Formative words

I've been thinking a lot recently about my paradigm of childbirth and how I got from point A (assuming I'd birth in a hospital with an OB and epidural) to point B (giving birth at home unassisted). Several things I've read, in particular, stand out in my mind. They made me uncomfortable. They challenged assumptions I had held about birth. I ready many of these after I thought I had already been converted and was done paradigm shifting!

1) Peggy Vincent's Baby Catcher. This book changed me from thinking "I would definitely want to give birth in a hospital. Maybe with a nurse midwife--that sounds nice" to "Of course I will give birth at home!" Peggy Vincent is a fantastic story teller, and I still crack up in parts even though I've read it oh, at least 6 or 7 times. She is more interventive than I would personally feel comfortable with, something I have noticed more after exposure to unassisted birth and to midwives advocating unhindered births.

2) This birth story: The Birth of Grey Forest Walt, and the mother's subsequent processing of that birth and her decision to have her next baby unassisted: The Birth of Samuel Rune. (Both stories are quite long, but really you need to read the whole deal in order to "get it.")

3) Midwife Jeannine Parvati Baker's words. The first two paragraphs are from her book Prenatal Yoga & Natural Childbirth. The last two paragraphs are from an article called Shamanic Midwifery: Hands That Heal Birth.

Actually I trust doctors more now for being so obvious about their beliefs. With midwives you never know if they will turn medical on you during a birthing. Unfortunately, almost all midwives will rely on medical technique in an emergency. That is, midwives who have such training. And those midwives with state license are the most dangerous as they are bound legally to respond in crisis in a medical way. There are very few midwives I know---and I know a lot of them having "un-trained" many through Hygieia College and touring the country speaking to birth audiences--whom I would trust to act harmlessly during a birth crisis. (64)

~~~

Halley [her sixth baby] was born without a midwife or doctor in attendance and no other adults for support. If birth is a natural expression of sexuality, why hire a paid paranoid "just in case?" In the words of Artemis, "Birth is as safe as life gets." We have now experienced the fullest expression of our sexuality and spirituality at once in freebirth and realize that if we needed no one present at the conception, we need no one present at the outcome of that loving ceremony, the birth. From this experience I deepened the vision received at Quinn's birth--this is possible for all families. Free birth and we free our selves from primal fear, from blaming others, from the cult of experts who from that point on attempt to take responsibility for our children's lives. The original lovers are most able to respond to our co-creation if we are present, without distracting fears and assessments from those who have been trained beyond their natural intelligence to just witness the ordinary miracle called birth. (85)

~~~

My community made me a midwife by asking me to attend births. Rather than getting trained by an institution, and learning a medical set of rituals to take women through birth, I apprenticed directly to birth itself. My promise as spiritual midwife is to honor the journey, be attentive to what presents itself, and remind a mother by my presence that she already knows how to give birth. I trust that if a woman consciously conceives her baby without the help of experts, she is able to give birth unassisted by the medical experts....In over a generation of attending births, every woman I have midwifed has given spontaneous birth.

Once I was called to a birth and forgot to bring my birthing kit. Then I realized that I am my midwifery kit--I had my ears through which I could hear the baby's heart, I had my hands through which I could feel the baby, and I had my heart--which loves the baby earthside.

4) This article by Gloria Lemay called "Interventions." Not the typical Big Guns that we natural birth people love to denounce: epidurals, Cesareans, inductions, EFM. Nope, in this article Gloria talks about the interventions that well-meaning midwives do, without even realizing how they are affecting the birth process. One of the most shocking and unsettling paragraphs at the time for me was where she discussed A Clear Road to Birth.

I will end this post with a long excerpt from her article, which appears in Midwifery Today (22 September 2002).

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"The first intervention in natural childbirth is the one that a healthy woman does herself when she walks out the front door of her own home in labor."

Michael Rosenthal, OB/GYN

This quote is an attention grabber and one that should set us all to thinking. We know about the "cascade of interventions" that sends most North American births down a tunnel of medical mishaps strip membranes, Pitocin gel induction, continuous fetal heart monitoring, pain medications, distress in the infant, cesarean, post-surgical infection, breastfeeding problems, postpartum depression, etc., etc., etc. Iatrogenic meddlesomeness at its most blatant is easy to spot and condemn. We like to shake our heads, point our fingers and tut-tut-tut about this type of intervention. 

But what of the interventions that we don't see, the ones we are guilty of ourselves? The Oxford dictionary defines intervene: "to interfere, modify course or result of events." Something that seems as small as turning on a light could be classified as "an intervention." Is it an intervention to wear perfume to a birth? To monitor the heartbeat of the baby every half-hour? To leave a clock within the mother's view? To watch the mother? To speak to the mother? To ask her to take a walk outside? To tell her husband to get in the water tub with her? Do midwives take any time at all to ask themselves these questions? 

What would "the course of events" be like if we weren't there? How could we possibly know? Recently I came into possession of an amazing video. This video is the raw home movie footage of the births that are shown in the unassisted birth film A Clear Road to Birth. There is no attendant present at the births. The families have, for the most part, just put the video camera on a tripod and let it run. The result is an amazing view into a place that I have never been privileged to enter--a birth that follows the natural course of events. I found it difficult to watch because it is so very intimate, and I wasn't sure that they'd want me to ogle their beautiful, private family moments. It is a sacred film. I came away from it with questions about how my presence at a birth affects the behavior of all the participants. The women on this film are not asking, "How much longer will it be?" They are not saying, "I can't do it anymore." There is no illusion or possibility of some other woman "saving" them. They are going to do it themselves, and they seem to have an inner core of resolve about it. Their husbands and children mostly seem "surprised" that the baby is really there. This is unlike births where there is an "expert" present, and the waiting and watching seem to go on forever. 

This film of unattended births leads me to question, "What about women who have unassisted prenatal care?" We are told that prenatal care is essential. We believe it is a cornerstone of good maternal/natal health. But is this true? Are there interventions that take place in childbirth classes that are subtle and affect the course of events? If we think of the spoken word as "an intervention," we must wonder if we are causing changes in the course of the birth long before the membranes release. I cringe at some of the "meddlesome midwifery messages" that women are given at prenatal checkups. Messages can be imparted both verbally and nonverbally. I remember when I took prenatal classes 25 years ago, the nurse managed to impart the message that she didn't approve of breastfeeding with just the look on her face when she said, "How many of you are planning to breastfeed?" Her attitude changed the course of events for a lot of the women in that class. It was absolutely an intervention. 

