Women's Equality Day

It was on August 26, 1920, that women finally obtained the right to vote with passage in the U.S. Congress of the 19th Amendment!

According to the website of the National Women's History Project:

"The observance of Women's Equality Day not only commemorates the passage of the 19th Amendment, but also calls attention to women's continuing efforts toward full equality. Workplaces, libraries, organizations, and public facilities now participate with Women's Equality Day programs, displays, video showings, or other activities."

You've probably guessed what I'm going to say, but I would love to see all women have equal access to to quality birth care--that would include the Midwives Model of Care (equally applicable in hospital settings as well), the Six Healthy Birth Practices (Lamaze) as the standard of care, and simple respect of women's voices about their wishes in birth. As it is now, women are limited in this equal access by geographic region, insurance coverage, financial need, legal restrictions, VBAC bans, and lack of available midwives to name a few. Some people take a, "where there's a will there's a way approach--I'd do anything it took to pay for my midwife and have my baby at home," but I believe it is much more complicated and multifaceted than that.

As I think about Women's Equality Day, I also think about this quote from Raven Lang in her 1972 classic, Birth Book:

“Birth has not only reached the absurdity of having to be relearned, it also has the absurdity of becoming a criminal offense if we are to go ahead with our ideals and do things the way we desire. And so, because of the system, midwifery as practiced in this book is against the law. It has become political. We didn’t make it that way. For us it is a beautiful, personal, spiritual, sexual experience. And for us to have that, we become criminals.”

I shared this quote on the CfM Facebook page and several people commented that not much has changed today...

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Molly
CfM Blogger

The Magic of Mothering

In Raven Lang's classic Birth Book, there is a section in it about "imprinting" (I think it has been established that human "imprinting" after birth doesn't technically exist, but when this book was written in 1972 it was one of the ideas). Anyway, there was a section about research done with baby goats done to look at the ability of a mother to protect her offspring from environmental stress. They separated twin goats and put some in rooms alone and the others in rooms with their mothers. The only difference in the room was the presence of the mother. An artificial stress environment was created involving turning off the lights every two minutes and shocking the baby goats on the legs ( :( ). After the babies were conditioned like this, they were tested again two years later. This time all the babies (now adult goats) were in rooms alone and were again "treated" to the lights off and shock routine. The goats who had been with their mothers during the early experience showed no evidence of abnormal behavior in the stressful environment. The ones who had not been with their mothers did show "definite neurotic behavior." Somehow, the presence of the mother alone served to protect the baby goats from the traumatic influences and keep them from being "psychologically" disturbed in adulthood.

Except for feeling sorry for the baby goats, I thought this information was very cool. How magic are mothers that just by being there we can help our babies--even if there is still something stressful going on, our simple presence helps our babies not be stressed by it and continue to feel safe. Magic!

This was included in the book because of the idea that birth may be a stressful environment for a baby and if the continuity of motherbaby is maintained after birth (immediate skin-to-skin contact and opportunity for breastfeeding), the baby does not become stressed or "neurotic." But...if the continuity for mother and baby is broken by separation (baby whisked away for weighing or whatever), both mother and baby are stressed by this and it may have an impact on their future relationship and behavior. The book also talks about how the sound of the baby's first cry has a sort of "imprinting" effect on the mother in that her uterus immediately begins to contract and involute after hearing her baby's first cry, whereas mothers who are immediately separated from their babies and do not make contact with them have a higher likelihood of postpartum hemorrhage (I have no idea if this has been debunked or not since the book was written in 1972, but it was an interesting idea to read about).

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Molly

CfM Blogger

Perennial Favorites

Recently, on the CfM Facebook page I posed the question: do you have a favorite birth book that you can re-read over and over, each time being engaged anew and/or learning something fresh from familiar words?

I asked the question because I am currently re-reading Birthing from Within for the sixth time. When I read this book, I find I always learn something new, gain fresh insight, or have ideas reinforced/validated. I read it for the first time during my first pregnancy and have read it during two subsequent pregnancies (and now again, during my fifth pregnancy) as well as two other times seeking insights and application for the birth classes I teach.

