Health Clubs, Heart Health, & Birth

Jan7

One of the things I enjoy about the book Mother’s Intention: How Belief Shapes Birth, by Kim Wildner is how straightforward, matter-of-fact and unapologetic the author is when exploring concepts, realities, facts, and beliefs about birth. In a section addressing perceived risk and birth, she shares an effective analogy about health clubs and heart disease paralleling the accident-waiting-to-happen mentality of modern obstetrics:

A multitude of things CAN go wrong with any system in the body, but seldom DO. Take the heart/circulatory system for example. Heart disease is the leading cause of death in the US. 873 per 100,000 die of heart disease (CDC). (Remember, natural birth is between 6 and 14 per 100,000 in the US, depending on the population.) Some have arteries on the verge of clogging. Some have heart defects they are unaware of. Some have damage they don’t know about. Something could go wrong at any minute and immediately available surgery can undoubtedly save lives.

Using the logic of obstetrics, all health clubs should be in hospitals and all fitness trainers should be cardiac surgeons. Any independent health club with ‘lay’ trainers would be ‘practicing medicine without a license,’ subject to prosecution. It’s for your own good.

In fact, in order to know if a problem is developing, close monitoring and ‘management’ is required. We will need to place straps on the muscles to measure the intensity of the workout. of course, it will be restrictive, but we need to know how hard the muscles are working to know if the heart can take it. We’ll need to monitor heart rate, blood pressure, fluid output. We’ll need to give an IV because with sweat excreted, you could dehydrate, and of course, we simply can’t take the risk of letting you drink anything lest you need emergency surgery….

Later in the book, the author employs another helpful analogy, again using cardiology as an example to make a point about inappropriately applied maternity care interventions:

What if…

You went to the doctor complaining of chest pain…not bad pain, but bothersome. To rule out a heart problem, the caregiver listens to your heart. He scowls, then excuses himself to make a phone call. He comes back in and tells you that you need to be admitted to the hospital for a test that requires the use of a drug. The drug has a low risk of serious complications, which is why you must be in the hospital, but he feels confident in taking that risk.

You go, and within minutes of having the drug administered, you have a heart attack. You are rushed into emergency open-heart surgery. Complications arise, but they are dealt with. You nearly bleed to death, but with a blood replacement you recover.

The repair doesn’t go well, which may mean you will need further surgery later…maybe even a heart transplant. You definitely will need to change your previously active lifestyle.

Later, you discover the call your care provider places wasn’t to a specialist, but an HMO lawyer who advised him not to let you walk out the door, just in case the routine examination missed a serious problem. You also learn there were less dangerous ways to determine if there could be a minor problem.

It turns out, you really did have a minor case of heartburn. All you have been through was avoidable, but “As long as everyone’s ok now…that’s all that matters”…right?

A comment like that, to a mother who has suffered unnecessarily, when she would have–or could have had–the result of a live, healthy baby without such sacrifice, disregards her feelings of loss.

Parents should be expecting more!

In Open Season, by Nancy Wainer, she refers to OBGYN care is referred to as “gynogadgetry.”

In The Doula Guide to Birth, I marked another quote that feels very relevant to the others above: [a March 2006 study in the American Journal of Obstetrics & Gynecology] “reviewed all fifty-five of ACOG’s current practice bulletins, calling these articles ‘perhaps the most influential publications for clinicians involved with obstetric and gynecological care.’ The study concluded that ‘among the 438 recommendations made by ACOG, less than one third [23 percent] are based on good and consistent scientific evidence.'”

Enough said.

The Illusion of Choice

Dec30

A choice is not a choice if it is made in the context of fear.

Informed choice is a popular phrase with birth professionals and healthy birth activists. I’ve read impassioned blog posts from doulas and birth activists claiming that if we support women’s right to homebirth, we must also support her “choice” to have an elective cesarean. But, I believe we have constructed a collaborative mythos within the birth activist community that an informed choice is possible for most women. The statistics tell us a different story. I do not believe that women with full ability to exercise their choices would choose many of the things that are typically on the “menu” for birth in mainstream culture.

What’s on the menu?

Women give their blanket “informed consent” to all manner of hospital procedures without the corollary of informed refusal–is a choice a choice when you don’t have the option of saying no?

In many hospitals, women are STILL not allowed to eat during labor despite ample evidence that this practice is harmful–is a choice a real choice if made in the context of hospital “policies” that are not evidence-based?

Women are told that their babies are “too big” and then “choose” a cesarean. Is a choice a choice when it is made in the context of coercion and deception?

Women choose hospitals and obstetricians that are covered by their insurance companies. Is a choice a real choice when it is made by your HMO?

Women choose hospital birth because they cannot find a local midwife. Is a choice a real choice when it is made in the context of restrictive laws and hostile political climates?

Women often state they are seeking “balanced” birth classes that aren’t “biased” towards natural birth (or towards hospital birth), but is a choice a choice when it is made in the context of misrepresented information? Because, as Kim Wildner notes, balance means “to make two parts equal”–what if the two parts aren’t equal? What is the value of information that appears balanced, but is not factually accurate? Pointing out inequalities and giving evidence-based information does not make an educator “biased” or judgmental–it makes her honest! (though honesty can be “heard” as judgment when it does not reflect one’s own opinions or experiences).

On a somewhat related note, recently, the subject of “quiverfull” families came up amongst my friends and comments were made about feminists needing to support those women’s “choice” to have so many children. However, I worry about women who are making reproductive “choices” in the context of what can be a very repressive religious tradition. Women’s choices about their lives are not always made with free agency. And, that is where some feminist critiques of other women’s choices come from–a critique of the larger context (patriarchy) rather than the woman herself. Is a choice a choice when it is made in the context of oppression?

