Revisiting My Barren Uterus

I've said this before, in other posts, how I get asked very frequently if I have children. People I care for are trying to feel out if I qualify in knowing what to do with a pregnant or laboring woman by having experienced it first hand. I am sure that most of the times they are just trying to connect with me on a more personal level while still having confidence in my care. But what some are hinting at, if not being outright overt, is "a real midwife has birthed".

Being the new midwife in my practice has prompted this question over and over by many of the women and their partners when they meet me for the first time. I've asked the other midwives if they get asked this question, and they do. So I asked the doctors (the female ones, at least) if their patients ask them if they have given birth. Not one of the doctors said they've been asked by a patient if they have children. I think this illustrates my point very clearly.

Perhaps because midwives are so accessible (in a figurative way, as we know there are not enough midwives in all areas of this country) people feel comfortable enough to ask personal questions of us. But my feeling is that there is more to it than that. What many are really asking is if they can trust us because they think we don't really know how to be "with women" if we haven't actually used our womenly parts in their full capacity. It's flat out hypocrisy in my opinion, if a woman would judge me on whether I've given birth or not yet not hold one of the doctors in the practice to the same standard.

I've put this question out there before, but am interesting in seeing what other things you all have to say. Do you think a midwife is more effective as a care provider if she's given birth?

My Take On Pit To Distress

Wow. This one has me shaking my head....pit to distress is a saying I've heard kicked around, but not in the sense that is being discussed in the blogosphere. Let me explain:

-Pit to distress is being discussed as a method of pushing the IV pitocin to a point of fetal distress, thus giving a reason for a c-section.

-Pit to distress has never been anything I have ever seen as a nurse or midwife as described above. But- and this is a big but- I've heard of it being used in the past a bit differently, before more research went into effective & safe protocols for labor induction and augmentation. But (again)- never in a way to purposely gain a reason for performing a c-section. It was done more because the thinking was "more equals better and gets the job done quicker" and then all of a sudden trouble began. Or, I've heard it being used to describe how a physician was on a nurses case for not "pushing the pit" fast enough (like every 15 or 20 minutes on the nose) and the nurse muttering something like: "what- do they want me to pit to distress here?"

I can not imagine that such pit to distress protocols for the sheer purpose of requiring or leading to a c-section for fetal distress exist. It is such blatant malpractice, I can't imagine that it happening on several accounts. First, the nurse is the one physically "pushing the pit". Labor nurses put their licenses on the line if they were to administer a medication that caused injury. If a physician or midwife was to order an unsafe dose at an unsafe rate, a prudent nurse will question the order. If she gets resistance, she goes to her charge nurse or manager. Ideally. And even if she doesn't go through her channels of management, she can "push the pit"slower than ordered based on fetal heart rate and uterine activity, or because she doesn't feel safe going at doses and rates ordered. Technically this is a med error because she is not administering a medication as ordered, but if there are protocols in place that dictates safe usage she usually just has to maintain proper documentation to say why she is "holding" the pitocin at whatever rate she is at.

There are standard protocols that most hospitals use when it comes to pitocin, so a provider who goes off the protocol is calling attention to what they are ordering. Here is another opportunity to question such use of pitocin.

There are "high dose" and "low dose" regimes published in the literature and obstetric textbooks. The high dose regimes are not necessarily more effective than low dose, in my personal experience, but they still have never been used that I've seen to purposely create a distress situation that requires emergent c-section delivery.

Not sure exactly how this all got started, but thought I'd throw in my two cents on the matter. I'd be interested in hearing from other nurses or midwives who have experience with this, either seeing it first hand or not at all. I've worked in several hospitals and have never seen the pit to distress thing as described by others.

New Students!

I love students.

If being a student could be a profession, I'd have more PhDs, DNPs, and other degrees that people would think humanly possible.

So I thought I'd share two blogs by student nurse midwives.

Reflections of an Aspiring Nurse Midwife is brand new....I'm waiting to hear her stories and thoughts on midwifery school.

Hands Are For Catching: Life of a Nurse-Midwife in Training has some very thoughtful posts and is a Helene Fuld Trust scholar. Impressive.

Life As I Know It

I have an overwhelming feeling that I have a way to go before I feel remotely comfortable in my new role. Working as a nurse midwife has been awesome and scary all at once. And tiring.

I hope to find the energy soon to elaborate.

O, Canada

Oh!! I am very excited about this- which I will just simply give you the link to Rixa's post on vaginal breech birth in Canada.

I guess this begs the question: when will the US "authorities" stop being so stubborn and start looking at the research?

The Midwife Sorceress

Ok, this is a personal issue, but one that I think many of you would find themselves as irritated about it as I am.

My husband has been on this tear of calling me the "Midwife Sorceress". I think that this comes from my recent career start (finally, I must say!) and that he's been on a wizards kick.

It annoys me.

Actually, it annoying the living fuck out of me.

Now, I know my husband is just being foolish. He usually can't let 5 minutes pass without doing something childish. However, he also knows that I am passionate about midwifery and try so very hard to dispel any myths about midwives. He's even done his fair share of teaching people around him about what I do when people ask him, "So what does your wife do?" to which frequently gets a response of "A mid-what?" or "Oh, so she delivers babies in the woman's home who is anti-doctor?"

So, clearly, he knows that midwives do not perform any magic or wave chicken feathers. But if anyone heard him call me a "Midwife Sorceress" they would easily conjure up images of what the "Midwife Problem" propaganda of 100 years ago provided- because this was such an effective campaign on part of obstetricians of the day much of the mainstream still believes much of what is said about midwives today.

I have solved this problem by providing a nipple tweak that he is sure to not forget next time he has an urge to call me a "Midwife Sorceress". So there!

In A Maternity Care Utopia:

....women would birth unencumbered by machines, IVs, and interventions that were not necessary....

....home birth would not be viewed as unsafe for low risk women....

....labor curves would be a vague guideline, not a rule....

....informed consent would really be informed....

....birth would be respected as a normal event....

....women would trust in their own strength and be empowered to have positive birth experiences....

....medical intervention would be available only when needed and used prudently....

....every woman would have one on one labor support....

....midwives would be embraced as the standard provider for maternity care, with all obstetricians specializing in high risk pregnancy and birth....