Monday, July 26, 2010

Midwife appointment

I had my first consultation visit with the HBAC friendly midwife I found--she's a good fit! I'm very happy!! I've also since learned that one of my previous initial consults, which was with a locum, was inaccurate in telling me the midwives in that practice don't normally attend VBACs at home. They do! All that stress, and I actually had more choices than I thought. Oh well. I found a midwife now, that I'm quite happy with. We went over the choices I'd like to make, the things I'd like to refuse, when we would be comfortable with certain interventions (ie, bleeding is a good indication for ultrasound, and during labour if fetal heart tones are difficult to auscultate with the fetoscope because of my position or something, the doptone might be a good option), and she and I are on the same page. Totally.
She DID play the dead baby card, once. It wasn't to convince me of anything, but it was in the context of discussing informed consent. She was trying to explain why informed consent includes detailed information and the signing of forms for refusal of routine procedures. It was in the context of a discussion of legal liability. But, still. The dead baby card is a frowned upon play. Not because neonatal deaths don't happen, but because it scares moms into making choices they are not comfortable with because they are naturally wired to protect their babies. The thing is, deaths are so rare. Another midwife I consulted with played the dead baby card for real--in the context of talking about HBACs. I was saying that in the rare event of uterine rupture (higher risk with VBACs, from 0.01% in normal pregnancies to 0.4% in VBACs--lower with subsequent pregnancies for VBACs, but I'm not sure to what rate, and increased 400% to 1.6% if a VBAC is induced), most ruptures are slow, giving time for surgery to intervene to save mom and baby. I was saying that in most hospitals, the golden standard from recognition of an obstetrical emergency to operating time is 30 minutes (and often takes as long as 40 minutes). Shorter time spans do happen, but it's exceedingly rare. Given that I live within 30 minutes of the nearest hospital, I feel that I have no disadvantage delivering at home, because that 30 minute golden standard is still probable. Midwives call ahead if a home birth needs transfer to a hospital, and get the ball rolling for an operating room if needed.
That midwife (not the one I saw today) pointed out that in the (VERY rare) instance of a catastrophic uterine rupture, a transfer to hospital would be likely to save me, but not my baby. "Though they likely couldn't save your baby in a hospital, either, but you would be physically closer to the operating room, so if they did get in within 15 minutes, it could be possible."

I'm all about informed consent. I want to know ALL the information for and against my decisions. But I do not want people to point out dead babies. It just makes statistical probability fade into the background and the picture of grief stand pretty stark in one's mind. I have read on the BC College of Midwive's website that 11 to 12 minutes from catastrophic rupture to fetal death is the correlation. 15 minutes is an unrealistic time frame for an operating room to assemble even in an emergency, and by then it would be too late anyways. 30 minutes is far more likely, and I would have all the inherent risks associated with hospital birth with no statistical advantage for neonatal or maternal outcomes.

So. I wasn't happy with that dead baby card.
Todays was less blatant, but my eyes DID almost pop out of my head when she mentioned a baby in Ontario who died of hemorrhagic disease of the newborn after her parents refused the Vitamin K shot, and the parents sued despite having undergone informed consent. She was talking about protecting herself as a practitioner, I'm assuming to reassure me that when I sign refusals, it is not because she disagrees, it's simply for legal reasons. But still. Dead baby?
Otherwise, my midwife is great. I like her style. She's a great mix of personal and professional, slightly scatterbrained (which makes her human), but really, really experienced (over 500 births), and very good at what she does. And she's all about women's choices. I'm all about full bodily autonomy. We're on the same page.

I'm so happy!


Riley came to the appointment. He pooped his diaper about 5 minutes in. But of course, one doesn't want to take 10 minutes out of a very full appointment time to change one's 2 year old's crappy pants, so we got to smell that for 45 minutes. ROCK ON!


Asheya said...

Yay! I'm so happy that you clicked with your midwife! What would you think about taking this post and just editing it a bit for the MCMC blog? I think it would be great to document your HBAC journey on our blog. And I think the informed consent/dead baby card discussion is quite important, and one that most women may not think about.

I really appreciate your point of view, and that you can state it so clearly.


Alex Maxim said...

Midwife Checking Pregnant Woman Baby's Heartbeat stock photo © MaximImages - stock photos in style