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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.

Talk Books: A Passion for Birth

Sheila

“We are only now beginning to discover the long term destructive effects on human beings and families of treated women as if they were containers to be opened and relieved of their contents.”

–Sheila Kitzinger

Sheila Kitzinger’s new autobiography, A Passion for Birth, is an absolute treasure. One of the most long-term and pivotal influences in the world of birth activism, I have quoted her work more times than I can count. In fact, I judge the quality of a book by the number of pages I dog-ear to return to. I turned down the corners of so many pages in A Passion for Birth, that it will take me a year’s worth of blog posts to share all the provocative quotes that caught my attention! While Sheila always included a personal flavor in her other books, this book is truly about her, her life, her passions, her family, her activism, her work. Interwoven throughout is the social justice oriented thread of her absolutely devoted dedication to women, feminism, and childbirth activism. Her book is very real, relatable, and readable as well as often charming. She doesn’t hold back from treading into controversial waters, however, and she is straightforward and unapologetic even when writing about topics that can be divisive in the birth world.

I was pleasantly surprised to discover the full-color series of photos in the center insert to the book, they range from Kitzinger’s childhood, a homebirth picture of the birth of one of her daughters, and ending with a poignant photo of Sheila’s casket, decorated by her family, resting easily on some chairs in the dining room of home she so loved.

An internationally recognized author and expert, Kitzinger was an anthropologist and one of the first professional people to acknowledge that women’s birth wisdom, stories, and experiences are worthy of study and attention. Spanning an impressive career of more than fifty years, Kitzinger’s anthropological and activist work was undertaken at a global level and her clear and unwavering commitment to social justice work and activism is a thread running strongly throughout her entire autobiography. The book takes us from Sheila writing and studying while sitting in a playpen in her yard (an effort to have a work area undisturbed by her five children!) to traveling with her family to Jamaica to study the birth customs and stories of the women there. Her identity as an anthropologist is clearly reflected in the cross-cultural birth experiences she surveys and describes and the autobiography includes lots of travel! It also includes homey touches like favorite recipes and descriptions of family traditions as well as stories of her own four homebirths, including that of twin daughters. I found myself wanting more content about her life with children, her life as a mother, which, while acknowledged and integrated through the text, was curiously absent from much of the narrative’s exploration. I was also curious to know more about the accident and serious brain injury experienced by her daughter Polly, which was mentioned somewhat incidentally (though it clearly had a significant impact on the family), as was the passing mention in a photo caption referencing her husband Uwe’s eye removal surgery.

Highly recommended to anyone with an interest in birth work, birth activism, feminist studies, women’s health, or anthropology, A Passion for Birth was compelling, inspirational, funny, straightforward, assertive, honest, candid, wry and dedicated.

“The way we give birth is an expression of culture. It can be spontaneous and instinctual, but it is still patterned by the society in which we live.”

–Sheila Kitzinger

Stay tuned for an ongoing series of themed posts based on additional content and thought-provoking quotes!

In a pioneering career spanning more than 50 years she campaigned for and oversaw a radical change in maternity care, placing women’s rights and choices at the very heart of childbirth. Her passion, research and knowledge of childbirth have had enormous impact on millions of women worldwide.

A Passion for Birth | Sheila Kitzinger | Pinter & Martin Publishers.

Publishing and purchasing details: 

Author: Sheila KitzingerSheila
Published: 7 May 2015
Binding: hardback
Format: 240 x 160 mm
Pages: 384
Illustrations: colour and b/w photographs
Pinter & Martin edition available: worldwide
Translation rights: Pinter & Martin

Also available from: Amazon.co.uk | Wordery | The Hive | Waterstones | Foyles | Mail Bookshop | Amazon.com

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

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Thursday Tidbits: The Return

1800276_792912184104774_7325239257627050486_nTwo months after Tanner’s birth, I still feel like I’m “coming back” from this trip.