I have learned a lot about how to question my own interference in birth from listening to Michel Odent. His message is repeated over and over: "The most important thing is do not disturb the birthing mother." What does a nice midwife do that would disturb? Several years ago, I went to a birth as assistant to the midwife. I was assigned to take a video of the birth and so I familiarized myself with the family's camera and began to do a little filming of the mother while she was in the water tub. I was getting some nice footage when, all of a sudden, the room went completely black, and I couldn't get an image in the camera. I looked up to see what had happened: the brother-in-law of the birthing mother had turned out the lights. I went over and turned them back on so I could get on with filming and, presently, the man came back and turned them out again! I was very annoyed and, in that moment, I realized that he was right! He was more in tune with what his sister-in-law needed than I was. Birth seems to flow best for human beings in the same conditions as most other mammals. Darkness, familiar smells, privacy and quiet are the main ingredients for a smooth birth. Who in North America can give these simple things to a birthing mother? Are we willing to trade monitoring and charting for births that truly flow along smoothly? Are we willing to sit, out of view of the woman, completely still while she focuses inward and makes her own journey to meeting her child? Can we forgo the acknowledgement and appreciation for all we "do" and be deeply satisfied with "being" unobtrusive? 

... I believe that the "3 Ps" of obstetrics should be "patience, patience, patience" and not "passage, passenger and powers." I am fond of the Buddhist words from The Tao of Leadership:

Being a Midwife

Remember that you are facilitating another person's process. It is not your process. Do not intrude. Do not control. Do not force your own needs and insights into the foreground. If you do not trust a person's process, that person will not trust you. Imagine that you are a midwife; you are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: "We did it ourselves!"

--The Tao of Leadership by John Heider

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Dr. John Stevenson

At the upcoming Trust Birth Conference next March, one of the speakers will be Dr. John Stevenson, an Australian family doctor who has attended many home births. He describes his style of practice here: Lessons from a Homebirth Practice. I am very excited to meet him. Carla Hartley, founder and director of the Ancient Arts Midwifery Institute, is currently collecting his wisdom from the births he has attended. I will definitely buy the book once it is out!

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The best dissertation aid ever...

...pickles!

I haven't started Zari on solids yet (unless you count all the bits of lint and dirt she picks up off the floor). Today, though, I wanted to see what she'd do if I gave her some food. So I pulled out a refrigerator pickle--sliced cucumbers marinated in water, vinegar, sugar, salt & pepper--and she went crazy over it. When it first made contact with her tongue, she pulled a face. But then she kept at it for about 10 minutes! Now the cucumber slice is a soggy mess, but it kept her busy for several minutes while I typed.

I understand why parents carry around little baggies of Cheerios. Can anyone say distraction technique?

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A Hospital Birth with Dr. Biter

Here is a vision of how hospital birth could be. I don't know if I feel encouraged or discouraged about this birth--encouraged that such a respectful, patient OB exists, or discouraged that this kind of birth doesn't happen more often in hospitals. I love the pictures of mom laboring on her hands & knees in the middle of all of the technology, and the doctor in a plain old t-shirt looking every bit as casual as the dad.

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Going to Arizona!

Zari and I are going to Arizona in a few weeks to visit a good friend and to attend a short birth conference. I've never been to the Southwest before, so I am sure it will be an adventure. I anticipate lots of fun in the swimming pool and late-night conversations while we nurse our babies. Well, maybe until 10 pm, because that's about as late as I can keep myself awake these days!

Also in the works is a Quadruple B get-together (Birth & Babies Bed & Breakfast) that I will be hosting at our B&B this fall. Once I've decided on the date, I will post details here and perhaps some of my IRL and virtual friends would like to come visit for a long weekend. Hint hint...start saving your pennies now! Free accommodations at my Arts & Crafts B&B, of course! We'll have lots of nurslings, lots of girl talk, and of course lots of good birth stories to pass around.

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The New Normal

Just out: an article about the medicalization of childbirth in Canada. It's called "The New Normal", written by Elizabeth Payne in The Ottawa Citizen.

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DIY Portland: Home Birth

Another radio program about home birth, including a discussion with a CPM about her views on unassisted birth. I've typed out the segment concerning UC below (since I need the transcripts for my dissertation).

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Host: Julie Sabatier
Guest: Susan Maray (spelling?), CPM and press liaison for MANA (Midwives Alliance of North America)

Julie: I’m curious if you ever consult with women who want to give birth without any assistant.

Susan: I have got those calls. There’s a movement called unassisted birth, and there are women who are having their babies without a midwife and with their partners. And if they have other children, with those children. I’m sure the numbers are very, very small. There are very few women who are looking for that kind of an experience. From my reading of it, it looks like some of those people believe that birth should be a very exclusively family-centered experience. Some of those women, from what I can tell, came to that decision out of really bad former experiences. I imagine some of those were hospital births and maybe some were home births. Having a midwife that didn’t meet their needs or having doctors that didn’t meet their needs, and they’ve decided to do an unassisted birth. I imagine some are having unassisted births because they can’t afford to pay for their birth, and that’s a frightening and horrible thing.

Julie: That sounds like a very scary prospect, I guess, but it’s not something you want to discourage people from doing if they’re very determined to do it. What kind of advice to you give when people say to you, “I want to do it myself”?

Susan: I rarely get consulted on the subject. The only time I’ve ever been consulted was when somebody called and said, “I’m planning this. If I needed a midwife, would you be willing to come?” And I wasn’t. What she was saying was, if there’s a problem, would you come. And I’m not really interested in cleaning up somebody else’s problem. My job, in my opinion, is to prevent a problem from occurring if I can and then deal with it if it’s something I couldn’t prevent. So I wouldn’t advise somebody not to have an unassisted birth if that’s what they were committed to doing. I think I would take the same approach I take with my own clients, which is educate yourself, make informed choices, and take responsibility for your choices.

Julie: Are there any advantages as you see them to doing an unassisted birth?

