The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

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One thing that has been on my mind lately, is the fear of childbirth (technical name, tocophobia).

Sometimes women are afraid of childbirth prior to having any children, and this is not really surprising — after all, the average woman will have seen few actual births, but only those portrayed in movies and on soap operas. Of course, those are all not just dramatized (fake) but are typically dramatic — water breaks and the woman has to get in the hospital this instant or the world will come to an end!! Or she’s stuck in the backside of nowhere in labor with just her husband (yes, I still remember when Jennifer had Abby on Days of Our Lives, and Jack was the only other person in the cabin, with serious snow outside), and everybody is panicking. Or labor is portrayed as the worst and most awful thing that it is possible to endure, until the magic epidural comes and makes everything all right. The other thing that is now available on TV, that I didn’t have as a child, are shows like “A Baby Story” which do portray actual births, but I notice that an inordinantly high number of those end in a C-section, or are otherwise highly interventive; and I’m not surprised that this leads to a fear of birth prior to the woman’s actually giving birth the first time. And this doesn’t even begin to touch on all the labor and birth horror stories that mothers for some reason feel so imperative to scare first-time pregnant women with.

Other women, however, have given birth before, and this experience has made them scared to have any more. Some women may choose never to have any more children at all (this happened to a friend of mine; her daughter is now about 8-9 years old). Or they may choose a C-section because they can accept pain from surgery and the attendant post-op pain (which may be manageable by narcotics), but they fear the lengthy but intermittent pain from labor. But there are other options.

After her first very painful birth, this woman was terrified to give birth again, but she chose to overcome her fears by using hypnosis to relax during labor. If you watch the video on that link, you’ll notice that they show a few clips from an online video of a woman using hypnosis during labor. That woman in the video was Independent Childbirth Educator Sheridan from EnjoyBirth blog whose painless childbirth using hypnosis (Hypnobabies) was what this Georgia mom saw that gave her the courage to try to give birth again. [I’ll clarify that although the news story referred to hypnosis during birth as “HypnoBirth,” that is a name for a particular type of childbirth hypnosis, and Hypnobabies is another, and it was this type that Sheridan used during birth, and what she teaches.]

The fear of childbirth is very real. And it’s understandable, considering all the negative images surrounding birth that we are bombarded by almost from our own births — and considering that most of us were born in less-than-ideal circumstances ourselves (my mom was under general anesthesia and given an episiotomy, and I assume I was dragged out of her womb by my head), perhaps it might be not too big of a stretch to say that we are surrounded with negative birth images from the time of our birth. But all too often, doctors are just willing to tell women who are afraid of childbirth, “Oh, don’t worry about a thing — if you don’t want to give birth, we can give you a C-section.” While I can accept that women should have the right to choose to give birth as they wish, I wish that doctors (and others) would give a little extra time to ask a woman why she’s afraid, and see if they can work through her fears, rather than just cutting her open unnecessarily. If her fear is irrational yet she holds onto it, fine, give her a C-section; but if she has a rational but misguided fear (for example, I heard recently of women who want a C-section because of a fear of their “vaginas exploding”), then get to the root of the fear! Instead of treating her like a little child who is afraid of getting her dress mussed by going outside, treat her like the rational woman she is, and give her true information to combat the

F-alse

E-ducation

A-ppearing

R-eal.

In a recent discussion we have had on our independent childbirth educators email list, the topic turned to one of the basic differences between supporting a woman through labor, and medicating a woman through labor; between listening to a woman’s complaints, and “fixing” a woman’s complaints; between most home births and far too many hospital births.

One woman told of an experience in supporting a woman through her labor.  The mother turned to her doula and husband once and said, “This sucks!” The doula answered, “Yes, I know it hurts, but you can do it.”  The mother responded, “Yes, I know I can do it. I just wanted to let you know it sucks!”

How many nurses, husbands, or other birth-support people would have heard the woman say that, and offered her medication to “fix her problem”? She wasn’t needing anything fixed — she just wanted to communicate. Isn’t there a whole industry in attempting to help men and women communicate, especially in marriage and other personal relationships? Why should we think that doctors (who are typically trained in the all-male tradition of med school for generations) and the medical establishment will know how to communicate in the all-female world of birthing mothers?  Men tend to want to know the answer. Doctors are also trained in how to fix problems, medically. Mothers want to talk about it first.

So many women just want to be listened to. These basic differences will not just disappear because women are in labor. Some people — both men and women, although men tend to fall into this much more easily than do women — just want to know the answer and use it to fix problems, even if the “fix” is something unwanted by the person who is dealing with the situation.

