Monday, March 11, 2013

what the what, Hudson?!

Please see Stand and Deliver's recent blog post ( regarding new restrictive policies at Hudson Hospital in Hudson, WI. In a nutshell, the hospital is severely restricting the practice of its birthing staff, specifically mandating cesarean birth for all breech presentations (which were previously able to be delivered by a provider with many years of experinece in vaginal breech birth), as well clamping down on VBACs, waterbirths, etc. Below is the letter I'm sending out tomorrow in response to the new policy --- won't you join as well? (Also, please note that Rixa at Stand & Deliver is having a giveaway to thank those who join the campaign advocating for the women who delivery at Hudson --- join in!!) "Dear Ms. Hegelberg, I am writing to you in regards to the recent policy change in relation to birth practices at Hudson Hospital. As a certified nurse-midwife providing care to women throughout the lifespan, I am deeply saddened to learn of the new stance being taken by the leadership and administration at your facility, specifically as it relates to the withholding of informed consent to women during childbirth. According to Hudson Hospital's own "Patients Rights and Responsibilities", provided to each patient upon entrance into the care system, your patients are assured the right to be informed of care options, treatment plans, and alternatives; similarly, the document ensures patients they will be given the opportunity to consent to any procedure prior to its undertaking, as well as the right to refuse any treatment with informed consent. According to the newly released policy, the practice of employing medical interventions is a national standard, and implementing this will allow Hudson Hospital to become consistent with other regional and national centers; yet I am aware of no other facility which denies a patient the legal right to refuse any treatment which he or she deems unnecessary or inappropriate after receiving informed consent. Please recognize, Ms. Hegelberg, that this is a legal and moral right of all competent, informed individuals, and denying it would appear to be treading on a very fine ethical boundary. The announcement that Hudson hospital will be forcing medical interventions on women and infants, regardless of their informed consent or screams of refusal, is unacceptable. As a healthcare provider, I recognize the increasing pressure on providers to perform flawlessly and prevent any errors; I have heard far too many lectures on risk management "from leadership's point of view". Whether these measures are being initiated following increasing insurance rates, in an effort to increase reimbursement rates, or to avoid hypothetical bad outcomes (which according to multiple research articles are much more likely with surgical birth) - they are directly in contrast with Hudson Hospital's purported commitment to providing "excellent patient outcomes". I urge you, and the rest of the board, to reconsider this ban on vaginal breech births, increased restrictions on water births, and forced interventions. Should these restrictions stand, I strongly consider you to make all changes publicly known to the women who have utilized your facility in the past; relying on your obstetrical providers to relay this information to the women and families who will be most affected by these alterations (and who may be most likely to change their birthplace as a result) is neither fair nor appropriate. With respect for the birthing practices that have made Hudson Hospital a supportive, welcoming haven in the past, I will await your reply in the days to come. In the meantime. I will recommend other facilities (including those who support vaginal breech birth, particularly with the experienced hands of skilled providers as recommended by the 2006 American College of Obstetricians and Gynecologists statement on the practice) to area women. Sincerely, {{me}}


A recent CNN article demonized a Pennsylvania doctor who is accused of providing abortions to women in what are described as incredibly filthy, dangerous, deplorable conditions ( Records show that the terminations occurred well after the legal cut-off for abortion, and that the man and his staff repeatedly manipulated records and communication with clients to portray pregnancies as being within the legal allowable limits. Without going into the more gruesome, heartwrenching accusations of the story - nor the spectrum of sociopolitical questions that it raises - I have to admit that I got caught up in the "comments" section of the article. (A bad habit of mine --- trying to defend what I see as the under-defended, unheard, unspoken --- and getting riled up by the trolls who exist simply to do just that online, it seems!)

