labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, September 30, 2007

The Lonely Soldier

I am so discouraged by the beliefs of some of my fellow midwifery students. Many of them do not believe in homebirths, VBAC’s, non-nurse midwives (such as CM’s or CPM’s), or other non-interventional childbirth. They think all births should occur in a hospital with sophisticated monitoring equipment and capabilities. What in the world are they doing in midwifery then?

One of the discussions in class led to the topic of litigation. The things coming out of some of their mouths were just repetitious dogma of ACOG and malpractice insurers. Some were saying how risky VBAC’s are, others saying so many things can go wrong at home. There were some actually accusing CM’s and CPM’s of not having a scope of practice and over stepping their boundaries by practicing medicine. Huh?

I posed the question of perception. Has the risk of uterine rupture increased with VBAC recently? No. Well, let me answer that with yes. It will increase when women who are VBAC-ing are given misoprostil. Here’s a thought: don’t give women misoprostil. Don’t mess with their labor. Again, what has changed that suddenly makes VBAC’s the devil’s labor?

The "things can go wrong at home" argument just doesn’t fly with me for reasons to not homebirth. Sure, put a high risk mother (for instance a woman with preeclampsia) in her home to labor and birth and you are asking for trouble. Put a low risk, healthy mom in her home to labor and birth and most of the time you will see a wonderful event. On the flip side, put a low risk woman in a hospital to labor and birth and watch the intervention rate sky rocket and her chance for a c-section at 30% (or higher depending on the hospital).

The other thing that bothered me was the misunderstanding of what non-nurse midwives are capable of. They are trained, skilled labor attendants. They are taught to watch for signs of possible trouble, and know their limitations (sound familiar? So do CNM’s!) and when to refer. I had no idea that there was such animosity towards what is commonly called “lay” midwives. And for the record, I don’t like the term “lay”. It doesn’t give the general public the right perception of who they are and the training and certification they have received. It makes them sound like they are a group of hippie women with armpit hair and hemp necklaces who decided to birth some babies out in a field.

Yet one more thing to make me feel like the lonely soldier fighting the seemingly impossible battle. How can things change when your colleagues don’t believe in real midwifery care?


Real said...

Wow. This post actually really depressed me. My perception has been that most CNMs don't use too much of the techno-birth junk and many of them are supportive of homebirth and have a good relationship with local CNMs. It's just depressing to think that maybe the up and coming generation of CNMs will be more Medically minded. Man...

alisaterry said...

Shouldn't the midwife instructor be telling these students these things? That doesn't make any sense.

Andrea said...

I found your blog just a couple months ago, and let me tell you, I heart you :)

I am a mother of 3 boys, 2 of which are ID twins, all born NCB at a hospital. My philosophy on birth is very parallel with yours. The only reason I had hospital births is because of a $200 co-pay (hospital) vs. a $5,000 out-of pocket fee (homebirth) and it simply came down to money. I was very fortunate to find an OB that is very supportive of NCB, and then it's the whole thing of walking it at 9 1/2 cm dilated (7 1/2 with the twins)....

I just started classes, enrolled as a pre-nursing student. I also work 30 hrs a week. I am hoping to apply to nursing school WI 09 with the goal of becoming a L&D nurse.

I just wanted to say it is so refreshing to read a L&D nurse blog that has the views that you have. I was amazed when I read you don't have children's very few women who come to the conclusions that you have before they give birth.

Good luck, you'll make a great midwife...those other people you are working with, their called MEDwives


Anonymous said...

Hang in there!! I know it is hard to swim upstream sometimes and very disheartening when you think you are sharing values and feelings with those who may be "like-minded" just to find out that they are not. I am a labor nurse who will start midwifery school in the spring and I had a beautiful homebirth three years ago with a CPM!! Boy did I get the looks and all the "what if" arguments but I did it anyway because I believe in a woman's body and I believe and trust in birth, so don't let them get to you! Just remember that although you probably won't get all of them to change their minds you may influence one or two of them to look at their way of thinking and re-examine their own beliefs regarding birth. Keep your head up because the difference you make will be in the lives and births of your clients and ultimately that is the goal!

Wabi said...

I'm really surprised that your midwifery program has attracted such a bunch of pro-intervention people! But I'm not surprised about the "lay midwife" bias. Those learning a set of skills in the classroom are likely going to scoff at those who do the same job without formal training. For better or worse, that's just human nature. You want to believe that the time and money you put into school makes you better at your job than you'd be without it.

