UK Homebirth Statement

In February I posted about the joint statement on homebirth issued by the Royal College of Midwives and the Royal College of Obstetricians and Gynecologists. Citizens for Midwifery has officially joined with other midwifery organizations in endorsing this statement.

It still remains absolutely stunning to me to see the different attitude expressed by RCOG compared ACOG! In the conclusion of the RCOG statement it says, "[for midwife attended homebirth]...outcomes are likely to be optimal." This is in such stark contrast to the statement widely publicized earlier this year from the American College of Obstetricians and Gynecologists.

Mothering in the U.S.

In the news recently is the sobering reminder that mothers in the U.S. face a variety of challenges to their health and wellbeing. From the National Association of Mothers' Centers e-news:

"...the United States placed 27th in an international ranking of best and worst countries in which to be a mother.

That's right, 27th!

The US-based, independent global humanitarian organization Save the Children has published its 9th annual Mother's Index as part of its State of the World's Mothers 2008 report. The well-being of mothers is analyzed and compared in 146 countries.

Analysts looked at a number of factors, including the likelihood of death in childbirth, female life expectancy, expected years of female schooling, maternity leave benefits, participation of women in national government, and the ratio of female to male earned income.

The US has the highest risk of maternal mortality in the developed world. Women are only 17% of elected legislators in the US Congress. There is no nationally guaranteed paid maternity or paternity leave, and women only earn 66% of what men earn. The US fell one place in the ranking this year, having held the 26th spot in 2007.

The top ten countries in which to be a mother include: Sweden, Norway, New Zealand, Ireland, Germany, France, and Finland. Other countries ranking better than the US are: Italy, the Czech Republic, Slovenia, Greece, the United Kingdom, and Lithuania."

CIMS has a new site!

The Coalition for the Improvement of Maternity Care Services has launched a lovely new site! Check it out soon and explore their useful resources section, learn more about the Grassroots Advocacy Committee, and check for updates on The Birth Survey project.

Of Midwives and Laws

There has been news lately from advocates in both Maine and Missouri regarding the licensure bills that they were attempting to pass this legislative session. In Maine, the licensing bill was rejected, but approved a new law allowing CPMs to carry and use certain medications (such as pitocin). You can read more about this on the Midwifery World blog.

In Missouri, valiant attempts to pass a bill licensing CPMs was thwarted in the last hours of the legislative session. The bill managed to make it through the Senate (a first in years), but with only hours left in the session it was not heard in the House and thus did not make it to fruition. Hopes have turned to the Supreme Court case regarding the bill from 2007 and a decision is expected on June 10. You can read more in this St. Louis Post-Dispatch article. (The article uses the term "lay midwives", though the bill was actually about Certified Professional Midwives.) There is additional information on the Midwifery World blog as well.

CfM News: Small Stone Birth Activism

The spring 2008 issue of CfM News contains an article I wrote called "Small Stone Birth Activism" about the many ways people can contribute to improving the birth culture in the U.S. I have uploaded a slightly edited version of the article here in case people are interested in reading it.

Business of Birth article

Google Alerts alerted me to the following blog article at babygooroo that quotes CfM President Susan Hodges. The article is a really nice look at The Business of Being Born and about the author's personal experiences with maternity care and deciding to switch OB practices when her first doctor was dismissive of her needs.

Celebrate Doula Month!

May is International Doula Month!

Here are a few ideas of how to celebrate International Doula Month in your community:

• Have a community family picnic in the park with a big banner announcing that it is doula month! Invite all of the local doulas and birth professionals as well as lots of happy families :)
• Ask the public library if you can use a window display area for a doula information display.
• Send a letter to the editor about doulas or about your personal experience with a doula.
• Send a present or thank you card to your doula (if you had one).
• Send a donation to a doula or birth organization.
• Wear doula t-shirts or other birthy t-shirts and carry tote bags from doula organizations.
• Ask pregnant women if they have a doula and be prepared to share information about all of the benefits of a doula.
• Send out press releases to local papers.
• Be a "day sponsor" on your public radio station.
• If you are a doula, perhaps sponsor a "contest" of some sort with doula services as the prize.
• If there is a community health fair coming up, plan a booth with information about healthy birth, doulas, midwives, and so forth. Many communities have health fairs or women's health events in the spring.
  

For some cool inspiration about promoting midwifery and homebirth in general at a public event or fair, check out this blog post from a midwife in South Australia!

