Why Do I Care About Birth?

Jul29

Some time ago I wrote a post on the Citizens for Midwifery blog 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? And, is it any of our business anyway?

Well, I’ve been doing some thinking and I made and shared a list of why I care on the CfM blog. However, I wanted to go ahead and share my reasons on this blog as well. This is why I care about about other women’s births:

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 due to induction, 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 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.

Conference Blessings

Jul27

This past week, I attended my first CAPPA conference (this one was in Charlotte, NC). I’ve been a member of CAPPA since 2004 and the thing that first attracted me to membership was the FREE annual conference. Now, six years later, I finally took advantage of going to one! I think it will be an annual tradition for our family 🙂 On the closing day of the conference, the MC asked us to consider how we had each been “blessed” at the conference this year and then to turn to the person next to us and share how we had been blessed. I thought of several things right away:

Meeting people face-to-face that I previously only had online contact with. There is no substitute for in person contact. It was great!
Attending Barbara Harper’s presentation on “Leave Well Enough Alone: Natural Third Stage.” It was VERY good. I also particularly enjoyed Andrea Sharpe’s presentation about empowering teen mothers and Barbara Hotelling’s “Your Body has the Power to Give Birth.”
Winning a birth bracelet from the Birth Behind Bars booth. They had an interesting project going on where you could submit a tip for the upcoming book 101 Ways to Support a Woman in Childbirth and have a chance to win a bracelet (as well as to get a nice purple “For the Love of Birth” lanyard for your name tag too). I love to win stuff and the bracelet is pretty 🙂
The between-session contacts and conversations. In addition to learning good information from the actual sessions, there is no substitute for the conversations that arise during breaks in the day—I met several really wonderful people just accidentally this way and I had some good, in-depth conversations about teaching methods and resources that would have been impossible to have if I’d only attended the sessions and then gone straight back to my room.
Being in an environment with 300 other women who also believe that birth matters.

With Barbara Harper

Opening for Birth

Jul24

Some time ago, I bought several large binders of back issues of The International Journal of Childbirth Education (ICEA‘s publication). The December 2001 edition of the IJCE contains an article titled “The Pelvis Revisited” by Elizabeth Noble. An interesting article overall, I particularly enjoyed the language of the section titled Opening for Birth:

“Birth is what women do. Women are privileged to stand in such power! Birth stretches a woman’s limits in every sense. To allow such stretching of one’s limits is the challenge of pregnancy, birth, and parenting. The challenge is to be fully present and to allow the process because of inner trust. How can women find their power, claim it, and stand firm in it throughout? The vertical position comes again into prominence. Women must ‘stand up’ for what they want and ‘on their own two feet’ by refusing to take their birth ‘lying down’! Being upright is essential for pelvic power–psychological strength, pelvic mobility, gravity’s assistance, pelvic pump efficiency, and the hygienic downflow of bodily fluids.”

In the September 1999 issue, the article “Belly-Dancing Through Pregnancy: A Way to Give Birth and Not Be Delivered” by Gaby Mardshana Oeftering caught my eye. In it, she also addresses the needs to build inner trust and to open to birth through physical movement and an active approach to birthing:

“Women expecting their second or third child don’t necessarily need this [traditional prenatal classes]. They are looking for a way to relax, find their inner selves, and get better acquainted with their bodies, their babies, and the process of birthing. When allowed to move during childbirth, many women instinctively start moving their pelvis in hip circles which are typical of belly-dance…All soft and gentle belly-dance movements are beneficial to pregnant women; for example, hip circles, the various hip-eights, and hip rocking. The rule is: all horizontal movements relax the uterus; vertical movements excite it. Physically speaking, all these movements strengthen and mobilize the pelvis and the legs and train the pelvic floor. They also activate deep abdominal breathing…the hip movements demand a lot of attentiveness and body awareness. On a mental level, this leads to better consciousness of tension and relaxation—a body feeling that is needed during birthing.”

