Thursday, December 25, 2008

Christmas Day - One year later

Reflecting back on December, one year after the death of my niece from brain cancer. I had expected to spend 2,3,4 days a week with my sister this month. Last year I was with her every day, but one, in the month of December as we cared for her daughter, in their home, until her death on Christmas morning. Our group only accepted one family for care this month, one family that Emme had helped before.

My niece, Meaghann, was a can-do person. She was bold and bright and ready for action. She was proud that I was a doula and a midwife. So it shouldn't have surprised me that she had plans for me this month. She seems to have orchestrated a connection with her that I'd be sure of.

It began with an invitation to a birth on my brother's birthday, Dec. 11th. The mother's midwife had a long drive and she was going fast. I was closer. Meaghann loved her Uncle Gordon, and he her. She was the first thing in his life that stopped his never-stopping activity and melted his heart. I remember the look on his teen age face the first time he held her.

Catching baby Ian that morning was a fun surprise, a little heads up for the next surprise.
On what would have been Meaghann's 36th birthday, the phone rang at 7:30. This surprise invite is told in part else where on this blog...maybe on Dec. 14th 08. I'd expected to be with Kathy that day for sure, but ended up at baby Tucker's birth. I couldn't reach Kathy by phone and when I stood quietly to "see" where she might be, I got that she wasn't at our Mom's that Sunday afternoon and so I could just as well stay at the labor which was going slowly. I "tuned" into what God's Will was for me to do and of course, thought of what Meg might think, me skipping out on her Mom. It was as if I could feel her suddenly saying with her wry wit, "Duh, you're a Doula!"

I'd told my midwife partners that I thought our next mom was going to go on Christmas and so I wasn't expecting to be at this birth. I'd reserved Christmas for Kathy. (My guys are so supportive and get this, and we were all to be together in the afternoon.)
But Emme and Clare said they'd call me just to keep me up dated. About 7 am Christmas morning Em called. Labor seemed to be moving fast. I thought, great, I can slip in, sit quietly in case they need me and be to my late sleeping sister's house right about the time she's wondering where I am. So clever, eh?

In a couple hours, we see that this birth isn't going fast, in fact, I think I can leave and come back. Kathy and I have a sweet morning. She says she's sad but not unhappy. She reads John 1 and 2 outloud to me while I make pumpkin pudding and wash dishes in her kitchen. Kathy read scripture to Meaghann every morning and they talked and then Kathy would (and still does) journal. When its time to drive to mom's, I ask Kathy if its ok to stop by the birthing family's home for an hour...

I arrive at 3 and "about supper time" the baby girl is born and its good to be useful. I get to my mom's about 8 and they're all still there. I snuggle up to my sister like we were kids and am glad she has me, her little sister. Later, I call to see how much the baby weighs, 11 and an half pounds! God is good and I guess I was where I was needed.

Its as if Meaghann gave me this gift. It would be just her style of humor, both her birthday and her Heaven day, her birthday into heaven. Like a wink.

And its good to have partners...

Monday, December 15, 2008

All together

Marion was the doula for a lovely couple having their first baby. I'm hoping they tell their story on the Spinning Babies Website. I'd gotten to meet them when their baby was still breech -he spontaneously flipped head down at 37 weeks gestation. Not surprisingly, he went on to labor in a posterior position. More challenging was his extended head (chin up, not flexed).

I got to be part of the action on day 3 of labor. Marion was so tired. She called at 7:30 am for some input but couldn't track the advice. I think she couldn't remember what sentence she started before she could finish it! So I asked if I could join them.

The midwife working with this couple was open and knowledgeable about maternal positions for posterior babes. I asked her, on the phone, as well as the parents, if it were alright to join them. I encouraged them to get started with as many of four techniques as they could, but emphasizing the Pelvic Floor Release. I mentioned that I had a story using these techniques on my web site and she surprised me by saying she had read it! (The long labor that wasn't)

  • Sacral floor release (a myofascial release)
  • Rebozo sifting (Manteado)
  • Pelvic Floor Release
  • Inversion (using the hospital bed with her elbows on the foot of the bed and her knees on the middle of the bed and then lowering the foot of the bed significantly)

Braving the predicted ice storm, I wondered what I'd find as the mom had already been 9 cm for some time. She was ready for some pain relief, and who wouldn't be. But I was hoping she could get that pelvic floor release in first!

This was a determined and clear minded mama who followed her instincts well and used all her resources to get through this challenging labor and bring forth her boy. Her mate was ever at her side and I don't think he slept more than a couple hours each 24 hour segment of this labor.

For the rest of the day a beautiful dance emerged. Not an easy dance, that's certain, but beautiful. Each person in the circle around this couple gave support and offered a significant gift to the effort.

We had a midwife that smiled and got right in with the maternal positions. She had the perfect balance of letting the parents lead the birth and keeping mom working --and feeling encouraged.
The nurses were positive, smiling and experienced. The nurse at the time of the birth herself had four posterior babies!

The Pelvic Floor Release allowed the first sign of progress in some hours. Right after it, the anesthesiologist came in and gave a light epidural. And the immediate check showed 10 cm at last. It was a first for me to (seem to) work so hand in glove with an anesthesiologist, but hey, every birth is unique! Other than that, my input was mostly smiles and the absolute knowledge that she could do this birth. (The midwife gave a verbal description of her internal exams so I could tell that the baby was going to fit with enough time and strong enough contractions. And yes, Pitocin was added following the epidural appropriately.)
The midwife had this mobile mom on hands and knees, sitting up right, and finally and most effectively, kneeling on the bed and hanging on to her husband's high shoulders. The head came down low enough now for the doctor to assist if needed. We rejoiced that a cesarean was pretty clearly avoided by this progress.

The doctor did come in and gave a try at manually rotating the baby's head. The baby's head came back to OP but he seemed to be able to have tucked the chin, because when he brought his hand out, the head almost came out with it! The baby was suddenly crowning. It'd now been close to 12 hours since Marion called me.

This little guy emerged so nicely once his chin was tucked; direct OP.

If permission is given, I'm hoping the mother's own story and a couple photos will appear at Spinning Babies.
I'm so happy to witness this birth. I'm sure they would have/could have done it without me, but what a wonder. Don't you wonder how we get to be blessed to be at Birth?? It did certainly take a team of
  • A mature and confident doula
  • A skilled and patient midwife
  • A nurse who smiled and did not act worried (as well as do all her tasks so professionally)
  • A doctor willing and able to do a manual rotation (though the baby would have been born about an hour later in this case, with out the manual rotation)
  • A doctor willing to trust the midwife and mother and let labor continue beyond the length of a usual 2nd stage (pushing stage)
  • And mostly, mostly,
  • A woman who was willing to continue against all logic and odds (in today's birth scene) and much of that was because of her mate's great support
  • and a doula that stayed the course with her for 3 days!
Happy Birthing!

Monday, December 1, 2008

Midwifery Now!

Midwifery Now! is a Minnesota midwifery 501C3 Organization listed in our state's midwifery statute as the agency responsible for submitting potential members to the Midwifery Advisory Board to the MN Board of Medical Practitioners.

We started MNow! in about 1998 as part of our legislative action. May 5, 1999 the Traditional Midwives bill was passed. The CPM credential is required for licensure in MN as a Traditional Midwife. Certified Nurse Midwives are licensed through the state Nursing Board.

Today we elected board members for the next 4 years. Co-Chairs, Jeanne Bazille, re-elected; Gail Tully; Treasurer, Amy Nyberg; Secretary, Tracy Meiers; Parent Member, Barb Stoss; Members at large, Sylvia Kosloski and Maureen Dahl. Retiring from the board were Kathy Ruggles and Kim Garrett who continue to serve on the sister organization, Minnesota Midwives Guild. Maureen Dahl is liason for MN Council of CPMs (MCCPM) and serves in both groups.

We hope to bring education and vision to parents and maternity care professionals and paraprofessionals through the coming years.

