12 January, 2011

Midwives Are Human Too - Part One.

While I completely believe in and support both home birth and midwife-assisted birth, in my case, the humanity and real lives of my midwives did not serve me in having a successful natural birth. This subject is a difficult one for me to talk about, mostly because we live in a small community where there are only a few practicing midwives, and any details I write can incriminate actual people, which I don’t want to do, because I’m not actually accusing anyone of anything. In fact, I know that, whatever the set up, giving birth is a giant, spiritual, and highly mysterious thing, and no matter what kind of provider we have, the reasons for the outcomes of our births are complex and deep.
In any case, I imagine being a midwife around where I live is hard, the general community (read: traditional medical) historically has not been supportive. One story I’ve heard happened several years ago: a midwife came to town and tried to set up shop, but the doctors at the hospital badmouthed her, and she found, with their vigor, it was impossible to sustain her business. The few midwives who are around are rather “underground” and practice midwifery far away from the county seat, or they are associated with a hospital outside our community, or they have recently finished their schooling and don’t yet know the climate in which they intend to practice. All that said, I hope, with younger people moving in and with more information in general out there about hospital births, midwifery will become an unconditionally accepted practice around here.
When I found out I was pregnant, I knew for sure I didn’t want a hospitalized birth; I had seen the hell my sister went through in the seventeen-hour birth of her daughter and was not impressed one bit with the hospital staff during her experience. I helped take my sister to the hospital back then and when we arrived, I could tell right away, they were not interested in the birth plan she had written. One Evil Nurse there scoffed at the piece of paper I handed her. She wanted to intervene and speed up my sister’s progress as soon as possible. She did intervene, against my sister’s wishes, and the usual difficulties ensued. If you’re not sure about the usual difficulties that go with medicalized births, I suggest you read The Feminist Breeder’s blog, which you can link to here.
So, midwife or hospital was not a question for me, I knew I wanted a midwife and I went with the one most utilized in our area and the only one I actually met. In hindsight, I can take responsibility for the fact that I didn’t research alternative birth options very well and I may not have picked the best midwife for me, even if my pickin’s are incredibly slim. Because I knew my daughter would be born in late October, I was concerned about snow in the mountain pass and with or without snow, worried about having to drive an hour and a half over hills while in labor, so I didn’t even look at options in the city where more options are available. I knew a few people who had seen my midwife and their experiences were mostly good, and the one friend who warned me that our midwife was “not very hands-on,” I didn’t listen to because I judged her when she told me she had “issues with women in general.” My midwife is the most well-known and certainly the most utilized in our county and while she lives a good distance from where I live, there’s no real mountain pass through which we had to travel.
The day we met in person, I liked her; I liked what she said about birth,I liked how she treated us, and I really liked her birth center – a clean, well-lighted place on the edge of a farm, by a river, in the backwoods. I wasn’t keen on the idea of birthing at my home, (although this midwife travels wherever she has to in order to do her job) because our house is small, the bathtub cramped, and our neighbors are loud and rowdy and drive their revving four-wheelers around all hours of night and day. I felt the midwife’s birth center to be more private and inviting for a nice birth than our own home. This woman had helped birth many hundreds of babies over thirty years of practice and I like how she treated me and my husband and thought she’d be just fine.
Then, our midwife told us about a doula who offered birth classes, not at our local hospital, but again, a ways away. We took the classes earlier on in the pregnancy than usual (when I was 6-7 months along rather than 8-9 months) due to scheduling and the fact that my husband is gone most of August and September. This doula was put together, had done several of her own natural births, offered a substantial class that was at least eight weeks long, and, best of all, she was an assistant to our midwife because she was also in training to be a midwife herself. And though we didn’t specifically hire her as our doula, because she was the midwife’s assistant and our birth teacher, we planned that she’d be at our birth.
Through all the prenatal checkups and throughout the birthing classes, I felt good about these two women. Though we did have to travel about forty-five minutes to get to the birth center, and an hour to get to the birth classes, the extra driving was a nice time to be alone with my husband and, still, we didn’t have to drive over snowy roads and/or into the big city to get to either place. During that summer, I read a lot of natural birthing books, like Birthing From Within and Ina May’s Guide To Childbirth. I educated myself about the complications of hospitalized labor, and read and loved Naomi Wolf’s Misconceptions. And I watched several videos about natural birth, water birth, and even one homemade video where a woman birthed her own baby in her own house so quickly that she literally caught that child in her own hand before the midwife even had time to arrive. That video seemed completely crazy to me and I actually hoped my child wouldn’t come quite that fast fast. After fifty-four hours of labor, that hope is funny to me now.
A couple of other facts to note: the summer of 2008 was a record year for babies being born. Our midwife said she would be attending about fifty births for the year, while her usual number was more like thirty. We had a hard time scheduling appointments with her late in the summer because she had such a high number of births to attend. When we did do the checkups, I could tell our midwife was overwhelmed; she looked tired and talked about all the births and how she needed more assistants. Also, I realized our birth teacher/midwife assistant’s life was not as put-together as it seemed when she ended up not showing for one of our classes only to apologize profusely later, and since she knew we drove a long way to get there, I had the sense her behavior meant there was more below the surface I couldn’t see. Still, I figured by the time our due date arrived, both our midwife and her assistant would be ready for us and present for our birth. I was wrong.
My daughter was already a week late. I was huge, tired of being pregnant, and ready for labor to begin. Finally on a Monday, I had some real signs labor was starting. I was supposed to have another check-up with my midwife the following day, but because I really felt like “this was it,” I called her to cancel the appointment and tell her I’d probably see her soon enough. When I reached her on her cell, she was at the hospital. She’d done a transport with one of her clients the night before, one of the very few transports she’d ever done during all her years of practice. The laboring woman did give birth vaginally to a healthy baby in the hospital, but only after thirty-six hours of labor with some harrowing moments. My midwife told me she was exhausted and glad I was canceling our appointment. I remember getting off the phone and thinking, “but for the grace of God go I,” that this woman was the one to do that transport. What could be the odds that I would have to transport, too?
