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Lamaze On Call Virtual Conference

September 19th, 2009 by avatar

Lamaze International Annual Conference

Can’t make it to Orlando? This year, Lamaze International is offering an at-home, at-office extension of the 2009 Annual Conference. A live Webcast of 10 conference sessions, 4 plenary and 6 concurrent sessions, the On Call Conference is an inexpensive and convenient way to learn and earn contact hours in an interactive environment. This all-new opportunity allows you to:

  • Listen to and participate in 60- or 90-minute sessions and access PowerPoint presentations—all in real time
  • Be eligible for up to 13 contact hours with no post test required
  • Share the experience with your colleagues and register as a group.

You can register for individual sessions or the entire package. The included sessions are:

PLENARY SESSIONS

Breastfeeding Made Simple
Kathleen Kendall-Tackett, PhD, IBCLC

Branding “Magic”: Can it Give Lamaze a New Image?
Sharon Dalrymple, RN, BN, Med, LCCE, FACCE

Message Therapy Research
Tiffany Fiels, PhD

Birth is Normal… But What is Normal Birth?
Penny Simkin, PT, CD(DONA)

CONCURRENT SESSIONS

Embracing Technology: Sharing the Magic of Normal Birth in an iPod Culture
Lisa Crane, MSN, RN

Cesarean Delivery on Maternal Request: Future Shock or Our Reality?
Barbara Hughes, CNM, MS, MBA, FACNM, LCCE, FACCE

Inspiration for Independent Educators
Ami Burns, CD(DONA), LCCE

Postpartum: The Neglected Phase of Childbearing
Penny Simkin, PT, CD(DONA)

¿Se Habla Español?: Providing Cultural Sensitive Childbirth Education for Latinas
Elena Carrillo, CD(DONA), LCCE, FACCE

Creating and Marketing Your Birth Related Business
Connie Livingston, RN, BS, CPCE, CD(DONA), CHBE,  LCCE, FACCE

Lamaze News

Home Birth: The rest of the story

September 11th, 2009 by avatar

As most readers of this blog are probably already aware, The Today Show ran an inflammatory piece about home birth this morning that parroted ACOG’s long-standing scare tactics and anti-midwife rhetoric.

Since I just wrote a post on the safety of home birth, I thought that rather than repeating the same old story that home birth is safe for healthy women with qualified attendants and access to referral, I would share with readers some other thoughts, culled from this blog, the rest of Lamaze.org, and other trustworthy resources.

One of the first posts I wrote for Science & Sensibility (actually written as a guest post at the Giving Birth with Confidence Blog while this site was getting up and running) was titled, “Why the Largest Study of Planned Home Births Won’t Sway ACOG.” ACOG prefers to hold home birth to a standard of evidence to which hospital birth was never held.  Even while actively compiling the lowest form of evidence on the supposed “perils” of home birth in a membership survey, ACOG repeatedly calls for a randomized controlled trial comparing perinatal death rates in the two settings, fully aware that such a trial is literally guaranteed never to happen. I discuss some of the reasons why in my post, concluding that we face much more urgent research priorities for the study of planned home birth than a full-scale clinical trial.

We need more and better research on home birth. We can use data from the Netherlands to determine the safety of home birth in systems that support and integrate home birth midwifery. After all, it is the only place left with a maternity care system that lends itself to home birth safety research, and national registers to conduct that research soundly. In the U.S., we must study how we can reform our maternity care system to provide access to midwife-led care in all settings, and best practices for caring for the women who rightly and inevitably will continue to desire birth at home.