Susan: In line with my thinking that if it’s empowering to have a natural birth at home with a midwife, I would imagine it’s even more empowering to have one without a midwife. If you have a birth that goes beautifully and you know you fully did it without anybody needing to be there, that would be a pretty life-altering experience. In preparation for this twin birth, I just watched a video of a woman giving birth to twins unassisted. Twins, unassisted--that’s amazing. The second one was a breech, which she didn’t know. There were a few swear words as she discovered that the second one was a breech, but she just calmly birthed her babies, catching her own babies, and her husband was shooting the video of it. I just thought it was amazing how confident she was and how happy she was. Yeah, I think that’s one of the big advantages of it.

Julie: That’s pretty amazing.

Susan: Yeah.

Julie: Thank you so much for talking to me...

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BBC interview about freebirth

This interview on freebirth just came out on the BBC. The show's host first interviews James and Julia Wilson, who had a midwife-attended home birth with their first baby, and an unassisted birth with their second. The next part of the program features Dr. Sarah Buckley and Sue McDonald from the Royal College of Midwives.

Here's the transcript of the interview, typed out painstakingly by yours truly:

~ ~ ~ ~ ~

Announcer: Those who want to give birth at home had a bit of a boost earlier last year, when the government promised that every woman who wants it will be able to have a midwife-assisted home birth by 2009. But there’s a growing movement of what are known as freebirthers. They’re women who decide to give birth at home without any medical assistance. Kathy Caton talked to Julia Wilson. Julia gave birth to her first child at home with a midwife, but decided with her second to go it alone. What gave her the confidence to go ahead?

Julia: I read quite a bit about what happens in the process of giving birth, so I felt quite confident in myself to be able to handle the situation. Whereas if you leave it up to the midwife and do your birthing experience with the midwife present, she’ll take over and do all the medical side. But I think it can be done by the woman herself. I also spoke to other mothers--not that other mothers could give me much positive feedback. Most birth stories I hear are horror stories, which is very sad.

Kathy: And why did you choose freebirth?

Julia: I had a successful first home birth and that was one of the major reasons. I thought, “well if I’ve done it once at home with a midwife present, then I can definitely do it again. I also dislike hospitals. I’m visually impaired so I like to know my surroundings well. Hospitals also make me feel like a victim. When I go in, I’m automatically the patient, I’m in pain, and I’m suffering some medical problem--which birth isn’t.

James: I’m James. I’m Julia’s husband.

Kathy: We’ve been hearing about the whole freebirthing experience. What were your thoughts on it?

James: I was quite happy with it really. Due to Julia’s visual impairment, anything that made her more comfortable with birth is good for me. Obviously, we’re not really extreme on the side of freebirth. The hospital is right next to the house. If there was a disaster we could always go in.

Kathy: Comparing your first and second birthing experiences, why were you unhappy with how the first birth had gone with the midwife?

Julia: I wasn’t unhappy. I had a lovely birthing experience the first time. But I felt although she was a lovely woman, she was still a stranger in my house. To be doing something so intimate as giving birth--for me--I wanted to have people that I have no inhibitions about. And I did have [them]. It’s only now, looking back, after two births and only having James present the second time, how inhibited I felt the first time.

Kathy: What was your role? What were you doing?

James: I was just present, I think. Holding Julia’s hand and trying not to answer the phone because other people were phoning us. Then after the baby was born, Julia lay back a bit and I got passed the baby, and I gave her a bath.

Kathy: It has been said that freebirthing is irresponsible.

Julia: Well I think that’s quite patronizing to women because they can make that choice themselves. Is it irresponsible? Have I checked that I’m physically healthy? Have I been to the midwife and checked that my pregnancy is going well? If I’ve done these things, then it’s not an irresponsible thing to do.

Kathy: Julia and James Wilson.

So how good an idea is it to go into labor with no medical support? Sue MacDonald is from the Royal College of Midwives. Dr. Sarah Buckley is an Australian GP and the author of Gentle Birth, Gentle Mothering. Sarah, why did you choose a freebirth for your fourth child?

Sarah: Well I’d had three very positive experiences of home birth previously. I’d had a midwife and a GP there. With this baby, my fourth baby, I wanted a different experience. I felt especially a little bit like Julia was saying, that there was some distraction, really, from having other people around. My third labor was actually 11 hours long. There were a lot of people there. I really wanted something that was more intimate, and I felt that labor would flow more easily if that happened. That certainly was the case. I actually had a 1 ½ hour labor with my fourth baby, and we had a bit of a surprise at the end. I think it flowed really because...

Kathy: What was your surprise at the end?

Sarah: She actually came out unexpectedly breech.

Kathy: One might have thought that you would have wanted some medical expertise. Now I know you’re a doctor. But for a breech baby to come out, surely having a doctor there would have been helpful.

Sarah: Well as I said I’m a doctor myself. My partner’s also a doctor. I think what happened at that moment was my instinct kicked in, and I did the thing that was totally appropriate. Now I’m certainly not advocating--actually I don’t advocate freebirth for anyone; I think it’s a really personal decision, and I wouldn’t advocate freebirth in that situation for other people either. But if I compare what might have happened if I’d had a more medicalized form of care, it would have been very difficult at that time, in the year 2000, to avoid a cesarean. It was the peak of the cesarean epidemic, if you like, for breech babies. So if I compare what happened for me with that baby with that possibility of a highly medicalized outcome, I think overall I made a very good choice. I think that the outcome for my daughter and for me and for my whole family was really enhanced because we made a very, you could say, extremely low technology choice.

Kathy: Sue, we’re getting the feeling that even a midwife present at a birth is an intrusion. Can you accept that?

Sue: Well, not totally because I think midwives are really very important to women, and you need to see them as a guide and support for the whole experience. But what Julia’s and Sarah’s stories both illustrate is the importance of, first of all, the midwife being able to get a relationship with the woman and work out together, as partners, what the woman wants for that pregnancy, for that labor and that early parenthood. It’s that sort of interaction and discussion that needs to take place in order for the woman to really get the experience she wants so that she doesn’t feel it’s an intrusion.

Kathy: What would you say a midwife crucially adds? We’ve heard from two women who’ve successfully done it on their own. Okay, one of them is a doctor and had a breech, but it was successful.

Sue: I think it’s about relationship, and I think it’s about guiding and supporting women through the experience. Obviously, both Julia and Sarah have done a lot of work and a lot of reading in preparing themselves, and that can be supported by midwives. And midwives don’t have to--and usually don’t--take over the whole business. They’re there as support and advice. And educating women rather than pushing in and taking over the whole experience.

Kathy: Sarah, it’s difficult to be confident, isn’t it, that a woman knows her own body well enough to know when something is wrong. They don’t all have your medical training.

