Hebrides midwifery documentary by Honey Bee Pictures

I'm excited to share a guest post from filmmakers Jacob ; Honey Hesmondhalgh-Scott of Honey Bee Pictures. They are crowdfunding to support their newest documentary project. 

Off the West Coast of Scotland lies some of the most remote islands in the UK, the Outer Hebrides.
With a rich cultural history, beautiful landscapes and a peaceful way of life, many thousands call these islands their home.

Living here comes with its own set of joys and challenges, but how does remote and rural midwifery impact a person’s pregnancy?

Especially if you’re unable to give birth on the island you call home.

A new feature documentary, currently in production, explores exactly this. It gives insight to the complications of pregnancy and birth in the Outer Hebrides and forms a portrait of the only midwife on the remote Isle of Barra.


Hebrides Midwifery Documentary - Trailer from Honey Bee Pictures on Vimeo.

On the Isle of Barra, Veronica, the island’s only midwife, expects 10-15 births per year, from a population of around 1,000. However, with no childbirth facilities on the island, all women leave at 38 weeks and travel to a hospital of their choosing to deliver. Meaning they could be away from home, away from family, for up to one month.

This upheaval can cause emotional, financial and physical stress. Though the NHS does provide some reimbursement, this never covers the costs in reality of moving a family away from their home.

The subsequent communication between hospitals and health boards, the crucial timing of the trip, the wellbeing of child and expectant mother, all falls to Veronica.

Previously a senior maternity co-ordinator in Lanarkshire, Veronica has been a midwife for 30 years.
Having dreamed of one day living and working in the Hebrides, 18 months ago, this became a reality and Veronica stepped back into community midwifery.

On an island with no obstetricians, gynaecologists, ultrasound equipment or labour ward, a tremendous amount of responsibility lies on veronica’s shoulders.

The Film

This independent documentary creates a striking portrait of life in the Western Isles--travelling with couples off the island across their pregnancies, flying out from the only airport in the world that lands on open beach, and learning first hand the realities of starting a family in the remote and rural Western Isles.

We hope to screen the film all over Scotland and the UK, in educational settings for universities and hospitals, international film festivals and online streaming platforms.

In other lovely news, Veronica has just been nominated for the Scotland Maternity and Midwifery Festival Achievement Award in recognition of her contribution to maternity services.

If you’re interested in supporting the film and keeping up to date with the production, we are crowdfunding to allow us to keep making the film.

If you can, please help by donating, sharing and spreading the film to your family and friends
Click here for the link and here for my Facebook page, where the film can be easily shared

To contact the filmmakers, you can get in touch through our website
www.honeybeepictures.co.uk.

Read more ...

Review of Touching Bellies, Touching Lives by Judy Gabriel

I'm excited about a new book about midwives of southern Mexico: Touching Bellies, Touching Lives: Midwives of Southern Mexico Tell Their Stories.

Written by Judy Gabriel, a doula in Oregon, this book tells the stories of more than 100 Mexican midwives. Judy has lived and traveled extensively in southern Mexico, and she was fascinated with the traditional midwives who were rapidly dying out, replaced by sterile clinics and sky-high cesarean rates.

Judy began compiling these midwives' stories by asking a simple question: "Can you tell me about the very first birth you ever attended on your own?" From this question emerges an astonishing set of stories. You learn about how many of these women received their training from birth itself. Often they were thrown into a birth because no one else was available, and soon they were being called to another birth, and then another and another...The midwifery of southern Mexico was organic and self-taught and fluid. It also has come under direct attack from modern Mexican medicine, and unfortunately this hostility has accelerated midwifery's decline and near-extinction.

Judy has organized the book into geographical regions, with brief narratives of her travels as she tries to locate and speak with as many remaining midwives as she can find. You'll travel with her from Oaxaca to Vera Cruz, from Tabasco to the Yucatan.

Each midwife's story is narrated by Judy, who sets the scene and describes the woman in vivid detail. Judy recorded and transcribed her interviews, so the stories also contain long passages from the midwives themselves. Judy has also included photos of nearly all the midwives--a wonderful way to connect to these wise women.

These stories gave me a glimpse into another world. Even though the midwives lived and worked in the 20th century, their lives were often unimaginably different from anything I have known. Alongside their midwifery journeys, you'll also read about the women's lives: childhood, marriage, babies, hardships. It's fascinating.

Reading Touching Bellies, Touching Lives sometimes feels like reading a eulogy: Mexican midwives are an endangered species, and their extraordinary knowledge and experience are dying out with them. The transition from midwifery to obstetrics, and from home to hospital, was even more dramatic and abrupt in Mexico than in the US, and the pendulum swung more violently as well. Of particular value are the midwives' skills with the rebozo and massage. Seemingly simple but remarkably effective, these hands-on skills have helped countless women have better-positioned babies, more comfortable pregnancies and labors, and fewer complications in labor.

We are lucky to have these midwives' stories captured in Judy's book. At the end, she gives me reason to hope that Mexico is starting to value its midwifery heritage: a new government-sponsored midwifery school in Guerrero trains midwives in both modern medicine and traditional midwifery skills and knowledge. If this trend continues, Touching Bellies, Touching Lives will be able to function not as a eulogy for a lost cultural practice, but  as a guidepost and inspiration for anyone wanting to learn about or promote midwifery in Mexico.

Let me end with a short excerpt from Hermila, a Oaxacan midwife. It's fairly typical of how many of these women became called into midwifery. She was 17 years old when she attended her first birth. She recalls:

One day the village priest asked me to help a woman in labor. I asked why the midwife Lupe couldn't help her, and he said Lupe was getting too old to work. He said I would know what to do because my grandmother had been a midwife.

I didn't know anything about childbirth. I'd never been with my grandmother when she attended a birth, and I hadn't had any babies myself. But the priest was insistent, so I went to the woman's house.

She told me what to do.  I just made a tea and fetched things for her and, when it was time, I held  my hand under her skirt to catch the baby. When the placenta came, I thought it was her insides, but she explained what it as. She said I had to tie something around the cord, so I tore a strip of fabric from the bottom of my slip and used that. I was afraid to cut the cord; she had to do that herself.

Two weeks later I was called to attend another birth. And then there was another... [p. 1-2]

To learn more about the book, visit the book's website Touching Bellies, Touching Babies.

Available for purchase on Amazon and from the publisher Waveland Press.

Read more ...

Help Midwives for Haiti at The Amazing Raise

Do you ever feel overwhelmed with the amount of suffering and need around the world? Sometimes I feel paralyzed because I don't know where to start and wonder if my small efforts will do any good.

Here's something you can do today (and only today!) to help a new birth center in rural Haiti:

Donate $50 or more before 6 pm today (Thursday) to help Midwives for Haiti purchase a vehicle for emergency transports.  

