The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

The McMoyler Method

These letters were written by a highly respected childbirth educator in the San Jose area:
 

Dear Sarah,

Thank you for your timely response to my exhaustive letter to you.  Unfortunately when I hear a L&D nurse say she teaches a "reality based" CB class I wonder...WHO'S reality?  The reality of a normal birth and the reality of a medically managed hospital birth are two opposing realities. Unfortunately for 1/3 of birthing mothers, the reality is a Cesarean. And for many, many more are the unnecessary inductions and 'routine' interventions that have caused unnecessary morbidity - and mortality - for countless mothers and babies.  This IS the reality of most hospital births in this country.

Unfortunately (and I am speaking from experience) many - too many - nurses have never ever witnessed a normal, un-medicated, un-wired, un-interventive birth in their whole career and I can add, most OB's.  Oh yes, they see the occasional mom come in at 9-10 cm and slip their baby out before there's time to hook her up or stick her, but nurses do not get the whole picture of what normal birth is. Normal birth is so much more than pushing a baby out of the vagina.

Because of the cascade of interventions, many nurses tend to form a huge fear and distrust of the process and also fear their superiors. I know for a fact that mother-friendly nurses are ostracized by their peers as "crunchy granola" types.

It is interesting that the "bad apple" doula ruins it for all, but the "bad apple" L&D nurse stays on, and on, and on.  And I have seen some BAD apple nurses in my day as well as physicians.

When I have conversation with the unit managers (Santa Clara County) about the lack of evidence-based care, most agree with me. I find that incredible! They agree that if some of their nurses practiced their 'art' the same way in ICU, they would not last the week. So, we won't talk about bad apples.

I know of whom you speak when you say "Physician groups", I think you really mean physician group (singular). Some physicians majored in the "I am God" course in medical school (and I know you have known some yourself), and hate the idea of giving up control to the mother, nurse and especially a doula.

So why do you think it is important to have their OB or Midwife "recommend" a doula (that they like)? Hiring a doula is a very personal choice for a couple to make. There are many "Meet the Doulas nights" offered in the Bay Area where couples can find a really good match or, get a referral list and make arrangements for private interviews.  Just because my doctor likes vanilla ice cream, does that mean that I have to eat vanilla ice cream when I really LOVE chocolate??

The fact that you "tried to strike balance whenever [you] could", is not making a concerted effort to strike a balance. As a nurse and a teacher, providing balanced and EVIDENCE-BASED information is the gold standard and a ethical necessity to allow for informed consent, or (God forbid) informed refusal to be given by the mother.

I hope you are able to present balance in your classes, and I do hope you open your class to other professionals in the trade. As a teacher myself, never in over 20 years, have I closed a class to anyone needing to observe for professional enrichment.

Sincerely,

Jeanne Batacan
 

[Sarah replied to Jeanne, but I don't have her permission to publish her e-mail here.]
 

The McMoyler Method - An evaluation from a respected childbirth educator

Dear Sarah,

I don't want to lambaste you but information about your new "method" of childbirth preparation has hit the Peninsula, South Bay birthing [professional] community like a bolt of lightning!  Many of us are members of Bay Area Birth Information, a non-profit organization of parents and a variety of birthing professionals including doctors, nurses, midwives, doulas, educators, massage therapists, chiropractors, authors, researchers, etc., etc.

Speaking for myself, as a 28 year veteran certified in childbirth, parenting and lactation education, I am not an RN but do hold a CA adult teaching credential.  I also worked with my mentor, the Chief of OB for a large South Bay hospital, for over 15 years. I am curious as to where you got your training to be a childbirth educator? Being a nurse, does not cut the mustard with me, as the four worst classes I have ever observed were taught by L&D nurses. They were not much more than hospital obedience courses. " This is what will happen to you and this is what we will haveyou do, and what we all want is a healthy mother and healthy baby" .  It reminds me of the joke slogan on tee shirts " Trust me, I'm a doctor" .

From a personal standpoint, I have to take issue with much of what you are doing. I know that from your perspective you are only trying to fill the fast track gap and make a living at it. But I have some real concerns about your approach and your marketing.

