July 12, 2013
Looking into the Future: Visioning Birth in 4012
This is Part 1 of Cathy Daub's report on the Mid-Pacific Womb Ecology Conference, held in Honolulu, HI in October 2012.
By Cathy Daub, BWI President
In October of 2012, I had the pleasure of attending the Mid-Pacific Womb Ecology Conference in Honolulu, HI.
The concept of Womb Ecology, which is promoted by Michel Odent, MD in his newsletters and books, is gaining acceptance and having a global impact. I was honored to be asked to present a workshop with midwife Elizabeth Davis entitled “Transcendent Emotional States in Birth.”
At the conference I was also pleased to speak several members of our BirthWorks Board of Advisors, including Michel Odent MD, Kirsten Uvnas Moberg, MD PhD, Elizabeth Davis, Jan Tritten, Suzanne Arms, and Heloissa Lessa, a midwife from Brazil who helped Michel Odent organize the conference.
The conference brought together representatives from 52 countries. As I gazed across the audience, I realized I was in the midst of more than 600 people who would be spreading the concept of Primal Health and Womb ecology to all corners of the globe. In a day and age when birth has become an industry, and technology, and obstetrical drugs are dominating the birth scene, I realized the magnitude of what was about to happen. We would be hearing speakers who would talk about the interaction between art, science, and techniques, and engaging meaningfully with the idea that interfering unnecessarily with the environment around the womb is fraught with dangers that can influence our health as adults.
One of the most interesting parts of the conference was a panel inviting speakers to share their vision of what birth will be like 2000 years from now, in the year 4012. Here are some highlights:
Vision for 4012 birth: Panel
Michel Odent asked a panel of experts what their vision was for birth in 4012.
Peggy O’Mara said we would be moving towards total trust of the body towards normal birth. There will be more midwives and fewer specialists.
Robbie Davis Floyd said we’ll be giving birth in 0-gravity space. There will be sophisticated technology and private enterprises such as hotels on Mars. Birth centers will orbit the earth and moon. She noted that birth on Star Trek were normal, natural birth. There will be an entire industry for orbital birth. Her fears included, “Will we be choosing the gender of our babies? Will we be ordering babies from a catalogue someday – breeding for color of hair, etc.?” Yet she does envision normal physiologic birth in 4012 believing that, “Mothers have the power to give birth and babies have the power to be born.”
Sarah Buckley envisioned a future where a loud noise lasting 11 minutes would cause the cessation of all electric fetal monitoring equipment, ultrasounds, and the clock. She asked what birth without monitoring would look like. There would be no more epidurals, inductions, and cesareans that were necessary would be short and efficient. She said Jan from Midwifery Today would train a new generation of midwives who know how to trust labor without technology. Love and connectedness would in our cells and generations of babies would be born that would lose the imprinting of fear in childbirth. Once physiologic birth is in place, we would have a generation of people who would treat the earth gently. There would be few obstetricians and attendants would be good at knitting.
Jackie Chang of Korea said that we will not argue about how we’re going to give birth anymore but will focus on maternal instinct and being ourselves. We will learn to be wise again and listen to each other. We will be dancing and singing together giving birth. Rapid changes are taking place in birth in Korea and not just in lifestyle – also in philosophy. Maybe some women need cesareans for their own survival and others need to be natural. Right now, cesarean mothers have an enormous guilty feeling after cesarean section. We must find out how we can be together so there is no judgment. Please don’t let one mother feel guilty.
Michael Stark MD said, “I’m afraid we don’t have good news for the future and in 4012 it will not be what we are expecting it to be.” He went on to say that 4,000 years ago in Egypt, there were midwives and midwifery schools. In 4012, he believes we will have produced artificial ways to conceive and give birth - the artificial woman.
Odent to Stark: You’ve made the cesarean so simple today – has this done more harm than good?”