Why exactly do women desire to birth at home? It’s is not because they are hedonistic or selfish, as ACOG likes to suggest. Judith Lothian, PhD, RN, LCCE, wrote recently about the qualitative research she will present at next month’s Lamaze Conference. (Rixa Freeze, PhD, Lamaze International’s 2009 Media Award recipient, has conducted similar research.) Judith asked women themselves why they planned to give birth at home, and then observed them doing so. Their responses describe motivations far from reckless desire and hedonism. She writes:

I was surprised that all of the women described themselves as “mainstream”. They all wanted a natural birth. All the women came to believe that “intervention intensive” maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. ‘Being Safe’ emerged as the theme that captured the essence of women’s decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

It seems likely that women believe that home birth is safer than hospital birth because word is getting out that hospitals routinely deprive women of the style of care that is proven to produce the safest, healthiest outcomes. Just last week, Lamaze released the third revision of the Healthy Birth Practice Papers, a collection of evidence-based articles about the care practices that ease and facilitate labor, prevent complications, and protect breastfeeding and early mother-infant attachment:

1. Let labor begin on its own

2. Walk, move around, and change positions throughout labor

3. Bring a loved one, friend, or doula for continuous support

4. Avoid interventions that are not medically necessary

5. Avoid giving birth on the back and follow the body’s urges to push

6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding

The 2006 U.S. Listening to Mothers II Survey revealed what anyone who advocates for home birth could tell you even without the data: almost no one who births in a hospital actually experiences these care practices. The survey found that fewer than 2% of women had all 5 of the care practices that the survey measured. (The practice they were unable to measure was “no routine interventions”. Since interventions are routine and rampant in hospitals, this likely means that the proportion of hospital birthing women who experienced all six care practices was effectively zero.)  Instead, the authors of the survey tell us what is happening in current, hospital-based maternity care:

The data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. This sounds alarm bells…Few healthy, low-risk mothers require technology-intensive care when given good support for physiologic labor. Yet, the survey shows that the typical childbirth experience has been transformed into a morass of wires, tubes, machines and medications that leave healthy women immobilized, vulnerable to high levels of surgery and burdened with physical and emotional health concerns while caring for their newborns.
- Maureen Corry, Executive Director of Childbirth Connection.

In fact, ACOG themselves acknowledged in a press release today that the current style of obstetric practice (high-tech defensive medicine) “ultimately hurts patients“.

I continue to believe that if hospitals provided the Six Healthy Birth Practices as the standard of care and offered evidence-based treatments for women and babies experiencing complications, hospital birth would be safer and so would home birth. That’s because midwives would initiate transfers with more confidence that it would improve the outcome, women would transfer more willingly, and care at the receiving facility would be safe and effective. What’s not to like about that plan, ACOG? Now, let’s make it happen!

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How Too Much Information May Cause Problems for Breastfeeding New Mothers

September 8th, 2009 by avatar

[Editor's Note: This is our fourth installment of guest posts from Lamaze International's 2009 Annual Conference speakers. Dr. Kendall-Tackett will present the Opening Plenary Address at this year's conference. You can listen to podcast interviews will all of our plenary speakers online. You can also read our other conference previews by clicking on the Lamaze 2009 Annual Conference tag. We hope to see you October 1-4 in Orlando at the Lamaze International 2009 Annual Conference. - AMR]

Kathleen Kendall-Tackett, Ph.D., IBCLC

Kathleen Kendall-Tackett, Ph.D., IBCLC

In modern Western cultures, mothers have more information about breastfeeding than any time in human history.  Unfortunately, most of this information is left-brained, which works well for some tasks, but can be a problem for breastfeeding new mothers. That is because breastfeeding is a right-brained activity. What do we mean by that? Think of left-brained instructions as head knowledge. Right-brained learning yields heart or body knowledge. To illustrate the difference, think about riding a bike. Did you learn by reading about it? Talking a class? Talking to other people about it? Or did you learn by just getting on a bike and doing it?

The Right-Brained Relationship of Breastfeeding

Mothers and babies have physiological responses that draw them to each other, that encourage them to look at each other, touch each other, and interact. Much of this behavior is guided by the right side of the brain. This is the side that has to do with affect or emotion.

