The Importance of Prenatal Education

By Mali Schwartz

There are many prenatal programs that have been developed over the years to help women cope with childbirth.  The first childbirth education programs in America were conceived by men such as Dr. Fernand Lamaze, a French Obstetrician who introduced The Lamaze Method in 1951 through observing birthing techniques in Russia.  Dr. Grantly Dick-Read, an English obstetrician, introduced the idea of childbirth as a natural process whose book “Childbirth without Fear,” was published in 1933.  Dick Read’s work helped spawn the natural childbirth movement in the 1960s.

As childbirth became influenced by more advanced medical technological advances and the cesarean section rate rose in the 1980s, a number of grassroots organizations were formed to help educate the public about their birth choices.  BirthWorks International was created to educate women about the viability of having a VBAC – a vaginal birth after a cesarean.  BirthWorks International is one of the most comprehensive prenatal education programs available today.  It offers a holistic approach that focuses on the whole person. 

The prenatal education a woman receives through BWI not only helps her to understand proper nutrition and learn about the physiology of birth, it also includes topics that more standard prenatal education programs don’t even touch upon.  For instance one area that BirthWorks focuses on is healing past emotional pain in preparation of birth.  If a woman can heal emotional scars from her past – which may go all the way back to childhood, she has an opportunity to clear out negative energy fields that can hold her back from having an optimal birth experience. 

One example of how deeply held feelings manifest in the body is when a woman may experience bad headaches, feelings of numbness and depression.  These symptoms are related to holding anger and resentment, but she hides these toxic feelings behind a smiling, cheerful demeanor that she shows to the outside world.  In order to understand why she holds such anger, she must first explore and look for hints that lead to an understanding of what is happening.

Emotions allowed to flow freely in the body invariably change.  Using anger as an example, anger that is held typically remains anger.  But anger that is felt and allowed to move typically changes into other emotions, often fear, sadness, or pain. 

As an integral part of her training to become a BirthWorks International educator, a trainee must enroll in a three day workshop where she is led through a series of exercises to help release any deeply held emotional pain she might hold.  This will help her to act as a facilitator for her students to help them clear their own emotional fields. 

For instance exercises that ground and bring energy down through the legs and feet as well as working with the breath, the body, and the energy fields, is a way to clear out dead energy.  This allows for a basic sensation of feeling and a sense of grounding.  Simple exercises that help to open the energy centers on the bottom of the feet by standing and rolling one foot and then the other on a small rubber ball, stretching the toes and soles of the feet, squatting and straightening out the legs until there is a strong sense of the legs, helps a woman to feel more connected to her lower torso and feet.  This in turn gives her a greater sense of solidity and balance. 

Even though some women may not even be aware that their bodies are holding negative energy patterns, a perfect time to clear out these stuck patterns is before they actually give birth.  By clearing emotional blocks, an expectant woman will have much more energy to birth her baby into this world. 

Enrolling in a BirthWorks International childbirth education class give women the latest cutting edge childbirth information as well as helping them to delve into the essence of their being. 

Join our Board of Directors!

Would you like to be part of the BirthWorks International team? We have several open board positions, and we welcome your application! To apply for any of the following positions, send a letter of interest, two letters of reference, and a current resume or CV to info@birthworks.org.

Your letter of interest should detail your skills and background, explain why you think you are the one for the job, and state your personal goals for the position. Application materials should demonstrate a working knowledge of the responsibilities required, and a desire to serve BirthWorks. 

Letters of reference should include: One letter and reference attesting to the applicant’s integrity and character, and one letter and reference addressing the applicant's organization and communication skills from someone who has observed the applicant at work in their field.

 

Director of Marketing

Function and Responsibilities

• Further the mission of BirthWorks through marketing opportunities
• Oversee the Marketing Committee
• Coordinate print, web and other marketing opportunities within the budget set by the Treasurer, with Board approval
• Responsible for setting up speaking engagements for herself and various Board members at national conferences in order to promote BirthWorks mission
• Responsible for setting up tables and/or print ads at national conferences. Will oversee staffing of tables with local Birth Works members.
• Coordination of media packet and necessary follow up
• Responsible for sending out press releases several times annually to promote various workshops, programs, conferences and position statements for BirthWorks
• Submit articles or information for BirthWorks publications as needed
• Participates in monthly Board of Directors Conference Calls

Skills/Experience Required

• Certified childbirth educator or doula with BirthWorks preferred but not required
• Good written and oral skills
• Excellent computer skills with internet access
• Ability to travel to annual Board of Directors meetings
• Participate in monthly BirthWorks conference calls
• Willingness to travel in local area for speaking engagements or as an exhibitor for BirthWorks.
• Previous experience in marketing and public relations

Eligibility Requirements

• Member of BirthWorks in good standing
• Unlimited computer and internet access
• Excellent interpersonal skills and ability to work well with a team

 

Director of Doula Program

Function and Responsibilities

• Responsible for coordinating and overseeing the Doula Program for BirthWorks.
• Oversee Doula Trainee Review Committee
• Coordinate with Board of Directors in developing new ideas for program development
• Make recommendations to the Board regarding changes in the Doula Program
• Submit articles or information for BirthWorks publications as needed
• Develop materials for the Doula Program
• Revise and update existing materials as needed
• Work with Workshop Coordinator to increase the number of BirthWorks Doula Workshops being held nationwide and overseas.
• Be on the Trainee Review Committee as a reviewer of doula students
• Participate in monthly Board of Directors Conference Call

Skills/Experience Required

• No unresolved grievances
• Be a Certified Doula with BirthWorks International
• Good written and oral skills
• Excellent computer skills
• Ability to travel to bi-annual Board of Directors meetings

