A Doula’s Experience with Breech

After a birth, it helps to get a perspective on what could have/ should have/ might have been different in order to learn and grow. Every birth story is different. Gloria

A DOULA WRITES:
The family had a super healthy (first) pregnancy, with opportunities
galore; access to acupuncture, chiropractics, yoga, watsu, massage,
walking, biking, good rest and healthy food (they are both vegan and
eat really well). They chose not to have any ultra sounds and had
her first internal exam at 40 weeks, at her request. She was quite
anxious about having internal exams, learned that it is possible to go
through pregnancy and birth without any fingers up her vagina and
decided that would be best for her. She asked for the exam at 40 weeks
because she felt it would be better to have a ‘practice’ exam in a non
labour situation to see what it would be like just in case she wanted
to have one in labour.

Throughout her pregnancy her various health care professionals
palpated her belly and were sure the head was down. I don’t touch
bellies, I just pay attention to how women are carrying and moving and
what they are saying, and it seemed like a vertex presentation to me
as well. At 39 weeks, her chiropractor and her midwives noticed a
difference, but figured maybe the head was engaged. On her due date
she had an appointment with one of her midwives, who is quite new to
midwifery and she basically freaked out from feeling what she thought
were hands presenting and told the family they must go for an ultra
sound the following morning at 8am. The family was left quite worried.
I asked what she felt about the baby’s position. She said she had been
feeling flutters down below, and figured it was simply mild
contractions. I also asked if she was feeling pressure up in her ribs,
or if she was pushing down on her belly in discomfort, and she said
she had been feeling that way all week. I told her not to worry and
offered to join her for the ultra sound in the am.

Later that night I received a call that labour had started, she had
been contracting since her midwife appointment, but thought it was due
to the internal exam. The contractions were building, so she called
the midwives and they told her to go straight to the hospital for an
ultra sound and one of the midwives would meet them there. The ultra
sound indicated baby was breech and the OB on call was one of the only
in the city who was open to vaginal breech births, although he clearly
stated he was not interested in any marathons and she would have 6
hours to labour (no pressure!) The midwife assured them he was good at
what he does, but he was known to have no bedside manner. That was
pretty clear, but they didn’t care.

At this point their midwife said they could go home to grab their
stuff and take a pause. She was well aware that this was a total game
change from their water birth at home plan, so taking a moment at home
seemed an important part of their birth experience. They called to
let me know the baby was in fact in a breech presentation and that
they were heading home to get their stuff. I was pleasantly surprised
they were encouraged to go home, and told them to keep me posted and
take their time. I said I would meet them back at the hospital when
they returned.

We met at the hospital at 9:45. The midwife did a very gentle and slow
internal exam and found her cervix was 4 cm and stretchy. They had her
on the monitors after that. I asked if she could be on hands and
knees, but they couldn’t get the heart rate as clear, so that was
ruled out. She was laying on her side and after 10 minutes on the
monitor we heard major dips in the heart rate over and over, tried
getting her on her other side and baby was still dipping quite a bit.
The midwife was concerned of a cord prolapse, so the nurse came in and
did a very different internal exam, got right in there fast and
vigorously and felt bulging membranes and what she thought was a cord.
Suddenly two nurses had their hands inside of her, it was terrible.
They said they were trying to push the baby up off of the cord.
breech presentations

You can imagine how intense this was for the mother to be. The room
filled with nurses and it was announced that she would have an
emergency cesarean birth. They wouldn’t let her partner go with her,
this was also terrible. The midwife wouldn’t take no for an answer and
got her scrubs on to accompany her. I stayed with her partner. He was
a mess. We found the only nurse on the floor and asked if she could
keep us updated and I asked if there was any way her partner could go
in. They were waiting for the doctor to come (this whole time with the
nurses hands inside of her…) the doctor would do one more check to
make sure the cesarean was necessary. The nurse grabbed scrubs for the father
and he got changed, but just as he was going to go in the doctor
arrived.

I later found out instead of determining whether a cesarean was
necessary, he yelled at the midwife for having let them go home. One
of the nurses spoke up and suggested they instead focus on the task
at hand and he determined the cord was not presenting, but a foot was,
and her cervix was 8cm dilated. They went ahead and gave her general
and she heard the OB yelling at her midwife as she went under. Her
partner and I waited in the hallway, he made a comment that being the
dad waiting in the hallway while his baby was born felt like we time
warped to the 1950’s.

