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In Praise of Midwives: Having a Baby Is Not an Illness

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There is a bill in the CO State Senate that brings back a flood of emotion for me. Senate Bill 088 re-authorizes midwives to practice a profession that has been in existence since time began -- assisting others in the natural process of becoming parents. The bill would also allow certified midwives to perform simple, basic procedures commonplace with normal, healthy, routine births -- administering common drugs, offering IV fluids when needed, and suturing tears which sometimes occur. The memories of a midwife being with me during my greatest joy, as well as deepest sorrow, have haunted me for twenty years. It is time to tell this story.

It was late 1988. I was a first-time pregnant mother in Ann Arbor, MI. I did everything I was told to do -- I was married, college-educated, ate organic food, and was in great health at the time. I knew pregnancy was a natural, normal process, and I was confident in my ability to be a great mom. I chose a team of nurse-midwives, childbirth educators and support people to help.

My midwife seemed as excited about my pregnancy as I did. Unlike traditional obstetricians, she spent a great deal of time with me -- asking me lots of questions, calming my fears, sharing personal stories, and chatting about things that are important to first time mothers. She told me about herbal remedies for mild discomforts, suggested books to read about parenting, gave me feedback about the names I was considering, and much, much more. Carol was part doctor, part "sister," and part friend. I adored her. I felt completely safe in her care.

My son Adam's birth in January of 1989 was picture perfect -- my sister flew in from Virginia, my husband coached my labor using the Bradley method, and our parents were all nearby in the next room when he arrived. I labored at home until the last minutes, because my frightened graduate student husband wanted me to be at the hospital at the very end -- "just in case." We quickly gathered the gentle recorded birth music, the video-camera, the massage balm, and our other necessities, knowing birth was imminent. Using no medications whatsoever, I had a perfectly natural and low-pain birth in a small triage room minutes after arriving at the University of Michigan hospital, attended by my midwife Carol, whose loving arms gently handed me my squirming son. I will never forget her giant smile when she commented, "He's just a little guy."

Despite the last-minute move to the hospital, my son came into the world surrounded by great joy, and with no "medical" intervention. We celebrated thirty minutes after his birth with a birthday cake, champagne, and a room full of people singing "Happy Birthday." The baby breastfed immediately, and after a few hours, I was back at home, where my midwife assisted me with my after-care and gave me many tips for caring for a newborn. Those early moments were golden.

My midwife-assisted birth had gone exactly as planned. There has never been a time more beautiful, more magical, and more empowering time in my life than my oldest son's birth. I felt connected to every mother who came before me for millennia. I felt confident to take on every parenting challenge that would come my way -- and in the past twenty-two years, there have been many!

Two years later, I was pregnant again. My husband was close to getting his Ph.D., and was completely consumed with that task. We were financially broke, and the second pregnancy had been a surprise. Our toddler son had been quite sick with asthma during his first two years, resulting in many trips to the emergency room and an extreme amount of stress for all of us. We were anxious to get out of our apartment next to the industrial smokestacks of a drug manufacturing plant and into a home in a cleaner area. I worried my son's medical condition was somehow related to the steam oozing out of the neighboring factory. Our moving couldn't come quickly enough for our little family. We knew things would be looking up for us after he graduated and got his first "real" job. (Incidentally, our son's asthma cleared up almost immediately after our move).

Once again, I went to my midwife, who had been more than a medical provider for me -- she had become my trusted friend. I was told my HCG levels were extremely high -- usually a sign of a healthy pregnancy, but in my case, it may indicate twins. At that time, there was some controversy in mothering magazines about the safety of ultrasound tests during pregnancy, so I decided not to have one. As my pregnancy continued, I became weaker and felt more and more nauseous.

During my third month, my husband was offered a job in Denver, and we decided we would move to CO. I was supposed to be doing our packing while he finished his dissertation, but my constant morning sickness and caring for my sick toddler prevented me from getting much done.