A problem with the heavily left-brained, instructionally oriented way that many mothers learn to breastfeed is that it doesn’t allow mother and baby to take advantage of their natural responses. So much breastfeeding education focuses on all the things mothers must to do get the baby to breastfeed, which ignores the baby’s role. That type of instruction can be helpful to solve a particular problem, but it can be a definite drawback when one technique or strategy is applied to all mothers. It also discourages mothers and babies from using their hardwiring. Worse still, this kind of education can encourage them to tune out their natural responses or to violate their instincts. It can be upsetting for all who are involved, sometimes creating a crisis where none existed before. Another problem with highly instructionalized left-brained approaches is that they can leave some mothers feeling incompetent because it feels as if there are ten thousand things they need to remember.

A different way to think about this is to consider how mothers throughout human history managed to breastfeed without all of the information we have now. When breastfeeding was the norm, girls learned about breastfeeding as they were growing up by seeing women actually doing it. Dr. Peter Hartmann, a well-known breastfeeding researcher, makes this point well. He asked a young Australian Aboriginal mothers, “When did you learn about breastfeeding?” She answered, “I have always known how to breastfeed.”

So how can mothers use a right-brained approach to breastfeed their babies? First, encourage mothers to take some deep breaths and let go of those worries about doing things “wrong.” Instead of thinking of breastfeeding as a skill mothers need to master, or a measure of their worth as mothers, encourage mothers to think about breastfeeding as primarily a relationship. As mothers spend time with their babies, they’ll start to feel more adept at reading their cues. As they hold their babies, the babies will start seeking their breasts. Breastfeeding will flow naturally out of their affectionate relationship. Based on her extensive clinical experience with mothers and babies, pediatrician and board-certified lactation consultant Dr. Christina Smillie has developed some strategies that can help you help mothers. Here are some specific things you can do.

Start with a calm, alert baby. Sometimes women wait to breastfeed until their babies are screaming. Think about yourself. Do you learn best when you are upset? Probably not. The other reason to start with a calm baby has to do with physics. When a baby is screaming, her tongue is on the roof of her mouth. Mothers will never get their breasts in their mouths when their tongues are like that.

Watch for early feeding cues. These cues include turning her head when someone touches her cheek and hand-to-mouth. Help mothers take note of when their babies starts smacking their lips or putting their hands to their mouths. This is an ideal time to try breastfeeding.

Encourage mothers to use their bodies to calm their babies. One way to calm a crying baby is by having mothers place their babies skin to skin vertically between the mothers’ breasts. A mother’s chest is a very calming place for her baby. Encourage mothers to try talking and making eye contact. All of these activities can calm the baby down, allowing the baby to seek the mother’s breast on her own.

Follow the baby’s lead. When a calm, alert baby is held vertically between her mother’s breasts, often she will begin showing instinctive breast-seeking behaviors, bobbing her head and moving it from side to side. Once babies start these behaviors, mothers can help in their efforts. Mothers should following their babies’ lead, supporting the babies’ head and shoulders, and encouraging their babies with their voice.

Have mothers play while they learn to breastfeed. Play is something that is largely absent from the mothers we see. It all seems so serious and they are terrified of doing something wrong. If mothers are feeling frustrated, encourage mothers to focus on their relationship with their babies and consider breastfeeding as a part of the larger whole. Breastfeeding will flow naturally out of their affectionate relationship.

In summary, if babies are healthy, they are wired to know how to breastfeed. It all doesn’t depend on mothers getting everything “right.”  Encourage mothers to relax and just focus on getting to know their babies.  The rest will follow.

Dr. Kendall-Tackett, Ph.D., IBCLC, is a health psychologist, International Board Certified Lactation Consultant and La Leche League Leader. She specializes in synthesizing current research on breastfeeding and related fields, facilitating the provision of evidence-based care. Dr. Kendall-Tackett has authored more than 180 articles or chapters and is the author or editor of 17 books on maternal depression, family violence and breastfeeding. This post was co-authored by Nancy Mohrbacher, IBCLC.