Saturday, November 29, 2008

Referring to Spinning Babies

Chiropractors and Midwives, doulas and childbirth educators, Hypnobirthers and; it seems like Spinning Babies is getting referrals from all over the birthing world.

What makes Spinning Babies useful? What would you like to see more of?

Let's dialogue. Join the Spinning Babies Facebook group. Or, comment here.

Here's today's fun email:
"thank you for your work--I send chiropractors to your site every weekend! it is such an awesome resource!

Jeanne Ohm, DC
ICPA Executive Coordinator"

See Dr. Jeanne Ohm speaking about natural birth and fetal rotation on You Tube. Click here for the video interview with Dr. Ohm.

My "niece" Melissa was in Orleans, California along the Salmon River when she met a midwife. Soon into the conversation they discovered their "Spinning Babies" connection. Melissa, Meaghann's sister via her Papa, has helped me in my office, and the midwife refers her moms to my site. A "chance" meeting shows just how prevalent Spinning Babies is becoming in the birth world.

Monday, November 24, 2008

Palpating today

Clare Welter and I were invited to palpate (feel with our hands) this Mama's baby both yesterday and today. Clare took these photos today.

Yesterday the baby was breech. I asked to attend the Ultrasound today and if I could palpate again, before the ultrasound, to draw a picture of what position the baby seemed to be in. Then we could compare the ultrasound picture with my palpation.

Here we are at the couple's home before the appointment.

Happily, the baby flipped head-down during the night!

Sadly, we weren't allowed to take pictures in the ultrasound room.

After palpating I drew the Belly Map.

Here's before and after...

See more about breech babies flipping to a head down position at the Spinning Babies Website.

Saturday, November 22, 2008

Midwives and Spinning Babies

For those of us who learned midwifery before the late 90s, before the fusion of midwifery education with the homebirth world, before doulas and Penny Simkin's physical therapy techniques came to the aid of birthing women,
the idea of midwife-directed techniques for labor progress seemed out of step with homebirth. Concern about a baby's position was sometimes seen as a betrayal of trust in the natural course of birth.

Yet, there is a tradition of midwifery to help women come into their natural attunement with nature. When our culture distorts the alignment of womens' bodies, by too much sitting, sitting with poor posture, crossing our legs, repeatedly stepping on the car's accelerator, etc., then it is certainly within the midwives role to help bring attention to the resulting malposition and help give the mother ideas to restore her alignment.

Spinning Babies is the active part of patience.

Thursday, November 13, 2008

Home Birth Surge

New York Times Home and Garden section featured an article on homebirth- Bringing Baby Home.

" 2006 home births accounted for only one-half of 1 percent of the city’s 125,506 reported births. But local midwives say they have been swamped with calls and requests in recent months, in some cases increasing their workload from two, three or four deliveries a month to as many as 10."

The surge is attributed to Ricki Lake's Business of Being Born. Go, Ricki.
Here in Minnesota, we hear our parents cite both BOBB and Orgasmic Birth by Debra Pascali-Bonaro as inspiration to seek our homebirth services in the Twin Cities.

Tuesday, October 7, 2008

Sign the premmie petition!

The March of Dimes notes a sharp rise in what they call Late Prematurity. Babies who are almost term, but not quite. They attribute this, in large part, to the increase in inductions in the US.
One of their points on this petition is

3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.

I'd like to invite you to join this effort by signing the petition. Click here to read the short petition.

Tuesday, September 30, 2008

Duluth is so BOLD

Duluth's Northland Birth Network presented an amazing trio of BOLD performances this past weekend. Actually, four performances; the first was a private showing for medical professionals. How brilliant is that?

Birth on Labor Day (BOLD) has been a September statement for several years. Playright Karen Brody wrote the dynamic dialogue after interviewing 100 women about their birth experiences.

And after each performance, a panel of local parenting and birth professionals were available to take audience questions. Spinning Babies (lil old me) was there on the Sunday afternoon panel, after a short recovery from the Orgasmic Birth events. It was fun to hear the Duluth moms talk together in surprised voices, noting that "Spinning Babies" was right here in Minnesota! :)

Debra McLaughlin, Caralee (sorry I don't have Caralee's last name right now) and an energetic cast brought the social issues of American childbirth to light, spot light, that is. BOLD will be an annual Duluth event. Other birth activists hope to present BOLD in the Twin Cities next year, as well.

My step son's UCDavis research on Breast Milk

What an amazing journey for this young man.

My husband Vic's son, John, has been studying breast milk for a few years now. The team he works with just published.
In the article photo, you can see John in the back, to your left, bearded in the dark jacket- another handsome Froehlich man. He is getting his PhD in chemistry and was already published, some years ago, as a second researcher for inventing a better process to test for contamination of the Scotch Guard molecule which has permeated every drop of water in the world. He turned 27 this year. Ok, I'm bragging, even though I get absolutely no credit for any of it. Its just joy to see him on his journey.

"The one thing that has evolved with humans, to nourish humans, is breast milk," says J. Bruce German, a food science professor at the University of California, Davis. "It is the ideal evolutionary model for what nourishment should be."

Article Title:
Unraveling Breast Milk
Analytical scrutiny reveals how complex fluid nourishes infants and protects them from disease

September 29, 2008 Volume 86, Number 39 pp. 13-17

Article Location:

From Chemical & Engineering News
A service of the American Chemical Society.

Orgasmic Birth

The Minnesota screening of Debra Pascali-Bonaro's documentary, Orgasmic Birth; The best kept secret, was a delightful success. The Riverview Theater, last Thursday, September 25th, felt between a celebration and a family reunion. So many new families greeting their midwives and doulas with hugs and smiles.

Debra was delighted with the turn out. She said it was the biggest screening of Orgasmic Birth to date! About 500 people were estimated to be present.

Her two other talks, while smaller, were dynamic and far reaching. The Friday morning workshop on local, national and global action in maternity care is still reverberating in my mind.

DVDs can be purchased locally by emailing speebee@gmail. Credit cards are not able to be used right now...and you have to be in the Metro area where you can come pick up the DVD. Otherwise, sale of the Orgasmic Birth DVD is due on Debra's site on Oct. 15th. We are selling the DVD for $40 as a fund raiser for several local groups.

Monday, September 8, 2008

AMA against homebirth, DONA for choice in birth

From the US News and World Report opinion page
Support for Home Births

You covered Ricki Lake's controversial documentary about homebirths which instigated a growing battle between the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association (AMA), midwives, and patients ["Ricki Lake Fires Back in Debate on Home Birth," "On Women,"].

The conflict is about the perceived safety of home births and the use of Certified Professional Midwives (CPM) or "lay" midwives. Last month, the AMA issued a resolution asking for legislation against home births and against "lay" midwives. DONA International, the oldest and largest association of doulas in the world, represents the thousands of women who cherish their ability to choose where they give birth and with whom. We also question the evidence supporting the ACOG and the AMA's statements that "the safest setting for labor, delivery and the immediate post-partum period is in the hospital." The largest, most respected study of home births found that among 5,000 low-risk pregnancies, babies were delivered just as safely at home with a CPM as in a hospital. Because most doulas work with midwives and physicians in a hospital setting, DONA International has no financial interest in the outcome of such legislation called for by the AMA. Our interest is in the scientific evidence and in maintaining the conviction that pregnant women, just as all other patients, are intelligent enough to give informed consent.

Debbie Young
DONA International
Jasper, Ind.

Go, Debbie!

Sunday, August 31, 2008

Gail writes to Dr. Phil about his request for homebirth horror stories

Dear Producers and Doctor Phil,

I've watched your show with gratitude from my mother's hospital bed, appreciating the healthy living concepts shared and in doing so, giving us a forum ...

You are seeking homebirth controversy. Why? You are about to examine two cultures and seeming to be willing to pit them against each other. I've been in both the home birth world and the hospital birth world for over 25 years.

...our mothers at home, though the medical model says they are the ones risking death, are giving birth to healthy children, are recovering well and, as one of the points of home birth, are physiologically intact including the love hormones that increase maternal competency and care giving behaviors.

