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February 17, 2011 01:50 PM UTC

In Praise of Midwives: Having A Baby Is Not An Illness

  • 23 Comments
  • by: nancycronk

Cross-posted on Huffington Post http://www.huffingtonpost.com/…

**************************************************

There is a bill in the CO State Senate that brings back a flood of emotion for me. Senate Bill 088 re-authorizes midwives to practice a profession that has been in existence since time began – assisting others in the natural process of becoming parents. The bill would also allow certified midwives to perform simple, basic procedures commonplace with normal, healthy, routine births – administering common drugs, offering IV fluids when needed, and suturing the tears which sometimes occur. The memories of a midwife being with me during my greatest joy, as well as deepest sorrow, have haunted me for twenty years. It is time to tell this story.

It was late 1988. I was a first-time pregnant mother in Ann Arbor, MI. I did everything I was told to do – I was married, college educated, ate organic food, and was in great health at the time. I knew pregnancy was a natural, normal process, and I was confident in my ability to be a great Mom. I chose a team of nurse-midwives, childbirth educators and support people to help.

My midwife seemed as excited about my pregnancy as I did. Unlike traditional obstetricians, she spent a great deal of time with me — asking me lots of questions, calming my fears, sharing personal stories, and chatting about things that are important to first time mothers. She told me about herbal remedies for mild discomforts, suggested books to read about parenting, gave me feedback about the names I was considering, and much, much more. Carol was part doctor, part “sister”, and part friend. I adored her. I felt completely safe in her care.

My son Adam’s birth in January of 1989 was picture perfect — my sister flew in from Virginia, my husband coached my labor using the “Bradley method”, and our parents were all nearby in the next room when he arrived. I labored at home until the last minutes, because my frightened graduate student husband wanted me to be at the hospital at the very end – “just in case”. We quickly gathered the gentle recorded birth music, the video-camera, the massage balm, and our other necessities, knowing birth was imminent. Using no medications whatsoever, I had a perfectly natural and low-pain birth in a small triage room minutes after arriving at the University of Michigan hospital, attended by my midwife Carol, whose loving arms gently handed me my squirming son. I will never forget her giant smile when she commented, “He’s just a little guy”.

Despite the last-minute move to the hospital, my son came into the world surrounded by great joy, and with no “medical” intervention. We celebrated thirty minutes after his birth with a birthday cake, champagne, and a room full of people singing, “Happy Birthday”. The baby breastfed immediately, and after a few hours, I was back at home, where my midwife assisted me with my after-care, and gave me many tips for caring for a newborn. Those early moments were golden.

My midwife-assisted birth had gone exactly as planned. There has never been a time more beautiful, more magical, and more empowering in my life than my oldest son’s birth. I felt connected to every mother who came before me for millennia. I felt confident to take on every parenting challenge that would come my way – and in the past twenty-two years, there have been many!

Two years later, I was pregnant again. My husband was close to getting his PhD, and was completely consumed with that task. We were financially broke, and the second pregnancy had been a surprise. Our toddler son had been quite sick with asthma during his first two years, resulting in many trips to the emergency room and an extreme amount of stress for all of us. We were anxious to get out of our apartment next to the industrial smokestacks of a drug manufacturing plant, and into a home in a cleaner area. I worried my son’s medical condition was somehow related to the steam oozing out of the neighboring factory. Our moving couldn’t come quickly enough for our little family. We knew things would be looking up for us after he graduated and got his first “real” job. (Incidentally, our son’s asthma cleared up almost immediately after our move.)

Once again, I went to my midwife, who had been more than a medical provider for me – she had become my trusted friend. I was told my HCG levels were extremely high – usually a sign of a healthy pregnancy, but in my case, it may indicate twins. At that time, there was some controversy in mothering magazines about the safety of ultrasound tests during pregnancy, so I decided not to have one. As my pregnancy continued, I became weaker and felt more and more nauseous.

During my third month, my husband was offered a job in Denver, and we decided we would move to CO. I was supposed to be doing our packing while he finished his dissertation, but my constant morning sickness and caring for my sick toddler prevented me from getting much done.

On the day I was scheduled to fly to Denver with my sister to look for a house to rent, I woke up in a pool of blood. My midwife, who was assisting another woman in labor, advised me by phone to go to the emergency room immediately. “Don’t even get dressed. Go in your nightgown”, she advised.

I had just had a permanent wave done to my hair the night before and had not yet had it styled or cut. It was sticking out around my head like “Oopsy the Clown”. My face was covered with acne cream from the night before. I must have been quite a sight when I arrived at the emergency room of the University of Michigan hospital.

