Birth Quotes of the Month

Nov26

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Birth and the Women’s Health Agenda

Nov13

Ready to be on the agenda, dangit!

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

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

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

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

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

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

The Beauty of a Nursing Mother

Nov13

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

—The Wisdom of the Body

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

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

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

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

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

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

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

Guest Post: More Business of Being Born Mini-Review

Nov9

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

More Business of Being Born

Down on the Farm: Conversations with Legendary Midwife Ina May

Reviewed by Summer Thorp-Lancaster

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

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

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

Birth Fear

Nov1

“…if you want to know where a woman’s true power lies, look to those primal experiences we’ve been taught to fear…the very same experiences the culture has taught us to distance ourselves from as much as possible, often by medicalizing them so that we are barely conscious of them anymore. Labor and birth rank right up there as experiences that put women in touch with their feminine power…” -Christiane Northrup

Since it was just Halloween, I wanted to re-post some things about fear and birth that I shared on another blog a couple of years ago. I encounter a lot of women who are very scared of birth, particularly of the pain of birth. Grantly Dick-Read’s Fear-Tension-Pain cycle has influenced the teachings of most natural birth educators and most people readily connect to the idea that fear leads to elevated tension in body which leads to increased pain (more about fear-tension-pain in a linked post below).

One of my favorite birth books, Birthing from Within, has several sections about coping with fear. The author’s idea is that by naming fears and looking them in the eye rather than denying they exist, you shift your thinking from frozen, fear-based, thoughts to more fluid, adaptable coping-mechanisms. There is a useful handout based on her ideas available at the Transition to Parenthood site.

I also think of this quote from Jennifer Block:

Why is it that the very things that cause birth related morbidity rates to rise are seen as the ‘safe’ way to go? Why aren’t women and their doctors terrified of the chemicals that are dripped into their spines and veins—the same substances that have been shown to lead to more c-sections? Why aren’t they worried about the harm these drugs might be doing to the future health of their children, as some studies are indicating might be the case? Why aren’t they afraid of picking up drug-resistant staphylococcus infections in the hospital? And why, of all things, aren’t women terrified of being cut open?

I actually was afraid of these things, which is part of why I didn’t go to a hospital to have my babies!

I hope some day all women will be able to greet birth with confidence and joy, instead of fear and anxiety. This does NOT mean denying the possibility of interventions or that cesareans can save lives. And, it also doesn’t mean just encouraging women to “trust birth.” Indeed, I read a relevant quote in the textbook Childbirth Education: Research, Practice, & Theory: “…if women trust their ability to give birth, cesarean birth is not viewed as a failure but as a sophisticated intervention in response to their bodies’ protection of the baby.”

Here are some more good quotes from Childbirth without Fear:

A well–prepared woman, not ignorant of the processes of birth, is still subject to all the common interventions of the hospital environment, much of which places her under unnecessary stress and disrupts the neuromuscular harmony of her labor.

–

It is for this reason that thousands of women across the country are staying home to give birth…Women are choosing midwives as attendants, and choosing birth centers and birthing rooms, in order to regain the peaceful freedom to ‘flow with’ their own labors without the stress of disruption and intervention. Pictures on the wall and drapes on the window do not mask the fact that a woman is less free to be completely herself in the hospital environment, even in a birthing room. The possibility of her being disturbed is still there.

–

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

–

When a woman in labor knows that she will not be disturbed, that her questions will be answered honestly and every consideration given her, then she will be better able to relax and give birth with her body’s neuromuscular perfection intact. The presence of her loving husband and/or a supportive attendant will add to her feelings of security and peace, so she can center upon the task at hand.

Childbirth without Fear was originally written in the 1940′s. The quotes above are just as relevant and true today.