Eligibility Requirements

• Member of BirthWorks in good standing
• Be a good team member of the Leadership Team
• Have unlimited access to computer and internet

 

Public Events Coordinator

Function and Responsibilities

• Works on a national scale to organize public events, national conferences and local birthing seminars.
• Furthers the mission of BirthWorks to provide opportunities to educate the public about safe birthing practices.
• Provides strategies and locations for BirthWorks public events and conferences
• Is part of a Leadership Team, working with the Board of Directors
• Coordinates print, web and other marketing opportunities within the budget set by the Treasurer, with Board approval
• Responsible for organizing the setting up of exhibit tables and/or print ads at national conferences and oversee staffing of tables with local BirthWorks members.
• Is part of a Leadership Team, working with the BirthWorks Board of Directors
• Opportunity includes meeting the changemakers in childbirth from the USA and overseas.
• Participates in monthly Board of Director Conference Calls
• Be willing to travel to BirthWorks public events and annual Board of Director meetings

Qualifications

• Member of BirthWorks in good standing
• No unresolved grievances
• Good written and oral skills
• Excellent computer skills with internet access
• Ability to travel to annual Board of Directors meetings
• Previous experience in organizing public events
• Excellent interpersonal skills and good Leadership Team member

 

Director of Public Relations

Function and Responsibilities

• To further the mission and vision of BirthWorks through public relations
• Develop strategies and use all means of social media to publicize the name and message of BirthWorks i.e. press releases, Facebook, Twitter
• Develop campaigns and slogans that help brand BirthWorks nationwide.
• Works with the chair of the Ambassador Committee to determine ways in which Ambassadors can help spread the name of BirthWorks..
• Develop materials needed to increase exposure of BirthWorks to other organizations and individuals working within the budget set by the Treasurer with Board approval
• Set up and promote speaking engagements for Board Members at conferences.
• Works with the Public Events Coordinator to set up exhibit tables and/or print ads at national conferences Oversee staffing of tables with local BirthWorks members.
• Works with the Director of Marketing to seek ways in which to further public relations with other birthing organizations.
• Update and promote media packet with necessary follow up making sure BirthWorks International is included in national and international publications (books, magazines)
• Is a contributor to the BirthWorks newsletter and works closely with the editor.
• Send press releases several times annually to promote various workshops, programs, conferences and position statements for Birth Works
• Submit articles or information for BirthWorks publications as needed
• Ability to travel to annual BWI Board of Director meetings
• Participate in monthly Board of Directors Conference Calls

Skills/Experience Required

• No unresolved grievances
• Good written and oral skills
• Excellent computer skills with internet access
• Ability to travel to annual Board of Directors meetings
• Willingness to travel in local area for speaking engagements as a representative of BirthWorks . Option to travel nationally, if desired.
• Previous experience in marketing and public relations

Eligibility Requirements

• Member of BirthWorks in good standing
• Unlimited access to computer and internet
• Excellent inter-personal skills and a good team member of the Leadership Team

 

Director of Publications

Function and Responsibility

• Responsible for the organizing and publication of BirthWorks quarterly newsletter and BirthWorks E-News
• Oversee the Publications committee, consisting of Editor of the Journal, Editor of the E-News and various writers
• Responsible for securing advertising for each publication
• Responsible for working with the responsible parties to oversee publications that Birth Works has in print.
• Submit articles or information for BirthWorks publications as needed
• Participate monthly Board of Director conference calls

Skills/ Experience Required

• No unresolved grievances
• Certified CCE or Doula with BirthWorks
• Good written and oral skills
• Excellent computer skills
• Ability to travel to bi-annual Board of Directors meetings
• Willingness to travel in local area for speaking engagements as a representative of BirthWorks . Option to travel nationally, if desired.
• Prior experience in editing and publishing is desired

Eligibility Requirements

• Member of BirthWorks in good standing
• Unlimited computer and internet access
• Excellent interpersonal skills and good team member

Book Review: New Mother by Allie Chee

Reviewed by Jane Beal, PhD, CD(DONA), CCE(BWI) & CLS

Allie Chee, author of New Mother: Using a Doula, Midwife, Postpartum Doula, Maid, Cook or Nanny to Support Healing, Bonding and Growth (Hestia Books & Media, 2012), is clearly an extraordinary person. She gave birth to her first baby at the age of 42 at home in the care of a midwife, but only after traveling to 50 different countries around the world, co-founding a leading financial industry publication, and owning her own cleaning business. So, as she says, “in the spirit of community” she offers what she has learned to her readers to help them “realize their dream of motherhood” (p. 20).

Allie Chee clearly values the opportunity for mothers to stay at home and raise their own children. She is in favor of families having servants to help make this happen well. As the daughter of a single mom who worked as a cleaning woman in Texas and as a woman who cleaned plenty herself—and then went on to own a cleaning business—she places a high value on service. Service is undervalued in our culture, but not in Chee’s family. In Chee’s view, service is particularly valuable to pregnant, birthing, and postpartum mothers. She has a good point.

Relying primarily on her personal experience, she talks in detail about the services she received from her OB-GYNs (only one of whom she kept as a back-up), two midwives (one of whom she fired), three doulas (all affiliated with her chosen midwife who were apparently in the role of apprentices), her two postpartum doulas (one of whom she detested), and a woman she hired who is, as she says, “a lot nanny, a little bit cook, and a tiny bit maid” (p. 125). She explains the qualifications she believes people in each of these roles should have and how she went about hiring them, giving the specific questions she asked in interviews and explaining the importance of contacting references. She emphasizes the importance of feeling that special “click” with people who are going to serve you.