Lamaze International Annual Conference

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The ethics of birthing babies

August 31st, 2009 by avatar

[Editor's Note: This is our third installment of guest posts from Lamaze International's 2009 Annual Conference speakers. You can read all of our conference previews by clicking on the Lamaze 2009 Annual Conference tag. We hope to see you October 1-4 in Orlando at the Lamaze International 2009 Annual Conference. - AMR]

Jennifer Torres

Jennifer Torres

It is late summer and nearly all media outlets in the US are abuzz with news of town hall shouting matches over health reform.  Americans – whose health system has the distinction of being the most expensive in the world (measured in dollars spent per capita) while leaving over 45 million people with no or limited access to care – are rightly fearful of change.  It is a case of choosing “the devil you know” over the uncertainty of reform.  Senators and members of congress are hearing stories of “death panels” that will deny care to the elderly and infirm, of benefits being taken away from medicare recipients and given to (illegal) immigrants.

Where are the ethicists?  Clearly questions about who should have access to what kind of health care is an ethical question, but if you look closely at the debates over health reform, ethicists show up only when the issues are related to the beginning and end of life.

It is a sad fact that the rise of bioethics as a profession has served to limit the range of issues that are considered “ethical.”  Ethical questions are restricted to those debated by “experts” — on television, radio, and on the pages of our newspapers — questions about stem cell research, cloning, and the end of life.

Those of us who work in and around childbirth know that questions of ethics and morality are not limited to the special issues taken up by bioethicists (the “experts”).  Think, for example, about the debates between hospital birthers and home birthers.  You are unlikely to see a bioethicist wade into this controversial topic, in spite of the fact that the conversation is rife with moral terms.  “Good mothers” give birth at home (or in the hospital), only a “bad mother” would consider subjecting her baby to all that technology (or the care of a midwife).   Good and bad.  The debate over where to give birth is framed in moral terms.  This is where the ethical rubber meets the road, in the moral aspects of mundane life.  The ethics of everyday life – more common and more important than cloning, stem cells, and pre-implantation genetic diagnosis to most of us – gets ignored by professional bioethicists.

So why do bioethicists ignore the ethics of everyday life? It has a lot to do with their academic approach to the subject.  When asked to consider the ethical problems associated with prenatal testing, most ethics pros will focus on the process of informed consent. Have the parents been told the risks and benefits of the procedure?  Have they given their free and informed consent?  The academic ethicist wants to be sure that the autonomy of the parents has been respected – if it has, there is nothing more to be done.

What’s missing here?  The ethicist has not asked how our culture (and economy) shapes our attitude about disability (and the possibility of parenting a disabled child) or how the way we pay (or don’t pay) for health care influences parents’ choices.  These everyday aspects of life play an important role in parents’ decisions about prenatal testing, yet the informed consent process does not address them. As long as parents make a “free” decision there are no ethical issues.

Come to the Research Papers session at the 2009 Lamaze International Annual Conference to hear more about the importance of everyday ethics.  Raymond DeVries and I will consider issues much on the mind of childbirth educators, from elective cesareans to epidurals to male infant circumcision to the use of educational materials paid for by manufacturers of baby products. We’ll talk about the standard bioethical approach to these issues and, more importantly, what this approach leaves out. You will go away with an entirely new perspective on the ethics of childbirth.

Jennifer Torres is a doctoral student in the department of Sociology at the University of Michigan. Her dissertation is an historical examination of breastfeeding discourse and how this changing discourse affects women’s decisions about and experiences of breastfeeding.

Her co-presenter, Raymond G. De Vries, Ph. D., is Professor in the Bioethics Program, the Department of Obstetrics and Gynecology, and the Department of Medical Education at the Medical School, University of Michigan.  He is the author of A Pleasing Birth: Midwifery and Maternity Care in the Netherlands (Temple University Press, 2005), and co-editor of The View from Here: Bioethics and the Social Sciences (Blackwell, 2007).  He is at work on a critical social history of bioethics, and is studying: the regulation of science; international research ethics; the difficulties of informed consent; bioethics and the problem of suffering; and the social, ethical, and policy issues associated with non-medically indicated surgical birth.

