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The Language of Birth
Remember that in a normal birth, mothers give birth and babies work to get themselves born by pushing off with their feet against the top of the uterus and by maneuvering their head to fit optimally through the pelvis. In a physiological birth, the birth attendant simply "attends" the birth, ideally supporting the mother-led birth process and intervening only when it is truly necessary.
Doctors truly deliver babies only by cesarean, forceps extraction, vacuum extraction or a variety of other invasive and often harmful interventions.
In the way that we're all trying to work towards giving babies
their birth right of a physiological birth, I think it would be
helpful to use the language of physiological birth.
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Request A Copy of Your Medical Records after
the Birth!
An Idea Whose Time Has Come
This idea came from a researcher in the field of prenatal and perinatal psychology who observed that the people who have control of the information have control of the research. If you want to be able to participate in long-term research studies about your child's health as a side effect of the procedures performed during pregnancy, labor and birth, and in the newborn nursery, then you will need to have a copy of your records.
"As a prenatal/perinatal therapist, such records can be invaluable in explaining a problem or validating a hunch about what happened to a baby/child presenting symptoms of birth trauma. . . .[I]f it becomes routine for mothers to request their medical records, it's possible that hospitals will become a bit less defensive about releasing them (fearing they'll be used to support litigation) and that the idea that this information is rightfully that of the parents (and the baby, really) might become more accepted. This would serve to support more and more research I see taking place down the pike as my fellow students in our field explore different aspects of pregnancy and birth and empower families to learn more about how birth relates to how their children think, feel and act in life. . . . So . . . let's think in terms of working towards having medical records of births easily and frequently released to mothers who request them, and having mothers empowered to believe they are entitled to this data and that it can ultimately benefit their understanding of their birth, and their child's well-being."
The researcher suggests asking for the full medical records
(including nurses' notes) of their birth (and/or child's nursery
stay).
WARNING!!! If you have Aetna health insurance, you may want to change at the next opportunity, when your employer has their annual "open enrollment". Aetna doesn't cover homebirth, citing a single study based in rural Australia which shows that high-risk births far away from a hospital are high risk. They further cite the policies of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, both business competitors to homebirth providers. Their policy statement ignores a mountain of evidence that homebirth is as safe as or safer than hospital birth for normal, healthy pregnancies.. If their policymakers have any integrity, this logic will soon lead to cessation of coverage for planned VBAC's . . . there's no dearth of studies and AAP and ACOG policies proclaiming the danger of VBAC's . . . and then they'll stop coverage for any woman who declines standard ACOG/AAP recommendations regarding routine ultrasound, routine induction, routine IV's, routine use of continuous electronic fetal monitoring, routine administration of antibiotics for all GBS positive women (up to 40% of birthing women), and prompt cesareans for any woman who fails to progress in a timely fashion during labor and pushing. They may also stop coverage for children who are not vaccinated according to the full schedule of vaccinations recommended by the AAP, even though many intelligent parents decline the newborn hepatitis B vaccine and practice selective vaccination according to their child's own needs.
If this is troubling to you, as it should be, let them know. You can easily send e-mail to Aetna's National Media Relations Contacts and simply tell them that they should not be in the business of denying coverage for reasonable healthcare choices, such as homebirth, waterbirth and VBAC. They will especially want to know if you are choosing another healthcare provider because of this unreasonable policy. You might also suggest that they expand their research beyond ACOG and AAP recommendations. They could start at: http://www.gentlebirth.org/archives/homsafty.html#References
If I can boycott Nestle, so can you!
If you need more motivation to boycott Nestle, then read: NESTLÉ BABY FORMULA UNDER FIRE FOR FALSE HEALTH CLAIMS
"Mr Ian Smith of York, gave his account of the company's ethics: "As one the members of Synod from York, where we have a significant Nestlé presence, I was invited, before the last debate on this subject in 1994, to meet some of their directors to discuss the issue. At that time they freely admitted that they were the market leaders of a trade that was being mishandled in some parts of the world. I observed that this resulted in many thousands of infant deaths. The response was that if they didn't sell the product someone else would. We've heard that line with regard to landmines recently: In other words, it's better that they're killed by our products rather than someone else's. Nestlé admitted that the business has its unethical side, but they still push it hard. They say they will stop - if others do too."
See also: Podcasts
You Tube Videos can be the easiest way to bring yourself up to date with some important birthing issues. This list is courtesy of Kelly Harrison.
EPISIOTOMY - If you want to see an episiotomy (or want to show someone), you'll find it in this video about 1min45sec into the clip. Then watch the MD pushing the baby's head.
EPIDURAL - The MD explains the steps he's performing. Note that the video is edited so that the time for the entire procedure is shortened.
C-SECTION (w/ "Mobius Extractor") - I find the pleasing music an odd contrast to the up-close cutting, prodding, tearing, etc. This leaves no details left to the imagination. The "extractor" is a new device. This video is supposed to illustrate the ease and benefit of using it. Shows stapling of incision. I can't help but feel sorry for the women behind the curtain.
C-SECTION (Hartford Hospital) - This is an hour-long "documentary" showing off the hospital facilities, but it also gives us a c-section up close, uncut, so you can get an idea of the time involved. The intro says there are over one million cesareans each year making it the "most common procedure." I love this doctor quote from the start, saying c-sec is "one of the most rewarding [procedures] for the obstetrician to perform." The baby is breech and the MD says delivery by c-sec is "safer" for the baby than vaginal birth. Also note lots of lavage and O2 for baby who is very floppy.
HOMEBIRTH - 6-min homebirth with use of dopler and amniohook to break bag of waters. Older sibling at birth.
HOMEBIRTH in the UK - delivered on all fours on Christmas morning. Only "technology" was dopler.
EDUCATION
Animation of the normal process of dilation and delivery.
Animation explaining "stations" relative to pelvic bone.
Animation of shoulder dystocia
HUMOR - This is the Monty Python Birth Skit, which is BRILLIANT. I love the part about the totally irrational depression the mother will experience, so "it's happy pills for you!"
Bill Cosby's old birth skit, in two parts, Part A and Part B.
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If you want to see a glaring example of how obstetricians don't GET the normal physiology of birth, you can go read their statement on Lay Midwives. Their first problem is that they don't understand the difference between a lay midwife and a Licensed Midwife or a Certified Professional Midwife. Here's a primer for them and for you!
A lay midwife has no formal midwifery education or training, so typically wouldn't carry anti-hemorrhagic drugs or resuscitation equipment.
A Licensed Midwife is a midwife who has satisfied the educational and experience requirements of her state to earn a license. Here's information about a California Licensed Midwife (LM), which is considered the most rigorous set of requirements. Here are photos of some of the equipment she might bring to a birth.
A Certified Professional Midwife (CPM) is a midwife who has satisfied the educational and experience requirements of the North American Registry of Midwives (NARM). CPMs typically train and practice in an out-of-hospital environment.
A Certified Nurse-Midwife is a midwife who has satisfied the educational and experience requirements of the American College of Nurse-Midwives (ACNM).
(Notice that the last three are not mutually exclusive. In fact, a single person could be an LM, CPM, CNM, CM, MD, RN, PhD if she wanted. In fact, there is a great deal of overlap among the formal certifications, but here's an easy way to think of it: The C is for "Certified", and this means that someone received a Certificate from a Certifying body. A license is from the state, and it gives someone the legal right to practice.)
One of the really funny things about ACOG's statement is that they seem to think it's very important for midwives to be trained as nurses first in order to attend births, but not for physicians. Have you ever heard of a nurse-OB? No, I didn't think so. In most countries, such as the UK, midwives are independent practitioners working in collaboration with physicians, and they specialize in midwifery directly, without detouring through nursing school. ACOG's repeated opposition to efforts by all kinds of midwives to reinstate their relationship as collaborative rather than supervisory emphasizes their desire to control women, birth and midwives. It is no wonder that they oppose midwives who train outside the hierarchical environment of the hospital, where the physicians are the ultimate authorities.
You can read more about the Different Types of Midwives.
Their second problem is their emphasis on hospital training, which is typical for nurse-midwives. Homebirth midwives are specialists in normal birth, with specialized training for handling birth emergencies in an out-of-hospital environment with the portable equipment and supplies typically used in a home environment. So it's obvious that they should be trained in the environment in which they expect to practice.
You can read the Bridge
Club's Letter to ACOG re: Improper Term "Lay Midwife"
[March, 2006]. (The Bridge Club is a committee composed of
midwives from the two main midwifery organizations in the United
States.)
Guide
to
a Healthy Birth - excellent resource from Choices in Childbirth.
Available online or for $1.50 by mail.
Listen
to Mothers: Surveying the Experience of Birth from Childbirth
Connection [8/28/13] - Childbirth Connection's ongoing
Listening to MothersSM Initiative is devoted to understanding
experiences and perspectives of childbearing women and using this
knowledge to improve maternity policy, practice, education, and
research. Listening to Mothers surveys enable us to compare actual
experiences of childbearing women and newborns with mothers'
preferences, as well as with evidence-based care, optimal
outcomes, and protections granted by law. Identified gaps present
opportunities to improve conditions for this large and important
population during this crucial period.
The
Other
Side of the Glass - Youtube video. Empowering fathers
to protect their babies and partners.
Easy self education about childbirth - audio file BIRTH - A one-hour public radio and audio documentary about the practices and perceptions of birth in America.
The companion piece, BORN: An
hour-long audio journey exploring the postpartum experience in
contemporary American life.
Wow! Now this is an idea whose time has come!
Lilah Monger is a co-ordinator for the AAMI Reading Rooms:
The childbirth reading room is designed to educate women about natural birth. Books are chosen for their promotion of birth truth and birth trust.
The unassisted childbirth reading room is similar in format to the childbirth reading room but features books that are recommended reading for women who are considering unassisted homebirth. Books are chosen for their promotion of gentle, unhindered childbirth.
The
midwifery
reading room is also similar in format but intended for
birth professionals and students.
Why
Your Baby's Birth Matters by Diane Wiessinger - A fabulous
summary of the most important aspects of birth from your baby's
perspective!
These articles are written by Ronnie Falcao, LM MS, the editor of the Midwife Archives and owner of gentlebirth.org
Homebirth Benefits - Why Homebirth Is Most Appropriate for Normal Birth
Dangers
of
Hospital Birth - Why Birthing in a Hospital Causes More
Problems Than It Solves for Normal Birth
What's the Best Way to Spend 80 minutes of your pregnancy? Listen to Your Body, Your Birth - Secrets for a Satisfying and Successful Birth - a great audio book from Lynn Griesemer. "80 minutes of warmth, common sense, humor, integrity and love that inspires, encourages and reveals secrets for a most rewarding birth experience - one you will cherish the rest of your life."
"This is the best audio resource about childbirth I've
encountered. It's got lots of wonderful tips and really does
capture the secrets in a way that's easy for women to
understand. I highly recommend it!" - [Ronnie Falcao,
editor, The Midwife Archives]
Indie Birth - an online homebirth magazine. Here's the purpose of Indie Birth:
To fire up the minds of modern-day mamas, so that they are inspired, educated and aware of all the choices surrounding them concerning their pregnancies and births.
To cater to those that are already independent, free-thinking and
maybe a little bit radical... and to transform those mamas not yet
in touch with their instinctive abilities to birth and nurture
naturally.
Seeds of
Compassion - from a conference Apr. 11-15, 2008, with the
participation of the Dalai Lama. When we look across secular and
religious wisdom traditions, and across human history and
cultures, compassion may well be the virtue that is valued most
highly and most broadly. The resources below seek to expand our
conversation about what compassion looks like in action and how
best to nurture it in future generations.
Check to see if the hospital you're considering is on the list of
Baby-Friendly
Hospitals and Birth Centers. A Sept., 2005 study
showed that these hospitals had higher rates of breastfeeding,
regardless of demographic factors that are traditionally linked
with low breastfeeding rates.
The Mommy Uprising By Tina Cassidy - They're fed up with the unwanted C-sections, the endless tests, the dubious interventions, and the scary advice from overworked, malpractice-spooked doctors. And Boston women are shunning the area's world-class hospitals to go to surprising lengths--and sometimes take big risks--to give birth on their own terms.
For expectant women, it's not too much to ask by Tina Cassidy. This great article will help you to understand why "less is more" when it comes to midwifery or medical support for a physiological process such as birth. (Tina Cassidy is also the author of Birth: The Surprising History of How We Are Born.)
Tina Cassidy's article is based on the Listening
to
Mothers surveys.
Why
do
women go along with this stuff? [Full text of Part
2]
Klein MC, Sakala C, Simkin P, Davis-Floyd R, Rooks JP, Pincus J.
Birth. 2006 Sep;33(3):245-50.
PREFACE: Normal childbirth has become jeopardized by inexorably
rising interventions around the world. In many countries and
settings, cesarean surgery, labor induction, and epidural
analgesia continue to increase beyond all precedent, and without
convincing evidence that these actions result in improved outcomes
(1,2). Use of electronic fetal monitoring is endemic, despite
evidence of its ineffectiveness and consequences for most
parturients (1,3); ultrasound examinations are too often done
unnecessarily, redundantly, or for frivolous rather than indicated
reasons (4); episiotomies are still routine in many settings
despite clear evidence that this surgery results in more harm than
good (5); and medical procedures, unphysiological positions, pubic
shaving and enemas, intravenous lines, enforced fasting, drugs,
and early mother-infant separation are used unnecessarily (1).
Clinicians write and talk about the ideal of evidence-based
obstetrics, but do not practice it consistently, if at all. Why do
women go along with this stuff? In this Roundtable Discussion,
Part 2, we asked some maternity care professionals and advocates
to discuss this question.
One of the simplest and best things you can do for your baby is
to work with your birth attendant to prevent premature cutting of
the umbilical cord. Take a copy of Clamp
the
Umbilical Cord Early and Risk Injuring Your Child's Brain by
G. M. Morley, MB, ChB (Ed.), FACOG, and discuss the issue with
them. [More info about premature
cord clamping/cutting.] While you're at it, you can
talk to your birth attendant about using a cord clamping system that is
breastfeeding friendly.
Study Shows Homebirth Superior to
Hospital Birth - A summary of the 2005 BMJ Homebirth Safety
Study.
Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review) - The Cochrane Collaboration is a committee of MDs who review all known research in their fields to produce summaries. This is a landmark abstract from The Cochrane Library, Issue 3, 2003 by Anderson GC, Moore E, Hepworth J, Bergman N
Make sure your birth attendant and hospital staff are familiar with this study!