Here's the medical director explaining how and why you can help:

Help our rural birth center get an emergency vehicle... and help us win $15,000 in the Amazing Raise! from Midwives For Haiti on Vimeo.

To learn more about the organization, visit Midwives for Haiti

Read more ...

Midwife memoirs from the UK

I've discovered a bundle of recent UK midwife memoirs. I was reading retired midwife Sheen Byrom's reflections on the Human Rights in Childbirth Conference and noticed she'd written a memoir called Catching Babies. From there, I found several other midwife memoirs, none of which I had heard of before. Any others I've missed?

• Catching Babies: A Midwife's Tale by Sheen Byrom
• Tales of a Midwife by Maria Anderson
• Journal of a Student Midwife by Ellie Ryan
• Midwife on Call by Agnes Light
• Call the Midwife: A True Story of the East End in the 1950s by Jennifer Worth
• Farewell to the East End: The Last Days of the East End Midwives by Jennifer Worth
• Twelve Babies on a Bike: Diary of a Pupil Midwife by Dot May Dunn
• It Shouldn't Happen to a Midwife! by Jane Yeadon
• Bundles of Joy: Two Thousand Miracles. One Unstoppable Manchester Midwife by Linda Fairley (biography)
• The Midwife's Here!: The Enchanting True Story of One of Britain's Longest Serving Midwives by Linda Fairley (biography)

Read more ...

Robin Lim named CNN Hero of the Year

Robin Lim, a midwife in Indonesia, was just named the CNN Hero of the Year! She was well-known among many midwives in Iowa (where I did my PhD work), where she practiced before moving to Bali. Here are some excerpts:

Robin Lim, an American woman who has helped thousands of poor Indonesian women have a healthy pregnancy and birth, was named the 2011 CNN Hero of the Year on Sunday night.

Through her Yayasan Bumi Sehat health clinics, "Mother Robin," or "Ibu Robin" as she is called by the locals, offers free prenatal care, birthing services and medical aid in Indonesia, where many families cannot afford care.

"Every baby's first breath on Earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving. But our world is not there yet," Lim said during "CNN Heroes: An All-Star Tribute," which took place at the Shrine Auditorium in Los Angeles and recognized Lim and the other top 10 CNN Heroes of 2011....

[Christy] Turlington Burns introduced Lim's video tribute during Sunday's show, before the Hero of the Year announcement. As founder of Every Mother Counts, she is also a passionate advocate for maternal health around the world.

"Eight years ago, after giving birth to my first child Grace, I felt what could have been a life-threatening complication," she told the audience of nearly 5,000. "It suddenly got very scary, very fast. If I hadn't received the expert care in the hospital birthing center I was in, then I may have not been so fortunate.

"My wish is that every mother all over the world has the same chance surviving childbirth I had. My friend Robin Lim shares that wish and she spends her days and nights making it so."

Read the rest here.

Read more ...

Birth Around the World: Birth at a midwife clinic in Japan

Sarah of Delightful Pregnancy gave me permission to repost Jamie's birth story. Jamie (who blogs at High Countries) gave birth in Japan to her second baby at her midwife's house. Sarah wrote to me in an email: "Not mentioned in my post are other tidbits from Jamie about her experience, including that during her stay at the midwifes home for several days postpartum, the midwife made her 3 home-made meals every day! Love that personal nurturing...every woman should receive this kind of care. Jamie even sent me some pictures of her meals, which I didn't post because of space, but they looked delicious."

Jamie's Birth Story

Sarah's words in black; Jamie's words in purple.

Jamie is one of those people that I can’t believe I’ve never met in person. We used to live in the same city, we have oodles of friends in common and both my husband and I have met her husband, Bryan. Jamie and her family moved from Nebraska to Japan a few years ago, which is where her second son, little Ezra, was born last fall. I always love to read birth stories, of course, but I also love to learn about birth in other cultures (because we Americans have so much to gain!). Jamie shared these details about her experiences having a midwife-attended birth:

• The midwife experience in japan is rather rare — only about 10% of births happen in midwife clinics, so my experience wasn’t the norm.  Many of my japanese friends were surprised and interested in giving birth at a midwife clinic (josanin).  All of the births in hospitals and birthing centers, however, are attended by midwives, and the dr. comes in to catch the baby.
• The midwife’s clinic is in her home.  She and her family live on the first level, where her office is also located, and there are three birth rooms upstairs.  She provided a few things (the baby’s clothes, blankets and diapers, and pads for me), but i had to bring my own pajamas, toiletries, and pain meds. 
• I gave birth and stayed in the same room.  Ezra slept in the bed with me, and if you have other co-sleeping kids, they are welcome to stay and sleep with you. (in japan, they co-sleep until age five or six.)
• She came and took the baby every day for a bath and to weigh him, and i took a shower while she did that.  Then she weighed me and “wrapped” me — she did a traditional japanese wrap around my waist and hips to help my hips close after giving birth.  It felt amazing!  After giving birth, you kind of walk around for a while feeling like your insides are going to fall out, but with that hip wrap, I felt totally normal.

**Renowned anthropologist/childbirth author Sheila Kitzinger said this about the practice of post-partum binding in Rediscovering Birth:  

My mother, who was a midwife in the years after First World War, described to me how she bound the new mother’s body firmly with wide strips of cloth from below the breasts to the top of the legs. Each time the midwife visited in the days following the birth she unwound the cloth strips, gave the mother a bed-bath, patted her dry, and then rebound her. She offered the intimate and nurturing touch which was considered an important part of postnatal care. In modern hospitals new mothers are rarely touched except to examine them, to check that the uterus is firm and…to examine the perineum. (p. 221)

This is the story of Ezra Dean’s birth:

on a rainy night in october, with less than 20 minutes left in the day, you came.  you were pink and slimy and quiet as you drew your first breath, and i was so happy to be done.  we leaned over you, your daddy and i both with our hands under your body, taking in our first looks of your nose, your mouth, your fingers and your toes.  you were beautiful.

i was certain that you would come late, as your brother was late, and your nana said i was late, and so was your uncle — it was the way of birth in our family, and you were no exception.  twice, i thought you were coming.  twice, i woke up in the middle of the night, experiencing the sensations and pains of your arrival.  once, i called our friend to come be with your big brother at 3am.  once, your father and i walked to pick up gum at the 24-hour convenience store at 4am.  twice, i fell back asleep after contractions stopped and my tears were dried, convinced that you were not coming like i thought you were.

five days after your due date, i woke early in the morning at 5:30a, once again feeling those pains.  they were slightly different, so this time, i was sure. we made the calls.  we packed the bags.  i took my time getting ready, not knowing how long it would be.  i did laundry and washed dishes.  i straightened my hair and put in my contacts.  i brushed my teeth and ate tiny snacks.  at 9am, your dad and brother and i went to a park to play.  i was having contractions 10 to 15 minutes apart, and they were getting stronger.  yes, i thought, this is it.  today, we would meet you — ezra dean.

