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Do Childbirth Educators Make a Difference?

December 22nd, 2011 by avatar

The other day, while looking through my issues of Birth for something else, I ran across a commentary* written by Lamaze teacher Betsy Adrian on why she was leaving the field after five years. She writes:

I realize now that my feelings of burn-out are much more than simply boredom with repeating myself for five years. What lies at the root of my feelings is the conflict between what I believe and what I felt I had to teach. I realized that I have had absolutely no impact on how people have babies. In fact . . . things are worse now for laboring women than when I started five years ago! Fetal monitoring is taken for granted, IVs are always started, almost everyone gets the “deluxe” high-risk treatment, whether they need it or not. . . . The cesarean rate is nothing short of alarming . . . . All of the things that I felt optimistic about early on are actually less likely to occur in a delivery experience now. I believe that childbirth is a unique experience of personal growth for a woman and her partner and that it should take place according to her needs and desires. Birth should never be “routine.” . . . [I]t became ultimately impossible for me to stand up in front of a class and expound on the virtues of fetal monitoring, IVs, being confined to bed, lithotomy position or limited nursing. I can’t do it anymore. I can’t even be “objective” and present both sides of each issue, as I have religiously done in the past. I did not arrive at my opinions irrationally. I read all the pertinent studies in fetal monitoring and IVs . . . and birthing positions. And the evidence is overwhelmingly against these routine procedures. Yet I knew that almost every one of my clients would experience all of these things anyway. I also knew that continuing to teach meant remaining in the good graces of my hospital and that if I became very vocal or militant about my opinions I would lose my source of income. . . . Sadly, I am done with childbirth education. . . . I can’t do it—not if my real purpose has to be to socialize women into accepting poor care, and that’s what we have been doing in too many cases.

Now here is the kicker: this commentary was written 30 years ago. How many childbirth educators could write the exact same commentary today? If a goal of childbirth education is to give women the information and tools they need to make decisions that best promote safe, healthy birth, clearly, we are not achieving it. The “alarming” cesarean rate Adrian cites is 35% at one hospital in her area. Thirty years later, the U.S. national average is 33%, and some hospitals have rates double that or more. Adrian attributes the failure to hospital-based childbirth education, closing with:

My ultimate hope is that childbirth education will move out of hospitals, back into the community where it belongs. Then we can devote ourselves completely to our clients, and not to the doctors and hospitals.

Is the problem simply that educators have to please their employers? I think this is an issue, but not the only one. I taught Lamaze classes independently from 1980 into the 1990s, yet, like Adrian, I quit because I could no longer stand watching my students lie down on the railroad track despite all I could do to tell them there was a train coming. And if hospital-based classes aren’t the only problem, what else is? More importantly, what more could—no, should—childbirth educators be doing about it, including hospital-based educators? What are your thoughts and ideas?

 

 

Reference
Adrian BK. Childbirth educator burn-out. Birth and the Family Journal 1981;8(2):101-103.

[Editor’s note: Excerpt from Birth contained in the post is used with permission by the publisher.]

Posted by:  Henci Goer


Childbirth Education , , , , ,

  1. avatar
    Nicole
    December 22nd, 2011 at 02:19 | #1

    I am definitely interested to hear what others think. I feel the same way after teaching now for ….. 5 years. :-) Here in BC Canada, we don’t have many Lamaze classes taught in-hospital, yet I am employed by an organization to which I am accountable …and although I teach the evidence based currculum as provided by Lamaze research, I still find myself watching what I say, “towing” the line so to speak. Covering my butt, and that of my organization. What I wouldn’t give to speak my mind sometimes!! Especially in the area of infant care. I look forward to reading what others have to say!

  2. December 22nd, 2011 at 05:13 | #2

    I took a hospital birth education class when I was pregnant with my first child nearly four years ago – that was more about what to expect during the birthing process and covered everything from the stages of labor to what expect when you’re expecting. It covered breathing techniques and pain management but not in any depth. With both of my children though, my pre-natal providers were both midwives and MD’s. I spent more time for routine pre natal care with the nurse/midwives who were wonderful in teaching me non-medication techniques an options. For my second, because I was doing a VBAC, I had an equal amount of MD visits and midwife visits, but I also took pre-natal yoga and exercised during most of my pregnancy, which I hadn’t done with the first one. I didn’t do this, but one of my co-workers used a doula as well and that was a tremendous resource for her.

