No, my wife is not pregnant. I’m not even married, nor do I have an expectant partner. I am a tenth grader from the
Tuesday, December 29, 2009
A Visit With a Midwife by Trevor
Wednesday, December 16, 2009
We Make Our Plans by Stephanie Penland
We make our plans; then God sits back and has a good laugh.
The story of Ezra’s birth begins many years before his actual birth. At one point I thought I was pregnant. I was nauseas and sick for 6 weeks. My sense of smell was heightened a hundred fold. I woke up every morning at 6 am sharp fully awake and ready to go. My world was turned upside down. However, no matter how many pregnancy tests I took, it said negative. At exactly six weeks from the morning I woke up I experience the worst pain and bleeding I’ve ever had and I’ve had some pretty terrible periods.
I was ready to be mom, ready to be pregnant. My husband however was not; so I tabled the idea and waited for Mike to catch up. I prayed that Mike would tell me specifically that it was time to start a family. A year and a half later he told me just that. So we went off the pill and started trying. It took four months to conceive.
On January 4th, the day before my birthday, I woke up and knew that I was pregnant. The events of the day proved my suspicions. I am, or was, a vegetarian who eats fish. At lunch, I craved meat so bad that I ate 2 chicken sliders, 2 beef sliders, a side of boneless Buffalo wings, and a plate of shrimp all in one sitting. Then I went home and had a steak for dinner, consisting of more meat then I had in the past 10 years.
Ten day later on January 14th at 7:00 am, the pee test was positive.
I started my prenatal visits like most women in America by making an appointment with the OB. After two visits, I was struck by how institutionalized my appointments were. I felt my convenient 15-minute appointments were just sterile. Now don’t get me wrong, I love my OB. She has always been attentive, and very good at what she does. It so happens she was pregnant when I saw her for my first appointment at 6 or 8 weeks and then I didn’t see her again for another two months. When she came back to work her outlook on water birth and home birth seemed to be different. She encouraged me to research these things and was supportive if I chose to go that route.
I started seeing Maria around my 5th month. From the moment I met her, I knew she was the midwife I wanted at my birth. My pregnancy was not a hard one, though I suffered with severe nausea that didn’t subside or lessen. I tried everything to make it go away and finally found Zophran, which just went generic. If I took this medicine, I could function normally; if I did not, I was sick as a dog and bedridden.
One of the best things about having a midwife instead of an OB as my caregiver is that Maria actually touched my stomach. She felt the baby every time and also used an old-fashioned stethoscope. Our appointments were also an hour long instead of 15-20 minutes.
The Birth
7pm
We went to dinner, Thai food. I felt great, like I was on top of the world yet scared and excited all in one and not quite sure of myself. I look back now and see that I was ready, preparing to give birth.
Tuesday Sept 29, 2009 11pm
Wake up to go to the bathroom. On the way there a warm liquid soaked my pjs. It wasn’t much and all I could see of it was my mucus plug, which had the same greenish snot color. The water didn’t appear to have any color. We called Maria and Christina my mentor to come over and then went back to sleep.
2am
Contractions were at the 511 stages already. I was really confused, as they seemed to be very fast and hard this early in the game. My mother and I woke up my husband and called Maria.
My thoughts at this point are excited. I am fully aware of my body, my mind is intact and I am ready for this. This is what I have been preparing for. It seems I almost instantly know what do yet at the same time I have no idea what I am doing.
5am
My husband is the best supporter. He holds me, caresses me, and gives me words of encouragement. He does everything I ask. I remember back to our prenatal class with Jane Austin and the question was asked, “What is my role in all this?” Jane answered, “Whatever she needs you to do.” Well I needed Michael to do a lot of things. I needed drinks, I needed to be held up, but most of all I needed his hand on my tailbone.
6 hours into it I was starting to get agitated. Maria suggested that I go into the shower. This was the best idea. The moment the water touched my skin I felt relief, and an awe, almost an ecstasy between contractions.
Earlier that evening I had given my mom the camera and showed her a few basic ways to use it and instructed her to take pictures, even though she was reluctant because she thinks she has no talent for these things. It turns out this was the best use of her. She took pictures while I was in the shower. Looking back at them now I am amazed at what I looked liked. I can feel the moment deep with in my bones, my belly is huge and bulging yet beautiful and just how it should be.
Morning 6am – 4pm
We try the tub. This is yet another miracle moment for me, a wave of pure lightness. As the contractions rush through my body I am able to lift my legs and hips off the ground and suspend myself in the tub. This is a most exhilarating feeling of floating and tensing up. Michael has now been applying pressure on my tailbone for about an hour. It turns out over the next two days his hand is on my tailbone almost the entire time.
After the tub we walked up and down the hall. At the end of the hall I would collapse into my husband’s arm as my body shook with the rush. It was as if I no longer existed but my body took over and the pain and tension and joy was all there was. Maria suggested I sit on the toilet for a while. By 1:00, we checked and I was still not fully dilated, only about 4. The whole day really passed in a blur of water, rubs, walking.
Evening 4pm – 11pm
At this point I was tired and my husband says that I looked at Maria and said, “Am I almost done?” I don’t remember this but I do remember thinking he was never going to come out and my tailbone was going to split in two.
The second midwife came and was very quite and calm. She checked me vaginally as well to get a second opinion, which was that I was 8cm or even 7 but that there was a lip over the baby’s head. They did try to move the lip while I was having a contraction. This was very uncomfortable, as was the catheter Maria also used to help the process.
In the evening my contractions started to slow down. They were irregular in time and in strength so we tried acupuncture. This worked really well for a time. It brought on the contractions really hard but didn’t keep them consistent. We tried homeopathic herbs with no results. Maria sat us down and gave us our options about going to the hospital or staying home. By late evening we were tired and I felt that I needed to sleep but my husband wanted to try more. So he walked me up and down the hall. Helped me with leg stretches and squats until I couldn’t hold myself up any more. At one point I was laying on the floor waiting for the next one and all of a sudden I threw up. Not just a little but everything I had eaten 20 hours earlier. Apparently I didn’t digest any of my dinner. It was embarrassing but honestly I was glad to get rid of it. Then the tears came and from what I remember, the rest of the evening was done. I slept on the couch waking up every ½ hour or hour for a contraction. My mother kept track of them, how long they lasted and how far apart. By morning I was feeling better but still very tired.
Thursday Oct 1
Morning Day 2
Michael and I decided to have a talk in the bedroom about our options. I told him that if I had to go through another day of this with no results, I didn’t think I’d have the strength to go the hospital. I would not be able to resist getting drugs or worse yet, they might have to do a cesarean. We prayed and felt the answer was to go to the hospital. When we told Maria what we wanted, she agreed that it was the best thing to do and that she was proud of me. That I had done a great job and did all I could.
I had a small bag packed just in case we went to the hospital. The car ride there was not fun. Thankfully I didn’t have a contraction in the car but his head was already so far down that nothing I did helped. Upon arriving at the hospital, my good friend Jackie was waiting for us. They got us situated with an IV and started fluids right away as I was slightly dehydrated even though Mike did a great job of making me drink the whole time. The nurses gave me a relaxer to calm me down because I was so tense but warned me that it would not help the pain of the contractions. They were right.
Now that I had the pitocin coming in strong and regular it was hard to get into a groove again. At home, it was easy as I was in familiar surroundings; I had all my props and comforts. I was now 8 cm and felt like things were going well until the head doctor on staff came in and informed me that if I wasn’t dilated at least 1 more cm by the time he came back in an hour then we would have to talk about cesarean birth. I freaked out. Thank God I had my support team there. Maria was great, she calmed me down and told me that it wasn’t going to happen, that we were so close, it would just take a little longer.
I spent most of the day in the shower. That is where I found my groove. Swaying back and forth, squatting with the water on my back was heavenly and hellish all at the same time. Jackie came in and told me that my contractions were 1 minute apart and that they were off the charts. She actually went and got the nurse who turned them down. I remember this because I was so far in my head that I was not able to speak. The nurses kept coming into the room asking me questions and pulling me out of this primal place. My husband, God bless him, kept them away as much as he could. They really wanted to make sure I wanted an epidural. He told me to just ignore anyone who comes in, to face the wall and keep doing what I was doing.
By late afternoon something had changed in me. Now I was out of the shower, the nurses changed me and dried me which was so helpful. For the next two hours, I was finally really pushing him out. I squatted, holding the back of the chair and screamed a real loud scream that I had not done yet. Maria suggested that I tuck my chin and instead of a high pitch scream, that I grunt down. When I did this, I felt his head move off my tail bone and down in the canal even further. It only took a few more of these to know that he was on his way. I was so tired, physically my legs could no longer hold me up. I had to rest so I got on the bed and that is where I stayed.
Michael was very tired as well. He would hold me up with each contraction, and my mom would put her hands on his back to keep him up. Jackie and Michael were amazing at keeping my spirits up, encouraging me and helping me physically. My mom was amazing too though at one point I looked over at her and she had the most depressing look on her face. I said, “Mom, that look on your face is not helping.” So she put away her fears and focused on my needs and that was the end of that.
