Business of Being Born: Classroom Edition

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via The Business of Being Born Classroom Edition.

It took me some time to get around to it, but I’ve finally finished exploring The Business of Being Born: Classroom Edition and its associated toolkit of educational materials! As a long-time childbirth educator and birth activist, of course I was interested in this classroom version of the (new) classic birth advocacy film, but I’m also a college professor and therefore was doubly interested—how might this resource be incorporated into one or more of my human services courses? As the BoBB companion site explains…

Childbirth is an issue most people do not engage with until they have experienced the maternal health system. The Business of Being Born: Classroom Edition reaches out to young adults BEFORE they confront their own birth decisions, both placing the issue on the radar and challenging the prevailing assumptions about birth providers and current obstetrical management trends. The goal is for the next generation of policy makers, practitioners, educators, and parents to approach birth decisions with awareness and confidence. Our strategy is to incorporate this evidence-based presentation into classrooms around the country. We envision empowering the next generation of parents to seek out systemic change and new policies supporting domestic maternity care…

via The Business of Being Born Classroom Edition.

The Classroom Edition of the film runs about 25 minutes and comes packaged with one of my all-time favorite resources for birth classes and tabling events: The Guide to a Healthy Birth from Choices in Childbirth. It also comes with two additional celebrity interviews, the short film Birth by the Numbers, and a instructor’s toolkit with classroom activities tying the themes of the film to major subjects such as Women’s Studies, Public Health, and Sociology.

My only critique of the classroom edition of the film is that the assembled quotes at the beginning of the film are put together in a choppy sort of way that makes it difficult to perceive (for the average viewer), which are the “good” (i.e. accurate) quotes and which are popular types of misinformation. There is also an odd, repetitively distracting, monotonal quality to the music that plays through much of the footage. Excerpted from the full-length film, the classroom edition still includes Ricki Lake’s homebirth in her bathtub, which was one of my top favorite moments of the original film. Content from a historical perspective as well as content involving the shadowing of a homebirth midwife and the personal stories from families choosing midwifery care were greatly reduced from the original version and the classroom edition seems to have more of an emphasis on sociocultural analysis. It is noted that 90% of women in many hospitals experience some type of labor augmentation (usually pitocin) and also that hospitals are businesses, businesses that are not really interested in having women hang around in the labor room.

One of the college courses I teach is American Social Policy. I have always been interested in birth change from a systemic (macro) level as a companion to change on the individual (micro) level, so I especially appreciated watching the Birth by the Numbers presentation included with the classroom edition of BoBB. When speaking about the idea that the increase in cesarean rate reflects maternal choice, public health professor Gene Declercq says, “this blaming of women is farcical. It is not about the mothers, it is about the way we treat care in the United States. Nobody ever wants to admit there is a difficult inherent in the system.” Well, I want to admit it and this is the kind of macrosystem-level change we talk about in my Policy course. At the companion Birth by the Numbers website, you can download a powerpoint presentation and other teaching tools, as well as watch the short film, in which public health professor Gene Declercq debunks popular myths about the causes of the United States cesarean rate increase. The film also looks at disparities in maternity mortality rates and tackles questions of systemic influences on maternal health outcomes.

So, are mothers really asking for cesareans?


Declercq also draws on writing from the classic obstetrics textbook, Williams Obstetrics, and shares this quote about one of the real reasons that cesarean rates continue to rise:
whycesareanAnd, he makes this important observation:womenhaventchanged
As Nadine Goodman says in The Business of Being Born Classroom Edition, “A woman will always remember how she was made to feel during her birth…if you don’t have the reverence and respect for birth, where do you go from here?”

Prior post about The Business of Being Born: Transformation Through Birth | Talk Birth

Disclosure: I received a complimentary digital package for review purposes.

Tuesday Tidbits: The Role of Doulas…

“So many of us are already working towards this aim – mamas (and groups) like LLL for sure, and doulas, women-centred midwives and July 2013 038doctors, and so many others…but really we need more. And there is no time or space for petty jealousies or in-fighting (and no judgments here, because it happens! I know the pain of this kind of sh*t, I’ve written a little about it before – and I may again – but it’s urgent we move beyond this if at all possible…) because we are already losing it – losing this capacity to give birth without intervention, to feed our babies from our own bodies, to experience love and connection in the fulness of which we are intended to be capable…” -Rebecca Wright (see more on why all of us are needed)

In “The Doula Phenomenon and Authentic Midwifery: Protection as a Keyword,” Michel Odent, writing in Midwifery Today issue 104, Winter 2012 describes the cultural conditioning of birth to think that women can’t do it on their own:

In this age of videos, photos and television, one cannot ignore that our current cultural conditioning is mostly determined by visual messages. Let us mention the powerful effects of the recent epidemics of videos and photos of so-called ‘natural childbirth.’ Almost always, several people surround the labouring woman. Young generations familiar with these pictures understand that the basic need of a labouring woman is to be accompanied by several persons. The effects of these visual messages are reinforced by the modern vocabulary, for example, to give birth women need a ‘coach’ (bringing her expertise) and support persons (bringing their energy). More than ever the message is that a woman has not the power to give birth by herself.

