December 2008


So, I just attended a very traumatic twin birth.  After watching the WHO film on vaginal breech delivery I was completely horrified at the lack of skill shown by these doctors.  The whole ‘hands off the breech’ was not present at all, nor was anything else for that matter. 

Here’s the short version as I am very tired.  Mom was a primip pushed beautifully…  She allowed her epidural to wear off to the point where she felt the pain of contractions enough to really push effectively.  She began pushing at 12:15a and baby A was born head first one hour later without incident.  Doctor did a completely unnecessary episiotomy without consent or even informing mom she was going to do it.  Nothing was said at all.  Baby B was transverse and that is when things got ugly.  The docs said they were okay with delivering him breech, but were very aggressive about getting him to turn.   The doctors hand was completely inside the uterus trying to grab an appendage.  The baby’s water wasn’t even broken, what did she think she was going to get a hold of!!!!  She finally broke moms water after 6 minutes of this manual attempt to turn the baby.  After the water broke, the doc grabbed the baby’s feet and pulled him through the vagina.  She continued to pull and pull on the baby and turn and pull on the baby, while the other doc pushed on the fundus and mom gasped she couldn’t breath.  Horrid!  Then, they both started pulling on the baby to get his head out.  They heard a pop when they broke this poor little 4 lbs 8 oz baby’s arm. His humeris.  I just can’t believe it!  They turned him nearly 360* using his body, pulling on his legs.  It was the most disgusting lack of skill I have ever witnessed.  It took two minutes, he was born barely 20 minutes after his sibling.  The rationalizations the docs gave were of course ‘well a broken arm is better than brain damage’ …  I am heartbroken. ~ B 

We were discussing a different subject just before B shared her doula birth story when an observation was made: many babies stop fussing when the person holding them stands up.  Perhaps, Ruth Trode mused, as a baby fusses or the environment is less than optimal for the person holding the baby that negative energy builds.  In that sitting position this energy finds pockets to “sit” in (think standing water).  When the adult stands up the energy is dredged and flows out into the air instead.

Have you ever noticed that a baby who sees its mother upset also becomes upset?  How is that?  A baby supposedly isn’t born feeling (else why would practitioners use invasive tools such as internal fetal monitors, IUPCs and pitocin?) so how would they have learned this facial expression means “sad” or which one means “happy?”  

Instantly I thought of babies during labor and how they show signs of stress first from interventions on mothers.  We know babies experience their mothers’ emotions.  They obviously experience energy …. why do I think this? Because they are not physically seeing the situation their mother is experiencing. They are in the womb.  It’s the ENERGY that they are feeling.  They are on a totally different plane than we are.  Then they are born and susceptible to losing the acuity of their intuitiveness and will instead learn how to compartmentalize instead.

This brought to mind how contrast colors grab newborns attentions, but blending colors don’t hold their attention as well. To me, I see that their world is so fluid in color, texture, sound and energy–there are ebbs and flows. It is only when we start defining the difference from black to white, here to there, me to you that we start down the path of seeing the world and the things in it as separate. Oh to be a baby again and see nothing as being separate.  ~Ruth, Musing on a cold, snowy day

It seemed to me that it is only we humans who have “evolved” (cynical) to see anything as seperate.  Witness this mother gorilla mourning the death of her baby .  Elephants also have a capacity many of us humans do not.  They also have a reverence for the life of their own.  They are who I think of when I hear the phrase “singing the bones.”

As we “listened” to B’s doula birth story what we felt in our hearts was more than the heartache of knowing this birth didn’t have to be this way.  Giving birth in anything less than humane care will tear us down as a society.  I seriously question who or which of us is the one that is “evolved.”

What deep wounds ever closed without a scar? ~ George Gordon, Lord Byron, Child Harold’s Pilgrimage

We continued to feel the reason for our being.  It’s not about restricting women’s choices or judging their choices.  It’s about whether or not THEY made the choice.  It’s not about what babies can tolerate.  It’s about why do they need to tolerate what practitioners impose on them?  

So begins a new year of sharing our message, how we give birth matters.  Not giving birth vaginally does not make a mother less of a woman.  Hearing us say this may surprise many who would claim we are inflexible wanting natural birth for all.  The practitioners who want to claim that we do not want to allow medications or believe cesareans are evil would rather you just turned away from us less you begin seeing those generalized statements for what they are: fear mongering of the worst kind; meant to stifle freedom.  When it permeates the laboring woman’s environment creating “atmosfear” that energy does make its way to the baby inside.

