Given Pause – An Appendicitis Story

I’ll never get to support my partner through labor and birth, simply because he’s a cis man, and well, it’s biologically impossible.

Of course, as a doula, I’ve supported and backed up birth partners again and again. I have a pretty good sense of how difficult it is to see one’s loved ones in pain. So why would I ever need the experience of supporting my partner myself?

After all, I know how to stand with clients – those in labor as well as their partners. I know how to help them through the uncertainties; how to facilitate communication with medical staff; and help clients build the confidence to cope with the intensity of transition or unexpected events. And, as a mother I have supported my children though pain and medical and emergency room visits time and time again.

I know how to “doula” my family as well as how to help others “doula” theirs. Or I did anyway, until it was about MY. PARTNER. And therefore, all about me.

Until the morning when I found myself packing all three wide-eyed, worried children into the car and driving their incredibly pale and, clearly suffering, dad to the ER, ushering them into a tiny triage space, and looking over to see a monitor showing his blood pressure was 60/20….wait, What?

Despite years of experience looking at and interpreting meaning from other people’s monitors, I could barely take the numbers in: “That’s not a blood pressure…that’s…woah, that is way too low.” I suddenly had no more doula skills at that moment, or in many of the moments that followed.

I struggled to call them back of course, and for most of the experience that followed, I did manage it. I was able to do what needed to be done: get the kids to a friend; get back to support Mr. K; stay by his side as he struggled through coping with the unknown, and pain, and waiting. There was so much waiting – first for a diagnosis: appendicitis, then for surgery, and eventually, through recovery.

Woven in between those moments of handling everything though, I lost it. I completely lost it. The fear and the uncertainty, relatively small in hindsight, became oh-so-large to me when I could not tell what was happening as the pain and intensity increased for him.

We had been told it would be hours before surgery and moved to a room to wait. In those moments as he lay there on his back with the pressure building and the feeling of being about to explode breaking through the morphine, he was convinced, and being pretty convincing, that his insides were going to burst any minute.

Granted, I know appendicitis is minor in comparison to so many other things. I feel certain now that we had the benefit of care we could fully trust and which was among the best in the world. Other loved ones have experienced and pulled through much worse. But until that day I had never truly looked at the possibility of the complete and utter end of my own reality with my partner. I had never considered myself possibly about to lose him, or ever been so unable to help anyone cope, most especially him.

Was his appendix truly about to burst as he feared? Did the doctors really know? Could things have changed that rapidly for him? He was in mental agony, the surgeon was busy, the nurses simply couldn’t respond fast enough, and I had no way to stop it or to “shut him off” as he was pleading.

Finally, he vomited and then came relief. We sheepishly understood that this was what had been causing the unbearable increase in pressure. Puke.

Man could I have used a doula right then. And for a brief period after he was finally able to sleep, I sat there and lost it. I sobbed and shook – at the fear and the uncertainty and just the sheer need to shake out the adrenaline.

So what happens for me as a doula now that I’ve gotten to experience losing my shit in a hospital setting over my partner’s appendicitis? Am I some sort of super doula, impervious to the unknown and never to lose it again? Better than ever at supporting both mamas and their loved ones? Nope. And maybe a little, yes.

Perhaps I have a few more drops of compassion to offer clients, gained through finding compassion for myself in that moment and in the days that followed. Through looking back and seeing how neither Mr. K. nor I could have done anything differently given what we knew, and that even if I would have myself behave differently now, I was doing only the best I could in the moment, as was he.

And with that new knowledge, and that new understanding, I hope I am just a wee bit better at being a doula – for myself and for others.

Give it up on #GivingTuesday for Chicago Volunteer Doulas

And I don’t just mean applause! Will you please join me in making a donation today?

Rachel and I aren’t just running businesses and making a living as doulas who happen to live in Chicago, we also take our obligation of service to Chicago’s communities of pregnant, laboring and postpartum people and families very seriously. One of the ways we do this is through our support of the organization Chicago Volunteer Doulas (CVD).

