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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Radical Doula

My blog post regarding the death of Dr. George Tiller caught the eye of Miriam Perez, an editor at Feministing. Miriam is also a doula and women's health activist who chronicles her work at Radical Doula.

Miriam interviewed me via email regarding my work as a doula, and I'm flattered to be featured by her work. Thank you, Miriam!

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A Tale of Two Birth Centers: Massachusetts and New Hampshire

I belong to a really wonderful and supportive e-network of doulas in Massachusetts. The members provide a wealth of information and a depth of experience from which I am lucky to be learning. Just this week, one of the doulas wrote that she was compiling a list of Birth Centers in Massachusetts and nearby New Hampshire.

A list of Birth Centers in Massachusetts is not hard to compile, as there are all of two, and they are not without their controversies. The Cambridge Birth Center has a high transfer rate to Cambridge Hospital, and The North Shore Birth Center, in order to avoid closure, will comply with remote external fetal monitoring by OB's at the North Shore Hospital on the campus.

But then there's New Hampshire, with its 5 birth centers: The Birth Cottage, The Monadnock Birth Center, The Coastal Family Birth Retreat, The Concord Birth and Wellness Center, and The Longmeadow Farm and Birthing Home. All safe, non-medical, home-like environments that offer the CHOICE to birth at their center or at home! They are all owned and run by midwives, mostly licensed NH midwives and one or two Nurse-Midwives. Each of the websites has legislative updates on the status of midwifery, insurance, and homebirth in New Hampshire. One web site states it so plainly: Almost all insurance plans now cover out-of-hospital birth services with a NH Certified Midwife. It's a sentence that almost strikes me as funny, since it is so far from Massachusetts truth.


As a proponent for choices in childbirth, I have alway philosophically maintained that the 2 Birth Centers we have here in MA offer a middle-of-the-road choice between homebirth and hospital births. But when I hear what is happening just over the border (the MA/NH border, not the US/Canadian border!), I do worry about some of the ways Massachusetts Birth Centers are forced to operate if they are to be in existence at all. Tomorrow, the MA Joint Committee will hear Senate Bill 847, which creates a Massachusetts Board of Midwifery, which would make the practice of midwifery similar to New Hampshire's. Until that bill is passed, the 2 birth centers we do have - operating under the heavy thumb of their affiliated hospitals -- will struggle to maintain choices for pregnant women in Massachusetts.

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Mind-over-matter, Butt-over-head

Last week, my client due next was found to have a breech baby. Determined to birth vaginally and without medication, she spent the better part of the next week lying down with her hips higher than her head, visualizing her baby spinning, and visiting an acupuncturist and a chiropractor trained in the Webster technique. She went in this week (36 weeks) for an external version, which many women describe as painful, pressured, and ultimately unsuccessful.

She said her OB kneaded her belly, gave a little push, then shrugged. "All set," she said.

"That's it?" asked my client.

Her OB nodded. "Baby's vertex."

Victory! A successful, easy version! I have to think that all the work my client did made it easier for the OB to spin the baby.

And now back to birth-planning...

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Doulas, How Do You Practice Self-Care?

When I meet with new moms either in private counseling sessions or support groups, I am a compassionate listener -- but I will be a harpy nag about one thing: self-care. It could be 15 minutes of reading People Magazine while the baby naps or keeping a jar of luxurious foot cream by the bedside table - whatever it is, I require them to care for themselves in some small way.

I've just returned from a birth, the first one I've attended since my extended pregnancy and maternity leave. It was a beautiful, satisfying birth for all involved, and I'm trying to decide what to do for myself today as a treat.

So, doulas, in the aftermath of a birth, when you've given nurturing care for hours, what do you like to do to care for yourselves? Please share, so that more doulas can take good care of themselves!

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Support Midwifery in Massachusetts!

Massachusetts Senate Bill 847 will be heard at the State House on July 28. This bill, as it similarly does in 26 other states, protects midwives and their practice, as well as the women who choose to give birth with them and receive other well-woman care from them.

Right now, Nurse-Midwives are under the supervision of MD's, and this bill would give nurse-midwives the ability to practice collaboratively with MD's. Nurse-midwives are the only midwives who can legally attend births in Massachusetts.

Additionally, this bill will allow Massachusetts to license Professional Midwives, who are stringently licensed in 26 other states. Professional Midwives go through rigorous training and education in order to care for healthy, uncomplicated pregnant and laboring women in out-of-hospital settings, such as birth centers and private homes.

This bill will regulate the practices of both types of midwives so that they practice a standard of care that is SAFE.

Please get involved! Perhaps you received care from a midwife - at home, in a hospital, or at a birth center -- and can attest to the quality of the midwifery model of care. Maybe you, personally, would not choose care from a midwife or to have your baby in any place but a hospital, but you DO believe that the only way to ensure quality health care for women is through a variety of evidence-based care, dispensed by a variety of highly-skilled professionals. All women can support this bill, because it is NOT about natural birth vs. epidural, homebirth vs. hospital birth, or one woman being stronger/better/smarter/more concerned about her baby than another woman.

This bill is about mothers and babies being born safely.

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Massachusetts Friends of Midwives asks: "If you can join us at the State House for the hearing, please do! Babies andsmall children are welcome participants on visits to MA Senators and Repsand are welcome in the Gallery during the hearing. Please use your judgment,however, as the day can be long (we will not know when during the day wewill be testifying). While we would love to have as many families as possible, we also realizethat sitting still for a couple of hours may not be in everyone's skill sets--adults included! For more information and updates, please check out the MFOM blog(www.mfom.org) . Thanks so much for everyone's ongoing support!"

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A Bumper Sticker (or a few of them!) is Worth a Thousand Words

Here's a photo that my brother-in-law took while vacationing in Philadelphia over the weekend. When I saw it, I jumped up and down, clapping my hands.

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Don't Push The River...It Flows By Itself

A beautiful blog post by Lindsay, who poetically describes how she discovered her own strength and the "vastness of her spirit."

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Who Needs a Doula?

Thanks, Kathy Peterson, for a concise and articulate explanation of one the doula's many roles -- advocacy.

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Birth Story, Take II

In my line of work, I hear or read birth stories -- a lot of them. It's no secret that the birth of my last child was a whirl-wind: abruption, extremely precipitous labor, a baby feared to be in cardiac crisis. My birth story is about a blissful intention that turned into a potential medical emergency, the kind of emergency that makes those fearful of out-of-hospital births feel smug. So when I hear or read the beautiful birth stories, a part of me still hurts. My birth story is full of disappointment and fear and politics: OB vs. midwife, blood, numb shock, the image of my non-breathing, seconds-old baby being shaken so vigorously that I, too, lost my own breath.

This week, at the Mass Friends of Midwives Birth Circle, a pregnant woman shared her fear about a repeat c-section. A midwife in the circle gave her wise advice. "Re-envision this birth," she said, "And imagine it as something beyond avoiding another c-section. Let that past experience go, and allow this birth to be all that it might be."