-----------------------------------------------------------------------------------
What is a doula? A doula is a non-medical labor support provider who offers her continuous emotional and physical support to women in labor, as well as information and support prenatally and postpartum. Doulas can make a huge difference in the quality of women's birth experiences, particularly in a hospital setting (research has demonstrated significantly lowered rates of interventions as well as increased satisfaction). You can read more basic information about doulas on the websites of the doula organizations DONA and CAPPA.

More about new CfM fact sheet

From Susan Hodges via the Grassroots Network:

Dear Friends,

CfM created a well-received poster for the Coalition for Improving Maternity Care (CIMS) conference in February titled What Does Good Maternity Care Look Like?, and we have made a hand-out version. The colorful flier (which also looks good in black and white) includes the Midwives Model of Care, CIMS Ten Steps of Mother Friendly Care, and Lamazes Six Care Practices that Support Normal Birth, side by side, with their urls, with the caption "Supporting evidence-based care, and promoting healthy mothers and babies!
We have now posted this flier here.

Please feel free to print it out and use it for classes, conferences, whatever. It gives a powerful message of "you don't have to take my word" for what constitutes good maternity care!

Sincerely,
Susan Hodges, "gatekeeper"

What Does Good Maternity Care Look Like?

Citizens for Midwifery has put together a nice new handout with three models of good maternity care presented side-by-side--The Midwives Model of Care, the Ten Steps of Mother-Friendly Care, and Six Care Practices that Support Normal Birth. It is great to have handout like this showing the compatibility between all of these evidence based models of healthy, effective maternity care and we are pleased to make it available!

Happy Mother's Day!

Some quotes from recent reads in honor of Mother's Day:

"We were all held, touched, interrelated, in an invisible net of incarnation. I would scarcely think of it ordinarily; yet for each creature I saw, someone, a mother, had given birth....Motherhood was the gate. It was something that had always been invisible to me before, or so unvalued as to be beneath noticing: the motheredness of the world."

--Naomi Wolf, Misconceptions

"I believe that these circles of women around us weave invisible nets of love that carry us when we're weak and sing with us when we're strong."

--SARK, Succulent Wild Woman

"The minute my child was born, I was reborn as a feminist. It's so incredible what women cam do...Birthing naturally, as most women do around the globe, is a superhuman act. You leave behind the comforts of being human and plunge back into being an animal. My friend's partner said, 'Birth is like going for a swim in the ocean. Will there be a riptide? A big storm? Or will it just be a beautiful, sunny little dip?' Its indeterminate length, the mystery of its process, is so much a part of the nature of birth. The regimentation of a hospital birth that wants to make it happen and use their gizmos to maximum effect is counter to birth in general."

--Ani DiFranco interviewed in Mothering magazine, May/June 2008

Happy Mother's Day!

Our Bodies, Ourselves: Pregnancy & Birth book news

I previously posted an excerpt of my review of the new Pregnancy & Birth book from Our Bodies, Ourselves. (My full review is available in the spring issue of CfM News.)

I just received an email from OBOS letting me know that the University of Michigan Health System is buying a huge quantity of the books to distribute to every prenatal client in their system. Isn't that great?! Wouldn't it be wonderful if other large institutions did this as well? The book is an affirming, empowering, woman centered book that is mainly based in a "climate of confidence." I would love to see that climate of confidence spread to become the norm in prenatal care and birth, instead of the "climate of doubt" in which many providers approach pregnant women, prenatal care, labor and birth.

Quantity discounts on the book are available for institutions wishing to follow the lead of the University of Michigan!

Maternal Mortality map

Jessica in MO sent me a link to the WHO graphic on maternal mortality rates (it is coded by color). You can view the image here. It is a dramatic visual, because I think most Americans would assume the US maternal mortality rate to be "blue" (which is the best-- less than 10 deaths per 100,000) along with Canada and Europe, but instead we are "green" along with Russia, Egypt, Latin America, and Turkey.

Breastfeeding & Birth Practices

I have a particular interest in the impact of birth practices on breastfeeding. Birth and breastfeeding are part of a continuum and it often seems forgotten or ignored that routine birth practices can have a significant impact on disrupting the breastfeeding relationship. Disturbed births lead to disturbed breastfeeding. An article I enjoy on this subject is one called "Winning at Birth" by Linda J. Smith, IBCLC (co-author of the book Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum ). In her article, Linda draws a parallel between preparing for an athletic event and preparing for birth (hence the use of the word "winning").

