Your own Midwife

Honestly, I’m not really sure hot to approach this topic.. The question is do you really need us? And if so, what for exactly? We all feel that we need someone there, a second set of eyes and hands, someone to tell you that you’re doing great when you’re doing great, to help you set aside the worries when you’ve read too many “What to Expect When You’re– OMG I NEED TO CALL TO CALL THE DOCTOR” crap comes up, you also need/want a midwife/doula/doc there so that if, in the unlikely situation, you do need help they know what to do. In the rest of the cases I think that most women, if not all, could midwife themselves if shown how and if they wanted to.

Here’s my story. When I was pregnant with my first child I realized that hospitals scare the b-jesus out of me and I would rather sit in tub full of boiling water than birth a child in one of those places (I have a mild case of white coat phobia, I think). So what did I do? I got a list of doulas and midwives and called every single one of them to do an interview + got myself the most “respectful” OB word of mouth could give me. I had a home birth with a midwife, doula, spiritual healer, friend, and, of corse, my husband all there. My OB was lovely, and I mean that in the most sarcastic way possible, I got pressured, pushed, and oh, he compared my body to a car that you have to take to mechanic to know what’s is wrong with it. I’m pig headed and usually stick my ground in a passive aggressive sort of way. My husband, on the other hand, has the mouth that on occasion says the things I’m quietly steaming over. When my OB compared my body to a car my wonderful husband looked him right in the face and said “But she’s lived in her body for 24 years and you’ve only met her!” Que imaginary happy dance going on in my head.

Anyway, case in point, no matter how long you’ve lived in your body, what better time to get to know it than NOW. When I gave birth to Milo I had a crew of wonderful people around me, I knew as much as I could gather about birth but mostly I put my body and my baby in other people’s hands and that was fine. First births are a little of “what the hell am I getting into?” so it’s a little different second time around. When I got pregnant with Ananda my midwife was busy with her own daughter who lives on the mainland. She could do some checks but would not be there around my due date. I felt empowered after my first birth and did’t think I would need the whole army. This time, after much thought and discussion my midwife convinced my husband and I to do labor “unassisted”. “Unassisted” in my case does not mean alone in the woods with wolves howling. My midwife got my husband and I prepared, gave us the tools we needed, and offered up a girl she had just begun training to be there. This was the experience that I needed, this was the experience that my daughter was calling for.

As my midwife prepared us all for my birth I learned not only what to watch for but also how to check my own dilation and effacement. It is pretty easy to feel the position of your cervix. If it’s high it usually means that you are ether pregnant or getting ready to ovulate but if you swat you can usually reach something that feels a little like a thumb nub. If you feel an opening you’re about one centimeter dilated. The thinner the lining the more effaced you are, the wider the opening the more dilated. Pretty simple actually. When I wanted to check on my progress through labor I didn’t wait until I was between contractions, notify someone, get into an odd position, and then have them check. I simply checked my own dilation in whatever position was best for me. The woman who was still learning wanted to feel as well for her own training. This really made it hit home how uncomfortable it actually is to depend on someone else to assess yourself. Usually by the time I was in the right place for someone else to check me I had another contraction coming on. In addition, simply having my hands down there helped me feel Ananda’s head crowning. I actually took the warm rags out of our helpers hand and put them on my own perineum and it felt about a million times better.

I am not some crazy warrior woman, I am not Ms. Get Down to Business and Do Everything Just So. I just know, that who is better at saying what is happening in MY body than ME? For me, doing things myself helped me feel powerful and fulfilled in my labor. I am not the best communicator when I am in pain, who is? But being able to assess the situation and read my own body was taking possession of myself in a way that was great!

In my current pregnancy my midwife asked me “How would you like to midwife your own prenatals?” Huh? What? I can? How cool is it to take charge of your own pregnancy and know what is going on whenever you want to. It’s great! I had my first prenatal the other week and we sat around discussing the subtitles of my urine. It’s really very simple and can be read just to tell you “I need to drink more water, or eat less sugar.” I lie down feeling my pubic bone and the top of my baby’s head, and then I fill out all the paper work for myself seeing first hand what it all looks like. I don’t remember my doctor ever inviting me to look at my own paper work much less fill it out myself! It’s nice to be treated like the expert in my own body, just being taught how to read it a little better. We’ve all been living in our bodies for how long. Don’t you think it’s time that someone treated you like you know a thing or two about it?

Giving you my 1/2 cent.

For a over a decade now Miami-Dade County’s Jackson Memorial has been collecting a half-cent sales tax to fund need care to the community at Jackson’s various campuses. Since voters passed it in 1991, the tax, goosed by the booming economy, has funneled $791 million into the hospital’s coffers. This fund is intended to keep Jackson in the business of providing needed services to the community.  Recently Jackson has announced a proposed closure of the Labor and Delivery Unit at their Jackson South Campus.  Normally I would not be sad to see a L&D unit shut it’s doors, but Jackson South is the hospital with the lowest rate of cesareans and, not surprisingly one of the best outcome rates.  It is the only hospital in the county where the majority of births are attended my nurse-midwives.

