The Road to Durban: Midwives Walking for the Women of the World
Last year Bridget Lynch, President of the International Confederation of Midwives (ICM), called on the midwives of the world to attend the triennial ICM Congress to be held in Durban, South Africa in June 2011. The ICM also called on 99 member associations in 88 countries representing more than 250,000 midwives to organize 5 kilometer walks in cities and towns across the world on International Midwives Day, May 5. On June 18 when the midwives of the world gather for the ICM Congress, they will complete the walk into the city of Durban in celebration of our commitment to improving maternal and newborn health globally.
This is the first time in the ICM’s history the Congress is being held in sub-Saharan Africa. This is a particularly significant opportunity for the ICM to bring visibility to midwives. The Congress will be taking place in an area of the world with the highest rates of maternal and newborn morbidity and mortality. With only five years left to achieve the United Nations Millennium Development Goals and improve maternal and newborn health globally, now is the time to highlight the central role of midwives in achieving these goals! In locations across the globe today, midwives and midwifery supporters are “Walking the Road to Durban” in solidarity. https://www.midwives2011.org/Congress/TheRoadtoDurban.aspx
Bringing the Message Home in the United States
Women in the U.S. are more likely to die of pregnancy-related complications than in 49 other countries, including nearly all European countries, Canada, and several countries in Asia and the Middle East. Worse yet, the maternal mortality ratio for American Indian/Alaska Native women is four times higher than the Healthy People 2010 goal (the national target set by the government) and eight times higher for African American women. Maternal mortality is the death of a woman during or shortly after a pregnancy (up to 42 days postpartum) and is calculated as the number of maternal deaths per one hundred thousand live births. The U.S. average rate was reported to be 13.3 deaths per 100,000 lives births according to Amnesty International’s 2010 report, “Deadly Delivery: The Maternal Health Care Crisis in the USA.”
In some places, and among some populations, maternal mortality is much higher. For example, in the state of Georgia the rate is 20.5 deaths per 100,000 births; in Washington, D.C., it is 34.9 deaths per 100,000 births; and in New York City, the ratio for Black women is 83.6 deaths per 100,000 live births, according to Amnesty International’s report.
More Midwives Mean Better Outcomes
As the ICM points out, “The world needs midwives now more than ever.” It is becoming increasingly clear that midwifery can be a solution to the outrageous statistics that continue to plague a nation that spends billions of health care dollars on maternity services alone. America also needs midwives now more than ever.
Today in Austin, many midwives, mamas, babies, and families met at Town Lake and walked the beginning of the “Road to Durban”, promoting midwifery care as The Gold Standard in maternal/child healthcare in the US and around the world.
I received several requests from people wanting to hear Stephanie’s great VBAC story that goes with the pictures in a previous post from December. I asked her if she would be willing to share what she had written about her pregnancy and birth on my blog. This is what she sent….so empowering!
March 30, 2010
I found out that we were expecting our fourth child. It only took me a few days to decide that I wanted to seek out more information on the possibility of attempting a VBAC with this child, despite the fact that I had already had three c-sections and no vaginal deliveries.
April 3, 2010
I sent the following letter to a handful of midwives in the Austin area:
My name is Stephanie and my family and I have recently moved here to Texas (I lived in NJ for 20 years) and I’m having a hard time finding some answers to a few questions I have regarding Midwifery laws, practices, etc. here in the state. So as a last resort, I thought I might directly contact some local midwives. Might be the best way to get the information, anyway!
A brief history–I’m 29 years old and have three children (5, nearly 4 and 8 months). All my children were born via c-section against my greatest wishes. First for failure to progress after 36 hours of labor. I was aiming for a Bradley birth in a hospital (hind-sight of course, tells me how dumb of an idea that was) and ended up being pressured to get an epidural after 24 hours of laboring then pressured to get a c-section after 2 hours of pushing and my baby still remaining high in the birth canal.