We must add that this cultural conditioning is now shared by the world of women and the world of men as well. While traditionally childbirth was ‘women’s business,’ men are now almost always present at births, a phase of history when most women cannot give birth to the baby and to the placenta without medical assistance. A whole generation of men is learning that a woman is not able to give birth. We have reached an extreme in terms of conditioning. The current dominant paradigm has its keywords: helping, guiding, controlling, managing…coaching, supporting…the focus is always on the role of persons other than two obligatory actors (i.e. mothers and baby). Inside this paradigm, we can include medical circles and natural childbirth movements as well.

Odent then goes on to explain that while the word doula comes from ancient Greek, actual modern-day Greek people advise him to use the word “paramana” instead, meaning literally, “with the mother.” He concludes his article with these important thoughts:

The doula phenomenon must be interpreted in the context of a period of transition. When the doula is understood as the mother figure a young woman can rely on before, during and after the birth, the doula phenomenon can be presented in a positive way as an aspect of the rediscovery of authentic midwifery. When, on the other hand, the doula is still another person introduced into the birthing place in addition to the midwife, the doctor and the father, her presence is counterproductive. If the focus is on the training of the doula rather than on her way of being and her personality, the doula phenomenon will be a missed opportunity. [emphasis mine]

I am concerned when I see rivalry between doula training organizations, because I think they are doing just this: focusing on the training of the doula rather than her way of being and her personality.

A long time ago I saved these two relevant, if somewhat opposing, quotes about doulas, culture, and advocacy:

First about doulas and collusion with patriarchy…

“I hate to say that the rise in popularity of doulas has done absolutely nothing to alter the status quo of hospital birth, but this seems to me to be true. In the past 10 or so years, the popularity of doulas has risen dramatically. And so has the rate of C-section and interventions in general. Am I suggesting correlation or causation? Absolutely not. Do I think that doulas are well-meaning, amazingly hard-working women who are truly passionate about women and birth and are trying to make a positive difference? Yes yes yes. But sadly, I don’t think they’re going to get anywhere. Because hospital birth is the collision of female power and patriarchy, and we aren’t going to change anything by behaving ourselves or adopting the approach of our oppressors. (No, this isn’t hyperbole. I really believe it).”

Doubts About Doulas (and patriarchy and stuff)

And, second about not bringing “politics” into the birth room…

“Now I understand there is a type of doula for everyone. Some women benefit from doulas with a more no nonsense attitude, the ones that don’t sugar coat things or come off more “militant”. Other women prefer a lighter touch or a more “middle of the road” doula. I respect the differences and the need for them. However, I believe there should be a separation of doula and advocate. Politics, in particular your own personal politics, have no business at the birth of your client. Once a client is in labor, any personal agendas should be checked at the door. There is a more appropriate time and venue to try and change faulty birth practices.

I think the same thing goes for the myth that we empower women through these actions at her birth. A woman’s power to advocate for herself and birth in the way she wants isn’t ours to give. It’s her birth and it has to be her job to find the power and be empowered. We can help, we can guide, we can even lead, but we can give that to anyone. Sadly though, through our actions, just like the hospital staff, we can take it away…”

Doulas and Advocacy: Are they mutually exclusive?

July 2013 036And, then, some more thoughts about the difference between activism and advocacy:

Activism, advocacy and support. As a birthworker I am always using one of these three tools. Sometimes I am using two at once, but never all three. And here is why: Support and advocacy can overlap. Advocacy and activism can overlap. But if you try to overlap activism and support you are going to be either ineffective, alienating, or both…

Activism, Advocacy and Support – To Brave Birth

We definitely need advocacy though and this is why:

Horrific abuse in childbirth happens every day in developing nations where women and their babies are often denied access to life-saving obstetric care.

Freedom for Birth – Can Anyone Argue Against Respecting Women’s Rights in Childbirth?

