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Continuing Birth Education (Free Webinar Round Up)

Nov26

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.

The Of COURSE response…

Nov16

“As long as women are isolated one from the other, not allowed to offer other women the most personal accounts of their lives, they will not be part of any narratives of their own…women will be staving off destiny and not inviting or inventing or controlling it.” –Carolyn Heilbrun quoted in Sacred Circles

I recently finished taking a class in Ecofeminism, which makes connections between the exploitation and domination of women and the exploitation and domination of the planet. Naturally, as I also did with breastfeeding as an ecofeminist issue, I made many connections between the theme of the class and birth rights for women. The author of the book Ecofeminist Philosophy, Elizabeth Warren explains that when you are part of an unhealthy social system, you are likely to experience predictable, even “normal” consequences of living in that system: “This element of predictability explains the appropriateness of what I call the ‘Of course’ response: ‘Of course, you feel crazy when men say it’s your fault that you were raped, or that you could have prevented it.’ ‘Of course, your life has become unmanageable…'” we live in a culture that expects women to do it all and to always love parenting. If we look at our mainstream culture of birth as an unhealthy social system, I find the same response is appropriate. You really wanted to have a natural birth and then your doctor scared you into having an induction and you ended up with an epidural, of course you feel like you ‘failed.’ You feel healthy and beautiful, but now your doctor tells you that you’ve “failed” the GTT and are now “high risk,” of course, you feel stressed out and…like a high risk “patient.” You tried really hard to labor without medications, but you were “strapped down” with IV’s and continuous monitoring, of course, you felt like a trapped animal and like you had no other choices but medications. Of course, you feel upset and discouraged that your baby is ‘rejecting’ you and your breast after having been supplemented with bottles in the nursery. Of course, you are crying all the time and wondering if you are really cut out to be a mother, when your husband had to return to work after two days off and you are expected to be back at your job in five more weeks. And, so on and so forth.

“The ‘Of Course’ response affirms that those who feel crazy, powerless, alone, confused, or frustrated within unhealthy systems such as patriarchy are experiencing just what one would expect of them.” What the model of medical birth as an unhealthy social system reveals is that “no matter where one starts on the circle…one eventually comes round to one’s starting point. The circle operates as an insulated, closed system that, unchecked and unchallenged, continues uninterrupted…” How does one break free of an unhealthy system? “Getting the right beliefs by rearranging one’s thinking is an important part of the process, but it is not enough.” [emphasis mine. Here, Warren goes on to explore the issue of rape, but I have adjusted her words to be about birth instead] One can have the “right beliefs” about the prevalence of unnecessary cesareans, one’s rights as a childbearing woman, and the institutional nature of birth in our country and still experience an unwanted and unnecessary cesarean section. One can understand connections among faulty belief systems, language that devalues women, women’s bodies, and the birth process, and patriarchal behaviors of control and domination and still witness the catastrophic impact of this domination. “So, even if one must start with oneself and one’s belief system, one cannot end there. Since the problem is systemic, the system itself must be intervened upon and changed—by political, economic, social, and other means.” –Karen Warren in Ecofeminist Philosophy, p. 211. (emphasis mine)

Sometimes I honestly feel like I am one of the few people who really notices or labels the powerful systemic context in which women give birth in America. A lot of pregnancy and birth books and pregnancy and birth bloggers focus on individual responsibility and “education.” If women are always expected to “stand up for themselves” in the birth room and “get educated” so that they, personally, can prevent themselves from having unwanted interventions, of course our rates of unwanted interventions continue to rise.

“Through the act of controlling birth, we disassociate ourselves with its raw power. Disassociation makes it easier to identify with our ‘civilized’ nature, deny our ‘savage’ roots and connection with indigenous cultures. Birth simultaneously encompasses the three events that civilized societies fear–birth, death, and sexuality.” –Holly Richards (In Cultural Messages of Childbirth: The Perpetration of Fear,” ICEA Journal, 1993)

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Call for your experiences – the impact of birth trauma and beyond | Rebecca A. Wright

Nov11

http://rebeccaawright.com/

An online friend and sister birth professional, Rebecca Wright, emailed me recently to share some information about an important new project that she is launching:

I’m planning to write a book on birth trauma that will centre on women’s voices and experiences. It’s not going to be so much dwelling on birth trauma (though there will be an element of that as I want people to understand that whether an experience was ‘objectively’ traumatic or not, it can have an enormous impact – and I think a lot of women say to themselves, ‘my experience wasn’t as bad as some others I hear about’ and so don’t feel able to validate their own feelings and experience). What I really want to focus on is a) the impact of birth trauma (or of ‘difficult’ birth experiences) on mothers, babies, partners, families; b) the many individual paths to healing from birth trauma that people have walked; c) rediscovering your power in birth and motherhood following a difficult or traumatic experience.