around 11am, after about five hours of here and there contractions that weren’t too bothersome, we went to get checked at the midwife’s.  i was 4cm dilated. and the contractions had stopped.  so we went for a walk.

your papa and i drove to kendai university and spent a few hours walking its hills, taking in the fall scenery, talking and musing and dreaming.  i even cried a little, which is normal for me these days.  it was a lovely time, but things had completely subsided.  it was 3pm.  perhaps you would not come.

we went home and i talked with a friend on the phone.  i ate a snack and fell asleep, sadness and frustration seeping over my heart.  am i doing something wrong?  why will he not come? at 5pm, i woke up and cried and prayed with your papa.  you would come when the time was right and determined, i wanted to believe it.  i would wait for that time.  God knew when it was, and things were safe in His hands.  i breathed a sigh of relief, knowing it wasn’t my will that made things happen.  our spirits lightened, we set out to fully enjoy the evening.  and we did.

at 6:30p, as we were on our way to eat, i started getting contractions again, only every half-hour.  the midwife wanted us to come after dinner so she could see how things were progressing. by 7:30, they were every 15 minutes, and more intense, and i was beginning to feel very ‘serious,’ as they say.  no more small talk. no more laughter. no more playing around.

at 8p, we arrived at the midwife’s, and she checked me — dilated to 6/7cm, and she told me you may come fast, so it would be better to come and stay at her house now.  we dropped off your big brother and our friend at home and returned to the midwife’s, excitement in your papa’s eyes and seriousness in mine, so very ready to meet you.

we listened to music.  we read.  i stopped everything to breathe and survive the contractions.  by 10pm, they were coming every 5 minutes and i could have no noise or distraction in the midst of them.  your papa gently stroked my back and did what he could to encourage me.  you were coming.  you were finally coming.
at 10:45, the contractions were one on top of the other, and i started to make a lot of noise.  the midwife rushed upstairs to help, and at 11:15, with a squeal of pain, my water broke.  i was ready.  i was so ready.

  

i had been laboring on my hands and knees and was too tired to move, so i started pushing from there and making more noises that sounded strange to my own ears.  i wanted this over.  i wanted to be done.  i wanted you here.  the midwife let your head crown just a little, and would gently push you back inside to help me stretch.  it was painful, and i kept asking your papa, “is he out yet? is his head out?”  finally, she let you make your way, and it was nothing but bliss to finally leave my hands and knees and sit with you in front of me on that october night.

  

you slid out into your father’s hands, and as i said, we both hovered over you, taking you in.  you were so distinctly you to my eyes.  not like your brother.  you had your own eyes, your own nose, your own hair.  just you.  your papa cut the cord and i took it all in. i could hardly believe the blonde haired, blue eyed babe in my hands was you, and you were mine.

    

and i was so glad the wait was over.  and you had finally made your way.
welcome, ezra dean, to this life of ours.
ezra dean o’donnell
6lbs 12oz
19inches
born in shizuoka, japan, october 22, 2009

Bryan, Jones, Jamie and Baby Ezra

Read more ...

Birth Around the World: Peace Corps volunteer in Paraguay

"Chingona" served as a volunteer for the Peace Corps in Paraguay and describes her recollections of the local birth culture. (Reposted from the comments section of the call for submissions).

I wish I'd known enough about birth to ask more and better questions when I was in the Peace Corps in Paraguay. I do know that they had a tradition of always having two older women at a birth. These women did not call themselves midwives, just "women who help other women." A midwife usually was only called for when there was a problem, like when the sun rose a second time on a laboring woman. The problem was that "calling for the midwife" meant sending a child on a horse some 10 miles away to the midwife's home, where he may or may not find her home. That woman, though a lay midwife, had also gone through a government training program and had a license to get pitocin, antibiotics and some other medications. She was very respected by the women in the region, while the health "professionals" - the nurses at the local health post - held her in contempt. There was just one motorized vehicle - a motorcycle - in the entire village - and the "hospital" (a rather abysmal place similar to what was described in Haiti) was nearly 20 miles away over rutted dirt roads that washed out in even moderate rain.

The government was doing a big campaign to try to get women to not birth at home, to go to the hospital instead. Many younger women from more modern/well-off families did this, but giving birth at home still was the norm. The routine cutting of large episiotomies was a major factor keeping women at home. When asked why they wouldn't go to the hospital, women would tighten their faces and say, in a low voice, "They cut you there." But doctors and nurses had been taught this was a requirement for a safe birth, especially in a primip.

I remember two births in one family that was very opposed to modern medicine and very dedicated to traditional remedies and healing. The daughter-in-law, just 14, was pregnant with her first child. That girl's mother was the sister of a well-known and respected midwife and called herself a midwife as well. But the other women didn't trust her and whispered about the bad outcomes of women and babies she had attended. She insisted on being the sole attendant at her daughter's birth, which turned out to be long and difficult, going on 48 hours. The mother-in-law gathered several other women and started fighting with the mother over what to do, how the birth was going, etc. The other women believed the baby was in a bad position, while the mother (of the laboring girl) insisted it wasn't. She finally allowed someone else to get involved when the mother-in-law threatened to bring her husband into the room. They did some sort of manipulation and the baby was born shortly afterward.

That story haunts me - I can't imagine being 14 years old, in the far-gone mental state of such a long labor, with all the women I trust to guide me through the process fighting with each other over my labor.

As far as I could tell, though, both mother and baby came through it okay.

A few months later, the daughter of that same family was ready to give birth to her first child. The family was shook up by the most recent experience, and she decided to go to the health post a few miles away (not the big hospital in town). As she stood out by the side of the road at 4:30 in the morning waiting for the bus, she decided her contractions were getting too strong and close together to take a ride and went back home. A few hours later, after just five or six hours of total labor, this very petite girl birthed a 9 lb. baby with no complications. I saw her a few hours later, resting happily in her own bed with the most alert newborn I've ever seen.

I'll tell just one more story - of a young woman who decided to go to town and wait at a cousin's house to go into labor so she could birth at the hospital. I don't know anything about her labor or birth, but I shared a seat with her on the bus two days after the birth as she tried to return home. It had rained and the bus stopped two miles out from our village because there was a steep hill down, across a precarious bridge and then up again to get to our village, and the bus couldn't make it in the mud. She had to walk those two miles with her baby with a still-raw episiotomy. She showed it to me a few days later - she was in agony, worried it was infected and wanted my opinion (no, I'm not a medical professional of any sort). It was a huge mediolateral episiotomy - almost two inches - and she had been shaved, too. That as my glimpse into hospital birth in Paraguay.

