Maternity Care Options

International Day of the Midwife

Posted on May 5, 2011 in Maternity Care Options | 2 comments

International Day of the Midwife

I just got back from the dentist. I really dislike going to the dentist but I needed a filling so there I was, lying in the chair, upside down, with my standard issue protective glasses, feeling very anxious. From my vantage point I could see a small bit of the ceiling tile, a big square bright light, and the faces of the dentist and the dental assistant. They were talking back and forth about something banal in the office. They passed instruments back and forth above me. My fists were clenched. The noise of the drill echoed in my head and I smelled burning tooth. At one point, the dentist was pushing hard on my jaw in a way that was painful. I was having a hard time swallowing. With the rubber dam in, I couldn’t speak or ask them to stop. I didn’t understand everything that they were doing, nor did I know what all of the tools were for. No one saw the need to explain step by step what was happening. I was powerless. I had no choice but to defer to the dentist because he has Knowledge that I do not. And I thought to myself, “this is not natural.” And then, with relief and wonder I thought, “Thank goodness the births of my children were not like this.” And I felt terribly sorry for the many many women who experience their children’s births the same way I experience the dentist. I thought of that ridiculous comparison between natural childbirth and having a tooth pulled without anesthetic. I thought of all the ways that medicine and power and birth are in such a huge big jumble in our culture. So today, International Day of the Midwife, while I was at the dentist I felt love, respect and gratitude for all the midwives out there: The ones who, in a world where birth often looks like this: photo credit: Mwesigwa can make it look like...

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A Quiet Example

Posted on May 9, 2010 in Birthing, Childbirth Options, Featured, Maternity Care Options | 13 comments

A Quiet Example

Welcome to the May Carnival of Natural Parenting: Role model This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Code Name: Mama and Hobo Mama. This month our participants have waxed poetic about how their parenting has inspired others, or how others have inspired them. Please read to the end to find a list of links to the other carnival participants. *** In 2005, we had a baby. We used midwifery care. We had a home birth. We had a son and we did not circumcise him. We used a cloth diaper service. We breastfed. Aaron and I were the first in our group of friends to have kids. At first it was kind of strange and we felt like outsiders among them. Life had changed in that instant, punch-in-the-face kind of way that seems normal among first time parents, and we found ourselves withdrawing from our childless friends. Out of necessity, we hunkered in and learned to parent. Along the way, one-by-one our friends joined us in parenthood. Five years later, nine of the couples that we regularly associated with back then either have kids or are pregnant. In this group of nine couples, seven used (or are using) midwifery care. The two couples that didn’t were pregnant with twins. Only one birth was by cesarean (and it was one of the twin births). Two couples had their babies at home and two more couples are currently planning home births. Surrounded by these people, I often make the mistake of thinking that midwifery care and home birth are more widespread than they are. But when you look at the data, a different picture emerges. According to the most recent reports from the BC Perinatal Health Program, only 5.8% of births in BC were attended by a midwife (versus 78% in our friends), and 29.3% of births were by cesarean section (versus 14% in our friends). In 2007/2008, there were 671 home births out of a total 43,505 births which gives us a home birth rate of 1.5%. If all goes as planned, the home birth rate among our friends will be 44%. Why is it that our group of friends has this vastly different set of statistics for their births? I suppose it is partly demographic. Perhaps we share similar mentalities that would predispose us towards these kinds of choices: cloth diapering, eating organic, and so on. We are friends for a reason. But it’s not like our friends are hippies. Overall, most of our friends are regular people, professionals, home owners. Aaron and I were probably closest to the home birth “type” – you know, living in a bus and sporting dreads and all. When I look at the numbers though and realize how different our group is from the rest of the province, I would like to think that maybe we were a positive example to our friends. I tried not to be preachy but I answered questions when they came our way. I only remember a few conversations and no one has ever said that we influenced them. I don’t take credit for their decisions. After all, I don’t think anyone chooses home birth because their friends did. You have to make that choice for yourself and you don’t make it lightly. You ask questions. You read. You talk to your caregiver. Yet, even knowing one person who has actually had a home birth can demystify it for you. Every single person who uses a midwife or has a baby at home helps to normalize birth options for everyone they know. Even if you never really talk about it you become a shining example that there is another way, that there are choices. So in some small way, I like to think that we did have a role to play, that we were a positive influence among our friends. Maybe when they walked into their first appointment with a midwife and she offered them a choice of birth place, they didn’t brush it off as quickly as they might...