Once on the bed and pushing really began, Dr. Norell came. She was the doctor we had seen for our hospital visit and we loved her. I was so happy that she was the one that was going to deliver my baby. Everyone was crowded around me. My legs were spread and my mother pushed one knee down and Jackie the other. I can’t explain how much it helped to have them pushing my legs to the bed. It was as if my body was a giant rubber band that needed to be stretched and maintained.
Someone said I can see the head, and he has hair. I was so excited. They asked if I wanted to touch but I was so inside, so concentrating that I did not dare. Then for no reason at all I put my hand down there and felt his head, and he really did have a lot of hair. After that my pushes were very strong. I wanted him out. They describe the head coming out like a ring of fire. To me it was like every pain, every anxiety, every hope and every fear all wrapped into one sensation. My belly was lopsided as I pushed him out. The moment he came out, the belly fell. There was a lot of commotion, excitement and still some pain. I can’t even describe the rush of emotions that hit me as his head passed the threshold and his body slid out. He was given to Michael to place on my chest. Everyone had a hand in pulling him out, my mom and Jackie both.
Oct 1st 6:27 pm
As he was coming to me I said, “Is this my baby? Is this my baby?” At the sound of my voice, his eyes found mine. He knew who I was and he pierced me with such a stare that I’ll never forget that moment and I knew beyond a shadow of a doubt that there was a God. That this baby that grew inside of me for the past 9 months was a miracle and was special.
They cleaned him while he was laying on me. I was unaware at the time that I was naked and looking back at the pictures my breasts are in every picture but I do not see myself as naked but as one with my baby in a pure and perfect state. The first cry he made was on my chest. Then they took him with Michael to the other side of the room to get cleaned up, measured and weighed. When he was placed on the scale at 8lbs 12oz, a cry of, “Oh my God” came out. No one expected him to be that big. I was still in a lot of pain and the placenta had not come out yet. Then I felt a shudder and gave a push and it slid out like a little fish. Now this may seem weird but it was almost orgasmic pushing out the placenta. It was so soft and supple compared to the hard head of my baby.
I can’t remember when he took his first suckle but I do remember it was amazing. A sensation and emotion I had never felt before.
I needed three small stitches. I have one real fear and that is getting stitches. I can’t believe the first time I get them is in my vagina of all places. I was rather numb from the birth and the shot they gave me before hand made me completely numb. Jackie held my hand because though I could not feel it, I could see the needle. It wasn’t that bad and at that point I felt like I could have gone through anything.
After the Birth
I feel like I was really prepared for all that had happened. I knew about each step. What home birth and hospital birth mean for procedures and care. I did not however realize what birth would do to my body the next few days and weeks. The first time I stood up a gush of liquid followed me all the way to the shower. Gallons of pee that had been blocked by my enormous baby fell out. I have to say here that the nurses were so kind and helpful, assuring me that it was not a problem at all. They brought us food, which was amazing, and helped us with all that we needed.
I was so sore, and the stinging was out of control. I expected this but not to this magnitude. Because my birth was so long and he was on my tailbone for almost 2 days, there was a lot of damage done inside. At six weeks when I had my last appointment, though the stinging had stopped, I was still sore.
We stayed in the hospital for two days. I could hardly move and didn’t want to leave in that condition. My baby was born. My husband was by my side. My mother, now a grandmother was waiting at home for us. It felt like the whole world stopped for us and life had just begun.
Tuesday, November 17, 2009
Hunter is here!
Alas, after a two week delay in the jungle,
Hunter Ezekiel Lane has arrived on November 15th, 2009 at 12:18 in the morning
after an epic and surprisingly peaceful 8 hour birth at home in a birth tub.
8 lbs 15 ounces
21.5 inches long
We are blessed and blissed out!
MamaFou, PapaFou, Bobby and Hunter
Tuesday, November 3, 2009
Birthing in Oaxaca
A friend of mine sent me this link to a birth she attended. It is a very cool birth story.
Saturday, October 31, 2009
Wednesday, October 21, 2009
Believe
Believe me, I have had my ups and downs. Some have recently been surprised to see my name after irate blog comments, “wow, that doesn’t sound like you,” is the usual response. Some have seen it on my face at work, saying, “Oh, so that’s what’s up.” And my partner is riding through the storm of each day’s report back of the latest news in midwifery. Good thing she is in the news and loves the drama. Of course, she’s on my side though and has lots of strategic ideas. But the latest midwifery round of betrayal and bad faith negotiating has made me look at my core. I ask myself: “What do I believe?”
I am not sure if I was always someone who subverted the dominant paradigm. When is it that you first notice that you don’t want to shop at the Safeway or Walmart? How does that even happen? How do those values arise? Why is it that some are unwilling to follow the flow and insist on following the beat of a different drummer? I grew up in a mainstream town, lived in a family that followed all the mainstream trends, from shopping at Sears to buying whatever was on sale in the Penny Saver. Does my father even now what Organic means? I am sure he does not.
So, when, how and why did that all come about? Wouldn’t it have been easier for me to just step in line and keep up with Joneses. It began in college. I fell into step with the hippies at the Crafts House and found a resonance there that was refreshing, different, exciting and inspiring. These were people who I wanted to be with. They had ideas that were different and unusual. Like vegetables. These people ate lots of them and some of them only at vegetables. Organic when possible. Simply by choosing different food to eat, I had stepped into a different world. A world largely different from the flow around us.
This world, of course, opened my eyes to other non-dominant paradigm ideas as well: tie dye, communal living, non-violence and enlightenment. My eyes were wide, my heart open and my mind filling with information. And of course, we were all together, living in the grooviest place on campus, the Crafts House.
So that is how it all began, I didn’t grow up a hippie or have any encouragement from my family. As a matter of fact, most I what I do and feel now, they definitely do not understand. In the same way that I can not understand them. But I moved out of the Crafts House, graduated from college, and began my life as an adult groover in earnest.
By many standards, I am not EVEN that groovy. I don’t spin wool, I don’t make my own goat cheese, I don’t even have a pet. But I do recycle, I do try to remember to bring my own bags to the grocery story, I compost my food scraps, and I practice as a midwife. A homebirth midwife, that is. A non-dominant paridigm midwife. I am out on the edges of society with the less than 1% of women and families who are choosing this too. Why are we here? Because we believe.
So, what is it that we believe in so strongly that we insist on swimming upstream? I started out believing when I was 12 years old that I wanted to help people. I wanted to deal with real life scenarios that would involve excitement, intrigue, precision, and healing. I wanted to immerse myself in a life where I was needed as an integral member of the community. I wanted to know people on a first name basis and sit down to dinner with them after a long day’s work. Being a country doctor may have fulfilled all of these wishes. But when I was a student in college, with all of the other pre-med students, I realized that I was not on a trajectory that would lead me to that end. I felt that I was at the beginning of a long journey that would propel me head-long into medicine, without knowing truly how to heal people. So, I changed course. I looked away from the dominant paradigm. I looked away from medical school. But at the time, I didn’t know where to turn.
Until I graduated and lived on the Vineyard for a summer. A friend of mine handed me Spiritual Midwifery and said I might be interested. There they were. The hippies, the counter-culture, the ones eschewing the dominant paradigm with aplomb and vigor. And they were having their babies in buses and on a commune with midwives. I knew this was it. This was the healing, the wholism, the community, the culture, the spirituality that I had been looking for. Midwifery would provide a connection to women and families and children and society. Midwifery would provide a spirituality that was rooted in everyday miracles and the unbridled power of women. Midwifery would provide a healing pathway for women as they reached deep down inside of themselves to find the inner strength to give birth. Midwifery would provide a healing pathway for families as the witnessing and participating in birth led to unparalleled bonding, love and admiration. Midwifery would provide a strong intellectual stimulus for my mind, ever searching for meaning behind the signals of birth, always fascinated and learning. Birth is never fully knowable. All of these things I believed as I finished my reading of Spiritual Midwifery, ran to the store and bought Heart and Hands, and transported myself to El Paso, TX to attend midwifery school.
It all began as beliefs.
Twenty four years later and almost having seen 1000 babies come into the world, it is much more than belief. It is deep inner knowing from having witnessed women in their travail, in their glory, in their achievement. The women themselves have been my teachers. The women and their babies. The women and their partners. The women and their wisdom.
I believe that women are strong, powerful and resilient. I believe that midwives are valued by their clients as trusted guides and facilitators of birth. Midwives hold women when they are most vulnerable: raw, open, surrendered. Midwives honor mothers for the amazing job they are doing, birthing their babies. Midwives touch women’s lives in a way that resonates for decades.
I believe in my work. I believe in the work of my colleagues.
