Inside the Midwife's Bag: 2010

Wednesday, November 10, 2010

Options abound for moms-to-be

CLICK this LINK to read the Chesterfield Observer article featuring ME, Kim Mosny!!

Former Home Birth client, Stephanie Mazzella and
her 9-mon old daughter, Rowan, with Kim Mosny.

Monday, August 23, 2010

If ultrasound destroys sperm, why is it safe for a fetus?

Facts VS Bias: An Analysis of the Wax Study

** sigh **

I have to completely re-write and re-compile all the information from a "Note" I posted on my HBMS FaceBook page, because FB "decided" that the content of my note "violated [their] Terms of Use." GRRrrrrr...
.

The note itself contained nothing "hateful, threatening, or obscene," nor did it "attack an individual or group, or advertise a product or service."

Thus, I must conclude that the photo, included with the note, of naked new mother holding her newly born baby was the material considered "obscene" by FB or was reported by someone who viewed my note. This is the photo that I attached to my FB Note. Obscene, isn't it?

Well, any whooooo.... on with my "Facts VS Bias: An Analysis of the Wax Study" note...

I was recently asked by a new client about the Wax Study, "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis." Am J Obstet Gynecol, 2010; 203(3) DOI: 10.1016/j.ajog.2010.05.028, which concludes that babies born at home have a mortality rate THREE TIMES HIGHER than babies born in hospital.

Their conclusion is controversial because many large and rigorous studies have concluded that homebirth and hospital birth have essentially the same safety for mother and baby. Some recent studies, including one from British Columbia, Canada, reported that planned homebirths actually have better outcomes for the mother compared to planned hospital births.

The study originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1. Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State's Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

The Coalition for Improving in Maternity Services ~ CIMS' advisor, Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia believes this is "an unabashed attempt to have poor science cover-unsuccessfully-a political agenda. I am very surprised that the [Journal] would publish it, let alone call it 'Editors Choice'."

So, how does one know WHAT to believe with regard to research, studies, meta-analysis, etc? How does one wade through the myriad of information available on the web to discover the FACTS and uncover BIAS, and political agendas?

Well, in THIS case, it is little 'ole ME to the rescue to help my clients and others interested in understanding quality research related to the safety of home birth. Thus, we begin with an exploration of much of the discussion surrounding this meta-analysis known as the Wax Study...

OK... So, now let us look at the research, articles, discussion and blogs regarding the Safety of Home Birth:

So... I will leave the rants and raves to the scientists, researchers, writers and other Blogsters.
I have compiled quite a bit of reading material here for those interested in learning.

What I KNOW is that home birth is SAFE. Home birth is made SAFER with one-on-one midwifery care and a skilled attendant at the birth. Safer still when a second attendant is present to assist the first.

Home birthing families do not choose home birth because it is "trendy" or "cool" or because some celebrity says they should. Women and their partners choose home birth because its their BEST CHOICE. It speaks to their sensibility, to their hearts, to their intellect, to their joy, to their minds, to their partnership, to their peace, to their spirituality, to their togetherness, to their concerns, to their interests, etc... etc... etc...

Home Birth is SAFE... otherwise I, a home birth midwife of 17 years, WOULD NOT/COULD NOT do this work. It is my calling, my job, my joy, my heart, my hands, my mind, my spirit, my responsibility, my promise, to protect mother's and baby's safe passage. Within that promise is the understanding that I am only the hand-servant through which health and life passes. I am not in control, as much as I might have thought I was in my early career, I have learned life & death's lessons, bitter-sweet and beautiful. I, too, surrender to the power of birth.

Home Birth is NOT for everyone. But for those who choose to give birth with midwives at home, let not your hearts be troubled by the controversy of biased agendas. It has and always will be YOUR RIGHT, YOUR CHOICE where and with whom to give birth.

Wednesday, August 18, 2010

The effective labour contraction ~ Midwife Thinking's Blog

Such a GREAT post about labor contractions.... I have to share with my Blog Followers!

The effective labour contraction ~ Midwife Thinking's Blog

Wednesday, July 21, 2010

Midwife means "with women" but wait, there's more....

NOTE: This article is not wholly my original content, but was adapted from an article shared by a student-midwife colleague (thanks Doran!) on a midwifery list serve. No authorship was offered, other than to refer to the author, "from a friend"... otherwise I would give credit where credit is due. Thus, I have "tweaked" and "fine-tuned" the original to fit my own perspective on the "job" of being a midwife. Enjoy.