Read more ...

Birth Around the World: Giving birth in Haiti

I've been following California midwife Maria Iorillo's blog Women in Charge for several years. She recently arrived in Haiti and is writing about her work with Midwives for Haiti.

In Day One in Hinche, she describes her first day working in the Hinche Maternity Ward. It's hard to read--the lack of basic health care supplies is astounding. The hospital in Hinche doesn't even have a bathroom. Laboring women have to provide their own bucket for elimination, catching blood & fluids from the birth, and holding the afterbirth. If a woman has a postpartum hemorrhage, she has to supply her own IV fluids and tubing.

It's a reminder that, no matter the maternity care problems we face in North America, some women have it far, far worse. Let's take a moment to be grateful and to donate to Midwives for Haiti. Here's an example of what your donation can do:

$50 will buy enough medication to stop postpartum hemorrhage 10 times.

$250 will pay a month's rent for our prenatal clinic in Hinche.

$1,500 will educate a skilled midwife for a rural village.

$2,500 will supply a village midwife with prenatal vitamins and antibiotics for one year.

$10,000 will pay the yearly salary, room & board, medications and supplies for a skilled midwife.

$30,000 will pay two midwife instructors for a year.

Read more ...

New York midwives and written practice agreements

A few days ago, The New York Times published this article about the current status of NY midwives: Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives. Since the closure of St. Vincent's, half of NYC's home birth midwives have been unable to obtain practice agreements. All midwives, hospital or home-based, currently need a signed practice agreement with either a hospital or physician. So New York state's midwives sought a legal solution to this impasse. Here's what happened:

A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.

In a memorandum, backed by a press conference in Albany on Thursday, the congress challenged the safety of midwife-attended births and suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors. “While this legislation does not intend to extend a midwife’s scope of practice, it has the ability to pave the way for midwives to open their own independent birthing centers,” it said.

Heaven forbid that midwives compete directly with physicians.

But wait--it gets even better. ACOG's reason for requiring written practice agreements is that without a practice agreement, giving birth with a midwife, including hospital-based midwives, will become terribly unsafe. The only thing standing between the laboring woman and disaster is this piece of paper. Here's how:

The obstetricians’ group has argued that written agreements are needed to keep women safe. Suppose a woman is giving birth in a hospital, attended by a midwife without a practice agreement, and the woman starts to hemorrhage, Donna Montalto, executive director of the New York division of the congress of obstetricians, said Thursday.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’ ” Ms. Montalto said.

Yes, in the absence of a signed agreement, physicians will be asked to come in from their children's sport games and attend to an unknown woman. Gasp. As if unknown women never go into labor when a physician is on call. As if attending physicians know all of the women they deliver personally--except for those pesky midwife patients.

Not only is this totally ridiculous--on-call physicians attend to whoever goes into labor, known or unknown--it distorts what would actually happen if a woman giving birth in a hospital with a midwife began to hemorrhage. The midwife would administer the same anti-hemorrhagic medications that a physician would! She wouldn't be calling a physician in from his son's baseball game to give her patient a shot of Pitocin or methergine.

I'm calling this one...

Code Mec!

Read more ...

Review of "Lady's Hands, Lion's Heart" by Carol Leonard

"A midwife should have a lady's hands, a hawk's eyes, and a lion's heart."

Aristotle

This phrase on the cover of Lady's Hands, Lion's Heart: A Midwife's Saga captures the essence of Carol Leonard's memoir. An apprentice-trained home birth midwife at the beginning of the American midwifery renaissance needed courage, skill, and highly attuned powers of observation.

Several blog readers highly recommended Lady's Hands, Lion's Heart when I compiled a list of midwife memoirs. Readers said that her book was "a terrific read. Unputdownable" ... "an emotional, powerful book. The stories of the women and of the midwife are vivid, passionate and moving." This book, surprisingly, had not yet made it onto my reading list. Clearly, that needed to change.

I contacted Carol Leonard about reviewing her book, and she graciously sent me a copy. Since then, we have corresponded on and off. She sends me updates of writing pieces she's working on, elaborates on the stories from her memoir, or tells me about her newest book project The Beauty Girls.

Lady's Hands, Lion's Heart is a memoir with two intertwined stories.* The first is--not surprisingly--the tale of Carol's midwifery career in New Hampshire from 1975-1987. After the not-so-great hospital birth of her son Milan in 1975, she was so fed up with the care she received that she left AMA in the middle of the night, yelling after her doctor "I am outta here!" Yes, Carol is one feisty character, and it only gets better.

Carol began her midwifery career in an unexpected venue--supporting women having abortions in a women's health clinic. (Today, such women are called "abortion doulas.") Around the same time, she started assisting an old-time family practice physician who attended home births, the only one left in the state. Before she knew it, she was catapulted into a career as a home birth midwife. It was the right time and place; the natural childbirth, counter-cultural, and back-to-the-land movements were going strong. Home birth fit easily into all three.

The other main narrative of the book is a love story. As her first marriage is falling apart, Carol falls in love with Dr. Ken McKinney, a handsome, sensitive, dedicated obstetrician whom she works with. Although they sometimes clash over certain obstetrical practices, he proves remarkably open to changing his practice style. This is a good thing, as they eventually marry and work in tandem. Unlike most American home birth midwives, Carol has access to a sympathetic backup OB who is willing to meet her clients at the hospital, no questions asked, night or day.

As Carol and Ken's relationship deepens in the book, they face increasing challenges. Carol learns how to work as an independent midwife--sometimes learning the hard way to be more patient or more humble. She also withstands considerable opposition from local physicians and hospitals and creates landmark direct-entry midwifery legislation. Ken's physician colleagues dislike his support of home birth (and his popularity with  patients) and eventually give him an ultimatum: stop providing backup to Carol, or lose your job. He leaves his group practice and forms a solo OB/GYN practice that becomes the most successful in town.

Lady's Hands, Lion's Heart is a gripping, fast-paced read. Filled with Carol's earthy humor and raw narrative style, you become immersed in the moment-to-moment life of a home birth midwife. Women birth in urban government-subsidized apartments and in quirky off-grid cabins. Carol climbs into tiny lofts, underneath a woman suspended midair, and through a storm of feathers unleashed by a laboring woman ripping apart her pillows. All in a day's work for a baby catcher.

This passage, which makes me laugh every time I read it, conveys how home birth midwives adapt themselves to laboring women's preferences:

Because Thea is so short, she braces herself, straight armed, in the space between the washer and dryer. This leaves her feet dangling about six inches off the floor. This is how she wants to do it--suspended in midair.


I on the other hand, am lying on my side, wedged in between both appliances. I am trying my best in these cramped quarters to guide the baby out. The amniotic fluid is dripping on my head. Dryer lint is sticking in my wet hair. I am covered, head to toe, with fuzz galls. When I finally stand up, I look like a gray Yeti.

