Update on North Carolina’s Certified Nurse Midwives

It’s been nearly two weeks since Dr. Henry Dorn informed the certified nurse midwives for whom he was providing physician back-up that he could no longer do so. When I wrote about this issue before, I said I didn’t know all the factors — and I still don’t.

I’ve heard that this was “in the works” for months between Dr. Dorn and the North Carolina board of medicine — and yet all of the affected certified nurse midwives were SHOCKED by his announcement email. I speculate that he knew something was happening and didn’t share information with his CNMs until it was official. However, nothing “official” exists yet: according to the North Carolina board of medicine, Dr. Dorn has no sanctions from them; he’s never even had a patient complain on record.

However, they cannot comment on pending complaints or investigations.

Just after Dr. Dorn’s announcement, I saw an email from the North Carolina board of medicine, sent to physicians, asking them to contact the NCBOM with evidence of adverse outcomes from homebirths — but only if it’s public record; no HIPAA violations, kthnxbai! (Note: I saw a picture of the email on Facebook, through a friend-of-a-friend, and I’ve searched in vain for it, but can’t find it right now.)

I haven’t heard of any particular incident that preceded Dr. Dorn’s decision and subsequent notice to the certified nurse midwives he was supervising. He has not made any public statement.

Today I read an article which noted that the Certified Nurse Midwives were given a 75-day “grace period” to continue practicing. Under the proposed law — which isn’t law yet, but is being followed as if a law — certified nurse midwives have 45 days to continue practicing after suddenly losing a supervising physician, while they search “diligently” for a new physician, and then can file for a 30-day extension.

So, this is a small victory for the certified nurse midwives — and more importantly, THEIR CLIENTS — but the problem is that the certified nurse midwife interviewed for the article said that she’d appealed to four obstetricians and had been turned down by all due to malpractice concerns. And I don’t think she’s in the minority; I think most of the certified nurse midwives will have a difficult time finding physician backup because of concerns about litigation.

Thus I bang my head on my parents’ lovely granite kitchen table (I’m on vacation. I’m typing this from my mom’s MacBook Pro. I have no idea how to cut/copy/paste, nor insert photos. Sorry!) Usually, North Carolina is busy insisting that certified professional midwives aren’t competent enough to legally attend homebirths (unlike in South Carolina, Tennessee and Virginia, to name just a few of our fellow southern states where certified professional midwives are legally recognized and allowed to attend homebirths). Nobody debates that a certified nurse midwife is a skilled attendant for homebirths. And yet, because of something that may or may not have happened, within legislation that is decidedly NOT transparent — the law is not very easy to read nor interpret regarding physicians supervising nurse-midwives — a lot of  pregnant women are without a provider come September.

These women may make up a small percentage of all the women who will have babies this year. But they matter. Their rights matter. They are not going to acquiesce on their home birth plans just because they are being strong-armed into a hospital birth — or being somewhat forced have a potentially-dangerous unassisted homebirth — just because their provider’s rights (and thus, their rights) are stripped. There must be a better way.

I hope to update again in the near future with more information.

A Midwife’s Birth Story

The writer of this beautiful birth story is a midwife. She gave me permission to share it. I thought it was a really unique birth story — she really describes her feelings of being both a midwife (not her own) AND a pregnant woman in labor. Clients will be lucky to have her!

As a childless midwife, you think that when you finally get pregnant and give birth, you’ll be more prepared than most. After all, you’ve seen this journey and you’ve been privileged enough to be allowed to walk with so many during such an amazing moment in time. You imagine that when it’s your turn to carry and birth a child, you’ll be a fabulous testament to the power of women’s bodies. You will be a natural rockgoddess, a shining example of pregnant and birthing fabulocity. Or at least I did. But nothing could prepare me for the intensity of CJ’s birth or the insanity which we call love that could propel me to do it all over again in a heartbeat.