And taking the advice meant for someone else, I want to re-envision my birth story and see what's bautiful. The story that shows my faith in birth and in my body. The one where I can feel the muscles of labor, and I command all other muscles to surrender to their activity. The one where I'm rocking and swaying, working with my body to move my baby down through my pelvis. The one where the sounds of my breath and voice -- formally trained from years of singing and yoga --are the soundtrack to my daughter's beginning. The one where I push two times, knowing that with the third one, I will do it, I will push past the resistence and not feel it break, but instead give way to a whole other person. And the one where my daughter latched right on to my breast and expertly nursed herself to beautiful pinkness.

Yes, that birth story. That's mine. That's the one.

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Keep on Movin', Mama!

Henci Goer has blogged for Lamaze's Science and Sensibility this week about a small study that suggests the high value of freedom and variation of mobility for laboring women.

Combine this with the ACOG's recently revised guidelines about external fetal monitoring (EFM). As a doula, as a woman in labor, I have seen how the fetal monitor seriously impedes a woman's range of motion. Movement, particularly bending over or forward, can either pick up the mother's slower heartrate or lose a heartrate altogether. The sheer frustration can make a woman surrender to the bed, despite her primal instinct to move with her labor -- if her care providers haven't already forced her to stay there for the sake of that printed read-out. But the ACOG now states that "although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions. " The low-tech and far less restrictive intermittent use of doppler radar or fetoscope, typically used in out-of-hospital birth, relays reliable information about fetal heart rate.

All the more reason for mamas to keep moving.

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Who's Birth Is It Anyway?

My customary closing, when I respond to an initial email from a woman looking for a birth doula, is "Enjoy the rest of your 40 or so weeks, and best wishes for a wonderful birth-day."

When we meet in person, I will start the conversation by asking "What are some of the ways you envision your birth?"

But who's birth is it, really? Isn't it the baby that is being born?

I admit I never gave much thought to this use of language until a friend was critical of someone else's homebirth. The woman blogged about her birth in heroic, Herculean terms, and my friend found it boastful. "It's just a notch in her belt," he argued. "And it shouldn't be about her. It should be about a healthy baby." His assumptions about the healthiness of homebirth aside, his feelings are only a reflection of the way birth is typically viewed: a medical event meant to be just barely endured. And if the birth is traumatic, the disappointment with the experience gets swept aside by saying "In the end, all that matters is a healthy baby."

Of course we all want a healthy baby. A healthy mother, too. But there are women who envision something different than a delivery that is done to them, under a cloud of fear and suffering. They want to experience the physiological process of birth: the wonder, the fear, the ecstacy, the pain, the awesome strength of her body's own power to thrust another human being into the world. Their babies will be born, and these mothers want to birth them.

To my clients, I wish them all a wonderful birth-day.


cross-posted on Massachusetts Friends of Midwives blog.

Birth and Death: Right Around the Corner from Each Other

In yesterday's NYT, an eloquent realization that midwives care for women and babies, and not just at the beginning of life.

Anyone who cares for a woman during childbirth -- or in this case, stillbirth -- our near-sacred calling is to create and hold space for the pain, the ecstacy, the joy, and the loss.

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O, Canada!

Released yesterday, the Society of OB/GYN's in Canada has stated that breech babies do not automatically indicate a C-section birth.

Hopefully, with policy leading the way, training will follow.

And then, wistfully, I hope that the US follows another one of Canada's leads.

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Pregnancy: Secrets & Lies

On my Facebook page, I have Laura Stavoe Harm's well-known (to the birth community) quote: "There is a secret in our culture, and it's not that childbirth is painful. It's that women are strong."

Upon reading that, one of my dear friends -- a soulful, humble, graceful, and honest mother of three --remembered something she wrote in her journal during her first pregnancy, about 8 years ago. She dug it up and emailed it to me. Boldly, I asked if I could put her personal words on my public blog, and she agreed (I told you she was wonderful!).

"The big lie of pregnancy is not that it’s easy, but that it’s difficult. Pregnancy is a whole body experience of your power. Like a sleeping giant, your body unfurls unto itself, yielding moment by moment into something amazingly big and then yes, even bigger than you had thought possible. Pregnancy streches you until you think you might burst. But the greatest secret lies in just how big you can become. And I don’t mean physically. It’s as if your body is simply mirroring a spiritual process, one that once you’ve experienced you understand why menstruating and pregnant women in indigenous societies were separated into tents next to burning, sacred fires. To our modern eyes, such practices seemed misogynist. But in reality, they were honoring the power of the divine by separating it from the mundane. The question is not why women should be allowed to be with men at such a time, but rather why men should be allowed to be with women."

To follow me on Facebook, become a fan of A Mom Is Born.

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Are you an Ungrateful Patient?

This week, the American Medical Association voted in favor of Resolution 710, an attempt to identify patients who are "abusive, hostile, or non-compliant."

I come from a family of medical doctors and nurses - my parents, my grandfathers on both sides, numerous cousins, and an extended family, all of whom could staff a large community hospital with all specialties. I appreciate doctors and the fact that, for many, practicing the healing science of medicine the way they dreamed of when they were students is simply not possible with our current system of medical malpractice and liability.

And so, if this resolution were about liability, I could probably understand it. In this litigious culture, it seems reasonable that doctors should have the ability to indicate simply that a patient has not complied with suggested care, and therefore the doctor is not responsible for the negative outcome that ensued.

But the introduction of the resolution is not about liability, and it certainly isn't about improving patient care or outcomes. The resolution is suggested because patients "are becoming more abusive and hostile toward physicians," and have "unreasonable expectations and demands," which includes "instantaneous cure," due to the "arrogance and/or the belief that they 'own' their physicians." The resolution further states that "the stress of dealing with ungrateful patients is adding to the stress of physicians, leading to decreased physician satisfaction." This isn't about an MD protecting him or herself from a malpractice lawsuit. This is about doctors made cranky because their patients are demanding to be collaborators in their own care. It is as simple as that.

But what's not simple are the implications. In maternity care, women who want to be supported in a low-intervention birth can indeed be identified as non-compliant, particularly when women have very little choice but to give birth in a hospital that sees childbirth as a medical malpractice suit waiting to happen. A healthy pregnant woman who wants to give birth safely and with minimal medical care is not asking for an "instantaneous cure." In fact, what she is asking for is time -- a whole lot of it -- so that her baby can descend into the pelvis as it is physiologically programmed to, and so that she can experience the sensations - yes, the pain! - of healthy, normal childbirth without the pressure of liability-based policies rushing her and quite possibly altering her body and her ability to give birth in a physiologically normal way ever again. I appreciate that doctors face malpractice threats that can indeed ruin their careers and their quality of life, if not their children's lives, but birthing women are a part of this same system, and we are fighting for our lives, too. We don't want to "own" our physicians, but we want recognition that we do own our own bodies, and that we cannot be subjected to unwanted medical procedures that are not based in sound evidence and do not increase the chance of a healthy outcome.

The implications go beyond maternity care. If an MD in any area of medicine identifies a non-compliant patient to a health insurance company, can that insurance company refuse coverage of a non-compliant patient?