On the day I was scheduled to fly to Denver with my sister to look for a house to rent, I woke up in a pool of blood. My midwife, who was assisting another woman in labor, advised me by phone to go to the emergency room immediately. "Don't even get dressed. Go in your nightgown," she advised.

I had just had a permanent wave done to my hair the night before and had not yet had it styled or cut. It was sticking out around my head like "Oopsy the Clown." My face was covered with acne cream from the night before. I must have been quite a sight when I arrived at the emergency room of the University of Michigan hospital.

The look on the portable ultrasound technician's face confirmed my fears -- something was terribly, horribly wrong. When a doctor I had never met before came in, he told me I had "a hydatidiform molar pregnancy" -- a potentially pre-cancerous condition where an embryo had started out, but as the pregnancy continued, the chorionic villi in the uterus grew out of control, resulting in a uterus filled with cancer, and maybe even, a dead fetus or "miscellaneous fetal tissue". A "simple" D and C (dilation and curettage) to evacuate the contents of the womb, followed by close monitoring from an oncologist, would probably mean a return to good health in about a year, he said. Barely looking up from my chart, he asked if I had any questions, then quickly left the room.

"What? I don't have a baby? I have cancer?" I sat in shock. The nurses moved in to prepare me for surgery.

"Here, drink this," someone ordered.

Before being able to comprehend what I was told, I was asked to sign a waiver to allow a roomful of pimply-faced medical students to watch my insides being vacuumed out as if I were a car. I was told I would be knocked out with general anesthesia first.

"Hell, no," I said. I was going to be awake. I didn't trust any of them. I opted for anesthesia which blocked the pain from the waist down only. Not only did I want to know what was going on, I wanted to see it.

"That's highly unusual," I was told.

"It's my body," I reminded them. "I am going to be awake." If a roomful of geeks and nerds barely out of their teens were going to see what remained of my baby and the cancer that engulfed it, why couldn't I?

A medical student friend later told me it probably had more to do with the fact they didn't want to have to be concerned with what I was hearing. He also told me I was the subject of grand-rounds that week. "Your blood test results were through the roof. You were quite the freak. Everyone wanted to see what came out of you."

After the procedure, I went home, depressed, confused, shocked, scared, and feeling battered. In a matter of hours, I went from expectant mother to cancer patient and "freak of the week." No one at the hospital said a kind word to me. Not one person said, "I'm sorry," "How terrible," or "Would you like a shoulder to cry on?" I never saw a social worker, a volunteer, or a chaplain. No one held my hand, except for my husband. Family members attended to me emotionally by phone -- I thank G-d for that. In those days, there was no internet to search to find support groups or for patient information -- at least not one I knew about.

We didn't have much time to find a place to live in Denver, so I rebooked my flight as soon as I felt strong enough. I was told I should find an oncologist in CO before doing anything else -- even before finding a place to live. "Your HCG level is so high it broke all records at our regional laboratory, indicating you may have a malignancy. The cancer in the uterus, although it is unlikely, could have traveled in your bloodstream to other parts of your body. You will need to have follow-up care immediately," the hospital said by phone. After many hours of long-distance phone calls and hassles with our insurance company, I found a doctor (my primary doctor needed to refer me to a specialist, but I didn't have a primary doctor in Denver yet, so I had to ask the Denver oncologist for a name, and then beg the person to give me a referral a thousand miles away, without ever having actually met me).

Fortunately for me, the primary care physician the oncologist in Denver referred to me was Dr. Dianne McCallister in Aurora. When I arrived at her office, she asked, "What's the problem?"

Through a huge box of Kleenex and more tears than I thought were humanly possible, I told her the story of how I went from being an expectant young mother to a cancer patient in one day, and was brand new to Denver -- my closest relatives and all of my friends were now one thousand miles away. Not only that, but I needed a pediatrician soon for my toddler son, too. Dr. McCallister then did what I wanted everyone to do up until that point. She hugged me.

