by Nekole Shapiro
Originally published in our Spring 2013 issue.
Our friend died last year.
She was pregnant with twin girls that would be daughters number 3 and 4. She lived in a state with one of the highest C-Section rates in the country, where alternatives to the medical model of birth–like homebirth and midwifery care–are scarce. When she was 36wks pregnant, I received a text message that the family had exhausted their search for a provider who would support her to birth her twins vaginally. Since she had birthed her first two babies vaginally without trouble, she did not understand why this would be any different. In that conversation I learned that because they could not find anyone to support her in a vaginal delivery, the couple had decided to do it on their own.
This did not sit well with me. This was not a family who said, We would like an unassisted vaginal home birth of twins. This was a family who felt they were left with no better option since no one would support them in what they saw as the best and safest option: a spontaneous vaginal delivery. I quickly got online and tried to track down someone to provide support. I was confident that I knew people who could help. Two midwives contacted me saying they could help. These two amazing birth keepers were willing to drive across several states to this family’s home and stay with them so they could support the mother in a vaginal birth. But, there was a snag — there was no money to get them there. By this time she was nearly 38 weeks pregnant. The midwives worked to help her find someone closer and our friends set up an interview to meet with the new midwife.
Next thing I knew, I got a text that she had birthed her twins: spontaneous labor at 38 weeks. I was elated and couldn’t wait to hear more. But then the second text came: she had lost quite a bit of blood and was in a coma. It was as though the Earth stood still for some moments. I was stunned and silenced; the first stage of grief took me. Communication was like a slow game of telephone as we tried to support each other and gather information. Our primary source of information came in the form of text messages from a father, now of four, whose wife was in a coma in the ICU and whose two newborns were in the NICU. Obviously, communicating with us was not the priority. Information flowed from him, to my mother, then to me. As we retrieved what information we could, both she and I contacted others to get an idea of why this was happening, what the prognosis was, and what could be done now.
At first, word from the hospital was promising. We felt fairly confident she would recover. They had her sedated and would soon take her off the medication. They expected her to wake up. She didn’t. They did a CT scan and saw no damage. But still she didn’t wake up. They did an MRI and saw some effects from the blood loss, but were still relaying hope. Every day that she didn’t wake up was another day we all hugged in our breath just a bit closer.
Then they reported that there was only brain stem activity. We started to process what seemed to be the inevitable and yet still unbelievable. We halted that process when we got a report that the doctors fully believed she would wake up. They thought she wasn’t waking up because her liver and kidneys were damaged from the blood loss so she was having a difficult time clearing her blood of the sedatives. This seemed almost too good to be true. We cried with relief and we waited.
But, it was too good to be true. The next update I got was via this Facebook post, “[My wife] has not, and will not, wake up again. She has been moved to a room where she will be kept comfortable until the end.” Some days later she passed away. My mind, just kept saying, “This is what is NOT supposed to happen!” But in fact, it had happened.
At first, I was quite shaken by these events and I knew others would be as well. I knew people would quickly say, “See, you can’t trust birth. Birth IS inherently dangerous. How dare you be one of those people who support anyone thinking otherwise! See what can happen?” But, I also knew that this is one story of many and I did not want my raw emotional state to start dictating my view of the world. I reminded myself that many people die in car accidents, but we have not outlawed cars. Fear and grief were gripping me as it does many in the face of such indefinable loss. I knew the first order of business was to feel my feelings and find ground again. I also knew this story and all that I learned needed to be shared, but I had to do my emotional work before I could get to the intellectual work.
I cannot tell you how grateful I am to the knowledge, training, and practice I have in emotional work. It played out so exquisitely as this all unraveled. I was able to identify my own stages of grief and those of the people I was supporting. I was able to let my emotions flow as they surfaced and support others as theirs did as well. While it was all quite consuming for some time, I eventually found my acceptance when this phrase popped into my head after shedding quite a few tears one night, “I am powerless over birth.” Isn’t this so very true? We work for what we believe and at the end of the day we are so very powerless.
Once I found my emotional ground again, my intellect could get to work contextualizing all that had occurred.
I was at a birth some time ago dancing with Mama, and I was blissed out in what I call the Oxytocin Loop,. The Certified Professional Midwife (CPM) had checked her at 6 cm, but she seemed very much in early labor. We walked outside. I pushed on her back and hips. We cracked jokes. It all seemed to be going just peachy to me. After about a day of this, the CPM seemed really stressed out. I couldn’t figure out why. At one point, we left the couple to make out in private for a bit and I got to sit and chat with the midwife. Eventually, it became clear that the CPM’s anxiety was rooted in the belief that a long labor could lead to a boggy uterus and hemorrhage. It was like a light turned on for me. It was as though this CPM finally explained to me so much of the unexplained anxiety I had felt in birthing rooms up until that point. As a mama who labored for 2.5 days and had a completely ecstatic birth, I never think of a day of labor as a long time. Hmm…. it was an interesting point for me to ponder. That mama went on to have a powerful vaginal water delivery about a day later. But this was my introduction to the fear of hemorrhage.