Your approach:

Referring to a woman's body knowledge as "the Stork", is very disempowering (IMHO). Women's bodies KNOW, their babies KNOW. They may not know it all -all the time but given half a chance, they know most of the time. Please don't give credit to "The STORK".

Many educators moved away, some years ago, from the Birth "PLAN" to Birth "PREFERENCES". It's true, that one cannot plan their entire birth experience, but they certainly should have preferences that are honored and respected. After all, it IS their body, baby and experience. You know that the hospital has a "plan". It is called protocol and procedure. Women choosing a home birth setting have to "plan". Sarah, you should know that women in labor cannot always verbalize what they want, and having their wishes on paper is a reasonable one.

As I watched your video, some of the mothers in the class looked terrified and uneasy. Intense information is just too much to take in, in six hours! I must say, that I have never seen a woman, who has been through any of my classes, react the way some did in the video, especially in the section - Partners are the Key to Coping. Scaring a woman to tears is not empowering. Presenting evidence-based information, knowledge, and coping skills is.

Your "reality based" approach is not necessarily the best approach, considering that 1:3 women leave the hospital recovering form major surgery birth. Most are subject to medically unnecessary interventions that impede labor and that the result of the medical model, in all it's glory, is a nation who is at the bottom of the list, of industrialized nations, in maternal and infant mortality.

It also looks like the couples in your class do not have the opportunity to practice together. Just you and the dads. I understand that you can't do a whole lot in 6 hours. I understand, because I, for a while, did weekend classes (8 hours). I had to stop because I felt, ethically, that my students were not getting their money's worth. They loved the "express" class but did not know that they did not know. Six hours/Eight hours, it's not enough time to mull over issues, practice together, read and discuss with classmates.

I'm curious as to how you present risk vs. benefit of intervention. Do you delve into the well documented 'Cascade of Interventions'? Are you providing full information? That topic is a full class of its own. Just teaching how drugs inhibit or block the mother's natural hormone production (endorphin and oxytocin especially), and how all that can adversely affect breastfeeding is time consuming. But, important information for them to ponder.

Doulas. Somewhere in your book I read that you do not advise your students to hire one. Making references that a doula would push out/away (my words) the father. Nothing could be further from the truth. Doula support is support of the birthing couple. We, as doulas want to preserve and enhance their experience as positive and joyful. I often have fathers, in tears, hug me and say "thank you so much!" Your statement "I am not anti- doula. I am on the other hand, pro - partner involvement. My interest is in inviting and supporting partners to be the primary support person, providing a sense of unconditional presence to the laboring woman."  Now, how does that work. You do not advise couples to hire a doula, but you are not anti-doula. Hmmm.

Some men are not culturally motivated or perhaps emotionally able to be a competent, experienced labor supporter. Some women do not want their partners to have to take on such a demanding, foreign roll. They want their partners to be there emotionally, fully FOR them. A doula's presence can help this happen.

Your Marketing:

As a member of ICEA, Lamaze Intl., CIMS, ANACS, BABI as well as some international doula groups, I have to take offense at your false elitism. Statements like "Unfortunately, traditional childbirth courses won't give you the knowledge, training, or preparation you need" are simply un-true. And, I suppose your 6 hour class does all that?

Putting down classes from Lamaze and Bradley, saying they are "last century" is a statement of irresponsible ignorance on your part. There are good instructors and bad instructors just as there are good nurses and bad nurses. The good ones keep up to date and evolve as they learn and mature. Certification courses from ICEA, Lamaze, Bradley, Birthing from Within, Hypnobirthing and the others from CAPPA and ALACE are continually evolving and maturing. From what I see and read, your "Method" is nothing but a collage of all of the above. Maybe not even all, but some.  Let's get real here Sarah. The "McMoyler Method" is nothing more than some of the above and the teachings of gurus like Penny Simkin, Janet Baleskas, Diana Korte, Michel Odent and many others. It's like me calling my classes the "Batacan Method" because my classes, I like to think, are unique and, by the evaluations, GREAT. But, MY method?  Hardly!  I know they were effective because I have 20 years worth of 'after baby' birth evaluations.

