Resolve Hospital in Ghana

In the most recent issue of the CAPPA Quarterly, I read an article about a midwife/childbirth educator at a small private hospital in Ghana, Africa. She founded it last year with her husband who is an OB/GYN. The hospital has 6 beds and is an alternative to the not-very-women-friendly care provided by government hospitals in Ghana. You can read more about the hospital on the Resolve website.

From scanning over the website, it seems like a more "medical model" than I personally prefer, but still a very interesting alternative model of care!

--
Molly
CfM Blogger

Book Review: She Births

Book Review: She Births: A Modern Woman’s Guidebook for an Ancient Rite of Passage
By Marcie Macari
Infinity Publishing, 2006
ISBN 0-7414-3390-7

255 pages, softcover, $23.95
http://www.shebirths.com

Reviewed by Molly Remer, MSW, ICCE

http://talkbirth.wordpress.com

She Births is a book that “goes beyond” the average birth book. It is a particularly good read for mothers having subsequent children—perhaps for a woman who is well read in the physiology and stages of labor and who wants to dig deeper into the emotional and spiritual meaning of giving birth. It is also helpful for first-time mothers, though I felt that there was a lot of content that seemed to assume the reader had already given birth (and was perhaps reading this book to reflect, process, and prepare for future births).

The emphasis of She Births is on childbirth as a rite of passage and as an opportunity for spiritual growth and personal transformation. There is a lot of content that has a very “New Age” flavor. While I personally do not mind—and actually enjoy—this framework, other readers may consider some of the sections to be offputting.

Each chapter ends with a short chapter-topic meditation and several pages of related journaling exercises.

The book contains a higher than average number of minor typographical errors, as well as odd mid-sentence capitalizations, and too-short dashes between ideas. Persistent capitalization of words such as Birth and Spirit were a bit distracting. The book contains a variety of empowering birth stories, but none of them have attribution, making it difficult to identify who was giving birth. (The author? The woman in the previous story?) It was hard to grasp who was the “I” reflecting and sharing in each story.

She Births has several particularly wonderful passages that are well worth quoting and it also has a lovely cover. It is a passionately written book that is very dynamic and “alive” to read. The book is strongly written—the author does not mince words nor attempt to “balance” her perspective and this can be a refreshing approach. She Births also raises thought-provoking questions such as, “The way a society views a pregnant and birthing woman, reflects how that society views women as a whole. If women are considered weak in their most powerful moments, what does that mean?”

–

Disclosure: I received a complimentary copy of this book for review purposes.

Crafts and Birth

I posted this a couple of years ago, but thoughts it was worth revisiting. Every year in April, I teach several classes at an annual craft camp in southern Missouri (not birth classes, this is part of my "other life"--this year I am teaching book binding, a bead ornament, and "card ladies"). However, I relate the experience to birth in the sense that people put a lot of time, energy, passion, and commitment into creating beautiful craft projects and works of art. And, we value the "one of kind" and the "unique." Giving birth is the ultimate creative act! Why is it treated as a medical event? As a one-size-fits all, follow-the-curve-or-else-have-surgery, experience? Each birth IS an extremely unique and "handcrafted" event in the life of a woman and of a family, but many women spend more time picking out the car seat than they do planning for their births.

Of course, these thoughts also reminded me of this section from an article in Midwifery Today:

While shopping [one] day, I noticed hand-dipped chocolates, homegrown vegetables, hand-spun wool, homemade preserves, cottage-industry soaps—all at premium prices, since they were made with care, individually, by hand, at home. I reflected, too, on how "old-fashioned" doctors, famous for house calls and compassion, are remembered fondly as part of the "good old days" and praised for their one-on-one caring. I mused how our society honors unique, special, one-of-a-kind items and services.

Yet when it comes to maternity care, it seems the bigger and busier, the better: high-tech procedures, standardized treatment, massive patient loads, in-and-out, assembly-line-style facilities. We are urged to leave the clean peace and quiet of home and go, instead, to a large, centralized center and entrust ourselves to a system of detached and often distracted institutional workers whom we've never met and may never see again. I find it hard to believe that anyone would consider hospital care preferable, if they really thought about it.

