Listen to National Experts: What the Birthing Women of San Luis Obispo Need to Think About!

These posts originally appeared as my Food for Thought series on Facebook. I wanted to provoke the women of San Luis Obispo county into thinking about their birth and parenting choices. By quoting directly from books I wish to stimulate discussion and encourage women to seek out information and become more educated. My hope is you will empower yourself through this process.

“Our lives begin to end 

the day we become silent about things 

that matter.”

~ Martin Luther King, Jr. 

from his unforgettable

 "I Have a Dream" speech

Doctor or midwife: How to choose which is right for you.

Baby Bonding and Attachment: Getting Parenting off to a good start.

Induction and Due Dates: What you need to know to keep anyone from scaring you into a decision.

Understanding Risks: Learning more so you can choose the risks you are most comfortable taking.

Parenting in Labor: Things to know about the decision to use pain medication.

Labor & Birth: Things to remember about normal labor and birth.

Speaking for Midwives at SLO's Historic Celebration

This is Nora Lewis the certified nurse midwife who caught my son at Sierra Vista Hospital in 1990. That birth changed my life forever and set me on the path to becoming a doula. When it was over I had many hurt and angry feelings and a million questions. After being part of many women's births over the years I have grown in my understanding of what occurred during my own labor and have come to a new perspective and deep appreciation for my midwife. Working side by side with many different midwives has given me a great respect for the women who answer the midwifery call and dedicate their professional lives to helping women all around the world. I was honored to give a speech about midwifery at the Birth & Baby Resource Network's historic celebration for the International Day of the Midwife and I was very grateful to be able to publicly thank Nora Lewis for her courageous stand with me that long ago August day.
My Speech.

Midwifery; a David and Goliath Tale

The story of midwifery in America is a classic power struggle for women’s rights, respect and choice; a tale of the clash of women’s culture and values with the male dominated spheres of science, medicine and finance. It is an ugly story laced with racism and class war fare. This struggle continues to walk the halls of political power and sits in insurance industry board rooms today.
It began as the eighteenth century was drawing to a close and the science of medicine was on the rise. Men for the first time began to move deeply into the privacy of the birth room, a place that in most cultures around the world is traditionally populated almost exclusively by women. This slow and determined encroachment into what had previously always been a woman’s world began the battle.

Before men became involved American midwives had always held a place of respect within their communities. Their skill at helping women during the birth process was of vital importance to all in the community. Women were encouraged to stay mobile as long as possible during the birth, the pain of the process was recognized but not believed to be insurmountable, the passage of time was noted but there were no standardized graphs labors had to abide by, and women utilized up-right physiologically sound positions for pushing a baby out.


When male doctors took over this all changed. Pain relieving drugs were used as an inducement to have doctors attend women’s births. These medications changed the balance of power forever; stripping the woman’s innate abilities. She became an object to practice medicine upon; someone who needed her baby delivered to her like a pizza instead of using her own physical power to bring her baby forth. Soon untested scientific “theories” blended with necessities created by using pain medications and women were routinely being cut and babies were being pulled out with forceps.

As the prestige of the medical profession rose, so did their power. In the end it came down to dollars and cents. In order to corner the market doctors began a campaign to stamp out midwifery. First they created a belief that birth was a medical event which could only be safe if attended by a physician. Doctors traveled in the upper circles of society. They convinced bankers, lawyers and other prominent society men to avail themselves of the best that the science of modern medicine could offer for their wives by using a physician. Men controlled the medical schools and women were not allowed to attend so female care providers slowly began to die out. In the early twentieth century not satisfied yet, they convinced the government to begin a propaganda campaign slandering midwives as dirty, illiterate, and ignorant. Eventually only poor women or newly arrived immigrants were still turning to midwives for care.


Meanwhile another huge shift in health care in our country was taking place. Hospitals were on the rise, with their bureaucracies, standardizations, schedules and sanitization of birth. Women were told it was best when labor began to leave their homes, where they had some control, and travel to a hospital, where they had no control. Hospitals lead to the immediate separation of the newborn from its mother and scheduled feedings. These disruptions in the process along with the drugs created babies who could not suck effectively, needing to be force fed from bottles. Soon the women of America thought their bodies were so defective they couldn’t even breastfeed their own children. Meanwhile the practice of midwifery was outlawed in most states.


But it’s hard to hold good women down. It is hard to stop women from answering the call to serve women; especially women in need. In the 1920’s nurses began to step forward to get additional training in the skills required to help low income women, the rural and urban poor. These were women who couldn’t pay doctors and hospitals, therefore providing them care did not threaten the medical establishment’s monopoly. They eventually founded specialized nurse midwifery schools and associations. From this branch was born the certified nurse midwife. In the 1960’s couples living on communes had turned their backs on many forms of the “establishment”. These female rebels began to birth their babies at home with the help of other women in their communities. The daring women who answered this call eventually became highly trained homebirth midwives. It took courage to be a midwife, to practice midwifery without a license. Not only could you lose everything, your home and your practice, you could be thrown in jail. In our county one traditional midwife was brought up on charges and convicted in 1982. Over time this branch of midwifery also adopted standards for training, created associations and worked hard to become legal once again. In California the legal battle culminated in 1993 in the creation of a system to license out of hospital midwives but it took 4 more years for the first group of midwives to be licensed by the state medical board.


All midwives are still fighting for the right to work as autonomous, respected members of the birth provider community. Whether they are CNMs who have made the choice to work in a doctor’s practice under his supervision because even if they could find a company willing to cover them medical malpractice insurance is prohibitive, or the LMs who can’t get insurance company’s to reimburse their clients for basic care the struggle continues. The California Medical Board is currently reviewing whether to change the language in the regulations governing LMs to allow them to order the life saving medications and tools they need to attend birthing women. And so the struggle continues.


This year on May 5th, the International Day of the Midwife, the women and their families who have been cared for so well for so many years by our community’s midwives will gather in Mission Plaza to honor 41 courageous, tireless, and caring professional women. The Birth & Baby Resource Network along with the co-sponsors of this year’s Birth & Baby Fair wish to invite you to join us at 10:30 for this historic event in the annuls of San Luis Obispo women’s rights.


Participate in BBRN’s on-line Midwifery Project at: www.bbrn.org.
Learn More about the History of Midwifery:
A Midwife’s Tale; Martha Ballard her Diary by Laurel Thatcher Ulrich
Motherwit; an Alabama Midwife’s Story by Onnie Lee Logan
Listen to Me Good; the Life Story of an Alabama Midwife by Margaret Charles Smith
Birth Matters; a Midwife’s Manifesta by Ina May Gaskin
A Short History of Midwifery: from Midwife Info an independent internet resource 
I am a Midwife, a movie trailer by the Midwives Alliance of North America
Fiction with Midwifery themes:
The Midwife's Apprentice by Karen Cushman
The Red Tent by Anita Diamant
Midwives by Chris Bohjalian

A Midwife's Story by Penny Armstrong and Sheryl Feldman

Doctor or Midwife: How to Chose Which is Right for You

Food for Thought: I have thought a lot about how women decide whether to use a midwife or doctor for their birth. I think it really comes down to life perspective. Do you focus on what can go wrong in life or on what can go right? This will be the defining reason for your choice. You will seek out and feel most comfortable with a care provider who mirrors your view of life. 