My second was an attempted VBAC (in the hospital as well–NJ is not a place where homebirths are common, thus my husband and family were VERY leery of my wishes for this, so we went to the hospital). My labor with my second child progressed very quickly and once at the hospital they required an internal fetal monitor (after breaking my waters). Once this was in place, my baby’s heart rate was recorded around 60bpm and not rising, thus ending my attempted VBAC in an emergency c-section.
My third child was born via scheduled c-section 3 days prior to her due date as the midwifery laws in NJ prohibit attendance at VBAC after more than one c-section, and my OBGYN did not want to allow me a trial of labor, nor would they schedule my c-section past my due date. (An aside–I went into labor at nearly 42 weeks with my first and at 41.5 weeks with my second child). I tried everything I could to go into labor with my third child, but to no avail. Otherwise I would have given myself a trial of labor at home despite my doctors demands!
All of that to say, we will be having a fourth, and in me is still a desire to attempt a vaginal birth. I came VERY close with my second (full dilation and pushing in the hallway on the way to the OR but the epidural had already kicked in to strongly). What I am looking for is information on whether midwives here in Texas are allowed to attend a VBA3C whether at home or in a hospital, and also, if you or any other midwives you know of would recommend for/against it. And if anyone is for it, have they attended any such thing?
I have aspirations of becoming a doula and possibly a midwife myself, so I consider myself fairly well educated for a layman. I have researched the risks, the pros and cons. I am not sold 100% either way without the input of a professional with experience. If I had my druthers, I would turn back time and change so many things about my very first birth… but alas, I cannot. But if there is a possibility of avoiding yet another surgery, a long recovery and more emotional trauma, I’ll gladly explore it.
Thank you in advance for any input you have to offer!
Many of the midwives I sent this letter to, did not respond. A few did and most of them advised against a homebirth in my situation. Two of them gave me the names of other midwives they recommended contacting. This is how I found Christy Tashjian. This was her email response to me:
Hi there, Thanks so much for contacting me. I really feel for your situation. I would be glad to chat with you on the phone and discuss options….It is fairly unheard of to do VBAC after 3 c/sections at home here in Texas….that said, I am not entirely against the possibility of helping you. We would have to REALLY talk about it thoroughly….
Christy and I got together on April 23, 2010 to discuss my aspirations. I drove to South Austin and met her at her office located on her farmette. We sat on a wooden swing in her front yard and talked while Zoe slept peacefully in her carrier and Elijah and Isaac ran around exploring the chickens, rabbits and turkeys. We talked about my birth history, what I came to learn through it all, and what I desired for this pregnancy and childbirth, despite what the “system” would probably allow. I did a lot of talking. But I felt listened to. By the end of our visit, I didn’t feel I had a read on whether I had Christy’s vote of confidence, but then again, I wasn’t sure I was all that confident either. I thanked her, hugged her and left after telling her I would be in touch.
I went home and took nearly the next 8 weeks to try and sort through things. I really wanted to come to a final decision–homebirth or repeat c-section?–before I established prenatal care anywhere. Time was running short. I was 15 weeks and still could not settle one way or the other. But I knew prenatal care was important, and aside from fear I still wanted to attempt a homebirth, so I emailed Christy asking her if she was still interested in working with me as a client. She said she was and we set up our first official visit for August 3, 2010.
Frank came along for my first prenatal visit. My mother happened to be visiting at the time which allowed us to keep the kids home with her. Frank and I went and chatted with Christy, reviewed copies of my medical records from Elijah, Isaac and Zoe’s births. We listened to the baby’s heartbeat, said goodbye and went home happy to be under such personal care.
The pregnancy was smooth sailing. Aside from the typical ailments–heartburn, back ache, etc.–it was fairly uneventful. We had our 20 week ultrasound and learned that we had another baby boy on the way. Samuel Lucas. We couldn’t wait to meet him.
