The Best of Both Worlds?

Freestanding birth centers often advertise that they are the "best of both worlds." For example, the Connecticut Childbirth and Women's Center states that "the birthcenter provides women with the best of both worlds--expert care provided by certified nurse-midwives, while emergency care is just a stone throw away" at the nearby hospital. I've often wondered about freestanding birth centers. I think they are fantastic for women who have a need to birth in some kind of institution (whatever that need might be: mental, emotional, lack of a safe home environment) but don't want the whole hospital runaround. I wish that there were more birth centers, so that it would be an option for any woman who desired it.

However, in light of some of the discussion about the photo essay about "homelike" birthing spaces, I'd like to offer up another view of birth centers as the worst of both worlds. Here's why:

Freestanding birth centers offer no technological or pharmacological advantages over home births. Midwives in both settings carry nearly identical equipment. It might vary slightly from midwife to midwife, of course, but there is no additional technology available in FSBC's compared to midwife-attended home births. In both settings, women will likely have access to:
- anti-hemorrhagic treatments and equipment (ranging from herbal tinctures to Pitocin, Methergine, Cytotec, IVs to replace fluid loss and/or stablize in case of transport)
- maternal and neonatal resuscitation equipment and skills (bag & masks, oxygen tanks, suctioning equipment, possibly meds & intubation supplies)
- suturing equipment and local anesthetic
- fetoscopes/dopplers for listening to baby's heart beat during labor
- other equipment for monitoring vital signs (BP cuff, stethoscope, thermometer, etc)

Women in both settings will need to transfer to a hospital for interventions such as:
- operative deliveries (vacuum extraction, forceps, cesarean section)
- analgesia (except in rare cases where some birth centers supply IM narcotics)
- anesthesia (spinal, epidural, etc)
- continuous Electronic Fetal Monitoring (external or internal)
- blood banks if a transfusion is needed

In a home birth, a woman is on her own turf. The midwife is the invited guest. In a FSBC, however, it is the midwife's turf. Often birth centers have a set of protocols that govern when a woman must transfer to a hospital or to OB care. The midwife at the birth center has final say over whether or not the woman can use the facilities. Like Tabitha and others have commented, no matter how nice the decor, it isn't the same at someone else's place. You don't usually feel the same sort of liberty or comfort or lack of inhibition as you would in your own space.

So perhaps birth centers are the worst of both worlds. There is no additional safety or access to technology in a freestanding birth center compared to home, and the woman is not on her own turf and ultimately cannot make the final decisions of when to stay or transport like she could at home.

Thoughts on this?

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mmmm....German cookies

Some cookies we always make during the holidays, from my German grandmother.

Lebkuchen

Lebkuchen is German for "bread of life"

2 lbs honey
1 lb butter (4 sticks)
2 tsp ground cloves
2 tsp ground cardamom
2 tsp ground allspice
2 tsp nutmeg
1 tsp salt
2 Tbs cinnamon
2 1/2 Tbs cocoa
1/4 cup brown sugar
6 eggs, well beaten
2 tsp vanilla
1 ½ tsp lemon extract
6 + cups flour
3 Tbs baking powder
Melt together the honey and butter. Mix spices, salt, cocoa and sugar. In a large bowl add spice mixture to melted honey/butter. When cooled, add eggs, vanilla, and lemon extract. Mix together 6 cups flour and baking powder. Add 2 cups at a time. Add extra flour (usually a few more cups) until dough is just stiff enough to roll out.

You can refrigerate this dough for a long time. Roll out and cut into shapes. Bake at 350. I don't know exactly how many minutes, but it depends if you want them chewy or crunchy. Frost with a thin glaze of lemon juice and powdered sugar. Add decorations.

Radar Kuchen

1 cup sugar
1 stick butter, softened
4 eggs
Finely grated lemon rind
4 cups flour
1 tsp salt
1 Tbs water
2 tsp baking powder
1 tsp cardamom
Cream together sugar and butter. Add eggs, lemon rind, and water. Add dry ingredients. Refrigerate for 1 hour. Roll out on floured surface until 1/4 to 3/8 inch thick. Cut into a 4x2 inch diamond shape with a 2-inch slit in the middle between the two points. Take one pint and fold through the middle slit. Fry in deep fat at 350 in an electric frying pan or medium-high on stove. Remove when brown on both sides. Place on a paper towel to remove excess oil. Sprinkle with powdered sugar.

