This blog piece is in direct response to the recent piece in the Huffington Post, “My True Feelings Regarding My Home Birth Experience” by Ashley Martin. Please take the time to read
her birth story before you read my response.
This is a sad story. As a doula I have listened to many sad birth stories over the years. Sad stories from home births. Sad stories from hospital births. Unfortunately negative births happen all too often although the vast majority of births in the U.S. have positive outcomes; healthy moms and healthy babies. When I hear a disturbing story I have learned to pause and think. To put it in context with all the birth stories I have heard and all the births I have witnessed. I have learned to dig deeper while at the same time to not judge either the mother, place or care providers. It is important to remember that this is HER story. Her perception of home birth based on her two experiences of home birth. I wish her title had been, "What MY Home Birth Was Like". This birth lives large in her mind and heart; although she had previously birthed at home and I can only assume it went well because she chose to birth this baby at home as well. The trauma of this second home birth has indelibly imprinted its personal message in her psyche. If we were to hear her midwife's or doula’s perception it might be vastly different.
When birth turns high risk it instantly becomes traumatic for mom and dad no matter where it takes place. No matter how blissful the labor. No matter how much they trust those around them or themselves or a higher power. Naturally parents are extremely grateful to the person or people who they perceive as "saving" their baby. I put saving in quotes because I paused and put this birth into context. I used this mom's words about the actual timeline to direct my thinking. I thought about the births I have attended in hospitals that suddenly took a turn into trauma. I thought about what I know about neonatal resuscitation and procedures and time lines.
It is very difficult for parents when they feel let down by ANYONE at their birth. It is even more devastating when it happens in the middle of a high risk situation. When one group of care providers points fingers and lays blame at another during the process, rather than working as a seamless safety net for mom and baby, then things really begin to unravel emotionally for parents. Through this mother’s words I can hear the echoes of the hospital staff blaming the care she was provided, although they were not their to witness it, before she entered their doors. I have walked the halls of our San Luis Obispo hospitals. I have heard these words of blame and yet I only hear words of support for all involved echoing down the hospital halls when one of their births suddenly turns into a dangerous mess. Even when a baby dies. Our culture is always looking for “the other”, the one who is different. The one we can safely blame because they are not like us.
When we add the fact that our culture insists on a perfect baby every time in every birth place AND a perfect experience, AND someone must be to blame when that doesn't happen it often surprises me that anyone is willing to help birthing women at all. When things go bad the people providing care have put their lives, their livelihoods and their families in the line of fire. This has happened in our community. It has happened to both midwives and doctors. Good people providing good care as best they could.
Now we need to look more deeply into this mother’s birth. Here are the facts she presented. She had a very rare presentation. We are not told when during the birth process this was discovered or what steps or actions were done based on this information. It may have been missed until the baby was close to crowning, especially if her pushing phase was rapid or she hired a midwife who believed in a hands out of vagina birth. It is easy to immediately jump to the conclusion that if it was missed it must mean that her midwife was not qualified or was somehow negligent. But consider that I have been at 2 different breech situations where, despite numerous vaginal checks by doctors, midwives and nurses, no one realized that the babies were breech during labor until mom was fully dilated. If they had come rapidly after reaching 10 centimeters we would have had accidental vaginal breech births. Breeches happen much more often than brow presentations so presumably all of these providers had had the opportunity to feel what a breech feels like; whereas very few providers have ever felt a brow presentation.
Her second difficulty was the shoulder dystocia. Now I know from my son's birth that shoulder dystocia is scary even in the hospital. Everyone in the room goes on high alert. I have seen this dealt with quickly, smoothly and successfully both at home and in the hospital. Actually as scary as it was for her it appears since her baby is fine that it was dealt with successfully at her birth too. She mentions receiving fundal pressure to help get her baby out. I too received fundal pressure. Is fundal pressure risky for mom? You betcha. I learned this long after my birth. Have I seen doctors and midwives deal with shoulder dystocia successfully with no further complications for mom and baby? Plenty! Can shoulder dystocia go horribly wrong? Yes. I know of 2 cases in our county where it went horribly wrong. One at a home birth with a qualified midwife and one in a hospital with an extremely qualified and well respected doctor. She says her baby was stuck for 9 minutes. I assume she means head out body trapped inside behind the shoulder trapped behind her pubic bone. What steps can one take at this point in a birth anywhere. You can move mom into different positions. You can reach inside and try to free the trapped shoulder or turn baby into a new position. You can push back on the shoulder to break the clavicle. Were these tried? We don't know. What we do know is you can not get a cesarean in under 9 minutes in a labor bed.
Then she says 911 was called at 1 minute after birth. That is a very quick response from a midwife and right in line with MOST hospitals. Currently our local hospitals have baby respiratory specialists standing by at all births. Don't let this fool you. This has only been the case in our community in the last few years. Before that, like many hospitals around the country, labor nurses would have been taking care of this baby until a specialist could be called in. Normally at a birth, home or hospital, babies are given help if breathing is difficult or heart rate is low. As the baby is worked on it is constantly assessed every 30 seconds to see if it is responding to the intervention. If not, a swift decision is made to continue and/or go the next step. This midwife knew in 1 minute that this baby needed more help than they could offer at home and the call was made. She did the RIGHT thing and called an ambulance to transport. The ambulance arrived, assessed and transferred baby into the ambulance by 6 minutes! Not sure how that is possible but bravo! I have seen respiratory specialist teams struggle much, much longer at the hospital bedside before transferring into the Neonatal Intensive Care Unit.