Most folks would say that I "deliver" babies (though I like to say that I "catch" them) and this is true, but it is a fraction of what I do.... what this calling requires of me. The contrast between the “jobs” within my calling are surprising to me and unknown by many, if not most, who see the signs on my car and think they know who I am.

I am a teacher of an age-old "profession" which carries great responsibility. It is almost a given that a midwife will train others to be midwives, this is how midwifery has survived all of these years. Though I don't feel that I am a great teacher, I love to share what I know… there is much to glean from me and if someone is willing and observant enough, they will learn the art & skills of midwifery as they sit at my side, as they lend me a hand, and as they serve the women with me.

You'll see me at the copy place as I work for hours, making copies, putting together the information that I have been given, and that I have created, that gives the best informed consent I can provide. I want all those who hire me to know who I am and what the responsibilities are when they choose to give birth outside of a hospital. Making copies, creating folders and booklets of information, ordering books and DVDs, staying informed in all the ways available. It can be exhausting, but I know it is a necessary part of being a current midwife, one who teaches others how best to interview a midwife & plan a home birth. I need to continue to learn and to discover, especially what evidenced-based care is - and practice it.

I can find a fetus’ heartbeat and can tell if it is breech, without a doppler or an ultrasound machine. I know of many ways to cope with weeks of nausea and what is safe to take - whether herb or medication and can explain how to time contractions and what to do if your baby is jaundiced. I know many tricks to get a baby to nurse and how to make an herbal bath. I can recommend holistic treatments for a myriad of maladies and complaints for pregnancy from heartburn to urinary tract infection.

I keep my supplies stocked and inventory my bags, car, office & home supplies to ensure I have everything I need for every birth. You will sometimes find me sterilizing instruments at midnight or 1 in the morning because they didn't get done earlier in the day and a baby might decide it's not going to wait until the midwife has time the next day.

I am trained and certified to resuscitate newly born babies, the ones that seem to think that breathing is an option… I don't allow them this lazy notion and go to work, convincing them that it’s not so bad here after all. Nevertheless, the greatest teacher I have ever had was baby Caroline, who taught me that it was not MY decision whether she stayed or left and that I could do everything right and yet I was not in control. She left.

I know how to follow directions and to be more dependable than my mother ever thought I could be. The weather can have little affect on my travel - I go when I am called and it matters not how bad the roads, although I do hate the ice & snow! My partner knows and understands this, a midwife needs one of those, too - an understanding partner. In bad, icy weather, he drives me to a birth or postpartum visit, no matter the time of day or night.

There is no job "beneath" my title - I wipe away vomit, clean toilets, and feed the family dog. I hope to never feel that I have "earned" anything better. A midwife should always know that she is there to serve, in any way that is needed, and it has nothing to do with what her needs are.

I am an ambassador for all midwives when I enter a doctor's office, clinic, or hospital and I take this responsibility very seriously. I've learned that I gain more trust and respect by saying fewer words and respectfully admitting our need for assistance and collaboration during a consult or transport. I have worked hard, for many years, but respect has been attained and my clients have received better care because of this simple principle of humility. A midwife has to be strong for her clients, they need to know she will not waiver. I have learned to have a “thick skin” when entering a hospital, while being professional and cooperative all at the same time. A midwife needs to learn from those who may not even realize that they are teaching her. There is always something to glean and take with you for another time. A midwife never stops learning. I have changed and matured over time, learning to be mindful and learning to listen to the voice of intuition.

Most of the time I truly love what I do - though my back, neck, arms and legs may ache and I have gone without food and sleep or had to miss a family celebration. I love the associations and sweet friendships I have made and the relationship that last beyond the years and the miles.

Midwifery is a precious calling and it truly can be the easiest thing in the world, but now you know that it comes with much more than just “catching babies”!

Saturday, June 26, 2010

Single-Layer C-Section Closure Ups Risk of Uterine Rupture

From Reuters Health Information

NEW YORK (Reuters Health) Jun 21, 2010

Compared with double-layer uterine closure, single-layer closure following caesarean section doubles the risk of uterine rupture during a subsequent trial of labor, Canadian investigators report in the July issue of Obstetrics and Gynecology.

