All Women Should Be Offered Midwife-led Care

This is a truly groundbreaking study: Midwife-led versus other models of care for childbearing women!

Background
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care.

Objectives
To compare midwife-led models of care with other models of care for childbearing women and their infants.

Main results
We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).

Authors' conclusions
All women should be offered midwife-led models of care and women should be encouraged to ask for this option.

Plain language summary
Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

Finding a Midwife in Maine

There are many midwives currently working with families here in central Maine, both CNMs (Certified Nurse Midwives) who attend births in hospitals, and CPMs (Certified Professional Midwives0 who attend births at home. There is also one independent, free-standing birth center in Maine, staffed by midwives: The Birth House, in Bridgton.

Waterville Women's Care
Rights at Maine General, Waterville Campus
Waterville
877-7477

Central Maine Medical Center OB/GYN
Rights at CMMC
Lewiston
795-5770

Women's Health Associates
Rights at St. Mary's Hospital
Lewiston
777-4300

The Women's Center
Rights at Miles Memorial Hospital
Damariscotta
563-4700

Mid Coast Medical Group
Rights at Mid Coast Hospital
[This group appears to include several offices at different locations with different phone numbers.]
Brunswick
729-4996

Cathy Heffernan, CNM
Winthrop Family Practice
Rights at Maine General, Augusta Campus
Winthrop
377-2111

Heather Stamler, CPM
Vassalboro
873-5225

Midcoast Midwifery
Christine Yentes, CPM
Monroe
525-7740

Morning Star Midwifery
Donna Broderick, CPM
322-6464
Ellie Daniels, CPM
338-0708
Belfast

Mother Bloom Midwifery
Anna Fernandez, Traditional Homebirth Midwife
Blue Hill
326-4373

The Pregnancy Support Center
Jan Willson
Lewiston
777-3776

Northern Sun Family Health Care
Sarah Ackerly, ND, CPM Topsham
798-3993

Birch Moon Midwifery
Holly Arrends, CPM
Bath
522-6043

Casco Bay Midwifery
Schyla St. Laurent, CPM
Falmouth
797-7463

Open Circle Midwifery Services
Robin Doolittle, CPM
Deirdre Sulka/Meister, CPM
Greater Portland
838-2157

Sacopee Valley Birth Services
Brenda Surabian, CPM and
Lindsay Johnston, CPM
Parsonsfield
329-2111

To search for more midwives in Maine, go to the Midwives of Maine website or the Find a Midwife section of the American College of Nurse-Midwives website.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Mother-Friendly Childbirth

What is mother-friendly childbirth?

Coalition for Improving Maternity Services (CIMS) offers several excellent articles on mother-friendly care:

The Mother-Friendly Childbirth Initiative outlines the principles of mother-friendly care. I highly recommend reading the two-page pdf, but these are the principles it highlights:

Normalcy of the Birth Process;
Empowerment;
Autonomy;
Do No Harm;
Responsibility.

Highlights of the Evidence is another two-page pdf that presents the evidence in very straight-forward, easy-to-read language.

***************************************

There are so many aspects of mother-friendly care that it's hard to pick one to focus on... To me, mother friendly care is…

• care that considers mother & baby together; what’s good for mother is good for baby.

• care that honors birth as the birth of a mother & family; as an opportunity to empower mothers as they begin their parenting journey.

• care that values mothers, encouraging and supporting them as partners…

But, I think one of the most significant things about mother-friendly care is that it is PERSONALIZED care.

What is “friendly” to one mother may be confusing, overwhelming, or aggravating to another.

For example, in my childbirth classes, we practice contractions holding ice. For the first practice scenario, everyone complains and moans and giggles about how uncomfortable they are. For the second practice, everyone focuses inward and listens to their breathing. The focused breathing practice goes by much faster, and is much less uncomfortable for most people; however, for others, all the distraction of people talking moves time faster. These practice contractions help them realize something about themselves: they might benefit from a big crowd of friends and family supporting & encouraging them during labor; for others, they think about having a quiet, cave where nothing is distracting them from their coping internally.

The point is, what is friendly to one person – no talking, or lots of talking – might not work at all for someone else. Or – it might work better one way for part of labor, and another way later.

Our friends know us. They listen to us. They treat us as individuals.

They know our history & our beliefs…
They know how we are trying to live and they support us…

Mother-friendly care comes from providers who take the time to listen to mothers, to learn about each mother’s history, what she believes about birth…

Does this mother love the water?
Is she anxious about needles?

Mother-friendly care comes from providers who take the time to consider how to best support each particular mother and baby on their birth journey…

Does she need a lot of step-by-step, close support, or would that distract her, pulling her out of her mammal instinctive brain?

…and who then follow-through, basing care decision on that particular mother & baby.

Finally, mother-friendly care is about trust. Friends can trust each other. Mothers should be able to trust that their caregivers will provide personalized care that is based on the best evidence, not on legalities and convenience; that the hospitals and birth centers where they give birth are crafting policies to support and encourage mother-friendly caregiving. With homebirths, families get to make up their own rules, with the guidance of their midwife!

Do I think that’s where we’re at, now, in Central Maine? Where most women give birth in places that support mother-friendly caregivers; that the nurses, doctors, and midwives are mother-friendly?

Sometimes, yes, but (so sadly) I do not think it is the norm here, or in the USA as a whole. Like many people, I struggle with this - how to be an active agent for change? how to encourage others to request (or to insist on!) this type of care? how to show them that they, and their babies, deserve it?

I went to see Birth last night in Gardiner - it was amazing, awesome, sad, beautiful, empowering. I wish the theater had been packed - it wasn't. I wish people had brought their teenage daughters (and sons) to continue an ongoing discussion with them about birth. I wish couples thinking about trying to conceive had come, to open/continue their discussions about the birth of their family. Not that the conversation afterwards wasn't fun and interesting; it was to me - it just would have been even more wonderful if it had reacher a broader segment of the population.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Maine's Biggest Baby Shower

Inland Hospital, in Waterville, ME is hosting MAINE'S BIGGEST BABY SHOWER, on Saturday, October 4th, from 9-11:30am. There are lots of informative, helpful exhibits, as well as food, gifts, and games. For more information, email inlandhospital@emh.org or call 861-3392. See the schedule.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Local Eating during Pregnancy: Part One

I'm finishing up the excellent book Animal, Vegetable, Miracle: A Year of Food Life, by Barbara Kingsolver, who is one of my favorite authors. And I'm finishing up my year of garden work: picking my winter squash and orange pumpkins, the last peppers and eggplant, and putting cold frames over the less-hardy greens. Three days of rainy weather approaching has made the task more urgent - I don't want my peppers and winter squash to get moldy! During the rain, I think we'll be inside peeling apples from our local orchard for applesauce and husking/blanching/freezing corn from a farm just up the road.

There are many advantages to buying & eating more foods locally and seasonally. Some help others most directly, but certainly affect us in the long-term: economic benefits for the local area and local farmers; less dependence on gasoline to bring the food to you; small farms often farm more sustainably and/or organically (even if they don't go through the process to be certified organic). There are other benefits that are just for the local eater her/himself: eating food that was grown for taste, not portability/storage (YUM!) as well as the additional nutrition offered by eating locally and seasonally.

