Three for Three

The last three births I've attended have been c-sections. And you know what?

It's OK.

Of course, all three pairs of moms and babies are utterly fine and healthy, all recovering normally with no complications, but that's not what my focus is. In broad strokes, I think the reason why I'm not disappointed is because all three moms had choices. All three went into their births so informed about their options, about the common interventions suggested even when a labor is progressing normally, and about typical complications in late pregnancy and labor. They questioned their care providers, not for the sake of being contrary or dismissive, but because they wanted to to be fully participant in their births and not have their births "done to" them.

When the course of their births turned in the direction of c-section, we took a look at every alternative and weighed options. And I know that later, when they review their births either a week from now or a year from now, they will have no regrets about avenues unexplored.

The Mother-Blame Game

Reading blogs can be a little bit like spreading rumours in high school -- there's a story, and the story changes with each person who passes it on, and the story you end up with is vastly different from the one you started with. Despite this, someone runs with this end-product story, believing it to be truth.

Take, for example, the story of a woman in a Chicago hospital who was given the wrong baby to breastfeed and is consequently suing the hospital for negligence. I heard about the story from this article, several hands later, which tangentially asks, "Would you breastfeed someone else's baby?"

That question, of course, is misleading -- because the woman in Chicago was never asked that question.

And the answers are heartbreaking and judgemental - the woman who was given the wrong baby to breastfeed is accused of being a negligent mother for not recognizing her own baby and for choosing not to room-in with her baby. Both the article and the comments review the history of wet nurses and wonderful stories of orphaned babies being fed by a community of breastfeeding women, and so her character comes under question -- perhaps deep-down she finds breastfeeding really disgusting, and why can't she be generous enough to share her breastmilk with another baby in need? Someone even suspects that she's a money-grubber, trying to get rich off the situation.

Acknowledging that we are a litigious society, which in part is the reason for high and unsustainable medical care costs, is important. Important, but far from the point. Suing the hospital for negligence is one of the options that exists among other formal, punitive, and ultimately corrective options. And clearly the hospital needs to be accountable for an identification error whose consequence could have been far worse -- the woman could have taken the wrong baby home, or medication could have been given to the wrong baby (and she's suing for $30K, by the way, which in the grand scheme of a hospital's budget is not a whole lot of money).

But how quick we mothers are to judge another mother. And I hear this kind of judgement, and the ensuing cycle of mistrust and guilt, more often than I like in the birth and parenting world -- between mothers who feel as though their births are being looked at critically by another mother, or their choices in how to feed their babies are being evaluated by another mother, or a mother who makes assumptions about another mother who is having a harder or easier time than she is.

What I have learned in parenting 3 children, in attending birth after birth after birth, and in listening to mothers tell their stories about motherhood, is that there is no singular, right way to go about these tasks. Despite so many options, and so many, many mothers out there, motherhood can sometimes seem like a very lonely place.

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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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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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