I asked this question and then went out of town for the day. When I returned, it absolutely made my day to see many responses to my question with lots of great books listed. Three other commenters shared that Birthing from Within is their favorite too and then there were over 30 other posts with other people's perennial favorites! Here is the list--I hope it will remind you to revisit some old treasures in your personal library.

• Ina May's Guide to Childbirth (this, and/or Spiritual Midwifery received NINETEEN recommendations!)
• Gentle Birth, Gentle Mothering by Sarah Buckley MD (x's 2)
  
• Journey into Motherhood, edited by Sheri Menelli. The commenter said, "LOVED it. read it over and over. Full of inspiring, uplifting, wonderful birth stories."
• Heart and Hands, by Elizabeth Davis (x's 2)
  
• "Anything written by Sheila Kitzinger. She is my fave birthy authoress!" [note from Molly: she is definitely one of my top favorites as well!]
• Hypnobirthing, by Marie Mongan (x's 3)
  
• Birth: The Surprising History of How We Are Born, by Tina Cassidy
• The Birth Partner, by Penny Simkin (x's 4)
• Your Best Birth, by Ricki Lake
• Gentle Birth Choices, by Barbara Harper (x's 2). Comment from FB fan: "It's the book I give to non-birth nuts to help them understand why I do what I do."
• Open Season, by Nancy Wainer. Comment from fan: "get's at the heart of things on every level-body, mind and politics" [note from Molly: I LOVE this book too. Very fire-y!]
• Orgasmic Birth, by Debra Pascali-Bonaro
• Osceola Guide to Natural Childbirth
• Birthing in the Spirit, by Cathy Daub
• Under the Apple Tree, by Helen Wessel
• Rediscovering Birth, by Sheila Kitzinger. Comment from fan: "that was the book that really opened my eyes when pregnant with my second child. It's a beautiful book." [I agree!]
• The Thinking Woman's Guide to a Better Birth, by Henci Goer
  
• Baby Catcher (x's 2)
• Birth Book, by Raven Lang. Comment from fan: "Just ordered another copy and I am 60!! I had it with my first born 34 years ago! Gave it away~thought it was out of print and discovered how to get a copy. It influenced me more than any other!" [Note: Birth Book is available in a limited edition from CfM!] Another fan then shared this nice story: "OOOOOH, I do love that one. I married into the most amazing family. My father-in-law's sisters gave me that one and this heirloom copy of Spiritual Midwifery (held together with tape and hairbands) when I married their nephew, to make sure I walked a clear road to birth! (OK...even typing this story has me tearing up! Never fails!)"
• The Vital Touch, by Sharon Heller was recommended as, "Not so much a 'birth book' per se, but more of a 'importance of touch and listening to our infants and children' kind of a book.
  

I hope this list inspires you to contemplate your own bookshelf!

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Molly
CfM Blogger
P.S. I kept accidentally typing "perineal favorites" as my title ;-D

Cesarean Awareness

Some time ago, I connected online with a new Lamaze childbirth educator named Kelli Haywood. Recently, she notified me about her cesarean awareness radio piece that aired on Mountain News and World Report. The piece is 30 minutes long and contains a lot of information about cesareans, necessary cesareans, informed consent, and so forth. As well as the childbirth educator speaking and sharing her personal story of her first birth by cesarean, she interviewed an obstetrician, CNM, and a CPM for the piece. And, a local mother shares her story of necessary cesarean.

As Kelli noted, "While the piece is particular to Kentucky and the mountain region, however, it also applies on the broader nationwide scope." I agree! It was definitely worth the listen and I enjoyed all of the perspectives shared. I was interested by some statements made by the OB that epidurals are perfectly safe and in some studies "lower the cesarean rate" (!?)--he then notes that this is, "probably because the patients are more compliant." (emphasis mine). Ah ha! This epidural information was followed up with additional information and resources from the CBE and CNM questioning the widespread use of epidural anesthesia.

The story is called Cesarean Birth and the Women of the KY Mountains and Nationwide.

There is also a companion article with additional resources available on Kelli's blog, Birth True.

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Molly
CfM Blogger

Why I Care

Some time ago I wrote a post about medical control as acceptable, in which I pondered the question of why do we care about birth, if many birthing women themselves don't really seem to care? Why do we make it any of our business what other women choose to do with their births?