I’d been having mild contractions on and off for weeks, but they were nothing to write home about. It got to the point that I pretty much put them at the back of my mind unless they were strong enough to stop me in my tracks. I’d been having ever-increasing lower abdominal/pelvic pain (which I later found out was caused by a separation of my pubic symphysis) the last trimester as the baby grew bigger. It was so bad, in fact, that getting dressed in the morning was so painful that I’d be in tears at times. So, the day before I went into labor, I woke up and declared aloud that I was DONE!!! I was only 38 weeks and a few days, but I woke up feeling like my body and baby were getting ready for labor and, frankly, I was tired of being in such pain on a daily basis. That night, I took an herbal tincture at regular intervals for a couple hours, had some nice contractions, and inserted some evening primrose oil capsules before bed.

The next morning, I went about my errands and then went to my prenatal appt. While listening to the baby’s heartbeat, my midwife and I immediately noticed his heartrate was slower than usual. Too slow. I turned to my left side. Still slow. Turned on my right. Still slow but picking up. It went back to normal shortly thereafter. Nothing like that had ever happened with him before and I was worried despite my midwife’s reassuring words. I drove home nervously and planned to use my doppler to listen again when I got home. Well, when I got home, I found his heartrate was slow again. With position change, it came back up and was great. An hour later, it was slow yet again and wasn’t increasing with position change. I called my midwife and my husband and we went to the hospital for evaluation. Turns out, my amniotic fluid was low, but baby was otherwise fine. The attending doc recommended I.V. fluids and a repeat ultrasound in 3 hours to see if there was any change. My midwife checked my cervix and told me it was soft and dilated to 2cm. Baby was moving well and his heartrate was normal. A few hours later, the ultrasound revealed my fluid level was back to normal and we were discharged around 2am.

On the way home, I noticed that I was having contractions every 12 min or so but I dismissed it as being due to a full bladder. I couldn’t possibly be in labor yet! After we got home, the contractions began to intensify a bit. I looked at my watch and thought, “Every 5 min? And this increasing pressure? Maybe I just need to go to the bathroom and then they’ll stop.” Because I just COULDN’T be in labor! The house was a mess and I hadn’t gone grocery shopping yet! I called my husband around 2:30am (He’d gone back to the office to wrap up a few things that he’d left when I’d called him frantically to take me to the hospital) and told him to come home so we can get some sleep “just in case I go into labor in the morning”. He came home and we got ready for bed. As soon as he turned the light off, the contractions got STRONG and were every 2 min. So much for sleep. It’s like my body was screaming, “DO YA BELIEVE ME NOW???” and yeah, I finally admitted to myself that I was in “early” labor. At first, I didn’t want to call my midwife because I knew she hadn’t slept much, if at all, either. But the contractions were intense enough that I knew she should be heading over. She arrived in less than half an hour while I was in the shower and proceeded to call the 2nd midwife over as well.

In the bathroom, I was mentally giving myself a pep talk that went kinda like this: “Get a hold of yourself, girlie! Why are you shaking? Cuz shaking comes with transition and you are NOT in transition yet. You’ve got about 12 more hours of this, so you’d better get a grip and hang on. What was that? An epidural? Ain’t no epidurals IN YOUR BATHROOM!!! You can do this. Breathe and hang the fuck on! Do not cry. DO. NOT. CRY.” I cried. Then, I threw up and cried some more. After leaving the bathroom, I asked my midwife to check me. I was 9 and a half centimeters! Holy shitballs! I was totally expecting her to tell me I was 4 – 5cm. Turns out, I was 4cm when she checked me earlier at the hospital! She didn’t want to state that I was 4cm because she knew I wanted a home birth and she knew there was a chance they might’ve wanted to keep me and induce labor.

At this point, I went back into the bathroom to seek refuge from the contractions by standing in the shower and sitting on the toilet. I distinctly remember thinking, “So, THIS is why women get epidurals. I totally get it now…How am I ever going to have the strength to do this again?” After leaving the bathroom, I asked the midwife to break my bag of waters. She was reluctant but she did it after I insisted. I was SO convinced that if she released my waters I would be able to begin pushing within minutes. Apparently, being in hard labor can cloud one’s judgement. Surprise, surprise. Thankfully, I had clear waters, baby had moved down, and his heart rate remained normal. Yay! Now the fun could begin. I wish I could say that the contractions were noticably stronger after releasing my water, but to be honest, I think my brain went into survival mode. I distinctly remember feeling desperation like I’d never felt before. I wanted to reach out and grab onto someone, anyone, to anchor me. My midwife urged me to push and I tried but it hurt so badly. It felt like something inside me was coming apart, like my internal landscape was being restructured with a wrecking ball. I yelled, “I CAN’T!” The two midwives and my husband encouraged me, gave me the old “Yes, you can! You’re doing it! You’re doing such an awesome job!” And I wanted to kick them all. Instead of resorting to violence, I yelled back, “NO, I CAN’T. IT HURTS. SOMETHING’S IN THE WAY!!!”