Just who, in fact, does this resolution serve? Will it result in greater doctor-patient relationships? Will it create better "job satisfaction" for physicians? It will only create more sick people who are ineligible for care. And that will not increase anyone's satisfaction at all.

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The MAMA Campaign

Midwives and Mothers in Action -- M.A.M.A -- is the collaborative effort to recognize Certified Professional Midwives and the care they provide as specialists in out-of-hospital births. Comprised of the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC), the goal is to gain federal recognition of Certified Professional Midwives so that women and families will have increased access to quality, affordable maternity care in the settings of their choice - at home, a birth center, or a hospital, and with the providers of their choice - Midwife, Nurse Midwife, or Obstetrician.

Overwhelming evidence proves that Certified Professional Midwives improve birth outcomes: through a lower c-section rate, more consistent prenatal care, and fewer costly medical interventions during labor and delivery. For this reason, M.A.M.A is working to bring real change to Health Care Reform and the American maternity care.

Please visit the M.A.M.A website to endorse the campaign, as a parent, a consumer of maternity services, a partner, a midwife, a doula, or all of the above! I did, and I'm proud of it.
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Oxytocin: The Love Hormone

(Unfortunately, the code on this news clip is faulty, so I can't post the video here -- but click on the title to see the video.)

My current childbirth fascination is with the hormones that start labor. Released by the brain, oxytocin is the hormone that causes the uterus to contract. Pitocin, the synthetic oxytocin used to induce contractions, is introduced directly into the veins by IV. So while Pitocin mimics oxytocin, it bypasses the brain, and the chain reaction release of endorphins that follows the release of oxytocin - the body's own painkiller - doesn't happen.

Incidentally, oxytocin is also released by the brain after you've had a good meal. So a delicious dinner and great sex makes for one fantastic evening! It's another good reason to eat in labor.

Another excellent discussion of the hormones involved in creating and sustaining a spontaneous labor is in the book Gentle Birth, Gentle Mothering, but Sarah Buckley.

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Women Must Be Informed, Political Collaborators in Their Own Care

Dr. Tiller's clinic in Witchita, KS, one of the few in the country that provides late-term abortions, is closing. With his murder, in addition to wiping out the life of a husband and father, the anti-choice movement has taken away women's access to critical, necessary services. And while the current political make-up shows that the anti-choice movement cannot overturn Roe v. Wade, Dr. Tiller's death is a reminder that all it takes is a sniper to reduce our choices even further. And since OB-GYN's aren't racing to provide abortion services at the risk of their own lives, Dr. Tiller's practice may not ever be replaced.

When I'm not a doula, I work as an abortion counselor. Although most of the women I meet with are between 4 and 7 weeks pregnant, the clinic where I work provides abortion services up until the 23rd week of pregnancy, which is the legal limit of abortion care in the state of Massachusetts.

Your reaction may be visceral, no doubt. At 23 weeks, abortion can be extremely difficult to understand or justify, and it is not uncommon to shake your head and say "I have a real problem with that," even if you are pro-choice. It is tempting, if not comforting, to separate yourself from a woman who would make this choice by assuming that she must be a monster. And I'll be honest and say that once I sat down with a woman who seemingly had no feelings about having an abortion in her 23rd week of pregnancy. It chilled me, her apparent lack of feeling. But many more times than just once, I have sat down with couples who are heartbroken: a routine ultrasound in the 20th week discovers massive deformities; an amniocentesis details profound genetic abnormalities that at are incompatible with all but the briefest of life, and suffering is certain; a doppler at 22 weeks returns no heartbeat, reducing a wanted and cherished baby into a diagnosis of fetal demise. And sometimes, due to the time it takes to run tests, or to the human inconsistencies of those who administer those tests, or the varying reliability of technology, a pregnant woman in those situations can be beyond 23 weeks. And so what do we do in the state of Massachusetts? We tell her she can deliver her dead, deformed, or doomed baby in a labor and delivery unit of a hospital -- which is as monstrous as it sounds -- or we recommend she travel immediately to one of the few clinics in the United States that can terminate her pregnancy. And with the death of Dr. Tiller and the closing of his clinic, there is now one less place where a woman in this delicate and devastating situation can go for care that is humane and treats her with dignity.

And on the other end of pregnancy, women are also losing choices in childbirth. In my line of work, I hear many birth stories from women, and the majority of them have the same eerie arc: first, induction; second, confinement to a bed; third, bone-crushing pain; finally, forced pushing while lying on their backs. Statistically, more than 30% of those stories end in c-section, and these are in pregnancies that had been normal, low-risk, and healthy. It's also the basic formula for reality birth shows on cable TV, where birth is boiled down to a medical event that skirts death practically every time.

VBACs are becoming harder to access, despite evidence that indicates that VBAC is lower risk than repeat C-section. Providers, among both OB's and L&D nurses, have attended fewer and fewer low-risk, healthy childbirths that are purposefully unmedicated and without interventions. What results over time is that if a laboring woman wants a natural birth, she could go to a hospital and have no medical professionals with the experience or willingness to support her desires. Birth centers are losing funding, and homebirth is either criminalized or unregulated in half of the US. In the other half of the country, the standards of care that do govern it are so limiting that its practice is nearly impossible but for a few renegade midwives who are essentially providing care without the benefit of professional support in case of a true obstetric emergency. Healthy women who could experience the normal physiological process of birth are beholden to the artificial constructs of time, liability, and television drama. The art of childbirth, and the choices that encourage birth as a safe, non-medical event, are being lost.

Unless we have a vision that is greater than the arguments of pro-life vs. pro-choice, homebirth vs. hospital, natural birth vs. epidural, we will lose what is truly at stake at the heart of these issues: choices. The quality of women's health care is dependent upon choices and access to qualified care providers, and women must expect no less than to be informed, political collaborators in their own care.

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What's in the Bag?

As a doula, I know the value of a held hand, whispered encouragement, and a guided breath. There is research out there stating that simply having a doula in the room -- even if she sits there and only observes -- increases birth outcomes. But still, what's in the bag?

In my doula bag, I've got heating pads -- the kind that are activated by air. I would like to carry a silk, rice-filled pouch that can be heated in the microwave and molded to a woman's body, but most hospitals don't allow them anymore. But the heat can feel wonderful against the back or belly during contractions. Conversely, I also carry cold packs, the kind that you squeeze until something inside pops, then shake, and the square becomes ice-cold. I don't use these too often, but when I do, it's often at the site of the IV or hep-lock (the port to attach an IV quickly). Some laboring moms like the ice on their foreheads or necks, when labor has them heating up, but I find that cold, wet towels are better for cooling them off. These are single-use plastic and chemical packs, so not very green; but in a hospital room, use of heat and cold is limited if available at all.

