Grassroots Network: Big Push exposes ACOG’s bogus research

Dear Friends,

The Big Push let folks know about ACOG’s attempt to collect anecdotal information about poor home birth outcomes; so many people posted good home birth outcomes, that ACOG quickly made the page password protected. The survey was poorly constructed with no way to verify any reports or avoid duplication, a good example of what ACOG considers “research”! Read the Big Push news release below, which includes a link to a copy of the survey page as it originally appeared.

Sincerely,
Susan Hodges, “gatekeeper”

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Trouble viewing this PushNews Release? Please visit the PushNewsroom here.

PushNews from The Big Push for Midwives Campaign

CONTACT: Katherine Prown, (414) 550-8025, katie@thebigpushformidwives.org
FOR IMMEDIATE RELEASE: Monday, August 31, 2009

Viral Internet Campaign Exposes Bogus Research on the “Problem” of Increased Demand for Midwife Care
Thousands of Activists Nationwide Force Physician Group to Scrub Its Website

WASHINGTON, D.C. (August 31, 2009)­In under 18 hours, a viral internet campaign targeted at the American College of Obstetricians and Gynecologists forced the group to take down a public plea asking its members to submit anecdotal, anonymous data about patients who planned out-of-hospital deliveries. According to the request, which was originally linked from ACOG's home page, the professional trade association for OB/GYNs is "concerned" about the "problem" of growing numbers of women seeking out-of-hospital maternity care.

"Just follow the money," said Steff Hedenkamp of The Big Push for Midwives Campaign. "ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they’re telling members to send in more of the same old tall tales that far too many OBs love to scare women with. Well, we have news for ACOG­it's not working."
The campaign to expose the physician group's plans began on Facebook and Twitter and rapidly drew thousands of women to ACOG's website, where they submitted their own data about their healthy deliveries in private homes and in freestanding birth centers throughout the country. In response, ACOG moved quickly to scrub its website and placed its request for unsourced data from members behind a password-protected firewall.

"This was almost as fun as last year's campaign pressuring the American Medical Association to back off from its ridiculous claim that Ricki Lake is responsible for the increase in out-of-hospital deliveries," said Sabrina McIntyre, mother of two. "The AMA and ACOG seem to forget that women are capable of making rational, informed decisions about our maternity care providers and birth settings. We don't appreciate fear-mongering tactics meant to try and scare us away from using safe and cost-effective, community-based alternatives to our current maternity care system."

"Analysts familiar with ACOG expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it. "ACOG admits in its own documents that they've been forced to use 'hardball tactics' against women who are advocating for choices in maternity care," said Hedenkamp. "Frankly, this latest stunt of theirs to troll for 'fresh' folklore reeks of desperation.

"The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushformidwives.org

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The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 | Washington, D.C. 20037-1434 | TheBigPushforMidwives.org

DVD Review: The Big Stretch

DVD Review: The Big Stretch
By Alieta Belle & Jenny Blyth
60 Minutes, includes 20 page booklet
www.birthwork.com

Reviewed by Molly Remer, MSW, ICCE
http://talkbirth.wordpress.com

The author of the book Birthwork is also a filmmaker whose recent project is the film The Big Stretch, which she co-created with another mother. The particularly special thing about this film is that it is all about women sharing their own experiences and feelings--unlike many current birth movies there are no "experts" present in the film (other than the true experts--women themselves!), the focus is on the families preparing for birth or reflecting on their past birth experiences. The many topics addressed are insightful.

The film's emphasis is on, "Women in different stages of pregnancy and preparing for a natural birth reflect on how they and 'stretched' in everyway - emotionally, physically and spiritually" and I enjoyed this "stretch" theme that ran throughout.

Introducing new scenes/topic is neat artwork and the images in this film in general are particularly gorgeous. In one exception, I was taken aback by footage at the close of the film of a totally naked man riding a bicycle and feel I should warn other viewers to be prepared for that!

The DVD is accompanied by a 20 page booklet full of questions that carries the themes from the film into personal questions to increase self-awareness during pregnancy.

The Big Stretch is a unique and beautiful film in which women’s voices are clearly represented. There are no titles, no degrees, no qualifications listed. This film is a perceptive “motherful” look at the many stretches of birthing: physical, emotional, mental, and cultural.

Book Review: Birthwork

Birthwork
By Jenny Blyth
Reprinted 2007
Softcover, 460 pages
ISBN: 0-9757610-0
www.birthwork.com

Reviewed by Molly Remer, MSW, ICCE
http://talkbirth.wordpress.com

From Australia, comes a gorgeous and unique book called Birthwork. It is such an amazing and compelling read that it took me a very long time to write my review—it is difficult to describe such a remarkable book. I have never read another book like this. It is truly extraordinary. Subtitled "a compassionate guide to being with birth," Birthwork was written for all birthworkers--anyone who works directly with birthing women (midwives, doulas, nurses, childbirth educators, physicians...).