Lamaze International Annual Conference

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An Interview with Stand and Deliver’s Rixa Freeze, Winner of Lamaze International’s 2009 Media Award

August 13th, 2009 by avatar

Earlier this year, I announced on this blog that, for the first time, bloggers would be eligible for Lamaze International’s Annual Media Award. The Media Award is intended for individuals or organizations shaping the public discourse about natural, safe and healthy choices for childbirth. With blogs and other social media now firmly on the scene, it was clear that restricting our award to “traditional media” would have been looking too narrowly.

Stand and DeliverThe response was tremendous, and we faced a difficult task of choosing from among many wonderful and informative blogs written by mothers, fathers, nurses, childbirth educators, doulas, midwives, and consumer advocates. But one blogger rose to the top. Rixa Freeze, MA, PhD, blogs at Stand and Deliver, and reaches over 30,000 readers a month. Known for her warm, thoughtful tone and expert critical analysis of all things birth- and mothering-related, Rixa has built a strong community of engaged readers who comment often, challenge Rixa and one another, and shape and shift a conversation about birth that very often trickles onto other blogs and online forums and, occasionally, even the mass media. Rixa will receive her award, along with the recipients of Lamaze International’s other prestigious awards (to be announced this Fall), on October 3 at the 2009 Lamaze International Annual Conference in Orlando.

Stand and Deliver, like many pregnancy and parenting blogs, started as a family affair. Rixa launched the blog as a way to explain to her family and friends why she was making certain pregnancy and birth choices, without the emotion involved in sharing these choices with unsupportive loved ones face-to-face. Over time, her blog has evolved to include a wider range of posts: research updates and analysis, guest posts, meditations on birth and mothering, academic essays, critiques of North American obstetric practices, links to blogs and news articles, birth stories, and book reviews. And, of course, updates and pictures of her beautiful family!

Rixa may be best known for her choice to have a planned, unassisted home birth, and later, to complete her doctoral dissertation (PDF) on the modern unassisted childbirth movement, the first analysis of its kind. Let’s be clear – Lamaze International does not endorse unassisted childbirth, and granting the Lamaze Media Award to Rixa should not be considered an endorsement of unassisted childbirth. But we feel that Rixa’s personal and academic journeys to explore the entire range of childbirth choices can help us better understand the practices that facilitate normal physiologic childbirth, and how to humanize childbirth in all settings.

Rixa agreed to answer some interview questions about her blog, her philosophy, and what she would like to see change in our maternity care system. We hope Science & Sensibility readers enjoy hearing from this powerful voice in the birth blogosphere.

Lamaze: Did you have an “a ha” moment about natural birth? How did you come to your beliefs about birth and our maternity care system?

Rixa: During my first year as a PhD student at the University of Iowa, a fellow graduate student had a baby. I had a few conversations with her about her pregnancy and birth. She initially wanted a home birth but was unable to find a midwife. (Direct-entry midwifery is currently illegal in Iowa, and there are very few nurse-midwives who attend home births. I knew next to nothing about midwifery, let alone that direct-entry midwifery was illegal in my state.) So she went with the CNM practice at the university hospital and was very disappointed with her experience there. She asked me if I had ever considered home birth, and I said something to the extent of: “Well, nurse-midwives in a hospital seem like a good idea, but I would NEVER give birth at home!”

Ha.

As it happened, I was also looking for a paper topic for a feminist research seminar I was taking. I decided that writing about home birth midwifery in Iowa would be really interesting, so I started reading. I checked out stacks of books. The first one I read was Peggy Vincent’s memoir Baby Catcher. I still remember the hallway and chair in the library where I read that book. It turned my worldview upside down and inside out. When I started reading, I imagined that when I had a baby I’d go to a hospital, have a nurse-midwife because they spend more time with you and are more personal than physicians, probably have an epidural, and that would be the end of my story. By time I finished the book, I was transformed. I knew deep in my soul that I would birth my babies at home.