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Open Letter to BC Homebirth Study Critics

Posted on Sep 3, 2009 in Birthing, Childbirth Options, Maternity Care Options | 3 comments

Open Letter to BC Homebirth Study Critics

Dear Uniformed Commenter After reading the newest study on the safety of homebirth, I sat back to read some reactions from the press and the public. I had a look at the CTV coverage and the CBC coverage and I read over the comments in reply to each story. Imagine my dismay when I read some of your reactions! I was rather glad that the comments were closed because I was too upset to post anything coherent or cool-headed. Frustrated, I can not stop thinking about your replies. First, I shake my head as it appears that you’ve neither read the study nor understood the very article you’ve responded to. You seem to have missed the point entirely. Your arguments fall into one of several categories: 1. The Personal Anecdote Rebuttal This is some variation of “I can only imagine how horrible our child’s birth would have turned out if we had tried to have a home birth” and then launching into your personal story where everything was touch-and-go but thankfully the medical staff at the hospital saved your baby. First of all, this is not a logical rebuttal to a scientific study. This is an emotional reaction known as a pathetic appeal. You are rejecting “a claim based on how it makes you feel without fully analyzing the rationale behind the claim”. You are appealing to people’s very real emotions about the health and safety of a tiny baby at the expense of being able to actually hear what the study’s authors are trying to tell you. While it is totally understandable that this is an emotionally sensitive topic for many, the problem is that you are overemphasizing the emotional component at the expense of the message (the logical component) – this is a flawed argument. Effective, yes – ad campaigns do it all the time, but flawed nonetheless. Secondly, while my heart goes out to you that you had a difficult and scary time at the birth of your baby and while I’m glad that modern medicine was able to save your baby, we can’t actually compare your situation with that of the study subjects. We have no way of knowing with the few details you’ve given if your particular circumstances would have made you an eligible sample for the hospital group. Perhaps you had complications or a high-risk pregnancy that would have excluded you from the study. Therefore, sadly, your situation is not a relevant point of comparison for a study that was looking at births fitting very specific criteria. If that is the case, even the study’s authors, home birth advocates, the BC College of Midwives etc. would all agree with you: your child’s birth should not have occurred at home because it did not meet the criteria to have a home birth safely. 2. The What If Question This argument boils down to “Yes, homebirth is fine as long as nothing goes wrong. But why chance it?” You have missed the point completely; the study concluded that home birth is as safe as hospital birth because in all the cases studied, virtually nothing did go wrong. The perinatal death rate was the same as for both hospital groups (in fact, it was marginally lower in the homebirth group). This what-if-something-goes-wrong argument was essentially what the study was trying to find out – how often does something go wrong at home? And the conclusion was, provided certain guidelines are followed: no more often than something goes wrong in the hospital. 3. The Get With The Times Blow Off This argument is the most uninformed of the bunch. You demonstrate your complete lack of understanding of maternity care and midwifery with variations of “Midwives are old hippies with no training and would be useless in an emergency” or “Stop being so full of yourself and your need to prove something – modern medicine is here for a reason, use it.” This brand of reaction is intended to silence anyone supportive of homebirth by insulting and denigrating but it only demonstrates your own ignorance. Midwives, in BC...

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Birth Choices – what is right for you?

Posted on May 19, 2009 in Birthing, Childbirth Options, Featured, Maternity Care Options | 0 comments

Birth Choices – what is right for you?

