Confessions of a “medwife”

true confessions

“Medwife” is a term of derision typically applied by lay midwives (CPMs, LMs, DEMs) to real midwives, certified nurse midwives (CNMs), to signify disgust with using actual medical knowledge in the care of pregnant women. This “medwife” wrote to me in the wake of baby Gavin’s death to express her sorrow at such a needless, senseless loss of life. During the course of our correspondence, she explained her philosophy to me so eloquently that I asked for permission to publish it as a guest post.

 

On being a Medwife:

I do not believe babies know when to be born at either end of the spectrum. I am certain no baby intends to die in his mother’s arms on the verge of viability or in her womb pushing well beyond the dates. I use tocolytics to provide steroid administration and provide neuroprotection, 17P to prevent a subsequent premature birth. I believe frequent antenatal testing provides a level of reassurance beyond 40weeks, but will nudge your baby along at 41 weeks with little left to gain from conservative management regardless of the reassurance.

I believe our bodies do grow a baby too big for us and I believe shoulder dystocia is a sentinel event even in the hands of the most experienced providers. It is not a situation caused by poor maternal positioning or relieved by Gaskin maneuver and certainly not in a bathtub of your living room. Watching a healthy baby die on the perineum is a vision to haunt your nightmares for a lifetime.

I don’t believe in the 39 week rule. It will prevent some early term birth admission to a NICU, but will also cause hesitation by providers to act for fear of statistical outliers and repercussions. I will play within the rules, but will not ignore the soft indicators or the intuition to act upon them.

I believe babies have a due date, placentas expire and not much good comes after 41weeks. I do not believe waiting for a baby to display signs of decompensation is the time to act. Perhaps a poor tracing, MSAF and a neonatologist fit into your 41 week plan, but then again perhaps you didn’t really want the intermittent monitoring, minimal attendants and delayed cord clamping.

I believe in preeclampsia. I respect its etiology, pathology and spectrum of progression. No diet, herb or pressure point will prevent the sequence of severity. If you argue or ignore the recommendation to move towards immediate delivery and days later your ICU admission or eclampsia means crash carts and ventilators…your partner has officially forfeited his right to ask “wasn’t there anything you could have done to have prevented this?” I will just walk away.

I believe GBS treatment does not include garlic or tea tree oil. Protecting your baby’s gut flora may seem so important now, but means so little in light of GBS meningitis and seizures or the dopamine drip in the midst of septic shock should it be your baby that becomes the statistic.

I believe in VBAC with a heplock, continuous EFM and my OR team within feet of your room. I will not push the limits. As wonderous a window into the womb as your translucent uterine serosa may be, its presence means this OR is just where you needed to be.

I believe twin births in a dimly lit room with hushed voices can be safe, but that room is best located as an OR and behind those dim lights and hushed voices lies the wonder and safety net of an OB, anesthesiologist and neonatologist.

I believe in Vitamin K. Your fears should lie not in the process of administration or theoretical risk of preservatives, but in the absence of its existence. The process or risk will be far from thought if your child is the child flown to tertiary care with ever expanding head circumference and abnormal neurologic exam.

I believe in Rhogam, its safety and its efficacy. Your unfamiliarity with hydrops fetalis in an era of rare sensitization does not lessen its impact on your baby when undergoing MCA Doppler flows, premature delivery and multiple blood transfusions. Your decision to ignore the real risks and let fear based blogs will not prevent this from being your baby or your regrets.

I believe in breastfeeding, BUT I refuse to allow a mother to feel any less a mother for how she chooses to feed her baby. You may never know what lies behind her decision to bottle feed, but you have an obligation to respect and honor it. Just as labor and birth is one miniscule step in the process of mothering, so is feeding method. In several years no one will know who was born how or who was fed what. It really is that simple.

I believe in the wonder of birth. An unmedicated natural birth and it still leaves me in awe of its beauty, but I also comprehend its functionality. Your coconut water, lavender and doula make you no stronger a woman than the woman next door with a continuous epidural catheter or the mother down the hall lying on the OR table laughing and smiling at her baby’s first cry. Birth is amazing, but it isn’t how we determine our strength.

I believe in interventions from AROM to EFM to Pitocin to forceps to cesarean birth. My responsibility is to observe for progress and wellbeing, as well as to utilize the interventions at modern medicine’s disposal to ensure the safest path and highest outcome. Although I cherish and find reward in the intimate relationship we develop over the course of your care, my responsibility is to the health and well-being of you and your baby. Do not confuse my caring and compassion as a desire to become your friend. I will hold your hand, I will be compassionate…but I will not be afraid to use my ‘dead baby card’ or alter my care to avoid ‘hurt feelings”. If that is what it takes to make you realize these evil interventions stand between the health of you and your baby or the risk to disability or death, I will play my ‘card’.

I believe in doulas by definition, not as adjunct providers. The security and support of a doula can be a positive contribution to your birth experience, but so can your labor and delivery nurse. Please don’t discount the skill and support of your nurse and don’t use a doula to make medical decisions. She has not the training or authority to do so. Your doula is there to support you through labor, not create an atmosphere of animosity.

I will listen to the woo and my office schedule will fall behind, but I will gain the trust that keeps you here and not in the hands of an unregulated, unaccountable and uneducated CPM or lay midwife . I will listen to words of concern, because I believe every mother inherently seeks to protect and desires the very best for her baby. I will seek to clarify, educate and empower in order for others to comprehend the science behind the care I provide and the recommendations I make. My care and recommendations will be based upon guidelines, developed and supported by the highest level of scientific evidence; not chat rooms or anecdotes. I will do this because it is my responsibility as a health care provider and is not intended to cause fear or to disillusion ignorant bliss.

I am saddened by the liberal application of the title ‘Midwife’. I am disheartened when my years of formal education and commitment to continuing professional growth are soiled by the unprofessional and unregulated ranks of others who feel it is their right to share this title. As much as I looked forward to holding the title of “Midwife” I feel relegated to distinguish myself from it.

As others attend Blessingways, perfect the art of holding space and call themselves midwives… I will sit here and read my Green and Grey journals, among RN’s, CNM’s and Physicians. For I am the Medwife and I will be here alongside my colleagues, our resources and interventions keeping birth safe…ready, willing and able to identify and intervene when it’s not. If in so doing I am less the Midwife and more the Medwife, there are no regrets.

  • Arielcnm

    I’m one of those CNMs that gets called a medwife. I PUSH BACK. I say those doing the name calling are charlatans, incapable of recognizing what it means to truly be “with women”. We owe women and babies nothing less than clinical excellence in midwifery, and that means CNMs.

  • Sheila A.

    And believe it or not, as a lavender-loving doula (also nursing student with intent to become a CNM), I actually agree with 90% of this post. 🙂

    • Guest

      Bounding sense of curiosity, what was the 10% you didn’t agree with. As you pursue your endeavor towards nursing and becoming a CNM, always keep an open mind and allow the science and your experience to shape you. Best wishes along your path.

  • MacArthur Obgyn

    Excellent post

  • DrDEG

    WOW! As an Ob/Gyn, I agree with all of these positions–would she come work for us? Very nicely put and completely on point.

  • Samantha

    My friend is attempting a home birth RIGHT now and I’m freaking out. I gave birth twice with a CNM in a hospital. It was great both times. It was great because even though I had attempted or envisioned natural births, I was SO relieved to get my epidurals! I was so relieved to be taken care of and kept safe. I trusted the Nurse Midwives and nurses to help me make the right decisions. I would never give birth at home. My second child had aspirated meconium and was a 0 at birth. The NICU doctor was in the room when he came out and swiftly brought him up to a 9. I was frozen during those moments when I was waiting to hold him. I was soooo grateful to the doctor and nurse who helped my baby.
    One thing I would recommend to mothers to be is meeting with the hospital anesthesiologist and make a plan about what kind of epidural you would prefer. Read about it. Getting an epidural can help you have a positive vaginal birth experience!

  • moto_librarian

    Thank you, Medwife, for all that you and your true colleagues do to keep us and our precious babies safe. My eldest child will turn five in August, and I know that had I not been in the hospital under the care of a CNM, I would almost certainly not be here to watch him grow up.

  • TellTheWorldWhatCNMmeans

    Something a friend posted on Facebook that reminded me of this article:

    “So, I want you all to know what a “nurse midwife” is, because when I say I want to be a nurse midwife, people get confused and think of the usual.

    I do not want to be a “lay midwife”. A lay midwife is what comes to mind when you hear “midwife”, but it shouldn’t be. Lay midwives are baby catchers without a formal education, relying on education passed down to them from other lay midwives and unable to provide proper fluids/medications, preventative care, and extensive ante/intra/post-partum safety measures for mom and baby. Having a lay midwife come to your home to deliver your baby is a personal choice, but what if there is an emergency? You have the most perfect pregnancy, and nothing seems wrong. Your contractions start, your pain begins, baby is descending, you’re pushing–and then something happens. You need extensive intervention. Where is your CNM to gather all the tools and knowledge that is necessary to save your life, or baby’s? Your herbs do not help. You trusted birth with all that you had, and now things are going wrong. So what is the next step?

    A “nurse midwife” is NOT a lay midwife. Certification in Nurse Midwifery (CNM) requires an extra years of education and clinical hours, a masters degree, and LOTS of experience in obstetrics and mother/baby nursing (if you want to be a good CNM). It is a professional degree. Nurse midwives work round the clock hours assisting their patients in deliveries, and take over the entire birth if the obstetrician can’t oversee it. They can diagnose and treat, as well as prescribe. They have tools to identify problems early, as to intervene early and to prevent complications. Their purpose is to ensure a safe pregnancy, labor, and delivery for both Mom and baby, oversee family interactions, provide education to new families, assist in contraceptive methods, provide postpartum care (sutures, hygiene) and provide Mom with the most comfort and support during a harrowing labor. Some go as far as getting onto the bed with Mom and helping her push, counting for her, rubbing her shoulders, etc. They are there for Moms that don’t have support, and for Moms who already do. Life-threatening situations, or ones that can result in lifelong problems, come up during labor more often than people think. CNMs are skilled in identifying risk factors, predicting what may happen, and preparing to save a life if need be. When all is on the table to save a life if need be, and there is no means to use any tools because pregnancy and labor is progressing well, they are there to hold mom’s hand and support her all the way through. BUT…doing so knowing very well all of the interventions on the table nearby–just in case.

    A nurse midwife is NOT a lay midwife.”

  • Deena Chamlee

    Bless her heart. And bless those in our profession that understands the outcomes of birth are in fact our responsibility. And not the responsibility of the fetus or mother.

  • MJ

    I am intensely grateful to and respectful of the midwife who cared for me during my last pregnancy, precisely because of the wonderful way her commitment to birth intersected with her professionalism.