Discovering the world of midwifery and home birth changed the way I think about birth. I used to see childbirth as disempowering and degrading. I resented that we as women had to go through such a horrible experience. And I felt that men definitely lucked out. Some of these attitudes came from a passive absorption of cultural images and beliefs about birth. In film, for example, giving birth is always horribly painful–the woman is screaming and sweating and out of control, swearing at her husband, and lying on her back with her legs spread open, exposed to the world. In addition, hearing stories of my own experience of being born certainly had an effect on me. My mom gave birth to me upside-down, strung up from the ceiling by her ankles, only her shoulder blades making contact with the bed. This was not her choice. Her physician believed that giving birth upside down would prevent hemorrhoids. My mother screamed to be let down, to no avail. (And she never had hemorrhoids, either, not with my older sister or any of my other siblings who were born more conventionally.) That was all I knew about birth until my graduate student years.

In a way, naming my blog “Stand and Deliver” brings the story of my own birth full circle. My mother was lain (upside) down and delivered of a baby. When I was in labor, I stood up and delivered both of my babies myself, with full autonomy over my body and my labor.

Lamaze: You have written extensively about both midwife-assisted and unassisted home birth, had an unassisted birth of your own followed by a midwife-assisted home birth for your second child, and for your doctoral dissertation examined the modern unassisted birth movement (PDF). Can you briefly discuss what you think the existence and apparent growth of the unassisted birth movement means for the broader maternity care reform movement?

Rixa: Although some women choose unassisted childbirth (UC) solely out of a desire to have an autonomous, undisturbed birth, many come to it from some sort of previous trauma, fear, or disappointment. Today’s obstetric climate pushes many women into considering alternatives, from birth centers to midwife-attended home birth to unassisted birth. Other women have had disappointing experiences with their home birth midwives–some traumatic, others highly disturbed and controlled–and they conclude that the only way to have a safe and satisfying birth is to have no one there to boss them around. Some women choose UC because all of their local hospitals have banned VBAC and they refuse to have an unnecessary repeat surgery. Whatever one’s perspective on unassisted birth, there is no question that the existence and growth of unassisted birth is, in large part, a vote of no-confidence in our maternity care system. Some women would still have a UC regardless of how many other options were available, but others would hire a midwife or perhaps even have a hospital birth if they felt that they would have control over what happened to them in labor. I was probably in the minority, because I choose an unassisted birth for my first baby. I had never had a traumatic birth experience that left me leery of all birth attendants. I wasn’t fighting for the right to have a VBAC. I choose UC freely, because I felt an intense need for privacy during this pregnancy and birth. I also came to UC from a deep background in midwifery. I had apprenticed with a home birth midwife for a year. I had read hundreds of books about birth. I had attended births in both home and hospital as a doula. I was certified in neonatal resuscitation.

The existence of UC has been used as a political tool to garner support for legalizing home birth midwifery. Advocates of home birth midwives argue that women will continue to choose home birth, and if midwives are not legal, they will choose “riskier” unassisted births rather than going to a hospital. While I’m not enthusiastic about this approach, it does seem to work.

I have mixed feelings about the increasing popularity and visibility of unassisted birth, because it is a choice that should never be made lightly. During the time that I have been following UC communities on internet discussion boards and forums, I have witnessed a trend devaluing education and preparation, dismissing midwives and physicians too quickly, and valuing intuition and the need to “trust birth” over everything else. Unlike other birth choices, unassisted birth carries a lot more responsibility on the parents’ end, as there is no one else there with birth skills or knowledge. I would almost prefer that UC remain invisible and “unpopular,” rather than the somewhat trendy thing it has become on the internet, to be sure that no one makes that choice for the wrong reasons.

Lamaze: You have written a lot about hospitals, and blogged about your experience touring local hospitals while pregnant with your son. What would you like to see change in hospitals? Do you think those changes are likely to happen?