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Q&A with Carla Hartley

Carla Hartley, founder and director of the Ancient Art Midwifery Institute, gave me permission to repost this recent email correspondence.

~~~~~

Dear Carla,

I am really confused by the unassisted birth movement within your midwifery study course. Why do we study all of this stuff to be educated midwives and right along side of this tell moms to just trust birth and have no one there?

Thanks for any time you can take to answer this for me.

Here is where I am coming from:

A: My course is really really really hard. It is comprehensive because I want midwives to KNOW more, so they are comfortable doing less. I saw a lot of midwives meddling with birth because many of them did not know enough to recognize variations of normal. Their education was based on EXPERIENCE only. Now in my grandmother’s day, experience was enough because it was NOT fear-laden. Birth was, as Sheila Kitzinger says, domestic, part of life. The experience of most of the midwives I had any contact with in my early days was based on fear. They did not start going to births because they believed in birth, so much as they wanted to help women avoid the hospital. Yet their lack of knowledge and trust of the birthing process meant that a LOT of women who started out at home ended up in the hospital anyway.

I recognized early on that because I had studied sooooooooooo much before I started apprenticing, things that panicked experienced midwives did not at all panic me. I understood the physiology. I knew that there were many possible birth scenarios that were NORMAL. I also saw that clients almost always depended on the midwife's knowledge and trusted her opinion on almost everything. That made me uncomfortable. One of the things that I believe people gain having a home birth is a sense of their own ability to make decisions about their children. If we as midwives don’t leave families CHANGED then I think we have missed a great opportunity to affect society in a very positive way. MUCH of what my students do is client education and the constant reminder that parents are their own authorities and the rest of us (doctors, midwives, doulas, childbirth educators) are merely paid consultants. Once that resonates with a couple, and they accept the responsibility that comes with authority, they change. They believe in their ability to make good decisions. That is HUGE!

B. I trust birth. Birth is inherently safe. Messing with it in any way compromises safety. It is an innate biological capability for most women to grow a baby and then EJECT a baby with no help from anyone. Midwives are NOT the guardians of normal birth. Birth is normal with or without midwives. But what midwives should be doing is acting as the guardian of the mother and baby's space, so they can do what they were made to do. Most women want that--but some don't. They just want to be in their own little world with no intrusion. That doesn't mean that birth is any less safe.

Midwives know a lot of things that can go wrong. That is why I think we do have to study and prepare to an extreme degree. We have to be sure that we don't CAUSE anything to go wrong. I think much of what we do has the potential to cause problems. I don't have time today to list those but they start with what we say, our own body language, what we wear (I hate scrubs in a home birth) and the things we think we have to measure, poke and prod.

Have you read my blog and the TrustBirth.com site? I trust birth—not birth attendants—for if you only trust birth that is attended then you really don't trust birth at all. You trust the attendant. And then you start over. Who? Doctor, surgeon, CNM, CPM, SIM*? And it goes on and on....NO, the truth is that women and their babies are quite capable for the most part to do it without anyone. Most women who chose home birth want a midwife and my goal is to help there be MORE midwives for them to choose from and midwives who are truly WITH WOMAN midwives and not birth managers.

I don't want to insult you in any way and I am glad to have the opportunity to help you understand what seems to many a real mystery but look at what you said in your post to me:

"Why do we study all of this stuff to be educated midwives and right along side of this tell moms to just trust birth and have no one there?"

Doesn't that sound a LOT like what docs believe about birth? Doctors don't own birth. Midwives don't own birth. Just because you study and sacrifice and put yourself in debt to become a midwife or doctor does not mean you own a woman's experience. It also does not mean that you are necessary. (OUCH!) Women and babies know how, if we will step back and let them. And we understand that our job is to serve them.

And I don't like the word "support" here because she is not a table we are holding up. I like "SERVE" because I think that is what midwives—well, everyone involved in birth—should be doing. SERVING.

In that framework—servant, consultant—it is quite possible to be a midwife who trusts birth and trust the woman and her baby. It is possible to be a midwife whose client calls AFTER the birth and says it just never occurred to me to call you, that the midwife would not be offended.

My very first official paying clients decided a couple months before the birth that they were going to DIY, as we called it back then, because I was uncomfortable about something I thought might present a problem. I was a rookie and was ultra cautious. Not afraid; I just wanted them to know that there could be a problem. After talking about it for a while they came to see me and said, “Carla, we are going to let you off the hook. We know you are concerned, but we really are not. So we are not going to call you when labor starts.” I cried. They said, “Oh no, don't be sad. You helped us realize that birth is safe and that few things go wrong if you don't mess with. You encouraged us to listen to our own instincts about birth and we know everything is going to be fine.. But YOU don't. And we understand that and we don't want to put you in a position of being concerned. We will call you when the baby is born and you can come see for yourself that we were right!!!!”

I quickly corrected them that my tears were not of rejection but absolute humble appreciation for what they were telling me. Just because I did not go to the birth (I went a few hours after) did not mean I did not serve them well as their midwife. I did not have to be the one to catch the baby. I did not have to watch or guard a perineum in order for her to have a baby without tearing. I helped them believe in themselves and THEIR ability to parent this child before, during and after birth. I did good! In my dictionary, I WAS their midwife.

If this doesn't answer your questions, please, please feel free to write again or call me. I am honored that you asked, actually. I do not see my job helping women become midwives and also supporting women who want to have their babies alone as a contradiction in any way because of what I believe that midwifery should be in the first place.

Carla Hartley

*SIM (Self-Identified Midwife) is a term used (often derogatorily) to describe midwives who choose not to become certified through a professional organization.

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"Homelike" birth spaces: a photoessay

These are photos I took for a research paper about the meanings of "home" in institutional birth spaces. The first set of pictures are from the University of Iowa's new Maternity Center. The second set are from a freestanding birth center in Des Moines, the Almost Home Birth Center.

UI Maternity Center
Text reads:
Labor/Delivery/Recovery room.
Labor & Delivery rooms adjacent to NICU.
Technology is hidden but still accessible.
Internet access.
Rooms offer a home-like environment.
Custom beds.
Whirlpool bath.
A La Carte menus available.
DVD/CD players.
Beautiful views from many rooms.
The "home-like environment" of the L/D/R room
The Stryker Adel bed, covered and uncovered
Hallway

Equipment closet inside room

Sliding artwork

Tub

Almost Home Birth Center
Birth Room 1

Birth Room 2

Tub

Bathroom
Living/waiting room

Library/reading room

Kitchen

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What direction?

I've been having a mini crisis of identity with this blog. I am so tired of "debating" birth choices endlessly and wonder whether all of the energy I (and many readers/commenters/bloggers) spend makes any difference. We're either preaching to the choir--fun but not really necessary or life-changing--or debating people who most likely won't change their minds anyway. On top of that, I'm feeling discouraged about the state of maternity care in North America and at the few real changes birth advocates have made in the past several decades. Floral wallpaper, tacky artwork, a table lamp, and a polyester comforter covering a hospital bed just doesn't cut it.

But it's almost like home! We'll hook you up to your Pit drip, your epidural, your catheter, your fetal monitor, and your automatic blood pressure cuff and you can watch TV, just like at home! Two-thirds of you will come away with a surgical scar in your belly or in your vagina. But you'll feel comforted by the "home-like environment" while you heal from your wounds!

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Bouncy ball!