I have been personally involved at CVD as one of the volunteer doulas since 2008 before the organization even had 501c3 status (as an official non-profit). I also serve on the board of directors, most recently as co-chair. I have become more and more involved in supporting CVD over the years because I see that there are multitudes of pregnant people who are left in the gaps between those served by community based doula programs and those who can afford the fees for private doulas.

These are the people who would otherwise not have doulas. This is where CVD comes in. CVD provides on call doulas to four different hospital midwifery programs in Chicago as well as offering traditional model private volunteer doulas to families with incomes under $50,000 per year. Until community based doula programs have expanded to meet the needs of unserved populations, and/or government funding and insurance reimbursement for private doulas is common place, volunteer organizations like Chicago Volunteer Doulas are essential part of changing birth culture. And so is our support.

I have volunteered at community based doula programs such as HealthConnect One, and also continue to work privately. I believe adamantly however, that *any* pregnant people or families who want a doula, need and deserve access to doulas.

One way that my co-blogger, Rachel, supports Chicago Volunteer Doulas in changing birth culture is through consistently offering a scholarship position in each of her DONA International doula trainings for a woman of color who is also a CVD volunteer. This is also, in my humble opinion, one of the ways Rachel is awesome, but I digress.

CVD is just a small part of changing birth culture, but for many Chicago parents, it has been an essential resource. Will you join us this Giving Tuesday and give what you can to Chicago Volunteer Doulas? Then please spread the word to others!

Thanks, friend!

Importing Midwives and Exporting Babies: Illinois’ Little Secret Gets National Attention

Illinois midwifery and home birth have gotten a lot of national attention lately. In late August, there was a Time Magazine article on the controversies surrounding home birth in the U.S.A. In the opening paragraph, there was a description of an Illinois home birth mama who eventually jumped the border to have her baby in Missouri because the home birth situation in Illinois was so full of angst.

Late last week, the New York Times published an entire article about Illinois home birth. The title was (to us activists) exciting and provocative – “Use of Midwives Rises, Challenging the State to Respond”. This article features an Illinois student midwife who crossed the border, moving to Wisconsin to complete her education and work legally. Also in the same article, is an Illinois mama who moved to Wisconsin to follow her midwife.

Is there a pattern here??  Yes – moms and midwives crossing the border into friendlier states. It’s as if there are signs at the border pointing AWAY from our state   →  This Way To A Better Birth.

This is only half the story, however. The Coalition for Illinois Midwifery is also aware of women bringing midwives IN to Illinois. Although not clearly stated in the NYT article, some of the mamas interviewed actually imported their home birth midwives from other states. And they’re not the only ones. Over the past several years Illinois home birth mothers have brought midwives in from Wisconsin, Iowa, Missouri, Indiana, Kentucky, Michigan, Minnesota, North Carolina, Ohio, Texas, Oregon, Montana, California, and probably quite a few more.

Bringing a midwife in or taking a jaunt across the border are both viable options for women, but are they really the best options?

Comfort is an issue. Anyone who remembers the last few weeks of their pregnancy knows the last thing they want to do is take a long drive anywhere, much less in labor.

Safety is an issue. Should a woman need a higher level of care, her imported midwife is unlikely to be familiar with the local options. And for mamas who have traveled, ending up in a strange hospital, miles from their supportive network of friends and family, can negatively impact their well-being.

Pride is an issue. Can we not serve our own?

With national attention finally on the subject, we can hope that our state legislature will find it in their hearts to make sure that women who choose home birth in Illinois, have enough providers willing to serve them. Given that we have at least 30 years of evidence that nurse-midwives and physicians cannot and will not meet that demand, it is time to recognize those who will and assure that they have met national certification standards. Licensure of certified professional midwives (CPMs) is the only way.

Otherwise we’d better start building those border signs.