Where do women get information to make their choices?

In his 2010 presentation, Birthing Ethics: What You Should Know About the Ethics of Childbirth, Raymond DeVries uses data from the Listening to Mother’s studies to help us understand where women are getting their information about birth—this is the context in which their “informed choices” are being made and this is the context we need to consider.

Our choices in birth and life are profoundly influenced by the systems in which we participate…

Some choices shaped by the system

Women learn from books and experiences of others (and self):

The number one book women learn from is What to Expect When You’re Expecting, which has been number four on NY Times Bestsellers list for over 500 weeks and counting.

According to De Vries, via the Listening to Mothers data, this is what women tell us about how they learn, what they learn, and upon what their choices are based:

Television explains birth
Pain is not your friend
But technology is
Mothers are listening to doctors (and nurses)
Medicalized birth allows mothers to feel capable and confident
Interfering with birth is mostly okay
Our health system works (mostly)
We like choice
We want to be “informed”

He also explains polarization: “We seek information to confirm our opinion. Contrary information does not convince, it polarizes.” How do we share information so that women can make truly informed choices without polarizing?

As advocates, I think we sometimes fall back on the phrase “informed choice” as an excuse not to be outraged, not to despair, and not to give up, because it promises that change is possible if only women change and most of us have access to change at that level.

Birthing room ethics

In another presentation, U.S. Maternity Care: Understanding the Exception That Proves the Rule, DeVries explores the ethical issues surrounding choices in birth, noting that “choice is central at all levels – but can choice do all the moral work?” We wish to respect parental choice, but information does not equal knowledge and we often err on the side of treating them as one and the same. In maternity care, often there is no choice. Tests become routine or practices become policy, and “information [is] given with no effort to understand parental values (the ritual of informed consent).”

Is choice possible while in active labor?
De Vries also raises a really critical question with no clear answers—is choice really possible during active labor? He also asks, “should a healthy pregnant woman be allowed to choose a surgical birth? But is it safe? The problem with data…Interestingly, those who think it should be allowed find it safe, and those who oppose it, find it to be unsafe.” When considering where this “choice” of surgical birth comes from, he identifies the following factors:

The desires of women
• Preserve sexual function
• Preserve ideal body
• The need to fit birth into employment
• Options offered by health care system

The desires of physicians
• Manage an unpredictable process
• The limits of obstetric education

Why should we care, anyway?

Another popular phrase is, “it’s not my birth.” I agree with the opinion of Desirre Andrews on this one:

“I do not believe in the saying ‘Not my birth.’ Women are connected together through the fabric of daily life including birth. What occurs in birth influences local culture, reshapes beliefs, weaves into how we see ourselves as wives, mothers, sisters, & women in our community. Your birth is my birth. My birth is your birth. This is why no matter my age or the age of my children it matters to me.”

Victims of circumstance?

While it may sound as if I am saying women are powerlessly buffeted about by circumstance and environment, I’m not. Theoretically, we always have the power to choose for ourselves, but by ignoring, denying, or minimizing the multiplicity of contexts in which women make “informed choices” about their births and their lives, we oversimplify the issue and turn it into a hollow catchphrase rather than a meaningful concept.

Women’s lives and their choices are deeply embedded in a complex, multifaceted, practically infinite web of social, political, cultural, socioeconomic, religious, historical, and environmental relationships.

And, I maintain that a choice is not a choice if it is made in a context of fear.

But, what do we know?

I read an interesting article by anthropologist and birth activist, Robbie Davis-Floyd, in the summer issue of Pathways Magazine. It was an excerpt from a longer article that appeared in Anthropology News, titled “Anthropology and Birth Activism: What Do We Know?” In the conclusion, Davis-Floyd states the following:

“Doctors ‘know’ they are giving women ‘the best care,’ and ‘what they really want.’ Birth activists…know that this ‘best care’ is too often a travesty of what birth can be. And yet on that existential brink, I tremble at the birth activist’s coding of women as ‘not knowing.’ So, here’s to women educating themselves on healthy, safe birth practices–to women knowing what is best for themselves and their babies, and to women rising above everything else.”

I believe that every woman who has given birth knows something about birth that other people don’t know. I also believe that women know what is right for their bodies and that mothers know what is right for their babies. I’m also pretty certain that these “knowings” are often crowded out or obliterated or rendered useless by the large sociocultural context in which women live their lives, birth their babies, and mother their young. So, how do we celebrate and honor the knowings and help women tease out and identify what they know compared to what they may believe or accept to be true while still respecting their autonomy and not denigrating them by characterizing them as “not knowing” or as needing to “be educated”? As I’ve written previously, with regard to education as a strategy for change: People often suggest “education” as a change strategy with the assumption that education is all that is needed. But, truly, do we want people to know more or do we want them to act differently? There is a LOT of information available to women about birth choices and healthy birth options. What we really want is not actually more education, we want them to act, or to choose, differently. Education in and of itself is not sufficient, it must be complemented by other methods that motivate people to act. As the textbook I use in class states, “a simple lack of information is rarely the major stumbling block.” You have to show them why it matters and the steps they can take to get there…

And, as the wise Pam England points out: “A knowledgeable childbirth teacher can inform mothers about birth, physiology, hospital policies and technology. But that kind of information doesn’t touch what a mother actually experiences IN labor, or what she needs to know as a mother (not a patient) in this rite of passage.”