The researchers therefore recommend that "single-layer closure be reserved for women undergoing tubal ligation or those who require very expedient closure of the uterus." There is no consensus on the best way to close the uterus after c-section, the authors note. Single-layer closure has gained popularity because it shortens operative time and needs fewer hemostatic sutures.

Dr. Emmanuel Bujold, from Universite Laval, Quebec, and colleagues conducted a case-control study among women who underwent a trial of labor following a prior single, low-transverse cesarean delivery. Patients were selected from deliveries at nine centers in the Montreal area between 1992 and 2002.

The analysis included 96 cases of uterine rupture matched to 288 controls by time period and hospital. Rates of single-layer closure were 36% and 20% in the two groups, respectively,
"In multivariable analysis, single-layer closure (odds ratio 2.69) and birth weight greater than 3,500 g (OR 2.03) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47)," the team reports. All ORs were statistically significant. On the other hand, suture material had nothing to do with outcomes.

Dr. Bujold and associates say it's possible that a single, continuous suture technique does not approximate the tissues precisely together, and they suggest that single-layer closure leaves a thinner or weaker scar more prone to rupture.

Obstet Gynecol 2010;116:43-50.

Tuesday, June 1, 2010

Natural Childbirth —You CAN Do it !

Right now, all over the world, tens-of-thousands of women are giving birth. Laboring in their own homes, in community birthing facilities (birthing homes & birth centers), and in hospitals, the vast majority of mothers, outside the US, give birth without the use of drugs and with minimal medical technology. They walk around, eat & drink, and actively push their babies out: sitting up, squatting, on their hands & knees, even standing! They remain safe, giving birth to healthy babies.
   Caught in the hands of midwives and given immediately to their mothers, babies suckle at the breast and gaze at the faces of their parents, rarely being separated. Having assisted throughout the labor & birth experience, the mothers’ partners share in the joy and work of birthing, often surrounded by other supportive family members and friends.
   In the United States, however, birth has become a medical event, separating families from their homes and loved ones. The medical model of obstetric care involves many interventionary procedures and the routine use of technologies, even though they have been proven to cause more problems than they prevent.“Just-in-Case obstetrics has become the modern way of managing birth in U.S. hospitals. The legal ramifications of “not” using such methods, should a complication or problem occur, are too great to risk, in the minds of most OB/Gyn’s today. In the last 80 years, the natural, normal function of birth, in our culture, has been taken out of the home and out of the family’s life experience. More often than not, birth is seen by mainstream American society as an emergency (watch an episode of “Private Practice”, “Trauma” or “Deliver Me”).
   The pain and discomfort of labor and birth is considered unacceptable by most medical professionals, having been trained to relieve pain, whenever possible. Women are told not to be “martyrs”... that they should not have to “endure” labor without drugs, as if birth were an excruciatingly, painful event. Many women insist on pain relief, most often through the use of epidurals, “as soon as possible” upon entering the hospital, often before hard, active labor has even commenced. The use of epidural anesthesia is at a record high today.
   Women share their birth experiences with other women much like men tell war stories. Using phrases like, “It was the most terrible pain I’ve ever had.” or “It was the worst experience of my life.” or “I don’t ever want to do that again.” When was the last time you heard a women talk about her birth as a “lovely” or “a wonderful, powerfully emotional experience”? It doesn’t happen much.
   With the pressures of their busy schedules, more and more women are opting for induction of labor with Pitocin® (a synthetic form of oxytocin, the natural chemical that causes uterine contractions, the let-down reflex of lactation, and orgasm) often before their due dates. Most do so due to the discomforts of term pregnancy, the desire to know when they will deliver, or so their doctor is sure to “be there,” rarely because the baby or mother is medically at any risk.
   The medical model of obstetrics deems that the routine use of technologies, drugs, and procedures, whether or not medically indicated, is necessary and prudent for all birthing women. All laboring women are considered “emergencies waiting to happen,” regardless of their risk factors or lack thereof. The American College of Obstetricians and Gynecologists’ (ACOG) current position is that home birth is unsafe, “Choosing to deliver a baby at home, is to place the process of giving birth over the goal of having a healthy baby.” Yet, they ignore the vast body of current research conducted across the globe to the contrary.
   The use of continuous fetal monitoring has been proven, in multiple studies, to be unnecessary; with outcomes for babies being no different than babies whose mothers are monitored intermittently (15 minutes out of every hour.) Outcomes for mothers are worse, however, with a higher rate of C-section and instrumental delivery, than those intermittently monitored. The monitor cords combined with the routine use of I.V. restricts movement and inhibits women from positioning themselves as they feel necessary, thus hampering their ability to cope with labor without pain relief... and thus, the domino-effect of cascading interventions begins. (see: http://www.richmondmidwife.com/Documents/DOMINO%20Effect.pdf)
   There are some serious, potentially fatal, risks associated with the use of epidurals, as well as many less serious risks that affect mothers and their babies. Yet doctors encourage women to get an epidural, claiming that its “safe” for her and baby, even though studies show that the use of epidurals causes slowed labor, often requiring pitocin augmentation. The combined use of these drugs can cause undue stress on the baby. For this reason, mothers are required to stay in bed and be continuously monitored.
   To speed stalled or slow-to-progress labor, a woman’s water (amniotic sack) is often routinely ruptured, even though doing so increases the risk of infection to both mother and baby, particularly in the hospital setting, where antibiotic-resistant bacteria thrive and are shuttled from room to room by the staff.
   Epidural numbness makes active pushing by the mother difficult, often requiring the doctor to perform an episiotomy (cutting the opening of the vagina) and use forceps or a vacuum extractor to pull the baby’s head out. Or the baby’s head can become wedged in a deep, transverse position (turned crossways in the pelvis) so that pushing or pulling the baby out vaginally becomes almost impossible, thus a C-section is necessary. And, there is growing evidence that epidurals cause infants to have poor initial rooting and suck reflexes, reducing their instinctive response to breastfeeding immediately after birth.