And, regardless of where or with whom or in which country women give birth, they deserve access to evidence-based care: What is Evidence Based Birth and Why Should I Care? — Giving Birth with Confidence

Birth is also a creative process:

“I believe that this is one of the important things about preparation for childbirth–that it should not simply superimpose a series of techniques, conditioned responses to stimuli, on the labouring woman, but that it can be a truly creative act in which she spontaneously expresses herself and the sort of person she is. Education for birth consists not, as some would have it, of ‘conditioning,’ but aims at giving a woman the means by which she can express her own personality creatively in childbirth.” –Sheila Kitzinger via More Thoughts on Birth as a Creative Process | Talk Birth.

And, birth matters a lot. It isn’t “just one day.”

“Homebirth cesarean mothers do not complete their births the way they planned, worked for, meditated on, and dreamed of. As a result, their births as mothers are left unfinished. As I told my therapist when my son was six months old, “His birth was finished but my birth, into being a mother, that’s been left hanging.” –via Homebirth Cesarean: “I was still an authentic mother.” – Momma Trauma.

In non-specifically-doula, but birth-related news, I finished some new sculptures and updated my etsy shop! And, one of my breastfeeding mama sculptures was featured in a neat Etsy treasury called Supporting Breastfeeding.

Yesterday, I finished downloading the The Business of Being Born classroom edition kit, which I’ll be reviewing here and hopefully using in my community development class in August. And, I’m also looking forward to finally watching/reviewing Birth Story: Ina May Gaskin and The Farm Midwives on Thursday with my Rolla Birth Network friends! Speaking of Rolla Birth Network, plans are underway for the second annual footprintscharmMamafest event in Rolla, MO on August 10th. This is a pretty epic event given our smallish town and associated resources. It really was great last year and I expect nothing less this year! I went a little crazy online and bought all kinds of supplies so we can make our own bindis at my booth at Mamafest. I also bought a lot of new charms for several purposes and I’m going to donate my favorite footprints-on-my-heart charms   to the Rainbow babyloss support group to make miscarriage memorial charms at their Mamafest booth.

And, finally, as I shared on Facebook earlier this week: I love it when my two-year-old points at my belly casts on the wall and says, GODDESS! And, I’m like, yes, yes that’s me… 😉

Birth Matters!

“A well taken care of and rested mama almost always translates into a well taken care of and rested baby. Respecting mothers is an act of social change.” —Mother Health International

“The way a society views a pregnant and birthing woman, reflects how that society views women as a whole. If women are considered weak in their most powerful moments, what does that mean?” –Marcie Macari (She Births)

“…it is not easy for women to lay claim to our life-giving power. How are we to reclaim that which has been declared fearful, polluting and yet unimportant? How are women to name as sacred the actual physical birth, which comes with no sacred ritual…?” –Elizabeth Dodson Gray

Birth matters. It truly does. The impact is often ignored or minimized, but giving birth remains one of life’s most profound, pivotal, liminal, and initiatory events. Bizarrely, this is overlooked by much of modern culture. We spent many thousands of dollars on weddings each year as well as months of planning and preparation for “just one day,” and yet in pregnancy and birth are willing to let insurance companies dictate access to care providers and let care providers dictate access to evidence-based care. Some time ago I expanded the wedding analogy into a satirical look at why birth matters:

You stop sharing your feelings, but you can’t shake the memories. What you expected to be a beautiful day filled with love and celebration was not and you feel a real sense of grief at the loss of your dreams. You know you shouldn’t feel this way. You know that what really matters is your healthy, happy husband, but you keep wondering if your wedding really had to be that way. Yes, you love your husband and you are so happy that he is healthy, but you also wonder if that really is all that matters. Don’t you matter too? Doesn’t your relationship matter? What about respect, dignity, love, and self-worth? Don’t those matter too? Wasn’t this a special life transition for your family? Wasn’t it the beginning of a special relationship together and couldn’t that relationship have been celebrated, honored, and treated as worthy of care and respect?

via All That Matters is a Healthy Husband (or: why giving birth matters)

And, in a different post I made a list of why I care about birth, concluding with the following:

Because I know in my heart that birth matters for women, for babies, for families, for culture, for society, and for the world.

via Why Do I Care About Birth?

So, I particularly loved this quote from Ani DiFranco and I had to turn it into a picture! 🙂


Women of Color Can Push for Better Outcomes: What Every Mother-to-Be Should Know About Birth

Guest post by Tara Owens-ShulerImage

As an African American Lamaze Certified Childbirth Educator, I have observed over my 18 years of teaching that childbirth education class participants are less likely to be women of color. My desire for more women of color to attend childbirth education classes is rooted deeper than just their presence in a classroom – it is rooted in my desire for more women of color to understand the disparities that exist in maternal and birth outcomes.