Prenatal visits continued to be pleasant and relaxed meetings. With such an uneventful pregnancy, my mind was very focused on reaching the end. Which also meant the need to make a final decision on where and how I wanted to welcome my baby from the womb. Towards the end of October I really began to feel pressure mounting to make a decision. I was entering into the final 6 weeks of pregnancy and I was still wavering, nearly day to day, on the decision. So much of me desired a peaceful, natural experience of birth. To be able to hold my baby after he came out of me. To enjoy those first precious moments not under the influence of heavy drugs while being strapped down to a hard table. But when I would try to imagine laboring in the comfort of my home, my mind would flood with images of “what-if’s”… uterine rupture, hemorrhaging, attempts to transport ending in loss of one or both of us. I would find myself in a vividly detailed world of the worst case scenario encased in fear. I struggled day to day with my oscillating confidence.
I decided that I needed some outside opinions; wisdom in the counsel of many. I sent out an email to a few of the “older and wiser” friends I have. I was not requesting their input from a medical perspective, but more so was I seeking to have them impart to me the correct way to seek Godly wisdom on this decision to be made. A few of them did not respond at all, a few of them responded with their opinion on homebirth, and one of them responded with precisely what I was requesting. She sympathized with my fears and confusion, she spoke into my need for wisdom and really was a God-send in my moment of weakness. She challenged me, by her own story, to search my heart and my motives. She advised that I fervently go to God in prayer.
It was early November. I spent some time in prayer and in reading, seeking and searching for answers. I had a long talk with Frank about her email to me and how it had sparked me to really do some “soul searching” regarding my ever-vacillating thoughts on how to welcome this child into the world. After we talked, I really felt I needed to journal. I needed to get all of these thoughts down on paper and sort through them. This is the entry in my journal that came as a culmination of my previous few weeks:
November 12, 2010
I feel torn between mediocre and mediocre. What an apathetic place to be. To make a choice between vanilla tainted one way and vanilla tainted another–all to result in an amazing end, provided the taint doesn’t kill me.
One month remains until my due date and I have never been less certain which course of action to take. It’s moments like this when all of my study, logic and reasoning seem most inconvenient. Why am I not like majority of women who just go about their lives, get pregnant, have babies and keep moving forward? My cousin’s wife had a baby just this morning–she was induced early because they were “expecting a large baby”. Labor and delivery went fine, producing a whopping 7lb, 8oz kid. This ANNOYS me on so many levels. That she conceded to an induction based on the doctor’s “guess” of a 10lb plus baby… that she was induced… that everything went fine despite the lies she was fed… and that in her ignorance she got what *I* have always wanted. it seems that no amount of self-education has gotten me anywhere in my desire for a natural birth.
Part of me deeply desires to do this at home. I want the challenge of labor in the comfort of my environment. I want my son to come into a peaceful place, surrounded by his family and not whisked away to be rubbed down, weighed, bathed and kept in a small plastic box by a total stranger. I want to be able to care for my newborn without the limitation of pain brought on by a freshly wounded abdomen. I want to sleep in my own bed with my husband on one side and baby nearby as we adjust to being a family of six. I would love all of this and more but I find myself fearful of the small chance of it all ending in disaster. But then I look at the alternative and shudder as well. Do I voluntarily walk into Labor & Delivery *asking* to be strapped down and sliced open again? Do I roll the dice, taking a chance that everything goes as smoothly as it has the last three times? Do I suck it up and deal with the stress of a hospital environment for another 96 hours of my life?
I want so desperately to do what is right and what is best. In the end, I want to enjoy my newest baby and us to both be well. In talking tonight, I’ve wondered if all I am fighting for is motivated by selfishness. I *do* feel like I’m being selfish, but for the “right” reasons–if there is such a thing. But perhaps I am looking to control this too much. Or maybe I am fighting the system more than is good for me or Samuel. Maybe my unrest about doing this at home is because there is a heart issue at hand here. I think I had sold myself on the idea of homebirth, but as the date draws near–the time to make the commitment–I’m getting cold feet and asking myself why. I don’t want to regret whichever decision I come to, but what is regret anyway, but a choice. A perspective. If I have another c-section will I forever wonder if I could have avoided it? There is an interesting difference this time that I just realized… with Isaac, I tried. With Zoe, my hands were tied. I had no options except perhaps, a date. This time my options are open–mine for the choosing. And I thought I knew what I wanted and now I’m not so sure.