   Breastfeeding, while proven to be the most superior food for the human infant through and beyond the second year, is still a taboo subject in our culture. Only a small percentage of U.S. mothers are fully nursing their babies by the age of six weeks, while the average age of weaning in the world population is between 3 and 4 years old! Our society does not value breasts for their primary purpose and function in the nurturing of infants; only as sexual body parts, not to be seen or talked about in public. Breastfeeding in public is often frowned upon; mothers have been asked to stop nursing, to leave, or have even been arrested for indecent exposure, just for feeding their babies! Nursing mothers resort to hiding out in bathrooms, sitting in corners with their backs turned, and draping themselves with blankets, all for the sake of sparing others from embarrassment or offense. In most municipalities, thankfully, this is changing and breastfeeding mothers may feed their babies wherever and whenever they choose.
   So, what should YOU do? How can YOU have a healthy, safe, memorable birth experience and successfully breastfeed your baby? Consider for a moment the generations of women in your ancestral history who birthed their babies as described in the opening paragraphs. Remember that your own body is designed to give birth without gadgets, procedures, and drugs. Trust your own instincts and your body’s ability to do the work of birthing and breastfeeding.
   Educate yourself by reading many, many books, magazines, and research papers regarding safe maternal/child health care. Minimize your risk factors by taking exceptionally good care of yourself: eat healthy, whole foods; take a walk everyday; get sufficient rest; and refrain from unhealthy habits (no smoking, caffeine, alcohol or drugs.) Invest in an independent childbirth education class; one that will spend the majority of time teaching you labor-coping techniques and birth physiology, rather than telling you about procedures and what to expect when you enter the doors of the hospital.
   Consider hiring a professional Birth Assistant, known as a “Doula” or “Monitrice” to provide the emotional and physical support you will need in the foreign environment of the hospital. Women supporting women through childbirth has been an ageless tradition common to nearly all the cultures of the earth throughout the centuries.
   It is unfortunate but true that, in just two generations of humanity, we have, in large measure, lost the knowledge, confidence, and respect for the normality of pregnancy, birth, and breastfeeding. For these reasons, the addition of the modern-day Doula to the birth team can be and is a valuable asset, not to be considered a trend or fad.
   The professional Birth Assistant expresses confidence in a woman’s body to birth normally, respect for the process of “natural birth,” and recognition of the transcendent and life-altering aspects of childbearing. She helps pregnant couples actively choose their means of care, enabling them to reclaim the process of birth, improves the quality of their experience, gives them confidence, and empowers them. She maintains a respect for the integrity of the birthing family, believing that they must be the central focus of the birth team.
   Parents must be empowered to make their own best choices and enabled to follow through on those goals without intervention unless medically indicated. The Doula’s role as a labor support person is augmented by her role as advocate for the birthing family (maintaining the integrity of their experience.) An experienced Doula’s value is measured, in large part, in that she provides her clients with information, education, and practical options and alternatives to a medicalized birth experience, so that they may give birth to their baby safely, with minimal or no medication or interventions; with great confidence, strength, satisfaction, and joy!
   Not only does a woman remember her birth experience, but she remembers the people who are with her and who help (or do not help) her. She remembers how she was treated; good or bad; with or without respect and dignity; as important or as insignificant; as the one in control or as a victim. Empowering, affirming words and practical, helpful emotional and physical support during labor and delivery impress forever on a woman. By “mothering the mother” during birth, the Doula can influence how a new mother will mother her own child. Her birth experience helps frame how she sees herself, her womanhood, and is the rite of passage to her motherhood. One of the Doula’s most important jobs is to protect and nurture the woman’s memory of her birthing experience. This, in and of itself, is of great worth.
   Another of the Doula’s roles is to facilitate the integration of new ideas, options, and coping skills for the couple. This includes grieving over what isn’t the “fantasy birth” and/or the “perfect baby." If the birth process requires medical intervention or the outcome is unexpected, the mother often struggles emotionally with this transition. The Doula knows that, when a birth experience deviates from normal, emotional support of the mother is of critical importance.
   The Doula individualizes the support she provides to meet each individual’s needs, always considering their feelings paramount to those of others and of herself. Because the needs of a laboring woman change throughout her birth; the Doula’s goals are to respond to the current and pressing needs of the woman and her partner “at this time” — “for here and now." This is a valuable asset for the couple so that they may find their own way through their birth experience.
   Expectant couples deserve loving, friendly, empowering care throughout their pregnancy & birth. Thousands of women give birth every day, yet every birth is a uniquely personal experience. The Doula serves her clients with genuine concern for their birth memories.
   Providing quality labor support to birthing women has been shown to significantly reduce the need for medication and other interventions, dramatically reduce cesarean and forceps deliveries, reduce maternal fever and infant sepsis evaluations (minimizing separation), increase maternal confidence, and ultimately provide for better outcomes for the mother, baby, and a successful breastfeeding relationship.
   For these reasons, the purpose and value of professional labor support, especially in our culture, should not be taken lightly. Dr. Marshall Klaus, MD, co-author of Mothering the Mother says, "If a Doula were a drug, it would be unethical not to use it."
    We give birth but a few times in our lives, and the impact of those moments stays with us, molds us, and affects our whole society. Thus, the resurgence of home births, the increased interest in natural birth, and the care offered by midwives. Midwives specialize in understanding normal aspects of the childbearing cycle. They serve and care for childbearing women: before, during, and after their pregnancies. The midwife attends childbirth, provides support during labor and delivery, and supervises the general health care of women and children directly after birth. She is trained to recognize deviations from the normal, recommend holistic means for bringing the situation back into the realm of normal, or refer to another practitioner when necessary. She believes it is important is to provide time for questions, teaching, and time to listen to the concerns and needs of the women they care for. Thus, the average midwifery prenatal appointment lasts an hour.