The systemic context…

We MUST look at the larger system when we ask our questions and when we consider women’s choices. The fact that we even have to teach birth classes and to help women learn how to navigate the hospital system and to assert their rights to evidence-based care, indicates serious issues that go way beyond the individual. When we talk about women making informed choices or make statements like, “well, it’s her birth” or “it’s not my birth, it’s not my birth,” or wonder why she went to “that doctor” or “that hospital,” we are becoming blind to the sociocultural context in which those birth “choices” are embedded. When we teach women to ask their doctors about maintaining freedom of movement in labor or when we tell them to stay home as long as possible, we are, in a very real sense, endorsing, or at least acquiescing to these conditions in the first place. This isn’t changing the world for women, it is only softening the impact of a broken and oftentimes abusive system.

And, then I read an amazing story like this grandmother’s story of supporting her non-breastfeeding daughter-in-law and I don’t know WHAT to do in the end. Can we just trust that women will find their own right ways, define their own experiences, and access their own knowings in the context of all the impediments to free choice that I’ve already explored? What if she says, “why didn’t you TELL me?” But, if we share our information we risk polarization. If we keep silent and just offer neutral “support,” regardless of the choice made, then doesn’t it eventually become that the only voice available for her as she strives to make her own best choices is the voice of What to Expect and of hospital policy?

“Our lives are lived in story. When the stories offered us are limited, our lives are limited as well. Few have the courage, drive and imagination to invent life-narratives drastically different from those they’ve been told are possible. And unfortunately, some self-invented narratives are really just reversals of the limiting stereotype…” –Patricia Monaghan (New Book of Goddesses and Heroines, p. xii)

—-
Related posts:

What to Expect When You Go to the Hospital for a Natural Childbirth
Birth & Culture & Pregnant Feelings
Asking the right questions…
Active Birth in the Hospital
Why do I care?

References:

De Vries, Raymond. May 20, 2010. Birthing Ethics: What You Should Know About the Ethics of Childbirth, Webinar presented by Lamaze International.

De Vries, Raymond. Feb. 26-27. U.S. Maternity Care: Understanding the Exception That Proves the Rule. Coalition for Improving Maternity Services (CIMS). 2010 Mother-Friendly Childbirth Forum

Last Minute Gift Idea: Rescue Gifts

Dec15

I received a press release recently with a neat last-minute gift idea that has relevance to birth activism—a symbolic gift of a safe birth kit for a mother in the developing world (I investigated a little and the organization is a legitimate humanitarian organization.) Here is the information:

Rescue Gifts help refugees and others who have been impacted by war and natural disaster. Holiday shoppers can choose a gift that inspires them and dedicate it in honor of a special person in their lives. The International Rescue Committee will send gift recipients a beautiful acknowledgement card with the gift giver’s personalized message.

There’s a perfect gift for everyone:

For a mom: A Safe Delivery ($24) can ensure critical supplies for the safe birth of a child in a crisis zone.

For a spouse: Emergency Food ($68) can deliver a month’s supply of vitamin-rich therapeutic food for at least 50 malnourished children in places wracked by food shortages or famine.

For the foodie or friend with a green thumb: A Community Garden ($60) can provide tools and seeds to refugees who have been resettled in the United States, so that they can grow their own fresh, healthy food in an IRC community garden.

For a teacher: A Year of School ($52) can supply the tuition, books and other materials for one year of a child’s schooling in a country recovering from war.

Shoppers who spend $75 or more will receive a fashionable organic cotton “Rescue” T-shirt designed and donated by Threads for Thought, or they can opt to have it sent as a gift.

Rashida Jones, IRC Voice and star of NBC’s “Parks and Recreation,” is promoting the Clean Water Rescue Gift and giving it to her friends this year. She says, “At an IRC refugee camp in Thailand, I saw that the ready availability of water transforms lives. I am buying this gift for my friends this holiday season.”

Parks & Recreation is one of my favorites TV shows, so it is fun to have that connection too. Of course, I inquired as to what exactly a “safe delivery kit” entails, because I do not want to inadvertently be promoting non-evidence based Western medical care practices in countries relying heavily on traditional midwives. I was told that, “as such, the Safe Delivery Rescue Gift represents the typical amount of money needed for the IRC to provide supplies and assistance necessary for a safe delivery. However, Safe Delivery Rescue Gift donations will be used where and when most needed in our wide-ranging humanitarian work in more than 40 countries and 22 U.S. cities. The IRC does provide and support pre and post natal care for new and expectant mothers and their babies. This includes training and equipping midwives like the ones in Tham Hin refugee camp in Thailand, although midwifery is not the only childbirth model that the IRC supports.”

If you’re looking for a last-minute stocking stuffer for a humanitarian minded friend or family member, or for a birth activist buddy, you might find the right gift at Rescue Gifts!

The Ongoing Crisis of Abundance

Dec7

In March, I lamented to my husband, “you can’t imagine the amount of things I think of doing each day and then have to let go of.” What is weird—and that I also told him then—is that many of those ideas only occur to me on that day and are not really that important. Very often, these are not life priorities—they are just things that pop up and catch my attention and I think, “I could do that!” So, things like blog carnivals at interesting and popular blogs (I could write an entry–I have tons of ideas regarding that theme!), legislative alerts from worthy causes (I should write a letter and help with this!), interesting articles and posts (I could read that, it would only take a minute!), contests to enter (I’d like to win that, I should enter!), volunteer roles (wow! Sounds so interesting, I’d love to do it!), trainings or conferences to attend (I should register!), neat homeschooling projects (hey, maybe next time the baby sleeps, I can start this with the kids!), a new book that catches my eye (I should order that!), great recipes (I could make that for dinner!) good quotes to share on Facebook, I could write an article about this!, or about that!, someone has a question I could answer, here’s a neat article (I want to share this with others!), ooh! More free books to put onto my Kindle, art ideas, journal entries, etc., etc. It never stops! And, these are usually in addition to my ongoing projects, ideas, commitments, responsibilities, laundry, meal preparation, things other people want from me and so forth. Oh, and did anyone comment on my Facebook status? ;-D

Too much?

