Why Choose a Midwife in Massachusetts?

Here is a fantastic video that wraps up so succinctly all the reasons why Massachusetts MUST pass a midwifery bill. This isn't about women craving an indulgent birth experience, but it is about giving pregnant women choices about their bodies, their babies, and their health.

"Congratulations! You're in labor!"

I've been thinking lately about a client, whose story goes something like this.

Something felt "different" when she was 36 weeks and 6 days pregnant, different enough to call her OB, who then asked her to come in to triage. She saw some bloody show, and it was more red than what she expected.

She was placed on a monitor for about 60 minutes or maybe a few more. It indicated not only a healthy fetal heart rate, but that she was having contractions every 3 minutes.

"Really?" she asked. She felt no contractions, or anything that she imagined contractions would feel like.

"Yes!" the nurse confirmed, teaching my client how to read the strip. "You're in labor! Congratulations!"

Since her contractions were three minutes apart, she was encouraged to admit herself to L&D, since she was going to have a baby that day. A check of her cervix indicated she was 3cm dilated. "Plus, it's quiet here today," she was told. "Perfect day to have your baby."

My client and her husband had left their home in the usual weekend disarray. And because they were not anticipating a birth at 36 weeks and 6 days, their home was not quite ready for a baby. Thinking that her time was limited, she and her husband decided to go home, to get as much done as they could before the early arrival of their baby, which, according to the fetal monitor, was imminent.

After getting home, they cleaned the kitchen. They prepared some dishes for the coming week, when everyone had warned them that it would be good to have food ready for the microwave. They straightened up their baby's room, folding the last of the freshly-washed onesies. They installed the car seat. They packed their hospital bags. They took a nap. And then they waited.

And nothing happened. At all.

Four days of nothing happening later, I was eating breakfast with them in their kitchen. I sat across from my client, chatting with her over a platter of bagels and a variety of cream cheeses. She was so very clearly not in labor. She'd even had a regularly scheduled prenatal appointment since her visit to L&D, and all was fine with the baby, who was perfectly happy tucked up safely inside her body.

My client asked me for an opinion on what I thought had happened, an explanation of the mucous and the bloody show. She was concerned, and maybe a bit discouraged, about why her labor had stopped, and I told her that I didn't think it had ever started. Ultimately, I guessed that she'd had some mild contractions, too mild to feel beyond a crampy sensation, yet enough to be traced on a fetal monitor, and probably enough to dislodge her mucous plug, which began her dilation. And most importantly, I told her that she made such a good decision to come home that day instead of admitting herself to L&D. Because had she chosen to do differently, perhaps we would have still been enjoying a lovely breakfast together at that moment, and she would have been holding a beautiful, healthy baby -- as she gingerly recovered from her c-section.

Science and Sensibility's Thoughts on the "SUV-Approach" to Maternity Care

Thought I'd share the latest post from one of my favorite blogs, Science and Sensibility from Lamaze.


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Our Deepest Fear Is That We Are Powerful Beyond Measure

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? "

I love hearing women, moments after they have given birth, reflect on their amazing strength. They say with wonder that they never knew they had it in them.

And after reading the above excerpt from a prayer by Marianne Williamson, I asked myself, what if women knew this about themselves before going into labor? Maybe some do, but they are unconscious to their strength. Maybe some have an inkling, but they don't have the self-confidence to admit it fully. Perhaps some are afraid of seeming boastful, particularly in regards to childbirth, an event that they may not have experienced before.

There is powerful fear about childbirth and pain. "Laboring Under an Illusion" is only one of the commentaries out there that examines the way popular media depicts birth, and how those depictions shape our beliefs about labor and delivery. Prime time TV, Lifetime Television, and The Discovery Channel show women giving birth in car accidents, under the threat of a medical complication, or in klutzy, slapstick fashion that parodies our accepted assumption that childbirth is inherently dangerous and humanly impossible without medical intervention.