The most maddening thing about the proposed closure is the reason behind it.  It seems that the specialty docs at Jackson are coveting the two ORs on the floor in order to have a full time bariatric surgical center.  While obesity is an issue in this country, I find it hard to believe that the tax payers who approved this tax over a decade ago would be happy to know that an OB unit with a great track record is being eliminated in order to make room for an elective weight loss surgery center.

This is just more proof that obstetrics is not based in science.  If it was, good outcomes would equal more funding for that program, not closure.  Shame on Jackson, shame on the Public Health Trust.

Modern Midwifery.

Midwives in New York need our help. Free Our Midwives is campaigning the New York State legislature to pass the Midwifery Modernization Act before the summer break. This is a piece of legislation that would free NY midwives from the archaic and patriarchal requirement of having an obstetrician ‘approve’ their practice & would allow midwives to function as the independent healthcare providers they are trained to be. Please join me in contacting NYS legislators to show our support of this legislation – let’s give it ONE BIG PUSH and get it passed this session!
Here is more information about the Act itself

And here is what you can do to help:
1) Please pass this call for action along to all of your friends, family, & midwives especially those living in New York.
2) If you live in NY, click here to find out exactly who to call/write.

Mother of Many: The Film

This was a very interesting animated film about the life of a hospital based midwife.  It’s in a film contest.  I’m interested to hear your thoughts.

Have you hugged a midwife today?

It’s the International Day of the Midwife and I’d like to give a huge shout out to my midwife, J.  

I’ve known J for a long time.  She was not my first midwife, but my longest midwife.  Her first birth as an apprentice was with my third baby and oddly enough, her last birth as apprentice was with my fourth baby.  She then went on to also attend my births for babies number five, six, seven and eight.  So, you could say we have some history.

J listens to me complain about how my hips hurt.  She comes over and patiently waits for multiple sets of little hands to feel my belly and listen to their siblings heartbeat in utero, each with a mini-lesson on how its done.  She laughs and cries with me.  She doesn’t freak out when I scream, “Come now!”  She doesn’t complain when we’re going on hour forty of labor, either.

She knows my quirks when it comes to pregnancy, but she trusts that I know my body and my “stuff” when it comes to statistics.  J leaves her own child at home to come be by my side.  She’s probably missed some fun events, dinners or heck, just quiet nights at home because I needed her.  I also know that she has cold hands that warm up after awhile, that she prefers hot soup and bread for an after birth meal and that she thinks my husband is a great cook.

She is also an amazing carpet cleaner, laundress and even makes a mean bed.  She’s a great photo grapher of newborns.  J even teachs a sweet little lesson to the older siblings on placentas after the birth – every time.

Whether you know my J or not, you know a midwife like her, be sure to take a minute to say thank you for everything that they give up so that women can have safe, satisfying births.

Loyally Devoted to Doctor

I recently read the book The Highly Sensitive Person by Elaine N Aron, Ph.D. In the chapter called Medics, Medication, and Highly Sensitive People, the author states:

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

Why Our Women are Afraid of Birth

Deliver Me

It is Tuesday, at 10pm while I settle in after getting my little ones to bed. I flip through the channels and settle on discovery healthy which is a personal favorite of mine, but it really has only recently become a favorite because of shows like I didn’t know I was pregnant. It fascinates me that women could make it though a full term pregnancy and not know they were pregnant, but that is just me, and the experiences that I had with my children is what makes me wonder how the heck women could not know they were pregnant.  But that is completely besides my point today.
So as I watch this show, I am noticing a trend. High risk, high risk, high risk, previous cesarean section, scheduled cesarean section, high risk, healthy first time mother, scheduled cesarean, high risk. Well I mean, that is how it is in Los Angeles right?  You would think so!  But apparently because only these crazy, scary, uncommon births make something called ratings, that is all they are going to feature on TV. Because in reality, no one wants to watch a natural birth or a home birth because no one is running around with a scalpel screaming about the emergency that childbirth is. Nor is the mother screaming for her epidural because she just cant deal with the pain of the 3 hours of labor so far.
But what we should be thinking about most importantly is the message this is sending. What is this teaching first time mothers or even young women that may not be planning on having children soon but will some day?  It is teaching them how scary, dangerous, and medical birth is supposed to be. But is that really how birth is? Of course not. Anyone who has taken the time to read the studies, and just not follow what mainstream society thinks is the right way to handle pregnancy will know that birth is not scary or dangerous or a huge emergency. While it can be in some cases, in most cases it can and will be beautiful when just left alone.