Rixa: At a bare minimum, all hospitals should implement Baby-Friendly and Mother-Friendly protocols. US hospitals have shown remarkably slow progress in adopting the Baby-Friendly Hospital Initiative. It began in 1991 and was introduced in the US in 1997, yet as of July 2009, only 83 hospitals and birth centers have Baby-Friendly status. Contrast this to the 19,000+ facilities around the world that have become Baby-Friendly. Implementation of Mother-Friendly protocols, which share many of the same conclusions as the Six Lamaze Healthy Birth Practices, has been even more sluggish. Surely we can do better!

There is a great deal of resistance to changing institutional protocols, even when those changes would benefit both mother and child. I like to call it institutional inertia. It’s discouraging to see how long it takes for evidence to translate into practice. We’ve known for several decades that the supposed benefits of episiotomies are nonexistent and that they are more harmful than helpful. Still, somewhere around 25% of women still receive them, and almost three-quarters of those women were not asked for their consent before the cut. For example, the first birth I attended as a doula was with an OB who had an 80% episiotomy rate for first-time moms, and a 50% rate for multips. And he saw that as a good thing. At this birth, the mom pushed the baby out too quickly for him to cut an episiotomy–a fortunate thing, given she was a first-time mom and had a heavy epidural–and he told her afterwards in a regretful tone that he didn’t have time to do one. And another thing: this mom was adamant that she did NOT want an episiotomy. Did her OB know that? I don’t know, but I doubt it. Did she know about his episiotomy rate? Nope. Was the OB aware of the vast research showing that episiotomies cause more harm than good? Either he wasn’t aware of the research at all, or he knew about the research and chose to ignore it. I don’t know which of those two scenarios is more disturbing.

Another pressing issue is the widespread ban on VBACs. ICAN recently surveyed all maternity hospitals in the US and found that 49% banned VBAC, either through formal written policies or by a defacto ban (no doctors would do VBACs at that hospital, even though they were not officially banned). With the national cesarean rate at 31.8% and rising, VBAC bans affect a vast number of birthing women. It is unethical for the ACOG to support women’s right to choose elective cesarean section while maintaining policies that are directly responsible for the VBAC ban and the subsequent rise in the national cesarean rate. Cesarean sections are not without a host of risks, and each successive surgery becomes more and more dangerous.

I know this would be nearly impossible to implement in a country where only 2% of women give birth out-of-hospital, but I would love for every hospital-based provider (nurses, midwives, and physicians) to have experience witnessing out-of-hospital births. I think a lot of hospital-based providers would do things differently if they had sufficient exposure to women laboring without all the gadgets and protocols. If you’ve never seen a woman kneeling or squatting or standing up to give birth, you’ll probably stick to what’s comfortable and familiar: the woman lying down with her legs pulled back, her perineum in full view.

I would also love to see hospitals and care providers “giving” (as much as I hate that word, since it’s not really theirs to give in the first place) women more autonomy in their pregnancy and birth care. I personally know women whose OBs have dropped them from care for refusing certain prenatal tests or procedures (such as amniocentesis or prenatal Rhogam) or for making their home birth plans known. I’d guess that many women do not even know they can refuse hospital protocols–they are told they “have” to have IV access, they “cannot” eat or drink during labor, they “have” to have continuous monitoring. If women do not even know they can say no, we have taken away their ability to make crucial decisions about their care, their bodies, and their babies–decisions that may affect them for a lifetime.

Lamaze: Do you think blogs and bloggers have a role influencing the quality and safety of maternity care? If so, how?

Rixa Freeze, MA, PhD

Rixa Freeze, MA, PhD

Rixa: This is a question best answered by my readers! I would hope that I and other birth bloggers have made a difference. I imagine that blogging has helped individual women think more critically about their maternity care and their birth options. I am a little less optimistic that blogging has, or will be able to, dramatically affect maternity care on a systemic level. But who knows? Perhaps our message needs to reach a critical mass and then–wishful thinking here–changes will start occurring rapidly. Think of the impact that Dooce, the mother of all mommy bloggers, will have on birth after she wrote about her empowering natural birth (in three parts: Part 1, Part 2, and Part 3) and enthusiastically endorsed Ricki Lake’s and Abby Epstein’s documentary The Business of Being Born and book Your Best Birth.