When a woman’s birth-support team moves too quickly from listening and encouraging – and the other basic tenets of female relationships and female support – they may undermine a woman’s innate courage and strength.  This can happen regardless of the sex of those who surround her in birth.

What if, instead of telling her “you can do this,” the doula had responded, “would you like an epidural?”  The mother may have heard, “You’re not strong enough to handle labor without drugs, so just go ahead and get an epidural before it gets any worse.”  For my part, I’m very vulnerable to suggestion during labor.  A question like that — as innocent as it sounds — may have been enough to make me say “okay.”  Because, after all, if the people who are watching me labor think I need an epidural, then maybe I do!

Fortunately, nothing like that happened during either of my labors.  Instead, the midwives asked open-ended questions, like, “What do you want to do?”  Every time they asked a question or made a suggestion (like getting into or out of the labor tub) I obeyed it as much as if it were a command; questioning it no more than if they had asked me if I wanted some cake, or if I should breathe.

Sometimes, women just want acknowledgement of what they’re going through, rather than changing what they’re going through.  At times labor hurts, it’s intense, you just can’t get comfortable and there is no way in hell you would call what you’re doing relaxation.  It can suck.  It’s time to honor that too.  Don’t fix us.  We’re not broken.

This post was prompted by another blog I read several days ago, in which the blogger said that we were. Although I have no intention of linking to said blog, you can take my word for it that this woman is well-known to natural-birth circles as being among the meanest anti-homebirth people out there, so this coming from her made me laugh.

But it got me to thinking. Undoubtedly, there are some mean pro-natural or pro-homebirth people — those who would demean the choices of women who choose to give birth in the hospital or to have drugs. But there are very many people who demean the choices of women to give birth at home or who refuse drugs. As a natural-birth advocate and a home-birth advocate, I am acutely aware of this kind of person, having had to explain myself and my choices numerous times to people who severely disagree with me.

This antagonism is not good. For either side. And it tends to exacerbate the differences until they seem to be huge and insurmountable, and indeed to make women who agree about a great many things into some sort of enemies, and to become super-sensitive to statements, when they ought not be. An example — on my own blog, one of my readers took exception to something I said about “not understanding why” a woman would choose an unnecessary Cesarean. She took it to mean, somehow, that I was saying that women who chose a C-section when they didn’t have to were somehow bad mothers. I meant nothing of the sort, and was just talking about practical, concrete matters like having a recovery of several weeks as opposed to several days, etc. Absolutely nothing about “motherhood”… but she read that into it. After my explanation, she commented again, thanking me for explaining my position and said she was sensitive on the subject, because of some harsh criticism she had endured in the past for her choice.

I know some people find that every difference in opinion or action must mean that they’re doing something either better or worse than someone else. But thinking about this further, let me take this to a ridiculous extreme. I had chicken enchiladas last night, did you? I’m planning on making pizza tomorrow night, are you? Do you feel like you made a bad decision to have tacos or spaghetti, or to go out to eat last night, now that you know that I made chicken enchiladas? I sure hope not! Do you think that I would have done better to have made what you had for supper last night? If you do, I beg to differ! I hope you’re at least smiling now. The point is, just because somebody does something different, it doesn’t always mean that we think we’re the best and you’re the worst because we’ve done it differently.

In our group of Independent Childbirth Educators, we have a several commonalities among us, but that doesn’t mean we’re all cookie-cutters in everything. Take diapering as an example. (It doesn’t come up much, so I don’t know for sure how many people do total cloth vs. total disposables, or are like me and do some of each, but I do remember at least one woman saying that after her emergency C-section, her baby was brought to her “in a disposable diaper, of all things!”) Why do some people use cloth diapers for their babies? Cost for one. (Does that mean that you’re a horrid spendthrift if you use disposables? No! That simply may not be a factor for you, although it might be for others.) Environmental concerns is another reason. (But that doesn’t mean that we think you’re “raping our beautiful planet” by using disposables.) Cloth diapers may possibly healthier for the baby — in terms of diaper rash (my sister-in-law’s son was horribly allergic to all disposables), or the chemicals used in making disposables being right on their skin 24/7. (But that doesn’t mean that we think you’re a dangerous mother for putting your baby in disposables.)

The point is, “different” doesn’t mean “bad”, and saying why we’ve chosen different things doesn’t mean that we’re “mean.” For one thing, our reasons for choosing the things we did may not be reasons for you. For another thing, we might be wrong in our conclusions, though based on the best research we could find at the time. And finally, in these types of choices, in the final analysis, it often just comes down to pure opinion. Just because you’ve chosen differently from me (and believe me, there are a lot of differences among the women of this group), it doesn’t mean that I think you’re a horrible person. And although I have reasons why I do the things I do, just because your conclusion is different, doesn’t mean your reasoning is faulty or your decision is wrong. Just different. And that’s okay.