We finally made it to Canada last night after many days of traveling. We broke up the long drive and visited three of our siblings and their children along the way. This video was taken at stop #3 at Eric's sister's house. She has two young children and another on the way. This was the first time Zari had ever seen her cousins.



It's a chilly -15 (Celsius) today. Eric is stranded right now and waiting for roadside assistance to arrive; the fuel lines froze in our VW diesel Golf and then the battery died after he put in a diesel antifreeze. Luckily he's only a few miles away and his dad is helping out with his car and cell phone. (And actually it was Eric's mom who was driving the car when the fuel lines froze...in the middle of helping another of his sisters and her family move.)

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New midwife blog

Housefairy's midwife just started a blog, Close to the Root, and I wanted to share it here. Lots of interesting questions and discussion are already sprouting up there!

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A nursing woman is a gift to the future

Read this thoughtful post about how "a nursing woman is a gift to the future."

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Under pressure

I contacted one of my advisers about deadlines for finishing the dissertation and graduating. If I want to graduate this spring semester, I have to have the dissertation finished a month before my defense date. Which means I have to have it done by early April! So the pressure is on to get the last two chapters written so my dissertation adviser can read them and give me feedback. Then I will do a round of revisions and send each revised chapter to my four other committee members. Once they read each chapter and give me comments/suggestions, I will do yet another round of revisions (hopefully fairly minor at this point) and have the finished product done about 4 months from now.

Some goals to get me from point A to point B:

• Finish chapter #5 by this weekend
• Write chapter #6 in December (chapter about the interplay of midwifery and UC)
  
• Write chapter #7 in January (conclusion: looking at existing birth paradigms, suggesting new conceptual models that include UC)
  
• Start sending out revised chapters to committee members in January& early February (this depends on how quickly I get comments back from my adviser)
• Receive comments from all committee members on all chapters by early-mid March
• Do final revisions last few weeks of March

Can I do it? We'll see...I really don't want to delay this any longer, since I am now paying tuition (over $800/semester for a zero-credit continuous enrollment) for the privilege of writing my dissertation.

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Value of skin-to-skin contact

This article from the Daily Mail shows how skin-to-skin contact--an element of kangaroo mother care--saved a very premature baby weighing only 20 ounces that doctors had given up for dead.

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2006 US Cesarean Rate

The CDC just released its preliminary birth data for 2006. For yet another year, the US cesarean rate has hit a record high at 31.1%. This is a 50% rise over the past decade, and almost a six-fold increase since 1970, when 5.5% of women gave birth via cesarean section.

A 31.1% cesarean rate translates into 1,326,725 surgeries. 1,326,725 women recovering from major abdominal surgery while taking care of a newborn baby.

Let's imagine for a moment that we had a radically different maternity care system that put the basic needs of laboring women first. Even if most women continued to give birth in hospitals, we could do things very differently. What if hospitals implemented changes similar to Michel Odent's maternity clinic in Pithiviers Hospital. These changes were inexpensive and low-tech, including:

• soft, large mattresses--no delivery tables
  
• large, deep birthing pools
• birthing chairs
• cozy and private rooms
• extremely limited use of Pitocin (around 1%) and pain medications
  
• low-profile midwives overseeing births and consulting obstetricians for complicated cases
• mothers encouraged to labor and birth in whatever positions felt most comfortable to them.
• emphasis on creating a private, warm, and safe environment for the mother to labor in
  

Odent's hospital was able to achieve a 6-7% cesarean rate while at the time having one of the lowest neonatal mortality rates in the world. Other hospitals were only able to achieve such low mortality rates via a very high cesarean rate. The Pithiviers clinic served an unselected population; in other words, it didn't weed out unhealthy or "high risk" women and send them to a larger facility. Read more about Odent's clinic in Birth Reborn (pictures below are from the book).

If our country had a 7% cesarean rate, we would only have 298,620 cesarean sections performed each year. More than a million women and babies would avoid major surgery with all of its physical and emotional costs.

A typical French delivery room

Pithivier's new birth rooms
Midwife and laboring woman

Upright, physiological birth
(Michel Odent is supporting the woman's weight
while the midwife waits for the baby to emerge)

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A different approach to pain relief

Britain's National Institute for Health and Clinical Excellence has just recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." Birthing pools are the most effective non-pharmacological form of pain relief and second-most effective overall. NICE has published clinical guidelines on intrapartum care. You can also read a summary of its findings here.

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A midwife's unassisted birth

I just came across this midwife's UC story--what a powerful, determined mama! She faced a rare but very serious emergency situation during the birth, a shoulder dystocia. Here is an excerpt from her story, right after she discovered the shoulder dystocia.

There are moments in life when adversity stares you in the face like a hangman daring you to overcome, all the while taunting and mocking your own inadequacies. For a fraction of an instant I felt crippling despair for that which there was no solution for. There was no one to help me or tell me what to do. There was no answer to the question "How"? I was going to lose my child and be condemned with guilt. I would fail to do the one thing my body was built best to do, right in front of my daughters and husband.

My husband broke through my paralyzing haze in the next instant by calling time (how much time had passed since the head had crowned). Reality struck me hard in the face as a contraction built up. I concentrated with all of my might and commanded myself to do this impossible thing. This was my birth, my baby and my body and I would make this happen RIGHT NOWWW!!!

I became instinctual. I opened my legs as wide as I could and braced my feet into the mattress. Then I reached over and behind my head and gripped the back board of the bed. Pulling on the back board, I hoisted my butt up off the bed, arched my back, rotated my hips in the air and pushed with all of the power any one woman can command from heaven and earth. I caught another breath, kept the movement of elevated hip rotation constant with the pressure of bearing down. I was not going to lose this child without a fight. The pain that always invaded my births dulled as I lost my temper and roared loudly through the pushes that brought to birth my child. Finally, I literally felt the release of her shoulder pressure from under my pubic bone as my child gushed forth into freedom.

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Midwives and doctors talk about breeches

I have interviewed several midwives and doctors as part of my dissertation research, and I thought I would share these comments about breech births with you (with their permission). Both of the midwives quoted here are very hands-off; parents almost always catch their own babies, and the midwives try to be as invisible as possible during the birth.

Dr. Sarah J. Buckley gave birth to her fourth baby at home unassisted, a surprise breech. I haven't interviewed her yet (although I will be meeting her this spring!), but the birth story is worth reading.

"Sarah" practiced for a midwife for a while in two Midwestern states. She currently lives in a state where midwifery is illegal and has decided not to continue her practice. She has given birth in a variety of settings, from UC to hospital.