I carry essential oils. If the mom wants a massage, I'll mix the essential oils into grapeseed oil (essential oils can't be used directly on the skin). Clary sage oil is reported to regulate the uterus and organize contractions, and lavender oil encourages relaxation. Lemon verbena oil can also cut right through a woman's nausea. I don't know what the science is behind aromatherapy, whether it achieves what aromatherapists claim, but they sure do smell good, and sometimes the smells of an antiseptic hospital, or the raw smells of birth, can make laboring women uncomfortable (remember that laboring women can have acute reactions to scents, however!). Any of these oils can go on the aforementioned wet towel, or on cotton balls, which are also in my doula bag.

I carry a deflated birthing ball and pump. If there's a ball already in the labor room, great! --but mine is always there just in case.

I bring a gardener's kneeling pad, so if mom is laboring on her knees, she's not on the hard linoleum.

I have a 6 foot long beautiful shawl, which can be draped over mom if she gets chills. The texture and colors are rich and luxurious, very pleasing to the senses. One of these days, I'd like to get a rebozo training, too.

I have two combs, one that mom can squeeze in each fist during contractions. When held perfectly, the teeth on the comb stimulate acupressure meridians that encourage labor to progress. And mom can squeeze them as tightly as she likes, dispersing the sensations of contractions as much or as little as she pleases.

Two cosmetics bag -- one for me, with saline solution, a contact lens case, tooth brush, toothpaste, hairband, and breakfast bars for quick energy; one for mom with hard candies, new lip balm, and a hair band for her.

And a hand mirror. Some moms want to see their baby's heads emerging. It can be great encouragement for only a few more pushes when she feels like she's got nothing left, and it can provide a view of that once-in-a-lifetime moment as the baby crowns. Hospitals haven't figured out yet that hand-mirrors are easier. Instead, they lug these heavy mirrors on rolling stands. Such a bother, and many laboring women still don't want people to "fuss" over them.

What's in yours?
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Your birth story is an important part of healthcare Reform

If you sought care from a Certified Professional Midwife during your pregnancy, or if you gave birth in an out-of-hospital setting, your story is symbolic of why maternity care reform is a critical part of health care reform.

Certified Professional Midwives decrease the c-section rate and provide women with individualized, nurturing care in their pregnancies, labor, and deliveries. Certified Professional Midwives are the ONLY birth professionals trained specifically in out-of-hospital birth.

The c-section rate is soaring, and women are losing choices in how they give birth. Please tell your birth story.

Time Magazine discusses homebirth

I found this online today. I'm not sure if it appears in the print version as well. Unfortunately, the article only mentions nurse-midwives, and it is a major oversight to omit the rigorous training of professional midwives who are licensed in 26 of our 50 states.

It has some sentences that seem promising enough at first glance: "Modern medicine can eliminate a lot of the risk (of childbirth)but in doing so, it can also turn what could be a joyous experience for the mother into the equivalent of an all-day appendectomy." But while the sentence acknowledges that many women are losing the joy of birth, the sentence doesn't acknowledge that modern medicine may create -- not eliminate -- risk in childbirth with unnecessary routine interventions and restrictive protocols. Also, deservedly categorized as "high-risk" are the premature births, but how many of those premature births could have been avoided had they not been caused by inductions before 42 weeks gestation, under the seductive guise that a scheduled birth is less stressful than a spontaneous one? Medically, a baby is full term at 37 weeks, but what if that baby wouldn't have been born until 41 if left on his own? That is 4 weeks his lungs would have had to mature in the safety of the uterus.

But the article does a good job highlighting some of the more-often discussed indications of why homebirth is a safe option, referring to the Oregon study and the British Medical Journal findings. It also makes a fair statement about why OB's may be "soured" on the entire concept of homebirth, as they only see the births that become complicated. OB's are never brought in on the homebirths that are progressing as normal, unmedicated, physiological labor should -- which is most of them! But combine that with our country's zeal for litigation, where there is zero tolerance for a less-than-perfect baby, it doesn't seem so unreasonable for an OB to be unsupportive of homebirth.

What I find most heartening, though, is that this article has appeared in Time -- hardly the publication of Radicals. Homebirth is slowly, slowly making its way into more and more women's menu of birthing options. Homebirth is also facing grave opposition, but I remain ever hopeful.

(cross-posted on the Massachusetts Friends of Midwives blog)

Do You Doula?

What's a doula?
Another great video sprung from the BirthMatters contest.

Great Videos on OPTIONS in childbirth

Virgina’s Birth Matters video contest is conjuring up creative juices — and giving us fantastic ways to let people know that there are MANY options to how you birth a child!! Here is Part One of South Coast Midwifery’s video, and when that’s done, you can watch Part Two. Southcoast Midwifery is in California, where it seems all of my midwifery books are based! Massachusetts will get there!

–maria
(this has been cross-posted on the Massachusetts Friends of Midwives blog)

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May 5th: International Day of the Midwife

The International Confederation of Midwives has chosen May 5th to celebrate midwives and midwifery — the International Day of the Midwife. Commemorating the day this year is the start of their campaign, “The World Needs Midwives Now More Than Ever!” By 2015, the ICM hopes to have 350,000 more midwives in practice, particularly in sub-Saharan Africa and South Asia, where the high maternal-infant mortality rate continues. The ICM is working hard to make midwifery an active agent of change in the UN’s Millenium Development Goals , which seek to end hunger, poverty, disease, and barriers to education and equality. Focuses on Maternal and Child health are major components of the UN’s goals.

As I continue to consider midwifery as a career, I’ve been completely absorbed in the politics of Massachusetts midwifery, comparing and contrasting my training options and how each would effect my family, and asking myself if I am ready to make the committment. Me, me, me, me, me.

But only now, as I read about the International Confederation of Midwives and the UN Millenium Goals, do I get a global appreciation for midwives and the critical role they play all around the world for women’s health.

Maybe I will celebrate International Day of the Midwife by sending a card to my midwife, thanking her (again!) for the amazing care she provided for me in my most recent pregnancy; I could send out a prayer of hope and gratitude for the women who are practicing midwifery in conditions of poverty and want that I cannot even begin to imagine; and maybe, just maybe I will make the final decision to answer the ICM’s call to be one of the 350,000 midwives the world needs by 2015.

(this has been cross-posted on the Massachusetts Friends of Midwives blog.)

What's a "midwife?" Please let the ACNM know.

This week, the birth blogosphere was abuzz with news that the American College of Nurse-Midwives has changed its position statement on midwife certification and its definition of what a midwife is.

Essentially, what it boils down to is that the ACNM will not recognize a midwife unless she has received her academic and clinical training in a formal education program. The North American Registry of Midwives is the national agency which certifies professional midwives. After a midwife has met conceptual learning objectives and gained significant clinical experience with out-of-hospital births and prenatal care, she can become a Certified Professional Midwife. There are a number of formal education programs in which an aspiring midwife can enroll; however, an aspiring midwife can obtain her theoretical and conceptual learning through apprenticeship, under the guidance of wise, experienced and mentoring midwives. It's probably the oldest, most traditional form of learning there is.

