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Wednesday, March 23, 2011

Peggy Vincent: Baby Catcher

After many stops and starts, I was finally able to finish this wonderful book. Baby Catcher (once I got started) was a quick read, and Vincent is a talented writer.

A couple chapters stood out for me the most, namely the first one, about a young black woman named Zelda, laboring with her third or fourth baby. She wanted to do it her way, but doctors and nurses - namely the nursing supervisor, Mrs. Purdue - were adamant that she labor in silence, on the bed. Doctors insisted on injecting her with pain meds even though she was coping well on her own, and one physician, as the baby was being born, finally gassed her - probably as a matter of course, because that's just how it's done, right? It was depressing - and launched Vincent onto her crusade as a midwife.

Fast forward a couple chapters, to where Vincent is assisting in the labor of none other than Mrs. Purdue herself. The wife of a university professor and herself an obstetrics instructor, she was laboring her way, with only Vincent's help. She didn't want drugs, she just wanted Vincent - to rock with her, sway, lean forehead to forehead in a motion of support. She coped with the pain, her way, vocalizing and doing whatever she had to do. Doctors - who were also colleagues - tried to intervene with pain medication, which she refused, and they finally acknowledged, "She's doing this her way."

My mind - and Vincent's - went back to Zelda, who as a young, unmarried, poverty-stricken black woman, was also doing it her way, but there was a clear difference. Vincent noticed the white, affluent, insurance-carrying wife of a professor had the rights to refuse meds and do whatever she liked, on her terms, but Zelda did not. The disparity in maternity care probably exists today, although few women want the natural birth that Mrs. Purdue sought, as Vincent notes. Her eventual return to hospital nursing reveals the differences in care between a home birth midwife and one who works in a labor and delivery unit: more time is allotted with patients at home, and Vincent notes that she often knew the personal lives of her patients; their relatives, children, lifestyles, and on and on. In the hospital, Vincent sadly acknowledges that she saw these women once and it's done, on to another patient.

One story that struck me, though, was the one about a home-birthed baby with clubfoot. Vincent, in her shock, tried to hide the baby's feet, but the mother knew better and immediately suspected something was wrong.

As a mother of a child born with clubfoot, I can relate on some level. As someone who was also born with severely clubbed feet, I wondered if this was how they treated my mom when I was born.

When I was born, my dad immediately came to her and said, "What's wrong with her feet?" My mom had no idea what he was talking about, which meant they had come to my dad and told him first before even telling my mom, perhaps in a measure to shield her from grief. It was my dad's worst nightmare confirmed: he had passed the "defective" clubfoot gene onto his child, and he felt terribly guilty about it. I was in casts for almost a year before having surgery.

Although ultrasound was not obviously a perfect science when Vincent delivered this baby, we knew ahead of time that my son had a clubfoot. While it was a big deal to us, we knew it wasn't life-threatening and were hoping for the best. Vincent may have been correct in her assumption that the baby's feet were really that bad. Who knows. I remember watching A Baby Story (gag) and was shocked out of my chair to see a baby girl with what looked like mildly clubbed feet, and an overzealous orthopedist who was scheduling her surgery at three months old. "No!" I practically screamed at the TV. I thought of the elderly Dr. Ponseti, who in his 90s, was still practicing orthopedics and employing his Ponseti Method on countless children, likely sparing them surgery that often causes pain and arthritis as the patient ages. I look at my own feet and wonder what could have been sometimes, but it's hard to say.

One thing I noticed in the book was the dad's comment about the foot not responding to gentle, or firm, massage. Perhaps the baby's feet were really that bad, and perhaps a gentler technique could have been employed; it's hard to tell. One thing I do think, though, is no parent is going to want to perform that kind of correction, however necessary, on his own child's feet. An objective, third-party orthopedist would likely have much better luck, simply because he's detached - it's not his kid. They suspected at first that it was positional, but in my experience those cases are rarely treated with surgery and can be manipulated rather easily.
Dr. Ponseti working his magic on a young patient.
(Photo: University of Iowa)
I thought back to our course of treatment on my son. He was casted while still in the hospital, and my mom watched as the doctor manipulated his foot into place. The baby cried, as any baby would that's having its' feet touched. My mom said the orthopedist wasn't necessarily being rough, but certainly wasn't gentle, either. I'm glad I wasn't there to see it. In my drug-induced state, I don't even remember seeing my son without a cast, and wished they'd just been upfront with me about it rather than trying to hide it from me.

When we were pregnant with our daughter, we saw on the ultrasound what appeared to be two very clubbed feet. While we were anxious, because we knew the family history, and the fact that while it's more common in boys, it usually affects girls even worse. We knew what we had to do: our son had been casted right away and then moved into corrective shoes at 8 weeks old, which is when correction should be complete, ideally. By five months, I knew his foot still wasn't in the right position, so we sought a second opinion and had a minor surgical procedure performed so his foot could be flat on the ground. I figured that while weekly orthopedist appointments were a huge pain in the butt, it wouldn't be too terrible since we'd been through it before.

My son was fitted with boots and bar
much like these. He wore them 23 hours
a day until he was about two years old,
and then only at nighttime after that
for about a year. 
Since our doctor had practiced the Ponseti Method on our son, it required regular manipulation of the foot and serial casting to hold the correction, which would be an alternative to surgery. The technique, which Dr. Ponseti had developed in the early 1940s, was often performed on pediatric patients by the doctor himself. The dude was ancient, respected and well-loved across the nation by parents and kids alike, who had been spared multiple, disfiguring surgeries because of this low-tech technique.

When we told my father-in-law, a retired orthopedist, about the baby's feet, he was skeptical. "I would just schedule the surgery," he scoffed. "I wouldn't even bother with that Ponseti stuff."

Boy, was I pissed. There was no way, I told him, that I would subject my daughter to a surgery that might not even be necessary. (Turns out it wasn't at all, because her feet were beautifully perfect when she arrived into the world.)

His reluctance to accept non-surgical technique reminds me of the medically-minded birthing community: why do what Mother Nature can in her own sweet time, with a much gentler approach, when we can get it over with more quickly? In their minds, science is better, faster, more efficient. Because it's available, we should use it, and use it often - whether it's needed or not. Because it's there.

While this isn't a pregnancy and childbirth book, I would almost consider it suggested reading simply for the perspective: births that are crazy, unpredictable, beautiful, and normal. Those kinds of tales never get old.


Camille.thomas said...

I loved this book! It really won me over to the beauty and practicality of home births, And Peggy Vincent is a fantastic writer. Thanks for sharing about the Ponseti method and your personal experience with club feet. Very helpful.

Jennifer Margulis said...

I read this book years ago and reread it recently for the second time. It is such a good book, albeit heartbreaking on many levels. Thanks for the review!