Sarah: No, that’s right. Can I just comment on what Sue said? It concerns having other people around. One of my understandings around this is scientific. I think if we look at the hormonal physiology of labor, which I do in a lot of detail in my book, we can see that having strangers around or the woman feeling uncomfortable in labor, actually raises the levels of her hormones of fight-or-flight: adrenaline and noradrenaline. They actually physiologically slow labor down. Not only that, they can divert blood away from the uterus and baby to the major muscle groups, because they’re there for fight-or-flight. They’ve evolved through millions of years of evolution to help women to have a safe labor and birth. The trouble is, with a lot of people around--and I know some midwives can have a very low-key presence--but just that presence of strangers as Julia describes it can activate that fight-or-flight reflex. So I’d say that it’s very important for women to feel totally comfortable and totally relaxed and, as I say, private and safe and largely unobserved in their labor. That’s actually quite a difficult environment to set up even for the best midwife. Midwives are my heroes. I wouldn’t say anything against them, but it is quite a difficult situation. Especially with the regulations; the midwife is largely there to observe the woman and make recordings. That’s part of her job to do that. So it’s a difficult role.

Kathy: Sue, can you see that? Mammals are sort of designed to go and crawl off into a quite place completely alone for their bodies to react completely naturally. Could that be the case with the human woman?

Sue: It’s absolutely so. There’s been quite a lot of research into this whole area. Indeed, the whole move towards home births and midwifery-led birth centers actually supports that. I absolutely agree with Sarah, because it is very important that you have that private feel. But you don’t need to have a lot of intervention and interference, because the midwife is there to monitor the labor and the wellbeing of the mother and baby, but she doesn’t have to be intrusive. Really, all that she’s saying is very similar, I think, to what I’m saying. About getting models of care that are truly woman-friendly and really finding out what is right for that woman, that baby, and that family.

Kathy: Sarah, on the websites of which there are several, there’s trading of information about freebirth, like how to figure out if the baby is breech. How dangerous is it for women simply to be exchanging information like that?

Sarah: I think when you choose to have this type of birth, what you’re taking on is a large responsibility and with that comes the responsibility to up-skill yourself as much as possible. This is one way that women can up-skill themselves. There are other ways; Julia talked about reading lots of books. There is information available out there. I think that women who choose this take a high level of responsibility, and it’s not just that they’re up-skilling themselves. It’s also in terms of arranging backups, arranging a flexible situation where they have access to advice, for example. Women may have someone they can ring up during labor. They may even have someone present there who has skills. Unassisted birth doesn’t necessarily mean it’s just the woman there. She may have a group of friends there, and that’s still a freebirth if none of them are actually the professional involved.

Kathy: Sue, how do you react to those kind of websites and that sort of exchange of information?

Sue: I think women always have exchanged information abut pregnant and birth, and that’s important for them to be able to have that experience. But on the other hand, there’s quite a lot of information that may be frightening or women may not fully understand. So I think having someone to support them, I think having some medical or midwifery knowledge is very helpful, even if it’s your own previous experience, because it can help you understand some of the terms and the reasons why particular things were done.

Kathy: Sarah, there are women in the developing world who are crying out for medical assistance during their birth. Doesn’t it seem bonkers for privileged Western women to be taking what looks like a setback?

Sarah: Hmm, that’s a good question. I think we’ve really also got to look at the nutritional status and the hygiene available to women giving birth, because I think that’s actually very different for women in Western cultures choosing freebirth than for women in developing countries. Because of their nutritional status, largely, those women are at high risk of complications and I think they do need midwives. If we look at healthy Western women, you could say that the need is low and the chance of complication is low because we are so healthy and well-nourished generally.

Kathy: Dr. Sarah Buckley and Sue McDonald. Thank you both indeed for being with us this morning. If you have a view on this subject, please let us know. Would you consider giving birth alone, or do you think it’s misguided?

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Home Sweet Home

We're visiting my parents for the week. Here's a picture of their first house. They lived in it the summer they got married on government land in Logan Canyon. They cut the poles themselves (of course!). We usually put the tipi out every summer when we were growing up. One of my favorite tipi memories is watching the complete BBC Pride & Prejudice inside the tipi with my friends--thanks to a very long extension cord.

Bath time with the cousins.

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Modern Childbirth: Failure to Progress

Here's a recent book review called "Modern Childbirth: Failure to Progress" by Sarah Blustain. She discusses 3 new books about the culture of childbirth in America. I've read Dr. Wagner's book and am eager to read the other two.

Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block. New York: Da Capo Press, 2007, 400 pp., $26.00, hardcover

Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner. Berkeley: University of California Press, 2006, 305 pp., $24.95, hardcover

Birth: The Surprising History of How We Are Born by Tina Cassidy. New York: Atlantic Monthly Press, 2006, 320 pp., $24.00, hardcover

Reviewed by Sarah Blustain

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Grazia article

For my North American readers, here's the Grazia article I was interviewed for (Issue 120, June 18, 2007). Although it's in first person, I didn't actually write the article myself. I just gave it a final thumbs-up once Miranda Levy had put it together. It was based on long phone conversations, emails, and blog posts. Of course it only skims the surface of my pregnancy and birth experience, as well as why I made this choice. I think she did an excellent job, however, in summarizing the essentials. I also love the British-isms! ("sitting on the loo" for example).

I have also included the letter page from the following issue, which features two very different responses to the article. Grazia also forwarded me all of the readers' letters they received. They ranged from supportive to neutral to vitriolic. Maybe I'll post choice quotes when I have the time...

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Another marathon analogy

I just read the newest issue of the International Doula (Vol 15, Issue 2) and it had an article comparing laboring to marathon running, complete with a tongue-in-cheek description of race guidelines, including:

• Time limit on the race: if you don't run fast enough, you'll be driven directly to the finish line
• Mandatory IV for all runners; absolutely no eating and drinking
• Pain medications strongly encouraged, beds provided all along the race to rest because the meds make you sleepy (but you still have to keep up the minimum pace!)
• "Synthetic energy" if you're not running fast enough

Paula Holland. "Birth--The 'Marathon' of Life." International Doula 15.2 (2007): 14-17.