As a doula in the hospital, I see how the supportive care of a woman bringing in a culture of love to the highly technological setting also improves infant and maternal outcomes. The hospital, where yes, people care, but more so, people are terribly afraid and overworked and must think of their legal security before health care.

Even so, as homebirth midwives, certified by means of a federally approved test, which was independently scrutinized seven-times, we work cooperatively with doctors and find an open relationship between home and hospital caregivers gives the most comprehensive care.

Did you know that homebirth midwives have the best maternity outcomes ever found by medical research? Repeatedly!

There is a crisis in maternity care in this country. It should be evident when the US and Cuba have similar infant mortality rates and yet we pay ten times the amount to achieve the same dismal rate. (CDC)

Please consider your platform to be a Gift and think about your full power available to communicate with our American public. To do so, you must come up to date with maternity issues and statistics.

You may like to read the British Medical Journal on homebirth in North America and see the statistics. Please don't stoop to slather your audience, emotionally, in a wallow of controversy.
Rather, present the topic as a cultural nexus, and if you must, an intelligent look at
the danger of jumping in based on ideology instead of developing a cultural competency that provides a way of assessing safety for homebirth. A competency that an experienced midwife can help parents obtain and utilize.

Fear is not a good platform, Dr. Phil. There is a movement going on in the world. You might be against it, but you will be trailing behind the changes surging up through the voices of families. In the 1980s there was a small blip of natural birth and VBAC which the medical intelligentsia has strategically sought to suppress. This time, families have YouTube, independent films, internet and regular gatherings to explore their values and options in childbirth care.

Love really is the answer. And to give birth in love is protective of that Love within which is seeking expression. To give birth in love requires not big-hearted doctors, midwives or nurses, no, its not that simple. To give birth in love is to give birth with the physiological, hormonal signals and processes intact. We have been designed in love. Birth is a sensitive period in which women can overcome much past trauma or disinterest and be born anew as a loving mother. Please check out the work of the esteemed Doctor Marshall Klaus for a better description.

I have much respect for you and yours, Dr. Phil. Lets get this right. We are talking about the cradle of our civilization- the birth and care of our babies and mothers. Its important that you get this right.

Gail Tully
homebirth mother and midwife

Tuesday, August 5, 2008

Pressure to have ultrasounds and induction

This is my letter to a friend whose obstetrician recommends weekly ultrasounds to see if her womb is becoming a hostile place for her baby. Yes, that phrase was used by a medical person to get her compliance.

"I was thinking more that it is the very serial ultrasound that is making the "womb a hostile place." As serial ultrasound is associated with loss of amniotic fluid, lower birth weight and IntraUterine Growth Retardation (a dysfunction of the placenta probably due to stress or damage of the placenta)...

Marsden Wagner, past European Regional Director for the World Health Organization writes about the mistaken reliance on ultrasound. He cites a research study and states,
"...ultrasound may lead to the very condition, IUGR, that it has for so long claimed to be effective in detecting."

There are two other links in this article to medical books on Ultrasound, including Ultrasound? Unsound.

The nature of female social networking is that our stress hormones encourage us to bond tightly with those we feel have power and can help us with that power. We fear offending them lest we lose their protection. This is the "tend and befriend" response that Shelley E. Taylor writes of. I talked about it in doula class. Its a classic reaction. Women will avoid being rude, as you say, or, what that really means, setting boundaries even if it means exposing themselves and their children to theoretical risk.

In domestic abuse, its walking the egg shell life trying to avoid violent outbreaks and hoping the children aren't going to be effected. On a milder scale, its form with pregnant woman is pretty common in prenatal clinics in our nation. Especially, women who have experienced loss and trauma. The comparison of the minor harm of poor or abusive treatment (defining your body as hostile towards your baby) to the death of your child seems like a no brainer. But when you see that it isn't an either/or situation you can begin to bring about your inner wisdom, your parenting instinct, your right to say "No, I will take this but not that."

A mother who can separate her relationship from her stress might say,
"I appreciate your help and the skills you bring, but I will limit my child's exposure to ultrasound. (Or induction or separation.) I understand you are concerned about lawsuits. Let's talk parameters and I will keep the communication open."

By agreeing with a protocol which goes against your better judgment, to do serial ultrasounds, you are giving them the tool to scare the crap out of you at 37 weeks so that you can accept induction from them without blame on either part. I really am not saying this in a harsh or insensitive way. My heart is calm.

I've just watched this happen for 20 years now, since this style of "preventative" care came about (preventing lawsuits).

If you were happy to risk induction because the risk of physical harm was higher than risk of induction, that is one thing. But the risk of emotional stress is not really more harmful than the common complications of induction. We can talk about what makes induction somewhat less risky: high Bishop score, intact water, slow, gradual drip, laboring out of bed, etc.

Me, on the other hand, really will support your path. But in that support comes a bit of information. I'm not your doula. You didn't ask for that. You asked for a voice who trusts birth amidst the technocratic model you are walking. If you want me just to nod and murmur loving thoughts only, I suppose I can do that. But it is hard when I see that the care you get is potentially the cause of the thing you fear. Thomas Strong, MD writes Expecting Trouble; The Myth of Prenatal Care in America.

Disagreement seems stressful. But soon you realize you can strengthen your relationship with your care givers in other ways than compliance. Once you have established that at the clinic you will begin to relax and narrow the kind of care you get to be that which is useful and good for your baby and you.

Talk to your mate, think about it, journal about it. Practice in small ways. Maybe take a big step, maybe not. Look past the due date and ask yourself, what will I remember about this time that will shape my life to come? What has made me the mother I am today (looking back from that future date)? Is it the mother I want to be? You can't find the full answer unless you can ask these questions without gut wrenching fear.

Let me know how these thoughts impact you. You are the Mama. You get to pick your choices. Among any of the above or others unmentioned here. You get to pick.

Be kind to yourself as you walk this path. It can seem lonely at times. But there are blessings in the hard choices we make."

Wednesday, July 30, 2008

Vertical Birth

Here is the Vertical Birth video recommended by Debra Pascali-Bonaro from her Orgasmic Birth blog. Make sure you read Mariana's blog. Mariana Bazo was the photographer for Vertical Birth. Wow.

Sunday, July 27, 2008

Orgasmic Birth showing in Minneapolis!

Birth Activists have banded together to bring Debra Pascali-Bonaro's Orgasmic Birth film here to Minnesota, Thursday, September 25, 2008. The full length film will show one night only at the historic Riverview Theater.

This post announces our new local website,

Buy your tickets online. They just may sell out. Business of Being Born sold out before both viewings in the Twin Cities. Don't be left out. Debra is presenting her film, and answering questions afterwards.

Tickets are sold online before the day of the film. If any seats are still available, they will be available at the door of the theater at 6:30, Thursday evening, 9-25-08.

Two other events are scheduled, a Thursday afternoon class with Debra and a Friday morning power brunch with Debra and community leaders. Tickets to those events will be offered soon. Plus, the Minnesota DONA group (DONA doulas) are having their annual picnic meeting the afternoon before the film.

Tuesday, July 15, 2008

Midwife in Mozambique

PBS aired a compelling story about midwives learning to do cesarean surgery to fill the shortage of doctors in rural Mozambique.

The young midwife featured is shown conducting a couple of repeat cesareans. One for a placental abruption for which uncontrolled bleeding leads to a hysterectomy. Another mother is given a repeat cesarean and she is clearly unhappy about. The supervising doctor/teacher tells the midwife to be kind to the mother, give her special treatment, that way when she is pregnant again she will come to the hospital at 8 months and they can schedule her next cesarean. The implication is to avoid a ruptured uterus. He wants her to have the opportunity for more children in a culture where 2 children are not considered enough.
Yet, when he leaves her to do the surgery to attend to other patients, the midwife is shown deciding for herself - while the mother sleeps under anesthesia - to sterilize the mother.

Whew. Interviewing the midwife later, it is clear that she doesn't have up to date information about the safety of vaginal birth after cesarean (VBAC). Also, it is clear that she really thinks she did this woman and her family a favor. She talks about missing her mother who died when she was 20.

