FrumDoula

I have had a variety of experiences. For my first child, I began with a midwife who was a CNM. She should have simply called herself a mini-OB. It would have been more honest. I changed practitioners at 32 weeks to a wonderful family practice doctor (a male, no less!) and had a fabulous birth, even with its attendant complications. If I had had a choice, I would have homebirthed. With my daughter, 6 years later, my husband (a DO medical student) and I chose to have a homebirth with a CPM. It is not supported in the research that nurse midwives have safer outcomes than certified professional midwives. My midwife has certainly had her share of unexpected outcomes, including hemmorhage, shoulder dystocia, decels, etc, some of which required transport and some which did not. Given the fact that she has caught something on the order of 1500 babies, I felt pretty safe with her. What concerns me about the differences between even CNM's and CPM's is not the birth per se, but the prenatal care. My CNM had 15 minute appointments, 30 at the most. She never asked me about nutrition, never suggested anything which could have improved my health. It was bizarre. My CPM came to my home, stayed for over an hour and ascertained what my eating habits were, as well as my general health. Appropriate tests were done, including urine dipsticks, blood tests, etc. In this way, she was able to make sure I continued to be low risk, thereby lowering the chance of poor outcome at the birth itself. It's a fallacy that CNM's are more prepared for birth than CPM's. The lay midwives I know study and apprentice for years. Sure, there are yahoo's out there, but we've all seen OB's who we wouldn't sent our PETS to, let alone entrust with our bodies and wee babes. The CPM track is rigorous and demanding. Different states have different laws which make it easier or harder on midwives, but this does not reflect on the inherent safety of direct entry midwives. Still, when it comes to the recommendations I give to my clients, I simply tell them to go to a practitioner they feel comfortable with, and who gives them good, evidence-based information. Not every woman is comfortable in every kind of birth situation. Alison

Stories on both sides are purely anecdotal, though hearing positive stories is certainly preferable to one's psyche! What you might consider doing is looking up the research on VBAC and see what it says. And there is a lot of it, some well-done and some poorly done. Henci Goer, a medical writer and childbirth instructor, has some excellent articles on VBAC on her website, hencigoer.com. Check that out. Also, the International Cesarean Awareness Network (ICAN) has tons of information. Hospitals that are banning VBAC out of concerns for "safety" are not doing so because of safety so much as litigation, which is very sad. Anyone see that Britney Spears had a c-section? Big suprise there. Alison

By sterile, I'm assuming you mean the atmosphere, as opposed to th e physical reality .... I always assumed hospitals were pretty filthy, especially after I worked in one. I can respect that you want to give birth in a place that you feel comfortable in. However, I have to address this point one more time, because it's one of the biggest myths of homebirth. Homebirthers are well aware of the risks involved, if only because everyone REMINDS you how "risky" it is to homebirth. (Despite the fact that this is also a myth.) In fact, I would gander that homebirthers are actually much more educated as to risks than most non-medical personnel who have hopitals births. People who homebirth end up educating the people around them often, because it is such a rare choice in the US. (Only 1% of us choose it, despite its' track record of safety.) Second, please know that many emergencies are handled at home, without a "mad dash" to the hospital. Most homebirth transfers are not for emergent reasons. And my midwife has handled cord prolapses, shoulder dystocia and a host of other problems at home without negative outcomes. (And let's not forget that some obstetric emergencies are iatrogenic.) By the way, even during my own homebirth, I had a little bleeding, and was given methergine. They also had Pit drawn up in case I needed that, too. Just an example of how one particular complication was dealt with. Just for the record, I would not recommend homebirth across the board, even for women who are medically low-risk. L&D RN's know this more than anyone, but so many women have no desire to truly take responsibility for their pregnancies and births that they are poor candidates for this kind of birth. Alison