    I know this is really long, but I hope it illuminates the experience of professional midwifery for those who are still wondering. And I also simply want to pay my respects to my ‘medwife’ for the ways she shaped my beautiful boy’s entrance to this world:

    – She became ‘friends’ with my four year old. At each prenatal appointment she would co-opt him to take my blood pressure and use the Doppler, and give him a pair of latex gloves to wear and another pair to take home. For a while he was adamant he wanted to attend the birth (even announcing loudly in the change room at the swimming pool one day that he CAN’T WAIT TO WATCH THE BABY COME OUT OF YOUR VAGINA!). When asked, my midwife was quite happy to have him present in the birth suite at the hospital, although ultimately I decided against it.
    – She liaised with an endocrinologist when some of my thyroid tests came back a little wonky (ultimately all was fine).
    – When my waters broke at 37 weeks exactly she took my call at 6am on a Saturday morning. When labour didn’t start she spoke with the registrar of the hospital and gained approval for me to remain at home for 48 hours provided I had an NST in the hospital both days and was thoroughly briefed about the signs of infection. She simultaneously scheduled an induction for 7am on the day the 48 hours expired.
    – She started my induction, consulted with the on call ob at various points about my syntocin levels, cheerfully unhooked me from the monitor when I decided I wanted to go to the toilet every 20 minutes, and ultimately, with a simple change of position got me from no labour into quite a lot of labour!
    – When she needed to do an internal exam to check that my hind waters were also broken she drew a diagram to explain what the hell hind waters were. She also had the ob come in and give her a second opinion.
    – For those who care about that sort of thing, not one single time did she enter my room without announcing herself behind the curtain and waiting for me to say it was OK. She spent hours just sitting in the corner of the room silently being ‘with woman’ – and with woman’s cEFM monitor
    – When I went through transition she called in a second member of her midwifery team, because you always have one attendant for mother and one for baby. She also changed her friendly, jolly tone immediately when I got all bolshie in transition and demanded in no uncertain terms that she take the cEFM pads off. That, apparently, was not going to happen.
    – She coached me through the pushing stage so expertly, including telling me when and how to stop so she could quickly and easily loosen the cord around his neck and allow my baby to be born through it.
    – She immediately put my beautiful son on my chest and continued to check his heartbeat and other indicators. Although his colour was a little dusky she was able to reassure me that he was fine. And she wasn’t just assuming – while I was crying in awe of my amazing third child she was checking all the indicators. (She later told me she’d rarely seen an obviously healthy baby take that long to pink up completely – about ten minutes. But that she knew he was ok because his trace had been consistently fine, he breathed immediately, his heartbeat when he was on my chest was good, he was strong and not at all floppy, his gums pinked up pretty much straight away, and he was looking for food almost immediately).
    – She didn’t raise an eyebrow at my husband’s dread of umbilical cords and waited until he was out of sight to ask whether I wanted to do anything with the placenta other than send it to medical waste. I realised in three pregnancies I’d never seen a placenta so she brought it over, poked around in it and explained some of what we were looking at. Then her team midwife merrily wheeled it off for disposal, joking as they did about the otherwise very professional trainer they’d had who thought all midwives should pray over the placenta before throwing it out. I have no doubt that if the placenta had held some meaning for me she would have been entirely respectful and accommodating of that (in fact, my hospital had a publicly available policy/procedure for taking the placenta home).
    – When we were moved from the birth suite to my private room (with bathroom, baby bath, and double bed for my husband to stay over) I couldn’t bear to have my little one in the mobile crib so I walked the corridors with him in my arms. I her if there was any OHS or liability reason why I should leave him in the crib. She said “he’s your baby, you just gave birth to him. No one is going to tell you what you can or can’t do with him”.
    – Next morning she was back and did my boy’s newborn check. When she found his fused toes she arranged for a paediatrician to come in and check they were not going to affect him functionally. She arranged his newborn hearing screen and did the recommended vaccinations. She also gave me the pertussis booster that is recommended for parents before they leave the hospital.
    – She came to my home three or four times over the following couple of weeks and did the vitamin K and all tests on my baby and I.

    I have a beautiful photo of her sitting on my lounge holding my son and beaming with joy. She looks like a young professional woman who loves her job and does it well. To me, hers should be the face of midwifery.

    • If I ever have children, I desperately hope that my experience is like the one you described. What a lovely person, and your son sounds awesome!

  • Zoe

    Sounds a lot like my midwife (or medwife, if you prefer). Ounce of prevention, and all that…I have no regrets about my c-section, in fact I’m grateful! Another time or place, and my sweet little boy wouldn’t be here. I’m thankful for my midwife who recognized the problem, I’m thankful for the OB on call who performed the c-section, thankful for the nurses who supported me through the whole thing, and finally, grateful for the science that saved my little boy!

  • StudentNurse

    So here I am in nursing school, going to the ER, going to Medsurg floors, going to psych units–and then there is the OB floor. It is my favorite, and is close to my heart. Do you know why? Because those on that floor know what they’re doing. Do you know who I look up to the most? A provider that has a background in nursing–care, compassion, and patient centered attention–as well as a provider that has professionalism and expertise, and continued education. Those are two very different realms but come together beautifully to make one of THE BEST kinds of providers. A NURSE MIDWIFE. The CNM that I follow on my floor is one of the warmest, most compassionate providers I have learned from. She is also tough, and will go out of her way to say NO DOCTOR YOU ARE NOT DOING THAT TO MY PATIENT when she sees fit. She’s not afraid. She is the same way with patients as described in this article–she will let them know the truth if there is a potential problem on the rise. Not to scare mom, but to help her make decisions that will greatly impact her life and/or her child’s life. The CNM is completely different from what I read that home birth midwives are. Where are the guts in home birth midwives? Where is their education? Where is the education that gives them backing to say “NO DOCTOR!”? Where is the background in nursing, where do they learn to have an eye for a problem? Not just intuition–but where do they learn true patient interaction? Where do they learn to apply their knowledge they learned in school? Oh–they can’t. Because home birth midwives do not spend 3-4 years EXTRA in college–usually no college at all. So how do they REALLY know what to look out for in their patient? This opinion of mine only becomes stronger as I spend more and more time on the OB floor. CNMs know when to intervene, and they even plan for it. They save lives. Thank you, you beautiful, educated nurse midwives, you.

    • MJ

      I couldn’t agree more.

    • Medwife

      I don’t have that kind of relationship with the OBs I work with. Turf battles are not cool. One thing I like about my situation is that we have good protocols for independent management vs consultation vs referral. If you call a consultant in on a patient you’re managing… Well, let’s say if you’re not going to take their advice, don’t call em.

      • LMS1953

        Thank you, Medwife. That is what collaborative care is all about.

        • Guest

          This takes me back many years to a conversation with two OB’s who were very blunt in stating they worked too hard for their degrees and would never risk their license to back up a CNM or GP. Didn’t hold it against them. They’re right, they did work hard to earn their licenses. When they started providing my back up a few years later, it really meant a lot and I didn’t take it for granted. When I take call and cover their practice for them now, it means even more. Yay, Collaborative Care!

      • StudentNurse

        Yep. Just want you to know as a student nurse and observer on my floor these TURF BATTLES are still very real and they happen. Not generalizing OB docs here, because almost all of them are good team players. Just used this as an example because IT HAS HAPPENED RIGHT IN FRONT OF ME while on floor. I can’t ignore that is still a problem only because some people have good protocols. You can have good protocols and still have issues even if everything you do as a nurse midwife is playing by the rules. This post is not meant to emphasize OB docs. If you look closer it is more about the intervening and care that is POSSIBLE for educated midwives to do, if they do so happen to be in this kind of situation. In any kind of situation, compared to home birth midwives. IT HAPPENS. it shouldn’t, but it does.

        • Medwife

          Ok. Just consider that perhaps the practice environment, including the protocols for consultation, co management, and referral, need improvement. Having pissing contents with the docs is not helping your patients.

          • StudentNurse

            You’re right, it isn’t. And I recognize that. However, I do not belong to the hospital as I am only on student grounds. This is not me interacting with the docs causing the problems. Can only do so much/say so much. But recognizing this in my environment is step 1, and something that I will carry with me forever as I become an RN and advance into specialty. This will be a drive to create change, or maintain it. It is sad, and wish I had power to change it.

    • Guest

      Many decades ago as a new nurse I was taught to always stand to offer your chair when a physician came on the unit. It was unheard of for a nurse to question a physician’s plan or order. Fortunately, those days have changed for the better where nursing and medicine collaborate in the best interest of the patient. However, power struggles can and do ensue with a detriment to the patient, as well as the culture of the institution. Nursing school is an excellent opportunity to observe provider interactions, but be sure to look a little deeper at the root cause of negative interactions and you may find the conflict has a base much deeper than you imagined. MDs and CNMs really must have mutual trust and respect for the abilities and expertise of the care one another provides in order for collaborative care to succeed. It’s not a matter of whether a CNM is ‘afraid’ to challenge and MD’s plan of care, rather the ability for both parties to communicate a plan and rationale in the best interest of the patient.

      As for your ability to see the difference between the backgrounds and education of a CNM and a lay midwife or CPM, kudos to you! Your passion certainly shines through! Best wishes to you in your nursing endeavors.

  • MistyMayIsMyName

    As a mother to be this is comforting to know that there are providers out there that really know what they’re doing–and despite taking away some the “natural” elements of birth, the interventions are what could save my soon-to-be baby’s life as my time for labor approaches. You never know what to expect. I am healthy, I have done what I need to do as an expecting mother, but with all of the health in the world I may still deliver with complications. thank you to who wrote this. Lets me know I am doing the right thing arranging for my CNM to be at my labor with my OB doc! Some friends pushed for home birth, but I know I’m in safer hands with my CNM.

  • Amazed

    Update on the c-section gorilla baby: she’s undergone a surgery but seems to be getting better now.

    http://www.theguardian.com/world/2014/mar/15/baby-gorilla-operation-c-section-birth

  • MrG

    “I am saddened by the liberal application of the title ‘Midwife’. I am disheartened when my years of formal education and commitment to continuing professional growth are soiled by the unprofessional and unregulated ranks of others who feel it is their right to share this title ”

    This really begs the question why the traditional midwifery organization, the American College of Nurse Midwives (emphasis on NURSE) continues to align themselves with these “unprofessional unregulated and less educated” people calling themselves midwives. ACNM should be indignant and remove themselves from those people soiling the great midwife name.

    http://www.midwife.org/The-Story-of-ACNM

    ACNM wake up! Defend your good CNMs!
    Don’t let other use your good names!
    Otherwise you go down with these bad people.