Baby was born at 10:45pm and dad held him for the first time in the
hallway at 11:10 pm. Apgars 8 & 9, and he was 5lbs 11 oz.

Mom and baby were moved to the recovery room and dad right away took
off his shirt and gave baby skin to skin cuddles until mom was ready.
At 12:45am the nurse said baby’s sugar was low and suggested formula
or glucose water. I asked mom if she was ready to try breastfeeding or
if she wanted me to get on the phone and call her friend who had
offered expressed breast milk if they needed. The nurses were outraged at this
suggestion, said they couldn’t allow it and so she did her best to
try breastfeeding. An hour later they did the sugar test again and it
was way up. The midwife and nurse were both in disbelief (the sugar
level raised from 1.9 to 3.7 in one hour!) The midwife commented how
interesting it was that they had no trouble believing the low number.
I told them it must have been the skin to skin contact with mom and
some colostrum that did the trick. Once they were settled and resting, I
drove home with their placenta and made them some quick prints and a
smoothie. They were happy to have had some of their birth wishes
granted.

Today the family is doing quite well. They are breastfeeding, resting,
eating well, have lots of support and are processing their unexpected birth
experience a little bit each day.

QUESTIONS:
– Could we have avoided those low decels if she could have been up on
her hands and knees?
– What happened when that nurse felt bulging membranes? Did she cause the membranes to release?
Or is it possible to feel a prolapsed cord through the bag?
– Could a baby with apgars 8 & 9 have been in such distress moments
before? (or was it that they were worried baby couldn’t handle two
more centimeters as well as pushing?)
– Was this the only way it could have happened? In general it felt to
me like everything happened as it had to, except those few questions
above that leave me feeling a bit curious.

I have never attended a cesarean birth (I have been a doula for four years).

Any way in which we can learn together from this story would be great.
Comments and feedback are very welcome.

Ruby

Gloria’s thoughts

    Dear Ruby, It’s getting to be hopeless to have a primip give birth vaginally to a breech.
    You must be traumatized/grieving about all this. Thank goodness you were able to give them some measure of getting their wishes met.:

    When the adrenalin gets going at a breech birth, they basically find reasons to head to the surgical setting. The cord wasn’t causing problems so, in hindsight, the heart tones were fine.

    Don’t know what the nurse doing the exam was intending but I would hope she was being careful NOT to rupture that membrane with a breech. Did she break the water bag? You would have seen amniotic fluid with clear poop coming out of the woman’s vulva after that exam if the membranes released.FOOTLING BREECH

    As far as diagnosing a prolapsed cord through the membranes with a footling breech, it might be possible because the bag is thin but it’s highly unlikely and, we know in this case (again, good hindsight), it wasn’t there.

    Apgars of 8 and 9 indicate a healthy, well grown term baby (again, golden hindsight). We do know that monitoring increases the risk of cesareans without any evidence that it is helpful in improving health.

    From what that dr with no bedside manner said, the woman wasn’t going to be given much of a chance to give birth vaginally. Since she hadn’t had previous uterine surgery, it would have been nice if someone with the skill to do a cephalic version had been there when she was first at the hospital. The baby presenting by the feet is the easiest to turn, especially if the baby is small and it’s early in the birth process. To be fair, a first birth with feet presenting is not a good vaginal birth risk to take. Luckily it is a rare situation to have so the numbers should be very low.
    footbreech

    If the caregiver is palpating bellies and listening with a fetoscope (instead of doppler) in the prenatal period, the caregiver should be picking up when it’s breech at 36 weeks gestation (if in doubt, the woman can have a one-swipe quickie ultrasound to double-check). At that point, if it’s discovered, there’s time/space to get baby turned to head down. As I said, a footling breech is easiest to get turned. Frank breech is a more optimal position for safe vaginal birth of breech but not for turning baby to cephalic. Querying rib pain, listening in the 4 quadrants with a regular fetoscope (and finding the true fetal heartbeat low in the pregnant belly) and observing the shape of the pregnant belly are your best tools for early diagnosis.
    Thanks for being there for this family. Gloria

SHIFTING MINDSETS

Every once in a long while, I get a letter like this that re-inspires me to keep going on my heart’s desired goal of equal rights for baby boys. Protection from mutilating surgery. I’m posting this to inspire others to keep on talking and trusting that the parents of today will eventually find the way to setting aside genital cutting. Love Gloria

Dear Gloria,

I decided I needed to write to you to let you know that all of your efforts towards ending circumcision are not in vain. I’m sure you already know that, but perhaps a story of victory will be of encouragement. When we met, I had honestly never heard anyone stand against the concept of male circumcision. I had never considered it anything like female circumcision. I grew up in a Christian home, where we leaned pretty Jewish in our theology and circumcision was considered incredibly important. When my brother was born my parents had a Christian doctor who was terribly against circumcision and they heeded his advice and left my brother intact. My mom especially has always regretted that decision, and felt that she wronged my brother by being persuaded by the doctor. My brother has had many obstacles in his life and somehow these obstacles were all directed back to the “lack of blessing”.

