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Guest Post: The Midwife as a Storyteller and Teacher by Patricia Harman

The use of old-fashioned narrative to influence, and inform patients about health practices

As an author of memoirs, historical fiction and children’s literature, I am a storyteller, but I’m also a nurse-midwife, and I use storytelling as one of my primary teaching tools.

Storytelling is uniquely human.  Anthropologists have argued that storytelling is pre-verbal, that pictographs on the inside of caves are in fact stories.  Form the earliest days humankind has used narrative to record history, to entertain, to convey experience and to transfer information.

To convey information in narrative form is something no other species can do.  It’s an evolutionary advantage and allows each individual to harbor  more information than personal experience would allow.

Using stories to teach patients is not unique to midwives.  All good providers use stories to illustrate May 2016 004how individuals can make better health choices.

We all know that many patients are non-traditional learners  and even those in higher education love a good story.  Research and statistics are boring for most people and easy to forget .  Many patients, even if given a handout drop it in the trash as they leave our office. They don’t have time to read it or are non-readers.

On the other hand, if I tell a tale, in an amusing way, about a young woman who refused to take her birth control pills because she was worried they would make her fat…and now she’s pregnant…that’s a cautionary tale and brings a smile and a knowing nod from the fifteen-year-old here to discuss birth control: That’s not going to happen to her!  

Using self-disclosure about your own life can humanize a professional relationship and help patients be more honest with you about their lives.  For example, I might say with a smile, that I’ve gone to Weight Watchers for so long I could teach the class, even though I’ve never reached goal weight.  The patient and I share a good laugh and now she feels comfortable telling me she can’t stand to look in the mirror, has tried four different TV diets and is terribly discouraged.  A door for real communication has opened.  She no longer feels alone and she knows she has me as a non-judgmental advocate.

Stories can accomplish what no other form of communication can do; they can get through to hearts with a message.  I might tell a very stressed-out college student, sitting on the end of the exam table, about a patient of mine who had two jobs and was studying nursing full time.  Last year she started getting a series of illnesses.  Next thing she knew, she flunked two courses, lost her boyfriend and had a motor vehicle accident.  The moral is clear: don’t take on more than is humanly possible.  And the tale is more likely to induce lifestyle change than a lecture.

All health care providers, surgeons, nurses, physical therapists, family doctors or midwives must be teachers.  If you missed that part in school, it’s not too late.  With humor and love we can become part of the human story that will bring health and hope to our patients.

For the past twenty years, Patricia Harman has been a nurse-midwife on the faculty of The Ohio harman-2008-by_bob_kosturko-330State University, Case Western Reserve University and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, an OB/Gyn, in Morgantown, West Virginia. Here they devoted their lives to caring for women and bringing babies into the world in a gentle way. Patricia Harman still lives with her husband, Thomas Harman, in Morgantown, West Virginia. She recently retired from her thirty-five years of midwifery so she could write more books for people like you!

My past reviews of Patsy’s books:

Past blog posts on the subject of story power: october-2016-240

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Talk Books: Lost on Hope Island

Patricia Harman is an experienced midwife, beginning as a community midwife in the 1960’s and goatmidwivesthen becoming a CNM and maintaining a busy practice with her obstetrician husband Tom. Her memories about midwifery practice are some of my all-time favorite midwifery memoirs. She has a delightful gift with sharing stories, wisdom, and creating what feels like a true relationship with the reader. Now, she has put her attention into a new project: fiction for middle-grade children. Her first child’s novel, Lost on Hope Island: The Amazing Tale of the Little Goat Midwives, tells the story of two siblings, Trillium and Jacob (ages 12 and 8) who are shipwrecked on a small island in the Pacific Ocean and separated from their parents.

