Friday, January 2, 2009

Jennifer Block "Pushes" Obama for better maternity care...Should she?

In the LA times, Jennifer Block, has a featured editorial discussing the state of maternity care in the US and our need for better recognition, funding and education about and for midwifery. I agree with all of that. It is a terrific editorial and I welcome the discussion that comes from it. What I don't welcome is the incessant push by many, midwives, homebirthers, doctors and well meaning organizations, for all midwives to be licensed and regulated.

For one thing, NARM, the National Association of Registered Midwives, who grant licensing in this country, do not provide a regulated, peer based checks and balances for their midwives. They have a grievance policy that allows clients to file a complaint against their midwife and mediation to work through problems, but NARM does not actually discipline licensed midwives. What this means is that once you have your certification, you can pretty much practice any way you like. You can use cytotec at a homebirth, for instance, and unless a birthing woman has a complaint against that practice, other midwives can do nothing about this. What does this mean for the birthing community?

I think it is a well known observation that women can have the most horrible birth, go through every intervention in the book, have a terrible time healing from episiotomies, stitches, catheter placement issues, and the humiliation they experience at many hospital births, but as long as they are sent home with a beautiful little baby, they tend to lay to rest the mistreatment they experienced during the birth and instead focus on the positive: loving and raising their child. Because of this, and often because of the guilt they feel over focusing on lingering birth trauma instead of their baby, many woman choose or neglect to be activists against their doctors, hospitals or maternity care in general. They don't write letters, they rarely prosecute and often times they don't even open up about their feelings for fear that friends and family will think them selfish or unreasonable. Afterall, they have a baby, they are alive, why should they care about the birth?

I think the thing to realize here is that terrible births don't just happen at the hospital. Just as there are unpleasant doctors, there too, are unpleasant midwives. It is often not about their training, but about their personalities, or their lack of sensitivity. We are all human afterall and not meant to be right for each and every other human, but there are also some actions at homebirths that are inexcuseable. They are not okay in the hospital, but really not okay at home, considering the lack of emergency management that is possible. A midwife should not ever use cyctotec to augment labor. A midwife should not cut umbilical cords before they have stopped pulsing, especially not if the baby needs resuscitation. A midwife should not strip membranes, or artifially rupture membranes or augment labors with herbs and homeopathics without and really good, research backed reason. Finally a midwife should not do multiple cervical checks, especially after the membranes have ruptured. These practices are good sense, but not common sense and NARM neither suggests nor enforces that certified midwives follow any guidelines or protocols other than their own. NARM is only there to register midwives, not regulate them.

So, what is the difference between a Certified Professional Midwife who has apprenticed for 3 years, finished their studies and is now practicing compared to a Lay/or unlicensed midwife who has apprenticed for 3 years, finished their studies and is now practicing? The difference is the $1400 that the CPM paid to sit for two different exams and the letters after her name. They are probably practicing in similar ways, perhaps with a senior midwife still overseeing their work. They are accountable only to themselves and the clients they work with and depending on the state they practice, maybe a governing state body, but NARM, does not continue to be a part of their lives except for a very vague peer review that can be done without much concern and an annual membership.
Now you tell me, why should we certify? I have many reasons why we should not, and many more reasons why I don't think states should be involved, let alone the US government, but why should we certify?