She’d like to reach out to mothers, but also their partners, and doulas (midwives, nurses, doctors, etc.) and she’s also interested in hearing from practitioners of whatever sort who work with women and families around these issues.

Full details are available on her blog:

I want this book to be made of women’s voices (and men’s as well). I want it to be a place where the unspoken is spoken clearly and openly. I want it to be a book that honours the sacredness of each birth journey, and each path to healing. I want it to be a book that opens doorways for those who are feeling lost or alone so that they can find hope and a way forward that is suitable for them personally. Most of all, I want it to be a book that shows that it is possible to reclaim your personal power in birth and mothering following a difficult or traumatic experience in birth.

via Call for your experiences – the impact of birth trauma and beyond | Rebecca A. Wright.

Make sure to check out her project and see if you can lend your voice to what sounds like a beautifully healing book!

And, speaking of birth trauma, a while ago, I also received a question via Facebook asking for recommended resources for healing from traumatic birth. Check out the series on Giving Birth with Confidence about traumatic birth prevention and recovery. Or, look into Solace for Mothers.

Eleven Years Ago…

Nov3

In 2000, while working on my block field placement (internship) in graduate school, I met a woman who would become my best friend and a profoundly influential part of my life. We shared a lot of formative life experiences of early adulthood together and I accompanied her to the hospital for the births of two of her children and she came to the birth center with me when my oldest son was born. While my own mother had all four of her children at home and so homebirth and natural birth were parts of my life history, I didn’t really begin to focus on birth as an issue until I was married and in my early 20’s. At this point, I was most influenced by the newsgroup misc.kids.pregnancy. So, I became both deeply interested in natural birth and also very invested in my friend’s birth plans and her ideas about birth. As her pregnancy progressed, she hired a doula that I came across at a street fair and took birth classes from her at the birth center in which I would later have my first baby.

After Maggie was born, I was more involved in her life than I have ever been involved with a baby that was not related to me and in a way that I’ve never been able to be involved again. Without any children of my own at the time, I was able to be present for my friend in a way in which I now see, few friends are able to be for each other, since most women who connect during their childbearing years are intensely embroiled in the needs of their own children and families. Looking back, I see I was like the best postpartum doula ever, without knowing that is what I was being at the time (and, I was free, and did it for a year! :)) After bringing over dinner every night for the first week, for the following year I then I went over to my friend’s house every morning and took care of the baby while my friend ate her breakfast, took care of herself, and went for a run. Then, we would walk in the neighborhood together for about an hour, talking about our lives, dreams, and plans.

Last year, that magical baby that had such a profound influence on my life and on my birthwork in the world turned TEN! I could hardly believe it. At that time, I asked my friend for permission to post the birth story I had written in my journal the morning after her baby’s birth. My friend granted me permission, but then several days passed and since it wasn’t the baby’s birthday any more, the story sat in my drafts folder for…another year. And, now, that magical, wonderful baby is ELEVEN! Here is her birth story, through my naĂŻve, pre-maternal eyes…

Maggie’s Birth

With my little friend, 2002

Journal Entry, 11/3/01. 12:22 p.m.

Returned home this morning at 7:15 after being at the birth of Kate & Dave’s baby girl, Maggie. I’m very tired, but I wanted to write a little bit anyway. We went to the hospital at 1:30 p.m. on Friday (11/2) after Kate’s water broke. She was still 2 centimeters at 9:00 p.m., so they started pitocin. At 12:00 a.m. the doulas arrived and Kate was 3-4 centimeters dilated. The doulas were absolutely wonderful at soothing and guiding her. At 1:15 a.m. she was 7 centimeters (!) and at a tiny bit after 2:00 a.m. she began pushing. Then, she pushed for almost four hours before Maggie was born at 5:51 a.m. (8lbs 10z).