My friend’s death was this fear realized. I needed to research and ponder where these events left me. I was pretty sure what the medical track would tell me. They would say she should have had the C-Section. But, I was less sure what those who support physiological birth would have to say. What could have happened for our friends had one of them been present or had they prepped a family for an unassisted birth?
I write the following in no way to point fingers or lay blame, but instead to share valuable information for anyone who may find him or herself in this situation.
I learned that my friends prepared themselves as best they could figure out. They studied up on twin birth, home birth, breech delivery, and shoulder dystocia. We are fairly sure however, they did not study up on hemorrhage. I have to wonder if the overpowering fear of hemorrhage has a bit of a muzzle effect on the topic. As I pointed out, I had never been aware of its grip on so many care providers until I had that conversation with the CPM.
Labor started and thirty minutes later the first baby made its entrance into the world. Five minutes later the second baby was out. The bleeding started after the babies were born and their shared placenta was still in the womb. They decided to go to the hospital. They cut the cord and got everyone into the car so they could drive to the hospital. During the car ride mama lost a good amount of blood and eventually fainted. Once they got to the hospital, mama needed to be revived and the babies were taken to the NICU. The babies never saw or felt their mama again and she never saw or felt them again.
When I heard this story all the actions made sense from a medical vantage point. I could see why they would be afraid of the bleeding and decide to get in the car. Of course, the hospital took the babies to the NICU and needed the mama clear as they stabilized her. I could see why the hospital felt they needed to keep the babies in the NICU and Mama in the ICU. If instead, I looked at it all through the lens of supporting the mama-baby system, there were definitely some inconsistencies.
I spoke to numerous midwives and learned what they would do in the face of the great H: Hemorrhage. This is information from people who focus on how to support the mama-baby system to stop bleeding first and foremost. Only as a last ditch effort do they apply heroic techniques that take the system over. I think this wisdom should be spread far and wide! Sadly, I sense we will hear more stories of women without support before we will see women getting better support. It is my hope that in a small way, proliferating this information could help make our friend’s death of some service to the greater world and not solely a loss to those who loved her dearly.
In the dialogs I had with these very experienced and astute midwives, I continually heard their skills as focusing in on keeping what I call the Oxytocin Loop going. I would go as far as to say that for them, this Loop is the primary medicine. Some of the conversations went to questioning who was present at the birth. Was anyone panicking? Was anyone interrupting the Oxytocin Loop? They mentioned keeping the cord attached and placing the babies skin to skin on Mama. Some suggested working towards a latch or providing luscious nipple stimulation. There were varying ideas about herbs and Pitocin. If all else failed, the most heroic move mentioned was a manual clearing of the placenta from the uterus. Since my friend was able to keep her womb as they stabilized her at the hospital, the midwives were fairly certain her source of blood loss was the placenta and thus completely manageable. This is a perception still haunting the many people who wished they could have been there to help my friend.
While there was talk of having her clear her bladder, there was also a focus on not moving her. It was suggested in this situation to call 911 instead of getting into the car. I could see how calling 911 would allow for the environment around mama and baby to remain fairly mellow and oxytoxin infused until the ambulance got there. And if she did pass out, the paramedics would be right there to support her. Finally, every midwife validated the information I got on Kangaroo Care at the Mid-Pacific Conference on Birth and Primal Health. Every single one of them said to get those babies on mama as soon and as often as possible. They all shared such great information with me and I am so grateful to them!
Hindsight is 20/20 and very sadly my friends did not have all of this information nor the support of someone who did at the birth of their third and fourth daughters. Would the outcome have been different had either of these things been true? Perhaps. I’ll go back to my earlier assertion: we are powerless over birth.
What I can say is this: the current system left our friend and her family with two options, neither of which matched with what they wanted. Their choices were to 1) have their babies cut out and venture the associated risks or 2) birth without a provider and venture the associated risks. This was no easy choice to make. It was a choice they should not have had to make.
Ultimately, this story is a horrific reminder of our broken system. If we walk out of a birth with this type of unfathomable outcome when in fact all the support needed was present, that is one thing. But, to have this outcome with a complete lack of support, that is simply unacceptable. Our system should be designed and focused on supporting mothers to birth the way they feel is best for them! No matter if she wants to birth her baby at home with no one present, in water at a hospital or utilize all the tools of modern medicine, in all cases, the education and support should be there. Perhaps this seems like a lot to ask. Perhaps it is a lot to ask. But quite frankly, we are a country that can take a group of people to the moon. We are a country that could wipe out the human population by pressing a few buttons. We are a country of people who can purchase just about anything we want anytime we want. We should be able to get this right! We can do better! We must do better, for the sake of the mamas, babies, and families yet to come.
Nekole Shapiro resides in Seattle, WA with her husband and two beautiful daughters. She lives a full life working with clients, attending births, teaching and writing anything to help more people embody birth. She focuses on oxytocin-infused states, birthing parts and healing birth trauma. Her teachings are igniting people on five continents. She has been called one of the leaders of the next wave of birth activists. Visit www.EmbodiedBirth.com to learn more about her. Take an online video or audio class and register to get her newsletter. You will be very happy you did!