Going to the PBS website, a short video shows American Certified Nurse Midwives working in the hospital environment. One midwife asks a woman, in for her first prenatal exam, if she wants a vaginal birth this time. The mother says she certainly does, she doesn't want a cesarean again.

What we work hard to gain or to hold on to here is already being eradicated as the physiology of birth is bypassed to spread obstetrics. It makes sense to take advantage of the African midwives' intelligence and add another life saving skill to her abilities. But what a loss to never teach a midwife midwifery.

Another risk of cesarean surgery

A 26-yr old woman was 8-weeks pregnant and experiencing some light bleeding. Her previous birth was by cesarean section. When an ultrasound was done to see the cause of her bleeding the technician could find no baby in her womb. Instead, the baby was developing in the separating edges of her cesarean scar!

I wonder what the conversation was like that lead to her agreement to have a hysterectomy and loose both her baby and her uterus. The medical notes were shared on Medscape Today, an excellent medical educational site by WebMD.

It is beyond sad that medical notes are written without reflecting the emotional journey of the patient. Here is an excerpt of the notes.
  • Sonographic evaluation revealed an empty uterine cavity and endocervical canal, but a gestational sac was seen in the myometrium anteriorly and at the level of the uterine isthmus. The gestational sac bulged anteriorly and was separated from the bladder by only a 7-mm layer of myometrium.
  • Our patient desired no future fertility and hysterectomy was selected to treat her cesarean delivery scar pregnancy (CDSP). Intraoperatively, a bulge at the level of the isthmus was noted anteriorly. The bladder was dissected from the lower anterior uterus, and the CDSP was seen distinctly. Hysterectomy was completed without complication. The patient's recovery was uneventful.
It sounds like the young mother was game for the hysterectomy. But the truth behind the statement is that she simply agreed to the surgery. What could she do? What options could she be offered? To continue the pregnancy and see if by some miracle she and the baby survived? The sac wasn't in the tube. But it seems unlikely the baby could go to term. Few women would have continued this pregnancy.

Still, I can't believe her thoughts when she woke the next day was that getting over this was "uneventful."

My thoughts are with her. And with our nation and world as the rising cesarean tide claims more and more lives, wombs, and hopes, as well as cumulative years of well being from the women of the world.

Sunday, July 13, 2008

Ricki and Jennifer Block the AMA

Isn't it great how things line up sometimes? First, Betty-Anne Daviss and Ken Johnson lead the CPM 2000 statistical collection. The British Medical Journal published the good news. Canada and Britain took the results seriously and began improving their maternity care policies immediately. (Even though Canada has the best infant survival rate in the Americas. That's how you have good outcomes.) Then, Ricki Lake makes her cathartic and timely film, The Business of Being Born.
And now we have Debra Pascali-Bonaro's Orgasmic Birth film. The crème for the top, you might say.

Whereas, Canada, the UK and many European countries respond to evidence with action, the US seems to wait for media attention. Suddenly, what has been being done behind closed doors is exposed--and so are the tempers!

The American Medical Association raises its hoary head and roars against humble midwives who expose the truth only by the simplicity of quality care.

Hey, if Cuba can beat US infant survival rate with 10 times less spending on average medical expenses per citizen, there should be no further surprise that independent, low-tech, high-touch midwives help parents with brilliant birth outcomes.

First, we wonder what's wrong with maternity services here. And suddenly we find the physician's power club racing to suppress the competition. No competition; no pressure to improve. Business, as usual.

Not so usual, however. There was a day when the family doctor or rising obstetrician would not induce a woman unless there was clear harm in waiting. Surgery was for life saving, not profit margins.

The March of Dimes sounds the alarm against the new epidemic of late preterm births and the resulting rise in infant death in the first year of life because of this. Is anyone listening?

For doctors, induction and scheduled cesarean are a strategy against malpractice premiums and litigation costs. For parents, interventions without immediate need can bring unforseen sorrow. Maternal death is more common now in the US than it was in the 1970s. Cytotec and rising cesarean surgeries being two leading reasons.

Home birth in Minnesota and the US occur in only .5 percent of the 4 million births a year in this country. The AMA is right to fear this tiny splinter peeling from their fortress wall. With media coverage, intelligent women
are starting to notice.

You can sign Citizens for Midwives' petition to the AMA to block their efforts against women's rights and scientific evidence.

Wednesday, June 25, 2008

Orgasmic Birth in the Twin Cities

An amazing gathering of concerned birth activists are joining talents to bring
Debra Pascali-Bonaro to Minneapolis/St. Paul with her film, Orgasmic Birth. We are excited to have this venue to inspire women into a new awareness of their ability to give birth.

You can buy a ticket to this event now.

Thursday, September 25, 2008
7 pm
Riverview Theater
3800 42nd Ave S. Mpls., MN 55406

Saturday, June 7, 2008

Menomonie Birth Center Visit

I'm staying this weekend at the Morning Star Womens' Health and Birth Center in Menomonie, Wisconsin. Paula Bernini is the Certified Professional Midwife (CPM) who nurtures this Victorian era "home" with antiques, birth motif and amazing garden. I don't know how she does it.

We spent some lovely time together weeding. Sitting for a cup of tea can be relaxing, but I'd rather do something. After the rains, the lamb's quarters were cropping up around her sitting bench. I asked her not to weed them, that I'd come back outside near supper time and pick a pan full for dinner.

I thought it was about time that I tried eating some lamb's quarters. I'd heard they were good food for years. So I washed 'em up and fried them in some butter with a bit of sweet red pepper and salt. OMG! Wow!

My blushing apologies to mother nature! I've been tossing these beauties out for years. In fact, they don't even grow in my yard anymore. I could cry. They are so tender and delicious! Tender and sweet, with a bit of an oxalic acid after taste, like spinach. Cooking them with a fresh mushroom to absorb the oxalic acid will cut that after taste away. (But you have to throw away the mushroom because that acid isn't good for the kidneys.)

I love spending time here at Paula's Morning Star Bed and Breakfast... I mean, Birth Center. Its a pleasant drive east from the Twin Cities. Close enough that families come from the Cities and even down from Duluth. Though Duluth is a bit of a drive.

Check out Paula's lovely new website, its inspiring! I looked at it's design longingly today as I have fussed and fretted over my blunders with my latest update.
Take care, watch the weather and when you're in Menomonie, stop by.

Tuesday, June 3, 2008

ScienceDaily (May 29, 2008) — During labor, the continued presence of a doula – an experienced non-medical female companion who provides continuous labor support – has significant beneficial effects for middle- and upper-class women in childbirth, even when they have their male partner or other family member with them, according to a new study in the journal Birth.

Over a 5-year period, 224 of a group of 420 pregnant women in their third trimester were randomized to have a doula accompany them during labor, and 196 women did not receive this intervention. Cesarean delivery rates decreased by 12%, the need for an epidural dropped by 11%, and the need for a cesarean after induced labor decreased by 46%.

The doulas arrived in early labor and stayed nearby until after the birth. The doulas also gave their characteristic reassurance and encouragement to the fathers attending the birth.

The authors were DONA International members Susan K. McGrath, PhD, and John H. Kennell, MD, of Case Western Reserve University. “Continuous support by a doula during labor is a risk-free, low-cost method of reducing cesarean delivery rates that should be available to all women.”

Susan K. McGrath PhD, John H. Kennell MD (2008) A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates
Birth 35 (2) , 92–97
Read the Conscious Woman blog on Michel Odent's comments about his Daily Mail interview about men at birth. In fact, here is Raquel's post:

Michel Odent on Men at Childbirth

I just received another email regarding the Daily Mail article that quoted Michel Odent as having said that men should not be at the birth of their child. Being too impatient to take the time to figure it out, I emailed Dr. Odent directly. He responded within an hour:”About the pages in Daily Mail, first I was not the author of the article. It was written by a journalist after an interview on the phone. Also it is probable that people just read the sensational title. In fact I have never said that men ‘should not be at the birth of their child’. Warmest regards, Michel

I hope that clarifies things for those of you who have been questioning that piece (which -as you may notice - I am not linking to). Beware the media, especially when it comes to childbirth!