    • The Bofa on the Sofa

      Why would they stand up to the CPMs when a large fraction of their membership agree with them? Shoot, how many WISH they had the “freedom” that the CPM has? CNMs are limited by restrictions that prevent them from doing what they want. CPMs don’t have that.

      • Guest

        Not speaking for all CNM’s, but I have to disagree. The last thing I wish for is the freedom to practice like CPM’s. They aren’t restrictions, they’re guidelines to maintain a level of care. I’m not a researcher so I don’t call it doing research…but I don’t hesitate to refer to the sources that HAVE done the research…Gabbe, ACOG & ASCCP or gyne-oncs and perinatologists. Quite a bit different from crowd sourcing FB or chatrooms and throwing caution to the wind of a CPM.

        • The Bofa on the Sofa

          You may not agree, but I contend that very many CNMs do.

          How many CNMs “wish they could do homebirths” but can’t because of those pesky restrictions? Very many, I think.

          • Guest

            I’m not sure what your basis is for that belief, but I would really be interested in knowing whether or not that question has ever been posed by researchers or a professional organization. Personally, I have never attended a homebirth in any capacity, never will. (I could see the hospital from my bedroom window when I was expecting my children, but you can bet I hopped in the car for the three minute drive to be sure that’s exactly where they would be born. If I’m not willing to risk giving birth at home (low risk multip, fast labors) with a nice view of the hospital, how on earth could I expect my patients to do so?!)
            Perhaps I am a wee bit isolated by practicing solely with hospital based CNM’s in my assumption. I could choose to attend homebirths, but I absolutely choose not to and it has nothing to do with restrictions.

  • Busbus

    I want you as my next midwife. 🙂

  • PrimaryCareDoc

    Again, who is referring to AMA women as “elderly” to their face? No one that I’ve seen.

  • RationalOB

    I would rather not use any terms such as elderly, obese, etc when talking to patients. How about direct language….”.your age may increase your risk of pregnancy complications but much of the risk is due to an increase in medical conditions as we all get older such as hypertension, diabetes etc. ” Then direct discussion as appropriate for individual patient and her questions.

    • LMS1953

      I think most professionals feel that way for the most part. The poster “Medwife” simply used the term “elderly primip” to talk ABOUT a patient and not TO a patient. We are all adults here and many of us like you are health care professionals and we enjoy a “safe refuge” where we can use terms and know that readers know what we mean. Like I said before, this is not, My OB Said What where phrases are presented with little context to invite an endless thread of snarky responses that somehow give women “empowerment”.

      Actually, I think it is rather patronizing NOT to use medical terminology in discussions with patients. For example, I have an iPhone app to calculate the BMI. I show the patient which zone she falls in. “Well, you calculate out to the obese zone, but if you lose 6 pounds you’ll just be overweight. Rome wasn’t built in a day. I’ll print out a BMI chart for you so you can set a week by week goal. I agree that some medical terms have pejorative connotations with the lay public but they can be easily defined “on the fly”. Besides, a most annoying part of our zeitgeist is that everything revolves around this group or that group being offended by something or other which offends the bejebbers out of me.

      • Guestll

        It’s completely patronizing not to use medical terminology in discussion with patients, especially when it’s particularly germane to their care. I never liked the term “spontaneous abortion” much, those were 4 babies that we wanted so desperately, but I get that it isn’t personal to me and the term is apt.

      • Medwife

        Exactly. 🙂

        Many of the readers of this blog don’t start out with the assumption that OBs and CNMs are cold, insensitive slice-and-dicers. My looking at the patient’s risk factors and adjusting my care appropriately is part of caring very deeply about her, her baby and her family. My top priority is that she end this pregnancy with a healthy baby (and healthy self too, of course). I am as nice as I can possibly be, and my patients seem to enjoy seeing me, but I will not pretend she’s not diabetic, or older, or overweight because it makes for awkward conversation.

        • Jessica S.

          During an ultrasound a few months back, the tech and I were chuckling over the term “geriatric pregnancy”. (She had two of her three kids after 35 and I’ll be 37 when this one is born.) She said “it’s definitely the only group I can be considered ‘geriatric’.” 🙂

  • LMS1953

    Quote: “I believe babies have a due date, placentas expire and not much good comes after 41weeks. I do not believe waiting for a baby to display signs of decompensation is the time to act. Perhaps a poor tracing, MSAF and a neonatologist fit into your 41 week plan, but then again perhaps you didn’t really want the intermittent monitoring, minimal attendants and delayed cord clamping.”

    Another great comment. Imagine if you own a car and “trust driving”. You never check tire pressure, washer fluid, radiator antifreeze or engine oil. Needle positions on the gauges are all “variations of normal”. Only when the engine light comes on is there concern to find a service station and the Chinese fire drill starts when smoke starts pouring from under the hood. Sometimes the car won’t go any further and a tow truck needs to be called. So, would you be surprised to learn that your car’s engine might be permanently damaged or “dead” and irreparable?

    Same with pregnancy and especially labor. I was in a group with several CNMs at a hospital attached birthing center. They all had the attitude that everything was fine with the baby as long as the proverbial engine light did not come on. “Well, doc, she’s been 5 cm for the past 4 hours but the baby is doing just fine. I think I’ll reposition her (ie, what I’ve called “do the Hokey Pokey”) and recheck her in a couple of hours to see if we should start some pit.” By the time fetal distress is recognized by interpretation of the EFM, the baby HAS BEEN DAMAGED and will probably not reach the full potential s/he was endowed with. Thankfully, the newborn brain has some resiliency and the damage may heal enough to be subtle in the future, but we will never know what could have been, will we?

    • Comrade X

      An ounce of prevention is worth a pound of cure. Most people intuitively understand that. I wonder what the psychological bug is that leaves some people desperate to deny it? It strikes me as relevant, because many of the same people who balk strongly at the notion of preventative obstetric care are the same people who balk at the idea of vaccination, probably the single greatest preventative care measure in the history of medicine.

      • Ducky

        I think in large part at the core of the “bug” is a broad belief system centered around the philosophy that nature is kind and that human intervention messes up nature. Like any other belief system it helps people to order a chaotic and potentially scary world, and provides community and a sense of identity.

        • GranolaTastesLikeFrootLoops

          How do they rationalize tornadoes?

  • LMS1953

    OT: I heard an update on the baby gorilla delivered by C-section at the San Diego Zoo. They said she had “breathing difficulties” and a “collapsed lung”. That kinda sounds like RDS which implies a premature delivery.

  • GiddyUpGo123

    I need to have another baby so I can have her as my midwife.

  • Sue

    Thank you for this article. While the rogues of the profession receive the prominence, I expect that majority of midwives work happily in hospitals with skills, medication and technology, and are happy to collaborate with other members of the team when needed.

    In Australia, where I live, the majority of uncomplicated births in public hospitals are managed by midwives, using all the advantages of the health sciences when needed.

  • Medwife

    This is a silly discussion. I didn’t tell her she was an elderly primip. I didn’t even use the term AMA. I said “over 35”. The internet does not know her and cannot figure out who she is based on my description of the situation, unlike the clients being publicly displayed by the pros on Midwifery Today. I give respect to all my patients, regardless of their ability to pay.

  • Trixie

    If anyone needs some lolz, Jenny McCarthy’s going down in flames on twitter right now. She asked her fans what their ideal quality in a mate would be, and hundreds of people are answering, “vaccinated!”https://mobile.twitter.com/search?q=%23jennyasks

    • Mishimoo

      That is beautiful!

    • The Bofa on the Sofa

      Are they also saying, “Someone who doesn’t think smoking, or even pretending to smoke, is cool?”

    • Coraline

      My husband and I had a good laugh over this!! What a brilliant response!!

    • Jessica S.

      This makes me so happy.

  • Medwife

    (Not the OP) this was so nice to read today. I “played the dead baby card” because I want the elderly primigravida involved to leave the hospital with a living baby, even if she has a surgical scar, and the doula was glaring at me the whole time. Whatever, lady.

    • MamaBear

      I have nothing against doulas, but a lot of them seem to go over the scope of practice. Most are not nurses or have any medical training. I think most provider/patient tension on the L&D floor is caused by doulas because they create this whole patient vs. the hospital war that doesn’t exist in most places. I think if more doulas would help the patient deal with the pain and let the medical personnel do their jobs everyone would get along better. I’m not a nurse ( thought about being an OB nurse once), but I this is just my two cents.

      • Medwife

        Usually I get along fine with the doulas. This one was just mad that I talked about cervadil and pitocin rather than primrose oil, acupressure, and nipple stim. I’m sure they’re hearing plenty of those options from her!

      • yugaya

        I’ve only met one doula ever and she is a psychologist and licensed therapist educated in US and Europe who later became a doula and lactation consultant. We met through mommy baby support group and mailing list that she runs for English speaking moms here and in five years that I have known her I have never seen or heard her cross the line of being anything other than a valuable resource of information, help and support. She never posted or talked rubbish or misinformation , and would give people a balanced and objective breakdown of all their options without resorting to paramedical advice or condescending lectures. Her and I, we pretty much have totally opposing views on childbirth and breastfeeding and parenting, but despite that she has provided me with immense and much needed support for bridging over a very difficult period in my life – when you have just had a baby in a new country and your language skills in your second language leave a lot to be desired for, without the network of your friends and family the post natal period is a sure pathway into major PPD. We met after I had my baby, but if I were having another child and if she hadn’t moved back stateside I would hire her in a heartbeat and want her with me in the hospital more than anyone else.

      • moto_librarian

        During my first pregnancy, I asked my CNM about whether or not I should get a doula. She was quiet for a moment, and then said that she did not find most of the doulas in our area to be helpful or easy to work with. She had one that she would recommend, but that was it. As it turned out, the on-call midwife who delivered me was the daughter of my L&D nurse. They made a great team.

    • Ellen Mary

      If you are really referring to a woman in her 30s or early 40s as ELDERLY, you are exactly what makes me consider HomeBirth. Terminology matters. If I am not called Elderly anywhere else on Earth, why would I want to be called that @ my baby’s birth?!?

      • auntbea

        Well, I might want to be called that if it meant I got to deliver with a highly educated care provider with my baby’s best interest at heart.

        • Ellen Mary

          Yk, it is not that huge of a deal in the end. Just offering a little perspective into the mind of someone who genuinely wants to give birth in the hospital but finds some aspects of HomeBirth very appealing because of terms like ‘elderly gravidia’ and the impersonal, ‘move it along gravidia’ nature of it all.

