Friday, July 31, 2009

Choices in Childbirth booklet

I absolutely love the little booklet "The Guide to a Healthy Birth" published by the NYC-based organization Choices in Childbirth. It is a handy size, attractive, full of good information, and so great to have available to give to pregnant women in your life (or people thinking about becoming pregnant, or to anyone!). I hand them out in my birth classes and also give them to other people I know. Anyway, I was excited to learn today from the Passion for Birth blog, that a new edition of the booklet is available!

You can download the pdf version directly here. Or, for very minimal shipping, you can order print versions here.

I just ordered 50 copies and I can't wait for them to get here! I think I only had about 4 copies left from my last order (of the previous edition), so I can't think of better timing :)



CfM Blogger

Birth & Politics

Just a quick quote this week from the book Homebirth by Sheila Kitzinger:

"Fathers' sharing in the birth experience can be a stimulus for men's freedom to nurture, and a sign of changing relationships between men and women. In the same way, women's freedom to give birth at home is a political decision, an assertion of determination to reclaim the experience of birth. Birth at home is about changing society." (emphasis mine)

CfM Blogger

Tuesday, July 28, 2009

Grassroots Network: MAMA Campaign Call for Action

Dear Friends,

You know the expression "act now"? Well, to insure access to midwifery care for American women, we all need to act now and help the MAMA Campaign. We don't want midwives to become a "limited time offer" in this country!

Arielle Greenberg Bywater, "gatekeeper sidekick"

Midwives and Mothers in Action--Inaction is not an option.

"Inaction is not an option."
-- President Obama regarding health care reform in a speech last week.

There is ACTION everywhere in all directions on health care these days…
Every day special interest groups spend a staggering $1.4 million lobbying
Congress to shut down the health care reform effort. How many are lobbying
to maintain the status quo in maternity care? How many are big medicine
lobbyists? Did you know the insurance industry unveiled a 7-figure marketing
campaign to protect their bottom lines? We are like actors in an epic
story—David and Goliath

We must answer this challenge:

  • Support the MAMA Campaign!

The pace of policy and debate is accelerating in Washington DC, and the
ACNM has increased its opposition to our Campaign. _And, MAMA marches on!
We continue to be applauded on the Hill for the progress we are making. We
successfully met with agencies responsible for fiscal reports for
Congressional initiatives and Medicaid programs. The pace of our DC visits
continues unabated—we seek to solidify early support and attain new
Congressional supporters.

And now, we must ramp up our Campaign to yet another notch in order to
achieve Medicaid coverage for all Certified Professional Midwives.

Please help us help you! [2]Support the MAMA Campaign TODAY—we must raise
$10,000 a week to ensure the Campaign achieves its goal!

Your donation supports increased access to providers for low income women.
Are you a midwife? A mother? A father? A childbearing woman? A grandparent?
A midwife supporter or a person who values choices in childbirth services?
We need you!

Already donated?
THANK YOU! Here's what else you can do!

  • Here is what moms, dads and grandparents across the country have to
say about CPMs and choices in childbirth. ([4]Scroll down on our home page
to view our new video.)

Forward this video to all your friends and colleagues and encourage them
to sign up with the MAMA Campaign ([5] )_

NEWSFLASH: MAMA is on Facebook and on Twitter—join us here:

The facebook group:

Click HERE for the link so you can tell your Congress members that you
value CPM services for maternity care and why CPMs need to be added to the
list of Medicaid providers. And a giant THANK YOU to all of you who've
already written your Congress members!


Friday, July 24, 2009

PUSH Alert re: Health Care & CPMs

The Big Push Campaign is seeking signatures on a new petition to support the inclusion of CPMs in health care reform. (This petition relates in part to opposition to CPMs that I posted about last week.)
PUSH TO OPEN Health Care Reform to
Certified Professional Midwives!

Today, right now, please go to

BE THE PERSON whose signature and whose action on behalf of out-of-hospital maternity care
pushes the button to open health care reform to Certified Professional Midwives!

