Empowering Birth Blog

Why We Must Stand Together

In my former life, I was a Ph.D. student (I left indefinitely during my first pregnancy) and an organizer for social justice at the Jewish Council of Urban Affairs in Chicago.  Much of my work centered around housing issues, specifically housing for the poorest of the poor, or public housing.  Few were interested in becoming intimately involved with the dwellers of Chicago's severely neglected, rat and crime infested high-rises where families struggled to survive.  I shared the poem below with those hesitant to get involved. I think it is an important one to read whenever we think that an issue is not MY issue.  Whether we decide to birth at home or in a hospital, with or without an epidural, assisted or unassisted, birth choice is an issue that touches us all, women and men.

First They Came for the Jews

First they came for the Jews
and I did not speak out
because I was not a Jew.
Then they came for the Communists
and I did not speak out
because I was not a Communist.
Then they came for the trade unionists
and I did not speak out
because I was not a trade unionist.
Then they came for me
and there was no one left
to speak out for me.

Pastor Martin Niemöller

If I rewrote the poem, it would go something like this:
First they came for the unassisted birthers, but I did not speak out, because I do not free-birth.  Then they came for those who birth at home with lay midwives, but I would would not speak out, because I would not have a home-birth with a lay midwife.  Then they came for those who birthed with Certified Professional Midwives, and I would not speak out, because I would not have a home-birth with a CPM.  And then they came for those who birthed in birth centers and with Certified Nurse Midwives, but I would not speak out because I would not have a birth in a birth center or with a CNM.  And then they came for me, and there was no one left to speak for me.

Dutch System of Midwifery Care Works

A new study1 looks at the process of midwifery-led delivery in the Dutch system.   Midwives make either no referral, referral (to an obstetrician) with urgency, or referrals without urgency once a woman is in labor.  The study, which examined 280,000 cases found that the midwifery-led referral system resulted in a small number of urgent referrals (3.6%) and satisfactory neonatal outcomes.  There were fewer referrals among women planning a home (rather then hospital) birth.

1MP Amelink-Verburg, SP Verloove-Vanhorick, RMA Hakkenberg, IME Veldhuijzen, J Bennebroek Gravenhorst, SE Buitendijk (2008) Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study, BJOG: An International Journal of Obstetrics and Gynaecology 115 (5) , 570–578     doi:10.1111/j.1471-0528.2007.01580.

Vision of Unity

Rixa's post, Vision of Unity, has gotten me thinking.... I had been thinking a lot about this subject lately, but it was Rixa's post that nudged my reflections in a more personal direction.  In my community, a midwife was "turned in" by another midwife (I am not going to discuss any details of the story) and the incident provoked much thought on how midwives handle their disagreements with other midwives and the negative energy in midwifery communities.  Birth is such an awesome, loving, empowering experience, where is there room for negativity among midwives, guardians of the sacredness of birth?  I have been surprised at the anger that has tried to creep in as a result of the above event, but that anger was a waste of energy.  Better that I practice yoga and send good energy to all of the midwives in my community.

But back to Rixa's post, I think that those of us who have had a difficult first birth followed by an ecstatic birth can easily assume that another mom with a birth experience similar to our difficult birth experience must of course be longing for an ecstatic birth and it is up to us to "save them" from a repeat of that experience in future births.  In our efforts to inform we might miss the fact that the mom in question did not view her birth as a "difficult" birth.  And if you are a person who has just a bit too much passion, like myself, you might  at times cross the line between gently encouraging women to educate themselves about normal birth and, in frustration, scaring them into better birth (which of course doesn't work).  Hence the "two best friends die after cesareans" slant.  Although there has always been only the greatest love and the best of intentions behind my posts (both on my blog and on my neighborhood news group), I realize that I need to work on my use of hyperbole and when presenting posts that clearly show support for my call to gentle birth, I must take care to inform and not use scare tactics.  This is an empowering birth blog, after all, and you can't force empowerment.