    I don’t know that I would necessarily take a hospital sponsored childbirth education class now, if I were to get pregnant for the first time now. I think that the information that I was provided during the class could have been gotten from my midwife and doctor and the internet. I was able to get the different breathing techniques from the pre-natal yoga and my doctors. I also feel like giving birth and being pregnant, like any other part of healthcare, is a very individual and personalized thing and the patient should be able to devise a program that works for them. When you take a class that is mainstreamed, such as one for a hospital, I think it takes away from that – the individual doesn’t always get full information and the person teaching can’t always give them all the information or options for whatever reason.

    Just my .02.

  3. December 22nd, 2011 at 11:24 | #3

    I couldn’t believe that was written 30 years ago! Cause like you said, the exact same thing could be said today. Perhaps, this is why I couldn’t fully get on board with being a Lamaze CBE, I did however decide to become a Birth Works CBE. Though I haven’t been certified yet, it spoke more to me about starting from the woman, the family, their feelings of things they need to work through and what they envision their birth to be like. Then providing them with resources to get that experience, or just supporting them in whatever decisions they make. My role in the ‘birth world’ is more advocacy, advocacy for those who are already in the field of doing home births, of childbirth education, of women/baby centered care. Cause most of the time, women/families don’t know where to find this information and if they don’t know it exists too than they can’t access it. This is the billion dollar question being asked here, what kind of education are we giving and how do we get people to really apply it to themselves and advocate for themselves.

  4. December 22nd, 2011 at 15:51 | #4

    Wow, that is crazy that was written 30 years ago!

    I teach Hypnobabies independently (not attached to a hospital in any way) and I feel I make a difference. But a lot of the differences I make are before the birth, encouraging mom to find a new provider if she isn’t happy with her current one. Encouraging moms to research the different hospitals and where they want to birth. We have one with a VERY high cesarean rate and the moms who are birthing there, I let them know and explain there are other wonderful options.

    There are still some of my students who get railroaded into interventions… but most avoid them or consciously and with appropriate information choose them, when actually medically needed.

    It is frustrating to see the moms who are informed, but you know their birth location and care provider will most likely create unneeded interventions. But I can’t make choices for them. I remind myself often, “It’s not my birth!”

  5. avatar
    Stephanie
    December 22nd, 2011 at 17:25 | #5

    As a previous childbirth educator, my question always is… “what is the motive of the educator?” Is my motive to get my clients to make certain choices? Or Is my motive to get my clients to ask themselves questions and figure out how to find the answers themselves, thus empowering them in the process? If I am tied to a particular outcome for their birth, then the information I am providing is biased at best and manipulative at worst. I did not become an educator to make sure that they give birth in a certain setting or with a certain provider and have a certain outcome with only certain procedures to be followed. My success as an educator is gauged by how well my clients can think for themselves, make their own decisions that THEY feel safe with, and know how to do that without leaning another “expert” in their life: me. I am not the expert and I teach them how to become their own expert, while teaching them how to trust themselves instead of expecting them to trust me.

  6. December 22nd, 2011 at 18:43 | #6

    So true. The more things change, the more they stay the same…or even get worse i.e with the c/section rate. I have taught for over 12 years and have always and still do – feel I make a difference (at least that’s what parents have told me.) However, for the past 7 years I have taught independently. I am able to provide evidence-based information. That said, my inspiration for becoming a CBE was the wonderful Lamaze class I took at a hospital when I was pregnant 13 years ago. I don’t think we as CBEs can change the world. but we can give parents the info. they need to make informed decisions for themselves. Whatever those may be.

  7. avatar
    Mindy Cockeram
    December 22nd, 2011 at 18:55 | #7

    I’ve decided to pick my battles because I know I can’t win em all. At the end of the day if my couples are happy with their birth experience, I am too. Having said that, I’ll never stop trying…….