And the McMoyler "Maneuvers". Really? Move over Penny!

Marketing your class to give the impression that having a healthy mother and healthy baby is your goal (and the goal of the medical staff), but not necessarily that of other classes/methods is just plain WRONG. That a mother wants to preserve her health and that of her baby is a no brainer. And is always at the top of everyone's list of priorities. That exact issue is one of the MAIN reasons some informed healthy pregnant women choose to give birth at home with a midwife.

Giving the impression that YOUR "method" involves fathers [and the others don't] is again a statement born out of either ignorance or slick marketing hype.

I will stop here. But I do want to share with you a little of what is being said about your method and marketing. The comments speak volumes. I hope you take the time to read and digest what is said and learn, if nothing else, that the medical model of maternity care is flawed and needs a paradigm shift soon.

Most Sincerely,

Jeanne Batacan, CMA, ICCE, CLC, CD, CHB

I watched the video and found it a bit scary.  The women in the room did not look comfortably reassured.  And I didn't like her comment that women down the hall screaming hadn't been McMoylerized (I know I'm paraphrasing here).  Very, very few women scream and, in my experience, it's when screaming is a cultural expectation.  The dad role playing with her did a great job.  I like that she emphasized the break between contractions.

I'm an L&D nurse and I do appreciate it when a family comes in with a birth plan, a list of birth preferences, or even as Sarah McMoyler terms it, "reality based goals."  I like it when a couple outright ask, in their birth plan or reality based birth goals paper, for a nurse who will be supportive of her choices and requests.  Nurses uncomfortable with the list would be more likely to ask for a different patient assignment, increasing the chances that a family will have a better matched nurse during labor.  I've never seen a birth plan with requests that conflicted with evidence-based practices.  I also prefer them to be well-edited.  Take out the request not to have a shave prep and enema.  Take out the request not to have a circumcision if the expected baby is a girl.  There is a strong anti-birth plan sentiment which was explored in Judith Lothian's "Birth Plans:  The Good, the Bad and the Future."  The last time I was at a birth with friends, they wrote a 3/4 page birth plan.  However, on the patient board, in the column for risk factors like hepatitis, were the words "BIRTH NOVEL."  Not very kind, nor supportive.

I've never worked with a doula I didn't like.  Sure personalities and skills differ, but it seems to me that these doulas are a good match for the families.  Doulas are important because they're chosen by the family and they stay for the entire labor and birth.  Nurses are usually assigned to more than one patient until one of the patients is ready to push.  And we will go home if our 12-hour shift ends twenty minutes before delivery.  I will also say that most L&D nurses do not have much experience with normal birth, non-pharmacological methods of pain relief, or the time or skills to provide the kind of care a doula can provide to a family.

I'm pro-partner, too.  However, the dads and other partners often show up at the hospital completely overwhelmed and unsure.  Most didn't go to childbirth classes, most haven't seen a birth before, and most are unprepared for the experience.  Things can completely begin to unravel as soon as the doctor orders an IV, Pitocin, blood work, monitoring, etc.  And when someone in the healthcare team suggests an intervention "for the baby" who will be the one to question the necessity?

I do not believe that "the couple in labor can be very well served by the healthcare team in the hospital" for a normal, low-risk birth.  Our "normal" is IVs, Fentanyl, Pitocin, continuous fetal monitoring, bed rest, ice chips, an epidural, a Foley catheter, and directed, hold-your-breath for a count of 10 pushing.

Hospitals are great places for high-risk care.  They're not so good for healthy, normal labors and deliveries.  Hospital administrators have to keep budgets in mind, keep physicians happy to keep their patients' business, worry about staffing, bed turnover, and patient satisfaction.  I can't help but think that McMoyler's book [I've only read the excerpt online and seen the video] would serve to make couples feel good about getting a typical hospital birth experience.

Three things leapt out at me: First, her smug assumption that staff support is sufficient ignores the large body of research that finds improved physical and psychosocial outcomes with the continuous presence of a trained or experienced woman who is not a medical staff member. Here is the Cochrane systematic review:

Hodnett E, Gates S, Hofmeyr G, et al. Continuous support for women during childbirth. Cochrane Database Syst Rev 2007(3):CD003766.