In a recent Science and Sensibility blog post by Christine Morton on maternal health disparities, she reviewed the work of several well-known public health researchers – Dr. Eugene Declercq, Dr. Mary Barger and Dr. Judith Weiss. Their findings point to the fact that African American women have higher rates of cesarean births at nearly every age group and across every level of education.

In addition, the U.S. Department of Health and Human Services reports that one of every five non-Hispanic,black births are pre-term, African American mothers experience an infant mortality rate twice that of non-Hispanic, white mothers, and breastfeeding rates among African American mothers are 16 percent lower than white mothers.

Given the disparities that exist in maternal and birth outcomes for women of color, I think April as Minority Health Awareness Month is a great opportunity to talk about a few other factors that minority moms or mothers-to-be can control or influence. It’s a hard reality that mothers face real challenges in getting the childbirth care they want and deserve. Even though medical evidence may tell us certain practices are good for mothers and babies, the “system” is not always geared to deliver that care. Health care providers are rushed, spread thin, or incentivized for practices that are not most beneficial to the mother.

Let’s go back to the fact that African American women have higher rates of cesarean births than non-Hispanic,white women. Is it because African American women are sicker and need to have a cesarean birth? Researchers report that this is untrue. They conclude that higher rates of cesarean births among African American women are a result of a shift in obstetric practices to focus more heavily on use of childbirth interventions. And, when we bring in an induction to the equation, there is a correlation between the increased rates of induction to the increased rates of cesarean births!

Research shows that babies pay a steep price for these early births caused by inductions or a failed induction, which led to a cesarean. Babies have greater difficulties breathing, breastfeeding, and maintaining their temperature, which usually means being separated from moms and spending time in the Intensive Care Unit. While an increasing number of hospitals and health care professionals are shying away from unnecessary cesarean birth and induction, it’s one of many care practices that just aren’t supported by good medical evidence.

So how can women of color push for better care?

  • Become an active partner with your care provider. While doctors or midwives have professional knowledge and skills, they may not know everything about your personal background and preferences. Finding a provider who will also act as your partner can help you push for the care that’s best for you and your baby.
  • Ask questions – lots of them! Labor and birth in particular can be unpredictable. That’s why it’s a smart idea to prepare a list of rolling questions throughout your pregnancy to help you determine if the right care is being recommended during labor, birth and after birth.
  • Do your research. Understand your available care options before, during and after labor at the hospital or birth center. If you know that during labor you’d like the ability to walk around, eat and drink – choose a birth facility that will be more aligned with your birth preferences or wishes.
  • Participate in a childbirth education class. Taking a Lamaze class will help you understand maternity care best practices and be better prepared to navigate your labor and birth. A childbirth educator will help you identify the right questions to ask when making decisions about your care.

I encourage all women – particularly African American women – to learn more about getting the right care in pregnancy and childbirth by attending a childbirth education class. Skipping out on childbirth education is a lost opportunity to stack the deck in your favor and become a well-informed consumer of evidence-based practices! As a consumer, it is your right to be a partner in your health care decisions.

Tara Owens Shuler, MEd, LCCE, FACCE is the president of Lamaze International. She has practiced as a childbirth educator since 1995. In 2005, she became the Director of the Duke AHEC Lamaze Childbirth Educator Program. In addition to training individuals to become childbirth educators and preparing expectant women and their partners for a safe and healthy birth experience, Tara provides labor support services. Along with coordinating the Lamaze program in the Duke AHEC office, Tara works with her statewide AHEC partners in developing continuing education programs and/or resources for healthcare providers in North Carolina and assists with the Duke AHEC PATHWAYS Health Careers program for K-12 students. When not working, Tara and her husband enjoy playing with their dog, Gramps, and traveling.

Visit Lamaze International for great resources to help mothers and mothers-to-be learn their options.

Birth Activism Opportunities!

Recently I got an email letting me know that I’ve been nominated for the Health Activist Hero Award in this year’s WEGO Health Activist Awards! Nominations are open through December 31st, 2012, after which judging will begin. You can “endorse” my nomination by clicking on the badge. You can also follow the happenings on WEGO’s Pinterest board. You can also nominate someone!  There are 16 award categories and there’s no limit to the number of people you can nominate with this quick form.

Second, Freedom for Birth just released a free 15 minute version of their documentary online. Check it out!