Buried in a rather forceful, and to some, offensive, post, are some interesting points by William. First off, if children do not have adults to speak for them, then they are going to be even more underrepresented than they already are. Adults speak for kids all the time on a variety of issues, and it's a legitimate thing to do. Whether or not we agree with the adult in question is another matter. William may not be the most tactful of posters, but I think he does care deeply for children. He obviously does not care for children being put into day care, and in this opinion he is far from alone. The mass exodus of women from the home and into the workplace has created as many failures as successes, and there is no doubt that there are children who could have benefitted from their parents' presence in their lives. High quality child care is not easy to come by, and many kids are in less than optimal circumstances. Look, the reality is that if you're putting your kiddo into day care 45-50 hours a week, it's going to have an effect on the child. Positive and negative. It's not an easy choice. And it can have major health ramifications, as one poster noted who had to wean quite early because her clinical rotations did not afford her the time to pump. Personally speaking, I would have found this unacceptable, and I would not have been willing to sacrifice my child's health in that way. (There's a real irony that a nursing student who is learning about promoting health is not given the time to provide the most optimal nutrition for her baby.) Some women have to work, some women want to. Some of us stay home. And we all beat ourselves up over it to some degree or the other. I do disagree with a poster who pointed out that even though her husband works and makes good money, she works to have an extra 40K around to provide her children with "everything". (Sorry I can't provide the exact quote.) Children, in my very humble opinion, do not need everything. They want us. I'm sure many a child would happily sacrifice a couple of Lego sets to simply have their mom present. Financial necessity and personal sanity (to a point), I understand as justifications for mothers with young children entering the workforce. Providing material possessions .... well, not so sure about that one. The original poster should consider all of these points of view, including Williams, as strong as it is. And the point about infertility is a very valid one, and quite on target. Are you willing to wait that long, only to find out there are problems? Are you willing to wean early because your program or job might not have adequate pumping facilities? Are you willing to hand over a significant amount of your childrearing responsibilities to another person? And let me add one other thought, which sucks, but which I must mention. My own child, at the age of 18 months, was struck by his day care provider and badly bruised. It was every parents' nightmare. Unless it's a family member (and heck, even then ...), no one loves and nurtures your child quite like you do, so make SURE you feel safe with that provider. My view point is not as rosy since living through that ordeal. The point is to seek very high quality child care, and to be willing to incur the major financial costs that usually go along with it. Good luck to you. It's a killer decision. Alison

A very gutsy move, if you consider health promotion and standing up for babies to be "gutsy". How sad that it is. There is such clear research about what those formula gift packs do to sabotage breastfeeding that any hospital handing them out to nursing moms should be ashamed of itself. There aer so many other products you could put in there. When I was discharged from the hospital with my ds, the nurse there actually tried pushing me into accepting the formula. ("But what if there's an emergency??") Well, as we've seen from the Gulf Coast, emergencies do happen, and I'll take breastmilk over contaminated water in my formula bottle, thanks. *shudder* This should be a call to action for hospitals and heath care professionals. My heart goes out to the bottle feeding moms down there who were probably panicked over not having clean water for their babies. Such a scary situation. But our society could help prevent some of those deaths if it wasn't so busy shoving formula at women at the dr's office, at the hospital, in major maazines and through direct advertising to the consumer. On another message board I frequent, many of the mothers said they would have accepted the emergency formula, drank it themselves to stay hydrated, then continued to nurse their babies and toddlers. Deb, I admire the fact that you do not partake in the meals and use formula products. (But heck, I admire you, period!) It is not always easy to take a stand on such things. But popularity is not my first goal, healthy moms and babies are. When I become a nurse (*please God!*), I will always try and put my patients/clients before profits. If a woman wants to bottle feed, I also believe that more education needs to be done regarding how to bottle feed. I'm sick to death of seeing propped bottles and babies not being held or forced to hold their own bottles prematurely. Bottle feeding can be done with so much love, and I think health care educators can stress that as well. Just a thought. Alison

Oh, and if they choose to not change anything at the clinic, I will let them know that any chance I get, I'll make sure that every nursing mother I know should NOT take their children to that clinic. Sometimes appealing to the financial side is the only route you have. Hopefully this will not be the case. I want to see the clinic succeed. But it needs to follow the osteopathic model of promoting health and preventing disease, not just treating illness. (Though as a clinic, they certainly stand to make more money from formula fed babies, since they generally suffer from more illness and have a higher # of doctor visits, according to the research.) *whew* Ok, I'm done. :) :) Alison