There are many paths to learning, and it makes sense that the art of traditional midwifery honors learning through apprenticeship. NARM certification is rigorous; it recognizes different paths to learning, and ensures quality practice and standards of care through its certification process. Additionally, its standards for certification are used by the 26 states that regulate midwifery, states in which CNM's, OB's and CPM's practice collaboratively in a variety of birth locations.

It is curious that in its definition of a midwife, the ACNM wishes to split the midwives certified by NARM into separate camps, legitimizing one and squeezing out the other. It is particularly disheartening in the 24 unregulated states like Massachusetts, where the only opportunity to learn midwifery is through apprenticeship. What gain does the ACNM have in only recognizing some CPM's?

NARM has created a petition asking the ACNM to reconsider its statement and respect the knowledge and diverse training that those who hold the CPM carry. At this writing, the petition has over 1160 signatures. Please take a few moments to sign the petition, taking action to protect birthing choices, which includes access to qualified, trained, experienced Certifed Professional Midwives.

(this has been cross-posted on the Massachusetts Friends of Midwives blog)

MRSA infections at Beth Israel Hospital in Boston

Click the title above, and you'll be linked to an article about infection control at one of Boston's largest hospitals. The hospital was found in serious non-compliance with infection control protocols, resulting in staph and MRSA infections -- in mothers and their newborn babies in the labor, delivery, and maternity units.

I don't wish to bash the BI. Two of my three daughters were born there. I had good experiences there. I hadn't developed an interest yet in midwifery, doulas, and non-medicalized, normal birth; my care there was a good match for what I valued then. As I learned more about birth as a non-medical event, I chose not to return to BI for my 3rd daughter's birth, but I have no regrets about decisions I made in the past.

But the situation, which could probably happen in any hospital in the country, can prompt more discussion about out-of-hospital birth. A healthy woman with a healthy pregnancy who goes into labor spontaneously at term should have the right to a homebirth or non-hospital birth center with a qualified and trained midwife. In the comfort of her own home or in a home-like setting, with the intimacy of loved ones around her, she can move freely through labor, feed herself and drink to thirst as she needs to in order to maintain her strength, and allow her body to engage in the uninterrupted physiological process of childbirth. That kind of normal birth is not medical, so therefore doesn't need a hospital and the whole hospital package -- like infections due to non-compliance of infection control protocol, or medical interventions that are either unwanted or not truly medically necessary, which leads to further interventions, which can then create an emergency. At the risk of sounding prosaic, hospitals are for sick people.

OK, Massachusetts Mommies! Get ready, get set...NURSE YOUR BABIES IN PUBLIC!!!!

Look what Massachusetts law now allows us to do. Although most of us have been doing it for years, now we nurse our babies in public -- at a restaurant, mall, you name it -- under full protection of the law!! (But I must say, I think the lead line of the article has a typo; "shouldn't" not "should.")

I fully intend to continue breastfeeding my baby in public -- now if only the weather would be as mommy-friendly as the law!

A C-Section rate of 18%???

Click on the title above to read about the amazingly low c-section rate at a New England hospital (woe that it is not in Boston...). The national average is 34%, and the hospital credits the Midwifery Model of Care for its low c-section rate. Let's hear it for midwives!!

The Third Time's the Charm

Probably from a random mailing list, I now have an annual subscription to an early parenting magazine. I was surprised when I saw the issue in my mailbox, as I had stopped reading any kind of parenting magazine a while ago, perhaps after my oldest turned 3. I found the content somewhat repetetive, and the recipes are nearly all irrelevent to a family dealing with a child's food allergies. Plus, the bewildering nature of babies was over for us (or so we thought!), so who needed a magazine?

My infant, nearing 8 weeks old, will sleep longer if she's on my body, so often I'm relatively immobile on the couch while she dreams away. Somewhat bored - and thoroughly jaded - I picked up the magazine and read the article "10 Signs Your Baby Loves You."

Sign number one - baby smiles. I remember those days, particularly with my oldest, colicky daughter; I kept waiting and waiting for the tiniest smile in between the screaming jags. If only the little corners of her mouth would turn upwards, it would mean she was content, even if just for a moment. The article wisely states that mothers should disregard the notion that it is just a gas bubble making their babies smile. Happiness is happiness, and so be it. Another sign that the babies love their mothers, according to the article, is their stare. It explained the vision of infants, and how at this developmental stage, they can see about 7-10 inches away from their faces. And wouldn't you know it, that's about how far away the face is of an infant's mother when she's feeding her newborn. Though they have no concept of it, the article promises that babies are in love with their mothers.

I rolled my eyes and picked up People magazine instead.

Just yesterday, I attended a Mom and Baby Yoga class for the first time. My first was far too screamy to attempt anything like that, and with the arrival of my second daughter, I barely had a chance to brush my teeth, let alone have the luxury of a yoga class with just her. I could tell I was the only Repeat Mom there. The First-Time Moms were enthralled with their babies, never breaking eye contact, drizzling teeny kisses at the toes of their infants as they swooped into Downward Dog, lifting their babies high above their heads with a "whee!!" as they elevated them into the air for Mountain.

Me? I just wanted a good stretch, to feel my body move again after a long pregnancy filled with modified bedrest, a rapid labor, and tentative post-partum weeks. I loved moving my body independently and realizing that my muscle tone, strength , and flexiblity still bore some semblance to what they had been. But I felt some pressure to do as all the other bright-faced, adoring new moms did. As I moved into Sphinx, I did as I was instructed and opened my eyes wide, my mouth too, all in rounded, surprised O's, and made eye-contact with my baby.

And wouldn't you know it? There she was, her unblinking eyes staring me down. Her haphazard, newborn jittery limbs quieted as she made micro-movements with her mouth to mimic me. Her tiny lips formed a tiny O, just like mine, and her eyes were riveted to me for the rest of the class.

The Divisiveness of The Atlantic Monthly's "Case Against Breastfeeding"

These are the kinds of debates I hate, largely because I refuse to take sides. Yes, I'm a doula. Yes, I have a bias for normal birth, and yes, that leads neatly into a bias for breasfeeding. But Hannah Rosin has some interesting points.

Having not done a literature review myself about the nutritional comparisons between breastmilk and formula, I am surprised, and frankly still skeptical, that medical meta-analysis is not overwhelmingly in favor of breastfeeding. And while I do know breastfed people and formula-fed people who are of equal health and intelligence, a part of me never questioned breastfeeding. Even if breastmilk were an utterly neutral liquid, it is what my body makes solely for my baby, who was also made by my body. In the natural order of things, of course I chose breast over formula.

But I like that Rosin is honest about the fact that breastfeeding is no picnic. Continuing to breastfeed your baby does require significant accomodations with work (many women will nurse for their maternity leave, and the return to work marks the end of nursing), patience from other children (how many times has one child needed something as soon as I settle in to nurse another?), the division of labor in the home, and yes --sleep. Episodically, I have been nursing for the last 7 years, for about a year and a half at a time. I cherish it, though sometimes I've been downright resentful that my husband can't nurse, too. And though it's been all natural and made-by-mom, one of my children has anaphylactic food allergies. Who would have known that until I eliminated her allergens from my own diet, my breastmilk was actually toxic?