It was really hard to watch and not be able to do anything for her. I can’t imagine what it would have felt like as her husband—someone that close in. She did a wonderful, wonderful job. No pain medication at all, even with the pitocin. She only asked about pain meds once (before the doulas got there). I felt completely in awe of her strength and power. She was so brave and so strong and so tough. Powerful woman stuff. I couldn’t believe that she pushed for four hours. I do not think I could have done it. The baby was worth it though—boy is she cute and pink and making me want to have one too!

I can’t really describe what this experience meant to me or how powerful it was. It was beautiful and strong. Kate is an amazing woman and I am awed by her bravery. She and Dave are so happy with their precious little bundle. I got to hold her too, when she was less than 30 minutes old and Kate was being stitched up (bad tear). I didn’t feel like much help to Kate, but being present mean a lot to me and I hope the fact that I was there meant something to her too. I’m so encouraged to see that a hospital birth can be pulled off so well.

Life is wonderful. Welcome, baby girl!

—

Happy Birth-Day to you both today, Maggie and Kate! You hold a deep and special place in my heart. You both changed my life forever.

Woman-Centered Collaboration

Oct8

I’ve posted a couple of times about a collaboration with the Women’s Health in Women’s Hands launch of the feminist women’s health classic Woman-Centered Pregnancy and Childbirth as a pdf version for free online. When I wrote my What to Expect post based on Woman-Centered Childbirth in 2009, I had no idea that one of the authors of the book would later find me on the internet, let alone distribute postcards at the National Rally for Change in Los Angeles containing a quote from me and link to my site. As I’ve said several times lately, I just love the internet. It is amazing to me that these types of connections and collaborations can occur over long distances and without face-to-face contact. Very cool!

Anyway, this week I received a promo launch packet for the online release of the book. It includes two printouts from my own website and the re-formatted flier based on my blog post, as well as a folder and postcards.
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And, then I took picture of the packet and included my own vintage copy of the original Woman-Centered Childbirth book 🙂
20121008-164812.jpgThis has been a fun link between past and present activism and between a foremother in birth activism and my current self!

Bits of the (Birth) Net

Oct6

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.

Listening

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.

Privacy

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!

Epigenetics

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

DVD Review: Laboring Under an Illusion

Oct2


DVD Review: Laboring Under an Illusion: Mass Media Childbirth vs. The Real Thing
Filmmaker: Vicki Elson
50 minutes, $39.99 (personal use­)
www.birth-media.com

Reviewed by Molly Remer, Talk Birth

Laboring under an Illusion is a treasure trove of discussion-provoking material. Filmmaker Vicki Elson is an anthropologist and childbirth educator who has created a striking documentary exploring media-generated myths about childbirth. As a childbirth educator, I often reference in my classes how our attitudes and expectations about birth are shaped by media messages—birth is an emergency, etc. This film eloquently and entertainingly provides 50 minutes of backup material for the idea!

The film blends media messages from comedy shows like Murphy Brown, Mad About You,and I Love Lucy, movie clips such as Juno, Coneheads, and Nine Months, along with “reality” based shows on Discovery Health with the inherently contrasting messages in clips of beautiful births from films like Birth as We Know It, The Business of Being Born, and Orgasmic Birth. It also contains brief voiceover narrations from “regular” women about birth. Occasionally, there is a scene with the filmmaker speaking directly to the viewer about concepts raised in the film. These scenes are less entertaining than the popular media clips and the friends with whom I watched the film wanted to fast-forward these segments—the media clips chosen so clearly speak for themselves that they don’t really need explanation, at least to the already birth-savvy viewer. Because of some strong language in the media clips, I caution parents to preview the film before sharing it with children.

Laboring Under an Illusion is an entertaining and illuminating film for consumers as well as for birth educators, doulas, and midwives. I highly recommend it!

—

Disclosure: I received a complimentary copy of the DVD for review purposes

Amazon affiliate link included in image.

