Tuesday, January 19, 2010

Why Choose a Midwife in Massachusetts?

Here is a fantastic video that wraps up so succinctly all the reasons why Massachusetts MUST pass a midwifery bill. This isn't about women craving an indulgent birth experience, but it is about giving pregnant women choices about their bodies, their babies, and their health.

Friday, January 8, 2010

"Congratulations! You're in labor!"

I've been thinking lately about a client, whose story goes something like this.

Something felt "different" when she was 36 weeks and 6 days pregnant, different enough to call her OB, who then asked her to come in to triage. She saw some bloody show, and it was more red than what she expected.

She was placed on a monitor for about 60 minutes or maybe a few more. It indicated not only a healthy fetal heart rate, but that she was having contractions every 3 minutes.

"Really?" she asked. She felt no contractions, or anything that she imagined contractions would feel like.

"Yes!" the nurse confirmed, teaching my client how to read the strip. "You're in labor! Congratulations!"

Since her contractions were three minutes apart, she was encouraged to admit herself to L&D, since she was going to have a baby that day. A check of her cervix indicated she was 3cm dilated. "Plus, it's quiet here today," she was told. "Perfect day to have your baby."

My client and her husband had left their home in the usual weekend disarray. And because they were not anticipating a birth at 36 weeks and 6 days, their home was not quite ready for a baby. Thinking that her time was limited, she and her husband decided to go home, to get as much done as they could before the early arrival of their baby, which, according to the fetal monitor, was imminent.

After getting home, they cleaned the kitchen. They prepared some dishes for the coming week, when everyone had warned them that it would be good to have food ready for the microwave. They straightened up their baby's room, folding the last of the freshly-washed onesies. They installed the car seat. They packed their hospital bags. They took a nap. And then they waited.

And nothing happened. At all.

Four days of nothing happening later, I was eating breakfast with them in their kitchen. I sat across from my client, chatting with her over a platter of bagels and a variety of cream cheeses. She was so very clearly not in labor. She'd even had a regularly scheduled prenatal appointment since her visit to L&D, and all was fine with the baby, who was perfectly happy tucked up safely inside her body.

My client asked me for an opinion on what I thought had happened, an explanation of the mucous and the bloody show. She was concerned, and maybe a bit discouraged, about why her labor had stopped, and I told her that I didn't think it had ever started. Ultimately, I guessed that she'd had some mild contractions, too mild to feel beyond a crampy sensation, yet enough to be traced on a fetal monitor, and probably enough to dislodge her mucous plug, which began her dilation. And most importantly, I told her that she made such a good decision to come home that day instead of admitting herself to L&D. Because had she chosen to do differently, perhaps we would have still been enjoying a lovely breakfast together at that moment, and she would have been holding a beautiful, healthy baby -- as she gingerly recovered from her c-section.