Interwoven throughout her chapters is Chee’s interest in traditional Chinese medicine, Ayurvedic healing, and vegan meal preparation. She highlights the Chinese practice of the “sitting moon,” a 30-40 day period after birth in which the mother keeps to her bed with her baby as part of her healing process. Americans typically go on the “honeymoon” when they marry, and many have heard of the “baby moon” (a honeymoon-like getaway for the married couple during the second trimester of pregnancy), but incorporating the “sitting moon” into family life could bring truly great benefits. Chee particularly endorses the book, Sitting Moon: A Guide to Natural Rejuvenation after Pregnancy by Dr. Daoshing Ni and Jessica Chen.

As Chee accurately observes, far too many mothers strain themselves physically and emotionally in the postpartum period, primarily by returning to work before they are fully recovered from childbirth. This is better avoided—and can be, according to Chee, with proper support from others. In a day and age when family members can rarely take time off work to be with a new mother and baby, servants, in Chee’s view, are the key.

While New Mother is a useful book, it may not resonate with everyone. Allie Chee’s heart is clearly sympathetic to single moms, but her primary advice about how to achieve staying home with your baby after childbirth with servants to help you is not something most new parents can consider. She does not offer specific advice on how to afford this goal (though she does promise to do so in her next book, New Family). In Chee’s case, it appears that her own past financial success combined with her husband’s willingness to be the primary breadwinner during their only child’s infancy has made this affordable for her.

Chee is clearly in favor of natural birth, but her view of attachment parenting is unclear. She mentions babywearing (with a story of how her postpartum doula recommended a wrap that did not work for her) alongside car seats. She does not endorse safe co-sleeping and on-demand breastfeeding (though she does mention these as options). So families planning to practice attachment parenting may wish to read Dr. Sears’ The Attachment Parenting Book.

Finally, Chee does not cite or list other useful resources new mothers may want to consult, including books on natural childbirth like Pam England’s Birthing from Within, Barbara Harper’s Gentle Birth Choices, and Ina May’s Guide to Childbirth (though she does mention Ina May herself). Penny Simkin’s The Birth Partner, Klaus and Kennell’s The Doula Book and Rachel Gurevich’s The Doula Advantage will give mothers a much clearer idea of what most doulas actually do. Families might want to research doula organizations like ALACE/ TOLABOR, BirthWorks International, CAPPA, DONA International, and ICEA, too (Chee only mentions DONA in a footnote) or investigate the main differences in training provided to OB-GYNs, MDs, DOs (not mentioned), CNMs, CPMs, lay midwives, and traditional birth attendants. The book has very-little-to-no discussion of the importance of childbirth education, placental encapsulation (a traditional Chinese medicine technique!) or lactation counseling and consultation. The role of the father is relegated to a few brief mentions.

That said, Chee’s book is easy to read and relate to overall. It explains why family servants are needed and what their roles can be. In the end, it achieves its goal of presenting the role of service to the family by doulas, midwives, postpartum doulas, maids, cooks and nannies as a highly desirable and potentially wide-spread norm for Americans in the future.

How caregiver inquiry can shape prenatal care and birth experiences

By Anna Holder, CCE(BWI)

"What’s your cesarean section rate?"
"What is your episiotomy rate?"
"May I eat and drink during labor?"
"May I have a doula/ lots of family/ a photographer at my birth?"

Women and their partners are often encouraged to ask these and similar questions when selecting a care provider for their pregnancy and birth, the theory being that the provider who provides the answers the woman and her partner are looking for will provide safe and effective care. What about compassion, satisfaction in the birth process and empowerment of the woman and her partner? 

The answers are in the questions -- the questions that the provider asks, that is.

When a doctor or midwife goes beyond impersonal lifestyle surveys and “intake” questions, they are able to establish a relationship of trust with their client. They are also gaining a unique and in-depth look into the lives of their clients. Conversely, women and their families are given a strong voice and are invited to become true partners in their care and birth process rather than obedient “patients”. If a provider can not be bothered to ask in-depth questions or encourage the birthing family to research both scientific evidence and their own personal realities, why would that provider value the laboring woman or her support team in the throes of labor? Moreover, if the woman and her care provider have not explored these issues in the relative calm of the prenatal period, how will the relationship between them play out in the excitement of birth?

Some questions prospective caregivers should be asking women are:

1. Tell me about your previous births or experiences with birth. What did you like or not like about them?

 This question encourages reflection on the part of the woman and her partner and identifies possible fears, expectations and goals. When started early, this dialogue can build a foundation of trust between provider and client as well as between the woman and her partner. It also helps to create a framework of what client and provider are working towards in regards to maternal and fetal health and birth process.

 I once had a client who wanted a vaginal birth after cesarean (VBAC). Her primary cesarean was for a breech baby where no option for External Cephalic Version (ECV) was offered. She was separated from her child for 3 hours and suffered Postpartum Depression. Upon learning of her second pregnancy, she chose a different provider and place of birth. When it was found that her second child was also breech, she was encouraged to try herbs, acupuncture and positional techniques before being offered an ECV. When the version was unsuccessful, she chose to go into labor on her own before a repeat cesarean was performed. She was never separated from her child and reported a great deal of healing from her first experience. As she had explained her hopes and fears to her doctor, she had her wishes honored and had a respectful birth. 

2. Why do you want to have or avoid particular tests or procedures? Have you read about the risks and benefits?

Asking this question sets the stage for informed consent or refusal and promotes research and accountability for the birthing family. When families are encouraged to participate in their care and hold some level of responsibility for it, they are more likely to make well thought out choices in addition to feeling more satisfaction with their experience.

The safety of VBAC is well documented. However, many obstetricians dissuade women from pursuing this option in spite of the most current recommendation by the American College of Obstetrics and Gynecology (ACOG) endorsing trial of labor after cesarean(s) (TOLAC). Even a cursory exploration of the current research would provide those wishing to have a VBAC with ample support of their goal.

