Scars remind us where we've been. They don't have to dictate where we're going

Sunday, May 15, 2011

Baby Catcher

I have been meaning to blog about this book since I finished reading it what seems like forever ago.  Here I am now, almost through Ina May's Birth Matters, and I haven't shared my thoughts on this book.

Put simply, it's magnificent. Basically, it is the story of one midwife's career--from hospital nurse to CNM attending home births and back into the hospital as a staff midwife.  What drew her into private practice was a realization that, in the hospital at the time she was a nurse (in the 1970s), birth was often treated as pathological until proven otherwise.  The stories she related of women being knocked out, tied down, and having all manner of things done to them without their consent were pretty horrific.  It's kind of hard to believe these kinds of things took place in hospitals in our country not so long ago.

One quote from early in the book, before Peggy opened her private practice, which really resonated with me, is "Women's bodies have near-perfect knowledge of childbirth; it's when their brains get involved that things can go wrong."  On that note, I ordered the EFT Manual recommended to me by J in the hopes that I can really get out of my head and release any fears I may have before T's birth, so that during my next labor, I can really shut my brain off and just let my body do its work.

Anyhow, I digress.  The meat of the book is spent sharing stories of clients and their births during her home birth practice.  Peggy is such an excellent writer--you feel like you get to know the women she talks about as intimately as she does.  I loved reading the stories of their births--they were so very different in how they labored, and it was nice to see how different women coped with the intensity of labor.  Some were funny, some complained, some were fascinated at what was going on in their bodies, and on and on.  Her client base ranged from those that had alternative lifestyles to the ordinary, every day woman.  All of the births were as individual as the women themselves, and there was always a sense of excitement and joy in her relation of their stories.  And a great deal of humor, which I loved--one of the reasons I love K so much is her ability to make me laugh, which I really value.

I was actually really saddened when I read of how her private practice closed, after being unable to renew her malpractice insurance as the result of being sued by a woman whose baby was damaged--not even a home birth client of hers, but a woman she had agreed to be a labor coach for until she transported to the hospital.  A woman who had been advised by her doctor to get to the hospital early in labor as he felt the baby needed careful monitoring.  However, this woman had her own ideas, it appears, and really wanted to birth her way, despite the warnings.  Due to an unfortunate set of events, this woman's baby suffered catastrophic brain damage as a result of a prolapsed cord.  Despite the fact that nothing Peggy did or didn't do would have changed the end result**, she was sued and forced to settle for a large sum of money, after which she could not retain malpractice insurance.  As an attorney, this part of the book really fascinated me.  I understand there are certain groups of people who feel that midwives should have to maintain malpractice insurance.  Here in Texas, CPMs are not required to carry malpractice insurance, and I personally, am just fine with that.  If they were forced to pay premiums on insurance, many of them could not afford to remain in practice--or they would have to charge so much for births that many women could not afford them.  And, in my opinion, choosing a home birth means accepting a certain amount of responsibility for whatever the outcome may be.  Yes, your baby could die or be damaged--very unlikely, but your baby could.  I think it would do home birthing women a great disservice to impose requirements on many competent, professional midwives that would force them out of practice.  And if we impose these kinds of requirements on home birth midwives, we run the risk of turning home birth into something potentially as litigious as hospital birth.  So many of the practices in hospitals are done out of fear of being sued, not necessarily what is in the best interest of mom and baby--precisely why some women are drawn to home birthing in the first place.  If we start imposing the kinds of requirements on midwives that would force them to operate more from a CYA standpoint, we run the real risk of losing any semblance of normal birth in any setting in the United States.  We also would run the risk of forcing women to choose between unassisted childbirth or having an attendant whose primary motivation may be ensuring they are not sued at the end of the day.  I would really hate to see what that would do to birth in this country.

After her practice closed, Peggy took a position as a staff midwife at a hospital, and it was actually really, really sad to see how different birth was there.  I am not ashamed to say I got a little misty eyed at all that she, and all her potential home birthing clients, lost.

Peggy includes an Epilogue on the situation of birth in the United States at the end of the book, and I agree with much of her sentiment.  In addition, she includes some Appendices--one is just a short list of advice and things she's learned throughout her career, another is a list of supplies for the home birth midwife, there is a recipe for caramels (mmmmm), as well as statistics on the safety of midwives, and on and on.