"Winning at birth - what an odd concept. Birth isn’t a contest. Or is it?...Birth is a very physical event, one in which our bodies have to exert themselves, perform. Birthing requires muscle control, determination, and grit. We even urge women to sign up for classes and practice. Women often grunt, groan, and make noise during birth just as athletes do. And because there is risk and a possibility for injury, the athlete is surrounded by skilled attendants."

As one of her tips for "winning at birth," she emphasizes choosing your birth attendant wisely (and I was happy to see she mentioned midwives as an ideal attendant to help you win at birth! Which then helps you "win" at breastfeeding.)

"Hire a skilled birth attendant as your coach. Your professional birth attendant’s attitudes and skill will play a major role in setting the stage for your baby’s birth. A professional midwife is an excellent choice, and many physicians actively support normal birth. Your professional attendant’s attitudes and beliefs about your ability to give birth normally and naturally will color all of her/his decisions and actions on your behalf. A good birth coach instills confidence, skill, and a winning attitude in her/his clients."

Speaking of midwives and breastfeeding, the most recent article from the International Breastfeeding Journal is titled "Assessing midwives' breastfeeding knowledge."

Cesarean Research

Last week I read a recent article connecting cesareans to a risk for strokes.

From the American Journal of Obstetrics & Gynecology 2008; 198: 391.e1-391.e7 (29 April 2008) via MedWire News Cesarean section (CS) delivery is an independent risk factor for stroke, a study of almost a million births has revealed. The researchers found that women who had cesareans had significantly higher stroke rates at 3 months postpartum, 6 months postpartum, and 12 months postpartum.

"Shiyng-Yu Lin and co-workers suggest CS delivery could alter hemodynamic and coagulation status, thereby predisposing to stroke.

'Based on the results of this study, a reduction in the CS delivery rate should prove to be beneficial for stroke prevention,' they conclude."

This week, another study reported that unexplained stillbirth is not linked to prior cesarean section. Source: BJOG: International Journal of Obstetrics and Gynecology 2008; 115: 726-31
(MedWire Posted: 6 May 2008).

International Midwives Day!

May 5th is International Midwives Day, which has been celebrated internationally since 1991. The theme for 2008 is Healthy Families: The key to the future.

Here are some ideas to mark this day in your community:

• Be a "day sponsor" on your local public radio station--either in honor of International Midwives Day or in honor of your own baby (but include in the day sponsor message that she/he was born at home with a midwife).
• Plan a simple community family picnic in the park (bring a banner that says what you're celebrating!)
• Send a press release to your local newspaper or radio stations.
• Wear pro-midwifery buttons or pins.
• Wear t-shirts or carry tote bags with pro-midwifery slogans on them.
  
• Ask every pregnant woman you see if she has a midwife!
• Make a donation to a midwifery or birth related organization (hmm...maybe CfM! ;-)
• Mark the day with a brief personal acknowledgment by lighting a candle for a bright future for midwifery everywhere.

You can read more about International Midwives Day on the Midwives Alliance of North America (MANA) website.

Robot Birth?

This article is from 2006, so it isn't new news, but was the first I had read about the kind of robot used to train people in obstetrics in managing birth.

From the article:

"The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It's better to make a mistake on a $20,000 robot than a live patient.

The Institute of Medicine, an arm of the National Academy of Sciences, estimates that as many as 98,000 U.S. patients die annually from preventable medical errors. [emphasis mine]

"We're trying to engineer out some of the errors,'' said Dr. Paul Preston, an anesthesiologist at Kaiser Permanente and architect of the hospital chain's 4-year-old pregnancy-care training program, in which Noelle plays a starring role. "

The robot is very technologically advanced and can be programmed for all kinds of "disasters" as well as for more straightforward situations. She "gives birth" to a baby with vital signs and respiration (both mother and baby can also urinate and bleed!). While I am certainly glad this teaching tool reduces the amount in which birthing women are used as guinea pigs, there is something about this "tool" that, quite frankly, really bugs me. I guess because birthing women ARE often seen through mechanical terms and as a collection of parts rather than a real, feeling, caring woman. So using a mechanical tool to prepare for attending real women in birth seems to reinforce that view of women, labor, and birth.

Thanks to Debbie in Missouri for sharing the link to this article in the first place.

In addition, I am editing this post on 5/11 to note I just read a more current article (from April 2008) on the Knoxville News site.

"'These drills are usually held for situations that don't happen very often but are very serious when they do happen,' Fry said. 'The nurses need to be able to act automatically.'"