3. What are you eating? How can I help you incorporate healthy changes?

Simply telling a woman not to smoke, drink alcohol and avoid sushi is not the same as ensuring proper protein intake and identifying any potential deficits in diet. By dedicating ample attention to nutrition, mother and baby can achieve optimal health while avoiding complications from morning sickness to pre-eclampsia.

I know of a woman who was planning a home birth with a midwife. At her home visit it was found that her blood pressure had elevated after she had been following a strict diet and herbal regime. After asking more questions and a tour of her cupboards, it was found that a powdered tea beverage the woman was drinking daily was delivering a whopping 27g of sugar.  The midwife counseled her that this was not helping her pressures and could make her already presumably large baby bigger. After removing the beverage, the woman went on to have a healthy 8lb 15oz baby at home 3 weeks later. (Okay, okay, the woman was me, but I still haven’t had any more chai).

Just as a provider’s cesarean rate doesn’t always belie their philosophy about birth, the number of births a woman has had doesn’t illustrate the unique circumstances present in her current pregnancy. The earlier providers establish a deep dialogue, the more compassion and satisfaction are united with safety and efficacy to provide better outcomes for moms, babies and providers.

Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital

by Cathy Daub,  PT

I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jersey and Florida have the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 

They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 

The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   

I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:

1. Where do you feel safe giving birth?
2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?

The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey¹ with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey

•         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.

•         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 

•         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.

•         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 

Few women used highly rated nonmedical methods of pain relief such as:

1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
2. Drinking or eating during labor,
3. Freedom of movement during labor,
4. Pushing and giving birth in non-supine positions, and
5. Supportive rather than directive bearing down. 

The Listening to Mother’s II survey concluded:

• Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
• The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.

These conclusions point to three concerns:

1. We need more childbirth educators.
2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.

Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.

Reference:

1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers

Birth Panel

by Anna Holder CCE(BWI)

Truth, like surgery, may hurt, but it cures.
- Han Suyin

The fourth annual Hudson Valley Birth Options panel took an especially hard look at the truth this year. As in previous years a number of childbirth educators, doulas, midwives and mothers form a panel for local families to explore their birth options. Families from a wide range of backgrounds and birth experiences attend in hopes of connecting with providers and to better understand the choices in pregnancy and birth.

It is interesting to note that the hospital with the highest cesarean section rate (58%) once again failed to send a representatives and that two Ob/gyns who were slated to appear did not. This year’s panel experience was different in that many of the women in the audience were moved to tears. A brunette raised her hand and began to speak

. “ This question is for any of you, I am just wondering if I have any options; I am 8 weeks pregnant and I have had multiple c-sections and it was so horrible that I didn’t want to have any more children and now i find myself pregnant and I just….”

She began to sob and was unable to continue. Luckily she was in a room full of support and love and thus was quickly surrounded by hugs and tissues. The most interesting development was from one of the older homebirth midwives in the area.

“ You have to leave the state. I can’t tell you what your birth will be like but if you want an honest chance at a vaginal birth, then you have to leave the state.”

            Even sadder is that the entire room full of women knew she was right. What kind of society are we living in where it is easier to schedule a major surgery with its inherent risks, than it is to have a natural, physiological birth?  What kind of society are we living in where mothers fear having more children because of trauma from previous births? What kind of society are we living in where a woman is told that her only option for a VBAC is to leave her home, children and familiar surroundings to go to another state? Someone brought up the familiar OB saying,” I don’t get sued for doing the C-section”

If the upper limit of the World Health Organization (WHO)  recommended rate is 15% then we can conclude that the other 23% in New York State and 17% nationally are more likely than not unnecessary.  Doctors are failing to practice by their governing bodies (ACOG) guidelines, which state that women should be given a trial of labor even after multiple cesarean sections.

The evening further explored:

• Suing for non urgent or emergent primary cesareans
• The limited availability of skilled providers to attend breech vaginal births and the failure to recognize breech as another variation of normal
• The fact that even positive birth stories can be detrimental by “setting the bar too high “ and influencing a mothers idea of a “good birth”

 It is clear that the climate of birth is changing, at least in New York State.

In a time when we are facing an ever-increasing C-section rate, there is a small but not discountable group of women rallying against it saying “We are taking back birth,” but  we need to remember is that we never gave it away in the first place!

The Power of a Birth Circle

By Molly S. Wales CCE(BWI)

Our small town of Athens, Ohio is home to a consumer birth group called The Birth Circle.  Over the ten years since it began, The Birth Circle has grown from a handful of mothers who got together to share their birth stories, to a powerful community organization that has made a substantial difference in the lives of birthing families, and in our local birthing climate as a whole.  We share information, offer support, and build friendships. We do not endorse or judge.  And as the director of this group, I have the great honor of witnessing how, every single time we gather together, whether to talk about potty training or pain management in labor, or to share a meal, or to grieve a childbearing loss, we lift each other up, and give each other courage, simply by being present.

Let me give you two examples of this from recent meetings.  A few months back, a new couple joined us for a discussion about gentle discipline.  They quickly shook my hand, took a seat, didn’t engage with anyone around them, and in general gave an impression of being very shy and conservative.  She was pregnant for the first time, and new to Athens, and I hoped that this meeting would open some doors for them, in terms of building community and answering questions about birth and parenting.  About halfway through the meeting, a mom seated on the floor across from them pulled her breast up and out of her shirt, and began to nurse her baby.  The dad looked at his wife with wide eyes, clearly a little shocked at how she displayed her breast.  Within seconds, the mother’s toddler came over, and she tandem nursed them for a while, the baby laying in her lap while the toddler kneeled and wiggled.  The new parents tried not to stare, but their discomfort was obvious.  I thought to myself, “We’ve lost them.”  When the meeting adjourned they rushed out, and I didn’t expect to see them again.  But to my great surprise and delight, at our next meeting a month later, there they were.  And at the next meeting, and the next.  They never spoke up, but they came to every meeting, and along the way their demeanor relaxed a little.  I don’t know what sort of birth they had, nor the sex of their baby, nor if they’re even still in town.  But I think of them often, and how their decision to return showed openness and courage, and I think of that mom, too, who tandem nursed so nonchalantly in public, and never knew how she’d so beautifully exposed this couple to a new idea.