Well, I've been doing some thinking and here is my list of why I care:

• Because women are suffering--birth trauma is real--see organizations like Solace for Mothers--and postpartum mood disorders are very common.
• Because babies are suffering--late pre-term births are increasingly common, many babies experience at least some post-birth separation from their mothers (which is not their biological expectation), and many babies spend time in the NICU. Infant mortality rates, especially for minority babies, are higher than in other industrialized countries.
• Because breastfeeding is suffering and thus public health is suffering (see my previous article on the birth-breastfeeding continuum)
• Because the physical costs of our current birth model are high--morality and morbidity rates are higher than necessary due to high volume of cesareans and many physicians and hospitals do not practice evidence-based care--continuing to deny laboring women food and drink and continuing to use Cytotec for inductions for example.
• Because the financial costs of our current birth model to society are high--birth is a multi-billion dollar a year industry. Some maternity care facts from CfM:
  • Over four million births in the US each year (26.4 births per 1000 women aged 15-44 years in 2004).
  • Second most common reason for hospitalization of women.
  • Care for mothers and babies combined rank 4^th for hospital expenses.
  • Hospital costs for deliveries mounted to more than $30 billion in 2004. More than 30% of births by cesarean section. ranking seventh highest total on the "national bill" for procedures (over $17 billion per year).
  • Of all births, 99% take place in hospitals, 90% are attended by obstetricians.
  • Over 6 million obstetric procedures are performed – the most common category of surgical procedures.

"The percentage of births paid for by Medicaid varies from state to state but can be as high as 50% or more in some states. Coverage by all insurers (Federal government, Medicaid, private, HMOs, etc.) varies; many will not reimburse for OOH births, and when midwives are covered, the reimbursement rate is only a percentage of the rate for physicians. We all pay for births, including unnecessary interventions and preventable complications and injuries, through our taxes, health insurance withholding, and individual policies."

• Because women's birth memories last a lifetime (see Simkin, Not just another day in a woman's life).
• Because women deserve better.
• Because I know in my heart that birth matters for women, for babies, for families, for culture, for society, and for the world.

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Molly
CfM Blogger

Being BOLD and Birthsmart...

Recently, the website/resource My Mommy Manual interviewed Karen Brody, founder of the BOLD movement and playwright of the play, Birth. The topic of the interview was "how to empower birthing mothers" and it was quite good. Brody placed great emphasis on the importance of having a "circle of women" and the importance of community and connection in increasing the odds of a positive birth experience. As part of this, she discussed the value of mother blessing ceremonies and I share her opinion of the importance of these ceremony. She also makes the point that body-centered preparation (such as yoga) helps you connect with the resources within you as well as surrounding you. I saw Birth in St. Louis last year and I'm looking forward to making another trek to see this powerful play again in St. Louis this year! (Sunday, August 29th at Schafly Bottleworks at 5:00!)

Related to empowering birthing women, birth activism, and raising awareness of the flaws within our current birth culture, check out this BirthsMart video by Heather Cushman-Dowdee (Hathor the Cowgoddess and compiler of a really wonderful book, Simply Give Birth).



I am looking forward to being at the CAPPA conference through the end of the week and will not be making my usual Friday post!

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Molly
CfM Blogger

Resources from Other Organizations

I have connections with a lot of wonderful organizations. While I've thought recently that perhaps I need to "throw my hat in" with one organization only (i.e. focus my efforts/energy), I also enjoy being a part of, and supporting, multiple organizations. I feel like each has something unique and valuable to offer and I have no problems networking with and being a member of--for example--almost all of the major childbirth education organizations, as well as multiple doula organizations, and others as well. I don't think it makes sense to be "exclusive" or competitive with each other--all of them wish to improve maternity care and birth choices for women and I like to help as much as I can! I also just love collecting information and resources and so it is delightful to be on all these e-newsletter mailing lists and so forth. Among many, here are a couple of resources that caught my eye this week:

1. Choices in Childbirth has a new service--a provider network (free for consumers to search and use, fee for professionals to list services). "Choices in Childbirth is an excellent tool for both mothers and mother-friendly care providers. We have hundreds of listings of midwives, doulas, acupuncturists, and more--everything a mother could need to create a mother-friendly birth experience that's right for her. For providers, it's a great way to advertise their services and promote the many options available to expectant parents." Speaking of Choices in Childbirth, one of my most favorite resources in the world to share with with parents in my birth classes is the Guide to a Healthy Birth.