For many women, pregnancy is a time when they are more motivated to learn about nutrition, and to make food choices based on what they learn. It's also a time when there is a more obvious link to other mothers - mothers past, animal mothers, our mothers, future mothers. One of my favorite books to read during pregnancy was a memoir-ish book called Having Faith: An Ecologist's Journey to Motherhood. The author, Sandra Steingraber, discusses her journey month-by-month through pregnancy, giving each chapter a moon name, from "Old Moon" to "Harvest Moon". She writes in the preface that "When I became pregnant at the age of thirty-eight, I realized, with amazement, that I myself had become a habitat. My womb was an inland ocean with a population of one" (ix).

So, in honor of the coming harvest, and for all of you mamas growing your babies in the "inland ocean", here are a few recipes I'll be using to take advantage of this beautiful (and delicious!) season...

KALE

This recipe, Dino Kale Saute, is my favorite ways to use kale - everyone I've made it for as always loved it. Kale is an excellent source of Vitamin C, Vitamin A, and Vitamin K and has calcium and protein in it (!!).

Dino Kale Saute

12 ounces dinosaur kale or regular kale, cut or torn into 1- to 2-inch pieces (about 12 cups)
2 tablespoons olive oil
1/4 cup soft sourdough or French loaf bread crumbs
1/8 teaspoon pepper
1 teaspoon white wine Worcestershire sauce
Lemon wedges (optional)

1. Rinse kale leaves thoroughly under cold running water. Drain well; set aside.

2. In a small skillet heat 2 teaspoons of the oil. Cook bread crumbs in the hot oil for 1 to 2 minutes or until browned. Season with pepper; set aside.

3. In a large, nonstick skillet heat the remaining 4 teaspoons oil. Add kale. Cook the kale, covered, for 1 minute. Uncover. Cook and stir for 1 minute more or until just wilted. Transfer kale to serving dish. Drizzle with Worcestershire sauce. Sprinkle with the browned bread crumbs. Squeeze lemon wedges over all. Makes 4 servings.

Nutrition Facts
Servings Per Recipe 4 servings
Calories 89, Total Fat (g) 5, Saturated Fat (g) 1, Cholesterol (mg) 0, Sodium (mg) 53, Carbohydrate (g) 9, Fiber (g) 4, Protein (g) 3, Vitamin C (DV%) 94, Calcium (DV%) 8, Iron (DV%) 8, Percent Daily Values are based on a 2,000 calorie diet


APPLES

Apples are delicious this time of year and there are so many kinds to choose from. Apples have some Vitamin C and are a good source of fiber.

Rustic Apple Sauce

Ingredients
4 cups cubed peeled Braeburn or Pink Lady apple
4 cups cubed peeled Granny Smith apple
1/2 cup packed brown sugar
2 teaspoons grated lemon rind
3 tablespoons fresh lemon juice
1 teaspoon ground cinnamon
1 teaspoon vanilla extract
Dash of salt
2 tablespoons crème fraîche (or full-fat yogurt or sour cream)
Preparation

Combine first 8 ingredients in a Dutch oven over medium heat. Cook 25 minutes or until apples are tender, stirring occasionally.

Remove from heat; mash to desired consistency with a fork or potato masher. Stir in crème fraîche. Serve warm or chilled.

Nutritional Information
Calories:140 (12% from fat)
Fat:1.8g (sat 1g,mono 0.5g,poly 0.2g) Protein:0.3g Carbohydrate:32.5g Fiber:2.3g
Cholesterol:3mg Iron:0.5mg Sodium:30mg Calcium:31mg

One of my favorite recipes comes from the mother of my best friend growing up. It's not really a recipe, actually: chop up an apple and a small handful of walnuts; add a couple of spoonfuls of ricotta cheese and a sprinkle of cinnamon. Yum!


PEARS

Pears are also in season in the fall. They have some Vitamin C and are a very good source of fiber.

Pear Clafouti

Cooking spray
1 teaspoon all-purpose flour
2 cups cubed peeled pear
3/4 cup all-purpose flour
1/4 teaspoon salt
1/8 teaspoon nutmeg
2 cups 1% low-fat milk, divided
3 large eggs, lightly beaten
1/2 cup sugar
1/2 teaspoon vanilla extract
Preparation

Preheat oven to 375°.

Coat a 10-inch deep-dish pie plate with cooking spray, and dust plate with 1 teaspoon flour. Arrange the pear cubes in the bottom of prepared dish, and set aside.

Combine 3/4 cup flour, salt, and nutmeg in a bowl. Gradually add 1 cup milk, stirring with a whisk until well-blended. Add 1 cup milk, eggs, sugar, and vanilla extract, stirring until smooth. Pour batter over pear cubes. Bake mixture at 375° for 35 minutes or until set.

Nutritional Information
Calories:230 (15% from fat)
Fat:3.9g (sat 1.3g,mono 1g,poly 0.5g) Protein:7.7g Carbohydrate:41.1g Fiber:1.8g
Cholesterol:113mg Iron:1.3mg Sodium:171mg Calcium:121mg


PEARS & APPLES

I think pears and apples are both excellent addition to spinach or lettuce salads. A salad with spinach or mixed greens, apples or pears, a sprinkle of sunflower seeds and some chopped cooked chicken or hard-boiled egg is an excellent lunch or dinner. Paul Newman's raspberry walnut salad dressing is a good one to try on this type of salad if you don't want to make your own balsamic vinaigrette. A sprinkle of (pastuerized!) blue cheese or goat cheese, or cheddar, can be nice too.

Pears and apples are also good served with this dip:

Cottage Cheese and Apple Snacks

1 cup low-fat cottage cheese
2 tablespoons peanut butter
1/4 teaspoon ground cinnamon or apple pie spice
1 to 2 teaspoons skim milk
3 medium apples or pears, cored and sliced

For dip, in blender container or food processor bowl place the cottage cheese, peanut butter, and cinnamon or apple pie spice. Cover and blend or process until smooth. If necessary, stir in enough milk to make dip of desired consistency.

Serve the dip immediately or cover and chill it for up to 24 hours. Serve dip with the apple or pear slices. Makes 6 (2-tablespoon) servings.

Nutrition Facts
Calories 106, Total Fat (g) 4, Cholesterol (mg) 3, Sodium (mg) 178, Carbohydrate (g) 13, Protein (g) 7, Percent Daily Values are based on a 2,000 calorie diet

Next week, I'll include more seasonal recipes for spinach, winter squash, pumpkin and more.

In the meantime, to learn more about eating locally, I recommend Kingsolver's book (of course) - as well as the Animal, Vegetable, Miracle website, which offers tons of online resources to learn more about the benefits of eating locally/seasonally and how to incorporate more seasonal/local food into your diet. There is also information on how to find local foods, and the recipes from her book (which I can't wait to try!).

