So tonight I called a midwife. She seems nice. I have lots of questions I’d like to ask her, but it’s kind of hard with the children going ballistic around me. We talked briefly about her experience.  She’s had 2 apprentices, both of which dropped out of the midwifery program at ATM. She requires her apprentices to be self starters, and to be able to work on their own. Her job, as she sees it is more of a guide and mentor. I like that.

She only handles about 14 births a year. She doesn’t advertise at all, as she feels it leads to finding more women with a romanticized notion of what home birth is. That’s fair, and I can see that completely. Many women I’ve met over the years have a romanticized notion of home birth as something glamorous, and easy.  While it may be beautiful, and powerful, it is most certainly not easy. It is called labor for a reason.

She mentioned what she calls “midwifery boot camp” out of  San Antonio. Dan and I talked briefly about it. I’ll likely do both paths. Spend some time as her apprentice following normal out of hospital births, and then hit up the birth boot camp in San Antonio to broaden my experience base, and meet my clinical requirements. Though the idea of moving to San Antonio for this experience is more than a bit daunting. I wonder if I can find a similar birth center to work out of in Houston?

While I don’t intend to start the apprenticeship immediately, I am hoping to strike up a conversational relationship with her so we aren’t perfect strangers when I am ready. I already know that she’s a very devout Christian, and finds that to be an important value in those she works with.  I’m hoping over time I can get to know her birth philosophy. Hopefully she is as hands off as I am in that regard. I asked her for her recommendation of a pediatrician for the kids. She gave me one she recommends to most of her moms, and told me that he is very laid back and doesn’t push vaccines. The fact that she brought up vaccines at all was somewhat surprising. I’d like to find out more about where she stands on that.

All in all I think I like her. I hope to chat with her more in the future, and sent her a friend request on Facebook.

The next big steps are finding the funding for beginning courses with ATM (or at least buying the books on their required/recommended reading list), and getting my professional Adult + Child CPR certification – apparently St. Joes has courses on them. Oh! I almost forgot, she also let me know that I may have trouble getting certified for neonatal resuscitation because the courses are usually only offered to nurses or doctors, but ATM offers courses on it quarterly, and they are usually announced via their mail list.

This next year is going to be busy. So much to do! I also need to figure out logistics of childcare with Dan. That may be harder than figuring out how to fund school…

I am a supporter of choice. Not because I would ever have an abortion, but because I view choice from the other end of the spectrum – the choice of the mother in where, how, and with whom she gives birth.

If we limit the choice  to very black and white – you’re pregnant and therefore you must have the baby, we also limit the choices later. Who decides where is safest? Home or hospital? Who decides which care provider is best? Midwife or OB? Who decides how she gives birth? Vaginally? Induced? Naturally? Medicated? Cesarean??

What happens if you completely disagree with the arbitrary choices assigned to you? What if the treatment your provider *advises* isn’t medically supported such as with Samantha Burton ? Since the woman’s rights to self determination have been superseded by the rights of the fetus – who gets the final say?

Our courts have already ruled that you aren’t required to give up a kidney to save your own child’s life. Even if you’re the only match. In pregnancy do women get the same consideration?

The Abortion Debate opens doors to a very slippery slope later in pregnancy. One that I would personally prefer to see remain locked. I am a mother of 7. I’ve given birth 3 times “against medical advise” – to healthy babies. I am very interested in maintaining women’s rights to sovereignty if not for myself, but for my daughters.

This is worth noting. Commentary will come later, when I’m not nursing.

C-Sections, Necessary or Not, Increase Maternal Morbidity and Mortality

NEW YORK (Reuters Health) Jan 11 – All cesarean sections put women at increased risk of adverse events, including death, according to the World Health Organization’s Global Survey on Maternal and Perinatal Health Research Group.

The group urges that cesareans be done only when medically indicated for the mother or the baby.

The article, published online January 12 in The Lancet, reports the third phase of the WHO global survey, which was conducted in 9 Asian countries in 2007 and 2008: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. It covers the outcomes of nearly 108,000 deliveries in 122 hospitals.

Earlier reports have come from Latin American and Africa.

According to first author Dr. Pisake Lumbiganon from Khon Kaen University, Thailand, and associates, the overall rate of cesarean sections was 27.3%, and the rate of operative vaginal delivery was 3.2%. The most common indications for cesarean section were previous c-section, cephalopelvic disproportion, fetal distress, and abnormal presentation.

China had the highest overall rate (46.2%) of cesareans, and by far the highest rate of cesareans without indication (11.7%). The country with the second highest rate of non-indicated cesareans was Vietnam, at 1%.

Compared with spontaneous vaginal deliveries, operative vaginal deliveries were associated with significantly more maternal deaths, with an adjusted odds ratio (OR) of 3.1.

Any operative procedure increased the maternal mortality and morbidity index (defined as blood transfusion, hysterectomy, internal iliac artery ligation, or death or ICU admission) to a greater extent than spontaneous delivery.

Specifically, compared with spontaneous delivery, ORs for the maternal mortality or morbidity index were 2.1 for operative vaginal delivery, 2.7 for antepartum cesarean without indications, 10.6 for antepartum cesarean with indications, 14.2 for intrapartum cesarean without indications, and 14.5 for intrapartum cesarean with indications.

For neonates, the risk of mortality was significantly increased with operative vaginal delivery (OR 1.6) and intrapartum cesarean with indications (OR 1.5), but decreased with antepartum cesarean without indications (OR 0.3).

For breech and other abnormal presentations, cesarean section – either antepartum or intrapartum — significantly reduced the risk of perinatal mortality but raised the risk of an extended stay in the neonatal ICU.

The perinatal mortality and morbidity index (defined as death or neonatal ICU stay of 7 days or more) was significantly higher with operative vaginal delivery (OR 1.9), antepartum cesarean with indication (OR 1.9), and intrapartum caesarean with indication (OR 2.1).

Dr. Lumbiganon and associates maintain that “the most important finding of the survey is the increased risk of maternal mortality and severe morbidity…in women who undergo caesarean section with no indication.” The increased risk is primarily due to higher rates of ICU admission and blood transfusion.

“If this operation is limited to medical indications and unnecessary use is avoided, resources will be used for a need and will not be taken from other parts of the health system,” the authors write.

In a commentary, Dr. Yap-Seng Chon and Dr. Kenneth Y. C. Kwek from the National University of Singapore suggest that “investment in training and clearer guidelines for vaginal birth after cesarean section, intrapartum management, fetal monitoring, and external cephalic version could have wider effect.”

They continue, “There is little wrong with medical interventions when indicated, but for those who are still inclined to consider cesarean delivery a harmless option, they need to take a cold hard look at the evidence.”

Lancet 2010.

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