The look on the portable ultrasound technician’s face confirmed my fears – something was terribly, horribly wrong. When a doctor I had never met before came in, he told me I had “a hydatidiform molar pregnancy” – a potentially pre-cancerous condition where an embryo had started out, but as the pregnancy continued, the chorionic villi in the uterus grew out of control, resulting in a uterus filled with cancer, and maybe even, a dead fetus or “miscellaneous fetal tissue”.  A “simple” D and C (dilation and curettage) to evacuate the contents of the womb, followed by close monitoring from an oncologist, would probably mean a return to good health in about a year, he said. Barely looking up from my chart, he asked if I had any questions, then quickly left the room.

“What? I don’t have a baby? I have cancer?” I sat in shock. The nurses moved in to prepare me for surgery.

“Here, drink this”, someone ordered.

Before being able to comprehend what I was told, I was asked to sign a waiver to allow a roomful of pimply-faced medical students to watch my insides being vacuumed out as if I were a car. I was told I would be knocked out with general anesthesia first.

“Hell, no”, I said. I was going to be awake. I didn’t trust any of them. I opted for anesthesia which blocked the pain from the waist down only. Not only did I want to know what was going on, I wanted to see it.

“That’s highly unusual”, I was told.

“It’s my body” I reminded them. “I am going to be awake.” If a room-full of geeks and nerds barely out of their teens were going to see what remained of my baby and the cancer that engulfed it, why couldn’t I?

A medical student friend later told me it probably had more to do with the fact they didn’t want to have to be concerned with what I was hearing. He also told me I was the subject of grand-rounds that week. “Your blood test results were through the roof. You were quite the freak. Everyone wanted to see what came out of you.”

After the procedure, I went home, depressed, confused, shocked, scared, and feeling battered.  In a matter of hours, I went from expectant mother to cancer patient and “freak of the week”. No one at the hospital said a kind word to me. Not one person said, “I’m sorry”, “How terrible”, or “Would you like a shoulder to cry on?”  I never saw a social worker, a volunteer, or a chaplain. No one held my hand, except for my husband. Family members attended to me emotionally by phone – I thank G-d for them. In those days, there was no internet to search to find support groups or for patient information — at least not one I knew about.

We didn’t have much time to find a place to live in Denver, so I rebooked my flight as soon as I felt strong enough. I was told I should find an oncologist in CO before doing anything else – even before finding a place to live. “Your HCG level is so high it broke all records at our regional laboratory, indicating you may have a malignancy. The cancer in the uterus, although it is unlikely, could have traveled in your bloodstream to other parts of your body. You will need to have follow-up care immediately”, the hospital said by phone. After many hours of long-distance phone calls and hassles with our insurance company, I found a doctor (my primary doctor needed to refer me to a specialist, but I didn’t have a primary doctor in Denver yet, so I had to ask the Denver oncologist for a name, and then beg the person to give me a referral a thousand miles away, without ever having actually met me).  

Fortunately for me, the primary care physician the Oncologist in Denver referred to me was Dr. Dianne McCallister in Aurora. When I arrived at her office, she asked, “What’s the problem?”

Through a huge box of Kleenex and more tears than I thought were humanly possible, I told her the story of how I went from being an expectant young mother to a cancer patient in one day, and was brand new to Denver – my closest relatives and all of my friends were now one thousand miles away. Not only that, but I needed a pediatrician soon for my toddler son, too. Dr. McCallister then did what I wanted everyone to do up until that point. She hugged me.  

“Didn’t anyone attend to your grief over losing your baby when you were at the hospital?” she asked gently.

“No. They told me ‘the embryo had not been viable for some time’. I don’t think they cared about anything other than their intellectual curiosity over my rare condition”, I sobbed. “I was treated like a freak by everyone I saw. I was in such a hurry to get to Denver, I didn’t have time to see my midwife.” I sobbed again.

Dr. Dianne cared for my body, as well as my soul. On a prescription pad, she once wrote, “Simple Abundance” – a book which reminds women of what’s important in life. She told me a family member, a Minister, had shared it with her, and it really helped her. I still have the book; I will cherish it always.

I went back to Ann Arbor after finding a home to rent and meeting my new doctors, to pack up the rest of our things. While there, I visited my midwife, who was shocked when I told her the brutal way I had been treated at the University hospital. She hugged me, she apologized, and she seemed truly horrified by the hospital’s complete lack of compassion and humanity. One of the other midwives who normally backed her up apologized profusely that they didn’t make it down to see me that day. I promised to keep in touch with Carol and let her know how I fared in Denver – a promise that we kept for a number of years.  