Sometimes I think I just like and care about TOO MANY things. All of these things splinter my attention in a million ways however, and also leave me with a persistent sensation of, “well, I didn’t get everything done today.” I continue to try to make sure to unsubscribe from email lists and blog subscriptions to cut down on this immediacy sensation that a constant influx of new information and ideas promotes. As I told my husband, “if I didn’t get that newsletter, or click on that article, or open that email, I would never have known about all those things I could have gotten done today.” Plus, there is always a new batch tomorrow! And, then I get a little depressed thinking why the rush to get things done and to finish? So I can die with a clear to-do list?! Come on!

Though actually, this is different than having “too many things to do”—because many of the things are new each day—it is part of managing the information flow into my life, I think. Some time ago I read this free book from Zen Habits and it was very helpful in its recommendations of how to sort through all of the clamor and focusing, but I think I’ve let go of those zen habits again in the last couple of months and need to try to re-read the book (but, OOPS, I’ve just turned that into another to-do!). I worked very hard before Alaina was born to trim away the extraneous so that I could focus intensively on her, but new and interesting things, ideas, and opportunities continue to emerge to take the place of what I trimmed away.

I want to remember my conditions of enoughness and to also make a new priorities/goals sheet so that when the baby naps, I know what’s at the top, rather than getting distracted. When each day ends, I continue to find I feel as if I have somehow failed. And, that I have let someone, some thing, or myself down.

When I was originally planning to share these thoughts so many months ago, I also remembered a poem I wrote when my first son was a toddler. I don’t have a toddler now…two kids and a baby instead…but the feeling of ideas building, cresting, and falling away is still familiar and my closing thought still a good reminder!

Vision

I cannot shake the feeling
That my life does not look
The way I want it to.
Each day, new big ideas build in me
And crest in a wave of vision
That finally breaks upon the shore
Of daily life with a toddler.

Reality.
Bound by the demands of everyday
Instead of grand and bold.

You’ll See It When You Believe It
Do I believe it?
Is this my journey?
Humbling
To watch the death of ego.

Be here now.
Am I?
Is it possible that where I am
And what I’m doing
Is exactly where I’m supposed to be?

—

And, then I remembered this quote from The Life Organizer by Jennifer Louden:

“Would a weight lift off my shoulders if I realized that it’s normal to feel pulled between choices, that it’s normal to want to do more than I have time or energy for, and that it’s normal to have to choose between two equally wonderful things, that it’s actually a sign I’m a fascinating, amazing person?”

That’s right. I’m a fascinating and amazing person. And, so are these three:

Choose wisely, Molly dear. Choose wisely!

I always say that I want to live well and wisely my one wild and precious life and to me that means making conscious decisions every day to pull my actions into alignment with my values. It is an ongoing process. I live in a rich and fascinating world. I can do it!

Birth Quotes of the Month

Nov26

As always, while these quotes are obviously not my own words, I do appreciate a link back to my site if you re-post them because I have a significant amount of legwork invested in finding and typing the quotes. Most are not recycled from other pages (I give credit if they are), but are typed up when they catch my eye in the books/magazines/journals I’m reading.

“The first few months after a baby comes can be a lot like floating in a jar of honey—very sweet and golden, but very sticky too.” –American College of Nurse-Midwives

“Your children love you. Be the trampoline for their rocketing and the cupped palms for their returning.” –Shae Savoy (in We’Moon 2011 datebook)

“There is nobody, out the other side of that sort of strong birth, who is not better prepared to meet the absolutely remarkable challenges of parenthood. When the power and trust is transferred to the mother, when she delivers her child, rather than ‘is delivered’ when she chooses, rather than ‘is allowed’, no matter what sort of technical birth she has, she is stronger, fiercer, and better. After a trip like that, you would kill for that child, and you know you can.” —The Yarn Harlot

Why do birth work? “I do it, because nothing else… nothing else, compares to watching a woman move mountains with her own self, to watching her rise to a challenge and meet the moment with all she has, and that experience is only enhanced when she is supported by those who care for her, respect her, and want her to be empowered by the journey.” –The Yarn Harlot

“We must act to keep the knowledge and the powers of women alive.” – Lynn Andrews

“Birth Freedom is inevitable. The natural progression is for people to move from tyranny to liberty. The agents of the status quo, however, rarely yield power without a fight.” –Senator John Loudon (ret.) in Midwifery Today e-news

“If I didn’t define myself for myself, I would be crunched into other people’s fantasies for me and eaten alive.” – Audre Lorde

“We have barely tapped the power that is ours. We are more than we know.” –Charlene Spretnak

“Woman is a glorious possibility; the future of the world is hers.” – Matilda Gage

“In everyone’s life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit.” ~Albert Schweitzer

“There is a sacredness in tears. They are messengers of overwhelming grief…and unspeakable love.” –Washington Irving

