Jun 24, 2018

Home Births and the Courts

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My third child, Yeshe, was born at home after such a gentle labor that her amniotic sac or caul was intact!  I was attended by two amazing midwives---my care during pregnancy, delivery, and postpartum was the best medical care I have ever received.  Yeshe was born at term and her unbroken sac (this it means my water never broke during labor or delivery) is such a portent for good luck & special powers that midwives honor this type of birth. And 19th century New England households used to keep these cauls in jars on mantelpieces in houses where their seafaring men were out to sea for safety.  Yeshe's name means wisdom in Tibetan, and her namesake was my teacher at the Karsha nunnery where I have lived and worked on/off for the 29 years, since 1989 (see my book: Being a Buddhist Nun, Harvard University Press 2004). 

Yeshe's birth gave me much pause in May and June of 2017 when I was forced to retell the story of her birth in a courtroom in front my ex (who lied and fabricated the details of her birth and immediate postpartum period), his lawyer, my lawyer, and audience of 3 friends and family I'd summoned for the day. Ashok, interestingly, had nobody present to support him in the courtroom, perhaps aware that his lies might be caught out by friends who know me and Yeshe's birth story. Here is a rough account of what I said under oath wrote and in a written rationale submitted to Judge Simmonds of Berkshire Probate Court in 2017:

Yeshe was born at home with the assistance of a trained and certified midwife with 30 years experience, who examined her at birth and again 24 hours later and found a healthy newborn with no jaundice.  At 48 hours after birth, a lactation consultant found Yeshe to be jaundiced, but this was hardly unusual given that jaundice affects 50% of all newborns born at term.  She advised us to have Yeshe's billirubin checked at the hospital or, if we preferred, she would return the next day to see if the jaundice was progressing or improving.  When she returned the next day and the jaundice had progressed, we took Yeshe to our pediatrician, Dr. Art, who confirmed severe jaundice and urged us to have blood test because she suspected Yeshe might have hyperbillirubemia due to a rare blood disorder called ABO incompatibility (blood incompatibility between mother and baby.)

First, ABO incompatibility 
affects less than 5% of all newborns in the US, and tends to manifest at 48 - 72 hours after birth. In short, most newborns who have this condition are asymptomatic at birth. 

Second, most of the 4 million babies born in US hospitals were not routinely screened for ABO incompatibility in 2007

Third, if Yeshe had been born in a hospital she would have been discharged. My midwife's son was born at Cooley-Dickinson hospital in Northampton with ABO incompatibility, and discharged one day after birth with no jaundice. At 2 days after birth he was brought back to the hospital by his own mother but nobody ever questioned her medical decision nor that of the hospital that discharged her son..

Fourth, Yeshe’s home birth was attended by a licensed midwife and she had no clinical signs of severe jaundice or ABO incompatibility at birrh, nor one day after birth when the midwife conducted her routine check up. 

Fifth, there was nothing about Yeshe's home birth or the midwife's care that caused Yeshe's jaundice. It was caused solely by the congenital ABO incompatility that had nothing to do with mode or site of delivery.

After Yeshe's lab test, we went home and waited for Dr. Art to call us with results on our home phone---we didn't have cell phones in 2007.  Because Ashok had turned the ringer off, we only checked our machine an hour after Dr. Art called.  I wanted Ashok to drive me to the hospital immediately, but he wanted to wait till my mother arrived to stay home with our twins, as it was Jan 2 and -10 F outside that day.  When we did arrive at the hospital, Ashok blamed our delay on me I later learned from parsing the medical notes and that was all Dr. Art needed to distrust me from that point onwards.  

Yeshe was admitted,  given an IV to avoid dehydration, and given phototherapy for two days until discharge 48 hours later. Upon discharge, we were given a home phototherapy device that we used a few more days. Yeshe experienced no sequelae of this incident, but Dr. Art was traumatized---perhaps because she was a new doctor and had seen so few cases of ABO incompatibility--shame on you Stanford Medical School for not preparing her betterD!---or perhaps  because she would subsequently alter medical records about this incident 10 years later in 2017, just days before our trial, so that the medical record would better reflect an email filled with mistakes and lies that she would submit in Ashok's defense to the court in April of 2016. In short, she was traumatized by her own role in helping a Judge award legal custody to my abusive ex. 