Stark: “There are currently high rates of cesarean section. It was never my intention to make delivery easier for the woman through cesarean section.” He went on to describe what the future might be with a civilization born by cesarean section. “Just 150 years ago, people tended to be smaller. In one to two generations, we have become taller. If we continue with this direction of more cesareans, we won’t need a wide pelvis and the pelvis may evolve to become smaller. Babies may have smaller necks and the head may become larger and pregnancy may take longer. If we don’t need to deliver by nine months, we might have more mature children with bigger heads.”
My hope is that small things can happen to change history. “Michel, I believe you are one of these people. In 4012 perhaps all the world will have Odent delivery rooms. Less is more. There is so much love in this hall, maybe it is like oxytocin spray.” Both of Dr. Stark’s grandchildren were born normally.
Odent: “In Rio de Janeiro, they use spray of oxytocin in the shop. It can reach brain receptors and in subtle ways make people feel comfortable and want to come back.”
Jan Tritten of Midwifery Today emphasized that we all have a responsibility to make decisions that will benefit future generations. We have a planet, food supply, and mothers to take care of. People in China and around the world want to change current birth practices. Oceans are going to rush in. So let’s take care of the planet and our mothers and babies. Two thousand years from now is only 80 generations.
Laura Uplinger, interpreter for the conference being fluent in four languages, spoke about how we can reach the golden age in 4012. Babies will be given better conditions and optimal biochemistry will be flowing in the mother’s blood. The importance of the Primal Period will be better understood. Every pregnant woman needs to eat well, feel joy, and be inspired by birthing. There will be more resources for mothers such as birthing centers built in gorgeous parks where pregnant mothers walk together enjoying joyful synergy. Hospitals will have closed their doors to birth. Breastfeeding will be a universal practice. Children will live longer and enjoy good health.
The panel ended with Michel Odent saying, “We have no concensus of childbirth in 4012. We need other conferences. Technology is going fast. We need to organize our next conference outside the planet earth – somewhere over the rainbow and at our next conference our dreams will come true.
We ended the panel by singing “Somewhere Over the Rainbow.”
June 21, 2013
Birth Is Instinctive
By Cathy Daub, BWI President
All visionaries on her platform were asked to provide a downloadable bonus gift. I offered and carried out a one-hour teleclass on the topic “Birth is Instinctive.”
The underlying message of my talk is that all women are born with the knowledge about how to give birth. Therefore birth is instinctive and what is instinctive doesn’t need to be taught. When people ask, “Then what are you teaching in your childbirth preparation classes?” I respond, “We are helping women to have more trust and faith in their body knowledge that already knows how to give birth.” This is accomplished through the understanding and practice of human values and provides a unique approach to childbirth preparation that is empowering and transforming in nature.
Those on the call had an opportunity to ask questions. Here are a couple I would like to share with you.
First question: I had a beautiful home birth with positive thoughts. I was confident about being able to birth my baby. But then I hemorrhaged after my baby was born. Now I’m pregnant again and have fears because of what happened the first time. What should I do?
Answer: Every birth is unique unto itself. We all know how different children are and even how different one labor is compared to another. Each is a new experience. Therefore we need not compare a previous birth with a new upcoming birth. It is good to say an affirmation (positive thought pattern) to yourself over and over again such as “I am birthing a new baby unique unto herself.”
Second question: I was with a woman who had a previous cesarean and worked hard to have a VBAC. She did all the right things, saying positive affirmations, finding a safe place to give birth, yet she had another cesarean. What can I say to her?
Answer: She needs your comfort, support, and love. She needs to know she did the very best she could and that she cannot ask more of herself than that. Everything in life is a learning experience. It is important that all women continue to love themselves regardless of the birth outcome.
Birth has the potential to be a peak experience in a woman’s life and my wish is for all women to experience the full potential of what it has to offer.
April 23, 2013
Book Review: Optimal Care in Childbirth
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by Jane Beal, PhD, CD(DONA), CCE(BWI), CLS
Henci Goer and Amy Romano, Optimal Care in Childbirth: The Case for the Physiological Approach (Seattle: Classic Day Publishing, 2012). 583 pp. $46 Paperback / $39 Kindle.