“Don’t you dare, for one more second, surround yourself with people who are not aware of the greatness that you are.” (Roots of She by Amanda Oaks, via @ROAR! Empowering Women to Give Voice to Their Truth)

“We all start out knowing magic. We are born with whirlwinds, forest fires, and comets inside us. We are born able to sing to birds and read the clouds and see our destiny in grains of sand. But then we get the magic educated right out of our souls.” -Robert R. McGammon

“It’s hard to describe if you’ve never been there, but to watch a woman access her full power as a woman to give birth is awe-inspiring, and I never get tired of being witness to it. It’s an honor to watch that transformation take place.” ~ Julie Bates, CNM

“The emerging woman..will be strong-minded, strong-hearted, strong-souled, and strong-bodied…strength and beauty must go together.” ~Louisa May Alcott

“We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them.” –Elizabeth Davis, CPM

“The women in labor must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told—who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain?” –Grantly Dick Read, Childbirth without Fear

“The purpose of life is not to maintain personal comfort; it’s to grow the soul.” –Christina Baldwin

“Everyone who interacts with a pregnant woman is, in some way, her ‘teacher.’ Telling birth stories, sharing resources, imparting obstetrical information, giving advice or warnings—these are all direct or indirect ways of teaching about birth and parenting. Whether you currently identify yourself as a ‘childbirth teacher,’ or you are a midwife, doctor, doula, yoga teacher, nurse, therapist, breastfeeding counselor, or you are simply a woman or man who cares about the power of the childbearing year, you already hold the power of mentoring within you.” –Pam England

“The purpose of our lives is to give birth to the best which is within us.” –Marianne Williamson

“There is no single formula for motherhood and writing that suits us all. Instead, there are many paths on this literary journey, all leading to the same destination, each equally valuable.” – Elif Shafak

“Remember our heritage is our power; we can know ourselves and our capacities by seeing that other women have been strong.” – Judy Chicago

“Scientific medicine has never been shy to dismiss if not denigrate any perceived threat to its values or power.” –from the book Breakthrough: How the 10 Greatest Discoveries in Medicine Saved Millions and Saved the World

“Midwives often forget that our beliefs in [mom’s] abilities can alter her accomplishments. It is important to check our hearts and push through any lack of belief that may inhibit her strengths. This may sound silly or ethereal, but I guarantee it can make a difference for a laboring mom and family.” ~ Carol Gautschi (Midwifery Today)

“Hormones have a kind of crazy rhythm that you can trust. Behind them is internal intelligence; try listening instead of controlling. When hormones are ‘raging,’ they exaggerate what’s already going on internally as a signal for us to pay attention and learn from it.” –Camille Maurine (Meditation Secrets for Women)

“Since the release of adrenaline is highly contagious, the main preoccupation of an authentic midwife, after the paradigm shift, will be to maintain her own level of adrenaline as low as possible when she is close to a labouring woman. Midwives of the future will also need to train themselves to remain silent, since language is the most powerful stimulant of the neocortex. The silent knitting session will be a necessary step towards an understanding of what authentic midwifery is. We present it as the symbol of a vital new phase in the history of childbirth and midwifery.” –Michel Odent (in Midwifery Today)

“Sons branch out, but one woman leads to another.” –Margaret Atwood (quoted in Sacred Circles)

“We can no longer sit back and debate whether maternity care is evidence-based. We have seen that over and over again, in most cases, it is not…” –Connie Livingston

“If the first woman God ever made was strong enough to turn the world upside down all alone, together women ought to be able to turn it rightside up again.” –Sojourner Truth

“The intrinsic intelligence of women’s bodies can be sabotaged when they’re put into clinical settings, surrounded by strangers, and attached to machines that limit their freedom to move. They then risk falling victim to the powerful forces of fear, loneliness, doubt , and distrust, all of which increase pain. Their hopes for a normal birth disappear as quickly as the fluid in an IV bottle.” ~Peggy Vincent

“The problem is not that obstetricians are surgeons. They are. The problem is that society has invested surgeons with control over normal childbirth.” –Michael Klein, MD (in The Journal of Perinatal Education)

“Perhaps the greatest gift that women can give their daughters is to take precious care of their own lives—to develop their natural talents and to honor the opportunities that come their way. By so doing, they become vital models for their children as well as full women in their own right.” ~ Evelyn Bassoff

“When one woman puts her experiences into words, another woman who has kept silent, afraid of what others will think, can find validation. And when the second woman says aloud, ‘yes, that was my experience too,’ the first woman loses some of her fear.” –Carol Christ

“Befriend fear, embrace struggle, trust nature, the process, and a baby’s wisdom.” –WYSH (Wear Your Spirit for Humanity see also https://talkbirth.wordpress.com/2011/05/25/birth-altar-wisdom/)

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Not only do I trust my body, I am in awe of all it can do. I don’t know if I will ever be able to accomplish anything as marvelous as birthing and nursing two babies. That is more amazing to me than running a marathon or climbing a mountain. I have created and nurtured life; nothing tops that. ” ~ Corbin Lewars (via Midwifery Today)

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

“I am sure that if the mothers of various nations could meet, there would be no more wars.” – E. M. Forster

“The strength that is displayed in labor and birth is something that no one can EVER take from you in your life. Elixir of courage.” –Desirre Andrews

Birth and the Women’s Health Agenda

Nov13

Ready to be on the agenda, dangit!