    Midwifery is quite possibly the oldest profession on the planet, as women have been helping women to give birth since the dawn of humankind. The term midwife, derived from the Anglo Saxon word, “mit wif”, meaning "with woman," was first recorded in 1300. Written accounts dating to the 2nd century confirm the role of midwives in the birthing process. Modern midwives provide care to women during normal pregnancies and deliveries and collaborate with and or refer to obstetricians or other physicians if health complications develop or the pregnancy becomes high-risk.

    As trained health care professionals with expertise in supporting women to maintain a healthy pregnancy birth, midwives offer individualized care, counseling, education, and support to women and their newborns throughout the childbearing cycle. Midwives provide continuous support to women with low-risk, uncomplicated pregnancies during pregnancy and labor. Communication between midwife and her client is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and encourage partner and family participation in the birth. They pay special attention to the family traditions, cultural values, and the personal preferences of the women in their care.
    Safety of highest priority in midwifery and studies show that outcomes are as safe or safer than similar birth attended by physicians and in hospitals. As part of their commitment to nonintervention, midwives do not advocate the use of pain medication, invasive procedures, and routine time management during the normal birthing process. They encourage women to actively participate in their birthing process.

The continuous presence of a midwife during labor can reduce:

the length of labor,
the need for pain medication,
the likelihood of forceps or other operative devices,
the possibility of cesarean delivery.