Here is Marsden Wagner, Ob-Gyn on the different perspectives of doctors and midwives. "Though midwives know what can go wrong during pregnancy and birth and know how to identify problems early and to cooperate with doctors in managing complications, their focus is on birth as a life-enhancing experience." This makes midwives a good match for women who naturally gravitate to a world and personal life view of staying in touch with everything that is right in the world and their bodies.

"Obstetricians, on the other hand, tend to focus on what can go wrong during pregnancy and birth. All doctors are trained to look for trouble (diagnose a problem) and decide what to do about it (decide on a treatment), and that is what comes naturally to obstetricians." So if your way of interacting with the world is to keep your eye focused on what can go wrong in life so as to prevent it from happening, then a doctor is a better fit for you.

Each choice can come at a price though. For a woman choosing a midwife it can be very difficult if the midwife finds an actual problem with the pregnancy or birth. The pregnant or birthing woman may have a hard time switching gears to focus on the problem in order to address it. Here is what Dr. Wagner says about the price the woman choosing a doctor pays, "In prenatal care they [doctors] take the same approach, focusing on what can go wrong and ordering numerous tests and screening procedures. This attitude casts a shadow over the maternity care a woman receives. When an obstetrician runs a test or gives a preemptive treatment, it is an unspoken vote of no confidence in the woman’s body.” I know women often feel each prenatal visit is like a pass/fail test. This is especially stressful on women who are high achievers. If they run into a perceived “failure”, at an office visit it can shake their confidence to their core and they may become obsessed with their fear of failure. This can lead to a rise in stress hormones which can spiral into more “failed” tests.  

Fresh New Pregnancy & Birth Book for Men

Finally a book by a man, for men about pregnancy and birth! As a birth educator and doula for 20 years I have read many wonderful books about birth, but I felt none of them was the kind of book a man would pick up on his own to read. Instead men have been reading the books their pregnant wives would ask them to read; the books that were full of info the women wanted their husband to know. But "Baby Daddy", by Clayton Connelly, is a book full of information men want to know. It is one dad’s humorous look at his personal journey through his woman’s first pregnancy. Connelly’s approachable writing style mixes laugh-out-loud personal experiences with sage advice from a dad who’s been there; sprinkled with just the right amount of facts and important information to open the eyes of a birth novice and get them thinking. "Baby Daddy" is the perfect gift for that friend who just found out the pitter patter of little feet is soon to be entering his life. Trying to find a way to break the news? Why not wrap it up and give it to your man or casually leave it on top of his fine bathroom literature. Although it is meant to be read in stages to go with each trimester, I guarantee once he starts he won’t want to put it down.

Clayton & his wife Jessica took my classes to prepare for the birth of their first child. Read this book to find out what was going on in Clayton's head during my classes.

Hear what the author has to say about the book: http://www.babydaddybook.com/Site/Baby_Daddy.html

Comparing Approaches to Pregnancy & Birth

"The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene, having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order not to be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect." — Ina May Gaskin (Ina May's Guide to Childbirth)

Photo Essay: A Santa Lucia Birth Center Birth

Parker Wilson became a part of one of my favorite familys on January 14.
Between Heather and John, brother and sister, I have been honored to be included in 4 of their family centered births; one at General Hospital, two at home and this one at the new birth center.

Peace Before the Storm

Shortly after arriving Mom and Dad settle into the birth tub. Candles, a beautiful serene room and a warm tub to relax in; exactly the experience Heather and Mike were looking for.

Moments Old

After an intense pushing phase Parker enters this world surrounded by family. Everyone crowds around the big double bed as tears of joy flow freely from Mom, Dad, Grandma, Aunt Emily and Uncle John. Still wet with amniotic fluid Parker is placed in Heather's loving arms to warm and dry.

First Step Toward Independence

After Parker has made the change to oxygenating his own blood, Dr. Dietrich, Licensed Midwife, deftly guides the new Dad through the ritual of cutting the cord that connects Mom and baby.

Precious Moments

Mom, Dad and Parker undisturbed together in the big bed with hearts over flowing. Time stands still. Disbelief that it is over quickly turns to awe.

Exploration

Heather and Mike tenderly get to know their new son. Amazed at his size. Wondering, at how vigorous, alert and healthy he is. The first hour of smell, touch and taste unwinds at its own unhurried pace. Loving gazes and excited exclamations of, "He has your nose" and "Look how long his fingers are" draw the new baby into the family.

Vital Statistics

After sufficient time has passed Dr. Dietrich starts the newborn assessments with the traditional weighing followed by a complete health screening of the new arrival done on the bed with Mom and Dad close at hand.

Life Begins

After only 3 hours Heather, Mike and baby Parker are ready to head home to start their new life together. They will be visited tomorrow by a midwife to make sure they are settling into their babymoon.

********
As a doula I am blessed to meet and work with many families. I met Heather 9 years ago when she needed someone to guide her and Valerie, her mother, through the birth of Heather's second son. This wonderful extended family accepted my help with open arms. Each birth has been unique. Each experience has had its own challenges along the way. My only regret is that I think this will be the last birth for a while. I'll have to wait for the next generation to start having babies but when they do; I'm there!

When Midwives Disagree

Midwives are human beings with all the good and bad that goes with that. The alternative birth community would like to present to the rest of the world a rosy picture of loving, nuturing and everyone getting along. They often paint the medical establishment as evil in contrast to themselves the angles of mercy and caring. Unfortunately in my experience this is far from the truth. The alternative birth community is just as full of politics, power stuggles and personalities as every other human endeavour. Money, group dynamics and territory are often issues. Opposing belief systems and practice protocols often clash. Often skills, abilities and safety get dragged into the fight. Yesterday I ran into just such a situation playing itself out on face book. It prompted me to write "A Good Midwife". Later I realized I wasn't done with my thinking on this topic. I wanted to explore how I felt about some of the underlying issues that I believe get in the way of building true community, true connection.

I believe:
The moment we think we know it all is the moment we stop learning. The moment we are convinced we know the TRUTH is the moment we stop seeking the truth. The moment we only see our differences is the moment we miss the opportunity to connect through our common bonds. The moment we believe there is only one way is the moment we have closed ourselves off to a world of possibilities. To think that we know all there is to know about something as complex and miraculous as birth is the height of egotism. Egotism is the opposite of midwifery, to be WITH woman, not above, not below but with. By being “with” we can learn much and we can teach much. From this all life flows.

A Good Midwife

Today I stumbled upon an online debate over different views of midwifery. As commonly happens in arguments each side seemed to think it was all or nothing. You must either believe totally in the rightness of their side or you were evil; a danger to your unsuspecting clients.

This got me thinking. As a doula I have been in the unique position of watching many different midwives and doctors working with birthing women. I have been present in hospitals, homes and a birth center. I have listened to women grieving and traumatized by their births. Contrary to popular homebirth myth these did not all happen in hospitals. There are times when women suffer terribly after their homebirth. Sometimes they are speaking to me during those early postpartum weeks and sometimes it is years later during their next pregnancy.


After listening and watching here are some of the things I believe makes a good midwife no matter where she practices.

A midwife needs to know when to keep her hands out of a client and when to put her hands in.

A midwife needs to have the ability to be patient, to move slowly and carefully and the ability to move quickly, decisively and without hesitation.

A midwife needs to absolutely trust birth, and a woman's instincts and birth intuitions, and yet be skilled enough to know when a woman needs guidance.

A midwife needs to know how to let the laboring woman be center stage, the lead in the play, while she is prepared to step in as needed in the supporting role, as the hero or just make a cameo appearance.