This book covers issues of a range and depth I’ve never before seen in a birth text. Subsections include titles like: touching vaginas, respect and relationship, dipping in and out of the birth milieu, group dynamics, conflict, birth culture, loving presence, birth is sacred, trauma release, letting down in the pelvis, and stresses and stretches of childbearing. This is just a sampling of the amazing, comprehensive range of topics explored in Birthwork. I particularly enjoyed sections on directed breathing and “dynamic anatomy in labour.” The book delves into a lot of the emotional and psychological elements of being in a caregiving field and also covers physical components as well.

The book includes lots of questions to ask yourself to increase self-awareness, understanding, and personal development and also exercises to try/explore. Some of the questions are difficult to answer and require you to take a deep look at your motives and ideas about doing birthwork.

The photographs are stunning and there is gorgeous cover art (front, back, and inside). Birthwork has a spiritual component that runs throughout—sort of an Eastern philosophy—that might not appeal to all readers.

The book includes sources and a glossary of fields of care, but no index and no resources sections. It is an expensive book, but so very worth it!

Birthwork is deep and intense. I usually read very quickly and this book took me several weeks to finish because it needs time and space to soak in and be absorbed. Truly a phenomenal read!

PushNews: Physician Group Pulls the Plug on Women’s Autonomy

Issues Policy Statement About What Women in Labor Will Be "Allowed" to Eat and Drink FOR IMMEDIATE RELEASE WASHINGTON, D.C. (August 25, 2009) – Displaying a stunning lack of regard for patient autonomy, the American College of Obstetricians and Gynecologists (ACOG) issued a statement this week declaring that the group will "allow" laboring women to drink "modest amounts" of clear fluids during labor while continuing to prohibit access to solid food. "Once again ACOG has issued a position statement with little regard for the evidence or for the ability of women to make decisions for themselves," said Susan Jenkins, Legal Counsel for The Big Push for Midwives Campaign. "It's insulting that ACOG actually believes that laboring women should be grateful that they will now be 'allowed' to have more than just ice chips, when we have long known how vital nutritional sustenance is to mothers and babies not only during pregnancy, but during labor as well." Hospitals routinely adopt ACOG position statements as standard policy governing the treatment of pregnant and laboring women, despite the fact that a number of the organization's position statements do not acknowledge all of the risks and benefits associated with common procedures. "ACOG is asking laboring women to do the physical equivalent of a marathon on the power of a 'modest' amount of clear liquid," said Sabrina McIntyre, mother of two. "Thanks but no thanks. I'll stick with my midwife and her wisdom of keeping up my physical stamina for such a monumental event." Policies restricting food and liquid intake date from an era when laboring women were routinely given general anesthesia and risked aspirating food into the lungs. Modern anesthetic techniques have virtually eliminated this risk, which is further reduced by the fact that only a tiny minority of laboring women, even among those who deliver via cesarean section, actually receive general anesthesia. "The women I care for eat when they are hungry and drink when they are thirsty, all without asking for ACOG's permission first," said Elizabeth Allemann, MD. "Women deserve to be fully informed about what the evidence actually shows, and it's time that the medical profession abandoned policies based on the outdated and paternalistic idea that patients should play no role whatsoever in the decision-making process." The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushformidwives.org ### The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 Washington, D.C. 20037-1434 | TheBigPushforMidwives.org

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The Unnecesarean also picked up this press release and shared some additional thoughts as well as a very amusing graphic--check it out!

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Molly
CfM Blogger

Birth Challenges

I've posted several times about the challenges being experienced by homebirth midwives in Australia (legislation has effectively rendered them illegal). Here is a clip from the "Aussie Labor Party" about this topic--love that the speaker refers to the political maneuvers used as "putting a bit of rancid ham in the legislative sandwich." He is a great speaker with lots of passion and great things to say about midwifery and homebirth being "snuffed out" by "sneaky legislation." Another good quote: "There's nothing illegal about homebirthing, but it is about to become that way under this lazy government." (hat tip to The Unnecesarean for the link to the video via Facebook):



Returning to US birth challenges, a well-known midwifery/homebirth supporter, Dr. Stuart Fischbein, is being threatened with sanctions and removal of privileges for supporting women in having VBACS and breech births. You can keep up with his situation on his blog.