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.    Copyright © 1996-2004, Midwifery Task Force

    Midwifery is based on a strong belief in partnership with childbearing women and respect for birth as a normal life event. Midwives strive to empower parents with knowledge and support their right to create the birth experience which is best for them. Midwives respect intimacy, privacy, and family integrity, and draw on their own patience and understanding to provide care during pregnancy and birth. Midwives trust birth. Midwives believe in normal birth.
   You are “made” to be able to give birth and to Do It very well! Seek out the very best and supportive people to assist you in your goal to give birth safely, to a healthy baby, in the manner that best suits your needs. You can make a difference in your own life and in the lives of those closest to you — your children and their children. Trust “Mother Nature” she has more experience than anyone on this earth! Essentially that means: Trust yourself!

Natural Childbirth —You CAN Do it !

Wednesday, May 5, 2010

Honoring Midwives on International Day of the Midwife

Moving to Virginia to continue my work as a home birth midwife and midwifery mentor to aspiring midwives has been a rich blessing in my life!

I honor the Guardians of Normal Birth... Midwives. Wise Woman~With Woman
I am grateful to be one, myself... to hold sacred space with mothers & fathers as they labor to bring their new ones into their homes.

What an awesome and sacred calling to be a handmaiden in this work! I am humbled by each and every moment that I am able to continue the tradition.

We all have the opportunity to HONOR our Local Midwives and affect the lives of women and babies a world away from us...

Join me and the Home Birth Midwifery Service at the OmMama Birth & Baby Fair Saturday, May 8, Lewis Ginter Recreation Association, from 10-2!

Donate to Midwives for Haiti, a Richmond based non-profit organizing midwives and other clinicians from around the world to instruct Haitian women in delivering prenatal care and serving as skilled birth attendants.

Today is International Day of the Midwife! Celebrate the great joy of being a midwife or being cared for by one! Tell a friend about midwifery and how it has changed your life!

A couple of midwives have changed my life.

First, Janet Scoggin, CNM, in Tempe, AZ. She cared for me and caught my third child, and blessed me with my own calling to become a midwife.

Second, Margie McSweeney, RN/CPM. She was my mentor, taking me on as a green, thirty-something year old apprentice, eager to learn and help. A labor/delivery nurse who helped women at the "Med" in Memphis TN, to give birth without intervention, Margie midwifed mid-south families for 20 years. She challenged me, she taught me and later gifted me her practice when she moved to Boulder, CO in 1999.

A true gem among gems. Margie taught me the heart of midwifery, combining art & skill... being ever-vigilant all the while being ever-patient.

Thank you, Margie, for being one of my most important life teachers.

Midwives do indeed catch the future. It is my privilege. It is my blessing. It is my calling.

Sunday, March 14, 2010

Blessings of a Mentor... sigh

I am just sitting her on a drizzly, overcast Sunday afternoon, contemplating the blessings of being a midwifery mentor.

Not all the blessings are good ones, mind you, but in giving them serious consideration, even significant struggles are blessings in disguise. The struggles that come with being hard on and critical of an apprentice, for example, or calling her on a poor decision she has made, or having to even reprimand her because of unprofessional conduct, are difficult to wade through and beyond, yet they challenge me to be consistent, a good example, and both fair and stoic in my role.

Midwifery apprenticeships are not just about completing the clinical, hands-on training and experience ("getting one's numbers"), but more so about how to "BE" a professional midwife: How to talk to clients, how to counsel them, how to filter what you say, how to think critically and act succinctly, what to do and when, when to do and not do, how to direct clients and when, how to advocate and educate...

I am blessed by watching an apprentice's eyes well with tears, realizing that catching babies is truly her calling. And another's eyes glisten and light-up at the invitation to enter into training with me. My own eyes fill when I am aware of one who is struggling, faltering in her actions, and disillusioned. Blessed still to be the one she looks to for critique, for direction, for help. And I sigh.

The mentor midwife is looked up to and admired, and yet we are only human. We make mistakes, we are defensive of our practice like a mother bear to her cub, we seek after a level of accomplishment in our work that is sometimes unreachable, and we dream, dreams.

My work as a mentor gives me great joy and sorrow. I have to be hard and I have to be a friend; and mostly I have to be available... which, is sometimes, the hardest of all. I am the nurturer to so many, and nurtured by few. Mind you, this is not a pity party session... just the hard truth. And my blessing.