Another example.  Every April we dedicate our meeting to sharing birth stories.  This last time was heavy with home births, with hospital birth stories (both natural and with interventions) interspersed in between.  After the meeting I got a call at home from a mom who was 38-weeks pregnant, who had decided, after that meeting, to change her care provider.  She was tired of “impersonal, rough OB care.”  She wanted to know about midwifery options.  I encouraged her to interview local midwives, and a few days later she called back to let me know she’d taken the plunge.  She had chosen a home birth team, had collected her records from her OB office, and was ready to come pick up a birth pool (we loan them out for free).  When she showed up with her husband, she was glowing.  They smiled ear to ear.  It seemed such a bold to move, to change caregivers so late in her pregnancy, and I commended her for her bravery.  “I would never have thought I could do it,” she said, “if I hadn’t heard those birth stories.”  What exactly was said that empowered her, I don’t know.  But that’s not really important.  She heard something that helped her take a critical look at how she was being treated, that helped her see and feel her own personal truth, and that emboldened her to make a decision that her  extended family perceived to be reckless, yet which was absolutely right for her and her baby.  Those are the times that I think, “Wow, we are changing the world.”

And that is the power of a birth circle.  The power of women and their families getting together to talk.  Not to compare, but to share.  We lift each other up.  We are challenged.  We teach and learn.  And with every tiny bit of support that is exchanged, intentional or not, we become more fulfilled people, and better parents for our babies.

Molly S. Wales is the director of operations of The Birth Circle in Athens, Ohio. 

www.athensbirthcircle.com

Value of a Doula

by Tiffany Hare

When people ask me what I do, I always respond by saying, “I’m a doula and a childbirth educator.” And then I wait. I wait for the look of uncertainty to fill the face of the person who asked me the question, or for them to say, “What’s a doula?” The word is still a very unfamiliar one in some parts of the country, and even though I live in a large suburban area outside of Philadelphia, many of the people I come into contact with outside of the birth-world have never heard of a doula.

And that makes me a bit sad.

I think back to a time when women were surrounded by other women during their labors and their  births; a time when by the time a woman had reached childbearing age, she would have seen birth happen so many times that she was well-prepared for it herself.

But we don’t live in that time. We live in a time in which birth is unknown and frightening to many women. It is during this time that we need doulas.

We need doulas to help us get the information that we need so that we are empowered to make the right decisions for ourselves and for our babies. Doulas can help us make decisions by providing us with information and guidance. Doulas help us through our labors and our births by offering constant companionship .

The value of having a birth doula cannot be underestimated. As anyone who has given birth can tell you, giving birth is one of the most life-alerting events that one can experience. Birth is an intimate event. It is an event that does not come with a do-over button. And while we can never predict an outcome, especially in an event as unpredictable as birth, we can take steps in order to achieve the birth experience that we dream of.  Doulas are one step you can take in order to get the birth that you hope for.

Since the beginning of human history, birth took place in the home, with family present, and with a midwife who was experienced in normal birth. Girls and women witnessed birth and experienced it long before they gave birth to their own children. Today, in a culture in which birth typically takes place outside of the home, most women have no experience with childbirth until they give birth themselves. It is a new and foreign experience for most of us.

On average, the length of time a woman who giving birth for the first time spends in labor is about eighteen hours. During most of that time, she and her partner are left to blaze this unexplored trail on their own. It can sometimes be a scary experience that is full of unknowns.

However, studies have shown that having a doula present at your birth can greatly increase your chance of having a birth outcome that you feel good about. Doulas can help to increase positive birth outcomes and decrease the use of medications such as Pitocin and epidural anesthesia. Doulas can decrease the total length of labor by about 25% and decrease the incidence of cesarean delivery by about 50%. Overall, doulas can help you avoid unnecessary interventions and they can help you get off to a better start with your baby and increase your chances of having a successful breastfeeding relationship.

A doula is present during the entire labor and her knowledge and experience can help the mother find confidence and security throughout her birthing experience. When a woman feels safe, confident and secure, oxytocin (“the love hormone”) flows freely and facilitates the progression of her labor. Feeling safe reduces the presence of adrenaline, the hormone responsible for fight or flight syndrome, which can slow or stall a labor. When a woman is supported by a doula, she feels that she has better control of her birthing experience, can make decisions with confidence, and is free to trust what her body is telling her. 

Birth is an event that is not forgotten. The experience stays with us throughout our lives. In birth, as in life, there are no guarantees, but having a doula present at your birth can help get one step closer to realizing the birth that you hope for. 

BirthWorks 5K Fun Run!

BirthWorks International will be hosting its first fundraiser, the BirthWorks International 5K Fun Run at Freedom Park in Medford, NJ.   The walk will be preceded by a free yoga class and registration.  After the walk, the rest of the day will include fun activities for the family, a mini pelvic bodywork class, vendors and much more!

The run will take place at Freedom Park in Medford, NJ on September 8, 2012.  The park is located at 86 Union St. in Medford, New Jersey.   The event will occur between 9am and 3pm.  There will be a free yoga session at 9am, taught by Tricia Heiser of the Yoga Sanctuary of Medford followed by the 5K Fun Run/Walk at 10am.  Cathy Daub, the president and founder of BirthWorks International, will teach a free pelvic bodywork class for expecting mothers at 12pm.  Furthermore, the event will hold various children’s races and activities.  Prizes will be rewarded to all winners.