One Minute to Sign It, One Minute to Push It On

Go to today to sign your name
to support including Certified Professional Midwives and out-of-hospital maternity care in federal health care reform. Then, help spread the word about the PushPetition to others.

It is so very important for us to show members of Congress (who continue to draft bills this week and next!) that there is widespread support for Certified Professional Midwives and out-of-hospital maternity care across our country.

If you are a midwife, doula, or childbirth educator, please send to your clients since they will always be the biggest supporters. Please post to other groups. We want to raise the roof with 10,000 signatures. Do your part -- sign today and PUSH it out to others! Share with friends, colleagues, post to Facebook and all your yahoo groups.

Incorporating CPMs into federal health care reform is something that both Democrats AND Republicans have been able to get behind in Washington.
They understand it will not only save lots of money, but also improve the health of mothers and babies.

Thank you!!!!

Relative Risks

During an ABC news segment about unassisted birth a while ago one of the physicians interviewed said that "The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child." Our culture in general has a fear of birth and sees it as a medical event fraught with danger and risk. Many women express fear of birth for a variety of reasons and "it is the most dangerous time in a woman's life" and "I almost died" or "I would have died [had I been giving birth at home]" are commonly expressed sentiments.

Dying in childbirth is an overinflated fear in the U.S. (in some other countries it is most definitely not and maternal and infant mortality remain a significant problem in the developing world). Perhaps it is not the most rigorous of analyses so take it for what it's worth, but some time ago I also came across the National Geographic "Ways to Go" chart which spells out odds of someone dying as a result of various turns of events. I think this chart puts some of our birth-death fears into perspective. The lifetime risk of dying of cancer 1 in 7 (heart disease is 1 in 5), motor vehicle 1 in 84. Falling is 1 in 214! Motorcycle accident is a risk of 1 in 1,020 and from smoke inhalation or fire 1 in 1,113. Accidental electrocution 1 in 9,968, legal execution is 62, 468, and there is a 1 in 144, 156 of dying in a flood.

Lifetime risk of a woman dying from childbirth (calculation includes dying of complications during pregnancy, birth, or abortion not just birth itself) is 1 in 3,750 in North America.

According to the Pink Kit, you and your baby have a higher chance of drowning than dying in childbirth (this is reinforced by the National Geographic article which lists drowning as 1 in 1,008).

According to Mother's Intention (2003) when writing about fear and birth, "statistically, they have a higher chance of dying on the way to the hospital (20 in 100,000 for car accidents in women of childbearing age) than they do during normal, natural birth (6 in 100,000) yet IVs aren't standard issue in cars. Of course, if they are one of the the 1 in 3...who get a cesarean their odds of dying are highest of all, 35 in 100,000." (These stats differ from those above, because the ones above are lifetime risk not episodic risk.)

Additionally, there is a 1 in 119 risk of dying from suicide and a 1 in 314 risk of dying as a result of firearms. Clearly, the hours of labor are not the most dangerous events ever experienced in a lifetime!

On a related note, Enjoy Birth recently had an interesting post up called Death by Cheeseburger? that explores the issue of aspiration during labor--quoted to one woman by her doctor as "the number one cause of death during birth."

CfM Blogger

Tuesday, July 21, 2009

Keepsake Ultrasound Ban

The governor of Connecticut recently signed a ban on "keepsake ultrasounds" (the kind that are performed "for fun" at a store in the mall, for example). The bill "bars anyone from performing ultrasounds on pregnant women unless a doctor orders them for medical or diagnostic purposes."

See: Conn. governor signs keepsake ultrasound ban

I have very mixed feelings about this ban. While I agree that unnecessary ultrasounds should not be performed, legal "bans" make me uneasy--for example, what if a governor decides "banning homebirth" is a good idea or "banning midwifery." When things like this happen, I start to worry about a slippery slope of governmental interference with parental health care decision-making.