I am not sure if I was always someone who subverted the dominant paradigm. When is it that you first notice that you don’t want to shop at the Safeway or Walmart? How does that even happen? How do those values arise? Why is it that some are unwilling to follow the flow and insist on following the beat of a different drummer? I grew up in a mainstream town, lived in a family that followed all the mainstream trends, from shopping at Sears to buying whatever was on sale in the Penny Saver. Does my father even now what Organic means? I am sure he does not.
So, when, how and why did that all come about? Wouldn’t it have been easier for me to just step in line and keep up with Joneses. It began in college. I fell into step with the hippies at the Crafts House and found a resonance there that was refreshing, different, exciting and inspiring. These were people who I wanted to be with. They had ideas that were different and unusual. Like vegetables. These people ate lots of them and some of them only at vegetables. Organic when possible. Simply by choosing different food to eat, I had stepped into a different world. A world largely different from the flow around us.
This world, of course, opened my eyes to other non-dominant paradigm ideas as well: tie dye, communal living, non-violence and enlightenment. My eyes were wide, my heart open and my mind filling with information. And of course, we were all together, living in the grooviest place on campus, the Crafts House.
So that is how it all began, I didn’t grow up a hippie or have any encouragement from my family. As a matter of fact, most I what I do and feel now, they definitely do not understand. In the same way that I can not understand them. But I moved out of the Crafts House, graduated from college, and began my life as an adult groover in earnest.
By many standards, I am not EVEN that groovy. I don’t spin wool, I don’t make my own goat cheese, I don’t even have a pet. But I do recycle, I do try to remember to bring my own bags to the grocery story, I compost my food scraps, and I practice as a midwife. A homebirth midwife, that is. A non-dominant paridigm midwife. I am out on the edges of society with the less than 1% of women and families who are choosing this too. Why are we here? Because we believe.
So, what is it that we believe in so strongly that we insist on swimming upstream? I started out believing when I was 12 years old that I wanted to help people. I wanted to deal with real life scenarios that would involve excitement, intrigue, precision, and healing. I wanted to immerse myself in a life where I was needed as an integral member of the community. I wanted to know people on a first name basis and sit down to dinner with them after a long day’s work. Being a country doctor may have fulfilled all of these wishes. But when I was a student in college, with all of the other pre-med students, I realized that I was not on a trajectory that would lead me to that end. I felt that I was at the beginning of a long journey that would propel me head-long into medicine, without knowing truly how to heal people. So, I changed course. I looked away from the dominant paradigm. I looked away from medical school. But at the time, I didn’t know where to turn.
Until I graduated and lived on the Vineyard for a summer. A friend of mine handed me Spiritual Midwifery and said I might be interested. There they were. The hippies, the counter-culture, the ones eschewing the dominant paradigm with aplomb and vigor. And they were having their babies in buses and on a commune with midwives. I knew this was it. This was the healing, the wholism, the community, the culture, the spirituality that I had been looking for. Midwifery would provide a connection to women and families and children and society. Midwifery would provide a spirituality that was rooted in everyday miracles and the unbridled power of women. Midwifery would provide a healing pathway for women as they reached deep down inside of themselves to find the inner strength to give birth. Midwifery would provide a healing pathway for families as the witnessing and participating in birth led to unparalleled bonding, love and admiration. Midwifery would provide a strong intellectual stimulus for my mind, ever searching for meaning behind the signals of birth, always fascinated and learning. Birth is never fully knowable. All of these things I believed as I finished my reading of Spiritual Midwifery, ran to the store and bought Heart and Hands, and transported myself to El Paso, TX to attend midwifery school.
It all began as beliefs.
Twenty four years later and almost having seen 1000 babies come into the world, it is much more than belief. It is deep inner knowing from having witnessed women in their travail, in their glory, in their achievement. The women themselves have been my teachers. The women and their babies. The women and their partners. The women and their wisdom.
I believe that women are strong, powerful and resilient. I believe that midwives are valued by their clients as trusted guides and facilitators of birth. Midwives hold women when they are most vulnerable: raw, open, surrendered. Midwives honor mothers for the amazing job they are doing, birthing their babies. Midwives touch women’s lives in a way that resonates for decades.
I believe in my work. I believe in the work of my colleagues.
Tuesday, September 29, 2009
Monday, September 28, 2009
Thursday, September 24, 2009
Normal Birth
"If midwives are to remain at the forefront of decision-making that supports "normal birth', they need to challenge the culture and constraints of the organisations within which they work and initiate research and reflection on the complexity of 'normal birth".
What is "normal birth" and is that really what we want? That was the topic of my class today with the UCSF CNM students. It is still orientation, so not a lot of homework yet, but we spent three hours analyzing the concept of normal birth. What is normal? Who gets to have a normal birth? If your birth is not normal, what is it-- abnormal? Birth: undisturbed, simple, uncomplicated, natural, physiological, ordinary. Do any of these words truly express what we know to be true? That birth is a complex, powerful process by which a woman transitions from pregnancy to motherhood. That birth has physical, social, emotional, cultural and spiritual implications. That birth is mysterious and contains elements that are unknowable. We as midwives are obligated to rediscover, redefine, preserve and honor normal birth. Let's continue the dialog.
Sunday, September 20, 2009
My Birth Story by Misha
I had a beautiful birth. It was not the birth I had envisioned but it was a great experience. We had planned to labor and deliver at home with our midwife, Maria Iorillo. We had a back-up hospital set up in case we needed to transfer for any reason.
Thursday, 9 p.m.
I lost my mucus plug but discovered I was leaking fluid. Thinking this was part of the deal with mucus plugs, I thought nothing of it until the leaking continued overnight. I was suspicious that my water had broken. I called Maria and she said she was 95% sure my water had broken. The goal now was to start contractions. We had 72 hours before I would have to be induced.
Friday, 5 p.m.
Ready to get this show on the road, I acted on one of Maria’s recommendations and drank 2 ounces of castor oil. She came by an hour later to check in on me. After testing the fluid, we were now certain my water had broken. She said to be patient and wait. She also left us with some herbs to try the next day if contractions didn’t begin overnight.
Friday, 7 p.m.
My first contraction came shortly after 7 p.m. Twenty minutes later I had the second. Ten minutes later another. Four minutes later another and from then on it was every four minutes. Each contraction was a minute or longer. We were in labor! After an hour of this we called Maria, as we had hit 4-1-1 (4 minutes apart, 1 minute long for 1 hour).
It was tough, intense and I was a little scared by how fast things seemed to be going. I labored mostly standing up, leaning over our dining table and breathing deep, loud, yoga breaths. It was rough but doable. I was having back labor but didn’t realize how intensely until Maria suggested Alan rub or push on my back during the contractions. SO helpful! Because my water had broken 24 hours before, our midwife decided to delay any internal exams until I had the urge to push to reduce the risk of infection to me and the baby.
After eight hours of contractions, I felt the urge to push and asked Maria to check me. I was only 2 centimeters. I knew I was in for a long haul. My mother and sister had both delivered their first children in eight hours so I was discouraged. We labored a bit longer but it was impossible to not push. There were signs I was dilating and we wondered if things were now moving faster so I asked Maria to check again. I was only 3 centimeters and my cervix was swelling. Not good.
We now had a couple options. We could keep laboring at home. This would require me to resist the urge to push, and hope the cervix stopped swelling and eventually get to 10 centimeters. If I couldn’t stop pushing there was the risk that my cervix would continue to swell and a c-section would be needed.
The other option was to go to the hospital and get an epidural to take away the pushing sensation. This would also increase the probability of a c-section but it also gave me a possibility of a vaginal birth, something that was really important to me.
We debated the options for a couple hours but it became clear to me I would not be able to resist pushing for another 7 centimeters. So we headed to the hospital.
Saturday, 6 a.m.
We arrived at St. Luke’s Hospital and waited as they drew blood and prepped me for an epidural. The staff midwife was optimistic I would continue to contract on my own since my contractions were regular, strong and long. The anesthesiologist arrived about an hour and a half later. He was awesome and got the epidural in between two really bad contractions. The epidural didn’t hurt and after it took affect, I barely felt anything. It kicked in almost immediately and then we tried to rest.
After the epidural my contractions slowed to 10 minutes apart and we decided to start pitocin to get them going again. Then the long waiting process began as we allowed my body to do its thing.
At 5:30 p.m. I finally fell asleep after not having a good night’s sleep in two days. When I woke up at 7 p.m. they decided to check me. In my groggy haze, I heard them say “You’re complete. We can start pushing!” I couldn’t believe we were finally there, 24 hours after my first contraction and almost 48 hours after my water broke, it was time to birth!
Saturday, 7 p.m.
The epidural made it difficult to feel all the contractions and push properly. I needed someone to literally push on me to give me a focal point to push back. I was also shaking uncontrollably from the epidural and adrenaline, so it was hard to get a break in between.
Saturday, 9:01 p.m.
I made steady progress and 1 hour 45 minutes later the midwife told Alan to come around if he was going to catch his daughter. Alan lovingly delivered our baby and placed her on my tummy at 9:01 p.m. The first thing I asked was “is it a girl?” Even though we were told the sex at an ultrasound, I knew there was a possibility they could be wrong.