Tying the two together thematically, is an excellent article from Dr. Marsden Wagner from 2000, that is a very accurate assessment: Fish can't see water. My favorite quotes from this article are as follows:

But we do not have humanized birth in many places today, including Australia. Why? Because fish can't see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalised birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized. This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization:

"By medicalising birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what 'non-medicalised' birth is. The entire modern obstetric and neonatological literature is essentially based on observations of 'medicalised' birth." - World Health Organization^[1]

Why is medicalised birth necessarily dehumanizing? In medicalised birth the doctor is always in control while the key element in humanized birth is the woman in control of her own birthing and whatever happens to her.

I think these observations are key. We have a majority of people in industrialized countries who do not know what normal birth looks like. Fear-based recommendations are then made for maternity care based on a "lens" of birth that only includes intervention and and interference.

--
Molly
CfM Blogger

Book Review: The Doula Guide to Birth

The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know
By Ananda Lowe & Rachel Zimmerman
Bantam Books, 2009
Softcover, 270 pages
ISBN: 978-0-553-38526-7
www.thedoulaguide.com

Reviewed by Molly Remer, MSW, ICCE

http://talkbirth.wordpress.com

The Doula Guide to Birth is written for pregnant women, though the title may suggest that it is for doulas. It also has a chapter and sections specific to birth partners. However, doulas will also find the book to be a friendly, enjoyable read and may pick up some fresh perspectives for their work with birthing women.

The book also includes (short) sections for often-ignored or marginalized segments of the birthing population such as same-sex partners, parents using a surrogate mother, and women planning for adoption.

The first five chapters of The Doula Guide to Birth cover benefits of doulas, the role of fathers/partners and the complementary nature of the doula role to other support people, general overview of labor, childbirth education options and medications, and finding a doula.

The later seven chapters delve deeper into less typical subjects such as doulas and medical providers, when should you really go to the hospital, labor techniques, unexpected interventions, birth plans/birth essays, and what really happens postpartum.

Though not a criticism per se, I did feel like the first half of the book reads very much like an extended “commercial” for doulas. The second half of the book really shines. My favorite chapter was “labor is not about dilation”: “Although there is currently a heavy emphasis on dilation, vaginal exams, and timelines for giving birth, labor is not about dilation. Your body knows how to give birth whether or not you ever have a pelvic exam during labor. Birthing women need encouragement to trust their bodies, and to be the stars of their own labors. Doulas help provide this encouragement. And the confidence a woman discovers in labor can help carry her through the demands of parenting and future challenges in life.” (emphasis mine).

The Doula Guide to Birth is supportive of the midwifery model in philosophy, but only includes very brief mentions of midwives, the assumption being that most births with be in the hospital.

The book has extensive endnotes and an appendix with a birth evaluation form.

Reducing Infant Mortality Film

In June I posted about a new film called Reducing Infant Mortality. Yesterday, the film was released and is available to watch for free!

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Grassroots Network: Big Push Health Care Strategy

Dear friends,

Below is a press release from The Big Push campaign. This strategy--of asking politicians to think about "beginning of life" issues as they think about "end of life" issues in terms of health care reform--may work well when you go to talk to your local legislators or Town Hall meeting about maternity care!

Sincerely,
Arielle Bywater, "sidekick"

Advocates Spotlight Absence of "Beginning-of-Life" Provisions in House Bill
Maternity Care Crisis Ignored as Controversy about End-of-Life Issues Continues

Washington, DC (August 17, 2009)­As the controversy over the inclusion of end-of-life provisions in the House health care reform bill continues, questions emerged about the lack of "beginning-of-

life" provisions in the bill that would expand access to maternity care providers and settings and ensure that patients receive adequate care across their life span.

"The U.S. has one of the worst infant and maternal mortality rates in the developed world," said Elizabeth Allemann, MD. "The cesarean section rate has skyrocketed to more than a third of all births in the country, and with nearly half of all births being paid for by Medicaid, taxpayers are getting hit hard. We have a crisis on our hands and we need to start paying as much attention to beginning-of-life issues as we do to end-of life-issues."

Among the measures being promoted by advocates seeking to reform the maternity care system is the addition of a provision to the House bill that would provide access to out-of-hospital birth and the services of Certified Professional Midwives, who are specially trained to provide it, for women receiving Medicaid.

"We know that women cared for by Certified Professional Midwives experience significantly reduced rates of low birth weight and preterm births, two of the leading causes of cost increases and growing racial and ethnic disparities in birth outcomes," said Jane Peterson, LM, CPM. "Moreover, Certified Professional Midwives are able to produce these outcomes at a fraction of the cost of traditional maternity care. The House bill represents a golden opportunity for us to embrace maternity care reforms that truly can make a positive impact on our health care system and on the lives of mothers and babies."

