Archive for March, 2010

“Labor of Love” by Cara Muhlhahn

March 2, 2010

These are my favorite quotes from “Labor of Love”.

The implication of his comment was that I was too intelligent to be a nurse of midwife.  It’s ironic, because in Danish society, midwives are the ones with the best grades.  They are more highly revered than doctors. (pg. 45)

In the United Kingdom, A joint statement written by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) in April 2007 states, “The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists support homebirth for women with uncomplicated pregnancies.  There is no reason why homebirth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families.  There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby. (pg 166)

From experiences like those that happen most often in hospital births, a woman doesn’t learn that her body is an amazing vessel of creation that can do things she never dreamed.  This feeling, that I exist to defend, is an intangible that is very difficult to study and often lost to articulation.  Instead, in hospital births, all to often a woman learns that her body can’t do these things, and she is left with feelings of inadequacy. (pg. 172)

That’s right:  home is definitely safer in terms of exposure to germs!  The mother’s body has already dealth with the germs that inhabit her home.  In Good Germs, Bad Germs: Health and Survival in a Bacterial World, author Jessica Snyder Sachs states, “Children absorb the good bacteria they need to have populating their own digestive tract from birth on.  A Caesarian birth for example, results in a baby who is not exposed to the bacteria found in the mother’s perineal area, which raises the risk of developing autoimmune problems like asthma and Type 1 Diabetes.” (pgs. 173-174)

Why do so many women sign up for the disempowerment and added risks that come with hospital birth?…A woman in an ob-gyn’s office feels she needs to cooperate even though her instincts might be telling her to disagree, or question, because this person is going to deliver her baby.  Her life and her baby’s life will eventually be in the doctor’s hands. (pg. 174-175)

This results in the insidious process of turning one’s own instincts and intuitions over to the advice of the experts, even and especially when it contradicts a woman’s intuition.  Many women make this unfortunate and unnecessary mistake.  They choose a doctor they hear is “good” and then turn off their own voice, replacing it with “the voice of reason” — that of the expert.  This process is facilitated even more by the hormonal state of pregnancy, which creates an unusual psychological vulnerability in the pregnant woman.  By the time labor begins, the hierarchical power relationship has been conveniently laid down.  It’s almost impossible at the late state for a woman to take back the power. (pg. 175)

All medical practitioners trained in this country, including nurse-midwives, are trained to ensure safety in potentially risky situations while simultaneously minimizing the risk of litigation in the event of a bad outcome.  There two themes are always presented together, enmeshed like Siamese twins.  Preventing a malpractice suit becomes integrated into every clinical judgment call.  The reason why doctors place so much emphasis on minimizing risk and liability is that they have come to see themselves as ultimately responsible for every element of every outcome.  This simply isn’t true.  We are all only players in a complex chain of events. (pg. 179)

And hospitals aren’t all bad.  We couldn’t do without them in cases of emergency.  They have lots of intelligent doctors and machines and equipment and medications on hand that are great to have at your disposal when things are abnormal or become dangerous.  They’re just not great places for normal birth. (pg. 181)

The homebirth midwives with whom I associate in New York City are all equipped to deal with each of these outcomes.  I’ll venture to say that more often than not, their vast experience can promote patient safety better than the judgment call of a first-year resident, fresh out of medical school, who may be the person attending to the labor floor of a hospital. (pg. 190)

Regardless of where a birth takes place, safety is conferred by the ability of the health-care provider to make a quick diagnosis and then to stabilize the patient.  This happens as a result of clinical skill and the provider’s paying attention, which is where the one-to-one patient-midwife ratio at home wins. (pg 190-191)

The ability to remain unseen and not only to allow the birthing woman to have her power, but to help her achieve it, instead of stealing that spotlight, is what makes a midwife…amazing. (pg. 225)

Lord knows I had said many pithier things about empowerment and other aspects of homebirth…I read that article and felt once again, Are these people for real? They have come so close to such a huge, sacred event, with such immense political repercussions, and then profaned it, oversimplified it, and reduced it once again to the black and white of one of the usual themes: those who choose homebirth do so to prove that they don’t need the establishment.  To them, it’s some sort of crusade of rebellion against pain medication that somehow involves healthy eating.  People who oversimplify homebirth miss the real meat of the matter. (pg. 226)

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