Here's an update. I complained to my doctor and stressed the liability part of it. Who knows if anything will change. While I was there, I asked for Miriam to be weighed, since she's 6 weeks old and I was curious. (She's almost 14 lbs and was 8 lb 9 oz at birth, so I'm thrilled.) When they went to weigh her, they pulled out a piece of paper to line the scale with, and what did it have written all over it??!?!?!?!?!?!?!? ENFAMIL. It was a freakin' advertisement for a formula company!!! Those of you who know me from my posts know that I had a total cow. I complained to the doc (boy, was SHE happy to see me! :) ) and to the clinic manager. The doc had a great response (she was very unthrilled to hear about the scale liners), but the clinic manager had some real gems. She justified the decision for a couple of reasons: 1. It was free, so they HAVE to use it. *ahem* If you had free stuff from Phillip Morris, would you HAVE to use that, too? 2. Even though some women nurse, and the clinics supports breastfeeding, some women just CAN'T nurse. Well, no duh, lady, but that doesn't mean you should give free formula advertising when the research says that doing so lowers breastfeeding rates. Really, her comment is about guilt. They don't want to make women feel guilty for not breastfeeding. Fine, don't. But don't sabotage the healthier choice, either. As a health care clinic, make your stand strong and unambiguous. Just because some moms can't or don't want to doesn't mean you remain "neutral". Have lactation consultants that you can call, have a mother-to-mother nursing group that meets at the clinic, have the #'s of LLL leaders women can call. And then maybe (*gasp*) you'll see your BFing rates rise. Oh, and you know what burns my hide, too? They put out the stupid formula papers, but had NO breastfeeding/nursing promotion posters up. Nada. (That was justified on the basis that the clinic is "new". Oh puh-leeze. It's been open since 2003.) In fact, the doc I met with said she and another doc tried to put out some BF pamphlets, and they mysteriously disappeared. I'm writing a letter to the head of the clinic (the pediatrician who is not really so BF friendly), and CCing it to the Dean of the medical school. I'm also going to offer to give a class on breastfeeding promotion, and will offer free posters as well. Anything to help change the attitudes floating around the clinic. My husband, who's a med school student, is going to contact the OB-GYN and Pediatric clubs on campus and enlist their help. Thanks for letting me vent, everyone. The situation is making me nuts. Still, there's possibility for change, and that warms the cockles of my heart. (Even though it may take guerilla tactics to do so. ) Alison

I am concerned not only about using Pit with a vertex presentation, but doing AROM when the baby is high. I'm not a nurse, but isn't that a contraindication because of the risk of prolapsed cord????? Alison

I have come to discover that work gets fit into my life. And children are the first priority. As SBE says, children don't fit into your life. They consume it. And it's a wonderful thing, too, but something to take into account. I also agree with taking time to be there during the child's first few months, at LEAST. My little girl is 6 weeks old today, and I simply can't imagine sending her to day care. She's still so LITTLE. I'm very thankful that my husband and I are making the necessary sacrifices to allow me a full-time job as a homemaker and mother. I've done the alternative, when my son was little, and it was rough. Good luck in your decision-making. Please remember that school will always be there, but children are little for such a short time, and you can never have it back. Alison

I was really shocked. Now, this front office is not exactly known for employing brainiac personnel. So I'm not suprised they're ill-trained. But this is MA 101 - she should have been taught this at her school. I'm going to complain again to the office manager and to the doc I'm seeing. I don't want to get her fired, I simply want proper procedures to be followed. This office is rife with problems anyway. The main pediatrician considers himeself to be very "breastfeeding friendly". Unless there's a problem, of course, and then it's straightaway to supplementing with formula. :angryfire Plus, they give out lots of samples of formula. *arg* The clinic is run by a medical school, and I'm in the process of speaking to the Dean about making the clinic Baby-Friendly. But if they're going to have to teach the MA's not to call themselves nurses (what a nitwit), then it may be a bit of an uphill battle. *sigh* But hey, I love banging my head against the wall, so I might as well take it on .... Alison