Lost on Hope Island is set in the modern day, it is not a Swiss Family Robinson reboot. On the island, the children must learn how to survive with only each other, and the goats the inhabit the island for company. They make some surprising (and convenient!) discoveries left behind by previous homesteaders on the island that help them survive and they develop close relationships with their goat friends. After the traumatic death of one baby goat, they learn how to help the nanny goats on the island give birth to their kids when they encounter difficulties (specifying that their mother and grandmothers are midwives and they know that if a mother isn’t have any trouble, it is best to keep your hands off and leave her alone!). This tale is not a fantastical or “glitzy” children’s read, nor does it shy away from complicated and difficult topics, instead it opens the door to real questions about relationships and feelings and how to draw on one’s own strength when you think you can’t go on. It is unusual to find a middle grade children’s book about realistic people in unusual, but not fantasy, circumstances. The book is illustrated with charming little hand-drawn pictures of the goats and the island’s adventures.

I read Lost on Hope Island out loud to my kids at bedtime over the course of a few weeks. My kids are ages 2, 5, 10, and 13. The older boys groaned a bit about reading it and found the goat-birth scenes to be a bit “icky,” but after they settled into the rhythm and pacing of the story, they listened with rapt attention and we often mentioned the story at other points during the day. My five-year-old daughter loved the book and it taught my nearly two-year-old son how to both say “midwives” (in a truly adorable fashion…he would get the book and bring it to me saying, “mid-wiiiifes”) and also “bey-aa” like the goats in the story.

If you are looking for a family read aloud, this adventure story with a birth-worker twist, is the book for you!

Past reviews of Patricia’s other books:


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

Crossposted at Brigid’s Grove.

Talk Books: Pregnancy, Childbirth, and the Newborn

March 2016 121Several months ago, I received an email from one of my former college students. His wife was newly pregnant and they had several specific questions. They asked for my help and recommendations with where to go for answers and without hesitation, I suggested a book: Pregnancy, Childbirth, and the Newborn. I was confident that not only would they find the answers they sought in the book, but also reliable, practical, helpful answers to questions they haven’t even thought to ask yet.

Co-authored by a foremost authority in childbirth and doula education, Penny Simkin, Pregnancy, Childbirth, and the Newborn was one of the first books I bought as a new childbirth educator in 2005. Now, newly revised and updated, the book has a companion website packed with resources to help you have a healthy pregnancy, a rewarding birth, and a nurturing postpartum.

One of the things I’ve always enjoyed about this book as a wonderful resource for childbirth educators are the line March 2016 119drawings illustrating a variety of positions and concepts. This new fifth edition has lots of black and white photos as well. The fact that the book is co-authored by a world-renowned doula, a nurse/lactation consultant, a nurse/childbirth educator, a social worker, and a physical therapist, means it is an interdisciplinary resource benefiting from the skills and professional experience of each co-author. Childbirth educators and doulas as well as pregnant couples will want to check out the companion website which has a plethora of pdf handouts available on numerous topics including comfort techniques, nutrition, and parental leave.

Evidence-based, comprehensive, and encouraging, Pregnancy, Childbirth, and the Newborn is an ideal companion for both childbirth professionals and expectant parents.


Pregnancy, Childbirth, and Newborn is published by Meadowbrook Press, an award-winning publisher specializing in pregnancy & childbirth, baby names, parenting & childcare, and children’s books & poetry: Meadowbrook Press. Pregnancy, Childbirth, and the Newborn

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

Guest Post: Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health

Leading Maternity Care Experts Release Issue Brief Encouraging Medicaid and Private Insurers to Cover Doula Care

WASHINGTON, D.C. – January 5, 2016 – At this time when most experts agree that not nearly enough women in this country receive high-quality maternity care, federal and state government agencies and health insurers should make doula care an option for more women by covering doula services. An issue brief released today by two leading maternity care advocates makes a powerful infographiccase for the health benefits of doula care for women and babies and the significant cost reductions that would result if more women used doulas – trained professionals who provide non-clinical emotional, physical and informational support before, during and after childbirth. The brief, Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health, is co-authored by Choices in Childbirth and Childbirth Connection, a program of the National Partnership for Women & Families.

In the brief, the authors summarize research showing that doula care reduces the likelihood of interventions such as cesarean birth and epidural while supporting shorter labor, spontaneous vaginal birth and other benefits to mom and baby. As the use of interventions decreases, so do associated costs, making coverage of doula care a cost-effective strategy for public and private insurers alike. The authors estimate that the reduction in cesarean births from the use of doula care could save Medicaid at least $646 million per year, and private insurers around $1.73 billion annually.