After a friend had a “pushed” birth followed by an unnecesarean a few years ago, I gave her a copy of Henci Goer’s The Thinking Woman’s Guide to a Better Birth. She had a VBAC the next time around, arriving at the hospital just in time to push out her second baby girl with her body’s own power. She was overjoyed!
Like The Thinking Woman’s Guide, Henci Goer’s new book, Optimal Care in Childbirth, co-authored with Amy Romano, MSN, CNM, presents research that supports evidence-based practices in maternity care. It specifically advocates physiologic birth and expectant management. But unlike The Thinking Woman’s Guide, the intended audience is not expectant parents, but caregivers: doctors, nurses, doulas, childbirth advocates, and midwives. Its purpose is not to help parents make wise decisions in childbirth (indeed, the complexity of the information presented here makes this book inappropriate for most laypeople), but rather to change practices in obstetrics and midwifery.
Optimal Care has been endorsed by Helen Varney Burst, CNM, Ina May Gaskin, CPM, and Penny Simkin, PT. It’s been adopted as part of the reading list for the NARM examination and as a textbook in some certified nurse midwifery training programs. This shows that it is already reaching the next generation of midwives. But it could clearly benefit doctors-in-training as well.
The book presents extensive mini-reviews of several hundred controlled randomized trials conducted between 1990 and 2010. The authors use these mini-reviews to support well-reasoned arguments against the liberal use of cesarean surgery, elective repeat cesarean, elective induction, augmentation of first stage labor, continuous electronic fetal monitoring, the use of IVs, the non per os (“nothing by mouth”) dictum, and epidurals. They further question the need for actively managed second stage labor, instrumental vaginal delivery, fundal pressure, episiotomy, actively managed third stage labor, and the harmful interventions of current, wide-spread newborn practices, including suctioning, immediate cord clamping, and separation of mothers and babies after birth. They make extensive, evidenced-based recommendations for optimal care in childbirth instead.
Goer and Romano make crystal clear that America’s over 30% cesarean epidemic is completely unnecessary, caused by economic factors (cesarean is quicker and more profitable than vaginal birth), legal factors (surveys show that doctors believe they will not be sued, or if sued, they will not lose if they have performed a cesarean, but this assumption has proven false) and social factors (convenience). It is not caused by a sudden inability among American women to give birth vaginally. The authors point out the risks to mother and baby from the first cesarean as well as risks in subsequent pregnancies. (Compare to Goer and Romano, “Vaginal or Cesarean Birth: What is at Stake for Mothers and Babies?”) They do the same with the subject of induction. Clearly, patience is never a greater virtue than when it is practiced by caregivers during childbirth. This point, and many others, are made persuasively.
Just three things gave me pause while reading this book: the recommendation to begin an induction of labor 18 hours after PROM (p. 157); the characterization of “the doula paradox” (p. 427-34); and the lack of strong support for homebirth (p. 501-30).
About PROM and induction: I’ve smelled chorioamnionitis in the labor room before, and as the colloquial saying goes, it ain’t pretty. No one wants a bacterial infection in the laboring mother to put the newborn at risk of sepsis, which usually necessitates a full work-up in NICU and antibiotics for both mother and newborn in hospital. That said, PROM is not the cause of infection. Bacteria is. And it’s the number of cervical exams after PROM that puts mothers at higher risk of bacterial infection. So the “optimal strategy” is not induction 18 hours after PROM; it’s no cervical exams after PROM.
Goer knows this. She advises in The Thinking Woman’s Guide, in her section "The Bottom Line on Induction for PROM," “refuse vaginal exams before active labor” (p.68), and “wait at least 24 hours before inducing unless you show signs of infection” (p. 69). In fact, 75% of women will spontaneously start labor by 24 hours, and 95% will deliver by 28 hours (see Constance Sinclair, A Midwife’s Handbook, p. 143), but only 50% of women will spontaneously start labor by 18 hours after PROM. So starting an induction at 18 hours is 10 hours short of a physiologic birth for 45% of women.