Gracious Heavenly Father,
I want to get to the bottom of this unrest. I want to make a pure choice. I want to do what is best and I would love to stand in confidence in that decision so that I may not continue to waver. Show me any clouded areas in my thought or deceit in my heart. Make my path straight. I want your will and your best for this birth and this precious baby… this gift you have given us. Thank you for this process–may I find more of You as I continue along this path. It’s hard to know exactly what to ask for or expect, but You are so faithful. I pray my motive be found pure in your eyes. And if it be your will, that all will go well as we welcome another member into our little family. Amen.
In the week following that journal entry, I found myself really feeling like I had finally sorted out some of the emotions pooling inside. Though the entry contained a lot of unanswered questions and uncertainty, something about getting them all out in some kind of order brought me peace about the situation. It was an odd calm that I was experiencing. I got together with Erica (my doula) and talked about it. I also talked with Christy about it. Each day I felt like I was waiting to wake up and be paralyzed by fear again, but it wasn’t happening. I ordered my birthing kit, washed Samuel’s little clothes and actually felt myself get a little excited at the prospect of having my baby at home.
During one of my prenatal visits, Christy had given me a stack of beautiful pictures that contained “birth affirmations”. Most of them had pictures relating to birth and a line or two of text regarding the birthing process, the power and ability of a woman’s body, etc. I took them home and read through them a handful of times. I found it hard to really read them as if they were my own. Having had my body “fail” me three times before as I had my babies, it was difficult to honestly recite something that talked about how “I trust that my body knows what to do”… etc. So I opted to write my own birth affirmation. Things I could go back and read while in the throws of labor to remind myself why I was doing what I was doing. Here they are:
December 3, 2010
My “Birth Affirmations”
*I have wanted a natural birth since before having Elijah. I feel it is the best, most peaceful and natural way to welcome a child into the world.*
*I have been *so close* to birthing two of my children. I don’t want to get that close and lose the opportunity because of fear or a decision within my means to make.*
*I have spent over 160 weeks of my life carrying babies… waiting to meet each one of them. A few more days, hours or minutes are mere moments in the grand scheme of life. I can wait a few moments longer.*
As the days got closer and closer to my due date, I grew more and more desperate for the *day* to come. My back was aching, I was tired and feeling quite useless around the house. I wanted to meet my baby. Here is a short journal entry:
December 9, 2010
Thirty nine weeks today. It’s been an overall good pregnancy. This last month or so has been tough with the tiredness and a lot of back pain. Sleep has been rough. But despite all that, I am so excited to be so close to the end. I cannot wait to meet Samuel… to see what he looks like, to hear his little voice, to kiss his little head and count his tiny toes.
I think I will miss being pregnant; I have enjoyed it every time. But I am more excited to meet this tiny munchkin than I am to remain pregnant. Samuel, please come soon! At least before Christmas–you have Christmas pajamas waiting for you! <3 I love you so much already!
My due date (December 16, 2010) came and went. In the back of my mind, I fully expected this would happen. Elijah and Isaac both arrived late… why should this one be any different? On December 22nd, I sat down and wrote this entry because I didn’t want to forget the course of events that had taken place that week, later to realize that I was in the beginning of real labor as I wrote:
December 22, 2010
I pray it’s almost time for your arrival. Last Friday, December 17th, I started having more frequent and stronger contractions. A few woke me out of sleep. I started getting really excited. I got up Saturday morning and decided to go out and finish up my Christmas shopping. The contractions slowed while I was out and about. That night they picked up again, but still didn’t feel strong enough to be serious.