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And, speaking of returning, last night I went back to teaching my in-seat class. I am grateful to have a husband who accompanied me to keep the baby close on site for nursing as well as for helpful parents who rearranged their schedules/lives to take care of our other kids while we were gone.

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At class last night.

As I mentioned in a recent post, I’d mentally prepared to be “off” until January and now that it is January, I have a feeling of being sped up in an unpleasant way. So, I appreciated reading this essay and the reminder: you just had a baby.

You just had a baby.

So, let’s stop pretending like that didn’t just happen.

And let’s give you some grace and permission.

You don’t have to answer every email, every text or every invitation that comes your way. You don’t have to keep your house clean or make fancy dinners this week or plan your family vacation for the year. You don’t have to take your toddler to the dentist or figure out how to save for college right now…

You Just Had a Baby | Ashlee Gadd.

While I do keep up with a large variety of projects, ideas, communication, and relationships, there is not a single day that passes that I don’t drop a ball, forget something, let something go (intentionally or not), or let someone down. There are emails I don’t answer, calls I don’t take, and text messages I don’t respond to as well as laundry I don’t fold and piles of clutter than don’t get put away, not to mention all the blog posts I don’t write. This simply has to be okay. I’ve joked with friends and with Mark that my “word of the year” should actually be “ruthless,” meaning that I must be ruthlessly assessing of how I spend my time, ruthless about cutting out non-essentials. Every day involves a pile of choices and some of them are hard to choose between, or to not choose. I must be ruthless in my discernment—choosing wisely, choosing carefully, choosing mindfully. My real word of the year is “grow,” while at the same time the message I’ve frequently been picking up in moments of synchronicity and surprising overlap is “let go.” So, maybe I’ve actually got a trifecta of words this year!

I already wrote about the breastfeeding brain in a recent past post, but it appears that there are permanent changes to the maternal brain as well:

The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live. I always liked Walker’s description because it’s more precise than the shorthand most people use for life with a newborn: Everything changes…

The greatest brain changes occur with a mother’s first child, though it’s not clear whether a mother’s brain ever goes back to what it was like before childbirth, several neurologists told me. And yet brain changes aren’t limited to new moms…

via What Happens to a Woman’s Brain When She Becomes a Mother – The Atlantic.

And, speaking of mothers and their childbearing brains, Childbirth Connection has produced two phenomenal new resources. There is a report by Sarah Buckley on the Hormonal Physiology of Childbearing and a companion booklet for mothers that simplifies the research into a user-friendly booklet on the role of hormones in a healthy birth. Great resources for childbirth educators and doulas.

For more see: Hormonal Physiology of Childbearing | Transforming Maternity Care.

Pregnant birthing mama goddess birth art sculpture (doula, midwife, birth altar, childbirth)

 

Sacred Postpartum, Week 1: Birth Stories and Vow

Backtracking a little into week one of my current Sacred Postpartum class, for the first week’s assignments in reviewing our own birth and postpartum experiences, I set up a mini sacred space and put on some of my birth power bracelets (Mark and I started making these recently and I love them! It is like carrying a mini-mantra, birth power reminder with me every day).

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I did my vow page and then a collage of reminders to myself. I made a birth stories page and then printed out copies of each of my kids’ birth stories and stapled them to the back of one journal page per story, including one for my third baby who was born in a second trimester miscarriage (the stories are all available on my blog here. I didn’t include pictures of the actual print outs! ). Then, I did a page on the front of each birth story with pictures of each kid and significant words/lessons from their stories. I ended with a collage of myself as I prepare for my upcoming birth at the end of this month (39 weeks now, 37 when I did the assignment) and took a picture of a blank page as well as a symbol of the story yet to be written…

(click for bigger pix)

I also just have to pat myself on the back again about having enrolled in these trainings at this point in my own pregnancy. It was a stroke of genius! And, while I knew I would benefit from them, I had no idea how very deeply I would do so.

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Sacred Postpartum, Week 2: Ceremonial Bathing

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My Sacred Postpartum class began last week, though this is my first post about it. One of the assignments this week was to prepare a ceremonial bath.