The book is told entirely in first-person present tense, which lends an immediacy to the story. (Short aside: present tense is quite difficult to sustain over a long narrative. At times it was hard to remember the correct sequence of events, as everything was told as if it were all happening right now.)

As American midwifery evolves and professionalizes, today's student midwives will likely have different formative experiences than the midwives of the 1970s. Carol Leonard's memoir preserves and documents the soul of American midwifery, including the founding of MANA. For those wishing to learn more about this rich heritage, Lady's Hands, Lion's Heart should be read in combination with Sisters on a Journey: Portraits of American Midwives.

Ladys' Hands, Lion's Heart is available through Amazon or directly from Bad Beaver Publishing. 

*Or three main story lines--after I wrote this review, I read on Carol Leonard's website Bad Beaver Publishing: 
"The story spans thirteen years--1975 to 1987-- and is told with three threads. The first thread is the home births and my apprenticeship with the wonderful old country doctor, Dr. Francis Brown, the only physician in the state who still attended births at home. He took me on as his sidekick, and we trooped around the New Hampshire countryside for years while my own practice was blossoming. The second thread is the renaissance of the profession of midwifery in the United States, despite formidable opposition from a jealous medical profession. The third thread is my love story with the impossibly handsome and brilliant obstetrician, Dr. Ken McKinney."

Read more ...

Midwifery in Illinois

I lived in Illinois for three years after completing my PhD coursework at the University of Iowa. Direct-entry midwifery in both Iowa and Illinios was (and still is) illegal. Citizens' groups in both states are currently trying to pass legislation to license Certified Professional Midwives (CPMs). A lot of people have told me that Illinois will probably be the toughest state for legalizing and licensing direct-entry midwifery, since it is the home state of the American Medical Association. I went down to the Illinois state capitol when Zari was a baby to lobby and testify in favor of licensing CPMs. There was a large group of Amish people present on that particular day to support the proposed midwifery bill. At that particular meeting, the home birth supporters got portrayed as religious nut-jobs. None of us were particularly happy about that, the Amish included.

Certified nurse-midwives can attend home births in both states, but Illinois is particularly difficult for home birth CNMs. They have to have a signed collaborative agreement with an OB in order to practice. As you might imagine, this proves incredibly difficult to obtain. One home birth CNM I know approached something like 100 physicians before she found one willing to take her on. And the supervising OB can dictate what the CNM can and cannot do.

Iowa is more friendly to home birth CNMs than Illinois. In Iowa, nurse-midwives are considered independent health care practitioners and do not need any kind of physician supervision or collaborative agreement to attend births. Still, in both states, there are very few home birth CNMs. Only 5 of Illinois' 102 counties have legal home birth attendants. The situation isn't much different in Iowa. This means that most women wanting home births in Iowa or Illinois will have to hire "underground" midwives.

For two fascinating, in-depth looks at contemporary direct-entry midwifery in Illinois, I suggest you read these two articles that just came out this week:

• An Illegitimate Birth: Kim and Steven McCarty put their baby in the hands of an unlicensed midwife by Tiffany McClain in the Chicago Reader
• Home delivery: Thirty years later, Illinois midwives fight for birth rights by Amanda Robert in the Illinois Times

Read more ...

Epic birth story, and a tribute

I've heard women say that getting in the car was the worst part of their labor. Well, if you think your 30 minute drive was bad, think again. One woman I've been corresponding with, Shaye Miller, drove across two state lines in order to birth with a supportive care provider. In the winter. On icy roads. But it worked out well for her, and she was able to give birth vaginally for the first time after having two cesareans (the first for "failure to progress" and the second an "elective" repeat cesarean). Read her epic birth story here.

For National Midwifery Week, she wrote a tribute to the CNM who attended that birth. An excerpt from her article:

Over a series of hour-long meetings, we discovered that the focus of a midwife isn’t solely on my uterus and vagina. A midwife seeks to assist, educate, and collaborate WITH the mother to achieve the healthiest birth possible. My mind was just as valuable to her as my pregnant body. On my couch we’d sit discussing the birth literature my husband and I were reading each week. She readily listened to my concerns and offered options for consideration. We discussed safety measures and what would happen if the need arose for a hospital transfer. In due course, I learned to listen to my body and to recognize when something wasn’t right. The power of posture and attitude was revealed to me as I worked through optimal fetal positioning methods. Our skeptical minds opened significantly during those hours of preparation and I loved it…every minute of it.

I also enjoyed the hour or two-hour long visits with the CNM who attended Dio's birth. I loved having someone to talk with about all of my concerns, fears, and hopes for the birth. And this kind of care isn't restricted to home birth midwifery. Remember, for example, Ruth Lubic's midwifery clinic for low-income women in Washington D.C. Doctors can also practice the midwifery model of care (and earn the title of MD--Midwife in Disguise).

The Midwives Model of Care can--and should--be found in any birth setting: home, hospital, or birth center.  Don't settle for anything less.

Read more ...

How many midwives...?

...does it take to change a lightbulb?

None, according to Erik Lee in Bossy Midwives. Sometimes we just need to lighten up a bit when we talk about birth. I think you'll enjoy his thoughts. A teaser:

An anesthesiologist, an OB, and a midwife walked into a bar. The anesthesiologist ordered a pitcher of stout and a double burger; the OB ordered a Reuben and a bottle of red wine; the midwife ordered their biggest plate of steak and fries with a margarita. They all sat in a booth and shared war stories.

A long time passed, and the three realized something had gone wrong with their order. They decided to find out what the problem was. They found the busboy just behind the swinging double doors to the kitchen. He was struggling to get their overloaded cart from the tiled kitchen to the carpeted dining area. The wheels kept catching on the bump.

The anesthesiologist kneeled down and examined the tires. “You just need to inject something here in the back,” he announced. “Then everything will go better.”

The OB leaned down to look at the carpet. “This part of the carpet is blocking the cart,” he announced. “Give me a knife and I’ll just give it a little cut to help it along.”

The midwife leaned over to the busboy and whispered loudly in his ear, “You can do this! Just PUSH!”

Read the rest here.

Read more ...

New Canadian home birth study

A study comparing the outcomes of all planned home births with registered midwives in BC is just out in the Canadian Medical Association Journal: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Other bloggers have already written up detailed explanations of the study's design and analysis, so I will suggest you read more on Lamaze's Science & Sensibility.