We waited for the cord to stop pulsing before cutting it. Alan cut it and then started holding the baby directly against his skin to keep her warm while the staff finished up with me. It was such a beautiful moment.
I had a first degree tear. After stitching me up and slowing down the epidural, Alan put the baby on my chest. It was such an awesome feeling to see and hold my daughter. She is beautiful and perfect and worth every minute of the adventure. I still cannot believe I did it. It is the craziest thing I’ve ever experienced in my life. Our birth experience was full of surprises and challenges, but it was amazing.
Marcelle Diane is named after our mothers. We loved both names and felt it was great to use family names. We are going with the nickname Ellie. She weighed 7 pounds 4 ounces at birth and was 19.5 inches long. She arrived 48 hours after my water broke and after 26 hours of labor. It was the most intense, beautiful, mystifying experience of my life. And I wouldn’t change it.
You can find out more about home birth transfer rates and safety in this British Medical Journal Study:
http://www.bmj.com/cgi/content/full/bmj;330/7505/1416
Thursday, 9 p.m.
I lost my mucus plug but discovered I was leaking fluid. Thinking this was part of the deal with mucus plugs, I thought nothing of it until the leaking continued overnight. I was suspicious that my water had broken. I called Maria and she said she was 95% sure my water had broken. The goal now was to start contractions. We had 72 hours before I would have to be induced.
Friday, 5 p.m.
Ready to get this show on the road, I acted on one of Maria’s recommendations and drank 2 ounces of castor oil. She came by an hour later to check in on me. After testing the fluid, we were now certain my water had broken. She said to be patient and wait. She also left us with some herbs to try the next day if contractions didn’t begin overnight.
Friday, 7 p.m.
My first contraction came shortly after 7 p.m. Twenty minutes later I had the second. Ten minutes later another. Four minutes later another and from then on it was every four minutes. Each contraction was a minute or longer. We were in labor! After an hour of this we called Maria, as we had hit 4-1-1 (4 minutes apart, 1 minute long for 1 hour).
It was tough, intense and I was a little scared by how fast things seemed to be going. I labored mostly standing up, leaning over our dining table and breathing deep, loud, yoga breaths. It was rough but doable. I was having back labor but didn’t realize how intensely until Maria suggested Alan rub or push on my back during the contractions. SO helpful! Because my water had broken 24 hours before, our midwife decided to delay any internal exams until I had the urge to push to reduce the risk of infection to me and the baby.
After eight hours of contractions, I felt the urge to push and asked Maria to check me. I was only 2 centimeters. I knew I was in for a long haul. My mother and sister had both delivered their first children in eight hours so I was discouraged. We labored a bit longer but it was impossible to not push. There were signs I was dilating and we wondered if things were now moving faster so I asked Maria to check again. I was only 3 centimeters and my cervix was swelling. Not good.
We now had a couple options. We could keep laboring at home. This would require me to resist the urge to push, and hope the cervix stopped swelling and eventually get to 10 centimeters. If I couldn’t stop pushing there was the risk that my cervix would continue to swell and a c-section would be needed.
The other option was to go to the hospital and get an epidural to take away the pushing sensation. This would also increase the probability of a c-section but it also gave me a possibility of a vaginal birth, something that was really important to me.
We debated the options for a couple hours but it became clear to me I would not be able to resist pushing for another 7 centimeters. So we headed to the hospital.
Saturday, 6 a.m.
We arrived at St. Luke’s Hospital and waited as they drew blood and prepped me for an epidural. The staff midwife was optimistic I would continue to contract on my own since my contractions were regular, strong and long. The anesthesiologist arrived about an hour and a half later. He was awesome and got the epidural in between two really bad contractions. The epidural didn’t hurt and after it took affect, I barely felt anything. It kicked in almost immediately and then we tried to rest.
After the epidural my contractions slowed to 10 minutes apart and we decided to start pitocin to get them going again. Then the long waiting process began as we allowed my body to do its thing.
At 5:30 p.m. I finally fell asleep after not having a good night’s sleep in two days. When I woke up at 7 p.m. they decided to check me. In my groggy haze, I heard them say “You’re complete. We can start pushing!” I couldn’t believe we were finally there, 24 hours after my first contraction and almost 48 hours after my water broke, it was time to birth!
Saturday, 7 p.m.
The epidural made it difficult to feel all the contractions and push properly. I needed someone to literally push on me to give me a focal point to push back. I was also shaking uncontrollably from the epidural and adrenaline, so it was hard to get a break in between.
Saturday, 9:01 p.m.
I made steady progress and 1 hour 45 minutes later the midwife told Alan to come around if he was going to catch his daughter. Alan lovingly delivered our baby and placed her on my tummy at 9:01 p.m. The first thing I asked was “is it a girl?” Even though we were told the sex at an ultrasound, I knew there was a possibility they could be wrong.
We waited for the cord to stop pulsing before cutting it. Alan cut it and then started holding the baby directly against his skin to keep her warm while the staff finished up with me. It was such a beautiful moment.
I had a first degree tear. After stitching me up and slowing down the epidural, Alan put the baby on my chest. It was such an awesome feeling to see and hold my daughter. She is beautiful and perfect and worth every minute of the adventure. I still cannot believe I did it. It is the craziest thing I’ve ever experienced in my life. Our birth experience was full of surprises and challenges, but it was amazing.
Marcelle Diane is named after our mothers. We loved both names and felt it was great to use family names. We are going with the nickname Ellie. She weighed 7 pounds 4 ounces at birth and was 19.5 inches long. She arrived 48 hours after my water broke and after 26 hours of labor. It was the most intense, beautiful, mystifying experience of my life. And I wouldn’t change it.
You can find out more about home birth transfer rates and safety in this British Medical Journal Study:
http://www.bmj.com/cgi/content/full/bmj;330/7505/1416
Friday, September 18, 2009
Noah Adriano
Here's the note from Mary, Noah's Mom:Dear Maria, Thank you so much for the care, attention, and guidance you provided through my pregnancy. Even being on vacation, thousands of miles away, you provided advice and reassurance during a challenging labor. Even though I didn't have my homebirth, I believe choosing the midwifery model of care helped me make good decisions. I felt in control, empowered, and had the mental fortitude to make it through 32 hours of labor!
Thank you so much, Mary, Dennis and Noah
Yes, while I was on vacation on the other side of the country, lovely Noah made his arrival on July 26, 2009. Mary and Dennis are the proud parents of this little one who came in at 8 pounds even. Mary is an amazing mama who showed her commitment and faith, letting go where she needed to and holding fast to the rest. Congratulations Mary and Dennis!
Thursday, September 17, 2009
The Birth of Kennedy Maria Shelby by Earth Lande
Kennedy Maria Shelby was born on Monday Sept.16th at 7:35am. She was 7lbs 4oz and 20inches long. She is a true and soulful beauty with Raven black curly hair, deep and shiny onyx colored eyes. She was made from love and is now and forever will be fully immersed in deepest love.
Bright and Early Sunday morning Kristine and I realized that the baby was really going to come soon. She started feeling menstrual like cramping that came in waves every 5 to 7 minutes. We were ecstatic and started to get everything ready. Kristine called Marcus and the three of us rearranged the house, filled up the birth tub and treasured the wonderful feeling of knowing there would soon be a beautiful baby. Sam was next to arrive with flowers and then Holly with wine and champagne. For the next 9 hours Kristine and her birth team just enjoyed each other’s company. We saged the house and made sure to sage each other and said what we wanted out loud for the birth. We created a birth shrine with candles, photos of family and symbols of strength. Later Kristine and Marcus took a walk, I read and did homework.. Marcus played beautiful music on the piano, Holly ,Sam, and I bonded over delicious wine as Marcus and Kristine slept.
Kristie Mattolli brought over the most amazing food and Sam made sure that Mama Hick’s ate...Later that evening Grandma and Auntie Shelby arrived. As nightfall came we all sat around talking about the future of this little one and Kristine got a chance to again talk about how the baby would sleep with her and Marcus, not be exposed to television and how pleased she was to be having baby at home. I was so impressed by her authentic faith in her body’s ability to birth her baby. She was the picture of tranquil strength.
We all knew that the baby was not coming that night. The midwife told Kristine to have a glass of wine and to get some rest. Holly’s 2 year old daughter, an out of this world beauty, had told Kristine early that day that the baby was coming tomorrow and it was going to be a girl. Only 4 other people thought she would birth a girl. Including Grandma and Auntie Shelby, Tess the baby and her friend Cheryl.