I work with clients prenatally to acknowledge their previous experiences of strength and endurance, both physical and mental, mind-over-matter, sheer will. I try to help them see how there is a strength within them that they have already called upon. And although we almost always have some point of reference that proves to them their power, the image of television birth and the war stories told to them by their friends are pervasive and creep into the little cracks of their otherwise solid foundation.

And so when a woman is marveling at her own power moments after she has given birth, at the miracle of what her body has made, I want to whisper to her: "You knew it all along."

The entire poem by Reverend Marianne Williamson can be found here.

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And if YOU saw this sign at your OB's office...

...what would you do?

So much has been blogged, Facebooked, and tweeted about this photo that I just had to jump on the bandwagon.

But the good thing is that Jill at The Unnecesarean is sponsoring a wonderful photoshop contest, for women to write in their spoof of this sign. See the entries, and celebrate your right to fully informed consent and choices in your health care.

One of the things I treasure about being a doula (and it's not spelled with an "h" for crying out loud!)is working with women who are exercising their autonomy - with decision-making, with marathon strength, with purposeful surrender. Even if you need the most medically-oriented birth, you have the right to participate in your care and explore all your options!

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September Snapshots

There are moments that will stick with me forever from this September:

-- Baby Ryan's parents: laughing and smiling as he entered the world so quietly, so gently.

-- What autonomy, what I value most in my work, looks like: Client F, who labored through the night and was admitted at 9cm, said to me: "An epidural was always a part of the plan. I'm not ready to deliver yet, and I need to sleep before I start pushing."

-- The power of love from a visitor: as the long night stretched into the day which also wore on, with virtually no change in the cervix whatsoever, Client A's best friend came into the room. The husband and best friend embraced the mother in an intimate circle and simply held her, overcoming the resignation in the room with love.

-- The muscular, sinewy strength of a laboring mother, whose low moans began ending in grunty pushes, reaffirming that birth is the most primal of all instincts.

Thank you to all my September families, for the privilege to participate.

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It's National Midwifery Week!

Please celebrate National Midwifery Week by honoring your midwife. What is ONE word that comes to mind when you think about your birth experience with your midwife?

I choose collaborative.

And to add, I will thank her again and again for how we worked together on my pregnancy and my daughter's birth, but also for how she shaped my work as a doula.

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Is Your Hospital Listed Here?

As of July 2009, there are 83 hospitals in the US that have been evaluated and deemed "Baby Friendly" by the Baby Friendly Hospital Initiative.

To be included on the list, facilities must meet 10 criteria, created by the World Health Organization, encourage breastfeeding by helping mothers initiate breastfeeding, appropriately training all staff, avoiding formula unless medically indicated, allowing “rooming in,” and other practices. These steps are also included among the Ten Steps for Mother-Friendly Care outlined for the Mother-Friendly Childbirth Initiative.

I'm surprised by this list -- I thought that a few more Boston area hospitals would be listed, and the single one that did is not the one I anticipated.

Hospital Based Doulas, Johns Hopkins

Here is a quick and simple article about how hospital-based doulas can enrich a woman's birthing experience. Note that the experience is mother-centered; the doulas do not have an ideal birth in mind for the mom, but they are there to support the mother and her needs as she defines them.

Unfortunately, the only two Boston area birth center/hospital-based doula programs have been wildly cut in the recession, with budgets for only the absolute, highest-risk mothers.
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More Labor Support is Necessary in Canada -- and in the US, too!

From The Daily News out of Canada, an article on how labor support can reduce surgical births by as much as 20%.

I'm curious as to what guidelines the Canadian Society of Obstetricians and Gynaecologists feel aren't being followed, guidelines that are aimed towards lowering unnecessary surgeries. From what I admit can be a jaded point of view, I'd never think that the American College of OB/GYNs would describe any surgeries as unnecessary, especially because hospital guidelines which dictate how a woman should labor seem to be in place for lowering unnecessary liability more than anything else. Hospital c-section is considered the gold standard of life-saving hospital care, which I think it can be when c-sections are truly necessary - but not when they are the self-fulfilling prophesies of labor practices that are not mother- and birth-friendly.
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