A midwife balances equally the importance of the mother's experience with the mother's and baby's safety.

A midwife needs to know when to lead and when to follow.

A midwife needs to know the depth of the waters she is swimming in and is prepared to transfer care when she is out of her depth.

A midwife needs to know how to guide without taking over control.

A midwife needs to know all the variations of normal, what they look like, what they sound like, what they feel like so she can help her clients be unafraid.

A midwife needs to know how to help without rescuing. A midwife needs to have the skills and character to rescue when it is needed.

A midwife needs to be skilled at suturing tears and vigilant at trying to prevent them.

A midwife needs to be able to monitor the health of the mom and baby through skilled and timely assessments, heart rate, blood pressure, and temperature without interrupting the flow of labor.

A midwife needs to understand every birth follows its own unique timeline and plan and that sometimes that plan includes transferring care or surgical birth.

A midwife needs to create a relationship of trust with her clients and has a responsibility to not break that trust.

A midwife needs to be able to speak to both the instincts and the intellects of her clients.


I have a deep respect for all the midwives I have watched supporting, guiding and sometimes rescuing my clients over the years. The work is complex, physical, emotional and draining. When births go as planned the midwife will be an adored friend for life. When births aren't the fantasy a woman imagined, the midwife will be blamed forever. It is often very difficult for the birthing woman to grasp all the pieces of what happened and why because she was in the thick of labor. Without real understanding, it is natural to blame the person she imagined was to keep all bad things from happening; the midwife. There are no perfect midwives, just as there are no perfect people. They are simply flawed humans with strengths and weaknesses just like the rest of us.


Thank you to Edana Hall, Brenda Ramler, Sandy Rodriguez, Tiffany Dietrich, Lisa Winick, Linda Seeley, Helen Cominos, and JoAnne Tarkington for devoting your careers to caring about women.

Do you have thoughts on what makes a good midwife? Comment here or email me: jjmstover@sbcglobal.net.

Having a Baby? Read these books...

One April a few years ago I picked up the phone. It was Brenda Ramler, a local midwife calling.

"Hi. I'm working on a recommended reading list. Do you have any books you think I should include?" Brenda is someone you can always count on to get straight to the point; a real straight shooter. One of the straightest shooters I have known in my life.

"Why? What's up?" I on the other hand am an information gatherer. I never like to express my opinion until I feel I know all the facts. You know, a lay of the land type person.

"I'm working on something to hand out at the Fair. I have a list but I'm looking for new ideas to add to it." She was talking about Birth & Baby Resource Network's annual Birth & Baby Fair. This fair was almost as old as BBRN itself and Brenda & I had been involved in some way every year since its founding.

That's another thing about Brenda, she is a worker. She never sees something she feels needs to be done and says, "I'm too tired" or "too busy." Besides that she is an organizational wizard and perhaps one of the most detail oriented people I know. On top of that she is passionate about birth. I should say natural birth. Birth the way she feels it was meant to be. Her vision of birth encompasses pregnancy, birth and parenting. To her birth is one piece of the whole; not an isolated, stand alone event.

She has strong opinions about all of it and doesn't mind sharing them. Actually I believe she feels it is her calling to share them with women and their families; a duty to herself and to God. Of course she shared them with her clients, but she would also share them with pregnant women she met at a coffee shop or in line at the grocery store. She moves through the world strong in her beliefs that women need to know. Why? So they can be responsible for themselves, for their births and for their babies.

This is not a unique belief in the "alternative" birth world. It is the founding principle of BBRN and many other organizations, but Brenda is unique in her power of conviction and willingness to clearly state the truth without fear of repercussions. Many people find this not an endearing trait. But as far as I can tell it never fazed Brenda what other people thought of her. She brought that power, conviction and confidence to every birth. It served her clients well.

She safely caught lots of San Luis Obispo county babies during her years here. She educated many women in their birthing and mothering abilities. She made an impact in our world one family at a time. She also impacted our birth community; educating assistants, doulas, teachers, and even doctors and midwives. I was one of those people. I was lucky enough to doula at a few homebirths with Brenda and she always made herself available to discussclient issues or situations. Now she has moved on to new adventures in new places with her husband. The women whose lives she touched will never forget her. Myself included.

Recently I found a copy of the list of books Brenda and I spoke about that day on the phone. I was in the home of one of her assistants who is currently training to be a midwife. I recognized it as soon as I saw it and asked Heather if I could have a copy. Many of these books are classics. The basics of birth and parenting do not change but the context of the cultural/financial politics which surround it continually changes. These books continue to be relevant because the underlying foundation of greed, power and mistrust of women's bodies remain as a constant at the core of our birth culture. I am happy to announce that these books and many others will soon be on loan again through the Birth & Baby Resource Network in the library at the Santa Lucia Birth Center.

Here is Brenda's Recommended Reading List:
Nutrition/Exercise
***********
Active Birth
Janet Balaskas

The Vegetarian Mother's Cookbook
local author Cathi Olson

Pregnancy & Childbirth
************
American Way of Birth
Jessica Mitford

A Wise Birth
Penny Armstrong

Birth as an American Rite of Passage
Robbie Davis-Floyd

Birth Reborn
Michel Odent

Gentle Birth Choices
Barbara Harper

Immaculate Deception II
Suzanne Armstrong

Natural Childbirth the Bradley Way
Susan McCutcheon

Pursuing the Birth Machine
Marsden Wagner

Special Delivery
Rahima Baldwin

Pregnant Feelings
Rahima Baldwin

Choosing Waterbirth
L. Bertram

Seasons of Change: Growing through Pregnancy & Birth
Suzanne Arms

Creating a Joyful Birth
Lucia Capprioni

Mind Over Labor
Carl Jones

Cesarean/VBAC
********
Open Season
Nancy Cohen

Birthing from Within
Pam England & Robin Horowitz

Rights & Responsibilities
****************
Birthing Normally
Gayle Peterson

Birth Your Way
Shiela Kitzinger

Obstetric Myths Versus Research Realities
Henci Goer

The Thinking Woman's Guide to a Better Birth
Henci Goer

Breastfeeding
*******
The Womanly Art of Breastfeeding
La Leche League International

The Nursing Mother's Companion
local author Kathleen Huggins

Babies & Children
**********
Natural Medicine for Children
J. Scott

Take Charge of Your Child's Health
G. Wootan

The Baby Book
Dr. Sears

Homebirth: Listening to a Master Midwife

Ina May Gaskin is America's premier midwife.If not for her I don't know what would have happened to birth in this country. Her book, "Spiritual Midwifery" reignited the flame of natural woman centered birth. Her personal life story is amazing and what she has achieved is incredible. The numbers of women's lives that she has impacted is unknowable. Like a pebble tossed into a pool her courage and belief in women has flowed outward in never ending rings. Take a moment to sit at the feet of a master and listen to the wisdom she has learned by witnessing women birth. Then visit her website at:http://www.inamay.com/ or buy her book, "Ina May's Guide to Childbirth" from my library.