Friday, February 1, 2008

A Reason to Break Bread Together

I ate lunch alone today. My son was spending a day with a sitter so I could get some school work done, but I had a work lunch date that didn't show, so it was just me and I was actually pretty sad to be all by myself. I was reminded of some amazing information that I read in Sarah Buckley's book Gentle Birth, Gentle Mothering, about love hormones and how they affect us emotionally and physically both during and after birth. The same hormones that are produced during labor and nursing are also produced while sharing a meal with a friend or loved one.
This goes beyond birth in many ways because in today's fast pace of society, we don't often have time to just sit, share and enjoy...things that we do when we are nursing or sharing a meal. Sure we eat, usually fast and without much thought to what we are putting into our mouths. But do we really enjoy most of the food we consume these days? How often do we potluck, finding ourselves laughing over warm bowls of soup and homemade bread. Finishing over cups of chai tea or hot cocoa. How often do we have the time?
I think to truly share a meal is to put yourself into the food and then reap the benefits of presenting that meal and watching it be consumed with pleasure and zeal...much like a baby nursing at the breast and very much like a mother putting heart, soul and energy into birthing a baby that they then take in with all of their heightened senses;absorbing every smell, movement and sound with unending pleasure.
This is not new information.
I have often wondered about the traditional American diet of meat and potatoes. How it could sustain multiple generations without problems of obesity or diabetes or keep young men during wars healthy and fit, though lacking in vitamin c and other long term essentials. Jerky and hard tack can keep a person alive for a long time if necessary, and with very little ill effect.
Then there is the typical European diet, lots of bread, cheese and red wine, consumed by a population that far surpasses the US in health and vitality, and recently made popular by the book "French Women Rarely Get Fat." Yes, we eat more processed foods now; Yes, we get less exercise, both of these are significant changes. What we have lost most though, over the period of industrialization, is The Family Meal. Not even to mention the need for mothers to have time to spend with friends just being.
Family, Friends, Food. The 3 F's.
The pace of our lives gaining in speed is analogous to the pace of our births. We are rushed into and out of our lives. Perhaps, because of this lack of time, we are missing out on some of the essentials that make us human. Will those hormones continue on through future generations if we no longer take the time to welcome them and put them to good use?

Wednesday, January 9, 2008

Waterbirth International Needs Our Help!

A few months ago I had the pleasure of speaking with Barbara Harper by phone. It started off with me calling Waterbirth International to get a new copy of a video that had arrived damaged. It turned into a wonderful conversation about my choice to become a midwife, the need for birthing iconoclasts that would uphold the freedom of women to birth the way they choose to birth, and the importance of sometimes disagreeing with the senior midwife who is training me. I learned a lot, I felt really good about myself and my profession after I hung up and I decided right then and there, to never deny a woman her choices just because of my ignorance or personal fear around those choices. After I educate myself further on a subject, if I then still feel unsure of the decision, I can discuss it without passion and emotions getting in the way of logic and trust.
Waterbirth International is all about education. Years ago, when someone thought of water during a birth, the Leboyer bath came to mind...for the baby, not the mother. Thanks to the incredibly hard work of Barbara Harper and other proponents of waterbirth, the world knows what we are talking about and thousands of women birth their babies gently into the water each year.
Now Waterbirth International is in debt and facing the possibility of closing forever. They put together an amazing conference in Portland last year that took all of their available resources and it is up to us, the professionals, students, parents and consumers to see to it that this amazing resource stays around for years to come. Please, please, go to the website: and make a donation, buy a book or dvd, or better yet, buy an amazing Birth Pool in a Bag to either use, rent out to other pregnant moms or give to a midwife that you love and adore. Doing any of the above with help Barbara and Waterbirth International keep educating the public about the joys and gentleness of waterbirth. Any amount you can donate is valuable. Get the word out and a dollar will turn into thousands. Thank you.

A message from Barbara Harper:

I cannot yet imagine a world without the voice and work of Waterbirth International - we get calls and emails every day from women who need help convincing one hospital or another to let them labor or birth in water. If we die - a big part of the movement dies. Waterbirth has shown us all that women know how to give birth and babies know how to be born. Water birth gave us "hands-off", sit back and let the baby out. I see waterbirth mentioned on Blogs every single day, not to mention Baby Story on the TV. I took Waterbirth International to ACOG two years in a row - and was the ONLY booth showing birth films to obstetricians and especially to student physicians. There were tears, laughter and outrage - just the thing to stirup those young crop of doctors. I am finally realizing a life's dream. But now I am faced with letting this dream go. Perhaps I have done enough.Perhaps it is time to quit.

About 18 years ago, maybe it was longer, when Mothering Magazine was facing bankruptcy Peggy did a heartfelt plea asking their readers to consider ordering a Life-time subscription. I think the subscriptions were $1000 or $1200, I can't remember now. I do remember that I couldn't imagine not reading my Mothering. So, I bought two and gave one to my obstetrician's office.

How can you help us stay open to take the next phone call? - to convince the next obstetrician to incorporate waterbirth into his/her practice - to work with the nurse midwives to install pools in their facilities? To educate an entire hospital on the benefits of allowing women freedom of movement in the water. How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen.
Do women really want waterbirth to be an available choice in every hospital? I think so. Can you help us by getting the word out on blogs and lists?