Thursday, May 29, 2008

Men at birth, Odent's view

Dr. Michel Odent was interviewed on his view about men in the birthing room. His view is that men should not be present at birth. Read the article.
There has been a lot of buzz in the local emails and I thought I'd share my response.

This freedom from ideological shoulding at birth is what we observe when a woman gets to be intuitive and voice her needs. When she is heard and respected. Its not about who is there, but about how they are in their being there, if you follow.

Hey, maybe what Odent is talking about is should dystocia. There is a need to reflect on how too much mental activity at birth, as in, trying to do everything right, is inhibitive.
(My next book could be called Resolving Should Dystocia. ;)

There is a place for leaders in movements to make strong statements. I think the media makes these strong statements even more ideological than the person sometimes intends. Though, in this case, it seems that Dr. Odent is quite adamant.

Odent is all about deep, hormonal intactness. If he isn't going to be loyal to that stand, then the point will not be made anywhere. He says similar things about doulas and fetal positioning preparation. He sees the importance of undisturbed birth, even describing Christ's birth in the manger as an inspiration to avoid the inevitable physiological interference that having helpers would entail. Such helpful interference that drying and warming and bundling incurs to skin-to-skin contact and breastfeeding and bonding .

Odent has a beautiful point about undisturbed birth. Lets not lose sight of his gift to us because his warnings are hard to integrate with what is current in birth practices. He is a visionary speaking.

We can bring the message closer to heart and start to remove the obstacles in our own words and actions to physiologic birthing, including our midwife and doula Care that is sometimes an obstacle.

Being in the present (right brain) and away from the should (left brain) during prenatals and labor would be so helpful towards promoting an environment safe for physiological, private and orgasmic birthing. Being in the kitchen might help, too! :)

Sunday, May 18, 2008

updating site

Hang on, I'm updating the shareware for
It will look different and be different. You may not find what you've seen before.
If you can't find something important to you, email me and I'll work on it.

Be warned, though, I am not researching or giving advice on pregnancy and postpartum aspects that don't have to do with fetal positioning issues. There are better sources for you on general and unusual pregnancy questions than me.

The links will take a long time to grow back up again. Sorry, I hope to have many more links soon.

Saturday, May 10, 2008

Intervention and support in difficult childbirth

More thoughts on how we give support in a long or difficult labor.

Too often, birthing families are pressed between the policy and the clock. Care providers are concerned with how a labor looks on paper, in the chart. How will this labor look in court? Their concerns overshadow the relationship they have with the mother and the mother is forced to submit to their comfort in their career. Suddenly we hear Dr.s, nurses and midwives yelling or cheerleading.

This very action pushes them further from the mother. They separate themselves from the mother by their perspective of what can she do for them, rather than what can they do for her. Can she hurry? Can she agree to intervention? What will I say at the desk? How will I chart this or write my report?

How can the busy hospital nurse, doctor or midwife support the birthing woman who is experiencing a long and/or difficult labor? It may be that they have to "act as if." They show a calm and trusting face to the woman. They sit down across the room from her and enter in to the rhythm of breathing. They smile, that half smile of contentment with what is occuring.

Of course, I am talking about when labor may be long, but there is no emergency. If you are reading this with strain and thinking, "but what if?" I would invite you to take a deep slow breath and let go of the adrenaline through which you filter birth. Breath in the endorphine state that gets babies out. Adrenaline holds babies in. Why would an entire culture of birth surround itself around the substance known for labor dystocia?

On the other hand, too much help can be distracting, too. The mother surrounded by too many caring people has to filter their words, actions and sometimes, chatter. They prop her up with morale building effort.

There are times in a long labor that a mother may have to go within herself to reflect. So support in a long labor can be required to ebb and flow. Rest is necessary, mentally as well as physically. The support person or people must be able to observe the needs of the mother, before she does, and adjust themselves accordingly.

The father may be present or not, depending on the situation, this discussion doesn't exclude him. The mate, both calm and attentive without asking too many questions, can be the determining factor in whether a woman feels safe to continue a long, challenging labor.

One constant person is often required. If so she needs to be in that midbrain state of the rhythm of labor. The mate may need her presence to model his. He observes and absorbes her calm. He falls into the rhythm of breathing, at least, when reminded.

Sometimes rhythm is missing from the labor, as sometimes happens when there is an asynclitic presentation, even in a calm, trusting laboring woman. Then that calm, mature woman becomes the rhythm. She holds the concept of peace and birth within her eye. Her breath reveals the rhythm, as does her movements and her half closed eyes that gaze beyond the woman.

Two womens' labors and the quality of care

Two women asked me about CPD earlier this week.
CPD is cephelopelvic-disproportion, meaning the baby doesn't fit the pelvis.

One woman was a first time mother working with our home birth midwifery group. She was at the end of her pregnancy with an OP baby. Body work hadn't helped her baby get turned to face her hip or back. The baby hadn't engaged. Being well read, she was now concerned that the baby wouldn't enter the pelvis and a cesarean would then be necessary.

Another woman emailed from the UK. She was pregnant with her second and remembering her first birth. The baby hadn't engaged. She had an early urge to push. Her midwife yelled at her, her words, to stop pushing. This went on and on. An epidural gave relief, but too much, she was put on her back and now had little ability to push when the time did come to do so. A vacuum, or ventouse, extraction was done. She was a bit afraid to hope for the coming birth of her second child.

Our first time mom had a strong urge to push before her cervix was fully opened as well. Instead of trying to stop her, we observed. Later, we encouraged her to push along with the urges. We alternated with asking her to breath through some contractions without pushing. Then, again, she let her body push spontaneously.

Her baby's head needed time to mold, so we asked her not to add to her body's spontaneous pushing. An asynclitic angle (tipped like listening) of the head was a significant factor in the length of time, so we asked her to push. We were exploring what might be the best way to help her. We tried varying how she pushed because this urge went on and on, like the UK woman's labor.

All the time her loving husband stayed at her side, patient and attentive. Her doulas stayed near. Her midwives honored the needs of the birth and introduced a very pointed conversation, gently. By stating that we wanted her to get what she needed, she took that idea around in her mind for a couple of contractions and replied that she was ready to explore what the hospital might have to offer her labor. IV fluids, Pitocin (Sintocin).

In the hospital there were a few more hours until, finally, the cervix was gone. The baby's head had molded enough and the mom's voluntary pushing now became effective. Now she pushed hard enough to realign the plates of California. Her baby was born, healthy and strong.

Both women had difficult births. Both were able to birth without surgery. One woman feels raped. One woman feels empowered.

Penny Simkin says we can't control how labor will go, whether difficult or not, but we can control how we care for women. She was referring to the respect, words and tone we use when talking with pregnant and birthing women. (Postpartum, too!)

I'll add that we can seek to honor the needs of labor, too. The clock is not a good guide for intervention. Giving the woman, in a non emergency situation, time to decide when its time for an intervention (perhaps as a tool for a long labor) considers her needs in the psychological transformation that partuition is. She needs to know her midwives not only hear her, but trust and know the variations in birthing.

Her decision is made not only from her physical and mental state, but made within her support community. She makes decisions among people who are important to her. This is part of her mother-making. A key part.

How the dream birth becomes the real birth is how the dream of her mothering becomes the mothering she actaully experiences. How her support people, including her midwives and doctors and nurses, respond to her needs and how they nurture her changing birth plan reflects on her acceptance of herself as a woman and a mother in her circle.

Choosing transport and an intervention doesn't mean that all her effort is done. There is more effort, more work. Contractions continue and the mother continues to labor. She is brought to yet another level of challenge. The challenge of having thought an intervention would remove effort and finding that it does not. It may help effort, but it does not remove the mother from the work of becoming a mother. She is in the midst of hard work. Work that is rewarded with a conscious connection to her child and to her awareness of the process of mothering.

All mothers deserve to be rewarded in the art of surrendering themselves for the needs of their children. There is not a mother that doesn't deserve our respect for that. Its not a question of the worth and beauty of mothers.