When I read this, I immediately thought of all the normal birth situations in which nurses also act "automatically" and pursue routines instead of individual needs and wishes :(

Research the kind of birth you want...

Though smaller scale, it was a nice change from the Time magazine article (see post below) for me to read the article "Research kind of birth you want and who can best deliver" in the Anchorage Daily News. The article quotes CfM in the definition of a midwife as: "a knowledgeable and experienced person (usually a woman) who helps a woman have a healthy, normal pregnancy and give birth to a healthy baby."

"A good midwife does this by offering education, counseling and support before, during and after the baby is born, by not interfering unnecessarily with the birth process and by getting appropriate medical attention for mother or baby if it should be needed."

Grassroots Network: Time Magazine Article

Grassroots Network Message 804020
Time Magazine: “Choosy Mothers Choose Caesareans”

Dear Friends,

Time Magazine (April 28, 2008 Special Environment Issue, page 65) includes a really poor article “Womb Service. Why more women are making caesareans their delivery of choice.” You can read it online (under the title "“Choosy Mothers Choose Caesareans”).

The author, a senior reporter with Time, apparently bought the medical myths -- that women are choosing cesareans, that they are “safe”, and that vaginal births cause pelvic floor damage -- hook line and sinker, and/or did little or no research on her own.

Time should hear from us! You can e-mail a letter to the editor by clicking on the author’s name on the on-line version, or writing to: letters@time.com. Do not send attachments, and include your full name, address, home phone, and note that your letter may be edited. If you look at letters that are published, they tend to be pretty short and are likely to have a bit of a punch or humor. However, the main point is that they should hear from a lot of us, whether or not any of our letters actually make the cut for publication.

The worst fallacy is that the author states that some of the rise in C-sections “can certainly be attributed to women with routine pregnancies, like Chung [the only mother featured] who make a pragmatic decision to keep their deliveries just as uneventful.” [not sure what the author means here as uneventful as??] In fact, the ONLY evidence collected about women choosing cesareans is the Listening to Mothers Survey which found that fewer than one percent of women who could ask for a primary cesarean section for no medical reason actually do so. Prior research claiming to indicate rising rates of “Patient Choice Cesareans” was based on hospital discharge data which shows only that there has been an increase in cesarean sections performed prior to labor for no recorded medical reason. The hospital data used did not include any information about women’s preferences or choices.

The author also states “Since doctors are sued more frequently after vaginal births than caesareans, surgery is often the prudent choice when there is even the slightest indication of a difficult vaginal birth.” In other words, the doctor’s fears of lawsuits trumps a woman’s right to true informed consent and to bodily integrity! Fear of a lawsuit justifies surgery!!

And the author states “Vaginal delivery can, for example, lead to future incontinence and pelvic damage…” This conjecture, widely touted by the obstetrical community as a justification for medically unnecessary cesarean sections, has been roundly discounted. Harmful birth practices by obstetricians, including drugs to intensify labor, epidurals that lead to medically assisted birth, episiotomies, supine (on the back) position for pushing, and breath-holding pushing on command definitely contribute to pelvic damage and may contribute to future incontinence, but these are not caused by vaginal birth itself.

A useful resource for facts, links and references on so-called maternal choice cesarean section can be found on the CfM site.

Sincerely,

Susan Hodges, "gatekeeper"

Birth Customs

"Pay attention to the pregnant woman! There is no one as important as she!"

(Chagga saying, Uganda)

I recently finished reading the very interesting book Mamatoto. I briefly referenced this book here a few weeks ago and it was fun to finally read it. The book is essentially a look at birth in a variety of cultures (including the US). It was published by The Body Shop in 1991. Even though it is "old" it isn't really "dated" since it is a brief overview of different customs and rituals and so forth and not a lot of statistics. There are a lot of absolutely fabulous (and fascinating) pictures and illustrations. These are probably the highlight of the book. Each chapter is followed by a "black page" of "facts you don't want to know" about such things are reproductive health care policies in Romania and things like that.

One of the things that struck me about this book was that there was little distinction made between the customs of other cultures and the customs of the US. For example:

"People in Tibet believe that whether or not labour is due, a child won't come out into the world unless the star under which it's destined to be born is shining. Western medicine has developed a way of starting labour artificially, by injecting into a woman's blood a simulation of the hormone oxytocin, which triggers contractions. For several years during this century, an unusual number of women laboured between the convenient hours of nine and five on weekdays...As the Malaysians say, a baby is like a fruit; it will be born when it's ripe."