Fathers, Fear, and Birth
Fear-Tension-Pain or Excitement-Power-Progress?
Cesarean Birth in a Culture of Fear Handout
Worry is the Work of Pregnancy

Milk, Money, & Madness

Sep7

In early August, I received a press email from Evenflo about their “in-law feeding frenzy” video. While I recognized they were attempting to be playful and funny, I chose not to share the video with my readers because I found several elements of it problematic. Rather than recognize the opportunity to create an internet stir over the video, I just wrote back to the company and told them, “I try not to encourage the notion of other people having a chance to feed the baby, so I do not plan to use the video myself—I would have been more pleased with it if somehow mom stood her ground and helped in-laws see that there are other ways to be involved with the baby other than by feeding it expressed milk. I don’t promote the idea that mothers need to pump, ‘just because.’” Considering what a controversy has now boiled up this week over Evenflo’s “funny” breastfeeding video, I confess I sort of feel like I missed my opportunity for a major wave of blog traffic by exposing the ad and expositing on the problems therein when I received it in August! 😉 However, when considering the controversy, I thought of some wonderful quotes I’d saved to share from the book Milk, Money, & Madness and so I’m sharing them instead.

Dia Michels is one of the co-authors of Milk, Money, and Madness and I’ve actually heard her speak twice—once in 2003 when I was pregnant with L and then in 2007 at the LLL of MO conference. I’m surprised at how thoroughly riveting a book about the “culture and politics of breastfeeding” can be and I highly recommend it to breastfeeding and women’s health activists.

In perfect response to the Evenflo video, we have this quote:

“Babies need holding, stroking, dressing, bathing, comforting, burping, and, within a short time, feeding solids. Dad can do every one of these. The desire to participate should not be confused with the need to give the baby the best of what each partner has to offer.”

I hear from people SO often that they want Daddy to be able to participate in baby care by giving the baby a bottle. There are LOTS of things that fathers can do for their babies, other than feeding—bathing, snuggling skin-to-skin, diaper changes, playing, babywearing, and just plain walking around holding the baby while mom takes care of her own needs.

And, here is an excellent quote with regard to public breastfeeding/breasts as sexual objects:

“When the attitude is taken that a woman’s breasts belong to her and no job is more important than caring for one’s young, the confusion between breastfeeding and obscenity goes away.”

And, then considering the argument that bottle feeding “liberates” women from the tyranny/restrictiveness of breastfeeding:

The liberation women need is to breastfeed free of social, medical, and employer constraints. Instead, they have been presented with the notion that liberation comes with being able to abandon breastfeeding without guilt. This ‘liberation,’ though, is an illusion representing a distorted view of what breastfeeding is, what breastfeeding does, and what both mothers and babies need after birth. [emphasis mine]

I’ve noted before that I am a systems thinker and I think this way about breastfeeding as well as many other experiences—breastfeeding occurs in a context, a context that involves a variety of “circles of support” or lack thereof. Women don’t “fail” at breastfeeding because of personal flaws, society fails breastfeeding women and their babies every day through things like minimal maternity leave, no pumping rooms in workplaces, formula advertising and “gifts” in hospitals, formula company sponsorship of research and materials for doctors, the sexualization of breasts and objectification of women’s bodies, and so on and so forth. According to the book, “…infant formula sales comprise up to 50% of the total profits of Abbott Labs, an enormous pharmaceutical concern.” And the U.S. government is the largest buyer of formula, providing it for something like 37% of babies. (I should have written that quote down too!)

I have a special interest in how women are treated postpartum and Milk, Money, and Madness has some gems to share about postpartum care as well:

An entirely different situation exists in societies where technology is emphasized. The birth process is seen from a clinical viewpoint, with obstetricians emphasizing technology. A battery of defensive practices are employed, some of which are totally irrelevant to the health of either mother or infant. Skilled technicians spend their time and the family’s money on identifying the baby’s gender and performing various stress tests. All the focus is geared toward the actual birth. After the birth, mother and baby become medically separated. The infant is relegated to the care of the pediatrician, the uterus to the obstetrician, the breast abscess to the surgeon. While the various anatomical parts are given the required care, the person who is the new mother is often left to fend for herself…All the tender loving care goes flows to the infant; the mother becomes an unpaid nursemaid. [emphasis mine]

When I do breastfeeding help with mothers, I always make sure I address the whole woman and do not focus only on the mechanics of breastfeeding. Recently a mother told me, “I don’t know if it was your breastfeeding advice or just the encouragement that helped most, probably both.” Women need both—“technical assistance” and emotional support. Sometimes, all they need is the emotional support and they can figure out the rest with some undisturbed time with their babies. The pendulum in breastfeeding support is shifting from active, “education” based strategies, to the recognition that often the best we can do for mothers is give them time to get to know their babies. Rather than offering positioning “advice” and “breastfeeding management suggestions,” we need to give her space, stand aside, and offer encouragement as she discovers her baby and the biological dance they are hardwired to engage in. The Milk quote continues with:

This may appear to be a harsh evaluation, but it is realistic. In western society, the baby gets attention while the mother is given lectures. Pregnancy is considered an illness; once the ‘illness’ is over, interest in her wanes. Mothers in ‘civilized’ countries often have no or very little help with a new baby. Women tend to be home alone to fend for themselves and the children. They are typically isolated socially and expected to complete their usual chores, including keeping the house clean and doing the cooking and shopping, while being the sole person to care for the infant… (emphasis mine)

According to the U.S. rules and regulations governing the federal worker, the pregnancy and postdelivery period is referred to as ‘the period of incapacitation.’ This reflects the reality of the a situation that should be called ‘the period of joy.’ Historically, mothering was a group process shared by the available adults. This provided not only needed relief but also readily available advice and experience. Of the ‘traditional’ and ‘modern’ child-rearing situations, it is the modern isolated western mom who is much more likely to find herself experiencing lactation failure.

I think these quotes are important because I think there is a tendency for women to look inward and blame themselves for “failing” at breastfeeding. There is also an unfortunate tendency for other mothers to also blame the mother for “failing”—she was “too lazy” or “just made an excuse,” etc. We live in a bottle feeding culture; the cards are stacked against breastfeeding from many angles–economically, socially, medically. When I hear women discussing why they couldn’t breastfeed, I don’t hear “excuses,” I hear “broken systems of support” (whether it be the epidural in the hospital that caused fluid retention and the accompanying flat nipples, the employer who won’t provide a pumping location, the husband who doesn’t want to share “his breasts,” the mother-in-law who thinks breastfeeding is perverted, or the video that promotes expressing milk so other people can feed the baby). Of course, there can actually be true “excuses” and “bad reasons” and women theoretically always have the power to choose for themselves rather than be swayed by those around them, but there is a whole lot that goes into not-breastfeeding, besides the quickest answer or what is initially apparent on the surface. As I said above, breastfeeding occurs in a context and that context is often one that DOES NOT reinforce a breastfeeding relationship. In my six years in breastfeeding support, with well over 600 helping contacts, I’ve more often thought it is a miracle that a mother manages to breastfeed, than I have wondered why she doesn’t.

For more about the relationship between birth and breastfeeding, check out my previous post: The Birth-Breastfeeding Continuum.

Check out those exclusively breastfed thighs!

Book Review: Homebirth in the Hospital

Aug31

Homebirth in the Hospital
by Stacey Marie Kerr, MD
Sentient Publications, 2008
Softcover, 212 pages
ISBN: 978-1-59181-077-3
www.homebirthinthehospital.com

Reviewed by Molly Remer, MSW, ICCE, https://talkbirth.wordpress.com

I would venture to say that most midwifery activists and birth professionals have said at some point, “what she wants is a homebirth in the hospital…” This comment is accompanied with a knowing look, a bit of head shaking, and an unspoken continuation of the thought, “…and we all know that’s not going to happen.”

Well, what if it is possible? A new book by Dr. Stacey Kerr, Homebirth in the Hospital, asserts that it is. She was originally trained at The Farm in TN (home of legendary midwife Ina May Gaskin) and after going to medical school realized that she, “…needed to balance my new knowledge with my old priorities. I missed the feeling of normal birth, the trust that the birthing process would occur without technology, and the time-tested techniques that help women birth naturally. And so it was that I went back to midwives to find the balance.”
If you are a dedicated homebirth advocate, I recommend reading Homebirth in the Hospital with an open mind—clear out any cobwebs and assumptions about doctors, hospitals, and birth and read the book for what it is: an attempt to create a new model of hospital birth. What Dr. Kerr proposes in her book is a model of “integrative childbirth”—the emotional care and support of home, while nestled into the technology of a hospital.

The opening chapter explores the concept of integrative childbirth and “the 5 C’s” of a successful integrative birth: choices, communication, continuity of care, confidence, and control of protocols (“protocols are the most disempowering aspect of modern maternity care…”).