Thinking on our discussion of how babies sense and absorb the energies of their immediate and intimate space the twin birth story came rolling in causing great shock to us hearing the story and emphasized our entire past 24-hour discussion:  how we birth and how we are born matters.

Peace on earth can begin at birth.

For more on the newborn birth experience visit Birth Psychology and Newborn Breath.

“Home Birth Experience 1: Decision and Expectation” is a midwifery clinic teacher’s summary of her interviews with eight women who planned ahome birth in the recent decade.  Author Alison Andrews proposes that the birth experience leaves a very strong imprint on the woman’s mind, while the medicalization of birth has reduced the birth experience to terms relating to a consumer decision, i.e. “satisfaction” or “attitudes on intervention.”  It is the desire to experience birth as an organic experience leaving its memory on the mother’s whole self that is a strong basis for choosing home birth over medicalized birth.

Women will share their birth experience with great detail and acuity in the days immediately following the birth, be it a positive or a negative experience.  The quality of that experience is beginning to be recognized as having a lifetime impact in other areas of the mother’s life, including her marital relationship with whoever was her partner at the birth.  As birth moved into hospitals through historical industrial developments technology served to also separate mothers mentally and emotionally from the xperience, fewer and fewer natural birth experiences existed tobalance the case for home birth as a safe and healthy experience.

Birth “narratives” in fact, are an essential and typical skill for the midwife to have.  The medical profession would relay a birth only in terms of patient notes, regardless of whether the birth was organic birth or some interventions were introduced.  This is a detriment to improving maternal health care because a mother’s birth story is a valuable data source recording live testimony to maternal health care protocols enacted upon them.  Based upon this theorem, Ms. Andrews interviewed eight women from her home region of South Wales with backgrounds ranging from affluent to indigent, from rural to desolate.  Of these women, seven had previously birthed in a hospital and therefore provided that experience in relation to their choice to birth at home.

The results concluded n two themes, each with secondary threads for further discussion.  The two main topics that women related the strongest emotion to was the decision to have a home birth and the expectations they held for their home birth experience.  the reasons behind their decision to birth at home ranged from pragmatic – fewer worries about child care for the siblings of the new baby – to addressing the need for intimacy via familiarity of surroundings.  These mothers also considered the risks of home birth, and in some cases the risk carried less weight in their decision-making process.  One woman sought only to ensure her midwife had basic emergency care items, while another retorted that things go wrong in hospitals too.  All women undertook some form of birth education and preparation but the preparation was more about the physical location itself than about their own body’s preparation for the birth.  This is interesting to note in direct contrast to the often reported indicator for hospital birth being about women desiring to be near pain relief or help if their body cannot manage the labor.  In other words, labor is in the eye of the beholder and that’s another post in itself!  To continue, the women’s expectations themselves were not of as great a note as the importance of recognizing that women held expectations for their births both in terms of the birth itself and the care they would receive.

This last consideration, it was observed, led to both discussion about holding dialogue with their friends and families regarding their decision.  It also led to strife with hospital care providers, who viewed the decision to birth at home as a personal indictment of both their profession and their personal reputation, rather than an honest examination into the quality of care – which is the basis for many of these mothers’ decision to birth at home.  It is this sole perspective from proponents for hospital birth that casts light on the goal of the medical profession: to lobby strongly to keep births in hospitals, although there is little evidence that home birth is not safe for lowl-risk, otherwise healthy women.  If this trend continues, concludes Ms. Andrews,

… childbirth … (will no longer be) part of life in the community for most women and will remain so as long as birth remains centralized in the hospital setting.

She quotes the Welsh Assembly government paper, “Delivering the Future in Wales,”  which concludes the option of a home birth with a skilled midwife must be a protected option.  Further, Britain itself is pleding to strive fora goal of a ten percent (10%) home birth rate based on utilizing home birth as a safe option in maternal health care birth choices.  this humble goal is indicative of the  deft persuasion and patience that will be required to advance the view of home birth is a complementary option to medical obstetrics.

Are you listening ACOG?  Complementary.  Working together.  Is it really your goal to improve mother and infant birth outcomes in the spirit of care and concern for humanity?

For more on the home birth decision making thought processes at large look into the Nursing and Midwifery Council report of May 5, 2005.

Works Cited:  Andrews, Alison, “Home Birth Experience 1: Decision and Expecation”; August 2004, Brtish Journal of Midwifery, Volume 12, No 8

ACOG State Legislative Update Year In Review (August 2007)” begins by noting “troubling trends” in state legislation and sets the tone for the bias of this opinion from the American College of Obstetricians and Gynecologists (ACOG).  There are four trends ACOG finds troubling: right to home birth bills are on the rise, more midwives not recognized by medical associations are being licensed by states, midwives appear to have a public advantage and finally that ACOG considers itself on the defensive today.