As midwife Gloria Lemay points out, in Europe, the recommendation is that babies be born within 24 hours after the first cervical exam – giving the mother weeks before induction might be necessary if no cervical exam is performed after PROM. In fact, when mothers experience PPROM (Preterm Premature Rupture of Membranes), most American doctors will sit on their hands while mothers are on bed-rest, waiting for the baby to mature as much as possible to increase the chance of survival outside the womb. They do wait for weeks with PPROM. And what if PROM is actually PPROM? Not all due dates are accurate. Again, patience is a virtue!
About the “doula paradox”: Optimal Care argues from survey data that doulas are not always welcomed or appreciated by hospital staff, which can lead to conflict, but on the other hand, doulas can be manipulated by hospital staff into “gaining cooperation” from the mother to submit to unwanted procedures. The authors conclude: “women are better off with doulas than not, but whichever path to doulas take, all too often they and the women they serve lose” (p. 430).
This strikes me as an oversimplification of the results of the 2003 Cochrane systematic review of 15 RCTs of continuous female labor support vs. usual care, summarized online here, which may be beside the point anyway. Goer and Romano’s evidence shows that choice of primary caregiver, not the doula, has the most effect on maternal outcomes in childbirth. Yet the authors do not consider the educated and experienced doulas who are steering women toward primary caregivers with low intervention and cesarean rates. And what does the Listening to Mothers II survey say about doulas? 88% of women gave doulas an “excellent” rating for their support, above both midwives (68%) and nurses (68%). That’s not a paradox. That’s the result of women actually getting the emotional and physical support they want in labor – from their doulas.
About homebirth: The authors ask the question, “Do we know if home birth is safe?” (p. 506). They note that “women perceive homebirth to be safer than hospital birth because they can trust their care providers, have autonomy, and avoid interventions that they do not want and are not supported by evidence” (p. 509). That sounds positive, but the authors go on to say:
"Improving hospital care may in fact be the most important strategy for improving the safety of home birth. If hospitals respected informed consent and refusal, if physiologic care was standard, and if hospital-based providers reliably offered evidence-based treatments for complications, fewer women would choose home birth…" (p. 509).
If. If. If. Maybe “Do we know of home birth is safe?” is not the most useful question. Clearly, homebirth can be safe for low-risk women with a skilled caregiver in attendance, and it appears that, statistically, such homebirth results in lower mortality and morbidity rates for mothers and babies than hospital birth. It’s more affordable, too. Even for high-risk women, midwifery care can be an excellent option that promotes maternal physical health and emotional well-being, which are of course related. Worldwide, midwifery care is essential to resolving preventable complications of childbirth, as the World Health Organization clearly explains in “10 Facts on Midwifery.” More midwives are needed everywhere, especially in the developing world, where hospitals may not be accessible or may refuse care to impoverished women. But the fact is, less than 2% of American women give birth at home.
So, as Miriam Perez points out, a better question might be, “Is hospital birth safe?”
In their conclusion, Goer and Romano make the argument that America’s maternity care system should be led by midwives, who would care for the majority of women using expectant management, while high risk cases could be co-managed with obstetricians (p. 450-51). European maternity care systems run on this model, and they have better maternal and perinatal outcomes than America does. Unfortunately, with fewer than 12,000 midwives in the country (about half of them CNMs and the other half DEMs, CPMs, RMs, or LMs), midwives are not in a position to handle the number of births in this country without doctors: almost 4 million per year. In contrast, there are about 40,000 obstetricians in America today. So many more thousands of midwives need to be educated and trained to fulfill Goer and Romano’s goals. Yet programs to educate them are few, and many are not affordable. Thus, what needs to happen to improve hospital birth in America right now is that the education and training of doctors needs to shift to support physiologic birth.
If more midwives held leadership roles in teaching hospitals, where they could be recognized as “experts in normal birth” and instruct residents, then doctors would learn a great deal that could change the maternity system overall. (This is currently happening in at least one hospital in the Denver area where I serve, as well as in hospital where midwife Betty Anne Daviss serves in Canada, so it is not as unlikely as it may sound!) If ACOG were to change many of its recommendations to doctors, advocating expectant rather than active management, this would also make a huge difference. But the economic, legal, and social factors currently working against change are powerful.