For us Mainers, I also recommend the Get Real Get Maine website, which has searches for specific food items, listed by county; pick your own farms; farmers markets; CSAs (community sustained agriculture farms that sell "shares" of their produce) and more.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Be BOLD: Birth Performances in Gardiner, ME

Karen Brody's play, Birth, will be performed at the Johnson Hall Performing Arts Center (280 Water Street) in Gardiner, Maine on Friday, September 26th at 7pm and Sunday, September 28th at 2pm. The Friday performance will feature a "talk back" discussion with area healthcare providers and birth experts. Tickets are $10, and are available at the door or by emailing BOLDinMaine@yahoo.com.

All profits are to benefit Birthroots of Maine.

About the play, from the BOLD website, www.boldaction.org

"Birth is a play based on over one hundred interviews Karen Brody conducted with mothers across America who gave birth between 2000-2004. It tells the true stories of 8 women painting a portrait of how low-risk, educated women are giving birth in America today . . . Moving between first-person monologues, some dialogue, and the voices these women heard on the day they gave birth, Birth confronts, what City Lights Theater Company has called, "The naked truth about childbirth in America."

"BOLD is an exciting, uplifting, and empowering answer to our nation's childbirth crisis. I support this movement with every fiber of my being" Christine Northrup, MD, author of Mother-Daughter Wisdom, The Wisdom of Menopause and Women's Bodies, Women's Wisdom

Playwright Karen Brody's blog.

More about BOLD, from the BOLD website, www.boldaction.org, below. The website has a great list of links and books, lots more about BOLD and Birth, as well as information on how you can contribute by organizing an event or through a financial donation.

"What is BOLD’s approach?"

"BOLD's approach to our mission is based on similar "theatre for social change" models (V-Day, The Innocence Project). Every September (and during the month of other Labour Day around the world) we support communities to organize a BOLD production of Karen Brody's critically acclaimed play, Birth, and a BOLD Talkback, take the play to a college campus to educate students about maternity care, or organize a BOLD Red Tent. The goal of each event is to engage communities in a discussion about how to improve their local maternity care issues. BOLD puts mothers at the center of solving their maternity care problems. At BOLD we ask mothers: what kind of childbirth conditions do you want? What do you deserve?"

"What does the BOLD acronym stand for?"

"Our acronym stands for Birth On Labor Day (BOLD). In 2006, BOLD's first year, over forty performances of Karen Brody's critically acclaimed play, Birth, were performed throughout the world over four days during the American Labor Day weekend. Since then BOLD has expanded to include events at other times beyond Labor Day weekend."

"Why BOLD?"

"Playwright Karen Brody wanted to find a way to honor mothers’ birth experiences, get communities talking about their local birthing issues, and raise money for organizations and small groups who are working to make maternity care mother-friendly. “One woman dies every minute throughout the world from a pregnancy or childbirth-related cause,” says Brody, “As a writer I wondered, why are we not telling this story? And as an activist I wondered, how can we tell this story in a way that will make a difference, that will shift the model of maternity care for women to the mother’s needs?”

I plan to go to the Friday performance - it's been on my "to do" list for a couple of years, but the dates have never worked out. I'm really, really excited to go!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Diddos for Kiddos - Consignment Sale in Central Maine

Diddos for Kiddos is coming up! Diddos is an awesome consignment sale (clothes, baby supplies, toys) in Augusta, Maine. There are new dates - Saturday, October 11th, from 8am to 6pm and Sunday, October 12th, from 8am to 4pm. Here's a pdf with all the information you'll need if you want to come to buy, or find out how to sell.

I've been doing this for years (buying and selling), and while it can get a little crazy, it's a lot of fun. The timing is great too - one sale in the fall (winter clothing, and holiday presents) and one in the spring (summer clothes, and presents for my kids' May & June birthdays).

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Resource Round-up

We camped up at Cobscook Bay State Park, visited the Windsor Fair, went apple picking and started school in the past ten days - whew! So, finally, here's a list of resources from my reading in the past two weeks:

The Lamaze weekly newsletter
Excellent, as usual, with information on how to handle unsolicited advice (my personal favorite response: "I'll keep that in mind..." prefaced with "oh..." or "thank you!" depending on the brand of advice & its delivery). Their breastfeeding expert had some very helpful tips in her answer to this common question: "Is there anything I can do to make sure I will have a good experience breastfeeding?"

Last week's newsletter had a chart that provided a summary of nutritional information - specific nutrients, why they're important, and what foods are good sources.


Hilarious Blog
Jeremy Adam Smith wrote a blog entry for the Mothering website that just cracked me up, called "I am a Porn Star".


New Products at Target!
I just read that Target has started carrying Bum Genius 3.0. I called to request information on stores here in Maine - it sounds like Topsham and Augusta have them on their computer but none in the store or ordered; Bangor might be having a shipment come in soon. To get information about locations near you, call the corporate customer service at 1-800-440-0680 and ask for stores in your area carrying these specific DPI (item #s):

wetbag (found by searching for “wet bag”): 030 00 2235
reuseable diapers: 030 00 2126

I also read somewhere (the new Mothering magazine?) that Target is carrying California Baby products - my local Target has them in stock, which I'm very excited about. We love the bubble bath, especially!


Homebirth Dads Video
The most recent Mothering magazine also included information about a film called Homebirth Dads. That's definitely going to make it into my birth class lending library, the next time I buy videos.


Long-term Effects of Pitocin Study
A really interesting study on Pitocin, on The True Face of Birth blog.

The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old...

The following is a summary of the findings that were statistically significant.

1. Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

2. Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

3. Two factors distinguished children born with Pitocin from those born without Pitocin.

The first was called “Assertiveness”, which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

It may be that a process described as “hormonal imprinting,” identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.

Claire L. Winstone, Ph.D.
Santa Barbara Graduate Institute July 2008

Protecting Infants and Children from Toxic Exposure: Cribs
"Friends of the Earth has found that commonly used baby and children’s products, and upholstered household furniture contain dangerous levels of toxic chemicals called halogenated fire retardants.

56% of all infant carriers, 44% of all car seats, 40% of all strollers and 19% of all portable cribs were found to have high levels of halogenated fire retardants."

There is also a link to "Safe Baby Products" - ones without halogenated fire retardents - at the bottom of the page.


Who Co-Sleeps?
Turns out, lots of people! Take this co-sleeping survey to add your voice, or view the results. Over 8,000 people have taken this survey!


Body & Soul Soothers - Links to articles on Mothering.com.


Is there lead in your prenatal vitamin?
I was shocked at the number of children's vitamins and prenatal vitamins that contain lead... Here's a website with additional information, including particular vitamins and how much lead they contain.

New Links & Resources

Before I get to the safety issues surrounding different birth choices, I want to highlight several of the interesting resources and links I've come across lately.

Some goodies from the Midwifery Today online newsletter "E-News 10:17", include a quote

"We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents."

— Elizabeth Davis
Excerpted from "Autonomy at Work: Woman-Centered Birth and Midwifery," Midwifery Today, Issue 42

and a link to an excellent, excellent article, "VBAC & Choice: Many Questions and a Few Answers", by Nancy Wainer. I bet the whole article is amazing.