Overall, this book was excellent--easy to read, and at the same time, extremely thought provoking.  A definite must read.

**As an aside, the paramedics in this story reminded me of the ones who transported me to the hospital during E's birth.  They weren't rude like the ones in the book, but they were definitely moving sooooooo slowly, as if nothing were emergent.  Luckily, nothing was, but if I had been ruptured, we would have been in a world of hurt.


  1. I loved that book! I am also of the sentiment of "if there wasn't malpractice insurance in the first place, there wouldn't be the same incentive for people to sue." It's like dangling a pot of money out there. The woman in the book made me particularly angry, because as you said, Peggy went out on a limb for her, only to be punished. Because the woman was terribly selfish and unwise, think of how many other mamas missed out on having homebirths with an amazing and talent woman.

  2. I love this book, & at this moment in time, believe that if I were a midwife carrying malpractice insurance, it would be one more thing that shifts the focus away from normal birth. Also, I try to remind people that just because doctors carry malpractice doesn't make a birth safer. Perhaps the opposite?

  3. Emily, I totally agree at being angry with the woman. Like the doctor said to Peggy when advising her to get a lawyer, though, certain types of people get really ugly when tragedy strikes. And I was really pissed at the system that forced Peggy's hand, even though she was not culpable at all. I was just really disappointed that her practice closed because of someone's inability to take responsibility for their own actions and decisions.

    Margaret, I agree--it's the opposite. How many discussions have been had lamenting the fact that nurses and doctors pay more attention to that little print out of baby's heart rate than to the laboring woman because it's something concrete that can be used as a defense in court? How sad that instead of focusing on more personalized care, which I think would improve outcomes, the focus is on creating and maintaining a defense in a potential lawsuit?

    I think the bottom line for me is this--accepting personal responsibility for the decisions you make, the risks they create, if any, and not trying to pass the blame in the event that something goes wrong. I think there are people out there who can't do this, and IMO, they shouldn't be birthing at home and then complaining that CPMs don't carry insurance.

  4. I loved this book when I read it early on in my pregnancy. I had just switched from my old OB to my homebirth MW and when to the library looking for some of the over 20 books they recommended I read... Baby Catcher was the only available. Can you imagine? Like homebirth is blacklisted even at the public libraries in Maryland.

    I was so hoping for an easy birth, like Peggy's second one, instead, I got one more like her third... haha.

    I agree with you and Emily on the malpractice. I had to sign a waiver saying that I wouldn't sue my MW's and that I agreed to the risks. I knew what the risks were, knew they were far greater in the hospital and happily signed the forms. Although, if my baby did have brain damaged and required around the clock care for god knows how long... I really dont know how we would have paid for it... especially if our insurance wouldn't cover it. Then whats a family to do? Hard questions.

    I wonder what was done 200 years ago... Poor family has a severely handicapped baby they cannot afford... I guess people would give the child to an orphanage. But who would take a child requiring medical treatment upwards of a million dollars a year? I don't know what the right answer is.

    In Peggy's situation, obviously she was not in th wrong even slightly. I would have sued the doctors at the hospital like crazy though. An unnecessary c-section to get out a brain dead baby. Sue, sue, sue. Or, said no myself. There has to be some blame put on the mother to agreeing to it. Although, the state may have sued her under the assumption that she caused the death of her own child... hmmm. its really complex, to say the least.

  5. Yeah, I thought a proper party might have been the doctor who insisted on the cesarean and then (gosh, this sounds awful), but worked for a really long time to bring the baby back. Of course, dealing with a baby who died would be horrific, but look what happened because this doctor was so intent on "saving" the baby. Did he really save him? That baby now had to live (still lives?) in a persistent vegetative state, with only base brain function--just enough to keep him alive, but he won't lead a meaningful life, in any sense of the way that phrase is usually understood.

    I think the mother was to blame for her behavior before the birth and her insistence on staying at home (and it appears she called Peggy late after labored had started, from what I understood), despite being told both by her OB and by Peggy that her pregnancy was too high risk (and not just because of her previous cesarean, but because of that particular pregnancy and that particular baby). She seemed intent on "putting one over" on her attendants, and doing things the way she wanted to do them, despite having the risks spelled out to her. And because of her own choices--which she absolutely had the right to make--her baby's life was compromised. Unfortunately, she couldn't accept the responsibility that went along with the decisions she made and Peggy, and her backup OB who was also not at fault (and had in fact, point blank told her NOT to do what she did), had to suffer for it.