When a woman becomes pregnant today, if they do not already have an Obstetrician they have been seeing for well women care since 16, or whatever age their parent decided it was the right them for them, what is the first thing that they do? They ask around their circle of female friends for the best Doctor out there because isn’t that what we all want? We want the one who is the BMW of pre natal care. Little do women know that they are really going to end up with the 1990 Dodge Dynasty when they take this route because hands off is better.
But because our society has told us this is the way things should be, they run off like lemmings right off the cliff of medical interventions landing in the valley of cesarean sections.

Maybe if the television channels like Discovery health followed a dozen home births or even aired The Business of Being Born they could get a popular, and controversial other side to what they are constantly airing. Maybe it will boost their ratings even more, maybe not?  But what it will do is give the other side of the whole issue. Let’s get Marsden Wagner to do a half hour special on Birth in The United States and see how many women run off to the midwives.  Instead they air these disgustingly inaccurate “Freebirthing” shows. They find the one idiot who is going to make women who choose unassisted birth look like a bunch of uneducated yokels.  Which is exactly what they did with their special on Unassisted birth.

I guess in the end, like anything else the television airs, it is biased and we shouldn’t expect much different.

The Infamous Cascade Chart

As someone strongly involved in the birth community, this is probably one of my favorite pictures floating around the internet that I run across every once and a while.? One day when I find out the person who actually put these thoughts and cascade of interventions into a physical chart to view, I am going to kiss them!

I have always loved how it starts with induction, because lets face it, so many women today are starting their labors with some kind of artificial labor stimulant. Whether it be pitocin, or the oh so dangerous cytotec. I can personally say I have been the victim of the cascade myself with my first child. Had I seen this before my pregnancy with him, I would have never opted for the induction. Many do not realize that induction in many cases will fail, almost half of the time according to the most recent figures, and when I quote that, I am quoting Robbie Davis Floyd in a 2008 interview, I believe it was in Pregnant in America but my birth/pregnancy movies and interviews all start to blur together when you watch so many of them. These babies are not ready to be born in many cases, especially when we are seeing these inductions before the “due date” or the 40 week gestation mark. Although we know that “due dates” aren’t much to put stock into, many women and providers use them as some type of eviction date, which history has shown to be a pretty bad idea. No one is going to be pregnant forever and many women left alone will go into labor on their own. Now granted, there are cases that induction is medically necessary and for these special cases, I am completely thankful. Without induction these women would be subjected to cesarean sections instead of labor inductions which could in turn be even more hard on their body, and experience over all.
What we do not understand with the induction of labor is, we are creating unnaturally strong contractions in attempt to simulate something similar to natural labor. As someone who has experienced pitocin labor, and natural labor, I would take a million natural contractions over being on the receiving end of pitocin again. The comparison in my opinion is not even in the same ball park. Another issue with these contractions as most know, is the fact that they are more likely to cause fetal distress on the baby because they are not natural contractions or what normal contractions are supposed to be. So in turn we are putting our children under unnecessary stress. Especially if they are not ready to come and join us in “our world” yet. Again something I learned with my first.
Then we have the provider who comes in and looks at the fetal heart monitoring and says, “Oh No! Your baby is in danger!!” So off to the operating room we go for an “emergency” cesarean which in reality was caused by the pitocin to begin with. You would think by this point there would be a bit of common sense in the Obstetric community to say, ya know, I think we are causing these actions instead of blaming the increasing cesarean rate on “patient choice cesareans” which only make up 3% at most of the incredibly high cesarean rate in our country.

But a cesarean is only one path that this induction cascade can lead to. There are still women out there that will have a vaginal delivery when subjected to a labor induction, but in turn these women have greater risks for other procedures including episiotomies which have all in all been proven to really have little to no benefit to women in the long run. While episiotomy rates are starting to decrease, they are still over used in many communities. For example, here in my state of Connecticut, some hospitals have an over 25% episiotomy rate, when science tells us there really shouldn’t be over 10%. Trying to obtain these numbers are like pulling teeth too FYI!

We also have vaccum extraction. I had never really discussed this or spoken with someone who experienced this until I met my Chiropractor in the summer of 2008. He was discussing with me why Chiropractic care in infants is important, and then he described his own daughters birth, they had applied the vaccum to the top of her head, and while “assisting” her out, they pulled so hard the vaccum literally flew right off of her head. My Chiropractor described it so vividly… “I thought her HEAD popped RIGHT OFF! I was horrified to even look!”? My heart broke for him because no parent should have to go through that kind of fright during the birth of their child!