  8. avatar
    Anne Flaherty
    December 22nd, 2011 at 20:20 | #8

    I taught Bradley classes from 1981-1993, and I had the same frustrations as the other posters even though I was completely indepentant of any hospital/doctor influence. I felt that my Moms/ Couples who went to a hospital to birth were lambs going to the slaughter.Especially if they strongly expressed a desire to have a non-intervention birth, the hospital staff was determined to “teach them a lesson.” I got to where I did not want to give classes to anyone having a hospital birth because I felt like they had a target on their back.

  9. December 22nd, 2011 at 20:38 | #9

    I feel I make a huge difference in the outcomes and experiences of my students, and apparently they do also, according to the testimonials on my website, http://www.supportedbirth.com. I have created my own course over the past 17 years and continue to develop what I learn and what I teach. I believe in meeting women wherever they are along the spectrum – from fear of birth to idealization of birth – and helping them move further along to a place of confidence and realism. Yes, some women end up with unnecessary interventions and c-sections, but that is where the sum of their choices led. Their choices may not be mine, but I believe they have still been influenced in a valuable and profound way by the education. The majority have positive experiences that they would not otherwise have had, including hiring labor support from my list of sliding scale doulas.

  10. avatar
    Jacqueline (Jackie) Levine
    December 22nd, 2011 at 22:58 | #10

    Dear Henci,
    A recent post of mine (May 31, 2011) on this blog, tells the tale of the birthing women I teach at Planned Parenthood of Nassau County on Long Island, NY and explained how I give every one of my classes and clients copies of studies that support best evidence care: studies from the Cochrane, advisories from the WHO on optimal care, and studies that that ACOG itself uses to advise its members on practice and policy. I build little edifices with those studies around each Healthy Birth Practice …for example: “Labor Begins on its Own”. To illustrate that caveat, (i.e., don’t let them induce you!) I provide ACOG’s own words on induction…and when my class reads from an ACOG bulletin that “A large , or even a very large baby is not a reason to induce”, and “induction carries some risks and should only be used to preserve the health of mother and baby”… the very words from ACOG to its member docs, my classes and my clients feel more and more able to confront the day when an OB may push them towards some arbitrary termination of their pregnancies.

    I put the very studies in their hands, and highlight the good parts so they can just read the salient stuff. *I* don’t tell them…it’s not me telling them, it’s the docs themselves. These women can now be skeptical if their own doc wants to do something that they themselves have seen to be contrary to evidence-based care. In that post from May, I said that for women to have credibility when asking for optimal care that “Credibility is the coin of the realm when women demand best–evidence care, and (their credibility) becomes a really perfect tool when paired with a thorough knowledge of one’s legal rights. Since birth is under the jurisdiction of this self-regulated medical community, birthing women must seem to be knowledgeable in “their” way to be recognized as credible. For the time being, then, perhaps we need to give women a different kind of “evidence,” by giving them a look into the medical community. If women can know more of what goes on inside the profession, if they know a bit of what the docs know, they feel a different level of empowerment. They feel a gravitas in the unfamiliar and sometimes hostile world of the hospital.”

    It is, perhaps, just a little unorthodox to hand out studies that the medical community uses to communicate with itself, and that you yourself have accumulated in your unending search for veritas. To cponvince and inspire my classes, I keep looking for studies that support and promote best-evidence care, print them for everyone, hand them out and discuss what docs are saying to each other. I have discussed, for example, one study in which they wistfully admit that that sonography is just not accurate for gestational age within three weeks in the last trimester, and perhaps amniotic spectroscopy will do thew tirck and be accurate to within two weeks, and won’t that be sooo much better? And one study that traces the diminishing accuracy of sonograms from 1st trimester on…. My classes know that their doc will never say that sonograms can be inaccurate, but wow, here’s real proof that sonograms indeed can be, and all this just helps them stay off those railroad tracks that you lament. If women come to Lamaze classes at all and keep coming back after class 1, we know that these are the women who want some knowledge and some control. We can build on that desire by bringing them to best-evidence care with proof…not my word or your word (though yours is a mighty word, indeed; I am one of your huge fans), but the words of docs themselves…docs who discuss that maybe using staples to close incisions will cause them to be looking at higher rates of wound infection, even though staple closure is quicker. I give them studies that carry them through all the hospital protocols, and show them that they may refuse routine treatment according to an ACOG practice bulletin on informed refusal. How much more powerful a tool can we give our clients than ACOGs own words?