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Home at last

We got in late last night, but Air France lost all of our luggage except the car seat. So we are home, but don't any clothes or diapers or extra shoes. Our suitcases are still in Paris and might arrive tonight. We had an adventure at the Paris airport: somebody had abandoned a bag, and the French police/military/bomb squad all arrived and cordoned off a big section of the terminal and exploded the bag. It was the loudest noise I have ever heard in my life. I think that's why our bags were delayed, because by time the bomb squad was finished blowing up stuff, we were quite late checking in.

We were in Paris for the end of the Tour de France, so we went to see the race on the Champs-Elysees. We didn't know exactly when the cyclists would be passing by, and we ended up getting there a bit early. About an hour or two before the bikes arrive, there's a huge parade of vehicles (race sponsors mostly) of all sizes and shapes. Cars shaped like tires, water bottles, sausages...it's pretty fun. Semi trucks decorated with the sponsors' logos weave down the street from side to side blasting their horns. Lots of music and people talking on loudspeakers. We all were pretty tired after 2 hours of waiting, so we went back to the hotel before the cyclists ever showed up. Frankly the pre-race stuff is more exciting anyway.

At the top of the Champs-Elysees, with the Arc de Triomphe in the background.

Zari enjoying the festivities.
Somehow she managed to fall asleep despite all the noise.
A few more pictures of our last days in France:

At church in the Marais (Jewish quarter), about a half block from the Pompidou center.

And finally, the obligatory visit to the Eiffel Tower:

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Ode to Cheap

Our students have returned home, and we are on our own for a few days before we fly home on Tuesday. We drove up to Paris and found a very cheap, very sketchy hotel for 31 Euros a night, which is amazing for Paris. It’s near the Tour Montparnasse on a calm residential neighborhood, and close to about 4 different metro stops.

This hotel is so sketchy it’s hard to describe. For starters, hotels in France are rated on a star system, from one to five. This hotel has zero stars. The stairs are uneven and slope sideways, so when you are going up or down you feel like you’re in a funhouse. Our room is quite small, and the bed is at best a full size. I can feel the springs on the mattress when I lie down. It’s a bit too cozy for three people so we made a soft bed on the floor for Zari out of extra blankets. I pick her up to nurse and lay her back down when she’s done.

The sink in our room is starting to come off the wall, and in a last-ditch effort to disguise that fact, the hotel owners put a lot of caulk in the gap. The caulk, of course, is completely gray with mold. I don’t think the floors have been mopped since the hotel opened. I think I saw a cockroach (dead) on the floor too. There is of course no television in the room, but we do have a bidet!

The toilet and shower are down the hall. Or rather, down the hall and down the stairs, since there is only one working shower in the entire hotel. One of the others no longer has a shower hose or curtain. The one on our floor has plastic tape across the door to prevent entry. More often than not there is no toilet paper in the WC. Back to the shower room: the ceiling is totally gray with mold, and it’s falling down in places. The light fixture is broken and now has just a bare bulb in the middle. The shower is tucked inside a small alcove. An odor of mold predominates, probably because there is no ventilation. (There is a small window, but it’s broken.) Mold is growing in all of the caulk and grout. The room’s door is peeling and starting to delaminate.

I love cheap. This hotel would probably horrify our students, who are used to a certain level of comfort and luxury. We don’t mind, because after all a hotel is just a place to sleep at night. What’s the point of paying an extra 20 or 50 or 200 Euros just for a fancier toilet or shower? When you’ve grown up camping—and I mean real camping, the kind where you have to boil your water from a stream and dig latrines—staying in any hotel is a luxury.

I will, however, not complain at all when I get back to our 1900 Arts & Crafts house with its king size bed and washing machine (it’s been 2 months since we’ve had one and that’s with cloth diapers) and handmade wool rugs and leather furniture.

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Loire Valley pictures

We took our students to the Loire Valley this weekend. You're seeing the chateau Chenonceau in the background.

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Chateau and ropes course

I have more pictures coming, but in the meantime here are a few from last week:

The Kangaroo: Eric helped a group of students do a ropes course while I played with Zari. It was located right on the beach and the weather was cool and windy. She was pretty cold by the end of the afternoon, so he snuggled her up inside his shirt.

Chateau de la Roche-Courbon: Last weekend's excursion was to a privately owned chateau about 45 minutes away. A family still lives in the chateau and opens it up to visitors. Zari particularly liked watching the swans and ducks.

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Labor and marathons

Disclaimer: In case anyone feels inclined to post a huffy comment about how childbirth and marathon running are NOT the same in every respect, please read this. Of course they are not identical. Of course the analogy breaks down at a certain point. I think the biggest difference between birth and marathons is that birth is something within every woman's capability, while marathon running is admittedly an extreme endurance sport.

I’ve often wondered why we don’t approach pregnancy, labor, and birth like we do marathon running. Pregnant women encounter so much negativity and fear: your baby might be too big or too small. You might develop toxemia. You are gaining too much or too little weight. You might hemorrhage and die. Your pelvis might be too small. Your baby’s head might become trapped. Your baby might go into distress. You probably won’t be able to handle the pain so you should consider an epidural. You don’t get a medal for having an unmedicated birth. All that matters is a healthy baby anyway.

What if we were as pessimistic about marathon running as we are about childbirth? Here’s my imagined scenario for a hopeful marathon runner, Ann:

Ann was in reasonably good shape and could run several miles, although at a fairly slow pace. She ran cross-country in high school and enjoyed it, even though she was usually one of the last to finish. She was inspired by several friends who had recently run marathons and decided she’d prepare for one.

Ann started researching how to run a successful marathon. She wanted to find training schedules, nutritional requirements for runners, and advice on good running shoes. She went to her local public library, which had a shelf of books that focused on the risks of marathons. Most discussed in great detail the various injuries common to marathon runners and only included short segments about success stories. They warned that although marathons can be empowering, most people cannot successfully train for or complete them. The books also emphasized the tremendous amount of pain that marathon runners experience. Ann knew that certain injuries were possible and although she appreciated the information, she preferred to have more information about how to prevent the injuries in the first place through proper training, stretching, and nutrition. She also wanted to read books that motivated her and assumed success rather than failure.

She knew that there must be more useful information out there, so she pulled up a chair to the library’s computer. She waded through pages of results, but she finally stumbled upon a small but vocal community of marathon runners who had successfully completed the race and who raved about the experience. Their stories were generally ones of triumph, confidence, and exhilaration. They talked about the hours of mental and physical preparation, the extensive research they did into ensuring they were in top physical condition, and the ways to prevent common injuries such as shin splints or knee problems. They supported each other when a runner didn’t reach her desired time, or when physical problems forced her to drop out of the race. They cheered each other on as race day grew nearer.

