Birth Book by Raven Lang!

CfM has exciting news! The beloved classic Birth Book by Raven Lang has been reprinted in a limited edition and CfM has copies for sale (we are still working on this catalog entry, so more information will be available on the CfM site in a few days). It is very difficult to find a copy of this book on the secondary market (such as from Amazon). In the early 70's, Raven Lang was a self-trained midwife in Santa Cruz, CA. She and her sister midwives opened a birth center and served many women before one of the midwives was arrested in an undercover sting operation by a law enforcement couple posing as homebirth clients. Birth Book was the first woman authored, empowerment model, homebirth-oriented book to come out of the childbirth and midwifery movement of the 70's (published even before the better known and also much beloved classic, Spiritual Midwifery).

The Our Bodies, Ourselves website has this to say about Birth Book:

"The Birth Book was truly a book of the early 1970s. It existed in one trade edition, went into several printings and passed too soon out of print. It possesses a rare vitality and ingenuity. Well-produced, it has the feel of grass-roots effort and inspiration and bespeaks an optimism hard to come by nowadays: 'We have been asking and asking the people in positions of responsibility to respond to our needs and the needs of our children. Now we realize that we must do more than just ask, so we have chosen to act...(joining) hands in a struggle for human birth.' (Introduction) It contains photo after photo of families and of women giving birth in many different positions."

The California Association of Midwives has more to add:

"Raven is perhaps best known for writing the Birth Book. When she wrote it, very little else had been published about birth. All that was in common circulation were Lamaze and Dick-Read. She felt that teaching only opened a handful of women to the possibilities of what birth could be. She wanted to shout it out to the world. The first edition of the Birth Book was self published. She had been in contract with a publisher, but she was informed that she would have to remove all pictures of vulvas and bottoms. She chose to publish herself instead. Today, editions of the Birth Book sell for as much as $200, so hold on to your copies, ladies, they are precious."

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Excited yet? I am! I cannot wait to get my copy of this historical treasure!

Grassroots Network--CIMS Forum

From CfM President Susan Hodges posting to the Grassroots Network email list:

Calling All Maternity Care Activists!

Dear Friends,

We do not "advertise" every birth and midwifery-oriented conference on the Grassroots Network, but here is an opportunity especially for birth activists, in conjunction with the Forum and Annual Meeting of the Coalition for Improving Maternity Services (CIMS).

The message below, from the CIMS Grassroots Advocates Committee, is about an opportunity to get involved by participating in a training that will take place on the first day of the forum, Thursday, March 6, in Orlando. This is an exciting opportunity to get involved in real
grassroots, bottom-up, projects that will help pregnant women get the information they need about their local maternity care providers in order to make informed choices.

The 2008 CIMS Forum: Mother-Friendly Care By All, For All, will take place on Thursday, March 6 - Saturday, March 8 in Florida (near Orlando). Find complete information here.

Please feel free to forward this message!

Sincerely,
Susan Hodges, "gatekeeper"

Original message:

Calling All Maternity Care Activists! Enjoy a Family Vacation and Reinvigorate Your Birth Activism! You are invited to attend the "CIMS Grassroots Advocates Ambassador Training for The Birth Survey" and become a project ambassador at the CIMS Forum in Orlando, Florida.

Interested in gathering obstetric intervention rates for the hospitals and birth centers in your area? Become a GAC STATS Ambassador and work with us to collect obstetric intervention data at the facility level for all 50 states. The public has the right to know what is happening
in our hospitals. We will provide you with the support, tools and guidance you will need to connect with the right people in your state, access the data, and get the data out to the public.

Want to help spread the word in your community about The Birth Survey? A consumer feedback tool similar to "Angie's List" or "Consumer Reports," but for maternity care where women provide and view feedback on specific doctors, midwives, hospitals and birth centers in their local community. Join the GAC Marketing Ambassadors and help make The
Birth Survey a success in your area. We'll provide you with marketing tools and materials designed to engage the public and generate excitement.

