I'm starting over. This used to be a blogspace for me to share personal stories related to my business, and it may be that again someday. But as I experience a huge shift in my existence, in my priorities, in my passion and purpose, I am transforming this blog into a place for me to share my journey. The ups and downs.
For now I'm keeping this blog and it's name and working into it, mostly because I was spending too much time trying to figure out a new name for my blog! So here's my reintroduction:
One Friday in July 2008, after about 12 years of talking and planning and dreaming of leaving America and living in Israel, I decided it was time to take the plunge. We made most of the necessary arrangements (for instance, we still having sold our house in NJ! And we decided to start out in an absorption center instead of looking for a more permanent living arrangement) and made the move!
I was 10 weeks pregnant when we arrived in Israel. We spent 5 months in a two room apartment, and then moved to the beautiful Golan Heights were we are renting a lovely home in the city of Katzerin. More about my move and my birth are in the previous post... so what's changed for me since my first post here?
Mothering 3 small children is a completely different universe than one or 2 was. And I am doing it in a new country, while mastering a new language, and while my (amazing) husband works a 12 hour shift at the local winery. It happens to be one of the largest wineries in the country and it produces some excellent wines - which we can't afford to buy, or a car for that matter.
For the past three months I've been home with my newborn, Kooshkoosh, and my 2 year old, the Dancing Queen. My oldest, SuperSkimpy, is in kindergarten
And this post in now over b/c Dancing Queen, in all her naked glory, just climbed into the Pack n'Play with Kooshkoosh! Gotto go save a baby! More later!
Wednesday, October 21, 2009
Friday, July 31, 2009
Why even doulas need doulas, and other lessons from my own birth
It seemed pretty simple. I've birthed 2 baby's naturally, one at home, I've attended numerous births and I myself am a trained birth professional. Not to mention my wonderful supportive and knowledgeable husband. So, all I had to do was find good homebirth midwife, and we'd be set for another calm, lovely homebirth.
Lesson #1: Even doulas need a doula. Every woman deserves to be supported by someone who is knowledgeable about birth (experientially or through training), and who's only concern is the birthing woman and her needs. Because I was on my own, I was trying to anticipate my own needs, and it kept me (among other things) from succumbing completely to my body and my labor. And once my labor did take over, I was left without an advocate.
I asked for names of midwives in the area of the country that I was moving to. I got a few recommendations. One of them called me, she seemed nice and experienced, and she took the time to talk to me and address my concerns. I spoke to her a few times before we met, and although I kept thinking that I should at least call and "interview" some of the other women on the list, I was drawn in by the ease of just continuing with this midwife and not expending the effort of calling other people, telling my whole story, asking my questions, etc... Especially since this was happening in the thickest part of our hectic and frenetic move across the world - and then across this country.
The Schwell Aliyah Adventure: A brief history of the events of the past year
(The link is to my husband's blog, if you're interested in more details and pictures and videos!)
Aliyah is a Hebrew word meaning "going upwards." It's also the word for immigration to Israel (and in fact to leave Israel and move somewhere else is known as "yerida" going down! It can be said that the spirituality of this place is uncontested.)
and I were experiencing a need to transition from our current positions into something more directly connected with our purpose. (There's a bit more background to this story, but it's not for the "brief" version!) Suddenly I was overcome with inspiration, as if the Biblical words that God spoke to Abraham were being spoken directly to me! "Lech One balmy Friday afternoon last July, I was driving through the towns of Central Jersey to buy wine for Shabbat and a birthday present for my son's 4th birthday. I was at a traffic light, going over in my head all my hopes and dreams and wondering what our next step was. Both YoramL'cha...." Go forth from your land, your birth-place, your Father's home, to the land that I will show you - and you will reap all he blessings that are your birthright.
I know this may sounds cheesy, but it literally happened exactly that way.
I called Yoram, who was bathing our 4 and 1.5 year old and I told him, "Yoram, this is it! We just have to go." My poor, exasperated husband, being splashed on, and attempting to keep one child from drowning the other, asked me, "Go where?!"
"To Israel, Yoram, we have no more excuses to push it off! We just have to go."
"Right now? Or can we discuss this more when you get home?" I conceded, told him I love him, and continued on my errands, feeling teary and emotional. I chose a bottle of Golan wine, because it has always been our dream to settle down in that region of the country.
Over that Shabbat, we talked about it, and why now, and what the immediate next step was. Yoram, being the more practical of the two of us, was concerned, but the idea of fulfilling our life-long dream at last seemed within our reach.
Over the next few months we started letting people know our plans, started the process of applying for Israeli citizenship, getting information about the upcoming Nefesh B'Nefesh charter flights, and I called the realtor who had sold us our house only 2 and a half years prior.
"Alex," I said, "We're making Aliyah in Dec, and we want you to put the house on the market."
He laughed, for two reasons. "Ayelet, I have sold a lot of houses in this community and I can't tell you how many times I've heard buyers say, 'in 2 years we'll call you to sell the house, because we're moving to Israel.' You are the first ones to actually do it!" And the second reason was, that in September of 2008, the housing market was already plummeting, and he thought we were a little crazy to choose to sell at that time. (The house, by the way, is still on the market - a lovely 3 BR house in Hillside, NJ - we are entertaining all offers!)
In late November, we discovered more exciting news, I was pregnant! Our flight date was just before the end of the first trimester, and although we were excited and happy, we couldn't help wondering how this might complicate our move. High on the list of questions was comfort. Because we were moving in such a short time frame, we had decided to move to an absorption center apartment until we could research and find a community in which to live. Absorption centers are not built for comfort. We didn't know what to expect.
When we arrived, we were greeted by Yoram's brother and sister and their families who had already come on Aliyah. The kids made cute signs and although we were exhausted, we were glad to see them! We boarded a cab from Ben Gurion airport in Tel Aviv to take us to our temporary dwelling in Jerusalem. The apartment was tight. It had one bedroom, a slightly larger common room, and a kitchen that could be occupied by two people, or by one pregnant woman at a time. And there was no oven, just a hot plate with two burners. It was not arranged to accommodate a family of 4 (and a half). Somehow we managed for almost 6 months.
During that time, we realized that our original thought of starting off renting something in the Jerusalem area before moving north in a few years, was silly. Staying in Jerusalem itself was nearly impossible due to the prices of apartments that were far too small to accommodate our family. Aside from the fact that city life was not our first choice. So that left us looking into the outlying villages, but we were wary of moving into a small community and becoming settled, only to move to an entirely different region of the country in a few years.
So we started the process of moving north. It was like starting our whole Aliyah over again! In February, we took a week long "scouting" trip up to the Galilee and the Golan, visiting different communities, talking to people about homes, jobs, schools... In the Golan, we fell in love. We knew that was where we needed to be - just as we had always dreamed.
For most of March and April we were away in the States, visiting with family, enjoying my brother's wedding, and gave me the opportunity to attend an incredible conference for business owners that affected me deeply.
When we got back to Israel, we started looking at rentals in a few of the communities we had visited. With our time at the absorption center running out, both in terms of our tolerance for it, and their housing policies, our search took on a bit more desperation than we had wanted.
A friend that we had met in the Galilee recommended we check out the "city" of the Golan Heights, Katzerin. I put city in quotes because although it is technically a city and not a moshav, or kibbutz, the entire city would fit neatly inside of Madison Square Garden! And although it has a supermarket, bank, restaurants, and schools - it is surrounded on all sides by open fields, forests and mountains. We got in touch with the handful of English-speakers in Katzerin, rented a car, and drove up to see the area on a Wednesday.
We decided to come back that Shabbat and see the community in repose. The family that hosted us arranged all our meals and somehow the entire community was informed of our coming. I felt as if they had rolled out the red carpet and struck up the band! We felt so welcomed! On Sunday we went around to look at some houses and apartments for rent and found one that seemed absolutely perfect. Three weeks later, we had moved in! (Pictures and videos of our house are on my Facebook profile: http://www.facebook.com/ayeletschwell)
Which brings us back to our birth story:
When we finally had moved in, I called the midwife, and we arranged a time for her to come and meet me. Her home is an hour away from mine. At that first meeting, we chatted, I asked her some questions, told her my history, and felt as she was leaving that something was not quite right. I couldn't put my finger on it, but I swept it away, because at that point I was 34 weeks pregnant, and my Braxton-Hicks contractions had begun to take on a more serious feel. My oldest son had been born at 36 weeks, and my daughter at 38. So I had no idea when this little one would come and I felt at a loss to begin looking for a new practitioner at such a late date. Especially with my whole story.