High-tech or hands-on? The choice is not new. In many cases, of course, mechanical and technological advances have been just that: improvements. Other advances, as we all know too well, have resulted in lasting harm.

— Judy Edmunds, excerpted from "A Grand Triumph," Midwifery Today Issue 37

(quoted in enews 8:20)

I am looking forward to this weekend away in a creative atmosphere and hope to get a lot of pending book reviews written in my time away!

--
Molly
CfM Blogger

New Birth Films

Via one of my favorite email lists (Independent Childbirth), I just learned about two new documentaries about birth.

From Australia, a documentary in the making called The Face of Birth:



And then a documentary about doulas called, Doula: The Ultimate Birth Companion:



Both look like very interesting contributions and I look forward to seeing the complete versions!

--
Molly
CfM Blogger

Cesarean Awareness Month!

I wanted to pass along a letter from ICAN about Cesarean Awareness Month (April). ICAN (International Cesarean Awareness Network) is a wonderful organization and I am so thankful for the wonderful work it does. I am also completely psyched that the ICAN conference is going to be in St. Louis next year--St. Louis is only about two hours drive for me and I am SO THERE for this conference! I have been an ICAN member for about two years now and I have really enjoyed several of their webinars.

When I think about Cesarean Awareness Month, I think of all the cesareans that don't happen when women receive the Midwives Model of Care. I also think about the rising cesarean rate--preliminary data is out and the rate as increased again to 32.3%.

Anyway, below is the letter from ICAN!

--
Molly
CfM Blogger
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Dear friend of ICAN,

Thank you for your continued support of ICAN's mission! In honor of Cesarean Awareness Month, I invite you to do something concrete to show your commitment to moms and babies everywhere. I encourage you to become an ICAN subscriber or renew your subscription by visiting the ICAN Bookstore or contacting your local chapter today.

Cesarean Awareness Month is the perfect time to subscribe to ICAN. In addition to reduced subscription rates, we will be offering three fantastic webinars, all of which are free to ICAN subscribers:

• Cesarean Scar Care in the Post-Partum Period: Sunday, April 11 at 7 pm EDT.
• ICAN Birth Class: Cesarean Prevention: Tuesday, April 20 at 9 pm EDT
• ICAN Birth Class: Journey to VBAC, date TBA

We also encourage you to join us for an ICAN meeting live, online on Thursday, April 15 at 9 pm EDT.

As always, ICAN subscribers also receive the Clarion, ICAN's quarterly print newsletter and discounts to the ICAN Bookstore and the ICAN Conference. Professional subscribers enjoy a free listing on ICAN's Professional Subscriber Network, and Childbearing Years and Lifetime subscribers will receive a special mention in the next Clarion. Subscribers who participate in our online forums also receive public recognition by means of special ribbons every time they post.

ICAN is an all-volunteer organization working tirelessly to improve maternal-child health. Through the financial support of our subscribers, we have been able to:Provide support through over 130 chapters in the US, Canada and around the world, through our 1-800 number and through our online forums

• Provide evidence-based information through our website
• Increase awareness of cesarean and VBAC issues through our blog and social networking sites.
• Offer live, interactive online webinars to educate health care consumers and professionals
• Send ICAN representatives to our nation's capital to bring light to insurance discrimination due to cesarean as a "pre-existing condition"
• Send ICAN representatives to conferences around the US to raise awareness of cesarean and VBAC issues

Thank you again for your support. Please let us know how you will be honoring Cesarean Awareness Month by sending an email to feedback@ican-online.org.