When you explained your stance I began a rigorous examination of what I had always held to be the only way. At first glance my stance was only fortified because the scripture that refers to circumcision is so clear. Through this act you will receive the blessings bestowed upon Abraham and his generations and without it you will be cut off from any blessings and considered outside of the family. It wasn’t until I started to research what circumcision really looked like at that time that I realized the problem. You may already know this, but in antiquity circumcision was a cut at the base of the foreskin with a heated knife and then a partial pulling away, with the fingernails, which left the foreskin attached at the top. When the battles began between the Greeks and the Jews over circumcision (Jewish women and children slaughtered by the Greeks over circumcision, therefore Jews hiding it or not circumcising, and Jewish zealots forcing circumcision on any Jew found in tact) the Jewish zealots began to enforce the full removal of the foreskin in order to prevent Jews from “hiding” by pulling the foreskin down over the tip.

I also learned that this full removal in North America was used as a form of physiological control over the population, doctors suggesting to use no pain relief in order to associate pain with that region and “curb sexual desires”. Pretty messed up.

The part that really got me was that the original concept of circumcision was a blood covenant. I knew it was a covenant but I had missed this crucial point. You see the Rabbis would suck a drop of blood from the site of the wound and spit it out as a sign of now belonging to the same blood covenant as Abraham.

Mohel sucking boy's penis after cutting foreskin.

Mohel sucking boy’s penis after cutting foreskin.

The problem with this today is that currently Jewish culture does no blood rituals. They stopped when the temple was destroyed, and let’s be honest if the temple was rebuilt they would have a big challenge on their hands because culture has changed and this is no longer acceptable. What this blood covenant means to me as a Christian is that I cannot partake in this ritual because I am under the blood covenant of Jesus and what He did on the cross. I would be choosing a lesser covenant, with Abraham, for my child.

Now that all sounds pretty fanatical and religious and obviously there would be other factors in my decision making process but these concepts were still lurking there in my mind. I was over the moon excited to have a baby girl, partly because I REALLY wanted another daughter, and partly because I still didn’t know what to do by the time she was born. I finally feel completely freed from this concept. I actually strongly believe most of what the Jewish culture followed in antiquity was based on the atrocities that already occurred around them in neighboring cultures. I believe the regulations God gave them prevented them from doing terrible things that were considered normal and that over the years as they were drawn away from those cultures and into the culture of Heaven they were released more and more from these old regulations. I believe God is about compassion, love, justice, kindness and protecting the weak; and the darkness of our culture is a remnant from choosing to walk away from God in the garden.
It therefore does not make sense for this tradition to continue, a tradition that seems to tie itself with the darkness of a past age we have thankfully walked away from. However, it is imperative that people really walk out the process of making that decision for themselves so they do not end up, like my mom was for a season, blaming their choice on someone else’s coercion. The reason I wanted to share all of this with you is because the arguments you were using to explain why circumcision needed to stop were not completely shifting my viewpoint. You see growing up a Christian in a non-Christian culture there were a lot of things I had to choose to do that no one else understood, like waiting until I got married to have sex. Friends scoffed at me that I could never “make it” but I did. I have a pretty determined personality and I am capable of holding strong to a conviction without making a lot of noise about it. It is similar to my convictions against vaccines and on limiting medical interference in life, I have wonderful family members who are so passionately against me in this area that it can feel normal to go against someone else’s convictions. I wondered if knowing a tipping point for someone like me, might give you better tools to help someone in the future to rethink their position.