Despite the deceptively simple sound of the assignment, this bath was an incredibly surprising and illuminating experience. I originally put off doing it because I had “too much to do” and then when I started getting it ready and setting up a little altar and doing the smudging, I felt both nervous and kind of apprehensive. I told my husband, “I think this is the first real bath I’ve ever really taken.” I’m not really a bath person. I took baths as a little kid and then moved on to showers and never took baths again except while postpartum with each of my kids. And, that is when I had my “breakthrough” moment. My eyes were prickling with tears and I said: “I associate taking baths with being weak and wounded.” I associate baths with cleaning blood away from myself and gingerly poking around for tears in my most vulnerable tissues. I associate baths with crying and holding my empty belly after the death-birth of my third baby in my second trimester. In fact, the last bath I remember ever taking in my current home was the one following his birth in which I sobbed my sorrow into the water and bled away the last traces of my baby’s life. (I think I probably did take a postpartum bath after the birth of my rainbow daughter the following year, but I don’t have a memory of it. The only bath I remember ever taking in this house was my post-loss, grief bath.) I associate baths with strings of blood and mucous floating away from me through the water and feeling injured, hurt, damaged and invalid. Deconstructed, taken apart. Lost. Shaking. Barely being able to lift my legs to get myself back out. Having to call for help and be dried off. Hollow. Changed forever.

For this bath, I set up an altar space, turned on my Sacred Pregnancy playlist, smudged the room and the tub. My husband brought me my October 2014 004mother’s tea (a blend I made last week with friends using the recipe intended for later in this class). I added salts from the salt bowl ceremony at my Mother Blessing. I added a little bit of my sitz bath mix. I added almond milk and honey. My husband went and picked a rose and scattered the petals in on top of me after I was in the tub. As I settled into my milk and honey bath, I felt restless at first, but then I calmed and my mind became more still. I went through my previous bath memories and I cried a little bit. I completely relaxed and sank lower into the water. I touched my body gently and honored what she has given and where she has been wounded. I rubbed my wiggling belly and talked to my baby about having a gentle, easy, smooth birth with a gradual emergence. My thoughts turned to my possible plans for water birth for this baby. I realized that my own “weak and wounded” bath memories are probably, in part, related to why I don’t feel particularly attracted to water birth (though I wasn’t really attracted before I ever had any kids either, so it isn’t all related to those past bath experiences). Can I be strong and powerful in the water, or is that just where I bleed and cry? I’ve been planning to try water during this upcoming birth because I’ve never done it before and because it might help prevent the issues with tearing that I’ve had in the past. However, I have had trouble actually picturing myself doing it. As I stilled into this peaceful, non-wounded, ceremonial bath, I could picture a safe, secure water birth better than ever before.

And, later that night we set this up in the living room…

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(glowing pumpkin head courtesy of the kids decorating for Halloween, not for Sacred Atmosphere!)

And, to finish the assignments for this week’s class, we made and enjoyed Thai sweet tea for dessert after dinner!

Sacred Pregnancy Week 4: Honoring, Sealing, & Postpartum Care

“I am the strength of all women who have ever birthed a baby and I am ready to join that tribe.”

–Anni Daulter (Sacred Pregnancy)

August 2014 055Me to my husband last night: “so, I know I might look like I’m just dancing around with flowers in my hair, but I’m really getting certified.”

<Mark wisely refrains from wide-open joke opportunity>

Yesterday, I finished the last assignments for my Sacred Pregnancy class. While I primarily took this class for personal reasons and am glad I did because I truly think it was the absolute BEST thing I could have done for myself to get ready for Tanner, to spend some time focused on my pregnancy, and to get ready for another mindful birth and postpartum experience. I have also completed all the work needed to be a Certified Sacred Pregnancy Mini-Retreat Instructor. On October 1st, I start the Sacred Postpartum training program—again with a dual purpose of personal enrichment and professional development.