As dear as breathing…


“If women lose the right to say where and how they birth their children, then they will have lost something that is as dear to life as breathing.” –Ami McKay

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” – Jennifer Rosenberg

Birth politics have been on my mind this week as I’ve come across various debates from within the birth profession about the regulation of midwives and the question of licensure, and then also the seemingly ever-present critiques of homebirth from outside the homebirth community. I don’t feel as if I have time lately to fully follow all the issues, but Citizens for Midwifery’s recent response to ACOG’s newest homebirth and maternal rights smackdown contains some important thoughts:

AJOG editorial rejects the ethic that autonomy is a fundamental human right

This article represents a serious attack on home birth and on patient centered care in the United States. The attack is based on poor research and runs roughshod over established rights to bodily integrity…

…not only does the article attack home birth, it also represents an attempt to “export” to the rest of the world a position that the obstetric profession, not mothers, should have the final decision on birth, at a time when that isn’t even legally defensible here in the United States…

…One contradiction stands out as the authors call for “safe, respectful, and compassionate” hospital delivery. No hospital birth can be truly respectful if the birth is happening in the hospital because the physician disrespects the woman’s right to an alternative and has rigged the system to eliminate access to all legal alternatives…

via Citizens for Midwifery

Related thoughts:

Maternal-Fetal Conflict?

The Illusion of Choice

“Woman-to-woman help through the rites of passage that are important in every birth has significance not only for the individuals directly involved, but for the whole community. The task in which the women are engaged is political. It forms the warp and weft of society.” –Sheila Kitzinger

Continuing Birth Education (Free Webinar Round Up)

I have a good friend who has become very interested in training as a doula. I love sharing information and resources with excited women new to the birth work field! It is rejuvenating and reminds me my own enthusiasm for women and birth. When I shared this same sentiment on Facebook a fan commented with this lovely observation: “Birth is an ever-evolving subject, and there are as many different ways to do it as there are fingerprints!! How could anyone get bored in the birth work field?? I love it!! It keeps me in the Presence of Now and reminds me of the Sacredness of Life…” 🙂

Anyway, I’ve been collecting books like crazy to lend to my friend (just a word: never ask me for a book about anything unless you are ready to be overwhelmed with options!) and doing so reminded me of some free webinars that have crossed my desk(top) recently as well as some other, older continuing education resources for birth professionals or aspiring birth professionals. I always go to books first and to written information. Love it. Can’t get enough words! But…many people learn better through other mediums. Here are some non-book, free possibilities for self-education in birth work:

Edited to add another free webinar from ICEA (with paid contact hour option) that I just learned about:

Prenatal Fitness Webinar
 Join us online 
 Thursday, December 13, from 9-10 pm EST for this new educational offering
worth 1.0 ICEA Continuing Education Credit!!
This offering is free for all participants to audit.
The continuing education credit may be purchased after viewing the webinar for $35.00 by clicking here!
Once the credit hour is purchased, print out your receipt for confirmation of your hour earned!

A reader also commented to share that she is enrolled in a free Coursera course on contraception (she also took one that looks great about community change in public health!). There are a variety of interesting looking courses available from well-known institutions in the Coursera offerings under Health & Society and Medical Ethics.

And, for those who do well with auditory learning, I have some podcast recommendations that are available on an ongoing basis:

La Leche League International offers a series of free podcasts, my favorites being:

And, the Motherlove blog has some awesome resources too, including:

And, finally there are some great free classes and certificate programs available from Global Health eLearning Center. Many are designed for global audiences and are not specifically geared toward doulas (or even midwives, but more of health workers in general). I particularly enjoyed this class: Healthy Timing and Spacing of Pregnancy

Enjoy! And, if you have favorite recommendations to add, please let me know! (free, please)

Due to reader request, a book recommendation post will soon follow! Past book recommendations can be seen in this post, as well as a postpartum list, and also in my book reviews section.

Bits of the (Birth) Net

The following is a collection of the bits and pieces that caught my attention and then were shared via my Talk Birth Facebook page during the last two weeks.


From a good article by the National Association of Mothers’ Centers in Mother Support: When Words Get in the Way

Words, whether written or voiced, are so very fragile. They can be bent or twisted, even become unrecognizable from their initial intentions. They can have different cultural meanings, regional understandings, and generational perceptions.

There will always be the opportunity for miscommunication…

Such a good reminder. What you say and what people hear are often two different things. What you say and what you mean can be different. How your words are received and interpreted can be very important and intent in many ways doesn’t matter! Communication is transactional process. A two-way process. And, it is symbolic. Meaning can never be fully interpreted and understood completely.