Home Birth—Why It's Necessary

By Ina May Gaskin, CPM
Originally published by Ina May Gaskin Productions, 2007-01-14
Simply put, when there is no home birth in a society, or when home birth is driven completely underground, essential knowledge of women’s capacities in birth is lost to the people of that society—to professional caregivers, as well as to the women of childbearing age themselves. The disappearance of knowledge once commonly held paves the way for over-medicalization of birth and the risks which this poses. Nothing in medical literature today communicates the idea that women’s bodies are well designed for birth. Ignorance of the capacities of women’s bodies can flourish and quickly spread into popular culture when the medical profession is unable to distinguish between ancient wisdom and superstitious belief. To illustrate, I would cite a National Geographic article (1) which states that, “…we [humans] can give birth to babies with big brains, but only through great pain and risk.” The writer, depending upon the work of two U.S. anthropologists, explains that the fact that our species walks upright causes inevitable pain and risk during birth, forgetting how easily we can go to our hands and knees if need be.

I would have had no way to know how well healthy women’s bodies can work in labor and birth had I not experienced a rediscovery of women’s capacities in birth, along with several hundred other people, as we established a midwifery service in our newly founded community in 1970. Most people would have predicted that my diving headlong into attending home births for friends and then training a group of midwives to work with me would have ended in disaster, given that I came into midwifery only with the training afforded by two degrees in English literature. What happened instead is that I received timely and essential help from a few generous, wise physicians, and our service was able to help the first 186 women give birth vaginally (without instruments or other medical interventions) before our first cesarean was necessary. It was not until birth #324 that the second became necessary. All of this was accomplished without negative consequences to mothers or babies.

This degree of success is hard for many physicians to believe, because it runs counter to what they have been taught. For many decades, physicians have been taught that the female pelvis is often too small to permit the safe passage of a term baby through it. Still, over the last three and a half decades, more than 2400 births have been attended within our midwifery service, with our cesarean and instrumental delivery rates combined still below 2 percent, in sharp contrast to the U.S. cesarean rate, which is now nearly 30 percent and climbing.

The publication of our early data in my first book, Spiritual Midwifery, in 1975, helped to encourage the natural childbirth movement that began in North America during the late 1960s. (2) This movement caused U.S. hospitals to radically reassess their maternity care policies during the 1970s and 1980s, leading them, for the first time, to allow family members to be present at births; to allow women, for the first time, to choose midwives as birth attendants; and to change—again for the first time, their policy of mandatory episiotomy. The natural childbirth movement, which was greatly inspired by home birth pioneers, also had the effect of drastically reducing the incidence of forceps deliveries, which had previously been used in more than 40 percent of U.S. births.

Midwifery care blossomed in the U.S. because of the home birth movement, as women who didn’t themselves want home births but who did want care that did not involve routine and unnecessary medical interventions and practices, such as pubic shaving, enemas, being forced to remain still while lying supine during labor (the painful position possible) and often mandatory pain medication, wanted to be able to choose the midwifery model of care in the hospitals where they would give birth. Women themselves began to force these changes by opting for midwifery care and by insisting upon doula care. All of these transformations demonstrated both to laboring women and to their caregivers that women are fully capable of giving birth without the mandatory use of several interventions once considered by U.S. obstetricians to be not only important but essential to the health of mother or baby.

I have not yet mentioned the long list of techniques and practices common to home birth midwifery, which have made their way into progressive hospital maternity care practice. Among these are the use of water tubs for alleviation of pain during labor, the all-fours position (sometimes called the Gaskin maneuver) to resolve the serious complication of shoulder dystocia (3-5), upright positions for labor and birth, the safety of allowing almost all women to enter labor without induction, the use of nipple stimulation to release the body’s natural oxytocin to augment labor (6,7) and the possibility of sleeping, eating and drinking during labor. It is no exaggeration to say that none of these techniques would have been adopted into hospital practice, had it not been for their having first been developed and tested in the “laboratory” of home birth practice. Medical research is expensive and thus rarely focuses on preventive measures or those which don’t rely upon pharmaceutical or technological products.

Another extremely important concept that arises from home birth practice is the recognition of what I call “sphincter law.” (8) This concept describes the common phenomenon, which occurs often in women’s labors, in which stress sometimes causes the cervix, once dilated in labor, to suddenly close, or for labor to stop. Having first observed this phenomenon in the early years of my practice, I found that other midwifery colleagues working in and out of hospitals and many labor and delivery nurses were also familiar with it. We found that such cases could safely resolve themselves, without medical intervention, by waiting for labor to resume in less stressful circumstances. Looking deeper into medical books written during the period when home birth was the norm, I found many 19th century authors who had also documented this physiological phenomenon, which is dependent upon an imbalance of maternal hormones during labor which can take place when the woman feels greatly stressed during the birth process. If current medical knowledge included these concepts which it once did, fewer women would be subjected to the risks of induction drugs, the use of which has increased sharply over the last fifteen years—not always with good results. (9)

Of course, this is not to say that women should be required to have home births. However, the option to give birth in the place of choice should be open to those women who desire it, as long as their physical condition permits it as a safe choice. The body of knowledge available to all maternity caregivers depends upon a full range of choices being available to childbearing women.

Notes

1. Ackerman J. The downside of upright. National Geographic July 2006, 126-145.

2. Gaskin IM. Spiritual Midwifery (1975) Summertown, TN: The Book Publishing Company.

3. Meenan A and Gaskin IM, et al. A new (old) maneuver for the management of shoulder dystocia, The Journal of Family Practice, 1991: 32:625-29.

4. Bruner J and Gaskin IM, et al. All-fours maneuver for reducing shoulder dystocia, The Journal of Reproductive Medicine, 1998; 43:439-43.

5. Gabbe SG, Niebyl JR, and Simpson JL. Obstetrics: Normal & Problem Pregnancies, 4th ed. New York: Churchill Livingstone, 2002.

6. Curtis P. A comparison of breast stimulation and intravenous oxytocin for the augmentation of labor, Birth, June 1999; 26:115-122.

7. Curtis P. Breast Stimulation to Augment Labor: History, Mystery, and Culture. Birth, June 1999; 26: 123-6.

8. Gaskin, Ina May. Understanding birth and Sphincter Law, British Journal of Midwifery, Volume 12, Number 9, September 2004.
9. Wagner M. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (2005) Berkeley, CA: University of California Press.

The Challenges of Being in Labor While Being a Mommy

I love this humorous account of a local homebirth. The humor comes from her no nonsense down to earth truth telling about the challenges of laboring and mothering at the same time. This is one of the difficult parts of having another baby. Women don't get the luxury of stopping motherhood while pregnant, birthing or recovering. No matter how many times I tell my experienced moms to have things arranged so you can drop everything, including your older child/children and zoom to the hospital I always arrive there before them! And then there is the issue of assuming this birth will be like the last birth; right? Enjoy Kelly's story!

Our little Alubia (bean in Spanish) was born on Aug.27, 2010; weighing 6 lbs 14 oz and measuring only 18 ¾ inches. She’s soooo small, but so cute. She has a full head of black hair and adorable chubby cheeks. We have named her Maui (Maria Luisa) and sometimes manage to NOT call her Alubia. Thanks, Maui, for the name.

Her birth story is very different than I imagined it would be, but it is still perfect (well, mostly). It turns out this labor stuff is complicated and having had a child only makes it more complicated. Who knew? This is the way things are supposed to be with a second birth: 1) The mother should know when labor starts. 2) The mother should remain calm during labor, because after all, she’s done this before and should be able to relax and breathe correctly. 3) The first child is NOT supposed to randomly start vomiting once labor starts and need his daddy. 4) The mother should be able to handle labor just fine if the father is temporarily needed by the older child. You know, the !Kung women only have birth attendants with their first child. After that, they go into nature and give birth alone and walk back to the village. So what’s a few contractions with no hubby, right? Well, none of that worked out well for me. And, I’ve also found out that the fact that everybody says that second labors can progress rapidly once they actually begin actually has a bit of a negative spin. They can take forever to “actually begin” and you should probably simply store your birth personnel (midwives, doulas, babysitters) in the garage or office or something so that everyone is ready to go right when you need them.

