Also, since you asked, I’m interested in learning what makes a person so high risk that they shouldn’t home birth. I’ve read in your FAQ’s about 3 conditions (that I do not have) but my OB/GYN says that I am high risk because I have Rheumatoid arthritis, Hashimotos, and PCOS. I thought these conditions make it difficult to conceive and sustain a pregnancy but the actual labor part should be normal, no? I’m very curious about this.
Thanks for your question! You are exactly right. All of those conditions do present some specific fertility challenges, and some do have some slightly higher risks during pregnancy (for example active RA does have some increase risk of preterm birth), but none that preclude a birth at home. We screen for the risks during pregnancy the same way whether at home or in hospital (to use my example earlier, there is nothing to be done with traditional OB care to *prevent* a PTB with active RA, so a pregnant person may as well avail oneself of the generally more robust prenatal care with a community midwife, who will facilitate a transfer to a hospital birth in the still unlikely chance of PTB). Most midwives will co-manage certain conditions with a trusted maternal fetal medicine specialist or other specialist (endocrinologist, for example). The *absolute* risk factors for homebirth are not many: placenta previa or accrete, active seizure disorder, certain heart conditions or fetal abnormalities, etc.
This helps so much as I am actively tuning out all of the negativity from my mainstream doctors about my “geriatric“ pregnancy (I’m 39). Thank you! We are doing IVF cycles right now so when I’m actually pregnant, if you’re still doing this work I’d love to consider working together. Thanks❤️
wow!! I wish that this type of insight into the MIC was better woven into doula training. I've had to learn it on the job (as we all do) and it's absolutely the hardest part of the job-trying to understand why many labor and delivery floors feel like a prison and how to advocate for our clients without making enemies...
Yes, I was so blindsided when I first started working as a midwife. The whole culture is so specific, and having had no experience in health care or even as a doula, I found it so overwhelming and stressful. I was TOTALLY unprepared for how much the culture around you is implicated in the care you give.
And ALSO that is to say I wish ANY of my education had gone to preparing me for that. I laugh now when I think how much of my education was memorizing guidelines I'd never even be able to use because every place I trained and worked had protocols totally different than what the literature said, and even within some of those institutions every OB had different standards, and I had to adapt to all of those variables. What a joke that no professor ever even HINTED at the fact that that was the case.
Agreed! I'm also coming to this from a doula perspective and resonated with a lot of what was written here. I've definitely found myself trying to not rock the boat too much so that I could push back later when it was "really needed."
I have a friend who works as a nurse on the L&D floor of the hospital I'm at most often—she recently told me that one time she heard a colleague ask "Who's the doula in the room" and they said "Oh that's Ashley (me)" and then a handful of nurses said "Oh she's such a great doula, she's the best, etc. etc." (which sounds like a brag here lol) and initially I was like omg! Wow, that feels so good to be liked, I'm so glad my work is appreciated... I was thinking about it later though and started to wonder if that means I'm just a really complicit doula? Do they like me because I don't push back enough and make their job harder? It's definitely something I've been thinking about—reading this newsletter is giving me more to chew on now too.
Yes, it's a total mindfuck. I worked SO HARD to be a well liked and trusted member of my team and then realized I had to ask myself what it meant to be well liked and trusted in a system that normalized violence and paternalistic, racist attitudes.
This was so helpful and clarifying for some of what my partner has been experiencing trying to work in schools and why they’ve only become more certain they cannot work in a school. Thank you.
Thanks for your comment. Yes, school is another form of institutionalization many of us take for granted or don't even see as institutionalization. This doesn't mean it provides *no* benefit for some, just that we should be actively engaged in what it means to institutionalize most children and how to minimize the harm that comes with that -- rather than naturalize it.
Ugh awful! It’s so hard to read this.
Also, since you asked, I’m interested in learning what makes a person so high risk that they shouldn’t home birth. I’ve read in your FAQ’s about 3 conditions (that I do not have) but my OB/GYN says that I am high risk because I have Rheumatoid arthritis, Hashimotos, and PCOS. I thought these conditions make it difficult to conceive and sustain a pregnancy but the actual labor part should be normal, no? I’m very curious about this.
Hi Jennifer,
Thanks for your question! You are exactly right. All of those conditions do present some specific fertility challenges, and some do have some slightly higher risks during pregnancy (for example active RA does have some increase risk of preterm birth), but none that preclude a birth at home. We screen for the risks during pregnancy the same way whether at home or in hospital (to use my example earlier, there is nothing to be done with traditional OB care to *prevent* a PTB with active RA, so a pregnant person may as well avail oneself of the generally more robust prenatal care with a community midwife, who will facilitate a transfer to a hospital birth in the still unlikely chance of PTB). Most midwives will co-manage certain conditions with a trusted maternal fetal medicine specialist or other specialist (endocrinologist, for example). The *absolute* risk factors for homebirth are not many: placenta previa or accrete, active seizure disorder, certain heart conditions or fetal abnormalities, etc.
Hope that helps!
This helps so much as I am actively tuning out all of the negativity from my mainstream doctors about my “geriatric“ pregnancy (I’m 39). Thank you! We are doing IVF cycles right now so when I’m actually pregnant, if you’re still doing this work I’d love to consider working together. Thanks❤️
wow!! I wish that this type of insight into the MIC was better woven into doula training. I've had to learn it on the job (as we all do) and it's absolutely the hardest part of the job-trying to understand why many labor and delivery floors feel like a prison and how to advocate for our clients without making enemies...
Yes, I was so blindsided when I first started working as a midwife. The whole culture is so specific, and having had no experience in health care or even as a doula, I found it so overwhelming and stressful. I was TOTALLY unprepared for how much the culture around you is implicated in the care you give.
And ALSO that is to say I wish ANY of my education had gone to preparing me for that. I laugh now when I think how much of my education was memorizing guidelines I'd never even be able to use because every place I trained and worked had protocols totally different than what the literature said, and even within some of those institutions every OB had different standards, and I had to adapt to all of those variables. What a joke that no professor ever even HINTED at the fact that that was the case.
Agreed! I'm also coming to this from a doula perspective and resonated with a lot of what was written here. I've definitely found myself trying to not rock the boat too much so that I could push back later when it was "really needed."
I have a friend who works as a nurse on the L&D floor of the hospital I'm at most often—she recently told me that one time she heard a colleague ask "Who's the doula in the room" and they said "Oh that's Ashley (me)" and then a handful of nurses said "Oh she's such a great doula, she's the best, etc. etc." (which sounds like a brag here lol) and initially I was like omg! Wow, that feels so good to be liked, I'm so glad my work is appreciated... I was thinking about it later though and started to wonder if that means I'm just a really complicit doula? Do they like me because I don't push back enough and make their job harder? It's definitely something I've been thinking about—reading this newsletter is giving me more to chew on now too.
Yes, it's a total mindfuck. I worked SO HARD to be a well liked and trusted member of my team and then realized I had to ask myself what it meant to be well liked and trusted in a system that normalized violence and paternalistic, racist attitudes.
This was so helpful and clarifying for some of what my partner has been experiencing trying to work in schools and why they’ve only become more certain they cannot work in a school. Thank you.
Thanks for your comment. Yes, school is another form of institutionalization many of us take for granted or don't even see as institutionalization. This doesn't mean it provides *no* benefit for some, just that we should be actively engaged in what it means to institutionalize most children and how to minimize the harm that comes with that -- rather than naturalize it.