Independent Childbirth is sponsoring Orgasmic Birth screenings across the country. One mother shared a copy of a VBAC Consent Form she was asked to sign.  Many hospitals ban VBAC altogether either legally because their insurance carriers will not protect them or with a “de facto” (in practice) ban.   Some hospitals do still allow them, and this form does a fair job of pointing out the risks and benefits of both a repeat C-section and a VBAC. However, it does not point out that women have up to a 3.6x higher risk of death if they have a C-section versus a vaginal birth. Here is a more complete and detailed list of the risks and benefits of both an attempted VBAC and a repeat C-section, based on the available research. Nowhere on the list does it list the risks of cesarean to the unborn baby. Did you know that your future babies’ health in utero is at risk when a cesarean is performed? This is because the growth of scar tissue cannot be controlled. We know of babies born prematurely as their placentas could not adhere at the scar tissue site from mom’s previous c-section. No, we don’t provide this information to scare you out of having a cesarean. If it’s necessary, it’s necessary. Please, the decision to have a cesarean is a serious one. You deserve to know all of the risks and you deserve to know what care practices can lead to unnecessary cesareans, repeat, unnecessary cesareans.

Many doctors state they don’t want to scare women about the risks of the procedures they use for birth care. Doctor, you need practice in communication skills. Women can handle hearing the truth! The risk of death to their baby is nearly 3 times that of vaginal birth. (This is for low-risk women!) Or, what about these risks now or in the future?

Here is a slightly different VBAC informed consent form, and the preface reads like this, in part:

Although the risks of a uterine rupture with a prior low-transverse uterine scar are not higher than the unanticipated risks of other complications that may arise during childbirth, in some communities, women who wish to try for a VBAC rather than schedule an elective repeat cesarean are often expected to assume responsibility for any or all negative outcomes.

To lower the risk of liability, some malpractice insurance companies in the United States have developed VBAC consent forms that physicians are required to discuss with patients who wish to labor after one or more cesareans. Some of these consent forms overstate the risks for laboring for a VBAC or minimize the risks for planning an elective repeat cesarean.

But some “informed consent” forms just ignore the risks of a C-section altogether! This webpage is just such an example, but it has been annotated by someone who is obviously very pro-VBAC to discuss more of the risk-benefit ratio of the two procedures.

The greatest obstacle to women’s health today is lack of public dialogue. Get yourself to an independent childbirth class where we want to hear YOU. We can provide answers outright and answers that help you discover for yourself what you want from your birth.

Winter is still here in Connecticut. I drove to Capitol Avenue to formally hear the opinion of the Connecticut Medical Examining Board regarding midwifery, specifically Direct Entry and Certified Practicing Midwives. It began with the lot of us being told the doors were being opened for us to to come in but we need to keep the noisemakers, meaning the children, out. Dennis O’Neill, MD, Chairman of the Board explained the acoustics were so poor in the Conference Room they could barely hear each other let alone the audience who might speak.
 
At this point in time we know only that the charges stemmed from a transport case, a transport that was timely and resulted in a positive outcome.
 
It has been reported by members in the midwifery community that the case was not the result of poor care, a complaint from the parents, nor was there a maternal or fetal death. Although I never caught the actual root of this case I did meet Donna Vedam who had been through this procedure before and realized her case was why we found ourselves here again. In her case, parents who were more than overjoyed with their birth experience wrote their insurance company asking them to consider covering homebirth in the future and wrote how homebirth saved money, reduced the use of interventions, and improved birth outcomes. Someone somewhere in the insurance company read the letter and thought this must be illegal! They forwarded the letter to the State to look into and Donna was accused of practicing medicine. That charge was dismissed as it was determined that she was practicing midwifery and midwifery is not medicine.
 
Since that precedence already exists, the Board has to step up the charge and go for practicing nurse midwifery without a license. It is a step toward regulating midwifery in Connecticut — and make no mistake about it — a step towards eliminating the “problem” of midwives enticing women away from OB income, and opening the window to the proven dangers of many routine interventions.
 
In less than four minutes total the issue was brought up and voted on. Dr. O’Neill relayed that the case was dragged out over 21 months with only 8 actual days of hearing, after which there was no explanation as to why it took this long to finally bring the motion to a vote. Dr. O’Neill simply said “it eventually lay around held up in some office somewhere …(until now).” As for this writer, what the summation hints to me is that the testimony presented during those 8 days took a lot of time and energy for the medical community to understand.
 