    When women are treated as though they deserve to know stuff that the docs know, and are given solid proof that they are easily able to grasp what’s going on behind the scenes, and should really know what is said about them and their babies and their care, it elevates the discussion, it elevates the class, and leads to a determination and confidence that is truly inspiring and breath-taking. When I talked about best-evidence care in the post mentioned above, I did say that that we have been “Pinning our hopes for sane and humane birth on it [evidence-based care ] [and] we expect that, at any moment, best evidence care must surely begin to prevail.” Maybe that’s too hopeful and maybe I’m close to burnout too…sometimes I feel that lurking presence, but I have to say that one good VBAC and a happy home-birther can bring me back to the front lines.

    So yes, we do make a difference in the only way that we can: one motherbaby at a time.

    Just anecdotally, we met of an evening at my doula group (Long Island Doula Assn) a few years ago, where you spoke, as you surely always do, with great verve, conviction, dedication and conviviality. It is a pleasure to comment on your provocative blog.

  11. December 23rd, 2011 at 09:38 | #11

    Hi Henci,
    thank you for posting this. Yes, it is sad, and no, I was not surprised to hear it was written 30 years ago.

    I have been teaching Bradley for 16+ years, and am happy to say that my classes have had a positive impact on the way my students birth. There are a number of elements that really do make a difference when influencing ones knowledge and resolve that are present specifically in Bradley classes. They include, but are not limited to, the length of the series (12 weeks), involvement/training of the woman’s partner, teaching how to stay healthy and low risk, & the emphasis on natural birth.
    It takes aprox. 12 weeks for a human to assimilate a new thought process, or diet and exercise plan. Support of a woman’s partner is not only important but may be key to holding on to the resolve not to use interventions in the face of hospital protocols. When I took lamaze I was told that there was no way to prevent a cesarean — not true. I was also told that the doctor would not suggest anything that I did not medically need — also not true.

    Now I know that Lamaze classes have changed in the last 20 years, But the one thing they did not do was extend the length of the series. Food for thought –

    The proof is in the statistics —my students have a 15% cesarean rate, and a 20% intervention rate. By keeping statistics we can monitor how much effect we do have.

    That said what we really need to do is keep educating the public about healthy choices for birthing women and their impact. We need to stop the socialization of women into medicalized birth by the media. One woman at time —keep at it ladies! As I used to tell Dr. Brewer “We will never surrender! “

  12. December 23rd, 2011 at 21:20 | #12

    This is one of the reasons why I’ve not only chosen to teach independently, but I’ve also chosen to open my own Prenatal Education Center – Shining Light Prenatal Education. http://www.shininglightprenatal.com

    While teaching Prenatal Yoga (pre-Lamaze certification) I found that what women need is continuity. They need the long-term support of an instructor throughout their pregnancy and their postpartum period. Seeing my prenatal yoga students from 15-ish weeks through birth allowed them to develop trust, research the information I give them, and follow up with me later. They send me such wonderful birth stories.

    During my market research for Shining Light, I came across this article “Childbirth Education in the 21st Century: An Immodest Proposal” by Charlotte A. De Vries, BA and Raymond G. De Vries, PhD http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174394/ Strangely enough, a former president of Lamaze says we need to open Education Centers – like Shining Light.

    By providing support and education from pre-conception through postpartum we truly give our mamas and their families the confidence they need to birth their way.

  13. avatar
    Sue
    December 25th, 2011 at 21:00 | #13

    As an outsider to the CBE world, I relate very much to the comments of Stephanie, who asks: ““what is the motive of the educator?” Is my motive to get my clients to make certain choices?”

    It seems to me that an “educator” whose aim is to change what occurs within hospital practice is working at a self-defeating aim. It is no wonder that this produces burnout. Even “armed” with medical research papers, as suggested by Jackie Levine, a novice to the practice of OB or midwifery cannot hope to understand the many factors that feed into decision making when the health care worker is responsible for the outcome – both morally and legally.