Recently, I feel myself intrigued by the possibilities of working with these women—those who are on their second or third pregnancies and who are seeking to “go beyond” traditional birth class information (that often assumes first baby status). I know that I, personally, have wanted new, fresh, inspirational birth information during each of my pregnancies—labor and birth 101, stages of fetal development, or even labor support and comfort measures isn’t “enough” for me anymore (and wasn’t after my first baby). The desire to honor the pregnancy experience, prepare for the birth experience, and to work with psychological and emotional elements of childbearing are still very much present though! I envision doing a series of “pregnancy retreat” type of things or other types of workshops that “go beyond” and help second, third, or fourth time mothers to spend some dedicated,special attention to each pregnancy and birth experience in a personally enriching and rewarding way 🙂

An Encouraging Thought…

Jul19

Some time ago I read the book Teaching Natural Birth. In it, the author shares this thought about the importance of teaching families about birth:

“We are not ‘hobbying’ or ‘playing house.’ We do this not because we like people or like babies, but because there are earthshaking issues involved in the way our culture is giving birth and raising its children…We are playing for keeps and the stakes are high. We are professionals. We matter. Always and indescribably.”

I do not view my birthwork as a “hobby.” I view it as my career/profession. I have noticed a tendency of people outside the “birth world” to look upon it as a hobby however. Reading this quote was a nice reminder that this work is important!

Poem: Thoughts on Risk

Jul8

Two years ago, I read Sheila Kitzinger’s book Homebirth. In doing so, I was struck anew how much I love her writing (I quote her often!). It is so lyrical and vibrant and really gets to the heart. I also deeply identify with it. I want to share a poem (not by her) that was in the book in the section about assessing risk and statistics and homebirth and is it really safe, etc. I feel like sharing it today (something that is difficult for me about pregnancy after loss is feeling more “at risk” about pregnancy than I have ever felt before—you know the quote, “birth is as safe as life gets” often said so blithely, has a different impact when you’ve been part of the statistics instead of “escaping” them. I still think the quote is true, but it is NOT a “light” quote!) :

Thoughts on “risk”
by Judith Dickson Luce (in Homebirth by Sheila Kitzinger)

word so small
born a verb
an “action word”

as I learned in 4th grade
I risk
you risk
she risks
even a noun something
I take
you take
she takes

in philosophy a description of what life is
with its own rewards:
I love and risk loss and pain
I try and risk failure
I trust and risk betrayal
I live and risk death
but we’ve moved so far beyond philosophy
to insurance–for anything and everything
to machines
to technology and control
(no daring)

and computers spit out the risk we are “at”
before we breathe
before we take a first step
that might lead us to fall
and the computers and the statisticians tell us
it is healthier and safer
and wiser not to take risks
since we are “at risk”
and they can reduce risk
and with it our capacity
for living
and touching
and caring
it’s safer that way
neater and more efficient
and definitely more sterile
and what more can we ask of life?
—–
Commentary by Tom Luce: “It’s very risky to be born since very few people who are born avoid dying (though many avoid living). If you are born there is a high statistical risk you might die.” 😉

Wordless Wednesday: Wallowing in Books

Jul7

Anyone who knows me in person knows how much I love books! I joke with my husband about feeling like I need some time just to “wallow” in all my books. This past weekend, I finally did exactly that—got out all the birth and childbirth education books that are my favorites or that I’ve been wanting to look through again, spread them all around me and just enjoyed 🙂 (while I love being a book reviewer, one drawback is that I spend so much time reading NEW good books that I don’t have a chance to re-read old favorites!) Notice there are also books on the couch behind me AND in a big stack on the end table next to the couch—these are not books I got out for wallowing purposes, but are currently in-process/being used books! And, yes, that large box next to me is full of books and also has books on top (these are kids’ books mailed to us recently though, not birth books). I also feel like pointing out that this is not a very figure-flattering dress I’m wearing and though, yes, I am pregnant, I am not really as big as I look in the picture.

So much for Wordless!