I have attended a few breeches and I have given birth to a frank breech of my own. Most of the time I think breech is a variation of normal but that it should be approached with respect. (The casual attitude some UC folk have about it bristles me a bit. Breech is like any other birth, you see a couple go well you have that honeymoon feeling, what's all the fuss? But if you ever see one go bad, well, it will stay with you a while.) I don't want to live in fear of the what ifs, but I do think it's important to respect the possibilities and be prepared to take responsibilities. I have seen enough to know that breech births have their increased rates of complications for good reason, probably the greatest of which is simple mishandling by caregivers. I think even well trained attendants tend to panic a little with breeches. They miscalculate how much time has passed and start maneuvers too soon. Dr. White advocated a serene labor (including semi recumbent [to prevent cord prolapse or premature urge to push] position for mom once the waters spontaneously rupture), a hands and knees position for breech birthing, and completely hands off approach. I am with him on that completely. I have seen the arguments for maneuvers and what not, and having seen a few breech births and watched even more videos, I can tell you his way is non-violent and so much more conducive to a good outcome. Basically I believe that if you follow those simple guidelines and you get a less than perfect outcome, well, there is nothing that could have been done to prevent it. While a cesarean will prevent entrapment and cord prolapse, it won't prevent a host of other issues for mother and baby. If the baby is breech because of a defect of some sort, giving birth by section will not change it. The stats are there...breeches are more complicated with or without section. So why have surgery?

Recently I've heard some UC folks make very casual comments about how easy it is to sweep an arm on a breech. Well, it often is, especially if the baby is small and the mama is roomy, has given birth before and is not in a panic. But, if the baby is full term, good sized it may not be so easy. Again not something to fear, but I think that one place where UC folks scare me a little is when you have someone who knows little about birth and there is this prevalent attitude of everything is normal, everything will be OK, don't say anything that might be negative or scary. But scary or not, birth is not a safe event. It is a life event and while most of the time it will all go just fine; sometimes it won't. I see it kind of like amusement park rides or getting on a plane. You're not going to tell somebody never to get on a plane or ride a roller coaster when we all know that it is generally safe and a good experience...but you wouldn't tell somebody that a plane crash or a roller coaster derailment is no big deal either. That's how I feel about complications. Not a reason not to UC, but not something to sweep under the rug and pretend scary stuff can't happen.

"Mary" is a practicing home birth midwife and shares these experiences with breech births:

I have had three experiences on my own. I had three within six months of each other. I had never before and never since had any. Weird. But I did learn that doing nothing and letting the mother rest as much as possible lying down are useful for the labor but not for the birth. Most of them did this and stood up right at the end when the baby was coming butt first. The one footling was in the pool, and the mom stood up at the last seconds for the head. I only helped one of them hands-on after the body. His arms were not coming down. The mom got to the edge of the bed and I supported him to hang, then reached around his back and pulled down each arm. The babies did fine though they needed a bit of work. One was 9 lbs and a first baby; he had some fluid to get out. But his cord was attached until hours later so I think that helped him. All the babies' cords were left intact. Always a good idea with any birth...I am a big Lotus birth advocate. Anyway, the others were fine except the footling one needed some rubbing up and a suck and blow over her mouth which her mother gave her. The other one came out wailing. I think it was strange to have three within such a short time.

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Children's Museum

Although I moved to our town over two years ago, I didn't know until last month that we have two Attachment Parenting groups within a 30 mile radius. So I decided to deal with a (for me) long drive because I really need female friends who share similar values, and Zari loves to be around other children. Today we met at a Children's Museum, and it was so fun! It is an amazing place, full of activities, toys, play gyms, art/drawing materials, interactive educational displays, and more. There are entire areas designed especially for infants and toddlers. So much that I can't even start to describe everything.

Zari enjoyed herself, and I got to meet several cool mamas. Some of us went out to lunch afterwards. I chatted at length with a woman who'd had two cesareans, both for breech presentation. For her next baby, she really wants to have a vaginal birth and in this area--as in most--that means a home birth. So we talked about breeches, midwives, home births, and other good stuff like research on vaccinations. So, was it worth making the 35 minute drive? Most definitely!

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Journal of Perinatal Education

The new edition of the Journal of Perinatal Education (volume 16, no 4, fall 2007) has several very interesting articles, many based on the Listening to Mothers II survey. Articles marked with a blue "F" are free to the public. If you are affiliated with a university, you can probably access the other ones through your university library.

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A simple breech birth criteria

Last spring, I had the pleasure of meeting Dr. Mayer Eisenstein, a physician who has attended home births in the Chicago area for several decades with HomeFirst. He worked with Dr. Gregory White, also with HomeFirst and author of the manual Emergency Childbirth used by police officers and EMTs.

While we were talking, Dr. Eisenstein told me of a simple criteria for predicting whether or not a vaginal breech birth will develop difficulties. He learned this when he was a young physician from Dr. Frank O’Connell, who was a senior obstetrician at St. Francis Hospital in Evanston, IL. Dr. O’Connell learned it from his father, also an obstetrician, who had worked as the Chair of Obstetrics starting in the late 1950s or early 1960s.

Rule #1: If the presenting part is at a positive station at 5 centimeters dilation, there is an overwhelming probability of an easy birth, irrespective of what part is presenting (foot, knee, butt) and irrespective of parity. In other words, it is just as true for primips as for multips, just as true for footling breeches as for frank (butt-first) breeches.

Rule #2: If the presenting part is at negative station at 5 centimeters dilation, there is a significantly higher probability of a difficult birth, irrespective of the presenting part or of parity.

These criteria are more accurate in predicting easy births than in predicting difficult ones. In other words, a women may still have a straightforward birth when the presenting part is at negative station, but it is just much more likely that difficulties will arise.

Dr. Eisenstein and some of his medical students reviewed over a decade of their records to see if this held up with the breeches they had attended. In over 100 breech births they had attended, the rule held true in all the cases.

Dr. Eisenstein added that it should be blatantly obvious at 5 centimeters that the presenting part is at positive station (this does not include zero station, only true positive station). No guessing.

Dr. O’Connell’s father also had another rule: “The sign of a good obstetrician is how few cesarean sections they do.” I like that one!

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Study about miscarriage

I am forwarding this information about a study on communication about miscarriage. If you are eligible, please participate!

Communication about Miscarriage

You are invited to participate in a study regarding communication about miscarriage. Through this study, I hope to provide insight into an understudied realm of family communication. To participate in this study, you must be at least 19 years old and have had a miscarriage within the last 2 years. Although you do not need to currently be in a romantic relationship you must have been married at the time of the miscarriage. If you are willing to participate, please visit the website (http://www.surveymonkey.com/s.aspx?sm=O6sKrZcQmKi4iG7kdwxjgw_3d_3d)
to complete the questionnaire. If you should have any questions, please contact me at the e-mail addresses listed below. Please pass on this information to anyone you know that might be willing to participate.

Thank you for your consideration.
Sincerely,

Cassandra LeClair-Underberg
439 Oldfather Hall
University of Nebraska-Lincoln
Lincoln, NE 68588
cunder @ bigred.unl.edu

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Blame the woman

Once again, women are simply too fat and too old, according to this recent article about rising maternal mortality rates in England. Oh, and they have the audacity to want a natural birth--which of course the article didn't bother to define--another alleged culprit behind rising mortality rates!

From the article:

But some medical staff and patient groups also fear the NHS’s policy to encourage “natural” birth without medical assistance is putting women at risk by denying them medical care in pregnancy and labour. Professor James Dornan, director of foetal medicine at the Royal Maternity hospital in Belfast, said: “Nature dictates that one in every 100 women will die while having a baby. The mortality rate in parts of Africa is now about 850 to 1,000 per 100,000. Left to nature that is what nature will do. I believe in women having choice but it has got to be informed choice.

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A family doctor's perspective on BOBB