One of the most significant of these factors is consumer demand for pain relief medications in the form of epidurals, which necessitates additional active management and often results in cesarean, especially when labor slows in first stage or the mother cannot make effective pushing efforts in second stage. Historically, we know that women led the way in demanding the “right” to pharmacological pain relief, following in the footsteps of Queen Victoria. Many women today may be unaware of the risks involved in making this choice, and caregivers certainly bear responsibility for negative outcomes that result from the epidural intervention (I’ve personally seen a woman paralyzed by a mis-managed epidural), but I think it’s important to acknowledge that the epidural epidemic is consumer-driven. The “failure of obstetric management,” as the authors call it, at least in this case, is shared with mothers demanding drugs in labor. That’s where childbirth educators have a key role to play, one which is not discussed in this book. Doulas can help, too, for their presence reduces the use of anesthesia and analgesia, but they attend fewer than 5% of births in America today.
Optimal Care in Childbirth is an ambitious book. In it, the authors have synthesized a tremendous amount of information in support of physiologic birth. So it is an incredibly valuable resource. Despite a few caveats (discussed above), I recommend it to all childbirth educators, doulas, nurses, midwives and doctors. If the strategies for optimal care in childbirth provided in this book were followed by caregivers in America, more mothers and babies would live and thrive.
by Jane Beal, PhD, CD(DONA), CCE(BWI), CLS
After a friend had a “pushed” birth followed by an unnecesarean a few years ago, I gave her a copy of Henci Goer’s The Thinking Woman’s Guide to a Better Birth. She had a VBAC the next time around, arriving at the hospital just in time to push out her second baby girl with her body’s own power. She was overjoyed!
Like The Thinking Woman’s Guide, Henci Goer’s new book, Optimal Care in Childbirth, co-authored with Amy Romano, MSN, CNM, presents research that supports evidence-based practices in maternity care. It specifically advocates physiologic birth and expectant management. But unlike The Thinking Woman’s Guide, the intended audience is not expectant parents, but caregivers: doctors, nurses, doulas, childbirth advocates, and midwives. Its purpose is not to help parents make wise decisions in childbirth (indeed, the complexity of the information presented here makes this book inappropriate for most laypeople), but rather to change practices in obstetrics and midwifery.
Optimal Care has been endorsed by Helen Varney Burst, CNM, Ina May Gaskin, CPM, and Penny Simkin, PT. It’s been adopted as part of the reading list for the NARM examination and as a textbook in some certified nurse midwifery training programs. This shows that it is already reaching the next generation of midwives. But it could clearly benefit doctors-in-training as well.
The book presents extensive mini-reviews of several hundred controlled randomized trials conducted between 1990 and 2010. The authors use these mini-reviews to support well-reasoned arguments against the liberal use of cesarean surgery, elective repeat cesarean, elective induction, augmentation of first stage labor, continuous electronic fetal monitoring, the use of IVs, the non per os (“nothing by mouth”) dictum, and epidurals. They further question the need for actively managed second stage labor, instrumental vaginal delivery, fundal pressure, episiotomy, actively managed third stage labor, and the harmful interventions of current, wide-spread newborn practices, including suctioning, immediate cord clamping, and separation of mothers and babies after birth. They make extensive, evidenced-based recommendations for optimal care in childbirth instead.
Goer and Romano make crystal clear that America’s over 30% cesarean epidemic is completely unnecessary, caused by economic factors (cesarean is quicker and more profitable than vaginal birth), legal factors (surveys show that doctors believe they will not be sued, or if sued, they will not lose if they have performed a cesarean, but this assumption has proven false) and social factors (convenience). It is not caused by a sudden inability among American women to give birth vaginally. The authors point out the risks to mother and baby from the first cesarean as well as risks in subsequent pregnancies. (Compare to Goer and Romano, “Vaginal or Cesarean Birth: What is at Stake for Mothers and Babies?”) They do the same with the subject of induction. Clearly, patience is never a greater virtue than when it is practiced by caregivers during childbirth. This point, and many others, are made persuasively.
