On the Road Again

You might be wondering why Bloody Show has been so completely quiet recently? Partly, this is due to being a busy precepting student midwife who spends most of her waking hours attending appointments and births. Partly, it’s because the puppy is so darn cute (or because chasing him down to get him to stop chewing on things isn’t exactly conducive to writing blog posts). Partly, it’s because my current preceptorship isn’t working out the way I hoped and dreamed it would. After much soul searching, I’ve decided to move on to another one. In 2 weeks, we’re packing up and moving (again) to the greater Phoenix, AZ metro area, this time with a puppy in tow. Not sure exactly where we’re settling down, but I’m excited to be joining a hopping homebirth practice that I think is going to be a great fit for both me and A. Chances are, however, that I won’t be posting much more in the next few weeks as we start out on this next big journey.

In the meantime, here’s a taste of what I’ve been up to besides precepting:

  • Kristin Kali of Maia Midwifery started a discussion group about Gender and the Childbirth Professional (see her invitation in the comments of this post). I missed the first call because I was at a birth, but I made it to the second one last week. I felt like I was falling in love for the first time, looking at the beautiful faces of my fellow discussion groupers. Staring at my computer screen and seeing queers of all stripes discussing birthwork and gender? Amazing! It’s already been a really healing experience.
  • I’ve been loving Autostraddle’s new series, the Ani DiFranco Appreciation Club. By my standards, she’s one pretty kick-ass woman. Plus, as y’all already know, she had a homebirth and has been using her experiences to promote homebirth in Ina May Gaskin’s new book Birth Matters and elsewhere.
  • After reading said book by Ina May Gaskin and experiencing a few complicated postpartum courses of care for some of our clients, I’ve begun doing a lot of thinking about how the dominant birth paradigm in the US fails women in the postpartum period in a myriad of ways. More to come on that later, likely.
  • Finally, I read Cara Muhlhahn‘s (you remember the midwife from the Business of Being Born, right?) book Labor of Love on a lark. Then Basil chewed up one of the corners and I had to pay the library a lot of money. Regardless, that book got me thinking a lot about midwives and ego, safety, the role it plays in births, and how it changes the experience of everyone involved.  Again, I’ll have more to say about this later, too.

The Whiteness of Homebirth

USA Today published an article this week about the 20% rise in homebirths between 2004 and 2008. What struck me most, though, was not the fact that homebirth has been on the rise, but that USA Today focused in so much on the racial disparities amongst women choosing (and in many places having access to) homebirth. I feel like it’s something I am constantly talking about and working towards remedying. It’s a bit surprising and surreal to see this angle of the story picked up by the mainstream press.

Fewer than 1% of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women — 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

“I think there’s more of a natural birth subculture going on with white women — an interest in a low-intervention birth in a familiar setting,” said the lead author, Marian MacDorman of the CDC’s National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Read the whole article here: Home births up 20%, driven by natural birth subculture – USATODAY.com.

My hope in all of this is that those statistics are changing, that midwives and clients are working together to change the face and make up of people who choose and can access homebirth. I feel really pleased to be working in a practice right now that is incredibly diverse as homebirth midwifery practices go. I’ve been here just over a month and I’ve met clients from nearly every racial background, lesbian clients, clients of many different nationalities and countries of origin. Interracial relationships are commonplace in this practice and our clients are all over the board in terms of class background. This practice has a thriving community in their midst and the midwives work very hard to ensure that this community continues to grow and develop as clients meet each other, network, become friends, and help each other through pregnancy and early motherhood.

Is everything perfect? Certainly not. We have a long way to go in Austin in terms of increasing diversity, especially amongst birth workers. And I definitely know that I am fortunate to be working for one of the most diverse practices in town. But it’s made me start to think long and hard about where I want to practice in the future. It’s helpful that Austin itself is a diverse locale and the sort of place where homebirth is a popular and accepted choice. Working with this practice and here in Austin makes me question on a deep level whether I’m willing to work long-term as a midwife in a less-diverse locale where there is less opportunity to co-create this beautiful, rich and diverse birthing community. Northern New England and central Texas and vastly different places and it shows in the practices I have been involved with. There is a palpable difference from a practitioner standpoint. And while I know that the individual practitioner has a profound effect on how diverse, inclusive, and accessible their practice is, so does the locale.

The Transformational Nature of Homebirth

I talk and think a lot about the transformational nature of homebirth, the way it is able to get under our skin and literally change who we are as parents and as people for the rest of our lives. I just stumbled serendipitously upon the story of Susan Goldberg‘s unintended homebirth. Goldberg is one of my favorite queer bloggers and her writing about her family never ceases to make me smile. Her birth story touches on the very core of the sweetness of homebirth and how it can linger with us years after the fact.