Her contractions were coming every 7-12 minutes by the time everyone left but me. When I left to get some rest at 9:45pm her contractions were again coming every 5 minutes lasting for 30 sec. At 12:45 am I got a call from Marcus that it was on. I returned to the house at 1:15am with Grandma Shelby. Her heavy labor came around 11pm. When I arrived the house was dark expect for a few burning ox blood colored candles. She was in the birth pool and I have never seen Kristine more beautiful. She exuded so much light and power. Her undeniable raw energy took my breath away. I knew instantly that I had walked in to a den where the veil between the spirit world and the physical world had been removed. I was humbled knowing the I was going to witness the most sacred rites of passage. The only sounds were of Kristine. She went from orgasmic like moans, to primal wails to screams of passion. Maria her midwife was there and so were Kristine’s parents. It was the most profound experience in all my 28 years. I felt emotions that I never knew existed. Kristine, my soul sister, went to an ancient place that only birthing women can go. We all knew that she was her animal self. She abandoned her understanding of the here and now and surrendered that night to power of giving life. I will never get over being a part of the most divine of life's transformations.
Marcus was amazing. He was there for her however she needed him, Maria was so lovely and calm and gave me a sense of peace. Sam and Holly were also outrageously wonderful both so in tuned to Kristine. There were times I thought why does she have to be in so much pain, I had to bite my tongue hard a couple of times to stop from crying. I just wanted to hold her and make the pain stop. Her parents were in total anguish during those last 3 hours. They know their baby girl and have never seen her in so much pain. Even though they wanted to call 911 they did not. Her parents were so scared for their daughter; however, their faith in her endurance and ability was stronger. Her birth angels were there. Making sure Kristine could handle what ever came her way. I prayed and visualized Kristine surrounded by all the wise women before her guiding her giving her the power to go on.
She did not find out how far she was dilated until she had the urge to push. By this point she was in her room with her knees on the floor resting her arms and face on Sam’s thighs who was lying on the bed. I was next to Maria acting as her assistant. Marcus was going back and forth between sitting next to Sam and lying on the floor when the baby’s head started to crown. Holly was filming the birth. The grandparents were watching from the doorway. She pushed for about 50 minutes. At the very end it was obvious that Kristine was starting to go to a place of fear. Maria told her something I will never forget. “ Kristine," she said in her serene voice of authority, "that place that you are going to when you scream, you have to go there and surrender to it, that is the ring of fire, you must go through it. You are at the last doorway. Walk through and you will have your baby." Kristine at that moment thought, I either surrender to the pain or prolong it for hours. Her water finally broke just moments before her angel was born. When the baby’s head came out we all started crying and smiling. Her baby was born and I could not believe that she was real. Thank you, Marcus and Kristine, for creating this life. Thank you, Kennedy, for choosing them, and thank you, Kristine, for deepening my faith that homebirth is normal birth. It was the most extraordinary miracle and most normal experience of my life.
Bright and Early Sunday morning Kristine and I realized that the baby was really going to come soon. She started feeling menstrual like cramping that came in waves every 5 to 7 minutes. We were ecstatic and started to get everything ready. Kristine called Marcus and the three of us rearranged the house, filled up the birth tub and treasured the wonderful feeling of knowing there would soon be a beautiful baby. Sam was next to arrive with flowers and then Holly with wine and champagne. For the next 9 hours Kristine and her birth team just enjoyed each other’s company. We saged the house and made sure to sage each other and said what we wanted out loud for the birth. We created a birth shrine with candles, photos of family and symbols of strength. Later Kristine and Marcus took a walk, I read and did homework.. Marcus played beautiful music on the piano, Holly ,Sam, and I bonded over delicious wine as Marcus and Kristine slept.
Kristie Mattolli brought over the most amazing food and Sam made sure that Mama Hick’s ate...Later that evening Grandma and Auntie Shelby arrived. As nightfall came we all sat around talking about the future of this little one and Kristine got a chance to again talk about how the baby would sleep with her and Marcus, not be exposed to television and how pleased she was to be having baby at home. I was so impressed by her authentic faith in her body’s ability to birth her baby. She was the picture of tranquil strength.
We all knew that the baby was not coming that night. The midwife told Kristine to have a glass of wine and to get some rest. Holly’s 2 year old daughter, an out of this world beauty, had told Kristine early that day that the baby was coming tomorrow and it was going to be a girl. Only 4 other people thought she would birth a girl. Including Grandma and Auntie Shelby, Tess the baby and her friend Cheryl.
Her contractions were coming every 7-12 minutes by the time everyone left but me. When I left to get some rest at 9:45pm her contractions were again coming every 5 minutes lasting for 30 sec. At 12:45 am I got a call from Marcus that it was on. I returned to the house at 1:15am with Grandma Shelby. Her heavy labor came around 11pm. When I arrived the house was dark expect for a few burning ox blood colored candles. She was in the birth pool and I have never seen Kristine more beautiful. She exuded so much light and power. Her undeniable raw energy took my breath away. I knew instantly that I had walked in to a den where the veil between the spirit world and the physical world had been removed. I was humbled knowing the I was going to witness the most sacred rites of passage. The only sounds were of Kristine. She went from orgasmic like moans, to primal wails to screams of passion. Maria her midwife was there and so were Kristine’s parents. It was the most profound experience in all my 28 years. I felt emotions that I never knew existed. Kristine, my soul sister, went to an ancient place that only birthing women can go. We all knew that she was her animal self. She abandoned her understanding of the here and now and surrendered that night to power of giving life. I will never get over being a part of the most divine of life's transformations.
Marcus was amazing. He was there for her however she needed him, Maria was so lovely and calm and gave me a sense of peace. Sam and Holly were also outrageously wonderful both so in tuned to Kristine. There were times I thought why does she have to be in so much pain, I had to bite my tongue hard a couple of times to stop from crying. I just wanted to hold her and make the pain stop. Her parents were in total anguish during those last 3 hours. They know their baby girl and have never seen her in so much pain. Even though they wanted to call 911 they did not. Her parents were so scared for their daughter; however, their faith in her endurance and ability was stronger. Her birth angels were there. Making sure Kristine could handle what ever came her way. I prayed and visualized Kristine surrounded by all the wise women before her guiding her giving her the power to go on.
She did not find out how far she was dilated until she had the urge to push. By this point she was in her room with her knees on the floor resting her arms and face on Sam’s thighs who was lying on the bed. I was next to Maria acting as her assistant. Marcus was going back and forth between sitting next to Sam and lying on the floor when the baby’s head started to crown. Holly was filming the birth. The grandparents were watching from the doorway. She pushed for about 50 minutes. At the very end it was obvious that Kristine was starting to go to a place of fear. Maria told her something I will never forget. “ Kristine," she said in her serene voice of authority, "that place that you are going to when you scream, you have to go there and surrender to it, that is the ring of fire, you must go through it. You are at the last doorway. Walk through and you will have your baby." Kristine at that moment thought, I either surrender to the pain or prolong it for hours. Her water finally broke just moments before her angel was born. When the baby’s head came out we all started crying and smiling. Her baby was born and I could not believe that she was real. Thank you, Marcus and Kristine, for creating this life. Thank you, Kennedy, for choosing them, and thank you, Kristine, for deepening my faith that homebirth is normal birth. It was the most extraordinary miracle and most normal experience of my life.
Wednesday, September 9, 2009
Just in case you missed it
Remarks of President Barack Obama – As Prepared for Delivery
Address to a Joint Session of Congress on Health Care
Wednesday, September 9th, 2009
Washington, DC
Address to a Joint Session of Congress on Health Care
Wednesday, September 9th, 2009
Washington, DC
Madame Speaker, Vice President Biden, Members of Congress, and the American people:
When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.
As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is many months away. And I will not let up until those Americans who seek jobs can find them; until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we have taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink.
I want to thank the members of this body for your efforts and your support in these last several months, and especially those who have taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation.
But we did not come here just to clean up crises. We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future – and that is the issue of health care.
I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.
Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.
We are the only advanced democracy on Earth – the only wealthy nation – that allows such hardships for millions of its people. There are now more than thirty million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.
But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.
One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.
Then there’s the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren’t any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It’s why so many employers – especially small businesses – are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It’s why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally – like our automakers – are at a huge disadvantage. And it’s why those of us with health insurance are also paying a hidden and growing tax for those without it – about $1000 per year that pays for somebody else’s emergency room and charitable care.
Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.
These are the facts. Nobody disputes them. We know we must reform this system. The question is how.
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.
I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.
During that time, we have seen Washington at its best and its worst.
We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.
But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.
Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.
The plan I’m announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it’s a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans – and yes, from some of my opponents in both the primary and general election.
Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.
What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
That’s what Americans who have health insurance can expect from this plan – more security and stability.
Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we’ve given ourselves.
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it’s a good idea now, and we should embrace it.
Now, even if we provide these affordable options, there may be those – particularly the young and healthy – who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don’t sign up for health insurance, it means we pay for those people’s expensive emergency room visits. If some businesses don’t provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek – especially requiring insurance companies to cover pre-existing conditions – just can’t be achieved.
That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.
While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.
And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that’s been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I’d like to address some of the key controversies that are still out there.
Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.
There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally. And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.
My health care proposal has also been attacked by some who oppose reform as a “government takeover” of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly-sponsored insurance option, administered by the government just like Medicaid or Medicare.
So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly – by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.