Wednesday, January 20, 2010

Health Care Reform ~ Answering a Niece's Questions...

I recently received an email from my 20-something year old niece, who Cc'd: her email to other important adult family members (such as her mother and our father [her grandfather])...

Here's what she wrote:

Subject: I need your opinion

Would you mind answering this question? I need a few opinions on the subject (short)..

Do you believe that the approach to health care in the US constitutes a social problem? Is our health care system in need of reform? Why or why not? What type of reform would you advocate?

Thanks so much!!

Love
A.

Here's my response back to her:

I agree with my dad, that no answer to your question can be short and also address your query,
"Why" or "Why not"

So I will do my best to be concise rather than brief.

As a health care provider and business woman, I have a different slant on the entire issue of healthcare reform, and all that these issues create in the way of debate and dialogue. Being intimately involved in helping families to pay for their maternity care, for example, and participating in their struggle to get their insurance to pay for their care. causes me a great deal of angst & aggravation.
Helping clients to make their best health care dollar choices is the most frustrating. Many people decide that paying a "small co-pay" to the doctor and hospital is "better" than paying me $3000. But in reality, they often end up paying thousands of dollars more than my $3000 fee for a birth experience that is FAR and AWAY different from that which they desired and hoped for.

I have to work extra hours "proving" to insurance that they should pay my assistant fee of $700 because her attendance at the birth is essential to delivering quality, safe care to my client. Yet they are just fine with paying for a epidural ($800 - $1200) despite the fact that it increases the risk of birth and neonatal complications.... I could go on with this rant and tangent, but I shall move on...

You asked: Do you believe that the approach to health care in the US constitutes a social problem?

Absolutely!! The distribution of quality health care in the US is most certainly a social problem. Both Medicare and Medicaid recipients, as well as those without insurance, suffer the most. Their healthcare needs are met, yes, but often at substandard levels of quality. At the delivery point, meaning the care given by nurses and doctors, the attitude has become insensitive and unsympathetic. The
work of caring for and helping people to be well and healthy as been replaced with callousness, cynicism, impatience, lack of compassion, and an overall disregard for a patient's rights. This is no more evident than in the emergency rooms across our country. People wait of hours, sometimes giving birth, collapsing, or even dying in ER waiting room! A social problem... most certainly.

You asked: Is our health care system in need of reform? Why or why not?

Of course it is in need of reform! Why?

* The United States is the only wealthy, industrialized nation that does not ensure that all citizens have health care insurance coverage. At least 15% of the population is completely uninsured and a substantial additional portion of the population is "under-insured", or less than fully insured for medical costs they might incur. That lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States, according to the Institute of Medicine; while a 2009 Harvard study published in the American Journal of Public Health found a much higher figure of more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance.
* The US health care system does not deliver equivalent value for the money spent. More money per person is spent on health care in the United States than in any other nation in the world, and a greater percentage of total income in the nation is spent on health care than in any other United Nations member state except East Timor. Despite the fact that not all citizens are covered, the US has the third highest public health care expenditure per capita. And medical debt is the principal cause of personal bankruptcy in the US.
* The US pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. Currently the U.S. has a higher infant mortality rate than most of the world's industrialized nations. The USA's life expectancy lags 42nd in the world, after most rich nations, lagging last of the G5 nations: (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th)!

And there are plenty of other reasons beyond these bullet points. Here is a very good article on understanding health care reform from a business perspective:
Understanding Healthcare Reform ~ Rethinking the Business of How Americans Receive Their Healthcare

You asked: What type of reform would you advocate?

Now THAT is THE question isn't it? That is exactly what all the wrangling is about. Private sector, Gov't option? Universal Coverage? And HOW do we do that?
The debate stems from basic questions:

* Is health care a constitutional right? Or...
* Is health care a responsibility or obligation, meaning an individual must purchase it for herself and her family like we do for food or shelter?
* Should access to care be equitable, despite of income, socio-economic status, prestige or class? (i.e. Should the child of an unskilled hourly worker have access to the same care options as the CEO of a large corporation, or a U.S. Congress member, or a retired union member? Should the child of a corporate CEO have access to better quality care than the child of a laborer?)

I am of the opinion that health care is NOT a constitutional right (meaning that the government must provide it).

My rational: the framers of the Constitution were smart enough to simply state that one of the main goals of government is to “promote the general welfare” of its citizens.