2. The Family Violence Prevention Fund is hosting a free webinar called Building Health Care Leadership: A Systems Advocacy Approach to Addressing Domestic Violence in the Health Care System, July 29, 2010, 11am-12pm PDT. Considering that many women experience domestic violence for the first time during pregnancy and that pregnancy is the most common reason for women to be in the medical care system, this is a quite relevant webinar topic for maternity care activists!

3. One of my very favorite "basic" pregnancy and childbirth books, Pregnancy, Childbirth, and the Newborn by Penny Simkin is coming out in a new edition this month. I'm so excited! New with this edition is a really helpful looking companion website.

Enjoy!
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Molly
CfM Blogger

Medical Control as Acceptable

Still going through my saved-things-to-blog-about and want to share these thoughts from the book Brought to Bed: Childbearing in America 1750-1950 in the epilogue:

Many of birthing women's successes in increasing their powers over childbirth procedures have depended upon women reeducating themselves about childbirth. The enormous proliferation in recent decades of popular literature about giving birth, much of which advocates decreasing routine medical interventions, is evidence of women's attempts to reclaim knowledge previously more commonly held within women's world. When birth moved to the hospital and became dominated by technical interventions, women lost their understanding and familiarity with the processes of labor and delivery. Many women, realizing that their lack of knowledge distances them from their own bodies, are trying tor recover some of that lost knowledge through self-education in normal functions...

In addition to the women who completely challenge medical authority and those who want to find ways to work in cooperation with it, there is a third group of American women today who find medical control of childbirth as practiced in most hospitals perfectly acceptable. They find the prospect of delivering babies frightening or uninteresting, and they wish to experience as little of it as possible. They want to be assured of a healthy outcome, but they do not feel the need to participate actively in bringing it about. They, like many women of the 1920's and 1930's, eagerly turn over their decision-making power to their doctors, who, in turn, readily accept it. The women hope that medicine can provide a streamlined and easy experience and that they will not have to suffer too much either in the process of labor and delivery or in its aftermath. Many women enter the hospital and emerge from it with their babies without having given the experience itself very much thought. (emphasis mine)

This third group (as discussed in the second paragraph) is a conundrum to me and I think it is the main reason why the birth culture in the U.S. ISN'T changing rapidly in response to evidence-based information, great books, informative publications and websites, helpful doulas, awesome childbirth classes, etc. How do you reach women who just don't care? And, why as advocates, do we care if they don't? :( And, is it any of our business if a large subset of the population finds medical control of birth perfectly acceptable and even desirable?

I'd like to explore why I think it is our business in a later post, but first I have to clarify why exactly that is...

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Molly
CfM Blogger

Continuing Education Resources for Birth Professionals

I love how the internet brings such a wide variety of wonderful educational resources right to our fingertips! Earlier this week I posted a link on the CfM Facebook page to some great presentation downloads from the 2010 CIMS Forum. Then, check out all these free podcasts from MIDIRS (Midwives Information Resource Services). Site registration is required to listen to the podcasts.

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Molly
CfM Blogger

Grassroots News: Good News for Kansas CPMs!

Dear friends,

Good news from Kansas! CPM's were officially recognized as legal practitioners in Kansas birth centers. Congrats, Kansas! Below is more information on the history of CPM's in Kansas, and the specificities of their recognition. As always, if you have any news items that you would like to share, please e-mail info@cfmidwifery.org.

History: a 1996 Kansas Supreme Court ruling stated that in the case presented against a direct-entry midwife, she was not violating the Medical Practices Act because midwifery was not the practice of medicine and she was working in conjunction with a supervising physician. This led many to interpret the law as meaning that direct entry midwives were legal but unregulated in Kansas. Others disagreed with the broadness of that interpretation, with concern that it applied only in that case and that it was contingent on working with physician back-up. Nevertheless, midwives have not been harassed in Kansas and have worked openly.