Insurance executives don’t do this because they are bad people. They do it because it’s profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called “Wall Street’s relentless profit expectations.”
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.
Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.
It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.
For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.
Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public – and that is how we pay for this plan.
Here’s what you need to know. First, I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.
Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn’t make us healthier. That’s not my judgment – it’s the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.
In fact, I want to speak directly to America’s seniors for a moment, because Medicare is another issue that’s been subjected to demagoguery and distortion during the course of this debate.
More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.
The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.
These steps will ensure that you – America’s seniors – get the benefits you’ve been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That’s what this plan will do for you. So don’t pay attention to those scary stories about how your benefits will be cut – especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.
Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system – everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.
Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.
Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It’s a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.
Add it all up, and the plan I’m proposing will cost around $900 billion over ten years – less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Most of these costs will be paid for with money already being spent – but spent badly – in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
This is the plan I’m proposing. It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.
That is why we cannot fail. Because there are too many Americans counting on us to succeed – the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.
I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death.
In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, and his children, who are here tonight . And he expressed confidence that this would be the year that health care reform – “that great unfinished business of our society,” he called it – would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that “it concerns more than material things.” “What we face,” he wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
I’ve thought about that phrase quite a bit in recent days – the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.
For some of Ted Kennedy’s critics, his brand of liberalism represented an affront to American liberty. In their mind, his passion for universal health care was nothing more than a passion for big government.
But those of us who knew Teddy and worked with him here – people of both parties – know that what drove him was something more. His friend, Orrin Hatch, knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient’s Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.
On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent – there is something that could make you better, but I just can’t afford it.
That large-heartedness – that concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people’s shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.
This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.
You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter – that at that point we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.
What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road – to defer reform one more year, or one more election, or one more term.
But that’s not what the moment calls for. That’s not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it’s hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history’s test.
Because that is who we are. That is our calling. That is our character. Thank you, God Bless You, and may God Bless the United States of America.
Monday, September 7, 2009
The Most Important Cards
Announcing the arrival of our little girl named Sophia Lotus!
On Friday June 25th, at 38 weeks, we learned that our baby was breech after Maria did not feel the head descending into my pelvis. At our home visit, Maria suggested that I get an ultrasound and that’s when my partner and I found out our little one was breech. I was devastated but knew the mantra... Healthy mom, healthy baby. With 2 weeks left until the due date, we were determined to do everything we could to have our baby rotate so that we could proceed as planned, naturally & at home. We tried an external version at UCSF, we swam, we walked, did yoga, acupuncture and inversions. On June 28th, Sunday morning at 2am after taking a midnight walk on the beach, I was coming out of a 20 minute inversion and my water broke two days after the ultra sound and 10 days before my due date. We both immediately knew that this meant a c-section was almost inevitable.
All our fears and uncertainty about being able to do a homebirth were washed away (pun intended) and we committed ourselves to ensuring a healthy baby & mama. Maria met us at UCSF within the hour after our call to her. When I was being examined at UCSF they said it might be possible to to a vaginal breech delivery but the baby seemed over 8 lb which is the limit. Maria was very supportive during the journey and was by our side the whole time. we decided to take the lowest risk alternative which was c-section before labor began. I really wanted to feel labor at that point and this was a big disappointment. The c-section was also supported by Maria who prefaced to me that she does not advocate very often for a c-section but she thought it was a good idea for us and our situation. One disappointment was the fact that I could not have both Maria and my partner in the Operating Room at the same time, only one in at a time. For this reason, I may not have another birth at UCSF again but otherwise the experience was fine... Considering my situation.
Sophia Lotus chose the time and nature of her arrival (much like her parents...who love to do things differently than what's expected of them). She was born at 6:45 am on Sunday morning, weighing a healthy 8 lb, 14 oz. Had we tried a vaginal breech delivery it would have likely been a disaster with a much higher risk to both mama and babe. Sophia is healthy and perfect in every way.
In the end, we were not expecting a hospital delivery but we were thankful for the support we received with Maria. Through our birthing classes we were taught a very important lesson of acceptance that what we want, may not be what we get. we are super grateful that the most important cards never had to be flipped and we are delighted to welcome such a wonderful little human being into our family.
Mishka, Kima and Sophia Lotus
Sunday, September 6, 2009
Eugene DeClerq
If you don't know who Eugene DeClerq is yet, check this out.
Birth by the Numbers
He is an amazing champion of midwives with numbers and research. AND he will be at the MANA conference. Are you sign up yet for this amazing conference in Asilomar, California?
Wednesday, September 2, 2009
ACOG, shame on you.
Another great homebirth
Here's what they're up to. ACOG, the American College of Obstetricians and Gynecologists, wants you to be afraid of homebirth. So, they put up a survey on their website asking for people to post all their "homebirths gone wrong" stories. Activists got wind of it and started to post their great homebirths. ACOG removed the survey to their members only area, away from public access and scrutiny. I could do the same, put up a survey on this blog asking for comments about people's bad birth experiences in the Hospital. If you want to tell your story, just comment to this post.But, hey, the story was on the Huffington Post. Let's expose ACOG for who they really are!
Read the story here.
Monday, August 31, 2009
Home birth is Safe!
Another study that shows that homebirth is safe when you have a skilled practitioner and the homebirth is planned. Thank you, Canada!
Friday, August 14, 2009
Home Birth in Jeopardy in Australia
What happened down under? Australia is about to launch a new law that will criminalize home birth. No good.
Saturday, August 8, 2009
From the Central Texas Midwives
Dear ACNM Board,
We are writing to express concerns about the ACNM’s opposition to the inclusion of CPMs in the Federal Medicaid bill. Our entire community, which is characterized by strong working relationships between CNMs and CPMs is disappointed and hurt that ACNM has choosen to take this position.
The Central Texas Midwives is a group of 38 midwives practicing in the Austin area. We are CNMs practicing at home, in a birth center and in the hospital and CPMs practicing at home and in a birth center. Most of the CPMs in our region have been apprenticeship trained through the PEP process. We consistently learn form each other. There is no line dividing us based on credentials. We highly value this dynamic and engaging relationship. We have a mutual respect for each other’s knowledge and experience, regardless of where or under what model that knowledge was acquired.
We are also a group of midwives who lobby our legislators for each other. Mutual support and respect has made midwives in our area feel good about ourselves as well as the kind of care that we provide to our clients. We believe that CNMs and CPMs alike do best when we can call each other freely for advice and support.
It is clear that the nation’s health care problems require leadership that is no longer stuck in the rigid, boxed-in thinking of old. We need leadership that is creative, flexible and willing to seek an inspired solution, which we believe includes CPMs. We cannot afford to quibble over who has the best and most valid training.
The mutual support of CPMs and CNMs in central Texas has made us a strong community. It is short-sighted to place an overemphasis on specific credentials. We believe that when one group of midwives seeks benefit by undermining another group, that undermines ALL midwives.
We would like to take this opportunity to extend an open invitation to sincere dialogue. We plan to continue to work together to strengthen midwifery and benefit our clients in central Texas. We hope that the ACNM will genuinely engage with the other midwifery organizations and will be open to information regarding the effectiveness of the apprenticeship model. We look forward to working together.
Sincerely
The Central Texas Midwives
Mary Barnett, RN, CNM, MN
Faith Beltz, CPM, LM
Jennifer Bennet, CPM, LM
Julia Bower, RN, CNM, MSN
April Bullock, CPM, LM
Lisa Carlisie, CNM
Amber Clarkson, CPM, LM
Debra Day-Camp, CPM, LM
Ann Dignon, RN, CNM
Roswitha Dowell, CPM, LM
Kristen Elliot, CPM, LM
Samantha Evans, CPM, LM
Michelle Fitzgerald, CPM, LM
Illysa Foster, CPM, LM
Laurie Fremgen, CPM, LM
Lauren Guehl, CNM
Kathy Harrison-Short, CNM
Cammie Hauser, CPM, RN, CNM
Melanie Henderson, CPM, LM
Heather Hilton, LM
GB Khalsa, CPM, LM
Keidi Kjerstad RN, CPM, LM
Siobhan Kubesh, RN, CNM, MSN, ICEA
Natalie Lake, CPM, LM
June Lamphier, LVN, CPM, LM
Jennifer Llana, CNM
Vicki Meinhardt, CPM, LM
Liane Miller, CNM
Marimikel Penn, RN-BSN, CPM, LM
Sara Pinkman, CNM
Heather Roberts-Schoen, CNM
Sarah Rudindsky, CNM
Sherry Russell, CPM, LM
Joan Smith, CNM
Patty Sprinkle, RN-BSN, CPM, LM
Jean Stokes, RN, CPM, LM
Lisa Sunden, CNM, FNP
Christy Tashjian, RN, CPM, LM
We are writing to express concerns about the ACNM’s opposition to the inclusion of CPMs in the Federal Medicaid bill. Our entire community, which is characterized by strong working relationships between CNMs and CPMs is disappointed and hurt that ACNM has choosen to take this position.