I hope this does not make you think less of me. You made it clear (when we first met) how against it you were, and I took that to heart. I felt that this was not something to be ignored when you so passionately battle to see it eradicated. I can now confidently say I agree with you wholeheartedly. From a Christian perspective I can say I believe it is wrong, and thought I do not know exactly how to work out the details I am pretty confident it is also no longer necessary for those of Jewish decent. I believe this concept of Bris Shalom would more than adequately cover the need for covenant and adhering to the bestowing of generational blessings. But, that is not my path to walk out.
Even before I completely agreed with you I was so impressed by your stance. I am honoured to know someone like you who is willing to protect these little lives no matter what the personal cost might be. I have so much respect for you. Thank you for what you do, -in birth and in protecting little boys. Shifting mind sets is no easy task. You are a true history maker. Love, Lydia

For more information on a naming ceremony that doesn’t involve any cutting or bleeding see: http://www.beyondthebris.com/2011/07/brit-shalom-alternative-naming-ceremony.html

MIDWIFERY IN CANADA, THE MESS WE’RE IN

Many people are confused about why Canadian birth attendants are prosecuted for the most minor actions. . . . calling herself a “midwife”, doing a vaginal examination at a woman’s request or with permission, advising a woman about how to eat for her unborn baby, etc.

Let me tell you how we got into the mess we’re in. Yes, it is a mess. Hundreds of thousands of dollars spent on legal actions, clients left upset and confused, hospital workers unclear about the legalities in their area, each province of Canada having a different wording in their Act, midwives mistrusting doulas and each other. It’s a climate of fear and turmoil that isn’t getting better after more than 20 years of legislating midwifery. (Ontario regulated in 1993, B.C. followed in 1998)

The first problem is that legislators tried to make laws to cover a life event that is natural and one that a woman can do all by herself, if she chooses. Birth is a normal life process. We don’t usually legislate who can be with an adult when they are in their own home. What can you make illegal about a woman having a baby and choosing someone to be with her? Well, you can make it illegal for that someone to charge money for being there. That doesn’t really fit with a concern for the well-being of the woman/baby. If a birth attendant is really wealthy can they go to help birthing women with no fear of the law? If the pregnant woman wants to donate money to her helper’s children, is that illegal? You can see it gets very tangled. The laws have been twisted and turned to try to make them less ridiculous as time goes by but no province has succeeded in coming up with wording that makes common sense.

Then, the law makers thought, “okay let’s make it illegal to do clinical acts like vaginal exams, injections, blood tests, etc.” Trouble with that is a) it is almost impossible to police these activities when they happen in a private home and, b) women allow their partners to perform vaginal exams all the time. Many massage therapists do pelvic therapy with vaginal exams, naturopaths, nurses, etc. so how does it help to say that one particular group cannot do vaginal exams? So, by saying that only a member of a midwifery disciplinary body may do a pelvic exam, things get almost laughable. Since any 16 year old boy can figure out how to do it, it’s hardly an act that needs 4 years of training. Many lay people have to give injections to their children/loved ones, learning how to draw blood takes about 2 hours, all these things are done by a myriad of workers in the community. It is grasping at straws to make these minor clinical acts a basis for a prosecution.
FirstNationsMW

The original intention of seeking licensure started with midwives wanting to be paid under the National Medical insurance plan and to be protected from prosecution/persecution from the giant medical monopoly. That intent backfired right away due to the medical profession. Instead of embracing the midwives as colleagues, they began advising the clients of registered midwives to sue their midwife. There have been lawsuits against registered midwives here in B.C. where millions of dollars have been paid out to families. If a child has any type of neurological damage, the family physician advises the parents that “ the money won’t come out of your midwife’s pocket. That’s why they carry insurance. The insurance is there and you don’t know if your child will need special care that’s not covered by the National Medical insurance plan when he/she gets older. You’d better sue now.” Of course, they would never say that if the care provider was a physician. You can guess what happened then. The insurance rates for midwives right across the country went through the roof. Different provinces have different schemes for covering the midwives but the bottom line is that the government really doesn’t want more midwives because each midwife has to be subsidized for about $30,000 per year in order to provide insurance for her practice. If the midwives had to pay it all, they would be out of business immediately. The government also doesn’t want to give them a raise which leads to a great deal of bitterness on the part of the registered midwives.

Registered midwives are between a rock and a hard spot. They want to follow their dream and have happy, contented clients BUT they rely on the physicians to give them hospital privileges and, if they don’t toe the line of what the doctors wish them to do, they can lose those privileges or even lose their registration.

So, when you’re wondering what’s going on with registered-midwife-generated court cases to pound unregistered birth attendants out of business in Canada, this is some of the background. Because the numbers of registered midwives is low AND the midwives are so limited by the medical profession, there exists an alternative birth attendant market. There are a number of women throughout the country who still go out to help at home births without a blessing from the medical profession/government. They simply don’t want to work in that space between the rock and the hard spot.