The dualism of blogging (and life)

Sep28

Yesterday, I found myself involved in two different conversations about blogging. In the first, I exclaimed to my friend, “do you have any idea how many things I want to blog about that I don’t?! I need a blog for, ‘the things I don’t blog about.'” In the second, some other friends said to me, “you’re just so open on your blog, I don’t think I can be that open.” We then went on to discuss the various crazy people we have known who we do not wish to have access to information about us or to know things about our lives. I’ve been writing this blog since 2007 and had another blog before that. While I have had people read and comment that I sometimes wish were not following my writing and while I’ve had a handful of negative/insulted comments, for all these years I’ve never had an actual bad experience with blogging. Sometimes I think it is the tone I maintain here—I rarely write prescriptively (i.e. here’s what YOU SHOULD DO) and I rarely write inflammatorily (i.e. why are some people such IDIOTS about this?!) and I rarely write controversially (i.e. down with circumcision!). I also consciously choose not to write in what I refer to as a “putting out fires” style. You may notice that when there is some new outrage in the birth or breastfeeding community, I rarely address it here. I’d rather focus on building something new and on what I can offer in terms of information, experience, or idea than to debunk, criticize, or expose. And, I don’t actually have time to keep up with all the drama even if I wanted to. I barely have time to keep up with my own life on my own little patch of the earth! I do occasionally reflect that this probably limits my site traffic in some ways—particularly when I choose to ignore something obnoxious that crosses my email box and later another blogger writes a witty exposĂŠ of the same subject and it goes viral throughout Facebookworldland—though I try not to compare myself to other bloggers or to have too much stats envy.

And, periodically, I get lovely emails like one from last week saying, “I love your energy and gentle voice.” 🙂 And, periodically, things happen and I see remarks on twitter referring to something I’ve written as, “I dislike the tone of it and its intention to demonise the health service.” 😦 The latter just happened last night in response to the publication of my What to Expect When You Go to the Hospital for a Natural Childbirth as an informational leaflet in conjunction with Women’s Health in Women’s Hands’ publication of Woman-Centered Childbirth in full text online. Twitter is too character limited for me to respond to the critique in full, so I said I’d write a follow-up blog post to explain. 20120928-141455.jpg A different organization (Women’s Health in Women’s Hands) converted one of my posts into this flier and it does not include my initial disclaimer expressing my trepidation about being perceived as “hospital-bashing” (it shouldn’t include that, because it is flier now, not a rambling blog post!). The article is NOT meant to hospital bash, it is meant to prepare and plan appropriately. I wrote it because I was tired of how betrayed my clients were when they planned beautiful, natural hospital births and then experienced many things on the list in my article. There is also a companion article and series of tips (I think on the back side of the tweeted leaflet as a matter of fact) about how to cope/navigate–the information is not meant to discourage, but to realistically prepare. Have a homebirth is NOT one of the tips, because this isn’t a home vs hospital article! Whew! See…too many words for Twitter, that’s why I rarely use it except FB auto-tweeting stuff.

So, which is it? Am I authentic and open, or keeping my mouth shut all the time?! Maybe both. What I know is there is a lot I don’t write about. I don’t write because I’m too scared, or too sensitive, or too fearful, or too self-righteous, or too busy, or too annoyed, or too scattered, or too embarrassed. I don’t write things because I have relatives who read this or friends who read this and I’d rather not share some things with some people. And, which is it? Do I have nice energy and a gentle voice or am I a strident hospital-basher out to demonize and victimize?!

And, I started to reflect that I guess I am all these things and how people experience me and my writing is in part up to me and in part up to them. Just like in real life. I can be gentle, kind, and nurturing. I can be critical, judgmental, and harsh. I can be helpful and I can be selfish. I can be patient and impatient. I can be friendly, I can be preoccupied. I can be energetic and enthusiastic and upbeat and I can be exhausted and defeated. I can be a fabulous, fun mother and I can be a distracted and grouchy mother. I can be funny and I can take myself too seriously. Different people, relationships, and environments bring out different expressions of who I am. Sometimes I really like myself a lot. I like who I am, I like how I move through the world, and I’m impressed with my own capacities. I have great ideas and solid values and principles and the ability to articulate those in writing. Sometimes I actually hate myself. I see only the bad parts and I wish I could just be better. I feel hypocritical and over aware of inconsistencies in my own thoughts/beliefs and my expression of my values in the world. I often want to be better than I am, but in rare moments of grace and self-compassion, I realize that I’m pretty good already. And, in some moments of self-righteousness and superiority, I actually feel better than some people in some areas/some ways!