Sunday came and went with some contracting but little else.
There was talk of a full moon on Monday night. Erica sent me an article describing not only a full moon but a total lunar eclipse that would paint the mood red and was happening on the night of the winter solstice. There were lots of people rooting for the full moon to bring on labor. Monday night as the sun went down, my contractions became increasingly stronger but still only every 15-20 minutes. These contractions, though far apart, certainly felt more productive. I awoke many times Monday night and by morning had lost my mucus plug. Though the contractions never weakened, they became more sparse throughout the day on Tuesday. I continued to lose more small bits of mucus throughout the day. By evening, contractions had picked up strength once again and were now feeling fairly painful, though still far apart.
As I tried to sleep Tuesday night, contractions were hard enough to wake me up for each one. That night the bloody show began. I had a 10am appointment with Christy on Wednesday morning. I got up, despite wanting to stay in bed, and drove to her office. She listened with the doppler to baby’s heartbeat and found it quite high in my belly. She asked me if I would like to get an ultrasound just to make sure Samuel wasn’t breech, as well as to have my amniotic fluid level checked. I thought it would be a good idea as well, so she called and set up an appointment for 3pm that day. Erica came with me to the ultrasound. Everything looked fantastic and baby is head down. I’m really hoping labor kicks in soon as this pre-labor period is getting quite tiring. And I’d really like to meet my newest little kid soon. =)
December 26, 2010
Within hours of writing that last entry, labor really started to pick up. I sent a text to Erica around 9pm to let her know that contractions were coming every 3 to 4 minutes, lasting about a minute each since about 8pm. Around 10pm I sent her another text letting her know that all my laundry doing and walking around was making it worse. I told her company would be nice. I had also sent a text to Christy at 930pm to update her on all that was going on. She asked if I could try and rest at all and told me to let her know when I couldn’t talk through the contractions anymore. I replied, saying that I felt I was almost to that point but perhaps once Erica saw me, she would be a better judge of that.
Frank was helping solve a crisis at work and finished up around 10pm. All the kids were in bed and sleeping. Erica arrived at 1030pm. She helped talk me through the increasing pain and massaged my back and thighs during contractions. She took out my birth kit and baby clothes, put plastic sheeting on my bed and got our room and bathroom set up. I had been in the shower when she arrived. I got out, got dressed and continued putt-ing around as my contractions grew harder. Erica was fantastic–she encouraged me and coached me through each contraction, reminding me to breathe and relax my shoulders and legs. Frank had put some Christmas music on in the bedroom which I then asked him to change to a mix of John Mayer, Coldplay, etc. As labor intensified, I would move from leaning on the wall or dresser or counter to being on my knees leaning over an ottoman. Evidently Erica was watching how I was progressing–she mentioned to Frank that with the laughing and joking in between contractions, things were not quite serious enough yet. I must have turned a corner a little after midnight because I was handed my phone to call Christy. I can’t even remember what I said to her, but I recall passing the phone back to Frank to get through another contraction.
Sometime shortly after that call, I decided to get in the tub. I think Erica had suggested the bath. I requested a nice hot bath be drawn. I got in and it felt so nice. From that point forward, nothing got any easier. I would have a contraction, try to breathe through it, feel like it would never end and then realize it was over the peak of strength. And then the next one would come all too soon. I remember asking Erica to remind me why I wanted to do this. It was so intense. I had Frank soothing me, gently tickling my shoulders, as Erica continued coaching me through each wave.
I had lost all concept of time. Part of me felt like it could be eternity before it would be over. Frank says that Christy finally arrived at 130am. She had asked me if I wanted to be checked and I told her no–I was too afraid to find out that I was nowhere near the finish line. Within minutes of her arrival, I began experiencing a new sensation at the peak of my contractions: every muscle in my torso would quake. At first, i wasn’t sure what the feeling was and I fought it. To describe it, I would have to say it felt as violent as vomiting except from the ribs downward, instead of up. I asked out loud about this new addition to my contracting after feeling it a few times. Christy said, “Does it feel ‘pushy’?” Ah. Yes. Pushy. Maybe that was it. Was this what it really feels like to have to push? At that point, Christy did an internal check and said I was complete and could feel free to push through those urges.