Book Review: Giving Birth with Confidence

Jul6

Since I recently wrote a post inspired by a quote from The Official Lamaze Guide: Giving Birth with Confidence, I figured it was high time that I share the review I wrote of the book! The review was originally written in 2007 for CfM News.

The Official Lamaze Guide: Giving Birth with Confidence. By Judith Lothian & Charlotte DeVries. Published in 2005 by Meadowbrook Press (307p), $12.00. ISBN: 088166474X

Reviewed by Molly Remer, MSW, CCCE

Very few pregnancy books deliver the message that we think pregnant women need to hear most: Birth is a normal and natural part of life….We believe deeply that birth is a process you can trust just as millions of women before you have. This belief isn’t sentimental; it’s based on our thorough understanding of the physiologic birth process and research that confirms interfering in that process is harmful unless there is clear evidence that interference provides benefits.

So begins an opening section of the book The Official Lamaze Guide: Giving Birth with Confidence. The degree to which the book accomplishes its simple message can be summarized with a simple review: Excellent! The Lamaze Guide is digestible and reasonable for busy people to manage at less than 300 pages of text and it contains a simple, profound, and elegant message that women in the U.S. desperately need to hear.

The book begins with defining normal birth as “…a normal birth is one that unfolds naturally, free of unnecessary interventions.” It then briefly explains the history of birth and how and why normal birth is not actually the norm in our culture. The authors then clearly address the following areas in one chapter each: early pregnancy; choosing a caregiver and birth site; middle & late pregnancy; preparing for labor and birth; the simple story of birth; keeping birth normal; finding comfort in labor; creating a birth plan and a baby plan; communication and negotiation; greeting your newborn; and early parenting. The authors are clearly very supportive of midwifery and the Midwives Model of Care (though it is not referenced by name) as well as of the benefits of a doula in the birthing room.

The book is framed in the context of Lamaze International’s powerful foundation, the Six Healthy Birth Practices:

The book is also guided by Lamaze’s comprehensive and lovely philosophy of birth:

Birth is normal, natural and healthy.
The experience of birth profoundly affects women and their families.
Women’s inner wisdom guides them through birth.
Women’s confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth.
Women have the right to give birth free from routine medical interventions.
Birth can safely take place in homes, birth centers and hospitals.
Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom.

After effectively bolstering the confidence of women in birth, The Lamaze Guide concludes with several useful appendices. The first is the excellent tool “Effective Care in Pregnancy & Childbirth: A Synopsis.” Though this information is easily available on the internet (see www.childbirthconnection.org), I find that many parents do not come across it on their own. How powerful to have it included for easy reference of indisputable evidence based practices. The Mother-Friendly Childbirth Initiative is included in another appendix as well as the always excellent text of The Rights of Childbearing Women. I was delighted to see all of these powerful documents in one place—and, in the hands of consumers who need to be aware of them.

This book is a refreshing presence on the shelves of my local bookstore (yes, there is only one retail book shop in my community and The Lamaze Guide is the only “alternative” birth book stocked in the store!). As I read the book, I kept nodding along and wishing it was in the hands of each pregnant woman in my community. Lamaze has a “name recognition” that gives this book the potential to have a wider and broader impact than other alternative birthing books which, though brilliant contributions, may only end up in the hands of “the choir.” The Lamaze Guide is written in such a matter-of-fact and comforting tone that I cannot see it being off putting to the average consumer as having “hippie” language or “extreme” ideas. The blueprint for normal birth that the book lays out is extreme compared to the standard practices at most hospitals, but the way in which the information is presented opens doors of communication, understanding, and exploration as well as providing the evidence basis to back normal birth. I would not hesitate to lend this book out as it will not scare anyone away with “weird” ideas. With the other books in my personal library, I have to carefully consider my audience before choosing which book has the right style and blend of information—not this one! It is good for everyone with its open, simple message. It is a good addition to lending libraries, personal libraries, to give as a gift, or to recommend to others. The Lamaze Guide is straightforward and clearly written with an unabashedly honest and truthful message of what normal birth is and how it can either be supported or undermined.

