Blog On! Part 1

I read a lot of blogs. Some are by midwives and nurses, some by doctors or paramedics, some by olim here in Israel [or getting ready to make aliyah], some are literary, some are about Judaism. (Reminder to self: update the blog list). One is by a woman who attempted a home birth with tragic results, and has subsequently, I am happy to say, had another, thriving baby. There are a few miscellaneous ones: Cranky Epistles, Respectful Insolence, Random Acts of Reality, A Little Pregnant. Some bloggers post regularly; some, like myself (yes, yes, I know -- stop hitting me!) blog only occasionally, and/or infrequently. Some have gone to that Great CyberArchive In The Sky, and are no more.



There are two which I enjoy for entirely perverse reasons. One is by a L&D nurse who's studying for her CNM as a Master's degree program through the Frontier Nursing School, and the other is by a woman who made aliyah with her husband and son just slightly more than a year ago. The reason I write "perverse" is that my own take on similar experiences is so different.



At Your Cervix used to be a very jolly-looking but very fat woman. When I began reading her blog, she was on the verge of having bariatric surgery, so I've followed her through not only the initial surgery, but the following operations (4, I think, so far). Between the descriptions of what she's gone through, and the photos she's posted that show the way she looks now, I am cured of any interest in having bariatric surgery myself. But, if she's happy, well, more power to her!



She works in a very large and high risk unit, and one would think that what she sees would temper her enthusiasm somewhat but she is what I call an "ideologic nurse" and will be an "ideologic midwife". I've never had this viewpoint. The only "failure" in obstetrics is when there is maternal or fetal morbidity or mortality, as far as I'm concerned. A vaginal delivery, preferably without any medication, isn't a "victory". It's nice when it happens, if the woman copes well with the contractions and the labor progresses normally, but it isn't something I feel is essential for the wellbeing of either the woman or her child, and it is that wellbeing that is paramount. At Your Cervix bemoans shifts where her patients are delivered by C-Section (in all fairness, some of the private attendings seem to rush to the OR, but let us not forget that women often choose doctors by word of mouth, and if they want oblivion in labor, they'll find a doctor who medicates heavily, or vice versa) and has stated that she wants to show "poor women" (i.e. those without private doctors, or on Medicaid,I presume) the "joy of natural delivery". In my experience, nearly all these women simply want to have their babies as quickly and painlessly as possible and get as much rest before they have to go home. They really don't want to be convinced to have what they perceive as a more difficult way to have a baby. (I once asked a neighbor where she intended to have her baby, and she named a hospital across town. Since my hospital, which was famed for it's advocacy of "natural" childbirth, was only about 2 blocks away, I asked her why she didn't register there. "I want an epidural as soon as possible. At Misgav Ladach, I've heard they don't give you anything". Of course, we did have an anesthesiologist 24/7, and any woman could have an epidural. But she would not believe me)



Call me old-fashioned, but I don't believe ideology has a place in good medical practice. There's no "one size fits all" and the art of midwifery consists of matching the treatment to the patient. I'm the midwifery professional, not the patient. Of course she can discuss things with me, and I'm willing to be flexible as long as the safety of the mother and baby aren't at stake, and of course the mother (and her partner) are entitled to full explanations of everything I do or propose to do (except in drastic emergency, when I can't take the time) but the bottom line is that I, and no one else, unless I bring in a doctor, is responsible for the woman's and baby's welfare. I'm frankly a little surprised at At Your Cervix. Radical direct entry midwives often espouse the "birthin's normal" philosophy out of pure ignorance of possible outcomes, but AYC works in a high-risk unit. (Mild snark: I wish she wouldn't use the word "birth" as a transitive verb. It's a noun.)