In the twelve months that followed, weekly blood tests indicated my record-breaking HCG level eventually returned to normal. CT scans, MRIs and x-rays indicated I did not have a malignancy anywhere in my body, and a year later, I was told I could try to have another baby. In 1993, Jonathan (Hebrew for “gift from G-d”) Lincoln was born. Two years after that, Jordan Eric joined the family. Both sons were born at local hospitals because my pregnancies were considered “high risk”. With Jonathan, I had eleven ultrasounds. The two obstetricians were nice women, but I never felt as close to them as I did to my midwife, or to Dr. McCallister.

My mother once asked me if I regretted seeing a midwife with my second pregnancy. “If you had an early ultrasound, you might have known there was a problem sooner”, she said.

I never regretted the decision to see a midwife. Carol gave me the option of having an early sonogram and I had turned it down – it was completely my choice. Whether I had an ultrasound or not, it would not have changed the outcome; I would have had a molar pregnancy, regardless.

My only regret was not asking my midwife to send another midwife to sit with me in the emergency room. I had been spoiled by my first pregnancy with Carol. I had been spoiled with the emotional, physical, psychological, and spiritual care I received from my first appointment to my last. I had been spoiled having a caregiver who was also my friend – a person who didn’t just see me as an I.D. number, nor a diagnosis, nor a payment code, but as a real person. I had been  spoiled by being treated like a human being every step of the way — a person with feelings, and hopes, and dreams. My first baby was spoiled, too — he had been welcomed into the world by a person who did what she did because she loved the miracle of birth, and saw her role of assisting at a birth as a privilege, not just a job.

My regret – my only regret – was that the tragedy of my second pregnancy occurred while I was in the hands of a medical establishment that did not know me at all. My regret was that I did not have my midwife at my side with me that day. She or one of her back-up midwives would have been there if they were not delivering other babies at the same time.

Twenty-two years later, I look at my three sons with pride. Pride that they survived being the children of a mother and father who raised them one thousand miles from any extended family. Pride that they have grown up as Coloradans – in a state I love, and will always call “home” because they grew up here. Pride that my kids will give something to Colorado when they finish college and get their own first “real jobs”.  Pride that despite our many challenges, we have the family we always dreamed we’d have.

To Carol Shulthies, Certified Nurse-Midwife, I thank you. I thank you for not only being with us as we started our journey as parents, but for showing us what really mattered in life — people — not lab results, not co-pays, not blood levels, not pounds gained, nor rates charged. Just people. If I am blessed to become a grandparent in my lifetime, during that first miraculous moment of holding my first grandchild, I will remember how you smiled when you handed my son to me.

And to the thousands of midwives who hold hands, comfort hearts, wipe tears, share smiles, and grow families, you have my undying respect and appreciation forever. May the Colorado  legislators who judge you today, know the importance of their decisions to the future of our great state.  

Comments

23 thoughts on “In Praise of Midwives: Having A Baby Is Not An Illness

  1. From Indra Lucero:

    Please help me call these committee members! Let them know you’re calling as a member of the Delivering Natural Care for Families coalition and that you support bill 088.

    Betty Boyd 303-866-4857

    Linda Newell 303-866-4846

    Irene Aguilar 303-866-4852

    Morgan Carol 303-866-4879

    …Kevin Lundberg (303)866-4853

    Joyce Foster 303-866-4875

    Shawn Mitchell 303-866-4876

    Ellen Roberts 303-866-4884

    Jean White 303-866-2586

  2. This is one of the most intimate and important experiences a person can have. If done well, it can be a transformative, transcendent, and empowering experience.  If not, it can be demeaning, dehumanizing and disempowering.

    At stake are core values of respect, dignity, empowerment, and humanity.

    I want to honor every woman who has gone through childbirth and ensure every woman has the right and the choice to have the type of delivery experience she thinks is right for her.

  3. I thank you for this post–your story is powerful and provoked both smiles and tears. It also made me feel more connected to my mother.

    I will call to support the bill, as a happy, healthy product of dedicated midwifery!

  4. Nancy

    Thank you for sharing your moving story. My two youngest sons were born at home with the help of midwives. I can still feel the hand of my midwife massaging my lower back during labor. A doctor would never do that! My midwives were professional, careful and respectful of the life-giving experience. I applaud those who make this moment so treasured. It is sad to think that had Nancy’s loss happened while the midwife was present, the use of a midwife may have been blamed. Untrue. life and death happen; and my dear Nancy, I only wish your midwife could have been with you during your horrible loss.  Colorado leaders: please support midwifery.