Ann posted her training schedule around the house so she would see it every day. She decided to maintain a positive outlook, knowing that top athletes considered mental preparation as important as their physical training. She dedicated time every day to meditation and visualization. She imagined what it would feel like to line up, waiting for the gun to signal the beginning of the race. She visualized her heart beating strongly, her blood supplying oxygen to her muscles, her breath even and steady. She repeated positive affirmations to herself, such as “It will be exciting and hard at times but I know I can do it.”

A few weeks later, Ann’s training was going well. She had missed a few days, but usually accomplished her daily goals. While the running itself was sometimes tedious and uncomfortable, she loved how she felt afterwards. Ann mentioned to a friend that she was training for a marathon and was surprised when her friend told several horror stories of marathon runners who suffered lifelong injuries—even one about a runner who drank so much water that he died during the race. Ann replied that she had carefully researched both common and rare injuries and that she was sure that she could either prevent them, treat them herself, or seek help if something serious arose. Her friend said, “But how can you be sure? You might die of a heart attack while you are running—you’d have no way to know it’s going to happen until it is too late. It’s just not worth the risk.”

Ann’s family thought she was crazy. Shouldn’t she be doing something more useful with her time? What if something went wrong? What if during the race she is in too much pain and can’t finish—then how would she feel? Anne told her family that she had done her research and that it was an important goal. She asked that they either speak positively about her upcoming race, or that they refrain from saying anything at all.

Ann noticed that the media always focused on the sensational stories of marathon running turned ugly. When TV crews covered races, they showed runners limping along, looking like death warmed over. They usually interviewed runners who had to drop out, giving them several minutes to tell their stories. Then, almost as an afterthought, they would give 30 seconds to a successful runner who looked exhilarated, if a bit tired and sweaty. Of course, after that runner was done speaking, the TV host would remind the audience that most people cannot complete marathons and that it was best not to get your hopes up. Good grief, Ann thought. I know plenty of people who have completed the race without dying or breaking a leg or permanently injuring themselves.

Somehow—maybe it was when she ordered a few pairs of her favorite running shoes—marathon support companies got hold of Ann’s address. Almost every day her mailbox had a new glossy ad for “pain-free, effortless marathons.” One company’s slogan was: We do all the work—you just come along for the ridetm. Inside the brochure, Ann learned that:

Marathons are a lot of work. The pain is excruciating. The risks of running so many miles are numerous. Why suffer when you can do it the Pain-Fretm way? For only 12 monthly installments of $199 each, you can finish your marathon in comfort and style in our patented Pain-Fre(tm) motorized vehicle. Our chauffeur will personally pick you up as soon as you feel too much pain. Once you are settled in your EZE-Ridetm seat, you will enjoy the view in comfort and luxury as you are driven to the finish line. You will receive a complimentary photo of you crossing the finish line on foot. Beverages not included. Runners will be assessed a $10/mile fee for any miles they run themselves. The fee is waived if you take the EZE-Ridetm in the first 5 miles. Due to liability concerns, rides are not available the first 4 miles or after mile 23.

Ann stacked these fliers beside her fireplace. After her long runs on Saturday, she’d run a hot bath, start a fire, and toss the fliers into the flames, watching the edges curl and twist. She imagined all of her fears melting away with those glossy advertisements.

Ann’s training continued. She enjoyed her changing body—seeing her leg muscles become more toned, noticing the articulations of each muscle group. Preparing for the race also gave Ann a heightened appreciation for good, nutritious food. Her body craved proteins, fresh fruits and vegetables, and complex carbohydrates. She ate sweets every once in a while but no longer enjoyed them.

Several months into her training, Ann heard of a disturbing new trend in marathon running: elective bone breaking or EBB. She knew that stress fractures were a common injury among runners, not to mention the rare but drastic broken bones from accidental falls. Apparently some people were advocating a new “preventive treatment,” which consisted of wearing bone fracture monitors while running. The monitors were touted for being able to predict bone fractures. Using information from the monitors, surgeons could then carefully finish breaking the bone (to ensure a clean, even break) and repair it in a controlled setting. The monitors were quite heavy and occasionally caused runners to fall and suffer extensive injuries. However, they were the hot new thing in running, touted as “every runner’s safety net.” One surgeon promoted the new technology as making the leg bones “better than new.” Has the world gone mad? Ann wondered. Why anyone would choose to have their bones broken before a serious problem even developed was beyond her. Fliers started arriving in her mailbox describing EBB. Ann had to smile when one company named itself EBB—Even Better Bones.

As race day grew near, Ann experienced a mixture of confidence and trepidation. She knew she had prepared thoroughly for the race, but she had never run 26 miles before. She decided that if something “went wrong” during the race and kept her from finishing, she would accept it calmly, knowing that she had done everything to ensure success. She continued her daily visualizations, imagining how empowering it would be to finish. The race would end in a beautiful river valley. Ann often swam in the river and knew that the cool water would feel incredible after the race. She kept this image in her mind: lying on her back floating in the clear water, her body suspended between water and sky.

On race day, Ann was surprised how crowded it was around the registration tents. There were almost as many marathon support companies as there were runners. She talked to a seasoned runner who warned her that it was just as bad even when the running began. Motorcyclists would drive alongside runners, asking them how much pain they were in, if they would like to drop out. Bystanders would hold signs saying “It’s never too late to give up.” “Drop out or drop dead.” “You don’t get a medal for finishing.”

One of Ann’s running partners, who had finished her first marathon a year ago, handed Ann a package while they were standing in line to register. It was a t-shirt with the slogan Drug-Free Zone. “You’ll need it,” her friend said, “especially around mile 22 where the race’s sponsors are handing out morphine pills. They know better to stay away from people with these shirts on, otherwise they’ll get an earful and the occasional well-aimed punch.” Ann grinned.

While she stretched, she turned inward, visualizing the stages of the race and repeating her affirmations. I can do it. I am strong. I am ready.

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Walking!

Zari figured out how to take steps when we were in the Mediterranean, and ever since then all she wants to do is walk around (with help, of course). Here's a short video taken in the cloister of St. Emilion.