I was right. I had an anterior cervical lip that had started to swell. My midwife had me blow “horse lips” for what felt like 3 years (really only about 30 min) until, suddenly, the urge to bear down became involuntary. My body was on autopilot. I had to give in and go where my body needed to go. It still hurt a bit to push, but I mentally coached myself, as I had done with so many other moms, to push past that spot. I looked up at our bedroom ceiling and recalled the many women before me who had to dig deep and find the strength to get through what I was currently experiencing. I called on my own mother, who died when I was 11, for strength. “I know you’re up there watching, so you’d better help me, dammit!”, I thought. By this point, I had lost all ability to speak coherently. I was delirious thanks to the oxytocin and the fact that I hadn’t slept all night. Between contractions, I’d fall asleep and actually dream! I pushed with every ounce of strength I had and, after what felt like 8 years, his head began to emerge. Somehow, I had the presence of mind to notice that CJ had an early deceleration of his heart rate as I was pushing and I knew he was moving in the right direction. My midwife brain was still working! In fact, I placed my hand between my legs to guard my lady parts and I birthed his head into my own hands. Without anyone telling me when or how to push, I instinctively waited for him to turn his head and shoulders before finally pushing out his body at 9:26am. My baby was out! All 6lbs 1oz of him!

Welcome to the world, CJ!

One of the midwives lifted Caleb up onto my belly while the other filmed the birth on her iPhone (Thank you, Dale!). Within minutes of his birth, Caleb was able to latch on and nurse successfully. I couldn’t believe he was out. To describe what I felt as happiness would be an understatement. I was beyond ecstatic! By far, giving birth to my son was the hardest and most incredibly amazing accomplishment of my life. As I’ve said to moms many times, giving birth naturally doesn’t make you a better woman or better mother. It’s what you are able to learn from your birth experience, whatever that may be, that does that. I hope that for me the lessons not only serve to make me a good mom, but also a better and more compassionate midwife.

Three surprising reasons I chose a homebirth

While I chose a homebirth for My Masterpiece because I believed so much in natural childbirth, by the time I was pregnant with Porcelain I had a few different reasons:

1. I’m a wimp.

No, really, I am. Planning an unmedicated birth and then going to a hospital is like — to me — being on Adkins and then going to a chocolate buffet. Most of my doula clients were hospital birthers, and those labor and delivery nurses like to push epidurals under the guise of sympathetic pain management. Every couple hours you hear: “Would you like something for your pain?” “How would you rate your pain, on a scale of one to ten?” Meanwhile, at home, my response of, YES, GOD, YES, and IT’S A SEVENTEEN might have gotten me a drop of Rescue Remedy. If My Chemical Romance could find it.

2. I’m lazy.

I don’t want to sit in the car while I’m labor. I don’t want to pack a bag. I don’t want to answer stupid questions by a triage receptionist about whether or not I have a car seat, or if I’m being abused. And most of all, I don’t want to clean up afterwards. After Porcelain’s birth, my midwife cleaned my toilet. I showered in my own shower and climbed into my own bed, and My Chemical Romance brought me a sandwich from McDeathald’s because it was Christmas and it was the only place that was open when he drove my mom to the airport.

3. I’m incredibly self-centered.

The idea of a STRANGER taking care of my baby and me on one of the five MOST SPECIAL DAY OF MY LIFE is absolutely unacceptable to me. Are you changing my sheets because you’re on shift and I happen to be there? No, ma’am, as they say here in the Carolinas. I will not be your “patient.” I only trust certain folks to see my va-jay-jay and although I may pay them, I also love them.