Warmly,

Desirre Andrews
ICAN President
www.ican-online.org

DVD Review: Dance of the Womb: Belly Dance for Pregnancy and Birth

DVD Review: Dance of the Womb: Belly Dance for Pregnancy and Birth
By Maha Al Musa, 2009
Red Polar Pictures
164 minute DVD, $49.95 (AUS)
http://www.bellydanceforbirth.com

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

Maha Al Musa has created a remarkable treasure for the birth world—an easy-to-follow, beautifully presented, step-by-step instructional bellydancing DVD called Dance of the Womb. Maha’s interest in Middle Eastern Dance was sparked by her Palestinian/Lebanese roots and she brings a lot of love and authenticity to her presentation of the dance techniques. Maha has also published a gorgeous companion book, also titled Dance of the Womb (see previous review).
Dance of the Womb contains a 45-minute dance stretch warm-up. The exercises are comprehensive, gentle, and easy to follow. There are also six instructional dance technique chapters that cover specific beginning bellydance movements.

One of the special treats of this DVD is the included 50 minute video about Maha’s own homebirth journey with her third child (at age 46!). It also contains interviews with several homebirth midwives. The still photographs and birth footage are beautiful and brought a tear to my eye several times! Another bonus feature is a seven minute guided relaxation exercise.

Dance of the Womb is a great introduction to the basic physical elements of prenatal belly dance and also to some the spiritual and rhythmic aspects of giving birth. The DVD is a gentle and nurturing experience for both pregnant women and the women who serve them.

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Disclosure: I received a complimentary copy of this DVD for review purposes.

Opinions: Herbal Inductions

In March, I polled the Citizens for Midwifery Facebook page for opinions on herbal induction methods—pros, cons, cautions, regrets, suggestions. Herbal inductions are definitely a topic with some controversy, which is why I asked about it in the first place!

My personal leaning is to stay far away from home inductions (though, as another woman shared, I do take evening primrose oil and drink raspberry leaf tea during pregnancy in general). I strongly feel that babies are like fruit—“best when they’re ripe”! I also feel like it is a contradiction to strongly support natural birth and homebirth and then to casually intervene with “natural” remedies to “evict” the baby before its own time.

However, I also recognize that women’s lives are complicated. I also know there are a variety of states with 42 week cut-offs for midwives to attend births at home and it must be very difficult to have to choose between being "risked out" of a homebirth that you have planned happily for and end up with a hospital birth or to try to "move things along" at home.

Here is a sampling of responses from consumers and midwives from across the country on this often controversial subject!

Worked:

Was just induced with my third baby. It worked! My midwife made me an herbal tea that included the cohoshes. She also stripped my membranes. About an hour and a half after drinking the tea I started having contractions. –EC

I also tried the blue and black cohosh with some but minimal results in the end castor oil and orange juice did the trick at 43 weeks. –AJC

Sure did! And, it worked. I started evening primrose oil capsules inserted vaginally twice a day for two weeks and black cohosh liquid four times a day for one week. Then I performed nipple stimulation to get things rolling. It worked wonders for me! I was in labor for 1 hr and 8 minutes with my third and last child. All this was done at the advice of my midwife. --SM

I used evening primose oil both orally and squirted onto cervix from 36 weeks on...it made my cervix much riper and easier for an AROM induction and needed very little Pitocin. –ASK

Strong red raspberry leaf tea and nipple stimulation. Worked within 12 hours with my second child. I was going for a VBAC, and the midwife had commented that she thought the baby was getting rather large. (I know, I know!) I wasn't about to go under the knife again and thought I'd just start trying some easy things on my own. Went in to labor the next day, delivered 30 hours later - on my due date, by the way. Oh, and he wasn't large after all. Only 7 lbs 7 oz! –ABL

Castor oil with number two worked like a charm and wasn't nearly as bad as I had heard. I also tried acupressure, reflexology and drank sage teas to soften the cervix. Too scared to try blue/ black cohosh. --RG

Didn’t Work:

Tried everything I could find in herbals and online, nothing produced contractions that had any ooomph or went anywhere. Ten days overdue the weather changed and baby came when he was ready (all 10lbs 14oz of him). Castor oil made me very sick, least pleasant home remedy I tried. –WE

At 42 weeks midwife had me do blue and black cohosh...yuck. Didn't work, upset my tummy, tasted like dirt of the earth. At 42 weeks any Mommy feels desperate, especially when a homebirth is at stake, but I feel body always knows best.--JLM