There are two things that I know for sure. I never wish to diminish another woman and to make her feel judged as unworthy or “less than” for her birth or mothering choices. And, at the same time, I never wish to lie to another woman either in an effort to prevent her from feeling those things…

Blogging does only convey a slice of the “real me,” but I also find it an authentic slice, an authentic form of expression, and a real experience of who I am, just not all of who I am. Ever. I can be both more and less than what speaks to you from these many, many pages of blog posts. More in that I am more complicated and think deeper and with more intensity than most people will ever know and less in that I’m multidimensional and flawed and real, not just words on a screen from one moment in time.

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Yesterday..taking my kids to the theater and taking a moment to point out the “hidden” Goddess right in the middle of town. Today, sitting on the bed in the dim light while Alaina naps, typing feverishly and feeling utterly swamped with the one million things I’d like to do with my life…

Domestic Violence During Pregnancy

Sep26

By Molly Remer, MSW, ICCE, CCCE

Violence during pregnancy is an unfortunately common experience. Between four and eight percent of women experience domestic (intimate partner) violence during their pregnancies. The incidence of violence increases for women with unplanned or unwanted pregnancies with 26% of pregnant teens experiencing intimate partner violence and 15% of all women whose pregnancies are unwanted being in an abusive relationship. Indeed, murder is the second only to car accidents as the most common cause of injury related death for pregnant women.[1] Sadly, these statistics are likely higher in reality due to underreporting or misclassification.

Despite prevalence and severity, domestic violence is not often addressed in the birth community. Books directed at pregnant women rarely even mention violence in pregnancy (and most do not even include it at all), even though the incidence is similar to the rate of premature births and much higher than the incidence of various pregnancy related complications that generally warrant at least a paragraph in birth literature (such as placenta previa). Likewise, books and training programs for doulas, birth educators, and other birth professionals, generally neglect to address intimate partner violence.

An introduction to the issue of domestic violence during pregnancy requires an understanding of the following dynamics:

  • Cycle of Violence—the concept that violent behavior in a relationship tends to occur in three distinct phases. In the tension building phase, the battered partner feels as if she is “walking on eggshells.” The abuser’s temperament and mood becomes increasingly unpredictable and volatile and culminates in the explosion/eruption phase in which an acutely violent incident occurs. Early in a relationship, this phase is often followed by the honeymoon phase during which the batterer is contrite, asks for forgiveness, offers gifts, and assures the woman that, “it will never happen again.” The length of each phase varies by couple and with their relationship. Over time, the tension building or explosion phases may be very prolonged, with little or no time spent in the honeymoon phase.

The cycle of violence continues to repeat and tends to escalate in severity, despite the assurances that the batterer makes during the honeymoon phase.

  • Domestic violence is about power and control. It is NOT about anger management, substance abuse (though substances can increases violent incidents), or “nagging” from a girlfriend or wife.
  • The abusive partner tends to tell the woman that the violence is her fault and that she provokes or deserves the abusive incidents. He often isolates her from people and situations that will help her know otherwise.
  • Abusive relationships may involve physical, emotional, or verbal battering and frequently some combination of the three. Physical abuse includes pushing, choking, kicking, sexual abuse and other means of physical control/harm as well as punching or slapping. Verbal and emotional or psychological abuse involves name calling, insults, berating, shouting/screaming, humiliation, threats, intimidation, destruction of property, isolation, activity restriction, abuse of pets, and withholding of economic, physical, or emotional resources. Women often forget to acknowledge some physical forms of violence like choking or pushing as “real” abuse and will often not consider themselves abused unless they have been punched or slapped by their husband or partner.
  • Women stay in abusive relationships for numerous reasons. Battered women often leave their relationships several times before they end it for good. Reasons are dynamic, complex, and individual. Some very basic reasons include hope, love, and fear. The most dangerous time in the relationship is when she leaves—it is then that she is most likely to be severely injured or killed. As a society, we should NOT be asking why women stay, we should be asking how we can stop domestic violence from happening.

 So, what can you do? If you are a pregnant woman who is being abused, please contact your local domestic violence shelter or hotline. Or, call the National Domestic Violence Hotline at 1-800-799-SAFE. Even if you do not feel ready to leave your relationship, many shelters offer “outpatient” support groups and counseling. If you are a prenatal health care provider (midwife, doctor, nurse, physician assistant), please include domestic violence screening questions during your prenatal visits and be alert and responsive to signs of violence. If you are a doula, birth educator, or other birth professional, include a discussion of domestic violence during your classes or prenatal visits and encourage exploration and acknowledgment of these issues during your networking with other birth workers. You may also wish to download and read the Center for Disease Control’s guide, Intimate Partner Violence during Pregnancy: A Guide for Clinicians. If you are a friend or relative of a pregnant woman experiencing abuse, help her develop a safety plan and encourage her to seek the services of a domestic violence shelter.