Today we have more choices than ever about how we birth. We have the choice of using a doctor or midwife for our practitioner. We have the choice of birthing in the hospital or at home. We can choose who is present at the birth. We can choose to hire a doula. We can choose between a multitude of prenatal classes ranging from hospital-run classes to private classes in Lamaze, the Bradley method or Birthing From Within. We can enroll our older children in Sibling Preparation classes, we can take prenatal yoga or prenatal pilates, we can bring music, pillows and massage oil to the hospital. We can choose to labour in the tub or the shower or on a birth ball. We can play cards or go for a walk. We can birth squatting or standing or via elective cesarean. We can even write up elaborate detailed lists of all of our preferences and give this Birth Plan to our practitioners. Faced with all of these choices, how do you know what is right for you? How do you know that the choices you made before the big day will still be right when labour starts – especially if you are a first time mom? Choice, in general, can be a double-edged sword. On the one hand, it is empowering and enriching to be given the opportunity to have a say in what happens to us. On the other, given too many choices or inadequate information to help in our decisions, the process of choosing can cause stress, anxiety and even guilt and depression. And when it comes to birth, it can give the misguided impression of control. Relinquish Control (even those subconscious thoughts…) The first thing you can do on your journey towards the right birth for you is to forget about those fantasies of your ideal birth. We all do it: we all have a vision in our heads of the way we hope our birth will proceed. These visions are rarely realistic (unless you imagined in your ideal birth that you would be half-naked on your hands and knees in a roomful of strangers). Birth is a dynamic process and we cannot control what happens. The woman who is determined to get her epidural before she’s finished with the hospital admitting desk may deliver baby at home in the bathroom attended by her partner. The woman who preaches natural birth from before conception may end up with a complication, or labour induction and a cesarean delivery. We’ve all read these stories and hoped it wouldn’t be us. But it could be. So the first step is to let go. Read everything you can get your hands on Knowledge is power. If you aren’t a reader, ask questions. Ask all the mothers you know what their experience was like. Ask your practioner all those nagging questions you’re afraid to speak out loud. Explore all the birth possibilities there are. Don’t shy away from those topics that you hope you won’t have to face (like having a long, drawn out back-labour or requiring a cesarean). Don’t write off ideas that are new to you (like homebirth, or hiring a doula). The more you can understand about the way labour progresses (or sometimes doesn’t) and the way labour is managed (or sometimes mis-managed), the better the chance that you will be able to play an active part in the process. Be Flexible (but know your limits) That is, be prepared to change your mind. Something that seemed right before birth may no longer be fitting during birth. Hell, something you asked for during one contraction, may not be what you want during the next. Accept the fact that you may need to revise your thinking in the face of new information. However, if at any time, you are uncomfortable with the care you are receiving, be confident that it is okay to assert yourself or have some intervene on your behalf. By trusting your instincts and your birth team, you’ll know when to stand your ground and when...

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International Day of the Midwife

Posted on May 6, 2009 in Birthing, Maternity Care Options | 0 comments

International Day of the Midwife

May 5th was International Day of the Midwife. This special occasion is near and dear to my heart. Both of my children were born with the help of midwives and I have spent the last 3 years spreading the word about how wonderful they are. I exhibited at the 2007 Canadian Association of Midwifery conference in Vancouver. The conference was held in Vancouver that year to also celebrate the 10th anniversary of the legalisation of midwifery in BC. At the conference, I bought a t-shirt that quickly became my favourite (coincidentally, I was even wearing it when I went into labour with my daughter last year) because of the colour, the fabric (organic cotton) and the message – 10 years of Registered Midwives. When I wear this t-shirt I often get asked if I am a midwife (sadly, the answer is no) and I always reply, “No. I just really like midwives!” Most of my friends have also had the opportunity to experience midwifery care so I occasionally get the mistaken impression that it’s more widespread than it is. Ann Douglas recently shared some of the results of the Canadian Maternity Experiences Survey and I was shocked to discover that only 6.1% of births are attended by midwives. I was well aware that though Vancouver struggles with a shortage of midwives I was lucky to live there because other communities have no midwives at all. I fervently believe that we need more midwives. Even so, I didn’t realise the numbers were as low as they are. The theme for this year’s International Day of the Midwife is The World Needs Midwives Now More Than Ever and you can read some info about this from a global perspective at the International Confederation of Midwives website. What does the picture look like in Canada? Midwifery is legal and government funded in the Western provinces and Ontario and Quebec. However, the territories and Maritime provinces are still struggling to have midwifery recognized and paid for through the healthcare system. Province Regulated Provincially funded Practising midwives Link British Columbia yes yes 120 bcmidwives.com Alberta yes in process* 30 albertamidwives.com Saskatchewan yes yes 5 saskatchewanmidwives.com Manitoba yes yes 40 midwives.mb.ca Quebec yes yes 100 canadianmidwives.org Ontario yes yes 450 aom.on.ca New Brunswick in process no 1 canadianmidwives.org Nova Scotia in process* no 7 canadianmidwives.org PEI no no 1 canadianmidwives.org Newfoundland and Labrador no no n/a canadianmidwives.org Yukon no no 1 canadianmidwives.org Northwest Territories yes yes 3 canadianmidwives.org Nunavut in process partial funding 3 canadianmidwives.org Source: Today’s Parent, March 2009 Some good news: Despite government regulation since 1998, Alberta just agreed to publicly fund midwifery. The deal was finalized in early April of this year. Nova Scotia has also proclaimed the Act Respecting Midwifery but have limited coverage to only a few districts within the province. Some bad news: The shortage of midwives is quite real and according to this recent Maclean’s article on the Midwife Crisis, it is just a part of a larger crisis within maternity care in Canada. The article’s byline goes so far as to say that “it’s a bad time to have a baby in Canada.” And in Ottawa, despite the fact that Ontario is one of the provinces that recognizes and funds midwifery care, there’s been a major step backward – the Ottawa Hospital has closed its doors to midwives. What Can You Do To Support Midwifery in Canada? Spread the word—tell your friends, family, co-workers about midwifery Share positive stories about midwives, doulas and birth Donate to your local midwifery association Join an advocacy group: Midwifery Coalition of Nova Scotia BORN PEI Yukoners for Funded Midwifery Learn more about midwifery in our northern communities – Inuit Midwifery Network Association for Safe Alternatives in...