          On the subject of risks, there ARE increased risks, but there are also prejudices & it is documented that women on either end of the age spectrum receive treatment that reflects prejudice more than medical indication at times. Dr. Amy discussed this to an extent during her post on the Friedman curve. I don’t dye my hair & several times in my most recent experience I started to feel a little bit like the staff was treating me like I was older than I really am because of that. Maybe not, but I am sure that women who are the right weight & age get better treatment in hospital birth, out of proportion to the reduction in risk that these factors actually confer.

          • Sue

            I wonder whether people whose gallstones are referred to as ”cholelithiasis” opt for a home cholecystectomy.

          • Irène Delse

            Ah, but the gallbladder doesn’t have the magical mystical connections of the uterus! You don’t grow babies in it, it has nothing to do with sex or the difference between males and females, and AFAIK religions have nothing to say about it…

          • Ceridwen

            “I am sure that women who are the right weight & age get better
            treatment in hospital birth, out of proportion to the reduction in risk
            that these factors actually confer.”

            For some reason you seem to be assuming that being treated like you are lower risk than you actually are is “better” treatment. This is just as poor of treatment as being treated as though you are higher risk than you actually are. It puts you and your baby at risk of complications going unnoticed and harm being done. How is that better care?

      • Ellen Mary

        And please no one say ‘that’s just the term they taught us in the textbook, what?!’

        Would it be right to throw ‘spontaneous abortion’ @ a miscarrying patient because it is technically correct?!?

        • Mishimoo

          I have had that thrown at me. My problem wasn’t with the terminology, it was with the lack of professionalism from the doctor and nurses when it came to providing adequate information and proper care.

        • Medwife

          I did not throw it at the patient. I am honest that it is the way their status is referred to in medical terminology. We generally have a laugh over calling a woman in her thirties “elderly”.

        • Medwife

          Would you rather go to a provider who ignores your risk status and holds your hand and cheers you on as your baby dies inside you?

          • Ellen Mary

            Why do you have to make it a choice? Nothing in providing safe care involves demeaning women with yesteryear’s outdated ageist, sexist terminology. Do I appear Hysterical to you? 😉

            I just had the healthiest pregnancy to date @ 36. And my providers never felt the *need* to use anything more than AMA. I thought I heard that a little too often for 36, when it was not relevant to any type of indication, but if I had heard ‘elderly’, especially for the first time in labor, I would have been unspeakably upset. If a woman sensibly chooses a hospital birth, why not drop the BS that makes it unpleasant & humiliating & does not contribute to a safe outcome? Why not just stick with AMA?

          • Stacy21629

            I’m sure there are plenty of folks out there that would be offended being told they are of “advanced maternal age” at just 36 years old. Medwife is concerned with the woman’s health and safety and the health and safety of her unborn child. Her doula is concerned about her “experience”. You’re really finding fault with Medwife’s terminology??? Where’s your outrage at the doula that wants to convince the mother that Medwife is wrong and everything will be ok…even if it increases the risk of the baby dying?

          • Ellen Mary

            I am. That doesn’t excuse a doula doing a very different also harmful thing. I am someone who takes medical terminology seriously & really appreciates a provider who uses it carefully & thoughtfully. As a 36 year old, I really don’t like the term ‘elderly gravidia’. Heads up, it is not too popular & has a quite accurate & non emotional substitute.

          • theadequatemother

            You don’t take medical terminology seriously tho. The function of medical terminology is to allow medical professions to have a shared and PRECISE language with which to commnicate and collaborate with each other for the benefit of our patients. I absolutely was taught the term “elderly primigravada” during medical school, and not just from a textbook but from preceptors. But I was also taught to communicate sensitively with patients and their families which involves treating them as individuals. So with some medical terms are appropriate while with others a different approach is required.

            I agree with other commenters, it appears you are insulted by the terminology because you are insulted that we would consider yor pregnancy to have certain elevated risks just because of your age. Well, we know that on a population basis those risks are there. Just because they didn’t happen to you doesn’t negate them. That’s the nature of risk. But what would be insulting is if those risks weren’t communicated to you. It sounds like your care providers did exactly what they needed to. Sorry if it bothered you to be called AMA or whatever but by being called that he were treating you like a responsible adult not a sensitive weak child. Celebrate it because it’s a good thing.

          • Jessica S.

            “You don’t take medical terminology seriously tho. The function of medical terminology is to allow medical professions to have a shared and PRECISE language with which to commnicate and collaborate with each other for the benefit of our patients.”

            / THIS!! /

          • Amazed

            “I’m sure there are plenty of folks out there that would be offended being told they are of “advanced maternal age” at just 36 years old.”

            Me, for one. I am almost sure I’ll be an elderly primigravida. Please call me that and not the offensive sweetening thing doctors say to their patients who are over 80.

            So, we’re in a tie. Ellen Mary’s sensitivities against mine. Why should her tender heart take priority over mine?

            I can see only one reason: I won’t expose my baby to a 450 % greater risk of death and 18 times greater risk of brain damage just because my poor heart could not take the description of the reality of my situation. So, “advanced maternal age” let it be.

          • Medwife

            If we’re being touchy, I don’t love the term “advanced maternal age” because the acronym “AMA” also means “against medical advice”. So I don’t like writing that someone is being tested for being AMA, like she shouldn’t be pregnant.

            Tomato, tomahto. Just get the NST!

          • Medwife

            Unspeakably upset? Humiliated? Whew. I’m so glad you’re not my patient! My homeless and drug addicted patients are really hard to keep healthy but they’re not shattered at the term “elderly”.

          • Guestll

            Ellen Mary, as one older (40 when my first and only was born) Mom to another, I get the feeling here that you’re not objecting to the terminology so much as you are to the designation. You just had the healthiest pregnancy to date at 36. Congratulations. You’re still AMA or an elderly gravida, and it was used on you because it is relevant to a type of indication — the DOB on your driver’s license.

          • Ellen Mary

            I don’t necessarily agree that my risks were that different at 34 years 11 months than they were at 36 years 1 month & I don’t agree that my risks are more like those of a 40 year old than a 34 year old (who I am much closer to in age), but I understand how the research is done, by grouping women into below 35 & above it. However the only designation I object to is as a statistic. My DH wisely reminded me that I am not one recently, and after way too much time reading about this or that risk, I needed to hear that.

            We can agree to disagree: I am just positive that I can get top notch medical care while only having my age referred to as AMA or the actual numerical value, rather than loaded, judgement laden words like ‘elderly’ and ‘old’ & I am positive that the words used by our care providers matter, if only from a public relations angle. After all, African American women have some higher risks in L&D, Dr. Amy has said that on here, does staff get to remind them of that constantly?

          • Stacy21629

            As long as the staff don’t refer to their increased risk being due to being a certain 6 letter word, then yes they SHOULD remind them that their race does in fact affect their medical risks. You’d rather they ignore it? If something about me changes the care I need, please tell me. Tell me each time it comes up so I never think that you’re doing something unwarranted. Tell me over and over again if that’s how often it needs to be emphasized.

            Much like you’re not an old laboring hag, you’re an elderly gravida. There is a right way and a wrong way and you’re STILL being too sensitive about the whole thing. Calling you “elderly” is so unimportant on the spectrum of “offensive things people are called”.

          • auntbea

            Well, if they ignored whether people were Jewish, they would miss diagnosing a lot of genetic diseases. Do you really think that doctors should not alert women to the risks they face because they might be offended by terminology. Do you really think that people who are black or jewish or older (or all three!) are going to become less black or jewish or old if we don’t mention it? Oh, and tell me again what’s wrong with being any if these things?

          • Yup. We’re Jewish, and our doctor explicity asked us about it because, funnily enough, thousands of years of marrying each other leaves you with more genetic issues than the average person. Just like being of African descent (or black) means you’re at higher risk of premature labor.

            Saying someone is something does not mean you are saying something is ‘wrong’ with them. It just means you are a person with X characteristic.

          • Guestll

            Actually, while the numbers may seem arbitrary as they are representative of population levels as a whole, you are a statistic. Statistics are just the aggregate of people. So while you may not have had an alarm clock go off in your body from 34 + 11 months to 36 + 1 month, the terms AMA and elderly gravida exist for a reason and it’s not to make women feel bad about not being 25 any longer.

            This cultural shift of “40 is the new 30/age as a social construct” crap is really not applicable when it comes to female reproduction.

          • Guestll

            Do they get to remind the of that constantly? How about, do they candycoat it and get caught up in semantics at the expense of ignoring risks but sparing sensibilities?

            Also, what the hell is wrong with being black?

          • Jessica S.

            You can disagree with it all you want, it ain’t gonna make your eggs any younger!

          • Bombshellrisa

            It’s not just the mother at a higher risk in a pregnancy after 35. Risks for certain things like Down’s Syndrome or Edward’s go up. Being able to have testing like the Harmony or Materni21 early since the risk is higher can allow a woman to weight all her options carefully.
            I just gave birth ONE day after I turned 35 (my due date was a month later) and I refused to believe that because I would have been a month over 35 if I went full term that I was all of a sudden an elderly pregnant woman who needed all sorts of extra tests. But I ended up with gestational diabetes, blood pressure creeping up and delivered a late preterm baby. All things that I was at increased risk of being “elderly”.

          • Mariana Baca

            “Elderly” is only ageist and sexist if you think there is something bad about the elderly. So check your own prejudices, maybe? Elderly is synomymous with advanced age — they both mean the woman is older. And there is nothing wrong with with a woman being older or being called old — it is not an insult. It just means there are statistically more health risks.

          • Comrade X

            ^^^ This ^^^

            “Elderly” is only an insult if you believe there is something bad about being elderly. I personally hope to live to 110 and be a crazy old bitch with a grey chignon and a mouth like a dutch sailor on shore leave.

            This reminds me of racist white people who hesitate to use the term “black” to describe people whose skin is brown, and instead say “coloured” with a little hesitant pause just beforehand, as if they’re about to say something DEVASTATING. #fuckthatshit

          • LibrarianSarah

            “Do I seem hysterical to you”

            Well…yeah a little bit. Freaking out over the word “elderly” hardly seems rational. Running to an inadequate care provider when you are at higher risk of complication seems even less so. Have you ever considered that your own reaction to the word “elderly” could be the result of your own internalized ageism and sexism? If you didn’t stake any value to your youth the term wouldn’t bother you. And I really don’t get how Advanced Maternal Age sounds better.

          • fiftyfifty1

            “if I had heard ‘elderly’, especially for the first time in labor, I would have been unspeakably upset.”

            Unspeakably upset. My goodness!

          • Jessica S.

            One hopes she would have a strand of pearls to clutch as she said it! “Well, I never!” 🙂

          • Captain Obvious

            “Do I appear Hysterical to you?” Yes. Then dont check your insurance coding bill, it will read elderly. As in high risk pregnancy.