    If, ultimately, the purpose of an “educator”‘s intervention is to reduce the intervention rates in hospitals, then the way to do this is not to try to set up either themselves or the mothers as alternative “experts”, but to become part of the policy-making discussion, using valid research and data. If, in the long run, both mothers and clinicians disagree with the CBE’s view, then continuing to promote a particular ideology can only continue to be self-defeating.

  14. avatar
    Jacqueline (Jackie) Levine
    December 26th, 2011 at 19:29 | #14

    @Sue It’s interesting that your feelings resonate with Stephanie’s questioning of her motives. You are correct in your wish, your hope, that CB educator’s motives in teaching are not to set themselves up as experts, but rather they should try to change hospital practice by becoming part of the “policy-making discussion, using valid research and data”.. .and that they will examine the best way to become part of that policy-making establishment. I also hope that all CBEs have a clear understanding of their motivations…about what sends them out to teach about birth.

    But no matter what motivates us, the facts are the facts and ACOGs own study, released this year, informs that only 30% of maternity practices are based on “Level A” evidence … in the words of that study…”good and consistent scientific evidence”. (Journal of Obstetrics and Gynecology: Scientific Evidence Underlying the American College of Obstetricians and Gynecologists’ Practice Bulletins, Wright, Pawar, Neha, Gonzalez, Sharyn et al.) How can anything have more importance than that a woman have best treatment and care? This isn’t about a ‘particular ideology” as you say, but about what’s good and careful treatment of birthing women. Every birthing woman is entitled not just to know that some protocols she will be subject to may be harmful to her or her baby, and that she has the right…no, the obligation and the responsibility to herself and her child…to ask for only evidence-based care. Moreover, she has the right to demand it. That’s the law. It’s informed refusal/consent. She has to know that she can refuse sub-optimal care, and CBE can teach her that. It matters little what motivates an educator if her clients are able to avoid harmful practices and are able to ask for evidence-based care with the confidence that comes from secure knowledge. That’s what is important.

    We are truly talking about health and safety. This is not about hoping to change the whole world, but just to assist and support one woman-at-a-time. . Read the Milbank report. It ‘s an important and influential research-based compendium that reports on the status of maternity care in this country. With maternal mortality rates high and increasing, this is not about setting oneself up as expert, this is about saving women from harm. That’s critical. AFE and placenta percreta? Both used to be very rare but are on the increase because of increased inductions/cesareans . These are life-threatening conditions. This isn’t about ego or thinking one is going to change the world. This is about arming our clients, each one, one-at-a-time, with the best info we have. Read what the World Health Organization has to say about what is healthy for birthing women and babies. It’s not about setting oneself up as expert, it’s about understanding things better than before… and staying constantly educated and updated with the latest info since we have to recertify often with continuing education credits… and yes, understanding that if, as you say, there are “many factors that lead to decisions” , women are entitled to know what those decisions are and if they are evidence-based. Even first-time mothers, who are as you say “novices to the practices of OBs or midwifery” should know about what can happen to them, and have some options where their care is concerned. Yes, “heath care workers are responsible for outcomes morally and legally” as you say, but are they not responsible as well for practicing best-evidence care? What about docs who still give episiotomies or clamp cords immediately without any scientific basis for their actions and against all studies that show harm? Should women not be informed? If a women’s requests can have some influence on her OB…after all, it’s the OBs who set policies within the hospitals…that may indeed have some influence on future policy, and by rights, it should. It certainly has had influence in the past. Think of this: when women began coming into hospitals for their births in the 1920’s, the hospitals advertised services to woo women to come in…touting flowers in their rooms and curtains on the windows. Women’s opinions were important to the hospitals as consumers of health care. An important element in changing policy in the 60’s and 70’s was the grassroots movement of women who were dissatisfied with anesthetized birth, and fostered a change in policy that led to fathers being welcomed into labor and delivery rooms and some hospitals building home-like suites with couches and other amenities. If women know what to ask for, they can change things for the better as they have in the past. Without any CBE, no matter the motive of the teacher, women are poorer in knowledge and in options. So as you said if “ultimately the purpose of an educator is to reduce interventions in hospitals” it may be that through education, women themselves will ask that routine interventional care be reduced, and best-evidence care will prevail. Burnout is understandable with things as they are, but the motives that move us as teachers are not that we want to be seen as experts, but rather to give women better chances to have better births. And women want to have good births…that’s why women come to CB education , and as a CBE, I know that this is true.