I used evening primrose oil orally and vaginally, as well as a few days of horribly disgusting black and blue cohosh. Unfortunately neither worked, leading to four days of pitocin. –AJ

I used the cohoshes to help aid a miscarriage (blighted ovum) and I couldn't get it to work. I tried for about a week. --WMN

My midwives had me drinking tons of black and blue cohosh during my labor. It helped speed up contractions but it wasn't enough to get the baby out. My water broke early on and my cervix didn't want to dilate on its own. I spent four days in labor at home before ending up at the hospital. I spent 12 hours there on a pitocin drip but never dilated past 7cm so I ended up with a c-section. --KZ

No Other Choices:

With my first, 11 years ago, I was 9 days overdue and seeing an OB that had scheduled an induction which I desperately did not want. I saw a Chinese herbalist on my own and he gave me a cohosh mixture that I took, I went into labor the next day, whether from the herbs or not I don't know...it was a rough labor. I don't know if it was the cohosh mix, a posterior baby, or the fact that she was 10lbs 4 oz and I weighed 100 lbs pre-pregnancy. Or maybe a combination of all. But the nurses at the hospital told me the contractions looked like "pitocin contractions," when I was in very early labor.

I don't know that I would do it again unless faced with another induction. With my second, nearly 5 years ago, I was 8 days overdue and while my midwives did schedule an induction, I didn't take any herbs and went into labor on my own.

With this one, I'll be at home, no one will be breathing down my neck threatening induction the second I hit 40 weeks, so I'm hoping it won't be an issue again! My body just takes 41 weeks to cook babies, that's all. –ET

As a first time mama who wanted to use the local birthing center it wasn't an option for me to be overdue by more than a day or two. So, two days before my due date I choose to "induce" with acupuncture which worked so well that I gave birth on my exact due date. And I attribute it to the acupuncture treatment! --LB

After three hospital inductions, I'm determined to not be induced with this one. I'm going to take a five week formula starting here in about two weeks, so I'll have to let you know then. –RJ

Tried it- didn't work! Had to revert to induction. In Texas midwives have to transfer care at 42 weeks... that's the only reason we induced. We tried blue/black cohosh, EPO, castor oil, red raspberry and membrane stripping, sex, walking and pumping/nipple stimulation. I was 100% positive of dates since we did IVF. None of it worked, so our choices then became cytotec and continue on at birth center with midwife or pitocin in a hospital with monitors and IV's. I don't agree with the 42 wk cutoff for midwives- it sucks. At 42 wks, baby weighed 7 lbs 10 oz. My 42 wk daughter weighed 8lbs 13oz and my almost 42 wk son weighed 8lbs 2 oz. Daughter came on her own, son was induced (found out later my bishop was a 1, so I shouldn't have been induced, but I didn't know any better then). --MM

I dealt with high blood pressure at the end of my pregnancy so I had acupuncture. I had to have two rounds of it but after the second round I went into labor 16 hours later. My water broke first and I wonder if that was due to the acupuncture. I am pregnant with my second and dealing with high blood pressure again and will be getting acupuncture in the next day. My midwife is also going to do a sweep. Sometimes you have to weigh you risks and for me getting baby out is important since my blood pressure seems to be rising. And I want to stay at home if at all possible. --AJ

Cautions:

I feel the need to point out (please don't judge) that cohosh is strong medicine and should be used only under midwife supervision. --SA

I was tempted last pregnancy but only went a few days overdue. I'm 39 weeks along right now and just miserable, with two young kids to care for already. But I'm holding out and letting nature take its course this time as well. Today at the park, another mom tried to sell me on the castor oil trick as it worked for her. I have another friend who did castor oil and was violently ill from it. Being as tired as I am, I can totally understand why many moms try various herbal induction methods. --FS

You know I am not a fan of inducing for any reason. That being said I know if you are being faced with an alternative less than appealing situation herbals might be a better solution.