So here’s how it started. Wednesday at noon, I went to put Xavi down for his nap, but just couldn’t. I had absolutely no way of keeping my eyes open. So I pulled out a comforter and pillow and lay down on the floor and tried to convince him to nap with me. No such luck. Under those circumstances, he wants to lay on top of you with you on your back and I just couldn’t do it while pregnant. Finally, I texted Eneko to come and put Xavi down for his nap. He did and then returned to work while I went and laid down. And then started vomiting and having very continuous Braxton Hicks contractions and feeling like I was going to die. So he returned home and worked from home, watching Xavi while I made friends with the toilet (like we haven’t spent enough time together during this pregnancy). I felt so icky and wretched, way worse than with any stomach flu I’ve ever had, but a little like I was in labor, but not for any real definable reason. Kristi came over to check me and said not yet and drink the following liquids and we all went to bed (not together, she went home, obviously). A little later that night, the vomiting and ickiness went away and real contractions began. So that happened for most of the night and by morning, I was sure the baby was coming that same day, on Thursday. So when Eneko woke up, I told him the good news and we started getting the house ready for the baby and then I went to lay down to rest between contractions. It was wonderful. I let Laura, our doula, know what was happening and that we would call her when we needed her. Meredith, our babysitter, was able to get her in-laws to come care for her son until when her husband got off work and she kept me company until Megan could come check me and tell me… ehhh, maybe it will turn into active labor, but maybe not today since it was in the early stages. Stay hydrated, well-fed, rested and probably tonight, after Xavi was in bed.

Discouraging, but Eneko, Xavi and I decided to do those final things before the baby arrived. We ate lunch, went to Trader Joe’s to get some stuff, got Alubia’s birthday for Xavi present from Whiz Kids (love that store!!!), went to Doc Burstein’s one last time to get ice cream (I imagine I will be dairy-free with this little girl too so gotta eat the good stuff while I can) and then came home to rest while California Pizza Chicken (according to Eneko) was delivered. All this time, I was having fairly regular contractions that were pretty strong and I was doing a good job of relaxing during them, visualizing progress and all that good stuff. And on Thursday night, NOTHING! No baby snuggling in bed with us when we woke up in the morning on Friday.

So after a contractiony breakfast, the decision was made to send Eneko to work. Who knows when this labor will start so we’re going to have to go on with our lives, just pausing to breathe every little bit. Xavi and I went to gymnastics and the contractions were pretty controllable while we were there and then we came home, prepared dinner and had our naps and our lunch (staying rested and well-fueled like advised). I was pretty miserable by now, but didn’t want to waste my last days of one to one attention with Xavi, so we went to Avila Valley Barn to feed the animals, ride on the tractor and get some "I-sheem." That tractor ride almost killed me. When we got home it was close to five, so we finished dinner and then sat on the sofa to read (Xavi is in the phase where he loves to have marathon reading sessions, having you read a book to him over and over and over and then choosing another and having you read that one over and over and over. Up til now this had been great for pregnancy because how often do you get to sit with a toddler???). By now, I’m moaning through the contractions and trying to read to Xavi. “A cow says Moo, A sheep says Baaa. Three singing pigs say AHHHHHHHHHHHHHHHHHH” and Xavi is getting upset and crying because that isn’t how the book goes and Eneko sends me a message saying he’ll be staying a little late to finish some stuff and I’m about to cry… But we survived that extra half-hour with no daddy and when he got home, he took Xavi on a bike ride and I got to have a few contractions without someone crying through them and flailing on my lap. Things seemed bearable once again. Eneko would be home all weekend and hopefully we would have a baby. Then during dinner, Eneko tells me about all the stuff happening in the office that weekend and I start freaking out. If he needs to work, he needs to work. Life can’t stop because I’m having contractions. But SERIOUSLY, it is sooooo hard caring for a toddler and having contractions. Should I call Sabrina to watch Xavi Saturday? But she needs to move and it’s her day off and she has her own family to take care of. And what if this goes on for days? weeks? It’s getting reaaalllly hard to relax during the contractions since it was getting really hard to relax period! And when you’re tense, they hurt so much more. And I was getting to my mental breaking point.

So my poor husband is trying to help and he offers to call one of the midwives to examine me and I say no, we have to wait until we are actually in labor. He offers to examine me and I say, no. Then I change my mind and decide that once Xavi is in bed, that would be a good idea and then I went to moan my way through the contractions in bed while he put Xavi to bed. By the time Xavi was asleep, I was so restless, moving from the ball, to walking, to laying on my side and just not feeling too great anywhere, knowing it was my fault, if I could just relax I wouldn’t have a hard time. So Eneko, around 8:30, checks and he says, “Not a 2 or a 5. A 3 or 4.” And I almost cried. Or maybe I did. Can’t remember. If it’s a 3, that means NOTHING. But if it’s a 4, then we’re in labor. But what if it’s a 3 and I stay like this for weeks???? He calls Kristi, against my advice, and reports his findings and asks for someone to come. And says he will set up the birth pool. I’m dead set against this, because, what if I’m not in labor? He wants to call Laura and Meredith too and I say no! And then beg for the pool because I can’t take it anymore and I need something to help. So he sets up the pool and it was like heaven getting into the warm water, but I still couldn’t relax because now we had an inflatable pool set up in the dining room in a house with a toddler and a cat (what could possibly go wrong there?) and what if this wasn’t even labor and if you can’t relax the contractions hurt and aren’t as effective which causes you to tense up more, which causes them to hurt more.

Poor Eneko is doing all of the last minute birth preparations for the house and wanting to call in reinforcements and I’m still saying no, not until we know for sure. Around 10, Megan and Edana arrive and begin unloading all the equipment for the birth and I am soooo frustrated because they might just have to pack all that stuff up and take it with them. I had thought one person would just come and do a quick exam. But, it turns out, surprise, it was labor. Finally Eneko gets to start calling help when Xavi wakes up. So Eneko is trying to call people and things aren’t working out. Meredith’s husband is working that night of all nights and Sabrina has to bring her little girl who is throwing up and he didn’t want that because it’s contagious. Turns out, I had understood that incorrectly. The reason Xavi kept waking was because HE was the one who was throwing up (probably what I had on Wednesday). So no babysitter. And I am freaking out again, because I really needed Eneko to help ME but it turns out it is hard to arrange for childcare via telephone while taking care of a vomiting child and massaging your wife’s back in the birthpool at the same time. Why isn’t there an app for that? Everything else seemed to happen in some kind of crazy blur. It seems like Laura, Meredith and Sabrina arrived about the same time, right when they were needed most and Eneko was able to focus on one thing, me, since Xavi was now in good hands :). Things were moving so fast at that time, or at least it seemed like it from my perspective. The contractions got crazy strong very suddenly and for two or three contractions it was really overwhelming and then we adjusted and the birth went on well. But certainly not gracefully. I was never really calm or centered or focused, even having to be reminded to breathe on way more than one occasion. I remember Xavi’s birth as being so peaceful but this one I think I will remember as more chaotic (entirely my own fault though). I think she was born just a little while later, totally covered in vernix, but adorable. And then we got those great moments you dream of in your pregnancy: time has stopped, you’re sitting in the pool, holding each other and your new baby, not feeling like pushing out the placenta, but knowing you will have to. And, yeah, after she was born, I was informed that it had indeed been labor :)

Anyhow, everything ended up perfect and everyone came through and then some, making our night exceptionally special. We got some amazing pictures, though all seem to have some kind of nudity, and it was great to see how my friends who had come to take care of Xavi ended up helping out with everything, as did our doula. It was so wonderful to birth our little Maui among friends.