I was in the bathtub, with legs outstretched, leaning against the back wall of the tub. I pushed through a few contractions in this position. Christy was monitoring the baby’s heart rate. At one point, his heart rate dropped low. She asked me to lay back a little further. I tried to, but felt the baby’s head descending in my pelvis and had an odd notion that I might push his head into the floor of the tub. At that point, I wanted to be on my knees. I flipped over and used Frank’s thigh (he was sitting on the tub edge this entire time) to lean my head against while pushing. I LOVED his thigh being there; it was so comforting to lean on him. I laughed a little in a short break between contractions, as I asked him to remove the wallet and chapstick from the pocket where I had tried to lay my head.
I continued pushing. I was being quite vocal at this point, moaning and then letting my voice rise in pitch as the intensity of the contraction rose. It was all I could as I tried to allow my body to lead me in each wave. In between pushes, I remember once laughing. I felt so bi-polar in that moment. I think someone made a similar observation and said something. Laughter sandwiched between such strong feelings and internal focus was odd, but wonderful.
I don’t know how long I was on my knees, though I remember them getting tired. Pushing became super intense and I started feeling a hot, burning sensation down below. I said something about the pain and Christy told me to push through it. I reached down to feel for a head. It felt as if there was a balloon making it’s way out in front of the baby’s head. The amniotic sac was still intact and had formed a small bubble. Erica and Christy both told me that I could pop it if I could but it was very thick and tough. I could not get a grip on it. I’m pretty sure I asked Frank if he wanted to feel it. He declined.
It may have only been a few more pushes accompanied by the intense burning and suddenly the baby’s head was out. The relief from the burning was amazing. With the next urge to push, I felt the baby slip out. I quickly reached down and picked him up from the water, unwrapping a cord from his neck and peeling back some of the amniotic sac that still covered him. I sat down and held him close. Our fourth baby, Samuel Lucas, had finally arrived. It was indescribably wonderful. In disbelief of what I had just accomplished, I wasn’t sure to laugh, cry or just be silent and enjoy this precious moment of which I had so often dreamt.
It was 2:16 on Thursday, December 23rd. We had finally met our fourth little one in the calm and quiet of our own home, surrounded by loving hands and accompanied by the rhythms of John Mayer while my older three slept peacefully in their bedrooms above. It was better than the best I had imagined. And I realized that despite my “odds”, despite the risks, I had done it all without fear. I had such a calm–an unexpected peace–during labor. It was a beautiful experience, and a beautiful evening. One I will not soon forget.
We spent the next couple of hours making sure I was stable and well patched up. I sustained a second degree tear and had lost a decent amount of blood. Christy stitched me up while I nursed Samuel. Erica made me a delicious bowl of oatmeal that Christy fed me. I was given hemhaw, methergine and a shot of pitocin to try and slow the bleeding. After a couple hours it finally slowed. Samuel was weighed and measured–8 lbs, 8 oz and 21.5″ long!–and Frank cut the umbilical cord when he was about an hour old.
Erica and Christy cleaned up, packed up and left around 530am. Frank and I laid in bed with our tiny newborn for a few hours sleep before the sun would rise and it would be time to introduce Samuel to his brothers and sister. It was all so perfectly timed and it all went so wonderfully. I could not have imagined it better. I am so thankful for this Divine orchestration, for the peace and calm I experienced, for the hands of Christy and Erica and my husband, who were so loving and encouraging and who believed in me and my body. I am so grateful. And I am so glad my little boy finally decided to come meet the world, even if he was a whole week past his due date. =)