Lesson #2: Always trust your instincts about your provider! Whether it proves right or wrong is irrelevant! If you feel at all uncomfortable with your care provider, you are headed for an uncomfortable birth experience - if for no other reason than that tension alone! It is never too late to review other options. And although I might not have been able to find another homebirth midwife at that time, I could have settled myself into the idea of a free-standing birth center. But I didn't even look into it.
I ended up staying pregnant for the next 6 weeks. And when my labor began, it was slow - very very slow. But there were so many factors! Based on my previous births, even with a slow start, once my body switches into full-on labor mode, I go very quickly. And considering that my birth team were spread out over the country, I wanted them there. So I called the midwife on Sat night July 18th. While she was on her way over, Yoram and I went for a long walk, and my contractions picked up even more. We got home and I prepared a few things and puttered around a bit, and when the midwife arrived, we looked at heart tones, and my blood pressure and everything looked great. I started feeling uncomfortable, and wanted to be in the warm water of my pool. The midwife warned that at this point the water can slow labor and not help it along. So I thought if it slows down, I'll get out, but at least I'd be comfortable for a little.
Well, my labor did slow down, and then the kids woke up (it was a little after 6am) and then the contractions stopped altogether. I slept most of Sunday. Monday I decided to ignore the contractions, and my mom arrived that evening. She told me she was exhausted and was planning on taking an ambien to help her stay asleep through the night and avoid jetlag. My body got the hint.
In the morning, though, I woke up with those deep, low down, this-is-it kind of contractions, and I called the midwife again. She said she'd come out, but to ignore her and do something fun with my mom and the kids. So we went for a walk. When we got back to the house, the midwife had arrived, and we helped her bring her things into the house. Heart tones sounded great, baby's head was still down (but could still be felt above the pelvis) and the contractions were getting stronger, but weren't getting into a pattern. So we continued to ignore them. We all went to the pool and had a great time! (again, pics and videos on facebook! some are on Yoram's profile.)
I called the midwife when we started heading out from the pool, and told her we were going to go get some food at the pizza store. She met us there. Somewhere between leaving the pool, and walking towards the pizza store, things changed. The contractions were coming on every 5 minutes, and I was no longer in a jovial mood. But I was hungry, and I got very focused on eating some pizza. We got to the store and started to move inside into the a/c, and were told that we would have to eat outside because they were expecting a group - I was going to strangle someone! But we ordered our pizza, and sat down in a shady, breezy spot. I ate my pizza, barely looking at anyone, only slightly aware of the needs of the children, who were being taken care of by my mother and husband.
I didn't quite get through two slices when I said, "I want to go home." The midwife brought her car around and me and my mom got in. Yoram walked home with the kids. In retrospect, I should have kept moving, because somewhere between getting into the car and getting out of it 3 minutes later at my home, I began thinking of things I needed to do and people I needed to call, or didn't get to call, or what have you, and the contractions started slowing down... I got into the pool, but it was already too late. When my son decided to join me in the pool, it was over. He's so sweet, and so nurturing and helpful, but he is also very engaging and I completely lost my focus and couldn't get it back.
The the emotional turmoil set in. My grandmother's passing just a week prior, my father not being able to be here, all the stress of the previous 6 months, and the fear that after all this, I might still not actually give birth and finally meet my baby.
Lesson #3: Keep Moving!! When the going gets tough, the tough get going, right?! It works in labor too! At that point, the midwife suggested that Yoram and I take some time together, but we should have left the house and gone walking! The contractions were still there, they just needed a nudge to get back on track. Plus, getting out of that environment would have been another way to get me back into my laborland head-space. And furthermore - it might have moved other digestion-related things (ahem) that might have also assisted in moving things along.
At this point, the midwife had a startling decision. She decided that she felt my baby was at risk of being slow rescusitating, because of all the starts and stops in labor, and she felt that it was no longer safe for me to give birth at home. Yoram and I questioned her, considering that his heart rate was fine, and that he was moving around before and after contractions, and that aside from my anticipation, I was feeling completely at ease with the baby's condition. She said, she has to consider that we are 30-40 minutes from a hospital, and she doesn't want to take a chance.
I was devastated. I felt betrayed. This decision felt wrong in every way. And not having a car meant that I hadn't seen any of the local hospitals, had not prepared for this eventuality in the least.
Lesson #4: Always prepare a back-up plan. It is true that most healthy women who plan a homebirth, have completely healthy, natural births and healthy babies at home. But on the rare likelihood of transfer, I would have been much more settled into this reality had I at least seen the hospitals, made some contacts there, known what to expect. Also, depending on where in the world you are birthing, writing up a back-up birth plan for hospital transfer might be helpful - and lets go back for a moment to lesson #1 - bring your doula!!! But I'll get to that more in a minute.
I spoke to a close friend who is also a midwife, but who lives too far away to have been my birth attendant. She brought into perspective the fact that what my midwife was actually saying was that she was no longer comfortable attending my homebirth. She was "opting out."
I cried all night, and resolved with my mother and Yoram that in the morning we would rent a car and Yoram and I would go check out the hospital that the midwife had recommended, which was in the holy and beautiful city of Sefat. We thought that, at the very least, we would get some time together in the city, and maybe even buy a new set of candlesticks, since I'd soon be lighting one more candle on Friday night.
My daughter, who's 2, was miserable that night. She wasn't feeling well at all. Congested and coughing and complaining that her mouth and ear were hurting (I'm pretty sure she's growing a molar) so we put her to bed in our room, propped up on pillows. Somehow, despite being so small she took up my entire bed! So when I finally did get to sleep, it was in the smallest possible area on my bed, and I was waking up from contractions.
It's now Wed morning, July 22nd - also Rosh Chodesh Av (the first day of the Hebrew month of Av) Yoram slept in and missed the 6:15 prayer service, he might have just prayed at home, but it was Rosh Chodesh and he really wanted to be at the service. So he went at 8:30 and my mother and I walked the kids to their respective camp/playgroup. Before we left, I put a few things into a shopping bag, in case we did end up in L & D that day.
On the way there, I continued walking through my contractions, on the way back, I couldn't. By the time we got home, stopping to chat w/my neighbor who offered to drive us to Sefat, the contractions were less than 5 minutes apart and I was moaning and swaying when they came to relieve the tension and the pressure of each intense wave.
My mom called the midwife, she didn't think we would make it to the hospital, so the midwife headed here and asked if she could send someone over who lived closer and ad attended many births. Presumably a doula. My mother agreed.
Lesson #5: Be wary of inviting people you don't know into your birth space. Especially having not heeded lesson 1, having your own doula who will preserve the sanctity of your birth space no matter who's there, or where you are. Because birth is not where you physically are. You can have a serene, loving, non-traumatic birth in an emergency operating room, if that is what is necessary, as long as you are prepared and supported in keeping the experience sacred.
Yoram came home minutes later and mobilized for birth. At this point, I wish we had not called the midwife till I was actually pushing, but she was already on her way.
This is where events begin to run into each other in my mind, so I'll relate it as well as my memory permits.
I know I was in and out of the pool. The woman from nearby arrived, I only remember that she had strong hands and she massaged my lower back through a few contractions. Sometimes Yoram was sitting behind me, sometimes my mom. The room seemed too bright. The midwife came in, my tension rose - but only as much as my primal being would allow. I wanted to be darker, I went to my bed, with Yoram. I was on my knees, hugging my pillows and leaning on the wall, Yoram massaged my lower back, the midwife came in and asked if the back pain was new. I gave her a look because I couldn't say, "I don't know and I don't care." She retreated and said something else. I was pushing on my next contraction. heart tones were fine. She wanted to check me - because of her fears. She said the baby's head was very high, she said it felt like there was swelling during the contraction. After the next contraction she checked again, and said, with distinct fear, the baby's head had receeded. She wanted to call the ambulance. I could only say ok.
In my head I didn't feel right, I wanted to ask her things, I wanted some options, but my voice couldn't get through the fog of focus anymore - and Yoram was getting scared for the baby. From that moment on, I was abandoned. No one there was there for me. The modwife was concerned for the baby, and for her own skin should something go wrong - or should someone suspect that this was a planned homebirth. Yoram was concerned about the baby and whether the midwife's fears were valid, and my mother was nudged out of the way and feeling uncharacteristically helpless.
I did the next contraction on the toilet, and it felt good. I should have stayed in there.