If these activities are of interest to you, please come to the GAC Ambassador Training at the CIMS Forum. Thursday, March 6th from 9am-3pm in Orlando, Florida. Click here to register.

Scholarships: A limited number of need-based full registration scholarships are available for the forum and training. Apply online for a scholarship.

CIMS Forum: To learn more about CIMS, the 2008 Forum, and to register for the CIMS Forum and the included GAC Ambassador Training please visit CIMS online.

For more information on the GAC Ambassador Training and The Birth Survey visit The Birth Survey site.

Please pass this announcement along to other interested activists, listserves, etc. Thank you and we hope to see you at the CIMS 2008 GAC Ambassador Training- CIMS Grassroots Advocates Committee.

More About Pushed (& more about evidence based care)

In October, I was delighted to finally read Pushed by Jennifer Block. I wanted to add my thoughts and comments to those shared earlier by Susan Hodges. This book is seriously GOOD! Wow! Lots of weighty, meaty information, scathing critiques, astute observations, and clever commentary. She has plenty of scientific backup for her claims and the book is written in an engaging, fast paced style that skillfully weaves facts into descriptive commentary and personal, illuminating interviews. I checked this book out of the library, but after seeing all of the data contained within--she's pulled together vast quantities of data about effectiveness of "routine" practices, etc. and made it accessible to the average reader--I knew I had to put it at the top of my Amazon wish list.

Pushed is a thorough critique of obstetrics as an industry and how women and babies are being HURT by the systems ostensibly in place to "protect" them. Especially thought provoking is her descriptive exploration of the cesarean epidemic. She points out on one occasion when discussing uterine rupture as the common reason used to deny women VBACs, that a cesarean is a "controlled uterine rupture." Later, in a separate section regarding blood loss during birth, she mentions that average loss is 300-500 mil and over 500 is considered a hemorrhage. She then notes that during a cesarean the average loss is 1000 mil. Reading that, I was struck with the realization that essentially with a cesarean you have a 100% chance of a uterine rupture AND a 100% chance of a hemorrhage. Wow!

During the conclusion of the book after a discussion about the NAPW and whether childbirth is a reproductive right or not:

"To her [a doctor who thinks it is not], it is a medical issue, one that may need reform, but one that belongs under the purview of physicians. 'To my mind, I'm all for people having a pleasant and safe birth experience,' she says. 'But my highest priority would be for them to have a safe birth experience.' But what's considered safe is political. What's safe changes. Thirty years ago obstetricians said VBAC was dangerous. Then they said it was safe. Now they've gone back to saying it's dangerous. ACOG says out-of-hospital birth isn't safe, but the research has consistently suggested that for women with normal, uncomplicated pregnancies it is not just safe, but safer, because those women are far more likely to have a normal, spontaneous vaginal birth and far less likely to experience harmful, unnecessary interventions...."

"...The goal is to have a healthy baby. 'This phrase is used over and over and over to shut down women's requests,' she [Erica Lyon] says. 'The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful'...What's best for women is best for babies. and what's best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the kind of experience that most women have. In the age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial considerations, by a provider's licensing regulations and malpractice insurer. The evidence often has nothing to do with it." (emphasis mine)

The only critique I have of this book is one I echo from several other reviews. The book fires you up and has a lot of passion and energy, but provides no outlet or ideas for where to channel that energy. There is no "resources" section, no suggestion to join Citizens for Midwifery or your state midwifery advocates, no list of birth-positive organizations who are working diligently for birth change in our culture, etc.

Cesarean Handout from Childbirth Connection & Mothering

In September, Mothering magazine published an excellent article called Cesarean Birth in a Culture of Fear. In addition to being a thought provoking analysis of technological birth in the US and the ever-rising cesarean rate, it was also extremely well illustrated (including a remarkable computer created image of a woman in a "traditional US hospital setting" that gives me chills--she has 16 different "attachments" hooked up to her as she tries to focus and give birth to her baby). There is a series of illustrations that very clearly demonstrate the step-by-step process of a cesarean in a way that we rarely see. Now, this useful article has been turned into a booklet and made available as a handout on the Childbirth Connection site!