          • Irène Delse

            As I said in answer to you upthread, biology doesn’t care that you use elderly, AMA or some other euphemism. The important thing is to recognize the added risk and act adequately. One of my best friends recently had her first child at 39, all went well, she was ecstatic after the birth of her daughter and all. But during the pregnancy, she took to heart the info from her OB/GYN re her age (including: no free standing birth center, plan from day 1 to go to the big hospital with 24h/24 anesthesiologists and the top tier NICU!), even though it felt disquieting at first to hear about the added risk and have more tests and monitoring. But she also new that the doctor and hospital staff wanted the same thing as herself: make the pregnancy and birth as safe as possible for her and her child.

            It’s great that your pregnancy was healthy and all went well. It’s great also that your doc was careful to respect your feelings. But maybe he was a bit too careful if your overall impression afterwards is “well I was healthy so why insist on my age?”

        • Sue

          ”And please no one say ‘that’s just the term they taught us in the textbook, what?!’

          Would it be right to throw ‘spontaneous abortion’ @ a miscarrying patient because it is technically correct?!?”

          I work in health care. I say ”elderly primigravida” and ”spontaneous abortion” in my documentation, but ”older first-timer” or ”miscarriage” to patients.

          This is a blog run by a retired obstetrician, not a clinic.

          • S

            Did i miss the part where Medwife calls her pregnant patients elderly to their faces?

          • Stacy21629

            I’m so confused…are there 2 ellen mary’s?

          • Young CC Prof

            Your disqus is flaking. Reload the page, and then everyone’s name will be fixed.

          • S

            Oops, my post was meant for Ellen Mary. Sorry to whomever i just responded to! (Disqus is fucking up all the usernames.)

          • Playing Possum

            I second you there, Sue. Why should this space be sucked into the pet names for things – “momma” and “bub” (“mum and bub doing well” makes my skin crawl). This is a scientific, evidence based discussion. Spade = spade. Terms like “advanced maternal age” or “elderly” or “incompetent cervix” or “parasitic fetus” or any number of unkind terminologies should be used. If I went to a website talking about bad motor mechanics, I wouldn’t expect them to only use non-emotive words.

            It’s not a personal attack on an n=1 experience. It’s stepping back from the personal and looking at the evidence. What happens when we start substituting with nice euphemisms? We get “rushes” instead of “painful contractions”, “not meant to be earthside” instead of “intrapartum death”. End rant.

          • Lion

            rushes has to be the one euphemism that irritates Mae the most. I had contractions and they hurt. Nothing rushed.

          • fiftyfifty1

            I’ve just thought about it and I’ve decided I don’t like the term miscarriage. It sounds too much like “a MIStake in the way you CARRIed the pregnancy”. It also has bad connotations because of its use in terms like miscarriage of justice. I prefer spontaneous abortion. Spontaneous expresses how it just happened all on its own. Abortion reminds me of when space missions are terminated prior to launch because some important science-y thing is not working. I have warm feelings for NASA which rightly is the envy of all other countries (apparently especially the UK. Rocket Man, Major Tom? Please! Song after song about space travel sung in those wimpy Bristish Accents. Does England even have a space program at all?)

            Anyway, don’t use miscarriage around me or I will be unspeakable upset.

          • Irène Delse

            The UK, I don’t think so. But the European Union does have a space program, with a space agency (the ESA, European Space Agency), contributes to the ISS, and since the early Eighties, built the Ariane series of rocket launchers for satellites. Still have to go through the Russian space facilities to send people into space, though.

          • KarenJJ

            I thought they had something when I lived there ten years ago. Didn’t they shoot a robot into space to send to Mars and then lose it somewhere?

          • Comrade X

            Don’t call The Sex God’s accent “wimpy” please! :p

          • Comrade X

            I’d just like to clarify that “The Sex God” refers to Mr Bowie, not Mr John. That is all.

          • Busbus

            fiftyfifty, you made my day 😀

        • OBPI Mama

          When I was looking at my paperwork after a doctor visit, it said “spontaneous abortion” for my reason of visiting… mind you, I don’t like that term, but that is what I had. It’s not personal, just what it’s technically called.

          • Young CC Prof

            When I had to go to the ER for bleeding, they put, “Threatened abortion” on the paperwork. Like you said, not personal, just what it’s called. And since putting the right words on the paperwork gets them paid, I don’t mind!

        • The Bofa on the Sofa

          The reason for our early ultrasound on our first was indicated as “Abortion – Threatened”

          Because that’s what it was.

        • Jessica S.

          It sounds like answer is “that is what’s on the paperwork”. So take it up with the insurance industry, I guess?

        • When I was 5 weeks pregnant and bleeding, that’s exactly what they said I had a 50% chance of experiencing. Fortunately, I am 24 weeks on Wednesday, but neither my husband nor I were offended by this despite the fact that our baby is as wanted as can be. I walked out with a paper telling me I had a ‘threatened abortion’.

          I had more issues with the ultrasound tech who rolled her eyes, sighed, and asked me who told me I was pregnant because she couldn’t see anything (she did a TV after my husband asked her to and there she was, a little poppyseed, but there all the same). That was rude, the kind doctor who explained spontaneous abortion to me was not.

          It’s a medical term. Just like ‘elderly’ is in this context.

      • Anj Fabian

        Priorities.

      • Trixie

        Ummm except in terms of childbearing, being in your late 30s or early 40s is riskier…because facts and science.

        • Ellen Mary

          Higher level of risk =/= Elderly

          Not a good idea to decide ahead of time what people can or can’t understand based on preconceived notions about their intelligence vs. yours. Advanced Age is quite easy for anyone to understand. Over 35 would be even easier.

          • Stacy21629

            Generally, I get 10-15 minutes in a room with an owner. I don’t have time to go over their entire educational history and figure out exactly what they can and can’t understand. I don’t use toddler-ese, but I don’t use words you need a medical dictionary for either. If a client says “I’m a nurse” I’ll revert to medical jargon, but generally I want to make sure folks understand what I’m saying. It’s not about intelligence “I’m smart, you’re stupid” people just don’t have exposure to it and they don’t know. When I go to the mechanic I don’t need a detailed description of every part in the car and what’s working and what’s not – give me a brief, layman’s understanding so I know why you want to charge me so much and move on.

          • You know, even when one is a nurse, it doen’t necessarily mean they know what you’re talking about. The last orthopedic patient I had was in 1965, and there have been a few advances in orthopedics since then, as I discovered when I had my hip replacement two years ago.

          • Ceridwen

            For this reason when my dad has medically trained patients he always says “I’m going to talk to you about this exactly the same way I do my other patients. I’d rather explain something you already understand than accidentally fail to explain something you don’t understand because I assume you’ll already know.” I think it’s a very good policy.

          • Stacy21629

            Got any more synonyms for us?

            It’s a term. Medwife didn’t say it with any ageist prejudice. She said it as a way to convey that, much like a 70 year old is more than 2/3 through their life-expectance and gets an AARP card, a 35-40 year old woman is more than 2/3 through her reproductive expectancy and gets extra scrutiny. Rather than chance speaking over a woman’s head in a stressful situation she used a “lay” term to convey her concerns in a way that the mother would understand. Did you even read her comment on how she presents it to mothers? She doesn’t walk into the room and say “well you old laboring hag, time to get this show on the road, you aren’t getting any younger after all”.

          • “well you old laboring hag…”

            Gee, I wish I’d thought of that, during my hospital career. Would have made my day, occasionally, walking into a patient’s room and saying that :-))

          • fiftyfifty1

            “Gee, I wish I’d thought of that, during my hospital career. Would have made my day, occasionally, walking into a patient’s room and saying that :-))”

            I wish you had said it to me…It would have made my day too!

          • GranolaTastesLikeFrootLoops

            Would have made my day, as well!

          • Trixie

            Incompetent cervix is an awful term too, but it doesn’t mean the patient is incompetent.

          • araikwao

            And “failed induction”, etc.. (although I guess in NCB you are considered a failure….)

          • yugaya

            I’m pretty sure that imaginations running wild under the influence of woo will only interpret it as ebil OBs intentionally devaluing the ‘power of birth’ by telling patients that their cervix is incompetent.:)

          • GranolaTastesLikeFrootLoops

            My cervix, however, is so incompetent that it’s the Moon Moon of all cervices. So, yeah, as a patient I am pretty incompetent. But then again, I don’t care what my OB says behind my back as long as he’s nice to my face and plays Mr. Tambourine Man when it comes time to deliver in that jingle jangle morning.

          • Coraline

            Why does “elderly” bother you so much?! Seriously?! It’s semantics. “Advanced Maternal Age”, “Elderly,” etc – what’s the big deal?! There are a lot of medical terms that don’t sound good to our unprofessional ears. So what?

          • The Bofa on the Sofa

            There are a lot of medical terms that don’t sound good to our unprofessional ears.

            And then there is pus.

            Come on, can’t you medical people come up with a better word than “pus”?

          • theadequatemother

            Pus = inflammatory exudate

      • Stacy21629

        Perhaps because we’re not talking about *life* years but *reproductive* years.
        In *reproductive* years, say 15-45, then 35-45 is “elderly”. And just as with elderly *life* years, there is an increase in risk, complications, morbitiy and mortality in the later *reproductive* years. Take issue with the term “elderly”, fine, but if doing so means you neglect the obstetric realities (or worse, you want an OB/CNM that neglects the obstetric realities) you are putting your chlid’s life in danger.
        Swallow your pride. It’s not about your feelings. It’s the medical reality. It’s a word. That’s it. A word that ensures you receive adequate, personalized care based on your individual risk profile. We cannot ethically treat a 22 year old primip the same as a 42 year old primip. I thought the NCB crowd wanted “individual” “personalized” care?

        • Ellen Mary

          Really, you are really arguing that ‘elderly’ is NECESSARY for communicating with prideful dummies who can’t understand the term Advanced Maternal Age? And that someone who has an issue with it needs to swallow their pride? Sorry, don’t buy it: I believe women can have a hospital birth without being subjected to yesteryear’s prejudices, which is exactly where the term ‘elderly gravidia’ comes from, in sharp contrast to AMA.

          • Stacy21629

            I deal with people every day regarding medical issues. Yes, I absolutely believe that 95% of the people I deal with can better understand “elderly” as compared to “advanced maternal age”.
            My comment regarding pride was not meant to be extrapolated to everyone.

          • Stacy21629

            Also:
            1. “elderly” = ageist, prejudice
            2. “advanced maternal age” = technical distanced doctor-speak

            Can’t win for trying. Seriously though…most folks understand “lay” words better. I believe 100% in giving folks the “right” medical term for things because I know 100% of them will go home and Google it and I want them to Google the right thing…but I move very quickly past the technical term to “here’s what this means in language you can understand”. Because understanding is KEY to compliance and good medical care. If folks don’t understand, they don’t comply and their medical care and outcome suffer for it.