I had to let go of all of the staff except one person to process orders. Miraculously, we made payroll today, but we can't hang on much longer. We need a miracle. If I need to call every single waterbirth parent personally, I will. I don't want 25 years of work to end over a measly $200,000. The work that we have done the last few years has been phenomenal. How God arranged for me to teach in hospitals and medical schools around the planet- Taiwan, Venezuela, Turkey, Mexico, Canada, Holland, Portugal, China,Trinidad, Croatia - I'll never figure that out. I laugh out loud sometimes when I get up in front of an audience of physicians in a medical school overseas - who all want to hear about waterbirth and the incorporation of Gentle Birth practices and principles into their routines.
Think about what you can do and call me if you want to chat or if you have some great ideas on how we can quickly move into the black and keep waterbirth alive and thriving. We need your help. Barbara Harper needs your help. The waterbirth/gentlebirth movement needs your help.

Barbara Harper, RN, CLD, CCE
Founder/Director Waterbirth
503-673-0026 -office
(out of US or in Portland)800-641-2229 - toll free
503-710-7975 - cell phone
We LOVE helping women get into Hot Water!!
And have been doing it for 24 years!!

Friday, December 7, 2007

Assisted Cesarean: Bridging the Hormonal Gap?

I am not sure how I feel about Assisted Cesareans. I guess the proof is in the pudding and if there is a doctor willing to go this far to give a woman a more humanized c-section experience, then I fully support that.

I mean, it is right there, all over her face, how strong the bonding is with this woman and baby

and how different that is contrasted with these cesareans:

Having never had a cesarean, I can't begin to imagine how this view must seem from the perspective of the mother. Looking up at a blue curtain, often restrained because of shaking and the need to protect the sterile field, some tugs and pulls and then suddenly the cry of a baby. Is the cry recognized right away as that of their child? Do we need both the visual and the aural in the first few seconds after birth to recognize our child? Or in fact, do we need the picture, the sound and most importantly the hormonal release in order to instantly identify and protect the child that is ours and ours alone?

Mom up there in the first picture is oozing with love hormones. Mom down below, a little dazed, happy but bewildered. I have seen this look at natural births as well, especially when labor is very fast, but the first touch usually resolves the shock and hormones start flowing. I have also witnessed moms take hours, sometimes days to fully come to terms with the reality of the baby that has been born via c-section. Where is the experiential proof of the birth of this child?

At least if women are able to experience assisted cesareans, they have the proof, there touch has a memory that will last a lifetime.

For a very clear and concise view of women's birth experiences as told through pictures,
It is quite amazing and you can't dispute what is captured on film.

Wednesday, November 28, 2007

Birth Choice is a Feminist Issue

Finally some discussions are happening about birth and feminism. I feel like feminists have covered so much over the years, and I benefit from the hard work of amazing women on a daily basis...but where is birth in all of this? Our rights as birthing women have gotten worse and worse and there has been very little discussion about birth as the other choice among feminists.

Now birth is my work, so of course it is the topic I eat, breath and dream about. I understand that we all have our focus and very little room in our already packed brains to branch out most of the time, but birth should be important to everyone. After all, it is the one thing that we all experience. It sets us up for failure or success for the rest of our lives. Birth makes the world go round, literally. No matter what your spiritual beliefs, the planet was born and we along with it.

Birth is the quintessential cause of our time. We have finally figured out the process of birth, for the most part. Contrary to what we believed for centuries, we now know that babies feel pain, so the world seems to be a little more empathatic to the baby's needs and feelings, and now we have effective ways of dealing with the very real, but not as common occurance of *true* childbirth emergencies. So why in the world are we still ignoring the physiologic and emotional needs of women during childbirth?

Monday, November 26, 2007

If I can help just one...

I have been thinking a lot about how best to help my clients work through a difficult birth. Because attending difficult labors/births take me to close to the emotions surrounding my own birth experience, I have a tendency to suddenly lose all of my energy after a birth, once I am home and with my family again. If it were possible, I would just wipe my hands clean of the woman's trauma and hold my son tighter, thanking whoever, that it wasn't me birthing that baby in that way.
This is just not the right way to go about healing trauma, I know that from experience. What I want to do is hold my clients against my chest so they can feel how similarly our hearts ache and beat with mourning. I want to get angry and rage and bring the same out of them. I want to write letters and start movements and pursue the birth machine with these mothers fighting along side of me.
I don't though, or can't. I feel all too often that my hands are tied and the best thing for both mother and baby is the ensure that nursing goes well and make sure that I follow up with visits and a few phone calls and lots of praise. The need to fill in the blanks for them is so great, but it is best if the process unfolds at a pace that is right for each woman.
I want to scream when horrible things occur at births and women go back to their providers for the their next child. But I get it. I understand how easily one can forget the pain, helplessness and fear that accompanies too many births in this world. Once you hold your baby and smell their head; Turn them over and look at their little butts; clean their bodies and relax into their nursing patterns; it all goes out the window.
I get it, I just don't want to sit back and allow it to happen anymore.