Speaking of Childbirth Connection, they also have another good
handout available titled Comfort in Labor. It is by Penny Simkin and it has TONS of great line drawings and covers a lot of labor support material in 14 pages. For doulas, it is almost like a "Cliff's Notes" version of a doula training!

Evidence Based Care

Simply put, evidence based care is care that is based on the best available evidence (research, studies, accurate, up-to-date published materials) and upon the individual woman’s unique situation. Any interventions are applied judiciously and with consideration of true medical indication and also the needs of the woman. Evidence based care is different than “routines” or “policies” which may or may not have a basis in evidence.

Childbirth Connection defines evidence based care as: "using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making."

The excellent exhaustive research summary and review A Guide to Effective Care in Pregnancy & Childbirth (also available for free download from Childbirth Connection) includes a helpful series of six tables classifying hundreds of maternity practices according to effectiveness and safety. The tables range from: "Beneficial forms of care" to “Forms of care likely to be ineffective or harmful.” Pregnant women and their support people may wish to refer to these tables in order to be informed consumers of the care they are being offered. They may also wish to refer to the tables and to the rest of the book if they are concerned about a test or procedure recommended by their caregiver or if they would like to suggest a practice that differs from that offered "routinely" at the location where they are choosing to birth or if they would like to double check the consistency of their local policies, procedures, and routines with the scientific research.

Lamaze's Six Care Practices, referenced earlier in this blog, are evidence-based practices that promote, support and protect normal birth.

Finally, Citizens for Midwifery has an excellent fact sheet summarizing the evidence behind the Mother Friendly Childbirth Initiative’s 10 Steps.

Giving Birth--Book Review

Giving Birth: A Journey Into the World of Mothers & Midwives by Catherine Taylor is one of my very favorite books about birth. Catherine Taylor is a skillful author and though this book is very factual and informative, it reads with the pace, intensity, and "intrigue" of a novel. It is unique among the many birth books I have read in its interweaving of her personal experiences and personal journey, with factual journalistic impressions and statistics. I enjoyed her descriptive style and the verbal portraits of the variety of midwives she encountered. The book also gave me some new perspectives on hospital based CNM practices as compared to traditional midwifery and homebirth-oriented midwifery practices.

The author is an Ivy League journalist who set out to study midwives after her less-than-satisfactory birth experience with her first son (hospital birth with a CNM). During the course of her research, she becomes pregnant with her second child. The book chronicles her interviews with a variety of midwives, her experiences shadowing midwives in home, birth center, and hospital settings, and her comments/observations about birth in the United States. She weaves her research together with the progress of her second pregnancy, her decisions about place of birth, her choice of midwife, and her experiences with training to become a doula (she trains with Birthing From Within & I found it really interesting to read a first hand account of that unique & inspirational training). The book concludes with the birth story of her second baby.

Cesarean Rate Continues to Rise (Grassroots Network)

From CfM President Susan Hodges regarding the CDC data released today about preliminary birth data and cesarean rates for 2006:

The Centers for Disease Control National today released the Vital Statistics Report "Births: Preliminary Data for 2006."

Several noteworthy items:

* "The cesarean delivery rate rose to 31.1 percent of all births in 2006, another record high. This represents a 3% increase over the 2005 rate. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade, from 20.7% in 1996."

* At the same time, preterm birth rates also rose slightly, and significantly since 1990. In particular, according to the report, late preterm births (those delivered at 34-36 weeks) have risen from 7.3% in 1990 to 9.14% in 2006. Late preterm births are associated with increased use of induction and planned cesarean sections, because actual gestational age often cannot be accurately known.

Read ICAN International's response, which includes references to studies regarding maternal mortality increases over the same time as the cesarean rate has been increasing.

Lamaze International has posted a news alert with their take on the reported 2006 data "Women Can Improve Childbirth Outcomes By Seeking Care Providers with Low Cesarean Section Rates."