The plan — not my plan — had been to labour at home and deliver at the hospital. Rowan, a breech baby, had been delivered by planned C-section, and our community standards did not allow a woman with a previous C-section to deliver naturally at home. Which pissed me off, especially after the OB/GYN with whom I was required to consult to get the green light on the natural birth started rhyming off all the reasons why a second C-section would be infinitely preferable: pain, incontinence, and all kinds of “damage” to my pelvic structures (which he would then have to repair, no doubt heroically), not to mention uterine rupture, the chances of which, according to the research, doubled from less than 1% to about 1.5% for births following a caesarean.

“In my career, I’ve seen that happen twice,” he said, looking at me coolly over the tops of his glasses. “Both times, the baby died.”

If I needed any more reason to want a home birth, this guy sealed the deal: the thought of him being on call when I went into labour was enough to make me contemplate heading to the woods at the first contraction.

Read the whole thing here: Mama Non Grata » The best eleven minutes of my life.

MANA! by Nicolle Littrell

Nicolle Littrell put together this charming film about MANA (Midwives Alliance of North America) filmed mostly at the MANA conference in 2008. She gets some great interviews with some of the most influential founding folks of MANA including Carol Leonard and Sister Angela Murdaugh. She talks with newer movers and shakers like Betty-Anne Daviss. She also gets some time with important non-midwives including Ricki Lake and Abby Epstein, Jennifer Block, and Barbara Katz Rothman. Littrell just barely scrapes the surface on ongoing MANA controversies such as the tension between CPMs and CNMs or the often swept under the rug issue of race and racism amongst homebirth midwives. Despite this, however, it is a well put together film and worth a viewing.

Littrell herself is pretty fabulous. She’s been spending her time filming homebirths here in Maine and documenting the thus far futile struggle for licensure in Maine. I met her because she came and filmed a birth I attended. Her short films featuring homebirths are very sweet and quite inspiring, if I do say so myself.

The Range of Normal

Recently, I attended an exquisitely beautiful birth. It’s not the first beautiful birth I’ve been to – I manage to find intense beauty even in some of the most complicated births. But this one felt different to me.

We are smack in the middle of our Labor and Birth Complications class and are learning about all sorts of things we hope never to see – some of these complications are fairly common and others, fortunately, are extremely rare. In this class, I definitely feel the pull to maintain my view of labor and birth as inherently normal within a broad spectrum of what is acceptable for a homebirth. Which doesn’t always mean this is an easy thing as I learned at my most recent birth.

Throughout this mama’s labor, I found myself much more vigilant and aware than I have been in the past about possible complications. Some of this resulted me providing better care than I have in the past. For example, now that we have studied fetal heart tone abnormalities in detail, I found myself being much more diligent at listening to with the doppler immediately after the end of the contraction and knowing exactly what I was listening for. It’s not that I didn’t know these things before, but learning about possible complications have cemented home for me the importance of this aspect of our care.

I also found that thoughts would flash through my mind. I found myself constantly double-checking to make sure that everything was ok. Is this bleeding normal or a sign of something else? How would you tell if this pain she is feeling is out of proportion to what you would expect – it certainly seems suddenly much more painful than it was during the last contraction. Ok, now the head is out. I wonder how long I would wait before I began to worry about whether this was a shoulder dystocia. On and on and on my mind chattered.

You know what though? It was comforting. I attended this birth with an absolutely clear head and felt like I finally understood everything that was happening. I had a context to place it in. It was like someone finally gave me the magic decoder ring and now instead of understanding every 4th or 5th word and just getting the general gist of paragraphs, I can now understand nearly every word and the meaning of every sentence. I figure that with time and experience, my hyper-vigilance will mellow out. For now, I’m just thrilled that the puzzle pieces are coming together for me. And I’m also pleased that I’m walking out of this experience still feeling very grounded in the knowledge that homebirth is safe and that there is a broad, broad range of normal.

Where To Apprentice

Where to apprentice? It’s on all of our minds these days at Birthwise. We have a presentation to give tomorrow about a state or birth center we’ve researched as a possibility to apprentice at. Let’s not even start talking about where any of us want to land as midwives. And maybe I’m speaking out of turn – maybe my classmates aren’t as confused about this whole thing as I am, but I am supremely undecided as to where I want to end up. I feel like it’s my senior year in college all over again – when people ask me where I am going to be and what I will be doing there, I tell them the neat pat little lie I made up just for this exact occasion. And it’s not a lie so much as it’s one very neat and tidy version of one possible future I can forsee at this very moment. And it comes with a grain of salt: this offer answer is subject to change from moment to moment.

But look at this – the CDC wants to make my life easier!! Did you hear about their study, “Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006“? On a very basic level, it says that homebirth is on the rise. Which is fantastic news. But then it has these beautiful maps telling you exactly where. Which for any midwifery student is a big red arrow telling what places you should think about living (Vermont anyone?) and what places you should not even bother with (Nebraska, perhaps) if you want to make a living as a midwife. Of course, this is an over-simplified explanation, but this is for me an incredibly helpful guide. Check out the report, particularly figures 5 and 6.