David A. Anderson, Professor of Economics at Centre College, calculates that if the rate of births that take place in private homes and in freestanding birth centers increased by less than ten percent, we would realize an annual savings of more than $9 billion. A 2008 study commissioned by the state of Washington found that its licensed midwife program generates a savings of more than $3 million to private and public insurers each biennium.

"With all of the talk about the importance of end-of-life issues," said Dr. Allemann, "It's time for us to also recognize that giving everyone a good start at the beginning of life has far-reaching implications for our health care system. Including out-of-hospital maternity care and Certified Professional Midwives in health care reform is a small but very important first step."

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating the public and policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and Certified Professional Midwives, the maternity care providers trained to provide that service. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushformidwives.org

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The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 | Washington, D.C. 20037-1434 | TheBigPushforMidwives.org

Book Review: We're Having a Homebirth

We’re Having a Homebirth
by Kelly Mochel
Softcover, Stapled, 16 pages
www.homebirthchildrensbook.com

Reviewed by Molly Remer, MSW, ICCE, http://talkbirth.wordpress.com

We’re Having a Homebirth is a delightful new children’s book with a contemporary feel. The illustrations have a very modern, almost “manga” type appeal.

The book is a nice, positive, simple account of birth at home—it addresses each key issue children may be concerned with in very basic, friendly terms.

My boys, ages 6 and 3, cuddled up as I read it aloud and both enjoyed it very much. They especially liked the part about the placenta and cord-cutting.

The book is very colorful and half of the pages each have a different, eye-catching background color as well (the other half have white backgrounds).

I recommend this little gem to families planning homebirths and also for midwives to have available in their offices or lending libraries.

Small in size and fairly brief at 16 pages, We’re Having a Homebirth is reasonably priced at $6.50.

Big Push Letter to the Editor Campaign

Thank you for signing the "I Pushed for Out-Of-Hospital Maternity Care" petition supporting Certified Professional Midwives! You joined nearly 7,000 family members who have signed the petition in just a few short weeks - truly an overwhelming display of support for the skilled, effective, and cost-reducing care that these out-of-hospital maternity care specialists provide.

While the right and the left fight about end-of-life decisions for Grandma, we are worried about the maternity care her granddaughter is receiving. We need to fight to make sure that the needs of mothers and babies are not ignored during the health care debate and that our health care system includes the full range of maternity care providers and settings for all women.

Today, you can take action to raise more public awareness of support for Certified Professional Midwives by joining our letter to the editor campaign. It will take just a couple of minutes and be another "push" for maternity care reform that puts mothers and babies in the forefront of the debate.

Economically, increasing access to Certified Professional Midwives is one of the smartest fixes to the national health care system that we can make. Economist David Anderson calculates that if the rate of births that take place in freestanding birth centers and in private homes increases by less than 10%, we realize an annual savings of more than $9 billion. Plus, along the way, we reduce disparate outcomes among racial and ethnic minorities and provide care at a fraction of the cost of traditional maternity care.

As you may know, Members of Congress are now back home for the month of August, and it is a prime time to make sure that your elected officials know they should support the effort to include CPMs in the list of Medicaid providers in whatever the final form healthcare legislation looks like.

Letters to the editor are powerful tools for not only communicating with the public, but with elected officials as well. They pay very close attention to what is printed in that part of the newspaper and in the online letters forum as well. Please don't set this aside: visit the Letter to the Editor campaign page to find newspapers in your area and use the talking points to quickly personalize and send your letter to the editor.

Each of us may feel very differently about health care reform, but the one thing we can all agree on is that ALL women in our communities deserve access to maternity care specialists who can save the system money AND who have a track record of improving outcomes for pregnant women who are at risk for having their babies too soon and at low birth weights.

Again, thank you for your support! Together, we are creating change and increasing access to Certified Professional Midwives for ALL families throughout the United States!

Book Review: Homebirth in the Hospital

Homebirth in the Hospital
by Stacey Marie Kerr, MD
Sentient Publications, 2008
Softcover, 212 pages
ISBN: 978-1-59181-077-3
www.homebirthinthehospital.com

Reviewed by Molly Remer, MSW, ICCE, http://talkbirth.wordpress.com

I would venture to say that most midwifery activists and birth professionals have said at some point, “what she wants is a homebirth in the hospital…” This comment is accompanied with a knowing look, a bit of head shaking, and an unspoken continuation of the thought, “…and we all know that’s not going to happen.”

Well, what if it is possible? A new book by Dr. Stacey Kerr, Homebirth in the Hospital, asserts that it is. She was originally trained at The Farm in TN (home of legendary midwife Ina May Gaskin) and after going to medical school realized that she, “…needed to balance my new knowledge with my old priorities. I missed the feeling of normal birth, the trust that the birthing process would occur without technology, and the time-tested techniques that help women birth naturally. And so it was that I went back to midwives to find the balance.”