Citizens for Midwifery's fact sheet "Out of Hospital Midwifery Care: Much Lower Rates of Cesarean for Low Risk-Women" is very relevant. Of course it is important to note that the rate for all "low-risk" women is lower than the percentage for "all women."

The Final 2005 Data has also been released today.

Reports of final data generally do not have significantly different numbers than the preliminary data, but the report and analysis is much more extensive.

As this newly released data hits the media, we can use the materials noted above to write powerful letters to the editor about why we need more midwives and access to out-of-hospital birth! A key question to ask is why obstetricians find it necessary to perform ever increasing numbers of cesareans on healthy low-risk women having healthy babies when midwives attending out of hospital births maintain an only 3-4% cesarean rate* (with safe results and healthy mothers and babies)?

(*Please note, I do not mean that midwives are performing cesareans themselves, but that women under their care only need to be transferred for a cesarean 3-4% of the time.)

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SEND US NEWS!
If you find news, resources or other valuable information that you think should be posted on the Grassroots Network, please send it to info@cfmidwifery.org with "for the grassroots network" in the subject line. We will definitely consider using them!

CONSIDER JOINING Citizens for Midwifery!
You can also join the Grassroots Network announcements-only email list by following the link at the bottom of the CfM home page.

Cesarean Voices--Book Review

Just in time to correlate with the sobering news of the ever-rising cesarean rate released by The Centers for Disease Control today, we offer this excerpt of a review from CfM Board member Carolyn Keefe of the book Cesarean Voices, published by the International Cesarean Awareness Network (ICAN). This book answers the question, "what's so bad about having a cesarean."

Birth advocates and professionals need to read Cesarean Voices as it will give them needed insight into this all too common experience. This book is especially important for those who try to provide support to mothers postpartum, either as family and friends or as postpartum professionals. Policy makers, legislators, regulators, and the media also need to read it and understand how this epidemic is affecting our entire society.

You can purchase Cesarean Voices from ICAN’s website. ICAN is offering bulk prices, so some organizations may want to purchase a few extra copies of Cesarean Voices to give to key local or state media outlets, policy makers, birth professionals, or to have in their own libraries. This little book packs a powerful punch, but it needs to land in the right place to make a difference.

The Official Lamaze Guide--Book Review

Excerpted from my Fall 2007 review of The Official Lamaze Guide: Giving Birth with Confidence:

This book is a refreshing presence on the shelves of my local bookstore (yes, there is only one retail book shop in my community and The Official Lamaze Guide is the only “alternative” birth book stocked in the store!). As I read the book, I kept nodding along and wishing it was in the hands of each pregnant woman in my community. Lamaze has a “name recognition” that gives this book the potential to have a wider and broader impact than other alternative birthing books which, though brilliant contributions, may only end up in the hands of “the choir.” The Official Lamaze Guide is written in such a matter-of-fact and comforting tone that I cannot see it being off putting to the average consumer as having “hippie” language or “extreme” ideas.

The blueprint for normal birth that the book lays out is extreme compared to the standard practices at most hospitals, but the way in which the information is presented opens doors of communication, understanding, and exploration as well as providing the evidence basis to back normal birth. The Official Lamaze Guide is straightforward and clearly written with an unabashedly honest and truthful message of what normal birth is and how it can either be supported or undermined.

Pushed--Book Review

From CfM President Susan Hodges' Fall 2007 review of Pushed by Jennifer Block:

I highly recommend Pushed! An eye-opening book for anyone who has not been directly involved in maternity care, and a great resource for birth activists, Pushed brings together all the important issues about maternity care, including the difficult and “grey” areas. Because it includes individual experiences and as well as facts and evidence, and is very readable, this would be an excellent book for any woman starting to think about maternity care (newly pregnant, or planning to get pregnant), and for family members who might not be supportive of midwifery care. Personally, I would also like to see every state health official, the members of every hospital board, all state public health personnel, and every medical and nursing student read this book, as one small step for raising awareness, a prerequisite for bringing about change.

Question of the Month--Preparation for Birth?

I'm starting a "question of the month" feature for this blog (at the end of the month I'll put the comments about the question together into a new post). Questions for future use in this feature can be submitted to me.