Anyhow, the next night, the labor I thought would happen did start. My husband timed the contractions and they were strong and long – for all my research, no one ever the early contractions could last two minutes each! Also, as the labor began, I noticed a strange pain in my lower right groin that was not in conjunction with the contractions. Even though I’d never been in labor, the pain there didn’t feel right to me. But I thought, well, I’m old and maybe this is just the way it is. I felt ready enough to have this baby, and we called our midwife a few times as the contractions progressed and she told us, since we did have a substantial drive to make, to come down early and labor in the tub. I was all about getting in the tub.
When we arrived at three in the morning, our midwife greeted us in the dimly lit birthing room, and then said she was going to bed, still exhausted from her previous client’s birth experience. She told us our birth teacher/midwife’s assistant was on duty, and the assistant got the tub ready for me while my husband promptly went to sleep on their big birthing bed. I slipped into the tub, where I breathed and felt all those contractions. And I felt very alone. I noticed out of the corner of my eye that the assistant went to sit at the window bench with her knees curled up and her thumbs pressing the buttons of her blackberry. I thought then she was perhaps timing my contractions, but I was wrong about that, too. I later learned she was attending to a serious personal crisis. And here’s where writing about all this is so sticky because, in this case, the devil really is in the details and, in this case, I feel anonymity is important. But the fact is that this assistant, while physically at our birth, was emotionally and mentally in a very different place that night. Her personal life was in chaos and there was no way for her to separate the two and, I’d argue, her presence at the birth center had deleterious effects on our birth experience.
The personal crisis precipitated miscommunication and misperception – the most egregious being that when I arrived and slid into the tub, the assistant said to me our midwife had guessed I was already at “about eight centimeters” and that information made me feel great, like I could really handle the upcoming transitional and pushing stages. Fast forward to the next afternoon when our midwife was awake, and I was still laboring with seemingly no change. Midwives are notoriously non-checkers as far as the cervical dilation goes – they know a cervix can open from zero to ten in two hours or twelve hours, so, until they feel that magical ten centimeters has been reached, many midwives believe routine cervical checking is invasive to the whole birth process. But by Wednesday afternoon, my midwife thought she should check and I was devastated to hear I was really only at five centimeters. She had me lay on the bed in a series of four awkward and painful positions to move the progress along, whereby I shifted from my side to my back to my side to my front with my arms stretched in different directions behind and under my back, suffering through each awkward pose for two whole contractions. The pain in my lower right groin never went away, and during this exercise, the pain there was excruciating. Plus, this exercise only moved my cervix to six centimeters. My mental strength diminished that afternoon and was only slightly bolstered when my husband and I went outside later for a walk around the farm; the autumn leaves glowing and the sun shining.
To be honest, much after this point turns blurry. I know I labored and labored and dilation did progress. I know my water broke around midnight on Thursday morning because I remember being in the tub again and feeling the whoosh come through me like a tidal surge. I know my midwife tried to help me again when I was sitting on the birthing stool. She told us I was dilated to about nine and a half centimeters, but there was still a little lip of the cervix that was in the way. Back in the tub a while later, I felt so much that I wanted to push and she told me to try and “maybe that cervix would move away.” I pushed for hours in the tub, squatting as low as I could while holding on to the little handles suctioned to the floor of the tub, one of which I kept ripping off with my effort. I remember my midwife sitting on the bench knitting booties and I thought that wasn’t entirely helpful. I remember showering and then getting back in the tub. I remember saying to myself I was going to have this baby by the time the candle perched on the end of the tub that a good friend had sent me burned down. I remember watching the candle snuff out.
So by mid-morning on Thursday, when still no movement down the shoot seemed to be happening, our midwife said we should transfer to the hospital forty-five minutes away. She gave me a tincture to help release me from the urge to push, because to not push after all those hours of pushing seemed impossible. The tincture worked and I slept much of the way, but not before I witnessed my husband break down crying when he called my mom to say we were going to the hospital.
Once we were at the hospital, I knew I was screwed and I swear the pain came back with a vengeance. All sorts of unwanted interventions happened, the IV’s, the antibiotics, the epidural, which by the time the anesthesiologist came, even I was resigned to take and with the relief that came, I could see why women would choose to get one. And there I lay, having de-dilated on the way to the hospital to a seven, and waiting again for that magical ten centimeters. My midwife was in a chair, my husband was settling into another bed, and that’s when the midwife assistant came into our room, bawling. Her crisis had reached a vortex, and she couldn’t stay. She had to go home and attend to her life. I said I was sorry. My husband went to sleep on the bed.
And here, while I lay in the sterile hospital, completely exhausted and hooked up to needles and drugs and my heart starting to break because I didn’t want all these interventions and intrusions while trying to bring my baby into the world, my midwife told me many of the details about her assistant’s life, details I used to hear about when I worked in social service. Details I knew all about, having to do with alcohol and violence and power and control. Details I’d heard before from many women and helped many teenagers recognize in their own lives. Details I was sympathetic about and had understanding for, but in my situation, with an IV in my arm and nurses coming in to check my contractions and the baby’s heartbeat and my dilation, talking about those details made me wonder whether if that was the time and the place to be hearing them.
Nonetheless, my cervix finally opened to the magical ten, forgot all about the assistant, had the nurses turn down the epidural so I could push, and I squatted like I’d never squatted in my life. In one ear my husband whispered, “you’re so strong, you’re amazing,” and in the other ear my midwife yelled, “push harder, push harder,” until at one point I just stopped pushing and said to her with a clarity that came from another world, “you know, you’re saying push harder, but I’m pushing as hard as I know how, and so I don’t know what you mean,” which sort of took her aback. And even though I could see the tiny wet hairs on my baby’s head in the mirror the nurses set up, all that pushing didn’t work, nor did the vacuum extractor, and then everyone started talking about the c-section, and after fifty three hours of labor, and twelve hours of pushing, I think even I threw in the towel. There was a moment, while everyone rushed around, getting my husband scrubs and making arrangements, when I turned over onto my hands and knees and felt my baby’s head inside of me and wanted so badly to push her out. My midwife was there beside me at that moment, and several weeks later, she said to me she wondered if she should have locked the doors and somehow gotten that baby out. But she didn’t.
After the c-section, our midwife met us in the temporary recovery room. She saw our daughter. But then she left to go home; she was tired, too. And just like that, both of care providers for the past nine-months of my pregnancy were gone and all these unfamiliar but capable hospital staff people were there to care for me. And then I hemorrhaged and all those complications ensued.
...to be continued...