Previous regulations for birth centers in Kansas required that the center be owned and operated by a physician or CNM, and be staffed with physicians and CNMs. One unique and brilliant CNM, Cathy Gordon, and her compatriot, Debbie Perry, CPM, have worked tirelessly for over two years to revise the birth center regulations to officially allow CPMs to work in them. These regulations just passed! Now, CPMs are legal practitioners in Kansas birth centers. Though not addressing home birth, these regulations provide a definite legal status for CPMs in Kansas. Since regulations hold the power of law, this is one more state where CPMs are recognized as legal providers of care.

Additionally, the language added by MAMA Campaign efforts to the birth center provision in the new healthcare law requires states to provide Medicaid reimbursement to any healthcare provider recognized by state law who is providing services in a licensed birth center. The CPMs in Kansas now fall under that definition!

The full text will not be on the web until July 9. If anyone wants the whole document as a pdf, should contact Ida Darragh at ivd@aol.com.

The language specifically designating CPMs as providers is:

Page 1024:
(f) ''Certified professional midwife'' means an individual who is educated in the discipline of midwifery and who is currently certified by the North American registry of midwives.
(g) ''Clinical director'' means an individual who is appointed by the licensee and is responsible for the direction and oversight of clinical services at a birth center as specified in K.A.R. 28-4-1305.
(h) ''Clinical staff member'' means an individual employed by or serving as a consultant to the birth center who is one of the following:
(1) The clinical director or acting clinical director;
(2) a licensed physician;
(3) a certified nurse-midwife;
(4) a certified professional midwife;
(5) a certified midwife; or
(6) a registered professional nurse.

Page 1029:
(m) Each patient shall be admitted for labor and delivery by a physician, a certified nurse-midwife, a certified professional midwife, or a certified midwife.

Way to go, Kansas!

Sincerely,
Stephanie Hucker and Willa Powell
Citizens for Midwifery

Maternal and Infant Mortality

Last month, I wrote a brief post about the Preconception Educators program sponsored by the US office of Minority Health. Since then, several other things have come to my attention that are related to either maternal or infant mortality. The Unnecesarean blog pointed out that there is an excellent video about infant mortality in the African-American population available from the Minority Health office. In fact, The Unnecesarean is also hosting a blog carnival about this video! (to run July 4th.)

The video is called Crisis in the Crib and emphasizes this fact: "The rate of death for black babies before their first birthday is twice the rate of white babies and greatly outpaces the national average."

Then, a friend sent me a link to an article about childbirth deaths focusing on the "350,000 women lose their lives each year giving birth or through complications of childbearing."

And, in the summer issue of Midwifery Today I read about the new report from Amnesty International called "Deadly Delivery" about the maternal health crisis in the US: "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women." Bringing it full circle back to the Crisis in the Crib, I think we could amend that sentence to read, "mothers and babies die...because it lacks the political will to make sure good care is available to all women and their children."

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Molly

CfM Blogger

Grassroots Network: Survey for Patients/Consumers on Overtreatment

Survey for Patients/Consumers on Overtreatment

Dear Friends,

Hope you all are enjoying the start of summer!

First of all, we at CfM apologize that our Grassroots News Messages have been so sparse lately. Much has been going on in all of our lives, and unfortunately our news messages have taken a back seat. In the coming months, we promise to refocus our energy and use this network to spread the news about maternity care. If you have anything that you are interested in sharing, we encourage you to contact us at info@cfmidwifery.org. Additionally, if you would be interested in helping regularly with the Grassroots Network messages, we’d love to hear from you.

Below is information regarding a survey from TreatmentTrap.org and Consumer Union's Safe Patient Project dealing with overtreatment. While the site doesn't specifically mention childbirth, overtreatment, unnecessary treatment and other errors are frequent in maternal health care in the U.S. We encourage you to share your experiences with these incidents, especially as they relate to childbirth. The survey reflects the beginning of attention to overtreatment in general, and an awareness of related issues such as a lack of informed consent and being given misleading medical information. This is a chance for all of us to draw the attention of the sponsoring organizations to the severe and costly problem of unnecessary and overtreatment in maternity care in particular. Through raising these issues, we can actively support a woman's right to the childbirth she sees fit, and her right to be treated honestly and respectfully by her care providers, both of which are essential for improving the state of maternal health care in the US.

Please read the information below and participate in the Survey!