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France pictures

In the cloister at St. Emilion

Playing in the fountain at the Place de la Bourse in Bordeaux
Place de la Bourse
Then & Now: 5 days, 2, 3, 4, 5, and 8 months.

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Vive la france!

I am still here, but quite busy working. Zari has been a good "assistant"--she comes everywhere with me, including the office. (She's here with me now, trying to eat the mouse pad.) We've been having unseasonably cool and rainy weather for this area of France (Charente-Maritime) but our students are still enjoying themselves anyway.

More later...

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Request for UK readers

I am trying to get a copy of Grazia that published reader's responses to the article about my UC. If anyone has a copy and would be willing to mail it to me (and I'll happily reimburse you), please contact me at stand.deliver at gmail.com. I'd like to have a copy for sentimental value, I guess. (I already have a copy of the original issue).

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I see London!

Zari will be your tour guide of London today. Note the handy Second Womb sling.

Parliament buildings and Big Ben

Globe Theatre

Westminster Abbey (your tour guide got tired and decided to take a nap)

Tower Bridge

St Paul's (okay, technically it's the rose gardens in front of the cathedral).
Nap time yet again. Being a tour guide is a lot of work.

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I see France!

We just did another 7 hour drive today, from Hyeres to Bordeaux. Whew! We took a long break in Carcassonne, which is best known for its medieval double-walled fortress (the castle in Robin Hood: Prince of Thieves and just about every other movie that shows a walled fortress). Eric lived there for several months, and we've visited it several times as a couple. The first time we stayed in Carcassonne was the summer that we hitchhiked all over France, with our backpacks and musical instruments. We spent a wonderful 8 days in Carcassonne in a nearby campground. Every day we swam in the pool (yes, most campgrounds in France have pools, and often restaurants), watched the Euro Cup games, walked around the medieval city, and played our instruments. Ahhhh, what great memories.

Pictures are from a swimming pool in Allevard-les-Bains (foothills of the French Alps), along the Mediterranean coast near Hyeres (the Presqu'ile and the fortified island of Port Cros to be exact), and two of Carcassonne.

Allevard. You might be wondering why Eric is wearing a speedo. They are required in all French swimming pools. They believe it's more hygenic. Don't ask me why.

Picking flowers in downtown Hyeres during the Fete de la Musique.
The next three pictures are from the Presqu'ile of Giens near Hyeres.
The island of Port Cros, which is now a national park.
There are 3 forts that you can hike to.
It also has some of the best snorkeling in all of Europe.

Carcassonne

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London!

After a hair-raising drive to the Marseilles airport--we got there with about 2 minutes to spare--we arrived in London this morning. We must have walked about 10 miles today, with Zari in the sling. Life is easy when you 1) have a sling 2) breastfeed and 3) have a Baby Bjorn Little Potty in your backpack: no need to pack food, haul around a stroller, or worry about running out of diapers.

We're taping the show tomorrow morning, and it will air on Wednesday. All 3 of us will be on the show (unless Zari is fussy). I think you can watch the program at GMTV's website.

I bought a copy of Grazia magazine at the airport, and I was quite pleased with the article, although a few of the changes I suggested didn't make it in the final copy. There are some great photos of me and Zari. I don't know if this is a praise or insult, but the end of the article is next to a photo of Paris Hilton (ugh, please, can't we read about someone else??). I'm going to contact Grazia about putting a copy up on this blog, since my North American readers can't buy the magazine.

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Travel

After a 7 hour car ride to the airport, an 8 hour flight (which of course was delayed), and a 7 hour drive from Paris to Grenoble, I am tired of traveling. Zari has done quite well considering. We're visiting some friends for a day or two, then heading to the south of France for a week of relaxation in Hyeres: snorkeling, swimming, and walking around the beautiful medieval city.

Then work starts: we run a study abroad program for high school students on the Atlantic coast. The students stay with host families, take 3 hours of French every day, and participate in several workshops (cooking, sailing, painting, etc) during the afternoons. We organize optional excursions and activities every day and several evenings a week, on top of what the students already have scheduled. July will be insanely busy, especially for Eric, as I will be less able to help out chaperoning during afternoons and evenings.

Grazia magazine in the UK just published an article featuring my unassisted birth story. I haven't seen it yet, but I am excited to read it. It's in first person, but I actually didn't author the article, just gave it my final thumbs-up. I talked to the writer for several hours, and she also read through my blog and corresponded via email. From all of this, she put together a narrative for the magazine.

Most exciting of all--we are going to London next week to appear on GMTV and talk about my birth! More details later, but I am quite looking forward to it. Plus I've never been to London before.

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Cabin fun

We've been enjoying hot, sunny weather at my family's cabin in northern Wisconsin. My whole family is here, including 3 of Zari's cousins.

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Where did FPMama go?

I just noticed that the FPMama blog is gone, and now there's some inane post about Angelina Jolie instead. What happened? I am quite sad--she had some great stories and fantastic insights.

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Dispense with Disposables

This blog post, "Dispense with Disposables," has some great ideas on how to replace disposable products with reusable ones. I already have implemented some of her suggestions--cloth diapering being the most predominant one for me--but I could easily do several others without too much hassle. I really should sew myself a few canvas grocery bags. I hate coming home with piles of plastic bags.

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News

My last day of internet access for a little while...So here is all the latest news:

• Zari just got her first tooth yesterday!
• I think I have mastitis, but it's getting better. The fever/chills are pretty much gone now.
  
• We found a dog sitter last minute. Whew!

I'll be without internet for a week, then once we arrive in France I'll have occasional access. So this blog will be a bit quiet over the summer.

I am hoping to bring back lots of beautiful sling fabrics from France. I'll post them to my Second Womb site when I return in August.

I'll leave you with this quote from Gloria Lemay, a midwife in British Columbia:

Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line.

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Last minute stress

We were all set to leave on Wednesday to go to a family reunion up north, then to France for the summer. I called Air France this morning to confirm a few details, such as seating arrangements and bringing our dog, which we have done for the past 2 years. Good things I called--it turns out they've raised their prices for bringing large dogs to $1,000!!! And they didn't tell me that when I called a month ago to ask about prices.

So now we are stressed: what are we going to do with our dog over the summer? Can we find a good dog & house sitter with only one day's notice? Ack!!!