These all often lead to epidurals, which especially if you are going to have a cesarean section, you will either have this or a spinal block. All types of anesthesia that will have a direct impact on the baby. Although I have experienced women told there will be no effects on their baby at all.
I am sure most know about the “breast crawl” and I can say after watching a baby who’s mother did have an epidural, as opposed to a mom who had a natural birth, there is no comparing the instincts of the baby. While I had epidurals with both of my children, I didn’t have the opportunity to breastfeed then until they were a little over an hour old. My first was almost 2 hours. For more information on epidural effects on babies, click this link!

The last thing I want to touch on is the separation of mother and baby after a cesarean section which is very common. It is pretty uncommon for an newborn to be allowed to stay in the OR with mom, although it does happen sometimes. I can really related to the lack of bonding, breastfeeding problems, and reduced bonding because of this because I deeply experienced this with the births of both of my children. While I bonded, it was not that “instant motherly love” I am sure most feel. It hurts me to this day to know that my bonding was an almost learned bonding because I knew as a mother it was something I needed to do in order to protect my babies.? While most women who have had cesarean sections are not quick to admit this, I think by discussing this and acknowledging that this is a true problem it will only help to improve it for others in the long run. I also noticed that mothers who do experience this may be ashamed or fearful to admit this because it make portray them in a less than perfect light, or maybe others may look down on them because of this, but they should not be ashamed. It happens and there is nothing we can do about it but help other women to not go through what we did!

Be empowered by your birth, no matter how you birth!
If it is a bad experience, help to educate others so they do not go through what you did, so they can avoid the pain or heartache you have dealt with!

CDC Releases New Report Comparing U.S. and European Infant Mortality Rates

The CDC National Center for Health Statistics (NCHS) released a new report this morning which compares infant mortality rates in the U.S. and Europe.

Authors of Behind International Rankings of Infant Mortality: How the United States Compares with Europe explored what they refer to as the recent stagnation in the U.S. infant mortality rate that has generated widespread concern among researchers, policy makers, health care providers and activists.

Using data from the United States? Linked Birth/Infant Death Data Set and the European Perinatal Health Report, authors Marian F. MacDorman, Ph.D., and T.J. Mathews, M.S. of the CDC National Center for Health Statistics found that the main cause of the United States high infant mortality rate when compared with Europe is the ?very high percentage of preterm births in the United States.?

According to the study, while infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

Discussions of the U.S. infant mortality rate are often countered with criticism that the U.S. records data differently than other countries, reporting very premature babies as live births. While this is true for five of the 19 European countries whose data was analyzed, 14 of the 19 European countries require that all live births at any birth weight or gestational age be reported.

The United States remains near the bottom of the rankings.

The report states, ?Reporting differences have little effect on the percentage of preterm births because most preterm births occur well after 22 weeks of gestation. For example, the percentage of preterm births for the United States in 2004 was 12.5% when all births were included and 12.4% when births of less than 22 weeks of gestation were excluded.?

MacDorman and Mathews attribute much of the high infant mortality rate in the United States to the high percentage of preterm births. Using the direct standardization method to apply the U.S. gestational-age specific infant mortality rates to Sweden?s distribution of births by gestational age, the NCHS found evidence that lowering the percentage of preterm births could have a dramatic impact on infant mortality in the United States.

November is also Prematurity Awareness Month.? Considering the risks involved in preterm birth, you may be wondering what you can do as a birth activist or as a parent.? Here are some basic things to consider:

• Let labor begin on its own. Without a valid medical reason, let your baby pick his or her birthday for the safest, easiest birth.
• Choose a practitioner with a low induction rate. If you have a midwife or doctor who rarely sees anyone who goes past their due date, it should be a red flag.? Ask the receptionist for her opinion of how many women go past 40 weeks. The answer might surprise you.
• Know the signs of preterm labor. If you think you’re having any of the signs of preterm labor, call your midwife or doctor immediately.? The sooner you get help, the more likely that premature birth can be delayed or stopped completely.
• Be mindful of the risk factors. Face it, you have responsibility for some of the risk factors.? While there are certainly some risk factors for preterm labor that you don’t control, take charge of the ones you can, including prenatal care, good nutrition, not smoking, etc.

The first Duggar grandchild is born at HOME.

Anna Duggar, famous for being the wife of Josh, son of Jim Bob and Michelle Duggar, had her first baby last night. While there were some cameras and video, like at many normal births, this baby was also welcomed lovingly into her parents arms at home in the presence of family, midwife and doula. Her baby weighed in at 8 lbs. Nothing seems too wild or out there, unless of course you think home birth is wild or out there. The funny thing is that the Today Show, infamous for their discussions of the horrors of home birth, laid low and said nothing. Why is that? Perhaps it was that Mackynzie Renee Duggar’s birth provided no drama.

If you’d like to share your thoughts with the Today Show, you can email them at Today@NBCUNI.com or send snail mail to:

NBC News
30 Rockefeller Plaza
New York, N.Y. 10112