I think this third pregnancy is helping me to temper my passion.  Why?  Because for the first time I am afforded the luxury of simply being pregnant, and that has had a calming effect on me, especially as I settle firmly into my second trimester (finally the unending nausea is behind me, the relentless exhaustion a thing of the past).  I am 23 weeks pregnant, oh joy!  Thanks Rixa for your beautiful post.  For a second I had the thought to go back and amend past blog posts, but that would be a bit silly and would be changing my history in a sense.  I will in the future remember the goal of a Vision of Unity.  Controlled anger, anger that leads to positive action, will at times have a roll in this journey, anger can be a great catalyst for change, but it should never outshine love.

As posted on Rixa's Site:

VISION of UNITY
                                           by Jeannine Parvati Baker

Like many of us, I have been praying with my ears, listening to midwives all around the world.
How can we (wo)manifest the vision of unity that would serve families?
Meditating upon the divisions between birth attendants, a vision came to me.
I saw a circle wherein the tribes called to heal the Earth by healing birth sat together.
It was a medicine wheel, with all styles of midwifery and obstetrics represented.
Across the wheel from me sat a medical doctor.
To each of my sides were medwives and CNM's, seated across from one another.
We defined the cardinal points in the wheel, but were not the whole circle.
From where I sat, I could see directly what was behind the doctor, and visa versa.
To either side I had an oblique angle to view my sister medwives and CNM's.
Then I realized why we needed one another. It is to keep us honest.
I can see what is the shadow of obstetrics, as the good doctor can see the shadow freebirth casts.
Nurses and medwives add to the bigger picture across the wheel from one another.
No one can turn around and see ones own shadow alone. This is how we serve one another.
All of us who attend birth are holograms in this circle of life. Each has the whole truth about birth within.
When we bring our versions of the truth together, there is a finer resolution and
multi-dimensional viewing into the great round of being.
In my vision, we are sitting in birth's circle, representing our various tribes.
Not my circle, not yours, but birth's circle.
Each tribe, each perspective, is precious to birth.
Together the living oracle will be voiced through all of us.
Let it be the voice of what the Earth needs through each of us.
Remembering this always: What we do to one, we do to all.

(http://www.freestone.org/hygieia)

Midwives Rising

Tonight I hosted a screening of The Business of Being Born.  I was a bit worried about attendance.  Given my constant nausea, exhaustion, and severe pregnancy brain (I actually forgot to introduce the organization that will receive the proceeds from tonight's showing), this wasn't the most spectacularly planned event, and yet we had a good fifty people in attendance!  It was a family-friendly, casual showing that brought together many pregnant moms, doulas, midwives, even an OB (a friend of mine who LOVED the movie by the way).  Everyone seemed to enjoy the movie (and the pizza) and we had a lively conversation for a good hour afterwards.

I feel as though there is a midwifery movement afoot.  Not only do I know quite a few people studying to be Certified Professional Midwives in the area but there is a group discussing the formation of a new birth center, a midwife who has started her own private practice associated with a local hospital, talk of a midwifery practice moving into another local hospital AND several Certified Midwives who lost their job when a local birth center closed and a local doctor practiced let their midwives go are now attending the home births of local women.  There was a lot of good energy in the room tonight.  Let's go out there and put normal birth back in the hands of midwives.  Tonight I am full of hope, may I keep this hope in my heart when things get tough.

Tearing Each Other Down is NOT Empowering

In the midwifery community there can sometimes be a little bit too much of the nah nah nah I am legal and you are not going on.  I also sense tension between CNMs and CPMs at times.  This drives me CRAZY!  All midwives should be supported.  Certified Nurse Midwives (CNMs) don't have as much freedom as Certified Professional Midwives (CPMs) because they must answer to their back-up physician (which can sometimes be extremely hard to find) but CNMs can work at birth centers around the country or in hospitals and thus have a more secure form of income and more family friendly hours.  A big part of my choice to be a Certified Professional Midwife is the fact that I have a husband who rarely travels, does not work long hours, and can take off to pick-up kids in a pinch if I am at a birth.  Having two members in a family with long unpredictable hours is asking for trouble.  (I am keeping this simple, there are of course other pros and cons to CPMs and CNMs and much more to my decision to become a CPM).