Its a question of how we care for women as they become mothers and the effects of our care on the quality of life for mothers and their babies.

Tuesday, May 6, 2008

Benefits of volunary licensure of midwives

In an email to a politically active friend here in Minnesota, I said something I'd like to share in general:

I would like to take this opportunity to praise our voluntary licensure for traditional midwives. The voluntary status of licensing traditional midwives in our state protects ALL midwives from:
  • Restrictions against helping women with normal birth including OB trends to label as high risks women with a certain maternal height and pregnancy weight gain combination, parity, etc.
  • Restrictions against helping women with a variation of normal; such as, weight gain, VBAC, Breech, Posterior (some physicians section women beginning labor/presenting in late pregnancy with a baby in an OP position) etc.
  • A monopolization of ideology in practice yet while promoting better practice standards,
  • Total adaptation of medical model midwifery because the traditional one faded away under the afore mentioned trends

Friday, March 14, 2008

Should I try for a natural birth?

The first questions you may ask yourself when you are deciding whether you want a natural birth or not, is likely to be,
Can I handle the pain?

Another question is, Is the baby positioned so he/she will fit? Or, simply, Will the baby fit?
(You may be wondering, how can an entire baby fit out that little hole, and what will it do to me?)

The answer to whether you can handle childbirth pain and whether the baby will fit is often the same, single answer. A well-positioned baby leads to a do-able labor and almost always fits the mother's pelvis.

What fetal position is good? Facing the mother's right hip (left occiput transverse, or left occiput lateral) or her back (occiput anterior).

A baby whose chin is tucked before labor will be able to rotate into a good position during labor, if they aren't already in one.

Most posterior babies, in which the baby faces the mother's front (and in my opinion, her left hip, too) will rotate to the anterior during strong labor contractions and then be born vaginally. A few posterior babies will be born posterior, and a few will need medical interventions, like Pitocin or a cesarean, to finish the birth. By far, most babies who start labor in a posterior position will rotate and be born in the anterior position.

For some women with a posterior baby labor will be longer than with an anterior baby. There may be challenges in the labor, such as starts and stops in contractions, clusters of very strongs contractions followed by almost no contractions, and subsequent emotional disppointments due to the confusion such a labor pattern can cause in the parents AND the birth attendants.
See more on posterior labor.

Is that a reason to skip labor and have major abdominal surgery for the birth of your baby?
Here are some other questions to ask:

What do you want for your baby? How do you want your first minutes and hours of your life with your baby? If you knew your second birth would be do-able would you go for it again?

What do you want for yourself? When you look back, what do you want to have learned about yourself? Where do you want to have taken yourself, spiritually, emotionally and physically, with this birth? Is that the place you want to live in?

A doula (doo-la) is a trained woman who will listen to your answers, help you find the truth in your journey and if you want to go with a vaginal birth, or even a drug free birth, she will help you gain confidence and comfort in preparing for and going through labor. I highly recommend finding a calm doula for your upcoming birth.

Wednesday, March 12, 2008

The New York Times doula article rebutal by Susan Lane

Pamela Paul's article in the Sunday, March 2 Times ("And the Doula Makes Four") left out key points. One is that it's very easy to find out if a doula is certified, because the agencies such as DONA International that certify doulas offer an on-line listing. DONA and the Coalition for Improved Maternity Services also offer a guide for interviewing doulas. Parents should get current references and contact recent clients of a doula they are considering. Ms. Sacher's comment at the end of the article is most appropriate- parents should be conscientious about selecting a doula as well as a physician. Most doulas will meet for an interview at the parents' convenience, making the process easier still.

Minneapolis and the state of Minnesota have more certified doulas per capita than any city or state in the country, and we have wonderful relationships with medical staff in hospitals around the state. The Childbirth Collective is a Minnesota nonprofit organization of doulas, homebirth and hospital midwives, psychologists specializing in perinatal issues, massage therapists and chiropractors with special certifications related to pregnancy, birth and postpartum. Doulas in Minnesota can register with the state, which confirms their certification and conducts a background check for doulas who are then listed on the Health Department website. Most major metropolitan areas have birth networks that can help with doula selection.

I wish Ms Paul had indicated if the doula who disappointed those parents was certified, and if the parents have contacted her certifying agency with their concerns. That would be most helpful to all doulas and future clients in her area.

Finally, given that our cesarean rate is an astounding 31% and rising nationally, and that our maternal mortality rate is rising in direct proportion, and that our infant mortality rate is worse than most industrialized nations, is it really the 1-2% of doula supported births we should be concerned about?

Susan Lane, CD DONA, LCCE, CLC

Minneapolis, Minnesota

Sunday, March 9, 2008

Birthing in the Field

Hi Gail,
I thought I'd send you a link to my blog where the birth story for Adeline Louise is located
The Inversion worked to turn her from breech to vertex but like her sister before her, AddyLou decided to present in the persistent ROT-Posterior presentation, then oddly, she rotated on the perineum so that her face was then fully looking at my right thigh. We had about 45 seconds of shoulder dystocia and then both her shoulders birthed at once. Miraculously my perineum was intact but for skid marks.
...I especially appreciated your website with this pregnancy for all the information and inspiration I found there. Knowing I had an anterior placenta, a transverse baby who moved to breech before vertex, then a persistently "mal" positioned baby was stressful but I took comfort and strength from the information and stories on your site.
While this third labor and birth was longer and more physically/emotionally challenging for me 7 hours to get an 8lbs 10 ounce, interestingly positioned baby out is really pretty good. Not a cake walk, for sure, but doable.
Thanks for all you do!
Brenda Sutherland-Field

Thursday, March 6, 2008

Fear of second birth after previous long labor

"I am almost 36 weeks pregnant with my second baby. My first son was born naturally, with no pain relief, no intervention and no instruments, after a 30 hour labour. It was very difficult but we pulled through and he was a very healthy newborn. He was average size (3.7kg). He had been LOA throughout the final months of pregnancy and was born LOA. I did a lot of positioning work then.

I would like to repeat that experience but am disheartened by the fact that the current baby has been completely posterior since week 33/34. He was LOA at the 33 week check, then in the following days I noticed he had shifted and I was having constant back pain that I had never had before in either pregnancy (pressure in the back). Then at the 34 week check he was confirmed posterior.

I stand or walk for most of the day. I don’t slouch on the sofa. When I sit my bump hangs forward.

I am concerned that when I go on all fours I am effectively doing an inversion and risk turning the baby breech. I feel that if I remain upright, the shape of my bump should by itself facilitate an anterior position. I don’t understand why the baby has turned posterior. I haven’t had back pain again so it doesn’t seem like he is trying to turn back at all.

I am terrified of a posterior labour. I don’t think I can handle anything worse than what I had last time, and that was with LOA. I have lost all confidence in my ability to have a natural birth. I would be very grateful for your advice."

You are facing a common dilemma. The second labor after a first, long labor.

Remember, most women having posterior labors have progressing and do-able labors. First of all, babies come out. You've done it before and you can do it again. There is an illusion that medicated birth is painless, shorter, etc. Its just different, it may be easier, but of course, most 2nd births are going to be easier anyway.

There are common mistakes about what to do to help a baby into a good starting position for labor.
Maternal positioning is only the second of 3 Principles, please visit the discussion of the Three Principles on my Pregnancy page.

You are not at all doing an Inversion when you are on all-fours.
The Inversion is a wonderful tool when used as shown in the video in this blog, search Inversion. Limiting the time you do the inversion will prevent the baby going breech. But you can do it daily for a short period of time, as shown in the video. Do not do the Inversion if your doctor or midwife has said that there is more amniotic fluid than usual (for instance, you measure 3 or more cms over dates).

The shape of your abdomen, your bump, as you call it, is not a reliable indicator of fetal position. Nor will it make your baby be anterior. You can try adding a pregnancy belt to see if that helps baby rotate, but I suggest body work. Myofascial work on your broad and round ligaments. Meanwhile, repeated Inversions will eventually help the broad and round ligaments as your pelvis comes into symmetry over time and repetition.