"Background: Early skin-to-skin contact involves placing the
naked baby prone on the mother's bare chest at birth or soon
afterwards (< 24 hour). This could represent a 'sensitive
period' for priming mothers and infants to develop a synchronous,
reciprocal, interaction pattern, provided they are together and in
intimate contact. Routine separation shortly after hospital
birth is a uniquely Western cultural phenomenon that may be
associated with harmful effects including discouragement of
successful breastfeeding."
Briefcase Full of
Diapers - The Working Woman’s Resource for Having and
Nurturing Healthy Children by Julie Fagan
From Birthing the Future - they offer information, ideas, conferences and inspiring books & videos. 970-884-4090
Birth in a Sanctuary - Imagine . . . a place where
everyone:
Honors the work you & your baby are doing
Values natural, normal birth!
Treats you as the amazing woman you are
Understands your baby is fully conscious and sensitive to
everything.
Respects that both of you need only positive words & images
Don't settle for a typical birth, create an extraordinary one!
The National
Childbirth Trust - From the UK, this site offers support in
pregnancy, childbirth and early parenthood. They have a
separate portal for
professionals.
You can also educate yourself week-by-week in your pregnancy with theLamaze Weekly Pregnancy Newsletter for Parents
Birth Blogs - Giving Birth
With Confidence - The authors of the Official Lamaze Guide
muse about birth, babies, and a whole lot more…
Empowering
Birth
Blog - A homebirth after cesarean healed my scars and
renewed my trust in birth. Trying to spread the message that birth
should be EMPOWERING.
Reclaim
Your
Right To Birth Right by Christiane Northrup, MD [10/16/09]
The Birth Ecology Project
advocates for midwifery, doula care, natural birth, conscious
parenting, and sustainable living. The Birth Ecology Journal
publishes articles and essays of quality on topics of interest to
parents, birth professionals, and birth advocates on the website.
Workshops for parents and professionals are also in the works.
Homebirth
at
the Hospital By Doula Giuditta Tornetta
Home
Birth
Talk provides information about the home birth option and
midwives, the facilitators of home births. Download or subscribe
to free podcast episodes fromMidwiferyWorld Podcast By Kris Bagiu,
CPM, LM
My first baby was born at home. The second (for lack of caregiver) was born in the hospital (within an hour of our arrival) into my husband’s hands while I squatted on the floor. The doctor who was called in by the nurse was too shocked to do much more than watch and the only words we heard from him were “oh my God!”. My husband reassured the OB (later featured in the local newspaper for having 4,000 births to his credit) with the words…”it’s okay we’ve done this before.” LOL
We left a few hours later. As “homelike” as that experience was there is no question that I was not in my home and that the offers of “help” (are you sure you don’t need a shot of oxytocin, wouldn’t you like to move to the bed for the birthing of the placenta, do you think it is wise for your 2 ½ year old to be in the bed with you, wouldn’t you like us to bathe your baby before leaving) wouldn’t have been uttered by the midwife who attended my first birth.
Some aspects weren’t even negotiable; I was required to leave in a wheelchair rather than walk to the front door and my baby needed a name before leaving if we wished to avoid extra administrative costs.
Although I had the complete support of my pediatrician (after interviewing a mere half dozen) even he made a mistake and suggested we test the baby for metabolic disorders before leaving. This of course proved to be too soon and the results came back with a diagnosis of cretinism!
Flowered sheets or not…they weren’t my sheets and didn’t smell like my laundry, the view out the window wasn’t my garden,
the people who knocked on my door weren’t my family members or guests, and the attitude of those talking about us outside the door weren’t the sounds of my household.
Was it a triumphant experience? You betcha! Did I use
it to motivate the dozens of couples taking my childbirth classes
to create their ideal (albeit hospital births)---but of
course!! Would I ever tell them it would be the same as
having a homebirth? NO.
National
Advocates for Pregnant Women (NAPW) - NAPW has a vision of a
world where women enjoy full personhood and where neither
pregnancy nor drug use serve as an excuse to dehumanize and punish
select groups of people
Dr Pregnancy is an
educational resource from the UK that seeks to celebrate the
wonderful world of pregnancy and childbirth.
There are hundreds of Articles from "Preconception Advice" and
"Pregnancy Fitness" to "Breastfeeding in Public".
We have an online Discussion Forum with a community of mothers
(and fathers) with expert advice. Come and join in and share your
thoughts on the wonderful world of pregnancy! You might
check out their page on Advantages
of
Natural Childbirth.
The Biology of Belief
reveals the leading edge science of how parenting programs a
child's genes and behavior. If you have a child, are
planning to have a child, or have ever been a child, this book is
for you.
Normal
Care
for Normal Birth by 2020 ~ Rehabilitating our National
Maternity Care policy by the year 2020 by Faith Gibson, LM CPM
Challenging
Chokepoint Medicine - For those of you who are most
interested in maternity care, midwifery and PHB, i think this
material will help you understand that the real root of these
problems -- the prejudice against physiological management and
midwives, the political issue of obstetrical supervision, the
escalating medicalization of normal birth through induction and
elective Cesarean -- comes from the same place and is a symptom of
basic problems with health care writ large.
Let
your
monkey do it! by Skylar Browning - a fun article written by
a dad about how the primal part of the brain controls birth.
Ten Moons Rising
- Holistic Family Education & Resource Center. "It is
painfully obvious that our society is in need of change, and it is
parents who will play a critical role in realizing that
change. For not only do we bring new life into the world
but, through the consciousness we bring to our children's earliest
experiences, we have the power to shift our current path from one
of fear and violence to one of transformation and healing."
They have an excellent links list.
The Landscape of Caring for Women: A Narrative Study of Midwifery Practice [Medscape registration is free.]
"Midwifery care has been demonstrated over and over to be
excellent and associated with positive maternal-infant outcomes. .
. . The midwives in this study were negotiators, not dictators.
They believed that power rested with the women and not necessarily
in themselves. This does not mean to imply that they were weak or
compliant; in fact, they were often the opposite. . . . In
addition, emphasis on presence and relationship, rather than
routine use of technology, may be misaligned with an institutional
and consumer fascination with machines as the solution to achieve
optimal birth outcomes. In this study, the midwife represented the
"instrument" of care. It was the midwife's ability to communicate,
engaged presence, and clinical judgment that presided, not the
technology that was used."
Home
birth: A woman's right to choose? By Mary Murry, R.N.,
C.N.M.
This article from the Mayo Clinic advocates for women to have the
right to choose where to give birth.
Pregnancy is a normal part of life. Typically, healthy mothers and babies don't require special medical attention. Choosing a facility that doesn't provide emergency services carries a small risk, however, since serious or life-threatening problems are possible during pregnancy or labor and delivery. In those cases, the need to transfer a mother and baby from a birth center to a hospital can delay care."This article does an excellent job of capturing the essence of birth center and homebirth care. Their only glaring omission is that they forget to mention the increased safety at home and in birth centers that comes from being away from dangerous hospital germs, which can kill vulnerable newborns. They also forget to mention that out-of-hospital birth is safer than hospital birth because of avoiding the dangers of pitocin, epidurals and artificial time restrictions. Keeping the baby with the mother and facilitating bonding and breastfeeding also improve the baby's health and prevent future health problems for the mother and baby.
In an age when women are choosing cesarean under the mistaken
impression that abdominal surgery is less painful and causes less
damage, it's important to remember that alternative birth
positions can prevent most perineal birth trauma; instead of
choosing cesarean to prevent perineal trauma, it seems important
to remember that there are other important choices one can make,
such as your choice of birth attendant. In
this
study, 73% of women attended by midwives birthed babies over
intact perineums.
Web-only resources written for
parents
fish
can't
see water - Why medicalised birth is bad for you. This
is a fabulous collection of information, including Marsden
Wagner's writings.
Aletha Solter's new book, Raising
Drug-Free Kids: 100 Tips for Parents, begins at conception
and includes a discussion of how the drugs used in labor and birth
predispose children towards drug abuse.
The "Trust Birth Initiative"
is an old/new concept in the birth field.
Women talking to women about birth.
Not another expert, not another class.
We facilitate discussion/support groups.
Meetings are usually in leader’s home, but may be in a library or
church nursery or community center.
The meetings are usually held one night a month.
The Circumfort
Kit contains sufficient quantities of materials to
effectively manage up to five potentially painful procedures that
are routine in the hospital. This is a kit for parents to
take with them to the hospital to make sure that their baby
receives adequate pain relief.
Home
Birth from the American Pregnancy Association
A Field Guide to Birthing: A
Conversation With Michael Witte, M.D., and Heidi Bednar, R.N.
- A great discussion of birth options from Medical Self Care,
edited by Tom Ferguson, M.D., 1978.
The goal of Prenatal Parenting
is a psychologically and physically prepared mother who will
birth a happy and healthy baby with full support from loved
ones. A family that follows the techniques described in Prenatal
Parenting:
The Complete Psychological and Spiritual Guide to Loving
Your Unborn Child will birth a happy and peaceful
newborn infant and help reduce the unacceptably high infant
mortality rate in the United States.
Bonding With Baby Before Birth (from WebMD) - Making a connection with your unborn child can strengthen the bond you share, make you feel closer, and enrich you and your baby's lives. Talk to the baby. Say goodnight before you go to bed, good morning when you wake up, and talk to it throughout the day. . . .
See also: Bonding and Prenatal Communication
It includes some wonderful articles:
Bonding with Your Newborn by William Sears, MD - This is the best, most accessible summary of attachment and bonding that I've seen.
The Chemistry of Attachment by Linda F. Palmer, DC (reprint)
A New Look at the Safety of Breastfeeding During Pregnancy by Hilary Dervin Flower, MA
Since the 1930s there was a steady reduction in the maternal
death rate each year until 1982. The Safe Motherhood
Quilt Project is a national effort developed to honor those
women who have died of pregnancy-related causes during the past
twenty years and to draw public attention to the unchanging
maternal death rate.
Quilt
honors
mothers who died giving birth - BY HOLLY TKACZYK - about The Safe Motherhood
Quilt Project
For a fun introduction to midwifery and natural childbirth, read
BABY CATCHER: Chronicles of
a Modern Midwife by Peggy Vincent. This is a
really fun, engaging book and will help you to get a sense of your
own strengths when it comes to birthing. It presents both
home births and hospital births in a way meant to avoid alienating
those on either side of what too often degenerates into a heated
argument about place of birth.
Think baby's first hours or even days don't make a
difference? Read The first hour
following birth - 4th September 2002 - In this article,
first published in Midwifery Today, Vol 61, 2002, Michel Odent
catalogues 12 perspectives on the first hour following birth.
Bursting
the bubble on mobile myths By Peter Cochrane [8/13/04] -
Beyond the critical issues of the importance of birth choices and
baby's first hour, there's the key issue of not being able to use
cell phones in hospitals. This article points out that the
cordless phones used in hospitals are more likely to cause
interference than cell phones, yet hospital staff seem to use them
freely.
Women of Spirit -
Ancient Women's Knowledge in a Modern Context - lots of wonderful
articles by Sarah J.
Buckley, MD
Maternity Wise
helps women learn about options and make informed decisions.
MidwifeInfo.com - Resources
for Midwives and their Clients
Ecstatic Birth is a
call for a revolution, a revolution in the way we think about
birth, and, as a result, the way we give birth.
CHILD MIRTH: A
conscious, empowering, lovingly supported pregnancy, labor, birth,
and postnatal experience that's respectful of the mother's needs
as well as the baby's; an ecstatic or orgasmic birth; mindful
parenting.
Planning a low-intervention birth? Wondering what your
chances are of achieving this? Read The
First
National Survey of Women's Childbearing Experiences:
In short, all but a tiny percentage had highly interventive births
although about half felt that a non-interventive, natural birth
was best. The ones with non-interventive births were the home
birthers. One-quarter had c/secs, and about 40% were induced.
Almost all felt they had enough information and participated in
decisions to the extent they desired, although most didn't know
there were drawbacks to epidurals or that they were entitled to
full info on interventions or that they could refuse them. Many
had experienced pp problems of various kinds, especially the c/sec
moms. One-third had clinical depression.
ROUNDTABLE
DISCUSSION:
PART 1 - Why Do Women Go Along with This Stuff?
Sheila Kitzinger, MLitt1* Josephine M. Green, BA(Hons), PhD,
AFBPsS, CPsychol2* Beverley Chalmers, DSc(Med), PhD3* Marc J.N.C.
Keirse, MD, DPhil4* Kathleen Lindstrom5* , Elina Hemminki, MD,
DrPH6*
PREFACE: Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early motherinfant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidencebased obstetrics, but do not practice it consistently, if at all.
Why do women go along with this stuff? In this Roundtable
Discussion, Part 1, we asked some maternity care professionals and
advocates to discuss this question. (BIRTH 33:2 June 2006)
Doctors are not scientists [BMJ 2004;328 (19 June)]
Lack of Evidence-Based Medicine
in Obstetrics
Maternal and Newborn Health also now online!
The following book was recommended for evidence-based care of uncomplicated labor and birth. Supporting your practice with evidence-based care is helpful when seeking reimbursement from HMOs and when challenged by supporters of increased use of technology. This is an inexpensive paperback and is available from WHO Publications Center USA, 49 Sheridan Ave., Albany, NY 12210. tel. 518-436-9686 or fax 518-436-7433 The cost is $10 with $5 for shipping. ($1 shipping for each additional copy.)
http://www.who.ch/pll/dsa/cat97/mat.htm#care
Excerpt of Summary of Research on Place of Birth (or the full section)
1997, iv + 54 pages
WHO/FRH/MSM/96.24; order no. 1930104
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Establishes universal guidelines for the routine care of women during uncomplicated labour and childbirth. Reflecting the consensus reached by an international group of experts, the report responds to the recent proliferation of practices designed to start, augment, accelerate, regulate or monitor the physiological process of labour in industrialized and developing countries alike. Recommendations for routine care are based on a critical review of what considerable research has to say about the effectiveness and safety of 59 common procedures and practices.
The report has six sections. The first establishes a definition of normal birth, and then considers the reasons why, in the interest of improving care, so many maternity services have uncritically introduced interventions that have been shown, in well-designed studies, to be useless, inappropriate, excessively costly, and frequently dangerous for mothers and babies. The differences between normal birth in hospitals and in homes, in industrialized and in developing countries are also considered together with the personnel, training, and skills needed to attend a normal delivery.