This article also reminded me of one of my own older articles, Listening Well Enough, which came to mind because I’m finishing up with the training of two women. The essay describes my own experience when I was training as a breastfeeding counselor in 2005.


The topic of what to risk sharing online came up with friends recently and I enjoyed this article about answering the question of How Much Of Your Private Life Should You Keep Private On Your Blog?

Childbirth Education

Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant…

The above is one of the concluding points from an interesting article from Birth Works International about supporting women without epidurals.

Good article from Lamaze about your breath and how it can help during pregnancy and birthing!

Virtual labor simulator!

Pushing Positions

Very interesting article on What is the Evidence for Pushing Positions?  Apparently there is more blood loss and second degree tears with upright pushing positions. Personally, I CANNOT imagine giving birth in a supine position. But, I’m also really, really, tired of tearing (tired enough that it is one of the factors in our decision not to have “just one more!” baby). For more thoughts about pushing, see previous post on Following Your Body’s Urges to Push…

And speaking of upright birth, Barbie homebirth photos! 🙂

Informed Consent

Valuable article addressing 10 Responses to Pressure to Consent (remember, it isn’t “informed consent” if you do not have the option of saying NO!)

Posts I’ve written about informed consent:

Prenatal Yoga

Online video prenatal yoga class: Prenatal Yoga – when you feel good, your baby feels good.

And my own prior posts on the subject:

Birthing Room Yoga Handout

Birth, this elegant, simple, yet intricate process has had unnecessary, complex, expensive technology superimposed onto it, creating a dangerous environment for birthing women.” -Alice Bailes

Loved this article on what really matters for midwives!


NEW STUDY: Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes. “As parents, we have to understand better that our responsibilities to our children are not only of a social, economical, or educational nature, but that our own biological status can contribute to the fate of our children, and this effect can be long-lasting,” said Mihai Niculescu, M.D., Ph.D., study author from Nutrition Research Institute at the University of North Carolina at Chapel Hill, in Chapel Hill, N.C.–Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes

After CAPPA this year, I wrote about epigenetics here: Epigentics, Breastfeeding + Diet, and Prenatal Stress

Call the Midwife

Fun! Ms. Magazine linked to one of my blog posts about midwifery in their post about the PBS show Call the Midwife!  And, after posting to the CfM Facebook page about how I didn’t get to watch the show myself because I have no TV channels, CfM fan Jackie clued me in that Call the Midwife is available online (no TV channels required!) Yay! 🙂

Older Posts of My Own

Birth Culture: “Birth is cultural, the way eating is cultural. We don’t just eat what our bodies need to sustain us. If we only did that, there would be no reason for birthday cake. Birthday cake is part of our food culture. The place you are giving birth in has a local culture as well. It also partakes of our national birth culture. Not everything doctors do regarding birth makes the birth faster or physically easier for you or the baby. Some things are just cultural.” -–Jan Mallack & Teresa Bailey

Creating Needle Felted Birth Art Sculptures: My first foray into birth art, before I fell in love with using polymer clay!

Centering for Birth: “Centering is a breath awareness strategy that I’ve adapted for use in birth classes based on the ten second centering process described in the short book Ten Zen Seconds…” Free handout available about centering for birth! (I was reminded of this post by Enjoy Birth!

Breastfeeding as an Ecofeminist Issue:“What happens when society and culture pollute the maternal nest? Is that mother and baby’s problem or is it a political and cultural issue that should be of top priority? Unfortunately, many politicians continue to focus on reproductive control of women, rather than on human and planetary health…”

During a week when I didn’t have time to craft delightful new blog posts, it was fun to have a post from a couple of months ago suddenly getting all kinds of hits and Facebook shares. Thanks, internet! ;-D (Around 150 shares on Facebook apparently. I ♥ Facebook!)

On Parenting Books

Mama Birth: Sadly, Parenting Books CAN’T Actually Raise Your Child: Enjoyed this post! (But I recommend NOT reading the comments on the original article she links to about “detachment parenting.” I lost about 30 minutes of my life, felt my blood pressure rising, and only made it to page three!)