          • The Bofa on the Sofa

            Seriously though…most folks understand “lay” words better. I believe 100% in giving folks the “right” medical term for things

            “From now on, “cervical mucous” will be called “icky sticky””

            http://www.youtube.com/watch?v=PGol5n1YT4w

          • Comrade X

            “…go pee-pee out of your seabiscuit…”

            OMG I’m laughing so hard.

          • Jessica S.

            YES!! Oh my word, I love that scene!!

          • Bombshellrisa

            It’s not a prejudice-it’s more like a way to understand what the care plan should be. I speak as someone who just gave birth as an “elderly” woman. It means higher risk, certain things need to be tested for, different precautions taken. It’s not an insult.

        • Sue

          ”Elderly primigravida” is a medical term. It’s useful because it is associated with a whole range of risks, which can be anticipated and better managed.

          • Stacy21629

            Is that comment an example of how to correctly use the term “elderly primigravida”? I’m not sure what point you’re trying to make with that comment. I thought you didn’t like the use of “elderly” at all.

          • realitycheque

            I think disqus is mucking up and switching usernames around on you. I see the above comment as being from Sue.

          • Stacy21629

            weird…I just saw Ellen Mary respond to herself twice. Reload! 🙂

        • MichelleJo

          I think the term “older primigravida” would probably be more acceptable to everyone. It just describes chronological age. The term elderly in normal conversation usually refers to someone’s frailty and inability to function as they used to.

      • AlisonCummins

        What’s wrong with elderly?

        • Irène Delse

          Yeah, when you think of it, isn’t it a bit ageist to want to distance oneself from the taint of words meaning “older”… Btw, I’m 45 in two weeks, and at times I feel downright ancient. 😉

      • MJ

        What are the other reasons you’re considering homebirth?

      • LMS1953

        V23 Supervision of high-risk pregnancy
        V23.8 Other high-risk pregnancy

        V23.81 Elderly primigravida
        First pregnancy in a woman who will be 35 years of age or older at expected date of delivery
        Excludes:
        elderly primigravida complicating pregnancy (659.5)

        V23.82 Elderly multigravida
        Second or more pregnancy in a woman who will be 35 years of age or older at expected date of delivery
        Excludes:
        elderly multigravida complicating pregnancy (659.6)

        V23.83 Young primigravida
        First pregnancy in a female less than 16 years old at expected date of delivery
        Excludes:
        young primigravida complicating pregnancy (659.8)

        V23.84 Young multigravida
        Second or more pregnancy in a female less than 16 years old at expected date of delivery
        Excludes:
        young multigravida complicating pregnancy (659.8)

        There are codes we have to use when we submit claims to insurance companies in order to get reimbursed for our services. Get over it. It is not all about you. I wonder if people who take offense at the drop of a hat when no offense was intended realize how offensive THEY are. This is not “My OB Said What”.

        • LMS1953

          I am 61. When I finish a first office visit with a pregnant mom who is 35 or older, and put in the V23.82 code to close out the EMR, I say, “Gee, I wish I was ‘elderly’ like you.” “Whatcha mean, Doc?” “Well, the code book here says your ‘elderly’, do you feel elderly?” We LAUGH about it. We CONNECT as humans. I then use that to segue into a discussion about increased risk for trisomies and whether she wants to pursue antenatal screening for aneuploidy.

          • Playing Possum

            I was hoping someone would mention how these idiosyncrasies make opportunities for connection and sharing.

          • fiftyfifty1

            I use the diagnostic term EDNOS (eating disorder not otherwise specified) to seque into the topic of feeling like your eating disorder is not good enough or legitimate because you are not markedly underweight and don’t carry the diagnosis Anorexia Nervosa. There can be a hierarchy among patients with eating disorders: AN>BN>EDNOS>>>>>>BED.

        • Captain Obvious

          ICD-10 is the “new” version of diagnosis codes and elderly is still the term ICD-10 uses

      • Coraline

        Yeah, maybe in “regular” conversation, we don’t refer to 35+ year old pregnant women as “elderly,” but medical jargon uses a LOT of terms that we don’t use in regular conversation. If this is a reason why you’d consider homebirth, that’s very unfortunate, and very uneducated.

        • yugaya

          @Ellen Mary

          It is appropriate usage within the boundaries of what is allowed and standardized. No implied derogatory meaning or connotation is intentionally conveyed by a speaker using word ‘eldery’ when discussing in medical context first pregnancy of a woman over 35. If you personally have problems with this expression, or for that matter any particular phrase or word in any context, usually it is enough to politely ask people you are communicating with to not use that expression when they are communicating with you.

          From your other comments it is clear that you not only have trouble with this one word, but with risks being associated with the age in relation to pregnancy : ” I don’t agree that my risks are more like those of a 40 year old than a 34 year old women who are closer in age to 32 than 45″ and ” I thought I heard that ( AMA) a little too often for 36, when it was not relevant to any type of indication,”.

          Ranting over supposedly the word ‘elderly’ being openly insulting and used with prejudice, when at the same time you are similarly bothered with usage of alternative expressions, and have clear disregard and contempt for risks which maternal age of over 35 carries because you yourself are only ‘slightly over 35 and feeling great’ is a bit on the hypocritical side.

        • S

          I think she brings up some good points (downthread) about stereotyping in medical interactions, though i fail to see how they add up to any cohesive argument against using jargon in conversations like this one.

          I really don’t see how this problem would be alleviated by choosing a homebirth midwife, especially since as a group they seem extraordinarily unaware of their own biases.

          • yugaya

            Because a lay midwife would probably not bring up additional risks associated with age. All ages are just a variation of normal age. Problem solved!

          • S

            As long as the midwife’s biases line up with your own, then it’s all good!

      • The Computer Ate My Nym

        “Elderly” is a moving target in medicine. If you had ALL you’d be ancient. If you had breast cancer you’d be young. If you had CLL you’d be practically pediatric. It’s all about how the condition behaves at various ages, what treatment options are available, and how people are likely to do with the condition. It’s not meant as a judgement or insult. (Though if it’s coming out so then people should watch their terminology and be more sensitive to the possibility of upsetting patients.) Incidentally, I’m 46. If I were pregnant I’d be ancient.

        • Young CC Prof

          “Adult-onset” asthma is after age 40. So when I got it at 29, it was NOT adult-onset. (Which I thought was funny as hell, actually. See? Not an adult yet!)

          Why the distinction? Because asthma which appears after 40 tends to have different characteristics than when the disease shows up in children or young adults. For one thing, adult-onset is far less likely to be related to allergies.

          • How weird, when I was diagnosed with asthma at 21, I was told it was adult-onset! I wonder why my doctor said that?

      • Comrade X

        Seriously? Get a grip. “Elderly” is a relative term. Nobody dies of SIDS at age 10, because they’re far too elderly. That doesn’t mean that 10-year-olds are suddenly being viewed by medical practitioners as doddering old pensioners. Seriously, get a fucking grip. It obviously means “pretty old for this to happen to them”. I’m about to turn 36. If I get pregnant, I’m well aware that my notes will describe me as an “elderly primagravida”, because amongst the cohort of “women who are pregnant with their first baby” I will indeed be much older than average, and this age difference will be relevant to my risks and the care I should receive. Doesn’t mean they’re going to be wheeling out the zimmerframe for me. Crikey.

        • PrimaryCareDoc

          I totally had to just google “zimmer frame!” Never heard a walker called that before!

          • Comrade X

            Didn’t even realise that one was a Britishism. 🙂

          • araikwao

            Ha, I always thought that was an American term!

        • Irène Delse

          Maybe docs could use the acronym POFT (pretty old for this) in their charts as a euphemism… :^)

        • The Bofa on the Sofa

          I don’t think I was elderly when we had our kids. But now, three years after the second, I don’t think that is a silly description at all.

          At least, that’s how I feel.

      • LibrarianSarah

        Yes it is completely rational to risk your baby’s life just so no one will call you OMG old! Do you just read through the comment section find something to get offended by so you can rationalize your desire to homebirth? If so, your decision making process if incredibly faulty.

      • Something From Nothing

        In the context of childbirth, a primp in her early 40’s IS elderly. We are talking about birth here, not life in general. A woman over 40 having her first baby has an almost 50% likelihood of having a caesarean. This is because our bodies do not birth well at this advanced age, when doing so for the first time. Me thinks you are a wee bit sensitive. Context, Ellen Mary, context.

        • Guestll

          Unliked that just so I could like it again. Thank you.

      • Gene

        You remind me of the woman who pitched an almighty fit when I diagnosed her with a “Threatened Abortion”. She thought I meant that she was “crazy” and “threatening to abort her baby” and how dare I?

        • Amazed

          Oh Gene, consider yourself lucky that she didn’t thought that YOU were threatening to abort her baby… somehow.

      • Irène Delse

        Would you prefer that the healthcare providers use another term for what is a very real risk factor in the context of pregnancy and childbirth? Biology is unkind. It doesn’t care if your doc or midwife call it “elderly”, or “35+”, or something else. What matter is to ensure that a woman of that age receives proper pregnancy & childbirth care, including I’m afraid making her aware of the added risk, so that she can make informed decisions.

      • Guestll

        My husband and I spent a lot of time, energy, and money trying to have a successful pregnancy. I was 37 when we started try to conceive.

        3 IVFs, 2 IUIs, 3 spontaneous abortions/4 lost babies (set of twins) and a partridge in a pear tree later, my daughter was born when I was a month shy of 40.

        The fertility clinic we used has an RE who specializes in the treatment of older (35+) women. Her average patient is 37, has never been pregnant, and by the time she sees the RE, has been trying for a year. She’s had some minor interventions, like Clomid and a HSG. The chances of her having a live baby at that point are 1 in 3.

        My former RE is brutally honest about the odds, and she loses a lot of patients this way — simply because women don’t like to deal with the reality that as we age, successfully reproducing with one’s own eggs becomes much more difficult.

        You *are* elderly when it comes to reproduction. You might get carded at the liquor store, you might be the youngest looking person at your 20 year reunion, you might be fit and healthy and feel better now than you did when you were 25. But your reproductive ability, in terms of conception and pregnancy and labour/delivery, has declined. Why ANYONE should have to pussyfoot around this is beyond me — ignoring reality or dressing it up as something more pleasant hinders, not helps, and it says “I’m too frail to deal with the truth.”

        • Jessica S.

          That sounds like a rough road. I’m so glad you had success in the end.

        • Laura

          Wow! Congratulations on the birth of your daughter! Your perseverance is admirable. What a treasure she must be! (And this is not imply that babies who are easily conceived aren’t a treasure, but there’s something to be said about that moment when your long-awaiting heart and arms are FINALLY filled -sweet!)