Now I have a feeling that if we have any more kids, I will not be allowed to participate in any decisions about phone calls. So unfair! I only messed up one time. Like the one time (our first “date”) when the action movie we went to see ended up being a graphic (or pornographic depending on your definition) movie about gay bank robbers. And now I’m not allowed to choose movies for us to go see anymore. People should really get more chances in life.

Home Birth... Why I Did It (& I'm Not a Hippie)

Not sure about where to birth, hospital or home? When trying to decide where to birth I always advise my clients to look deep into their hearts and listen to what it is telling them. Where will you feel safest? For some moms that is the hospital and for others it is at home.

Recently I had a client who was preparing for the birth of her second child. She was having a difficult time deciding between Sierra Vista or French Hospitals. She had a lot of negative feelings about her first birth but was choosing to return to the same hospital, even though she dreaded it, because of fears about safety issues for her baby. Her heart was conflicted. I encouraged her to listen to her heart and decide. She planned to return to the hospital of her first birth. That was the plan. It was all settled. Everyone knew that was the plan . . . until she was on the way to the hospital. Then her heart spoke to her again and said, "you have nothing to fear for your baby. She is fine and healthy. Go to the hospital where you think you can labor best." And that is what she did. She changed her plan.

Read one Illinois mom's thoughts about making her choice posted August 4, 2010 on Ireport at CNN.com

I gave birth to my son at home.

And no, I’m not a hippie. I’m a college educated, business minded woman who made an informed choice about the labor and delivery of my second child.

Giuseppe Massimo “Max” entered this world at 11:46 pm on March 4th, 2010 in our bedroom of our Northbrook, IL home. I wouldn’t change a thing about the labor and delivery. It was one of the most incredible moments a family can have. I’d like to tell you a little more about what led up to that special moment.

When my husband and I first learned I was pregnant a second time, We weren’t even considering a natural birth, let alone a home birth. My first child was born in the hospital, I had been given an epidural, and I just assumed I’d do the same for the second. A few months later I learned that one of our neighbors had delivered all three of her children at home. I’m sad to say that my first reaction was “why in the world would anyone ever want to do that??” But something kept creeping up in my mind, I was truly intrigued by the idea. A few weeks later I talked with a friend who had done a natural birth. I’ll never forget the day when we met over coffee and I heard her birth story and the emotions she had around her natural childbirth. I was amazed by her story and yet sad when I realized my feelings about my first birth were nowhere near that happy, passionate or memorable. Don’t get me wrong, I love my daughter dearly, but her birth was not as I had always envisioned. I then started to open my mind about the idea of natural childbirth and began doing some detailed research. What I found both elated and saddened me. I was thrilled to learn about all of the wonderful benefits for both mom and baby when childbirth is left to naturally run its course. But I felt so dismayed that the majority of women are never exposed to this information. They don’t really know they have a choice. Society puts so much pressure on them to have a fast labor, make sure it’s painless, and get in and out of the hospital quickly. There are so few natural birth advocates out there, likely because hardly anyone is doing it as its not likely to be covered by insurance or endorsed by your OB/GYN. Plus there’s a stigma. As I mentioned, I’m not a hippie, but everyone assumes you are some free lovin’, incense-burning, crazy lady that has no regard for her or her unborn’s health when you tell them you are having a home birth. The reality is that for healthy women with no pregnancy complications, natural childbirth is much safer and healthier for both mom and child (when the birth is attended by a certified midwife). If you think about it, people go to hospitals because they are sick, childbirth is the only thing they go there for that is a completely natural process. Why is that? Well, it all has to do with the mighty dollar. It’s a big business and insurance companies and doctors solve for the riskiest cases, and then apply that logic and methodology for all. Patients assume this is best, but its simply not. History has shown this time and time again.

I encourage you to do your own research on childbirth, but I’ll give you a bit of the basic info that I’ve learned over the last year. There’s more to childbirth then simply getting the baby out. A complex chain of events occurs with the mom and baby as labor and delivery progress. When left untouched, natural hormones enter the mother and baby that make the birth easier for both and also create a stronger bond with mom and baby. Natural birth babies are more responsive and much more likely to successfully breastfeed. Passage through the birth canal helps squeeze all of the fluids out of the baby’s lungs enabling better breathing after birth. The benefits of natural birth go on and on, all leading to a happier, healthier baby and mom.

So, why at home then? Sure you can have a natural birth in the hospital, right? Not always. You may go in with a birth plan, but hospitals have their own agendas. They minimize the risk and get you out quickly so they can get a new mom in. With 1/3, yes ONE THIRD of women in the US now having c-sections, I didn’t want to take my chances. The rate was under 5% in 1965 when hospitals began to keep track of the numbers. Now it’s over 30%! What happened? Well it’s not that women are smaller, or babies are that much bigger, it’s now a matter of convenience. But not for the mom, its for the hospital, doctors and insurance companies. C-section rates are actually highest at 5 pm and 10 pm. Why? So doctors can get the birth over with and get home for dinner or bed. They can opt for the c-section and be out of the hospital on their way home in less than 30 minutes. And at that point, weary moms are likely not to argue. You simply assume the doctor knows best.

I’m guessing that even with my natural birth plan, if I had been in the hospital I would have ended up with Pitocin (drug used to speed up labor, but reduces the mom’s natural birth hormones) and likely a c-section. At home it took me 30 hours to labor Max down. And at 9 lbs, it took me over an hour of pushing. Likely not something a doctor would have the patience to wait out. But my midwife stayed calm and relaxed, she knew the baby would eventually emerge. She was a great coach and I felt confident she had the experience to handle any situation. This is important to note, as I don't believe in unattended home births. A home birth should always have an experienced midwife present.

And sure, it was painful, REALLY painful. But the instant my son was born, I felt 100 times better than I did with my first baby. My connection with him was instant and he immediately latched on to breastfeed. My husband also enjoyed the experience much more at home. First, he always wondered why I didn’t seem to show a strong connection with my daughter when she was first born. With Max he was in awe of the immediate deep bond. Additionally, he was able to really participate. He was able to help much more at home and actually catch the baby as he emerged. Plus, we all got to sleep in our own bed that night. We wouldn’t trade the entire experience for the world.

My hope is that by sharing my story, I may encourage at least one mom to do her own research so she can make the best decision for her childbirth experience. Women need to start reclaiming their baby’s births. I’m certain almost all women are capable of a natural birth, and if they take back that right, we will have healthier and happier moms, dads and babies out there.

What speaks to your heart? Where will you feel safest?

You Don't Know How Lucky You Are

I don't believe the birthing women of San Luis Obispo have a clue how lucky they are. Even many of the women working in our birth community don't know how lucky we are. We are so busy being in the here and now of our little corner of the world we assume this is how it has always been, this is how it is everywhere. Those of us working in the "alternative" birth community often see only the negatives. Guess what? Your perception is wrong. There are so many positives going on every day in our community. There is constant movement toward making births better for all women and their babies.

