Friday, April 25, 2008

Research the kind of birth you want...

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

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

Wednesday, April 23, 2008

Grassroots Network: Time Magazine Article

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

Dear Friends,

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

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

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

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

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

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

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


Susan Hodges, "gatekeeper"

Friday, April 18, 2008

Birth Customs

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

(Chagga saying, Uganda)

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

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

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

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

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

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

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

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

Friday, April 11, 2008


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

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

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

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

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

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

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

More about the documentary quoted from the site:

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

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

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

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

Friday, April 4, 2008

"War Zone Doula"

In this quarter's edition of DONA's publication International Doula, I read a riveting article called "War Zone Doula" about a woman who traveled to Afghanistan to volunteer as a doula at the largest maternity hospital in the country. Similarly to my post recently about A Book for Midwives, this article was also difficult to read because of the conditions in which the women labored and the manner in which they were treated. Afghanistan has the highest maternal death rate in the world and conditions in the hospital described were deplorable--no hand washing, reusing the same gloves, women all laboring in the same room, women having to labor two to a bed, only one cup to drink water with, and things like that. What we are familiar with as the Midwives Model of Care was not present and, as described in this article, the midwives, nurses, and doctors working with these women did not speak to the women, make eye contact with them, offer them information following exams, or show any empathy or nurturing towards them.

This was a very interesting article and if you have a chance to read it, I'd recommend it!

Edited to add: Sheridan left a comment on this post wondering about what kind of access these women have to giving birth at home instead. I don't know, but it is a good question--what is the availability of homebirth midwives like in Afghanistan? Since the hospital culture described seems similar to US hospital culture in the late 1800's and early 1900's when birth was moving into hospitals, I wonder what the homebirth midwifery environment is like? Here is an article and a link to the Midwifery Today page about Afghanistan.

Business of Being Born Popularity

I was interested to read recently that since the film The Business of Being Born is number 28 in the Top 50 of Netflix's instantly watched films. 85,000 people have rented the film from Netflix already (or have it in their queue) and then 14,000 have watched it "instantly" (this is what puts it at #28). I think this is fantastic!

Wednesday, April 2, 2008

Cesarean Awareness Month

April is Cesarean Awareness Month! Cesarean Awareness Month is an "internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It's about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section."

Who should care about cesarean awareness? "Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It's for daughters who don't realize what choices are being taken away from them. It's for scientists studying the effects of cesareans and how birth impacts our lives. It's for grandmothers who won't be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans."

Why have a cesarean awareness month? Because cesareans are SERIOUS. "There is no need for a 'catchy phrase' to tell us that this is a mainstream problem. It affects everyone. One in three
American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world."

For more information visit ICAN.