How I Knew I Was Having Twins

Ah, memories. Picture it, summertime in Michigan, nine years ago…

A little over nine years ago, I found out I was pregnant. And pretty early in the game, I realized something was amiss. First of all, I was violently ill 24/7. Second of all, I was in maternity clothes about seven seconds after I peed on a stick.

31 weeks

But the most obvious sign was in conversations with other pregnant women. You know when you’re pregnant and you run into other pregnant women and you both kind of grin at each other and chat for a second? As it was my first pregnancy, I had no idea what I was supposed to look like, but I’d see another woman who approximated my size and ask her when she was due.

Me: “How far along are you?”

Pregnant woman with adorable little bump: “Seven months now. How about you?”

Me: “Um… three months. Yep, 13 weeks.”

Pregnant woman with adorable little bump: **crickets**

That conversation happened three times.

Then, JUST before the ultrasound that confirmed twins, I was standing in line at the grocery store buying Ben and Jerry’s and Goldfish Crackers tofu-dogs and raw broccoli when the woman in line behind me tapped me on the shoulder.

“Excuse me, are you pregnant?”

I looked at her. It was pretty obvious I was pregnant. I was overweight at the time, but I had a giant bump and if it wasn’t from pregnancy there was probably something seriously wrong with me.

“Well, I just had to tell you that you’re HUGE.”

Me: **crickets**

Even I, never at a loss for words, was dumb-struck.

I have seen a lot of pregnant women with large bellies at the end of their pregnancies and during labor. I used to be a doula, and I was an apprentice midwife briefly. But pregnancy with twins is just a different look. The belly is not just big, it’s more like… filling. It stretches in every direction and seems like it is about to take over the world and eat everything in its path, like The  Blob. Check out these bellies from the Natural Birth of Twins and Triplets video — especially the woman pregnant with triplets at the end!

 

Dear North Carolina: Legalize Certified Professional Midwives!

I had a homebirth in Arizona, and then another homebirth in North Carolina. In Arizona, Certified Professional Midwives are legally allowed to provide prenatal care and attend homebirths.

Not so in North Carolina.

North Carolina is one of a few states that does not recognize the legal status of Certified Professional Midwives. That means a midwife who has passed a national evaluation program of midwifery skills, the North American Registry of Midwives, is not legally recognized as a provider of prenatal care or birth. Our neighbors in South Carolina, Virginia, and Tennessee all recognize the CPM credential. But not North Carolina.

I’m attending the Birth Freedom March in Raleigh, NC, on March 2, and afterward I’m meeting with my representatives. I’m bringing my homebirthed-in-North-Carolina baby. I want to tell them that the midwifery model of care is important to me. I want to tell them that out-of-hospital midwifery with a trained midwife is safe and should be an option for women in North Carolina. Because it’s not just about homebirth; it’s about giving women options for their own healthcare. And I support that.

 

Guest Blog: A Dad’s Perspective on Homebirth

I asked My Chemical Romance to write a little about my homebirth with Piece de Resistance. I asked him to do this the day or two days after the birth, so it was fresh in his mind. Here’s what he wrote:

So this homebirth went much better.  Compared to birthing at a hospital, things were much more at ease.  Granted, at the hospital, they have everything medically that might be needed, but homebirth is only for normal women, right?  We had what we needed here, plus some extra stuff for good measure.  Other than that, I can’t think of a benefit to a hospital birth.  Here, I had access to my own food and water.  I could cook something if I wanted to.  I had comfortable chairs to sit in and I knew my way around.  The midwife was a visitor in my own house, rather than me being a stranger in a hospital.  It was just easier and less stressful to be here, which I think really helped Cinco de Mommy.  Like me, she was comfortable in her surroundings.  It’s like when you have a cat that is giving birth.  They always find a quiet, out-of-the-way place to deliver.  It is where they feel safe.  Same here.  Despite our science and technology, we are basically mammals that want to deliver in comfort and safety.  Where else is better to get that that in your own home?

And the recovery time was awesome.  Right away, after the delivery, we could relax on our own bed and just chill out.  We felt comfortable having people stop by immediately, rather than resting up in a hospital for a day or two and then coming home.  As much of a disruption the labor and delivery can be, having the “rock” of being home made everything that much better.

I would do it again and I would recommend it with all of my conviction to anybody that is a good candidate.

 

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