CHARGES AGAINST BIRTH ATTENDANT, LISA KUSCH

Lisa Kusch Case in Saskatchewan, Canada

When a birth worker is charged with an offense in Canada, she receives legal advice not to discuss the case and not to speak with the clients involved. This makes things very difficult because she must raise funds to cover expensive legal bills and she can’t campaign on her own because of these restrictions.
I have asked for facts from different sources and submit the following information for those who are helping with the funding and care about my friend, Lisa Kusch.

Lisa in 2015

Lisa in 2015


In October 2016 Lisa was charged, as follows:
“It is alleged that between the 29th day of October 2014 and the 29th day of November, 2014 in Saskatoon Saskatchewan, Lisa Kusch “ DID ENGAGE IN THE BUSINESS OR PRACTICE OF MIDWIFERY, WHILE UNAUTHORIZED TO DO SO, CONTARY TO SECTION 23(2) OF THE MIDWIFERY ACT” (see below for the wording of that section of the Act).
That’s it. There are no specific details of what Lisa did or did not do. It seems to me that this is an overly broad and vague accusation. The document with the allegation was accompanied by emailed complaints filed by the birthing woman and the attendant at the birth (a doula/friend of the woman who accompanied her when she transported to the hospital).

Some of the information I have gathered which is to the best of my knowledge:
1. Lisa was not present when the baby was born.
2. Lisa is not a Registered Midwife and doesn’t represent herself as a Registered Midwife. That has been agreed upon by all parties and she is not accused or charged for this.
3. The woman was having her first baby and transferred to hospital for pain management. I am told that the baby was delivered by non-emergency c-section, at the mother’s request. The medical reason given was failure to progress.
4. Mother and baby were discharged from hospital on a normal schedule.
5. Lisa is accused in the complaints of causing poor outcomes and delayed recovery, due to excess blood loss during the surgery.

If Lisa is found guilty of a summary offense the result will be a fine of up to $4000. This is not a criminal case and it is not a civil case. The burden of proof is on the Crown to prove that the defendant practiced unauthorized practices according to the Midwifery Act of Saskatchewan. If one reads the applicable section of the act quoted in the charge above, it is vague in its definitions.
This case will set a precedent as it is the first in Saskatchewan and will have national implications.
The trial date is now set for October 24, 2017.

Start of Section 23 (2) No person shall engage in the business or practice of performing any of the authorizedpractices described in subsection (1) with respect to another individual unless:
(a) the person is a member who is authorized by his or her license to perform
that practice;
(b) the person is authorized pursuant to another Act to perform that practice;
or
(c) the activity is one of daily living and is performed by the individual or by
a person on the individual’s behalf. (end of section)

I submit the above to help people see the bones of this complaint and action against Lisa Kusch. Thanks for reading. I will update/edit as more info comes to light. Gloria Lemay, July 12, 2017

Some people have asked if they can send money for Lisa’s fund by bank transfer so I’ve set up a separate email and bank account for that purpose. The email address is lisakuschfund@gmail.com I’ll post periodic messages on the GoFundMe page about the total that comes in via bank transfer.
Lisa Kusch

The GoFundMe page to donate to the legal fund is at https://www.gofundme.com/lisakusch

Hypoxic Eschemic Encephalopathy (HIE)

    Hypoxic

= below normal levels of oxygen

    Eschemic

= restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism (to keep tissue alive)

    Encephalopathy

= a disease in which the functioning of the brain is affected by some agent or condition

HIE Help Center
Mar 7, 2017
Dear Ms. Lemay,

My name is Genevieve and I’m writing to you as a fan of Wise Woman Way of Birth and a contributor to a new website devoted to childhood disability. Our website specializes in helping parents care for their children with HIE. We know that your posts approach a number of different topics surrounding birth, and we found the post “$70 Million Birth Injury Case” to be quite similar to our website’s platform and goals.

We understand that many parents may be going to your site and reading about birth injuries, perhaps after facing a diagnosis they aren’t sure about themselves. We would thus be so grateful if you considered adding a link to our page, which discusses HIE, a neonatal brain injury that causes disability throughout childhood and adulthood. I help run www.HIEHelpCenter.org, an informational website for parents of kids that were recently diagnosed with hypoxic-ischemic encephalopathy (HIE). Our website is one of the only sites devoted to HIE on the Internet, and in order to raise awareness of this particular disability, we wanted to ask you if you would consider including us as a link on your blog in a blog post.