And though I cherish nursing, not all mothers do. Though many of them want to, it is painful, and they cannot continue, regardless of the support of numerous lactation consultants. (And I am a little taken aback by the way Rosin diminishes lactation consultants. Perhaps it is because she doesn't understand how, LC's -- most of them nurses -- have assisted enough women with breastfeeding to meet the thousands of contact hours needed to be certified. ) For others, due to a variety of hormonal reasons, milk production is low, which can then lead to the relentless path of nursing-pumping-supplementing with the dreaded formula leaving no time at all to actually enjoy a newborn baby, but plenty of time to be anxious that the baby is dehydrated and starving. And for some mothers, mothers who are equally devoted to their children and absolutely selfless in ways of mothering that I could never be, breastfeeding requires mental and emotional space that is just too intimate, maybe even stifling. I have worked with too many women for whom breastfeeding was at the cost of their mental health, and I find that unacceptable. No amount of colostrum or antibody is worth that.

But what I find most upsetting about the article is not the article itself, but the comments that are being left in the blogosphere, comments that question Rosin's personal decisions, her parenting skills, and her devotion as a mother. The comments only prove that there are indeed breastfeeding fascists out there, as the author calls them. I don't like this debate because there is no answer, only judgment, and its a tension that I see in the birth world too often. It is the breast vs. bottle chapter, like the natural vs. medical childbirth chapter preceding it, in the book of how women deride each other's choices. Rosin's article shows that statistics can be used to prove a point as well as its counterpoint, but nothing is more salient than a community of mothers who feel supported and respected by their peers, employers, family members, and care-providers, so much so that they feel confident in the informed choices they have made and can resist the need to judge the choices of others.

Ummm, WHO delivered that baby?

I have been co-moderating a mothers e-group for a few years. It is a wonderful, supportive, and caring resource of information for moms in Boston. Every now and then, a newly pregnant mom asks for recommendations on an OB or midwife (usually an OB). The responses come pouring in, women sharing their stories about the tender prenatal care they received from one provider or the wonderful support given by the OB who happened to be on-call when they went into labor. But the one thing that makes me crazy is that this is said, over and over again: "Dr. (insert name) delivered my baby."

It doesn't matter how it happened: medicated or unmedicated, induced or spontaneous, vacuums or forceps. Mothers deliver their babies. Doctors and midwives attend births, assist births, catch babies, and perform procedures, but Mothers Deliver Their Babies! Even the babies who are born via the surgical skills of high-risk OB's, their mothers deliver them from the safety of their bodies, releasing them into the big, wide open, world to give them life.

Curtain Call

Has the fat lady sung?

Somehow, unimagineably, I've gotten my period. My youngest is only 6 weeks old, and I am nursing around the clock. With my other daughters, four, maybe even five months went by. Of course, I crawled the internet, using every combination of search term possible, and out of the possible explanations for the bleeding -- placental site not healing, retained placenta, or onset of menstruation -- I'll take menstruation. But everything I read says that rarely a breastfeeding woman may get her period at 6 weeks postpartum.

I'm beginning to dislike that word rare. It is rare to experience problematic bleeding in late-term pregnancy; it is rare for a placenta to abrupt from the uterine wall; it is rare for a labor to be precipitous. Yet all of it has happened to me in a single pregnancy. I am the 1 out of the such-and-such number.

My husband and I, after our initial shock, embraced the idea of a third child. I told myself that while pregnant I would savor each minute, as this opportunity was a gift; even better than a second chance -- a third one. To be a mother for a third time meant that the anxiety was gone, as was the worry that I was always doing something wrong, or that something in the pregnancy was going wrong. I had faith in my body when the exhaustion felled me, trusted my circle of friends enough to rely on them heavily for the care of my children when I couldn't get off the couch, and believed so much in the process of undisturbed birth that I didn't panic when the force of rapid labor yanked me by the wrists and tied me to a runaway train, screeching to a halt with the birth of a baby in less time than it takes my first two daughters to watch a movie.

And now it's all over. My period has returned. The pregnancy and birth are behind me, and it happened in an instant.

My precious, impossibly perfect third daughter is sleeping in my lap as I write this. Her breath makes the sound of tiny whispers, and her eyelids flutter as she dreams. Her lower lip quivers occasionally. She is the last baby I will nurse, the last baby whose sweet milky breath I will feel against my face, whose soft, round downy head I will caress. I want to savor this, too, but just as I grab hold of one moment, it slips through my palms and is gone.

Is it REALLY about the epidural?

When I tell people I'm a doula, one of the responses I get is a shake of the head, coupled with "Nah, I go for the drugs!" Or "Why should I experience pain if I don't need to?"

I loved this entry from the blog "Empowering Birth." What woman wouldn't want to walk away from her non-medicated birth experience with the sense that now she can accomplish anything in the world? What woman wouldn't want that feeling from ANYTHING? What mother wouldn't want that feeling for her daughter? The craving for this experience is what motivated me to have my third child with midwives at a birth center.

But as I delve deeper into the world of birth -- as a mother who has had three wildly different birth experiences, as a doula who has attended many births, and as an aspiring midwife -- I dare to say that it is NOT about whether a laboring mom gets an epidural. Pain is subjective. What one woman can tolerate for 24 hours, another may not be able to tolerate for 24 minutes. Is one woman stronger than the other? Is one woman's birth better than the other? A woman's body has the ability to grow and birth a child. There is, in fact, nothing more natural than that act of creation and birth, epidural or drug free, at home or in a hospital. Witnessing a birth is a phenomenal, powerful experience no matter how the birth happened and what circumstances led to its unfolding.

Because I am a trained mental health clinician, I know that people have all kinds of experiences and make very different decisions than someone else would in the exact same circumstance. None of it is up for judgment, and as a birth professional with a background in mental health, I'm very cautious about even the mildest suggestion that a woman who chooses an epidural is less-than or that the babies had a less-than birth. In fact, I'm very cautious about the suggestion that a woman who chooses an elective, first-time cesarean is less-than.

My birth passion is more focused on freedom of choices. Is a pregnant or laboring woman making a decision about her baby's birth out of fear? Does she have the supportive people she needs to form a circle around her? Is she making an informed decision about her body, which decades of trends and popular culture have taught her to dislike and distrust, if not abuse? Natural childbirth is not only about the epidural. It is about our culture; our love and reliance of technology over our instincts. It is about our need to control a normal, healthy process that should be allowed to take its own path and power and time, and intervening only when it is medically necessary. It is about a culture that focuses on liability and lost income or productivity more than the intangibles, like faith and trust.

Actually, I think that the last thing natural childbirth is about is that epidural. It is about all that is normal about birth. That we don't know when it will begin, nor do we know how long it will take. It can surprise us, and yet if we can remain watchful while still being patient and respectful of the process, it will reveal itself as all that it is meant to be.