The four sections which constitute the core of the report systematically review the available evidence for and against the use of specific procedures in general labour care and during each of the three stages of labour. Details of this evaluation range from the advisability of withholding food and drink during labour, through a review of evidence demonstrating that routine use of episiotomy is harmful, to a description of several non-invasive, non-pharmacological methods of proven efficacy in pain relief.
In a key achievement, the final section classifies each of the 59 practices considered into one of four categories: clearly useful, clearly harmful or ineffective, inadequately supported by research findings and thus to be used with caution, and frequently used inappropriately.
"... contains several important messages, messages that are
perhaps more crucial for the developed world than for the
non-industrialised countries, although they, too, will find much
that is useful here..."
- Midwifery Digest
To order, send e-mail to QCORP@compuserve.com
For those that don't know, this book is a guide to a huge two-volume book in which the studies done on most everything done in obstetrics have been evaluated and conclusions drawn. This work is also the basis for The Oxford Database of Perinatal Trials.
The smaller, very readable paperback Guide is available for $28.95. Amazon.com has a review, including the table of contents.
The most valuable part is the section in the back:
What's the evidence about Home
versus hospital birth (Cochrane Review)?
The Midwives Model
of Care is based on the fact that pregnancy and birth are
normal life events.
P
e a c e f u l B e g i n n i n g s - a
collection of several of the more popular and useful articles and
information sheets that I written or put together during the
1970’s and 80’s for use in childbirth education classes, for the
expectant and/or new parent clientele of health care providers,
and for educating the general public.
If you want to have a little fun while learning about pregnancy
and childbirth, check out the new game - "Who's Having This Baby Anyway?"
Even if you're planning a medicated hospital birth, this is the
closest thing to informed consent you'll get, and you owe it to
yourself and your baby to learn some of the realities that the
hospital glosses over when they pretend "the drugs don't get to
the baby".
Technology
in
Birth: First Do No Harm by Marsden Wagner. M.D. - a great
discussion of the concept of appopriate technology and the folly
of using technology as if it carries no risks.
Cesareans:
Are
they really a safe option? by Henci Goer - If you watched
the recent segment on Good Morning America [June, 2000] addressing
the safety of cesareans and the issue of a woman's right to choose
this surgical procedure, you probably ended up feeling quite
confused.
BirthChoiceUK - This non-commercial website helps women in the UK choose where to give birth using information about maternity care, maternity statistics and research-based information about childbirth.
Has
the
medicalisation of childbirth gone too far?
Richard Johanson, Mary Newburn, and Alison Macfarlane
BMJ 2002; 324: 892-895.
Getting
What
You Want from Your Birth Experience an article by Doris
Haire
4 minute speech to convince you to have
natural childbirth
Kim's Collection of Woman's Wisdom - great site for inspiration and self-education.
Mother's Intention: How Belief Shapes Birth by Kim Wildner
Reports on Birth Preference Options - This page contains reports, free for personal use, that explain the origins of the interventions often found on birth plans, their rationale & medical indications for use, and the scientific evidence either supporting, or not supporting, their routine use. From Women's Wisdom,
What is Fearless
Birthing™? - It is a program of self-discovery. It is
nothing short of a map to the place where mother's intuition
awaits. It is a way to access the 'instruction manual' that does
come with each child!
My Words
of Wisdom - a collection of articles,
poems and opinions from Patti Blomme, author of the site Heads Up! All About
Breech Babies - Feed the Mother, Rest during
Labor, Birth's Most Dangerous Enemy, The Missing Link, A Rant on
Choice, The Chemical Symphony of Birth, She Could Have Died,
Innocent Ignorance, Can you Homebirth in a Hospital, I Can Do It,
A Father's Affirmation, Ode to An Epidural, Ode To A Home Birth,
Little Wonder
Birthing
the Easy Way -Learning the Hard Way - a book about birthing
by Sheila Stubbs
Tips for Labor - A Midwife's Suggestions
after Birthing Her First Baby by Joanna Baldwin, LM
A
Father's Anger and Birth Love by Bill McCracken - "the time
is coming where fathers will unite to stand up for their rights as
the loving protectors of childbirth." And Bill DID go on to
have
the birth he envisioned.
Evaluated Childbirth
- a terrific site for women looking for support for natural
childbirth
There’s
no
Place Like Home - The advantages – and joys – of giving birth
where you live By Pam England, author of Birthing From Within
This is a fabulous article from Mothering Magazine:
Revealing
the
Real Risks: Obstetrical Interventions and Maternal Mortality
Issue 118, May/June 2003
By Marsden Wagner
I must applaud all of the women who try to find caregivers before
they become pregnant. They are more likely to find someone
who "clicks" with them, than when those pregnancy hormones are
flying and they just want to make a decision so they can feel that
everything's calm. At least, until they're eight months
pregnant and push comes to shove about testing or induction.
Ask the hard questions early in care.
You can ask questions from The Midwife Pro (Midge
Jolly, LM, CPM) (formerly at Moms Online - oxygen.com)
The Compleat Mother - The
Magazine of Pregnancy, Childbirth and Breastfeeding - This
quarterly magazine is a wonderful source of affirming information
and support for following a path that is in your family's best
interests, even if it's different from the mainstream path.
They also offer some absolutely wonderful publications, "Birth
Pleasure", "Birth Joy", and "Breastfeeding Anyway".Two of
these are described on the web pages, or you can order them
in bulk (10 for $20 + $3 shipping) from jody@minot.com
At BabyCenter.com they take weekly polls. Out of 5,717 respondents to the question: "Will you use drugs during childbirth?" 66% said yes, and 33% said no.
In a separate question, 15% of 2,888 women who planned an unmedicated birth actually had one.
If you're serious about wanting an unmedicated birth, make sure
you're setting yourself up for success - hire a supportive
practitioner and a doula and choose a birthplace where you know
your choices will be honored. Personally, I think homebirth
is the easiest such situation to arrange, but some women can make
hospital birth work for them, too.
As you're making your birth choices, keep in mind both your own experience and your baby's experience. Here's a terrific picture of a baby that is halfway born looking absolutely ecstatic. Here's more information about the baby's experience of birth.
Your baby really does care about his or her birth experience!
TLC's A Baby Story sometimes has homebirth or birth center birth stories that can give prospective parents an idea of how they contrast with the standard high-intervention hospital birth.
Baby McGlynn - Twenty-five years after getting married and raising four children, Jack and Karen McGlynn are expecting again. At 43, Karen's desire for a natural home birth makes for a tricky delivery, but they know they can make it as long as they're together.
Baby Armstrong - Barry and Brenda prepare their two sons, Brendan and Brian, for the birth a third boy by painting a welcome home sign and attending a baby shower. The baby gets yet another B-name, as Blake is born in a water tub at a birthing center.
Baby Johnston - Both previously married, Julia and Ross are expecting their fifth child. This close-knit family home-schools and will all participate in the home birth with a midwife in attendance.
Baby Panec - Keri and Elliot commissioned an artist to create a unique nursery for their first child in their brand-new home. For the water birth, Elliot climbs in the tub with Keri to offer support during the labor and to watch with joy as their son, Eric, is born.
Baby Rachwal - Steve, an art director, and Karen, a professional storyteller, have arranged their careers for the tag-team parenting of their daughter Hyla and their new baby. They are planning a home delivery, complete with birthing tub, midwife and labor assistant.
Baby Herren - When Kathleen met Bill, they were stunned to discover they shared the same last name; but they also shared a commitment to traditional family values and their faith. This match made in heaven will give birth to their second child at home.
Baby Andrews - After deciding on a natural home childbirth, Robin and Ryan attend breastfeeding class and Robin checks out cloth versus plastic at Dydee Diaper Service. With 15 family members present for the painful natural birth, Ivy Rae is born at home.
Baby Bagnell - Chiropractors and parents Larry and Karen Bagnell believe in living life naturally with minimal medical intervention. They will apply those beliefs to the birthing process with a drug-free labor and delivery at home.
Baby Morgan - This unconventional couple prepares for their first child by hiring a body-cast sculptor to commemorate the birth. Then, they visit their pastor to plan the non-denominational christening before Sierra Rose is born by natural water birth.
Schedules
for
A Baby Story for the next month
What
Does Safe Motherhood Mean? - Safe Motherhood in the USA
means that no woman should die or be harmed by pregnancy or
birth. from Safe
Motherhood Initiatives-USA
Lists, lists
and more lists - a great list of lots of different support
lists.
Why
Have
Natural Childbirth? - an essay written by a mom who found
her birth experience wonderfully transforming.
Drugs in Labor - Why aren't We
Screaming? - How do drugs in labor affect your child's
intelligence, motor development and socialization?
Natural
childbirth
options - even CNN is jumping on the midwifery bandwagon
Five Good Reasons to Delay Clamping the Cord - Hospital personnel have their agenda based on schedules and check-off lists, and it's unlikely to be in synch with your agenda to take advantage of those special birth hormones that give your baby a once-in-a-lifetime chance to bootstrap the way nature intended. Delaying clamping of the cord is your biggest ally in keeping the baby with mom ?smile>. I don't know if nature anticipated obstetricians, but the umbilical cord was certainly a clever way of giving them a hint that the baby is meant to stay with the mom after the birth. Too bad they've not gotten it quite yet.
Don't Cut The Cord! - a great summary article with tips for parents planning to give birth in the hospital.
Risks of Premature Cutting of the
Umbilical Cord, with some tips on encouraging the hospital
staff to provide the best care for your baby.
Birthing from Within -This Book is Absolutely Terrific and All the Rage! |
 |
There is a great new book available called BIRTHING FROM WITHIN
by Pam England and Rob Horowitz that addresses birth as an
emotional and spiritual process. Pam was my childbirth
educator and one of my midwifery mentors. I can attest to her
wisdom and to the transformative nature of her childbirth prep
classes. [They have a Web
site with information about courses for educators
and parents.]
Independent Midwifery in
the UK
Bornfree! The
Unassisted Childbirth Page - When I first heard about the
unassisted childbirth movement, I was dumbfounded. It
sounded so terrifying, so risky, almost irresponsible even to
consider it! Then I read the book. Wow! What a
gift Laura Kaplan Shanley has given us. [More about Unassisted Childbirth]
If you want to buy a video that you'll want to watch over and over again to see how calm and relaxed this mom is, check out the DVD, Psalm & Zoya - The Unassisted Homebirth of Our Twins.
Although this family arranged to have a midwife attend their birth, the babies came before the midwife could get there. Both parents (and the older sibling) are amazingly calm, even with the footling breech. If pregnant women watched this video every day of their pregnancy, they'd have a very different view of labor and birth!
I also think it's really important for all midwives to see footage of at least one unassisted birth, and this particular video has it all! Here's a blurb from the web page, but I'll add "Breastfeeding an older sibling during labor".
· A vertex birth
· A footling breech birth
· Use of a “birth ball” during labor
· Mother performing her own vaginal exams
· Mother catching her own babies
· A child present at birth
· A calm birth environment
· Birth sounds
· Smiles and laughter during labor
· Breastfeeding of twins
What an eye-opener. Well worth the purchase price!
Delivery Room Tragedy - Dangers of Vacuum Extractors
ABC's 20/20 did a piece on the dangers of vacuum extraction, which is preferable for many reasons to a cesarean in the case of a difficult birth. However, this piece and mainstream medicine completely ignore the superior alternatives:
"BIRTH CONTROL
- When did the movement to empower pregnant women to make
informed choices turn into a guilt-laden cult?" by Nina
Shapiro. This controversial article about epidurals and
other drugs for labor generated a number of responses that may
help you to figure out what you really want your labor to be
about. This copy of the article is hosted at a very
interesting French site (with articles in English) called Sorceresses
Reborn.
OUT
OF
THE WOMB, INTO THE FIRE - The Myth of the Safety of Hospital
Childbirth
(A Response to Nina Shapiro’s article "Birth Control" in The
Seattle Weekly, November 26, 1998) by Jock Doubleday
Choosing
An Obstetrician or Midwife: What is the difference? by
Suzanne S. Powell, ICCE
Association of
Texas Midwives' Daily Gestational Age and EDD Calculator -
This is easier to read than "the wheel" for some people.
Giving Birth:
Challenges and Choices (1998, 35 min, color, stereo) A model
for normal childbirth, addressing popular misconceptions and
hospital routines, focussing on issues of pain, fear, midwifery,
doulas, babies; featuring Dr. Christine Northrup, OB.
By Suzanne Arms
Yvonne L. Crynn's site The Midwife and
Home Birth, including Midwifery/Homebirth
Articles and information about the video, Home Sweet Homebirth-
This site is intended to help you educate yourself and others
about the choice of midwifery and homebirth. Families need to be
aware of birthing options. Midwifery is a model of care
which includes good nutrition, skillful midwifery, natural
childbirth, homebirth and breastfeeding. Also available in Spanish
- LA PARTERA Y
PARTO DOMICILIARIO
The passion of mothering is not a New Age idea; it's a Stone Age absolute.Leilah's web site includes a fun, humorous article, What I Can Expect When I'm Expecting (which is always) - written while pregnant with her eighth child - just one of the many excellent articles from her Birth Love Columns in the Online Birth Center News. She also has a new book available - "Resexualizing Childbirth" - A collection of essays by Leilah McCrackenDeep within us is a fantastic pulse of ferocious love: it binds us to our babies, and makes us vigilant in their lifelong care. This pulse has been eroded by the institutionalization of many basic life events; most significantly, childbirth and learning.
Instead of ancient mothers selfishly guarding the individual loves and virtues of our children, we become modern custodians for the state - breeders and caregivers of an easily manipulated populace. Women must once again claim birth as a powerful, liberating life event- instead of a painfully medicalized one; and families must allow themselves to learn and stay together in the short time they have- and shun the bizarre lessons in life given by often hostile institutions whose main focus seem to be that of severing families and crushing true intelligence.
It is revolutionary to reject what society so stringently dictates, and revel in being Mother: not as a producer of marketable goods, but as the conduit of life itself.
One of Leilah's most recent pieces, Being Born Blessed (born in
the rain), is well worth the small membership fee. Or . . .
thanks to her generosity, it is also available
at gentlebirth.org
Welcome to the Labor of Love An Internet Community Built by Parents for Parents
Options
for Childbirth - Hospital, Birth Center, Home
A woman gives birth the easiest where she feels the most
comfortable.