CfM Blogger

Monday, July 20, 2009

Pit to Distress

There has been a lot of chatter on the internet recently about the "pit to distress" phenomenon apparently practiced in some hospitals. The phrase referred to the administration of Pitocin until the baby goes into distress and a cesarean can be performed. The Unnecesarean blog (as well as others) covered the topic in such depth, I don't have much to add! See this post and this post for her thoughts and quotes from a variety of sources. She quotes Keyboard Revolutionary (who I believe started the whole blog-flurry) as saying, “'OBs, do you still think women are choosing not to birth at your hospitals because Ricki Lake said homebirths are cool? Do you still think we are only out for a 'good experience?'"

Nursing Birth also has an excellent post on the subject.

All these posts and the "pit to distress" subject keeps making me think of the quote that opens Henci Goer's Obstetric Myths vs. Research Realities book: "Facts can be disproved, and theories based on them will yield in time to rational arguments and proof that they don't work. But myth has its own furious, inherent reason-to-be because it is tied to desire. Prove it false a hundred times, and it will still endure because it is true as an expression of feeling...It is illogical--or at least, pre-logical; but from this very fact it gains a certain strength: logic may disprove it, but it will not kill it."

This, to me, explains the essence of why harmful maternity care practices continue to persist in hospital settings.



CfM Blogger

Saturday, July 18, 2009

ACNM Opposition Letter

On Wednesday, the American College of Nurse Midwives (ACNM) posted a letter to Congress expressing opposition to the proposal to federally recognize Certified Professional Midwives under the Social Security Act (which would make CPMs eligible for Medicaid reimbursement). The letter emphasizes differences in educational preparation for CNMs vs. CPMs. ACNM also sent a letter to the membership regarding the organization's opposition to the MAMA Campaign.

The Midwives Allianace of North America (MANA) has responded to these letters here with an exploration and critique of some of the claims made by ACNM.

Citizens for Midwifery is part of the coalition of organizations behind the MAMA Campaign that supports federal recognition of CPMs.

CfM Blogger

Friday, July 17, 2009

Homebirth in the Hospital

I recently finished reading a new book called Homebirth in the Hospital (watch for my full review in the fall issue of CfM News). The book proposes an "integrative" model of childbirth--integrating natural childbirth with modern medicine. Interestingly, immediately after finishing the book I happened to come across the website of an OB practice in New York City called Village Obstetrics. With the tagline "minimally invasive obstetrics," this practice seems to be exactly the sort of integrative practice proposed by Stacey Marie Kerr in her book. I thought it was a neat coincidence. I was especially interested in the practice statistics on the Village OB site--they are excellent! (And it goes to show that when providers are proud of their stats, they have no trouble sharing them. It is a red flag if you ask a practitioner about their stats and they "aren't sure" or an unwilling to reveal them to you.) Without including scheduled cesareans (which appeared to be for legitimate reasons), they have a 6% cesarean rate (+ an additional 15% for various reasons)!

The Homebirth in the Hospital book doesn't address statistics specifically, but I assume physicians following that model would have similar, lower rates of interventions. (Do note that there are other things on the Village OB site, such as encouragement of continuous monitoring, that do not seem consistent with an integrative model.)

I finished the book (and the OB practice's site) feeling like a "homebirth" in a hospital is most definitely not for me (not really enough like homebirth at all!), but also feeling glad and optimistic that there are medical care providers out there who are seeking to practice in integrative ways that respect birth and women. I also am fully aware that the vast majority of American women give birth in hospitals and I think we desperately need other hospital-based healthy birth options to meet those women's needs!

I was also reminded of a section in the book Birthwork that addresses complementary care:

Parents who have quite comfortably given birth naturally and taken responsibility for their health are often perplexed by the zeal with which the medical model is upheld and promoted...Conversely, ardent natural birth activists can similarly perplex and infuriate those who have been grateful for necessary medical help their received when they gave birth in a hospital.