If you are a dedicated homebirth advocate, I recommend reading Homebirth in the Hospital with an open mind—clear out any cobwebs and assumptions about doctors, hospitals, and birth and read the book for what it is: an attempt to create a new model of hospital birth. What Dr. Kerr proposes in her book is a model of “integrative childbirth”—the emotional care and support of home, while nestled into the technology of a hospital.

The opening chapter explores the concept of integrative childbirth and “the 5 C’s” of a successful integrative birth: choices, communication, continuity of care, confidence, and control of protocols (“protocols are the most disempowering aspect of modern maternity care…”).

This section is followed by fifteen different birth stories, beginning with the author’s own (at a Missouri birthing center—my own first baby was born in a birth center in Missouri, so I felt a kinship there).

The births are not all happy and “perfect,” not all intervention-free, and most are quite a bit more “managed” and interfered with than a lot of homebirthers prefer (one is a cesarean, several involve epidurals or medications). I, personally, would never freely choose a “homebirth in a hospital” (I also confess to retaining a deep-seated opinion that this phrase is an oxymoron!). However, that is not the point. Over 90% of women do give birth in a hospital attended by a physician and I appreciate the exploration of a new model within the constraints and philosophy of the hospital.

The book closes with a chapter called “how to be an integrative childbirth provider.” The book has no resources section and no index.

I certainly hope that doctors read this book. I am also glad it is available for women who feel like homebirth is not an option or not available and would like to explore an integrative approach. Even though my opinion is that none of the births are really “homebirths in the hospital” as most bear little resemblance to the homebirths I know and love, unlike the content of the standard hospital birth story, they are deeply respectful births in the hospital and that’s the issue truly at the heart of this book.

Fatherhood Resources

Rather than repeat myself here, here is a link to a post I just wrote at ICEA about resources for fathers. Two of them are homebirth specific, the others are more general.

I've noticed more and more resources becoming available for fathers to be and I hope the trend continues. I believe that men, women, babies, and society all benefit when fathers are invested in fatherhood!

--
Molly
CfM Blogger

August 15th is Birth Trauma Awareness Day

I wanted to pass along the information I received about Birth Trauma Awareness Day:

Press release:

http://www.birthtraumaassociation.org.uk/PDFs/BTA_day_2009.pdf

Read more at :

http://www.birthtraumaassociation.org.uk

From the website.....

Post Traumatic Stress Disorder (PTSD)

When we talk of birth trauma, we mean Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. We also include those women who may not meet the clinical criteria for PTSD but who have some of the symptoms of the disorder.

PTSD is the term for a set of normal reactions to a traumatic, scary or bad experience. It is a disorder that can occur following the experience or witnessing of life-threatening events. We usually recognize these as things like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. However, a traumatic experience can be any experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby) so it is now understood that Post Traumatic Stress Disorder can be a consequence of a traumatic birth.

Characteristic features of PTSD include:

• An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
• A response of intense fear, helplessness or horror to that experience.
• The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
• Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
• Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time).

It is important to remember that PTSD is a normal response to a traumatic experience. The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are beyond the sufferer's control. They are the mind's way of trying to make sense of an extremely scary experience and are not a sign individual 'weakness' or inability to cope.

Who gets Birth Trauma?

Birth trauma is in the eye of the beholder’
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)

It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person.
For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.

Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD which include a very complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors. They include:

• Lengthy labour or short and very painful labour
• Induction
• Poor pain relief
• Feelings of loss of control
• High levels of medical intervention
• Traumatic or emergency deliveries, e.g. emergency caesarean section
• Impersonal treatment or problems with the staff attitudes
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Baby’s stay in SCBU/NICU
• Poor postnatal care
• Previous trauma (for example, in childhood, with a previous birth or domestic violence)

In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support.

Finally, men who witness their partner’s traumatic childbirth experience may also feel traumatised as a result. Please see our ‘partners’ section

What is different about Post Natal PTSD?

It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as childbirth can be traumatising but it has been clear for many years that women can suffer extreme psychological distress as a consequence of their childbirth experience for a complex variety of reasons which are frequently related to the nature of delivery. Unfortunately, the difference between the common perception of childbirth and some women’s experience of it means that women who suffer Post Natal PTSD symptoms frequently find themselves very isolated and detached from other mothers. They also find themselves without a voice in a society which fails to understand the psychology of childbirth and which therefore expects mothers to get over their birth experience very quickly.

Consequently, women affected by Postnatal PTSD often find that there is nowhere to turn for support because even other mothers, who have not had traumatising births, can find it hard to understand how affecting a bad birth can be. This can make sufferers lonely and depressed as they often feel they are somehow ‘weaker’ than other women because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’. They may feel incredibly guilty as a result.