The Mothering email newsletter also offered a great article, "Easing Tension and Fear in Natural Childbirth by Understanding Sphinct*r Law*: A Conversation with Ina May Gaskin" as well as information about how to attend a free "webinar" (I've done two through Lamaze so far, and they've been great) on cosleeping, presented by James McKenna and Dr. Paul Fleiss. To learn more and how to sign up, visit http://www.mothering.com/interactive/webinars/cosleeping.html. I'll "be there".

In the Lamaze online newsletter for "Week 11" (no, I'm not pregnant - just checking out their resources!), there was an ask-the-expert question about pregnancy classes. The question was: "I’m in my first trimester with my first baby. I plan to take childbirth classes closer to my due date. But I feel like there is so much to learn about pregnancy—not just the birth. My doctor answers some of my questions during my prenatal appointments, but there isn’t enough time for all of them. Is there a class I can take about pregnancy?" I wonder if there is enough interest to do a pregnancy class here in Central Maine? I would love to do a class for moms/partners who are TTC or are newly pregnant - to answer questions about pregnancy, prenatal testing, exercise and nutrition, and also to talk about choices for care providers and hospitals. At the point when most of my clients' take classes, they have to be supremely unhappy with or uneasy about their care provider to change (though some still do!). I'd love to offer women/partners the information they need to think through their choices before their third trimester! Any thoughts on pregnancy classes? Oh - and if you're reading this and wondering, I would happily do a private pregnancy class - just send me an email!

Also, my local LLL leader sent out an email with information about new resources from the US Department of Health and Human Services, Health Resources and Services Administration regarding breastfeeding and employee/employer policies. They're free, too.

"The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: For Business Managers"

Abstract: This manager’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It focuses on a company’s potential return on investment in the areas of employee retention, health insurance, absenteeism, productivity, and employee loyalty. The booklet includes profiles of companies with existing supportive lactation programs and references.

"The Business Case for Breastfeeding. Steps to Creating a Breastfeeding Friendly Worksite: Employees' Guide to Breastfeeding and Working"

Abstract: This employee’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It includes information on where to find breastfeeding help and support, how to begin breastfeeding at home, and how to adjust to breastfeeding at work. The booklet includes support websites, figures, and guidelines for addressing supervisors.

The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: Easy Steps to Supporting Breastfeeding Employees

Abstract: This human resource’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It details an integrated approach to implementing a cost-effective lactation support program. The booklet gives steps to support breastfeeding employees, explains how to merge work requirements with employee needs, offers program options, and outlines the program’s return on investment for the company. It includes profiles of employers with existing supportive lactation programs.

I ordered ten of each, completely for free (including S&H) just now, very easily.

And lastly, The True Face of Birth blog has had some great posts in the past few days, including one about doulas ("Doulas Make a Difference"), which sites a RCT (randomized controlled trial) study about doulas; one about "The Dance of Breech" with great drawings and links; and a reminder that "The Birth Survey is Here!" - yay! There doesn't seem to be any information for Maine mothers yet, but hopefully there will be soon.

Enjoy the links!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

*Sorry about the asterisk - that word was attracting some unwanted attention from search bots.

Choosing a Care Provider & Birth Place

In many parts of the United States, women can choose between a hospital birth, a birth center birth, or a homebirth; they can choose an OB doctor (obstetrician), a FP doctor (family practice), a CNM (certified nurse midwife) or CPM (certified professional midwife). Different states have a variety of legal options, and even in the states where homebirth isn't explicitly legal (or is explicitly illegal) there are "underground" networks of midwives. To find out more about the status of midwifery in your state, visit the Midwives Alliance of North America (MANA) chart.

In Maine, there is currently one birth center, The Birth House, located in Bridgton, and run by Birthwise Midwifery. To find a birth center outside of Maine, try searching the American Association of Birth Centers Find a Birthcenter page - though there may be a birth center in your area that is not accredited.

There are also quite a few CPMs who attend homebirths in Maine. For more information on finding a midwife to attend your homebirth, you can visit the Birthing Your Baby Local Resources page or the Midwives of Maine site. To find a CNM for a hospital birth, visit the Find a Midwife section of the American College of Nurse-Midwives website.

If you're interested in learning more about your options, there are lots of websites and books to help you explore.

BOOKS

The Birth Book(1994), by William Sears, M.D., and Martha Sears, R.N.
The Sears' dedicate a whole chapter, "Choices in Childbirth" to discuss the many options that are available to birthing women. There is in-depth information about choosing a birth team (who your care providers will be), questions to ask during the interview process, choosing labor-support, choosing a birth place, and choosing childbirth education classes.

I especially like their "Sample Prenatal Interview List":

"While quizzing your prospective doctor [or any care provider], be sure you know where he or she stands on these important topics:

labor management

pain management

natural childbirth

walking during labor

improvising various labor and birth positions

electronic fetal monitoring: continuous, intermittent, telemetry, none

labor-support persons: professional assistant, baby's father

episiotomy: how often performed, alternatives

forceps and vacuum extractors

birth plans

criteria for cesarean birth

vaginal birth after cesarean

use of water during labor [or birth]

epidural anesthesia

childbirth classes

pregnancy health: exercise, nutrition, weight gain, etc.

hospital affiliations

routine prenatal screening tests

call schedule (group or solo practice; birth philosophy of covering [providers])

vacation schedule (in case it's during your due date)

fees, insurance plans (usually handled by office staff)

What would birth look like in this country if most women asked some questions about their care providers philosophy before or during the first visit. What would happen, I wonder, if women no longer accepted vague reassurances when they asked about cesarean birth rates? What would happen if women flocked to care providers who allowed eating and drinking, who encouraged women to give birth in a position that was comfortable for her, even if it was not on the bed, even if it was in a tub!

The reality, though, is that, right now, most women do not ask questions about the routine care practices of their care providers. It's not that there are wrong answers (well, vague or misleading or dishonest answers are wrong) - the philosophies of the birthing woman/family and the care provider either match, or they don't. But if a woman doesn't find out until the birth that the hospital's routine care involves an IV, and the care provider will harass her if she doesn't submit to one, or that the care provider does not believe that a natural tear is better than an episiotomy and so routinely preps and performs them, even when a woman states that she does not want one - that's too late to make a change, obviously.

Unfortunately, I'm not exaggerating. I had a client who was really afraid of needles, and was very concerned about a routine IV. She didn't want one unless absolutely necessary. I encouraged her to ask her care provider what her options were regarding an IV, given her personal fear of needles. My client had the conversation with her care provider, who said - "If you don't have an IV, your baby might DIE!!" and who went on to explain how important she believed a routine IV is to the care of mothers and babies. My client was horrified by the scare tactics used by the care provider, and since she found out in plenty of time (second trimester) that her philosophies didn't match her care provider's, she changed practices (yay for her!).