Gentle
Birth
Alternatives - Links to Great Web Sites
The Midwifery Link,
a resource guide for finding midwifery, doula, parenting,
vaccination and related issue information on the Internet.
Alternative Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
Home Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
Water Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
The
advantages
and disadvantages of homebirths, birth centers, and hospitals
Is
Homebirth For You? 6 Myths About Childbirth Exposed
Online version of a pamphlet created by the now-defunct Friends
of
Homebirth in Texas.
Mother Friendly
Childbirth Initiative
Baby
Friendly Hospital Initiative
A Nurse Speaks Out About Hospital Care
- she shares her frustrations with assembly-line birth and the
crazy economic pressures that result in suboptimal
maternity/newborn care.
What
price
for a perfect delivery? - The importance of continuity
of care is highlighted in this article from the UK. I'm
amazed that it considers a three-midwife group to offer
"continuity of care" though!
Our culture tends to be very undereducated about the importance of sensible postpartum recovery. Women bounce back much more quickly and easily when they are pampered for the first few weeks. And new babies are less likely to have colic.
Here's a good book to read BEFORE baby comes, because you'll be too busy afterwards:
The Keys to Postnatal Rejuvenation
How to Avoid Colic, Avoid Postpartum Depression, Experience Deep
& Profound Rejuvenation
"Many cultural traditions use the same principles after
childbirth, the ones which statistically don't have problems. The
language is the same - mothering the mothers with TLC, warmth,
oiliness (internal and external), massage, simplicity, moisture,
favoring sweet, sour and salty tastes, specific foods, freshly
cooked (not raw) soupy foods, herbs, and of course rest - these
are keywords to favor. The details even of these considerations
are significantly more under guidance (and communication
with/advice of your primary care provider is essential with
pre-existing medical conditions)."
The
Trials
of the Midwife
by Katie Granju - From Minnesota Parent, October 1997
A must-read article for anyone trying to understand why the
healthcare system in the U.S. continues to snub the midwifery
model, despite reduced Cesareans, proven safety, and lower
costs.
The State of California Access for Infants and Mothers (AIM) Program is a new program. It provides low cost health insurance to pregnant women and their infants who are not eligible for no-cost Medi-Cal or health insurance. The pregnant woman will choose a health plan that serves the area she lives in. The AIM Program is part of California's efforts to increase health care for mothers and their infants.
Access for Infants and Mothers Program (AIM)
c/o Healthcare Alternatives
P.O. Box 15248
Los Angeles, 90015
213-742-0487
800-433-2611
The AIM program provides health care to pregnant women with no
health insurance for their pregnancy and who are not receiving
health
insurance through Medi-Cal.
The State of California, Managed
Risk Medical Insurance Board (MRMIB) office performs
outreach for the Access
for Infants and Mothers (AIM) Program - low cost health
insurance for middle income pregnant women.
Medical Patient Modesty,
a non-profit organization to promote stronger medical patient
modesty. They have a directory of
all-female OB/GYN practices.
See also: Online and Offline
sources of information
Viva La
Evidence - great YouTube video by James McCormack - a song
all about evidence based healthcare
You won't be sorry you took the 4 min. to watch this video!
New for 2008 / 2009! a new report, Evidence-Based Maternity Care: What It Is and What It Can Achieve.
The report takes stock of the U.S. maternity care system,
identifies many opportunities for improving the quality, outcomes,
and value of maternity care, and presents policy recommendations.
Understanding
Evidence-based
Healthcare - This web course has been created by the United
States Cochrane Center as part of a project undertaken by
Consumers United for Evidence- based Healthcare (CUE), and is
designed to help consumer advocates understand the fundamentals of
evidence-based healthcare concepts and skills. Registration is
open and free of charge.
The FP Revolution - The Family
Practice Newsletter - The new web-based source of
contemporary information on primary health care for professionals
and consumers. Sponsors of the novel health care e-zine, -
Dr. Colin Kopes-Kerr continues "to scan, review, analyze, and
promulgate those sources of clinical information that I believe to
be most practical, most cost-effective . . . "
The Death of Evidence-Based Medicine? - June 12, 2002 -
"The New England Journal of Medicine will announce Thursday that
it has given up finding truly independent doctors to write and
review articles and editorials for it, as a result of the
financial ties physicians have with so many drug companies in the
United States. The Journal says the drug companies' reach is just
too deep."
Evidence-Based
Medicine
Simplifies Practice [Medscape registration is free.]
Evidence-Based
Medicine:
Here to Stay or Gone Tomorrow? [01/04/2005 - Medscape
registration is free.]
There seems to be a new movement towards educating parents about the practice of "evidence-based medicine"; this means that practitioners make recommendations based on medical research, rather than on concerns about liability or "the way they've always done things".
There seem to be more and more books that focus on evidence-based medicine instead of simply telling you what your practitioner is likely to recommend. I think this trend is very beneficial for the well-being of mothers and babies and for consumer rights and advocacy.
Here are some good books about Evidence-Based Medicine:
Obstetric Myths Versus Research Realities: A Guide to the Medical Literature - This is the book that seems to have started this whole movement. It's very technical and perhaps best suited to healthcare practitioners or childbirth professionals. [Based on this work, we can no longer say that a great deal of American obstetric practice goes forth without adequate research. It is now more accurate to say that many interventions are used routinely or frequently in spite of research that has clearly shown that the procedure is being used inappropriately in this country." - Judith P. Rooks, CNM, MPH - Midwifery & Childbirth in America (1997)]
The Thinking Woman’s Guide to a Better Birth by Henci Goer - Practical recommendations for better births based on recent obstetric research. This book is a joy to read, and it provides lots of good, solid, valuable information. ***** FIVE STARS ***** You can also read Henci's articles about When Research is Flawed: Critiques of Influential Research Studies by Henci Goer
Pregnancy, Birth and the Early Months by Richard I. Feinbloom M.D. - This is a very common-sense book that manages to avoid a lot of the emotion about different birthing philosophies.
Care Practices That Promote Normal Birth from the Lamaze Institute for Normal Birth
DRUGS
NOT
FDA APPROVED FOR OBSTETRICS - There have been no
adequate and well-controlled studies to determine the delayed,
long-term effects of the drugs listed below on pregnant women or
on the neurologic, as well as general, development of children
exposed to the drugs in utero or during lactation. Such use is
defined by the FDA as "off-label" use. This list
includes fentanyl, morphine, terbutaline, Cytotec (misoprostol),
Duramorph, Narcan (naloxone), Prostin E2 (dinoprostone),
Vistaril and Xylocaine (lidocaine hcl).
Munchausen
Obstetrics - The American Way of Birth: Trauma and Brain
Damage (excerpt from a letter to a legislator) by Rich Winkel
What You
Should Know About Filing Your Health Benefits Claim - If you
are an employee or family member of an employee who receives
health benefits from a health plan provided through employment in
the private sector, a Federal law, the Employee Retirement Income
Security Act (ERISA), protects you. Among the protections, ERISA
sets standards for administering these plans. Those standards
require plans to give you important information about the plan and
to have a fair process for handling benefit claims.
How
Using Our Power as Consumers Could Change Maternity Care Forever
by Sarah Clark [1/15/16]
Should
You Ever Prepay a Hospital Bill? by Donna Rosato [4/12/18]
from Consumer Reports - More hospitals are pushing patients to pay
in advance. In some cases it may make sense.
Weighing
Your
Health Plan Choices - Consumer Reports, Sept., 2005 - the
Overview is available for all to read. [You must pay to subscribe
to Consumer
Reports
Online.] This article has a later section - How
to
appeal denials of care
The
Secrets
of Medical Decision Making: How to Avoid Becoming a Victim of
the Health Care Machine by Oleg I. Reznik
This book will help you understand all the forces at work behind
the recommendations you get from your healthcare providers.
A must read!
Health Choices from
Consumer Reports - Use our Health Plan Report Card and Recognized
Physician Search Tool to ensure that you and your family are
receiving the highest-quality health care available in your area.
A Consumer
Guide to Handling Disputes with Your Private or Employer Health
Plan - Kaiser and Consumers Union have a great set of web
pages about Consumer Rights and Health Insurance.
Consumer
Reports
Medical Guide - Compare disease and drug treatment options
12
Phrases Said to Birthing Women that Steal Our Power and How To
Change the Conversation
RealAge.com - Information about
avoiding disease, the effects of aging, and medical errors.
WebMD.com - Recommended by
Consumer Reports for health-related tools.
The Pricing of U.S. Hospital Services: Chaos Behind A Veil of Secrecy [Medscape 01/12/2006
How
Childbirth
Went Industrial: A Deconstruction by Henci Goer
Among the many good reasons for seeking an out-of-hospital birth, one reason is to avoid infection. It turns out that hospital infections are a growing, but hidden problem. In fact, in most states you cannot even find out how your local hospital stands regarding infections.
The organization Consumer Union is working to do something about
this problem. You can read about their Stop Hospital
Infections campaign at:
http://www.consumersunion.org/campaigns/stophospitalinfections/about.html
She Births: A
Modern Women's Guidebook to an Ancient Rite of Passage
WHAT
YOU
DON’T KNOW CAN HURT YOU: KNOWLEDGE IS POWER IN A
DOCTOR/PATIENT RELATIONSHIP - on the www.obgyn.net site.
The Cato Institute's Policy Analysis #246: "The Medical Monopoly: Protecting Consumers or Limiting Competition?" by Sue A. Blevins.
YOUR
RIGHTS
AS A HOSPITAL PATIENT IN NEW YORK STATE - Maternity Section
Raising your child in a toxin-free world - Four
Steps
To Organic Motherhood - . . . Katie and Mic LeBel knew they
wanted to raise their children in an environment as free of toxins
as possible.
I have Kaiser in southern California and while I was only
pregnant for 13 weeks before my miscarriage, I have no complaints
about my prenatal care whatsoever. I also felt that except
for the one OB who tried vehemently to persuade me to miscarry
naturally (instead of having a D?C), the midwives, OB's and OB
Nurses were all wonderful.
This has been my experience as a labor coach. If you're high risk and need to be in a hospital, Redwood City Kaiser is my all-time favorite, now that they've got "almost" full-time midwife coverage again.
Statistically, the safest births are those with the least intervention, so they're also going to be the cheapest. This puts the HMO and the consumer/client/patient on the same side in terms of wanting to avoid interventions. This is so different from the non-HMO hospitals, where they make more money by doing more procedures and by extending the hospital stay.
I've labor coached three births at Kaiser-RC and had great experiences all three times. In fact, two of those births are the all-time best hospital births I've witnessed. The staff was very respectful of the parents' wishes for a calm, quiet, gentle birth, and they came through beautifully.
They were even supportive of the parents' desire to delay the newborn screen (aka PKU/heelstick) until the sixth day, when it's more accurate.
When you're shopping around, make sure to ask lots of questions about the things that are important to you. If you're looking at Kaiser, ask your local Kaiser hospital how many midwives they have on staff, and whether there are gaps in the coverage. If you're considering other insurance plans, ask whether they cover doulas or other professional labor support. If you want to make sure you have as many options as possible, also make sure they cover homebirth.
And, be sure to get it in writing. ?smile>
From: C-upi@clari.net (UPI)UPI Science News
Subject: Consumers' report makes hospitals improve
Organization: Copyright 1997 by United Press International
Date: Tue, 18 Nov 1997 8:35:06 PST
WASHINGTON, Nov. 18 (UPI) -- Getting hospitals to wake up and improve their services may be as simple as publishing a consumers' report.
Missouri researchers released a study today showing that overall, hospitals offered more options with better outcomes just a year after the release of a comparison of care for pregnant women.
Daniel Longo (``LONG-goh'') told a meeting sponsored by the American Medical Association today that a shoppers' guide put out by the state health department lowered the rates of cesarean sections. Longo and colleagues found that within a year C-sections had dropped 6 percent in places the consumers' guide noted as high-rate hospitals.
Longo, from the School of Medicine at University of Missouri in Columbia, says many of the more limited hospitals beefed up services to match the competition. Half of the places the report identified as lacking follow-up programs filled that gap within a year. A third of the more limited hospitals added a nurse educator to coach breast feeding. And 43 percent of the hospitals without car seat programs offered one by the time Longo surveyed.
The researchers also found that zestier competition cut health costs. Longo found that improvements in ultrasound use and C-section births, first-time and repeats, saved some $2 million in just one year.
A 1992 Missouri law required the health department to start publishing these hospital consumer reports. Longo points out that a new consumers' report, on emergency rooms, is scheduled for release Friday and that the researchers plan to track its effects.
However, the obstetrical analysis, published in the Journal of
the American Medical Association, has already made Longo a
believer in the reports' power. He says, ``My advice to people in
other states is, if you don't have one, talk to your
politicians.''
Not to say this always happens, but the trend is, you go to have your baby, it's supposed to be a painful but happy occasion, but once you get in the hospital you quickly learn that You personally have no rights. The reality, at least the way I heard it from the doctor at the meeting I went to, is that the hospital staff and doctors can do to you whatever they feel like doing, and say it was medically justified, and they don't feel they have to answer to anyone. And then you go home and get the bill for this baloney.
I seem to be reading more and more about how hospitals are trying
to attract more birthing women by offering deluxe accommodations
and food. I actually find this a disturbing piece of
evidence that birthing is big business and susceptible to all the
weird forces associated with money and power.
Henci Goer's Letter to the San Jose Mercury News, 6/24/05
To the Editor:
Choosing where to have a baby based on whether it offers afternoon tea (Moms Feted Like Royalty, Mercury News, June 21, 2005) is like choosing a car because you like the cup holders instead of on crashworthiness. The savvy woman has more substantive issues. She wants to know:
What is the cesarean section rate? A cesarean is major surgery with all that implies in terms of pain, recovery time, and hazard, especially hazards for future pregnancies. Research shows that cesarean rates should be less than 15%.
How often is labor induced? Research does not support the principle rationales for inducing labor. Among other risks, induction doubles the likelihood of cesarean surgery in first-time mothers.
What percentage of women have epidurals; what comfort measures are available? Where most women have epidurals, other options tend to disappear. A host of potential complications follow in the wake of having an epidural and the other interventions that an epidural makes necessary. The same is not true of comfort measures such as tubs, showers, birth balls, and rocking chairs.
What are the usual practices for laboring women? Research shows that continuous electronic fetal monitoring, routine I.V.s, denying oral intake, breaking the bag of waters, confinement to bed, pushing and giving birth while lying on the back, and episiotomy—cutting the vagina to enlarge it for birth— offer no benefits but have harms. The episiotomy rate should be 10% or less.