    1. The loss would have been difficult regardless, but I think the care that a midwife can give because of the time and love and energy they invest in their patients cannot be understated. I don’t know the statistics, but I do know my midwife spent hundreds of hours with me. My OB’s time may have been measured in dozens of hours.

      My second OB was a very sweet woman, and was able to deliver my son without having to do a C-section, even though he initially presented breech (she turned him internally — a risky procedure many OBs do not want to even try). My last OB did not get to the hospital fast enough to help with the delivery. A nurse delivered my last son just minutes after I made it to the hospital. She praised me for being calm and confident. “Every birth should be like yours”, she said. I give all the credit to my first caregivers/educators. Having a baby is a lot like an athletic competition, and a good coach can make all the difference.  😉  

      1. I wish I could correct a comment (frustration). My midwife did not spent hundreds of hours with me. I meant my childbirth preparation as a whole was that long. I had a great Bradley instructor that was recommended by the practice. We met for several months. I also read all of the books they recommended. I was free to call often to ask questions, and I did.

        The continuum of care I received from the OBs with later pregnancies was good, but not as holistic in nature. If I had a question, they asked the doctor and then the receptionist called me back. It was time consuming, so I learned to save them all up for the doctor’s visits. With the midwives’ practice (several worked together), it felt a little more relaxed — they were more likely to call me back themselves. Hope that makes sense.

  5. Just over three years ago, we were fortunate for our son to be born at home.  My wife was a neonatal nurse at the time.  She was so inspired by the experience that she chose to become a Certified Nurse Midwife.   I’m incredibly proud of her and the work that she does.  Nancy, thank you for posting this.

  6. From Senator Carroll:

    SB 88 Direct Entry Midwives (Carroll/Lundberg – Acree) passed today on a vote of 8 – 1 out of Senate health, increasing safety options to moms & babies and increased disclosures to patients

    1. I’m sorry and happy for you at the same time. For the story, not really the bill, which is great on its own.

      My oncologist says he’s sorry you had a doctor who made things worse. For some reason GP’s and others who don’t deal with cancer everyday have a hard time knowing how to react. He doesn’t understand why they choose abrupt and rude, but it’s shockingly common. We work all the time to stop this happening. At least your story may help someone else before they know they need it.

      As a side note: I tend to think doctor (my doctor, who’s family now) automatically, but my sister’s closest birth times were picked by midwives all three times (she dates and marries tiny men who make tiny babies). She didn’t choose natural though, the births just happened that quickly! Fortunately they’ve all (I have 15 nieces and nephews – one more this April) hit the ceiling they’re so bouncing.

    1. I loved the book “Spiritual Midwifery”. Pretty dated vocabulary, but the content is amazing. I read it many times when I was a young, pregnant woman!

  7. Your experience at UM with your mole were terrible and inexcusable.

    I don’t have the time (I’m abroad at a medical conference), but I must make some clarifications and some devil’s advocacy.

    SB88 is about “direct entry” midwives, which means they have no specific medical training, as opposed to CNMs, who are first trained as nurses.  The term “midwife” is overly broad.   The re-authorization bill is controversial more about scope of practice, rather than existence of practice. Should people with no medical training be authorized to prescribe and administer medications?

    It is too easy to take a “my anecdote trumps your data” approach, and conclude Midwives good, doctors bad.

    From the American Congress of OB/GYN statement on home birth:

    although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births

    and food for thought .

    Not trying to be an ass, but I have to get back to class.

    1. Thank you for those points. I am not data-unfriendly, and like you, I want the best for all women and babies.

      The website you pointed to also has anecdotes that are horrible, but they are also anecdotes, not data. Clearly, there are horror stories on both sides of the argument — hospital and home births.

      I do understand the difference between direct-entry midwives and nurse-midwives. In my limited experience, a nurse-midwife would be the best of both worlds. A woman could have the psychological, spiritual, and emotional care she deserves from another woman (and yes that was very important for me), with an attendant who knows warning signs, and who would have privileges at the nearby hospital if something went wrong. I was fortunate Carol was a certified nurse-midwife.

      Regarding the statement above, I have to say I am skeptical of statements put out by any party that has a financial attachment to the issue. The AC of OB/GYN has a vested interest in discrediting homebirth, so I take their statement with a grain of salt, just like I would a similarly issued statement from a midwive’s group. I have a financial interest in neither.

      I would love to see data to back up the  statement you posted above. It is interesting it only mentions the babies. I do know that the rate of cesarean sections in hospitals is sky-high. What is the rate of infection, complications and/or death for the mothers in hospitals compared to home births?

      How much support is given for breastfeeding in hospitals versus home births, and what are the lifetime ramifications in terms of infant, child and adult health that result from that support or lack thereof?