In short, this study compared all BC planned midwife-attended home births with midwife-attended hospital births (the same midwives, since Canadian midwives practice both in home and hospital) and physician-attended hospital births. Both hospital groups met the same eligibility requirements for home births, meaning they were equivalent in health factors, risk status, etc. In other words, all of these women having hospital births could have chosen home births if they had so desired, under the BC midwifery regulations. From the abstract's conclusion:

Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

Like the Dutch home birth study that came out earlier this year (abstract available here), this Canadian study has a strong comparison group--something lacking in the CPM 2000 study in the BMJ.

I found the comment section in this news article about the study quite interesting. I really don't think most of the commenters actually read, or understood, what the study was saying. Rather, the comments were a series of emotional reactions for and against home birth. You know, "my baby would have DIED if I had been at home!" and "I will NEVER go to a hospital for childbirth again because it was so AWFUL!" Sometimes evidence from really good studies simply doesn't matter. It's more about emotion, perceptions of risk, and the need for a compelling narrative that makes sense of and gives finality to their birth experience.

I'm sure there is lots of discussion going on out there. For example, Woman to Woman Childbirth Education includes a comment by Gloria Lemay, in which she argues that the registration of BC midwives has not been a good thing overall. Any other good links/commentary about this study?

Read more ...

Interview with Melissa Cheyney

Several weeks ago I posted about collaborations, transfers, and attitudes towards home birth, including the research of OSU professor and CPM Melissa Cheyney into physician's perceptions of home birth. Cheyney and co-researcher Courtney Evans have published their findings in the March 2009 issue of Anthropology News. The article, "Narratives of Risk: Speaking Across the Hospital/Homebirth Divide," is available here as a PDF. In addition, RH Reality Check featured an interview with Melissa Cheyney about her research.

I am especially interested in reading the protocol she is helping create for collaboration between OBs and home birth midwives. It's the first of its kind and will hopefully pave the way for better collaboration and communication between the two groups of birth attendants.

Some excerpts from the interview:

Newman: How can providers who are already open and amenable to working with midwives help foster a more supportive culture among colleagues, as you suggest in the proposal?

Cheyney: One of the mechanisms for maintaining distrust between midwives and obstetricians is what my colleagues and I have termed “birth story telephone.” This is very similar to the childhood game of telephone where as the story spreads from one individual to another, it grows in nature and the details change substantially. As home and hospital birth stories are told and retold, and filtered through the lens of the teller, details shift to match the preconceived worldview of the teller. For example, a non-emergent transport for a slow, uncomplicated and non-progressive labor can turn into a mother laboring at home for days with poor heart tones and a uterine infection before the midwife reluctantly brings her in. By the time the story has been passed along, mother and baby who were actually never in danger were saved from a near death experience by the hospital staff.

Conversely, hospital births where a woman feels too many interventions were used can be constructed as abusive or traumatizing to the woman after numerous retellings. These stories effectively maintain the home/hospital divide. Physicians and midwives can work to overturn that divide by refusing to participate in “telephone,” by being committed to accuracy and professionalism; sharing only the stories they have first-hand knowledge of. Midwives and physicians who have positive experiences working with one another also need to speak up regarding those positive interactions.

Newman: What are some of the stereotypes or judgements held by midwives about OBs/physicians?

Cheyney: Let me begin with this caveat, midwives often hold fewer misconceptions about obstetricians because we actually get to see hospital deliveries when we transport. We have first-hand knowledge of the model of care that we often critique. However, very few physicians ever attend a home delivery, and yet feel very comfortable critiquing that option.

That said, because midwives often hear stories of hospital births from clients who are unhappy with the experience and are now seeking an alternative, many maintain an outdated view of hospital deliveries as inhumane and impersonal. The vast majority of women, about 70% in the United States, leave the hospital feeling it was a positive experience. Only about 30% leave with regrets or frustrations about their experience and treatment. We as midwives disproportionately serve that 30%. This can prevent us from seeing the work that obstetricians are doing to humanize and individualize birth in the hospital.

Finally, while obstetricians can envision a world without midwives, midwives cannot envision a world without obstetricians. Thus, midwives have a larger incentive to work towards positive relationships with back-up physicians.

Read more ...

Not staying true to my word…whatever that means

In the past few days a reader posted the following comment:

why are you using a medwife? I was a little disappointed in you for not UCing, and now it's like wow you must not really stay true to your word.

She also emailed me this message:

Are CPM's illegal in your state if not why are you [not] using one? CNM's are really dangerous and I thought every unassisted birther knows this. They are more like medwives which to me would be way too scary. So why are you using one?

I would like to respond to these two comments. I am trying really hard to keep my tone restrained. Believe me, you don’t want to fall on the wrong side of someone who taught university-level rhetoric. So pardon me if I come off a bit strong at times.

Overall, these comments epitomize dogmatism and fanaticism at their worst—blind adherence to a belief system, inability to see beyond a narrow worldview, lack of experience with the messiness and subtleties of real life (or should I say real birth?), a black-and-white perspective in which choices are either absolutely Right or Wrong regardless of context, and gross generalizations.

Now, onto some particulars:

The “medwife” comments
Without having ever met the midwife I am seeing, the poster makes sweeping assumptions about her practice style and philosophy of care, simply because of the initials behind her name. I have worked with and know both direct-entry and nurse-midwives, and I have learned that you cannot assume anything about their style of practice from their educational background. To automatically label any CNM a “medwife” (a term used disparagingly to indicate a midwife who acts more like an OB than a midwife, in other words someone who is very medically/technocratically oriented) is not only insulting to the many CNMs who are very holistically minded, it also functions as a red herring, diverting attention away from important issues. We’re not going to move forward in our effort to improve birth culture and practices if we throw around pejorative terms like these.

For an interesting examination of the ideological conflicts (perceived or real) between DEMs and CNMs, I suggest reading Mainstreaming Midwives: The Politics of Change, edited by Robbie Davis-Floyd. It is true that there is, at times, an ideological divide between DEMs and CNMs. Davis-Floyd includes these two quotes in her introduction:

CNMs think DEMs have copped out, and DEMs think CNMs have sold out.
Joyce Roberts, President of the American College of Nurse-Midwives, 1999

One group needs to tighten up, and the other group needs to lighten up!
Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005

“I was a little disappointed in you for not UCing”
I’m always a bit surprised to hear people tell me this. These comments imply that other birth choices are somehow inferior, less worthy of admiration, or indicative of weakness or lack of principle. If anyone is going to be disappointed in my birth choices, it should be me and me alone. If having an unassisted birth is right for one birth but not for another, then why should anyone be disappointed? Is there some hidden contest I’m supposed to be participating in, some Uber-Alternative-Mama medal I’m supposed to be aiming towards?