Sincerely,
Stephanie Hucker and Susan Hodges of Citizens for Midwifery

New Survey Launched to Query Patients/Consumers on Overtreatment

A new survey is being launched to enable patients to share their experience of overtreatment, an emerging quality and patient safety issue in health care today.

The survey is a partnership between TreatmentTrap.

org and Consumer Union's Safe Patient Project. While not a scientific survey, it aims to elicit patient experiences of overtreatment to raise public awareness. Patient experiences of overtreatment can be useful to health care leaders and policy makers as they establish priorities to reduce overuse.

The survey can be found by going to: www.treatmenttrap.org. Click on "Share Your Story" and you will be directed to the CU Safe Patient Project survey.

The "Share Your Story" survey asks two questions: "Have you had medical care you thought was unnecessary?" and "Have you declined medical care you thought was unnecessary and obtained a medically appropriate alternative?"

The survey prompts respondents to share experiences of overuse including those identified as overused by the National Quality Forum's National Priorities Partnership. These procedures include: spine surgery, heart bypass surgery, hysterectomy and prostatectomy.

For further information, contact Rosemary Gibson at rosemarygibson100@gmail.com

Book Review: Breastfeeding Facts for Fathers

Since Father's Day is this weekend, I thought this was a perfect book review to share!

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

Since partner support of a breastfeeding mother is one of the most important factors in breastfeeding success, the short book Breastfeeding Facts for Fathers is a valuable book indeed. Written in a clear, straightforward format, brief one-page sections address topics like, “why you want your baby breastfed,” “is formula really so bad,” “a happier, healthier mom,” “sex and the breastfeeding woman,” and “when breastfeeding is not advised.” There is also a brief segment about safe co-sleeping. These sections are followed by a brief FAQ addressing topics such as how often mom should breastfeed, how to know baby is getting enough milk, how long to breastfeed, nipple piercing, breast implants, alcohol, and breastfeeding in public.

As a quote in the book states, “Having a father is critical to the healthy development of a child. Being a father is critical to the healthy development of a man.” Providing breastfeeding information specific to fathers, Breastfeeding Facts for Fathers supports this healthy development of father, mother, and baby.

A Spanish edition, a low-literacy (abridged) version, an ebook edition, and a hospital edition (co-sleeping information omitted) of Breastfeeding Facts for Fathers are all available at various affordable prices from Platypus Media.

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

Book Review: The Littlest Sister

Book Review: The Littlest Sister

By Leigh Schilling Edwards

Strategic Book Publishing, 2008
ISBN 978-1-60693-041-0
14 pages, softcover, $12.00
http://www.facebook.com/pages/The-Littlest-Sister/317995643791

Reviewed by Molly Remer, MSW, CCCE

http://talkbirth.wordpress.com

Written from the perspective of a family’s middle child—the big sister of a hospitalized baby—The Littlest Sister is designed for siblings of a baby in the Neonatal Intensive Care Unit (NICU). It would also be a good book for a child who was formerly a preemie themselves. There is an older brother in the story as well, which enables readers of either gender can easily identify with the children.

Color snapshots of a real family grace each page and make the book very genuine and true-to-life. The baby in the book was born at 30 weeks and has Down Syndrome and a mild heart defect. The pictures and text contain a lot of details children will identify with—there is a picture of the big brother touching the baby in her isolette, pictures of the baby sister with a tube in her nose and monitors attached, and so forth. Bottle feeding is mentioned briefly and I wish breastfeeding had been mentioned as well

I have a special interest in the subject area because I worked for the Ronald McDonald House for four years. Written in a warm, personal tone, using easy to understand language and simple descriptions, The Littlest Sister would be a great addition to the lending library resources of Ronald McDonald Houses or NICU facilities.

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

Maternal-Fetal Conflict?

Mamatoto is a Swahili word meaning "motherbaby"--reflecting the concept that mother and infant are not two separate people, but an interrelated dyad. What impacts one impacts the other and what is good for one is good for the other. The midwifery and birth communities have used this concept for quite some time and more recently some maternal health researchers have also referenced the idea of the "maternal nest"--that even following birth, the mother is the baby's "habitat."