I was pressured to get my labor started at 42 weeks and we pushed the cohoshes and in my opinion it just elongated my labor for 3 + days. Babies come when they are ready. --HB

I do NOT recommend generally. I also oppose 'labor prep', 'last 5 (or 6) weeks formulas', and 'gentle birth formula' for the same reasons. Herbs are medicines--not harmless, but to be respected. There are gentler ways to prepare the body to birth in its own time. I get the Texas law thing, as I've worked there, but it doesn't make it right or safe or healthy. –CR (midwife)

I've been attending home births for about 31 years, over 2200 babies. My first reaction to this question is that an induction is an induction, whether you choose "natural" methods or pitocin, cytotec or whatever, it's still an interference in the natural hormones and rhythm of birth, and I discourage the women coming to me from trying to start their labors except for the most serious of situations. I sincerely feel that interfering in birth puts us in the same category as the doctors and hospitals we strive to be apart from and better than. The method of interference isn't important, it's that we interfere at all.

Having said this, I have had mothers attempt to jump start their labors with herbs and I have very rarely seen it work. Of course we have no idea when labor is going to start on it's own, so it's hard to tell if a herbal mixture has started labor or if it was just a coincidence.

I do know that herbs, castor oil and the like cause ineffective contractions that tire the mother out and leads to a woman who is more exhausted than she need be for a labor that might follow closely on the heels of an "induction". I have also seen herbs cause nausea, vomiting and general ill feelings in women...certainly not the conditions most women would desire to start labor in....

In the rare situation when I have helped women to get into labor, I find that a good "stretch and sweep" usually does the trick. It might need to be done a couple of times, but if the cervix is even a little ready it usually responds well. When we do feel the need to get a labor going I always do it in the morning, after mom has had a good nights rest and breakfast, that way if it doesn't work, it will generally peter out in the evening and mom can get to bed at a reasonable time and we can attempt again the next day. Sometimes when we have attempted this the mom will take some herbs to "supplement" the induction, but I don't see them helping much...but it does help the mom feel like she's doing something to make it happen, which can help with her mental attitude...not a bad thing at all.

I have pretty strong opinions about midwives being the protectors of normal birth. Even when a women is sick and tired of being pregnant we need to encourage her to let nature do it's thing. I tell women that one of the most important roles I have in their pregnancy is reminding them at 9 1/2 months pregnant what their beliefs were when they were 3 months pregnant. –MD (midwife)

I just want to comment on the acupuncture/acupressure thing. At my regular scheduled prenatal massage, at 40 wks - 2 days, she did reflexology/trigger point massage with me -- I honestly did not think it would work. About 15 hours later I started contractions - which led to a 48 hour labour with no progress, baby in wrong position, homebirth dreams broken, transfer to the hospital after 38 hours for pitocin drip and a posterior delivery. Baby also had a very poor latch for breastfeeding, sucking reflex not fully matured. All due to an early delivery? Most likely. Due from the reflexology? Who knows. I'm now pregnant with our second and do not plan on interfering with nature's plan in any sort of way! --AM

With regard to castor oil, I have had students for whom it has had mixed results. Either it did not work, or resulted in a protracted labor. In one case the midwife commented that the baby probably would have been born then anyway—four days after inducing with castor oil. As for 5W mixture taken at the end of pregnancy--experiences resulted in harder than normal contractions that did not necessarily produce good results --I think we can try to force the issue all we want, but if a woman isn't ready, then she isn't ready. Restrict induction to only medically necessary. According to Dr. Marsden Wagner --Inducing for dates alone is inappropriate. --AVH

Other Ideas:

Perhaps a much safer method of induction would be reflexology and/or acupuncture. I did acupuncture when I was a week past my due date, but I'm terrified of needles so I think that could have prevented it from working...who knows…

There are no harmful side effects to worry about with acupuncture or acupressure or reflexology, and at least if they don't put you right into labor they make you a little more comfortable. My midwife did tell me that it might take more than one session to work (speaking of both methods). –SS

I took evening primrose oil (EPO) and red raspberry leaf tea for the last several weeks of my pregnancy, but I don't really consider them "induction" methods, since I took them for so long. Both times, I went into labor at 39w1d and had the baby the following day (1st labor 9 hours). However, a SIL went into labor both times within hours of using EPO one time (both times she was about 39 weeks). –KP