Another key point in the Sears' list is knowing the call schedule of your provider. So many of my clients are surprised to hear that the providers in the office alternate - if there are four providers on a call schedule, a birthing woman has a 25% chance of being cared for by her primary care provider during her birth. There are ways to make this more palatable, by meeting all the care providers in the practice, and knowing that they have similar philosophies about routine care, for example. But here's another personal example - my sister in PA went to a well-known OB/CNM practice, who asked women to meet all the possible care providers who might attend the birth - there were something like ten. So much for continuity of care! Yes, she had a ten-minute appointment with each provider, but did she really get to know any of them? No. For her second baby, she went to a birth center - for that reason and many others.

Another section in the Sears' chapter on choices that I really appreciated personally was their discussion of in-hospital vs. out-of-hospital classes. Here's part of it:

"Ideally, schools should prepare students for the real world in a variety of circumstances. In-hospital classes prepare you for the birth policies of that hospital. On the other hand, out-of-hospital classes have the advantage of describing a variety of birth choices so that you can prepare for the birth you want - but one that the hospital may not be willing to deliver. Ideally, birth place, birth attendant, and childbirth educator should all share the same birth philosophy, but where this is not the case, a good childbirth class should help you understand your doctor better and enable you to work with him or her and the hospital staff to achieve a birth that is safe and satisfying. Look for an instructor who emphasizes flexibility and good communication between parents and professionals" (51-52).

Sometimes people wonder why I don't teach for a hospital, or why anyone would need or want to take a class that wasn't provided by the hospital. I like the freedom to teach what I believe is most important; I like to teach about making informed choices, and encourage my clients to think of themselves as consumers, not as "patients". I think there is value to being outside of "the system", free from any influence other than my clients' best interest. My philosophy isn't that all women should give birth one way, or another - instead, I encourage mothers/partners to think about what they want in the birth experience, and to communicate with their care providers. Birth is a once in a lifetime experience - even if a woman has several babies - each birth is that baby's only birth. I do encourage flexibility; though we talk about birth plans, we also talk about living in the moment and doing "the next best thing" if the first best thing doesn't work out, which we all know sometimes happens. Birth is a part of life! Plus, I have small classes (one to four couples), I can work my schedule to accommodate people who call me a month before they're due, or who work at night, etc., and I offer unlimited telephone and email support. It's a good deal for everyone!

Anyway, back to resources... Next up is Mothering Magazine's Having A Baby, Naturally (2003), by Peggy O'Mara. She also offers an entire chapter on "Making Birth Choices - Choosing Your Place of Birth and Your Birth Attendant". O'Mara lists "reasons to choose" and "reasons not to choose" to birth at home, a freestanding birth center, or at a teaching/large hospital; she also mentions a few other choices like smaller hospitals, alternative birth centers within hospitals, and water birth. There is an explanation of the typical care provided by midwives, obstetricians, and family physicians.

O'Mara offers several considerations at the beginning of the chapter to help families assess which birth setting might work best for them, including information on safety and cost. She goes on to write:

"A more important 'cost' to assess, however, has to do with the effects that birth trauma and general hospital-style treatment have on the bonding between a mother and her child. High levels of stress incurred in hospital settings can seriously affect a parent's ability to function well in the difficult weeks after birth. Many women agonize about their negative birthing experiences, including unnecessary interventions and unkind or patronizing treatment, for months or even years after birth. Since birth sets the stage for your early parenting experiences, it makes sense to avoid anything that increases stress for you or reduces your ability to bond with your child. Making a decision on where your baby's birth will take place is second in importance only in making the decision to become parents in the first place! Take time to explore all the options you have" (35).

The "Which One is Best for Me?" list of considerations is also helpful:

"There is no formula that can help a mother-to-be decide what type of care provider will be best for her. That is because every provider is different, even within such different categories as 'obstetrician' and 'midwife.' Some obstetricians are very open to the idea of a birth with minimal or no interventions [like my daughter's birth, born after minimal procedures while I squatted on a birth stool, the OB hovering to play catch on the floor - it was great!]. Some midwives may practice in hospitals and be much more likely to rely on technology than others [my sister, who had her membranes sweeped, water broken, Pitocin, Nubain etc. & etc. had a "medwife" - a medically-minded midwife].

For this reason, it is necessary to interview several candidates before making a final decision. It also helps to know that no decision is absolutely final. While it may not be ideal to change birth attendants midstream, it is better than working with someone you find you are unhappy with. To decide who to interview, consider these points:

Check to see if this person is able or willing to attend a birth in the location you have chosen. Most doctors will not attend home births, so this will narrow your field automatically.

If you want an attendant who will be with you throughout most of your labor, you should consider using a midwife. Obstetricians will generally only be with you during the final stages of labor, checking on you intermittently beforehand. You will be attended to by labor nurses for the most part.

Know that midwives spend significantly longer on regular checkups than most doctors do, from twenty to forty minutes per visit. Again, there are always exceptions to this.

Cesarean section rates, on average, are much lower for midwives than for medical doctors. In addition, rates of successful VBACs (vaginal births after a cesarean) are better for midwives. Certified nurse-midwives, for example, have a rate of 11.6 percent for C-sections and 68.9percent for successful VBACs. The national average is, respectively, 23.3 percent and 24.9 percent [much higher national average C-section rate now, hovering around a third of all births].

Choosing a male ob/gyn, rather than a female increases your chance of ending up with a cesarean section by 40 percent.

Using a family practice physician can be advantageous if this is a person who is already very familiar with you and your family. Perhaps this will be the same person who is going to care for your newborn" (42-43).

Finally, O'Mara suggests questions to ask during the interview process, and some pointers on how to communicate effectively with your care provider.

Another great book resource is Henci Goer's The Thinking Woman's Guide to a Better Birth (1999). She includes three separate chapters on choices for care during pregnancy and birth, "Professional Labor Support: Mothering the Mother", "Obstetricians, Midwives, and Family Practitioners: Someone to Watch Over You" and "The Place of Birth: Location, Location, Location". There is some very solid information in these chapters, including interview questions, lots of lists of pros/cons, some advice on what to do when provider choice is limited, either by insurance or by medical conditions or mother's location, a thorough comparison of birth sites that is really terrific, and more.

There are some great "reality checks" throughout these chapters, including the following in the labor support chapter: "If you are a first-time mom planning a hospital birth, you're probably assuming that your nurse will shepherd you and your partner through labor. Ever-present, she will comfort and ten you. I suppose it happens occasionally, but not often. Studies show that the average labor and delivery nurse spends fifteen minutes of her eight-hour shift [italics mine] offering physical comfort measures, providing emotional support, or advocating for her patients. Another study showed that time with laboring women didn't increase even with a group of nurses who acknowledged the importance of labor support and when that was the study's intent. Meanwhile, with staff cutbacks the order of the day, even the best-intentioned nurse has not time to labor-sit" (177).