I completed some of the activities out-of-order and finished the silk painting and honoring crown from week 3 in conjunction with the postpartum and “sealing” work of week 4.

I chose to use my drumstick as my stick around which to wrap my silk, since the drum is one way I express myself. Bringing the words painted on the silk into my drumming seemed like a logical companion. My silk power was bold fearlessness! Zander and Alaina also worked on small pieces of silk with me.

I’d delayed making the flower crown I thought because I’d told myself that I’ve already had several flower crowns at different ceremonies and so making another one for “no reason” felt kind of redundant. However, after I finished my second silk painting, I looked behind me and saw some wildflowers and I realized I did want to make a crown and I wanted to be with real flowers and not artificial. I’d been going to do artificial since I have some and thought then I could at least check it off the list. I don’t like fake flowers though, I like real ones. As soon as I realized that there were enough wildflowers scattered around the yard that I could make a real one, I got excited about the idea. My daughter helped me find and cut the flowers and then we put it together. And, then took some picture with my new silk and the crown together.

“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

I love the idea of a post-birth sealing ceremony SO much. This is similar to a mother blessing, but it is held postpartum to help “seal” the birth experience and welcome the baby and the mother into motherhood (or mother of however-many-children-hood). Absolutely wonderful. I also love the song Standing on the Edge from the Sacred Pregnancy CD. I identify with it so much as I prepare for my next birth as well as to welcome a new baby who I wasn’t expecting to have. As I’ve noted often in recent blog posts, I’m working very hard to wrap up a variety of projects so that I can cocoon with my new baby and give him and me the time and space I know we will need after birth. I have gotten better and better at taking care of myself postpartum, in asking for what I need, and getting very, very clear with my support people about what is most important to me.

We actually made the flax pillows for the sealing ceremony at the beginning of the week and then used them on Sunday (Alaina and I made the PPD tincture together the same day as the pillows). My husband tucked me in with the flax pillows and scarf and draped the silk painting across me as well. I lit my pregnancy candles and listened to Standing at the Edge. I spoke aloud the things I celebrate myself for–all the projects and children I have given birth to.

As I was setting up my wrap and pillows, my almost-11-year-old son had said he’d like to do it too. So, after my own sealing experience, each of my kids in turn got sealed in the scarf with the flax pillows. And, then they went and got my husband and we sealed him too! For each, I offered a blessing: “I’m glad you were born. I’m glad you are my son/daughter/husband. I love you. Thank you.” I placed my hands on different parts of their bodies as I spoke and then ended with kiss on the forehead. They all loved it and were very calm and contemplative. I think it was good for all of us and was, in its way, a “sealing” of their births and our relationship.

While I always have had a mother blessing ceremony before the baby’s birth, this time I’m going to make sure to do a postpartum sealing ceremony as well. The birth I actually sealed most consciously was the second trimester birth-death of my third son. On my due date with him, which also happened to be my birthday, I did a ceremony outside by our little labyrinth and the tree where we buried him. I spoke aloud, “I am not pregnant anymore,” and took time to hold and honor the powerful, honorable, birth and release I’d given him.

I’ve written a lot about my own postpartum thoughts, experiences, and feelings and they are grouped under the appropriate category on my blog here.

I also want to share a picture of my new mother-of-four goddess pendant! This pendant, too, has been part of my personal emotional preparation to integrate the new baby into my maternal identity. It took a long time for us to get the cast right for this sculpt and I’m so happy to have it to wear now.

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 The Sacred Pregnancy online retreat training experience was a very positive one. Lots of personal benefit as well as professional development! I’m so glad I decided to go for it!
August 2014 070Past posts in this series:

Sacred Pregnancy Week 1, Part 1: Sacred Space

Sacred Pregnancy, Week 1, Part 2: Connecting

Sacred Pregnancy Week 3, Part 1: Fears & Forgiveness

Sacred Pregnancy Week 3, Part 2: Empowerment and Self-Care