Lamaze: Your blog strikes a remarkable balance among personal testimonial, comprehensive and nuanced analysis, sociopolitical commentary, and more light-hearted fare. It’s a balance that I think really resonates with your readers and sets your blog apart from many others. How do you determine this balance? And how do you decide when the personal is personal and when the personal is political (or “blogworthy”)?

Rixa: There’s no formula or pattern I try to follow; it’s how I avoid blogging boredom. I sometimes worry that my personal posts–you know, the everyday stuff like “we went the park and Dio spit up on me 5 times and Zari said something really funny”–are too mundane. But if I didn’t have those things about my everyday life, my blog would become too one-sided, too heavy-handed. What I post also depends on how much computer time I have. Reporting news or sharing interesting links is much faster than writing original essays or critiques. Since the birth of my second child, I’ve had much less free time to blog. I often need to put the computer down and spend more time with my family, especially my husband. My computer time is usually in the evenings once the kids are sleeping, but that’s also the only time my husband and I have to share with just the two of us.

Lamaze: What are some of your favorite posts?

Rixa: In rough chronological order:

Better is not good enough

My hospital rant

I am selfish

Cesarean sections and SUVs

Pregnant women are second-class citizens

Formative words

Is fat a moral failure?

Vision of Unity

10 Responses to ACOG’s statement on home birth

Let’s talk about pain (with links to earlier posts about pain)

On your back, please

More! Better! BirthTrack (TM)!

Mother who have lost children to death

Have patient’s rights undermined obstetrics?

Is brown the new green?

Biodynamism–Body and Soil

Conversation with the ultrasound tech

Working through some conflicted feelings and The root of my worries and midwife’s role at my birth: about hiring a midwife for my second pregnancy after having an unassisted birth

Not staying true to my word…whatever that means

Belly photos

What does giving birth feel like?

Litigation and the obstetric mindset

Burn the male midwife!

And, of course, the birth stories of my daughter (a planned unassisted birth) and my son (a midwife-attended home birth)

As I browsed through my blog to choose these posts, I was struck by the evolution in my writing and thinking. I’m still mostly the same person I was three years ago, but I see a definite maturation in my posts: more nuance, less emotion (although my passion for all things birth & breastfeeding still occasionally escapes), less dogmatism. I’m glad to see these changes; it means I am continuing to evolve as a blogger and as a mother.

Lamaze: What are some of your favorite blogs (birth-related or not)?

Rixa:

Taurus Rising: An Aussie who writes about food, sustainable living, gardening, and occasionally birth stuff

Balance: Chou writes all about food, food, and more food (and is a good friend of mine). She’s currently doing a PhD in food studies. Lots of great recipes and ideas.

Casaubon’s Book: food, peak oil, sustainability, gardening, farming

The Unnecesarean: sharp, sometimes biting, often funny blog about cesareans and VBAC.

Baby Makin(g) Machine: a future mama thinking hard about how she wants to mother

House Fairy: a fierce, honest mama of five

Keyboard Revolutionary: mama of 2, first born by c-section and second a HBAC, I love her birth posts

Feminist Childbirth Studies and The Feminist Breeder always give me things to think about

Nursing Birth and Reality Rounds are both fantastic L&D nurse blogs

The Happy Sad Mama: mother of three children; the first, Charlotte, was stillborn at term

Mom’s Tinfoil Hat: ob-gyn student who trained with midwives in a freestanding birth center before medical school

I am stopping here, otherwise the list will become too long! I have links on my sidebar to the many other fantastic blogs I visit regularly. (I’m still working on updating my breastfeeding links, so keep an eye out for them in the future.)

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