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

The brief provides key recommendations to expand insurance coverage for doula care across the country:

  • Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
  • The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
  • State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
  • The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
  • Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
  • State legislatures should mandate private insurance coverage of doula services.

The issue brief and a new infographic illustrating the importance of coverage for doula care are available at http://Transform.ChildbirthConnection.org/Reports/Doula and www.choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage.

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About Choices in Childbirth

Choices in Childbirth is a non-profit organization that works to ensure access to maternity care that is safe, healthy, equitable, and empowering. Our mission is to promote evidence-based, mother-friendly childbirth options through public education, advocacy, and innovative policy reform. Learn more at www.ChoicesinChildbirth.org.

About the National Partnership for Women & Families

The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. Founded in 1918, Childbirth Connection became a core program of the National Partnership in 2014. Childbirth Connection programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation. Learn more at http://Transform.ChildbirthConnection.org and www.NationalPartnership.org.

Tuesday Tidbits: Postpartum Planning

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My post from last week about recovering from childbirth sent me on a blog-excavation mission for all the posts I’ve written about postpartum care. This is just a sampling (I’ve written a lot on the subject):

“I needed a maternal figure, a dedicated and present midwife, dear and loving friends. I was blessed with one out of three. It could have been worse. The only people I know who did just fine in the postpartum period are those who score the triumvirate: well cared for in birth, surrounded by supportive peers, helpful elders to stay with them for a time. The others, wild-eyed at the supermarket, prone to tears, unable to nurse or sleep or breathe, a little too eager to make friends at baby groups – I can spot them at 20 paces. We form a vast and sorry club…”

via My friend breastfed my baby | Life and style | The Guardian.

Source: Weekly Tidbits: Birth, Postpartum, the Triumvirate, and Anthropology | Talk Birth

Other, experienced women can be our most powerful source of support:

Women around the world and throughout time have known how to take care of each other in birth. They’ve shown each other the best positions for comfort in labor, they’ve used nurturing touch and repeated soothing words, and they’ve literally held each other up when it’s needed the most…

–The Doula Guide to Birth

Source: Tuesday Tidbits: Postpartum Recovery | Talk Birth

I’ve spent a lot of time talking and writing about the culture that surrounds us and the resultant impact on our birth, breastfeeding, and early parenting experiences:

The United States are not known for their postpartum care practices. Many women are left caught completely off guard by the postpartum recovery experience and dogged by the nagging self-expectation to do and be it all and that to be a “good mother” means bouncing back, not needing help, and loving every minute of it.

Source: Tuesday Tidbits: Postpartum Mamas | Talk Birth

It isn’t just me writing about the impact of culture on maternal mental health, this post calls it like it is:

Let’s stop torturing mothers. Let’s stop ignoring the problem of expecting new mums to get back to normal. They are not normal, they are super important, and we need to value them and treat them with the greatest respect, if we don’t want them to break into a million pieces, shattering the lives of all those around them.

Source: Torturing new mothers and then wondering why they get mentally ill. | Mia’s Blog

This insightful article full of helpful tips for supporting postpartum women by my friend Summer got a lot of attention when I re-shared it on Facebook last week:

An unfortunate by-product of our society’s refusal to see birth as a monumental event is the lack of a babymoon or restful, supported postpartum period. Most of the time, moms and dads are expected to pick up with their everyday lives almost immediately.

The Incredible Importance of Postpartum Support | Midwives, Doulas, Home Birth, OH MY!

I offer some survival tips here: Postpartum Survival Tips | Talk Birth

And, one of my favorite guest posts that I’ve ever hosted on this site is this one about postpartum planning: Guest Post: Mothers Matter–Creating a Postpartum Plan | Talk Birth

When considering postpartum planning as well as talking about it to others, I find that visualizing the placental site that is healing can be a helpful jolt reminding us how important good postpartum care is:

“Remind them that a true six-week postpartum window allows for the placenta site to fully heal and supports minimized bleeding and stronger recovery.” An excellent tip for educators and doulas from Barbeau is to illustrate size of placental site healing area with hands like small dinner plate—if this was outside the body, how would you care for yourself…

Source: Timeless Days: More Postpartum Planning | Talk Birth

And, some final reminders about good postpartum care for women themselves and for those who love them:

I recently finished a series of classes with some truly beautiful, anticipatory, and excited pregnant women and their partners. I cover postpartum planning during the final class and I always feel a tension between accurately addressing the emotional upheavals of welcoming a baby into your life and marriage and “protecting,” in a sense, their innocent, hopeful, eager, and joyful awaiting of their newborns.