  6. Oh yah, I totally agree. I definitely think that baby would have been much better off not surviving. It has been my belief for a while now that quality over quantity. I would much rather really live for a short time, then simply exist for a long time. And I wish the same for my kids. A screaming unresponsive vegetable is not living. Being hooked up to machines and confined to a bed is not living. Thats existing. That baby was put into out of home care and the mother reported that the child simply screamed. What a horrible life for both the child and the family. I would much rather bury my child then have to visit them screaming in torment in some home, while simultaneously going bankrupt paying for it, thus damaging the lives of my other children and destroying my marriage.

    Yeah, that was the weird part for me though, the doctor, if I remember, didn't want her having a HBAC. There was no way they could have known that the cord would prolapse was there? It may have just been coincidence that they were very concerned over her previous csection and she ended up with cord prolapse. I wish I could remember the details from the book. But bottom line, definitely no one at fault for the brain damage. Thats why the mother actually sued for wrongful life. So sad.

  7. Yes, I agree with quality over quantity and would want the same for my children as you.

    The baby had an unstable lie, which actually puts the baby at a greater risk for umbilical cord complications. That is why the doctor told her he could no longer be on board with her laboring at home for a long time, and she needed to be monitored from early in labor. I don't think Peggy even did HBACs, as a rule, because she told this woman that she would have to have her baby in a hospital when she initially tried to hire her. I'm not sure if that's just because of where they were in the country or at the time HBACs weren't really considered, but Peggy said she could deliver her in the hospital, but not at home. Since the baby did have such an unstable lie, a prolapsed cord became a concern, and that's why she was told to come in early--of course, you can't predict these things, but there are some risk factors that increase its incidence and an unstable lie is one of them.

    I actually was a little unclear about whether the woman did wait too long to call Peggy. Her water was broken when Peggy got there, but I wasn't sure whether she knew it or not--and there was meconium, which the mother described as bloody show over the phone (it appears she was confused about this?).

    And don't even get me started on those slow poke ambulance drivers! Can you believe they were actually arguing with Peggy about needing her license and all that when there is a baby dying right in front of them?!? That whole birth was such a tragedy of errors--the mother wasn't the only one at fault, for sure, but I felt a good deal of responsibility fell on her shoulders.

  8. About the paramedics, when we took Bradley classes, there was a fireman/paramedic in the class with his wife. He had never delivered a baby, but he said that all the men he worked with hated OB calls and would complain when they got a call to transport a woman in labor or deliver a baby.

    We saw the couple again at the reunion after our babies were born, and his wife said that, about 3 weeks after their son was born, her husband responded to an OB call and delivered a baby in the ambulance.

    Maybe paramedics should be required to read some of these books and take some natural childbirth classes, too. :)

  9. Lauren, I definitely agree they should! There are so many (well, relatively many :) stories of babies being born in ambulances or with EMT assistance, I think a lot of people think they have this specialized training when they really don't. I know I used to think so!!

    This couple was a home birthing family? Or at least an out of hospital birth? I wonder if he felt their birth was good practice for his hospital transport :)

  10. Melek, it's Catherine (Cakewalk), but I think you were asking me about the EMT in my Bradley class. Their birth was actually an all-natural hospital birth, but she had some complications during the birth and had to have surgery immediately following it, though their baby was fine. I think the baby he delivered in the ambulance came much faster and easier.

  11. Oh my goodness, Catherine, I totally brain farted out of nowhere! Ha! What in the world?!?! That's mommy brain at it's best :)

  12. Off topic a bit, but once my mother fell and hit her head and when the "emts" came they said she needed a neck brace on, then proceeded to open up INSTRUCTIONS on how to put one on... uh... i was like, havent you done this before? "No, we're only ambulatory drivers, theres no law in MD requiring licensed EMTS to ride in an ambulance." HUH? They just need a special drivers license! Then they said they had to bring her down the stairs on a stretcher board and kept flipping it over to see which side of it was the right one. i almost told them to leave and that i would take her. incompetent fools!

  13. Lauren, knowing you, I'm laughing because I can only imagine what choice words you had for them! I would pay good money to have seen the look on your face LOL!