The Science and Sensibility blog is hosting their sixth blog carnival around the theme of mother-baby togetherness after birth, based on Lamaze's Healthy Birth Practice #6: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding.

This carnival topic prompted me to revisit a post I made some time ago about 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, now President 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 cesarean 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.

As we consider healthy birth practice six, 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."

--
Molly
CfM Blogger

Preconception Educators

“People can feel especially fragile about giving birth because they hate to think they ‘did it wrong.’ We may defend one way of doing it because it is too threatening to think that there might have been a better alternative to the way we gave birth…go gently, and avoid the impulse to polarize or convert. Encourage each person to speak of her own experience in ‘I’ statements…” --Sacred Circles

I shared this quote in another blog post some time ago. It reminds me that perhaps the best avenue for birth advocacy is to back up and start talking to young women in high school or college, and not in trying to “preach” to other adult women who in all likelihood have very complicated reasons for making the choices they are making (and not being “enlightened” as to the “empowering way!” is usually not one of those reasons). If birth advocates are actually going to make meaningful changes (instead of enemies, or at least making women feel “unheard,” unacknowledged, dismissed, or misunderstood) they/we probably need to reach women before they are in that “fragile” or defensive state with regard to their own experiences.

Then, I received a notice about the federal Preconception Peer Educators Program (A Healthy Baby Begins with You), which trains college students as peer educators. A training is being held in Chicago in September to coincide with Infant Mortality Awareness Month and the program is seeking: 500 students/advisors from 20 states and the breakdown is as follows:

• 20 states
• 5 universities per state
• 4 students and 1 advisor per university

They are also encouraging each school to send at least one male student, which I think is good.

The emphasis of the training and program seems to be on reducing infant mortality, which of course is an important goal, but also one that is inextricably linked to optimal care of the mother (i.e. the kind of care offered by the Midwives Model of Care). So, I would hope to see more content within the program about maternity care, midwifery care, and birth rights in general, but I think it sounds like a very interesting, important, and useful program!

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Molly
CfM Blogger

Book Review: Brought to Earth by Birth

Book Review: Brought to Earth by Birth
By Harriette Hartigan
Motherbaby Press, 2008
ISBN 978-1-890-44642-0
93 pages, softcover, $25.95
www.motherbabypress.com

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

Written by well-known birth photographer Harriette Hartigan, Brought to Earth by Birth is a lyrical ode to the power of birth and babies. The book feels like an extended “poem” expressed in both word and image. The emphasis of the book is the black and white photos of pregnant women, families, and newborns that grace the pages. There are several photos of women in labor and a couple of breastfeeding images. Surrounding the photos are carefully chosen quotes and gentle words.

Brought to Earth by Birth is separated into six “chapters” and contains several birth photos, but no crowning photos or any other photos that some may consider “graphic.” The book is short—under 100 pages—and some photos were familiar to me (cover images in birth publications). The concluding emphasis is on the newborn, the one who is, after all, “brought to earth by birth.”

The book would make a nice gift for a midwife, doula, or childbirth educator and is a nice “waiting room” book to browse through. It would also make an inspirational mother blessing gift. As the author states, “The experience of birth is vast. It is a diverse tapestry woven by cultural customs, shaped in personal choices, affected by biological factors, marked by political circumstances. Yet the nature of birth itself prevails in elegant design of simple complexity.” Brought to Earth by Birth is a lovely glimpse of some strands of that elegant tapestry.

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

Film Review: Natural Born Babies

Film Review: Natural Born Babies
South Coast Midwifery, 2009
DVD, 24 minutes, $24.95
www.naturalbornbabies.com

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

This lovely short film produced by a midwifery service in California, is a great “ad” for the benefits of homebirth and of midwifery care. Natural Born Babies has a very clean, fresh, and contemporary feel and features a multicultural collection of homebirth families talking about their experiences in front of a white screen. Something that is particularly striking is that some of the people speaking with love and enthusiasm about their midwives and their birth experiences include a cardiologist, an anesthesiologist, and an ER physician!