JenFW said...

Wow. Processing this through writing has to be a good thing. Are you discovering anything new as a result? And does the writing relieve the burden?

Nancy Slavin said...

Yes, the processing is a long overdue good thing. I don't know so much that I'm burdened, but I do need to write my own ending, rather than the event itself determining the end. As another writer said, "if we write it down, it can't own us."

However, that said, this midwife topic is tricky and I think the rest of the story to come was very circumstantial, very unusual, and my own personal karmic deal, not one that I think is the norm for midwives, thus why I'm reluctant to put it out there, but I said I'd write until I was done writing, so.....

Helen said...

Hey Nancy, Well I gone done and did it, I told my new Labor Doula workshop class ( a big room full of AWESOME women hoping to become labor doulas) about your blog. So, I hope they tune in and read it!!! Glad you posted this one, there is SO much for midwives and doulas to consider with this experience! Thanks again for awesome, honest writing about very important stuff.

Helen said...

Oh, also, about YOUR comment: you know, you really never know if this has happened to others, which is why you shouldn't feel reluctant to put it out there. NOTHING should be hidden imo, as long as the motive is not cruel or unkind: and your motive is anything but.

Nancy Slavin said...

Thanks Helen - definitely the reason I put this out publicly is in case there's just one woman who's had a similar experience and would like to know she's not alone.