BirthWorks International embodies the philosophy of developing a woman’s self-confidence, trust and faith in her innate ability to give birth.  BirthWorks seeks working relationships with other childbirth related organizations, striving together to help birthing families make more informed and safe choices for birth.  It is our mission to train childbirth educators and doulas that in turn provide evidence-based, current information to birthing families through a unique experiential approach that is based on human values.  All proceeds from this event will fund programs that help educate and empower women and families around the world about safe birth practices and natural birth options.

            

    Being an international organization, we are aware that many of our friends and colleagues are unable to attend this event on September 8^th; however that should not discourage anyone from helping us raise the funds necessary to provide these programs and research to birthing families and enhance their knowledge and experience during this special and important time in their lives.  Please join us as a virtual walker.  By registering online at www.active.com/running/medford-nj/birthworks-international-5K-run-walk-2012, you can support BirthWorks and its philosophy by asking for sponsorship and donations from family, friends or co-workers.  Thank you and good luck!  

Silence In Labor

by Mali Schwartz  

Why is it so important to create a quiet, peaceful atmosphere during labor?   And how can women take charge of creating a peaceful environment no matter where they choose to give birth? 

The Leboyer Method, established by Dr. Frederic Leboyer in the 1970s was proven to minimize the trauma and stress experienced by a baby at birth.  This method of delivery advocated giving birth in a quiet room that had low or dim lighting.   Not pulling on the baby’s head; placing the baby on the mother’s stomach; not cutting the baby's umbilical cord until it has stopped pulsating, and placing your baby in a warm bath shortly after birth were other ways to ensure a less stressful birth. 

This method has had some influence in delivery rooms where noise levels are minimized to make the atmosphere more peaceful for mothers.  According to an article found on the website (pregnancy-info.net), “many midwives and doctors are willing to incorporate some, if not all, of the facets of the Leboyer method into the birth experience.”

Dr. Michel Odent, another birth pioneer who has conducted extensive research on how womb ecology can impact human development, has proven how important the quieting of the neocortex is during birth.  BirthWorks International provides a link on their website where anyone can access Odent’s primal health research.

According to Odent, the neo-cortex is the center for what we commonly consider our intellect.  It is the part that allows us to be logical and also creates our sense of inhibition, giving us our civility and our modesty.  When we are being stimulated intellectually or feel we are being watched, the neocortex is active.  This is not conducive to laboring women, who like mammals need no distractions while in labor.  They naturally focus inward and shut out the outside world.  Dark, warm, quiet surroundings are critical for her to maintain this space of consciousness safely and have the best possible labor and birth experience/outcome.

Engaging the birthing woman in discussion is not a good idea.  Other triggers that should be avoided are watching television, bright lights, feeling cold, and feeling observed.  Even music with certain beats, tempos and lyrics may cause– without the woman’s total awareness– a stimulation of the neocortex.   Although a woman might not even be aware when her neocortex is being stimulated, it’s vital that this part of the brain be at rest so that primitive brain structures can more easily release the necessary hormones such as endorphins, serotonin, acetylcholine, and vasopressin which help relieve stress and pain.

Have you ever heard someone say “I feel like I was on another planet,” while she was giving birth?  This means that the activity of her neocortex was reduced.  This reduction of the activity of the neocortex is an essential aspect of birth physiology.   Even the slightest attention can keep her from the true meditative nothingness of the primal consciousness her birthing body seeks.

What can we do to reach this state of meditative nothingness?   A book “Frequency: The Power of Personal Vibration,” helps us to understand how to intentionally work with energy to transform our lives.   Author Penny Peirce makes a leap that science has not yet made – namely that the energy frequencies of matter have matching consciousness frequencies.  In describing the four categories of brain waves from fastest to slowest -  beta, alpha, theta and delta, it is interesting to note that the fastest brain waves correspond with lower frequency waves, while the slowest brain waves correlate with higher frequency - expanded awareness. 

According to Peirce we can influence our personal vibrations, although our personal vibrations are also affected by vibrations in the world, other people’s vibrations, and our environment.   Peirce believes that we all have the power to determine how we want to feel and when we choose to attune to the frequency of our soul, a new perception based on our souls expansive, loving wisdom opens to us.

The Leboyer method, Dr. Michel Odent’s neo-cortex research and author Penny Peirce understanding of personal vibrations can empower us with the knowledge of how important silence is during labor.  With knowledge comes wisdom – the wisdom to create a peaceful, loving atmosphere in which to welcome a new life into this world.

Women Face the Risk of Pelvic Organ Prolapse after Childbirth

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

 One of the main reasons pelvic organ prolapse (POP) occurs is due to childbirth. The stress of birth can, in some cases, shift the organs in the pelvis from their normal positions. The most common organs affected during childbirth are the bladder and the uterus itself. When this occurs, the symptoms can be mild or severe, depending on the type and extent of the prolapse.

 The most common symptom is a feeling of fullness or pressure in the lower abdomen. Frequent urination and incontinence are common with a prolapsed bladder. As the prolapse worsens, the feeling of pressure can change to pain, and the condition can be very uncomfortable and debilitating.

 There are several treatments for pelvic organ prolapse, and recently, the use of an implant called transvaginal mesh has become very common. During this procedure, a light mesh material is inserted through the vagina to help secure the prolapsed organs. While in theory this seems like a great solution for pelvic organ prolapse, in reality there have been numerous complications associated with this procedure.