More specifically the 10th Amendment to the Constitution states:
"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

This will be used by the citizenry to challenge the current health reform bill as unconstitutional. Forcing a citizen to buy health insurance and fining those who do not, is unconstitutional, pure and simple.

What do I support?

* Health Insurance Industry Regulation ~ more regulatory control over the business/industry of Health Insurance so that people have easier access to coverage, and so that the services that they desire can be rendered by the provider of their choice, in the facility/place of their choice, and that the costs are controlled so that the bill is paid by insurance without question about the service or its veracity;
* Tort Reform ~ caps on the amount that can be sued for, limiting "defensive medicine" practice, and eliminating frivolous lawsuits,
* Easier Access as a Medicaid Provider ~ making easier for licensed providers like myself to become Medicaid providers and get paid for services rendered,
* Cost Transparency ~ currently patients have little idea of what health care really costs, which is considered to be one of the reasons health care in the United States is so expensive,
* Controlling Billing fraud and Overcharging for Services ~ this takes place in both government payment systems and private
* Controlling the costs of drugs & devices ~ Patients in the United States pay more for drugs and medical devices than patients anywhere else in the world
* Prohibiting Payments to Doctors and other health care providers by pharmaceutical companies and medical device companies
* Transparency in Error Reporting ~ Medical error transparency will improve safety. Safer health care leads to fewer lawsuits which then means lower healthcare costs overall.
* Reducing Prescription Drug & Medical Procedure Errors ~ Clearly, patient safety must be considered among the many issues in health care reform. It's ties to the cost of care, malpractice suits,etc... are important in the bigger picture.

Not a short or easy answer... but I took that time to give you one.

Smooch!
Kim

Friday, January 1, 2010

Midwifing MaMa...

Our "MaMa," Corinne Acker Bowen Smith Leon Jester, passed peacefully on November 29, 2009 just before 9 pm. Her son, David (my partner), and I were with her as her life slipped quietly away.

She was in hospice care, at home, succumbing to Congestive Heart Failure (CHF) and COPD associated with the CHF. While on oxygen she was completely lucid and planned her entire funeral with us! (Yes, she really did!) She said she wanted everyone to wear black because it was the best way to honor the dead. She told me that she wanted to be dressed in black, she said, "because it is the most appropriate and most dignified color for a woman of my age."

As she was weaned from the oxygen (the 25 liter/min concentration she required to maintain normal O2 saturation was not feasible to continue, nor did she want to...) she asked me to make sure to paint her nails. She told David that she was not afraid and that she was ready to go. She told him that her brothers and sisters had come for her and they were waiting for her. We knew that. She had been talking to them Sunday a week before, both in her sleep and while awake! That was both cool and creepy at the same time, I must admit!

In the remaining 3 hours of her life, as we sat with her and helped ease any suffering with sublingual (oral) Morphine, I found myself midwifing her across the threshold of this life and into the next. Her transition was similar to women who give birth... she needed us right there, touching her, soothing her, and offering her melted ice cream and a cold cloth to her lips. I said similar phrases: "Its alright..." "You are doing just fine..." "We are right here helping you..." "Just let it happen, you are gonna be just fine." "Its okay to cry..." "You are a wonderful mother!" "That's right, that's good..." And as the end was near, "Let it happen, just go on, let it happen! You can do it." And she did, she passed across that seemingly impenetrable plane and became new again. How bittersweet it was to hold her, stoke her hair and midwife her as she died.

I learned a lot from Corinne that night. I learned that I have the capacity, somehow, to be strong and resolute, even amidst my own sorrow and during painfully sad moments. I learned that a dying person deserves to be honored and to have dignity in their final hours. I learned that strangers CAN be both the worst and the best resources available to you. I learned that hospitals and hospital personnel don't do death any better than they do birth. I learned that I can stand in the face of death and not be afraid. I learned that there is peace and serenity in death. I learned that my future may very well be in hospice and palliative care.

As I midwifed Corinne into her new life, I saw myself renewed and recommitted to the sacred. Birth & Death are inexplicably sacred... Thank you, MaMa, for being another important teacher in my life. I love you dearly and honor your memory in my heart, mind & spirit, every day! You were a beautiful, vibrant woman who loved life and loved living it fully! You can be sure that I will take good care of David as he takes care of me.

Rest in Peace, dear Corinne. You certainly deserve the break!
(Click on the above sentence to view MaMa's SmileBox memorial.)