Some Certified Professional Midwives work legally, others practice in states where it is "illegal."  But in some states CPMs practicing legally (with a license) are not allowed to use oxygen (occasionally needed to resuscitate babies) or pitocin (needed to stop a hemorrhage).  Is there a difference between a licensed midwife illegally using pitocin and oxygen despite having signed an agreement with the state releasing her right to use these materials and an unlicensed midwife who uses these materials?  Both midwives are using the proper equipment to help their clients birth, neither midwife is supported by the letter of the law (both I believe are supported by the spirit of the law).  And yet I've seen licensed midwives adopt a holier then though attitude.  Licensing is a whole other issue and one I think I will address in another post....  Fight for licensing but do it in a way that empowers midwives.  Taking the right to use pitocin and oxygen away from midwives is NOT empowering.  And the law in Tennessee recently changed making transport after the bag of waters has been broken for 12 hours mandatory.  WHAT?

I just needed to vent a bit.  There are advantages to being a Certified Nurse Midwife and to being a Certified Professional Midwife and the route you choose is a personal choice, let us not forget that!  And as for midwives practicing illegally, perhaps it is better to let the communities they serve have their babies without help at home by themselves risking poor outcome for mom and baby.  The reality is that in areas where midwives are illegal there are often communities, such as the Amish, who will have their babies at home whether the doctors like it or not.  Shouldn't they have the support of a trained midwife?  Once upon a time people running the Underground railroad were "breaking the law." There have been numerous times in history where people have chosen to follow their conscious or the spirit of the law rather then the letter of the law.  Is it any different for midwifery?  All midwives support women.  Let us all support midwives!

History of Midwifery

Ok, so my first post didn't work out today, not everyone could open the link.  So I am trying again.  This is a short post because school starts next week for the kids (three days a week for Khady and two mornings for Fen, yay for some me time at last!) and there is much to do!  I am reviewing the history of midwifery for the new midwifery study group that I've joined.   We have real homework to do, I am a bit overwhelmed and not sure how I am going to keep this blog up and get homework done for our monthly study group meeting but we shall see....  So here is a link to a good article on the history of midwifery in the U.S.

De-mystifying midwives

There are a lot of misconceptions out there about midwives.  One common myth is that if you are under midwifery care and need physician back up, you are SOL.  A good midwife maintains a working relationship with at least one physician and will consult with a physician when the midwife feels the mom she is working with might not fit into the category of normal birth and will transfer the woman to obstetrical care when necessary.   All certified nurse midwives and certified midwives are required to have physician back-up.  While a certified professional midwife is not required to have physician back-up the midwifery model of care requires that she identify and refer women requiring obstetrical attention.  Below is a brief passage on the Midwives Model of Care taken from the North American Registry of Midwives website.

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:                   

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
• providing the mother with individualized education, counseling and prenatal care, continuous hands-on assistance during labor and delivery and postpartum support;
• minimizing technological interventions; and
• identifying and referring women who require obstetrical attention.

The application of this model has been proven to reduce the incidence of birth injury, trauma and cesarean section.

Please be assured, having a good midwife does not preclude having access to obstetrical advice if it is needed.

                                     

A Big Fan!

I am going to be a midwife some day, but my gut feeling is that I will practice for a few years and then use what I've learned about birth to organize for change.  I've always been an organizer at heart.  When I read the story about Ruth Lubic in today's Washington Post Magazine I felt the inner fires stir.  It just isn't right that a birth center that does so much good is often one step away from closing.  I am a big fan of Ruth Lubic, creator of the DC Birth Center.  I hope that one day, when the kids are older, I too will offer women who might not have had such a choice, the chance of birthing with a midwife.