She also ignores that we have no such evidence for the presence of a male partner. This is not to say that his presence is not important, but dads need support and guidance too, and they aren't likely to get it from staff. This brings me to my second point: she misunderstands the role of the doula, which, of course, is to support the couple, not coach the mother. Last, but not least, is the patronizing assumption that if a woman must have a doula, she should get one approved by her care provider. Reminds me of the bad old days when women were supposed to get approval from their doctors to take childbirth education classes. Amazing! It's 2008 and she's still talking about needing to have others make choices for women because they aren't capable of doing it for themselves.

Yeah, that last part about "inquiring with your doctor or midwife for names they recommend" really chapped my hide as well.  Her statement that she is not anti-doula, but IS however "pro-partner involvement" is confusing, since the two are not mutually exclusive.  It reminds me of the "do you want a happy birth experience or a healthy baby?" argument: in this day and age, why can't a woman have both?

And how does an "entire message" get received "not as intended"?  Did she not read her own book before publishing?  Either you give doulas praise, or you don't.  If she's received several other communications from doulas, then the public most likely perceives her stance as anti-doula. Anyone who is pregnant and does even a little research on doulas is going to be impressed with the statistics.  Those who are looking for a theatrical birth class that condones epidurals and interventions will seek out a class that encourages that.  Her stance that the couple is "very well-served" by the hospital staff is reminiscent of birth in the 50's:

I can speak as a Midwife working in this system for many years now, seeing with my own eyes what happens to OB nurses, especially if, like this lady has, been an L&D nurse for so many years. Sadly as many of you have witnessed, a lot of the OB nurses seem very scared of normal, natural labors and in this modern system they all are trained in the medical model where scheduling, controlling and making their life easier is the way to go.

Correct me if I am wrong but I think this is the concept that Ms. M.  is teaching and yes, she probably is successful as 80-90% of her clients are epiduralized and they and she are probably quite content with the outcomes, despite the C/S rate, the episiotomy and 3rd/4th degree tear rate, the vacuum/forceps rate and of course not to forget the epidural rate and the use of Pitocin which goes hand in hand with the above!  The women are blind to the fact that statistically, if they are suckered in to this way of thinking by this book and these classes, then they are all in the Titanic together, and it is only a matter of time before their ship sinks!

I am sure Ms. M.  has seen an opening in the market where money can be made especially given the intervention rates, as this isn't going to change overnight. What a concept - 'OK, if these women are all going to get epidurals, then why not let them feel good about it?" Of course let's not tell them the whole truth, otherwise they may just end up wanting to do 'Natural Childbirth' and that wouldn't be the intention of these classes would it?

I believe we/you/ this community of advocates has to continue to be present in L&D's everywhere, keep the new grad doulas coming because the Midwifery community certainly isn't around much.  We at [hospital] are trying to educate as we go so that the younger more inexperienced nurses can see what happens, they see us trusting in the process of labor and slowly they begin to get it also. The Doula community has I think a rough time when it comes to how they are viewed by the staff and it is really sad this has happened. It's like Doula is a dirty word and it is so not like that - how can you start to build bridges?

Why is it that the bad childbirth books always do better than the good ones? Isn't the cream supposed to rise to the top?

McMoyler Method.

Doesn't something have to be original for someone to label it a method? (invent a different way of doing something) What is she doing differently? Except for teaching the medical model - your body doesn't work right so we will help you model?

Does she know that every other childbirth method out there is also "pro-partner involvement" and "invites" the "supporting partners" to be the "primary support person"?  I haven't read her book yet, but this sounds like a lot of marketing-speak, in order to bring in business.  I was not impressed with her website's "healthy mom - healthy baby" priority listing, as it's what everyone wants (duh), and she seems to completely discount the journey to actually achieving that healthy mom and baby. Seems the actual experience of childbirth is sacrificed on the altar of medical technology. I know how important that actual journey of birth is, and she is selling an inferior service if she thinks that people will love her "working alongside medical professionals" line of thinking.