Someone brought me a skirt, and someone else grabbed the shopping bag and somehow I made it down the stairs. I wasn't working with my body anymore, I was so confused, and no one was talking to me. The EMT's came in, and then I was on a stretcher, and they were buckling it, and I was screaming, and then the midwife and Yoram and I were in the ambulance (although, Yoram was made to go to the front, so he wasn't with me. Only the totally clueless EMT, and my fearful, useless midwife, who was calling herself the doula at this point.
The ride to the hospital was horrific. They wanted to start an IV, my eyes must have been shooting daggers. They tried to take my blood pressure, putting the automatic cuff on my arm and then forgetting it was there - it got so tight, and wouldn't go down, b/c I was gripping hte stretcher for dear life, and we were bouncing all over the place. So until I started crying that my hand was going numb, he finally took off the cuff. He tried to get a pulse-ox, but I threw the thing off my finger. Then he stuck on EKG monitors, the glue from which are still on my shoulders and ankles. I was screaming, the pressure was building, and I had no respite. No calm voices, no one to bring me back into my body and guide me. Not even Yoram's strong hands to center and steady me. I was on my own.
I screamed for the driver to stop the car and let me push without moving, the EMT in the back kept telling me he would stop after the next intersection - I found out later that he was motioning to the driver to keep going. I wanted to throw something at the driver but I was afraid to let go of the stretcher. No one was listening to me. My water broke, and I had some relief. And then the baby's head descended and was squatting on the stretcher, and everything was moving, and I just had to push this baby out. And somewhere in the darkest reaches of my mind was a small voice trying to tell me to breath, and not to push so hard - but I couldn't listen. There was no one to mirror it, no one to magnify that inner voice.
The midwife told me that I should catch my own baby, b/c I had the cleanest hands. I felt his head coming through, I felt the burn and I knew he was tearing me up inside, b/c I couldn't control his descent. And no one supported my perinium to provide counterpressure. Yoram was behind me by now. But I was barely aware of it. We stopped finally, because we had pulled into the entrance of the hospital and my baby was born, and he was blue. He gave a weak cry, and I held him and massaged him and then the doors opened and the ambulance was packed with people yelling and making a fuss and someone clamped my baby's cord! And I screamed - but it was too late because it was some plastic thing that couldn't be taken off. My poor baby, fighting to fill his lungs and they stripped him of his lifeline! And they took him away from me and I screamed and kicked and spat at them to give me back my baby - miraculously someone did and I didn't let him go again. They didn't suction him, or anything, he pinked up on his own. I just held him in my arms, and massaged his chest, and then the midwife did say something useful, she told me to give him a breath. Finally he filled his little lungs and gave a wail no thanks to the hospital staff, ambulance staff, or my own birth attendant.
They wheeled me inside, and someone started tugging on the cord to pull out the placenta and I yelled again for them to stop and let me push it out, but they didn't listen. And then a doctor was suturing me, and I asked her where I tore, and I couldn't understand what she was saying, and she wouldn't let the midwife watch. It seems that I didn't tear on the outside, but I had 5 stitches behind my perinium. All I know is that right now as I type this, it still stings.
I refused the pitocin drip, tried to nurse my baby - who was rooting but still screaming too much to latch on, and massaged my own uterus. My blood pressure did drop pretty low, though, and I knew I hadn't eaten or drank much since the morning. (By the way, he was born at 12:30 - only 3 hours from the time I arrived home with my mother.) I let them give me IV fluids, I did not want to pass out. When they asked me if I had any questions, I said, "yes, how soon can we leave?" I was told that I just need to tell the nurse upstairs, and sign out, and we can leave whenever we want.
The hospital stay was not an improvement on the experience and we checked ut as soon as they let us... but maybe that is in a future post.
My beautiful boy weighed 3.3 kg (7lbs 3oz) at birth on Wed July 22, 2009. By Sunday he had regained his birth weight plus 5 oz, b/c he's nursing non-stop! This past Wednesday, at his Brit Milah, we gave him his name: Yitzchak, after my father's father who passed from this world only 2 years ago. The name Yitzchak literally means "he will laugh" and maybe that is a lesson too. I'm not sure why my Tzachi had to be born in the way that he was. I don't know what purpose it served for me or for him. Of course I am grateful to be holding my healthy baby, but that doesn't take away the trauma of the experience - of having my needs and desires ignored, of the pain of giving birth in a moving vehicle, of the additional recovery time that I now have, and the loss of the experience I had envisioned. And that is another lesson.
Lesson #6: Don't be appologetic about your birth! This goes for having an amazing experience, or a traumatic one. Women who have had beautiful births are often afraid to talk about it, so as not to offend women who had unpleasant births. And those of us who've experienced trauma in our births feel guilty about not just being grateful to be healthy and having a healthy baby. Remember that statistically the outcome of "healthy mother and baby" is all but guaranteed in developed countries - even for women in a moderate risk category. The fact is that women who are getting regular pre-natal care, who have access to appropriate health care and nutrition emerge from birth alive and well with an equally vital infant. So it is completely valid to view the birth experience as an entity in and of itself.
If you had a wonderful birth - don't be afraid to share it! You own that experience, and it's memory will be a source of strength for you for the rest of your life!
And if you're experience was less than wonderful - it is yours to grieve, and learn from and hopefully grow from.
Part of writing this has been an exercise in letting go and forgiving those involved - and forgiving myself. But it was also important to me that I share this because this is what I do, and women like me are among the women that I serve. So in sharing my story, I hope I have also conveyed some wisdom that can be incorporated into your birth choices.
From the depths of my heart,
~Ayelet
Lesson #1: Even doulas need a doula. Every woman deserves to be supported by someone who is knowledgeable about birth (experientially or through training), and who's only concern is the birthing woman and her needs. Because I was on my own, I was trying to anticipate my own needs, and it kept me (among other things) from succumbing completely to my body and my labor. And once my labor did take over, I was left without an advocate.
I asked for names of midwives in the area of the country that I was moving to. I got a few recommendations. One of them called me, she seemed nice and experienced, and she took the time to talk to me and address my concerns. I spoke to her a few times before we met, and although I kept thinking that I should at least call and "interview" some of the other women on the list, I was drawn in by the ease of just continuing with this midwife and not expending the effort of calling other people, telling my whole story, asking my questions, etc... Especially since this was happening in the thickest part of our hectic and frenetic move across the world - and then across this country.
The Schwell Aliyah Adventure: A brief history of the events of the past year
(The link is to my husband's blog, if you're interested in more details and pictures and videos!)
Aliyah is a Hebrew word meaning "going upwards." It's also the word for immigration to Israel (and in fact to leave Israel and move somewhere else is known as "yerida" going down! It can be said that the spirituality of this place is uncontested.)
and I were experiencing a need to transition from our current positions into something more directly connected with our purpose. (There's a bit more background to this story, but it's not for the "brief" version!) Suddenly I was overcome with inspiration, as if the Biblical words that God spoke to Abraham were being spoken directly to me! "Lech One balmy Friday afternoon last July, I was driving through the towns of Central Jersey to buy wine for Shabbat and a birthday present for my son's 4th birthday. I was at a traffic light, going over in my head all my hopes and dreams and wondering what our next step was. Both YoramL'cha...." Go forth from your land, your birth-place, your Father's home, to the land that I will show you - and you will reap all he blessings that are your birthright.
I know this may sounds cheesy, but it literally happened exactly that way.
I called Yoram, who was bathing our 4 and 1.5 year old and I told him, "Yoram, this is it! We just have to go." My poor, exasperated husband, being splashed on, and attempting to keep one child from drowning the other, asked me, "Go where?!"
"To Israel, Yoram, we have no more excuses to push it off! We just have to go."
"Right now? Or can we discuss this more when you get home?" I conceded, told him I love him, and continued on my errands, feeling teary and emotional. I chose a bottle of Golan wine, because it has always been our dream to settle down in that region of the country.
Over that Shabbat, we talked about it, and why now, and what the immediate next step was. Yoram, being the more practical of the two of us, was concerned, but the idea of fulfilling our life-long dream at last seemed within our reach.
Over the next few months we started letting people know our plans, started the process of applying for Israeli citizenship, getting information about the upcoming Nefesh B'Nefesh charter flights, and I called the realtor who had sold us our house only 2 and a half years prior.
"Alex," I said, "We're making Aliyah in Dec, and we want you to put the house on the market."
He laughed, for two reasons. "Ayelet, I have sold a lot of houses in this community and I can't tell you how many times I've heard buyers say, 'in 2 years we'll call you to sell the house, because we're moving to Israel.' You are the first ones to actually do it!" And the second reason was, that in September of 2008, the housing market was already plummeting, and he thought we were a little crazy to choose to sell at that time. (The house, by the way, is still on the market - a lovely 3 BR house in Hillside, NJ - we are entertaining all offers!)
