos, and videos can be found at www.spencerandbrown.com/ouidamae.

2008-11-11T22:32:00.001-06:00

I'll be brave and share this photo. That's my first baby, Torgo, wondering what's going on in there.

Part 2, or "Why I'm not planning a hospital birth"

2008-10-09T15:03:00.002-05:00

Birth has the potential to be the most empowering, or consequently, disempowering event a woman will ever experience. I believe she deserves to have the experience she wants, whether that be unassisted or planned medicalized birth or c-section. What I believe is unfortunate, however, is how many woman who plan for a natural childbirth in the hospital do not walk away empowered by the experience because, unbeknownst to them, what they wanted was never a realistic option due to the way maternity care is handled in the U.S.

I am not against hospitals or doctors. I have met many wonderful doctors and the fact is that most women have a satisfying birth experience in the hospital. But that is not what I want, and the more I think about routine hospital policies, the more it saddens me on a deep personal level. Because no matter how supportive my doctor is, his opinion has no bearing on hospital policy.

There are a multitude of policies and interventions that are frequently complained about (for good reason), but these are the ones that make the idea of a hospital birth horrific to me. They may seem like little things, but the more I think about them the more I feel a very deep sense of sadness.

The first thing I think about is having to take off my own clothes and put on a hospital gown. Why? What bearing does being made to wear a "patient uniform" have on the outcome of my birth or the wellbeing of myself or my baby? Of course I could say no, but the fact is that right from the time I walk in the door I am being told that I have no power, not to mention being labeled a "difficult patient", dooming myself to being treated with disdain for disrupting the status quo.

The second thing I think about is the IV, or in the very least, a heplock. Why? Because if I were to hemorrhage, they might not be able to get an IV in quickly? In all my years of having routine blood draws no one has ever had trouble sticking a needle into my vein. Even I know this seems trivial and I'm not sure why it bothers me so much as I'm not afraid of it and I understand the rationale, but for some reason it just always springs to mind as a source of disempowerment and great disappointment that the hospital does not, in practice, believe I have the right to bodily integrity and autonomy.

Speaking of bodily integrity, the third thing I think about is having an episiotomy performed on me without my consent or, in many cases, forewarning. I know that my doctor would never do this, but what if he can't be there? Again, I'm not against doctors and I hate to sound like a stereotype. But the fact is this does happen every day, because despite the good ones, there are doctors out there who believe that their opinions are always in the best interest, and therefore supercede, the will of the patient.

The final thing, and perhaps the one that tugs at me most deeply, is having to fight to retain physical custody of my baby. Even hospitals that support "rooming in" ("allowing" the baby to stay in the room with the mother) have protocols that mandate the baby be taken away at certain times for examination and observation. I have waited a lifetime for this baby, and the idea of having to ask permission to hold my baby, much less fight for that right as a mother, breaks my heart.

I never expected to have these feelings. But it's a funny thing what happens to you when confronted with a different side of the reality you live. I am among the more mainstream of home birth midwives and home birthing mothers. I believe doctors and hospitals have their place, and I feel fully prepared to accept their help if needed. I am strong, yet the fact is the one encounter I have had with medical management of this pregnancy, my first ultrasound, which should have been the most exciting and happy event to date, was incredibly disappointing and disempowering. I was never expected nor offered to witness the scan, to be a part of the exploration of my baby. Considering that the ultrasound tech knew that the reason for the scan was to "determine viability", meaning it had become uncertain whether or not my baby was still living, I was not offered a single word of reassurance or given any information about what was being witnessed on the screen by the stranger waving the wand over my cold, exposed belly. It was not until she was finished with the scan that she showed me an imagine of my baby, one that even though I was told represented a perfectly healthy fetus, laid there unmoving on its face inside my belly with no visage of a beating heart or, in fact, any sign of life whatsoever. No information was volunteered to me. Everything I know about my baby (that the heart was beating, that he or she is growing appropriately, that the baby is healthy as well as can be determined), I had to specifically inquire about. I left the office, and sit here tonight, still in disbelief that the glossy black and white photos sitting before me are actually pictures of a baby that grows inside me.

** I am behind on posting and this was written some time ago. I am happy to report that my subsequent ultrasound (which was not performed in a medical office) was a very empowering experience, and that we are expecting what appears to be a very healthy baby girl!

Why I'm planning a home birth

2008-06-26T21:45:00.001-05:00

In my attempt to experience my own pregnancy as a mother rather than a midwife, a lot of my already deeply held beliefs about birth have become more real and tangible to me. Of course it was a given that I would have this baby at home, but my reason for supporting home birth has become much more personal now that I've chosen it for myself and my baby.