Like all great systems of belief, the revelations and tools of borth modern medical birth and natural birth are there to be embraced by those who choose to embrace them, and to be kindly offered to those who may benefit from them. We need to begin by negotiating the confusion that exists around the availability and right to medical help for a planned natural birth, and the availability and right to birth naturally within a medical setting. Rather than insisting on one right away, we need to appreciate that different systems of care can be complementary and helpful to one another. They can work together.
This section also reminded me of the recent study from the Netherlands about the safety of homebirth and how their maternity care system is is much more cooperative than we see here as it promotes access to midwifery as well as a good transportation and referral system (which necessitates working, egalitarian relationships between care providers).

CfM Blogger

Legislative Alert re: Birth Centers

From the American Association of Birth Centers:

Medicaid Birth Center Reimbursement Act
Introduced in the Senate - S.1423

This has been a very busy week week in Washington, DC! In the Senate, U.S. Senators Barbara Boxer (D-CA) and Mark Begich (D-AK) introduced S.1423 the Medicaid Birth Center Reimbursement Act to ensure Medicaid birth center facility fee payments to states.

In the House, the health care reform bill H.R. 3200 "America's Affordable Health Choices Act of 2009" was introduced. This bill includes the birth center bill language but it does not guarantee that all state Medicaid plans will cover the facility fee.

It is CRITICAL that we have strong co-sponsorship for our bills in the House and the Senate. This means that we need YOU and your colleagues, family members, clients and friends to contact your federal Senators and Representatives RIGHT AWAY.

Continue to work in the House and the Senate to secure co-sponsors for our bills (H.R. 2358 and S.1423).
1) Call your U.S. Senators and Representatives. Click here for directions on how to contact your Representatives and Senators and what to say. After you have made your calls, please call or email AABC's lobbyist Karen Fennell and tell her who you talked with and any comments or additional information requested. Call Karen at 301-830-3910; Send email here. This report to Karen is important so that she can follow-up.

2) Invite your Senators and Representatives to an Open House at your birth center during the August recess (the entire month of August). Invite the media and your clients to come. This is a win-win. The legislators and the birth center will receive positive press. We will develop an "Open House" packet and post it online in a few days for you to adapt for your community.

3) Attend the town hall meetings on health care reform that are being held across the country and make your voice heard at those meetings.

We MUST be prepared with strong co-sponsorship to move our legislation.
Who is already a co-sponsor?

House Bill H.R. 2358
Sponsor: Susan Davis (CA)
Co-Sponsors: Gus Bilirakis (FL), Lois Capps (CA), Robert Whittman (VA), Tammy Baldwin (WI), Sander Levin (MI), Diana DeGette (CO), Eric Massa (NY), and Janice Schakowsky (IL)

Senate Bill S.1423
Sponsor: Barbara Boxer (CA)
Co-Sponsor: Mark Begich (AK)

We need EVERYONE to take action and ensure that our bill is passed as soon as possible!


Jill Alliman, CNM, MSN
Chair, Legislative Committee
American Association of Birth Centers

Thursday, July 16, 2009

Letters Needed to Australia Senate Committee by July 20

Received this message from the Maternity Coalition in Australia:

You may have heard that women's right to choose homebirth with a midwife in Australia is currently under threat.

Three Bills have been introduced to our Commonwealth Parliament to implement the Government's maternity reform agenda. These Bills give Medicare (government healthcare funding) and subsidised insurance to eligible midwives - a huge breakthrough for Australian women. It means that from November 2010, Australian women will be able to choose a midwife in private practice to provide them with continuity of care through pregnancy, labour and birth.

The problem is that the Government doesn't intend the funding or insurance to cover homebirths, at this stage. And under proposed National Registration rules, midwives will need insurance covering every aspect of their practice, in order to be registered. Effectively this will prevent midwives in private practice attending women birthing at home from 1 July 2010.