This is a terrible burden for women to shoulder and one which profoundly affects their lives. The nature of PTSD means that constant ruminating on the birth experience is beyond the sufferer's control but this is constantly misunderstood, even by health care professionals. Unfortunately, for women suffering from Postnatal PTSD, their detachment from others and the lack of support provided to them can mean that relationships with friends and family may deteriorate. For example, many women end up feeling torn between their desire for more children and their determination to avoid another pregnancy. They may also lose interest in sex and these problems can place a great strain on relationships.

Worryingly, it is suggested that women may also try and avoid medical treatments like smear tests.

For many women, their greatest concern is the day to day difficulties they encounter bonding with their baby who may be viewed as a constant reminder of the trauma they have experienced.

The BTA aims to tackle this isolation by offering women much needed support and showing them that they are far from alone. By working together and providing women with a voice, we hope that we can help change those practices which contribute to Postnatal PTSD.

Isn't this just Post Natal Depression?

No. PTSD can overlap with Post Natal Depression (PND) as some of the symptoms are the same, but, the two illnesses are distinct and need to be treated individually.

Unfortunately, because awareness of this issue is generally poor, many women are wrongly diagnosed with Post Natal Depression and are prescribed medication that may do little, or nothing, to help their situation. Women tell us that they are frequently told by their health care professionals that they should try and 'move on' with their lives or that they should just be grateful that they have a healthy baby. Unfortunately, this type of reaction shows a gross misunderstanding of the nature of Post Natal PTSD and may actually exacerbate the feelings of guilt and isolation that women already feel. Women may then end up with prescriptions for anti-depressants, simply because doctors do not understand the disorder.

However, it is important to note that depression can go hand in hand with Postnatal PTSD, so not everyone is misdiagnosed and if you have been prescribed anti-depressants, this may well be an appropriate course of action for your particular circumstances. If you are concerned about this issue in any way, you must speak to your health professional (e.g. GP or Health Visitor) for further advice. Please show them a copy of our leaflet if they appear to be unaware of Post Natal PTSD or the fact that it requires specialised treatment.

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Also remember the wonderful resource Solace for Mothers which provides numerous services for people who have experienced birth trauma.

--

Molly

CfM Blogger

The Birth Survey is One!

One year ago, The Birth Survey launched nationwide! What an exciting project this is. I felt honored to take the survey earlier this year and I hope many people continue to do so and help make transparency in maternity care a reality.The Birth Activist blog is having a birthday giveaway in honor of the special occasion. For details check out this post.

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Molly
CfM Blogger

Children's Books about Birth

I am looking forward to reviewing a copy of the new children's book We're Having a Homebirth by Kelly Mochel.

I also recently learned about another newish children's book, this one focusing on the doula's role. Called Being Born: The Doula's Role, it appears to have really nice illustrations.

Speaking of nice illustrations, my all-time favorite children's homebirth book is Runa's Birth. The illustrations are amazing--I love the tiny details like little shells/rocks on the windowsill and phone messages on the bulletin board.

Another book about homebirth that I enjoy reading to my kids is Welcome with Love. It also has nice, softly drawn pictures.

We also have the book My Mommy's Midwife (which has children's drawings as the illustrations).

Additionally, as I've mentioned here before, North Carolina Homebirth has a free children's coloring book available on their site called There's a New Baby in My House.

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Molly
CfM Blogger

Jennifer Block Articles

I've been out of town for a while, so I'm a little behind in mentioning some new articles by Jennifer Block that were published recently.

On RealityCheck she wrote about birth and medical care reform: Where's the Birth Plan? In the article, she points out: "A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. (Right now, just one percent do). If America is serious about reform, midwifery advocates are saying, 'Hey, how about us?'"

And on Babble, Block wrote a thought-provoking article called Birth Wars: Who's really winning the homebirth debate. There is a sort of "companion" article on the same site, Pushing Back, that takes a critical look at whether the natural childbirth movement has "gone too far."