  15. avatar
    Lydia
    December 27th, 2011 at 09:42 | #15

    And do you provide them with information about how risks of stillbirth start to rise after 39 weeks? Do you give them a feeling for the overview of the medical literature as a whole or just cherry pick what you like?

    Do those who come to you understand that they are entering into a “learning process” subject to a particular philosophical slant as much as if they entered a Pregnancy Crisis Center funded by a pro-life group?

  16. December 27th, 2011 at 11:16 | #16

    I currently teach classes with my business partner as independent educators. We teach in a rural area, so getting involved with a care provider or hospital to teach classes would help us actually take our work into something that creates a bit of an income for us. However, it the thought of being beholding to any one entity makes me nervous. As an independent educator I do feel like I make small differences here and there. I helped one mama avoid an unnecessary induction. Through education and doula work I feel like there have been potential c-sections avoided as well. I am able to share information about breastfeeding and offer support in an area that has dismal breastfeeding rates. Most of my classes so far have been taught as private classes as well, so I can tailor the class to meet the needs of that particular couple. There are a lot of pluses to that… while there are pluses to having group classes as well. But, I don’t see myself being able to say that an epidural is the first choice for pain relief, or that most women need one – I don’t believe that. I believe an epidural has its time and place. I also couldn’t support induction or c-section due to baby size without a clear medical necessity after a trial of labor. Nor elective inductions without a clear medical reason simply because someone is near or has reached the 40 week mark. These are things I fear I’d be pressured to be silent about if I taught through a system or entity.

  17. avatar
    Nicole
    December 27th, 2011 at 21:27 | #17

    Interesting responses ….and as I thought about it some more, I have come to realize that my motive as an educator is most definitely to give them the ability to ask questions. To make informed choices – whether it’s informed consent or informed refusal. To learn to use their “BRAIN” so they too can be aware of risks and benefits, of alternatives and other options. If I can get them to see the importance of that, then I think I have achieved my goal. It IS hard though, at reunions, to still hear story after story of interventions that led to unnecessary outcomes due to pressure from within the medical system. And yes, it is pressure from within the medical system. And there is an incredible difference between midwifery clients and medical clients – not just in birth outcomes, but in BIRTH SATISFACTION. Upon further reflection, I am aware that in classes where there are mostly midwifery clients, I teach differently, and hear much happier stories later on in comparison to classes where there are mostly doctor clients. Food for thought there too. Here in BC, our College of Midwives is currently collecting data to prove to our government that we NEED more midwifery funding to meet the demand that we currently cannot do. I do believe that that is a key to reducing interventions generally speaking.
    Again, in further reflection (also based on previous comments), I realize that when I DO hear stories of women who DID question their OB’s, or whatever other careprovider they had, and got answers they were satisfied with, and carried on with their decisions … that satisfies me and gives me the energy to keep on doing this work, one class/one woman/one baby at a time!

  18. avatar
    Walker Karraa, MFA, MA, CD
    December 29th, 2011 at 21:54 | #18

    I would like to thank you, Henci, for offering a good topic for consideration. I think reflecting on history is a valuable educational tool in and of itself.

    I would like to suggest generally that the comments be kept to a word count maximum.

  19. December 30th, 2011 at 12:30 | #19

    Lydia :
    And do you provide them with information about how risks of stillbirth start to rise after 39 weeks? Do you give them a feeling for the overview of the medical literature as a whole or just cherry pick what you like?
    Do those who come to you understand that they are entering into a “learning process” subject to a particular philosophical slant as much as if they entered a Pregnancy Crisis Center funded by a pro-life group?