Do you have a doula who is mature and calm?

I've helped many women, as a doula and as a midwife, with just your situation. Very often their labors are delightfully shorter than the first, in spite of having a posterior baby the second time.

You don't have to start with an anterior baby, you have to start with a tucked chin.
It also helps to have a relaxed pelvis, pelvic floor muscles, and uterine ligaments and be moving with your labor, in positions that help the uterus line up with your pelvis. You can do that with the Inversion, Chiropractic and the Pelvic Floor Release.

You may have to face the fear of a 30-hour labor again so you can get past that and get on with a second labor. The real labor. Not the labor in your mind. There is only room for one head in your pelvis, and it isn't yours.
Look at When Should I Worry?

Once you do that, you can enjoy the wonder of this child and this remarkable journey you are on.

How do you want to remember this pregnancy? Let go and find some joy here. I will try and follow this advice in my day today while I hold you in my heart and trust that you will find your way. I know you can.

Have a brave and wonderful birth.

CIMS congress in session

The Coalition for Improving Maternity Services (CIMS) is now in session, March 6, 2008.

There will be the release the International MotherBaby Childbirth Initiative on Saturday, International Women's Day. If you have time check out the MotherBaby web site

The purpose of the IMBCI 10 Steps is to improve care throughout the childbearing continuum in order to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies around the world.

A consumer version of the Initiative, "Having a Baby? Ten Questions to Ask" is available.

Sunday, February 24, 2008

Safety and Risk

Like all matters of the heart,
As in all true passions of art,
Birth calls for the fullness of your madness.

Too reserved and cautious an approach will be met with equal fears and self protection.

To give ourselves fully is to be met fully,
For Spirit responds as is trusted;
being the key to finding yourself face to face with mystery

Light and color play between the scene and the painter and is lost to those who already view the picture they seek


Tuesday, February 19, 2008

That's why they call it labor and not epidural

Love and vision brought it all together, though it was tough at the end.
Such a birth helped the family go deep into where they were really at, and look at beliefs and see if the beliefs were assumptions and not really the fiber of their lives
in an era
when the hospital culture is permeating even them.

They had to ask, what is the culture of homebirth and the mystery and the walk? And am I there, or am I not? Is it really ok to be there or am I wrong?
and what is the box I long for anyway?
and its rules
and the schedule that trims your life and your passion for a safety that isn't even safe?

Will we trade one hard walk, when others look down on it, when we ourselves are lifted up by it?
Will we take on the safe road? The trauma there, though hidden, is absolute.
We have to surrender the praise of the passive
and find the birthing within

Thursday, February 7, 2008

ACOG's loose cog on homebirth and Gail's comments

I got an email from my friend Debra Pascali Bonaro today. She's always up to date. She sent along the following statement from American College of Obtetricians and Gynecologists.

Wow, see ACOG's news release below against Home Birth... ACOG must be feeling
threatened from all the discussion about Home birth...The Business of Being
and more movies in the pike that are creating awareness and discussion.
I can't wait till we release Orgasmic Birth this spring. [Premiers in Minneapolis, September 25th, 2008]

As Christine Morton wrote: "interesting way they discount research showing
safety of home birth with trained midwives in attendance and end up
accounting for the rise in cesareans in terms of women¹s desires and
bodies. Hmmm."

I hope some of our groups will be responding to this... From a PR
perspective this is great... It shows they are threatened and this will
keep the dialogue going I hope.
Debra Pascali-Bonaro

Here's the statement:

For Release:
February 6, 2008
ACOG Office of Communications
(202) 484-3321
ACOG Statement on Home Births

Paragraph 1.) Washington, DC -- The American College of Obstetricians and Gynecologists
(ACOG) reiterates its long-standing opposition to home births. While
childbirth is a normal physiologic process that most women experience
without problems, monitoring of both the woman and the fetus during labor
and delivery in a hospital or accredited birthing center is essential
because complications can arise with little or no warning even among women
with low-risk pregnancies.

2.) ACOG acknowledges a woman's right to make informed decisions regarding her
delivery and to have a choice in choosing her health care provider, but ACOG
does not support programs that advocate for, or individuals who provide,
home births. Nor does ACOG support the provision of care by midwives who are
not certified by the American College of Nurse-Midwives (ACNM) or the
American Midwifery Certification Board (AMCB).

3.) Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre. Despite the rosy picture
painted by home birth advocates, a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. Attempting a
vaginal birth after cesarean (VBAC) at home is especially dangerous because
if the uterus ruptures during labor, both the mother and baby face an
emergency situation with potentially catastrophic consequences, including
death. Unless a woman is in a hospital, an accredited freestanding birthing
center, or a birthing center within a hospital complex, with physicians
ready to intervene quickly if necessary, she puts herself and her baby's
health and life at unnecessary risk.

4.) Advocates cite the high US cesarean rate as one justification for promoting
home births. The cesarean delivery rate has concerned ACOG for the past
several decades and ACOG remains committed to reducing it, but there is no
scientific way to recommend an 'ideal' national cesarean rate as a target
goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean
Delivery to assist physicians and institutions in assessing and reducing, if
necessary, their cesarean delivery rates. Multiple factors are responsible
for the current cesarean rate, but emerging contributors include maternal
choice and the rising tide of high-risk pregnancies due to maternal age,
overweight, obesity and diabetes.

5.) The availability of an obstetrician-gynecologist to provide expertise and
intervention in an emergency during labor and/or delivery may be life-saving
for the mother or newborn and lower the likelihood of a bad outcome. ACOG
believes that the safest setting for labor, delivery, and the immediate
postpartum period is in the hospital, or a birthing center within a hospital
complex, that meets the standards jointly outlined by the American Academy
of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that
meets the standards of the Accreditation Association for Ambulatory Health
Care, The Joint Commission, or the American Association of Birth Centers.

6.) It should be emphasized that studies comparing the safety and outcome of
births in hospitals with those occurring in other settings in the US are
limited and have not been scientifically rigorous. Moreover, lay or other
midwives attending to home births are unable to perform live-saving
emergency cesarean deliveries and other surgical and medical procedures that
would best safeguard the mother and child.

7.) ACOG encourages all pregnant women to get prenatal care and to make a birth
plan. The main goal should be a healthy and safe outcome for both mother and
baby. Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. For women who choose
a midwife to help deliver their baby, it is critical that they choose only
ACNM-certified or AMCB-certified midwives that collaborate with a physician
to deliver their baby in a hospital, hospital-based birthing center, or
properly accredited freestanding birth center.

# # #

The American College of Obstetricians and Gynecologists is the national
medical organization representing over 52,000 members who provide health
care for women.

Gail's Reactions

ACOG's statement includes misleading projections, emotionally-based opinions, fear, and just plain self serving PR. I'd be nice, but ACOG has been promoting its position with false and jilted accusations against non OB birth attendants for decades and it gets tiresome.

First of all, Mehl in the 70s and, currently, Daviss and Johnson in this decade have constructed excellent research on the safety of homebirth with non-nurse midwives. CPM2000 research outcomes have been available for plenty of time now for a fellow of ACOG to read it. Canada and Britain embrace the quality job done by Betty-Anne Daviss and Ken Johnson, though, like the doula studies, its rare that an American physician doesn't block, obscure and resist evidence-based innovations that would require them to share care in the birthing room.

Gail's rebutal:

1st paragraph
"No warning" --?! Trained homebirth Midwives handle birth emergencies very well. Ken Johnson shared that though homebirth midwives may experience higher numbers of shoulder dystocia [presumably due to higher average birth weights among homebirth families] there were no deaths and fewer adverse outcomes when compared to
shoulder dystocia in hospital birth statistics. I'm waiting for specifics on that finding from Ken. I mention it here as an example.