One comment that particular irked me came in response to a comment I made which offered some defense of the women who may have sought this man's supposed "care" (I use the word lightly --- as much as I wish to presume his innocence until court proceedings are complete... the mama/baby lover in me is broken up reading and hearing the stories of the women who survived procedures at this clinic). In the midst of hundreds of comments calling for the women who had been victimized to be charged with murder, I related that for many women, an unintended pregnancy is not just a momentary emergency or stress that can be more or less resolved once the shock has passed, and resources found, support gathered; I posted details that had been published in several news outlets previously (the story had broken over a year earlier) to clarify that many of the women had been deceived into thinking they were much earlier into their pregnancies, and that several related stories of being forced against their will into completing the procedure after having second thoughts.

Following this plea for understanding and empathy, another commentator argued (repeatedly) that "the idea of 'unintended pregnancy' is the most ridiculous thing I have ever heard" (or something similar - I cannot pull up the actual thread today). This particular person's feeling was that by engaging in sex, the woman was asking for pregnancy and therefore responsible for the intention of it when the pregnancy did occur. And, as with any argument - there was no negotiation. According to my newest friend, the purpose of intercourse is solely procreation; sex = babies, and for any woman to deny that fact - or to deny the product of the act, specifically, by seeking an abortion, is absurd. If you're having sex, suck it up and have the baby, apparently.

Clearly, contraception may be a moot point for this fellow (for the sake of convenience I will imagine this poster was a male, although it may have just as easily been a woman of course). The argument that women who take EVERY single precaution to avoid pregnancy can still become pregnant was irrelevant. You know, like the woman who is taking oral contraceptives (which are supposed to be 95%+ effective --- so pretty darn good --- and doesn't miss a single one) and still ends up missing her period, and ... surprise!! Or, the couple who religiously uses a condom every single time they have sex --- but apparently there is a failure... surprise!!! Or... the mom who has an IUD placed (the one that is 99% effective...) yet still ends up with you-know-what ... surprise!!! Or --- these are always my (not) favorite --- the mother who *just* gave birth, is coming back to the clinic in two weeks for her first postpartum checkup to discuss contraception (and was under strict instructions not to have anything near her vagina until then for several reasons, including but not limited to increased fertility) --- but who is pressured (or forced?) into sex within a few days of birth... surprise!!

And that doesn't even go into the *unusual* cases --- you know, the incest cases, the rapes, the pregnancies which result from forced prostitution or that risk a mother's life...

What would a "surprise!" be in your life? Ten years ago, it would have been --- a surprise, all right! The Warm One and I wouldn't have been married, but I imagine we would've figured it out. Our families may have been a bit disappointed, but as with most families I think a baby can be enveloped with love and understanding --- especially given that (at that point) we had been together several years, well into our college educations, and stable for the most part. A struggle - but okay. Five years ago? Well, five-ish, years ago, anyway --- the Mini-ist would have just been born... the surprise would have been completely overwhelming. I was deeply buried in the shadows of postpartum depression, begging my provider for help and barely mentally/emotionally/spiritually alive. The presence of another life - even the glimpse of that thought in the year ahead - may have been enough to topple me over the precarious edge that I teetered on. Today? A surprise would test us, again, in many similar ways; the fear of coming to that same cliff, pulling the Warm One and the Mini's along (much less another blessed life) terrifies me.

Yet, if my 99.8% effective contraceptive method failed, and our path in life led to these hypothetical crossroads? We'd deal, I think. The same comforting thoughts that come to me picturing that surprise 10 years ago kick in --- family, the Warm One, faith in "what will be, will be..." Somehow, I think, a child would be loved. My sister and her girlfriend? My brother and his wife? Here, with us, to affirm my own faith in my body and mind --- that I am not broken, that I can be a mother even in those first hard weeks when everything fell apart last time?

And then I think about the women I see, and the differences in what a "surprise" means to them.... less food (or no food) for the children they have. Beatings from their partners. Knowing that the growing life in their body is being bathed in chemicals as often as they take them in. Another child,longed for --- only to be taken away "to a better/safer/cleaner home". Lost hope.

How would your surprise fit?