A doctor raised his hand to move to uphold, another seconded, and then all of the Board Members unanimously declared to uphold the decision.
 
Neither the motion nor the decision were ever actually stated, but it was to cease and desist, don’t do it again — “it” being practicing medicine without a license. What this hints to me, the writer, is that formally stating the decision would require an explanation supporting the decision and no one was prepared to do so, either as a subversive tactic for the day (we were actually thrown out, prevented from taking a peaceful group photo in the lobby), or as an ongoing tactic of “because we can.”
 
What is important for all women to know is that the board isn’t made up of consumers or consumer advocates. If it were, it would have members such as homebirthers Jennifer Wisner, Tammy Gallo, Tara McElfresh, Lisa Breton, Aja McCarty, and Bruce and Randy Neely who were here with their homebirthing daughter, Kendra Smith. They might have included a gentle birth La Leche League leader like Rebecca Cronon.
 
I think the Board’s worst fear, though, is that a member of their own community, someone like Susan Parker, RN, CEN might have been on the Board. As a hospital-based nurse, Susan has seen “the worst of the worst including witnessing a maternal death just six months before” she herself gavebirth. The experience left her even more determined to birth at home.
 
Which hospital you ask? Avoiding that hospital in particular won’t keep you any safer in birth. Maternal deaths in hospitals are everywhere like Hawaii, California, and New Jersey, as well as many other states and the truth behind the stories aren’t being told. Consider this, embolism is one of the leading causes of maternal death. Risk of embolism increases with surgical procedures and the cesarean rate is climbing steadily!
 
We are not arguing that no one ever needs to birth in a hospital nor that everyone needs to birth at home. The point is that we have medics who do not know normal, natural childbirth, but they are making unfounded decisions about a non-medical event. This, while they are forgetting to investigate their own at the least, and turn a blind eye to their own at worst.
 
The midwives’ next step is an appeal or to argue for the right to argue the decision. 
 
I may not have been alive in 1692 but what transpired over the past few years and culminated in today’s five minutes in Hartford, Connecticut, could only have been done better were the Board Members in period costume.

Recently The New York Times wrote about doulas and the article left a negative impression about doulas, and tossed in a criticizing lactation consultant comment as an aside. To take the view that the New York Times article does–as an across-the-board view that doulas are problems–is an error. The paper presented a complaint rather than pursuing a couple of viable angles: the many expectations that mothers and partners have of labor support today, and the licensure of female support at birth such as midwives, birth educators in the role of birth support, monitrices (someone who has been trained to provide some clinical assessment in labor usually while mother is at home) and doulas.

There are now many birth support and whole birth health care options for women to learn about, choose from and advocate for change. Midwives, independent childbirth educators, doulas, birth centers, homebirth and breastfeeding are now more commonplace subjects to bring up when planning birth. Women today are realizing that they need to avoid interventions such as induction which carries a higher risk for cesarean or just arriving at the hospital too early; and there are options available to support their refusal to fall in line with industrialized birth. In response, hospitals are trying to offer more and more amenities but many parents recognize that in spite of measures by hospitals to draw them in by offering a luxury tub or more comfortable birth room furniture, hospital birth is still hospital birth. Seeing the smoke and mirrors, women who still choose to birth in a hospital may seek additional independent female support in birth which has been shown to be a positive influence on outcomes. However the benefits of the additional birth support is very clear in the birth community and we hope the media will take the time to do more in-depth articles on the anthropology of women in birth, culturally and traditionally.

It is confusing for the public to read contradictory articles posted by the same journalism venue such as this one from CNN that says doulas advocate for you and then CNN also posted this article stating “doulas are not supposed to offer a medical opinion….strictly to motivate the mother.” What remains the focus for women is that we still need to think independently, make our own choices and employ those who support our choices from birth care to birth itself. Women have many different reasons for hiring a doula besides strictly whether or not to ask them to advocate. Doulas can make fathers and siblings comfortable with birth and help them enjoy birth too! There are obstetricians, midwives and labor and delivery nurses who have witnessed doulas as an extra pair of caring hands so that all participating in the birth remain fresh and positive during a labor and birth–especially an intense birth. Doulas help military moms birthing without their partners. Doulas are sometimes even interpreters! This is a day that many never imagined: birth support, midwives, homebirth, unassisted birth, informed birth, etc. are all in the headlines!

In many states women’s choices are being restricted and the birth community continues to work together for the greater benefit of society at large ~ improving mother and baby outcomes ~ and for the mothers and babies where you live!