Just three things gave me pause while reading this book: the recommendation to begin an induction of labor 18 hours after PROM (p. 157); the characterization of “the doula paradox” (p. 427-34); and the lack of strong support for homebirth (p. 501-30).
About PROM and induction: I’ve smelled chorioamnionitis in the labor room before, and as the colloquial saying goes, it ain’t pretty. No one wants a bacterial infection in the laboring mother to put the newborn at risk of sepsis, which usually necessitates a full work-up in NICU and antibiotics for both mother and newborn in hospital. That said, PROM is not the cause of infection. Bacteria is. And it’s the number of cervical exams after PROM that puts mothers at higher risk of bacterial infection. So the “optimal strategy” is not induction 18 hours after PROM; it’s no cervical exams after PROM.
Goer knows this. She advises in The Thinking Woman’s Guide, in her section "The Bottom Line on Induction for PROM," “refuse vaginal exams before active labor” (p.68), and “wait at least 24 hours before inducing unless you show signs of infection” (p. 69). In fact, 75% of women will spontaneously start labor by 24 hours, and 95% will deliver by 28 hours (see Constance Sinclair, A Midwife’s Handbook, p. 143), but only 50% of women will spontaneously start labor by 18 hours after PROM. So starting an induction at 18 hours is 10 hours short of a physiologic birth for 45% of women.
As midwife Gloria Lemay points out, in Europe, the recommendation is that babies be born within 24 hours after the first cervical exam – giving the mother weeks before induction might be necessary if no cervical exam is performed after PROM. In fact, when mothers experience PPROM (Preterm Premature Rupture of Membranes), most American doctors will sit on their hands while mothers are on bed-rest, waiting for the baby to mature as much as possible to increase the chance of survival outside the womb. They do wait for weeks with PPROM. And what if PROM is actually PPROM? Not all due dates are accurate. Again, patience is a virtue!
About the “doula paradox”: Optimal Care argues from survey data that doulas are not always welcomed or appreciated by hospital staff, which can lead to conflict, but on the other hand, doulas can be manipulated by hospital staff into “gaining cooperation” from the mother to submit to unwanted procedures. The authors conclude: “women are better off with doulas than not, but whichever path to doulas take, all too often they and the women they serve lose” (p. 430).
This strikes me as an oversimplification of the results of the 2003 Cochrane systematic review of 15 RCTs of continuous female labor support vs. usual care, summarized online here, which may be beside the point anyway. Goer and Romano’s evidence shows that choice of primary caregiver, not the doula, has the most effect on maternal outcomes in childbirth. Yet the authors do not consider the educated and experienced doulas who are steering women toward primary caregivers with low intervention and cesarean rates. And what does the Listening to Mothers II survey say about doulas? 88% of women gave doulas an “excellent” rating for their support, above both midwives (68%) and nurses (68%). That’s not a paradox. That’s the result of women actually getting the emotional and physical support they want in labor – from their doulas.
About homebirth: The authors ask the question, “Do we know if home birth is safe?” (p. 506). They note that “women perceive homebirth to be safer than hospital birth because they can trust their care providers, have autonomy, and avoid interventions that they do not want and are not supported by evidence” (p. 509). That sounds positive, but the authors go on to say:
"Improving hospital care may in fact be the most important strategy for improving the safety of home birth. If hospitals respected informed consent and refusal, if physiologic care was standard, and if hospital-based providers reliably offered evidence-based treatments for complications, fewer women would choose home birth…" (p. 509).
If. If. If. Maybe “Do we know of home birth is safe?” is not the most useful question. Clearly, homebirth can be safe for low-risk women with a skilled caregiver in attendance, and it appears that, statistically, such homebirth results in lower mortality and morbidity rates for mothers and babies than hospital birth. It’s more affordable, too. Even for high-risk women, midwifery care can be an excellent option that promotes maternal physical health and emotional well-being, which are of course related. Worldwide, midwifery care is essential to resolving preventable complications of childbirth, as the World Health Organization clearly explains in “10 Facts on Midwifery.” More midwives are needed everywhere, especially in the developing world, where hospitals may not be accessible or may refuse care to impoverished women. But the fact is, less than 2% of American women give birth at home.