How do you promote successful breastfeeding? Among other measures, hospitals supportive of breastfeeding keep mothers and babies together day and night, do not give babies water or formula, do not give babies pacifiers, and do not give out formula samples.
How do you ensure my right to informed consent and informed
refusal? Any advocate for normal birth who works with pregnant or
laboring women can recount story after story where women were
given inadequate information, no information, or misinformation or
were pressured into consent. Denying vaginal birth after cesarean,
which forces women to agree to cesarean surgery in order to obtain
medical care, is the most salient example of this, but it is only
the tip of the iceberg.
Sincerely,
Henci Goer
______________________________________________________________
Henci Goer's latest book is The Thinking Woman's Guide to a Better
Birth. You can find out more about her and her book at http://www.hencigoer.com/.
Previously appearing on ParentsPlace.com as the "Birth Guru," she
is now a resident expert on Lamaze International's website, the
Lamaze Institute for Normal Birth, at
http://normalbirth.lamaze.org/.
MotheringDotCommune
Forums at Mothering
Magazine
EmpoweredChildbirth
· Birthing in Love and Wisdom (A Yahoo Group)
20ishAPPregnancy
-
Pregnancy list for young mothers interested in practicing
attachment parenting. Topics of discussion may include gentle and
low internvention methods of birthing, including midwife assisted
and homebirthing, breastfeeding, herbal and homeopathic medical
treatments, non-circ'ing, non-vacc'ing, vegetarian and vegan
living, and other alternative, natural life styles
Homebirth Email List
at kjsl.com - This forum is for anyone who is interested in
supporting and learning about homebirth.
Yahoo!
Groups
Birthdates - groups of women due or babies born in certain
time periods.
A Comment on Natural Childbirth,
including mention of the "Steiger curve" of penile performance.
A Thanksgiving Dinner to
Remember - some more humor about a medicalized family
event
Mother Care,
Whelping Information & Beautiful Canine Birth Pictures!
from Mari-May Kennels. This is a great description of how to
provide hands-off labor support for dogs, and it's amazing how
much of it applies to humans, too!
This brief essay, "Midwife Leaves
Illinois After Legal Harassment" helps illustrate what may
happen to the good midwives in your state, province or country if
the birthing families and caring citizens don't support them.
You can donate money to Citizens for Midwifery by just spending a
few minutes on-line. Check out: www.iGive.com
- CfM is listed with organization and receives money everytime one
of us visits the site. Just by signing up and designating
CfM as your charity of choice, CfM receives $2.00. Then CfM
gets 10 cents everytime you visit and make ten quick clicks after
that. You don't have to spend anything to make a donation to
our cause.
Citizens for Midwifery - print out the membership form at the bottom of their online brochure to join.
Coalition for Improving Maternity Services (CIMS) - help circulate the The Mother-Friendly Childbirth Initiative or volunteer to serve as a liaison for getting a local birth service designated as mother-friendly. [Mother-Friendly Childbirth - Highlights of the Evidence]
Contact your local midwifery
organization and ask how you can help.
You might also point out to them that homebirth saves the
insurance company (and ultimately your employer) lots of money, so
they should consider covering it at in-network rates even for
out-of-network providers, or actively lobbying homebirth midwives
to join their network.
I *always* talk about my positive birth experiences, make sure
women know their opinions, answer any questions Im asked (normally
after I've asked them leading questions ;-) !!!) and stayed
involved in my local hb assoc so other women continue to have info
/ access to the same services I did. Other little
things I did were put home birth stickers on my car bumper, added
a "I was born at home" badge to my nappy bag and also I've made up
a carry bag that has my HB assoc logo and "Home Birth Naturally"
on it which I use for shopping etc.- this gets *lots* of
looks in the street and I can see them reading and then looking at
normal me! This has gone down so well that my HB assoc
has decided to take on the idea and we are next month making 100
of these for free gifts to homebirthing mums in our area!
Midwifery Stamps - U.S. Postage - This doesn't really support midwifery financially, but it helps to recognize the work of two women who have left their mark on midwifery:
Mary Breckenridge adapted the British combination of nursing and midwifery to serve the rural poor of Appalachia through the Frontier Nursing Service, which she founded in 1925. These 77-cent stamps are postage for 3-ounce pieces, which is exactly what my intro. packets weigh. What better way to send them than with Mary Breckenridge?
Virginia Apgar, a doctor, developed the Apgar system for
assessing a baby's condition at birth. The scoring system is
somewhat outdated, but she was one of the first, possibly the
first, whose name was used to coin a birth-related term.
It's such an irony that so many of these birth-related terms have
mens' names attached to them, totally ignoring the thousands of
midwives who preceded them.
Some Possible Examples:
The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower for midwife-attended births compared to physician-attended births with comparable risk factors. (Midwifery care, social and medical risk factors, and birth outcomes in the USA, J Epi ? Community Health, MacDorman M, Singh G, 1998;52:310-317)More facts available from the Citizens for Midwifery Fact SheetsIt is much more difficult for obstetricians to defend high-technology, high-intervention obstetrics when midwives and a few doctors are meanwhile showing that a much less expensive type of maternity care is equally safe. -- Marsden Wagner (World Health Organisation maternity specialist.) Editorial in The Lancet.
The World Health Organization (WHO) states that the preferred location for most births is outside the hospital, either at home or in a birthing center, and that out-of-hospital birth should be implemented and maintained as the basic standard for all midwifery education and training programs.
From the CDC bulletin: National Infection Control Week is October 18-24 (1998). Each year, approximately 2 million patients develop a hospital-associated infection, and an estimated 88,000 patients die as a direct or indirect result of such infections.
Dr. DeLee, who introduced forceps and episiotomy around the turn of the century, stated just before he died that if he had his whole life to live over he would do home births and nothing else, realizing that the majority of his work was probably going to do bad instead of good.
-Mayer Eisenstein, MD in Safe Alternatives in Childbirth
Send more
suggestions for this list.
A
listing of routine hospital procedures with links to pages
that analyze each procedure.
Association
of
Nurse Advocates for Childbirth Solutions -
WWW.ANACS.Org - "We foresee a time... when all childbirth
professionals will support women in their childbirth choices and
nurses will all practice evidence-based maternity nursing and
actively facilitate childbearing women to have the most optimal
birth with as few interventions as possible." Parents can
join this organization and further their own goals by supporting
and participating.
Tips for Labor from an OB Nurse
"Birth
as
an American Rite of Passage" is a book by writer and medical
anthropologist, Robbie
Davis-Floyd. Dr. Davis-Floyd is renowned for her research in
the field of birth. This website decodes the messages
conveyed by hospital birth rituals otherwise known as "standard
procedures for normal birth". These ritual procedures, common in
many American hospitals, make birth appear to conform to the
technocratic model and babies appear to have been produced by
society. Each procedure is explained in detail in the body of the
chapter.
Gracious
Births by Judy Edmunds - a midwife contrasts her experience
of home labor, hospital birth and homebirth.
I have delivered two babies in the past two years and both
naturally (no drugs or interventions). I see you are getting
advice about having a "birth plan" so I thought I would share with
you that one of the best things we ever did was NOT have a "birth
plan" but rather a "Birth Preferences" sheet. Honestly I know it
sounds stupid but my doula suggested it and even my OB commented
on how that language is so much less off putting to hospital
staff.
One more step in the non-offending birth plan / preferences is to not show the staff what you've written down. We simply discussed what we wanted with our OB during regular visits, and my husband and I were clear with each other on what we wanted. I wrote down a sheet of my preferences (see Ina May's Guide to Childbirth... it helped me immensely), and made sure my husband had a copy. It was for him to be able to stick up for us, not to give the staff (which could potentially annoy them).
Other things I'd echo from what others have said: make sure someone sticks to your child like glue from the moment they're born. We asked for our child's hands to not be washed, but my husband noticed that the nurses kept trying to distract him or get him to leave while they gave dd her bath. And be very clear about all the ointments and shots... they will try to persuade you. Regularly and often. It gets really annoying.
Just remember that when you go into a hospital, the staff has
habits and routines which work for most of the people who come
through. So if you want something different, you really need
to go in knowing that you're challenging a system, even if it
doesn't seem like that big of a deal to you. Every time
there's a shift change, there will be someone new who will
notice that you haven't done X, and they'll ask you about
it. It's all a part of their hospital routine. You
just need a plan for how you're going to remind them that you're
different.
There's a list for women who have suffered birth trauma, i.e. birth experiences so traumatic that it continues to affect them very seriously - BirthTraumaSupport@egroups.com. This exchange may help women to appreciate the importance of the choices they make:
I am a childbirth educator and work very hard to get people to
plan their births and have dialogue with their care providers. I
encounter families that just walk in and lie down, and let the
doctors do what they will. Such a setup for misery. What can I
tell people that will help them to see that birth matters, that
the choices that are made affect the outcome, that technology has
risks?
My opinion is to tell them that the #1 thing Dr's do when you
just, as you say, "come in and lie down", is they automatically
give you the birth THEY want. By that I mean they put your labor
and delivery on THEIR schedule. They will induce you so they don't
miss their kid's birth day party, they will break your water and
strip your membranes, give you pitocin, etc.... until your healthy
and normal labor becomes something very rushed, medical, unnatural
and extremely controlled. There becomes NOTHING beautiful and
natural about it. And, if they are busy and impatient, (which they
always are), then instead of letting you pass your placenta
naturally, they will push on you, yank on your cord, and rip it
out as if you could never do it for yourself because somehow they
render you helpless and insufficiently equipped to do what women
have been doing without all this "help" since the beginning of
time. That's what I would tell them. Knowing what you want is only
half the battle. Having someone to ENFORCE your wishes in the
midst of all the medical intimidation is the other half. So in two
words I will tell you what the key is..... TRUSTED DOULA
I disagree. To ask a doula to take on the responsibility of fighting your battles for you is unfair.
If you don't want to be induced, hire a midwife or doctor who doesn't induce labor. If you don't want electronic monitoring, don't go to a place where that is standard while you're in labor. If you don't want the placenta "delivered," hire someone who doesn't do that.
It's highly unlikely that you can, while giving birth, also
manage to convince some L & D nurse that everything she has
been taught to do is wrong. Much easier to just hire someone who
agrees with you in the first place. The likelihood of negotiating
a homebirth in a hospital is pretty slim.
Shame of it is many do hire people they think will respect their
wishes, but when push comes to shove they say, "It must be done
for safety sake."
Ten Questions To Ask Your
Neonatologist
See also: Legal Issues - Informed Consent
Midwives
Code
of Professional Ethics from Artemis House
ICEA Statement on Informed Consent
Getting a stubborn patient to say Yes
- an article written by and for OBs about how to coerce laboring
women to agree to routine treatment.
The Issue of Informed Consent:By Katherine A. Dettwyler, Ph.D., Associate Professor of Anthropology, Texas A?M University, Specialist in Infant Nutrition
The New Zealand College of Midwives statement on Informed Consent.
The Code
of Health and Disability Services Consumers' Rights from New
Zealand.
Being able to pull this card from your wallet when confronted with urgent or major treatment/test decision manages your mind and keeps the questions consistent throughout test/treatment discussions. A very upset or shy person could just hand the practitioner the card and ask that all discussion occur within that format. As a practitioner myself, I use it to organize my thoughts and keep my discussions complete, informed and consistent.
Key Questions About Your Care
Answers to the following questions will help you participate in your care responsibly and help you know what to expect.
When a Test is Suggested:
Please order and disseminate the card freely....this is just
another way to make for educated, informed people who may then
choose midwifery care.
Clients cannot be expected to know what no one is teaching them.
I couldn't resist forwarding this post on to these lists as I am
appalled by its contents. I guess it is something many of us
suspected, but to have it stated at an ACOG meeting is terrible.
Please read on as this may affect the way some of us talk about
birth plans and assertiveness and doctor/patient relationships!
I have been a silent observer on the list for about a month. I haven't written because I am just an aspiring midwife/ student and I will be unsubscribing voluntarily next week. I respect that many midwives feel a need for a private space without us "wannabes," but I just couldn't resist responding on this topic before I go.
As far as parents' right to refuse eye drops for their babies- I have been doing my senior thesis on the legality issues of midwifery, (I must say I am not a law student though, I am studying women's health and development/ population) and my research in the law libraries led to the issue of mothers refusing medical treatment for their unborn babies. I would like to remind everyone that there has been a terrifying precedent set in many state courts which allows doctors to perform a variety of interventions on the pregnant woman and her fetus against her will. Examples include experimental operations in utero to prevent deformity- not even to save the life of the fetus! Of course, there have been many court-ordered C-secs, court-ordered hospital births (the pregnant woman in AL who had wanted to birth with a midwife was arrested and court ordered to have the baby in the hospital). The law has been very severe to "protect" babies inside mom, and it seems even worse with babies outside mom. Even the religious exemption has been overruled lately... very scary from my perspective.
I attended an ACOG course on obstetric emergencies, and one
section, "how to deal with the difficult patient who presents a
birth plan" sparked the comment from one of the teachers, "Tell
her whatever she wants to hear and when she is in labor you can do
anything you- the dr.- want because the courts have accepted the
argument that the pain of labor is so intense she is not in her
right mind and can not make decisions that hold legal weight...(a
paraphrase from my memory) Of course, the official ACOG book says
to cooperate with the woman if possible first because courts have
been "very reluctant" to force women to have procedures...the
courts are becoming less and less "reluctant".
I have an article called "Abuse and Neglect of the Unborn" which
has a section on precedents set in parents refusing care for their
children (unborn and born), and a (pretty extensive) collection of
articles from legal journals on (lay) midwives' court cases around
the US, and the debate over regulation and enforcement. If anyone
needs a place to start in creating a legal defense or wants copies
of any info for file just in case, please email me at
tammy.nakanishi@sit.edu Thanks for letting me listen, I learned a
lot.
Winkler, Rosenthal. Sexist practice in medical school- vaginal examinations on women without consent. Needle 1988 June:10-11.
Phillips A. When what you don't know can hurt you. Guardian 1991 Jan 22:34.
Bewley S. The Law, medical students and assault. BMJ 1992:1551-53.
Robinson J. Are we teaching students that patients don't matter?