Faced with a doctor gap, more hospitals turn to "Laborists" to deliver babies

Please click on the title above to read a Boston Globe front page article, published 2/22/09, about how hospitals are dealing with a shortage of OB's. This is exactly the reason why we need more birth choices, particularly in Massachusetts. Midwives, both CNM's and CPM's, can ease the burden on L&D units by creating more birth center births and homebirths, as they do in most countries around the world! The midwives would be able to attend more births, and the OB's could care for the much smaller percentage of births that actually need obstetrical intervention.

I come from a family with a number of doctors, so I have a very personal understanding of the pressures MD's face because of liability and soaring malpractice insurance costs. Because of my family, I'm also not as quick as others are to blame OB's for the medicalization of birth. But imagine if birth in this country were not driven by fear -- the OB's fear of being sued and watching a life time of work go down the drain for themselves and their families; the expectant parents' fear that the totally normal and healthy process of birth will go utterly awry unless it is interfered with; the mothers' fear when they go post-dates, because they can't spare precious maternity leave days waiting around for labor to begin.

So who is benefitting from the 15 minute prenatal visit, from theVBAC bans, from the c-section rate that is nearly 40%? Who is dictating all these policies? This really is a call for a reform of the insurance and medical malpractice industry and how it has burdened health care and effectively damaged our understanding of birth.

Time Magazine discusses "The Trouble With Repeat Cesareans"

Please click on the title above to read about the theoretical and practical struggles between repeat cesareans and VBACs. The article references the International Cesarean Awareness Network, which is probably still considered "radical" for mainstream birth. But Time is the furthest thing from radical!

What is great about the article is that its conflicting viewpoints can encourage women to be more and more educated about choices they have for birthing.

The Nature of Nature

As a doula, I have seen a million natural birth videos, showing women with glowing, ecstatic faces. Their births are peaceful and gentle, transcendent. Or the stories are of Homeric journeys, women whose bellies are their body armor, and in the mist of a new morning after a long, dark night, rise triumphantly. Women who cry out, "I never knew I had such strength!"

I engage in a fair amount of childbirth education with clients. While I worry about the woman whose idea of birth comes from reality TV or prime time dramas made for entertainment purposes, I worry equally about the woman who has only watched videos that promise her either bliss or empowerment -- in exchange, all she has to do is birth naturally. I do emphatically believe in the revolutionary idea that childbirth is not something we should be taught to fear; but as birth professionals it is critical that while we educate women to trust their bodies and trust the process of birth, we should also remember that the uninterrupted process of birth can be full of surprises. Nature - responsible for crystal streams, painted mountains, and skies spotted with sparkling jewels - is also responsible for hurricanes and gale-force winds.

As a pregnant woman anticipating my 3rd labor, I made all the right choices for a natural birth: I got prenatal care from midwives, chose a birth center instead of a hospital, and shook my head when well-meaning friends suggested that it was time for an induction as I got more uncomfortable. I was determined it was going to happen naturally, and it did. But my labor was naturally precipitous, and if I were to compare it to something in nature, it would be a riptide.

There are women whose birth stories have them, somehow, scanning the ocean in search of the crest of the wave, and once found, they ride it, shifting their weight here and there so that they don't fall if they begin to lose their balance. The sea water is spraying them in the face, and the mix of salt and perspiration on their skin is invigorating, affirming. And then there are other women in the riptide who are like me. I didn't fight it. I didn't navigate it. I didn't negotiate with it in any way. For weeks I have struggled with the mental picture of me being knocked down by a single wave; but I am starting to see that a woman's strength in birth is also in the letting go and allowing herself to tumble fearlessly with the current, never losing sight of the belief that, when the energy of the tide is through, she will find herself upright again on the shore.

Happy Birthday, to my Biggest Little Girl

Seven.

She was born seven years ago today -- tonight, actually, at 9:10PM. Seven years ago, to riff off of my business name, a mom was born. And as a mom, I've learned so much, now that I'm a mom 3 times. With my youngest, a mere 23 days old, if she begins to cry while I'm in the shower, it's OK. If I opt to stay in bed, nursing while half asleep in the pre-dawn hours instead of changing her heavy diaper, it's OK.

But my oldest was colicky the minute she came out of my body, and she remained stubbornly so until she was about 4 months old. As she wailed for hours, I would rock her, nearly begging her to tell me how I could make things better, because if she would just tell me what it was she needed, I'd move mountains to get it for her. Nearly hallucinating from lack of sleep while riding a post-partum rollercoaster, I would look at her and be so overwhelmed by her tiny might, yet so frightened of the powerful love and obligation I felt for her. I would alternate between wanting to put her back in my body to protect her and then wanting to completely shut off my feelings for her so that I would never hurt for her, dream for her, hope for her, or disappoint her.

And even though today we celebrate her seventh birthday, she will always be my first, taking me on my first trip around the block of motherhood. It's a burden she must carry, as the child whom her parents learn off of, who in the mix of sisterhood and birth order will always be the one who should "know better."

But she is also the one who holds my heart captive, who opened my eyes to miracles and all that the world has to offer, who taught me what it means to belong wholly to another human being. She split my heart open like the little bean plant she grew from a seed in her science class, reaching out and upward for the sun.

Happy Birthday, to the one who made me a mother.

High-Tech vs. High-Touch Maternity Care

Please click on the title above to read a simple, straightforward summary about the benefits to keeping interventions low in childbirth, from Consumer Reports -- a fairly benign publication that reaches out to a wide segment of people, not just alternative health or alternative birth populations!

In the Company of Midwives

2AM, January 25 (Sunday)
My 7 year old is sleeping beside me. Last temperature check was 102F. We are both tossing and turning, keeping each other awake. I feel a slight, quick gush in my underwear and go to the bathroom, anxious that my water has broken. But it is blood, bright red like a period, and some of it thick.

My husband is sleeping in the 7 year old's bed, which is downstairs beside the 4 year old's bed. I wake him up to tell him what is happening; he doesn't tell me for a few days that this frightened him.

But I'd seen blood before in this pregnancy. I already knew what came next. Call the midwife on call, go to triage - which is in the hospital, and not the Birth Center where I was aiming to give birth when the time came - be placed on an external fetal monitor for an hour or so, and then go home because the baby is fine, I am fine. The blood is a mystery, but then it goes away. And so it went, just like that. During the whole thing, while waiting for the midwife on call to call me back, while waiting for the cab, while in the cab going to the hospital, I have a contraction or two. Nothing big, nothing regular.

8PM, same day. Same thing.
My dear friend comes to put my kids to bed, and this time my husband comes with me. Bleeding stops, the baby is fine, fine, fine; the midwife on call acknowledges the continuing mystery, cautions me with specific instructions on when to return, then says I can go home. We are heading out the door, jackets on, when the attending OB says no. She says I should stay overnight for continuous fetal monitoring, but adds "If I could make you do what I really want you to do, I'd induce you now." She says, despite the baby being fine, despite my not having any pain, despite the bleeding which has again stopped, despite the absence of any immediate certain problem, "What's the point in being pregnant anymore? You are already full-term." I know if I stay, even if the baby continues to be fine throughout the night, that in the morning I will be faced with induction. She says if I insist on going home, I must sign a waiver that I have signed out Against Medical Advice.