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6 months

A bit late, since Zari is already 7 months old:

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Request from Laura Shanley for photos/footage

"I am in the process of creating a DVD that will contain photos and footage of unassisted births set to music. The DVD will be sold on my site. I will also be sending it to television production companies, news programs, and magazine and newspaper reporters who express an interest in writing a story or airing a program about UC. The couples who contribute to the DVD will retain their rights to the footage. They will also receive a percentage of the profits. To contribute please contact me at laurashanley @ comcast.net."

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Pregnant women are second class citizens

A fundamental right of all adult Americans is that of physical self-determination and informed consent to medical procedures. During a 1914 court case (Schloendorff v. Society of New York Hospital), Justice Cardozo articulated a patient’s right to self-determination:

Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and the surgeon who performs an operation without his patient's consent commits an assault for which he is liable for damages. This is true except in cases of emergency, where the patient is unconscious and where it is necessary to operate before consent can be obtained.

Our current understanding of informed consent is based largely on that 1914 decision. Today, before any medical procedure can occur, a patient must be fully informed about the procedure, including potential risks and benefits as well as reasonable alternatives. The person obtaining consent must be sure the patient has understood what was explained, and the patient has to document in writing that she understands the risks and agrees to the procedure.

Except pregnant women, that is.

There are several examples of court-ordered obstetrical interventions—usually cesarean sections—where a woman’s fundamental right to determine what happens to her own body is blatantly disregarded. Even more disturbing, a large percentage of physicians and lawyers support forcing procedures on pregnant women despite their expressed refusal. A 1987 study in the New England Journal of Medicine surveyed heads of maternal-fetal medicine department. 46% of the respondents supported court-ordered obstetrical interventions. A 2007 study of attendees at the annual meetings of the American College of Obstetricians and Gynecologists and the American Health Lawyers Association found that “51% described themselves as highly likely to support a court order.”

The following story from Dr. Marsden Wagner’s new book, Born in the USA, illustrates the degree to which fundamental human rights are now at stake in the realm of maternity care. (Dr. Wagner was contacted by the family and their lawyers, reviewed the case, and followed the progress of the litigation to its end.)

A woman in northern Florida we will call Ms. P had a normal vaginal birth with her first pregnancy. Her second birth, however, ended with a C-section that she believed was unnecessary, so when she got pregnant a third time, she sought a local midwife and signed on for a planned home birth.

Ms. P had a normal pregnancy, and when she went into labor, her mid­wife came to her home to attend the birth. The labor progressed nicely, but after some hours Ms. P was having a hard time keeping fluids down. Since the local hospital was only a couple of blocks away, her midwife suggested that they go over to the emergency room for a short time to get an intra­venous drip (IV) to hydrate her, and then return home.

In the ER, Ms. P told the staff that she was giving birth at home and would like an IV for a short time. She was put in a room and told to wait for a doctor. When the doctor arrived, he asked if she had had a previous C-section, and when she replied yes, the doctor said that he wanted to admit her for an immediate C-section. Ms. P said, "No thank you, I just want the IV, and then I'm going home." The doctor became adamant, telling her that she "must" have a C-section, and said that he would con­sent to give her the IV only if she consented to the C-section. When she refused his attempt to coerce her, the doctor said that if she did not con­sent to the C-section, the hospital would get a court order to do the C-section. The doctor then asked her to wait, and left the room.

As is typical in any hospital, word of what was going on in the ER spread among the staff. After a few minutes, a nurse ducked into the room where Ms. P was waiting and whispered, "If you don't want to have a cesarean sec­tion by force, you better get out of here quick. There is a back entrance to the ER if you go out and turn right."

Ms. P escaped by the back entrance and went home, where she contin­ued her labor without the benefit of an IV. (Note that the hospital never offered Ms. P the option of having a vaginal birth in the hospital with a staff doctor handy.)

Meanwhile, the chief of obstetrics called an emergency meeting with the hospital administrator and told him that the woman's baby was in grave danger of dying due to a ruptured uterus if an emergency C-section was not done quickly. What he said is not true. Studies have shown that Ms. P's C-section meant that she had a slightly higher chance of uterine rupture than a woman who had never had a cesarean, but the risk was still small—espe­cially since labor was not being induced with drugs—and the chance that the baby would die was even smaller. The hospital administrator, however, was not an obstetrician and had no idea whether or not the information was accurate. He called a local judge and told him to rush over, as it was a life-and-death situation. The judge came to the hospital and was told the same story by the obstetrician. He signed a court order for an immediate C-section—by force, if necessary.

Ms. P was continuing her labor at home when there was a knock on the door. She opened the door to the local sheriff, who was a friend of hers and a member of her church. The sheriff said, "I'm really terribly sorry, Ms. P, but I have here a warrant for your arrest." Shocked, Ms. P said, "What on earth for?" The sheriff answered, "I'm terribly sorry. I don't know what the hell is going on. My orders are to take you to the hospital, in handcuffs if necessary."

Against her wishes and the repeated objections of her husband, Ms. P was taken to the hospital, taken to the surgery ward, tied down on an operating table, and given a forced C-section. The story doesn't end here. Ms. P and her husband sued the doctors and the hospital. However, in Florida a judge must decide if a case deserves to go to trial, and another local judge decided that Ms. P's case was not worthy of proceeding, so her case never went to trial—a shocking miscarriage of justice, given the serious violation of Ms. P's basic rights. Since then, Ms. P has had another baby, born vaginally at home with no problems. Needless to say, there was no visit to the hospital during the labor.

It is important that women in this country become aware of the danger to birthing women and join the movement to protect them. Ms. P's fam­ily's wishes were not honored, and her body was invaded against her will. Her human rights were violated.... Treating pregnant women in this manner goes against the Nuremberg Code and the Helsinki Accord, which explicitly state an individual has absolute rights over her or his own body and no medical treat­ment can ever be forced. Cases like this indicate a dangerous trend in U.S. maternity care toward totalitarian control of a woman's reproductive life by doctors.

References:

Samuels TA, Minkoff H, Feldman J, Awonuga A, Wilson TE. “Obstetricians, health attorneys, and court-ordered cesarean sections.” Womens Health Issues. 2007 Mar-Apr;17(2): 107-14.

Veronika E.B. Kolder, Janet Gallagher, and Michael T. Parsons. “Court-Ordered Obstetrical Interventions.” NEJM 316.19 (May 7, 1987): 1192-1196.

Patient’s Rights: issues in Risk Management

Marsden Wagner. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (University of California Press: 2006).

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