The Central Texas Midwives is a group of 38 midwives practicing in the Austin area. We are CNMs practicing at home, in a birth center and in the hospital and CPMs practicing at home and in a birth center. Most of the CPMs in our region have been apprenticeship trained through the PEP process. We consistently learn form each other. There is no line dividing us based on credentials. We highly value this dynamic and engaging relationship. We have a mutual respect for each other’s knowledge and experience, regardless of where or under what model that knowledge was acquired.
We are also a group of midwives who lobby our legislators for each other. Mutual support and respect has made midwives in our area feel good about ourselves as well as the kind of care that we provide to our clients. We believe that CNMs and CPMs alike do best when we can call each other freely for advice and support.
It is clear that the nation’s health care problems require leadership that is no longer stuck in the rigid, boxed-in thinking of old. We need leadership that is creative, flexible and willing to seek an inspired solution, which we believe includes CPMs. We cannot afford to quibble over who has the best and most valid training.
The mutual support of CPMs and CNMs in central Texas has made us a strong community. It is short-sighted to place an overemphasis on specific credentials. We believe that when one group of midwives seeks benefit by undermining another group, that undermines ALL midwives.
We would like to take this opportunity to extend an open invitation to sincere dialogue. We plan to continue to work together to strengthen midwifery and benefit our clients in central Texas. We hope that the ACNM will genuinely engage with the other midwifery organizations and will be open to information regarding the effectiveness of the apprenticeship model. We look forward to working together.
Sincerely
The Central Texas Midwives
Mary Barnett, RN, CNM, MN
Faith Beltz, CPM, LM
Jennifer Bennet, CPM, LM
Julia Bower, RN, CNM, MSN
April Bullock, CPM, LM
Lisa Carlisie, CNM
Amber Clarkson, CPM, LM
Debra Day-Camp, CPM, LM
Ann Dignon, RN, CNM
Roswitha Dowell, CPM, LM
Kristen Elliot, CPM, LM
Samantha Evans, CPM, LM
Michelle Fitzgerald, CPM, LM
Illysa Foster, CPM, LM
Laurie Fremgen, CPM, LM
Lauren Guehl, CNM
Kathy Harrison-Short, CNM
Cammie Hauser, CPM, RN, CNM
Melanie Henderson, CPM, LM
Heather Hilton, LM
GB Khalsa, CPM, LM
Keidi Kjerstad RN, CPM, LM
Siobhan Kubesh, RN, CNM, MSN, ICEA
Natalie Lake, CPM, LM
June Lamphier, LVN, CPM, LM
Jennifer Llana, CNM
Vicki Meinhardt, CPM, LM
Liane Miller, CNM
Marimikel Penn, RN-BSN, CPM, LM
Sara Pinkman, CNM
Heather Roberts-Schoen, CNM
Sarah Rudindsky, CNM
Sherry Russell, CPM, LM
Joan Smith, CNM
Patty Sprinkle, RN-BSN, CPM, LM
Jean Stokes, RN, CPM, LM
Lisa Sunden, CNM, FNP
Christy Tashjian, RN, CPM, LM
Too Many C-sections
Thank you Carolyn McConnell for this editorial in Crosscut.com from Seattle, WA.
Thursday, July 23, 2009
Tuesday, July 21, 2009
Not In Our Name
If you are a CNM, now is the time to stand with all midwives. If you support CPMs, please contact the ACNM with your opposition to their statement on CPMs. It is truly unrest from within that will move the monolith.
Monday, July 20, 2009
Another View Birth -- a HBAC story
Here's my story:I guess it would be best to begin my birth story with my first birth, the birth of my son, Max. Being pregnant with him was as glorious as any first pregnancy could get, zero illness and with all the delightful firsts, thankfully. Like many births that begin in the hospital however, Max's went the way of the c-section. The records show that there were multiple reasons for this, ie, not specifically conclusive; fever (fear of infection - even though I had had IV antibiotics the ENTIRE TIME), fetal heart rate decelerations, CPD, FTP, ETC. Let me just say, I thought I'd "listen to my body" and wrote out a "birth plan". To be fair, "listening to my body" often meant having that 5-inch thick sandwich or going on a Hagen-Daaz run in the middle of the night while pregnant. I believed myself young and fit enough to forego extra Yoga and workouts, that I knew enough about birth in general to do a 3-hour birth class, alone. Sixty-plus pounds later and about 3 weeks overdue, I “listened” to my body and begged to be induced, all day long, crying in hormonal desperation until they admitted me into the hospital. My mother, husband and I waited an hour until we were able to get into a small, triage room, where we stayed for 12 hours until my water broke with little to no fanfare and zero pain. We were then allowed to move into a true L&D room. The birth ran the gamut; IV for GBS antibiotics, Pitocin to get “going”, crazy, intense and inconsistent contractions, birth plan out the window, self-administered Fleet enema, fentanyl, an epidural, 3 hours of pushing, all eyes but my own seeing my son’s head, all eyes on the monitors, not me, 7 very different labor nurses, 4 Ob's, a pack of interns, a nice 1.5 hour wait for an anesthesiologist, busy with 3 other cesareans, for my URGENT cesarean, during which I actually had to let them know my leg was not on the table...After a total of 32 hours, Max arrived. I sent my anxious husband away to accompany our son with instructions to not let his eyes off of him. The next 9 hours before I saw my son were spent catching sleep in dopey, exhausted bits, interrupted by rounds for stats and sudden panics about Max’s whereabouts. I couldn’t even hold him when he was there. All that I could manage to voice was an inaudible whisper to bring him closer. I consoled myself that I needed the rest. The maternity ward was no better. Waiting for the next 3 days as per protocol and an additional day for blood test results to show Max was infection-free, was almost as bad if not worse. What might have seemed a not unusual tiff with my mother, saddled with the coming off of drugs and hormones and no sleep, my nurse interpreted as a situation to remedy. Herself a young mother of a 3-month old without decent rest, she took it upon herself, even when I emphatically said I wanted no such thing to happen, to tell my Korean mother that only spouses were allowed to sleep over, shoving the Patients Rights book at her and asking if she could read English. My mother has only lived in the US for 35 years. Unfortunately, mom thought I had orchestrated the whole thing. It was flat out awful, even with my linebacker-sized baby finally with us. I felt assaulted, traumatized, disappointed, misled and totally distrustful of my own judgment. The minute we walked through our own doors and put the carseat with Max still in it down, I bawled into my husband’s shoulders. I never wanted another baby again and I’m sure my husband believed I meant it.
At my 6-week check up, I broke down when asked how it all went. Semi-jokingly, I said I was finished with having kids, but mentioned a possible future birth, a possible VBAC. It was quickly stated that I had an 8% chance of successful VBAC, and a 50-60% chance of having the EXACT same traumatic experience, whatever that meant. As soon as I was pregnant again, I could easily schedule a cesarean again and choose the birthdate, bypassing all of the trauma I had previously experienced. I was stunned. Something was deeply unsettling to me, made obvious when my husband asked, "When are you going to write those thank you notes to the doctors?" and my reaction, borderline violent. A year and a half later, a nurse handed me some tissues to dry my eyes after a routine Pap and suggested that I might try some therapy for PTSD-like symptoms. I cried ANY TIME someone asked how the birth was, no matter how hard I tried not to shed a tear.
Though I know not all cesarean births go this way, I also know many do, leaving women severely shaken in their views of everything birth related and sadly at times, in their views of themselves. This very fact should make us reexamine birth from beginning to end more closely.
Let me be clear that I was not so much upset about the cesarean section as I was about the entire chain of events that led to it. In all honesty, the surgery was the easy part. For the second time around, I simply wanted a different experience, one that I owned, one that I was consciously aware and in charge of, with people around me who supported that very wish and respected me enough to talk to me informatively and sensitively.
The same nurse who suggested therapy also reassured me of my willingness to try for a VBAC, vaginal birth after cesarean. I undertook much research before getting pregnant the second time. The occasional homebirth story simply came along with the information that I found. My intention was to go for a VBAC in a hospital setting. I never sought out homebirth as an option, but after getting pregnant again, everything slowly began to point in that direction. After several interviews with OB's about protocols and management of VBAC's, an open house visit to a birth center, more interviews with doulas, I felt somehow stymied and disconnected to my choices. Everything was very what THEY’D do and not what they’d do WITH ME. Tons of emphasis on cesarean prep, just in case. Even a more stereotypical doula was excitedly talking about EFM and quicker access to epidurals so I could just wait and then vaginally birth. What about birth prep? I appealed to a great neighborhood resource, the Potrero Hill Parents Association, for names of anyone, anything VBAC related and one name appeared several times. It was the name of a midwife who has practiced for over 25 years in San Francisco. I decided to meet her as a possible doula candidate.
