by MotherWit | May 6, 2010 | Uncategorized
I came across this from a couple of friends who sent this to me a year or two ago. It really sheds an interesting light on the fears surrounding postdatism. It is an exerpt from a forum on the subject, by an Australian doctor.
“In the eight years when I practiced homebirths as a registered
doctor, out of 1,190 bookings I had 106 post mature babies (more than forty-
two weeks) of which three went to forty-eight weeks, a few more went to
forty-six weeks, and lots went to forty-four weeks—and all those babies
fared very well. I did lose one at forty-two weeks, which is not outside
the obstetricians’ limit. Of those 106 post mature babies, only one fitted
the textbook description of post maturity, looking like a little wrinkled
old man with stained skin, but that baby was extremely alert, and insisted on
looking around the room instead of suckling.
What decided me to do no inductions for post-maturity was a very early
mother in my homebirth series who refused induction despite my anxiety,
went to forty-four and a half weeks and gave birth to a chubby pink,
strong,healthy baby, with absolutely no sign of post maturity. If I had lost
one of those 106 babies who went past forty-two weeks, obviously I would have
done some deep soul-searching, but I doubt whether I would have changed my
mind.
Babies mature at different rates, not at exactly forty weeks, just as
we adults do not become senile at seventy years.
Some might say I was lucky to deliver 106 post mature babies without
losing one, but remember that my clients were mostly very health-conscious,
especially regarding diet. None of them was driven to homebirth by
financial difficulties—quite the reverse. In Australia it is far cheaper to
birth your baby in hospital. I should also mention that I tend to disregard
meconium as a supposed sign of fetal distress, because of other possible causes,
for example, if the mother took laxatives.
I feel the advice from the midwives was always correct. I would not
rely on ultrasound to establish dates. The best check, if the mother presents
early enough, is that before ten weeks the fetal heart is more than 160,
often 180, but by twelve weeks it usually settles to 144 or less. But my
present mood is—don’t be fussy about dates. When you estimate the due date (I
use 283 days, i.e. nine months and ten days, slightly more accurate than
the received forty weeks), also advise the prospective parents not to tell
friends and relatives the precise date, but be vague, like “before the new
year” or “before Thanksgiving,” so that they will not be pestered by
nervous well-wishers if they go past the “due” date.
Marion’s response in The Birthkit Issue 25 is very good [“A CNM
Discusses Post maturity Syndrome”], but I must take issue with one sentence. She
says “Post maturity syndrome has recognized signs, and that’s why the
pediatrician who tried to resuscitate Barbaranne’s baby knew it was forty-four
weeks.” With the background of my experience with post mature babies, which is
far more comprehensive than most other practitioners under the rule of
induction at forty-two weeks or earlier, I have to assert categorically that the
so-called recognized signs of post maturity are fallacious because
babies mature at different rates. Those signs are practically never due to
real post maturity, they are more likely to be due to other factors like a
severe illness during pregnancy, or placental infarction well before term. I
knew that post maturity signs were unreliable long before I ever started
attending homebirths, because I can still remember the famous and respected
pediatrician Kate Campbell telling us students about post mature
babies having long hair and long fingernails and other signs, and premature
babies having the reverse. But once I got into general practice and was
delivering babies in hospital, I noticed that those signs were most unreliable,
and that some babies born before term had long fingernails and hair, and
some babies born after term did not. In any case I cannot share Marion’s
confidence that the pediatrician who tried to resuscitate the baby
knew it was forty-four weeks, even though he said so. I know pediatricians and
obstetricians better than to trust a statement like that.”
Dr. John Stevenson
Victoria, Australia
by MotherWit | May 4, 2010 | Uncategorized
The more I doula (yes, I use the word “doula” as a verb with impunity), the more I see terrible imbalances in hospitals between hyper vigilance and negligence.
I’m not a clinician of any sort, and I appreciate the medical care that is given to my clients to help them have a safe birth. But some things don’t look so safe, and it strikes me as very strange sometimes what is focused on, and what goes under the radar.
I have questions. If a woman’s waters have been broken for a certain amount of time, infection becomes a huge concern for the hospital staff. Synto is started if labour doesn’t start at what they deem is an appropriate time. I know there are other reasons besides infection women are told to go immediately to the hospital when their waters are broken, but the reason mainly told to the birthing women themselves is so the staff can monitor for and treat potential infection. But if a woman has to hang out in the hospital, which is crawling with germs, and be examined frequently (they say they won’t do it a lot with broken waters but still do anyway a lot of the time), which pushes bacteria wombwards, how does this help her deal with potential infection? Not only that, but a couple hospitals here don’t use sterile gloves for examining a woman with broken waters. Many staff members will come into the room, NOT wash their hands, rummage around in the little box with the regular examination gloves, and do vaginal exams with those. So their hands, which have goodness knows what germs on them, contact the gloves they wear for the exam as well as some other gloves in the box (which will contaminate the hands of those who HAVE washed). And then they examine the cervices of women whose waters are broken telling them how worried they are about infection. Hmmmm. Meanwhile, evidence shows labour stimulation can increase the rate of C-section….which increases the chance of infection.
