Monday Musing… Don’t Change That Date!

Over the years I have heard a lot of pretty ridiculous things OB providers have told women. I have heard women verbally bullied and virtually forced into hospitalizations, procedures, inductions, tests, etc in the name of “safe obstetrics.”  The other day I was completely enraged because I was reminded, some doctors are taking the bull shit to a whole new level.  I’m convinced many of them REALLY believe women are stupid and incapable of making good decisions. 

I have a friend whose sister is pregnant.  During a recent conversation I asked about her sister.  I was especially concerned since the last time we spoke her sister was being referred to the MFM (Maternal Fetal Medicine high risk folks) because something on her early ultrasound was suspicious for downs syndrome. 

My Friend:  ”Well… that  issue (The Downs Syndrome) has been resolved apparently because they have discharged her from the MFM BUT…. Now, the new thing is… her doctor is telling her he thinks she is going to have the baby early…. “

ME:  “HUH?? WHY??? What do you mean??? Shit… he is already setting her up mentally for an induction…  What’s her due date?” 

My Friend:  “Well it was March 8th but at her last appointment he felt like she might go in early. Told her she might be ready around February 28th”

ME:   *gasp* “Are you F-Bomb kidding me??!! That’s bull-shit. She had multiple ultrasounds with the MFM. If her due date needed to be changed they would have said something.  You don’t just all of a sudden change somebody’s due date at this stage. He is setting your sister up so he can schedule an induction. She will be 39 weeks then. That’s some straight bullshit. Tell your sister to call me.”

My Friend:  “Wow…. She has said she definitely doesn’t want to be induced”

Me:  Well he is playing games and setting her up for an induction. Putting bull shit in her head now makes it easier for him later. Tell your sister to call me…

I was pissed!!!  The bottom line is this:  The earlier the ultrasound, the more accurate the estimated “due date” (EDD) Each time you get another ultrasound it is possible that they will give you a new “due date.”   Regardless of the so-called new due date your original due date DOES.   NOT.   CHANGE. 

Ultrasounds and their ability to predict due dates are affected by a number of things including but not limited to:  the skill of the person doing the ultrasound, what they measure to obtain the date, the approximate gestational age of your growing baby, and the percentile growth or size of your infant.

Most women these days get at least two ultrasounds.  The first ultrasound, usually called your “dating ultrasound” is done as early as possible.  If it’s done during the first 12 weeks of pregnancy, it is the best predictor, after the date of your last menstrual period (LMP), of your EDD.  It is pretty accurate to a few days.  If the difference between your LMP due date and your first trimester ultrasound due date is more than a week, your provider will assign the ultrasound due date. If the difference is less than a week, they should go with your LMP date but many don’t. IMO its because they are more comfortable with technology than they are believing a woman knows her cycle but that’s a post for another day.

Some where between 18-22 weeks most women receive their second ultrasound, often called an anatomy scan.  As your baby grows and is somewhere on either side of “average” this anatomy scan may produce a different EDD, but it does NOT  really CHANGE your due date.  An ultrasound at this gestational age is not as accurate as the earlier ultrasound.   If you have a good ultrasound during the first twelve weeks of pregnancy, there should be no reason to change your due date.

After the first trimester, ultrasounds have a margin of error of up to 10 days.  After 26 weeks of pregnancy that margin of error increases to THREE  WEEKS!!! That’s up to 3 weeks wrong in either direction.  This means if you did not have an early ultrasound, and you don’t know your LMP, and you get an ultrasound that says you are 32 weeks… you could be anywhere between 29 and 35 weeks. That is the nature of the ultrasounds.

If you had your initial ultrasound during the first 12 weeks of pregnancy, or shortly thereafter, be VERY leery if your provider wants to change your date, especially to an earlier date.  Just because your baby may “measure big” does not mean that your baby is gestationally older. It just means you have a baby on the high side of average.  (Not that “measuring big” is all that accurate anyway but that’s also a post for another day)  If you are like my friend’s sister, and you had multiple ultrasounds, and all of a sudden your provider tells you they need to make your due date earlier… all I can say is RUN!!!  Or at a minimum get to asking some SERIOUS questions. Your birth experience and may depend on it.

Were you constantly confused because your due date kept changing? Were you induced because of a new due date that made you  ”post dates?”  I would love to hear about it.