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Rebirth: Maternity Care Alternatives

Posted on Feb 3, 2009 in Birthing, Childbirth Options, Featured, Maternity Care Options | 0 comments

Rebirth: Maternity Care Alternatives

Planning to have your baby in the hospital? You might have to contend with some of the symptoms of an over-burdened healthcare system. Maternity wards can be over-crowded and under-staffed. Hospital stays are getting shorter. And if you happen to go into labour at the wrong time, you could be sent to another city’s hospital because all of the hospitals nearby are at capacity. What if our maternity care system could be over-hauled to relieve the burden? What are the realities? Fewer doctors and nurses Besides the well-publicized shortage of nurses, Canada also faces a shortage of physicians who attend births. Between 1992 and 2004, the percentage of general practitioners who attended births fell from 28% to only 13%. Rising Costs Having a baby in these technological times is not cheap. The average cost for a vaginal delivery is $2,800. For a caesarean, it is closer to $5,000. This does not include the added costs associated with length of hospital stay or neonatal care. With every epidural, there is an added expense for the anesthesiologist and with a BC cesarean rate approaching 30%, costs are rising for maternity care. Shorter Stays An obvious cost-cutting measure is to shorten hospital stays. The average length of stay for a vaginal birth in BC has fallen to only two days. For a cesarean birth, it is less than four days. Women are being sent home to care for newborns within a couple of days of major abdominal surgery. What happened to resting and recovering from birth? How would a new system look? Midwives Midwives are trained specialists in birth. They have usually completed four years of practical training. Their appointments run about fifty minutes (as opposed to the standard ten minutes with your family doctor). They often do home visits in the first week after baby is born to help initiate breastfeeding and to monitor mom and baby. Mothers report excellent continuity of care and higher levels of satisfaction with their births and their care. The midwifery model of care tends to be cheaper than the current medical model. Midwives believe that birth is a natural physiological process. Though trained to spot and mitigate problems, midwives adopt a fairly hands-off approach as caregivers. Births attended by midwives show a lower incidence of epidural use, episiotomy, and cesarean section. The benefits are not just higher maternal satisfaction, but also much lower costs. Homebirth & Birth Centres In the last two hundred years, medicine has managed to pull birth firmly into its clutches. Contrary to all logic, with birth, we take women who are healthy and place them in the hospital as a preventative measure (in case something goes wrong) and then we treat them the same way we treat the sick and injured. Since when is pregnancy a disease? Modern medicine can be thanked for the low incidence of infant and mother mortality associated with birth today. We know more about the human body, more about birth, more about infection. We know to keep wounds clean. We have antibiotics and other modern drugs. We can save moms and babies from situations that would have claimed their lives only 100 years ago. But that does not necessarily mean that birth belongs in hospital. We can transfer our medical knowledge to other places, like the home. Recent studies show that with healthy pregnancies free of complications, planned homebirths attended by trained midwives are as safe as hospital births. For low risk women, we can achieve safe birth at home and reap a dual benefit because there are advantages to birthing where a mother feels safest and most comfortable. We can also find a middle ground instead of polarizing between hospital and home. Imagine the power of a birth centre: birthing in a homelike setting with a midwife, a birth pool, medical equipment tucked out of sight and the potential of a quick transfer to hospital if need be. On the flip side, imagine the benefits for our rural and northern communities that don’t have hospitals have their own. Mothers would no longer have to travel...

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