I had a client recently whose waters broke with an exam, and she was told that in 4 hours, if she didn’t birth, she’d be given an IV and Synto, etc. But hello, the water was thick with brown meconium, and was pouring out in great gushes. After all this talk of infection and interventions for the prevention of infection, I wonder why nobody thought to listen to the baby’s heart after those waters released. As a doula, if I see meconium in the waters, I high tail it to the hospital. I have to, because I’m not in a position to monitor a baby. I understand that meconium is a potential sign of distress. So if it’s a potential sign of distress, why would they have waited over an hour before monitoring the baby, favouring to focus on the evils of potential infection?
I have seen incredible hyper vigilance over a woman’s pain with a pointed obsession to eradicate it, but lack of attention to the actual birth. I have heard doctors, even when their patients are fully dilated, strongly encourage them to take an epidural because the pain will only get worse (?????). Some are so focused on draping those sterile sheet jobbies all over the mom because birth is all dirty and we need to prevent infection (again) for her and her baby (?????), the baby practically falls on the floor because the actual WOMAN is receiving no attention when she’s yelling THE BABY IS COMING! Or, they go and cut a woman’s perinuem par routine, which can cause terrible pain and infection, in spite of all this talk about HAVING to do things to prevent infection. Or in all the fuss about pain and infection, the damn resuscitation equipment has not been checked to ensure it’s working properly (and yes, I have been in situations where a baby needed this equipment and it wasn’t immediately available because it hadn’t been properly set up).
I have stories. Oh, I have stories. I don’t tell most of them to protect the privacy of my clients. I also don’t want the mistake of one person to colour a person’s entire view of the hospital. I don’t want to breed mistrust. But maybe this is why doulas are having issues in the hospital…not because we actually offend and antagonize the staff with even our most gentle questions, but because we are the witness in the room.
I’m feeling a little raw from a couple of RIDICULOUS things I have seen in hospitals this past week. I don’t expect perfection from nurses and doctors, and many of the things that go on are not their fault…sometimes it’s administration and understaffing or auxiliary staff issues. But it would be nice to be able to trust that the important things will be tended to immediately, the rare potentials will be inconspicuously prepared for but not obsessed over, said obsession leaving little room for presence for the here and now, and people saying things that make SENSE. I cannot tell you how tired I am of reasons being seemingly plucked out of the air to justify actions. I heard someone say to a client of mine who wanted to push on her side, the practitioner being very uncomfortable with this position, “well, um..it’s not safe to push that way because the pressure of your arm against your inner thigh could cause an embolism.” How’s that for evidence based practice?! How’s that for fear mongering? Even an honest, “I’m just not comfortable with this position due to a lack of experience with it,’ would be acceptable rather than that garbage. I just don’t get this system sometimes. Not at all. And nobody seems to be able to give consistent answers, and culpability can be iffy. But if I even take on a tone in my voice that is perceived as (though it isn’t intended to be) snippy, I could potentially be black listed, laughted at, yelled at, insulted, and hated on sight. Doula work is beautiful, amazing, and wonderful….but it is not for the feint of heart.
by MotherWit | May 1, 2010 | Uncategorized
It has been awhile since my last blog…just to let you know I’m still here. I am focusing all of my energy right now into fundraising endeavours for my trip to Madagascar, as well as preparing for the Doula Training Intensive this summer. Preparing a training manual is no easy feat. So much of my writing energy is being used at the moment.
I had Friday off…meaning no clients, students to speak with, births, classes to teach, or school holidays at home with the kids. Of course, there was some administration to tend to, but I spent most of my day cleaning, laundering, and meal planning, and WOW is this weekend ever going smoothly! We woke up early and went out for groceries and a few anuals to fill in the garden as the perennials take up their rightful spaces in my young gardens. To not have a weekend spent mucking out a terribly neglected mess of a home is such a blessing! To not have to spend all Sunday doing the week’s laundry makes me wonder at the possibilities of the day open to us tomorrow. I’m thinking of buying an apple tree to plant in my yard, and to finally get that last placenta out of the freezer and committing it to the earth. My little Finn is quite excited about the idea of planting his placenta. He is fascinated with his umbilical cord, and likes to look at it on occasion, but is fine with finally burying it.