Thirty Years Too Long

Journalist Amanda Robert’s story highlighting the homebirth situation in Illinois, says it all in the tag line: “Thirty years later, Illinois midwives fight for birth rights.”

For 30 years the state of Illinois has been aware that some 800 – 1000 Illinois women per year choose home birth and choose the care of a midwife especially trained to attend home deliveries –  a direct-entry midwife (entering the profession directly rather than through nursing – sometimes also called lay midwife).

Thirty years ago midwives and families lobbied the state to license such midwives and were turned down. Every so many years they went back and were turned down again.  Yet home birth persisted.  It did not go away.

Since the year 2000, home birth and midwifery advocates have gone to Springfield for every session under the banner of the Coalition for Illinois Midwifery.  As the Coalition, we’ve developed the language of the licensing bill to reflect the standards of the time. Instead of talking about lay midwives we are talking about CPMs (Certified Professional Midwives) – women (or men) with years of training, who have passed a national exam administered by a credentialing organization that is accredited by the very same organization that accredits the nurse-midwives organization.

We’ve gained the support of the Illinois Public Health Association, the Illinois Society of Advanced Practice Nurses, the Illinois Maternal Child Health Coalition, and even the AFL-CIO. And most importantly, we’ve set the highest level of educational requirements for state licensure of CPMs in the nation.

House Bill 226, the Home Birth Safety Act, is currently is gaining momentum in the Illinois House.

Home Birth STILL persists and rates are climbing –increasing 5% from 1990 to 2006, according to the CDC.  It is time for our state legislature to take action and finally license and regulate the midwives who are out there attending it. Thirty years is a long time to stay underground.

CNMs, CPMs and DEMs…Oh My!

Note: This is a first post by doula extraordinaire, midwife-in-training and legislative advocate, Rachel Dolan Wickersham. Amy and Rachel are thrilled to begin our work as a team to bring ChicagoDoula to you in its new format as a collaborative birth blog. Enjoy!

I’ve had a lot of requests for a basic primer on the different types of midwives available to home and hospital birth mothers and families. Generally, everyone understands that midwives have a more holistic approach than MDs, spend more time with their clients, and get better outcomes for both mother and baby. However when it comes to figuring out which type of midwife is best for a given situation, the devil is in the details. Here is my best shot at sorting out who’s who.

CNMs and CMs  (Certified Nurse-Midwives and Certified Midwives)

CNMs receive a degree in nursing and then go on to get a master’s degree in midwifery in most cases. There are a number of CNMs who have a bachelor’s in nursing and a certificate in midwifery, rather than a master’s, but basically, it’s nursing plus midwifery training. Starting in 2010, a graduate degree will be required for all CNMs and CMs.

CMs receive midwifery training alongside CNMs. They are part of the same program, however before the midwifery training they do not receive an RN. They do however, have to receive a bachelor’s before the midwifery training because they will be receiving a master’s in midwifery. Those who already have a master’s degree in a related field, may earn a certificate.

Both CNMs and CMs sit the same midwifery exam to receive their credential. The exam is administered by the AMCB – American Midwifery Certification Board. One is not required to prove out-of-hospital experience in order to sit the exam or receive a CNM or CM credential.

CNMs can practice in all 50 states. CMs can practice in 3 states – New York, New Jersey and Rhode Island. The vast majority of CNMs- or CMs-attended births occur in hospital settings. Less than 5% are outside of the hospital in homes or free-standing birth centers.

DEMs and CPMs

DEMs are direct-entry midwives – midwives who do not enter the profession through nursing. They learn through a variety of pathways. Possibilities include but are not limited to formal midwifery schools such as Seattle School of Midwifery, exclusive apprenticeship, or a combination of the two. These midwives may or may not use the same textbooks as CNMs and CMs. They may or may not be legal within their state. They do not carry a national certification unless they choose to become a CPM (see below).  They may or may not have education equivalent to that of a CNM/CM.  Whereas the CNM/CM proves her entry-level competence by passing the AMCB exam and earning her CNM/CM credential, the DEM who does not become a CPM has no such designation.