Though it can be very awkward to address domestic violence issues with women directly and can feel like an intrusion into private lives, if you choose silence, you contribute to a continued culture of fear, shame, denial, and invisibility for the many women experiencing violence during this time in their lives. Acknowledging the reality and prevalence of violence against women in our culture and encouraging open, respectful, and assertive dialog about it is a powerful tool in reducing the occurrence. Strive to help bring violence against pregnant women into public view instead of considering family violence to be private, family business. Women and babies are too important for us to remain quiet.

Portions of this article are excerpted from the booklet Talking to a Battered Woman: A Guide for the Short Term Helper by Molly Remer, MSW, ICCE. This booklet is available as free pdf file on Molly’s website (http://talkbirth.me). Molly is a certified childbirth educator, the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, and a college professor.

[1] National Coalition Against Domestic Violence Fact Sheet “Reproductive Health & Pregnancy,” http://www.ncadv.org/files/reproductivehealthandpregnancy.pdf

This article was originally published in Citizens for Midwifery News and was later reprinted in International Doula along with a companion sidebar by Susan Hodges.

Related post: Birth Violence

Guest Post: Abuse of pregnant women in the medical setting

Sep26

This post is a companion piece to my article, Domestic Violence During Pregnancy, and was previously published as a sidebar in Citizens for Midwifery News and later in International Doula.

Abuse of pregnant women in the medical setting

 By Susan Hodges, founder and past President of Citizens for Midwifery

Have you or someone you know experienced rude, abusive or violent treatment at the hands of obstetricians or other hospital staff? Abusive behavior, in or out of the hospital, can include threats, coercion, yelling, belittling, lying, omission of information, lack of informed consent, misrepresentation (of medical situation, of interventions, of reasons they “need” you to do something or not do something), and so on. For example, nurses yelling at a woman to push is abusive, even if the nurses don’t intend to be abusive. An OB lying to a woman that her baby is “too big” (something that neither he/she nor anyone else can predict), telling her she “needs” intervention, and then not providing complete information about the risks and benefits of the intervention, is abusive behavior. Unwanted and unnecessary surgery (such as episiotomy or an avoidable cesarean section) is no less violence against a woman than hitting or strangling – most of us have just not thought about it in that way. The fact that most women are persuaded that they “needed” the intervention, that it was because their body was somehow defective, is another aspect of the abuse (blaming the victim).

While the situation is different from domestic violence in some ways, it is also similar. Abuse in the medical setting is also about power and control, the pregnant or laboring woman is often blamed for her situation, and verbal and emotional abuse can be similar. Because we are taught to “trust your doctor”, and in fact there is an explicit assumption of trust in the “fiduciary relationship” between the woman and her doctor who is an “expert”, most of us do not think about the possibility of abuse, and many of us stay with the OB or feel we have no choice about our health care providers or settings, especially when we are in labor. Also, the doctors and staff generally are not even aware that their behavior or actions are abusive.

Forty years ago, domestic violence happened, but was hidden and accepted. A lot of women had to do a great deal of work to come up with the language and the legal strategies, and to educate women, law enforcement, judges, mental health workers, and many others to get us to the point where we are today, where at least the problem has a name and at least some of the time women can fight back with the law on their side.

It is extremely difficult to deal with an abusive OB (and it might be hidden abuse, manipulation, etc.) in the middle of labor, just as is very difficult to effectively deal with an abusive spouse in the middle of the abuse. The childbirth community is only just now beginning to recognize that women are being abused in many ways in the present system of maternity care.  We don’t really have special words for it yet. We do have some legal underpinnings to fight at least some of it, but we are in the very early stages. It will take recognition of the problem on a larger scale and by women who are not being abused by OBs to bring this issue to public attention, create language for it, and use legal tools to end it. We have a lot of work to do.

Have you experienced abuse? At the least you can file a complaint. See “Unhappy With Your Maternity Care? File a Complaint!” at http://cfmidwifery.org/Resources/item.aspx?ID=1

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Related post: Birth Violence