We spent most of the day out and about and planting in the black and white garden, and will now cook a lovely dinner. A normal weekend like this is heavenly. I think I’m going to try to take every Friday off just to clean, prepare, and schedule. I turn on music and it doesn’t even feel like a chore as the broom and I dance our way along. My daughter Oona cooked some lovely banana chocolate chip muffins for dessert. Maybe I will even just put up my feet and watch some hockey with my husband tonight. Or maybe a game of Trivial Pursuit with the kids. Or a walk to the lake with the dog. Ah, the evening is young. I will wait until the kids are in bed to do a bit of work.
by MotherWit | Apr 25, 2010 | Uncategorized
I am blessed to have family in the UK. This means I get to visit England every couple of years, and LOVE visiting London and the English countryside. My sisters live in London, and so does my little nephew Antony…any excuse to visit him is a good one.
My father is originally an Englishman, born in the town of Goole in the Yorkshire region. The Everest family has apparently been there for around 1000 years or so. He came to Canada at the age of 14, and a few years later met my mother who herself was originally from Holland (born at home just after the Nazi occupation of the Netherlands ended).
I feel a strong connection to my English roots. My Great Great Grandmother Charlotte, whom I have spoken of here on occasion, was a doula in Goole many years ago. Obviously, the word “doula” was not used back then. My Nana was raised by her Granny (Charlotte) after the death of her mother, and Nana used to tell me stories of waking in the middle of the night to knocks on Charlotte’s window. She used to keep a broom outside her house so the husbands or mothers of labouring women could use the end of the broomstick to tap on her upstairs bedroom window to fetch her. Charlotte was known in town as a wonderful helper to families. She wasn’t a midwife…she was just the lady in the town the midwives consulted when they were having issues with babies not making timely appearances. From all accounts, Charlotte would come into the house, assess the situation, get the woman in some crazy position, and then the baby would usually come out soon after. She knew how to keep the environment calm. Midwives trusted Charlotte to labour-sit their clients when they were at other births and couldn’t make it to the home yet. Often the midwife would show up to the house with the baby already born, the house clean, and food prepared. When someone died, Charlotte was called to comfort the family and lay out the body.
I would give anything to go back in time and talk to this Great Great Grandmother of mine, who was apparently an amazing story teller. I wish I could have sat at her feet as she rocked in a chair by the fire, soaking in years of wisdom, becoming rich with story. I have dreams of going to births with her, learning the nuances of her ability to hold a space with such calm.
My Great Great Granddad was apparently a bit of a lush, so after coming home from a birth Charlotte would sometimes have to dress herself in her husband’s clothes, pull his cap down low over her face and pretend to be him, working on their barge which distributed coal and other goods. Without her taking over on these hungover occasions, they wouldn’t have had any livelihood, as her doula work didn’t pay more than a loaf of bread or cake now and then. My Nana told me when one of her husband’s fellow barge drivers would pass Charlotte on the dock, they’d say, “Hiya, Ned,” and she’d lower her voice, tuck her hat down a little lower over her face and answer, “Hiya,” My Nana, also an exceptional story teller, told me Ned would wake up from his stupor and say, “Ah, Charlotte….for all thy faults, I love thee still.” There is even a family story of Charlotte having been chased by Jack the Ripper in Leeds, but as Nana would say, “Ah, but that Charlotte…she could spin a yarn!”
What touches me most, is that Charlotte was completely uneducated. My Nana would see her pick up a book sometimes, but more often then not, she held it upside down. Her skills as a doula were gleaned from observation, common sense, and intuition…the very definition of MotherWit. Hence the name of my doula company, in honour of Charlotte.
My heart is full thinking of you, my doula sisters out in the UK, continuing the work of the traditional birth supporter like Charlotte, now within the new high tech birth culture. If you’ve ever encountered a soft, firm, reassuring voice in your right ear you can’t identify when you’re in a really sticky birth situation, feel your shoulders drop as a calm envelops you and you suddenly know exactly what to do, know it might be Charlotte, or perhaps even one of your own Great Great Grandmothers whispering down their support. Light a candle for her when you’re finished, whisper back your thanks, and always trust that voice. As a Native American Grandmother said to me once, “We are the answer to our Ancestors’ prayers.”
by MotherWit | Apr 25, 2010 | Uncategorized
Wow, 100 blog posts already! Am I a windbag or what?! I only started writing this blog a few months ago, and here we are at 100 so soon.
To celebrate, I wanna send you all some sugar. To my enthusiastic readers, love to you! Your responses and stories keep me inspired. To my devoted sister bloggers, I read you voraciously and appreciate you deeply, even if I don’t always have time to comment.
Thank you all so much for dropping in.
Love and light,
Lesley
www.MotherWit.ca