Thank you for your time!
Sincerely,
Genevieve Kotasek
HIE Help Center Community Outreach Coordinator

From: Gloria Lemay
June 10, 2017
To: HIE
Hi Genevieve, you wrote to me some time ago and I have just now been able to go and see your site. I looked over the “prevention” section and was surprised to NOT see two of the prevention things that I think are most crucial to making sure that infants get all the oxygen to their brains that they need.
1. leaving the umbilical cord alone (not cutting) until it has fully stopped pulsing. (Resuscitation can be done, if necessary, right on the mother’s abdomen and the cord is the baby’s life line)
2. avoiding the use of pain meds in birth. The mother has been so careful to not drink alcohol, take drugs unnecessarily, and eat well. Then, on the day of the birth, she is medicated for many hours with an epidural which freezes her from her breasts to her thighs. This is right where the baby is located. That baby is getting all that numbing medication, too. Moral support and less systemic meds would be a better way to go. Any woman who knows that her baby might be brain injured by an epidural would say “no” to it. Better to have a day of pain than a lifetime of suffering for the child. Most women don’t know about that and the doctors don’t realize it because they don’t see the problems that the child faces.

I think this is the type of information that could really give your readers power in the face of HIE. Gloria Lemay, Vancouver BC Canada
“$70 Million Birth Injury Case”

Midwifery History Canada

I’m posting this article from 1991 to make the history of midwifery struggles in Canada available online. Thanks to Andre Picard, writer for the Globe and Mail (Canada) for granting permission. Gloria

Midwives no longer shrugging off attacks
ANDRÉ PICARD, The Globe and Mail (Canada)
Friday, November 29, 1991

THE death of a baby last week in Montreal has reignited the debate over one of the most emotional social policy issues in the province – midwifery.
Isabelle Brabant, a self-trained midwife who has delivered more than 400 babies, arrived at a hospital less than 10 minutes after the baby stopped breathing during a home birth and her resuscitation efforts failed. Doctors were also unsuccessful in reviving the infant.
Dr. Augustin Roy, president of the Quebec Corporation of Physicians, wasted no time condemning the tragic events, saying “home birth is a quasi-criminal act for a woman who has had a cesarean in the past.”
In the past, proponents of midwifery have shrugged off such attacks, saying doctors are more interested in maintaining the status quo (including revenues from hospital births) than in improving the quality of treatment.
Yesterday, however, they decided to draw a line in the sand.
“We’ve tolerated this witch hunt for long enough,” said Marie-Claude Desjardins, president of Naissance-Renaissance. “We demand that obstetrical violence end. . . . We demand that respect of women begin.”
Michele Champagne, president of the Quebec Alliance of Practicing Midwives, said: “Midwives are not endangering the lives of women and children any more than doctors are, and to suggest otherwise is a lie.”
Statistics compiled by the Office of the Coroner show there are about 350 deaths a year of children in their first week of life. One a day.
In the past five years, six of those deaths have been after midwife- assisted births. One a year.
There were about 97,000 births in Quebec last year, slightly more than 1,000 of them midwife-assisted.
Yet, midwifery remains in a strange sort of legal limbo. Last year, the government announced, as part of its massive health-reform package, plans for pilot projects that would lead to the licensing of midwives and their practicing in hospitals alongside doctors.
But the plan is stalled by the insistence of doctors’ groups that “self-trained” midwives be ruled inadmissible.
Because midwifery is not formally recognized in the law, there are no standards, but the Association of Practicing Midwives insists on all its members having a minimum of three years of training, and that at least two qualified midwives assist in home births. But, as the law stands, midwives are banned from doing their work in hospitals.
Polls in the province show 80 per cent of voters in favour of legalized midwifery, and legalization of the practice in Ontario has turned up the heat to the point where Quebec Health Minister Marc-Yvan Cote warned doctors that if they continue with their obstructionist tactics, he will skip pilot projects and go directly to legalization.
Three years ago, Ms. Brabant was attending another birth where the baby died. The subsequent coroner’s inquest, which many feared would be the death knell of the movement, exonerated her, and support for the cause has grown tremendously.
This time the Office of the Coroner has decided an inquest is not even warranted. That fact, coupled with the reaction of Dr. Roy, has convinced midwifery proponents that victory is near.
Micheline St-Onge, a parent whose child died during birth at a hospital, drove the point home, by bringing the debate back to its roots.
“We have to do everything to ensure the comfort of women and the safety of their children, so ultimately they must be allowed to make the choice between having their baby delivered by a doctor or a midwife,” she said yesterday.
“Very few people know just how painful it can be to lose a child,” Mrs. St-Onge said. “Why have things degenerated to the point where we have lost sight of that, where the death of our children is used merely to score” debate points.
“No child’s life should be cheapened to that point.”