In late November, we discovered more exciting news, I was pregnant! Our flight date was just before the end of the first trimester, and although we were excited and happy, we couldn't help wondering how this might complicate our move. High on the list of questions was comfort. Because we were moving in such a short time frame, we had decided to move to an absorption center apartment until we could research and find a community in which to live. Absorption centers are not built for comfort. We didn't know what to expect.
When we arrived, we were greeted by Yoram's brother and sister and their families who had already come on Aliyah. The kids made cute signs and although we were exhausted, we were glad to see them! We boarded a cab from Ben Gurion airport in Tel Aviv to take us to our temporary dwelling in Jerusalem. The apartment was tight. It had one bedroom, a slightly larger common room, and a kitchen that could be occupied by two people, or by one pregnant woman at a time. And there was no oven, just a hot plate with two burners. It was not arranged to accommodate a family of 4 (and a half). Somehow we managed for almost 6 months.
During that time, we realized that our original thought of starting off renting something in the Jerusalem area before moving north in a few years, was silly. Staying in Jerusalem itself was nearly impossible due to the prices of apartments that were far too small to accommodate our family. Aside from the fact that city life was not our first choice. So that left us looking into the outlying villages, but we were wary of moving into a small community and becoming settled, only to move to an entirely different region of the country in a few years.
So we started the process of moving north. It was like starting our whole Aliyah over again! In February, we took a week long "scouting" trip up to the Galilee and the Golan, visiting different communities, talking to people about homes, jobs, schools... In the Golan, we fell in love. We knew that was where we needed to be - just as we had always dreamed.
For most of March and April we were away in the States, visiting with family, enjoying my brother's wedding, and gave me the opportunity to attend an incredible conference for business owners that affected me deeply.
When we got back to Israel, we started looking at rentals in a few of the communities we had visited. With our time at the absorption center running out, both in terms of our tolerance for it, and their housing policies, our search took on a bit more desperation than we had wanted.
A friend that we had met in the Galilee recommended we check out the "city" of the Golan Heights, Katzerin. I put city in quotes because although it is technically a city and not a moshav, or kibbutz, the entire city would fit neatly inside of Madison Square Garden! And although it has a supermarket, bank, restaurants, and schools - it is surrounded on all sides by open fields, forests and mountains. We got in touch with the handful of English-speakers in Katzerin, rented a car, and drove up to see the area on a Wednesday.
We decided to come back that Shabbat and see the community in repose. The family that hosted us arranged all our meals and somehow the entire community was informed of our coming. I felt as if they had rolled out the red carpet and struck up the band! We felt so welcomed! On Sunday we went around to look at some houses and apartments for rent and found one that seemed absolutely perfect. Three weeks later, we had moved in! (Pictures and videos of our house are on my Facebook profile: http://www.facebook.com/ayeletschwell)
Which brings us back to our birth story:
When we finally had moved in, I called the midwife, and we arranged a time for her to come and meet me. Her home is an hour away from mine. At that first meeting, we chatted, I asked her some questions, told her my history, and felt as she was leaving that something was not quite right. I couldn't put my finger on it, but I swept it away, because at that point I was 34 weeks pregnant, and my Braxton-Hicks contractions had begun to take on a more serious feel. My oldest son had been born at 36 weeks, and my daughter at 38. So I had no idea when this little one would come and I felt at a loss to begin looking for a new practitioner at such a late date. Especially with my whole story.
Lesson #2: Always trust your instincts about your provider! Whether it proves right or wrong is irrelevant! If you feel at all uncomfortable with your care provider, you are headed for an uncomfortable birth experience - if for no other reason than that tension alone! It is never too late to review other options. And although I might not have been able to find another homebirth midwife at that time, I could have settled myself into the idea of a free-standing birth center. But I didn't even look into it.
I ended up staying pregnant for the next 6 weeks. And when my labor began, it was slow - very very slow. But there were so many factors! Based on my previous births, even with a slow start, once my body switches into full-on labor mode, I go very quickly. And considering that my birth team were spread out over the country, I wanted them there. So I called the midwife on Sat night July 18th. While she was on her way over, Yoram and I went for a long walk, and my contractions picked up even more. We got home and I prepared a few things and puttered around a bit, and when the midwife arrived, we looked at heart tones, and my blood pressure and everything looked great. I started feeling uncomfortable, and wanted to be in the warm water of my pool. The midwife warned that at this point the water can slow labor and not help it along. So I thought if it slows down, I'll get out, but at least I'd be comfortable for a little.
Well, my labor did slow down, and then the kids woke up (it was a little after 6am) and then the contractions stopped altogether. I slept most of Sunday. Monday I decided to ignore the contractions, and my mom arrived that evening. She told me she was exhausted and was planning on taking an ambien to help her stay asleep through the night and avoid jetlag. My body got the hint.
In the morning, though, I woke up with those deep, low down, this-is-it kind of contractions, and I called the midwife again. She said she'd come out, but to ignore her and do something fun with my mom and the kids. So we went for a walk. When we got back to the house, the midwife had arrived, and we helped her bring her things into the house. Heart tones sounded great, baby's head was still down (but could still be felt above the pelvis) and the contractions were getting stronger, but weren't getting into a pattern. So we continued to ignore them. We all went to the pool and had a great time! (again, pics and videos on facebook! some are on Yoram's profile.)
I called the midwife when we started heading out from the pool, and told her we were going to go get some food at the pizza store. She met us there. Somewhere between leaving the pool, and walking towards the pizza store, things changed. The contractions were coming on every 5 minutes, and I was no longer in a jovial mood. But I was hungry, and I got very focused on eating some pizza. We got to the store and started to move inside into the a/c, and were told that we would have to eat outside because they were expecting a group - I was going to strangle someone! But we ordered our pizza, and sat down in a shady, breezy spot. I ate my pizza, barely looking at anyone, only slightly aware of the needs of the children, who were being taken care of by my mother and husband.
I didn't quite get through two slices when I said, "I want to go home." The midwife brought her car around and me and my mom got in. Yoram walked home with the kids. In retrospect, I should have kept moving, because somewhere between getting into the car and getting out of it 3 minutes later at my home, I began thinking of things I needed to do and people I needed to call, or didn't get to call, or what have you, and the contractions started slowing down... I got into the pool, but it was already too late. When my son decided to join me in the pool, it was over. He's so sweet, and so nurturing and helpful, but he is also very engaging and I completely lost my focus and couldn't get it back.
The the emotional turmoil set in. My grandmother's passing just a week prior, my father not being able to be here, all the stress of the previous 6 months, and the fear that after all this, I might still not actually give birth and finally meet my baby.
Lesson #3: Keep Moving!! When the going gets tough, the tough get going, right?! It works in labor too! At that point, the midwife suggested that Yoram and I take some time together, but we should have left the house and gone walking! The contractions were still there, they just needed a nudge to get back on track. Plus, getting out of that environment would have been another way to get me back into my laborland head-space. And furthermore - it might have moved other digestion-related things (ahem) that might have also assisted in moving things along.
At this point, the midwife had a startling decision. She decided that she felt my baby was at risk of being slow rescusitating, because of all the starts and stops in labor, and she felt that it was no longer safe for me to give birth at home. Yoram and I questioned her, considering that his heart rate was fine, and that he was moving around before and after contractions, and that aside from my anticipation, I was feeling completely at ease with the baby's condition. She said, she has to consider that we are 30-40 minutes from a hospital, and she doesn't want to take a chance.
I was devastated. I felt betrayed. This decision felt wrong in every way. And not having a car meant that I hadn't seen any of the local hospitals, had not prepared for this eventuality in the least.
Lesson #4: Always prepare a back-up plan. It is true that most healthy women who plan a homebirth, have completely healthy, natural births and healthy babies at home. But on the rare likelihood of transfer, I would have been much more settled into this reality had I at least seen the hospitals, made some contacts there, known what to expect. Also, depending on where in the world you are birthing, writing up a back-up birth plan for hospital transfer might be helpful - and lets go back for a moment to lesson #1 - bring your doula!!! But I'll get to that more in a minute.
I spoke to a close friend who is also a midwife, but who lives too far away to have been my birth attendant. She brought into perspective the fact that what my midwife was actually saying was that she was no longer comfortable attending my homebirth. She was "opting out."