This was brought home to me in a very powerful and personal way the first time I attended a birth outside of our community. Being with my sister-in-law as she birthed at a hospital in Berkeley was an eye opening experience. A few years later attending another sister-in-law in Nevada taught me to treasure our hospitals and the people working in them. I can't tell you how grateful I am to be working as a doula in SLO.

So let's focus on the positives please! Here is a list:

Twenty years ago when I had my son if your baby was born in need of serious medical attention he was flown by helicopter to Stanford. Moms, dads and babies were separated until the mom was recovered enough from the birth to drive up to the Bay Area. Then the staff at Sierra Vista got together and created our local NICU. This was a huge project which now benefits women, babies and families in our community every day. Now if you are a high risk mom or have a high risk baby you have a place to go close to home and the support of family and friends.

When it became clear to everyone that General Hospital was probably going to no longer be funded by the county French Hospital stepped up to fill the gap. General had always been the low-tech family friendly hospital. French Hospital with it's small size and supportive staff is an excellent hospital for women going for a less medicalized birth approach.

Not too many years ago the best we could do for using water as a pain relief method was a shower. Now we have labor tubs at all three county hospitals where women can seek pain relief without the use of narcotics and needles. Want to birth in water? You can rent a tub and birth at home with one of our skilled homebirth midwives.

Fifteen years ago when a friend needed a specialized ultrasound done to check out the chambers of her baby's heart she had to travel to the Bay Area. Now for women who need specialized monitoring of their pregnancy we have qualified perinatologists with ultrasound capabilities far beyond what we once had.

We have lots of OB doctors with lots of different personalities and philosophies and styles to choose from. If you want to use a midwife instead we have an ever growing choice. There is something for every woman on the menu. Want to birth in the hospital but with a midwife? Guess what? We currently have two different certified midwifery groups working with two different doctors. Don't want to go to the hospital? We have two different licensed midwives to choose from and by this time next year we should have several new midwives joining their ranks.

Don't feel comfortable either birthing at home or in the hospital? Guess what? We have an out-of-hospital birth center currently under construction. It is due to be open for women with December due dates. Watch their progress on facebook.

I remember when your only choice for birth education was to take Lamaze at the hospital or Bradley outside the hospital. Now you can choose from these as well as Informed Birth & Parenting, Hypnobirthing, Birth Works or Birthing from Within. There is something for everyone from over the grade to the south county.

We have many other support groups and professionals for new parents in our area. Need free breastfeeding help? Call the Warm Line at 541-BABY. Want a breastfeeding support group? Try our local La Leche League meetings. Speaking of breastfeeding; we have excellent lactation consultants working in and out of our hospitals. Need postpartum support and counseling? Call the Postpartum Hot line at 549-7786. Need a shoulder to cry on about a negative birth experience? Go to one of our ICAN meetings. We have mommy support networks both on line and in person such as SLO County Mommies. We have parenting classes through Parent Participation throughout the county or Andrea Herron's Growing with Baby.

Considering using a doula at your birth? Go to the resource guide at the Birth & Baby Resource Network: wwwbbrn.org. We have a whole list of doulas working in the community and new ones getting trained all the time. The perfect match to your personality and belief system is just waiting for you.

As a doula these last items are the most important to me.

When the American College of Obstetricians and Gynecologists created new rules which required anesthesiologists standing by for a woman to be "allowed" to go for a vaginal birth after a previous c-section Sierra Vista stepped up and did what was necessary to make that happen for our community. Guess what? We have the only hospital for hundreds of miles that will do v-bacs. I recently had a client who moved back here from Santa Barbara just to be able to successfully v-bac!

Need a c-section? Our hospitals are actively working to create them to be as family friendly as possible given their staffing and geography restraints. They are trying to keep moms, dads, and babies together as much as possible. And guess what? Usually your doula, as well as your husband, can be with you during the entire process.

Last I would like to speak about the relationships with the hospital staff and doulas in our community. It has been many years since I was introduced at a birth as a doula and felt open hostility from the nurses. Now the staff has grown in their understanding and acceptance of the value of doulas within the hospital setting so much that I have even been paired with new nurses so they could be part of a "natural" birth. I would like to also say that anytime I have had doula clients with special needs or situations in preparing for their births both Marie Chaney, Maternal Child Assistant Director, at Sierra Vista and Charley Ault, OB Nurse Manager, at French took the time to speak with them and did their best to accommodate their needs and desires.

So within SLO town the picture looks pretty rosy but step outside this box and the picture gets ugly fast. There are hospitals that won't "allow" doulas to be present at births. They also don't "allow" birth plans or want couples who have taken classes which encourage natural unmedicated births. As a doula I have run into open hostility, been excluded from c-sections, had my client's pre-arranged wishes for their births ignored and witnessed verbal disrespect bordering on abuse of a mom preparing for a cesarean birth.

So thank you to all the women over the years who have tried to make this community more mother/baby friendly. A mountain of sand can be moved one grain at a time.


To read more about life outside our bubble go to A Sign on the Door.

The Day President Obama Signed the Health Care Bill

Published in the SLO Tribune on Friday March 26, 2010

Hidden in the thousands of pages of the Health Care Bill that President Obama signed into law were some items very few people were aware of that will effect women all across the country. They target issues concerning maternity care and they have the power to change our beliefs about where, how and with whom women should be giving birth in our country.

Did you know forty-two % of all births in the U.S. are paid for through Medicaid reimbursement? Now women will have a choice of how they use that money. They can continue to choose to birth in a hospital with a doctor but they can also choose to have a Certified Nurse Midwife attend them in a hospital, or they could attend them at an out of hospital birth center. Another option is to have a Certified Professional Midwife attend them at an out of hospital birth center. This doesn’t just represent more freedom for women to choose the birth the want it also represents a huge cost savings to the Medicaid budget. The average hospital birth with a doctor attending costs approximately $20,000. It skyrockets to $60,000 for a cesarean section birth. With our national cesarean section rate climbing every day this is a serious chunk of change. On the other hand the average cost for a birth center birth is approximately ¼ of that or $5000. Not all women should be birthing in birth centers with midwives but if just 5% of women choose this option it will mean millions of dollars a year saved.

Did you know until today they was no widespread standardized assessment of the maternity care being offered in this country? Statistics relating to the benefits and risks of current practices in use today, such as, induction of labor, medication to speed labor, or drugs for pain relief were not being kept in a national database. Over time this data base will yield important information for women and their care providers. Helping them base their care on informed choices.

Did you know women were being denied health care coverage because they had given birth by cesarean section? This was being labeled a pre-existing condition which ruled them out of further care. On top of that the current stance of the American College of Obstetricians and Gynecologists about vaginal birth after cesarean section makes it impossible for many women in the U.S. to do anything except have a repeat cesarean section for all future births. Until today women were faced with the choice of letting their insurance company limit the size of their family or pay about $60,000 per child.

Did you know until today your insurance company could deny you care simply because you were pregnant? Stopping this practice has the potential of effecting millions of women and babies. Guaranteeing access to quality maternity care impacts not just this generation but the next as well.

Thank you to Representative Capps for working to pass this important legislation for women and babies. When asked about this piece of the bill she said, "I know that bringing a new life into the world can be the most profound moment in a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health."

More Great News About the Health Care Legislation!

This just e-mailed to me from Childbirth Connection, another group that worked hard to get important items for women and babies included in this bill.