Among members of the audience for The Business of Being Born was a family physician who attends births and her youngest daughter. She emailed me some of her thoughts about the documentary and gave me permission to repost them here. I highly admire her dedication; she works hard to give women hands-off, physiological births in a hospital setting.

Overall, I was impressed with the movie. I tried to look at it with two viewpoints in mind. One, my own sort of "birth junkie" self. Two, I tried to see it as my mostly mainstream clients and acquaintances would.

I was pleased overall with the births they showed, and I loved many of the commentators. I loved that the births were shown to unfold in their own time and that the mamas looked free to move on their own and birthed upright. I love that upright birth center birth where the mama is so joyous right after. I thought Michel Odent was absolutely great. I liked the juxtaposition of the "woman on the street" type comments in between, too--sadly, all those women ready to sign up for their epidural are what I deal with a lot of the time and are very realistic.

It was funny, because looking at the births, I actually thought some were a bit hands-on for my taste. (Why does the midwife have her hands around that woman in the water? What was she trying to do?) On the other hand, I think a mainstream viewer might think they were too "non-medical" especially since Cara can't seem to get gloves on in time ever.

I cried at every one of those births. Don't know what was up with that! My little dd even kept asking me if I was okay. (I cry a fair amount of the time at actual births, though, too--you'd think I'd get over it.) I think if people watched this movie and the only thing they took away was visions of women pushing their babies out standing, squatting, in the water, whatever, that would at least be a start. I find that I have to talk quite a bit during prenatal care about how women should try out different positions ahead of time and see what feels comfortable to them, and how we will be encouraging them to move any way they feel comfortable during labor and pushing. Sometimes family members especially are just shocked when the birthing woman ends up standing or squatting or kneeling. Sometimes I think they then think I'm a little nutty or not very professional, because I "let" this go on. Fortunately, usually the birthing woman herself can verbalize how being free to choose her position made her feel better, or that it was more effective for pushing, or whatever.

I was disappointed in the ending. I don't think they explained enough what was happening, and I was disappointed that the final interview blew off any benefits of homebirth and implied that it's all nice if you can have it, but thank God we had this cesarean and saved my baby. I actually think in her particular case transferring for a breech, growth-restricted baby was probably a good idea--but there had to have been a better way to wrap up that movie than Abby saying "Oh well, at least I got a healthy baby" you know?

I wish they'd wrapped up with some kind of activism information--like talking about CIMS, or ICAN. Here's where you can start to change the world kind of info.

The discussion after was really something. It was interesting to hear people's stories and encouraging to hear so many women who think this stuff matters. It was also discouraging, though, to hear how people struggle to get the birth they want. I am pretty disappointed in this whole VBAC thing, and disappointed especially that so many "low-risk" providers are just giving up VBACs and verbalizing that it's just too bad, so sad for the women involved, but nothing we can do. The midwife who talked expressed similar feelings to what I've been hearing from other family docs: "Oh well, we just can't because of these rules." I feel like so many birthing women basically can only have midwifery, or at least woman-centered physician care, if they are low risk, don't have any problems or inconvenient history, and do what the low-risk provider wants. Otherwise, you are stuck in the OB system and have to take the full court press. It's just not fair and I can't figure out how to fight it. Especially in this stupid state. I wish women like that woman who had an episiotomy against her will would make complaints--take it to the hospital administration, the chief of medical staff, and the medical board for failure to get informed consent. I know one complaint is not likely to do anything, but if there were more and more, I think hospitals and regulatory boards would have to listen. It is not okay that thousands of women are treated as if their wishes don't matter one bit routinely in the name of "standard of care."

I actually think all of medicine needs to be reworked. Something I was trying to say, and may not have got it out coherently at the panel discusson, is that having doctors in charge of medical care and responsible for the outcomes doesn't benefit anybody. If birthing women were in charge, in power, and responsible for decision making (not really so much the outcome, because there is so much that is up to chance), I think they would be more satisfied--AND doctors maybe could relax some. Because I think if we stopped this patriarchal, authoritarian way of practicing medicine there would be far fewer lawsuits. If every woman got actual informed consent AND had the opportunity to make her own decisions and then got supportive care when they needed/wanted it, they would be far less likely to sue. (I just went through a long involved discussion with a new client about VBAC and feel I gave her a good understanding of the risks either way, but she is really stuck in that no one in driving distance who takes her insurance does VBACs anymore--doesn't matter how informed you are if your options are so limited.) As a profession, though, we docs don't want to give up the power. We want to be in charge, want to be seen as demi-gods often, and don't want to present our selves as fallible humans doing the best we can with the knowledge we have and freely sharing that knowledge with our clients.

I'm not sure how to make a change in modern obstetrics, but I think one factor is that women have to refuse to accept paternalistic, condescending care. I don't care what kind of choices women make, but they need to insist on accurate information and fully informed decision making.

OBs need to get out of the business of normal maternity care. We have put normal care into the hands of folks trained in the abnormal. You know the saying, “if the only tool you have is a hammer, everything looks like a nail?” If you are looking for trouble, you generally find it one way or the other. Somehow, we have to get in through our heads that women's bodies have not changed that much in the last 30 years, so if the cesarean rate has sextuptled (and it has!), something must have changed in doctors. I'd like to see more consumer-driven organizations getting more and more active and making more of a mainstream presence. I mean, how many women even know there is something like ICAN or CIMS?

The problem, too, is that it seems that as a whole group, women may not care that much about birth. I wish this was more of a feminist issue--I don't understand why women are willing to be condescended to in this area and have choices taken from them. Have you ever read Barbara Katz Rothman? She is a feminist writer who has done a lot of work on birth politics and talks about how she talked an OB into attending her first home birth by basically appealing to the female OB on a feminist basis. (The book is In Labor: Women and Power in the Birthplace.) I just don't see that happening any more. I went into medicine out of a desire to provide woman-centered care from a background of feminist ethics. I feel more and more out of place in modern medicine every year--my colleagues think I'm sort of nuts, my family suffers from me not being there, and even many of my clients don't seem to care much about having the chance to direct their own care.

I wish I could have come to the rest of the discussion. Did you all come up with any way to change the world?

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November Carnival of Breastfeeding: Book Reviews

Join in this month's Carnival of Breastfeeding featuring book reviews! Last month, I reviewed Andi Silverman's Mama Knows Breast; read it here. You can also read other book reviews at the following sites:

Motherwear Breastfeeding Blog: A Book For Everyone On Your List
Breastfeeding Mums Blog: Book and Video Reviews
Tales of Life With a Girl on the Go: The Best Gifts
Breastfeeding 123: Review of Baby Matters
Crunchy Domestic Goddess: What Do Babies Want
Mama Knows Breast: Review of bOObs: A Guide to Your Girls
The International Breastfeeding Symbol Blog: The Baby Book and Unconditional Parenting.
Hobo Mama: Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent.
On School Street: Blindsided by a Diaper: Over 30 Men and Women Reveal How Parenthood Changes a Relationship.
James and The Giant Moose Blog: Having Faith: An Ecologist's Journey to Motherhood.

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Comments from Lynn Griesemer

Lynn wrote me these comments about her interview with To The Contrary and gave me permission to repost them here:

I visited your blog and just want to say a few things about your To The Contrary comments. These are shortened comments for lack of time