I also really wish that there was a large study conducted that tracked pregnancy complication rates for VBAC. I'm one of those rare souls who has actually experienced uterine rupture first hand. (Not in VBAC, though -- just the last arc of a nightmare spiral of fertility complications and hearache.) I can't be cavalier about the dangers because dear God, it was deadly serious when it happened. Yet finding good stats on risk of rupture when you have a preexisting scar on your uterus and are pregnant again is really, really difficult. Yes, we know misoprostil increases risks, but what about other scenarios? There's not a ton of data outside of the inductions. Given the seriousness of the options involved, there ought to be more studies tracking what's going on.

ellen dee said...

you're not alone. it's so hard to believe how scared of birth some of my co-workers are. i arrived to atart my shift a couple of weeks ago and heard the day charge nurse telling of how she had just discharged a triage patient who was from out of town and planning a homebirth with a midwife. "i think i finally managed to convince her that it wasn't such a good idea."

how can i convince my co-workers that, for low-risk women, sometimes birth in a hospital (particularly inductions at 38 weeks with a cervix closed, thick, and high) isn't such a good idea?

Dr. Confused said...

I think I'm seeing some of those midwives for my pregnancy right now. I really wish that I could trust that the "midwifery model of care" is really all it's cracked up to be: trusting in normal birth, evidence-based, non-interventive. Instead my midwife talks about malpractice, how she fits into a larger system, and how "the concept of informed consent is evolving." I hate that I have to make my decisions defensively, to protect against interventions that have little to do with the best care for me and my baby. I wish I could just relax and trust my midwives.

razorbackmama said...

I've had 6 babies...3 in a hospital with OBs, 2 in a hospital with CNMs, and 1 in a freestanding birth center with a CNM. (One of the hospital/OB births WOULD have been a CNM birth, but both of my CNMs were out of town due to an emergency.) The birth center birth was my 3rd most interventive birth. She felt that my contractions weren't "doing enough" (even though I was progressing 2 cm/hour), so she gave me some herbs. At 9 cm she broke my water because ????????? When I hit 10 cm she had me start pushing, even though I did not feel the urge yet. And take it from me...when you have a 15" head coming out of your you-know-what, you need every bit of that urge to get that sucker outta there!!!

VERY frustrating.

The stand-in OB in the hospital was WAYYYYYYYYYYYYYY less interventive than the CNM at the birth center.

AtYourCervix said...

I concur with your frustrations about the field that we're both in (only I can't say that I'm a student midwife yet!). I get so frustrated with the medical model that the CNMs follow where I work. Of course though, I work in a hospital setting. Just today, I had a patient who eventually wanted "something" for her pain, but outright refused anything for pain (I offered, I have to every now and then, part of my job as the L&D nurse - pain assessment and interventions as offered/needed).
Several minutes later, her midwife and MD went into the room. Oh gee, now all of a sudden she wants an epidural? More like the doc and CNM told her to get one. Ugh. She was doing so well too.

Christina said...

I just had a very successful VBAC in May, and I now see just how lucky I was to have a supportive OB and a supportive hospital. My VBAC went as smoothly as it possibly could, even with having an epidural due to exhaustion 14 hours in.

Ohio State has done a study on VBACs, I think, and if I remember right, they found complication rates for VBACs were not statistically higher than those for repeat c-sections.

I'm shocked that midwife students are so focused on interventions and so anti-VBAC. I'm in my first quarter of nursing school, and shared my VBAC story with one of my instructors. She asked me to remind her of it next quarter when we do our labor and delivery clinicals, because she wants me to put together a presentation on the topic and present it to fellow students.

I'd also like to be a L&D nurse, and I want to work at a hospital that is VBAC friendly.

(PS - Thanks for your recommendations on stethoscopes! Your recommendation was also seconded by other nurses I know, so I went with it.)

nurse mama said...

That is very, very sad to hear. I went to a midwife practice for both my children. Both were hospital births attended by midwife. I definitely would have done a homebirth if my insurance covered it.

I don't really understand why someone would want to become a midwife if they didn't believe in VBACs and homebirths.

another student said...

I'm so sorry that you've found that your cohort of students are so pro-intervention, anti-homebirth & vbac. While you may be a lonely soldier at your school, take heart, there are a lot of us out here who share your views. If there are any women in my program who are against homebirth & vbac, they haven't said anything. Sure there are some who are more ok with interventions than others, but they are not the majority.
There are plenty of midwives who are fighting right beside you, I hope you'll meet some soon!
-another snm

Julia said...

This just makes me sad. Of course, I have a vested interest in VBACs should I ever try this pregnancy thing again.

Hopefully your cohort will open up to the non-medicalized side of birth.

ornery dandelion said...

You took the words right out of my brain!

I'm also in a program where my firm believe in the midwifery model of care(whether it be CM, CNM, or CPM) and homebirth is in the minority. These students did know what midwifery was when the signed up for their Masters programs, right?

It makes me incredibly sad at times. But more often it's making me determined to make a difference.

Thank you for reminding me I'm not alone!!