Hi all. So I called my FP's office to schedule an appointment for a lump I found in my breast. No big deal, probably a milk duct since I'm a lactating mom, but I wanted it checked out all the same. So I call the office for an appointment. The woman I spoke to was nice enough, and offered an appointment a week from the time I was calling. I questioned if I should be seen sooner or if it was ok to go a week out. So she starts asking questions, kind of assessing the situation. Well, I'm dumb but not stupid, so I ask, "Are you a nurse?" And she says, "Yes, I am, I'm Dr. S's nurse." And then I say, "Are you an RN or an LVN?" And she says, "I'm neither. I'm a Medical Assistant." AAAGGGHHH. I replied, "Then you are not a nurse and you shouldn't be trying to assess over the phone." I wasn't trying to be a rude b*tch, but when a MA, who has very limited medical training, is trying to assess a breast lump over the phone, she should not pass herself off as a nurse. I spoke to one of the docs in the clinic, who is a friend, and I told her she needed to speak to this "nurse", because that MA was opening the clinic up to major medical liability if she screwed up and assessed something or someone she wasn't supposed to. Am I off here? Or am I just being a cranky new mom? I guess I'm just protective of the title "nurse", since that implies a certain skill and knowledge set. Alison

Homebirth: Been there, done that, have the placenta buried under the tree to prove it. :rotfl: I have had one wonderful hospital experience and one great homebirth. Very different experiences, both very satisfying. In an interesting counterpoint to those nurses who wouldn't homebirth because of what they've seen, I decided to homebirth in part because of what I've seen in the hospital. But you guys know my story, so I won't pontificate any further. Alison

It has nothing to do with proving oneself. It has to do with safety, as well as women having the fullest range of safe options. Insurance companies should not dictate care to physicians. Nor should women be scared into having a c-section, as they often are. lady partsl delivery is generally the safer option all around. VBAC is not without risks, but neither is a cesarean, and I get rather tired of people assuming it's risk-free. (And physicians presenting it as such.) I also get tired of women being scared out of the VBAC option, when the research shows that it's safe. Anecdotal evidence is all well and good, but give me a decently done study any day of the week. I'm sure the RN's on here have seen the good, bad and ugly with each option. Ain't no perfect option. But women are getting scr*wed right now out of a perfectly legit birth option. And we are heading back into "once a c-sec, always a c-sec" mentality. A 27% cesarean rate is just horrible. Is a woman who is VBACing considered to be "high risk" by ACOG standards? There are midwives in my area who will do VBAC homebirths. I'm not sure it's any riskier, statistically speaking, than the risks from a guaranteed cesarean delivery at a local hospital.

Hi everyone - Just wanted to post a link to this article in my quest to make everyones' day a little more depressing. :) On a personal note, just wanted to say that my little Miriam and I are thriving. I felt fantastic after the birth and life is pretty much back to normal. She's gaining tons of weight, which is so gratifying. Her new double chin and chipmunk cheeks suit her, and it's a nice way to endorse breastfeeding. :) I had mastitis a couple of weeks after the birth, which was a real pain, but we got through that, too. One treatment I used was having a wonderful osteopath do a breast manipulation on me. It WORKED. Amazingly so. No need for antibiotics. If any of you know mother-friendly DO's, I would recommend this treatment to anyone. It sure beats having to resort to antibiotics and the possible risk of thrush. I ended up going back to my husband's med school and being the guinea pig for the DO students to learn about the manipulation. I can now say I've been fondled by a large group of my husbands' fellow students. ;P Anyway, here's the article. Those of us in the birth world could see this battle coming a mile away, and it's only a matter of time before women begin suing to have a VBAC. http://news.yahoo.com/s/usatoday/20050824/ts_usatoday/battlelinesdrawnovercsections

This is so criminal. Women should at least know that they're a guinea pig. I mean, to get a VBAC, you have to sign a million waiver forms indicating your informed consent, though it's often more of a scare tactic. But for Cytotec? Nada. Seems you only get to be informed if the doc or hospital wants you to be. Scary. Alison