The first part of the film is titled Interventions and features both men and women speaking about birth, referencing how pregnancy and birth are treated like medical conditions and including a lot of discussion about the prevalence of cesareans. The point is made that, “no epidural can replace human touch.” The second part is titled The Birth Specialists and points out that OB/GYNS are pathology specialists, whereas midwives are trained in normalcy—“we take low-risk women, and keep them low-risk.” Midwives are specialists in normal pregnancy and birth. Because of the film’s emphasis is wholly on out-of-hospital birth and hospitals are critiqued very soundly, hospital-bound couples viewing the film may find that it causes their defenses to rise.

Several of the parents are holding their babies as they speak and a CNM speaks briefly as well (citing both ACNM and MANA). The CNM manages Orange County’s only accredited birth center. I enjoyed the presence of a bio-physicist dad originally from Holland saying, “everyone I know was born at home” and noting that “you give birth the same way you live.” Several of the couples speaking do refer to the father as “delivering” the baby, which is a long-term pet peeve of mine.

Special features include a 10 minute version of the film, an outtakes section, and a look inside the South Coast Birth Center. At the end of the film we see that one of the couples is the director/producer of the film.

Natural Born Babies is a fast-paced film and though it is filmed in a “talking heads” format, it cuts quickly from person to person, thus keeping the viewer engaged. If you are looking for an informative video that is homebirth and midwifery friendly, but that does not include any birth footage, this would be a good addition to your library.

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Disclosure: I received a complimentary copy of the film for review purposes.

Happy Mother's Day!

There are a lot of events to honor in May! International Day of the Midwife was May 5th and Mother's Day is rapidly approaching on May 9th. May is also International Doula Month and Pregnancy Awareness Month. And, Birth Activist is having a Mother's Day blog carnival.

So, I found it fitting this week to share a book review about a nurturing little book for mothers:

Book Review: 25 Ways to Joy & Inner Peace for Mothers
By Danette Watson & Stephanie Corkhill Hyles
Watson & Corkhill Hyles, 2006
ISBN 0646-46588-0
84 page hardcover book & 60 minute CD set, $24.95
http://www.awakenyourbirthpower.com

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

Consisting of a book and CD, 25 Ways to Joy & Inner Peace for Mothers contains 25 short breathing meditations with accompanying whimsical, colorful drawings. The meditations are on topics such as “surround yourself with mother energy,” “embrace change,” “feel reverence,” and “trust the rhythm of your baby.”

The final third of the book contains breathing tips, tips for using the meditations in life, and then “10 Healing Practices for Mothers” that are a very nice addition. This segment is followed by “Questions for Inner Exploration” that include journaling questions and prompts based on each of the meditations.

It is not clear at first glance, but 25 Ways is designed for mothers of newborns and infants, not mothers of older children (though, of course, most of the meditations could be adapted to apply to older children). The addition of “new” to the title would have been a useful clarifier.

Inspiring, empowering, and renewing, 25 Ways to Joy & Inner Peace for Mothers is a lovely and nurturing little manual that would make a nice blessingway gift for a pregnant or a congratulations gift for a special new mother.

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Disclosure: I received a complimentary copy of this book for review purposes.
Review originally published in the CAPPA Quarterly, April 2010.

International Day of the Midwife (& the changing nature of communication...)

May 5th is International Day of the Midwife! A 24-hour virtual event in honor of the day is being held here and there is a lot of interesting content scheduled, including a free workshop about using social networking.

Social networking brings me neatly to my next topic, which is the changing nature of internet communication. I've noticed that a lot of the things I would have posted to this blog in the past, I am now posting to CfM's Facebook page (or, alternatively, I'm noticing that plenty of other people have already posted the article link, video, what have you and so I see that I don't need to do it).

While I still plan to post to this blog, I think I am going to transition away from my Friday posting schedule and only post when I have original content to share, longer articles, action alerts specific to CfM, Grassroots Network messages, or reviews, and keep more of the casual, information-sharing content on the Facebook page instead.

I also have my other blog (personal + birth education business) where I post my own articles/ideas about birth-related subjects, which limits my availability to generate original content for this blog versus just reporting on other peoples' content.

I've noticed that the various email lists I belong to are much more quiet lately and also much less likely to share article links, etc. I think it is for the same reason--these things are shared most commonly on Facebook now, which removes the need to share via other means. I wonder how communication will continue to change/evolve over the next handful of years?! Who knows what the next big thing will be?

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Molly
CfM Blogger