A Senate Committee is investigating all the facts relating to insurance for homebirth so our politicians can make an informed decision. This committee is seeking submissions on the issue.

We believe it’s vital that the Senate Review committee receive submissions from internationally-respected organisations and professionals.

Please consider writing a brief submission from your organisation to the Senate Committee telling them that it is essential that women retain the right to choose homebirth, with a midwife in private practice.


If midwives lose their right to attend homebirths in Australia, other countries’ governments could use our example to enact similar legislation.

Mothers and midwives across Australia are working tirelessly – holding rallies, writing letters to politicians, meeting with them, speaking to bureaucrats, writing submissions, etc.

We implore that you add your international voices to ours.

Please forward this email far and wide amongst your networks.

See attached:
+Maternity Coalition’s fact sheet about the issues as we understand them
+Homebirth Australia’s info sheet on how to make a submission to the Senate Review committee

Melissa Fox
Mother of Lily (4) and Mia (1)
Maternity Coalition Inc
Ph: +61 7 3846 4664
Mob: +61 404 88 2716
Web: Maternity Coalition

Monday, July 13, 2009


A couple of interesting articles caught my eye today:

Delivering Affordable Health Care--this article in American Prospect talks about recent midwifery legislation in Idaho and also raises the point that homebirth and midwifery care are good for the "pocketbooks" of both women AND the government. It was written by doula-blogger Miriam Perez who also writes an interesting and thought-provoking blog called Radical Doula.

Why mothers should put up with pain of childbirth - by a male expert in midwifery was published in the Daily Mail this week. The article is getting a lot of critical comments along the lines of "no uterus, no vote," which I can see the sentiment behind. However, his basic point is a sound one (I think!): "[labor]..should be considered a ‘rite of passage’ and a ‘purposeful, useful thing.’"

Community-Based Doulas: A Good Investment in the Future was published on The Huffington Post last week. Written (surprisingly to me!) by Jane Fonda, she talks about her hope that one day every WIC program in the country will have a community-based doula program. As a matter of fact, in Springfield, MO about two hours from where I live, there is a program similar to what she describes called The Doula Foundation of Mid-America. I'm hopeful the this program will spread closer to my own community within the next several years. A similar article was included in the new book The Doula Guide to Birth that I am presently reading.

CfM Blogger

Friday, July 10, 2009

Nice New Resource

Injoy has teamed up with Lamaze to produce a nice little website with pdf handouts and video clips about "how to have a better birth." Titled Mother's Advocate, the site also has a nice 18 page booklet available called Healthy Birth Your Way. The handouts and video clips are based on Lamaze's Six Care Practices (last year CfM developed a handout incorporating these practices called "What Does Good Maternity Care Look Like?").

CfM Blogger

Free Domestic Violence Resources

When I was a junior in college, I began volunteering at a shelter for battered women (every Wednesday morning I answered the crisis line and every Saturday night I worked alone as "shelter relief" doing anything that needed to be done). I connected deeply with this work and it was tremendously important to me. I carried my passion for it into graduate school and did my master's "block field placement" at another shelter for battered women. Though it has now been quite a few years since I last set foot in a shelter environment, I will always have a special interest in domestic violence and the needs of battered women. My life's passion has shifted to birthwork and activism for healthy birth options for women, but this passion is firmly rooted in the commitment to women's health and social justice for women that blossomed in me during those many shifts at the shelter in college.

I've written previously about violence against women both medical and domestic and I was excited to learn from a post on the allDoulas forums that there is new FREE Online Training for Health Care Professionals about domestic violence during pregnancy available from Safe Place, a shelter in Austin, TX.

"Domestic Violence & Pregnancy: Effective Screening and Intervention is a 1.5 hour on-line training is intended for staff nurses, advanced practice nurses, physician assistants, social workers, case managers and physicians in the Ob/Gyn and family planning settings. This training will explore the fundamental domestic violence knowledge required to identify, treat, document and, if necessary, report domestic abuse. CNEs (Texas) and CEUs (Texas) are available."