What happened during the first minute? Was the baby dried and stimulated? This is the first step taken with any baby in trouble. Yes I can see by the photos this was done immediately. I see the assistant about to put the baby stethoscope on and listen to the heart rate. The mother tells us the assistant was warned to listen carefully and be sure of her assessment. Was this baby suctioned? Did they use only a bulb syringe or the DeLee which the hospital would have used? This mom doesn't say. Was the baby given oxygen? Yes. I know this from the photos. I can also see the baby has the slightest bit of pinking up beginning to show which indicates that his system is trying to circulate blood and that blood is oxygenated. They are also in the process of cutting the cord. This might be done if they are about to start CPR and therefore need to move the baby to a firm surface. Did the baby require CPR? Did the baby respond to CPR? The mother doesn’t tell us. Perhaps because she was in too much shock to take it in. She also doesn't tell us how long she pushed or what the baby's heart rate was during labor; especially pushing. Without all of this important information I have no way to assess the quality of the care provided by her midwife or if anything would have been different about her birth if it had taken place in a hospital. This may be an excellent midwife taking exactly the same steps they would have taken at the hospital in the same order and with the same rapidity.
We also don’t know what “life-saving” steps were taken by the traditional medical staff. Did the EMT need to do infant CPR when they arrived? How did the baby respond? What was the baby's condition when it arrived at the hospital? Did they need to intubate this baby so it could breathe? Perhaps, but there is no sign of that in the photos. The baby appears to have a line of fluids going in indicating medication of some type. Could this simply be the antibiotics so often given to home birth transport babies because of the perceived bias of a “dirty” home environment? Perhaps. Perhaps not.
She also feels that she almost died during this process. Women can die during birth. It happens due to hemorrhage. When a woman hemorrhages there is blood. There is LOTS of blood everywhere. This mom mentions no blood. Remember her description of the bathroom floor? She talks about baby poop being everywhere but not blood. Could she have bled too much? Perhaps. I have been with moms who have bled too much. Most of them were in the hospital. They received the same medication and physical manipulation a mom would receive at a home birth. As a birth assistant at a home birth I have held the medication drawn up in a syringe ready to go as the midwife monitored the bleeding and made a careful assessment about how much blood the mom was losing. Did this mom need medication and receive it? Did she need it and not receive it? We don't know. There is so much about this birth that we don't know. Making ANY decisions about the quality of care she received or the safety or risk of home birth is impossible based on the facts she has given us, no matter how compelling her story is. No matter how much it tugs at our hearts or shocks us.
This woman's perception of her son's birth IS important to me. It makes my heart ache but it doesn't cause me to believe more or less in place of birth. It DOES get me thinking more about what a woman needs to feel positively about her experience. The importance of having quality communication before, during and after a birth is very important. When a birth becomes traumatic or suddenly high risk this is a critical component that often gets lost. This is where I know this mother was let down. No woman should feel she was not listened to during her birth or have to "fight" to get her records. No woman should ever feel the need to make the statement, "I was misled, lied too, and manipulated. Informed consent? Hah. I wish. I left my birth feeling broken, beaten down, cheated." Unfortunately I have seen this too often with too many care providers in too many places. It is their fear response. They go on the defensive because they fear for themselves and their families.
To help a mother heal from trauma it is critical to keep blame, of the mother or any of the people who helped her, out of the conversation. Listening to her truth. Helping her sort through and understand the facts. Helping her go beyond her fear and shock and pain. This is important. Unfortunately rather than seeing this birth as unfolding just as it should; a hard labor followed by swift action to turn around a potentially bad situation by her midwife, the EMTs, the doctors and nurses, with a healthy mom and baby in the end, she is stuck in the negative feelings of guilt, blame and shame.
I do not know Ashley Martin. I do not know her midwife. I do not know what happened at her birth. I do know how she feels about it. I also know my own birth experience which took place in a hospital and included a posterior labor and a long pushing phase and a scary shoulder dystocia and in the end a happy healthy mom and baby. It took me 20 years and witnessing 100 births to stop blaming myself and/or my midwife. I can now confidently say we both did everything we could and my birth unfolded just as it should and I am grateful to my midwife and proud of my strength. I can finally claim the words "birth warrior" for myself.
I do believe many women are told, or choose to only hear, the roses and fantasy of fairy tale
birth. Let’s get real ladies. Birth isn't all orgasms and euphoria. Birth
may have that, but birth is life and life is messy and risky and that is why it is miraculous. It is time we embraced the miraculous.
For another perspective and some of the missing puzzle pieces of this birth please check out the
birth photographer's account. Remember we are not sitting in judgement. We are NOT trying to decide whose account is the "truth". For this mom, in despair over her birth, her truth is ALL that matters to her. I would caution anyone who would judge all of home birth through the lens of this one birth.
You finally arrive at the room where you will meet your baby face-to-face and there it is; the bed. It's presence dominates the room. Next to it stands all the technology money can bring to birth; fetal heart monitor, contraction monitor, computer, read out screens, audio controls, blood pressure reader, oxygen saturation tester, IV pole with computerized medication administration box attached, in other words, all "the machines that go beep". Still it is the bed that seems to suck the life out of your idea of an active birth; an instinctual birth. Your nurse cheerily asks you to pee in a cup and climb into the bed. So after all that walking, and sitting, and rocking, and kneeling what should you say or do? 