The same thing happened as always whenever I was asked about my first birth - tears, big, bitter, pitiful tears. Only, when I met Maria, it was the first time I felt like someone understood where exactly those tears were coming from. It wasn't so much that I was disappointed in myself or the hospital, but that I believe in my core of the value of birth, perhaps in the same way one might hold high the experience of pregnancy or breastfeeding as nonnegotiable aspects of early parenthood. I firmly stand by the motto, "To each his own". To me, a VBAC at home was what became the best decision for our family.
It took months more of work at my midwife's behest. Utmost, I had to make sure I was a good candidate for VBAC at home. This was hotly contested between hospital staff. Where one said I was fine and could follow parallel care between midwife and hospital, another said any birth at home is atrocious and irresponsible. However, according to them all, my VBAC chances shot up significantly once the news was out that I was even remotely considering homebirth. One thing was agreed on after that, that my body had the "memory" of getting all the way to pushing and nearly crowning. This was only encouragement.
I had to "deal" with my anger and flatly come to the conclusion that what happened before was the only way my son was going to come home to me, that I couldn't dissect the experience in any way and find one particular person or thing to blame. It was what it was, but it was a big deal. Ok. Fortunately, as time went on, I began to view the first birth as a benefit, an advantage: EXPERIENCE.
My partner, my husband, had to be on board, and this was difficult. One can only imagine the total helplessness he must've felt after going into our first birth supposedly prepared and witnessing what may have looked like sheer torture for me. His impression was that his wife and son were saved. I would like to say I won the case through all the bookmarked pages of studies and journals that deem homebirth safe, the statistics on successful VBAC anywhere, etc, but it was really our deepening trust and in our relationship with our midwife, our birth instructor and ourselves that closed the arguments. We simply came to feel prepared for birth wherever it would end up. Even back on the table.
The last half of my second pregnancy, I knew I wanted to try anything and everything that might up my chances of a successful home VBAC, or HBAC. These things included prenatal yoga, chiropractic care, acupuncture, massage therapy, psychotherapy, hypnotherapy, a doula also seeking a VBAC, meditation/visualization, reading, exercise, a well-managed diet (no more Hagen-Daaz), all of which were practiced and administered by a network of people who were very familiar with each other - a family if you will. Most importantly, however, I very much consciously worked on surrounding myself with "believers", those who believed in me, nay-sayers be gone. I canceled lunches with people who said, "You're nuts!". To my surprise, supporters were found in those I thought would be negative. I simply had to be genuinely wholehearted in my sharing the wish for a homebirth and own the work involved.
For our back up hospital, we chose UCSF. Four main reasons brought us to that decision - nurse midwives attend the OB patients, a practice that made us more comfortable in knowing, mobile EFM so I could walk around, bathtubs for each room to relax in and the knowledge that many critical neonatal emergencies end up there. The last, we didn’t focus on, but was nice to know.
I tested positive for Group B Strep again. As per protocol in the hospital, I would be given antibiotics intravenously. What were my options now? Maria was great. We discussed a month long course of oral antibiotics, which didn’t come about. Instead, we decided to loosely follow a diabetic diet to greatly reduce sugars which feed the bacteria and continue to qualitatively test the GBS, high, medium or low growth. After several weeks we got it down to low, but not zero. I had read a Bay Area Homebirth Collective newsletter about a mom using the surgical cleanser, Hibiclens, directly on herself since GBS is passed through contact. We decided to go this route. At this point, I felt all boxes were checked and bases covered.
Even after all of this, my conviction and confidence stronger than ever, I could not avoid the last panic late into my pregnancy. "What if I have to transfer and have a cesarean again?" As I waited for one of my lovely, long prenatal appointments, serendipity prevailed. My midwife's office is a shared space with chiropractors, one of whom was a patient of my midwife and happened to be there. She simply started telling me of her homebirth experience without my asking. Her experience ended in a transfer and cesarean AND she was pleased. How? Because she went for it, was prepared, respected, consulted, advised, supported and sincerely cared for. I was calmed and mentally began to consider how I'd want to handle the least sought after of my scenarios.
One term used to describe a doula, or midwife acting as doula, is advocate. Key to my comfort with a transfer to a hospital was that my midwife would then be my advocate, like a lawyer to consult with once given some terrible news. This seemed much more supportive and protective than a doctor handing over a clipboard to sign surgical consent in mid-contraction. I actually imagined the comfort in saying, “Talk to my advocate.” But, I had to go deeper. Worst case scenario would be that a baby would not come home with us. I was reminded of a question we asked Maria very early before working with her. We asked if she had ever dealt with the death of a baby whose birth she attended. To be sure, this was extremely unpleasant, but I felt it necessary to ask. I felt I should've asked for my first birth in hindsight. The ensuing story obviously brought us to tears, but after processing it further, I realized how comforting in that event that that young family had an advocate, a gentle care provider, a MIDWIFE who’d been with them throughout the process, a friend to humbly share and support in that harrowing moment.
My due date came and went, my calm and patience wavered. Three days later on a sunny afternoon, my water broke. I was elated to finally feel that sensation, not having done so the first time. This was it! I had had a couple of "practice" labors, or "false" labors that lasted about 4 hours each, in the two weeks before. They were helpful in getting me somewhat dilated and really “prepped” to step up to the real deal. Our family went out to Indian dinner, while I had mild contractions 10 minutes apart or so. I literally tried to welcome and savor every one. We came home, bathed and put our son to bed. Max was 2 years and 8 months old and had been told of a new sibling, a sister on the way. I kept quiet that I was in labor to him so he wasn't anxious. We had hoped he would sleep through it all as I labored on another level of the house and if not, a sitter would take him elsewhere. Two and a half seemed too young for me to not worry about him and be able to focus on birthing. My husband and I lay down and listened to relaxation tapes I'd made during hypnotherapy, trying to stay rested and calm. The contractions were like clockwork - coming quicker and stepping up in intensity - all very manageable.
Around midnight, the contractions were 3 minutes apart and I had to stop what I was doing and breathe through them. I couldn’t even stand to be talked to, no outer focus, only in. We called our doula and midwife who said they'd be there in about an hour. The birthtub was made ready downstairs near our guestroom, easy after the practice of two false starts. My doula arrived at the same time as my midwife and her apprentice. At the same time, my son woke up. We called the sitter. My contractions were strong and I wanted nothing more than to get in the tub. I was checked to be 7 centimeters! And all of it accomplished before anyone had arrived. We quickly used the Hibiclens, which stung like alcohol, but otherwise, forgettable. The sitter took my son to her house, sadly without a g'bye, but gladly without a clue, I relaxed in the warm water, in the dimly lit and heated room. I only came out twice to check the cervix, it was that comfortable.
Three more hours passed with the rhythmic progression of contractions, rest, heart rate checks, dilation checks, peppered with calming voices of support and encouragement. When it seemed about an hour or so was left to the main event, another midwife arrived. This is standard practice. My team then consisted of husband, doula, two midwives and an apprentice. I was surrounded by believers and in fact, a team of women who felt honored in the presence of birth ~ amazing. My mantra was that I be yoga's corpse pose in between contractions. It worked. I slept. I had prepared by meditating on a chart given by my hypnotherapist of a typical hour of active labor - a 1.5 minute contraction divided into three equal parts is, 30-seconds rise, 30-seconds peak, 30-seconds fall. Being 3 minutes apart, as contractions usually are in this stage, means that in one hour, there is 15 minutes of contractions, only 5 of which are peak, leaving 45 minutes of absolute nothing - REST. I focused on the resting for endurance, my husband in the water supporting me as I leaned into him.
The final stage kicked in. I started to question my resolve. I was too tired. I vomited. I was ready to get this over and done with. I thought of my visualization exercise about an animal. For me it was the mother wolf, and her deeply impressive message that our strength and authority as mothers is inherent, natural and unquestionable. I got motivated. Because of the way I asked for counter pressure on my back and hips, it was thought I was having back labor, baby facing up, so I floated on my back in the water when it was time to push. I could feel her head, but to tell the truth, that made me lose concentration. I focused on the contraction. Not wanting another contraction, I pushed a bit quicker than I should've, resulting in a tear and need of stitches.
Eva was born in the water at 4:15AM on a wet Spring day in April. My husband laughed so hard while I sat in the water feeling a mixture of amazement, joy and great relief, like something was lost, but found again and better. I joked to get pregnant and do it again, right away. A far cry from the first experience. So tired after that last push, I leaned my sleepy head onto my laughing husband's chest as he sat behind me. But then, Eva was placed in my arms and everything hit me. I didn't just DO IT, have a natural childbirth, as one OB said she understood as my sole reason to choose homebirth. No. I totally overcame a very dark and disappointing obstacle, place, thing that had resided within me, through this birth experience. Something that weighed me down as I tried to accept it and go on loving my first bundle of joy. I came out on the side of bliss that all parents want to have somehow, something that is your new baby AND the birth. I was wholly transformed. The experience carried me through most of that first sleepless year and to this day, perhaps for always, and made an impact on those in the room and others in my life. When I think back on that entire process culminating into that moment, I feel the most tender kind of joy. It has become a touchstone. I own it, but I share it. Everyone's experience is unique. To each her own.
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