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Molly
CfM Blogger

PushAlert: South Dakota Mother to Walk Across the State for Access to CPMs

Hundreds to Join Her in Show of Support for Change in State Law to Increase Access to CPMs FOR IMMEDIATE RELEASE: Wednesday, August 12, 2009 CENTERVILLE, SD (August 12, 2009) – Beginning on August 21, local mother Debbie Pease will walk four miles in 11 communities across South Dakota, completing the 44th mile of her journey on her 44th birthday just six days later in Sioux Falls. She and hundreds of citizens from across the state, who are joining her along the way, are walking to raise awareness about the need to change state law to authorize Certified Professional Midwives, who are specially trained to provide out-of-hospital maternity care, to practice legally. "Families in Minnesota, Montana, and Wisconsin have been benefiting from the services of Certified Professional Midwives for years," said Ronda Kvigne, who was forced to cross state lines in order to deliver her last baby under the care of a Certified Professional Midwife. "It is high time that South Dakota families had the same opportunities." Certified Nurse-Midwives are trained to provide hospital-based care and are legally authorized to practice in all 50 states. Fewer than 1% of nurse-midwives nationwide provide maternity care in private homes or freestanding birth centers, and only one nurse-midwife in South Dakota provides out-of-hospital care. As a result, families in most parts of the state who choose to give birth outside of the hospital—most often for religious, cultural or financial reasons—are left with no access to legally-practicing midwives with expertise in out-of-hospital delivery. "The first step is to license and regulate Certified Professional Midwives so that families who choose out-of-hospital delivery have access to providers who have met the appropriate educational, training, and credentialing standards," said Travis Brink of SD Safe Childbirth Options, Inc, a consumer advocacy group that is working to expand maternity care options in the state. Demand for the services of Certified Professional Midwives is on the rise throughout the country, while The Big Push for Midwives, a national campaign to license them in all 50 states, has been making steady progress. Since 2005 six states have passed legislation legally authorizing Certified Professional Midwives to practice, and last year Idaho became the 26th state to do so. Legislation is pending in an additional 18 states. "The research consistently shows that Certified Professional Midwives have excellent outcomes at significantly reduced costs," said Pease. "The state of Washington commissioned a study that found a biennial savings to public and private insurers of more than $3 million. My hope is that the incredible outpouring of energy generated by the Walk for Midwives will compel policy makers in South Dakota to take notice and to recognize the need to change our laws so that families in our own state have access to the safe, proven, and cost-effective care offered by Certified Professional Midwives." Pease will begin her walk at 8 a.m. on Friday, August 21 in Spearfish at WomanKind Midwifery located at 544 N 7th Street. Everyone is invited to walk a distance that is comfortable for them and learn more about this issue. There is no fee to join the Walks, but everyone is encouraged to buy a T-shirt and/or make a donation to SD Safe Childbirth Options, Inc. For more information about each of the 11 Walks and to download photos, please visit WalkForMidwives.com. ### If you would like to Walk for Midwives in your state, check out Debbie Pease's PushTips for how to plan your event here.

Birthing Bodies as Machines

From the book In Labor: Women & Power in the Birthplace:

Under the title Normal Delivery, an obstetrical teaching film purports to show the 'use of various drugs and procedures used to facilitate a normal delivery.' another 'normal delivery' film is a 'demonstration of a normal spontaneous deliery, including a paracervical block, episiotomy.'

These are the normal, noninterventionist techniques, the physician just helping things along. The analogy that comes to mind is of the person with a new color television, endlessly fiddling with the fine tuning, occasionally giving a whack on the side for good measure. The person's not really doing anything to the TV--not taking off the back panel or rewiring. Once the body is conceptualized as a machine, then it is going to be treated in much the same way as any other machine in our society--pushed to be more efficient, more economical, faster, neater, quieter. An infinite number of procedures and interventions are so readily normalized because that fits in with our view of the world: one is compelled to take action in order to get results. In medicine, as in much elese in technological society, even action with very little chance of success is preferable to no action at all, on the spurious assumption that doing something is better than doing nothing.

I really like the analogy of tinkering with the television.

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Molly
CfM Blogger

Grassroots Network: News from MAMA Campaign

Dear Friends,

Below is the latest news from the MAMA Campaign, which continues to work hard to get CPMs added to the list of Medicaid providers into the health care reform bills that are developing in Congress. Regardless of your personal opinion about “health care reform” overall, having CPMs listed as Medicaid providers definitely would be cost effective and would increase choices for all pregnant women.

If you have not already done so, I strongly encourage you to visit www.mamacampaign.org to find out more. Sign up to endorse the campaign (and receive news e-mails directly), make a donation if you possibly can, find fact sheets and other resources specific to this campaign. Congress is now in recess for August so your Senators and Representative are likely to be in their home districts. Consider making an appointment to meet with your Representative and/or Senator, or at least writing a letter – you can find examples, how-to’s, talking points and fact sheets on the website.

Hope you are having a good summer!

Sincerely,

Susan Hodges “gatekeeper”

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“Sometimes the most direct route to your heart’s desire is a path full of twists and turns…” (Anonymous)

Well, friends and supporters of the Mothers and Midwives in Action (MAMA) Campaign ­we are certainly on a road full of twists and turns…We are also moving fast and keeping many apples in the air to ensure that the path is an upward, successful climb.