      • Jessica S.

        If you are over 35, you’re considered “advanced age” for pregnancy. It is what it is. Whether it is said to your face or not, doesn’t change reality. You can inform people how to address you, if that makes you more comfortable. Or you could relax a little bit. If that’s the worst thing that happens during your pregnancy and delivery, I think you can count your blessings.

  • Mishimoo

    This was perfect, thanks for sharing! Hopefully it helps to change people’s minds.

  • Allison

    Fantastic. Thanks for sharing.

  • Maria

    This is a great post and I think it is a perspective that more people need to see. Thank you for sharing it and thank you to the person who shared her thoughts with you in such a wonderful way.

  • Guest

    Absolutely beautiful. You shame the birth hobbyists who call themselves “midwives.”

    • The Bofa on the Sofa

      This is the beauty of it.

      Those are the ones who thumb their noses at the “medwives.” In response, here is the medwife who accepts that title as a crown.

      “Medwife – you say that if it’s a bad thing?”

      • CrownedMedwife

        Love this! “Medwife-you say that as if it’s a bad thing!” After years as a SOB lurker and through the written thoughts of Bofa, Antigonos, Medwife, Dr. Kitty, Anj and so many others, I’ve come to realize it’s time to stop fighting Medwife as a derogatory term. It that’s what makes the distinction between a competent evidence based practitioner and the infestation of the woo of unregulated self proclaimed providers…I’ll be taking that crown please.

  • Irène Delse

    Great post! I hope many expectant parents read this.

  • AnotherGuest

    Beautiful, love this!

  • LisaL

    “Birth is amazing, but it isn’t how we determine our strength.” YES! I saw someone post some BS poem some crunchy mom posted about how she’s strong for giving vaginal birth to breech twins.
    I rolled my eyes so much, My eyes would’ve rolled out of my head if they weren’t attached so well 😛

    • Dr Kitty

      I think the lady who carried two car seats into her post natal appointment, 5 weeks after having a CS at 35 weeks for medical indications and said “Am I Buggery!”to my inquiry as to whether she was breast feeding her twins is strong.

      Seriously, she walked up a flight of stairs carrying twins in car seats less than six weeks after a CS, and looked totally in control of the situation.

      THAT is strength!

  • LMS1953

    I really appreciated Medwife’s comment about the 39 week rule. There is not a week goes by that does not have a national news report about a mom delivering outside a hospital – one day on a sidewalk in Manhattan, another day on a snow drift in Atlanta. So a multip comes in at 38w5d in the middle of a winter storm for an office visit and is found to be 4cm dilated with no contractions. Her last labor was all of two hours. She lives an hour away. Only a fool would not admit her, perform AROM, maybe add a soupçon of pit augmentation and plan to catch the baby in a couple of hours. But the 39 week Nazi is worse than a fool. Since states can deny payments, there will be strong administrative pressure to disallow any and all <39w admissions except for active labor, SROM or dire emergencies. Any that do will be subject to QA review a month or two later when nobody will recall the two inches of ice on the freeway or the tropical storm/hurricane that was lurking in the Gulf – never mind the intuition/common sense at play in the OP. The same "zero tolerance" that gets a first-grader suspended for biting his cheese sandwich into the shape of a handgun will get a board certified obstetrician with 30 years of experience reprimanded be cause some 39 week Nazi knows how to use an OB wheel.

    • Dr Jay

      Exactly this. Since when do we endanger the life of mum & bub to prevent a little TTN? I’ll take a baby whose breathing up a little over a dead one any day of the week.

      • LMS1953

        In the US, some states will DENY Medicaid payment to the hospital and OB if them deem that an “elective” delivery was done <39w – guess who gets to define "elective"? guess who gets the monetary benefit of that decision? – while some states are falling over themselves to mandate Medicaid and private insurance coverage of CPM services.

    • Minor correction – it was a pop tart. And it was an adult who thought it looked like a gun; the kid claimed it was shaped like “a mountain”

    • The Computer Ate My Nym

      So admit her for monitoring? High risk for premature labor or something like that? Or admit her and induce her anyway and when your admin objects point out that eating the cost of this admission is cheaper than paying off the malpractice suit?

      • Medwife

        If someone like that walks in at 4cm I’d call it admission in active labor and AROM for “augmentation”. You can make a reasonable argument for 4cm and any contractions being in “active labor”.

  • anh

    Tears! Love this.

  • SpecialPeopleMilk

    BEAUTIFUL!!!!!!!!!!! Lots of hugs to whoever wrote this… 🙂 You are amazing.

  • Laura

    I’m grateful for the “medwives” who took me seriously when I suspected my intense itching was cholestasis and started treating me and monitoring my baby closely even before my blood tests came back, and there was no question that I would be induced early. I’m also grateful that the “medwife” who attended my induction suggested an epidural because I was tired and I wasn’t making any progress. All hail medwives!

    • MaineJen

      I’m grateful for the “medwife” who attended me during the first part of my hospital stay when I was having my son. I’d had SROM but contractions were a no-show; I was leaking water every time I moved, but my body was doing exactly nothing about it. She said I could wait through the night for labor to start on its own, but if I still wasn’t contracting/dilating the next morning she would be more comfortable inducing me. This being my first baby, I was disappointed as I had heard about the ebils of induction, but she was so matter of fact and reasonable about the whole thing, I felt okay about it. I have always been grateful for that. Her shift ended soon after dawn and another doctor ended up delivering me, but she’s the one who assessed and set me on the right path in the beginning. Yay for CNMs!

    • Elaine

      I too am grateful for the CNMs who attended the births of my children. I was a lot more woo-infested when I had my first and the midwife I saw the most often was great about explaining stuff to me in non-scaremongering ways. She attended my daughter’s birth and everything was absolutely textbook perfect and she wasn’t trying to push any interventions because, duh, I didn’t need them!

      And with my son who was born last month, a different midwife attended the birth, and while she was pretty hands-off for the entire, oh, hour and a bit that I was in the L&D room before his birth, she didn’t hesitate to spring into action with pit and efforts to get the placenta out when she felt I was bleeding too much during third stage. That is why one hires a care provider… someone with clinical training and judgment who will USE said training and judgment to decide what is best.

  • Zornorph

    And that is what a midwife is supposed to be. Nothing more can be said.

  • violinwidow

    Great post, one that every student midwife should read.

  • Staceyjw

    I really like the point that avoiding some proper interventions will mean many more later on. (the comment about not getting the stuff you want because of postdates need for MFMs, etc). I think this point cannot be repeated enough.

    NCBers often end up with so many more interventions because of their attitude and early refusal (and then they blame the hospital). In one case I know of, mom refused needed pitocin augmentation, and kept on laboring unmedicated. A day later, she was too tired to push, and ended up with a CS once baby couldn’t wait any longer. This is pretty common, enough so that I heard that nurses joke “a long birth plan means a CS”.

    The NCBers just don’t get that judicious use of induction, augmentation and monitoring actually allow more VB than avoiding those things- besides saving lives.

  • Jennifer

    I love this, so eloquently stated! I hope many, many people have the opportunity to read this and be educated.

  • Monica

    Well said. I sure appreciated the “medwife” in my first birth (in the hospital) who knew enough to know she needed to call a doctor in to stitch me up because it was beyond her expertise. Pretty cool to be able to have the best of both worlds like that.

  • Anonymous

    I believe in interventions from AROM to EFM to Pitocin to forceps to cesarean birth. My responsibility is to observe for progress and wellbeing, as well as to utilize the interventions at modern medicine’s disposal to ensure the safest path and highest outcome. Although I cherish and find reward in the intimate relationship we develop over the course of your care, my responsibility is to the health and well-being of you and your baby. Do not confuse my caring and compassion as a desire to become your friend. I will hold your hand, I will be compassionate…but I will not be afraid to use my ‘dead baby card’ or alter my care to avoid ‘hurt feelings”. If that is what it takes to make you realize these evil interventions stand between the health of you and your baby or the risk to disability or death, I will play my ‘card’.

    This paragraph in an of itself shows the difference between a competent Nurse Midwife and a “midwife” in and of itself. Great post.

  • I had a Medwife at my Dr’s office who explained to me how grave my youngest child’s situation was. Nothing but caring and support. She listened to what happened to Mary Beth, absolutely floored. I don’t think she realizes how much that meant to me.

  • Burgundy

    I had two wonderful “medwife” oversaw my two pregnancies. I had 2 wonderful teams of OBs, medwife and nurses during both deliveries. I would not trade my experiences for anything and I always boasted about the great invention of epi.

  • Burgundy

    A bit OT, but if a gorilla needed a c-section, why would anyone assume that human race was designed to give birth?

    http://www.nbcsandiego.com/news/local/Baby-Gorilla-Born-Via-C-Section-250255941.html

    • YogaMathMelon

      If only the gorilla had believed in birth a little more…

      • Burgundy

        laughing so hard that I spit my coffee on my keyboard. Please pass some tissue over here, would you?

    • The Bofa on the Sofa

      Am I the only one who read that and thought, “I bet there was meconium…”

      • Burgundy

        they also put a hat on the baby gorilla… the bonding is ruined now. The mama gorilla won’t be able to smell her baby.

    • Trixie

      It’s because that gorilla isn’t living a natcheral paleo existence in the wild and they were observing her while she tried to give birth.

    • Are you nuts

      OK that baby gorilla in a hat is the cutest thing I’ve ever seen. I’m pregnant with a human baby, but now I’m thinking I might trade it for a gorilla!

      • Dr Kitty
        • Are you nuts

          Ooooh my goodness, now I am nothing short of obsessed. Thank you for posting!

          • Dr Kitty

            My motto:
            If at all possible, give the pregnant lady what she wants!

            You’re welcome.

          • The Bofa on the Sofa

            I just got it (sorry, it’s that kind of week – I am quicker to pick up feces flinging jokes)

            Good one, though.

        • Amazed

          It’s lovely! I am in love with this gorilla baby, she’s adorable!

    • Dr Kitty

      I saw that too.
      I love the way the vets are like “sure, we could have waited, but have you SEEN this perfect baby? Why would we risk it?”

      BTW zoo vets don’t have golf games and malpractice suits to worry about. If they call a CS, it was DAMN necessary.

      • Are you nuts

        I hope all the crunchy gorillas don’t give her a hard time for allowing the cascade of interventions.

        • Jessica S.

          No kidding! There would be literal feces flying, as opposed to the figurative flings on the interwebz. 😉

          • The Bofa on the Sofa

            No kidding! There would be literal feces flying

            Hmmm, Jessica, didn’t I recently accuse you of being my wife?

            Another thing you have in common with her: with this comment, I have to say, I love you.