This time, I started with a new quote that I think is beautifully true as well as appropriately cautionary: “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

Source: Some reminders for postpartum mamas & those who love them | Talk Birth

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Thursday Tidbits: Recovering from Birth

December 2015 029“Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead…that I’d finally found my sport.”

–Joyce Maynard

People often use running a marathon as a metaphor for birth. Turns out that science has discovered that birth is actually more difficult…

“The researchers used MRI equipment typically used to diagnose sports injuries to explore the full scope of trauma that a woman’s body experiences during childbirth. The MRI images revealed that almost 25 percent of women had fluid in the pubic bone marrow or fractures that are similar to stress fractures that athletes often suffer. And 41 percent of women had pelvic muscle tears.

Also revealed by the study is the startling statistic that 15 percent of women never fully recover from the birth-related pelvic injuries.”

Science Says Childbirth Is Harder Than Running a Marathon – In The Loop Tips & Advice | mom.me

The same research was covered in this post as well:

Childbirth, as anyone who’s been through it knows, can feel very much like an extreme sport. And, it turns out, some childbirth-related injuries are surprisingly like sports injuries, including the very long time they need to heal.

The bottom line, Miller says, is: “if women don’t feel that their body is back to what they expected after six weeks, it’s not in their heads. Women do some self blame or feel like they’re not as robust as their sister or friend. But they may have one of these injuries not visible on clinical exam.”

Source: Childbirth As An Extreme Sport — And Why Its Injuries Can Take So Long To Heal | CommonHealth

I do have to admit that I perhaps would have re-titled the articles: “Science Reports Something Most Women Have Known Since the Beginning of Time,” but, oh well. Picky me.

I’ve written about birth and marathons in several past posts. Giving birth is the original “extreme sport.” One that tests your reserves, your endurance, your courage, and your stamina like nothing else. Truly, we have the comparison wrong. Running a marathon is kind of like giving birth, rather than vice versa! The first older blog post of mine isn’t related to childbirth/sports injury, but instead the emotional satisfaction of finishing your “marathon”:

She goes on to share: “I want that feeling of going beyond what you think is possible for laboring women. If you let go of control and allow the process to unfold, you are so proud of yourself. Then pride morphs into self-confidence and trust. What a perfect combination for parenting. When it comes down to it, you have to do this by yourself, be it labor or running. You might hear other laboring women around you or have the support of crowds in a race, but it’s still up to you. there’s a start and a finish and only you can see it through. Fortitude brings a new self-awareness and strength that feels overwhelming…I know one of my greatest challenges in the vocation of perinatal education is getting women to trust the process and her own capabilities before labor. My practice runs helped prepare me for the marathon, but there is no practice run for labor. Women must rely on their confidence and the legacy of the many women who have birthed before them…”

Source: Births & Marathons | Talk Birth

Women giving birth often experience a sort of post-race euphoria:

Those who push themselves to climb the last hill, cross the finish line, or conquer a challenging dance routine often report feelings of euphoria and increased self-esteem…women who experience natural birth often describe similar feelings of exaltation and increased self-esteem. These feelings of accomplishment, confidence, and strength have the potential to transform women’s lives. In many cultures, the runner who completes the long race is admired, but it is not acknowledged that the laboring woman may experience the same life-altering feelings… —Giving Birth with Confidence (by Lamaze International)

Source: Birth Feelings | Talk Birth

And, they can draw on those feelings for strength again and again:

“Whether it be the thick memory of enduring a non-medicated labor and finally pushing our third child into the world, despite feeling as though I hadn’t an ounce of energy left, or the meager sprint I managed as I neared the finish line of the marathon…, I hold tight to these images as proof that I can and will be able to rise to the occasion–again and again, if and when I need to-–because the ability to do so is in my very bones. Because I am a woman.”