I cried all night, and resolved with my mother and Yoram that in the morning we would rent a car and Yoram and I would go check out the hospital that the midwife had recommended, which was in the holy and beautiful city of Sefat. We thought that, at the very least, we would get some time together in the city, and maybe even buy a new set of candlesticks, since I'd soon be lighting one more candle on Friday night.
My daughter, who's 2, was miserable that night. She wasn't feeling well at all. Congested and coughing and complaining that her mouth and ear were hurting (I'm pretty sure she's growing a molar) so we put her to bed in our room, propped up on pillows. Somehow, despite being so small she took up my entire bed! So when I finally did get to sleep, it was in the smallest possible area on my bed, and I was waking up from contractions.
It's now Wed morning, July 22nd - also Rosh Chodesh Av (the first day of the Hebrew month of Av) Yoram slept in and missed the 6:15 prayer service, he might have just prayed at home, but it was Rosh Chodesh and he really wanted to be at the service. So he went at 8:30 and my mother and I walked the kids to their respective camp/playgroup. Before we left, I put a few things into a shopping bag, in case we did end up in L & D that day.
On the way there, I continued walking through my contractions, on the way back, I couldn't. By the time we got home, stopping to chat w/my neighbor who offered to drive us to Sefat, the contractions were less than 5 minutes apart and I was moaning and swaying when they came to relieve the tension and the pressure of each intense wave.
My mom called the midwife, she didn't think we would make it to the hospital, so the midwife headed here and asked if she could send someone over who lived closer and ad attended many births. Presumably a doula. My mother agreed.
Lesson #5: Be wary of inviting people you don't know into your birth space. Especially having not heeded lesson 1, having your own doula who will preserve the sanctity of your birth space no matter who's there, or where you are. Because birth is not where you physically are. You can have a serene, loving, non-traumatic birth in an emergency operating room, if that is what is necessary, as long as you are prepared and supported in keeping the experience sacred.
Yoram came home minutes later and mobilized for birth. At this point, I wish we had not called the midwife till I was actually pushing, but she was already on her way.
This is where events begin to run into each other in my mind, so I'll relate it as well as my memory permits.
I know I was in and out of the pool. The woman from nearby arrived, I only remember that she had strong hands and she massaged my lower back through a few contractions. Sometimes Yoram was sitting behind me, sometimes my mom. The room seemed too bright. The midwife came in, my tension rose - but only as much as my primal being would allow. I wanted to be darker, I went to my bed, with Yoram. I was on my knees, hugging my pillows and leaning on the wall, Yoram massaged my lower back, the midwife came in and asked if the back pain was new. I gave her a look because I couldn't say, "I don't know and I don't care." She retreated and said something else. I was pushing on my next contraction. heart tones were fine. She wanted to check me - because of her fears. She said the baby's head was very high, she said it felt like there was swelling during the contraction. After the next contraction she checked again, and said, with distinct fear, the baby's head had receeded. She wanted to call the ambulance. I could only say ok.
In my head I didn't feel right, I wanted to ask her things, I wanted some options, but my voice couldn't get through the fog of focus anymore - and Yoram was getting scared for the baby. From that moment on, I was abandoned. No one there was there for me. The modwife was concerned for the baby, and for her own skin should something go wrong - or should someone suspect that this was a planned homebirth. Yoram was concerned about the baby and whether the midwife's fears were valid, and my mother was nudged out of the way and feeling uncharacteristically helpless.
I did the next contraction on the toilet, and it felt good. I should have stayed in there.
Someone brought me a skirt, and someone else grabbed the shopping bag and somehow I made it down the stairs. I wasn't working with my body anymore, I was so confused, and no one was talking to me. The EMT's came in, and then I was on a stretcher, and they were buckling it, and I was screaming, and then the midwife and Yoram and I were in the ambulance (although, Yoram was made to go to the front, so he wasn't with me. Only the totally clueless EMT, and my fearful, useless midwife, who was calling herself the doula at this point.
The ride to the hospital was horrific. They wanted to start an IV, my eyes must have been shooting daggers. They tried to take my blood pressure, putting the automatic cuff on my arm and then forgetting it was there - it got so tight, and wouldn't go down, b/c I was gripping hte stretcher for dear life, and we were bouncing all over the place. So until I started crying that my hand was going numb, he finally took off the cuff. He tried to get a pulse-ox, but I threw the thing off my finger. Then he stuck on EKG monitors, the glue from which are still on my shoulders and ankles. I was screaming, the pressure was building, and I had no respite. No calm voices, no one to bring me back into my body and guide me. Not even Yoram's strong hands to center and steady me. I was on my own.
I screamed for the driver to stop the car and let me push without moving, the EMT in the back kept telling me he would stop after the next intersection - I found out later that he was motioning to the driver to keep going. I wanted to throw something at the driver but I was afraid to let go of the stretcher. No one was listening to me. My water broke, and I had some relief. And then the baby's head descended and was squatting on the stretcher, and everything was moving, and I just had to push this baby out. And somewhere in the darkest reaches of my mind was a small voice trying to tell me to breath, and not to push so hard - but I couldn't listen. There was no one to mirror it, no one to magnify that inner voice.
The midwife told me that I should catch my own baby, b/c I had the cleanest hands. I felt his head coming through, I felt the burn and I knew he was tearing me up inside, b/c I couldn't control his descent. And no one supported my perinium to provide counterpressure. Yoram was behind me by now. But I was barely aware of it. We stopped finally, because we had pulled into the entrance of the hospital and my baby was born, and he was blue. He gave a weak cry, and I held him and massaged him and then the doors opened and the ambulance was packed with people yelling and making a fuss and someone clamped my baby's cord! And I screamed - but it was too late because it was some plastic thing that couldn't be taken off. My poor baby, fighting to fill his lungs and they stripped him of his lifeline! And they took him away from me and I screamed and kicked and spat at them to give me back my baby - miraculously someone did and I didn't let him go again. They didn't suction him, or anything, he pinked up on his own. I just held him in my arms, and massaged his chest, and then the midwife did say something useful, she told me to give him a breath. Finally he filled his little lungs and gave a wail no thanks to the hospital staff, ambulance staff, or my own birth attendant.
They wheeled me inside, and someone started tugging on the cord to pull out the placenta and I yelled again for them to stop and let me push it out, but they didn't listen. And then a doctor was suturing me, and I asked her where I tore, and I couldn't understand what she was saying, and she wouldn't let the midwife watch. It seems that I didn't tear on the outside, but I had 5 stitches behind my perinium. All I know is that right now as I type this, it still stings.
I refused the pitocin drip, tried to nurse my baby - who was rooting but still screaming too much to latch on, and massaged my own uterus. My blood pressure did drop pretty low, though, and I knew I hadn't eaten or drank much since the morning. (By the way, he was born at 12:30 - only 3 hours from the time I arrived home with my mother.) I let them give me IV fluids, I did not want to pass out. When they asked me if I had any questions, I said, "yes, how soon can we leave?" I was told that I just need to tell the nurse upstairs, and sign out, and we can leave whenever we want.
The hospital stay was not an improvement on the experience and we checked ut as soon as they let us... but maybe that is in a future post.
My beautiful boy weighed 3.3 kg (7lbs 3oz) at birth on Wed July 22, 2009. By Sunday he had regained his birth weight plus 5 oz, b/c he's nursing non-stop! This past Wednesday, at his Brit Milah, we gave him his name: Yitzchak, after my father's father who passed from this world only 2 years ago. The name Yitzchak literally means "he will laugh" and maybe that is a lesson too. I'm not sure why my Tzachi had to be born in the way that he was. I don't know what purpose it served for me or for him. Of course I am grateful to be holding my healthy baby, but that doesn't take away the trauma of the experience - of having my needs and desires ignored, of the pain of giving birth in a moving vehicle, of the additional recovery time that I now have, and the loss of the experience I had envisioned. And that is another lesson.
Lesson #6: Don't be appologetic about your birth! This goes for having an amazing experience, or a traumatic one. Women who have had beautiful births are often afraid to talk about it, so as not to offend women who had unpleasant births. And those of us who've experienced trauma in our births feel guilty about not just being grateful to be healthy and having a healthy baby. Remember that statistically the outcome of "healthy mother and baby" is all but guaranteed in developed countries - even for women in a moderate risk category. The fact is that women who are getting regular pre-natal care, who have access to appropriate health care and nutrition emerge from birth alive and well with an equally vital infant. So it is completely valid to view the birth experience as an entity in and of itself.
If you had a wonderful birth - don't be afraid to share it! You own that experience, and it's memory will be a source of strength for you for the rest of your life!