Ashok's oral testimony was so full of confusion and lies it perpetuated the Judge's suspicion about my medical decision.  Ashok accused me of not having Yeshe's billi levels checked at birth--patently impossible as Yeshe was born at home and a billi test requires taking blood and a sophisticated laboratory analysis that can take hours. Ashok's attorney, Diane DeGiacomo also asked Ashok during his oral testimony, “did a doctor test Yeshe's billi levels at birth?”  This question is absurd given Yeshe was born at home and there was no doctor present--doctors have not been present at home births for nearly a century!   In short, Ashok and his attorney were accusing me of not having an intervention at home that was not even routinely prescribed in hospital births!  Neither the judge nor any of the attorneys noticed.   

Ashok was so confused in court he brought up my breatfeeding of Yeshe during her 48 hour stay in the hospital--not quite realizing I was doing what the doctor ordered and what was lifesaving at that point. What he failed to note was that Yeshe's IV had fallen out the first night in the hospital and so breastfeeding was the only way to keep her hydrated and alive, failing insertion of another IV, which could have further side effects--infection and stress.  Further, if that IV fell out, Yeshe would need a transfusion and transport to the Springfield NICU 2 hours away.  

There is only one major and deadly side effect of phototherapy treatment, namely dehydration.  If a newborn is not given an IV or breastfed, the phototherapy lights––which are so intense that newborns wears black foam glasses so as not to suffer retinal damage and routinely get sunburned––are deadly for newborns whose systems are easily shocked by disturbances of warmth, hydration, and nutrition.  The nurses on shift understood the urgency of my breastfeeding every few hours to keep her hydrated, but Ashok described it as problematic to a Judge and a courtroom that had almost no understanding of neonatal health or survival. 

In an email submitted to the court as well as to the court-ordered GAL who was investigating our case for a year, Dr. Art would argue that Yeshe's case was one of the 'most traumatic moments' of her career.  She may have meant the longer term effects of her decisions, as well as her choice to first lie and later change Yeshe's medical records 10 years later, deleting entire pages and changing notes in relation to Yeshe's billirubin incident and her subsequent asthma. In short, Dr. Art needed Yeshe's medical record to more closely reflect the email she wrote defending my abusive ex, Ashok, and guaranteeing that the Judge would award Ashok legal custody months after our trial.  

Things got even more complex when Dr. Art found out that Ashok had lied to her office about his ongoing physical abuse of our our son Krishan since 2014 (violent shoving, pushing him off the porch, slamming him into walls, kitchen counters, stoves as recently as June 2018).  Rather than admit to how her suspicions about homebirth had muddied the waters and caused her to distrust me, Dr. Art discharged all 3 children from her care, when I pointed out the numerous--and there were over 50 at last count---places that she had changed the medical records shortly before they were subpoenaed by the court in April of 2017 and again in September of 2016 when I finally shared with her the history of Ashok's abusive behavior.  

Why does this story matter? 

It was as if I had a scarlet letter on my forehead during that trial--only H for homebirth---rather than A for adultery.  

If you have a home birth, your Pediatrician might actively work against you for the next decade of your children's care 
In fact, she might even support an abusive ex who is physically assaulting your children. 

Dr. Childsy Art, never trusted me again after I had a home birth, and seemed to forget that I stayed home for two years taking my twins to every medical appointment, developmental check ups (the two most important of which at Dartmouth Ashok failed to even attend), weekly and daily developmental therapy with in house  physical and occupational therapists prescribed by her office.  She knew I studied neonatal and maternal health, as well as midwifery care.  

Once the Judge and Ashok's attorney knew I had a home birth, I was already suspect.  It did not matter that I have been studying neonatal and maternal health for 20 years, blogging for 14, written several published essays, and currently writing two books on maternal and neonatal health. I am editing my next book, Sustainable Birth, with  two amazing women, Robbie Davis-FLoyd and Betty-Anne Daviss, who are writers, speakers, and front-line advocates for midwives and home births for more than 35 years now. 

It is only by telling the truth that we can hope to bend the arc of justice away from lies and misunderstanding.  dedicate this book and my work to birth activists around the world who 
fight to given women healthy choices around birth even as courts and doctors in our medical-industrial complex obstruct take away those choices every day....   

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