Now, this doesn’t mean that I am abandoning unassisted birth in principle or even in practice. To be more precise, my seeing a midwife this pregnancy, or my having an unassisted birth last time, goes no further than myself and my own experiences. I don’t uphold any one path to giving birth as The Only Right Way To Have A Baby. I do believe strongly in undisturbed birth, in supporting and facilitating the physiological and hormonal process whenever possible, and in gentle and empowering births that bring health and healing to mothers and babies. So yes, I do think that our national cesarean rate is atrocious, that far too many mothers and babies come out wounded and shell-shocked from their births, and that we have a lot of changes to make in both hospital and home birth culture. But I don’t for a minute believe that UC is more “pure” than having a midwife, which in turn is supposedly “better” than a birth center, which is of course preferable to a CNM-attended hospital birth. And don’t even mention those awful OBs who just want to slice & dice women, who only care about getting home for dinner…

So let’s please get beyond these trite beliefs and assumptions. I understand why some readers might be curious about why I am seeing a midwife this time, and I am more than happy to enter into a dialogue about that. But I am surprised at the inference that my actions during this pregnancy constitute a betrayal (of what? I’m not sure) or that I am “not staying true to my word.” I never remember making a vow to have unassisted births for the rest of my reproductive life. (Now granted, if I felt it was right for each pregnancy, I would gladly do so!) Did I miss something here?

I will be honest and admit that I do have some trepidations about having a midwife present. I think with any birth choice there are unknowns that can bring worry or doubt. During Zari’s pregnancy, I had moments when I wondered if I was really making the right choice, wanting to be sure my personal preferences weren’t getting in the way of what was best for me and the baby. This time around, as I have mentioned in other blog posts, I have wondered how I will be able to balance my need for privacy and autonomy with my desire to have a midwife present for her emergency skills & knowledge. I don’t know if there’s ever a perfect balance to these sometimes conflicting, sometimes converging, needs. Last time, I knew clearly that I needed to do it alone. This time, I feel more strongly the need for additional options and resources, even as I wonder if or how the midwife's presence might alter my ability to labor. Still, I feel good about continuing along the path I have chosen. A lot depends on what happens as labor unfolds—will I call her early? late? will my birth unfold quickly enough that she arrives after the fact? I don’t know—I can only say that I will be closely following the intuitive and spiritual promptings that guided me strongly and clearly during Zari’s birth. If I do that, then there is no room for doubt.

To conclude this post, I wanted to include a recent comment from another reader, Irene, in the hopes that I have answered her questions and concerns adequately. She has identified the core tensions that I, and many other women, experience between privacy, autonomy, and security. After reading my post about working through some conflicted feelings, she wrote:

Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregnancy and birth are so personal and intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy…

For myself, the only reason I would want a midwife around would be for the afterbirth--in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definitely result in more complications. (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up Pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.

Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife; I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a midwife), I realized just what a tough position you are in. In a way I think you are looking for what we all want—privacy & autonomy, but a midwife would provide the added benefit of security. Ironically, a midwife would also take away some of the privacy and autonomy so really it is such a tough call.

I look forward to reading your birth story.

Read more ...

New midwifery program in Canada

My mother-in-law just sent me a link to this article, Calgary college plans midwifery degree. There will finally be another four-year midwifery degree program in Canada by as early as 2010! This is much-needed, as there are currently only six midwifery education programs in the entire country. In addition, demand for midwives vastly outnumbers supply, so many Canadian women wanting midwifery care are unable to access it. The degree program will be offered through Mount Royal College in Calgary, Alberta.

Canadian midwives are required to obtain a university-level degree in midwifery. In provinces where they are legally recognized, they attend births at the location the woman chooses (home or hospital or, if available, freestanding birth centers). For more information on midwifery in Canada, visit the Canadian Association of Midwives.

Read more ...

Cesarean section and VBAC, again

Here are a few recent articles that are worth reading given recent discussions about VBACs, cesarean sections (elective or otherwise), and the ever-climbing cesarean rate.

The first is an excellent, thorough article in The Poughkeepsie Journal covering the trend to perform cesareans more and more often: Birth by Surgery: The Skyrocketing Cesarean Rate. The author did quite well in covering the salient issues in depth. The article begins with the story of a woman who had an "elective" cesarean for a large baby that turned out to be 2 1/2 lbs lighter than the ultrasound estimate:

Two weeks before Kristi Ashley gave birth to a son in 2007, an ultrasound exam estimated the baby at a hefty 12 pounds, 10 ounces — too big, her doctor believed, for a safe vaginal delivery. After the child weighed in at 9 pounds, 4 ounces in the delivery room, Ashley came to believe that the planned cesarean section she had, with its attendant pain, long recovery and what she called "emotional damage," may have been a rush to judgment.

"It's very hard to go up against your physician, especially at the 12th hour," said Ashley, 38, of Hopewell Junction. "I think doctors are very quick these days to get scared. They would rather opt for the surgical solution."

Determined to avoid another surgical birth and aided by a supportive doctor, hospital and birthing coach, Ashley last month did something that has become increasingly rare for post-cesarean women today: She gave birth vaginally, to another son.

In an era of soaring malpractice premiums, technology that sometimes sets off false alarms, physicians pressed for time and mothers-to-be conflicted by fear, cesarean-section birth is soaring to its highest levels ever. Read the rest of the article here.

The next article by the same author, Modern medicine increasingly intervenes in the birth process, discusses many of the same issues, in addition to the increasing medicalization of childbirth.

In the decade through 2002, something momentous happened to babies in the wombs of American women, especially white women. The average time fetuses spent there decreased from 40 weeks to 39.

The decline, reported in a 2006 study in the medical journal Seminars in Perinatology, appears to have little to do with nature.

Instead, earlier births may be the outcome of “increased use of induction (of labor) and other obstetric interventions such as cesarean delivery,” said a January report by the U.S. Centers for Disease Control. Prematurity rose 20 percent since 1990, the report said, and the rate of low birth-weight babies hit a 40-year high.

“We are shortening the gestational age,” said Dr. Carol Sakala, program director for the research and advocacy group Childbirth Connection. “That is a big interference with mammalian evolution, human evolution.”

Researchers, midwives, birth coaches and mothers point to such data as symptoms of a flawed system of birthing in America, one they say over-manages, over-medicates and over-monitors labor and delivery, often leading to unnecessary cesarean-section births. Read the rest of the article here.

The last article is a glimmer of hope amidst the gloom of our contemporary obstetrical culture. In C-section births fall, one hospital has lowered its cesarean rate (18% last year, usually around 16%). Some of the key practices the hospital has adopted are taking a midwifery approach to childbearing with a focus on facilitating spontaneous, natural births, minimizing the routine use of technology and interventions, and offering and encouraging VBACs.

While more and more women choose to undergo Cesarean section births despite a national push by the federal government to decrease the number, the local rate has declined and is well below the state average.

North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent, according to reports released by the state Department of Public Health.

The hospital also has a better prenatal care record, according to the reports: 94 percent of women giving birth have had nine or more prenatal care visits versus the state average of 87 percent having that many visits.