And if you're experience was less than wonderful - it is yours to grieve, and learn from and hopefully grow from.
Part of writing this has been an exercise in letting go and forgiving those involved - and forgiving myself. But it was also important to me that I share this because this is what I do, and women like me are among the women that I serve. So in sharing my story, I hope I have also conveyed some wisdom that can be incorporated into your birth choices.
From the depths of my heart,
~Ayelet
Thursday, June 25, 2009
Where am I going with all this...?!
I came across this again today, it is one of my favorite quotes - and somehow it always tends to pop up when I need to remember it!
Sometimes I just feel like, "who am I? I'm just some shnook with an idea. How can I really make a difference?" But when I read those words, I remember that I just have to run with this, that I have to keep doing what I'm doing and let it grow and go wherever the One who inspired it intends for it to go...
(It doesn't take away the fear, though!)
Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others. (Marianne Williamson)Last night I hosted the call on Postpartum health, it was an amazing call, and we had a huge turnout! And not only that but I am already talking to 4 other experts about being featured in the coming months! I started the Conference on MotherBaby Wellness in a flash of inspiration because the opportunity to interview Shoshana on such a relevant topic came into my life and this all just grew around it - but I had no idea where it would go!
Sometimes I just feel like, "who am I? I'm just some shnook with an idea. How can I really make a difference?" But when I read those words, I remember that I just have to run with this, that I have to keep doing what I'm doing and let it grow and go wherever the One who inspired it intends for it to go...
(It doesn't take away the fear, though!)
Tuesday, June 16, 2009
AMA to Label "Ungrateful Patients"
It seems that the American Medical Association is discussing a resolution at their next meeting that will allow them to include "non-compliant" and "ungrateful" in patients' records.The article is featured on the ICAN website, because of it's implications in maternity care.
It can be read here. Please do me a favor - don't just read the response of ICAN. Scroll down to the bottom and open the actual resolution sheet (it's resolution 710) and at least skim the actual resolution. And while you're at it, take a look at some of the other resolutions on the table for next week's meeting of the AMA.
I do take issue with the Michigan Delegation's proposal to label non-compliant or ungrateful patients. I take issue with it because it opens a Pandora's box on what can be considered "non-compliance." But I happen to have also noticed Resolution 709, presented by the Kansas Delegation, which proposes that the AMA take into careful consideration how new payment methods might impact the patient-physician relationship, and provide action steps for physicians to follow in order to make sure that where their money comes from does not affect the way they care for their patients!
If we are going to talk about the arrogance of physicians who want to have a way to label patients as ungrateful, we must also mention the sensitivity of physicians who recognize that the patient-physician relationship is based on the statute of "First do no harm." and not, "first check how much I can get paid for this."
So, as I learned from studying the Rabbis of old, I will start with the bad and end with the good.
The problem with Resolution 710 is that it doesn't give any guidelines for what is considered "ungrateful" or "non-compliant." It seems clear that the purpose for the resolution is a measure of CYA (cover your a**!) where if a patient refuses care and has a negative result, or if the patient is hostile and therefore is difficult to treat, then having a code in their record about that helps the doctors to defend themselves.
But then we come to what else happens with those codes? For example:
So I reassure her. The measurements are based on ultrasound information, which is notoriously unreliable for measuring. There is absolutely lifesaving information that can be gleaned from the use of ultrasound, but accurate measurements are not one of them. In fact, the margin of error for u/s measurements after the first trimester is +/- 2lbs!! That's a huge margin!! That means if you are being told at 34 weeks that your baby is likely to be 8lbs - you may just as well be looking at a 6lb baby! And conversely, if you are told that your baby is not growing, and is measuring behind dates (another reason for induction) you may be told that you're baby is only 4lbs at 36 wks, when really, if allowed to go to term, you'd be having a bruiser of a 9 pounder!
'Please consider,' I tell my imaginary client, 'the risks of an early induction. That your baby really is up to 2 lbs smaller that the measurements and might require NICU care; that pitocin use can create overly-intense contraction which can lead to uturine hyperstimulation, stress in the baby, increased pain requiring the use of narcotics - which have all of their risks; and all in all you could end up with a cesarean to "save your baby" which you would have never needed had you been allowed to go into labor all on your own when you and your baby were ready. Plus remember that giving yourself the freedom to use different positions in labor and pushing will allow you to birth whatever size baby your body can grow!' (Except under 3 very specific circumstances, which are not the case with my particular client)
She weighs the pros and cons and decides that she does not want to be induced based on the ultrasound measurement, and thank you very much, Dr. X, but I will go ahead and wait until I go into labor on my own.
Unless there are very clear guidelines on the resolution to define what is "non-compliant," my client here may very well find that label on her chart (or not, depending on whether she has access to it!) and how will that affect her reception at the Labor and Delivery ward? How will the nurses and residents react to knowing that they have an "ungrateful," possibly "hostile" patient on their hands? And heaven help her if she also shows up with a doula! Now they know they're in for a fight!
If the resolution passes - and even if this resolution just brings to light a sentiment among doctors, then the need for women to be very well informed about their options and the research sky-rockets!
And that is my complaint with the AMA Resolution 710.
Now for the praise:
Kudos to the Kansas Delegation for bringing up a very real and tangible problem in the health-care world! This is something that Henci Goer talks about extensively. It is the problem of health care providers thinking about their bottom line when considering patient care. It is no secret that physicians can bill for every intervention they use. For maternity care this is especially problematic, because unfortunately money can cloud judgement and things that seem "harmless" like constant fetal monitoring, and mandatory IV fluids, and AROM (artificial rupture of membranes - breaking the bag of waters) are easy little things that can add to doc's paycheck - but evidence is very clear that these have very little benefit, and can lead to additional interventions directly from their use.
I do hope that resolution gets passed and that the AMA does take a good look at the importance of the patient-physician relationship and how to preserve the trust between doctor and patient by providing care that is solely beneficial to the patient's needs, regardless of the profit of the physician.
What does this all come down to? It seems to me that with all the pressures and limitations that physicians deal with from insurance companies and legislation, the standard of care has become more complicated than just serving their patients. Unfortunately, the true answer and cure for this is total health care reform, and complete re-education of the meaning of health and wellness for physicians and for us (those who are served by the physicians!). In the meantime, it would be very scary for doctors to have the ability to assign value judgements on their patients - even though there may be situations where they are justified. And at the same time it is extremely important for doctors to put their patients' health above their bottom line - after all, if you are studying to be a doctor for the paycheck, then you were always only going to be serving yourself.
It can be read here. Please do me a favor - don't just read the response of ICAN. Scroll down to the bottom and open the actual resolution sheet (it's resolution 710) and at least skim the actual resolution. And while you're at it, take a look at some of the other resolutions on the table for next week's meeting of the AMA.
I do take issue with the Michigan Delegation's proposal to label non-compliant or ungrateful patients. I take issue with it because it opens a Pandora's box on what can be considered "non-compliance." But I happen to have also noticed Resolution 709, presented by the Kansas Delegation, which proposes that the AMA take into careful consideration how new payment methods might impact the patient-physician relationship, and provide action steps for physicians to follow in order to make sure that where their money comes from does not affect the way they care for their patients!
If we are going to talk about the arrogance of physicians who want to have a way to label patients as ungrateful, we must also mention the sensitivity of physicians who recognize that the patient-physician relationship is based on the statute of "First do no harm." and not, "first check how much I can get paid for this."
So, as I learned from studying the Rabbis of old, I will start with the bad and end with the good.
The problem with Resolution 710 is that it doesn't give any guidelines for what is considered "ungrateful" or "non-compliant." It seems clear that the purpose for the resolution is a measure of CYA (cover your a**!) where if a patient refuses care and has a negative result, or if the patient is hostile and therefore is difficult to treat, then having a code in their record about that helps the doctors to defend themselves.
But then we come to what else happens with those codes? For example:
A pregnant woman in her 3rd trimester is told by her doctor that she is measuring "large for dates" - that her baby is very big, and might be too big to be born vaginally. He tells her that it will be safer to induce early, before the baby grows anymore. Or he tells her that a cesarean delivery is very likely. She calls me (yes, it's a shameless plug!) and asks me why her doctor is saying this? She's very scared about birth and now she's even more nervous that she won't be able to get her baby out! And why would her body make a baby she can't birth?