J. Med Ethics 1985; 11:15-21.
It seems that a nursery nurse turned them into CPS (Child
Protective Services). This was after the dad asked her if someone
else could try to place an IV on the baby. She had been trying for
45 min. and when the dad asked her to stop and let the baby rest
while they got someone else she claimed he was interfering with a
needed medical procedure. The police came 20 min. later.
My experience here was with child protective being brought in
against a family for trying to take their newborn out of the
hospital AMA. The family was accused of depriving the child
of 'standard of care' treatment, which was interpreted as child
abuse. The crazy part was that this was for prophylaxis --
not treatment of any diagnosed condition. Once the court order was
presented, this family buckled under the pressure and left the kid
for treatment, rather than risk having him taken. Crazy that
educated parents really have no choice sometimes!
I had a similar experience with transport.White,middle class
married couple,early twenties.Transport after 2 and 1/2 hours of
pushing with no descent,mom pretty tired,dad scared and frazzled
etc.Vacuum extraction,apgars 8?9.OB announces that she saw pus on
the baby's head,and that the baby is grunting and retracting.She
calls in Peds and they have mom sign a form for treatment except
that mom refuses to have a Lumbar Puncture done unless bloodwork
indicates a problem.They are then threatened with losing custody
of the child unless they cooperate.They agree,baby and mom were
kept for three days,baby in isolation,tests were all negative.The
OB requested 3 months of followup for this "at risk" couple from
social services!
|
Voice of Experience: There is a lot of anxiety among
pregnant women these days - our country is at war, and the
political environment is very adversarial. This isn't a
supportive environment for birthing women. My personal
recommendation would be for women birthing for the first time to
take two different birth classes - one Bradley class to help
educate you about the physical aspects of childbirth, and another
class that focuses more on the mental/emotional aspect of
birthing: Hypnobirthing or Birthing from Within. It's
possible that BirthWorks
classes would satisfy both needs.
Do
They
Deliver? - Comparing the Claims and Philosophies of Natural
Birth Methods Can Be Challenging, Learns a Mother-to-Be by Lindsay
Moran [8/22/06]
Sacred Birth Workshops: Childbirth Preparation for the Heart, Mind and Spirit with Stephanie Dawn - The Sacred Birth Workshop was designed to explore conscious conception and fertility, and to empower your pregnancy, childbirth and your postpartum life as parents…
Using spiritual tools, as well as practical steps and insights,
Stephanie Dawn shows you the way to the pregnancy, birth and life
of your dreams!
Breck Hawk, RN, midwife, doula and author of Hey! Who's Having This Baby
Anyway? has created Childbirth Awareness classes for
newly pregnant women / couples. - These classes are called iCARE
(Improving Childbirth Awareness for a Richer Experience) and are
not designed to take the place of classes that already exist out
there. They are an added bonus to the education that
pregnant women need to have the safest and richest experience in
their baby's birth. The classes are designed to be taught
before a woman chooses which direction she wants to go with her
labor.
Adele Szilardi's The Bay Area
Childbirth Education Locator
Western
Canada Birth Professionals Directory
What's the difference between BirthWorks and Bradley? How can I get more information about both?
Sorry for the newbie question - we just decided to have a home
birth (YAY) - and I would like to find a method that
works. We used Lamaze with our first child and it
didn't work very well. It might have also been the
surroundings, the quick labor and the busy hospital room
but...I'd like to explore my options.
Birth Works is a childbirth education program that teaches women
that there is no one right way to give birth. Instead of
focusing on breathing patterns, Birth Works helps women to look at
(and deal with) the beliefs and attitudes that they have about
birth, as well as dealing with grieving and healing, using
breathing and visualizations, affirmations, etc. It really
is a wonderful program, that I think could have saved me from an
unnecessary cesarean. But then again, if I hadn't had that
cesarean, I wouldn't be training to teach Birth Works!
http://www.birthworks.org/
888-TO-BIRTH (862-4784)
mailroom@birthworks.org
"BirthWorks is:
A childbirth education and teacher certification program
with an innovative and experiential design. Birth Works®
embodies a philosophy that develops a woman’s self
confidence and trust in her innate ability to give birth.
The classes are experiential and provide both a physical and
emotional preparation for birth. Birth Works® classes are
taken by new parents, and parents with prior cesarean or
vaginal births. Our comprehensive program meets the needs of
parents planning hospital, birthing center or home births.
It is based on the belief that the knowledge about how to give birth already exists within every woman."
and
http://www.bradleybirth.com/
(800) 4-A-BIRTH
Bradley Childbirth class goals are for:
"you and your baby to have the best, safest, and most rewarding
birth experience possible. For that reason we endorse and
teach the following ideals in classes:
1. Natural Childbirth
2. Active participation of the husband as coach.
3. Excellent nutrition, the foundation of a healthy pregnancy.
4. Avoidance of drugs during pregnancy, birth, and breastfeeding
unless absolutely necessary.
5. Training: "Early-birth" classes followed by weekly classes
starting in
the 6th month, continuing until birth.
6. Relaxation and NATURAL breathing.
7. "Tuning-in" to your own body.
8. Immediate and continuous contact with your new baby.
9. Breastfeeding, beginning at birth.
10. Consumerism and positive communications.
11. Parents taking responsibility for the safety of the birth
place,
procedures, attendants, and emergency back-up.
12. Parents prepared for unexpected situations such as emergency
childbirth, and cesarean section."
Call the organizations above, and see what instructors are in the
area. Both methods are great!
Birth Works® childbirth
education
Utilizing
Energy
Psychology Techniques During Pregnancy: Empowering Parents
to Decrease Stress, Heal, and Optimize - Seminars,
Workshops, and Events by Wendy Anne McCarty, Ph.D., R.N.
The Prenatal
Parenting Program consists of 8 modules filled with
exercises to manage fears, reduce stress, change unwanted
behaviors, and to prepare spiritually and psychologically for the
most important gift parents give their child - a healthy and
peaceful birth. The best way to find the closest Prenatal
Parenting Program to you is to email
them
with your address including the zip code or call
610-727-4145.
Mindfulness-Based
Childbirth
& Parenting Education Program is modeled on the
pioneering work of the Mindfulness-Based Stress Reduction Program
at the University of Massachusetts Medical Center founded by Jon
Kabat-Zinn, Ph.D. Through meditation, yoga, awareness of breathing
and group dialogue we learn a precious life skill that can hold us
as we engage in one of the most important, joyful and stressful
jobs on the planet, that of giving birth to and parenting the next
generation.
Lamaze International -
Lamaze works great for some people.
Although this isn't a form of childbirth education, per se,
their Pink Kit
"provides you with the knowledge you need to understand your
unique body structure and how it works. Using this information,
you will gain a new understanding of pregnancy, labour and
birth." The Common
Knowledge Trust endeavors to help transmit the diverse
health knowledge from cultures worldwide and to encourage the
preservation of this knowledge.
The Pink Kit is a
comprehensive, multi-media (book, video-tape and audio tape)
childbirth preparation kit for homestudy. Quite well
done. The video is the most informative, covering breathing,
relaxation, "mapping your pelvis", effective positions and
exercises for pregnancy and labor, as well as, core concepts
relating to "know your body" and issues of self-empowerment.
The Side 1 of audio tape includes detailed instructions for
prenatal perineal massage (self or with your partner's
assistance). Side 2 of audio tape is the sounds of a mother
"breathing" her baby out during a birth that takes place at
home. I own three copies that I loan to parents.
Especially those that are not overwhelmed by the inundation of
information and are self-motivated to learn on their own.
Magical Beginnings,
Enchanted Lives - This program offers an intuitive natural
access to the child bearing year. Since our society is fear
based in its approach to childbirth the program offers a new
method of discovering what childbirth as a whole family experience
means. The Magical Beginnings, Enchanted Lives program
offers the mother, father, and child a pactical tool based on the
consciousness model recognizing that we are an integration of
body, mind, and spirit. Having the whole family practice
this model within the program helps our approach to childbirth
dramatically change.
Joyous Birth
League International - JBLI intends to boldly reclaim the
term “natural childbirth,” to henceforth exclusively describe the
physiological (characteristic of or appropriate to an organism's
healthy or normal functioning) process of birth as it occurs when
completely free from outside influences and interventions or
mental, emotional, and spiritual hindrance from the woman herself.
[1/05 - these pages weren't accessible, but maybe they'll
re-appear!]
Is There a
"Method" for Achieving Naturally Painless Birth? (Updated
September 2003)
The McMoyler Method is not very well
thought of by the birth professionals I know.
The Mind Body Center: Leclaire Hypnobirthing Method in Pacific Palisades, CA
What is Fearless
Birthing™? - It is a program of self-discovery. It is
nothing short of a map to the place where mother's intuition
awaits. It is a way to access the 'instruction manual' that does
come with each child!
|
Find A Doula - findadoula.com
Night Doula
Care - a website that lists *just women that work at night*
as a night doula or baby nurse
For extra credit, you might be able to find a local midwife who
provides in-home postpartum care for mother and baby. This
allows you to receive regular checkups in the days immediately
after the birth without exposing your baby to the germs and stress
of a trek to a doctor's office or clinic.
I just found out that the ACOG recommendations are to have one
nurse for at most four laboring women. Yikes! No
wonder the nurses can't provide individual care and are pressing
the women to get epidurals and be on constant monitoring.
They can't possibly be running from room to room and providing
intermittent auscultation for four women at a time. You can
read more about the Benefits of
Doulas.
California
Birth
Services Directory at Birth
Alliance.com
Adele Szilardi's The Bay Area Doula
Locator
Frequently
Asked Questions About Doulas/Childbirth Assistants
Massachusetts
Friends of Midwives Directory of Birthing Resources
Western
Canada Birth Professionals Directory
Look in the Yellow Pages under Labor Coaches, Doulas and
Midwives. Many midwives are also available for labor coaching in
your home for early labor and then accompany you to the hospital
as an advocate.
Midwifery
Today's Directory of E-mail Addresses
DONA - Doulas of North America
ALACE - The Association of Labor
Assistants and Childbirth Educators
doulabirthconnection
Yahoo! group is to connect newly trained birth doulas with
pregnant women seeking free or low cost doula services.
Look in the online FREE YELLOW PAGES!
yellow-page.net
|
Finding a Midwife from Citizens for Midwifery:
Midwife Referral
Directory from the Midwives' Alliance of North America
maintains
You can also search for midwives in your area using the online FREE YELLOW PAGES! yellow-page.net
South
Peninsula Midwives for the San Francisco area's South Bay
To
find
a Naturopathic Midwife in New Hampshire, Oregon,
Pennsylvania, and Washington
Dr.
Mercola
writes about homebirth - Dr. Mercola's article about
homebirth has some suggestions for finding a midwife.
Shonda Parker maintains a referral list, featuring Christian
midwives.
From Giving Birth - A Journey into the World of Mothers and Midwives by Catherine Taylor:
Did you know? Midwife-attended births in the United States have doubled in the past ten years. Midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality (infant death in the first month) than doctors attending comparable births. Midwives who attend hospital births have a cesarean rate that is half the national average.
The dutch have the lowest percentage of babies and mothers who die or are injured during childbirth. they also have the lowest rate of medical intervention at birth. 70% of their births are with midwives and 1 in 3 births take place at home.
The Midwifery and Medical Models of Childbirth Care from midwifeanddoula.com
There are many different types of midwives, and each state may create its own midwife designation. In a number of states, their state licensing program uses the same standards as the NARM CPM . . . in those states, a Licensed Midwife is functionally equivalent to a CPM.
The Midwifery Model, Care Provided by Midwives, Types of Midwives
and How to Choose a Midwife from . . .
Check the web pages of your state
midwifery organization to see if they have a referral
service.
Ideas from Midwifery
Today:
Sometimes you have to be a private detective to find a
midwife. Since the choice of a birth practitioner is one of
the most important decisions you'll ever make, a careful search is
worth the extra effort.
California
Birth
Services Directory at Birth
Alliance.com
Massachusetts
Friends
of Midwives Birthing Resources Directory
Western
Canada Birth Professionals Directory
Nurtured.Com
Birth
Team Directory
Midwifery
Today's Directory of E-mail Addresses
Look in the Yellow Pages. Ask the local La Leche League folks.
Look in the online FREE YELLOW PAGES!
yellow-page.net
There's also a physician group called the Homefirst Health Services - Physicians who do home births in and around Chicago.
Can't deal with the American birth system? Can't find a homebirth midwife in your area? Having trouble finding birth attendants for VBAC?
On a quiet, beautiful and secure country estate, overlooking the
central valley of Costa Rica, Central America, Birth-my-baby offers two
modern homes for expectant mothers to have their babies in peace
and gentleness.
|
The
International Lactation Consultant Association (ILCA) - Find
an LC by zip code.
Holistic Pediatric Association
- The HPA is committed to supporting parents who seek a healing
model of health care, helping parents reduce the use of
ineffective and harmful drug treatments, and empowering parents to
build healthy bodies and spirits in their children. Find a
practitioner in your area by searching our Health
Professional Directory.
Pediatric Holistic Health
Education and Research - The International Chiropractic
Pediatric Association is a non-profit organization dedicated
to advancing awareness of the family wellness lifestyle.
They offer a referral
directory.
Family
practice doctors are a great option for the entire family,
and they're less likely to recommend hospitalization and extreme
testing for typical childhood conditions.
Shonishin &
Kids - Shonishin (children's needle therapy) is a unique and
specialized pediatric style of acupuncture that developed over 250
years ago in Japan. It recognizes the fact that children do not
like needles and has instead developed specialized treatment
techniques, many of which are non-invasive and thus not
frightening to the child. In ancient China, when acupuncture was
first being described, nine kinds of needles were described,
several of which had rounded ends, being rubbed or pressed on the
skin instead of inserted into the body.
Family
Physicians can be an excellent choice for the whole family!
Attachment
Parenting International (API) is starting a Listing
of Medical Associates
Association of Perinatal Naturopathic Doctors (APND) - Members of the APND share a vision of universal "care". Care at the beginning of life begets care for all life. A natural birth allows powerful bonds to form with the newborn and mother - bonds, which inevitably expand outward to include the family, the community and ultimately, society. (This appears to be a Canadian association.)
American Association
of Naturopathic Physicians - Directory
- You can search for Pediatric naturopaths or those who
specialize in Women's Health.
The California Naturopathic
Doctors Association (CNDA) is a professional association of
naturopathic doctors (NDs) who live and work in California.
Directory - You can search for Pediatric naturopaths or
those who specialize in Women's Health.