"I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before," Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. "It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby." Read the rest of the article here.

Read more ...

Wednesday wrap-up

I might start doing a weekly wrap-up of miscellaneous news & articles that I find interesting. If I wait much longer than week, they start piling up rather quickly:

Speaking of upright/vertical birth...

• This midwife-designed stainless steel mirror is designed especially for women adopting upright birthing positions
• Mom's Tinfoil Hat had some thoughts about Standing up for birth

Home birth

• The "Authorities" Resolve Against Home Birth: a recent editorial by Nancy K. Lowe, editor of the Journal of Obstetric, Gynecologic, & Neonatal Nursing ( Volume 38, Issue 1, Pages 1-3). Click on the article title for the full text. An excerpt from her editorial: "The point is that we have no system of maternity care in the United States that provides a healthy woman the choice of giving birth at home and if she needs to transfer to a different type of care during labor, the transfer is easy. We do not have a system in which this woman is treated with respect and kindness, and her provider either maintains responsibility for her care or professionally and respectfully is able to transfer responsibility to another provider. Interestingly, while ACOG and AMA have declared that hospital grounds are the only safe place to give birth in the United States, the National Perinatal Association (NPA) adopted a position paper in July 2008 titled, 'Choice of Birth Setting.' The paper supports a woman's right to home birth services....Further, in Canada following the model of British Columbia, the province of Alberta has recently expanded its health care system to include women's access to midwifery services 'in a variety of locations including hospitals, community birthing centers, or in their homes.' "
• Two Charleston Gazette articles: Midwife delivers babies in mothers' homes and Home delivery: After three hospital births, fourth-time mom was determined to deliver the old-fashioned way
• A Herald Tribune (FL) article narrates how a home birth unfolds in Home Delivery
• An article featuring Womancare Midwives of North Idaho
• Tribute to Maude Callen, a nurse-midwife serving rural South Carolina for over 70 years. Make sure you click on the Life photo archive for lots of fantastic pictures!
  
• Adventures in (Crunchy) Parenting wishes to move beyond binary views of safety
  
• Future Search Conference on Home Birth currently being planned. From the description:
• It will be a multi-disciplinary consensus conference of key stakeholders around the provision of home birth services in the United States, to be convened by the University of California San Francisco and various organizations, including the American College of Obstetrics and Gynecology the American Academy of Pediatrics, the Association of Certified Nurse Midwives, Mothers and Midwives Associated, Lamaze International, Association of Women Hospital Obstetric and Neonatal Nurses, and the International Center for Traditional Childbirth. Further, it is hoped that public health practitioners and students, insurers, government agencies, health economists, medical anthropologists, state and national legislators, and women who have given birth will be among the eventual participants. The purpose of the conference is to start to bridge the "divide" between the medical and midwife communities over out-of-hospital births in the United States. Safety of birth in any setting is of utmost priority. Rights to choice and self-determination and culturally appropriate healing are also core values in American discourse that influence this issue. The purpose of this multidisciplinary conference of key stakeholders will be to craft a consensus policy and strategy on provision of home birth services. The project may also inform regulatory discourse, alternative funding structures, and the required modifications of curricula to prepare physicians and midwives in urban, rural and remote settings to provide maternity services across birth settings.

Research studies & articles

• Evidence-based labor and delivery management. Berghella V, Baxter JK, and Chauhan SP. Am J Obstet Gynecol. 2008 Nov;199(5):441-2. From the abstract: "Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, "hands-on" method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided." (Email me for full text).
  
• Born in the USA: Exceptionalism in Maternity Care Organisation Among High-Income Countries by Edwin van Teijlingen, Sirpa Wrede, Cecilia Benoit, Jane Sandall and Raymond DeVries. Sociological Research Online, Volume 14, Issue 1. From the abstract: "In lay terms, childbirth is regarded as a purely biological event: what is more natural than birth and death? On the other hand, social scientists have long understood that 'natural' events are socially structured. In the case of birth, sociologists have examined the social and cultural shaping of its timing, outcome, and the organization of care throughout the perinatal period. Continuing in this tradition, we examine the peculiar social design of birth in the United States of America, contrasting this design with the ways birth is organised in Europe."
• Postnatal quality of life in women after normal vaginal delivery and caesarean section. Behnaz Torkan, Sousan Parsay, Minoor Lamyian, Anoshirvan Kazemnejad, and Ali Montazeri. BMC Pregnancy Childbirth 2009; 9: 4. From the conclusion: "Although the study did not show a clear cut benefit in favor of either methods of delivery that are normal vaginal delivery or caesarean section, the findings suggest that normal vaginal delivery might lead to a better quality of life especially resulting in a superior physical health. Indeed in the absence of medical indications normal vaginal delivery might be better to be considered as the first priority in term pregnancy." (full text available by clicking on article title).
• Health Care Reform in the U.S. Organisation for Economic Co-operation and Development Working Paper #665, Feb. 6. 2009 by David Carey, Bradley Herring and Patrick Lenain. From the abstract: "In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance." Full text PDF available by clicking on the article title.

VBAC & Cesarean Section

• List of abstracts on VBACs with twin gestations
• Some NHS trusts will no longer offer primary elective cesareans because of cost and safety issues. Read more in Caesarean births rationed by hospitals in order to cut costs
• A midwife-led initiative in Southampton has lowered cesarean rates and boosted VBAC rates

Birth Centers
For Expectant Moms, a Happy Medium Between Hospital and Home Births: profiles the struggles of one birth center to obtain permission to open

Breastfeeding
Pedialyte Alternative recipe (not necessary for breastfeeding babies, but great for older children & adults)

Gardening
25 plants you should consider growing

Read more ...

Midwifery model of care

I enjoyed Jill's recent post about her thoughts on the midwifery model of care. She contrasts her two very different birth experiences and the types of care she received. I especially agree with her take on birth plans:

I'll never sit back and put 100% of my trust in any physician ever again. Even with my home midwives, the majority of the learning, research, and general work I did was fueled by my own desire, not by what they told me to do. It is so incredibly important for women to educate themselves on what's going on with their bodies, especially if they are using a model of care that doesn't take a personalized approach.

It's been said that if you need a birth plan to tell your provider what you want, then you've got the wrong provider. I think this is very true. I didn't even need to think about writing a birth plan with my home midwives, because not only had we already discussed in depth what I wanted and expected during labor, but it was assumed that, barring any medical necessity or danger, I would be getting what I wanted anyway.

She saw midwives for both of her pregnancies, so it's not simply the provider's initials or location that determines the quality of care a woman will receive.

I also wanted to urge any of you living in Virginia to contact your local representatives about some restrictive midwifery legislation recently introduced to the House of Representatives. Jill has more about it on her blog.

Read more ...