Saturday, November 24, 2007

Who Am I? How Did I Get Here?

Inspired by an MDC post, SO: Midwives, Birth trauma and Conclusion for the parents..., I have decided to put it all out there. This blog is my release of emotions about my birth, your birth, upcoming births, any birth that I have an inkling to talk or rant about, including the birth of me as a hands off, non-interventive, fun loving, balls to the wall midwife.

I am 30 years old. A mother, wife, doula, apprentice/primary under supervision midwife, non-creating artist, reader, and lover of nature.

Almost 5 years ago I was faced with a stressful, very difficult decision put forth to me by my then midwife and her partner. I lived in Washington state where the regulation of midwifery and homebirth is both thorough and oppressively strict. Some may argue that this makes it safer, I believe these laws restrict birthing women's choices and allow the state to dictate the ways in which a midwife can provide care for their clients, often at the expense of both mother and baby's well being. I was 42 weeks in my pregnancy and told that my midwife could no longer attend my birth at home because of state law. After several unsuccessful attempts to induce "naturally", including using acupuncture, herbs, homeopathy and finally the dreaded castor oil, my baby and were definitely not ready for labor to begin. By this time I was under a lot of stress and felt completely defeated. My midwife discussed the issue of me being what she considered post dates with her consulting OB. Without ever meeting me in person, looking at my chart or reviewing my perfectly normal, healthy non-stress test results, of which I had 5, the OB told me he had "not had any woman go past 42 weeks since 1984 and it wasn't going to happen with me." I was advised to report to Tacoma General the next morning for induction with cytotec. My husband and I pushed this date back two more days to give me time to go naturally and weigh the pros and cons. I couldn't even think at this point and just died, right then and there. With fear, reluctance, loathing, anger and sadness, I went to the hospital and started the induction on Thursday, Dec. 26, 2002. I was given no information about the possible side effects of cytotec, pitocin, epidurals or narcotics, not by the nurses, doctors or my midwife who came along to act as my doula, though I had my acupuncturist and a good friend in attendance with that role. Though I was told the entire time that I couldn't do it, that he was too big, that I was too tired, that I was selfish, that my uterus was too weak, and finally that I would kill him if I didn't consent to a c-section right away, after 3 1/2 days, the firing of one doctor, and an epidural on the morning of the 3rd day, my son was born vaginally with a nuchal arm and big 2nd degree tear at 3:11pm. He weighed 8lbs 9oz, was 21 1/2 in. long and the hospital pediatrician on call evaluated him and said he could not be any older than 39weeks, tops.

Now here is where my frustration comes in most. My husband and I knew my dates were not accurate. I have always had irregular, anovulatory cycles, we had been trying for several months to get pregnant and had stopped charting to help the spontaneity. When I met my midwife I made it clear to her that my dates were just guesses based on when hubby and I had sex. I agreed to an ultrasound to try and date the pregnancy but it was after 20 weeks, so the accuracy of the revised date was unreliable, even though I know now that it would have been correct. I didn't know this because no one told me at the time. I agreed to non-stress tests because I intuitively knew that my dates were off, my baby was fine and the tests would prove this. What I didn't know was the the consulting OB would not accept the revised due date or the NS test results. He went off the original date given and treated me like a cow. I felt like he couldn't wait to get in there and pull that calf out.
No one told me how important that due date is in a state where the midwives wear shackles. No one told me I could birth with a non licensed midwife or drive down to Portland, OR and have my baby with a midwife who followed her intuition instead of her politician. Most of all, no one told me that the decision was mine and mine only and to listen to my heart and my baby. If I knew then what I know now I would have birthed unassisted and had by beautiful son at home.

So that is who I am now and how I got here. The birth of my son defined me and will shape the rest of my life. I am the midwife that I never had. The keeper of birth justice. The voice of informed consent. The holder of memories that drive me to be better.