So, December's question of the month is: In our current birth culture is it possible for a woman to plan to "just experience" rather than "prepare for" birth?

I have some thoughts to share, but I'd love to read what other people have to say first!

Grassroots Network--New Websites of Interest

From Susan Hodges, CfM President...

The Midwives Alliance of North America has just announced a beautiful new public education website Mothers Naturally, which also includes listings of midwives, information about natural pregnancy, home birth, midwives and birth stories. The site is a work in progress, with
plans to expand content.

Another interesting and beautiful new website is Conscious Woman. This site is a source for interactive online workshops, at moderate prices (with CEUs) with an awesome array of presenters. If you are interested in hearing and seeing Diane Wiessinger speak for yourself, her session "What Would Mammals Do?" is one of the upcoming workshops available from Conscious Woman. You can also sign up for a half hour, free session that introduces and lets you try out the WebEx technology used for the sessions. Plus there are forums.

Many of you probably have seen Ricki Lake's new film The Business of Being Born. On the site is a trailer for the film, information about how you can schedule a screening, where it is being
shown, Ricki's blog, and more to come.

Did you get a chance to read Jennifer Block's excellent book Pushed: The Painful Truth About Childbirth and Modern Maternity Care? Block has an excellent site as well: Pushed Birth. While clearly one part of its function is to market the book, she also keeps an active blog that
highlights key news articles and other new information – a good site to check out frequently!

Ken Johnson and Betty-Anne Daviss, authors of the study on birth outcomes for Certified Professional Midwives that was published in the British Medical Journal, now have a website. Probably of greatest interest is the "Answers to Questions" page, where they answer clearly and in some detail some questions people have had about the study. Even if you did not have questions, this page is very educational. (If you are not familiar with this study, check out CfM's summary online)

If you are not on the Grassroots Network email list, you may easily join!

The Waterbirth Book

Janet Balaskas is the author of the classic childbirth book Active Birth. Less well-known is her also excellent, The Waterbirth Book, which was published in 2004. In this book, Janet Balaskas offers a comprehensive & inspiring guide to waterbirth for both parents & midwives. Her book is detailed, straightforward, and supportive.

The book contains sections about historical and cultural perspectives of waterbirth, the benefits of water in labor and birth, what to expect and how to prepare for a waterbirth, personal stories, how to choose and use a birth pool, information about the use of water during each stage of labor, and specific information/instructions for midwives.

The Waterbirth Book is quite good, comprehensive, and informative. It also has some nice black & white photos. It is very up to date. It is geared toward a UK audience, so some of the language/stats are based on that audience (for example, it assumes that midwives are legal & that one will readily be present at your birth--I wish the same were true in all US states!).

Book Reviews

Over the next several days, we will be posting a series of short book reviews. We hope this might be fun or helpful for people seeking excellent gifts for their doulas or midwives or for their birth educator or birth activist friends!

The first brief review is of the book Rediscovering Birth by Sheila Kitzinger. This book is a large hardcover coffee table type of book with many wonderful photos. The photos are the best aspect of this book and one that can keep you busy for hours! This book is not really designed as a "preparation for birth" book or as a guide to birth, but as a celebration of the beauty of birth and of pregnant women. It is also an anthropological, sociocultural, and historical look at birth. My observation is that many people are unaware of this book and as such it would make an interesting and unusual addition to a personal or professional library! It is an excellent read for people wishing to go beyond "the same old thing."

Rediscovering Birth is also on the required reading list for BirthWorks childbirth educator certification.

Becoming an Informed Birth Consumer

There are several helpful ways to become an informed birth consumer:

Read a book such as Henci Goer's The Thinking Woman's Guide to a Better Birth.

Hire an Independent Childbirth Educator (someone who works independently and is hired by you, not by a hospital). Some organizations that certify childbirth educators are The Association of Labor Assistants and Childbirth Educators (ALACE), Childbirth and Postpartum Professionals Association (CAPPA), BirthWorks, Bradley, Birthing From Within, Lamaze, and Childbirth International. Regardless of the certifying organization, it is important to take classes from an independent educator who does not teach in a hospital.