Source: Woman Rising | Talk Birth

Mothering can also feel like a marathon:

“My body? I was ashamed to admit that, after two powerful homebirth experiences, I no longer felt intimately connected to my body. Pregnancy and giving birth were all about every little feeling in my body; mothering felt like a marathon of meeting everyone else’s needs and rarely my own…Most days, the question I asked was, ‘How are their bodies?’ My body was in the back seat, unattended, without a seatbelt.”

Source: Tuesday Tidbits: Birthing Bodies | Talk Birth

This article about recovering from a Cesarean Birth After Cesarean (CBAC) is packed with helpful information:

As we have discussed, everyone celebrates a VBAC but many CBAC mothers feel alone and unsupported, both in their physical and emotional recovery. This needs to change.

Source: The Well-Rounded Mama: Physical Recovery After CBAC

And, this article has some ideas to share about lowering back and pelvic pain during pregnancy: The Birthing Site – 5 Things you can do to Help Lower Back and Pelvic Pain in Pregnancy

All of these posts and topics remind me of the importance of planning wisely for postpartum:

My son’s birth was a joyous, empowering, triumphant experience, but postpartum was one of the most challenging and painful times in my life. I had not given myself permission to rest, heal, and discover. Instead, I felt intense internal pressure to “perform.” I wondered where my old life had gone and I no longer felt like a “real person.” A painful postpartum infection and a difficult healing process with a tear in an unusual location, left me feeling like an invalid—I had imagined caring for my new baby with my normal (high) energy level, not feeling wounded, weak, and depleted.

Source: Planning for Postpartum | Talk Birth

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Wednesday Tidbits: Books, Babies, and Breastfeeding Mama Ornaments

In February of 2014, I sat on the stones in the woods, came face to face with a raccoon in the tree and suddenly knew that I was pregnant again. In October of 2014, I sat on the stones in the woods awaiting the imminent arrival of my new baby boy. This week, I sat on the stones in the woods with a baby boy who is now approaching his first birthday. The wheel spins quickly.

12074630_1672247639654118_5798984318455904624_nAfter feeling a little fried and exhausted from parenting this teething whirlwind of a toddling boy, I enjoyed reading this article about motherhood as a spiritual practice:

Motherhood is a deeply spiritual act. We birth another human soul at great personal cost, and are tasked with providing for that baby and raising them to adulthood. The daily grind of being a mother, of constantly putting somebody’s needs before your own is the most character-building exercise I have ever had to do. No spare time is squandered, no act of love too great. On those days where the house is a mess, everybody is crying and I’ve made five cups of tea all gone cold, taking the time to remember the sacredness of what I am doing, the beauty and the impact of my every decision on these little one’s lives. I am the Mother. I am not the clean, clinical mother with the apron tied around her waist but I am infinitely more valuable than that.

Source: Motherhood and Spirituality — Mama Bird

(Note: I also know awesome mothers who rock aprons!)

It made my heart so happy to read these words from Rachael at Moon Times about my new Earthprayer poetry book: “a beautiful book of poetry that calls to earth women, earth mamas, wood pixies…”

The book is available on Amazon US and Amazon UK as well as from our Etsy shop. I’m also working on developing a free companion e-course!12115561_1673721906173358_8351932066983960577_nSpeaking of books, I contributed to the Indiegogo campaign for Pam England’s newest book. I love Pam’s work and it has left an indelible imprint on my own births, life, and work.

Support Birthing From Within’s new book and our vision for changing the conversation about birth.

Source: New Birth Book: Ancient Map for Modern Birth | Indiegogo

Is it too soon to mention Christmas? We’re working on some Christmas ornaments! I’m excited to see holiday lights behind these luminous mamas.

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I was interviewed by KNOWHEN this week, talking about TTC, birth empowerment, birth education, and pregnancy loss: Molly Talks About Childbirth & Her Own TTC Story – KNOWHEN

And, speaking of pregnancy loss, in October we honor Pregnancy and Infant Loss Awareness Month. Please feel free to use this photo as your own profile picture on Facebook if you need to do so:
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