So I reassure her. The measurements are based on ultrasound information, which is notoriously unreliable for measuring. There is absolutely lifesaving information that can be gleaned from the use of ultrasound, but accurate measurements are not one of them. In fact, the margin of error for u/s measurements after the first trimester is +/- 2lbs!! That's a huge margin!! That means if you are being told at 34 weeks that your baby is likely to be 8lbs - you may just as well be looking at a 6lb baby! And conversely, if you are told that your baby is not growing, and is measuring behind dates (another reason for induction) you may be told that you're baby is only 4lbs at 36 wks, when really, if allowed to go to term, you'd be having a bruiser of a 9 pounder!
'Please consider,' I tell my imaginary client, 'the risks of an early induction. That your baby really is up to 2 lbs smaller that the measurements and might require NICU care; that pitocin use can create overly-intense contraction which can lead to uturine hyperstimulation, stress in the baby, increased pain requiring the use of narcotics - which have all of their risks; and all in all you could end up with a cesarean to "save your baby" which you would have never needed had you been allowed to go into labor all on your own when you and your baby were ready. Plus remember that giving yourself the freedom to use different positions in labor and pushing will allow you to birth whatever size baby your body can grow!' (Except under 3 very specific circumstances, which are not the case with my particular client)
She weighs the pros and cons and decides that she does not want to be induced based on the ultrasound measurement, and thank you very much, Dr. X, but I will go ahead and wait until I go into labor on my own.
Unless there are very clear guidelines on the resolution to define what is "non-compliant," my client here may very well find that label on her chart (or not, depending on whether she has access to it!) and how will that affect her reception at the Labor and Delivery ward? How will the nurses and residents react to knowing that they have an "ungrateful," possibly "hostile" patient on their hands? And heaven help her if she also shows up with a doula! Now they know they're in for a fight!
If the resolution passes - and even if this resolution just brings to light a sentiment among doctors, then the need for women to be very well informed about their options and the research sky-rockets!
And that is my complaint with the AMA Resolution 710.
Now for the praise:
Kudos to the Kansas Delegation for bringing up a very real and tangible problem in the health-care world! This is something that Henci Goer talks about extensively. It is the problem of health care providers thinking about their bottom line when considering patient care. It is no secret that physicians can bill for every intervention they use. For maternity care this is especially problematic, because unfortunately money can cloud judgement and things that seem "harmless" like constant fetal monitoring, and mandatory IV fluids, and AROM (artificial rupture of membranes - breaking the bag of waters) are easy little things that can add to doc's paycheck - but evidence is very clear that these have very little benefit, and can lead to additional interventions directly from their use.
I do hope that resolution gets passed and that the AMA does take a good look at the importance of the patient-physician relationship and how to preserve the trust between doctor and patient by providing care that is solely beneficial to the patient's needs, regardless of the profit of the physician.
What does this all come down to? It seems to me that with all the pressures and limitations that physicians deal with from insurance companies and legislation, the standard of care has become more complicated than just serving their patients. Unfortunately, the true answer and cure for this is total health care reform, and complete re-education of the meaning of health and wellness for physicians and for us (those who are served by the physicians!). In the meantime, it would be very scary for doctors to have the ability to assign value judgements on their patients - even though there may be situations where they are justified. And at the same time it is extremely important for doctors to put their patients' health above their bottom line - after all, if you are studying to be a doctor for the paycheck, then you were always only going to be serving yourself.
Sunday, June 14, 2009
Messages from the Universe
There have been a lot of "things" going on in my life over the past year... Deciding to live our dream and move 6,000 miles away from everything familiar, making that move within 5 months, living in a one bedroom apartment with 2 kids and no oven for almost 5 months while we figured out where to settled down, navigating new bureaucracies and systems - including a health care system that is more foreign to me than anything else, and finally finding a beautiful community and a home - all while being pregnant!
So far, my baby's have been born before that magical "40 week" date, and this time seems to be no different, but the stress has actually been moving my pregnancy along even faster than it's ever been for me. My birthing choices have lead me to homebirth as the best option for me and my family - but safety in homebirthing practices preclude pre-term labor - so if I want to have my baby at home, we have to hang on for at least 3 more weeks! (Bringing us to 37!)
My adventures in bedrest over the past week have actually been enlightening, and I learned something that competely came out of left field, but is so relevant in pregnancy and birth that I had to share it with you.
One of the things I've decided to do to pass the time is to knit a baby blanket, this is my first patterned knitting project - for the knitters out there: until now I've basically been making garter stitch scarves. For you non-knitters, that means I've only been doing one stitch! So for this pattern I had to learn to purl. The pattern goes, knit 4 purl 8... knitting 4 - no problem, but then I got to my first purl and by the end of the row, my string was tangled, the thumb on my left hand was cramping and I was ready to call it a day! Instead of throwing the "blanket" it, I decided to try something else. I went through my yarn stash and found a worsted-weight cotton
yarn, and some size 7 needles. I casted on a far amount and just went at it in stockinette stitch (that's where you knit 1 row, and purl the next, it's the one that gives you those neat little "v"s on one side of the fabric!) The first row of purling was just as much of a disaster as the blanket, but after 4 more rows, I was purling like a pro! I made myself a nice little square, bound off and now my baby also has a soft little cotton washcloth!
But that's not the point. The point is that when I first tried that pattern, my hands felt completely awkward, I was in pain, and felt completely discouraged. My truth at that moment was, "I cannot purl. My hands won't do it, I'm not coordinated enough, and there's just no point, because this is one of those (few!) things that I'm just not good at." Two hours later, I was a master purler and the woman who "couldn't do it" didn't exist anymore. My confidence skyrocketted, my pain was gone, and now I've done 12 more rows of the blanket! It looks great!
What does this have to do with birth? Many of us start off our pregnancies, or journey into pregnancy with some fear. Fear around conceiving, miscarraige, morning sickness, pre-natal complications, diagnostic tests and screenings, labor pain, birth, becoming a parent... They may stem from your own previous experiences, second hand stories from you mom or grandmother or friends, books, media - or even straight from your care provider! You may be thinking, "I can't do this! My body just isn't made for it, not every woman can give birth, that's why there are drugs and cesareans," and the internal chatter can go on and on...
But here's the real TRUTH! Pregnancy, labor and birth are just as much a muscular interaction as knitting is, or learning to swim or an exercize or dance routine, or training for a marathon or riding a bicycle. The "pain" associated with childbirth is a muscular pain, not an injury pain like dental work or a broken leg. And just like you wouldn't run a marathon without training - just like you wouldn't take a narcotic towards the end of your aerobics workout to stop the burn - you can train your uterus, you can move with the burn of contractions and work to relieve the intensity. And as you experience these changes in your body, you feel powerful, capable, fearless! (And by the way, feeling a little invincible doesn't hurt when raising kids either!)
The cesarean rate in the US is over 30%. That statistic states that 1 out of every 3 women in NJ is incapable of birthing her baby... how's that for confidence?! If you're not ready to throw the knitted blanket in - if you know you don't want to be in that 30%, but don't know how - I'm here to tell you that you can! And fighting those statistics is as simple as getting the support and information you need to purl that next row! That's what being your Virtual Doula is all about.
Visit me at www.wholebodybirth.com for more information and to find the balanced, evidence-based answers to all concerns, from pre-conception to postpartum!
In service and with love,
~Ayelet
So far, my baby's have been born before that magical "40 week" date, and this time seems to be no different, but the stress has actually been moving my pregnancy along even faster than it's ever been for me. My birthing choices have lead me to homebirth as the best option for me and my family - but safety in homebirthing practices preclude pre-term labor - so if I want to have my baby at home, we have to hang on for at least 3 more weeks! (Bringing us to 37!)
My adventures in bedrest over the past week have actually been enlightening, and I learned something that competely came out of left field, but is so relevant in pregnancy and birth that I had to share it with you.
One of the things I've decided to do to pass the time is to knit a baby blanket, this is my first patterned knitting project - for the knitters out there: until now I've basically been making garter stitch scarves. For you non-knitters, that means I've only been doing one stitch! So for this pattern I had to learn to purl. The pattern goes, knit 4 purl 8... knitting 4 - no problem, but then I got to my first purl and by the end of the row, my string was tangled, the thumb on my left hand was cramping and I was ready to call it a day! Instead of throwing the "blanket" it, I decided to try something else. I went through my yarn stash and found a worsted-weight cotton
yarn, and some size 7 needles. I casted on a far amount and just went at it in stockinette stitch (that's where you knit 1 row, and purl the next, it's the one that gives you those neat little "v"s on one side of the fabric!) The first row of purling was just as much of a disaster as the blanket, but after 4 more rows, I was purling like a pro! I made myself a nice little square, bound off and now my baby also has a soft little cotton washcloth!But that's not the point. The point is that when I first tried that pattern, my hands felt completely awkward, I was in pain, and felt completely discouraged. My truth at that moment was, "I cannot purl. My hands won't do it, I'm not coordinated enough, and there's just no point, because this is one of those (few!) things that I'm just not good at." Two hours later, I was a master purler and the woman who "couldn't do it" didn't exist anymore. My confidence skyrocketted, my pain was gone, and now I've done 12 more rows of the blanket! It looks great!