So, as Miriam Perez points out, a better question might be, “Is hospital birth safe?”
In their conclusion, Goer and Romano make the argument that America’s maternity care system should be led by midwives, who would care for the majority of women using expectant management, while high risk cases could be co-managed with obstetricians (p. 450-51). European maternity care systems run on this model, and they have better maternal and perinatal outcomes than America does. Unfortunately, with fewer than 12,000 midwives in the country (about half of them CNMs and the other half DEMs, CPMs, RMs, or LMs), midwives are not in a position to handle the number of births in this country without doctors: almost 4 million per year. In contrast, there are about 40,000 obstetricians in America today. So many more thousands of midwives need to be educated and trained to fulfill Goer and Romano’s goals. Yet programs to educate them are few, and many are not affordable. Thus, what needs to happen to improve hospital birth in America right now is that the education and training of doctors needs to shift to support physiologic birth.
If more midwives held leadership roles in teaching hospitals, where they could be recognized as “experts in normal birth” and instruct residents, then doctors would learn a great deal that could change the maternity system overall. (This is currently happening in at least one hospital in the Denver area where I serve, as well as in hospital where midwife Betty Anne Daviss serves in Canada, so it is not as unlikely as it may sound!) If ACOG were to change many of its recommendations to doctors, advocating expectant rather than active management, this would also make a huge difference. But the economic, legal, and social factors currently working against change are powerful.
One of the most significant of these factors is consumer demand for pain relief medications in the form of epidurals, which necessitates additional active management and often results in cesarean, especially when labor slows in first stage or the mother cannot make effective pushing efforts in second stage. Historically, we know that women led the way in demanding the “right” to pharmacological pain relief, following in the footsteps of Queen Victoria. Many women today may be unaware of the risks involved in making this choice, and caregivers certainly bear responsibility for negative outcomes that result from the epidural intervention (I’ve personally seen a woman paralyzed by a mis-managed epidural), but I think it’s important to acknowledge that the epidural epidemic is consumer-driven. The “failure of obstetric management,” as the authors call it, at least in this case, is shared with mothers demanding drugs in labor. That’s where childbirth educators have a key role to play, one which is not discussed in this book. Doulas can help, too, for their presence reduces the use of anesthesia and analgesia, but they attend fewer than 5% of births in America today.
Optimal Care in Childbirth is an ambitious book. In it, the authors have synthesized a tremendous amount of information in support of physiologic birth. So it is an incredibly valuable resource. Despite a few caveats (discussed above), I recommend it to all childbirth educators, doulas, nurses, midwives and doctors. If the strategies for optimal care in childbirth provided in this book were followed by caregivers in America, more mothers and babies would live and thrive.
January 26, 2013
We Must Do More to Honor Birth as a Peak Life Experience
by Molly Wales, CCE(BWI)
Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.
Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.
 |
| Molly with her newborn daughter |
My name is Molly
Wales. I am the director of The
Birth Circle (a consumer birth group) in Athens, Ohio, and am a BirthWorks
childbirth educator. I’m here
today to talk to you about why I believe that we aren’t doing enough in our
country to honor birth as a peak life experience. Perfect for Labor Day!
A short review
of where I stand: I believe that
all people are deserving of equal treatment and opportunity. I believe that a woman is born with the
knowledge of how to give birth, and that if Mom can give birth with people who
make her feel safe and secure, she’ll be able to follow her instincts and her
body and her baby will know just how to work together. I believe that a woman should have the
right to give birth wherever she pleases, with whomever she pleases. And I believe that birth is a hugely pivotal
moment in life, and that the birth experience has a life-long impact on the
mother, the child, and on their relationship.
These views do
not represent the norm in our society.