See also: Chiropractic Care,
Prenatal Breech Issues,
and Chiropractic Care
for Babies and Children
The International Chiropractic Pediatric Association has a particular interest in birth-related matters and maintains a Referral Directory.
In some states, chiropractors are licensed to attend births.
Practitioner
Directory:
How to find a Chiropractor from holistic.com
Find a
chiropractor in your area
International Chiropractic
Pediatric Association and referral
directory.
SORSI - The Home of Sacro
Occipital Technique with a web page to help you
locate a doctor.
There are many paths to good health. Here are some other locator services:
Mercury Free, Holistic, Biological Dentists
Registered
Craniosacral
Therapy Practitioner
Possible Questions to Ask a Caregiver Who May Attend Your Home Birth
List
of 47 Questions to Ask a Midwife During an Interview (with
printable) by Shannon Brown
Here's a list of
questions from my page about Local Resources in the San
Jose/Peninsula area.
Even midwives who live in rural areas can participate in online peer review groups or in peer review sessions at state and national midwifery conferences.
Midwives who do not regularly attend peer review may be what are
called "renegade midwives" who do not believe in community
standards of midwifery care and who simply practice according to
their own way of thinking. It's possible that such a midwife
might be perfect for you, but you should know that she may
practice very differently from other midwives in your community,
and you may be surprised at some of her opinions and
recommendations. Please use good judgment in choosing your
midwife, as you would with any healthcare provider.
Having a Baby? Ten Questions to Ask - How to identify mother-friendly birth attendants - a handout from The Coalition for Improving Maternity Services (CIMS)
Check to see if the hospital you're considering is on the list of Baby-Friendly Hospitals and Birth Centers. A Sept., 2005 study showed that these hospitals had higher rates of breastfeeding, regardless of demographic factors that are traditionally linked with low breastfeeding rates.
CIMS also offers numerous resources for individuals and
organizations who support mother-friendly care. These include fact
sheets (Breastfeeding
Is
Priceless, The
Risks
of Cesarean Delivery to Mother and Baby, Problems
and
Hazards of Induction in Labor), questionnaires (Are Your
Birth Classes Mother-Friendly?, Is
Your Doula Practice Mother-Friendly?).
IMPORTANT - Recent discussions postulate that routine use of the
Ritgen maneuver to force premature delivery of the baby's head
increases the likelihood of shoulder dystocia. Ask your
practitioner whether they routinely use the Ritgen maneuver and at
what percentage of births they have used the Ritgen
maneuver. [The Ritgen maneuver is performed by applying
moderate pressure from beneath the baby's head to the baby's chin
to force premature extension and delivery of the baby's
head. Co-incidentally, it was traditionally used with an
episiotomy; when the Ritgen maneuver is done to a mother with an
intact perineum, it inevitably tears the perineal tissues because
the unnatural extension of the baby's head widens the diameters
significantly.]
Hiring
Your Birth Attendant: Questions to Ask When Choosing a
Hospital, Doctor, Birth Center or Midwife
A
simple, effective list of questions for a birth attendant
Consultation
Questions
for Prospective Midwives
Questions for Clients to Ask Midwives
More Questions for Clients to Ask
Doctors and Midwives
Regardless of the exact letters after your birth attendants name,
it's important to ascertain that they are trained to attend birth
in the place where you're planning to give birth. If your
birth attendant was trained in a hospital where the neonatal team
always handles the babies, they may never have learned how to
provide standard newborn care or to handle newborn emergencies;
you need to ask where she got her training and experience in
handling newborn emergencies, assessing the newborn, assisting
with breastfeeding, etc.. If your birth attendant was
trained in a birth center, they may not have the expertise in
managing epidurals or interfacing with the NICU that you might
need in a hospital birth.
Questions for Clients to Ask Doctors
Questions for Clients to Ask
Obstetricians
When interviewing my first midwife, I failed to ask *very* specific questions about 'protocols' when things step outside of 'normal'. I failed to ask her to define diabetes -- something she risks people out for. My definition of diabetes and her definition of diabetes turned out to be 2 different things. Unfortunately, we discovered this when I was 30 weeks pregnant. She risked me out for failing a GCT (her protocol) -- I had to look for another midwife who viewed gestational diabetes in the same manner as I do. That is, if my blood sugar levels are controlled through diet/exercise, the "GD" is not 'active' (for lack of a better word) -- therefore, should not prevent me from birthing at home. In my mind, having the label GD and at the same time having normal blood sugar levels controlled through diet and exercise, being in the hospital would have been a very foolish move on my part considering all of the interventions my baby and I would have been subjected to in order to satisfy protocols for GD moms and babies of GD moms set forth by doctors, hospitals, etc.
With that said, I think you also have to ask yourself what kind
of midwife you want. Knowing the answer to this question
will help you to formulate specific questions which address your
personal needs. Do you want a midwife who has protocols for
every little thing so you do not have to make decisions when
something comes up (my first midwife did not want me to make any
decisions about GD under her care)? Or do you want a midwife
who will help you find a solution to problems (if a problem comes
up) which fits your individual needs? If you choose the
latter (btw -- there is nothing wrong with choosing the former if
that is what you feel comfortable with), do you want a midwife who
will *support* informed choices you make even though those choices
aren't ones she would personally make?
I intend to ask about the GD stuff, and the handling of breech
births, and their opinion and experiences dealing with VBACs, and
also the waterbirth aspect. What am I missing?
Aside from the obvious questions about training, etc., it sounds
as if you may want to ask questions about how they handle
conflicts, how many births they consider a full load, how many
births they've missed, etc.
Some midwives have a checklist covering all aspects of care. This lists all the things they'll be covering with you and might be interesting to read..
Also, you may want to ask what their rates of tearing and suturing are. Be sure to ask how many first, second, and worse degree tears, and what percentage require suturing. This will give you some idea, but it's also important to know that deciding whether a tear is a first or second degree tear may be somewhat subjective. A midwife who doesn't see much tearing at all may be more likely to call a minor tear a second degree because she sees so few.
So, after you ask for the numbers, ask what she finds works best to prevent tearing.
Ask what she recommends to avoid posterior and breech presentations.
Ask about the rates of hospital-acquired infection and antibiotic-resistant infection in your hospital?
You might also ask how she keeps current. A midwife who wants the best for her clients is always looking for better ways to serve them.
Oh, also, ask thorough questions about her thoughts on going postdates. This may not be such a big issue there, but it's a biggie here.
And, of course, ask how she feels about clients making decisions different from her recommendations.
Also, ask how long your appointments are and how much education she incorporates into these appointments.
And ask for several references and see if their experiences bear
out what the midwife told you.
I'm still working on my list of questions for a doctor, but right after "What is your c-sec rate?" is "What is your epis rate?" and I expect to get a number. Anything as vague as not "without the mom's permission" would make me wonder why the doctor wasn't as eager to brag about her epis rate as she was about her c-sec rate. Maybe my husband's right, maybe I am paranoid.:-)You should be paranoid. Unfortunately, it's a mistake to assume that any caregiver shares your values and priorities.
I work both as a homebirth midwife and as a labor coach for women birthing in the hospital. I have occasionally worked with women who had found wonderful OBs, who promised not to cut an episiotomy. Unfortunately, they also didn't seem to know enough about avoiding tearing, and suturing was required.
Specifically, ask any caregiver what they do to avoid tears and the need for suturing. Ideally, waterbirth would be universally available. At the minimum, you should hear something about a slow, gentle birth rather than Olympic-style pushing, especially once the baby is crowning. There's a great deal of debate about the value of warm compresses and perineal massage, so answers may be all over the place on this question, but the caregiver should have considered them and have good reasons for what they do in this regard. Most also flex the head as they support the perineum, which should continue to be supported as the shoulders and body are born. Ask how they manage this. It's best if they have four hands or an assistant.
Many midwives have tear rates under 20%, and not all of these
need suturing. If your caregiver can't tell you their suturing
rate, it's obviously not very important to them. If it's important
to you, it's probably worth discussing further.
First, ask them for their statistics in writing. If they're telling the truth, they shouldn't mind putting it in writing.
Ask about rates for all the things that matter to you, but the rates they should have handy are:
Ask them what they think of homebirth? The answer to that question can tell you a lot about whether they truly consider birth a normal physiological process. It will also tell you a lot about their view of having the family in control of the circumstances of birth. Again, prejudice against homebirth is prejudice against empowering the family.
And if they tell you that homebirth is just unsafe, ask them for references supporting their assertion. Any caregiver who is still parading this tired old prejudice doesn't place much value on presenting you with accurate information.
Ask them what kind of birth gives them the greatest feeling of
satisfaction - an uncomplicated birth where they're basically just
keeping an eye on things, prepared to intervene if necessary, or a
birth where they have to use their skills to "save the mom or
baby". People do the things that feel the best to them. (And
again, this is generally a big difference between MDs and midwives
(homebirth or hospital); midwives believe they have done their job
when the mother gives birth, reaches down to bring her own baby to
her belly, and is left to follow her instincts about interacting
with the baby, without need to suture or inject anything; MDs
believe they have done their job when they've used their most
sophisticated skills to save lives.)
Think about the implicit promises that were made by your providers . . . we'll help you do what's best for yourself and your baby. How many people here believe that their providers followed through on that promise?Not me. But that is what they say, and I pinned them in that meeting June 30. They admitted there that they practice as they wish because of the legal climate. Then I told them, "But no-one says this when I come in for prenatals. I was never told that you practiced that way. I was told you would take care of me and my baby and that everything was for my baby's good." Silence and some snorts were my response. What COULD they say?
Statistics don't give the whole picture, but they help to remove some of the deceit in those empty promises.Yes, if you could get them. My CNMs spent so much more time with me than any OB I'd ever seen, were friendly, funny, kind, involved, remembered my name, and never seemed to be in a hurry. THAT alone sold me. What a sad, sad commentary on our health care system. That emotionally I was willing to give up (Oh well, it'll be all right anyway. WRONG!) my right to the statistics, the details of their usual procedure, because I mistakenly thought A) they liked me B) they knew what they were doing and C) they were honest.
I think all midwives (and all other birth providers) should spell out exactly what kind of care they provide. I think they should make their protocols accessible to their clients, and I think the rates of infections at their hospital should also be available. Without this information, how can you make any kind of informed choice?Are you kidding? Remember how many times I had to ask to get the c/s rate which when finally given was FALSE!!!!!!
And I'm sure I've mentioned the list of questions I went with (how many of your clients labor in different positions? with IV? with monitor? etc.) that I never even asked because I got the message that I didn't need to worry about that because I wasn't going to have problems anyway...after all I was low risk perfect health and taking excellent care of myself.
I didn't know that then. I was naive and misinformed despite
being a Bradley student. I thought these people sincerely cared
about me and my birth. They appeared to. They most certainly did
appear to. But they did not REALLY care.
This may seem odd, but I was surprised that my midwife didn't
wear gloves at my birth. In some ways, it seemed much nicer
that my baby wasn't being touched by nasty latex or vinyl, but
then I realized that my baby was basically being exposed to the
germs of every other family this midwife had ever served.
That wasn't such a happy feeling. It's worth asking whether
your midwife wears gloves at all times at the birth?
I would love to see these promises made more explicit. This is why I keep urging people to ask for statistics. No, of course no doctor is going to admit that they routinely perform unnecessary procedures, so they say they only cut episiotomies "when they're necessary". But if you can get the statistic from them in writing, and it says that they are necessary 95% of the time, that tells you something. If you can get your midwife to provide, in writing, the average amount of time she was at a birth with her previous five clients, this will give you a good guess of the amount of time she will spend with you.
Statistics don't give the whole picture, but they help to remove some of the deceit in those empty promises.
I think all midwives (and all other birth providers) should spell out exactly what kind of care they provide. I think they should make their protocols accessible to their clients, and I think the rates of infections at their hospital should also be available. Without this information, how can you make any kind of informed choice?
When it comes to protocols, though, my feeling is that "my protocols" will be parameters within which I'm comfortable working. Then I'll present clients with a long list of choices they can make within those parameters. I'm happy to make recommendations, of course, but the choice must rest with the client. They're free to choose to follow all my recommendations, as many probably would, but this approach should solidify in their minds that they can change any of this at any time.
Theoretically, this is how it works now even with all medical providers. Ha, ha.
In reality, most people are never told that they have the right to decline any offered care. (Assuming their provider doesn't get a court order to force care on them and/or call in Child Protective Services. Sigh.)
Typically, providers simply state the recommended care as if it's incontrovertible, i.e. "We test for GBS at 36 weeks", "All first-time moms need episiotomies", or "The state requires that we vaccinate newborns with HepB." There's no recognition that every person is supposed to be choosing components of their care. Instead, they choose "a caregiver" and then figure they just have to suffer the consequences of that choice.
I have been hearing some very disturbing indications that even
the illusion of choice will be disappearing. I've heard that HMOs
require that women submit to certain types of procedures in order
to continue prenatal care with them. And I've heard that other
insurance companies are denying coverage to unvaccinated children.
Very disturbing.
What are their episiotomy and suture rates?
What do they find most successful in preventing tears?
Ask for the details of their protocols in writing for:
Also, you might try stopping in at the office just to chat with the women who are carrying newborns and/or strike up conversations with women who look very near birth and ask if you can call them afterwards.
You might also try asking the childbirth instructors, labor
coaches and midwives what they think of the caregiver?
In our case, the midwife failed to prepare us for many of the procedures that could occur in case of transport to hospital. This would be an issue that I think should be discussed with homebirth parents, even though most homebirth parents don't want to face that reality. But the real issue as I see it does not revolve around what we discussed in prenatal care, rather it is how the midwife was not there for us in labour, did not give us the dignity of informed choice with regards to vaginal exams, AROM, etc.. Not having given birth before, we did not know what to expect or ask, even though I was well read. I had a classic posterior labour, and wish the midwife had told me positions to adopt so as to help baby rotate, which could have avoided AROM and subsequent transport.
I guess it really is this midwife's personality, and not an issue
that she failed to bring up with us. She did everything
"technically" right, according to the backup midwife, but she
wasn't there for us emotionally at all. Birth is magical, and far
from being a purely physical event, hence the emotional upheaval
in women where this process is violated.
So for me my written birth plan helped me to know what I really wanted in my birth. It never seemed to be viewed by obstetricians as a guide to follow to the T.