Background: I was asked to be interviewed for the show, not knowing the format. I was hesitant and reluctant to agree to an interview: The executive producer would interview me for 25-30 minutes on the topic and then edit it down. She did not say how much editing. I thought the show was 30 minutes devoted to one topic. I should have done my homework before agreeing. I also asked if there was a format where I could sit on the panel during the discussion. She said that's not how they do it. They interview me and then put the program together, with panelists selected ahead of time (usually women with political backgrounds). I recommended a few names to her thinking she would select one (such as Naomi Wolf, Robbie Davis-Floyd, Suzanne Arms and 1-2 others), but I later saw on the website that there is a list of about 16-20 panelists that they select.

My best experience of media exposure regarding unassisted birth was when I was interviewed for a live midday news program (1998 in South Carolina)--4 minutes of unedited comments.

What she put together did not make me shine, but yes, they were my words, spliced together to form what she thought would do justice to the topic or what would make for good television. The final product and panelists reveal the public's view of birth, so it was not surprising to me to see the end result. I can't be upset about it since I had no power over the final presentation, just like the Washington Post article at the end of July, which had misquotes--the number one being "Unassisted birth hammers home what it means to be a woman." Ouch! Those were not my words, but were condensed from something like, "Unassisted birth reveals a highlight of femininity" or something like that.

I have been criticized and my advice is: I am not the world's best speaker, nor am I photogenic. However, I am deeply passionate about birth and almost obsessed about the importance of birth and how it it is so crucial to our civilization. Those who criticize should step forward and try to get in the media. I respond to the media when called upon. (I'm not saying you are critical at all--I'm thinking of others who are quick to write emails.)

Feminist: If someone asked me, "Are you a feminist?" I would say yes, but the yes is qualified to include the concept that women can and should be able to make a full spectrum of choices--what is right for their lives. I would not join NOW or NARAL--their objectives and philosophies do not mesh with mine. (During the To The Contrary interview, I was asked a few questions twice, worded slightly differently probably to elicit certain comments from me. I am aware of these tactics and was ready for that.)

Daddy delivery: This phrase is the biggest insult to unassisted birthers--especially since it is sometimes used by unassisted birthers! I hate the phrase, which was referred to by many people in Charleston, SC several years ago. I don't know why these women who take the bold, countercultural action of having an unassisted birth refer to it as daddy delivery. It undermines what unassisted birth is all about. No one delivers a baby. Ultimately a woman gives birth, even in a hospital. However, I might say a C-section was a delivery. Generally, I refer to "delivery" as hospital birth and "birth" otherwise. And "daddy"--that is just too cutesy.

The woman is in charge of her birth. She selects who she wants at the birth and gently guides or directs--not really directs, but lets the ebb and flow go how she sees fit. She includes her partner how she sees fit and he takes her lead. Dads should not coach, nor should anyone. I suppose that's the feminist in me. It is the woman who is the queen of her birth.

Maybe unassisted birth is the ultimate feminist act. I'll have to think about that.

I saw somewhere an article that talked about unassisted birth as a militant movement. I think of militant involving some or all of the following: battle fatigues going to war / shield of armor / military / loud obnoxious megaphones shouting and picketing / angrily lobbying based on fear, ego, selfishness or power--everything that is not peaceful.

Unassisted birth is first and foremost peaceful for women, babies, families, communities, the world. Militant is contrary to what it is all about. Many of the unassisted birthers I personally know are humble, just going about the business of life, and many of their acquaintances do not know they birthed unassisted. It's important for a segment of society to work hard at making positive change and I commend people for spending the time and effort at lobbying for important causes.

The final thing I want to say is that almost every time you are on a TV show or interviewed for a newspaper article, there will be subtle or blatant misquotes, misrepresentations, or comments pieced together that lead to slight inaccuracies. It's also very difficult to capture the essence of unassisted birth in a short newspaper article or TV segment. There are so many deep facets to the whole issue. I'm still glad I decided to appear on To The Contrary. It was a good experience / practice.

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Class Presentation

I gave a presentation for my husband's freshman writing class about the unassisted childbirth movement. Zari came with me, of course, so I suppose you could say it was her first day of college!

The class is doing a project that involves reflexivity: getting to know a group that has different values and assumptions and examining your own preconceived notions and trying to see things through the group's viewpoint. The whole class is working on a presentation about unassisted birth. As part of it, several of his students came to the screening of The Business of Being Born to have a better idea about childbirth in contemporary America. They stayed for the whole discussion too!

All of this college must have worn Zari out. I nursed her during the Q&A after my presentation because she was really cranky. She conked out and didn't wake up for almost 3 1/2 hours!

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BBBB BOBB and other business

I had a fabulous weekend with women & their nurslings coming in from several different states for a Birth & Babies Bed & Breakfast get-together. We also watched a screening of The Business of Being Born. Now the house is so silent and empty with everyone gone.

Most of the audience stayed for the discussion after the film--we had lively conversations about VBAC bans, the disappearing art of vaginal breech birth, how to find midwives in midwife-unfriendly states, and how to bring about changes in our current maternity care system. The discussion carried on for several more hours at my house.


We also did made birth art with silk painting and learned how to make jewelry.


On Friday night, the dinner conversation must have been quite exciting because Zari fell asleep right in the middle of eating.



More pictures forthcoming, once other attendees send me theirs! Many thanks to everyone for coming from so far away. We had women from Iowa, Arizona, Missouri, Connecticut, and Michigan!

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I did it!

I ran a half-marathon this morning. The weather was great: sunny, clear, very little wind, and a bit on the chilly side. Ignore the pink spots on my shirt--I spilled juice on myself during the run.

My deerskin finally arrived (4 pounds of scrap leather) so I made Zari some shoes since she didn't have any and it's been too cold to go barefoot. I used the Chloe Toes pattern. I first made a pair of red shoes in 12-18 month size, but they were too big. So I made 2 more pairs in the 6-12 month size, which fit perfectly: the brown and tan ones below, and a pair of black Mary Jane style shoes.

Zari had bed head this morning.

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Request for animations of labor interventions

I received this request for information and thought I'd see if anyone can refer me to the proper source:

Do you know of any animations/simulations of labor (similar to those seen on National Geographic channel's "in the womb" series) of how amniotomy, lithotomy position and other managed labor practices affect the ease of the baby's navigation out of the uterus? I am looking for something based in science that shows how these managed childbirth practices make it harder on the baby.

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Lots of misc news

No particular rhyme or reason to what will be on this post, but here goes:

The Mother.Culture.Art breastfeeding photos are online again. They show the various ways breastfeeding is understood in our culture.

I have a plugged duct that is quite painful, enough that I didn't run this morning.

I made butter yesterday! I started buying fresh organic milk from a local farmer, and I thought I'd see if you could really make butter by shaking the cream. One mason jar and 15 minutes later, I had butter! I still have to knead the butter to get any pockets of buttermilk out.

Vanessa, the woman who had an unassisted birth in Le Premier Cri, just posted a comment on this blog. Bienvenue! I translated the information about her birth on the film's website. I invite any native French speakers out there to suggest revisions. There are several phrases that I couldn't find an exact English equivalent for, so I took some liberties. Here goes:

~~~~~

Vanessa, 32, and Mikael, 36, live in a collective with eight other people, a group of activists, artists, and organic farmers who met each other in the intersection of alternative ways of life. Their house in Maine reflects their values—it’s a retreat for city dwellers, surrounded by woods and fields, on the edge of a lake.

Vanessa fully embraces her pregnancy. It is her first baby, who is very much wanted and hoped for. Not only for her and Mikael as a couple, but also for each of their house mates.

Vanessa chose to give birth unassisted by the medical profession, deciding instead to take the responsibility of her son’s birth into her own hands. She is convinced that her body will know how to give birth and that if a problem arises during the birth, that she will be able to resolve it herself. She wants no outside interventions during the birth: “My reasoning is that if a problem presents itself, I will sense it. Women have always had that intuition. Giving birth unassisted is an affirmation of feminist and anarchist beliefs: nobody is better qualified to birth my baby than myself.”

Still, her decision worries some of the members of the group. Some would like a midwife there just in case...A legitimate concern, because it is also the first birth within the group, the first infant of the collective. A lot of their hesitations surfaced—primarily the worry that nobody in the group would know how to identify an emergency situation.

But Vanessa responds that it would be impossible to give birth the way she feels is best with a midwife waiting in the closet. “I would always be aware of her presence.” 

Vanessa is doing her own prenatal care. She does yoga and has regular massages. She drinks homemade herbal teas made from red raspberry leaves and nettles for her and her baby’s health. She is serene as she awaits the birth of her baby. 

She hasn’t decided yet where in the house she will give birth. Outside is probably out of the question because it will almost certainly be too cold. She will have a birth pool in the room. But she wants to leave everything open, to have complete liberty during the entire process to decide how and where the birth will unfold. The longer her pregnancy continues, the more Vanessa feels that her decision is right. 

“I want to be the only one deciding how I feel and how the birth should unfold.” Above all, she wants to ensure that she does nothing to hinder the process before it happens. She notes any desires or wishes that arise. Still, in order to have complete spontaneity during labor, everything needs to be well set up in advance.

Her final wish is to have a “lotus birth”—not cutting the umbilical cord and keeping the placenta and baby together until the cord falls off by itself a few days after the birth. “I really want this to be a rite of passage for me and my baby, and in order to for this journey to take place, you have to take risks and be willing to embrace the possibilities.” The knowledge of the risk she is taking is part of her journey, but she places her faith in nature, trusting that her baby will arrive safely into the world. She awaits as the full moon draws nearer.

Unassisted Birth
In the United States giving birth at home without medical assistance (called “unassisted birth” or “undisturbed birth”) is a growing trend. No doctor, no midwife, no nurse. The woman gives birth alone, with her family, or with close friends, whatever suits her best. Some women give birth outside, others in water, in the living room, or in a birthing room prepared especially for the event. 

A recurring theme in the unassisted birth movement is the right to have the freedom of choice and autonomy in making health care decisions. 

The unassisted birth movement is a militant protest against the over-medicalization of pregnancy and birth. Its supporters--including committed environmentalists, intellectuals, artists, and feminists—wish to overturn the established order and to bring childbirth back to its original meaning: bringing life into the world in a truly natural manner. Giving birth, according to women who choose unassisted birth, is a creative act that should unfold exclusively according to the mother’s desires, because they believe that what is good for the mother is also good for the baby. 

The unassisted birth movement proclaims that birth is a natural physiological process that does not need medical intervention. According to the movement, we are all in charge of our bodies, and the birthing mother is the best qualified person for bringing her baby into the world as long as she knows her body well. She knows what is best for her and for her baby. No one else has the right or the ability to tell her what is best for her. Medical procedures and technology are unwelcome intrusions, and women’s perceived dependence on medical experts leads them to accept treatment that in any other circumstance would be unacceptable. Women also reclaim their right to birth their babies into their own hands. 

Unassisted birth is also about facilitating mother-baby bonding. No one, except perhaps the baby’s father, should intervene in or interrupt the mother-baby pair after the birth. In France, the movement has no official representation. There are some reports of unassisted births, but no formal organizations exist that promote the practice. 1-2% of women in France give birth at home, but generally with a midwife in attendance—a practice quite common, for example, in the Netherlands. 

For more information:

Unassisted Birth
http://www.unassistedchildbirth.com
http://rachyllgyne.tripod.com/thebirthofgreyforestwalt

Home Birth
http://www.fraternet.org/afar
http://acchoucherautrement.free.fr/index.htm

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Exercise update

Just ran 11 miles and I feel good. Last Saturday I tried to run, but I was super weak from the nasty illness I'd had and only made it about 2 miles. Next Saturday, weather permitting, will be my half-marathon! I figure it shouldn't be too hard to go from 11 to 13 miles. Plus the week after is a big get-together and the screening of "The Business of Being Born," so I wanted to finish my running before then.

Housefairy and Kelley: how is your exercising coming?

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Happy Birthday!

One year ago today I gave birth to Zari on the floor of my master bathroom. Now she's walking, crawling, eating food, terrorizing the dog, and getting more personality every day. How does that happen?

I feel like I should write something very profound, bordering on sentimental, but I can't think of a way to express the entirety of a year in a few words. So let me leave you with some pictures of Zari on her first birthday, in her Little Red Riding Hood costume I made for her. More pictures to come after her birthday party tonight.

But before you get to see the pictures of the costume, you get a blow-by-blow of its creation. Because of course I can't just go out and BUY a Little Red Riding Hood costume, or even just red fabric and a cape pattern. Nope. That would be too easy. I had to dye pieces of wool and silk, devise a pattern myself, and then sew it with lots of "help" from Zari. The wool is stuff I bought waaaaay back in high school. I made several baby blankets with it and had a long, narrow piece left over. The silk charmeuse scraps are left over from making my wedding dress.

The wool & silk awaiting their destiny, next to a pot of acid dye from Dharma Trading Co.

Dyeing in process.

Fabric is cut out. I wanted to make a big hood--I think they look more dramatic--
but it ended up way too huge. Oh well. It's still cute.

Zari helping me sew.

...And the end result!

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Le Premier Cri (The First Cry)

I just discovered this fantastic French film Le Premier Cri that premieres tomorrow on Zari's birthday! It follows pregnant women all around the world, as they live, work, and give birth. You can download a trailer at the website. (For you non-French speakers, click on "La Bande Annonce," then on "Version Longue.") You can also click on different countries on the globe and read about the mothers profiled in the film.

The American woman featured in the film had an unassisted birth! And in Mexico, two friends have ocean births surrounded by dolphins, with the same midwife. I can't wait until this comes out on DVD!