What does this have to do with birth? Many of us start off our pregnancies, or journey into pregnancy with some fear. Fear around conceiving, miscarraige, morning sickness, pre-natal complications, diagnostic tests and screenings, labor pain, birth, becoming a parent... They may stem from your own previous experiences, second hand stories from you mom or grandmother or friends, books, media - or even straight from your care provider! You may be thinking, "I can't do this! My body just isn't made for it, not every woman can give birth, that's why there are drugs and cesareans," and the internal chatter can go on and on...
But here's the real TRUTH! Pregnancy, labor and birth are just as much a muscular interaction as knitting is, or learning to swim or an exercize or dance routine, or training for a marathon or riding a bicycle. The "pain" associated with childbirth is a muscular pain, not an injury pain like dental work or a broken leg. And just like you wouldn't run a marathon without training - just like you wouldn't take a narcotic towards the end of your aerobics workout to stop the burn - you can train your uterus, you can move with the burn of contractions and work to relieve the intensity. And as you experience these changes in your body, you feel powerful, capable, fearless! (And by the way, feeling a little invincible doesn't hurt when raising kids either!)
The cesarean rate in the US is over 30%. That statistic states that 1 out of every 3 women in NJ is incapable of birthing her baby... how's that for confidence?! If you're not ready to throw the knitted blanket in - if you know you don't want to be in that 30%, but don't know how - I'm here to tell you that you can! And fighting those statistics is as simple as getting the support and information you need to purl that next row! That's what being your Virtual Doula is all about.
Visit me at www.wholebodybirth.com for more information and to find the balanced, evidence-based answers to all concerns, from pre-conception to postpartum!
In service and with love,
~Ayelet
Tuesday, June 2, 2009
An Answer to Postpartum Depression
I read this article today about a study done in Canada to see if allowing new moms to get more sleep in the hospital would have a positive impact on staaving off PPD.
I wanted to share my thoughts:
It does make absolute sense that getting as much sleep as possible in the post-partum period would stave off ppd. However, I have to disagree on the method. It seems like just another medical "band-aid" to me as opposed to actually looking at the core of the problem and curing that.
In times gone by, a birthing mother's community supported her completely through her birth. There weren't such things as "hired" doulas b/c your mother, aunt, neighbor, sister... was with you and supported you as a doula does now. After the birth, the women of the community would care for the new mother with everything from housework to cooking to laundry to caring for older siblings for at least 6 weeks. Mom and baby did nothing but lie in bed, nurse and sleep.
The reason new mommas don't get enough sleep after birth is because they aren't supported in the same way as we once were.
In my opinion, it is a sad commentary to say that the only way we can re-create that support is by increasing our stay in the hospital - where the nurses are caring for several babies at a time, many are left to cry in their cribs - esp if mom has opted to exclusively breast-feed, and mom is just further from her natural environment, rather than supported in it.
I'm not saying it's an easy fix, and I'm not arguing that we need more sleep! I am saying that the true answer is not having your baby cared for by others - it's educating women and families on the importance of postpartum support. And creating support systems within communities and families to aid new mothers in transitioning to life with a newborn (even if the new baby is not the first).
After Odeliya's birth, my midwife came for the first pp visit the next day. She sat Yoram down and explained to him that I am considered "postpartum" for the next 6 weeks and whatever he has to do to make sure that my job is sleeping and caring for baby - he needs to do it. The risks are not just PPD, also hemmorage, uterine prolapse, and prolonged healing that can occur if mom is expected to go back to her "normal" routine within those first 6 weeks.
If you are at risk for PPD and want to know how to make sure that you have the support you need to be cared for after your birth, email me to set up an intake appointment to assess your needs and set up a plan so that you are looking forward to having your baby - instead of dreading it!
Love,
Ayelet
I wanted to share my thoughts:
It does make absolute sense that getting as much sleep as possible in the post-partum period would stave off ppd. However, I have to disagree on the method. It seems like just another medical "band-aid" to me as opposed to actually looking at the core of the problem and curing that.
In times gone by, a birthing mother's community supported her completely through her birth. There weren't such things as "hired" doulas b/c your mother, aunt, neighbor, sister... was with you and supported you as a doula does now. After the birth, the women of the community would care for the new mother with everything from housework to cooking to laundry to caring for older siblings for at least 6 weeks. Mom and baby did nothing but lie in bed, nurse and sleep.
The reason new mommas don't get enough sleep after birth is because they aren't supported in the same way as we once were.
In my opinion, it is a sad commentary to say that the only way we can re-create that support is by increasing our stay in the hospital - where the nurses are caring for several babies at a time, many are left to cry in their cribs - esp if mom has opted to exclusively breast-feed, and mom is just further from her natural environment, rather than supported in it.
I'm not saying it's an easy fix, and I'm not arguing that we need more sleep! I am saying that the true answer is not having your baby cared for by others - it's educating women and families on the importance of postpartum support. And creating support systems within communities and families to aid new mothers in transitioning to life with a newborn (even if the new baby is not the first).
After Odeliya's birth, my midwife came for the first pp visit the next day. She sat Yoram down and explained to him that I am considered "postpartum" for the next 6 weeks and whatever he has to do to make sure that my job is sleeping and caring for baby - he needs to do it. The risks are not just PPD, also hemmorage, uterine prolapse, and prolonged healing that can occur if mom is expected to go back to her "normal" routine within those first 6 weeks.
If you are at risk for PPD and want to know how to make sure that you have the support you need to be cared for after your birth, email me to set up an intake appointment to assess your needs and set up a plan so that you are looking forward to having your baby - instead of dreading it!
Love,
Ayelet
Sunday, May 17, 2009
News from Whole Body Birth!
Hi all!
We're in the process of some major changes both for Whole Body Birth, and on a personal level, and I thought this might be the best way to share it all with you.
On the business side:
And with around 10-12 weeks left until my baby is due, I am finally able to start the process of finding a homebirth midwife, and making the appropriate arrangements for a successful home birth.
With so much going on, and so much in-progress, I wanted to make sure you had a way of knowing how I can support you right now, even though my site is not yet updated!
And if you're not already signed up to receive the e-zine, you can sign up right on our homepage at www.wholebodybirth.com
I can't wait to hear from you!!
In service and with love,
~Ayelet
We're in the process of some major changes both for Whole Body Birth, and on a personal level, and I thought this might be the best way to share it all with you.
On the business side:
- I had a new logo and header designed for the business that really conveys the essence of what Whole Body Birth is all about!
- I also hired a web designer to fully redesign the site and bring all the functionality that I want you to be able to receive from www.wholebodybirth.com!
- My exceptional VA, Jacki, is redesigning my newsletter so that I can share relevant articles and information with you twice a month, and also have a format that includes a Reader's Highlights section - where I can feature your stories as well! The first issue will include two stories of courage and perseverence from two incredible women who were willing to trust their intuition and save their babies!
And with around 10-12 weeks left until my baby is due, I am finally able to start the process of finding a homebirth midwife, and making the appropriate arrangements for a successful home birth.
With so much going on, and so much in-progress, I wanted to make sure you had a way of knowing how I can support you right now, even though my site is not yet updated!
- As I write this, I am building a resource list, and a network of professionals that can support you from pre-conception through kindergarten! They include: fertility experts, nutritionists, fitness and yoga experts, midwives, doulas, OB/GYNs for both normal and high risk pregnancies, peri-natalogists, NICU nurses, lactation specialists, parenting experts, experts and advisors in special needs children.... If you can immagine you'll need someone, they'll be accessible here! And you can be sure that if they are in my network they are vetted for mother-centered care. They are trustworthy, and informative, and have a balanced and evidence-based practice!
- While I am developing an incredible system to mentor women and couples through conception through birth, I will be hand-tailoring private mentoring packages to each individual woman and couple. For information about that and to set up your Initial Interview, email info@wholebodybeauty.com and put "Initial Interview" in the subject line.
And if you're not already signed up to receive the e-zine, you can sign up right on our homepage at www.wholebodybirth.com
I can't wait to hear from you!!
In service and with love,
~Ayelet
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