Don’t Take a Detour Miss Harris…

In December, The Grio posted a few of articles re: doulas and home birth.  One of them was:  Home birthing helps black women reconnect with African roots. The title, the article, and the accompanying video left a LOT to be desired.  None-the-less, I was happy to see that homebirth was being discussed in a forum widely read by African American women. The way I see it, the more we talk about it, the more women will know that they have options and alternatives.

Last week, I came across another article, a response of sorts to that Grio piece:  If Natural Homebirth Brings Me Closer to My Roots, I’ll Take a Detour.  Intrigued by the title, I read it and shared the link.  The reactions to the article were strong, and we were all concerned about the lack of informed information presented in the article.

Initially, I was simply going to make a comment at the end of the article.  Then I decided it deserved more time and attention. My response follows below. But before you get to it, let me clarify that while I am a natural birth advocate and supporter of home birth, I understand that not everyone will, nor should everyone deliver at home.  And, I don’t believe we can make any blanket statements re: homebirth having anything to do with “going back to ones roots.”  The reality is, regardless of race, a woman should birth where she is safest and most comfortable. FYI, the hospital may or may NOT be that place.

Now on to the above mentioned article. Per Miss Janelle Harris… “Our foremothers may have been able to stretch out in their homes with a supportive doula by their sides, but they also weren’t battling external stressors like money and relationships and health care and family medical leave and jobs and transportation issues.  It was a different, simpler world”  

*Coughing and choking* HUH??? So I guess slavery, Jim Crow, abject poverty, segregation, discrimination, mutilation, lynchings…. None of those were external stressors.  And while I suppose picking cotton for Massa did come with a sort of “job security,” I don’t think it was accompanied by a stellar salary or medical benefits. Transportation? Yep walking was always a sure fire way for our foremothers to get from place to place.  Relationships?? Between the selling, and lynching of chosen partners, and rape from others….  Yea… a  “different simpler world.”

Miss Harris preceded that statement by saying:  “But most of Black women’s issues lie not in the hospitalization during labor, but the health risk we suffer leading up to childbirth”  There is one truth here. Yes, many African American women have health risks leading up to birth.  What I can assure you however is that there are MANY things that take place INSIDE the hospital to high and low risk mothers alike that affect outcomes. And African American women with no medical risk factors, high soci-economic status, great prenatal care and good education suffer at the hands of the medical obstetrical establishment. Don’t believe me? Check out  “When the bough breaks” Episode 2 of the ground breaking PBS documentary “Unnatural Causes, Is Inequality making us Sick”

One of the things that annoyed me most while reading this article was Miss Harris’ lack of knowledge about the preparation, training, and skill sets of doulas, midwives, and obstetricians. She says:  “I don’t discredit the wisdom and ability of a doula to do what a doula does or a midwife to do what a midwife does, folks go to medical school for a reason and learn things you and I and madame doula and midwife wouldn’t begin to know because that’s not our training”

The reality is Madame Harris while it may not be part of YOUR training it is a part of MY training and you my sister are WRONG.  In fact, Midwives are MASTERS at normal birth. Obstetricians on the other hand are educated in intervention, surgery, and problems. In theUnited States1 out of 3 women has a cesarean section not all because she originally needed one or because her pregnancy was high risk. It’s often because those “folk” who go to medical school learn about surgery more than they learn about labor and quite frankly they enjoy the pay check that comes from a 30 min surgery instead of helping a mother with a 16 hour labor. As a midwife, I have taught many a physician a thing or two or three about normal birth.  Midwives not only BEGIN to know more about normal birth than OB/GYNs we FINISH knowing.  And for the record, midwives are trained and are VERY knowledgeable and skilled to handle birth emergencies.

I found it quite interesting that as Miss Harris shares her personal birth story, she tells us that she had plans for a natural child birth: “I’m not knocking natural birth. I had my daughter naturally… I didn’t pop so much as a Tylenol before she made her grand debut.  That was always the plan way before I went into labor.”  She did not share with us why that was her plan, but it leads me to believe she did some research and then made an educated, conscious decision to avoid meds during pregnancy AND labor. Kudos Miss Harris for that!!

Like most first time laboring women, after 16 hours of labor and getting to transition, during a car ride to the hospital, she found herself asking for medicine. This is not uncommon. Anyone who is in the birthing profession has seen this happen many times. Transition ain’t easy and without proper support from a doula, midwife, or family member with natural birth experience this happens often.  Per her account, she was unable to get medication because by the time she arrived she was ready for delivery.  She has no idea how lucky she was.