This section is followed by fifteen different birth stories, beginning with the author’s own (at a Missouri birthing center—my own first baby was born in a birth center in Missouri, so I felt a kinship there).

The births are not all happy and “perfect,” not all intervention-free, and most are quite a bit more “managed” and interfered with than a lot of homebirthers prefer (one is a cesarean, several involve epidurals or medications). I, personally, would never freely choose a “homebirth in a hospital” (I also confess to retaining a deep-seated opinion that this phrase is an oxymoron!). However, that is not the point. Over 90% of women do give birth in a hospital attended by a physician and I appreciate the exploration of a new model within the constraints and philosophy of the hospital.

The book closes with a chapter called “how to be an integrative childbirth provider.” The book has no resources section and no index.

I certainly hope that doctors read this book. I am also glad it is available for women who feel like homebirth is not an option or not available and would like to explore an integrative approach. Even though my opinion is that none of the births are really “homebirths in the hospital” as most bear little resemblance to the homebirths I know and love, unlike the content of the standard hospital birth story, they are deeply respectful births in the hospital and that’s the issue truly at the heart of this book.

—-

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

Omega 3 Fatty Acid Supplementation During Pregnancy

Aug6

This week, I was contacted about some new research being presented at the The Era of Hope conference in Orlando, FL about omega 3 supplementation during pregnancy reducing the risk of breast cancer for the baby girl in the future. Era of Hope is a scientific meeting funded by the Department of Defense Breast Cancer Research Program (BCRP). I was offered the opportunity to do a short interview with the researcher, Dr. Georgel:

Q. What are some easy tips for pregnant mothers to increase their consumption of omega 3 fatty acids?

A. Select the right type of oil when you go shopping:

Avoid corn oil and chose canola oil instead. Price is similar and canola proper ratio of omega 3 to omega 6 fatty acids (i.e., 1-2).
Wild caught salmon is a viable option; avoid farm-raised
Walnuts and broccoli are also good foods to incorporate into your diet.

Q. Are supplements (i.e. fish oil or flaxseed oil in capsule form) as effective as other foods?

A. Yes, if you select them properly. Read the label; for fish oil, you have to make sure that the amount of omega 3 fatty acid (combined EPA plus DHA) is around 1600 mg/day. If the label says, “essential fatty acids,” it usually contains and high level of omega 6 and low omega 3 (which is not optimal) so you want to avoid those.

Q. Is the effect dose dependent? (i.e. how much do women need?

A. Yes, 1600mg of combined (EPA plus DHA) omega 3 fatty acids per day.

Q. Since it is World Breastfeeding Week this week, I’d love to tie this research in to research we already know about the role of breastfeeding in reducing a woman chance of breast cancer. Any thoughts on that?

A. Our research indicates that the maternal diet (in utero and during breast feeding) containing omega 3 fatty acids has the potential to reduce the female off-spring’s incidence of breast cancer.

I also asked about the following: finally, there is some evidence that supplementation with EFAs postpartum has an effect on reducing the incidence of postpartum mood disorders. Any thoughts on how prenatal supplementation might have a similar impact? But, since Dr. Georgel’s research does not explore mood disorders, he was unable to comment on this question. Here are two great handouts from Kathleen Kendall-Tackett about EFA supplementation postpartum:

Can fats make you happy? Omega-3s and your mental health pregnancy, postpartum and beyond

Why Breastfeeding and Omega-3s Help Prevent Depression in Pregnant and Postpartum Women

Health Care or Medical Care?

Aug5

For quite some time, breastfeeding advocates have been working to change the language of infant feeding to reflect that breastfeeding is the biological norm (and formula feeding is the replacement/substitute). This includes sharing about the “risks of formula feeding” rather than the “benefits of breastfeeding” as well as encouraging research that no longer uses formula-fed babies as the control group or considers formula to be a benign variable (i.e. the babies in the breastfed group of many research projects also received some formula, but since our culture views formula as the “norm,” this was not seen as a conflict). I love Diane Wiessinger‘s example—would we ever see a research project titled “Clear air and the incidence of lung cancer.” No! Problem behavior is linked to problem outcomes in other areas of research, so it would be “Smoking and the incidence of lung cancer.” However, we routinely see research titles like “Breastfeeding and the rate of diabetes” rather than linking problem to outcome–“Infant formula and the rate of diabetes.”

