Thursday, January 10, 2008

Gloria Lemay responds

Here is a response to the Good Morning America piece on UC from Canadian midwife* Gloria Lemay. She originally posted it on the main ICAN list.

“The baby could be born in a breach [sic] position, or with the umbilical cord wrapped around its neck. The mother could suffer from significant tearing or from a maternal hemorrhage and bleed to death in as little as five minutes.”

Dear Women,

The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.

I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.

First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING. Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough IV fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could. I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.

Think about it--would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes? I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1,000). Two women have required transfusions. The other 8 recovered with IV fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.

What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post-operative mothers very distressing.

I hope this information is helpful to you.

As far as the other nonsense this person is trying to frighten you with:

1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.

2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs.” Breech presentations are about 3 percent of births.

3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.

Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at http://www.consciouswoman.org/
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008

* Gloria Lemay cannot officially call herself a "midwife," according to British Columbia ruling. Only midwives belonging to the BC College of Midwives may use that title. She is allowed to advertise as a "birth attendant."

13 comments:

  1. Jen.b.in.az1/10/08, 9:57 AM

    Oops, I see you posted this response as was typing my hasty not-so-eloquent one LOL. Thanks again...

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  2. i like that.. "smart babies wrap the cord around their necks to keep them out of trouble"

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  3. HOw does a cord around the neck keep babies out of trouble?

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  4. I think she means that it will keep a cord out of the way so there isn't a cord prolapse.

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  5. I saw this on MDC this morning, been meaning to post it on my blog as well.

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  6. I love Gloria and enjoyed her take on this. I enjoy non hysterical, factual, calm, informative info and attitude. Thank you!

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  7. I think I just fell in love with Gloria Lemay.


    I appreciate her calm.

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  8. Thank you for this informative post.

    -H

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  9. Gloria is talking RUBBISH. Dangerous rubbish. You never EVER have an hour to get a woman out of danger or stop her bleeding out. I have myself witnessed an amniotic embolism.

    Gloria is dangerous, misinformed & uneducated.

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  10. Navelgazing Midwife also discussed AFE on a recent post, taking Gloria to task for this. I'd be curious to ask Gloria herself about the statement; I suspect she was only referring to postpartum uterine bleeding/bleeding from a tear--not to the rare but definitely very dangerous instance of AFE. I know that other people have different experiences with PPH needing much faster resolution than Gloria says.

    In addition, I am curious why Dr. Kloosterman (professor of Obstetrics and Gynaecology at the University of Amsterdam and Director of the Midwives Academy in Holland) would tell her this without good reason. I'm not trying to blindly defend Gloria here--I am truly curious to know more about that conversation she reported.

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  11. Even if she's only talking about postpartum haemorrhage, she's still talking dangerous rubbish. Blood flows through the placenta at a rate of 500-800ml/minute. The vast majority of the time, the uterus contracts and retracts rapidly after the placenta separates, effectively stopping the blood flow. However, it can (happen that the uterus does not contract - perhaps because of some retained tissue (placenta, membranes) or for other reasons. Even if it's a relatively rare event, and even if most times the blood flow is less than 500mls/minute - a separated placenta and an uncontracted uterus are a dangerous situation. The immediate treatment for postpartum haemorrhage is the same in home or hospital: 'rub up' a contraction, put the baby to the breast (natural release of oxytocin), oxytocic drugs (ergot, syntocinon/pitocin). Futher steps, like removal of retained placental tissue - require transfer to hospital and theatre.

    Fear of postpartum haemorrhage doesn't have to stop women choosing homebirth (in the UK, homebirths are attended by midwives as standard NHS care, although concerns would be raised if she had particular risk factors for/with PPH - one of which is your Hb levels to start with) - but it's misleading crazyness to deny that serious PPH happens 'naturally'. Of course it can, it's one of the leading causes of maternal mortality worldwide.

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  12. This comment has been removed by a blog administrator.

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  13. Note: Comment deleted because of a confidentiality agreement between Gloria and her client.

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