      Last, my blog diary was intended to illustrate the things that data cannot convey — the intangible rewards for the mother of feeling safe, trusted, respected, and nurtured when a member of the health care industry does not see her as a “patient” but rather a “client” — a human being, rather than a “diagnosis”. All too often, American hospitals are like cold, impersonal, factories where the emotional needs of the clients are forgotten. My blog diary is one more of those stories. If it makes one nurse, one midwife, one medical student, or one doctor, take pause for five minutes and think about what their clients are going through, I have succeeded.

      Thank you again for your thoughts, and may the Creative, Healing Spirit of the birth process bless your work always.  

  8. The title of your diary is exactly what the Catholic church is saying  about healthcare reform treating birth control as preventive medication, which would require they be covered free of charge.

    “Pregnancy is not a disease to be prevented, nor is fertility a pathological condition,” said Deirdre A. McQuade, a spokeswoman for the bishops’ Pro-Life Secretariat. “So birth control is not preventive care, and it should not be mandated.”

    1. I don’t see the natural process of becoming parents a disease, obviously. We agree on that point.

      I do think part of that natural process of reproduction is a woman using her brain to manipulate conditions that may result in conception, or not, during a particular episode of sexual intercourse. My own religious views teach that sex is not only for procreation. My own religious views teach it is a form of communication and celebration within a committed relationship. Some of those sexual acts will result in pregnancy, while others will not. I think we may differ as to whether or not G-d intended for sex to be only for that purpose.

      Here’s an anaology: I use my car to get back and forth to work, and that is primarily why I have a car. I also use it to pick up my kids, or go shopping, or just to drive to the mountains to soothe my soul. I take car ownership very seriously. I have a license. I keep my car maintained, and I am very, very careful to obey traffic safety laws so I do not hurt others with my car. My car brings me satisfaction, whether I use it for one purpose or another. In my personal faith, I see sex the same way.

      The use of my car also impacts others. If I do not maintain my car properly, it will spew harmful poisons which could mean the life and death of those people around me who may have asthma. A faulty brake system could also mean taking the life or limb of other people.

      A woman of child-bearing age affects people around her if she is becomes pregnant. If she has other children, it impacts the resources she has to raise the other children. The woman is responsible to make sound decisions about whether or not she brings another baby into her family, just like a car owner has to decide if he/she has the resources to take care of his/her car.

      If we truly lived in a socialist society, as many Republicans assert we are becoming (we aren’t), the entire society would realize we are all better off when cars are maintained, and babies are cared for properly. When the entire society decides to “own” those situations, and freely shares resources to address those needs (without capitalist notions of ownership preventing collaboration), personally I think we would all be farther ahead.

      As a spiritual person, I would have no trouble banning abortion if we got rid of private ownership. Until and unless we all see that every baby is the equal responsibility of every single member of any society, and raising those children should be shared financially, we cannot outlaw abortion or contraception. As long as we treat babies like property (a direct result of capitalist philosophy), we must give women choices if they cannot afford to raise those babies.

      That is just my own opinion. I respect yours may be different than my own.

      1. I guess I would have a problem with banning abortion, even under those perfect circumstance described above. As a physician, you may appreciate this unlikely scenario.

        In my molar pregnancy, I never had a fetal heartbeat. They looked for one, but when they couldn’t find one during those first few months, they said my HCG levels were relatively high and my belly was growing, so there was probably a baby (molar pregnancies are pretty rare, so without bleeding at that point, they did not really even consider it as a possibility). I was told they sometimes cannot hear a fetal heartbeat at every appointment — that’s why they consider lots of other signs of a healthy pregnancy. At the next appointment, they would check it again. I woke up in a bloody bed before the next appointment.

        But what if I had the kind of molar pregnancy where there was a viable fetus and choriocarcinoma, as some women have? (For those who are following this thread, that means a baby and cancer growing in the uterus at the very same time, or a baby in the uterus and cancer growing elsewhere.) Should my husband and toddler son have risked losing their wife/mother if I bled to death, or if the cancer killed me first, to save the fetus I was carrying? In my faith, and in my heart, the answer would have been “no”. If I had to make that decision — my own life or my fetus’s — and I am glad I was not asked to do so, I would have chosen my own life. Why? Because my baby at home needed me more.

        I have many wonderful friends who are Catholic, Daft, and I am not disparaging your faith. I am just saying my own faith helps me feel good about the things I believe. In the end, I know we both believe in loving our family members, and we appreciate the miracle of life — even if we don’t agree on exactly when that life begins.

        Shalom/Peace/Nemaste to you, Daft.

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