 These complications have been reported with increasing frequency to the Food and Drug Administration (FDA). Between the years of 2008 and 2010, more than 2,800 complaints about the transvaginal mesh procedure were logged. The FDA has made these complaints public in order to help patients realize the risk they are facing if they elect to go ahead with this procedure.

 The most common side effect following transvaginal mesh surgery is the erosion of the mesh into other organs. This erosion can cause bleeding and other side effects. Another common complication is the actual wearing through of the vaginal walls, as the mesh presses against them. This is a very serious complication that can result in internal bleeding and serious infections. Because of such severe complications, mesh users have started to file a transvaginal mesh lawsuit against the mesh manufacturers.

 Other side effects noted by the FDA include pain and neuromuscular problems following the procedure. Unfortunately, many doctors are not aware of the complications that their patients are facing with this procedure. It appears that few are properly trained in the insertion of the transvaginal mesh, and this in part explains the high rate of complications associated with the procedure.

 The FDA is continuing to monitor the problems associated with transvaginal mesh surgery. The agency has ordered dozens of mesh manufacturers to conduct safety studies on their products.

 If your doctor has recommended transvaginal mesh, it is vital to understand the potential risks you may face. While all surgical procedures carry risks, the number of complaints associated with mesh are cause for real concern.

 Ask your doctor if there are alternatives to this procedure. For minor cases, simple muscle exercises can be used to help shift the prolapsed organs back into place and strengthen the vaginal walls. Serious cases can be fixed with a surgical procedure that does not include the insertion of the mesh.

 If you feel that you are not receiving enough treatment options, don’t be afraid to ask for a second opinion from another surgeon or specialist. You deserve to know the true complications associated with transvaginal mesh, and you deserve to have a surgeon who has been properly trained in the procedure before going ahead with surgery.

Exploring The Home Birth Option

“I really want a home birth but…” How doulas and childbirth educators can help expectant parents explore the home birth option. By Monica Basile, CPM

 How many times as a doula or childbirth educator have you heard someone say, “I really want a home birth, but…?” Usually this is followed by a list of perceived barriers to home birth or misconceptions about home birth, rather than personal convictions, structural barriers, or health concerns that might make hospital birth preferable or necessary. When a woman says to me, “I really want a home birth but…” what she is usually communicating is that she has an active desire for home birth but does not know how to realize that desire, or has not explored it fully enough to feel confident in her decision about her birth place.

  As a home birth parent myself, and as someone who has been teaching childbirth classes and attending births for 16 years, it’s taken me a while to discern how to best respond to clients when they say this. Years ago, I would simply let it go. I’d be thinking to myself, “this person needs better information,” but because I didn’t want to be perceived as trying to sway anyone’s birth decisions, I’d respond by saying things like, “it sounds like you’ve thought about your choices and that the hospital is the right place for you.” What I now realize is that this expression can be an important invitation to us to share information and engage parents in a process of self-discovery to help them clarify their desires and options.

 It’s no wonder that many people don’t know how to pursue home birth. We live in the midst of a culture of birth fear, which spreads mostly misinformation and misrepresentations of birth, especially home birth. Depending on where you live, home birth midwives may not be able to practice legally, and may therefore be extremely hard to locate or financially inaccessible. Friends and family members may be skeptical or unsupportive, and your client might not know anyone who has had a home birth. Although many women feel intuitively drawn to home birth, it can be hard to imagine the practicalities of making such a countercultural decision.

 Helping a woman to conceive of ways to manifest her deepest wishes for birth is an important task - one that can inspire a lifetime of empowered decision-making. I encourage all doulas and childbirth educators to not shy away from these conversations, but to undertake them in a compassionate, thoughtful, and nonjudgmental way, without attachment to the ultimate decision. I believe strongly that each person has the right and the ability to decide what kind of birth is most appropriate for them, and that everyone deserves access to information with which to evaluate the choices available. In this spirit, I offer some strategies for sharing information and drawing out clarity with those considering home birth

  Address Common Concerns. First of all, it can be useful to explore the “but” in the statement “I would like to have a homebirth but...” Often, these “buts” are simply misapprehensions about home birth that come from either the imagination or the media. (For example, “I want to have a home birth but I don’t want to have to clean up all that mess.”) Here are some of the concerns I hear most often:

  Mess: Birth is actually not as messy as one might think, and midwives tend to have a very efficient system down for mess prevention and cleanup. Typically, when the midwives leave the home after the birth, it’s cleaner than before they got there.

  Cost: Depending on what state you’re in, and your midwife’s credentials, home birth midwives may be able to accept Medicaid and/or private insurance. If not, it never hurts to ask a midwife about payment plans, bartering, and sliding scales for students or those with low incomes. Often, the cost for a midwife’s services is less than or equivalent to insurance deductibles.

  Small space: Although different midwives have different preferences, I have attended many home births in small apartments; even in boarding rooms. Even in large homes, midwives often find themselves in close quarters when women decide to give birth in the corner of a bedroom, between the bed and the wall, for instance.

  Other children: Depending on the age(s) of the child(ren), and the mother’s preference, it may or may not be desirable for siblings to be present at a home birth. I recommend having someone who can be on call to take care of older siblings, either at home or away, depending on the preferences of all involved. I have never encountered a sibling who was voluntarily present at a home birth who felt traumatized by the experience. This can be an extraordinarily special way for children to bond with the new baby.

  Switching care providers: If your client has an established relationship with a care provider in a hospital-based practice, it can seem difficult to end that relationship. However, this is usually a very straightforward process. There’s no point at which someone is obligated to stay with a care provider they don’t like, or who doesn’t suit their birth plans. Sometimes, people choose to continue concurrent care with the original provider after making plans to switch to a home birth midwife.