In the Fall issue of The Journal of Perinatal Education (Lamaze), there was a guest editorial by perinatologist Michael Klein called “Many Women and Providers are Unprepared for an Evidence-Based Conversation About Birth.” In it he notes:

Childbirth is not on the women’s health agenda in most Western countries…It never has been. Osteoporosis is. Breast health is; violence against women is. Why not childbirth? Because women, understandably, do not want to be judged only by their reproductive capacities. Women are multipotential people. Among many potentialities, they can rise to the top of the academic and corporate world. Giving birth is just one of many things women can do. But now is the time to add childbirth to the women’s health agenda; it is because of the lack of informed decision making that birth should be added to that agenda, lack of information, misinformation, and even disinformation. The time is now.

…What really matters is attitudes and beliefs, which are much more difficult to change than putting away the scissors and hanging some plants. These are systemic issues. (emphasis mine) It is all about anxiety and fear. The doctors are afraid…The women are afraid…Society is afraid and averse to risk.

So how can you make a revolution when so few individuals are unhappy with current maternity care practices? The most unhappy and well-informed women select midwives, if available. The most fearful women select obstetricians. Providers are not going to initiate the revolution to make childbirth a normal rather than high-risk, industrialized activity…Women are going to have to take the lead…

The problem is not that obstetricians are surgeons. They are. The problem is that society has invested surgeons with control over normal childbirth.

I keep wanting to write an article called, “is evidence-based care enough?” because we see this phrase used so often in birth advocacy work. It is kind of the companion phrase to the, “women just need to educate themselves” line of thought, that, quite frankly, is also just not enough. And, I think the reason it isn’t enough—all of our education, all of our books, and all of our evidence—is because it isn’t information itself that really needs to change, it is women’s feelings and beliefs about birth (and the medical system’s feelings and beliefs about it too, in addition to their practices) and changing those sometimes feel like an insurmountable task. As I’ve written before, much of the time it isn’t that we actually want women to know more, we want them to act differently. And, a choice made in a context of fear is not an informed choice at all.

The Beauty of a Nursing Mother

Nov13

“The beauty of a nursing mother can never be explained by a little oxytocin around the milk glands.”

—The Wisdom of the Body

(in a section discussing the biology and physiology of milk production and delivery)

I’ve mentioned before how very much I enjoy the Diane Wiessinger’s conference presentations. In 2007, I attended her amazing session called “Watch Your Language” that was about how we talk about breastfeeding. An example of a problem word when it comes to breastfeeding–using the word “special” to describe breastfeeding: a “special bond” a “special nursing corner” etc. and also using the word “perfect” (which communicates something that isn’t reasonable or that “real” people can’t do or live up to). She encouraged us not to “glorify breastfeeding” like this. Breastfeeding ISN’T special, it is NORMAL. A breastfed baby has a “normal bond” with its mother! Human milk isn’t the perfect food for babies, it is the NORMAL food for babies.

A long time ago I also marked the following quote to share from K.C. Compton in an article in Utne about baby boomers:

“We discovered firsthand the radical nature of simple acts: Sit in the front of the bus, ask that your husband be present during his son’s birth, decide to feed your infant with your own breasts, refuse the nuclear power plant being built just up the road. We also learned how much more effective those acts can be when compounded by the hundreds and thousands, their feet on the street…”

And, then this reminds me of a powerful editorial by Peggy O’Mara, urging women to see their mothering as a political act:

See your mothering as a political act. The way you talk to your child becomes his or her inner voice. The way you model acceptance of your own body becomes the way your daughter learns to accept hers. The way you model the distribution of chores in the household provides a blueprint for your children’s marriages. Bringing consciousness and awareness to the small acts of your life with your family can change the world. Your mothering is enough.

…As mothers, we think that our concerns are the concerns of the many. We have to make sure that they are. As mothers, we hope that our children are protected by society. We have to act when they are not. As mothers, we have authoritative knowledge about our own experience, an experience we have in common with millions of women. We can build a more just society on the ground of this common experience.

Guest Post: More Business of Being Born Mini-Review

Nov9

In conjunction with the More Business of Being Born giveaway I’m currently hosting, I’m also pleased to share this mini-review of the first installment (Down on the Farm) guest posted by my friend and colleague, doula Summer:

More Business of Being Born

Down on the Farm: Conversations with Legendary Midwife Ina May

Reviewed by Summer Thorp-Lancaster

http://peacefulbeginnings.wordpress.com
http://summerdoula.wordpress.com

The first installation of More Business of Being Born, Down on the Farm: Conversations with Legendary Midwife Ina May, is infused with loving scenes of midwifery care, loads of vital information and even a few jokes (such as a gift referencing Ina May’s infamous “sphincter law”). We are given an up close view of the well-known Farm in Tennessee, whose Midwives boast an exemplary track record of Midwife attended, out-of-hospital births. This record includes a less than 2% cesarean section rate in over 2500 births. Throughout the interviews, Ina May’s (and the other Midwives featured) reverence and respect for the Midwifery Model of Care is ever-present. Her passion for the safety and overall well-being of the motherbaby is palpable and stirring.

It would be impossible to cover the many aspects of birth, or even just Midwife attended out-of-hospital birth, in a full length film, let alone an episode, but this piece successfully touches on many topics and will (hopefully) lead to further discussion amongst viewers. As an activist, I found myself left with a renewed sense of action or purpose, a desire to do more and help more so that all mamas and babies have the opportunity to experience birth as the positive, loving and intimate experience it was meant to be as well as a deeper understanding of the crisis surrounding our medical model of birth. I would recommend this film to everyone, as the state of maternity care affects us all.

What Really Scares Me: Social Attitudes Towards Women

Nov2

The following items all came across my desk (top) last week and it seemed fitting to put them into one post.