The revolution must have dancing; women know this.
The music will light our hearts with fire,
the stories will bathe our dreams in honey
and fill our bellies
with stars.
-Nina Simons via Rebecca A Wright, Doula

Becoming an Informed Birth Consumer (updated edition)


“Birth is life’s central mystery. No one can predict how a birth may manifest…Our dominant culture is anything but ‘natural’ so it is no surprise that childbirth, even with the most natural lifestyle lived by an individual family, sometimes needs intervention and medical assistance. This is not to say that any one mother’s efforts to have a natural childbirth are futile. Just that birth is bigger than one’s personal desires.” –Jeannine Parvati Baker (in The Goddess Celebrates: An Anthology of Women’s Rituals, p. 215)

It’s Labor Day and it is also the start of Empowered Birth Awareness Week! A blog carnival is in full swing at The Guggie Daily and I’ve been having some thoughts about birth as a consumer issue. Very often, it appears to me that responsibility for birth outcomes is placed on the mother—if only she’d “gotten educated” she would have made “better choices.” Many people have a tendency or overlook or minimize the impact of the context in which she makes her choices. In that way, I appreciate Baker’s observation about that birth is bigger than one’s personal desires. That doesn’t mean that we can’t take vital steps to alter the larger culture of birth in which we make our choices, however, and one of those ways is to remember to think about birth as a consumer issue.

Though it may not often seem so, birth is a consumer issue. When speaking about their experiences with labor and birth, it is very common to hear women say, “they won’t let you do that here” (such as regarding active birth–moving during labor). They seem to have forgotten that they are customers receiving a service, hiring a service provider not a “boss.” If you went to a grocery store and were told at the entrance that you couldn’t bring your list in with you, that the expert shopping professional would choose your items for you, would you continue to shop in that store? No! If you hired a plumber to fix your toilet and he refused and said he was just going to work on your shower instead, would you pay him, or hire him to work for you again? No! In birth as in the rest of life, YOU are the expert on your own life. In this case, the expert on your body, your labor, your birth, and your baby. The rest are “paid consultants,” not experts whose opinions, ideas, and preferences override your own.

There are several helpful ways to become an informed birth consumer:

  • Read great books such as Henci Goer and Amy Romano’s new book Optimal Care in Childbirth or Pushed by Jennifer Block.
  • Hire an Independent Childbirth Educator (someone who works independently and is hired by you, not by a hospital). Some organizations that certify childbirth educators are Childbirth and Postpartum Professionals Association (CAPPA), BirthWorks, Birthing From Within, Lamaze, and Childbirth International. Regardless of the certifying organization, it is important to take classes from an independent educator who does not teach in a hospital. (I’m sure there are lots of great educators who work in hospitals, but in order to make sure you are not getting a “co-opted” class that is based on “hospital obedience training” rather than informed choice, an independent educator is a good bet.)
  • Consider hiring a doula—a doula is an experienced non-medical labor support provider who offers her continuous emotional and physical presence during your labor and birth. Organizations that train doulas include CAPPA, DONA, and Birth Arts.
  • Join birth organizations specifically for consumers such as Citizens for Midwifery or Birth Network National or International Cesarean Awareness Network.
  • Check to see if you have a local birth network in your own community or even start your own (I recently co-founded one in my town!)
  • Talk to other women in your community. Ask them what they liked about their births and about their care providers. Ask them what they wish had been different. Pay attention to their experiences and how they feel about their births. If they are dissatisfied, scarred, unhappy, and disappointed, don’t do what they did.
  • Ask your provider questions. Ask lots of questions. Make sure your philosophies align. If it isn’t a match, switch care providers. This is not the time for misplaced loyalty. Your baby will only be born once, don’t dismiss concerns your may have over the care you receive or decide that you can make different choices “next time.”
  • Find a care provider that supports Lamaze’s Six Healthy Birth Practices and is willing to speak with you seriously about them:
  1. Let labor begin on its own
  2. Walk, move around and change positions throughout labor
  3. Bring a loved one, friend or doula for continuous support
  4. Avoid interventions that are not medically necessary
  5. Avoid giving birth on your back and follow your body’s urges to push
  6. Keep mother and baby together – It’s best for mother, baby and breastfeeding

These care practices are evidence-based and form an excellent backbone for a solid, mother and baby friendly birth plan.

Why “evidence-based care” though?

Because maternity care that is based on research and evidence for best practice is not just a nice idea or a bonus. It isn’t just about having a “good birth.” Evidence-based care is what mothers and babies deserve and what all birthing mothers should be able to expect! Here is a great summary of pregnancy and birthing practices that the evidence backs up:

20120903-142510.jpgRemember that birth is YOURS—it is not the exclusive territory of the doctor, the hospital, the nurse, the midwife, the doula, or the childbirth educator. These people are all paid consultants—hired by you to help you (and what helps you, helps your baby!).