Hypnosis is ~80% effective in inducing labor, as is the Webster chiropractic technique. If a mom 'has' to be induced, they can start with cervical gels to see if that gets labor going, rather than starting with Pit. And, if she does need Pit, she can agree to just a small amount to see if it works. Once labor gets going, they can stop the Pit to see if her body keeps going on its own. I also believe in letting nature take its course, and hate to see women induced. Babies come when they're ready. –JB

Ylang ylang got my contrax going when my water had broke but with no action. I got an herbal belly rub and bath with ylang ylang, sandlewood, rose, clary sage.... oh goodness is was wonderful and WORKED! –LP

I hate the fact that women are under such pressure to produce the baby on a certain date. I waited out my last 43 week pregnancy and had a quick, spontaneous labour and a healthy baby (9lb 4oz, born at home BBA!). When the baby is ready, it will come. AIMS in the UK has a fabulous booklet on induction that you may like to have a look at (www.aims.org.uk)--I wish women had more support from their care providers, friends and families to consider alternatives to induction like monitoring baby and mother's well-being from 42 weeks and acknowledging that the normal length of pregnancy is not 40 weeks. --RW

My son was "late" by everyone's book except for my own, and I was facing the possibility of having to go to the hospital to be induced. My MW did not have hospital privileges there, so the doctor would be someone I had never met before.

My MW suggested acupuncture to help labor get started. I scheduled the appointment for the afternoon before my "time" would have been up.

In the meantime, my MW advised that I take primrose oil and after five days of taking that, she gave me a tincture of Motherwort, (a dropper full, undiluted) and a tincture of Angelica (5 drops) to take diluted in a glass of water. Each were to be taken three times a day. They seemed to help. She mentioned not being a fan of the cohosh, except to aid in stopping hemorrhage.

My labor began the morning before my acupuncture appointment was scheduled and labor lasted about 11 hours. –KF

My water broke early in the morning of January 30, 2008. Cumin tea (gross), long walks, and nipple stimulation (w/breast pump) failed to bring on active labor. Late in the afternoon of January 31, I went to the acupuncturist. Active labor started at 7:00 and baby was born 12 hours later. Labor ramped up VERY quickly - I suspect that to at least some degree my experience mimicked that of someone induced via drugs. --GB

Thank you to everyone who shared opinions and experiences!

--
Molly
CfM Blogger

CfM Achieves All Maternity Care Goals!

Citizens for Midwifery is pleased to report that, with an extra bit of effort, we have achieved all of our organization's stated aims over the course of the last two months. The following goals have been met:

• All women now have equal access to high-quality care that follows the Midwives Model of Care, and, due to recent federal legislation, all maternity care is fully subsidized and/or covered by insurance, and the government has launched a comprehensive effort to encourage lower-cost out-of-hospital and non-medicalized birth.
• All midwifery licensing is now federally recognized, and the government's recent reports on the vast benefits of midwifery care are encouraging more and more women to seek out midwifery services.
• Due to the above, new Cesarean rates are starting to come in, and the percentage is down to about 15% of all births.
• Also due to the above, new Epidural rates are starting to come in, and the percentage is down to about 20% of all births.
• All American hospitals have recently adopted the Mother-Friendly Childbirth Initiative and have replaced standard L&D wards with 90%+ birthing rooms fully equipped with tubs, birthing stools, and free doula services.
• Due to the new across-the-board Baby-Friendly Hospital standards that have come out of the Mother-Friendly Childbirth Initiative, 95% of all American women are now breastfeeding for at least a year.
• The World Health Organization is now promoting the American model of maternity and midwifery care, what with its excellent outcomes and evidence-based policies, as the gold standard in the world.

In light of all of this, Citizens for Midwifery has decided to disband its board, but only after we use our remaining funds for one last annual board meeting at an all-inclusive Caribbean resort.

Happy April 1st, everyone! May it one day not be such a joke!

--Arielle Greenberg (CfM Board)