First, I'd like to say that I think a lot of families who choose home birth live in a different place, mentally and spiritually, from more mainstream families. I don't mean a place of denial or ignorance, I mean a place where the world and our place in it is viewed differently. I don't think we live in a superior place, though I have trouble describing it in a way that doesn't come off as sounding superior. I, personally, feel more connected to the universe than what I observe in most people. I think this stems from my Unitarian beliefs, especially our Seventh Principle, "Respect for the interdependent web of all existence of which we are a part". It is also my observation that I care much more deeply for the inherent worth and dignity of every person and practicing justice, equity, and compassion in human relations, which happen to be our First and Second Principles.

All three of these guiding principles are reflected in my belief in home birth. I am reminded of a conversation I once had with my minister. During a time of personal crisis I confided in her that despite my calling to be involved in the miracle of birth, I did not recall ever feeling the spiritual high I imagined would be inherent in being the first person to touch a brand new human being. She asked me why, then, did I do it? Without hesitation I replied that despite the visceral gut feeling I was missing, I believed firmly in the empowerment of women through their birth experience, the sacredness of the birth event, and the importance of that experience in the cycle of the family. To that the minister replied, "Through your work you are living the principle of upholding the inherent worth and dignity of the women, babies, and families you serve, and you work is your spiritual practice". I will never forget that moment, as it was a hallmark in my development as a human and reinforced my sense of purpose and belonging in the universe.

I live deeply connected to the interdependent web of existence, and for this reason I am more attuned to the workings of my body and the natural processes of birth and death. I know that for most women having a baby at home with a skilled midwife is at least as safe as hospital birth, but even if it weren't I'm not sure it would sway my decision to birth my baby, as I live my life, in tune with nature. Despite all evidence to the contrary, many people do not believe that home birth is safe, yet no one tells the Amish that they are being selfish, ignorant, and putting their babies at risk. Why can I not be afforded the same respect?

Music City Community Chorus announces June 5 Concert

2008-06-02T14:24:00.002-05:00

Music City Community Chorus Announces June 5 Concert
American Choral Classics: Billings to Bernstein

May 12, 2008 (NASHVILLE) - The Music City Community Chorus presents American Choral Classics: Billings to Bernstein a free concert of chorus music by William Billings, Randall Thompson and Leonard Bernstein on Thursday evening, June 5 at 7:30 pm at the Cathedral of the Incarnation, 2015 West End Avenue in Nashville Tennessee.

For this current season’s Music City Community Chorus outing, conductor Renee Grant-Williams has chosen to present Modern Music and David’s Lamentation by William Billings, followed by Randall Thompson’s The Peaceable Kingdom and Alleluia. The evening will round off with the Chichester Psalms by Leonard Bernstein accompanied by the Excelsior Instrumental Ensemble. World-renowned bassist, Dave Pomeroy, will make a guest appearance.

“Our diverse group of singers is rapidly developing into an ensemble that has its own identity and sound,” says Grant-Williams. “This chorus provides an opportunity for a wide range of singers to experience classical music, to learn new skills, and to grow vocally.” The sixty-voice chorus is under the umbrella of the Metro Nashville Community Education program.

American Choral Classics: Billings to Bernstein is free to the public. The concert begins promptly at 7:30 pm on Thursday, June 5, 2008 at the Cathedral of the Incarnation, 2015 West End Avenue in Nashville Tennessee. Call 615/244-3280 for interviews or additional information. Auditions for the Fall season will begin in August. www.MusicCityCommunityChorus.org

home birth safety and unassisted birth

2008-05-03T19:32:00.003-05:00

I recently came across another home birth safety study that had been previously overlooked in my research. Neonatal mortality in Missouri home births, 1978-84 by Schramm, Barnes and Bakewell, published in the American Journal of Public Health, August 1987. You can access the full text of the study in pdf from that link.

I have chosen to list this study twice on my home birth safety page as it offers mixed results on the safety of home birth. On one hand, the study did find a higher neonatal mortality in the home birth group (almost twice the expected rate). On the other hand, the data teased out some important factors that are essential to consider when discussing home birth safety. Namely:

"Nearly all of the excess [infant mortality] was found in the two attendant types with the least training: non-Missouri Midwifery Association midwives [religious midwives, those who identified themselves as midwives on birth certificates or who were identified by other sources in the study as midwives but were not recognized by MMA], and the 'other' category [primarily fathers, but also paramedics, chiropractors, friends of family or anyone else not identified as a midwife or physician]."

"Neonatal deaths for unplanned home births were over 35 per cent higher than expected."

The important thing to consider when discussing the safety of home birth, and the fact that is highlighted by the results of this study, is that planned home birth attended by a skilled attendant is a safe option for low-risk women.

