Two weeks ago I sent this letter off to my local newspaper, Chico Enterprise Record.  This morning a friend called me to say it had been published.  They cut out a bit, but the main message is there.  This is a bad move for EnloeMedicalCenter -- it shows that despite the practices the facility is trying to implement, by losing their option for midwifery, they don't really care about patient-centered care and holistic alternatives to harsh (over)medicalization when it comes to their mothers and babies.  All I envision is, these new, beautifully spacious and accommodating rooms, with private bathrooms, tubs, and a nice place for a partner to sleep, while a woman does not have the option of a practitioner whose goal is to be "with women," during the birth experience.

Here it is:

Chico is losing a valuable resource. Soon, there will be no certified-nurse midwives delivering babies at EnloeMedicalCenter. Enloe has painstakingly taken the difficult steps toward becoming a baby-friendly hospital. This is an arduous process, and once achieved, it will place Enloe on a list of only 77 U.S. hospitals that can boast of such status. This program "promotes, protects and supports breastfeeding." The core tenets include avoiding artificial nipples and unneeded supplements, and keeping mothers and babies together during their stay. This is best for babies.

Enloe has recently adopted the Planetree Philosophy designed to treat patients in a kind, compassionate way, and to put their needs first. This is best for patients.

The midwifery model of care focuses on birth as a normal life event, not a medical crisis where a woman needs saving, perhaps from an iatrogenic intervention. All over the world midwives safely help babies into life, and it has been this way since the dawn of man. Midwives in our area provide safe, gentle, kind and compassionate birth options — whether a certified midwife at a hospital or a community midwife at home. This is best for women. It is unfortunate that Enloe will no longer have a place for families choosing midwifery care. — Stacie Bingham, Chico

For more information:

Health Care Crisis Claims Chico Midwifery

Enloe Addressing Provider Squeeze

Midwives Should not be Eliminated

Letter to Midwifery Patients and Supporters



If you are in support of women having the option of a midwifery-assisted birth at Enloe, please take a minute to let the facility know:

Patient Service Excellence

I was recently asked how women in general have the courage to go through birth more than one time.

My response:  Are you kidding? When I think over my last birth experience (11-05), I keep wishing I could go back to that last hour of most intense, hard, full-on kill-me-now labor. While it was hard and intense, what I remember and long for is the closeness that was in that room with my mom, husband, doula, and midwife. The quiet support they offered me. The jokes in between contractions. The anticipation of knowing the baby would be here soon. There was such a special feeling shared amongst us all -- like there was absolutely nothing else happening anywhere else in the entire world, or universe, for that matter.

Yes, during that intense time I said two funny things I 150% meant. 1) I told my midwife, "I'll let you pull him out with a vacuum, you know." 2) I told the room, "I don't think I can do this again."

My first baby was pulled out via vacuum after three hours of pushing. I felt let-down and insignificant, like my doctor could not help me push him out by suggesting another position, or just letting me take my time -- it was more like she wanted to get home. My dh knew I would be so upset if I actually did have this baby pulled out that same way, so he knew he would not let me do that (if it were not needed). My midwife laughed, too -- she recognized it as a cry for help and plea of desperation, but not what I really would have been happy with in the long run.

When I said the second thing I meant I could not have another baby after this. My midwife looked at my husband and said, "Do you want to get this in writing?" I held strongly to this until day 6 postpartum -- and then I remember thinking, "I would do it again."

There is just something so incredible about being on the cusp of that life-changing experience. I think I would have 5 labors/births to not have to go through 9 months of pregnancy, that's really where the draining experiences come in my opinion!

Before my first baby, I didn't have so much fear simply because I had no idea what to expect.  After my first, and seeing how things went and knowing more, yes I was pretty scared to have another baby. After my second I was even more scared -- they say the third birth is a wild card, and I also had this cognitive distortion that, well babies and I were safe the first and second time, so something bad is bound to happen now! 

After my third birth I felt like, heck -- they are just starting to get good! Having my third baby made me want to have another one, and I never felt that way before.

I had a doula birth this weekend. This family was having their second baby; I was with them during the hospital birth of their first daughter almost two years ago. This time they planned a homebirth with our community midwife (whom I love).

I was struck by this couple's groundedness during their first birth. Mom labored for about 5 hours, and then had her baby, with no interventions or medications. She never complained, even when it was within her rights to do so. She never said, "This hurts," or "I want this to be over," or "It's hard." She did not utter one complaintive word during the whole birth. It really got me thinking: There are people out there who never complain; they just deal with what life offers them and move through it. Wow.

After their baby's birth, Mom started losing a lot of blood. Her placenta would not release from her uterus and come out. Because of this, her uterus could not clamp down, the process which normally shuts down the full-force of that bleeding. Her midwife tried quite a few tricks before she had to call her supervisory physician for advice. Now, I don't think she really needed "advice," but the way the laws work here, she had to inform him of the situation and see what he recommended. They discussed manually extracting the placenta, and the doc agreed the midwife could try it -- that would keep him home for the time being.