Hopefully you have not heard responses like the ones listed below from your caregiver. If you have, Henci Goer suggests, “these behaviors will tell you that you have the wrong person, someone who wants to coerce rather than convince you” (196). Here are the “red flags” listed in The Thinking Woman’s Guide to a Better Birth:

• Scare tactics. “We can do that – if you don’t care what happens to the baby.” “Which would you rather have: a nice experience or a healthy baby?” You can have both. In fact, the things that make a nice experience also make for a healthy baby.
• Anger. “And where did you go to medical school?” “I can’t take care of you if you don’t trust me.” Of course you should trust your caregiver, but the trust must be earned.
• Ridiculing your concerns, desires, opinions, or competency to participate in decisions about your care. “I see you’ve been reading those women’s magazines.” “You want natural childbirth? I think that makes about as much sense as natural dentistry.”
• Patronizing you. “Don’t worry about a thing; just leave everything to me.”
• Vagueness. It’s a bad sign when you can’t pin a caregiver down enough to get at least ballpark estimates of personal statistics such as cesarean rates . . . It’s also bad when the caregiver says you can do anything you want during labor and won’t specify what situations might preclude that" (196-197).

Finally, there are some great suggestions regarding choices for provider and location in The Big Book of Birth (2007) by Erica Lyon, who was the education coordinator and administrative supervisor at the Elizabeth Seton Chilbearing Center in NYC. A few of suggestions in this chapter include:

"Check if your practitioner's belief system matches yours. There is a range of how practitioners 'manage' or 'care for' women, from authoritarian to nurturing, of how available and accessible they are. Most of us know whether we want someone more authoritarian who can tell us what will happen [debatable, I think, if anyone can tell us for sure what's going to happen, other than a baby is going to come out, some way or another!] and what to do when we're birthing our baby, or someone who is more nurturing and gives us more personal responsibility. Asking questions to gauge if this is a good match so that you are relaxed and feel you can trust your practitioner in labor is very important . . . If you think your practitioner is eroding your confidence, causing unnecessary concer, or looking for problems where they don't exist, then changing may be a good course of action" (269).

"Think outside the bassinet. By this I mean look at models of care around the world that get good (better than the U.S.) outcomes and try to model your care after that [planning to discuss this in my next post]" (270).

Stop reading What to Expect When You're Expecting, or any book that has headlines like "Warning" or "Danger". The anxiety such a book produces is not helpful . . . to normal pregnancy and produces a lot of unnecessary guilt and concern [time enough for that after the baby is born & you're parenting - hahah!]. No one can tell you what to expect, only the various paths and options and how all of these can be relative at times" (270).

"Take a moment and be honest about your concerns and fears. Understanding our emotions and psychology does not necessarily give us more control over a situation but it does help us cope and identify what we truly need" (271). This is so important! I ask all my moms to ask themselves "What is most important thing your care provider could do during the birth to help you?" and they think for a minute and come up with an answer. Then I ask - "Have you talked to him/her about this?" and as of yet, every single mother has said, why no, I haven't. So there it is: care providers cannot read minds. And sometimes, we ourselves aren't sure what is most important if we haven't taken some time to think about it; only after the fact can we identify something that could have been done differently to improve our experience. So, I encourage women to do a lot of reflecting themselves, and then have some honest conversations with their partners and their care providers about the kind of care and support they want for the birth!

And the last one I'll mention from this terrific section, "Give some thought about what might make this more manageable for you. In which areas do you need reassurance? . . . Labor and birth are challenging no matter how we do it, but what can you put in place for yourself that will give you confidence and help you go through it . . . When we take care of the mother, we take care of the baby. (The baby is still part of us at this point!) As I write this, I can hear the 'reactive' voice to this statement: 'How selfish! Labor is not about the woman, it's about a healthy baby!' Yes, at the end of the day absolutely true; however we women know that and we will make decision that help us cope and meet that objective. (To imply otherwise is a wee bit patronizing.) . . . with information and support, we move through labor knowing that we are doing what we have to, what we believe in, what we are capable of given all the variables - and that it is okay" (272).

Two other very interesting books about care during pregnancy and birth in the United States are Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block and Born in the United States: How a Broken Maternity System Must be Fixed to Put Women and Children First, by Marsden Wagner. I'm sure there are other books that I'm not mentioning - if you're thinking of one that has helpful information on choosing a care provider or the birth place, please leave it in the comments!

WEBSITES

The excellent organization Childbirth Connection offers an entire section on Choosing a Caregiver, highlighting the importance of making an informed choice about, what the different care provider options are, and other insightful information. I appreciate that they also include reasons that are "insufficient" for choosing a caregiver:

"It is not wise to select a caregiver solely because:

that person practices near your home or workplace — convenience is nice, but you may need to travel further to find the right person

you know someone who worked with that person — even if recommended by a friend or relative, you will want to be sure that a maternity caregiver's style will meet your needs and values and reflects the best available research

that person is a woman, or a man — if you have a preference for caregiver gender, you will want to be sure that that person's maternity philosophy and style of practice match well with your needs and values and with the best available research

that person has been your provider for well-woman or primary care — you will want to learn about that person's maternity philosophy and style of practice before making your decision."

The next pages offer information on midwives and obstetricians and family physicians, as well as "Best Evidence (a discussion of studies done about differences between midwifery and obtetric care)," "Tips & Tools" (interview questions, etc.), and "Resources" (links to helpful resources).

Childbirth Connection offers a similar set of resources about Choosing a Place of Birth: a review of the options, best evidence, tips & tools, and resources.

Childbirth Connection offers many more terrific resources, including an important free .pdf called The Rights of Childbearing Women, as well as a free .pdf download of the Listening to Mothers surveys (interesting to get a picture of what birth has been like in the United States for the past few years), and the amazing resource A Guide to Effective Care in Pregnancy and Childbirth - buy it on Amazon for a lot of money or read the sections that interest you here for free! A Guide to Effective Care "is an overview of results of the best available research about effects of specific maternity practices. The full text of the current edition (Oxford University Press, 2000) is available on this website [linked chapter by chapter] courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr." I could keep highlighting useful information for their site like the pregnancy pictures and stages of pregnancy etc. & etc. but really, go check it out - amazing resources!

Coalition for Improving Maternity Services (CIMS) has some useful downloads on its site, including information the Mother-Friendly Childbirth Initiative with links to "Evidence Basis for Mother-Friendly Care" and "Having a Baby? Ten Questions to Ask" and other helpful documents.

UNICEF and WHO joined together to create the Baby Friendly Hospital Initiative, with an explanation of what a "Baby Friendly" label means, and a list of "Baby Friendly" hospitals and birth centers. In Maine, as of July 2008, we have Central Maine Medical Center in Lewiston, Maine General Medical Center in Augusta and Waterville, Miles Memorial Hospital in Damariscotta, and York Hospital, in York.

Citizens for Midwifery offers a chart Ideals vs. Reality in U.S. Births, which compares the WHO recommendations, CIMS recommendations, and U.S. reality as of 2004.

So that's my highlight of information that could help a mother (and her partner) choose the kind of care provider and birth setting that will work the best for them, as well as information on interviewing/choosing a specific provider and setting. The most important things to remember, in my opinion, are that you do have choices, and that the choices you make can have a very significant impact on your birth experience. If you're not happy with the care you're receiving or the setting you initially chose - please consider reviewing your options. One of the statements that is repeated over and over in all the books and sites I include in this entry is the importance of making choices about provider and setting that are right for you and your family as you get ready to meet the new little person growing inside of you.