            God that’s funny.

          • Jessica S.

            I’ll be here all week, folks! 🙂

          • The Bofa on the Sofa

            Sure, that’s an easy thing to say on Friday at 5 pm…

          • Amazed

            Yet another victim of failed bonding. Now, we have to watch helplessly as the lives of the mom and this cutest baby gorilla are ruined.

            On the bright side: they still have ones.

    • LMS1953

      Following a vaginal birth in the wild, does mama gorilla eat the placenta or does Big Daddy get first dibs?

  • YogaMathMelon

    I had two “medwife” attended births in a hospital setting. They were both beautiful and fantastic in their own ways. Thank you for sharing!

  • areawomanpdx

    Great post! Thank you for sharing your thoughts, medwife!

  • WOW. All of it. Thank you.

  • Mel

    I wish all moms had the ability to see the beauty in learning to roll with the punches life gives during pregnancy, labor and delivery. I don’t think there is anything wrong in dreaming about how you wish labor or delivery goes, but life is much less suffering when you can separate dreams from reality.

    God knows I dream of never being in physical therapy again or a life blissfully free of anxiety. It’s a nice dream, but not reality yet. And so, I go through physical therapy and avoid anxiety triggers and take medications. I don’t wait until I can’t walk or am so panic stricken I can’t function in hopes that my dream will magically appear.

    • sleuther

      This is true in life and also becomes increasingly true as you proceed through the course of parenting.

      I don’t see a lot of woo even at the elementary-school level (maybe they’re all homeschooling?) – but honestly, if you can’t handle a birth that didn’t go quite the way you envisioned it, how in blue blazes are you going to deal with a (wonderful) kid who can’t seem to make friends in 3rd grade? How do you explain death to a five-year-old? All the early battles-over-feeding kind of start to pale in comparison.

      In my experience, everything gets more nuanced the farther you go along the parenting path, and these “one-theory-to-explain-everything, natural childbirth, exclusive BFing for 5+ years” strategies aren’t going to get you very far….

      • No kidding! Like you have TIME to angst over your uneccesarian once they’re mobile and the defiance kicks in!

      • Mom in Eugene

        You don’t see them after preschool for a few reasons.

        There *are* fewer of them, overall. You see more among baby and toddler groups simply because NCB exploded recently, enlarging their numbers. In places where this philosophy has been widespread for years, you can see them through all grade levels. Even so, there will be fewer post elementary school simply because kids get their own minds, and can no longer be controlled. Few areas are crunchy enough to have kids through high school still doing NCB/AP/US seriously. (CAM is the exception!)

        Crunchy moms in areas where they aren’t majority, that cannot US, HS or find/afford an alternative school will generally get loosened up over the years. The constant exposure to the mainstream means they must chill, or push away friends for their kids. Sure, they may still go online, or stick with similar adult friends, but they aren’t as extreme anymore.

        The ones in crunchy ruled areas (my city) are more able to isolate themselves within their own groups, and in their own schools. The longer they do this, the more extreme, and exclusive, they tend to get. They are the worst of the “BF police”, even 10yrs after their last babe weaned. In most areas, they will have to unschool, or homeschool, but where I live they have an entire K-12, and a run much of another K-8 school. The few stuck in public schools will still push the woo on everyone, emboldened by their peer group, and local politics that support their nonsense.

        The truly hardcore HBers, birth warriors, lacto-fascists, and alt med pushers, are the same from birth on out. So long as they can immerse themselves with likeminded people, and have their beliefs mirrored back at them from the other places they frequent, they don’t mellow. Thankfully, the older their kids get, the less they can do this, so overall there will be fewer. But believe me, they still exist at all grade levels.

        • Amy M

          Ugh, what a huge waste of effort. If only it could be channeled toward something worthwhile, like ending child hunger, or something.

        • sleuther

          Yikes. (Not sure what “CAM” is…) This is truly weird for me to hear about. I live in New England, and I certainly have my share of crunchy friends (believed strongly in BFing, NCB in a hospital with a Nurse/Midwife, bedsharing, etc.) but usually not all across the board…. and no one in my circle of friends pushed those beliefs on anyone or acted bitchy or judgmental about it when people chose a different path. (And I would know, because I’m pretty much the anti-attachment parent…)

          These days, most of the crunchy friends are doing other crunchy stuff, like buying organic and farming chickens in their backyards. Their kids are mostly great. (A couple of pains-in-the-asses, confidentially, mostly in one family that enforced NO boundaries, but that’s another story.) And I even started a compost heap and successfully lobbied to install solar panels on our roof…so maybe I’m finally catching on to the Crunchy Train…..! 😉

          • DaisyGrrl

            CAM is complementary and alternative medicine. Think naturopaths, chiropracters, and woo-pushers of all shapes and sizes.

          • Mishimoo

            I’ll join you! 😛
            I grow organic fruit and veggies, looking at getting some chickens, have solar panels and NEED a water tank…but all of that is because I have the time and inclination to do it.

        • sleuther

          Also I’m very firmly of the belief that we should all get together again when the kids are 30, and evaluate then. (Or maybe just watch reruns of “Absolutely Fabulous.”) I’ll bring the wine.

        • Anj Fabian

          I wish I could remember where I read this.

          The OP talks about her mother who teaches special needs children. She’s wondering why these children have problems when many were were born via “perfect water births”.

          I was all “……..” but it was not the time or place to point out that the perfect water birth might not have been as perfect as the mother thought.

        • Dr Kitty

          I’m so glad I live where I do.
          Crunchy is seen as a minor affliction here, they don’t have much traction.

          • The Bofa on the Sofa

            I’ve mentioned it before, our baby class had a notable LACK of “instruction” in “natural” methods. I even mentioned it afterward to the instructor, that I expected more of the pillows and breathing practice, etc, but we did basically none of it.

            She told me, more than 90% of the moms just get epidurals anyway, so it’s not worth wasting time on it.

            I think it is safe to say that the NCB movement does not have much traction at all.

            Interestingly, the instructor was a very active LC, and very heavily pushed BF (with a lot of the misleading propaganda). However, she also was ok with us using formula (supplementing), because she knew that my wife was doing what she could. IOW, she was not “breastfeeding uber alles” but was, you’re breastfeeding? Good for you!

          • Guesteleh

            “breastfeeding uber alles”

            I heard the Dead Kennedys as I read this.

          • Christina Maxwell

            It’s great that woo is not a problem where you are Dr. Kitty, it gives me some hope. Where I am (Eastern Scotland) the woo infestation is both alarming and increasing. In my area new -NHS- birth centres have sprung up, up to 40 miles from the only ‘proper’ maternity unit in the area. One centre boasts of a 79% waterbirth rate. To get OB care or even access to the maternity unit you have to have pretty serious complications. It is terrifying.

      • The Bofa on the Sofa

        Sniff….once again, sleuther nails it spot on.

        I was thinking the exact same thing: parenting is ALL ABOUT “rolling with the punches,” and dealing with the unexpected.

        • sleuther

          Thanks Bofa! All of my parenting knowledge and advice can pretty much be summed up in Anna Quindlen’s essay “Goodbye Dr. Spock” which is easily available by Googling (I’ll post the link below but I don’t know if Disqus allows links…)

          http://grownandflown.com/goodbye-dr-spock-by-anna-quindlen/

          • The Bofa on the Sofa

            Ha! All of my parenting knowledge and advice can pretty much be summed up in this:

            “Fuck if I know, what if I try this? Does that work?”

            Of course, that’s based on the questionable premise that I have parenting knowledge.

          • KarenJJ

            Exactly how we managed to “decide” to try to do sleep training with one kid and not another and partially breastfeed one kid and not another and also ended our very short trial of cloth nappies.

            It basically went:
            “Farrkkk, that’s not working too well. Let’s try something else”.

          • Maria

            This is great! Thanks for sharing it. I like to believe I am a “roll with it” kind of parent, but I am really just deluding myself. I can get quite stressed about the little things and it is good to have some perspective from time to time!

      • Guest

        Nailed it. When your child is in Middle School, it simply will not matter if you breastfed, babywore, or coslept. Cloth diapers and organic food will have nothing at all to do with giving her the skills she will need in middle school. What will matter is whether from her toddlerhood you set reasonable limits. It will matter if you taught her resilience and a sense of humor. It will matter lots whether you taught her to be self-sufficient. Because the first time a pack of mean girls goes after your kid is a lot more painful than the first night she fusses alone in her crib because you’ve had enough and she needs to sleep.

    • And you might as well learn to roll with the punches in pregnancy, because after that you’ve got the kids, and they certainly don’t follow a one’s prewritten plan.

  • The Bofa on the Sofa

    I am saddened by the liberal application of the title ‘Midwife’. I am disheartened when my years of formal education and commitment to continuing professional growth are soiled by the unprofessional and unregulated ranks of others who feel it is their right to share this title. As much as I looked forward to holding the title of “Midwife” I feel relegated to distinguish myself from it.

    Yep.

    I am glad this person feels this way. However, I will reiterate a point that I have made before, which I think is reflected in the quoted paragraph:

    The statements that “there are some good practitioners” or “not everyone is a loon” in themselves are a serious indictment, and an indication of a profession with a serious problem.

    • Isn’t the whole point of a degree or formal accreditation to guarantee that they are a “good practitioner”?

      • The Bofa on the Sofa

        Yes and no. It’s supposed to ensure minimum levels of competence. However, there are always outliers. Some doctors are morons, as are some teachers, etc.

        However, when people say, “That doctor is a moron” doctors don’t respond with “Well, not all doctors are bad.” The response is more like, “Unfortunately, there are some morons”

  • Mel

    “I do not believe waiting for a baby to display signs of decompensation is the time to act”

    THIS. A. MILLION. TIMES.

  • Captain Obvious

    I believe ECV can be a good intervention. But with a 1/286 risk for an urgent cesarean because of this procedure, it must be performed in L&D, and not in an office, with precautions in case your ECV attempt does not go as planned. And just because your baby is breech, doesn’t mean you’re always a good candidate for a version attempt. Obesity, anterior placentas, low AFV, IUGR, macrosomia, nuchal cords, and other factors need to be considered. If you are a good candidate and informed of the risks, then we can arrange an ECV to be done in L&D.

    • Mishimoo

      100% this! I was booked in for an ECV in L&D and was well informed of the risks including the potential need for an emergency caeserean. I didn’t end up needing the ECV, but I was glad to have the option to have it done as safely as possible.

  • Comrade X

    Wow. Thank you for that. Highest respect to you and all your colleagues (midwives, nurses, doctors) for the amazing jobs you do.

  • Couldn’t have said it better myself. Exactly my sentiments, “medwife”.

    I am actually proud to be called a medwife, btw.