This experienced, well-respected-in-her-field midwife then slowly reached her hand into this new mother's birth canal in hopes of bringing the placenta down and out. This mom was stoic. With her midwife's hand in her uterus, she did not cry, scream, or make any "normal" sounds one would associate with this very painful procedure. She knew this was work that had to be done. Her husband watched as what her called "rivers of blood," ran out of his wife. After a second attempt at this and still no placenta, the midwife administered narcotic medication to help the mom relax and feel markedly less pain. She also called the doctor back, and he was on his way. The third attempt did not look promising. "Visualize your placenta letting go -- visualize it releasing." Just as the doctor opened the door to the room, the midwife came out of this new mother's uterus, placenta in hand.

21 months later this mother is laboring again. I joined them at about 8 in the evening. We went for a walk, stopping every few minutes to "honor the contractions," as the mother put it. Around 10 the midwife and her assistant dropped by, fresh from another birth. This mother guessed she was about 2-3 centimeters, still in early labor. The midwife suggested we all go home and let Mom and Dad get some rest.

I watched a movie when I knew I should have gone to bed. Then I dawdled around a bit more, getting to bed at 1:15 am. I placed the phone on the windowsill so I could reach it if they called, then I snuggled into my pillow. Just as I shut my eyes, the phone rang. I was back at their house at 1:30.

Mom still wasn't quite in active labor yet, but things were picking up. We moved from a hands and knees position over the couch, Dad holding both her hands and me pressing on her back, to the birth tub, to the bathtub, and then back to the couch. She laid on a mattress on the floor for a while, still being diligent enough to get up and go pee every 30 minutes or so.

At about 5 am Mom decided she wanted to lie down in her bed. She crawled up into the middle, facing her husband, and I laid facing her back. For the next hour, the three of us moved into place when her contractions would start -- I would press on her back, Dad would offer his hands to be squeezed, and Mom would make the noises to cope with the sensation. As her voice tapered off, slowly I would lighten my touch, and Dad would claim his hands back. Then we would sleep. Dad laughed at one point that it was a good thing they had a kind-sized bed. Mom and Dad (can't say for myself!) would both snore between contractions. I knew I was dreaming because I would wake up with other thoughts deep in my mind. But we would shift into action to help support this woman as she moved through this experience of labor.

At about 6 am, Mom said the sensation had shifted, and she felt, at certain points during a contraction, a little like she wanted to push. Although she had a longer latent phase than with her first birth, I imagined once she got close to complete, she wouldn't have to push for very long. I made the call to the midwife, and she was there by 6:30.

Mom was checked and found to be 4 centimeters, almost fully effaced. She decided to "do laps," around the circle of her living room, dining room, and kitchen. This helped the intensity and regularity of her contractions. By 8 she was feeling the urge to push, and the midwife found her to be without any cervix. After a few different pushing positions, the mother eased her baby out sitting on a birthing stool. She was asked to, after the birth of the baby's head, breathe through contractions so the midwife could suction the baby's airway as there had been some meconium in the water. Baby came out, right to Mom's chest, Mom was leaning against Dad and we were all struck by the beauty of such a simple birth.

But only for a moment.

What was said not to happen again did indeed happen. The placenta was not coming out. Through nipple stimulation, herbal tinctures, and finally a shot of pitocin, the placenta stayed tight. This midwife also tried to manually extract it. One, two, three times -- to no avail. Mom was losing blood. It was not critical, but the midwife feared if we got Mom up and out the door to the car, she would likely lose a lot of blood by the time she arrived at the hospital. The decision was made to transport by ambulance. Mom and Dad were calm. They knew this must be done, so they simply got down to business and made the best of it.

Mom went in an ambulance and her midwife followed behind. Dad dressed and diapered the baby, I threw together essential items for Mom and Baby, and then we headed to the hospital, too. The midwife's assistant stayed and began the clean-up.

The doctor-on-call tried to manually remove the placenta twice, and he was going to try one more time, before Mom said, "No, I will go to surgery." They took her back and gave her general anesthesia, and then they were able to fully remove the placenta; the placenta that did its job so well -- too well. Mom and Baby were reunited, and aside from a delay in breastfeeding that seemed made up for later, are doing just fine now.

On the way to the hospital, Dad shared with me, "Having been through this before, I knew what to expect. I also knew she did not lose as much blood this time as she did the first time. I wasn't worried at all."

I asked Mom later, are you still glad you planned a homebirth? "Absolutely. I had a wonderful birth at home and aside from the placenta thing, I wouldn't have changed a thing."

Birth doesn't often go as we plan. We can be in-tune with our bodies and our babies and understand sometimes physical need has to take priority over envisioned ideal. Even if we are caught sleeping on the job.

A few relevant resources for further exploration:

-Homebirth Safe for Low-Risk Women
-Choosing the Right Sized Bed
-Bedsharing with Your Baby (couldn't find anything about bedsharing with your doula, sorry!)