I learned that almost every pregnancy and childbirth are healthy events and medical attention is not necessary in the least. I couldn't believe how wonderful an experience pregnancy and childbirth were for me once I adopted this attitude! What glorious fun!!! I wish it could be this way for all women that are normally healthy. You do not need to be super human despite what so many try to tell you. Home is a very healthy environment to have and keep one's baby.
I also said "No" to all internal exams and ultrasounds this pregnancy, and once I was on the homebirth route I never felt I had battles anymore about these decisions. I trusted my vagina and pelvis and didn't feel I needed someone looking at it, much less take the risk of having some infection introduced. Ultrasound of any amount has never really been proven safe. Besides, for me there is nothing I could find out on an ultrasound that would make me carry or birth my baby differently. I enthusiastically allowed the fetoscope (like a stethoscope) to monitor baby's heartbeat in prenatals and labor.
See also: Money and
Paperwork/Health Insurance Plans - Getting Payment
healthinsuranceinfo.net
- Consumer Guides for Getting and Keeping Health Insurance
Helpful
Hints
for Dealing with Your Health Insurance Company
As a former hospital employee, I can say that professional fees
are always billed separately and don't include hospital fees. If
you call the registration dept they will give you your specific
breakdown based on insurance as well as cash pay amount if you
decide to go that route ( which they provide discounts of up to
75% of cost). Just make sure you ask for a financial counselor.
Claims
Resolution Services for Patients
Negotiating for Health Insurance
Coverage
Appeal Solutions
provides medical claims resolution products and services to the
healthcare community. Our only focus is on assisting the
healthcare community become more effective at overturning denied
or incorrectly reimbursed medical insurance claims. They
have some sample
appeals
letters.
I've heard the following ranges of prices for homebirth midwives
providing typical full-service prenatal care, birth services,
postpartum care and lactation consulting and newborn care.
(Cost of "average" home, where stated, in parentheses for
perspective)
Alexandria, Virginia - $3500-$4000 ($150,000)
Houston - $4500 ($150,000)
Los Angeles - $4200 ($450,000)
Dallas/Ft. Worth - $2000-$2500 for direct pymt,
more if billed through insurance ($?)
New York City - $3800 ($?)
Long Island - $5000 ($?)
Quebec - $3000-$5000 ($?)
South Dakota - $3000 ($?)
Tennessee. $2800 ($?)
Maryland, rural - $1500-$1800 ($?)
Las Vegas, NV - $1400 ($?)
Washington, DC - $1500-$3400 (birth center)
Northern Florida - $2500
Southern Florida - $3200
"There’s nothing to compare with the birth of your child
not your wedding day, a trip to Hawaii, or a new car. Be
willing to give birth the same consideration of financial
investment as those other special times." from Santa Cruz midwife, Laura
Maxson LM.
I used to think that charging $3000 for a birth was an awfully lot of money for someone to make for essentially a week's work. And I've heard people say that midwives must make a lot of money because they multiply the midwife's fee by 52 weeks, assuming she does one birth every week of the year., but as I got to know my midwife more, I started to get a sense of the costs of running a business:
First of all, she probably isn't attending 52 births each year. She may have to turn down births some months if she's already got 4 clients signed on that month, and there may be other months where she doesn't have a full schedule. I know my midwife doesn't use that extra time to go to the beach - she reads journals and books to keep up with her profession, she re-works her practice protocols and handouts, etc.
Also, I guess even midwives deserve a vacation now and then. Well, I guess I'd really have to say that *especially* midwives deserve a vacation now and then. Some of the women in my women's group talk about labors that went on for days and days, which must be really draining on the midwives, and that doesn't even take into account the additional stresses of transporting into the hospital.
In addition to the 40 hours or so of her personal time that goes into direct contact with the client, she also spends probably a couple of hours on the phone with each client, and she must spend additional time maintaining charts and reviewing lab results, etc.
She also has to maintain a business - I figure the cost of maintaining a home office is probably about 1/5 the cost of renting a house in your neighborhood. My midwife seems to have more ways to communicate than a Vulcan - she's got her business line, her personal "hot line", her pager and her cell phone. Mine happens also to have Internet access so she can show me lots of research online when I've got questions. I figure her "communications" costs alone must be over a hundred dollars each month.
Then she's got her professional fees. In our state, renewing a license costs $200 every other year, but in order to get her license renewed, she must get about a week's worth of continuing education credits. For a midwife who's always on call, the best way to do this is often to do it all in one shot by going to a big midwife conference. Between the conference fees and the travel expenses, this must cost about a thousand dollars. And I know those professional journal subscriptions can be pretty expensive. A midwife's business is basically a consulting business, and the rule of thumb is that the cost of running the business (paying for their own health insurance, paying self-employment taxes and social security, providing office space and the basic operation of the business, having some vacation and sick time) is basically half the consulting fee. So, if a midwife charges $3000, she probably only gets to use about half of that as income, and that's still before taxes. Plus, being a consultant myself, I know that 15% of her income off the top goes to self-employment taxes.
Then, when I think about her expenses for each birth, well, obviously, there's transportation expenses. Whether you live in New York City and she takes a cab to your birth or you're out in a nice, rural spot, I suspect midwives must incur expenses between $50-$100 for transportation for the four home visits for each birth.
Then there's the equipment and equipment maintenance and sterilization. I used to think midwives just went home from births and went straight to bed for twelve hours. It turns out that one of the first things they have to do when they get back home, however exhausted, is to sterilize their instruments and repack their bags, because you never know who's going to call next or when. That whole process seems to take about three hours, from what my midwife says.
I've also noticed that a lot of the equipment she uses is disposable, obviously, for health reasons. This is stuff in addition to the birth kit we ordered. For example, the special suction device she used even for the light meconium costs about $15 in the Cascade catalog, and the ambu-bag that she had to open "just in case", even though it wasn't used, costs more like $30. My midwife also uses lots of incidental herbs and homeopathics that she doesn't charge for. It turns out that the vitamin K is also kind of expensive, and I don't know about the eye ointment she used.
My midwife doesn't carry liability insurance, but I suspect that's a big ticket item if yours does.
Oh, I forgot, the biggest expense for the birth itself is the fee paid to the second midwife. I don't know how much you'd charge to be on call to come out in the middle of the night to offer your highly skilled services and possibly provide life-saving procedures, but I assume it's several thousand dollars. In actuality, I think they charge each other a ridiculously low fee, sort of as a reciprocal professional courtesy.
Oh, duh, another thing I forgot is that when you compare a homebirth midwife's fee to the fee of a hospital birth attendant, you're comparing apples and oranges. When you have a hospital birth, the bulk of the care is provided by hospital staff, which all shows up in the hospital bill, rather than in the obstetrician's fee. I started to think about the numerous hospital staff I saw during my time there, and I know their salaries must come out of the money my insurance company pays the hospital. First, there were the administrative people who handled the insurance. Then there were the nurses, who provided about 18 hours of care before the OB showed up. Then there was the cast of thousands that showed up for the birth itself. I know some of those people were there in case my baby needed resuscitation, and I guess this is what the second midwife usually does? So it's not fair to count those people twice. But then there were the postpartum nurses, plus the nurses in the maternity unit, plus the lactation consultants, plus the nursery staff. Oh, and, of course, there was the janitorial crew that came in to clean up the birth room as I was being wheeled out. Most midwives seem to wears lots of hats - they handle the administration stuff, labor management, the birth itself, take care of both the mom and baby immediately after the birth and then continue to provide check ups and are available for care during the next six weeks.
Anyway, by the time I got done thinking about all this, I figured
my midwife really doesn't charge much for offering the incredible
services she provides, all the while having to fight "the
establishment" that is trying to take away her license or put her
in jail.
In Florida, HMO's must cover midwives, whether hospital or
homebirth; it's written into the law in 641.31. If I
remember right it is about paragraph 18, but it reads: "Health
maintenance contracts which provide coverage, benefits, or
services for maternity care shall provide, as an option to the
subscriber, the services of nurse-midwives and midwives licensed
pursuant to chapter 467, and the services of birth centers
licensed pursuant to ss 383.30-383.335."
For care providers who aren't covered by health insurance plans,
some will accept alternative forms of financing, occasionally
including barter or payment plans that extend beyond the birth
date. Do ask about these.
I just don't know how we're going to pay a midwife at a time when
I'm going to stop working, and we're going to have the extra
expenses of a new baby!
Have you thought about trying to borrow money from your parents
or from your 401K plan?
I was shocked when the midwife I called said she charges
$3000. One of our local childbirth educators is also a
midwife and charges very local prices, and I'm thinking that may
be all we can afford.
I am very curious what price you were hoping for. Be
very cautious of anyone asking for much less. As you could
imagine that person would not have the training or skill.
This is nothing to play around with. In addition to
prenatal appointments at her office, a midwife would have many
hours, energy, and responsibility left with the remaining part of
your pregnancy. Just one example is she would be coming to
your house for 4 home visits. A home visit before the birth,
the birth, and 2 postpartum visits. Prenatals are every week now
and each one lasts an hour. There are also 2 other
postpartum visits done in the midwife's home. Can you
imagine what this would all cost if it was an MD? I know
that some midwives are willing to take delayed payments or
barter. I also know that it is an unexpected expense.
You can have the birth that you want. It is time to really
think about what you want and why, and go with that.
Isn't it funny the way people will spend thousands and thousands
of dollars on a fancy wedding but don't want to pay a couple of
thousand dollars for a great birth experience for themselves and
their baby? Maybe if they thought of the birth as a baby welcoming
party, they'd be more comfortable paying for it. Heh, maybe
midwives should start advertising themselves as entertainment for
the baby welcoming party! It might solve some of their legal
problems, and I've heard midwives say some pretty funny things
when they've been up several nights in a row with a first-time
mom! [VBG!]
My husband is pretty careful with money, but he agreed
wholeheartedly to paying our midwife out of pocket. He said
that even thousands of dollars would be less than what we paid for
counseling after my first birth, not to mention the formula we had
to buy when the breastfeeding relationship didn't work.
It sounds like he's careful with money in that he's happy to
spend it on the important things, which is the best kind of money
management.
Yes, people really need to think about what they want, etc., and figure out how important a good birth experience is to them and to their baby.
People are so funny sometimes. They want a midwife with lots of training and experience, but they somehow imagine that because birth is so sacred, she should work for free. I'm sure many of them would like to be able to do that, but I suspect they have bills to pay, too. (And I have to say, you couldn't pay me enough to be on call 24 hours/day almost every day of the year and to have to work a shift that simply doesn't end until the baby is born and the mom and baby are safe. What a hard way to make a living. I can't imagine anyone would be doing this kind of work for the money. I assume they do it for the love of mothers and babies and earn what they can to support themselves. Most of the midwives I know are not living in lavish style, even in our very affluent area.)
I sat down once and figured out the amount of time a midwife has to put into each birth: if you figure you start seeing the midwife in your fourth month, say around 16 weeks, then again at 20, 24, 28, 30, 32, 36, 36, 37, 38, 39, 40, 41, plus 4 postpartum visits, assuming an average of an hour apiece, that's already 17 hours of direct contact, not including preparation or post-appointment charting. Then add in travel time for one prenatal home visit, the birth and three postpartum visits, assuming an hour each - that's another 5 hours. Then you're already up to 22 hours, not counting the birth. If you're lucky and have a relatively fast active labor and birth, she may only be there for 6 hours before the birth, and then she'll be there 3 or 4 hours after the birth. So time spent directly providing care for you is probably an average of about 32 hours. And that's not counting all the extra time for first-time moms, or the phone calls. And it certainly doesn't take into account the time she has to put in maintaining a business and keeping up with her profession, such as online groups and conferences, which most professionals get paid for.
Anyway, I know midwives often say that one birth/week is about the right work load in terms of being able to provide good care to each client. So I figure her work time averages out to about 40 hours per client. That's a whole work week.
So, I figure people should be willing to pay their midwife at least the amount that they earn in a week, plus her supplies, equipment and travel expenses, plus the cost of a second midwife or any other help that is included in the fee. Suddenly $2500 isn't looking like that much. And if you put some effort into it, you should be able to get insurance to cover most of it.
And, as those credit card ads say, "Midwife fee, $2500.
Postpartum doula, $200. Birth kit, $50. The adoring
gaze of your newborn resting peacefully in your arms after a
gentle birth in your own bed . . . Priceless."
I think some of this attitude comes from the feeling that our health care should be paid for by health insurance, and we tend to be very stubborn about not wanting to pay anything that we think should be covered by health insurance. Yes, in fact, midwives, doulas and home health care should be covered by health insurance. But if we're not, are we really "getting back" at the health insurance by going along with their rules about what they think we should be doing about our birth?
I've read some of the information about the link between a baby's
birth and bonding experience, and things later in life like
violence and teenage drug use, and I'm thinking that a couple of
thousand dollars is looking cheap to protect myself and my baby
from a bad experience. Also, I've read the stories on the
ICAN page about marriages that were severely harmed by an
unnecessary cesarean - the women felt betrayed that their husbands
didn't support them better. Those aren't the sorts of things
that show up as "risk factors" for the standard birth experience,
but they're awfully important to me!
For those of you wondering why I chose to have my second child
with an OB in the hospital after my first baby was born at home, I
know that must have sounded odd! I hated the fact that I had to
have a hospital birth, but at that time direct-entry midwifery was
illegal and my insurance would not cover a birth center birth. I
could not afford to pay for the birth myself so I had no choice! I
was heart broken! My hospital birth turned out to be the nightmare
that I had feared, but it was a learning experience! I will never
have a baby in the hospital again unless medically necessary!!!!!
My insurance wouldn't pay a dime for my homebirth. I kept
telling them that they were crazy, that I was saving them
thousands of dollars, but they wouldn't pay due to the legal
status of midwives in my state.
Even if insurance won't cover the birth attendance part, I think it's worth pursuing reimbursement for the other services that midwives provide.
For example, you could ask your midwife to write up an invoice for labor support services, lactation consultant services and postpartum doula services, all of which are customarily included as part of homebirth midwifery care.
Especially if your midwife includes a letter explaining that her labor support allowed you to avoid expensive procedures such as IV, epidurals and operative delivery, and that her excellent postpartum doula care allowed you to reduce your time in the hospital by 48 hours, which is the amount of time that insurance companies are mandated to cover here in California.
As the consumers, homebirth parents need to be consumer activists, lobbying so that their state laws support midwifery and so that their insurance companies provide reasonable reimbursement.
Otherwise, homebirth midwifery is an endangered occupation.