It is up to the consumer to discern their DEM’s level of education and expertise through asking questions, contacting references, and examining any evidence their DEM provides (such as certificates of training in neonatal resuscitation, etc).  In some states, licensure is offered to DEMs who meet certain requirements. Often, but not always, the requirement is to earn a CPM (certified professional midwife) credential.

Some DEMs wish to prove their competence by meeting certain criteria and then sitting a national exam. These DEMs become CPMs (certified professional midwives).  They may still receive their education through a variety of routes, (see DEMs above) but it is almost guaranteed that they will learn from the same textbooks as CNMs and CMs because the national certification exam draws questions from materials in these textbooks.

The national certification exam for CPMs is administered by NARM (North American Registry of Midwives). NARM’s exam tests for the same body of midwifery knowledge as the AMCB‘s exam.  It does not test for advance practice nursing skills and knowledge (such as knowing how to calculate and prescribe narcotics doses for pain relief in a hospital birth)  because CPMs are not nurses and are intentionally, out-of-hospital providers. In addition to passing the exam, in order to receive a CPM credential, the applicant must prove documented out-of-hospital experience (something CNMs and CMs do not need to do).

CPMs are legally allowed in 26 states and are selectively ignored in other states. Only 11 states actively ban them. In some states they even get Medicaid reimbursement, as can CNMs.

CNMs, CMs and CPMs have all earned certificates demonstrating competence in midwifery. Consumers should be able to verify proof of their certification. In the case of CNMs in all 50 states and CPMs in some of the 26 legal states, one can verify their state licensure.  Where licensure is not available, it is up to the consumer to ascertain proof of education. To see a list of legal states for DEMs and CPMs, go to www.mana.org and click on the resources tab.

Illinois

Since I live in Illinois, I can comment on our situation here.

In Illinois we have no CMs. We have many CNMs. Most practice in hospitals. At this writing, there are no free-standing birth centers for them to practice in, though a law establishing a pilot project of such centers passed in 2007.

Five nurse-midwifery practices offer homebirth services in the Chicago area. Two practices offer homebirth services downstate. Altogether, these practices are based in only 5 out of 102 Illinois counties.

Currently in Illinois, DEMs of all kinds, including CPMs, are illegal but there is a bill before the Illinois House for licensure of DEMs requiring the CPM credential as proof of competence. Licensure would also require an associate’s degree with specific science-based coursework in addition to the CPM.

There are DEMs all over the state of Illinois. Some are in the open. Some are underground. Here in the Chicago area, we have only a few CPMs.

CPMs are legal in some neighboring states (Wisconsin and Missouri). They are generally allowed/ignored in Michigan. Iowa and Indiana are working on licensure for CPMs, as is Illinois.

For more information on Illinois Licensure, go to www.illinoismidwifery.org
For more information on CPM licensure nationally, go to www.thebigpushformidwives.org

Homebirth Safety Act Update – And Pictures!

Despite a setback earlier this month, and what this article might lead you to believe, Rep. Julie Hamos and the co-sponsors of the Illinois’ Home Birth Safety Act, HB 226, are still working on getting the bill passed this session. They need all the help we can give them to turn legislators’ “no’s” into “yes’s”.

If you live in Illinois, please let your legislators know that you support HB 226 and women’s right to give birth where we choose. You can go here to find out who your state representative and senator are and get their phone numbers and mailing addresses. For tips and talking points you can refer to info here and here.  This bill needs ALL the support we can give it, so please understand – I am asking YOU to join me and do this!

As an incentive, I finally finished going through my pictures from the road trip I took with my kids to lobby for the bill earlier this month. (Thanks to Kathleen, for helping me figure out how to post them). The photos aren’t going to win any awards (except maybe one that Elijah took). But they tell the story of the day, so have a look at them and then support the effort and call and write your legislators!