Health care reform action has EXPLODED this week in Washington, D.C. Support for federal recognition of Certified Professional Midwives has been building and very much a part of the action this week. Even as we write to you all today, analysis of the status of amendments in the U.S. House Energy and Commerce Committee is neither complete nor final.

The House of Representatives has adjourned for the August recess and the Senate will adjourn at the end of next week. Lots of outreach to Congress members can happen during the August recess and that will be our focus. What is clear is that our work together will continue throughout the August recess and into Congressional debates in September. Fasten your seatbelts, sound the alarm, we are all in this TOGETHER!

For more about the process of overall health care reform in Congress, visit http://www.uhcan.org/.

NEWS of SUPPORT: MAMA is thrilled to receive full recognition and support from major national organizations this week:

National Women's Law Center
Our Bodies Ourselves
National Women's Health Network
Raising Women's Voices
Childbirth Connection
Coalition for Improving Maternity Services (CIMS)

FINANCIAL NEWS: MAMA is nearing the halfway mark in raising the minimum money essential for the success of our Campaign. We have roughly $70,000 in hand or pledged. ALERT! We must stay on our pace of raising $10,000 a week for the rest of the Congressional session in order to complete our goal. To ensure skilled help in Washington DC and well-organized coordination of our country-wide support, we must continue to call out to all supporters for help with this financial reality. Thanks to all of you who have already donated. Do send our message far and wide to your friend and family networks!

For more reasons to donate, watch this! Hear what moms, dads and grandparents across the country have to say about CPMs and choices in childbirth. Please watch this inspiring video and send it on to friends, family and clients.


NETWORKING NEWS: Join us on Facebook and Twitter!
Our network is growing and with your help we can reach more supporters to our cause. Please invite your Facebook Friends to join the MAMA Campaign Facebook Group. Visit our group and click on the "Invite your Friends" link on our page. You will be able to send a message to all of your Facebook friends asking them to join the MAMA Campaign!





Subscribe to the MAMA Grapevine ­MAMA’s blog-- to get the latest updates on the MAMA Campaign, articles on Health Care Reform, and personal stories about how CPMs can be an integral part of quality maternity care. Link our blog to your Facebook, Twitter, and other networking site profiles with a simple click!

Please help us help you! Support the MAMA Campaign TODAY

HEARTFELT THANKS FOR ALL YOUR SUPPORT!

World Breastfeeding Week!

Today is the first day of World Breastfeeding Week, celebrated annually around the world August 1-7 since 1990. (Communities can choose to celebrate WBW on other dates, as needed.)



The theme of this year's celebration is Breastfeeding: Prepared for Life and focuses on the lifesaving nature of breastfeeding, in emergencies and in everyday life. Breastfeeding or not breastfeeding has lifelong implications for both mother and child.

I always like to use WBW as an opportunity to draw attention to the relationship between birth and breastfeeding--put simply, undisturbed birth leads to undisturbed breastfeeding, disrupted birth contributes to disrupted breastfeeding.

More good information and ideas for acknowledging World Breastfeeding Week can be found at the following:

La Leche League in the USA Web site: WBW 2009 Celebrations: "Breastfeeding: Prepared for Life"

World Breastfeeding Week website

World Alliance for Breastfeeding Action (WABA)

United States Breastfeeding Committee: Breastfeeding: A Vital Emergency Response. Are you ready?

National WIC Association Flyer: Action Ideas for WBW 2009

More information about the theme, from WABA:

OBJECTIVES OF WORLD BREASTFEEDING WEEK 2009

• To draw attention to the vital role that breastfeeding plays in emergencies worldwide.
  
• To stress the need for active protection and support of breastfeeding before and during emergencies.
  
• To inform mothers, breastfeeding advocates, communities, health professionals, governments, aid agencies, donors, and the media on how they can actively support breastfeeding before and during an emergency.
  
• To mobilise action and nurture networking and collaboration between those with breastfeeding skills and those involved in emergency response.

RATIONALE

• Children are the most vulnerable in emergencies – child mortality can soar from 2 to 70 times higher than average due to diarrhoea, respiratory illness and malnutrition.
• Breastfeeding is a life saving intervention and protection is greatest for the youngest infants. Even in non-emergency settings, non-breastfed babies under 2 months of age are six times more likely to die.
• Emergencies can happen anywhere in the world. Emergencies destroy what is ‘normal,’ leaving caregivers struggling to cope and infants vulnerable to disease and death.
• During emergencies, mothers need active support to continue or re-establish breastfeeding.
• Emergency preparedness is vital. Supporting breastfeeding in non-emergency settings will strengthen mothers’ capacity to cope in an emergency.

Breastfeeding is a critical public health issue around the world. Breastfeeding matters!

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Molly
CfM Blogger