In Gratitude for Traditional Midwives

About ten years ago, when my dear wife was about 8 months pregnant, we found out that our daughter (we didn’t know the sex until birth) was in the breach position and despite efforts to flip her using acupuncture, moxibustion, Mozart CDs played close to the birth canal, lying on a tilted board, and doing underwater back flips in a hot tub (Upel doesn’t know how to swim so we didn’t get very far with this one) – our little Pema was stubbornly keeping her head next to mama’s beating heart. Our options were running out. We were told by our midwife at the time that Upel would need a c-section and that our home birth plan was no longer an option.

I did some research on planned (vaginal) breech delivery, including extensive critiques of the Term Breech Trials which indicated – to me – that the risks to the baby of a planned vaginal breech delivery were significantly less than the risks to the mother from a surgical birth. The only problem was our current midwife would not support us in going this route (in part because she lacked the training, but probably for political reasons as well).

So we searched around and found a midwife named Shaheeda Pierce. Shaheeda lived on Vashon Island at the time, but we also had a doula (on this side of the ferry). Shaheeda was both knowledgeable and kind, and had attended many breech deliveries and knew the various techniques. I think she had trained with Ina May Gascon (author of the well loved book, “Spiritual Midwifery) among others.

To make a long story short, Upel entered labor at home, but then the delivery was stalled with our little Pema spreading her two legs out – as if to say…”this is going to happen my way!”. She was never in any distress though. Shaheeda was monitoring vital signs using a somewhat antique listening device called the human ear, aided by a funnel! When Upel ran out of energy, we calmly drove to Swedish, and Pema was born via c-section about thirty minutes after our arrival..

The surgeon filed a claim with the State against Shaheeda, citing malpractice. The rationale behind the malpractice claim was that she should never have allowed Upel to attempt a vaginal breech birth at home. Pema’s Apgar scores at 1 and 5 minutes were something like 4 and 5 respectively (practically perfect), not indicative of a stressed baby. Mom ended up having a horrendous hospital experience with a bacterial infection developing from the incision, a spinal headache (later misdiagnosed for days) due to at least six epidural punctures from the student intern (there is a more complete account of our hospital experience somewhere buried in my blog – I’ll try to come back and post the link).

I believe that birth politics is the more likely reason Shaheeda was burned at the stake – in the end, she was forced to close her practice and move to Canada. We were present at the 5 day DOH health court trial and testified in her defense. The state paid a doctor $200/hour to testify against Shaheeda. He was present for all 5 days – that’s about $8000 in his pocket, with the funds coming out of the state midwifery program according to our lawyer.  I heard that there was a pattern at the time of the DOH prosecuting midwives and paying doctors to testify as a way to gut the program. Also testifying against Shaheeda was our original midwife. Sad.

Pema is now close to her 11th birthday and doing fine, as is Upel. The cesarean rate continues to rise and one less midwife – one with unique skills and a huge heart – is no longer practicing in the U.S.

Epilogue 2013. I am taking a class in Developmental Psychology and reading the text-book about birth one day, I remembered something that Shaheeda had said. Here’s a picture of the illustration in the textbook. On page 102, the answer to the observation quiz reads: “The birth attendant is turning the baby’s head after it has emerged; doing this helps the shoulders come out more easily.”

I emailed Shaheeda: “I thought that any effortful turning of a baby’s head is extremely ill-advised and can cause spinal injury. I thought it was more correct to simply support the baby’s head and allow it to move as the baby natural rotates?”

Shaheeda wrote back:

“You are correct. It is absolutely contraindicated to twist a baby’s head as the baby is emerging at a birth. SO……what are we actually doing as the baby is emerging? Some of us are praying. We gently support the baby as it is emerging, because they are slippery and sometimes they come out fast. So we always try to catch them before the first bounce!

There is one maneuver that we may use for a head-first baby if we have reason to believe that they shoulders will not be born easily. The reason could be that the baby is born to the chin and then stops and the head turns blue or purple, or the size of the baby is very large for the mother, or history of a previous baby being stuck at the shoulders. In this case, we may gently rock the head from side to side one or more times to encourage easy birth of the shoulders, but never twisting.

The head is usually born with the baby facing the mother’s rectum as the head is born. This is because for most babies and pelvises, this is the easiest fit down the tunnel for the baby. After the head emerges, almost always the baby itself rotates with no help from anyone so that the shoulders of the baby line up with the shape of the women’s yoni- once again, for the simplest path.

You might consider contacting the publisher of that book so that they could print a correction, in the event that someone has an emergency unattended birth where someone who read that book thinks they are helping by doing what they saw depicted. Instead, they could be causing a brachial plexus injury that may or may not ever heal.”

I wrote to the publisher of the book – The Developing Person Through Childhood and Adolescence, 9th edition, 2012, Kathleen Stassen Berger. Here is her reply:

“Thank you so much for this. I once read that the head needs to be turned — it makes much more sense that the baby turns itself. I appreciate your midwife — yes, praying is the right move, and yes, we don’t want the baby to bounce!  And i also appreciate you.  As for me, I am mortified.  I will send this to my editor, to see if a correction is possible. Thanks so much. Be well.”

Future mothers – you know how to give birth. It’s in your genes. It’s not intrinsically complicated, though it’s obviously a lot of work (thanks mom!)  Of course, it is your right and duty to avail yourself of all that modern medicine has to offer as you plan for your birth experience. But don’t forget to look at outcome statistics. Last time I looked, utilizing the skills of a midwife and a doula lowered your chance of having a cesarean from around 30% to around 10%. Of course, rates probably vary by state, city, and individual providers – do your homework! Most women in urban areas live close enough to a hospital so that if you are in good health, you can labor at home (or a birth center) and if any issues arise whereby advanced medical intervention is required, there’s usually plenty of time to transfer during labor.

Thank you Shaheeda, and thank you to all of your teachers and all traditional midwives for your skills and care.

Reference: Traditional Midwives are Midwives