The first is with regard to the Boxing Federation wishing to make the female boxers box wearing skirts:

That’s right, skirts. The AIBA has introduced a trial alternate uniform, asking female boxers to wear skirts because it will make the women easier to distinguish from the men, as if the completely different bodies wasn’t enough. Poland adopted the uniform, calling the uniforms more “elegant” and “womanly.”

via Boxing federation wants female boxers to wear skirts – Fourth-Place Medal – Olympics Blog – Yahoo! Sports.

As you might imagine, the comments on this article with alternately hilarious and maddening (seriously, reading comments on a news article is the quickest way to both cause my blood to boil and to simultaneously despair at the future of humankind). I liked this one though:

“So I guess the AIBA thinks Americans are so stupid that when they see ‘Women’s boxing,’ sports bras, longer hair, and oh yeah, women, we can’t figure out what gender it is until we see skirts.

‘What sport is this?’ ‘Boxing…but those don’t look like men…what the hell are they?'”

But, why stop at skirts?! Why not lingerie! That’s what the Lingerie Football League is in favor of:

The LFL claims its emergence in 2009 “formally shattered … the ceiling on women playing tackle football.” Thankfully, the visionaries at the LFL have devised a way to offer such athletic empowerment to our younger generation with their decision to start a youth league:

“With the growing popularity around the LFL, younger and younger girls are starting to dream of playing LFL football,” its website reads. “In recent months and years, parents of young ladies routinely contact LFL league offices inquiring about everything ranging from what size football do you use to what form of training should I place my daughter into now to prepare her for LFL Football. [sic]”

…Look, I know we can’t shield our little girls with a protective glass box and expect them to never be exposed to the harsh reality that at some point in their lives, probably sooner rather than later, they will viewed as sexual objects. But do we need them to feel it before they know how to multiply double digits? I can appreciate that the LFL youth league will be fully clothed, but just the mere association with the word “lingerie” will instill in the girls that one day, if they want to play with the big boys, they’ll be forced to strip down to do so.

via Talking Smack — Are you ready for some T&A? – espnW.

What an excellent concluding point. This article reminded me of the sexyfication of Halloween costumes for girls in recent years. And, also of conversations recently amongst my friends about “appropriate dress” and how restricting girls’ clothing choices is damaging too, just like clothing that objectifies girls/women is damaging. We usually conclude that dressing in a way that makes YOU feel good is what matters (and being able to make your own choices about what that is). When think about things like the LFL though, I just wonder if it is even possible to tease it apart anymore—are girls learning that there is any other way to feel good about themselves other than how they look while playing football in a bra?! Likewise, we’ve also had conversations about how little girls are often complimented on their clothes and how “cute” and “pretty” they are and much less often about how brave and smart and strong they are. But, likewise, sometimes it is also nice to be told you look cute or pretty—when I feel cute or pretty it feels nice to have that acknowledged rather than to be ignored PCishly. I think it is hard to tell where it comes from.

So, this brings me to my third disturbing experience. I frequently receive press releases about a variety of products related to pregnancy, birth, parenting, and women’s health. Some of them I write about, some of them I don’t. I usually refrain from posting about the ones I find ridiculous or insulting, because I don’t want to have this be a place in which I mock things and I also don’t want to insult or point fingers at the press people who contact me with these “news” items. However, in the context of the above, I cannot help but mention that I received a release about a new procedure for those of us who are seeking, “completely new buttocks” with just two quick, nearly painless doctor’s visits! According to the release:

Dallas, Texas, October 28, 2011 – A stitch in time can re-align. At least, that’s the concept behind a new minimally-invasive cosmetic procedure to lift and shape the buttocks called the Brazilian Thread-Lift.

“I’ve never seen anything this quick and this dramatic,” says Dr. Bill Johnson at Innovations Medical in Dallas. “After two simple, 45-minute procedures using only local anesthetic, a patient can completely re-shape her backside.”

During the first visit, while under local anesthesia, the patient has several specifically-designed sutures or plastic threads strung under the skin and across each buttock. The entire procedure takes less than an hour. The threads have a series of thin knots covered by tiny cones which can be placed easily and with minimal discomfort. The cones create small fibrotic areas that function like little ligaments. After three months, the patient returns for an equally-brief follow-up visit, during which the physician gently tightens each thread, providing a smooth, even lift… (emphasis mine)

While they term it “small fibrotic areas,” I read purposeful internal scarring in the name of “beauty” or sexiness and I find it deeply disturbing. What does it say about our cultural attitudes towards women that anyone would desire OR promote purposely creating scar tissue in your butt so that you look more “youthful”? Because, after all, nothing says youthful and sexy like fibrotic areas that help pull your butt fat into place.

And, this reminded me that on a recent trip out of town we passed a “women’s health office” of an OBGYN. In largest print on the clinic’s sign was, “laser hair removal.” Ah, yes, because the most pressing mission of a women’s health surgeon should be to rid the world of excess body hair. That really inspires confidence. And, it also makes me wonder what is happening socioculturally, that anyone would consider it appropriate to see a physician for hair removal. How could we possibly be having a national health care crisis when such fabulous services are available on every street corner?! Considering that being pregnant and giving birth are medical conditions requiring “delivery” via the medical model of care, I guess it is not such a leap to think that those pesky stray hairs could also warrant medical attention. Perhaps we will reach a point in the future where anything having to do with women and their messy, excess hairy, birthy, butt fatty bodies will be dealt with by professionals. Wearing skirts.