© Copyright 2016 The Globe and Mail Inc. All Rights Reserved. Permission to share obtained.

Newborn Girl born at home

Newborn Girl born at home

globe-and-mail-logo

Breastfeeding Benefits

This is a good checklist of all the benefits that breastfeeding provides and the
risk of using any kind of subtitutes. Thanks to the California Dept of Health for
creating the poster. Gloria

Preparing for a Home Birth

Home Birth Supply List

Please let me know well in advance if you are unable to find any item on the list. Collect all supplies and place them into a box. Place the box in an easily accessible place. Please tell the midwives where the supplies are kept when they arrive for the birth.

 24 flat incontinent pads to use under Mom’s bottom (22” x 24”)
 1 box of 4”x4” gauze squares
 2 boxes of Super Kotex pads (overnight)
 1 box or bag of salt (cheap, for stained linens)
 1 450 ml bottle of Hydrogen Peroxide (for removing stains from carpets, etc.)
 1 small bottle of bleach or Sudsy Ammonia
 1 100 ml bottle of Witch Hazel
 1 sealed small bottle of Olive Oil for perineal massage, baby’s bum
 1 bag of “pure” cotton balls
 2 large green garbage bags
 2 Plastic sheets (shower curtain liners work)
 1 flashlight with extra batteries
 1 plug-in room heater (if needed)
 1 hot water bottle
 1 nail brush
 1 tea strainer
 Womanly Art of Breastfeeding (book)

Nice Extras:
Bath pillow, candles, ice cubes, popsicles, plant mister, music, camera/film, tapes, thermometer, massage cream, heating pad, small Fleet Enema (if you get constipated a lot in pregnancy), reusable cotton menstrual pads.

Preparing Your Home:
Make up 5 casserole dishes to get you through the first days after birth and freeze them. Put a plastic sheet on your bed in the last week of pregnancy in case your waters break. Dust and clean the bedroom. Clean the toilet and bathtub. Clear off the top of a chest of drawers or other surface for us to put our instruments on. Make arrangements to have your pets out of the house during the birth.

Sterile Linens:
 6 face cloths
 6 bath towels
 2 bed sheets
 2 cotton cloth diapers
 6 receiving (flannel) blankets for baby
 1 undershirt and nightie/sleeper for baby

Put clean linens in HOT dryer for one half hour. During the last 10 minutes throw in 3 brown paper grocery bags and heat them through. When dryer finishes, fold the hot linens with clean hands and put them in hot bags. Seal them with staples or tape and label the outside. Store in a dry place. You do not need to use your best linens…clean is our main concern.

Electrolyte Balanced Drink (Labour-Ade):
1/3 cup lemon juice
1/3 cup honey or maple syrup
1/4 tsp salt
1 crushed calcium tablet (or 1/4 tsp calcium powder)
enough water to make 1 quart

Mix all ingredients together- use warm water to help dissolve the honey and calcium, and then chill. You can also make ice cubes. Buy enough ingredients to make 4 quarts. This is a delicious drink for after the birth as well. *After the baby is born you can add 1/4 tsp. cream of tartar to this drink to assist with peeing after the birth.

Your Newborn Baby—What’s Normal?

    Parents’ Guide to the Newborn

Keep your caregiver informed of any concerns about your baby.
Phone number of dr., public health nurse, midwife, or other provider Name_______________________Phone_____________________

Your baby’s breathing

Noises such as snuffles, grunts, wheezes, etc are not a concern by themselves. Babies can be noisy breathers. They have small amounts of mucous in their airways from the birth process and they are adjusting to air breathing. It is normal for the breathing to be irregular—sometimes rapid and then followed by slow, deep breathing. When your baby cries vigorously, he/she will become redder in the face and take deep, gasping breaths. This is normal.

Concerns about breathing to notify your caregiver about are:

1. Chest retractions–if your baby draws the chest wall in noticeably when breathing and you can see the outline of the breast bone with every breath.