I am a frequent poster over at a natural family living forum where unassisted childbirth is a popular topic. This has always been a fascinating proposition for me and I find myself being asked for my opinion on the topic at an increasing frequency. My thoughts on the concept walk a fine line between upholding the natural physiologic process of birth while recognizing that the birth process does pose some inherent risk. However, that risk does not mean that most births would be safer in a hospital attended by a physician. It does mean, as the above research demonstrates, that the risk is greatly reduced by being attended by a skilled professional who is trained to recognize and manage unforeseen complications, whether that be a physician or a trained midwife.

Is unassisted birth dangerous? That depends on your concept of danger and what constitutes an acceptable rate of mortality and morbidity. I believe that "risk" is a fixed, absolute statistic while "danger" is a subjective evaluation. Some would argue that no amount of unnecessary risk is acceptable in any circumstance and that mothers who choose unassisted birth are negligent, dangerous, simply bad women. I do not fall into this camp. I do not believe unassisted birth is dangerous because I do not believe birth is dangerous. I know the risk that sometimes bad outcomes occur, and that risk can be reduced by the presence of a skilled midwife and the emergency equipment she brings to a planned home birth. However, ultimately, I believe it is a mother's right to examine that risk and evaluate for herself whether it is a "danger".

My personal opinion? It is a woman's sacred and autonomous right to apply her beliefs and world view to her decisions regarding her birth. But when asked my professional opinion, as in all aspects of midwifery care I must defer to evidence-based practice. Study after study has demonstrated the safety of planned home birth with a skilled attendant, but ultimately they do not uphold the same outcomes for unassisted birthing.

Michel Odent on fathers in the delivery room

2008-04-23T11:01:00.002-05:00

This article has garnered quite a lot of attention lately. In it, French obstetrician and natural birth and midwifery advocate Michel Odent purportedly claims that the father's presence in the delivery room is detrimental to the birth process. His comments seem quite incendiary and have a lot of natural birth advocates up in arms. Home birth adversaries have latched onto the article in an attempt to discredit Odent has being a stodgy traditionalist with sexual issues and anxieties.

Odent's comments in this article are very bold - too bold, in fact. It is important to note that this article, published in a sensationalist UK newspaper, does not accurately reflect Odent's opinion on the subject. Although the author did speak with Odent during the writing of the piece, the quotes are not directly attributable to Odent himself. In fact, Odent has responded to queries about his comments by email:

About the pages in Daily Mail, first I was not the author of the article. It was written by a journalist after an interview on the phone. Also it is probable that people just read the sensational title. In fact I have never said that men 'should not be at the birth of their child'.

Warmest regards
Michel

As a fan and student of Michel Odent for many years I am familiar with his theories on the effect of the father's presence at birth. His thoughts on the matter were published in a 1999 Midwifery Today Article, "Is the Participation of the Father at Birth Dangerous? It is important for critics and supporters alike to actually understand Odent's position before taking up sides with or against him.

Baby mix-ups

2008-04-15T20:03:00.003-05:00

Yet another reason to consider home birth: Hospital Sued After Baby Switch

"Sitting in her hospital room in Marion, Ill., 17-year-old Kassie Hopkins knew something was wrong when she looked at the newborn officials told her she had given birth to a day before.

Mary Jo Bathon had the same feeling but left Heartland Regional Medical Center with the hospital's assurance that the baby she had was her son. She headed home to Pinckeyville, an hour away, making a stop to buy baby supplies.

But in fact, hospital workers had inadvertently switched the babies."

To beat all, when the hospital realized the mistake (according to the article), they left a message on one of the mother's answering machines, specifically "asking her to return the baby and retrieve her real son". Not that there's anything actually appropriate to say in that situation. Just, wow.

Such mix-ups are not a rare occurrence, though fortunately few of these reports are from American hospitals.

Well, here I am.

2008-04-09T21:25:00.000-05:00

I've been entertaining the idea of a professional blog for some time now and finally decided to take the plunge. A dear friend recently pointed out that I have always been a writer, and I always have something to say, and just maybe there's someone out there who is interested in hearing.

I was trying to think of a good way to start this blog off but just haven't found it yet. I thought maybe the "5 things you would never guess about me", but I can't think of 5. I'll keep thinking.

I will take this opportunity to plug my new website: nashvillemidwife.com. It is a work in progress, as I switch over from the oldy-but-goody HTML tables to the supposedly easier style sheets. I published the FAQ last night and the summary of home birth safety studies today . I must admit that, being as familiar as I am with the body of research, I was actually surprised that the list boiled down to 35 pro-home birth studies to just 3 against (none applicable to low-risk planned home births with trained midwives). Are there others out there I'm missing? If so, please send them my way.