I absolutely loved seeing Western culture put into the proper context like this. Too often we see our way as THE way and forget that much of what the dominant culture views as normal for birth is not necessarily truly normal, but is instead and artifact of, or custom of, our culture. Viewed from a distance the routines of birth in American are just interesting customs--in Tibet, born when the proper star is out, in the US, born when artificial hormones are injected...

I may not be explaining myself clearly--I just found the "distance" in perspective refreshing and interesting. It reminded me of the work of anthropologist Robbie Davis Floyd whose book Birth as an American Rite of Passage explores the "ritual" elements of hospital birth in America and compares and contrasts the "technocratic" model of care with a holistic, woman-centered model of care (an example of which would be the midwives model of care). She asserts that there are many elements of hospital births that serve as rituals to reinforce the technocratic model (rather than to serve actual purposes, but instead to send cultural messages as well as to initiate the baby into the technocratic model). Examples of ritual elements include putting on a hospital gown, riding in a wheelchair, and having a routine IV. These elements serve to enculturate the woman and baby into a particular model--a ritual function--rather than an individually appropriate method of care.

Another example from the Mamatoto book that I enjoyed was as follows:

"'Home birth' can mean different things to different people. It can mean a bedroom, dimly lit and scented with myrr; a sweatbath perched on a Guatemalan hillside, or a birthing pool in an English flat; a warm fireside in a Himalayan kitchen; the packed-snow sleeping platform of an Inuit igloos; or a one-room shack in Jamaica, with a washing line dividing the family bed and the children waiting on the other side for a first glance at the baby who will be held up for them to see. When a woman gives birth at home, she and her family have a degree of control over the event; it's their domain."

In short, at home the family is on their own "turf" rather than in the "culture" and "ritual elements" of an out-of-home environment.

BIRTH Tour

Last spring, my local public radio station (Rolla, Missouri) aired Thin Air Media’s production of BIRTH, a one hour long documentary about childbirth in America today. BIRTH is an audio journey through practices and perceptions of birth in America and was developed by Public Radio International for Women's History Month, March 2007.

This program helps frame birth as an issue of political, cultural, and social concern. Instead of a “fringe” issue accessible only to readers of Mothering or Compleat Mother, a program like BIRTH brings childbearing to national, public awareness. I feel optimistic that the increasing visibility of birth issue via media sources such as this indicate we are reaching a “tipping point”—a critical mass of public awareness generating a pendulum swing to true social change/transformation in support of normal, healthy birth as a family event, instead of a medical diagnosis.

A small criticism of the program is that it is difficult to get any sense of who is speaking at any one time—could be dozens of people (it is) or just five (it isn’t). There is no transition between the speakers or introductions of them. It is confusing and lacks continuity. It may also be difficult for the casual listener somewhat difficult to assess the “message” or primary theme.

One of my favorite quotes from the program is as follows (a young man speaking):

“Anybody who has witnesses a woman give birth, their wife, or whoever it is. Just seeing the commitment, the love. Just phenomenal. I mean, how we have evolved to this point and that we just should be bowing down to women as just these special, special creatures…”

How crucial it is to hear this message. Deeply hear it. Thanks to the BIRTH Tour many people had the opportunity who otherwise may never have done so.

To read more about the program or to purchase a copy of it ($20) visit Thin Air Media's site.

-----------------------------------------------------------------------------------------------
More about the documentary quoted from the site:

"BIRTH: A one-hour documentary about the practices and perceptions of birth in America.
Starting with early perceptions, we move through the process of birth beginning before labor, continuing during labor, and following the actual event. With a multiplicity of voices woven with sound we examine the process of birth from an emotional, physical and philosophical perspective.

As we move back and forth through time and from person to person, we discover how stories from our lives, history, media, and the medical institution enter into the culmination of the actual birthing process.

Birth is a rite of passage through which all human beings pass. Is it the same as it ever was? Why do some women feel deeply empowered by their birth experiences and others feel stripped of their motherhood? Where do our expectations about how we give birth come from, and how do they play out when we approach the event? What is the baby’s experience? And what about the father’s role?

Turn on the television or watch a movie and you're likely to see birth portrayed as an emergency medical procedure. Is this a true depiction of what happens? Perhaps, and yet there are many ways in which to approach the experience. Above all else, we are biologically predisposed to be interested in this topic. Quite simply, when it comes to birth everyone can relate."