The problem she is concerned about - that the midwives and I and she are all concerned about - is that my placenta is abrupting. The midwives have cared for me with due diligence. And even though it cannot be ruled out with 100% certainty, this would be an atypical presentation of abruption. I am a good patient; I follow instructions well, and I am not unreasonable. I just want to go home and let labor start on its own, and I know it will soon. The OB states frankly that I'm probably not abrupting, but because she cannot guarantee it, she'd rather keep me close by. She states that sometimes if abruption happens it maybe can happen really quickly. I appreciate that she wants to keep me safe, but I also feel that in the absence of any other symptoms, normal birth prevails. She is pretty and young with eyeglasses that are trendy but not so funky as to undermine her authority. She says "You're also over 35. Statistically you are at high risk for many problems."

I sign out AMA.

1AM, January 26 (Monday)
Bleeding again. I am a good patient; I follow instructions well, and I am not unreasonable. I return to the hospital and settle in for the night, fetal monitors belted to my belly. I know I will not be leaving this hospital again, not with this baby still inside my body. I know I will be induced by morning.

8:30AM, same day
It is a new morning. I never hear from the OB again, but the shifts have changed, and now my midwife is on duty. She sits beside me and holds my hand to tell me gently that she's sorry, but I can't give birth at the Birth Center anymore. It's easy to let that go, as my big concern is with induction. I am having contractions, but if they come regularly, they are mild and barely a distraction. Conversely, if they are strong and require my full attention, they last only 30 seconds. Meanwhile, the bleeding has not subsided like it has every time before. In fact, though it is not a hemorrhage, perhaps it is even slightly increasing.

My midwife explains the reasons why induction is warranted, and I believe her, not only because she has seen me more than a dozen times through the course of this normal and healthy pregnancy, but because she is presenting me with induction options. She has not dictated my care, then placed orders with a nurse and disappeared. She has remained sitting beside my bed and holding my hand, and she explains each choice to me, knowing what my hopes and preferences have been for this labor. In fact, when my husband walks in to the room, she explains it all a second time, for his benefit. Contractions are still coming, but they remain inconsistent. So we choose a course of action together, my midwife, husband, and I, one that will allow me to have as normal a birth as possible.

11AM, same day
Somehow, I missed breakfast. I cannot go into labor on an empty stomach, and clear fluids certainly will not sustain me through the workout that is childbirth. My midwife orders me a lunch. She takes heat from the Attending OB. "She's not in active labor," she tells him, which is the hospital policy. "She's not in any labor at all, and she's hungry."

12:30PM, same day
There is a delay in the induction. Pharmacy hasn't delivered the drugs yet, and there are some patients in triage who need evaluation. I eat - plentifully. I put my fork down, push the tray away, and suddenly a force wraps itself around my mid-section. I close my eyes and breathe through it, and it keeps on going. A minute and a half goes by before the contraction lets go of me. The room is suddenly as hot as July, and I feel another one coming. I stand up, hold on to my husband, let my knees go weak and try to relax every single muscle in my body so that my uterus is the only muscle efforting. Another minute and a half goes by. My eyes are closed, and I hear my midwife enter the room. There is a small space between the surges of contractions, and just as I feel another one coming upon me, she says it. She says it for me, because the contractions have taken all my breath, and I can no longer talk. She says, "You're in labor, Maria. Let's cancel that induction. This is all you."

Same day, some time after 12:30PM and before 1:47PM
I take my face away from where I have buried it in my husband's neck, regain my stance and say calmly "I can do this," while catching my breath. My husband holds me and tightens his arms around me, telling me silently that he believes me. I hear my midwife's affirmation, "You can do this, Maria."

1:47PM, January 26 (Monday)
My daughter is born. Official time from start of labor to birth is 1 hour and 17 minutes. She is caught by my midwife, who later writes in the chart:
NSVD
It stands for Normal Spontaneous Vaginal Delivery.

Precipitous Labor

"pre cip' i tous: adj. Like a precipice; extremely steep; abrupt or ill-considered. "


That is the definition found in the 2nd edition of the American Heritage Dictionary. Medically, a precipitous labor is a labor that results in a birth in 3 hours or less. We all have seen on the news the story of a woman whose baby was born in a car en route to the hospital, or whose kindergartener knew enough of his numbers to call 9-1-1. Like many doulas, I have a precipitous labor clause in my contract to ensure I get paid, even if I miss the birth. I suppose many of us, if we attend enough births, will experience (or miss experiencing, even) a preciptious labor or two -- but for the most part we wouldn't bet on it, and wouldn't want to.

Just over 2 weeks ago, I gave birth in an hour and 17 minutes. I have a friend who said that she had a quick labor, too, and then she described how she pushed for just 20 minutes. She had obvious pride in her birth story, so I didn't tell her that her labor wasn't anything even close to mine. My labor was rapid. Like, really rapid. Like at 12:30PM, I was eating lunch and chatting with my husband, and then by 1:47PM there was a baby in the room. The dictionary definition of "precipitous" is far more accurate than the medical definition; my labor was like being thrown off a very steep cliff with no chute, and I free fell all the way until my daughter exploded out of my body.

A goal of natural childbirth requires values clarification, a real sense of why you want to birth naturally: do you believe in normal birth, and that in the absence of true medical necessity, there is no need to intervene with its process? Do you believe in your own primal strength? Or do you want your strength challenged? I've even had a client flat out say she was so terrified of needles that in fact an epidural was far more frightening than unmedicated childbirth. Natural labor also requires planning and practice; in other words, lots and lots of fore thought. And all my plans were tossed out the window - there was no time to collect myself, no time to process, and I had to use only what remained: my instinct - to breathe and keep the air moving through my body; my husband - whom I held on to for dear life as he supported my weight and helped me rock and sway through this deft force of nature, and my midwife - who, despite the collective surprise of everyone in the birth room at such a swift and decisive labor, entirely believed as I did that nothing was ever wrong, and there was nothing to be afraid of.

I am left with the sense that I didn't so much give birth as I did give way to birth, and I am feeling far more humbled by nature than I am empowered or heroic. My "precipitous" labor certainly was "abrupt", though not "ill-considered," and yet, in the end, just as it was meant to be.

Selma Hayek promoting maternal/child health in Sierra Leone

Please click on the title above to see Pampers and Selma Hayek use their name and brand recognition for a truly humanitarian purpose in Sierra Leone.

Two things strike me here in this video: 1) often as breastfeeding advocates and educators, we begrudge the obstacles to our goals (think: mall foodcourt nurse-ins, Applebees demanding a diner cover herself up, Facebook banning photos of breastfeeding -- yet the struggle of a developing nation is so primary and undeniably, utterly humbling. It should serve as a reminder that American women are breastfeeding in luxury, regardless of what we encounter in our professional lives; 2) Selma Hayek breastfeeds an ailing baby, and it exemplefies generosity, selflessness, beauty, and grace in one gesture.