In 2004, I wrote a booklet called Talking to a Battered Woman that I recently decided to make available as a free pdf from my personal site.
CfM Blogger

Tuesday, July 7, 2009

Items of Interest

On the Mindful Mama website this past week I was interested to read an article called Five Things Every Woman Should Know Before Giving Birth.

Written by the author of a fairly new book titled Homebirth in the Hospital, she suggests 6 "C's" for having a "homebirth in the hospital":
  • First, take responsibility for your choices.
  • Expect communication to be open and flowing both ways
  • Pay attention to continuity of care
  • The confidence you have in your provider and in your birth team is essential.
  • In any hospital, there must be control of protocols...I can not stress this point strongly enough: Protocols are the most disempowering aspect of modern maternity care, giving the message that our bodies don’t really know how to have babies without someone else managing the process for us.
  • Finally, the sixth C to consider, the one that should never be allowed into a birth: conflict. Conflict releases stress hormones that work against the powerful hormones that facilitate birth. Humans are mammals, and no mammal gives birth easily when fearful or in an unsafe situation. If you resolve most issues long before your first contraction, you shouldn’t have to fight for your choices while you are in labor.
The author is also interviewed in a video clip on the site about Finding Your Power in Birth:

Also from Mindful Mama is another short Penny Simkin video called Alternative Ways to Relieve Labor Pain (she teaches a hand massage technique):

Finally, I'm a little behind in mentioning this, but a Letter to the Editor from OBOS director Judy Norsigian regarding Evidence-Based Labor and Delivery Management was published in the American Journal of Obstetrics and Gynecology in May. The conclusion of the letter was: "In the absence of adequate evidence, we believe that the American College of Obstetricians and Gynecologists should retract its strong opposition to home births."

CfM Blogger

Saturday, July 4, 2009

Australia Homebirth Video

This is a video with images drawn from a rally in Australia to protest the recent legislation that threatens to destroy homebirth midwifery:

View this montage created at One True Media
~ we love homebirth ~

CfM Blogger

Friday, July 3, 2009

Maternal-Fetal Conflict

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, Board member Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:
[quoting the expert physician interviewed for the segment] "The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesearean delivery, and women who insist on denying this right are irresponsible."

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!
In the book Birth Tides, the author discusses maternal-fetal conflict:
According to obstetricians, the infant's need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother's desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby's needs against those of the mother, setting 'overriding' physical needs against 'mere' psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother's body--the 'hard and soft passages,' as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about 'carrying' babies, they do not see themselves as 'carriers,' any more than they regard their babies as 'parasites' in the 'maternal environment.' If you see your baby as a part of you, there can be no conflicts on interests between you.
I previously linked to a book review that explores this concept of the more aptly described "obstetric conflict" in even more depth.

Tomorrow is Independence Day and I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto--or, motherbaby--the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what's good for one is good for the other).

As Willa concluded in her CfM News article, "...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor."

CfM Blogger

Wednesday, July 1, 2009

Physicians & Birth

A few weeks ago, I read an older book titled Woman-Centered Pregnancy and Birth. I marked the following quote to share because I thought it succinctly summed up one of the primary issues in maternity care:

"The major problem which arose almost as soon as physicians started attending women in birth is the same problem which exists today in obstetrics: physicians use their medical techniques when they are not really necessary and their technology and practices often create more problems than they solve. It is possible to appropriately apply this criticism to nearly every form of technology which has been used by physicians on women in birth from the 1500's to the present."

I also noted an observation from the book Birth Tides: Turning Towards Homebirth: "To these people, it seems as thought the medical system has been reduced to a form of social control. [Another woman] makes the point, however, that controlling women has always been an intrinsic part of antenatal care."

I think the recent AMA resolutions I've posted about and the situation with private midwifery in Australia lend credence to the idea that the medical system is a form of social control!

CfM Blogger