Happy exploring, and best wishes for making the best choice possible!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Pregnancy and Birth: What Are My Choices?

I love birth stories. I've read lots of them, in various books* and online**. I've also heard a lot of stories from friends, relatives and strangers, as well as watched some on television, ranging from pure entertainment on sitcoms to "info-tainment" shows like Baby Story, to excellent documentaries***. Because of my passion for birth, I've searched for stories that are outside of the mainstream experience - natural birth stories, home birth stories, etc. When I was pregnant, I wanted to understand my full range of options, not just what "everyone else" does.

Right now in the United States, there is a narrative that describes the birthing experience for a significant majority of women. It goes like this:

"I thought I might be in labor... I was really excited! I called my doctor... contractions got stronger... went to the hospital... They settled me in bed with an IV and the fetal monitor... my contractions were really painful, so I asked for an epidural... the pain mostly disappeared, yay!... the nurse checked me and told me it was time to push, so I pushed lying on my back (or kind of propped up) and pushed some more! and then my baby was born!"

According to the Listening to Mothers Survey II (2006):

87% of women are attended by a doctor for their prenatal/birth care (obstetricians - 79%; family practice doctors - 8%)

94% laboring/birthing women are monitored by the electronic fetal monitor, 93% of those continuously (76%) or most of the time (17%)

86% laboring women used pain medication during labor: 76% spinal/epidural and 22% narcotic (Nubain, Stadol, Demerol), and

92% of women push and give birth lying on their backs or propped up in a semi-sitting position.

Other common components of the "mainstream" birth story include:

41% caregivers tried to induce labor, with an 84% success rate --> 34% births are inductions

75% women stay in bed after they are admitted to the hospital, and

80% have an IV.

This birth story works really well for some women, and not very well for others. It's the "normal" story - the one that most people tell, the one easiest to access over & over again. For example, TLC offers summaries upcoming "A Baby Story" episodes: in the first twenty, there is one mention of a midwife, one mention of a homebirth, three cesarean births, and many, many variations on "the" birth story I told above.

But: this story isn't the only story! Birthing women do have other options. Other stories exist, showing women different possibilities:

9% of women are attended by midwives for their prenatal/birth care

3% use doulas for support during labor and birth

1% birth at home or in a birth center

3% are not attached to a fetal monitor, and had their baby's heartbeat monitored exclusively with a handheld device, and

6% use a deep tub for pain relief.

These possibilities do not exist for women who are unaware of them. If a woman has never heard of giving birth at a birth center, that possibility does not exist for her. If she thinks that the only safe way to give birth is with a doctor in a hospital, she probably won't explore other options. If she has never read or heard people talking about a birth experience that did not involve medication, that possibility may not seem very real. As Diane Korte, author of A Good Birth, A Safe Birth explains it, "If I don't know my options, I don't have any."

A helpful resource: Building Confidence, the free Lamaze newsletter, offers some useful perspectives in their Week 9 email about how to "Take Charge of Your Care".

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Where does a woman begin her exploration of options? Let's start with two of the biggest choices a pregnant woman has to make about her and her baby's care for pregnancy and birth: caregiver and birth place.

Women can give birth in a hospital, at the birth center (in Maine, we have The Birth House), or at home.

Women can choose to give birth attended by an obstetrician (OB), a family practice doctor, or a certified nurse midwife (CNM); in Maine, these providers commonly practice in the hospital setting. Some women choose to use a certified professional midwife (CPM) for a provider, and have their babies at home or at a birth center. Occasionally women may need the additional expertise of a perinatologist, who specializes in care of women and babies with higher risks of problems. And even more rarely, women decide to give birth at home, unattended.

[For a list of birth places and providers in central Maine, visit Birthing Your Baby's local resources page.]

Provider and birth place are interconnected. Most providers practice only in specific settings; OBs and CNMs generally have "rights" at one - sometimes two - hospitals. CPMs attend births at home or at a birth center. The decision needs to be made quickly. If a woman finds out she's pregnant at four, five, or six weeks, she has only a few weeks to make her first prenatal appointment; most providers want to see her at the end of her first trimester (10 weeks or so).

For example, for my first baby, I had narrowed down the practice I wanted to go to because of the quality of the hospital and its location (less than five minutes away). When I called to schedule my appointment, the receptionist asked if I wanted a midwife or a doctor. The midwife option had never occurred to me... so I just said, doctor. And there. My decision was made. Of course, if I hadn't received care that "worked" for me, I would have changed providers. But that would have taken time and energy, and is something few women actually do.

My first experience mirrors the decision-making process that most women go through to choose a provider. According to Listening to Mothers II (2006), women choose a provider for the following reasons:

47% provider is covered by her insurance

42% past experience with provider or group

26% recommendation from family or friends

26% nearby

18% mother's philosophy

17% attends at her preferred hospital

Before my second pregnancy, we moved further away from the hospital I had my daughter at, so I needed to go through the decision-making process again. This time, I chose a hospital because of its nursing staff - excellent nurses who supported the natural birth process and who had enough time to monitor me with a doppler instead of the EFM. This hospital was not the closest option, but it fit well with my developing philosophy. I also chose a practice of a midwife and an OB, and was seen by the midwife. That way, I knew who would be attending my birth unless the midwife had an emergency or I needed the care of an OB. Again, this decision was influenced by my first birth. My provider was part of a 4-doctor practice, and I hadn't laid eyes on the caregiver who attended my daughter's birth until I was in labor! It turned out fine, but I realized that I was lucky, and it became important to me to minimize the chances of that happening for my son's birth...

During the next few weeks, I will be posting with suggested resources to help women find the setting and provider who will best fit their needs. I'll be discussing the safety of various settings and providers, as well as an in-depth explanation of each kind of setting and provider.

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BIRTH STORY RESOURCES

One thing to keep in mind: birth stories, and information about birth itself, are a little like food - some is junk and some is nourishing. As much as reading, viewing, and discussing birth and birth stories can be positive, too much can be overwhelming. Stories that are scary or unsupportive - you know, the ones so many strangers (and sometimes friends) horrify women with at the end of their pregnancies - are best ignored, if it's not possible to get away from the "well-meaning" narrator. The Birthing From Within website offers a great article, called Information vs. Awareness, about using information to nurture yourself.

*Books with Birth Stories

Ina May's Guide to Childbirth;

Journey into Motherhood: Inspirational Stories of Natural Birth

Adventures in Natural Childbirth

Baby Catcher: Chronicles of a Modern Midwife

A Midwife's Story

Giving Birth: A Journey into the World of Mothers and Midwives

Delivery: A Nurse-Midwife's Story

**Online Stories

My kids' birth stories, plus a client's birth story

Birthstories

Making Leta

MoonDragon Birth Stories - scroll almost all the way down

My Big Ugly VBAC

North Carolina Homebirth Birth Stories

Circle of Life Midwifery Slide Show

Birth Story Diaries

***A Few Video Stories

Birth Day

The Business of Being Born

Gentle Birth Choices

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

Breastfeeding Resources for Central Maine Mamas

LA LECHE LEAGUE MEETINGS IN CENTRAL MAINE

The Augusta/Gardiner Group meets on the third Tuesday of each month. Contact Katherine via email or at 582-8250 for more information. I think Katherine is also organizing or has organized an evening meeting time as well.