2. Prolonged rapid breathing–the rate of breathing in a healthy calm newborn should be about 30 to 40 breaths per minute. If the baby is doing a panting breathing when calm (60 or more breaths per minute) for more than 15 minutes, have your caregiver check.

3. If your baby seems to have worrisome breathing and blueness around the mouth, call your caregiver.

FEEDING Within 8 hours of birth, the baby should be waking to feed every two hours and latching on to the breast well. Demanding to be fed is a very good sign of health in a newborn. Your baby needs only what is in the breast, do not feed water. If baby seems lethargic and doesn’t wake to feed for 4 hours, call your caregiver immediately. This behavior might mean the baby has a serious infection.

COLOUR A small amount of blueness and coolness in the extremities (hands and feet) is normal. Some mottling of the chest and tummy is normal. Many parents are alarmed by the baby’s whole body going dark red like a strawberry, this is a normal result of changing blood circulation in the newborn. Generalized blue or gray colouring (rare) would be alarming.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

TEMPERATURE Only take your baby’s temperature under the armpit. Digital thermometers can be purchased for about $12 at the pharmacy. If the temperature falls below 36.1 degrees Celsius (97 F) or goes above 37.2 degrees Celsius (99F), look to see if you have bundled the baby too warmly or if the baby needs more covering. Adjust the baby’s garments and recheck the temperature in 15 minutes. Call your caretaker if abnormal temperatures persist. The usual rule of thumb for baby covering is to look at what the adults are wearing and then add one more layer for the baby. The baby being skin to skin with the mother is a good way to help the baby have a normal temperature and breathing rate.

URINE The baby may only have one wet diaper per day for the first two days. Once the breast milk is in, the baby should have at least 6 very soaked diapers in 24 hours. Urine should be colourless. Some babies have crystals in their urine (orange staining that looks like face makeup) and this is not a concern in the first 3 days. After the third day, that orange staining can be a sign that the baby is dehydrated. Increase the time at the breast and advise your caregiver. Little girls may have a spot of blood in their diaper which is their first menstrual blood, this is normal. By the fourth day, the baby should have at least 6 very wet diapers per day (the diaper will feel heavy in your hand).

BOWEL MOVEMENTS In the first 24 hours of life, the baby will pass meconium (blackish, tarry stools). Next, the stools will be brownish, greenish and quite soft. Once the milk is fully in (around day 3 of life) the baby’s stools are the colour and consistency of yellow mustard. The baby should have two poops the size of a loonie (silver dollar) as a minimum every day. A well fed baby usually has much more than the minimum.

UMBILICAL CORD Fold diapers down away from the drying umbilical stump. The cord will be dry and blackened within 24 hours and the clamp can be removed. The stump usually rots off by 5 to 10 days after the birth. Don’t put peroxide or alcohol on the cord. It heals best if left alone. Because it is rotting flesh, there is usually a foul odor when it is ready to fall off and it can be quite goo-ey looking. If there is redness on the abdominal skin surrounding the belly button area, notify your caregiver.

EYES The policy in hospitals is to treat the baby’s eyes with an antibiotic cream called “Erythromicin”. If you do not want your baby to receive this antibiotic, let your caretaker know in advance and sign a waiver. Newborns can have plugged tear ducts which cause discharge to accumulate in their eyes. Bring any discharge concerns to the attention of your caregiver.

INTACT PENIS Keeping your son’s penis intact is now the recommended policy of physicians’ groups. There is no special cleaning that needs to be done. Simply bathe your baby in a warm bath and leave the foreskin alone. The foreskin is attached to the glans in babies (much like the fingernail is attached to the finger) and the separation process may take years to complete. Only the boy should retract his own foreskin, this should not be done by parents or medical professionals. For more info on caring for your intact son, there is a handy free brochure at this link http://www.nocirc.org/publish/pamphlet4.html

JAUNDICE Yellowing of the skin of the newborn in the first 24 hours of life is unusual and should be called to the attention of your caregiver.
After Day 2, some yellowing is normal. Usually the face and chest are the most yellow places on the body. The baby may be sleepier than normal with jaundice and you may have to wake the baby to feed every two hours. It’s important that the baby remains well hydrated in order to get rid of the yellow cells from the body. Let your caregiver know if you are having trouble waking/feeding the baby or if the yellowness extends out to the hands and feet.

Slightly jaundiced newborn

Slightly jaundiced newborn

Gloria Lemay, Vancouver, BC
March 2016