Consider hiring a doula-- a doula is an experienced non-medical labor support provider who offers her continuous emotional and physical presence during your labor and birth. Organizations that train doulas include ALACE, CAPPA, and DONA.

Join birth organizations specifically for consumers such as Citizens for Midwifery or Birth Network National.

Talk to other women in your community. Ask them what they liked about their births and about their care providers. Ask them what they wish had been different.

Ask your provider questions. Ask lots of questions. Make sure your philosophies align. If it isn't a match, switch care providers. This is not the time for misplaced loyalty. Your baby will only be born once, don't dismiss concerns your may have over the care you receive or decide that you can make different choices "next time."

Find a care provider that supports the Six Care Practices that Support Normal Birth and is willing to speak with you seriously about them:

• Labor begins on its own
• Freedom of movement throughout labor
• Continuous labor support
• No routine interventions
• Spontaneous pushing in upright or gravity-neutral positions
• No separation of mother and baby after birth, with unlimited opportunities for breastfeeding

Remember that birth is YOURS--it is not the exclusive territory of the doctor, the hospital, the nurse, the midwife, the doula, or the childbirth educator. These people are all paid consultants--hired by you to help you (and what helps you, helps your baby!).

Birth is a Consumer Issue

When speaking about their experiences with labor and birth, it is very common to hear women say, "they won't let you do that here" (such as regarding active birth--moving during labor). They seem to have forgotten that they are customers receiving a service, hiring a service provider not a "boss." If you went to a grocery store and were told at the entrance that you couldn't bring your list in with you, that the expert shopping professional would choose your items for you, would you continue to shop in that store? No! If you hired a plumber to fix your toilet and he refused and said he was just going to work on your shower instead, would you pay him, or hire him to work for you again? No! In birth as in the rest of life, YOU are the expert on your own life. In this case, the expert on your body, your labor, your birth, and your baby. The rest are "paid consultants," not experts whose opinions, ideas, and preferences override your own.

As Mary Rucklos Hampton says (quoted in CfM News):

"The effort to separate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women."

Fall Issue of CfM News!

The fall issue of CfM News is now available and contains a variety of articles and reviews. We have articles about the BOLD movement, about the launch of The Birth Survey in NYC this summer, an update about midwifery legislation in Missouri, an article about domestic violence during pregnancy (and abuse of pregnant women in the medical setting), summaries of CfM's experiences at recent conferences, legislative workshops in South Dakota (whose consumer group has a website with several excellent and useful fact sheets!), and the two page new Mother Friendly Childbirth Initiative "highlights of the evidence" fact sheet.

Reviews included of:

The new Ricki Lake and Abby Epstein film The Business of Being Born.

The ICAN published hard-hitting book Cesarean Voices.

The educational edition of the beautiful film Birth as We Know It.

The widely appealing book The Official Lamaze Guide: Giving Birth with Confidence--a short review is: Excellent! I think the Lamaze name gives this book widespread appeal and acceptability to the "mainstream." I wish it was in the hands of all the pregnant women in my town!

CfM Vision + Ideals vs. Reality

CfM has a Vision: The Midwives Model of Care is universally recognized as the optimal kind of care for pregnancy and birth, and is available to all childbearing women and their families. To achieve this vision, CfM promotes the Midwives Model of Care by providing public education about midwifery, the Midwives Model of Care and related childbirth issues, and by encouraging and supporting effective grassroots action.

The World Health Organization (WHO) and the Coalition for Improving Maternity Services (CIMS) both recognize midwives as the appropriate birth attendant for normal births. WHO recommends out-of-hospital birth as preferred and CIMS recommends the location for birth that is preferred by the mother. Based on 2004 data, the ideal is much different than the reality for most women in the United States where less than 8% of births are attended by midwives and 99% of births take place in hospitals. WHO and CIMS also recommend that electronic fetal monitoring (EFM) *not* be used routinely, though when last accounted for 85% of women experienced EFM during their labors. The organizations also recommends against the routine use of pain relief medications during labor and 80% of women in the US used pain medications in labor. The suggested induction rate is 10% or less when in reality it is at least twice that percentage (48% according to the 2005 Listening to Mothers II report). The WHO states that the systematic use of episiotomy is not justified, but the US women still have a 23% chance of having one. Finally, the cesarean rate recommended by the WHO and suggested by CIMS is 10-15%, where is has reached 32% in the United States as a whole (and is much higher in some areas and hospitals).