“As long as birth- metaphorically or literally-remains an experience of passively handing over our minds and our bodies to male authority and technology, other kinds of social change can only minimally change our relationship to ourselves, to power, and to the world outside our bodies” – Adrienne Rich (Of Woman Born p185)

Related posts:

Birth class handouts

Can I really expect to have a great birth? (updated edition)

What to Expect When You Go to the Hospital for a Natural Birth

Active Birth in the Hospital

The Illusion of Choice

Musings on Story, Experience, & Choice

This post is updated from a previous edition.

Birth Customs

“Pay attention to the pregnant woman! There is no one as important as she!”

(Chagga saying, Uganda)

The book Mamatoto is a look at birth in a variety of cultures (including the US) that was published by The Body Shop in 1991. Even though it is “old” it isn’t really dated since it is a brief overview of different customs and rituals and so forth and not a lot of statistics. There are a lot of absolutely fabulous (and fascinating) pictures and illustrations and these are the highlight of the book. Each chapter is followed by a “black page” of “facts you don’t want to know” about such things are reproductive health care policies in Romania and things like that.

One of the things that struck me about this book was that there is little distinction made between the customs of other cultures and the customs of the US. For example:

“People in Tibet believe that whether or not labour is due, a child won’t come out into the world unless the star under which it’s destined to be born is shining. Western medicine has developed a way of starting labour artificially, by injecting into a woman’s blood a simulation of the hormone oxytocin, which triggers contractions. For several years during this century, an unusual number of women laboured between the convenient hours of nine and five on weekdays…As the Malaysians say, a baby is like a fruit; it will be born when it’s ripe.”

I absolutely love seeing Western culture put into the proper context like this. Too often we see our way as THE way and forget that much of what the dominant culture views as normal for birth is not necessarily truly normal, but is instead an artifact of, or custom of, our culture. Viewed from a distance, the routines of birth in America are just interesting customs—in Tibet, born when the proper star is out, in the US, born when artificial hormones are injected…

(Since first reading this, I use the baby is like a fruit quote regularly.)

I may not be explaining myself clearly, but I find this distance in perspective refreshing and interesting. It reminds me of the work of anthropologist Robbie Davis Floyd whose book Birth as an American Rite of Passage explores the “ritual” elements of hospital birth in America and compares and contrasts the “technocratic” model of care with a holistic, woman-centered model of care (an example of which would be the midwives model of care). She asserts that there are many elements of hospital births that serve as rituals to reinforce the technocratic model (rather than to serve actual purposes, but instead to send cultural messages as well as to initiate the baby into the technocratic model). Examples of ritual elements include putting on a hospital gown, riding in a wheelchair, and having a routine IV. These elements serve to enculturate the woman and baby into a particular model–a ritual function–rather than an individually appropriate method of care.

Another example from Mamatoto that I enjoyed is as follows:

“‘Home birth’ can mean different things to different people. It can mean a bedroom, dimly lit and scented with myrr; a sweatbath perched on a Guatemalan hillside, or a birthing pool in an English flat; a warm fireside in a Himalayan kitchen; the packed-snow sleeping platform of an Inuit igloos; or a one-room shack in Jamaica, with a washing line dividing the family bed and the children waiting on the other side for a first glance at the baby who will be held up for them to see. When a woman gives birth at home, she and her family have a degree of control over the event; it’s their domain.”

In short, at home the family is in their own personal culture rather than having to adapt to the customs, culture, and “ritual elements” of an out-of-home environment.

When I think about American birth customs and culture, the first thing that comes to mind is this potent illustration from Mothering Magazine’s powerful article Cesarean Birth in a Culture of Fear, which was then published in booklet form by Childbirth Connection:

20120813-083208.jpgIn this image we see a woman immersed in the hospital birth culture found in many hospitals in the US.* She is hooked up to a potential of 16 different attachments. When I see this image, I instantly see why women might not want to “be martyrs” and thus go ahead and have any medications offered to them. It can be very difficult to stand in her personal power and embrace her own body’s rhythms and rituals when she is literally strapped down in this manner. I also think of this quote:

“Since beliefs affect physiologic functions, how women and men discuss the process of pregnancy and birth can have a negative or positive effect on the women that are involved in the discussion. Our words are powerful and either reinforce or undermine the power of women and their bodies.”–Debra Bingham

*Note: I am fully aware that this may not be what birth looked like in your hospital, but I’m speaking generically about many hospitals in the nation.

Modified from a post originally posted at Citizens for Midwifery

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