2nd paragraph and Gail's comments:
"ACOG acknowledges a woman's right to make informed decisions regarding her
delivery and to have a choice in choosing her health care provider, but ACOG
does not support programs that advocate for, or individuals who provide,
home births." So, ACOG acknowledges that women are choosing homebirth providers, but doesn't support homebirth programs or providers. Thats a relief. I wouldn't trust an ACOG based homebirth service. The transport rate would likely be 100%, eh?

3rd paragraph and rebuttal:
"Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre."
Will ACOG rebut the cesarean fashion raging in Hollywood?

"Despite the rosy picture
painted by home birth advocates, [Again, I'm loving living in the Light and Color as a homebirth midwife. Inside joke, and reference to Susan Sarback's School of Light and Color.] a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. "
We covered this in paragraph 1.

"Attempting a
vaginal birth after cesarean (VBAC) at home is especially dangerous because
if the uterus ruptures during labor, both the mother and baby face an
emergency situation with potentially catastrophic consequences, including
death. Unless a woman is in a hospital, an accredited freestanding birthing
center, or a birthing center within a hospital complex, with physicians
ready to intervene quickly if necessary, she puts herself and her baby's
health and life at unnecessary risk."

My friends who work as hospital employees on Labor and Delivery tell me of mistakes that cost lives and ruptures. Mistakes such as attempting to flush the uterus of meconium or increase amniotic fluid by replacing the natural fluid with a saline solution-only not to notice that the solution is blocked by the baby's head and can't exit. The fluid builds up until the uterus ruptures. Then, there is the continued use of cytotec for induction and its causal increase in uterine rupture, and a subsequent rise in amniotic fluid embolism of over 200%. Amniotic fluid embolism is almost always fatal to the mother, and that is also true against the healthy mother, and she doesn't have to have had a uterine scar for a cytotec rupture.

Let's address the speed of surgery necessary for saving a baby after a catastrophic rupture. Another friend spoke of an induced VBAC mother on an epidural complaining of uterine and shoulder pain. She was told repeatedly that the epidural wasn't taking fully and that she was fine. That is, until the baby died. Then the doctors discovered that her uterus had been ruptured for some time- time enough to have done surgery hours before and save her baby.

Homebirth midwives tend to listen to mothers. Homebirth mothers do not have epidurals which can confuse symptoms. Other problems may occur with home VBAC, and rarely they will, but lets not confuse location of birth with the illusion that death happens in one place and not another. Facts, irrefutable data, exist to show the safety of homebirth.

4th paragraph and rebuttal:
ACOG is looking to see if a reduction in the cesarean rate is necessary? Would a plumber seriously tell the building commission one toilet per house is all that is really necessary? No offense to plumbers, please note, who do not, mind you, in any way imply that homeowners should install a toilet for every person in the house to protect them from the effects of incontinence. Nor do plumbers advocate studies to see how many feet of pipes American cities and towns could bear before the public noticed adverse effects, such as soil erosion, or problems with laying streets, and raise an alarm that would outweigh the monetary benefits to their profession. However, ACOG and many OBs talk of cesarean studies to see how many medically unnecessary cesareans could be done before the public complained of loss of mothers, injuries to too many mothers and children, etc. Right now, obstetrics supposes that the corresponding higher maternal death rate is acceptable at a 30+% cesarean rate.

Gail's comment on paragraph 5:
Women risk the increased injury of having an Obstetrician care for them rather then a Family Practice doctor or Midwife. Non medically trained midwives have been shown to have the lowest injury rates of trained birth attendants. (Mehl)Link

Paragraph 6:
References that refute ACOG's claim that homebirth hasn't been adequately studied is aptly addressed at the following links:
British Medical Journal, CPM2000
Midwives Alliance Homebirth References
Ronnie Falcoa's posting of Homebirth and Out-of-Hospital Birth, Is it safe?
Excerpts from Experts on homebirth safety at Heritage Homebirth
From Mothering Magazine and Pam England There's No Place Like Home.

Paragraph 7:
Thomas Strong, MD succinctly challenges the ACOG and medical prenatal care system in his book, Expecting Trouble. Women come to homebirth midwives sometimes just to get the superior prenatal care. We often spend 45 minutes to an hour with families. Nutritionally based prevention is limited in clinic settings. However, many homebirth midwives give extensive nutritional counseling to prevent anemia, preeclampsia, postpartum hemorrhage, to enhance the health of the baby and mother and postpartum recovery.

ACOG says, "Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. "
Let me share an excerpt of an email I sent to a grandmother who works with infant loss in her occupation. She was worried about her daughter's upcoming homebirth:

"Remember the risks of birth are three, " Gail wrote,
  1. "Those we have no control over and will happen no matter home or hospital;
  2. Those that are due to interference or neglect by well meaning caregivers that misunderstand the physiology of birth (again, no matter where they are or got their training and in spite of intent);
  3. And last and least often, by delay in emergency help.

There are uncommon events that can make a lovely home birth turn sour or tragic. I acknowledge that.

But there are common and standard events that interrupt bonding, breastfeeding and a mother's perception of her ability to parent and succeed as a woman, mother, wife and community contributor that happen with every hospital birth. Yes, I mean to say every. Even those rare, good hospital births with wonderful, skilled and intuitive care providers like [your daughter's Family Physican used for her first child's birth].
These interruptions in the physiology of human birth come from birthing outside of a woman's own environment. These interruptions can not be made up, but they can be compensated for. We now have generations of human mothers compensating for poor birth environments and the subsequent adverse effect on mothering and self. We are the walking wounded.
[Your daughter], along with other home birth mothers, just doesn't think that accepting some harm, the certain harm of disrupting the physiology of childbirth, is worth accepting to avoid the very small risk of harm due to the location of a home birth. Most emergency cesareans take 20 minutes or longer to begin, did you know that? You may find the CPM study useful."

ACOG concedes:
"For women who choose
a midwife to help deliver their baby, it is critical that they choose only
ACNM-certified or AMCB-certified midwives that collaborate with a physician
to deliver their baby in a hospital, hospital-based birthing center, or
properly accredited freestanding birth center."

CNMs offer a wonderful service to American women. And CNMs will remember when ACOG was against their profession. Birth Center advocates will remember when they were attacked by ACOG.
Let's not fall into the pattern of the recently oppressed once raised now turning on those below them in the hierarchy of (supposed) power. Midwives must stand together. Submission of midwives under physicians may have a similar dynamic of how a battered wife will submit and stand by her man as she and her children are lost or emotionally distorted beyond recognition.
Professor Shelley E. Taylor, PhD on Womens' Stress Response

We have to speak up for homebirth. Our future depends on safe and gentle, physiologically centered birth care. Not only from midwives, but doctors, nurses and family members, is physiological and kind care needed.

Here is an email sent to me about this entry:

"Great response as I too, was going to add, they should practice what
they preach. "Childbirth decisions should not be dictated or influenced
by what's fashionable, trendy, or the latest cause célèbre." I can't
tell you how often dr.s I have asked about the increase in C birth reply,
"My hands are tied as women come in asking for it at their first
prenatal visit." Sounds like the woman is blamed again rather than the
dr. giving reassurance a vaginal birth is safer and natural.

Since I am the 'grandmother' you speak of, it was great! I'll forward
this to [her] sister who is having a home birth in five weeks. Keep up
the good work!


Wednesday, February 6, 2008

Minneapolis Birth ranks high

Alisa Blackwood, a local doula here, sent this around today:

Fit Pregnancy magazine has named Minneapolis the 2nd best city to have a baby in (behind Portland, Ore.). One of the reasons?
"Minneapolis has one doula for every 37 live births, the highest ratio in our survey. The national average is one doula per 649 live births."

Go doulas! Link to the Minneapolis "report card" and look up other cities here:


Alisa Blackwood
Freelance Writer & Birth Doula...and here is Alisa's signature quote:

"Peace: It does not mean to be in a place where there is no noise, trouble or hard work,
it means to be in the middle of those things and still be calm in your heart."

I wonder how we'd rank if we included our homebirths - hey, that's a question
Betty-Anne Daviss and Ken Johnson could answer if the stats collected on their

website, Understanding Birth Better, for the certified professional midwives (CPMs) were examined for such data. Just a thought.

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.