My only critique of the book is that in contains no real acknowledgment of the several other well known and effective organizations that train and certify birth educators (other than Lamaze International itself). Conspicuously absent from the resources pages are any of these other organizations.

In conclusion, The Lamaze Guide is a source of information that women need to have and a message that women need to hear. I think Giving Birth with Confidence accomplishes its purpose skillfully and has the potential to be a transformative influence. I hope women read it, absorb it, and begin to Celebrate Birth!

Birth Feelings

Jul5

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)

This is so true and so often overlooked or diminished in our modern birth culture. Comments such as, “you don’t need to be a martyr” or, “would you get a tooth pulled without medication?” or, “there are no medals for natural childbirth,” or, “in the end, all that matters is a healthy baby!” fail to acknowledge the transformative power birth holds in women’s lives. I think these comments (and the many others like them) often come from one of two places: the first being a place where birth did NOT hold transformative power in that speaker’s life (and, this is something I have to acknowlege as real—birth can be transformative, but it isn’t always, AND it can be a powerful influence in a negative sense as well [i.e. a woman who really did suffer during birth and/or was abused and/or experienced any variety of traumatic things, whether or not we, the listener, “know” that some of those things could have been avoided with different choices, etc., etc.]).

The second place, I believe is one that many medical care providers come from in that they do not want to look at the reality of the importance of birth because then they would have to confront the reality of how they may have interfered with or “ruined” birth for so many women. Perhaps that isn’t true or is a “bad attitude” or judgment on my part coming through, but that is how it looks to me from the outside. It is easier to dismiss natural birth advocates as “zealots” and mothers who wish to birth unmedicated as “martyrs” than to critically examine the institution’s birth practices and policies.

Related to the initial quote, here is a previous post about Birth and marathons…

As a side note, I really like the book I quoted—Giving Birth with Confidence—as a good “basic” birth book for pregnant women. I’m glad it is usually available in “conventional” bookstores as many other birth book treasures are not!

A Fantasy

Jul2

Several years ago, I requested permission to reprint an essay from La Leche League International’s book Learning a Loving Way of Life. The essay is a birth/breastfeeding parody and I realized I’d never shared it here (please do not reprint without permission!).

A Fantasy

By Melanie Axel-Lute

Time: The not-too-distant future.

Scene: A Doctor’s office.

Doctor: Yes, Judy, the test is positive—you are going to have a baby. Now I’ll just give your instructions for the artificial womb.

Judy: Well, doctor, I have been planning to be pregnant.

Doctor: (surprised) Oh! I do have a few patients who say they’d like to try that. It’s very difficult nowadays, though, so many pressures on the modern woman. Of course, I’m all for it. It is the best thing for the fetus, though the new artificial wombs are very good. Now—have you done any preparatory exercises?

Judy: I didn’t think about that.

Doctor: You’ll find it very hard then, especially at first. I usually have my patients do several months of sit-ups and leg-lifts.

Many women say they’d like to try being pregnant, but they have to give it up in a few weeks. They have morning sickness and are very tired. I always recommend that anyone with nausea switch to the artificial womb.

Being pregnant takes a lot out of a woman. You’ll need your strength for the baby. And you don’t seem very big through the pelvis. You may not be big enough to be pregnant. I’ll have to test your amniotic fluid to see if it’s adequate.

It’s very hard to judge the weight of the fetus when it’s in a human womb, too. Some women worry whether it’s gaining enough weight. I always like to start intrauterine feedings at about two months.

Now, how long had you planned to be pregnant?

Judy: I planned on letting the baby be born naturally.

Doctor: (shocked) Oh, my! That’s really not necessary, you know. Most of my patients go for about three months—that’s the critical period—although a few stick it out for six. More than that is definitely unnecessary.