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Comments about To The Contrary

I part ways with Lynn Griesemer over the father's role in unassisted births. We've talked about this, and she has more of a "daddy delivery" philosophy about unassisted birth. I don't think men should be "front and center" in births. Women should be. After all, they are the ones giving birth! It's really not that hard to catch a baby, yet when men (or doctors) do it, they get all sorts of glory and acclamation. My husband's role at the birth was to sit in the other room and wait as I birthed our daughter (and to be errand boy when I needed food & drinks). Now, that was exactly what I wanted and needed him to do, so it's not like I resent that in any way. The most significant thing he did for me--more important than any coaching or catching or delivering--was giving me blessings when I asked for them. (LDS lingo here...let me know if you haven't a clue what I'm talking about.) The blessings gave me absolute certainty that both I and Zari would be perfectly healthy and that the birth would go smoothly. There is no machine, no test, no care provider who could do that!

Even though Lynn would not identify herself as a feminist, I do agree that birth issues are noticeably absent from almost any feminist platform. That's a shame, I think. The National Organization for Women has recently made some statements about birth issues, including a statement against VBAC bans, but otherwise feminism has been oddly silent on the birth side of "reproductive rights." I also think that the almost exclusive focus on abortion has alienated many women who are concerned with the rights of childbearing women. Women need more opportunities to unite, and unfortunately the abortion issue is one really good way to keep women divided.

Dr. Healy claims that she supports patient's rights to refuse treatment, yet she undermines that by her statement that "when you’re making that decision for a child, it’s a very different situation." Is it different? Pregnant women have the same medical and legal rights as non-pregnant people (with the very disturbing exceptions of court-ordered obstetrical interventions). This is the same double-talk that ACOG uses in its statement against home birth: "Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births" because "the American College of Obstetricians and Gynecologists believes that the hospital...is the safest setting for labor, delivery, and the immediate postpartum period." ACOG's active opposition to out-of-hospital births stands in direct contradiction with its claim to support women's choices in health care.

It's kind of like saying "We support your right to choose any color of car you wish. But you can only have a blue car, because we believe that all other colors are unsafe. In addition, we will actively oppose any car manufacturers who promote, sell, or distribute non-blue cars. We can do this, because we have a monopoly on the $33 billion-a-year business of car manufacturing, sales, and advertising. But remember, we support your right to choose!"

I agree with other commenters that Dr. Healy skimmed over the issue of babies dying in hospitals. Yes, it's true that neonatal deaths are fairly uncommon anywhere in developed countries. But her comments imply that a hospital is the only place that the low death rate can be ensured, and that any infant deaths that occur in hospitals are unavoidable.

The doctor also shows a blatant lack of knowledge about unassisted birth, or home birth in general, with her claim that first-time mothers do not make that choice. What irks me is that her statement will be taken as factual and authoritative, simply because she is a physician.

I am also puzzled by her comment that "you don’t know the health of that baby until that baby arrives." Isn't that one of obstetric's main claims--that it can monitor, assess, and predict the health of babies during pregnancy and birth? Why else all the monitoring during pregnancy (ultrasound, screening tests, etc) and birth (electronic fetal monitoring)? Is her statement an admission that the standard obstetric care really cannot predict outcomes with any accuracy, let alone avert them? Or is her comment meant to mean that women birthing at home cannot know whether or not their baby is healthy while it is in utero? Because certainly women can and do feel their baby kicking and moving, listen to the heartbeat, and keep track of the baby's growth. Read that way, her statement implies that a physician has a better knowledge of the unborn baby than the mother herself.

Of Eleanor's comment--which I find immensely condescending and anti-woman--let me just say that safety, satisfaction, and empowerment are not mutually exclusive. In fact, the factors that bring unassisted birthers pleasure (privacy; security; complete freedom to move about, eat, drink, and vocalize; not feeling observed or monitored or pressured to birth in a certain amount of time; lack of drugs and interventions and their known side effects; absence of stress and fear; optimal hormonal levels that help the mother experience ecstasy and bliss; ability to focus on labor and not on outside distractions) also enhance the safety of both mother and baby. The pitting of fetal safety versus maternal satisfaction is a cornerstone of the obstetric worldview, as Robbie Davis-Floyd notes in Birth as an American Rite of Passage. The midwifery paradigm, in contrast, perceives the mother and baby as an inseparable, mutually dependent unit. What is good for the mother is good for the baby, and vice-versa.

I fear that this discussion of safety is quickly turning into a dissertation itself, but let me briefly add some insights from Sarah J. Buckley. She argues that the safest, easiest, and most ecstatic births are ones that are undisturbed:

"Anything that disturbs a labouring woman’s sense of safety and privacy will disrupt the birthing process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women...On top of this is another obstetric layer devoted to correcting the 'dysfunctional labour' that such disruption is likely to produce. The resulting distortion of the process of birth—what we might call 'disturbed birth'—has come to be what women expect when they have a baby and perhaps, in a strange circularity, it works."

In contrast, undisturbed birth and its “optimal hormonal orchestration provides safety, ease, and ecstasy." She explains: “When a mother’s hormonal orchestration is undisturbed, her baby’s safety is also enhanced, not only during labour and delivery, but also in the critical transition from womb to world....[I]interference with this process will also disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe.” She uses two analogies to explain the optimal conditions for undisturbed birth: lovemaking and meditation, both of which necessitate privacy, quiet, and freedom from feeling watched. “If we were to consider giving birth as the deepest meditation possible, and accord birthing women the appropriate respect, support, and lack of disturbance, we would provide the best physiological conditions for birth.” [1]

I also want to say that childbirth was definitely something that I embraced and enjoyed in many ways. Some parts were challenging, some were very very exhilarating. Pain was present at times, but so was immense pleasure, experienced in the form of an incredible endorphin rush between every contraction. Five minutes after the birth, I said, "that was hard work, but definitely doable." Distance runners experience this same mixture of pleasure, pain, exertion, and exhilaration. I can say this from personal experience, since I am very close to running a half-marathon. My longest run so far has been 10 miles.

Now, in case you are tempted to dismiss my experience by figuring that I must have an unusually high pain tolerance, let me set the record straight: I was known for my extremely low pain tolerance growing up. I would scream and wail over every little thing, so much that my mom didn't believe me when I broke my wrist and waited 10 days before taking me in to the doctor!

Eleanor's disparaging comment about enjoying labor and birth is destructive and indicates either some very traumatic personal experiences giving birth or very strong cultural programming that birth is inherently and inescapably traumatic.

And the final panelist...where to start? She reiterates that choosing to birth at home unassisted is selfish, yet her own childbirth preferences (using drugs, including general anesthesia) confer no physiological benefits to mother or baby during normal labor, and also pose many significant risks, as Dr. Buckley has thoroughly documented. We could very well argue, with much more substantial evidence than any of the panelists had, that any mother taking drugs for pain relief is selfish--caring more for her own experience than for the baby. (Not saying that I want to use this label, because there is too much woman-hating and guilt spreading out there already).

This concludes tonight's episode of "Rixa writes, raves, and rants whilst remaining reasonably restrained in her responses."

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[1] Gentle Birth, Gentle Mothering 110-114.

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