The Bangor Group meets on the first Wednesday of each month at 10am. Contact Melanie via email or at 942-2362 for more information.

The Lewiston/Auburn Group meets on the second Wednesday of each month. Contact Nancy via email or at 782-6645 for more information.

The Brunswick Group meets on the third Monday of each month at 9:30am. Contact Linda via email or at 221-

Complete list of LLLI meetings in ME, including Bridgton, Camden/Rockland, Skowhegan, Norway and others.

HOSPITAL BREASTFEEDING SUPPORT GROUPS
Many hospitals offer breastfeeding support groups, which can be a terrific breastfeeding (and parenting!) resource. Most are led by trained lactation consultants. You can also contact the lactation consultants listed for information on breastfeeding classes to take before your baby's birth. Some hospitals also sell breastfeeding supplies. I know MaineGeneral in Augusta does, and Mid Coast Hospital in Brunswick does as well.

MaineGeneral Augusta Campus, offers a general breastfeeding support group, led by Janet Sirois (626-1426). This group meets four times a month at MaineGeneral Medical Center, Augusta Campus, 6 E. Chesnut Street, Augusta. Meetings alternate between Tuesdays, 6 to 8 p.m., or Wednesdays, 12:30 to 2:30 p.m. Call Janet for a schedule.

MaineGeneral Waterville Campus, offers a general breastfeeding support group, led by Cheryl Bean-Moody (872-1625). This group meets twice a month, 12:30 to 2 p.m. or 6 to 7 p.m., in Dean 2, MaineGeneral Medical Center, Thayer Campus, 149 North Street, Waterville. Call Cheryl for a schedule.

Inland Hospital offers a breastfeeding support group ,led by Connie Finley (861-3100). This group meets most Fridays at 1pm at the hosptial's birth center. Call Connie for a schedule.

I think Central Maine Medical Center (CMMC) in Lewiston has a support group, but I can't find it on their website. For additional information, contact Gloria Oullette or Vicki Roy, their lactation consultants, at 795-2528.

St. Mary's Hospital, in Lewiston, does not offer a support group, but you can contact their lactation consultant, Gail Martell, at 783-6987 to get breastfeeding class information.

Mid Coast Hospital, in Brunswick, offers a range of breastfeeding services. These include a Nursing Mother's Tea held the 1st Wednesday of each month from 7-8:30 p.m. and the 3rd Wednesday of each month from 10-11:30 a.m. in Mid Coast Hospital’s Café Conference Room, 123 Medical Center Drive, Brunswick, breastfeeding classes, and a boutique that sells supplies. Jerri Walker is Mid Coast's lactation consultant, she can be reached on Mondays, Wednesdays, and Fridays at 373-6530.

THE WIC PROGRAM
WIC (Women Infants and Children Nutrition Program) also offers breastfeeding resources, including breastpumps for women who meet certain criteria.

From their site: Who can apply for the Maine WIC Nutrition Program? Women who are pregnant, breastfeeding or had a baby in the past six months. Infants and children up to the age of five including foster children. Fathers may apply for their children. You must live in Maine or be a migrant working in Maine.

Locations include:

Midcoast Maine Community Action Program
34 Wing Farm Parkway, Bath, ME 04530
Tel: 442-7963 or 1-800-221-2221

HealthReach Network
263 Water St., 4 th Floor, Augusta, ME 04330 (621-6202)
63 Eustis Parkway., Waterville, ME 04901 (872-1593)
165 North Ave., Skowhegan, ME 04976 (474-7463)

Western Maine Community Action Program
1 Auburn Center, Auburn, ME 04210
Tel: 795-4016 or 1-877-512-8856

If you know of any other breastfeeding resources for Central Maine mamas, please leave a comment!

Christina @ Birthing Your Baby
Independent Childbirth Classes in Central Maine

Central Maine Birth Discussion Group: Books, Film & Advocacy

Sometimes after reading a book about birth or watching a birth-related film, I really wished I belonged to some kind of discussion group - to hear about what others thought about certain ideas or what connections they made, and to ask the questions that came up for me in my own reading/viewing.

There are spaces online to do this, and of course it's fun to debrief with similarly-interested friends & family... but lately I've been thinking about how wonderful (exciting, interesting, productive... I could go on ;-) it would be to have a Birth Discussion & Advocacy Group (hospital and homebirth) here in Central Maine.

Southern Maine has Birth Roots, and there is the new birth center in the Sebago-region, The Birth House, but I'm unaware of any kind of discussion/advocacy group in the Augusta area. It's easy to get to Winthrop (where I'm thinking of for this) from Augusta, Hallowell, Gardiner, Lewiston & Auburn, and even Waterville.

Some potential books/films I'm thinking of to discuss:
Pushed: The Painful Truth About Childbirth and Modern Maternity Care or The Business of Being Born or The Baby Catcher or Ina May Gaskin's Guide to Childbirth etc. Anyone have any suggestions?

What's motivated me to finally start putting this idea out there is the Lamaze Webinar, "Starting Conversations for Change" that I "attended" a few weeks ago. You can view it yourself from this page: Lamaze International Webinars.

The presenter, Debra Bingham, outlined the critical importance of working for change: the Cesarean-birth rate, the fact that maternal mortality is slipping back to where it was in the 1970s (yes, how it's recorded has changed, but it's still under-reported now), declining access to VBAC, declining percentage of women spending the first hour of their babies lives with their babies (according to Listening to Mothers II) etc. & etc.

Bingham asked - how many of the hospitals in your area use the Lamaze Six Care Practices That Support Normal Birth?

1. Labor begins on its own
2. Freedom of movement throughout labor
3. Continuous labor support
4. No routine interventions
5. Spontaneous pushing in upright or gravity-neutral positions
6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding

She recommended forming small "women's advisory" groups to find out what care is like in local hospitals, discuss what changes need to be made and how to go about implementing those changes, and then to track success. She used the acronym MAP-IT (mobilize, assess, plan, implement, track).

While pregnant women and women who have recently given birth can be powerful change agents by "voting with their feet", asking questions, giving feedback, etc., we who want to see change happen need to also act. Agents for change need to be a larger, more-diverse group in order to be successful.

Bingham asked participants to consider whether or not this statement was true: "“I can implement mother-friendly & baby-friendly care in my community."

This post is the first concrete step in my journey to answering that question. My goal is to set up an initial meeting to introduce ourselves, to discuss our purpose(s), and to plan a book/film to discuss and a meeting date etc.,

If you think you'd like to attend a discussion/advocacy meeting - as a woman who is planning a pregnancy, who is currently pregnant, who wants to process a recent (or not so recent) birth... who is a "birth junkie" or a birth professional etc... leave me a comment or send me an email!

Christina @ Birthing Your Baby
Independent Childbirth Classes in Central Maine