The facts ACOG provides are clear and succinct in their first two cases, but are opinion laden in the latter.  More home birth bills are being introduced and those that have been in debate for years now are finally passing.  For example, Virginia recently passed legislation protecting women’s rights to birth at home and in 2007 Missouri granted midwives licensure.  It is also true that states are granting Certified Practicing Midwife (CPM) licensure, hands-on training including non-medical skills.  This is not the same training model as the medical path for midwifery recognized by ACOG and the American College of Nurse Midwives.  ACOG does not debate the safety of home birth but rather goes into examining why midwifery and home birth are gaining groundswell support.

 ACOG tells us that midwives have learned how to “work” the legislative system and are now using the same tactics ACOG has used themselves: lobbying and propaganda.  Midwives have been so successful that they have garnered endorsement from the American Legislative Exchange Council (ALEC) for a model to license Certified Practicing Midwives.  ALEC’s endorsement is powerful because it is conservative in nature and therefore, an endorsement renders the CPM licensure model credibility.  ACOG’s illogical stand is, without medical training, midwives are an unsafe choice.

However, ACOG pointedly leaves out the basis for recognizing midwifery: it is not the practice of medicine.  This is critical to understanding the process by which midwifery is recognized and can be protected as a viable option for birth care.  Connecticut is undergoing the struggle to create a definitive line on the issue of whether or not midwifery is practicing medicine.  Almost ten years ago midwife Donna Vedam found herself on trial for practicing medicine.  The courts determined she was, in fact, practicing midwifery and midwifery is not medicine.  Then in 2006 the state’s Medical Examining Board (MEB) found another case to try, midwives who made the right decision, transferring a mother whose birth was not an emergency but should have the medical care her evolving situation might call for available.  The educated decision these midwives, Joan Mershon and Mary Ellen Albini, made in transferring the mother is argued by the MEB as practicing medicine.  There is an irony as midwives finding themselves hounded for providing midwifery care are also persecuted for transferring the mother into appropriate medical care.  The outcome of the birth was a fine healthy baby and mother.  Both mother and father refuse to testify against the midwives.

 ACOG states that midwives have the public advantage of winning support through the use of the buzz words “safety” and “choice.”  Their case – that this advantage is an unfair one – is not fact based.  They argue that home birth is safe in the Netherlands only because everyone lives near a hospital.  There is no evidence in that statement at all.  It only implies that home birth is safe only when it takes place near a hospital.  Their statement is not a case and it is clear they cannot even make the effort to understand what home birth care is.  It is evident that they fear what they do not understand, what is different.  

Further, ACOG also argues that comparisons of home birth and hospital birth cannot be compared because the studies are not scientifically rigorous.  This also ignores the basis for home birth care: birth occurs naturally and organic without active management.  Therefore as each mother-baby pair is unique, they cannot be controlled.

ACOG’s final cited troubling trends is, interestingly, presented last.  It should have been first as it clearly state’s the article’s bias: ACOG is on the defensive.  ACOG is clearly feeling not only outmaneuvered, but also recognizing that they placed themselves in this position.  For example, it is ACOG who made it difficult for hospitals to provide care for women who want birth vaginally after having had a surgical delivery (cesarean) also known as a VBAC (Wagner).  Yet, their position in this paper is that women are seeking out alternatives, home birth with midwives, since their care providers cannot provide VBAC as a birth care option.

ACOG closes the article stating that their position is that legislative support for midwives is not won on merit but rather a sympathetic public and press.  Additionally, ACOG says, it finds itself in a situation where showing up in large numbers when they can give testimony makes them appear to be engaging in a “turf battle” rather than a credible alliance.  This is the plea that they make to find or create alliances with other organizations.  Make no mistake, this is not a light objective to note as some pediatric and newborn service providers have jumped onto ACOG’s wagon.  

This written public statement is clearly an opinion piece reporting facts that are driving ACOG to explore options for defeating midwifery and home birth as a legally protected option for women.  It fails to cite any merits for this position and in fact the “uninformed public” they lament could also be the informed reader’s lament for the uninformed public may not understand that denying American women access to home birth is a clear violation of every American citizen’s right to privacy and right to choose what care or actions are taken upon their bodies.

What did 2008 bring us at Independent Childbirth?  Many, many, natural, spontaneous unmedicated labor and birth over an intact perineum taking places in homes, birth centers and a few hospitals under the expert care and guidance of independent midwives and enlightened midwifery/ob practices.