It’s so interesting to me that Ms. Harris labored at home without a midwife or a doula. She arrived to the hospital just in time to give birth but has a negative response to the idea of home birth. The way her story reads, a few minutes more and she would have been having her baby on the side of the road… She was moments away from a Free Birth which is in fact an out of hospital birth without a trained provider.

I challenge the notion she gives in her article that the hospital means rapid, appropriate, safe help is within immediate reach. From the article:  “When it comes to bringing my baby into this side of life, I want it done as safely as possible.  The moments when things go wrong are precious.  I want someone there who knows how to handle them. Like right there. In the room, not a hop-in-the-car or cab ride away”

I am not sure how many labor and delivery units Miss Harris has worked on but I can tell you from almost 18 years of experience, it’s a RARE occasion that any physician, except in a teaching institution is like “right there.”  I have been the person making multiple calls, and placing many pages to a physician who is asleep, out to dinner, at a party, etc who takes their sweet ole time to hop in a cab or car to get to the hospital. Most often in these cases, what is now an emergency in the middle of the night is the direct result of the medications and procedures ordered in the name of a safe hospital birth.

Madame Harris, my dear sister, you had the wonderful opportunity to labor at home.  You did not LABOR in the hospital.  You were not strapped to a bed for more than 24 hours because your provider decided to induce you before your body was ready. You were not denied movement, drink or food. You were able to ambulate, and to go to the bathroom as you wished.  While you did not birth at home you actually had a totally unassisted/unmonitored labor which is actually more radical to some than a having a home birth with a trained professional.  The great part is as a result of you staying home you were able to listen to your instincts; to listen to your body; and do what was needed to ensure your baby moved through your pelvis safely and normally.  Believe me when I tell you… in the hospital that would not have been possible.

So I say to Madame Harris and to all the women who don’t understand the realities of hospital birth… while home birth is NOT for everyone, PLEASE don’t be fooled by the false security of the hospital.  The VAST majority of emergencies that happen in hospitals happen because we cause them. We restrict movement, we give meds, we starve women, we rupture bags of water, we use continuous monitoring and ALL of these things can cause problems. Miss Harris, I ask that the next time you make a decision to write an article about the value of hospital birth you do a bit more research, and may the information you find help you to Birth Something Beautiful™

In Birth and Love
Nicole

We’ve Been Called to the Mountain…

It has been MONTHS (October 2011)  since I helped organize the ICTC South East Black Midwives and Healers Summit. During the summit, I was unable to blog as I had intended. As a key organizer and M.C., quite frankly, I could not find the time or energy. After the summit, I had every intention of doing a series of blog posts and for a variety of reason it never happened.

After such a long delay, I thought I might never do a post about the summit at all.  As things would have it however, there was, and continues to be, a message from the Summit I feel compelled to share.

From day one of the summit, I knew we were in for a powerful weekend. During our opening ceremonies, Imam Mikal Shabazz brought us a message, one that, in my opinion, became the most important message of the entire summit.

He began… “This is a Summit, and not a conference… According to the dictionary, what is a summit? A summit is a place where the highest levels of leaders and officials gather… And when we think about a summit in the natural environment, a summit is the highest peak… and when you reach the summit you have accomplished something but what you have accomplished is not reaching the summit in and of itself but reaching the summit and then taking a look out into the horizon and seeing what you can see from the summit that will benefit others”

He reminded us that both Moses and Dr. Martin Luther King Jr, were called to the summit… to the mountain top… and let us know that WE too had been called.  We sat at attention as he assured us, if there was any doubt that we had been called… “You are here, so that means you were called.”  And with that he asked… “Why are we here?? That’s something we have to reflect on. Many have been called, few have been chosen and YOU are here, and there is a reason why you are here.”  That set a powerful tone.  Yes we had been called and we knew we had a serious task ahead.

This message, this idea of being “called,” is not new to birth workers and it was reiterated the following day by Sula “The Doula.” She added another dimension as she shared a lesson she received.  Her teacher reminded her that as she accepted her calling, she must recognize her calling came with a window of opportunity. What are you going to do while that window is open he asked her? And she asked us the same question.

I was overwhelmed with emotion the entire weekend. Through the words of Imam Shabazz, Sula “The Doula”  and others, it was confirmed that I was walking on my path and my life is being divinely guided. On my 1.5 hour drive home I cried tears upon tears of joy and gave thanks for the revelations I received. I realized that have been called and my window of opportunity is NOW.