Similarly, “intactivists” (people who oppose circumcision) have pointed out that there should be no need to refer to some boys as “uncircumcised”—being uncircumcised is the biological norm, it is “circumcised” boys that should received the special word/label. (On a related side note, I have written about “pleonasms”–words that contain unnecessary repetition–and birth and breastfeeding in a previous post.)

So, this brings me to another need for a change in the common language–correctly identifying whether we are really talking about “Health Care” or “Medical Care.” This was originally brought to my attention by Jody McLaughlin the publisher of Compleat Mother magazine. We have a tendency to refer to “health care” and to “health care reform” and “health insurance” and and “health care providers” and “health care centers,” when it reality what we are truly referring to is “medical care”—medical care reform, medical insurance, medical care providers, and medical care centers. As Jody says (paraphrasing), “we do not have a HEALTH care system in this country, we have a MEDICAL care system.” She also makes an interesting point about a trend to re-name medical care systems with names that use the word “health” instead:

This is what I have observed: Our local facility was called Trinity HOSPITAL, later re-named Trinity MEDICAL CENTER, and now it is Trinity HEALTH.

In the late 70’s and early 80’s the discussions centered around the MEDICAL crisis, MEDICAL reform, MEDICAL insurance and MEDICAL care cost containment.

MEDICAL insurance morphed into HEALTH CARE insurance. MEDICAL reform morphed into HEALTHCARE reform.

This is a difference with a distinction.

Health care includes clean air and safe water, enough good food to eat, exercise, rest, shelter and a safe environment as well as healing arts and the availability of and appropriate utilization of medical care services.

Medical care is surgery, pharmaceuticals, invasive tests and procedures. Malpractice tort reform is on the agenda too but no one is talking about reducing the incidence of malpractice, or alleviating the malpractice crisis by improving outcomes.

Why does this discussion belong here? First, I wanted to address it because I have a special interest in our use of language surrounding birth and how that language can impact our birth experiences. Secondly, if we emphasize that birth is a normal bodily process, a normal life function, and not an illness, we need to make sure that we are focused on health care services for birth, rather than medical care services. Personally, I think the midwives model of care can truly be described as health care, whereas standard maternity care in the U.S. can much more aptly be described as medical care.

Maternal-Fetal Conflict?

Aug1

“You will have ideas, options and paths to ponder, but you will also have a sense of possible directions to take as you consider midwifery, childbirth education, or being a doula or an activist. Your path may be circular or straight, but meanwhile you can serve motherbaby while on the path, with a destination clearly in mind.” She also says, “I use the word midwife to refer to all birth practitioners. Whether you are a mother, doula, educator, or understanding doctor or nurse you are doing midwifery when you care for motherbaby.” —Midwifery Today editorial by Jan Tritten

Mamatoto is a Swahili word meaning “motherbaby”–reflecting the concept that mother and infant are not two separate people, but an interrelated dyad. What impacts one impacts the other and what is good for one is good for the other. The midwifery and birth communities have used this concept for quite some time and more recently some maternal health researchers have also referenced the idea of the “maternal nest”–that even following birth, the mother is the baby’s “habitat.”

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:

[quoting the expert physician interviewed for the segment] “The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesarean delivery, and women who insist on denying this right are irresponsible.”

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!

In the book Birth Tides, the author discusses maternal-fetal conflict:

According to obstetricians, the infant’s need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother’s desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby’s needs against those of the mother, setting ‘overriding’ physical needs against ‘mere’ psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother’s body–the ‘hard and soft passages,’ as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about ‘carrying’ babies, they do not see themselves as ‘carriers,’ any more than they regard their babies as ‘parasites’ in the ‘maternal environment.’ If you see your baby as a part of you, there can be no conflicts on interests between you.

I previously linked to a book review that explores this concept of the more aptly described “obstetric conflict” in even more depth.

I think it is fitting to remember that mother and baby dyads are NOT independent of each other. With a mamatoto—or, motherbaby—mother and baby are a single psychobiological organism whose needs are in harmony (what’s good for one is good for the other).

As Willa concluded in her CfM News article, “...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor.”