  Encourage parents-to-be to interview a midwife -- or several. Know your local midwives, and if an expectant parent is considering home birth, encourage her to contact a midwife for a consultation. This is the number one most important resource you can offer. Most people considering home birth have a long list of questions that only a prospective midwife can answer. Usually people want to know what happens in case of complications, and what reasons a hospital transport would be necessary. Rather than speculating on these answers, it’s much better to talk to a midwife about reasons and protocols for transport. (When I was pregnant, I asked my midwife about complications, to which she replied, “which complications are you most worried about?” I realized then that I didn’t really know – I was just duplicating the fears that others had voiced to me. My midwife empowered me with specific information, and I felt both comforted and capable of educating my concerned family and friends.)

 Your client has nothing to lose by interviewing a midwife; a consultation does not obligate her to enter into a midwife’s care. If she decides to pursue home birth, this will put her on her path. If not, she can rest easy knowing she has investigated every option available and made a truly informed decision.

  Share evidence-based information on home birth safety. In 2005, The British Medical Journal published the largest, most well-designed study to date of out-of-hospital birth in North America. The study found that planned home births attended by Certified Professional Midwives are just as safe for low-risk women and babies as hospital birth, with many significant benefits over hospital birth in terms of lower cesarean rates and lower rates of common interventions, such as induction of labor. This study is just one in a large body of literature documenting the excellent outcomes associated with midwife-attended home births. The World Health Organization, the American Public Health Association, and the American College of Nurse Midwives all support increased access to home birth as a safe, responsible choice. A link to this study, as well as plenty of other good information, is available here: www.mothersnaturally.com

  Be clear about legal status in your state. Some people erroneously believe that home birth is illegal. This is not the case – a parent may choose to give birth wherever she wishes. There are no laws against having a home birth. Laws pertaining to home birth apply to birth attendants. In 27 states, direct-entry midwives (non-nurse midwives trained specifically in home birth, and credentialed as CPMs, or Certified Professional Midwives) are licensed, easily accessible, and accepted as part of the health care system. In the remainder of US states, licensure is not available for direct-entry midwives, and in several of these states, practicing as a midwife is illegal. This does not, however, mean that there are no midwives in states without licensure – it just means finding one to work with will be more difficult. Educate yourself and your clients about the legal status of midwifery in your state. You can find a state-by-state chart of midwifery laws here: http://mana.org/statechart.html and find a link to your state friends of midwives organization here: www.thebigpushformidwives.org

  Encourage honesty and harmony with spouses/significant others. It’s common for a pregnant woman’s partner to feel protective, and sometimes this manifests in disagreements about birthplace. Help pregnant women to remember that they have the same ultimate desire as their partners: a healthy birth with a healthy mom and baby. I always encourage expectant couples to go together to a consultation with a midwife, so they both get a chance to voice their concerns and ask questions. This provides a good foundation for further discussion.

  Encourage autonomy in relationships with parents and siblings. Many people express extreme apprehension about a lack of support from family members. There are several potential ways of dealing with this. Protecting one’s inner peace about the choice to birth at home may mean not sharing this information with family until after the birth. For some, on the other hand, it can be very empowering to discuss their decision and share information with family members. Sometimes, inviting a family member to be present at a home birth can be an effective and mutually satisfying way of garnering support. In any case, and regardless of birthplace, becoming a parent ushers in a growth transition in which new parents differentiate from their own parents, and it can be helpful to put this in perspective.

  Encourage positive community. If a woman or couple has never met other home birth parents, it can be very isolating to choose home birth. Share information about birth circle groups, La Leche League or other breastfeeding support groups, home birth meetups, Holistic Moms Networks, childbirth classes, Babywearing groups, or other potential resources for positive community building.

  First births are important. It’s not uncommon to hear someone say, “Maybe I’ll plan a home birth next time.” This is a good opportunity to ask questions like, “How is it that you envision a future pregnancy and birth as being different from this one?” Many people have the idea that they will “know better what they’re doing” and be more self-possessed with second or subsequent births. This might a good moment to remind your client that her body already knows what to do, and that the capacity to give birth already exists within her. You may also want to help her keep the importance of the first birth in perspective: avoiding a primary cesarean has been identified as a key factor in avoiding maternal and infant morbidity associated with repeat cesareans and birth complications resulting from previous surgery. The cesarean rate for planned home births in the U.S. is roughly 4%, which stands in sharp contrast to the national cesarean rate of 32%.

  Pay attention. Sometimes, a woman will say “I really want a home birth but…” and may not actually feel at all comfortable with home birth. Instead, saying this may be a way for her to communicate her orientation toward a more holistic mindset in general. If this is the case, she will likely not engage actively with attempts to open up an in-depth discussion of home birth. Listen attentively, follow her lead, and remember, it’s up to that mother-to-be to know what’s right for her birth.

  Home birth may not be the right choice. There are several reasons that home birth may not be the right choice for your client. One woman’s perceived barrier may be a very real barrier to another woman. If home birth is ruled out for any reason, you can still provide, or refer her to, doula services to help her maintain continuity of care and preserve other birth preferences. If you don’t have access to home birth midwives in your area, as is unfortunately the case in some parts of the country, further options to explore include traveling to give birth, unassisted birth, birth centers, or hospital birth.

 By sharing this information and giving our clients the opportunity to explore their thoughts, desires, hopes, and fears, we fill an important role: that of taking women’s desires for birth seriously. This is an invaluable service, regardless of the decisions our clients ultimately make about where to give birth.

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 Monica Basile is a BirthWorks Certified Childbirth Educator, DONA Certified Doula, and Certified Professional Midwife. She is the mother of a 15-year-old son born at home, and is a co-founder and member of Friends of Iowa Midwives. She holds a PhD in Gender, Women’s, and Sexuality Studies from the University of Iowa.