"Didn't anyone attend to your grief over losing your baby when you were at the hospital?" she asked gently.

"No. They told me 'the embryo had not been viable' for some time. I don't think they cared about anything other than their intellectual curiosity over my rare condition," I sobbed. "I was treated like a freak by everyone I saw. I was in such a hurry to get to Denver, I didn't have time to see my midwife." I sobbed again.

Dr. Dianne cared for my body, as well as my soul. On a prescription pad, she once wrote, "Simple Abundance" -- a book that reminds women of what's important in life. She told me a family member, a minister, had shared it with her, and it really helped her. I still have the book. I will cherish it always.

I went back to Ann Arbor after finding a home to rent and meeting my new doctors, to pack up the rest of our things. While there, I visited my midwife, who was shocked when I told her the brutal way I had been treated at the university hospital. She hugged me, she apologized, and she seemed truly horrified by the hospital's complete lack of compassion and humanity. One of the other midwives who normally backed her up apologized profusely that they didn't make it down to see me that day. I promised to keep in touch with Carol and let her know how I fared in Denver -- a promise that we kept for a number of years.

In the 12 months that followed, weekly blood tests indicated my record-breaking HCG level eventually returned to normal. CT scans, MRIs and x-rays indicated I did not have a malignancy anywhere in my body, and a year later, I was told I could try to have another baby. In 1993, Jonathan (Hebrew for "gift from G-d") Lincoln was born. Two years after that, Jordan Eric joined the family. Both sons were born at local hospitals because my pregnancies were considered "high risk." With Jonathan, I had eleven ultrasounds. The two obstetricians were nice women, but I never felt as close to them as I did to my midwife, or to Dr. McCallister.

My mother once asked me if I regretted seeing a midwife with my second pregnancy. "If you had an early ultrasound, you might have known there was a problem sooner," she said.

I never regretted the decision to see a midwife. Carol gave me the option of having an early sonogram and I had turned it down -- it was completely my choice. Whether I had an ultrasound or not, it would not have changed the outcome; I would have had a molar pregnancy regardless.

My only regret was not asking my midwife to send another midwife to sit with me in the emergency room. I had been spoiled by my first pregnancy with Carol. I was spoiled with the emotional, physical, psychological, and spiritual care I received from my first appointment to my last. I was spoiled by having a caregiver who was also my friend -- a person who didn't just see me as an I.D. number, nor a diagnosis, nor a payment code, but as a real person. I was spoiled by being treated like a human being every step of the way -- a person with feelings, and hopes, and dreams. My baby was spoiled by being welcomed into the world by a person who did what she did because she loved the miracle of birth, and saw her role of assisting at a birth as a privilege, not just a job.

My regret -- my only regret -- was that the tragedy of my second pregnancy occurred while I was in the hands of a medical establishment that did not know me at all. My regret was that I did not have my midwife at my side with me that day.

Twenty-two years later, I look at my three sons with pride. Pride that they survived being the children of a mother and father who raised them one thousand miles from any extended family. Pride that they have grown up as Coloradans -- in a state I love and will always call "home" because they grew up here. Pride that my kids will give something to Colorado when they finish college and get their own first "real jobs." Pride that despite our many challenges, we have the family we always dreamed we'd have.

To Carol Shulthies, Certified Nurse Midwife, I thank you. I thank you for not only being with us as we started our journey as parents, but for showing us what really mattered in life -- people -- not lab results, not co-pays, not blood levels, not pounds gained nor rates charged. Just people. If I am blessed to become a grandparent in my lifetime, during that first miraculous moment of holding my first grandchild, I will remember how you smiled when you handed my son to me.

And to the thousands of midwives who hold hands, comfort hearts, wipe tears, share smiles, and grow families, you have my undying respect and appreciation forever. May Colorado's legislators who judge you today, know the importance of their decisions to the future of our great state.