Americans, in general, are taught not to trust birth. Many, if not most, fear it. And so we keep developing new ways to
manipulate and change what already works. And as we force our control like
this, the effects are disastrous.
According to a
recent Amnesty International report, “The USA spends more than any other
country on health care, and more on maternal health than any other type of
hospital care. Despite this, women in the USA have a higher risk of dying of
pregnancy-related complications than those in 49 other countries, including
Kuwait, Bulgaria, and South Korea.”
What?! WHAT?! Why is this happening? What has gone wrong with maternity care
in our country?
Imagine a mom
has her first visit with her care provider, be it an OB or midwife. She’s told, “You are capable of having
this baby without drugs. And if
that’s what you choose, we will support you in that. If you or baby needs medical attention, we’ll be here. But otherwise our job is to let your
body do what it was created to do.”
If that were that norm, we wouldn’t be in such a crisis. Rates of intervention would drop
substantially, and our moms and babies would be healthier.
But that isn’t
the kind of support that moms in our country generally receive, unless they
choose a home birth assisted by a midwife. Because OBs and hospital-based midwives work under protocol
and deadlines that rush the process and place little to no value on the
emotional importance of the experience.
Now I don’t mean to say that the OBs and midwives themselves don’t value
the experience, necessarily, but rather that they are put under restraints that
severely limit what they can do to honor birth as normal and natural, and to
work with a mother on her body’s own timeline.
For
example: One of my students
recalled going in for her very first visit with her OB, to talk about her
exciting new pregnancy. The doctor
told her, “You’ll go into labor, you’ll come to the hospital, and we’ll get you
an epidural.” Notice the
commands. Notice the lack of
choice. Notice the complete
failure to acknowledge this mom’s innate ability to give birth to her baby on
her own. In one short sentence,
her power was robbed from her.
Or another
student, who, while having a perfectly normal labor at the hospital, noticed
that everyone in the room kept their eyes fixed on the monitor, telling her
when a contraction was coming, telling her how hard it was…when all she wanted,
needed, was some eye contact, someone to acknowledge that SHE was doing the
work here, and that she was a healthy human mother, not just another illness
hooked up to a machine.
And so most
moms, at least in our country, never get that chance to realize their own
power, that chance to feel accomplished as a mother, right from the very start,
those sensations of labor that combine intense vulnerability with unimaginable
atomic power. When a woman gives
birth naturally, she has to open up, physically and emotionally, to greet her
baby. It is an incredible start to
the mother-child relationship, one of deep bonding, as mom and baby work
together through one of life’s greatest challenges. If we in the U.S., this world power, honored birth as the
baby’s start to life-long mental health, and as the mother’s chance to untap
her human potential, just think of how we could empower whole generations of
women and children. I remember
saying to my little Lola, six short months ago, as I held her there on my
living room floor in the darkness of the morning, “We did it, honey, we did
it!” So she was born into that
joy, that total soul bearing, that pride.
What an advantage for us both. And I am no extraordinary woman. Most healthy women are capable of
having their babies without medical intervention. Now certainly homebirth isn’t the right choice for every
woman, but imagine what a difference that would make, in our country and in the
overall state of our planet, if the majority of mother-baby pairs were trusted,
unrushed, and just given a chance to let their bodies work in their own way.
But they
aren’t. Instead most pregnant
women in the U.S. are highly uninformed.
They are treated as if their pregnancies are an illness. In labor, they
are offered drugs when they should be offered emotional encouragement. And yes, of course, a healthy baby and
healthy mom are the most important things. But they aren’t the ONLY important things. There is a chance there for a peak life
experience, for both mom and baby, a chance for that relationship to begin with
a surge of strength, hormonally and emotionally, that fortifies them for years
to come, if not for their whole lives.
In the end, it’s
all about creating a peaceful world, isn’t it? And where better to start, than our barest beginning.
December 13, 2012
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.
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.
November 27, 2012
Join our Board of Directors!
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Member of BirthWorks in good standing
- Unlimited computer and internet access
- Excellent interpersonal skills and good team member
November 8, 2012
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.
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.
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