Recently, I had been challenging myself and trying to understand my role as a midwife. I have been looking, reading, listening, searching for a sign, direction, the perfect push to move me in the direction I was to go. There have been times when I felt like I was less of a midwife because I was not “catching babies.” This summit, with its many words of encouragement, and the revelations I received assured me that I was on my path. The summit gave me confirmation.

On the last day of 2011, I was literally on a mountain. I did not reach the summit of Haleakala but as I enjoyed the incredible views from the mountain, I felt an overwhelming sense of peace, and I was reminded of the messages from October. I have been called, and I am humbled by the reality of what that means. I am grateful for the opportunity to serve women, to assist with the ushering in of new life. I know that as I continue on my path as a “virtual midwife” and pregnancy coach, as I continue in my role as the South East Regional Rep for ICTC, whether I work as a home birth midwife or hospital based midwife, all of these things allow me to serve… to be… to do what I have been called to do.

ALL of us, who do this work have been called. Are you a birth worker? If so, you too have been called to the mountain top. Have you accepted your calling?  We know it to be a calling. We know it to be a work of passion and humility. We know it to be a labor of love and I am honored that I have been called. I accept my calling and look forward to helping you Birth Something Beautiful in 2012 and beyond.

In Birth and Love
Nicole

Stop Bey Bashing and Focus on Helping Women Birth Something Beautiful™

WOW!!! So much is being said re: Beyonce’s birth. I didn’t even know she had given birth until I got to my computer this afternoon.  And folks have been goin HAM.  I guess I have been too busy dealing with the issues in MY life to know what was happening. But after a few tweets and FB postings I was FORCED  to read an article or two, or three LOL…

But seriously folks… every woman has a right to Birth Something Beautiful™ in the way she thinks is best for herself and her family.   I want a home birth. Some think that’s crazy. She had a c/section  and unless HIPPA laws have been broken that’s about all we really know. (UPDATE… apparently we know little to nothing… Sooo  she didnt have a c/section per this article… which is one of my points anyway)  So lay off… get a life…  and let’s focus on the mothers and babies that  NEED our attention; The ones that can’t afford to block off an entire hospital floor.  The babies too numerous to count that never reach their first birthdays. The mothers that remain virtually nameless in our larger society because so few of us really KNOW a woman who died from complications of childbirth.  Let’s lend our attention, our focus, our blogging, our voices  to the real issues around birth. Stop bashing Beyonce for the decision she made (especially since we don’t know the details of her experience) and let’s focus on  educating as many women as we can so that they will have the information THEY need to make wise choices for themselves and their births.  Now take a listen to Glory as father Jay-Z celebrate lyrically the birth of his daughter. 

While you are listening… think about the REAL issues and ask yourself what have YOU done TODAY to help make sure that the pregnant girl down the street or the pregnant woman in your office building has the information SHE needs to make informed decisions.   As Birth Advocates who are against the unnecessary medicalization of birth, our job is not to spew hate, make accusations, and judge. Rather we are here to help, to love, and to support women Birth Something Beautiful™.  Let’s go make THAT happen!

In Birth and Love
Nicole ~ Don’t forget to follow me on Twitter @SistaMidwife

#GiveThanks for 2011… OR… Happy New Year!!

It’s December 31, 2011 and as the New Year arrives in every time zone in the United States, I will be on a plane in the air; Sleeping hopefully, on a red-eye flight to Chicago.  Sooooo I wanted to take a moment NOW to say have a safe, fun filled, blessed, New Year’s Eve celebration.

Twenty–twelve is going to be a FANTASTIC year.  I believe it. I have claimed it.  And it is so. We all have the ability to make it so.  Have you claimed your blessings for 2012??

If ever I was in doubt… 2011 showed me that yes, in spite of how things may look… The Universe does support me.  The Universe supports all of us! Two thousand eleven reminded me that perception is important and gratitude is essential.  #Givethanks for 2011.

This week, I had the wonderful opportunity to work in Hawaii.  It made for a few VERY long days.  I also had some free time and actually survived the “Road to Hana” yesterday!

Whenever I spoke about my work trip to HI, I mentioned that I would be flying home on a red-eye flight on Dec 31^st. I would often get the reaction “What!? You are going to be in flying on New Year’s Eve” and I am like “Yep… coming from HAWAII!!!!!!!!  “ They are thinking… what a boring way to spend the night. I am thinking…

How great is that?!!  Yep!!! Twenty-twelve is going to be a GREAT year to Birthing Something Beautiful!! It’s all in how you look at it. #Givethanks

Love, Peace, and Blessings to you and yours!!!  Happy New Year!!

~Nicole~  @SistaMidwife