The Value of Sharing Story

Oct12

“..no matter what her experience in birth was, every mother knows something other people don’t know.”—Pam England

“Stories are medicine…They have such power; they do not require that we do, be, act anything—we need only listen. The remedies for repair or reclamation of any lost psychic drive are contained in stories.” –Clarissa Pinkola Estes

Every woman who has given birth knows something about birth that other people don’t know. She has something unique and powerful to offer.

As birth professionals, we are often cautioned against sharing our personal stories. We must remember that it is her birth and her story, not ours. In doula and childbirth educator trainings, trainees are taught to keep their own stories to themselves and to present evidence-based information so that women can make their own informed choices. As a breastfeeding counselor too, I must remind myself to keep my own personal experiences out of the helping relationship. My formal education is in clinical social work and in that field as well we are indoctrinated to guard against inappropriate self-disclosure in a client-helper setting. In each environment, we are taught how to be good listeners without clouding the exchange with our own “baggage.” The messages are powerful—keep your own stories out of it. Recently, I have been wondering how this caution might impact our real-life connections with women?

Nine months after I experienced a powerful miscarriage at home at 15 weeks, a good friend found out at 13 weeks that her baby died. As I had, she decided to let nature take its course and to let her body let go of the pregnancy on its own timetable, rather than a medical timetable. When she emailed me for support, it was extremely difficult to separate our experiences. I kept sharing bits and pieces of my own loss experiences and then apologizing and feeling guilty for having violated the “no stories” rule. I kept telling her, “I know this isn’t about me, but I felt this way…” I told her about choosing to take pictures of the baby and to have a ceremony for him at home. That I wished I had gotten his footprints and handprints. The kinds of personal sharing that may have been frowned upon in my varied collection of professional trainings. After several apologies of this sort, I began to reflect and remembered that what I hungered for most in the aftermath of my own miscarriage was other women’s voices and stories. Real stories. The nitty gritty, how-much-blood-is-normal and did-you-feel-like-you-were-going-to-die, type of stories. Just as many women enjoy and benefit from reading other women’s birth stories, I craved real, deep, miscarriage-birth stories. These stories told me the most about what I needed to know and more than organization websites or “coping with loss” books ever could.

I had a similar realization the following month when considering the effectiveness of childbirth classes and trying to pin down what truly had reached me as a first time mother. The question I was trying to answer as I considered my own childbirth education practice was how do women really learn about birth? What did I, personally, retain and carry with me into my own birth journey? The answer, for me, was again, story.

On this blog, I have a narrative about my experiences during my first pregnancy with being able to feel my baby practicing breathing while in-utero. More than any other post on the site, this post receives more comments on an ongoing basis from women saying, “thank you for sharing”–that the story has validated their own current experience. In this example, rather than getting what they need from books, experts, or classes, women have found what they needed from story and, indeed, most of them reference that it was the only place they were able to find the information they were seeking.

And finally, as breastfeeding counselor, during monthly support meetings, I cannot count the number of times I’ve seen mothers’ faces fill with relief when another mother validates her story with a similar one.

So, what is special about story as a medium and what can it offer to women that traditional forms of education cannot? Stories are validating. They can communicate that you are not alone, not crazy, and not weird. Stories are instructive without being directive or prescriptive. It is very easy to take what works from stories and leave the rest because stories communicate personal experiences and lessons learned, rather than expert direction, recommendations, or advice. Stories can also provide a point of identification and clarification as a way of sharing information that is open to possibility, rather than advice-giving.

Cautions in sharing stories while also listening to another’s experience include:

Are you so busy in your own story that you can’t see the person in front of you?
Does the story contain bad, inaccurate, or misleading information?
Is the story so long and involved that it is distracting from the other person’s point?
Does the story communicate that you are the only right person and that everyone else should do things exactly like you?
Is the story really advice or a “to do” disguised as a story?
Does the story redirect attention to you and away from the person in need of help/listening?
Does the story keep the focus in the past and not in the here and now present moment?
Is there a subtext of, “you should…”?

Several of these self-awareness questions are much bigger concerns during a person-to-person direct dialogue rather than in written form such as blog. In reading stories, the reader has the power to engage or disengage with the story, while in person there is a possibility of becoming stuck in an unwelcome story. Some things to keep in mind while sharing stories in person are:

Sensitivity to whether your story is welcome, helpful, or contributing to the other person’s process.
Being mindful of personal motives—are you telling a story to bolster your own self-image, as a means of pointing out others’ flaws and failings, or to secretly give advice?
Asking yourself whether the story is one that will move us forward (returning to the here and now question above).

While my training and professional background might suggest otherwise, my personal lived experience is that stories have had more power in my own childbearing life than most other single influences. The sharing of story in an appropriate way is, indeed, intimately intertwined with good listening and warm connection. As the authors of the book, Sacred Circles, remind us “…in listening you become an opening for that other person…Indeed, nothing comes close to an evening spent spellbound by the stories of women’s inner lives.”

Molly Remer, MSW, ICCE, CCCE is a certified birth educator, writer, and activist who lives in central Missouri with her husband and children. She is an LLL Leader, a professor of Human Services, and the editor of the Friends of Missouri Midwives newsletter. She blogs about birth, women, and motherhood at https://talkbirth.wordpress.com.

This is a preprint of The Value of Sharing Story, an article by Molly Remer, MSW, ICCE, published in Midwifery Today, Issue 99, Autumn 2011. Copyright © 2011 Midwifery Today. Midwifery Today’s website is located at: http://www.midwiferytoday.com/