Many women feel their experiences and the interventions involved with their births were unique to them, when they actually experienced what Naomi Wolf terms a "stereotypical bad birth."

LLL of MO Conference

Last weekend I attended the LLL of MO conference (the lovely conference logo to the right was designed by the talented Summer Hill). I was thrilled to attend several presentations by Diane Wiessinger. Diane is a gifted speaker with lots of powerful insights about birth and breastfeeding (or, as the other headline speaker, Dia Michels, said "we should have a new word--birthandbreastfeeding"). The two are inextricably linked and it DOES matter how and where you give birth. As Diane said, "It's the birth, silly!"

With regard to birth and the impact of birthing practices on breastfeeding Diane makes comparisons to other mammals. Human mother and baby pairs are also mammal pairs and are biological primed to expect certain things and to thrive in some circumstances and not in others. One of her analogies is of moving a mother dog to another setting to give birth:

"Your pet dog is in labor. Instead of leaving her in the quiet corner she has chosen, you bundle her into the car and take her to a strange, brightly lit house bustling with strangers who keep poking and peering at her. As each puppy is born, it is positioned at one of her teats for a few minutes to see if it will latch on. If it doesn't latch immediately, it's washed, wrapped, and put in a separate box until later."

Would we expect this dog mother to have an easy labor and birth? Would we expect her well-wrapped baby to suckle well when returned to her after several hours of separation? Would we be the best people suited to determining when and how often the puppies needed to nurse and how often their mother should be with them? NO! The mother's biology and the puppies' biology are what facilitates smoothness in birth and breastfeeding, NOT the things that are done to them by others.

Diane also shared the following description of why your baby's birth matters:

"A trip to a strange place with strange smells. Bright lights, busy people. Numbness. A carefully cleaned and wrapped baby who doesn't stay with Mama. Any other mammal would reject her baby after a beginning like that. Which means that most American mothers have to welcome their newborns with their heads and not their hearts. Not the best start for confident mothering. Not the best start for breastfeeding. Not the best start for love."

She also says, "Don't be fooled by the Birth Channel. A normal birth is not a medical event or a source of horrible pain. It happens on its own, with the woman moving in whatever way feels right to her, feeling the labor and feeling--being--in charge. Find someone who will support this." (Hint: A provider who practices The Midwives Model of Care supports normal birth like this!)

An interesting new website called Conscious Woman has recently been launched. This site is a source for interactive online workshops. If you are interested in hearing and seeing Diane Wiessinger speak for yourself, her session "What Would Mammals Do?" is one of the upcoming workshops available from Conscious Woman! How neat to have a site available like this to bring important speakers and sessions right into the comfort of your own home.

MANA Conference

Susan & Nasima recently attended the MANA conference in Florida. They found the plenary panel on racism important and consciousness raising and were glad to attend. Attending conferences and networking with other childbirth-related organizations is an important element of our aim of "getting the word out" about midwives and the Midwives Model of Care.

Access to the Midwives Model of Care

At the core of the Midwives Model of Care is deep respect for the normalcy of birth and for the uniqueness of each childbearing woman and her family. This approach to maternity care promotes health and helps to prevent complications. Care providers who practice this model of care have excellent outcomes while providing safe, individualized care.

Access to the Midwives Model of Care is severely limited or nonexistent in many places due to state laws and regulations, hospital policies, economic structures, and misinformation that prevent or discourage qualified caregivers from providing this kind of care.

Citizens for Midwifery works to change those factors that restrict the availability of the Midwives Model of Care.

The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

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