    As Jackie wrote so eloquently, what makes for a safe, healthy birth is not a matter of philosophy, belief, or opinion, but the consensus of the obstetric research and therefore a verified fact. By contrast, your assertion that stillbirth rates rise after 39 w is not accurate. An analysis of U.S. births in 2005 reported a rate of 1.4 per 1000 in weeks 37 to 39, a dip to 0.9 in weeks 40 and week 41, and a rise to 1.7 at or after week 42: http://www.ncbi.nlm.nih.gov/pubmed/19294965?dopt=Citation — and those are numbers in the overall population; we do not know what they would be in women with no factors predisposing to stillbirth. Correct me if I am wrong, but I assume you were making an argument for elective induction to avert the risk of stillbirth, but inducing labor is consistently found to double the risk of cesarean. Cervical ripening agents do not decrease this risk, and, of course, the earlier you induce, the more likely the woman has an unfavorable cervix. Cesarean surgery has adverse consequences for women, their babies, and subsequent pregnancies, including an increased risk of neonatal death after adjustment for confounding factors in the current pregnancy and an increased risk of infertility, pregnancy loss, and perinatal death in subsequent pregnancies.

  20. avatar
    Betsy Adrian
    February 17th, 2012 at 12:41 | #20

    Wow! It was exciting to see me resurrected from the dead! I’m the Betsy Adrian who wrote the excerpt. (I am happy to report that my daughter delivered her baby with a CNM in a hospital and avoided a c-section because the CNM knew what she was doing.) I have a hard time with the fact that nothing has changed for the better in 30 years; in fact things are worse. I wish I could be more encouraging. I think natural childbirth will continue to be a “fringe” activity and childbirth will continue to be more & more medicalized and interventionist. At least 30 years ago we didn’t see a lot of c-sections scheduled for convenience and now it is an accepted practice. I also have seen very little interest in my daughter’s generation in natural childbirth. Enough rambling. Keep up the good work. There are people who still believe that what you do is worthwhile.

  21. July 18th, 2012 at 12:49 | #21

    Actually, I have seen the opposite in the years that I have been doing birth work in general. I am now a midwife, but started out 8 years ago as an ALACE trained doula and childbirth educator. I was taught that it is important to look at the birth culture around us, specific to our area, and teach accordingly. For instance, EVERYBODY who teaches or does doula work has always said, “wait till the cord is done pulsing before you clamp/cut.” Sure that makes total sense…except have you ever met a first time parent who knows what a cord looks like when it’s done pulsing? I haven’t. As a matter of fact, I have met only two OBs who actually have ever seen a cord done pulsing of it’s own volition. Instead, I teach my students to wait until the placenta is born before they consent to clamping and cutting of the cord. This means that they have a leash holding baby to Mama for skin to skin AND that in nearly every case the placenta is done sending blood to baby. I have nobody telling me that I am or am not “allowed” to recommend that, only the encouragement to be a thinking person and use what I know and look at what is going on in our local birth culture.

    I have only ever taught out of hospital classes, and only ever have I been able to rely on word of mouth to fill my classes. And fill them I do! And honestly, in our area in the last 8 years, women’s choices have actually expanded. It seems that the practitioners in our area are reading the signs that women are looking for evidence based care, and are at the VERY least expecting informed consent when they have procedures. Or at the very least they realize that women ARE seeking midwives and a homeier environment, so to make their paychecks they figure they have to provide it! Regardless, our community now has two hospitals with midwives who I would be happy to have attend my own birth, and to whom I feel entirely safe sending my friends and family for in-hospital care. And believe it or not, one of the worst offenders for non-evidence based care is now seeking Baby Friendly status–and one of the other hospitals in it’s health system has already attained Baby Friendly Status. I almost fell over when I heard that. We also have a boom of doulas, new/ young out of hospital midwives, and childbirth educators as well.

    Does that mean that all is well? Not at all. Our big University Teaching Hospital (the only one, actually, which places baby on mother’s chest AT BIRTH and leaves them there while the surgeon is closing DURING A CESAREAN SECTION)has just finished building it’s new L&D unit where they have prepared for a 50% cesarean rate. *sigh* We still have a long way to go. But I have been heartened at the surge of changes that have taken place for the better even in just the last few years.

    And I’ll tell you what, within three classes in my 9 class series, 75% of my students who WERE with an OB change practitioners to a midwife at one of the “safe” hospitals. The remaining students typically have one of the two “safe” OBs in our area, who both trained with midwives in their Residencies. When women HAVE the information, they much prefer a practice which at least attempts to practice evidence based medicine and strives for informed consent and discussions rather than pompousness and directions.

  1. December 22nd, 2011 at 01:40 | #1