Have you thought about what people will say? Most people don’t mind seeing a woman pregnant with a tiny fetus, but when it gets to be more than six months—well! It’s just very unusual.

Besides, have you thought about how tied down you’ll be? You’ll have to take that fetus everywhere. Women really need to get out alone once in a while, you know. I feel that most women who prolong pregnancy like that do so for very selfish reasons.

Judy: I want to go ahead with it anyway.

Doctor: (patronizing) Well, I guess I just have to let you try it for a while and see how it goes…

This essay was reprinted with permission from the book Learning a Loving Way of Life, published by La Leche League in 1987. The essay reprinted was originally written in 1978. LLLI is the world’s foremost authority on breastfeeding. For a wealth of breastfeeding information, support, resources, or to purchase a copy of the book referenced, visit: www.llli.org.

Manual Clot Extraction Following Birth (Sequestered Clots)

Jun29

There is a new blogger at Science and Sensibility—a science writer (and pediatrician) named Tricia who is going to be writing about patient safety and other interesting topics. She wrote an article for the online medical journal Pulse about her traumatic post-birth experience that involved (among other things) a large number of clots and a painful manual extraction.

What an intense story it was. I had a manual clot extraction following my first son’s birth and my uterus literally HURT while reading her story and remembering that experience. However, unlike Tricia, I was at a birth center and had a very gentle, caring doctor who was wincing as she did the extraction saying, “I’m sorry, I’m sorry. I know this is hurting you.” Even so, it was an excruciatingly painful experience—the most painful physical experience I’ve ever had. Uteruses are simply not MEANT to have hands in them. And, birth is about things coming out, not going in! I was left with lingering questions about why the doctor did a manual extraction instead of having me squat to see if the clots would come out on their own. Perhaps it was a more serious situation that I realized at the time and she was just playing it cool. I can find almost no information online about this type of an experience, just a small mention in one of my midwifery texts about “sequestered clots,” which is I guess what I experienced.

Reading about this other blogger’s experiences really brought back this painful experience for me. I have noticed a tendency amongst childbirth educators and doulas to sometimes only focus on the good and empowering parts of births and to overlook or not mention the “traumatic” parts. Personally, I felt so good OVERALL about my birth experiences, that it seemed like a “betrayal” of sorts to talk too much about the parts that were not as good. While I experience giving birth as the most powerful, transcendent, empowering, and just super awesome cool, experience of my life, when I take a couple of steps back into memory I also realize that each of my births involved a certain element that was significantly traumatic as well. With my first it was the manual extraction and then my postpartum recovery from what I feel like was a very mis-diagnosed/poorly treated labial tear. With my second, it was recovery from a very similar tear right next to the old one (but with the visually traumatic addition of bruises). I really felt like I had “failed” in some way to have not protected myself from tearing again in such an unusual and very awful way. Someday I would like to write a blog post or article about this—I find that labial/clitoral tears are a significantly overlooked subject in the birth and midwifery literature. Indeed, I hadn’t even it was possible to have a non-perineal tear. If they are mentioned, it is in some dismissive way about “skid marks” or “labial split” or “a little burning when you urinate,” not in terms of the fairly significant genital mutilation I experienced.

I also had an intense amount of clots following my third birth (second trimester miscarriage at home)–-“only” the size of grapefruits though, not “frying pans” as in Tricia’s story-–and when I finally went into the ER about it they acted like I was making a big deal out of nothing (“people have miscarriages all the time. They’re very common.”) They were not “sequestered” though, they were coming out (and coming out, and coming out). Despite these experiences, I was never classified as “hemorrhaging”—the ER doctor even said (with a shake of her head like I was an idiot), “you’re not hemorrhaging.” And, indeed, I did not have any postpartum symptoms of hemorrhage—no anemia or anything like that (though yes, loud heart-pounding-in-my-ears after this third birth). In addition to the more obvious trauma of having my baby die, the experience of very truly feeling close to death—of no longer being able to distinguish whether I was fainting or dying—is the thing I can barely talk about from this birth experience.