Dear Friend, On Sunday, March 21, the House of Representatives took a courageous and giant step toward a better health care system for America’s women, babies and families with the passage of the Patient Protection and Affordable Care Act. This legislation will make a significant difference in the lives of millions of women, babies and families by expanding access to health insurance, ending insurance industry practices that discriminate against women, and improving the quality and cost of health care.

Childbirth Connection worked hard over the last year to ensure that the special needs of women and babies were considered in health care reform. We are happy to report that our efforts resulted in provisions in the bill for measuring and reporting on the quality of adult health care covered by Medicaid. Because Medicaid pays for about 42% of births in the country, this provision offers important opportunities for using performance measurement to improve the quality and value of maternity care. Childbirth Connection is committed to ensuring that the new performance measurement program gives appropriate attention to childbearing women and newborns. We will work on implementation with the Centers for Medicare and Medicaid Services and other stakeholders.

This accomplishment would not have been possible without the support of many individuals and organizations committed to significant improvements in maternity care access and quality. Special thanks to Representatives Elliot Engel and Lois Capps, as well as the staffs of the House Energy & Commerce and Senate Finance Committees for supporting these important quality improvement provisions. We also thank the many national organizations and countless individuals who advocated for these provisions.

Other provisions in the bill that will benefit women and babies include:

Health insurance coverage for women before, during and between pregnancies
Medicaid reimbursement for licensed caregivers offering services in licensed birth centers
Medicaid reimbursement of the birth center facility fee
100% reimbursement of Certified Nurse-Midwives’ services in Medicare Part B
Elimination of denial of insurance coverage due to pre-existing conditions such as being pregnant, having had a cesarean section, or being a victim of domestic violence
Workplace protections for nursing mothers
Screening for postpartum depression
Prenatal and postpartum nurse home visits for low-income, first-time families and their children Coverage for a range of preventive services including screening for diabetes and heart disease.

This is all great news for women and families, but there’s still more to do. Please contact your senators (click on “Web Form”) and ask them to pass the reconciliation bill to further strengthen health care reform provisions.

With the President’s signing of the Patient Protection and Affordable Care Act into law today, please join with Childbirth Connection in celebrating the path-breaking provisions that will be carried out in the weeks, months and years ahead.
Best wishes,

Maureen Corry
Executive Director
Childbirth Connection

Historic Health Care Bill for Women, Maternity Care and Midwives

I just watched President Obama sign into law the health care bill. People may disagree about this bill and what it means for our future. I'm not going to discuss the total bill. What is important to me is something few people are aware of. Buried in this bill is a very important piece of legislation that speaks directly to women & midwives. Because of the passage of this bill women on Medicaid can now seek midwifery care from both a Certified Nurse Midwife or a Certified Professional Midwife and birth their babies in out of hospital birth centers. This is a huge step forward for CPMs in their desire to be acknowledged as birth professionals providing safe care for healthy moms and babies during birth. It will make birth centers more financially viable due to Medicaid reimbursement and therefore will lead to more birth centers being opened and more out of hospital births occurring. This is greatly needed at this time in our country to balance the current medical birth climate and bring down the huge cost of maternity care.

I was very proud to watch our Representative, Congresswoman Lois Capps, at the signing ceremony. I would like to thank her for her dedication and work, for her caring about women's health issues and for her support of midwives & midwifery. I would like to thank the women who cared enough to take the time to sit down with me and Betsy Umhofer, Rep. Capps local liaison, and present to her why she should support this important piece of legislation: Jessica Elliott, past president of BBRN & current midwife in training, Edana Hall, Licensed Midwife, Miday Johnson, Certified Nurse Midwife, Megan Bochum, past local International Cesarean Awareness Network leader and student midwife, Janet Murphy, Cal Poly Child Development Specialist, and Stephanie Wilson, LMST and SLO-Child Abuse Prevention Council Postpartum Depression Specialist. It was women like this all around the country speaking up that made this moment in our history happen. Congratulations!

A Victory for Mothers and Babies!

I am too busy to write but there has been lots of important news about birth lately in the news. Here is the latest as of this morning. . .

This is an e-mail sent to me from the Mama Campaign, an organization that is dedicated to getting women more access to quality midwifery care in all birth settings.

Midwives and mothers, babies and families, are victors today! With the passage of the Senate health care reform bill in the U.S. House of Representatives on Sunday, March 21, and the signature of the President in the coming days, several provisions that will significantly benefit mothers and babies will now be the law of the land! These provisions will increase access to birth options for low-income women across the country, and will improve the quality of maternity care for all women in the years to come. The MAMA Campaign is proud to have had a role in improving conditions for midwives and mothers in this landmark legislation. The following are now law:

MAMA Campaign’s “partial victory”:
*Senator Cantwell’s provision that will have the effect of requiring Medicaid reimbursement for licensed CPMs offering services in licensed birth centers
*American Association of Birth Center’s provision that mandates Medicaid reimbursement of the birth center facility fee
*Childbirth Connection’s provision requiring quality assessment and improvement measures specific to maternity care
*American College of Nurse Midwives’ equitable reimbursement act for Certified Nurse Midwives
*Giving birth, having a cesarean section, or being the victim of domestic abuse will no longer be considered pre-existing conditions and used to deny insurance coverage to women!

What Happens Now With This Legislative Process?Last night, the House of Representatives passed the Senate health care reform bill that contains the above provisions and the President will sign this bill into law in the coming days. The House also passed a companion reconciliation bill, popularly called a “side car" or "fix it”, to address the House’s concerns about the Senate bill. This companion bill now goes to the Senate for consideration. It is expected that debate will begin in the Senate on Tuesday, and that Republicans will introduce a number of amendments, with debate taking several days. The Senate will be considering this bill under the reconciliation process which requires a simple majority to pass, and Democrats appear confident that they have the votes to pass this bill in the Senate.

Thank You for Your Role in This Victory!Thank you to each and every one of you who supported the MAMA Campaign and these provisions for women and families. Every letter that you wrote and every dollar that you gave made a difference! We look forward to working with you this year as the MAMA Campaign continues the effort to cover all CPM services in all settings in the Federal Medicaid program.Moving Beyond Health Care Reform- MAMA Continues to Fight for CPMsMAMA continues to be on the move for midwives and mothers in Washington, D.C!

The MAMA Campaign Steering Committee met in Washington, D.C. two weeks ago, March 5th – 7th, to evaluate the campaign to date and to re-commit to working together to achieve our central goal: to amend the Social Security Act to require the reimbursement of all CPM services in the Federal Medicaid program. On March 5th, 8th & 9th, steering committee members met with 35 Congressional offices on behalf of midwives and mothers. It was clear in these visits that our policy gained significant support in 2009 in key offices and that this support can be leveraged as we move forward in 2010.

You will be hearing from us over the next weeks and months, asking for your input, your engagement and your support as MAMA continues to do our part to improve maternity care in the U.S. and to increase women’s access to Certified Professional Midwives.

Thank Your Legislators!If your Senators and Congress Members voted for health care reform, including the provisions for women and families, please write to them to thank them. If your legislators voted against health care reform, please write to ask them to ensure in Federal legislation that women have access to Certified Professional Midwives, a high-quality, low-cost option. As always, your legislators need to hear from you on behalf of midwives and mothers!

Support Your MAMA! In celebration of the passage of our “partial victory” and in support of our on-going work to cover all CPM services in all settings in the Federal Medicaid program, please consider donating to the MAMA Campaign today!If you have any questions, concerns or comments please contact the campaign at mailto:info@mamacampaign.org..